Análise das condições psíquicas de crianças e adolescentes submetidos à institucionalização / Analyses of the psychic conditions of children and adolescents undergoing institutionalization / Análisis de las condiciones psíquicas de niños y adolescentes em institucionalización

INTRODUÇÃO: As instituições de acolhimento visam suprir as necessidades materiais e emocionais daqueles que são colocados sob tutela do Estado. Contudo, alguns estudos evidenciam que é comum que instituições de acolhimento sejam deficitárias em relação ao número de funcionários que compõem a equipe técnica e que, em alguns casos, a criança ou adolescente permanece mais tempo nessas instituições do que o previsto pela legislação. OBJETIVO: Analisar se o período de permanência em uma instituição de acolhimento constitui um fator agravante para a manifestação de sofrimento psíquico. MÉTODO: A pesquisa foi realizada com 4 sujeitos institucionalizados (dois há mais tempo e dois há menos tempo) de uma casa de acolhimento localizada no município de Ourinhos ­ SP e com 4 profissionais da equipe técnica do local. Os dados foram coletados mediante entrevista semiestruturada, lúdica, anamnese, observação, análise documental e aplicação do teste projetivo HTP. RESULTADOS E DISCUSSÃO: Observou-se que o tempo de acolhimento institucional é um fator que promove o aumento do sofrimento psíquico de pessoas institucionalizadas, pois, comparando-se o adolescente que residia há mais tempo no local e os demais, foi constatado que ele possuía mais prejuízos em seu desenvolvimento. Além disso, foi constatado que muitos dos sofrimentos das pessoas acolhidas eram resultantes de vivência anteriores à institucionalização. CONCLUSÃO: foi verificado que o processo de institucionalização caracteriza um rompimento doloroso entre o sujeito e suas figuras cuidadoras, pois, mesmo o acolhimento propiciando boas condições estruturais e materiais ao sujeito, ele não está preparado psicologicamente para um rompimento.

INTRODUCTION: Foster care institutions aim to meet the material and emotional needs of those placed under the tutelage of the State. However, some studies show that it is common for shelter institutions to be deficient in terms of the number of employees that make up the technical team and that, in some cases, the child or adolescent stays longer in these institutions than what is provided for by law. OBJECTIVE: To analyze whether the period of stay in a foster care institution constitutes an aggravating factor for the manifestation of psychic suffering. METHOD: The research was carried out with four institutionalized subjects (two for a longer and two for a shorter period) from a shelter located in the municipality of Ourinhos - SP and with four professionals from the local technical team. Data were collected through semi-structured, playful interviews, anamnesis, observation, document analysis, and application of the HTP projective test. RESULTS AND DISCUSSION: It was observed that the time of institutional reception is a factor that promotes the increase of the psychic suffering of institutionalized people, because, comparing the adolescent who lived longer in the place and the others, it was found that he had further damage to their development. In addition, it was found that many of the sufferings of sheltered people were the result of experiences prior to institutionalization. CONCLUSION: it was verified that the institutionalization process characterizes a painful rupture between the subject and his caregivers because, even though the reception provides good structural and material conditions to the subject, he is not psychologically prepared for a rupture.

INTRODUCCIÓN: Las instituciones de acogida tienen por objeto satisfacer las necesidades materiales y afectivas de quienes se encuentran bajo la tutela del Estado. Sin embargo, algunos estudios muestran que es común que las instituciones de acogida sean deficientes en cuanto al número de funcionarios que integran el equipo técnico y que en algunos casos el niño, niña o adolescente permanezca en estas instituciones más tiempo de lo que marca la ley. OBJETIVO: Analizar si el tiempo de permanencia en una institución de acogida constituye un factor agravante para la manifestación del sufrimiento psíquico. MÉTODO: La investigación fue realizada con 4 sujetos institucionalizados (dos por más tiempo y dos por menos tiempo) de un albergue ubicado en el municipio de Ourinhos - SP y con 4 profesionales del equipo técnico local. Los datos fueron recolectados a través de entrevista semiestructurada, lúdica, anamnesis, observación, análisis de documentos y aplicación de la prueba proyectiva HTP. RESULTADOS Y DISCUSIÓN: Se observó que el tiempo de acogida institucional es un factor que promueve el aumento del sufrimiento psíquico de las personas institucionalizadas, pues, al comparar el adolescente que vivió más tiempo en el lugar y los demás, se verificó que tenía más perjuicios a su desarrollo. Además, se constató que muchos de los sufrimientos de las personas acogidas se debían a experiencias previas a la institucionalización. CONCLUSIÓN: se constató que el proceso de institucionalización caracteriza una ruptura dolorosa entre el sujeto y sus cuidadores, ya que, aunque la acogida proporcione buenas condiciones estructurales y materiales al sujeto, éste no está psicológicamente preparado para una ruptura.

Malaria and COVID-19 prevalence in a population of febrile children and adolescents living in Libreville

Background: Patients with acute febrile illness need to be screened for malaria and coronavirus disease 2019 (COVID-19) in malaria-endemic areas to reduce malaria mortality rates and to prevent the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objectives: To estimate the frequency of children and adolescents with COVID-19 and/or malaria among febrile patients attending for malaria diagnosis Method: This cross-sectional study was conducted in a sentinel site for malaria surveillance during the SARS-CoV-2 pandemic (Omicron variant), from October 2021 to December 2021 in Gabon. All febrile patients were tested for malaria using microscopy. Severe acute respiratory syndrome coronavirus 2 was detected by real time polymerase chain reaction (RT-PCR) and rapid antigen tests developed by Sansure Biotech®. Results: A total of 135 patients were screened. Their median age was 6 (interquartile range [IQR]: 3­14) years. Malaria was confirmed for 49 (36.3%) patients, 29 (32.5%) children, 13 (59.0%) adolescents and 7 (29.2%) adults. The frequency of COVID-19 cases was 7.4% (n = 10/135), and it was comparable between children (n = 6; 6.7%), adolescents (n = 2; 9.1%) and adults (n = 2; 8.3%) (p = 0.17). Malaria and COVID-19 co-infections were diagnosed in 3 (6.1%) patients from all the age groups. Participants with a co-infection had a higher median temperature, a higher median parasitaemia, and were mostly infected with non-falciparum malaria. Conclusion: COVID-19 cases and cases of malaria/COVID-19 co-infections were found in febrile children and adolescents. SARS-CoV-2 testing should be included in the screening of suspected malaria cases.

Sempre serei sua mãe: luto e ressignificação de mães de crianças e adolescentes em tratamento oncológico / I will always be your mother: grief and reframing of mothers of children and adolescents undergoing cancer treatment / Siempre seré tu madre: duelo y redefinición de madres de niños y adolescentes en tratamiento contra el cáncer

INTRODUÇÃO: O luto é um processo de ajustamento à perda, seja ela antecipatória ou não, visando a construção de uma realidade diferente da imaginada. OBJETIVO: O presente artigo tem como objetivo compreender como mães de crianças e adolescentes em tratamento oncológico ressignificaram a vida diante do luto do filho. MÉTODOS: Foi realizado um estudo de campo, qualitativo e descritivo com cinco mães que vivenciam/vivenciaram o processo de luto do filho, no mínimo há um ano, sendo o filho criança ou adolescente, que esteve em tratamento oncológico. O instrumento utilizado para coleta de dados foi a entrevista semiestruturada. RESULTADOS: Os resultados obtidos indicam que a experiência do luto para essas mães se caracteriza por um processo de transformação e adaptação singular. As principais estratégias encontradas por elas para o enfrentamento do luto que contribuíram positivamente para ressignificar a perda foram: o apoio dos familiares e amigos; compartilhar sentimentos e experiências com outras mães enlutadas; voltar a trabalhar; perpetuar a memória do filho falecido; uma nova gravidez; guardar objetos do filho perdido; modificar espaços da casa; a espiritualidade; e a realização de sonhos próprios e do filho que faleceu. CONCLUSÃO: Foi possível observar que o processo de ressignificação é carregado de dor e dificuldade, além de tristeza, culpa e outros sentimentos negativos. Destaca-se a importância nesse processo do apoio de familiares, amigos e instituições, além da espiritualidade e busca por novos momentos de vida.

| INTRODUCTION: Mourning is a process of adjusting to loss, whether anticipatory or not, aiming at building a reality different from the one imagined. OBJECTIVE: This article aims to understand how mothers of children and adolescents undergoing cancer treatment have re-signified life in the face of their child's grief. METHODS: For this purpose, qualitative research was carried out with five mothers experiencing / experienced the child's mourning process, at least one year ago, the child being a child or adolescent, who was undergoing cancer treatment. The instrument used for data collection was the semi-structured interview. RESULTS: The results obtained indicate that the experience of mourning for these mothers is characterized by a unique process of transformation and adaptation. The main strategies they found to cope with grief, which contributed positively to redefining the loss were: the support of family and friends; sharing feelings and experiences with other bereaved mothers; back to work; perpetuating the memory of the deceased child; a new pregnancy; guarding objects of the lost child; modify spaces in the house; spirituality; the realization of own dreams and the son who passed away. CONCLUSION: It was possible to observe that the reframing process is fraught with pain and difficulty, in addition to sadness, guilt, and other negative feelings. The importance of supporting family members, friends, and institutions in this process is highlighted, in addition to spirituality and the search for new moments in life.

INTRODUCCIÓN: El duelo es un proceso de adaptación a la pérdida, anticipatoria o no, con el objetivo de construir una realidad diferente a la imaginada. OBJETIVO: Este artículo tiene como objetivo comprender cómo las madres de niños y adolescentes en tratamiento contra el cáncer dieron un nuevo sentido a sus vidas ante el dolor de sus hijos. MÉTODOS: Se realizó un estudio de campo, cualitativo y descriptivo con cinco madres que han vivido / vivido el proceso de duelo de su hijo durante al menos un año, siendo el niño un niño o adolescente, que había estado en tratamiento contra el cáncer. El instrumento utilizado para la recolección de datos fue la entrevista semiestructurada. RESULTADOS: Los resultados obtenidos indican que la experiencia de duelo de estas madres se caracteriza por un proceso de transformación y adaptación singular. Las principales estrategias que encontraron para afrontar el duelo que contribuyeron positivamente a replantear la pérdida fueron: el apoyo de familiares y amigos; compartir sentimientos y experiencias con otras madres en duelo; volver al trabajo; perpetuar la memoria del niño fallecido; un nuevo embarazo; guardar las pertenencias del niño perdido; modificar espacios en la casa; espiritualidad; y la realización de sus propios sueños y el del hijo que murió. CONCLUSIÓN: Se pudo observar que el proceso de resignificación está plagado de dolor y dificultad, además de tristeza, culpa y otros sentimientos negativos. En este proceso se destaca la importancia del apoyo de familiares, amigos e instituciones, además de la espiritualidad y la búsqueda de nuevos momentos en la vida

Hypertension among children aged 11-15 years in secondary schools, Vientiane Capital, Lao PDR / Lao Medical Journal

Background@#Hypertension in children is one of major concerns in public health. However, there is no evidence within the Lao population. Therefore, we aimed to determine the prevalence of hypertension in children and adolescents aged 11-15 years old.@*Methodology@#A descriptive, cross-sectional study was conducted in children and adolescents aged 11-15 years old at secondary schools of Vientiane Capital, Lao PDR. Two secondary schools were purposively selected, Vientiane and Bornagnao schools. The data were collected using questionnaire form.@*Result@#A total of 365 students were included in the study of which 50.7% were male. The mean age was 13.7 years old (Min=11 and Max=15). The majority of students were of Lao Loum ethnicity (95.1%). Of 365 students, 140 (38.3%) had high blood pressure during the survey. Of these, 99 (27.1%) people were at pre-hypertension, 6.3% in stage 1 and 4.9% in stage 2. Most (74.5%) of included students had normal Body Mass Index (BMI). Students with overweight and obesity were significantly more likely to have hypertension than others (p<0.001).@*Conclusion@#We found a high prevalence of hypertension in secondary school students particularly in those overweight and obese. Therefore, it is important to provide appropriate education at school to reduce the risk factors as well as hypertensive screening.

Estudio de las propiedades psicométricas de la Escala Barratt de Impulsividad (BIS-11) en niños y adolescentes / Study of the psychometric properties of the Barratt Impulsiveness Scale (BIS-11) in children and adolescents

Resumen El objetivo de este estudio fue identificar y confirmar la estructura trifactorial de la Escala Barratt de Impulsividad (BIS-11) propuesta para adultos (Patton, Stanford y Barratt, 1995) en una muestra de 600 niños y adolescentes entre 9 y 17 años de edad (M = 12.9, DT = 2.3). Para el análisis factorial los datos fueron divididos aleatoriamente en dos. Con la primera submuestra se realizó el Análisis Factorial Exploratorio, en el que se identificaron tres dimensiones. Posteriormente, con la segunda submuestra se llevó a cabo el Análisis Factorial Confirmatorio. La solución factorial resultante de 19 ítems arroja adecuados indicadores de ajuste (CFI = .909, IFI = .912, RMSEA = .043 CI [.032 - .054], x2/gl = 1.561). El alfa Cronbach total ha sido a = .795. Las escalas obtienen coeficientes aceptables para estas edades, Impulsividad Atencional con a = .641, Impulsividad Motora a = .659 e Impulsividad no Planificadora a = .727.

Abstract The aim of this study was to identify and confirm the trifactorial structure of the Barratt Impulsiveness Scale (BIS-11) proposed for adults by Patton, Stanford and Barratt (1995) in a sample of children and adolescents. The sample consisted of 600 children between of 9 and 17 years old (M = 12.9, SD=2.3). For the factorial analysis the data were divided into two random samples. In the first subsample the Exploratory Factorial Analysis was performed, and three dimensions were identified. Subsequently, in the second subsample, Confirmatory Factor Analysis was performed. The factorial solution of 19 items showed adequate fit (CFI = .909, IFI = .912, RMSEA = .043 CI [.032 - .054], x2/gl = 1.561). The total Cronbach alpha was a = .795. Each scale has acceptable coefficients: Attentional Impulsiveness a = .641, Motor Impulsiveness a = .659 and Non-planning Impulsiveness a = .727.

Child and Adolescent Psychosocial Care Center service use profile in Brazil: 2008 to 2012

Objective: To describe the service use profile of Child and Adolescent Psychosocial Care Centers (Centro de Atenção Psicossocial Infanto-Juvenil [CAPSi]) in Brazil regarding diagnostic categories, sociodemographic aspects, and care modalities between 2008 and 2012. Methods: A descriptive, ecological study was performed using data from the Unified Health System regarding high-complexity procedure authorizations (Autorização de Procedimentos de Alta Complexidade [APAC]) for the period from 2008-2012. The variables sex, age, diagnosis (F00-F99 of ICD-10), and type of care provided were examined. The data were processed using TabWin and STATA version 12. Results: A total of 837,068 records were examined, each representing one visit to CAPSi. Most visits were by male users (68.8%). The most common diagnoses were hyperkinetic disorders (13%), pervasive developmental disorders (12.4%), and conduct disorders (8.4%). Conclusions: Behavioral and emotional disorders that usually appear during childhood or adolescence and psychological development disorders were frequent, with more than 50% of the latter comprising autism spectrum disorders. Regional differences were observed, with a higher presence of this diagnosis in the Southeast, while the North and Northeast had a high percentage of visits due to mental retardation.

Caracterizando a psicologia policial enquanto uma psicologia social jurídica / Characterizing police psychology as a social legal psychology / Caracterizando la psicología policial como una psicología social jurídica

Este artigo problematiza o cargo de Psicólogo Policial, pioneiro na polícia civil do estado de Santa Catarina, dando ênfase a uma abordagem da Psicologia Social Jurídica neste campo. Esta perspectiva coloca ênfase nos direitos humanos, na comunidade, em aspectos de cidadania, prevenção e redução da judicialização das relações sociais. Neste contexto, devido a uma parceria da Universidade Federal de Santa Catarina (UFSC) com a Secretaria de Segurança Pública do Estado de Santa Catarina, houve a inserção de estagiários de Psicologia nas Delegacias de Proteção à Criança, ao Adolescente, à Mulher e ao Idoso da região metropolitana da Grande Florianópolis. A partir das experiências destes estudantes, busca-se elucidar de que forma as práticas em uma organização como a delegacia especializada podem dialogar com a proposta de uma Psicologia Social Jurídica, utilizando gênero e violência como categorias de análise

This article problematizes the position of Police Psychologist, pioneer in the civil police of the province of Santa Catarina, focusing on the approach of a Legal Social Psychology in this field of action. This perspective places emphasis on human rights, on the community, on aspects of citizenship, prevention and reduction of the judicialization of social relations. As a result of an agreement between the University and the Secretary of Public Security of the State of Santa Catarina, interns from the bachelor in Psychology were placed in the commissariats for the Protection of children, adolescents, women and elderly of the metropolitan region of Florianópolis. From the experiences of these students, it is sought to clarify how the practices in an organization such as the specialized commissioner can dialogue with the proposal of a Legal Social Psychology, using gender and violence as categories of analysis

Este artículo problematiza el cargo de Psicólogo Policial, pionero en la policía civil de la provincia de Santa Catarina, centrándose en el abordaje de una Psicología Social Jurídica en este campo. Esta perspectiva coloca énfasis en los derechos humanos, en la comunidad, en aspectos de ciudadanía, prevención y reducción de la judicialización de las relaciones sociales. Resultante de un acuerdo entre la Universidad y la Secretaria de Seguridad Pública de la provincia de Santa Catarina, ha ocurrido la inserción de estudiantes de prácticas en Psicología en las comisarías de Protección al niño(a), al adolecente, a la mujer y al anciano(a) de la región metropolitana de Florianópolis. Este artículo problematiza el cargo de Psicólogo Policial, pionero en la policía civil del estado de Santa Catarina, dando énfasis a un abordaje de la Psicología Social Jurídica en este campo. Esta perspectiva pone énfasis en los derechos humanos, en la comunidad, en aspectos de ciudadanía, prevención y reducción de la judicialización de las relaciones sociales. En este contexto, debido a una asociación de la Universidad Federal de Santa Catarina - UFSC con la Secretaría de Seguridad Pública del Estado de Santa Catarina, hubo la inserción de pasantes de Psicología en las Comisarías de Protección al Niño, al Adolescente, a la Mujer y al Anciano de la Mujer región metropolitana de la Gran Florianópolis. A partir de las experiencias de estos estudiantes, se busca dilucidar de qué forma las prácticas en una organización como la comisaría especializada pueden dialogar con la propuesta de una Psicología Social Jurídica, utilizando género y violencia como categorías de análisis

Impacto da tecnologia em grupanálise com crianças e adolescentes / Impact of technology on group analysis with children and adolescents / Impacto de la tecnología en grupanálisis con niños y adolescentes

Vivemos numa sociedade cada vez mais informatizada, sobrecarregada de estímulos e de exigências tecnológicas onde praticamente desde o nascimento que o ser humano tem contacto com estas interfaces. Perante esta realidade questionam-nos: onde fica o lugar do brincar, do simbólico, da criatividade e da intersubjetividade no desenvolvimento das crianças/adolescentes? Qual é o impacto que a tecnologia tem na criação da identidade das nossas crianças, de que forma se reflete na interação com os outros, nas suas escolhas? Qual o papel da Grupanálise e do Grupanalista nesta realidade?

We live in an increasingly computerized society, overwhelmed with stimuli and technological requirements where practically since the birth that the human being has contact with these interfaces. Faced with this reality we question: where is the place of play, symbolic, creativity and intersubjectivity in the development of children / adolescents? What is the impact that technology has on the creation of our children's identity, how is it reflected in the interaction with others, in their choices? What is the role of Group analysis and Group analyst in this reality?

Vivimos en una sociedad cada vez más informatizada, sobrecargada de estímulos y de exigencias tecnológicas donde prácticamente desde el nacimiento que el ser humano tiene contacto con estas interfaces. Ante esta realidad nos cuestionan: ¿dónde queda el lugar del juego, del simbólico, de la creatividad y de la intersubjetividad en el desarrollo de los niños / adolescentes? ¿Cuál es el impacto que la tecnología tiene en la creación de la identidad de nuestros niños, de qué forma se refleja en la interacción con los demás, en sus elecciones? ¿Cuál es el papel del Grupoanálisis y del Grupanalista en esta realidad?

Impacto de condições bucais na qualidade de vida de crianças/adolescentes com Síndrome de Down e de seus familiares / Impact of oral conditions on the quality of life of children/adolescents with Down Syndrome

O objetivo deste estudo foi avaliar a percepção dos pais/cuidadores sobre o impacto das condições bucais na qualidade de vida de crianças/adolescentes com síndrome de Down (SD) e de seus familiares comparados com crianças/adolescentes sem SD. Trata-se de um estudo tranversal comparativo desenvolvido com 144 crianças/adolescentes com SD de quatro a 18 anos pareados por sexo e idade com 144 crianças/adolescentes sem SD, assim como os pais/cuidadores dos indivíduos de cada grupo. Para avaliação do impacto de condições bucais na qualidade de vida de crianças/adolescentes, pais/cuidadores responderam a versão curta do ParentalCaregiver Perceptions Questionnaire (P-CPQ), o qual é composto por três domínios: sintomas bucais, limitações funcionais e bem-estar. Para a avaliação do impacto da saúde bucal das crianças/adolescentes na qualidade de vida de seus familiares foi aplicado o Family Impact Scale (FIS) composto por quatro domínios: atividade dos pais/familiares, emoções dos pais/familiares, conflito familiar e encargos financeiros. Além disso, informações sociodemográficas e de saúde geral das crianças/adolescentes foram coletadas por meio de um questionário estruturado auto-aplicado. Um único examinador avaliou os seguintes indicadores clínicos: cárie dentária (CPO-D/ceo-d), consequências clínicas da cárie dentária não tratada (PUFA/pufa), sangramento à sondagem periodontal (ISS), presença de placa visível (IPV) e má oclusão (IED). A má oclusão foi categorizada pelo Índice Estético Dental (IED) em má oclusão ausente ou leve (IED 25), má oclusão definida (IED de 26 a 30), má oclusão severa (IED de 31 a 35) e má oclusão muito severa (IED 36). A examinadora foi treinada e calibrada para realização do exame clínico. Para cada condição bucal avaliada, foram determinadas as concordância inter-examinador (k = 0,81 a k = 0,92) e intra-examinador (k = 0,89 a k = 0,94). Os coeficientes Kappa mostraram-se satifatórios para realização do estudo epidemiológico. O teste Wilcoxon comparou os domínios e o escore total do P-CPQ e do FIS entre indivíduos com e sem SD. O teste qui-quadrado de Pearson, exato de Fisher e de tendência linear foram empregados para avaliar a associação entre o escore total do P-CPQ e do FIS com os dados sociodemográficos, com os dados de saúde e com os indicadores clínicos das crianças/adolescentes com SD. Os mesmos testes foram empregados para testar a associação entre o escore total do P-CPQ com as variáveis independentes para as crianças/adolescentes sem SD. As variáveis que apresentaram um nível de significância (p < 0,25) na análise bivariada foram incorporadas no modelo final da regressão de Poisson (IC: 95%, p < 0,05). Pais/cuidadores das crianças/adolescentes com SD apresentaram uma percepção mais negativa sobre as repercussões das condições bucais na qualidade de vida de seus filhos quando comparados à percepção dos pais/cuidadores dos indivíduos sem SD (p = 0,02). A mesma tendência também foi observada para o domínio de limitações funcionais (p < 0,01). As variáveis clínicas determinantes para uma percepção negativa dos pais/cuidadores de indivíduos com SD foram conseqüências clínicas da cárie dentária não tratada (RP = 1,72; IC = 1,04 2,84) e presença de placa visivel (RP = 1,48; IC = 1,08 2,03). Inversamente, para o domínio sintomas bucais pais/cuidadores das crianças/adolescentes sem SD apresentaram uma percepção mais negativa do impacto de condições bucais na qualidade de vida de seus filhos quando comparados à percepção dos pais/cuidadores dos indivíduos com SD (p < 0,01). Os determinantes para este resultado foram visita prévia ao dentista (RP = 2,19; IC = 1,32 3,63), conseqüências clínicas da cárie dentária não tratada (RP = 2,43; IC = 1,22 4,83), sangramento à sondagem periodontal (RP = 1,86; IC = 1,29 2,70) e má oclusão severa (RP = 3,33; IC = 1,07 5,00). Não houve diferença entre os grupos com e sem SD quanto ao impacto das codições bucais das crianças/adolescentes na qualidade de vida de suas famílias para os domínios e para o escore total da FIS (p > 0,05). As condições bucais determinantes para o impacto negativo na qualidade de vida das famílias de crianças/adolescentes com SD foram cárie dentária (RP = 3,95; IC = 2,09 7.46), conseqüências clínicas de cárie dentária não tratada (RP = 1,83; IC = 1,18 2,84), maloclusão definida (RP = 2,75; IC = 1,23 6,13) e má oclusão severa (RP = 2,82; IC = 1,02 7,74). O impacto das condições bucais na qualidade de vida de crianças/adolescentes com SD mostrou-se mais negativo quando comparado ao de crianças/adolescentes sem SD. As conseqüências clínicas da cárie dentária não tratada e a presença de placa visível foram determinates para o impacto negativo na qualidade de vida relacionada à saúde bucal das crianças/adolescentes com SD. Experiencia de cárie dentária, conseqüências clínicas da cárie dentária não tratada, má oclusão definida e má oclusão severa foram as condições bucais determinantes para o impacto negativo na qualidade de vida de seus familiares.

Impact of oral conditions on the quality of life of children/adolescents with Down syndrome The objective of the study was to evaluate the impact of oral conditions on the quality of life of children/adolescents with Down syndrome (DS) and their family members compared to children/adolescents without DS. This is a comparative cross-sectional study. Participated in the study 144 children/adolescents with DS aged 4 to 18 years matched by sex and age with 144 children/adolescents without DS, as well as the parents/caregivers of individuals in each group. To assess the impact of oral conditions on the quality of life of children/adolescents, parents/caregivers answered the short version of Parental-Caregiver Perceptions Questionnaire (P-CPQ), which consists of three domains: oral symptoms, functional limitations and well-being. The Family Impact Scale (FIS) was used to assess the impact of oral conditions of children/adolescents on the quality of life of their family members. It consists of four domains: parents' activity, parents' emotions, family conflict and financial charges. In addition, sociodemographic and general health information of the children/adolescents were collected through a structured questionnaire. A single examiner assessed the following clinical parameters: dental caries (DMF-T/dmf-t), clinical consequences of untreated dental caries (PUFA/pufa), gingival bleeding (GBI), visible plaque (VPI) and malocclusion were evaluated (DAI). Malocclusion was categorized by Dental Aesthetic Index (DAI) in absent or mild malocclusion (DAI 25), defined malocclusion (DAI of 26 to 30), severe malocclusion (DAI of 31 to 35) and very severe malocclusion (DAI 36). The examiner was trained and calibrated to perform the clinical examination. For each oral condition evaluated, the inter-examiner agreement (k = 0.81 a k = 0.92) and intra-examiner (k = 0.89 a k = 0.94) were determined. The Kappa coefficients were satisfactory for the accomplishment of the epidemiological study. The Wilcoxon test compared the domains and the total score of P-CPQ and FIS between individuals with and without SD. Pearson's Chi-square test, Fisher's exact and linear trend were used to evaluate the association between the total P-CPQ and FIS score with sociodemographic data, health data and clinical indicators of children/adolescents with DS. The same tests were used to test the association between the total P-CPQ score and the independent variables for children/adolescents without DS. The variables that presented a level of significance (p < 0.25) in the bivariate analysis were incorporated into the final Poisson regression model (CI: 95%, p < 0.05). Parents/caregivers of children/adolescents with DS presented a more negative perception about the repercussions of oral conditions on the quality of life of their children when compared to the perception of parents/caregivers of individuals without DS (p = 0.02). The same trend was also observed for the domain of functional limitations (p < 0.01). The determining clinical variables for a negative perception of the parents/caregivers of individuals with DS were clinical consequences of untreated dental caries (RP = 1.72, CI = 1.04 - 2.84) and presence of visible plaque (RP = 1.48, CI = 1.08 - 2.03). Conversely, for the domain of oral symptoms parents/caregivers of children/adolescents without DS presented a more negative perception of the impact of oral conditions on their children's quality of life when compared to the perception of the parents/caregivers of DS individuals (p < 0. 01). The determinants for this result were a previous visit to the dentist (RP = 2.19, CI = 1.32 - 3.63), clinical consequences of untreated dental caries (RP = 2.43, CI = 1.22-4.83), gingival bleeding (RP = 1.86, CI = 1.29 - 2.00) and severe malocclusion (RP = 3.33, CI = 1.07 - 5.00). There was no difference between the groups with and without DS regarding the impact of the children's/adolescents' oral coding on the quality of life of their families for the domains and for the total FIS score (p > 0.05). The oral conditions determining the negative impact on the quality of life of families of children/adolescents with DS were dental caries (RP = 3.95, CI = 2.09 - 7.46), clinical consequences of untreated dental caries (RP = 1.83, CI = 1.18 - 2.84), defined malocclusion (RP = 2.75, CI = 1.23 - 6.13) and severe occlusion (RP = 2.82, CI = 1.02 - 7.74). In general, the impact of oral conditions on the quality of life of children/adolescents with DS was more negative when compared to children/adolescents without DS. The presence of clinical consequences of untreated dental caries and visible plaque were the determining oral conditions for a negative impact on oral health related quality of life of children/adolescents with DS. Dental caries, clinical consequences of untreated dental caries, defined malocclusion and severe malocclusion were the determinant oral conditions for the impact on the quality of life of families of children/adolescents with DS. Key-words: Down Syndrome. Oral Health. Children/Adolescents. Quality of life. Oral Health-Related Quality of Life.

O efeito do esporte adaptado na qualidade de vida e no perfil biopsicossocial de crianças e adolescentes com paralisia cerebral / The effect of adapted sports in quality of life and biopsychosocial profile of children and adolescents with cerebral palsy

RESUMO: Objetivo: A participação em atividades esportivas e recreativas promove a inclusão e a qualidade de vida (QV) de crianças/adolescentes com deficiência. Este estudo visa avaliar e descrever o efeito do esporte adaptado (EA) na QV e o perfil biopsicossocial de crianças/adolescentes com paralisia cerebral (PC). Métodos: Foram avaliados e encaminhados ao EA (futebol e natação) 47 crianças e adolescentes com PC. A QV foi avaliada pelo Instrumento para Avaliação de Resultados de Reabilitação em Pediatria (IARPP) e o perfil biopsicossocial pela Lista de Verificação Comportamental para Crianças/Adolescentes (CBCL). Foram verificadas as influências de sexo, idade, raça, renda, escolaridade e topografia da espasticidade. Resultados: Dezessete crianças/adolescentes praticaram o EA e foram reavaliados após um ano. Foi observada melhora significativa nas dimensões transferências e mobilidade (p=0,009), função e extremidade superior (p=0,021) e função global (p=0,004) do IARRP. Houve melhora significativa considerando as síndromes problemas de atenção (p=0,026) e problemas de déficit de atenção e hiperatividade (p=0,008) na análise do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM) Orientado (CBCL). Crianças com diplegia obtiveram mais benefício que aquelas com hemiplegia em relação às dimensões dor e conforto (p=0,02) e dimensão global (p=0,027) (IARPP). Os meninos apresentaram maiores escores em total de competência (p=0,048); o grupo extremamente pobre obteve maiores índices na síndrome quebrar regras (p=0,008). Conclusão: O EA apresentou efeito positivo na QV e no perfil biopsicossocial das crianças e dos adolescentes com PC dessa amostra, especialmente considerando: função global e de extremidades superiores, capacidade para transferências e mobilidade, e benefícios nos problemas relacionados às dificuldades na atenção.

ABSTRACT Objective: The participation in sports and recreational activities promotes inclusion and the quality of life (QOL) for people with some type of disability. This study aims to evaluate and describe the effect of adapted sports (AS) on the QOL and biopsychosocial profile of children/adolescents with cerebral palsy (CP). Methods: Forty-seven children/adolescents with CP were evaluated and referred to AS (soccer and swimming). The QOL was evaluated by the Pediatric Outcome Data Collection Instrument (PODCI) and the biopsychosocial profile by the Behavior Checklist for Children/Adolescents (CBCL). These instruments considered the influence of gender, age, race, social income, education and topography of spasticity. Results: Seventeen children/adolescents who practiced AS were re-evaluated after one year. There was significant improvement in the dimensions of transfers and mobility (p=0.009), upper extremity function (p=0.021) and global function (p=0.004) of IARRP. There was significant improvement considering the attention disorder syndrome (p=0.026), and the attention deficit hyperactivity disorders (p=0.008) in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented analysis (CBCL). Children/adolescents with diplegia obtained greater benefit than those with hemiplegia in relation to the comfort and pain (p=0.02) and global dimension (p=0.027) (PODCI). The boys had higher scores in total competence (p=0.048); the extremely poor group obtained higher levels in the breaking rules syndrome (p=0.008). Conclusions: The AS had a positive effect on the QOL and biopsychosocial profile of children/adolescents with CP in this sample, especially considering the global and upper extremity function, capacity for transfers and mobility, and benefits in the problems related to difficulties in attention.

Medicinas complementarias]/alternativas en adolescentes con trastorno déficit atencional/hiperactividad y trastornos del ánimo / [ign]Complementary/alternative medicine in adolescents with attention deficit hyperactivity disorder and mood disorders

Las Medicinas Complementarias/alternativas (MCA) cada día son más utilizadas por los pacientes, incluidos niños y adolescentes. En Chile el Ministerio de Salud (Minsal), ha ido reconociendo y regulando alguna de ellas, aunque todavía existe gran desconocimiento sobre su efectividad y seguridad. OBJETIVO: Revisar la evidencia disponible en relación a las MCA en adolescentes con Trastorno déficit atencional/hiperactividad (TDAH) y trastornos del ánimo. METODOLOGÍA: Se realizó una búsqueda bibliográfica en PubMed de artículos de revisión del tema, publicados los últimos 10 años, con las palabras claves "Complementary/Alternative Medicine/Therapies"; "Attention deficit disorder with hyperactivity" y "Mood disorders" combinadas con "Children/Adolescents". Se complementó con otras fuentes de información consideradas relevantes. RESULTADOS: Mundialmente ha habido un aumento progresivo de publicaciones en relación a MCA. No obstante, no todos los estudios son de buena calidad metodológica, y la mayoría de los estudios en población infanto-juvenil señalan resultados inconclusos. En TDAH se han demostrado beneficios con ácidos grasos omega 3. En relación a otras MCA y TDAH, no se han demostrado efectos favorables superior al placebo. Varios estudios presentan fallas metodológicas y hacen faltan más estudios, lo cual imposibilita tener conclusiones al respecto. En trastornos del ánimo, hay varias terapias promisorias, como es el ejercicio físico, la terapia de luz, la hierba de San Juan y algunos tipo de meditación como el Mindfulness. En Chile, todavía no hay estudios en este grupo etario, siendo importante poder desarrollar líneas de investigación en esta área en virtud de la situación actual del país.

The Complementary/Alternative Medicine (CAM) have been increasingly used by patients such as children and adolescents. The Ministry of Health in Chile (MINSAL) has recognized and regulated some CAM, although there is still unknown their effectiveness and safety of these. OBJECTIVE: Review the available evidence regarding the use of CAM in adolescents with the attention deficit hyperactivity syndrome (ADHD) and mood disorders. METHODOLOGY: A review of the related literature about this topic on PubMed, focus on the last 10 years and using as a keywords Complementary/Alternative Medicine/Therapies, Attention deficit disorder with hyperactivity, Mood disorders, and Children/Adolescents. The revision was also complemented with other sources of information. RESULTS: Globally there has been a progressive increase in publications in relation to the CAM. However, not all studies follow a good methodology and the majority of the studies in adolescents show inconclusive results. The ADHD studies have shown benefits when using omega 3 fatty acids. Regarding other CAM and ADHD, the evidence does not show any favorable results beyond placebo. Though some of these studies have methodological mistakes or lack of enough studies, making it impossible to have conclusive. In mood disorders, there are several promising therapies, such as: physical exercise, light therapy, St. John’s Wort and some kinds of meditation like Mindfulness. In Chile, there are still no studies in this age group, which makes important the development of a line of research in this area.

Effect of CDC73 gene mutation on clinical characteristics of sporadic children/adolescent-onset primarg hyperparathyroidism / 基础医学与临床

Objective To summarize the characteristics and molecular genetics of sporadic children /adolescent-onset primary hyperparathyroidism PHPT patients and analyze the difference of characteristics between patients with and without CDC73 gene mutations .Methods Germline mutation analyses of MEN1, CDC73, RET, CDKN1B, and CaSR genes were performed in 22 sporadic children/adolescent-onset PHPT patients .Their clinical data were retrospectively analyzed.Results Four patients were found to carry CDC 73 mutations with the mutation rate of 18%(4/22).Patients with CDC73 gene mutationshad higher rates of parathyroid carcinoma and atypical adenomas than those without ,and the recurrence rate postoperatively was as high as 50%.Conclusions Genetic mutation testing is recommended in spo-radic children/adolescent-onset PHPT patients, especially the CDC73 gene.

Analysis on geographic distribution of high blood pressure prevalence in children and adolescents aged 7-18 years in China, 2014 / 中华流行病学杂志

Objective To understand and evaluate the characteristics of geographic distribution of high blood pressure prevalence in children and adolescents aged 7-18 years in China in 2014,and provide evidence for the prevention of hypertension in children and adolescents.Methods The data of 2014 Chinese National Surveys on Students Constitution and Health conducting 31 provinces (except Hong Kong,Macao and Taiwan) were collected.A total of 216 299 children and adolescents who had complete blood pressure records were selected as study subjects.The low,middle and high prevalence areas were identified according to their high blood pressure detection rates in the children and adolescents,＜4％,4％-7％ and ＞7％,to analyze the geographic distribution of high blood pressure prevalence in the children and adolescents.The environmental data in the capitals of 31 provinces in 2014 were collected to analyze the correlation between environmental factors and blood pressure Z score in the children and adolescents.Results The average detection rates of high blood pressure was 6.4％ in 31 provinces (1.5％-14.2％).The high prevalence areas were mainly distributed in the eastern China,especially the Circum-Bohai sea area,low prevalence areas were mainly distributed in the central and western areas of China and some provinces in the east.Correlation analysis results showed that the annual average temperature,annual average air humidity and local altitude were negatively correlated with blood pressure Z score,including diastolic and systolic blood pressure,in both boys and girls.The annual average sunshine time,PM2.5 and PM10 concentrations,content of SO2 were positively correlated with blood pressure Z score in both boys and girls.Conclusions There was a significant difference in high blood pressure of children and adolescents among 31 provinces.More attention should be paid to the children and adolescents living high prevalence area.And it is necessary to understand environmental factors which can affect the blood pressure of children and adolescents.

Analysis on geographic distribution of high blood pressure prevalence in children and adolescents aged 7-18 years in China, 2014 / 中华流行病学杂志

Objective To understand and evaluate the characteristics of geographic distribution of high blood pressure prevalence in children and adolescents aged 7-18 years in China in 2014,and provide evidence for the prevention of hypertension in children and adolescents.Methods The data of 2014 Chinese National Surveys on Students Constitution and Health conducting 31 provinces (except Hong Kong,Macao and Taiwan) were collected.A total of 216 299 children and adolescents who had complete blood pressure records were selected as study subjects.The low,middle and high prevalence areas were identified according to their high blood pressure detection rates in the children and adolescents,＜4％,4％-7％ and ＞7％,to analyze the geographic distribution of high blood pressure prevalence in the children and adolescents.The environmental data in the capitals of 31 provinces in 2014 were collected to analyze the correlation between environmental factors and blood pressure Z score in the children and adolescents.Results The average detection rates of high blood pressure was 6.4％ in 31 provinces (1.5％-14.2％).The high prevalence areas were mainly distributed in the eastern China,especially the Circum-Bohai sea area,low prevalence areas were mainly distributed in the central and western areas of China and some provinces in the east.Correlation analysis results showed that the annual average temperature,annual average air humidity and local altitude were negatively correlated with blood pressure Z score,including diastolic and systolic blood pressure,in both boys and girls.The annual average sunshine time,PM2.5 and PM10 concentrations,content of SO2 were positively correlated with blood pressure Z score in both boys and girls.Conclusions There was a significant difference in high blood pressure of children and adolescents among 31 provinces.More attention should be paid to the children and adolescents living high prevalence area.And it is necessary to understand environmental factors which can affect the blood pressure of children and adolescents.

Rol de las funciones inhibitorias en la memoria de trabajo: evidencia en niños y adolescentes / Role of Inhibitory Functions in Working Memory: Evidence in Children and Adolescents / Rol das funções inibitórias na memória de trabalho: evidencia em crianças e adolescentes

Objetivo. Distintas posturas teóricas han planteado una relación estrecha entre memoria de trabajo (MT) e inhibición. Por ello, el objeto del presente estudio fue analizar el rol que juegan los procesos inhibitorios de inhibición perceptual o acceso, inhibición cognitiva o borrado e inhibición de restricción en el desarrollo de la MT entre los 8 y los 18 años de edad. Método. La muestra estuvo conformada por 277 participantes de la ciudad de Mar del Plata, divididos en tres grupos de edad (8-9 años, 10-12 años y 17-18 años). Los participantes fueron evaluados con una tarea compleja de MT (amplitud de oraciones) que permite obtener, además de la amplitud verbal de la MT, distintos indicadores sobre las funciones inhibitorias. Resultados. Los resultados del estudio mostraron que el desempeño en MT es más elevado en los participantes de mayor edad, siendo significativo el efecto diferencial de la edad sobre la MT. En cuanto a las funciones inhibitorias, se observaron efectos significativos en relación con el tipo de inhibición y grupo de edad. Conclusión. En concordancia con estudios previos, se encontraron relaciones entre la MT y las funciones inhibitorias de acceso y restricción no siendo esta relación influida por la edad.

Objective. Different theoretical positions have posted a close relationship between working memory (WM) and inhibition. Therefore, the aim of this study was to analyze the role played by inhibitory processes or perceptual inhibition, cognitive inhibition and restraint inhibition in the development of WM between 8 and 18 years. Method. The sample consisted of 277 participants from the city of Mar del Plata divided into three age groups (8-9 years, 10-12 years and 17-18 years). Participants were assessed with a task of WM that provide several indicators of inhibitory functions. Results. Study results showed that performance in WM is higher in older participants, with significant differential effect of age on WM. Significant effects were observed in relation to the type of inhibition and the age group. Conclusion. Consistent with previous studies, a small relationship between WM perceptual inhibition and restraint inhibition, this relationship is mediated by age.

Escopo. Diferentes posturas teóricas tem planteado uma relação estreita entre memória de trabalho (MT) e inibição. Por isto, o objetivo do presente estudo foi analisar o papel desempenhado pelos processos inibitórios de inibição perceptual ou acesso, inibição cognitiva ou apagado e inibição de restrição no desenvolvimento da MT entre os 8 e os 18 anos de idade. Metodologia. A amostra foi conformada por 277 participantes da cidade de Mar del Plata, divididos em três grupos de idade (8-9 anos, 10-12 anos e 17-18 anos). Os participantes foram avaliados com uma tarefa complexa do MT (amplitude de orações) que permite obter, além da amplitude verbal da MT, distintos indicadores sobre funções inibitórias. Resultados. Os resultados do estudo mostraram que o desempenho em MT é mais elevado nos participantes de maior idade, sendo significativo o efeito diferencial da idade sobre a MT. Em quanto às funções inibitórias, foram observados efeitos significativos em relação com o tipo de inibição e grupo de idade. Conclusão. Em concordância com estudos prévios, foram encontradas relações entre a MT e as funções inibitórias de acesso e restrição não sendo esta relação influída pela idade.

Condición física y riesgo cardiovascular futuro en niños y adolescentes argentinos: una introducción de la batería ALPHA / Physical fitness and future cardiovascular risk in argentine children and adolescents: an introduction to the ALPHA test battery

Introducción. Altos niveles de condición física están relacionados con la salud cardiovascular de niños y adolescentes. Actualmente, en Argentina, no existe la aplicación sistemática de una batería para evaluar la condición física en el ámbito escolar. El propósito principal del estudio fue aplicar la batería ALPHA para determinar la condición física en una muestra de niños y adolescentes argentinos, y establecer la proporción de sujetos con nivel de capacidad aeróbica indicativo de riesgo cardiovascular futuro. Población y métodos. Una muestra de 1867 participantes (967 mujeres) de entre 6 y 19,5 años fueron evaluados con la batería ALPHA. Se midieron cuatro componentes de la condición física: 1) morfológico: estatura, peso corporal y perímetro de cintura; 2) muscular: test salto de longitud; 3) motor: test de velocidad/agilidad (carrera 4 x 10 m); 4) cardiorrespiratorio: test course navette de 20 m y cálculo del consumo máximo de oxígeno. Se calcularon los percentiles 5, 25, 50, 75 y 95 para los principales tests. Resultados. El índice de masa corporal medio fue 20,8 kg/m², y el 7,8% se clasificó en la categoría obesidad. Además, los participantes masculinos, en comparación con los femeninos, obtuvieron un mayor rendimiento en todos los tests de condición física (P < 0,001). En el 31,6% de los participantes se observó un nivel de capacidad aeróbica indicativo de riesgo cardiovascular. Conclusiones. La muestra de niños y adolescentes argentinos de sexo masculino presentó mayores niveles de condición física. Estas diferencias se incrementaron con la edad. Aproximadamente, 1 de cada 3 participantes tuvo un nivel de capacidad aeróbica indicativo de riesgo cardiovascular futuro.

Introduction. A high level of physical fitness is associated with cardiovascular health in children and adolescents. At present, there is no systematic implementation of a test battery to assess physical fitness at schools in Argentina. The main objective of this study was to implement the ALPHA test battery to determine the physical fitness of a sample made up of Argentine children and adolescents and to establish the proportion of subjects whose aerobic capacity is indicative of future cardiovascular risk. Population and methods. A sample of 1867 participants (967 girls) aged 6 to 19.5 years old assessed using the ALPHA test battery. Four components of physical fitness were measured: 1) morphological component: height, body weight, and waist circumference; 2) musculoskeletal component: standing long jump test; 3) motor component: speed/agility test (4x10 m shuttle run); 4) cardiorespiratory component: course-navette 20 m, shuttle run test and estimation of maximal oxygen consumption. The 5th, 25th, 50th, 75th, and 95th percentiles were estimated for the main tests. Results. The mean body mass index was 20.8 kg/m2, and 7.8% of participants were classified as obese. In addition, male participants had a better performance in all physical fitness tests when compared to girls (p< 0.001). An aerobic capacity indicative of cardiovascular risk was observed in 31.6% of all participants. Conclusions. Argentine male children and adolescents included in the sample showed higher levels of physical fitness. Such differences increase with age. Approximately one every three participants had an aerobic capacity indicative of future cardiovascular risk.

Implementación de un cuestionario de calidad de vida relacionada con la salud para niños y adolescentes con enfermedad celíaca / Implementation of a health-related quality of life questionnaire for children and adolescents with celiac disease

Introducción. En los pacientes con enfermedad celíaca, medir la calidad de vida relacionada con la salud permite un abordaje integral. Objetivo. Evaluar la implementación y la sensibilidad al cambio de la versión argentina del cuestionario específco CDDUX para medir la calidad de vida relacionada con la salud en niños y adolescentes. Métodos. Estudio descriptivo, observacional, longitudinal y prospectivo. Participaron niños y adolescentes de 8 a 18 años con enfermedad celíaca, su padre o tutor, y un gastroenterólogo. La calidad de vida relacionada con la salud se evaluó con el CDDUX y la sensibilidad al cambio, mediante la variación de su puntaje aplicado en dos oportunidades y una escala de percepción del cambio desde la opinión del paciente y su padre. También la experiencia en su implementación con un formulario sobre fortalezas y debilidades completado por pacientes, padres y gastroenterólogos. Resultados. En la primera entrevista 118 binomios niño/padre completaron el CDDUX y registraron la experiencia; 102 lo completaron en dos oportunidades. Los puntajes totales fueron más elevados en la segunda (p= 0,009 y 0,003, respectivamente). Hubo congruencia entre la percepción de cambio expresada por el niño y por el padre, y la diferencia en el puntaje del CDDUX entre consultas (p <0,001). Tamaño del efecto estandarizado: 0,52 en el caso de los niños y 0,45 en los padres. Hubo acuerdo del 64% en las opiniones de los niños con los padres (kappa 0,20) y del 51% con los médicos (kappa 0,10) respecto del cambio entre consultas (mejor-igual-peor). Los gastroenterólogos también registraron su experiencia con el CDDUX. Hubo consenso en que fue satisfactoria y de utilidad. Conclusiones. El CDDUX demostró estabilidad test-retest y sensibilidad al cambio. Hubo visiones diferentes respecto del cambio en la calidad de vida relacionada con la salud del niño, con mayor acuerdo entre los niños y los padres que con el médico. Este cuestionario es aceptado por los niños, los padres y los gastroenterólogos.

Introduction. Measuring health-related quality of life inpatients with celiac disease allows a comprehensive approach. Objective. To assess the implementation and sensitivity to change of the Argentine version of the CDDUX disease-specifc questionnaire to measure health-related quality of life in children and adolescents. Methods. Descriptive, observational, longitudinal and prospective study. Participants were 8 to 18 year old children and adolescents with celiac disease, their parents or legal guardians and their gastroenterologists. The CDDUX questionnaire was used to assess health-related quality of life, and sensitivity to change was evaluated using the variation in the score obtained on two different occasions and a scale of change perception from the patient's and his/her parent's standpoint. The questionnaire implementation was appraised using a strength and weakness form completed by patients, parents and gastroenterologists. Results. The frst interview was conducted among 118 child/parent dyads who completed the CDDUX and recorded their experience; 102 completed the questionnaire on two occasions. Total scores were higher the second time (p = 0.009 and 0.003, respectively). There was consistency between the perception of change expressed by the child/adolescent and the father/ mother, and the difference in the CDDUX score obtained at different consultations (p < 0.001). Standardized effect size: 0.52 for children/adolescents, and 0.45 for parents. A 64% agreement was observed among the opinions of children/ adolescents and their parents´ opinion (kappa 0.20), and a 51% agreement was found among them and their gastroenterologists (kappa 0.10) in terms of change between consultations (better, the same, or worse).Gastroenterologists also recorded their experience with the CDDUX. They agreed that it was satisfactory and useful. Conclusions. The CDDUX questionnaire demonstrated test-retest stability and sensitivity to change. Different opinions were obtained regarding change in children/adolescents health-related quality of life, with a better agreement among children/adolescents and their parents than among them and their physicians. The CDDUX questionnaire has been accepted by children/adolescents, their parents and gastroenterologists.

Cross-sectional association between sedentary behaviors and overweight/obesity among children and adolescents in Chengdu, Sichuan / 中华流行病学杂志

Objective To explore the situation of sedentary behavior and how it correlated to overweight/obesity among children and adolescents in Chengdu,China.Methods A total of 2 211 children and adolescents aged 7-15 years old were recruited in Chengdu city by using the cluster random sampling method.This was a cross-sectional study which aimed to collect data on anthropometry including height and weight and information on basic characters and sedentary behavior by using a self-designed questionnaire.Results According to IOTF criteria,the reporting rate of factor as ‘watching TV ≥2 hours per day on weekend’ showed statistically significant differences among normal,overweight and obese groups (34.80％,4.21％ and 1.92％ respectively,P=0.016 0) in boys.The reporting rates of ‘doing homework ≥2 hours per day’ were 12.17％,0.89％ and 0.49％ respectively (P=0.036 0) and statistically different among the three groups,in girls.Similar results were obtained in boys based on the WGOC criteria.However,there was no statistical difference seen on sedentary behaviors among the three groups in girls according to WGOC criteria.After stratified by age groups,rates on ‘ watching TV on weekend’ were statistically different among normal,overweight and obese group in 13-15 age group in girls (P=0.035 1).Physical activity level (PAL) was positively associated with WHR among both boys and girls when grouped according to PAL (Schofield).However,it was positively associated with WHR only seen in boys according to Chinese Nutrition Society (CNS) criteria.Conclusion The reporting rates of sedentary behavior in obese children were higher than that in overweight/normal ones.However,the correlation of sedentary behaviors on overweight/obesity called for further studies.

Reliability and Validity of the Revised Summary of Diabetes Self-Care Activities (SDSCA) for Malaysian Children and Adolescents

Background: Self-care plays an important role in diabetes management. One of the instruments used to evaluate self-care in patients with diabetes is the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. A validated instrument in the Malay language is used to assess self-care practice among children and adolescents with diabetes in Malaysia. Objective: To translate and evaluate the psychometric properties of the revised version of the SDSCA questionnaire in the Malay language. Methods: Forward and backward translations were performed. An expert panel reviewed all versions for conceptual and content equivalence. The final version was administered to paediatric patients with diabetes between August 2006 and September 2007. Reliability was analysed using Cronbach’s alpha and validity was assessed using exploratory factor analysis. Results: A total of 117 patients aged 10–18 years were enrolled from nine hospitals. The reliability of overall core items was 0.735 (with item 4) while the reliabilities of the four domains were in the range of 0.539–0.838. As core item number 4 was found to be problematic and it was subtituted by item 5a (from the expanded SDSCA) to suit local dietary education and practice; and the reliabilities of the overall core item (0.782) and the four domains (0.620 – 0.838) improved. Factor loadings of all the items were greater than 0.4, loaded into the original domains, and accounted for 73% of the total variance. Conclusion: The Malay translation of the revised English SDSCA is reliable and valid as a guide for Malaysian children and adolescents suffering from diabetes.

Trastornos de la conducta disruptiva en la infancia y la adolescencia: diagnóstico y tratamiento / Disruptive behavior disorders in childhood and adolescence: diagnosis and treatment

Disruptive behavior disorders (DBD) in childhood and adolescence are among the most frequent reasons for consultation and counseling. In Oppositional Defiant Disorder (ODD), psychosocial management is the therapeutic intervention of choice. Training parents and caregivers in the behavioral management of the child or early adolescent (12 to 15 years) is the best interventions. Behavioral perspective needs to cover all contexts: family, school, and the child. The clinician must make an individualized treatment plan. The parents suggested interventions should be based on those with the greatest empirical evidence. The use of drugs may be useful as an addition to psychosocial interventions for symptomatic treatment and comorbid conditions. Severe and persistent ODD may require prolonged and intensive treatment. Brief interventions are usually ineffective. Conduct disorder (CD) is a mixed manifestation that needs biological, psychological and social therapeutic intervention. Psychopharmacological treatment alone is never enough. Studies with drugs for the treatment of CD may be grouped by type of drug used: mood stabilizers, antipsychotics and stimulants. The overall effect size of psychotropic agents in the treatment of aggression is 0.56. Currently only three psychosocial treatments have been adequately evaluated: A) Training for parents, B) Cognitive training in problem-solving skills and C) Multisystemic therapy. Conclusions ODD and CD are among the most frequent and severe mental disorders in childhood and adolescence. The treatment of these conditions must be multimodal or multisystemic, including pharmacological, psychoeducational and psychotherapy.

Los Trastornos de la Conducta Disruptiva (TCD) en la infancia y la adolescencia constituyen uno de los motivos más frecuente de consulta. En el Trastorno Negativista y Desafiante (TND) el tratamiento psicosocial es la intervención terapéutica de primera elección. Los programas de intervención desde una perspectiva conductual abarcan todos los contextos: familiar, escolar y del propio niño o adolescente. El clínico debe considerar importante cualquier información obtenida de otros informantes, vgr. maestros, para realizar un plan de tratamiento individualizado. Las intervenciones sugeridas a los padres deben basarse en las de mayor evidencia científica. El uso de medicamentos puede ser útil como tratamiento adjunto a las intervenciones psicosociales, para el tratamiento sintomático y el de las comorbilidades. Cuando el TND es intenso y persistente se pueden requerir tratamientos prolongados e intensivos. Las intervenciones cortas usualmente son inefectivas. El Trastorno Disocial (TD) es un fenómeno que por su naturaleza mixta, biológica, psicológica y social, requiere de una intervención terapéutica integral. La magnitud del efecto global de los fármacos en el tratamiento de la agresión es de 0.56. Actualmente sólo tres tratamientos psicosociales han sido adecuadamente evaluados: a) El entrenamiento para padres, b) el entrenamiento cognitivo en habilidades para resolver problemas y c) la terapia multisistémica. Conclusiones Los padecimientos externalizados como el TND y el TD; constituyen algunos de los problemas más frecuentes y graves dentro de los trastornos mentales de inicio en la infancia y la adolescencia. El tratamiento de estos padecimientos debe tener un enfoque multimodal o multisistémico que incorpore las aproximaciones farmacológicas, psicoeducativas y psicoterapéuticas necesarias.