Impact of COVID-19 on physical and mental functioning in adolescents with disabilities in a sports nongovernmental organization / Impacto da COVID-19 no funcionamento físico e mental de adolescentes com deficiência em organização não governamental esportiva

Abstract Objective: This study aimed to assess physical and mental health, and health-related quality of life (HRQL) parameters in adolescents with physical disabilities enrolled in a sports nongovernmental organization (NGO) versus adolescents without disabilities during coronavirus disease 2019 (COVID-19) pandemic. Methods: This cross-sectional study included 30 adolescents with disabilities and 86 adolescents without disabilities who responded to an online questionnaire with sociodemographic data and self-rated healthcare routine information during the COVID-19 quarantine. Validated self-report versions of the Strengths and Difficulties Questionnaire (SDQ), Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0), Pittsburgh Sleep Quality Index (PSQI), and Pediatric Outcome Data Collection Instrument (PODCI) were also applied. Results: The median of emotional [4 (0-10) vs. 5 (0-10), p=0.018] and prosocial [7 (0-10) vs. 9 (3-10), p=0.006] problems was lower in adolescents with disabilities versus adolescents without disabilities. Adolescents with disabilities had significantly lower global function [68 (21-99) vs. 94 (67-100), p<0.001] and higher happiness scores in the PODCI scale [90 (65-100) vs. 80 (0-100), p=0.016] compared to controls. Logistic regression analysis demonstrated that physical activity/week (OR=1.03; 95%CI 1.01-1.05, p=0.002) was higher in adolescents with disabilities compared to adolescents without disabilities. However, housework activities (OR=0.14; 95%CI 0.04-0.43, p=0.001) and screen time ≥3 h/day (OR=0.09; 95%CI 0.02-0.38, p=0.001) were lower in adolescents with disabilities compared to adolescents without disabilities. Conclusion: Adolescents with disabilities attending a sports NGO were not at higher risk of adverse health-related indicators; despite showing reduced physical function, they reported more physical activity, higher happiness, and less screen time compared to adolescents without disabilities during the COVID-19 pandemic.

Resumo Objetivo: Avaliar os parâmetros de saúde física e mental, de qualidade de vida relacionada à saúde (QVRS), em adolescentes com deficiência física matriculados em organização não governamental (ONG) esportiva vs. em adolescentes sem deficiência, durante a pandemia da doença do coronavírus 2019 (COVID-19). Métodos: Este estudo transversal incluiu 30 adolescentes com deficiência e 86 adolescentes sem deficiência que responderam a questionário online com dados sociodemográficos e informações de rotina de saúde autoavaliadas durante a quarentena da COVID-19. Versões validadas de autorrelato do Strengths and Difficulties Questionnaire (SDQ), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0), Pittsburgh Sleep Quality Index (PSQI) e Pediatric Outcome Data Collection Instrument (PODCI) também foram aplicadas. Resultados: A mediana de problemas emocionais [4(0-10) vs. 5(0-10),p=0,018] e pró-social [7(0-10) vs. 9(3-10),p=0,006] foi menor em adolescentes com deficiência vs. adolescentes sem deficiência. Adolescentes com deficiência tiveram função global significantemente inferior [68(21-99) vs. 94(67-100),p <0,001] e pontuações de felicidade mais altas do PODCI [90(65-100) vs. 80(0-100),p=0,016] em comparação com o grupo sem deficiências. A análise de regressão logística demonstrou que a atividade física/semana (odds ratio — OR=1,03; intervalo de confiança — IC95%=1,01-1,05,p=0,002) foi maior nos adolescentes com deficiência. No entanto, atividades domésticas (OR=0,14; IC95%=0,04-0,43,p=0,001) e tempo de tela ≥3 horas/dia (OR=0,09; IC95%=0,02-0,38,p=0,001) foram menores nos adolescentes com deficiência. Conclusões: Os adolescentes com deficiência que frequentam uma organização não governamental (ONG) esportiva não tiveram maior risco de apresentar indicadores adversos à saúde; apesar de apresentarem função física reduzida, relataram mais atividade física, maior felicidade e menos tempo de tela em comparação com adolescentes sem deficiência durante a pandemia da COVID-19.

Physical and mental health impacts during COVID-19 quarantine in adolescents with preexisting chronic immunocompromised conditions

Abstract Objective: To evaluate physical and mental health indicators in adolescents with preexisting chronic immunocompromised conditions during coronavirus disease 2019 (COVID-19) quarantine. Methods: A cross-sectional study included 355 adolescents with chronic conditions and 111 healthy adolescents. An online self-rated survey was used to investigate socio-demographic features, healthcare routine, and the quarantine impact on physical and mental health. The validated self-reported version of the Strengths and Difficulties Questionnaire (SDQ) was also applied. Results: The median of age [14 (10-18) vs. 15 (10-18) years, p = 0.733] and frequencies of female (61% vs. 60%, p = 0.970) were similar between adolescents with preexisting chronic conditions and healthy adolescents during quarantine of COVID-19 pandemic. The frequencies of abnormal total difficulties score of SDQ were similar in patients and controls (30% vs. 31%, p = 0.775). Logistic regression analysis showed that being female (OR = 1.965; 95% CI = 1.091-3.541, p = 0.024), fear of underlying disease activity/complication (OR = 1.009; 95%CI = 1.001-1.018, p = 0.030) were associated with severe psychosocial dysfunction in adolescents with chronic conditions, whereas school homework (OR = 0.449; 95% CI = 0.206-0.981, p = 0.045) and physical activity (OR = 0.990; 95% CI = 0.981-0.999, p = 0.030) were protective factors. Further analysis of patients with chronic immunocompromised conditions and previous diagnosis of mental disorders (9%) compared with patients without diagnosis showed higher median of total difficulties score (p = 0.001), emotional (p = 0.005), conduct (p = 0.007), peer problems (p = 0.001) and hyperactivity (p = 0.034) in the former group. Conclusion: Adolescents with preexisting chronic immunocompromised conditions during COVID-19 quarantine were not at higher risk of adverse health indicators. Being female, fear of underlying disease activity/complication, and household members working outside of the home were relevant issues for adolescents with preexisting chronic conditions. This study reinforces the need to establish mental health strategies for teens with chronic conditions, particularly during the pandemic.

Diagnostic operationalization and phenomenological heterogeneity in psychiatry: the case of attention deficit hyperactivity disorder / Operacionalización diagnóstica y heterogeneidad fenomenológica en psiquiatría: el caso del trastorno por déficit de atención con hiperactividad

Abstract Introduction We assessed the impact of polythetic conceptualizations of mental disorders on the validity and reliability of psychiatric diagnosis, with a specific focus on two levels of heterogeneity: phenomenological and pathophysiological. Objective We investigated this issue using attention deficit hyperactivity disorder (ADHD) as an example. Method We examined individuals from two samples enriched for psychopathology (n = 1 255 children in Porto Alegre and 1 257 children in São Paulo, Brazil). We conducted a series of data analyses to investigate phenomenological heterogeneity, including confirmatory factor analysis. We also investigated pathophysiological heterogeneity using symptom-level regressions between ADHD symptoms and four neurocognitive processes consistently linked to ADHD (working memory, inhibitory control, intra-subject variability in reaction times, and temporal processing). Lastly, we assessed the performance of polythetic systems for reliability testing inter-rater and test-rest reliability of two well-known symptomatic scales. Results Among the 116 200 possible combinations of symptoms to achieve DSM symptomatic threshold for categorical ADHD diagnosis, we found 173 combinations in the two independent samples, and only four were replicated in both samples (2.3%). We also found that the number of ADHD symptoms is a poor indicator of variation in the general ADHD latent trait. Overall, symptoms did not have specific profiles of associations with any of the neurocognitive processes. Reliability analyses revealed that increasing the number of items augments overall reliability of measurements. Discussion and conclusion Our findings illustrate both potential benefits and problems inherent to the polythetic system for ADHD. Implications for the search of mechanisms underlying psychiatric disorders are discussed.

Resumen Antecedentes Evaluamos el impacto de las conceptualizaciones politécnicas de los trastornos mentales en la validez y la fiabilidad del diagnóstico psiquiátrico, con un enfoque específico en dos niveles de heterogeneidad: fenomenológico y fisiopatológico. Objetivos Investigamos este problema utilizando el trastorno por déficit de atención e hiperactividad (TDAH) como ejemplo. Método Examinamos individuos de dos muestras enriquecidas por psicopatología (n = 1 255 niños en Porto Alegre y 1 257 niños en São Paulo, Brasil). Llevamos a cabo una serie de análisis de datos para investigar la heterogeneidad fenomenológica, incluido el análisis factorial confirmatorio. También investigamos la heterogeneidad fisiopatológica utilizando regresiones al nivel de síntomas entre los síntomas del TDAH y cuatro procesos neurocognitivos consistentemente vinculados al TDAH (memoria de trabajo, control inhibitorio, variabilidad intrasujeto en tiempos de reacción y procesamiento temporal). Por último, evaluamos el rendimiento de los sistemas politéticos para la prueba de confiabilidad interevaluador y la confiabilidad test-rest de dos escalas sintomáticas bien conocidas. Resultados Entre las 116 200 posibles combinaciones de síntomas para alcanzar el umbral sintomático del DSM para el diagnóstico categórico de TDAH, encontramos 173 combinaciones en las dos muestras independientes y sólo cuatro se replicaron en ambas muestras (2.3%). También encontramos que la cantidad de síntomas de TDAH no es un buen indicador de la variación en el rasgo latente general del TDAH. En general, los síntomas no tenían perfiles específicos de asociaciones con ninguno de los procesos neurocognitivos. Los análisis de confiabilidad revelaron que aumentar el número de artículos aumenta la confiabilidad general de las mediciones. Discusión y conclusión Nuestros hallazgos ilustran tanto los beneficios potenciales como los problemas inherentes al sistema politécnico para el TDAH. Se discuten las implicaciones para la búsqueda de mecanismos subyacentes a los trastornos psiquiátricos.

Socioeconomic diversities and infant development at 6 to 9 months in a poverty area of São Paulo, Brazil / Diversidades socioeconômicas e o desenvolvimento infantil de 6 a 9 meses no estado de São Paulo, Brasil

Abstract Introduction The effects of socioeconomic disparities on cognitive development tend to emerge early in infancy and to widen throughout childhood, and may perpetuate later in life. Although the study of how poverty affects early childhood has increased in the last 20 years, many of the effects remain largely unknown, especially during the first year of life. Aim To investigate the influence of socioeconomic status (SES) and maternal education on infants' language, motor and cognitive development. Methods The cognitive, language and motor skills of 444 infants aged 6 to 9 months selected from a poor neighborhood in São Paulo, Brazil, were evaluated using the Bayley Scales of Infant Development. A questionnaire on socioeconomic background was administered to the participants' families. Results A positive association was found between SES and infants' performance on language and motor scales. Additionally, higher maternal education was associated with higher language and cognitive scores. Conclusion Our findings indicate that SES effects are detectable very early in infancy. This result has implications for the timing of both screening and intervention efforts to help children overcome the consequences of living in poverty.

Resumo Introdução Os efeitos das disparidades socioeconômicas no desenvolvimento cognitivo tendem a surgir no início da primeira infância e a se ampliar ao longo da infância, e podem perpetuar-se mais tardiamente. Embora estudos mostrando os efeitos deletérios de um menor nível socioeconômico (NSE) no desenvolvimento na primeira infância tenham aumentado nos últimos 20 anos, muitos desses efeitos ainda permanecem desconhecidos, especialmente durante o primeiro ano de vida. Objetivo Investigar a influência do NSE e da escolaridade materna no desenvolvimento linguístico, motor e cognitivo do bebê. Método Foram avaliadas as habilidades cognitivas, linguísticas e motoras de 444 lactentes com 6 a 9 meses de idade selecionados em um bairro de baixo NSE na zona oeste de São Paulo, Brasil, utilizando-se as Escalas Bayley de Desenvolvimento Infantil. Um questionário também foi administrado para coletar dados sobre o background socioeconômico das famílias das crianças participantes. Resultado Foi observada uma associação positiva entre NSE e o desempenho dos lactentes nas escalas de linguagem e desenvolvimento motor. Adicionalmente, maior educação materna esteve associada a escores mais altos nas escalas de desenvolvimento linguístico e cognitivo. Conclusão Os resultados deste estudo indicam que os efeitos do NSE são detectáveis muito cedo na primeira infância. Este resultado tem implicações para o timing de avaliações e intervenções que possam ajudar as crianças a superar as consequências de viver na pobreza.

Methylphenidate use in children with attention deficit hyperactivity disorder / Uso de metilfenidato em crianças com transtorno de déficit de atenção e hiperatividade

A Brazilian Health Technology Assessment Bulletin (BRATS) article regarding scientific evidence of the efficacy and safety of methylphenidate for treating attention deficit hyperactivity disorder (ADHD) has caused much controversy about its methods. Considering the relevance of BRATS for public health in Brazil, we critically reviewed this article by remaking the BRATS search and discussing its methods and results. Two questions were answered: did BRATS include all references available in the literature? Do the conclusions reflect the reviewed articles? The results indicate that BRATS did not include all the references from the literature on this subject and also that the proposed conclusions are different from the results of the articles chosen by the BRATS authors themselves. The articles selected by the BRATS authors showed that using methylphenidate is safe and effective. However, the BRATS final conclusion does not reflect the aforementioned and should not be used to support decisions on the use of methylphenidate.

O Boletim Brasileiro de Avaliação de Tecnologias em Saúde (BRATS), em matéria sobre as evidências científicas da eficácia e segurança do metilfenidato para o transtorno de déficit de atenção e hiperatividade (TDAH), gerou controvérsias sobre sua metodologia. Considerando a relevância do BRATS para a saúde pública no Brasil, realizou-se análise crítica dessa matéria ao refazer a busca do BRATS e discutir sua metodologia e achados. Foram respondidas duas perguntas:o BRATS incluiu todas as referências disponíveis na literatura? As conclusões refletiram os textos revisados? Identificou-se que o BRATS não incluiu todas as referências da literatura sobre o tema e que as conclusões propostas estão diferentes dos resultados dos artigos escolhidos pelos próprios autores do BRATS. Os artigos selecionados pelos autores do BRATS apontam para a eficácia e segurança do uso do metilfenidato. Entretanto, a conclusão final dos autores não reflete isso e não deveria ser usada como referência para orientar decisões sobre o uso do metilfenidato.

Can countertransference at the early stage of trauma care predict patient dropout of psychiatric treatment? / Contratransferência no atendimento inicial de vítimas de trauma pode predizer o abandono do tratamento psiquiátrico?

OBJECTIVES: To investigate the association between feelings of countertransference (CT) at the early psychiatric care provided to trauma victims and treatment outcome. METHOD: The Assessment of Countertransference Scale was used to access CT after the first medical appointment. Fifty psychiatric residents cared for 131 trauma victims of whom 83 percent were women, aged 15 to 64 years. Patients had been consecutively selected over 4 years. Were evaluated the clinical and demographic characteristics of patients and the correlation with the therapists' CT feelings. Patients were followed-up during treatment to verify the association between initial CT and treatment outcome, defined as discharge and dropout. RESULTS: The median number of appointments was 5 [4; 8], absences 1 [0; 1], and the dropout rate was 34.4 percent. Both groups, namely the discharge group and the dropout group, shared similar clinical and demographic characteristics. A multivariate analysis identified that patients with a reported history of childhood trauma were 61 percent less likely to dropout from treatment than patients with no reported history of childhood trauma (OR = 0.39, p = 0.039, CI95 percent 0.16-0.95). There was no association between initial CT and treatment outcome. CONCLUSIONS: In this sample, CT in the initial care of trauma victims was not associated with treatment outcome. Further studies should assess changes in CT during treatment, and how such changes impact treatment outcome.

OBJETIVOS: Investigar a associação entre contratransferência (CT) no atendimento psiquiátrico inicial de vítimas de trauma e desfechos do tratamento. MÉTODO: A contratransferência de 50 terapeutas foi avaliada através da Assessment of Countertransference Scale após o primeiro atendimento de 131 vítimas de trauma (83 por cento mulheres, idade entre 15 e 64 anos) selecionadas consecutivamente durante 4 anos. Foram avaliadas características demográficas e clínicas dos pacientes, e investigaram-se seus correlatos com os sentimentos contratransferenciais dos terapeutas. Os pacientes foram acompanhados ao longo do tratamento para verificar a associação entre a CT e o desfecho do tratamento, operacionalizado como alta ou abandono. RESULTADOS: A mediana de consultas realizadas foi 5 [4; 8], faltas 1 [0; 1] e taxa de abandono 34,4 por cento. As características demográficas e clínicas dos pacientes dos grupos alta e abandono foram similares. Na análise multivariada, identificou-se que pacientes com relato de trauma na infância tiveram uma chance 61 por cento menor de abandonar o tratamento que pacientes sem relato de trauma na infância (OR = 0,39; p = 0,039; IC 95 por cento 0,16-0,95). Não foi detectada associação entre sentimentos contratransferenciais iniciais com os desfechos do tratamento. Conclusões: A CT no atendimento inicial de vítimas de trauma não esteve associada ao desfecho do tratamento. Estudos futuros devem avaliar a modificação da CT ao longo do tratamento e seu impacto sobre os desfechos.

Violência sexual e sua prevalência em adolescentes de Porto Alegre, Brasil / Sexual violence and its prevalence among adolescents, Brazil

OBJETIVO: Verificar a prevalência da exposiçäo à violência sexual entre adolescentes estudantes de escolas estaduais. MÉTODOS: Foram selecionadas 52 escolas estaduais de Porto Alegre, RS, Brasil, com ensino fundamental completo, por meio de um processo de amostragem aleatória, estratificada de acordo com o tamanho das escolas. Foi selecionada, em cada escola, uma turma de oitava série por sorteio aleatório e foram incluídos todos os adolescentes presentes nas salas de aula que consentiram em participar do estudo. Foi utilizado o instrumento Triagem da Exposiçäo de Crianças à Violência na Comunidade para identificar jovens que foram vítimas, testemunhas ou que conheciam vítimas de atos de violência sexual. RESULTADOS: Foram incluídos 1.193 adolescentes, representando 10,3 por cento dos alunos matriculados na oitava série da rede estadual da cidade. Vinte e sete (2,3 por cento) adolescentes relataram ter sido vítimas de violência sexual, 54 (4,5 por cento) ter sido testemunhas de algum tipo de violência sexual e 332 (27,9 por cento) relataram conhecer alguém que tenha sido vítima de violência sexual. CONCLUSOES: A exposiçäo à violência sexual pelas três formas de contato relatadas mostrou-se freqüente entre os adolescentes estudados. Säo necessários estudos que abordem a violência sexual como um fenômeno social amplo, com múltiplos fatores associados, amparando estratégias comunitárias de prevençäo e de tratamento

Adolescents exposed to physical violence in the community: a survey in Brazilian public schools

Objective. To determine the proportion of adolescents who have been exposed to physical violence in the city of Porto Alegre, Brazil. Methods. Fifty-two Porto Alegre public schools that offer basic primary education (grades 1 to 8) were selected through a random sampling process stratified according to school size. In May-November 2000 a screening survey that identifies exposure to violence¾experienced personally, witnessed, or knowing victims of violent acts¾was administered to all students who were attending a randomly selected 8th grade class in each of the 52 schools. Results. The total number of adolescents included in the analysis was 1 193, representing 10.3 percent of the students enrolled in 8th grade classes in the city's public school system. On average, each adolescent had been exposed to 19.8 incidents of violence (standard deviation (SD) = 8.5): 2.0 incidents personally experienced (SD = 2.1), 8.5 incidents witnessed (SD = 4.0), and 9.3 knowing a victim of an incident of violence (SD = 4.1). In our sample, the variables of being male (P < 0.001), being in an older age group (P< 0.001), and not living with both parents (P< 0.001) were independently associated with exposure to more incidents of violence. Conclusions. We found a high prevalence of incidents of violence among the adolescents in our sample in Porto Alegre. Considering the particular burden inflicted by violent acts on adolescents, health professionals must develop effective approaches to actively identifying, intervening in, and preventing community violence

O médico, o estudante de Medicina e a morte / The doctor, the medical student and death

O presente trabalho tem como objetivo discutir algumas idéias a respeito da morte e do morrer e refletir sobre a presença da morte em nossa vida e na prática médica. Os autores revisam várias contribuições psicanalíticas sobre o significado da morte individualmente e das suas expressões na cultura ocidental. Destacam que as dificuldades que o indivíduo encontra ao elaborar sua própria morte se refletem no modo como a sociedade contemporânea, na qual se incluem os médicos de um modo geral, reage frente ao morrer...