Trastornos de la conducta alimentaria en adolescentes: una mirada integral / Eating disorders in adolescents: a comprehensive approach

Los trastornos de la conducta alimentaria (TCA) son enfermedades muy serias que se inician habitualmente en la adolescencia y en general han ido en aumento en los países en desarrollo. Actualmente, diversos factores obstaculizan su prevención, pesquisa y tratamiento en el país, siendo uno importante la escasez de capacitación de los profesionales de salud en este tema emergente. El objetivo de este artículo es contribuir al conocimiento que poseen los pediatras sobre los TCA en la adolescencia, mediante una revisión actualizada de la literatura en el tema. En esta publicación se abordan la principal clasificación internacional de los TCA en uso en la literatura científica actual y la epidemiología, etiología, el impacto en la salud integral, la presentación clínica y el tratamiento de los TCA más frecuentes en la adolescencia.

Eating disorders (ED) are very serious diseases that usually begin in adolescence and have, in general, been increasing in developing countries. In the country, there are currently several fac tors that hinder their prevention, detection, and treatment, where the lack of training of health professionals in this emerging issue appears as an important one. The purpose of this article is to contribute to the knowledge that pediatricians have about ED in adolescence, through an updated review of the literature on the subject. This publication addresses the main internatio nal classification of ED in use in the current scientific literature and the epidemiology, etiology, impact on comprehensive health, clinical presentation, and treatment of the most common ED in adolescence.

Trastornos de la conducta alimentaria en adolescentes: rol del pediatra: recomendaciones de la Rama de Adolescencia de la Sociedad Chilena de Pediatría / Eating disorders in adolescents: role of the pediatrician: recommendations of the Adolescence Branch of the Chilean Society of Pediatrics

Los trastornos de la conducta alimentaria (TCA) han adquirido relevancia en la pediatría chilena. Su tratamiento debe ser realizado, de preferencia, por equipos multidisciplinarios especializados o con alto grado de capacitación en la problemática. Sin embargo, los pediatras generales tienen un rol fundamental tanto en la prevención como en la pesquisa temprana de estas patologías. El objetivo de esta publicación es proporcionarles recomendaciones prácticas sobre las intervenciones que pueden llevar a cabo durante la atención de adolescentes, para la prevención de los TCA, la pesquisa precoz y evaluación de quienes ya los presentan, y su derivación oportuna a tratamiento especializado.

Eating disorders (ED) have become relevant in Chilean pediatrics. Their treatment must be prefe rably carried out by multidisciplinary teams with specialty or a high degree of training in the pro blem. However, general pediatricians have a fundamental role both in the prevention and in the early detection of these pathologies. The purpose of this publication is to provide them with practical recommendations on interventions that can be carried out during adolescent care for the prevention of ED, the early detection and evaluation of those who already have them, and their timely referral to specialized treatment.

Comentarios sobre aspectos clínicos y epidemiológicos del trastorno por atracón / Comments on clinical and epidemiological aspects of binge eating disorder

Antecedentes: el trastorno por atracón frecuentemente se asocia con enfermedades psiquiátricas asociadas, dentro de las cuales se encuentra la obesidad y sus consecuencias. Objetivo: describir aspectos clínicos y epidemiológicos del trastorno por atracón, en particular, su prevalencia, sus factores de riesgo, etiología, elementos desencadenantes, diagnóstico y sus consecuencias. Método: se utilizó como buscador de información científica a Google Académico. Se utilizaron como palabras clave: trastorno por atracón, trastornos de la conducta alimentaria y obesidad. Fueron evaluados artículos de revisión, de investigación, y distintas páginas web, que en general, tenían menos de 10 años de publicados, en idioma español, portugués o inglés. Esto permitió el estudio de 70 artículos, de los cuales 45 fueron referenciados. Conclusión: la prevalencia del trastorno por atracón es variable y en relación con la muestra estudiada. Los factores de riesgo causales son multifactoriales, y resultan de la compleja interacción de factores psicológicos, físicos y socioculturales que interfieren en el comportamiento del individuo, que dificultan la comprensión de su etiología, en la que intervienen varios elementos, y puede ser desencadenado por diferentes situaciones de la vida cotidiana. Su diagnóstico se realiza aplicando los criterios del Manual Diagnóstico y Estadístico de Enfermedades Mentales, Edición 5. Como consecuencia pueden aparecer obesidad, estados de culpa, tristeza, auto-rechazo, problemas al relacionarse con el entorno, dificultades laborales, e incluso, autolesiones e ideación suicida(AU)

Background: binge eating disorder is frequently related with associated psychiatric illnesses, among which obesity and its consequences are. Objective: to describe clinical and epidemiological aspects of binge eating disorder, in particular its prevalence, risk factors, etiology, triggers, diagnosis and its consequences. Method: Google Scholar was used as a scientific information search engine. The following were used as key words: binge eating disorder, eating disorders and obesity. Review articles, research articles and different web pages were evaluated, which in general were less than 10 years old and in Spanish, Portuguese or English languages. This allowed the study of 70 articles, of which 45 were referenced. Conclusions: the prevalence of binge eating disorder is variable and in relation to the sample studied. The causal risk factors are multifactorial, and result from the complex interaction of psychological, physical and sociocultural factors that interfere in the behavior of the individual, which hinder the understanding of their etiology, in which several elements intervene, and can be triggered by different situations of daily life. Its diagnosis is made applying the criteria of the Diagnostic and Statistical Manual of Mental Illnesses, Edition 5. As a consequence, obesity, guilt, sadness, self-rejection, problems relating to the environment, labor difficulties, and even self-injury and suicidal ideation may appear(AU)

Impacto psicosocial de la diabetes mellitus tipo 1 en niños, adolescentes y sus familias: revisión de la literatura / Psychosocial impact of type 1 diabetes mellitus in children, adolescents and their families: literature review

La diabetes mellitus tipo 1 es la patología endocrina crónica más común en niños. El tratamiento incluye dieta, actividad física, medicación con insulina y un autocontrol adecuado. Este autocontrol puede ser dificultoso, provocando que niños, adolescentes y sus familias sufran diversas complica ciones psicosociales. Existe una relación inversa entre autocontrol y presencia de complicaciones psicosociales, siendo los principales problemas ansiedad y depresión, donde los adolescentes llegan a ser 2,3 veces más propensos a presentar problemas de salud mental. Las familias se ven afectadas inicialmente en el período de debut por un estado de shock, con sentimientos de angustia e ira. Los necesarios cambios de hábitos y estilos de vida pueden generar problemas psicosociales entre los que destacan trastornos ansiosos, depresivos y alimenticios. Posteriormente, el niño o adolescente y su grupo familiar pueden transitar a un nuevo equilibrio caracterizado por un buen autocontrol y adherencia al tratamiento o profundizar los trastornos individuales y grupales, trastornos que pue den reaparecer, especialmente en la adolescencia. El tratamiento integral de la diabetes mellitus tipo 1 requiere atender estos aspectos mediante equipos multidisciplinarios que incluyen profesionales médicos y del ámbito psicosocial. En esta revisión se analizan los principales aspectos relacionados al impacto psicosocial en niños y adolescentes con diabetes mellitus tipo 1 y sus familias.

Type 1 diabetes mellitus is the most common chronic endocrine pathology among children. Treatment includes diet, physical activity, insulin medication, and proper self-control. This self-control may be difficult, resulting in children, adolescents and their families suffering diverse psychosocial complications. There is an inverse relationship between self-control and psychosocial complications, the main problems being anxiety and depression, where adolescents are 2.3 times more likely to have mental health problems. Families are initially affected, in the debut period by a state of shock, with feelings of distress and anger. The necesary changes in habits and lifestyles can lead to psychosocial problems, including anxiety, depression and eating disorders. Subsequently, the child or adolescent and his or her family group may move into new balance characterized by good self-control and adherence to tratment, or deepen individual and group disorders which may reappear, especially in adolescence. The comprehensive treatment of type 1 diabetes mellitus requires addressing these aspects through multidisciplinary teams which include medical and phychosocial professionals. This review analyses the main aspects related to the psychosocial impact of diabetes mellitus type 1 among children, adolescents and their families.

Dysfunctional eating behaviors, anxiety, and depression in Italian boys and girls: the role of mass media

Objective: Extensive research has implicated identification with characters in mass media in the emergence of disordered eating behavior in adolescents. We explored the possible influence of the models offered by television (TV) on adolescents' body image, body uneasiness, eating-disordered behavior, depression, and anxiety. Methods: Three hundred and one adolescents (aged 14-19) from southern Italy participated. They completed a questionnaire on media exposure and body dissatisfaction, the Eating Disorder Inventory-2, the Body Uneasiness Test, the Beck Depression Inventory, and the State-Trait Anxiety Inventory - Form Y. Results: The main factors contributing to females' eating-disordered behaviors were their own desires to be similar to TV characters, the amount of reality and entertainment TV they watched, and the discrepancy between their perceptions of their bodies and those of TV characters. Friends' desire to be similar to TV characters contributed most to depression, anxiety, body uneasiness, and eating disorders for both males and females. Conclusion: Our data confirm that extensive watching of reality and entertainment TV correlates with eating-disordered behavior among females. Moreover, the well-known negative effects of the media on adolescents' eating-disordered behaviors may also be indirectly transmitted by friends who share identification with TV characters.

Transtornos alimentares em homens abstinentes de substâncias psicoativas em tratamento ambulatorial / Eating disorders in males abstinent from psychoactive substances during outpatient treatment

Introdução: A alimentação exerce um papel similar ao da droga psicotrópica pelo prazer que dá às pessoas, já que age no mesmo sistema de recompensa cerebral. Assim, o objetivo deste trabalho foi identificar a relação entre abstinência de substâncias psicoativas (SPAs) e transtornos alimentares em homens adultos em tratamento ambulatorial no Ambulatório de Adição da Unidade Álvaro Alvim do Hospital de Clínicas de Porto Alegre, RS, Brasil. Métodos: Estudo transversal desenvolvido com 40 pacientes homens e realizado através de aplicação de questionários. O transtorno da compulsão alimentar periódica (TCAP) foi mensurado através da Escala de Compulsão Alimentar Periódica (ECAP), e para a anorexia nervosa foi utilizado o Eating Attitudes Test (EAT-26) ou Teste de Atitudes Alimentares. O estado nutricional dos indivíduos foi obtido através dos dados de índice de massa corporal (IMC). Resultados: O tempo de abstinência informado foi de 8 meses. A prevalência de obesidade foi de 17,5%, de sobrepeso, 37,5%, de eutrofia, 42,5%, e de desnutrição, apenas 2,5%. Quanto ao IMC, a média foi de 26,59 kg/m2 , o que caracteriza uma amostra com sobrepeso. Os indivíduos que apresentaram diagnóstico de TCAP foram aqueles com os valores de IMC significativamente mais altos (r = 0,47; p < 0,01), o que aponta uma relação de quanto maior o IMC, maior a pontuação para compulsão alimentar periódica. Conclusão: O perfil nutricional dos dependentes químicos em abstinência se caracteriza pelo excesso de peso, o que sugere uma troca de substâncias de abuso, com os alimentos de alto valor calórico e baixo valor nutricional entrando como substitutivos. Portanto, é importante que sejam promovidas novas estratégias terapêuticas para um melhor atendimento nutricional dos indivíduos em abstinência (AU)

Introduction: Food and psychotropic drugs play similar roles in terms of the pleasure they bring to people, since they act on the same brain reward system. Thus, the aim of the present study was to identify the relationship between abstinence from psychoactive substances and eating disorders in adult males during outpatient treatment at the Álvaro Alvim Unit of Hospital de Clínicas de Porto Alegre, RS, Brazil. Methods: A cross-sectional study was conducted in 40 male patients with the application of questionnaires. Binge eating disorder (BED) was measured by the Binge Eating Scale (BES), and the Eating Attitudes Test (EAT-26) was used for anorexia nervosa. Nutritional status was obtained through body mass index (BMI) data.Results: The informed period of abstinence was 8 months. The prevalence of obesity was 17.5%; overweight, 37.5%; normal weight, 42.5%; and malnutrition, only 2.5%. The average BMI was 26.59 kg/m2 characterizing a sample with overweight. Individuals who were diagnosed with BED are those with significantly higher BMI values (r = 0,47; p < 0,01), so the higher the BMI value the higher the binge eating score. Conclusion: The nutritional profile of abstinent drug addicts is characterized by excess weight, which suggests an exchange of substance abuse, with high-calorie, low-nutrient food becoming a substitute. However, it is important to promote new therapeutic strategies to improve nutritional care of abstinent individuals (AU)

Modelo etiológico dos comportamentos de risco para os transtornos alimentares em adolescentes brasileiros do sexo feminino / Modelo etiológico de los comportamientos de riesgo para los trastornos alimenticios en adolescentes brasileñas del sexo femenino / Etiological model of disordered eating behaviors in Brazilian adolescent girls

Resumo: O objetivo foi construir um modelo etiológico dos comportamentos de risco para os transtornos alimentares em adolescentes brasileiros do sexo feminino. Participaram 1.358 adolescentes de quatro cidades. Foram avaliados os comportamentos de risco para os transtornos alimentares, insatisfação corporal, pressões midiáticas, autoestima, estado de humor, sintomas depressivos e perfeccionismo por intermédio de escalas psicométricas. Peso, estatura e dobras cutâneas foram aferidos para calcular o índice de massa corporal (IMC) e o percentual de gordura (%G). O modelo de equação estrutural explanou 76% da variância dos comportamento de risco (F(9, 1.351) = 74,50; p = 0,001). Os achados indicaram que a insatisfação corporal mediou a relação entre as pressões midiáticas, autoestima, estado de humor, IMC, %G e os comportamentos de risco (F(9, 1.351) = 59,89; p = 0,001). Vale destacar que embora os sintomas depressivos não tenham se relacionado com a insatisfação corporal, o modelo indicou relação direta com os comportamentos de risco para os transtornos alimentares (F(2, 1.356) = 23,98; p = 0,001). Concluiu-se que somente o perfeccionismo não aderiu ao modelo etiológico dos comportamentos de risco para os transtornos alimentares em adolescentes brasileiras.

Resumen: El objetivo fue construir un modelo etiológico de los comportamientos de riesgo para los trastornos alimenticios en adolescentes brasileñas del sexo femenino. Participaron 1.358 adolescentes de cuatro ciudades. Se evaluaron comportamientos de riesgo para los trastornos alimenticios, insatisfacción corporal, presiones mediáticas, autoestima, estado de humor, síntomas depresivos y perfeccionismo mediante escalas psicométricas. Se calculó peso, estatura y dobleces cutáneas para calcular el índice de masa corporal (IMC) y el porcentaje de grasa (%G). El modelo de ecuación estructural expuso un 76% de la variancia de los comportamientos de riesgo para los trastornos alimenticios (F(9, 1.351) = 74,50; p = 0,001). Los hallazgos indicaron que la insatisfacción corporal medió la relación entre las presiones mediáticas, autoestima, estado de humor, IMC, %G y los comportamientos de riesgo para los trastornos alimenticios (F(9, 1.351) = 59,89; p = 0,001). Vale destacar que pese a que los síntomas depresivos no se hayan relacionado con la insatisfacción corporal, el modelo indicó relación directa con los comportamientos de riesgo para los trastornos alimenticios (F(2, 1.356) = 23,98; p = 0,001). Se concluyó que solamente el perfeccionismo no se adhirió al modelo etiológico de los comportamientos de riesgo para los trastornos alimenticios en adolescentes brasileñas.

Abstract: The objective was to construct an etiological model of disordered eating behaviors in Brazilian adolescent girls. A total of 1,358 adolescent girls from four cities participated. The study used psychometric scales to assess disordered eating behaviors, body dissatisfaction, media pressure, self-esteem, mood, depressive symptoms, and perfectionism. Weight, height, and skinfolds were measured to calculate body mass index (BMI) and percent body fat (%F). Structural equation modeling explained 76% of variance in disordered eating behaviors (F(9, 1,351) = 74.50; p = 0.001). The findings indicate that body dissatisfaction mediated the relationship between media pressures, self-esteem, mood, BMI, %F, and disordered eating behaviors (F(9, 1,351) = 59.89; p = 0.001). Although depressive symptoms were not related to body dissatisfaction, the model indicated a direct relationship with disordered eating behaviors (F(2, 1,356) = 23.98; p = 0.001). In conclusion, only perfectionism failed to fit the etiological model of disordered eating behaviors in Brazilian adolescent girls.

Obstetric complications and mother’s age at delivery are predictors of eating disorder symptoms among Health Science college students / Complicações obstétricas e idade materna no parto são preditores de sintomas de transtornos alimentares em estudantes universitários da área da Saúde

ABSTRACT Objective To identify the association between perinatal/neonatal factors and symptoms of eating disorders among college students. Methods Four hundred and eight college students (283 women), aged 18 to 23 years old, enrolled in the first semester of a Bachelor of Health Science degree program were included in the sample. Eating disorder symptoms and body image dissatisfaction were assessed with the Eating Attitudes Test and Bulimic Investigatory Test of Edinburgh. Information regarding birth weight, breastfeeding, obstetric complications, mother’s age at delivery, type of delivery, and birth order were self-reported by the volunteers after consulting their parents. Association between perinatal and neonatal factors and symptoms of anorexia nervosa and bulimia nervosa were assessed by binary logistic regression adjusted for sex, age, and body mass index. Results The likelihood of presenting with symptoms of anorexia nervosa was 0.5 time lower for those students born from the oldest mothers (odds ratio – OR=0.37; 95% confidence interval – 95%CI: 0.17-0.83). Relative to bulimia nervosa, the risk was higher among students who reported obstetric complications (OR=2.62; 95%CI: 1.03-6.67). Conclusion We observed the association between perinatal and neonatal factors with symptoms of eating disorders in college students.

RESUMO Objetivo Identificar a associação entre fatores perinatais/neonatais e sintomas de transtornos alimentares entre estudantes universitários. Métodos Quatrocentos e oito estudantes universitários (283 mulheres), com idade entre 18 e 23 anos, matriculados no primeiro semestre de cursos de Bacharelado na área das Ciências da Saúde foram incluídos na amostra. Sintomas de transtornos alimentares e de insatisfação com a imagem corporal foram avaliados por meio do Eating Attitudes Test e do Bulimic Investigatoty Test of Edinburgh. Informações sobre o peso ao nascer, aleitamento materno, complicações obstétricas, idade materna no momento do parto, tipo de parto e ordem de nascimento foram relatadas pelos voluntários após consulta com seus pais. A associação entre fatores perinatais/neonatais e sintomas de anorexia nervosa e bulimia nervosa foi avaliada por meio de regressão logística binária ajustada por sexo, idade e índice de massa corporal. Resultados A probabilidade de apresentar sintomas de anorexia nervosa foi 0,5 vez mais baixa para os alunos nascidos de mães mais velhas (odds ratio – OR=0,37; intervalo de confiança de 95% – IC 95%=0,17-0,83). Em relação à bulimia nervosa, o risco foi maior entre os estudantes que relataram complicações obstétricas (OR=2,62; IC 95%=1,03-6,67). Conclusão Observou-se associação entre fatores perinatais e neonatais com sintomas de transtornos alimentares em estudantes universitários.

Personality prototype as a risk factor for eating disorders

Objective: To establish whether the risk of suffering from an eating disorder (ED) is associated with the high-functioning, undercontrolled, or overcontrolled personality prototype groups. Method: The Revised NEO Personality Inventory (NEO-PI-R) and the Eating Disorder Inventory 2 (EDI-2) were administered to 69 patients diagnosed as suffering from EDs (cases) and 89 people free of any ED symptoms (control group). A cluster analysis was carried out to divide the participants into three groups based on their scores in the Big Five personality dimensions. A logistic regression model was then created. Results: Participants in the undercontrolled group had a risk of suffering from an ED 6.517 times higher than those in the high-functioning group (p = 0.019; odds ratio [OR] = 6.517), while those in the overcontrolled subgroup had a risk of ED 15.972 times higher than those in the high-functioning group. Conclusions: Two personality subtypes were identified in which the risk of EDs was six times higher (the undercontrolled group) and almost 16 times higher (the overcontrolled group). Prevention and treatment programs for ED could benefit from focusing on the abovementioned personality profiles.

Practices related to late-onset sepsis in very low-birth weight preterm infants / Práticas relacionadas à sepse tardia em prematuros de muito baixo peso

OBJECTIVE: To understand the practices related to late-onset sepsis (LOS) in the centers of the Brazilian Neonatal Research Network, and to propose strategies to reduce the incidence of LOS. METHODS: This was a cross-sectional descriptive multicenter study approved by the Ethics Committee. Three questionnaires regarding hand hygiene, vascular catheters, and diagnosis/treatment of LOS were sent to the coordinator of each center. The center with the lowest incidence of LOS was compared with the others. RESULTS: All 16 centers answered the questionnaires. Regarding hand hygiene, 87% use chlorhexidine or 70% alcohol; alcohol gel is used in 100%; 80% use bedside dispensers (50% had one dispenser for every two beds); practical training occurs in 100% and theoretical training in 70% of the centers, and 37% train once a year. Catheters: 94% have a protocol, and 75% have a line insertion team. Diagnosis/treatment: complete blood count and blood culture are used in 100%, PCR in 87%, hematological scores in 75%; oxacillin and aminoglycosides is the empirical therapy in 50% of centers. Characteristics of the center with lowest incidence of LOS: stricter hand hygiene; catheter insertion and maintenance groups; use of blood culture, PCR, and hematological score for diagnosis; empirical therapy with oxacillin and aminoglycoside. CONCLUSION: The knowledge of the practices of each center allowed for the identification of aspects to be improved as a strategy to reduce LOS, including: alcohol gel use, hand hygiene training, implementation of catheter teams, and wise use of antibiotic therapy. .

OBJETIVO: Conhecer as práticas relacionadas a sepse tardia (ST) nos centros da Rede Brasileira de Pesquisas Neonatais (RBPN) e propor estratégias para redução da ST. MÉTODOS: Estudo transversal, multicêntrico da RBPN, aprovado pelo CEP. Três questionários sobre higienização das mãos, cateteres vasculares e diagnóstico/tratamento da ST foram elaborados e enviados aos coordenadores de cada centro. O centro com a menor incidência de ST foi comparado aos demais. RESULTADOS: Todos os 16 centros responderam aos questionários. Quanto à higienização das mãos: 87% usam chlorhexidine ou álcool 70%; 100% álcool gel; almotolia/leito em 80% (50% dispõem de um dispensador para cada dois leitos); Treinamento prático ocorre em 100%, teórico em 70% dos centros e 37% treinam uma vez/ano. Cateteres: 94% têm protocolo para passagem, 75% grupo de inserção. Diagnóstico/tratamento: hemograma e hemocultura são usados em 100% dos centros; PCR em 87%; 75% usam escores hematológicos; oxacilina e aminoglicosídeo são usados como terapia empírica em 50% dos centros. Características do centro com menor incidência de ST: rigorosa higienização das mãos; grupos de inserção e manutenção de cateteres; uso de hemocultura, PCR e escores hematológicos para diagnóstico da ST; tratamento empírico com oxacilina e aminoglicosídeo. CONCLUSÕES: O conhecimento das práticas de cada centro permitiu identificar aspectos a serem aprimorados como estratégia para a redução da ST incluindo: uso de álcool gel, treinamento em higienização das mãos, implantação de grupos de cateteres e uso racional de antibióticos. .

Discomfort associated with fixed orthodontic appliances: determinant factors and influence on quality of life

OBJECTIVE: To investigate the determinant factors of discomfort attributed to the use of fixed orthodontic appliance and the effect on the quality of life of adolescents. MATERIAL AND METHODS : Two hundred and seventy-two individuals aged between 9 and 18 years old, enrolled in public and private schools and undergoing orthodontic treatment with fixed appliance participated in this cross-sectional study. The participants were randomly selected from a sample comprising 62,496 individuals of the same age group. Data was collected by means of questionnaires and an interview. Discomfort intensity and bio-psychosocial variables were assessed using the Oral Impact on Daily Performance questionnaire. Self-esteem was determined using the Global Negative Self-Evaluation questionnaire. Statistical analysis involved the chi-square test and both simple and multiple Poisson regression analyses. RESULTS: Although most individuals did not present discomfort, there was a prevalence of 15.9% of impact on individuals' daily life exclusively due to the use of fixed orthodontic appliance . Age [PR: 3.2 (95% CI: 1.2-8.5)], speech impairment [PR: 2.2 (95% CI: 1.1-4.6)], poor oral hygiene [PR: 2.4 (95% CI: 1.2-4.8)] and tooth mobility [PR: 3.9 (95% CI: 1.8-8.1)] remained independently associated with a greater prevalence of discomfort (P ≤ 0.05). CONCLUSIONS: Discomfort associated with the use of fixed orthodontic appliances exerted a negative influence on the quality of life of the adolescents comprising the present study. The determinants of this association were age, poor oral hygiene, speech impairment and tooth mobility. .

OBJETIVO: investigar os fatores determinantes do desconforto atribuído ao uso do aparelho ortodôntico fixo e sua influência na qualidade de vida de adolescentes. MÉTODOS: participaram desse estudo transversal 272 indivíduos, com idades entre 9 e 18 anos, estudantes de escolas públicas e privadas, que usavam aparelhos ortodônticos fixos (braquetes). Os participantes foram selecionados aleatoriamente, entre 62.496 indivíduos da mesma faixa etária. A coleta de dados foi feita em forma de entrevista e questionário. A intensidade do desconforto e variáveis biopsicossociais foram avaliadas por meio do Oral Impact on Daily Performance (OIDP). A autoestima foi determinada pela Global Negative Self-Evaluation (GSE). A análise estatística envolveu o teste qui-quadrado e a análise de regressão de Poisson, simples e múltipla. RESULTADOS: embora a maioria dos indivíduos não apresentasse desconforto, observou-se uma prevalência de impacto na vida diária devido, exclusivamente, ao uso do aparelho ortodôntico fixo, de 15,9%. Variáveis idade de 15 a 18 anos [RP = 3,2 (IC 95% = 1,2-8,5)], dificuldade de falar [RP = 2,2 (IC 95% = 1,1-4,6)], dificuldade de limpar a boca [RP = 2,4 (IC95% = 1,2-4,8)] e mobilidade dos dentes [RP = 3,9 (IC 95% = 1,8-8,1)] permaneceram associadas, de forma independente, à maior prevalência de desconforto (p ≤ 05). CONCLUSÕES: desconforto associado ao uso de aparelhos ortodônticos fixos influenciou negativamente a qualidade de vida de adolescentes. Os fatores determinantes foram idade, dificuldade de limpar a boca, de falar e mobilidade dentária. .

Impact of an educational program on the feeding of neurologically impaired children / Impacto de uma acao educativa na alimentacao de criancas neuropatas

PURPOSE: To verify the impact of an educative program focused on aspects related to feeding developed with a group of caregivers of children with chronic non-progressive encephalopathy. METHODS: Cross-sectional comparative study conducted with 30 children diagnosed with chronic non-progressive encephalopathy and their caregivers with the use of a questionnaire and video recordings of a meal conducted by the main caregiver. In order to verify the impact of an educational program in the knowledge and conduct of caregivers, patients were divided into two groups: study - consisting of caregivers submitted to a questionnaire and a video recording before and after the educational program; control - group in which caregivers underwent the procedures in two occasions, but without access to the educational program. RESULTS: Around 93.33% of caregivers were females, most had low educational level, and only 10% had a professional activity. Previous knowledge of caregivers concerning feeding was restricted, with 66% of caregivers not knowing what aspiration was, 60% being unfamiliar with the complications associated with such occurrence, and 86.66% stating that there is no relation between voice and swallowing. During feeding, only 26.66% of the caregivers used verbal commands related to feeding, and 50% did not realize the difficulties presented by their children. We observed a difference with regard to knowledge and conduct in the study group only. CONCLUSION: The educational program had a positive impact on the knowledge and conduct of caregivers concerning the feeding of their children with chronic non-progressive encephalopathy. .

OBJETIVO: Verificar o impacto de uma ação educativa voltada aos cuidados com a alimentação desenvolvida com um grupo de cuidadores de crianças com encefalopatia crônica não progressiva (ECNP). MÉTODOS: Estudo comparativo transversal realizado com 30 crianças com ECNP e seus cuidadores, tendo-se realizado aplicação de questionário e registro de uma refeição conduzida pelo cuidador principal. A fim de se verificar o impacto da ação educativa no conhecimento e conduta dos cuidadores, estes foram divididos em dois grupos: estudo, composto por cuidadores submetidos à aplicação de questionário e registro em vídeo antes e após realização da ação educativa; e controle, grupo submetido aos procedimentos em dois momentos, porém sem acesso à ação educativa. RESULTADOS: 93,33% dos cuidadores eram do sexo feminino, a maioria apresentou baixo nível de escolaridade e apenas 10% desenvolviam alguma atividade profissional. O conhecimento prévio dos cuidadores quanto aos aspectos relacionados à alimentação foi restrito, tendo 66% destes referido não saber o que era aspiração, 60% afirmado não saber as complicações associadas a esta e 86,66% terem negado existir relação entre voz e deglutição. Durante a alimentação, apenas 26,66% dos pais fizeram uso de comandos verbais relacionados à alimentação e 50% não perceberam as dificuldades apresentadas pelo seu filho. Observou-se diferença quanto ao conhecimento e conduta de cuidadores apenas no grupo estudo. CONCLUSÃO: A ação educativa realizada apresentou impacto no conhecimento e conduta dos cuidadores quanto à alimentação de seus filhos com ECNP. .

Eating Disorders are Real Treatable Medical Illnesses

Eating disorders frequently appear during the teen years or in young adulthood. Common eating disorders include nervosa; bulimia nervosa and binge-eating disorder. Eating disorders affect both men and women

Controle neuronal e manifestações digestórias na paralisia cerebral / Digestive tract neural control and gastrointestinal disorders in cerebral palsy

OBJETIVOS: Abordar as peculiaridades do controle neuronal digestório e descrever as principais manifestações digestórias na paralisia cerebral, atentando-se à importância do diagnóstico precoce para intervenção interdisciplinar eficaz. FONTES DOS DADOS: Revisão sistemática de 1997 a 2012 das bases de dados MEDLINE, LILACS, SciELO e Cochrane Library. Incluem-se 70 artigos, como revisões relevantes, estudos observacionais, ensaios clínicos e estudos de prevalência. Excluíram-se pesquisas qualitativas. Os termos pesquisados foram: paralisia cerebral, disfagia, doença do refluxo gastroesofágico, constipação intestinal, infecção respiratória e gastrostomia. SÍNTESE DOS DADOS: O controle adequado do trato digestório depende do funcionamento e integridade do sistema nervoso. Como indivíduos portadores de paralisia cerebral possuem anormalidades estruturais evidentes no sistema nervoso central e periférico, estão mais propensos a desenvolver distúrbios do trato digestório, com repercussões nutricionais. As alterações vão desde imaturidade neurológica até interferência do estado de humor e capacitação dos cuidadores. Trata-se, portanto, de etiologia multifatorial. As desordens digestórias mais prevalentes são disfagia, doença do refluxo gastroesofágico e constipação intestinal, com consequentes quadros de infecções respiratórias de repetição e repercussão deletéria no estado nutricional. CONCLUSÕES: Indivíduos com paralisia cerebral apresentam alterações neurológicas do controle do sistema digestório, portanto manifestações digestórias são frequentes. As questões abordadas são fundamentais para profissionais das equipes interdisciplinares que atendem indivíduos com paralisia cerebral acerca da importância da anamnese ampla, exame clínico e complementar detalhado que incluam investigação das desordens gastrointestinais associadas e suas consequências. A detecção precoce dessas alterações digestórias pode respaldar medidas de reabilitação mais eficientes no sentido de melhoria da qualidade de vida desses indivíduos.

OBJECTIVES: To examine the neural control of digestive tract and describe the main gastrointestinal disorders in cerebral palsy (CP), with attention to the importance of early diagnosis to an efficient interdisciplinary treatment. SOURCES: Systematic review of literature from 1997 to 2012 from Medline, Lilacs, Scielo, and Cochrane Library databases. The study included 70 papers, such as relevant reviews, observational studies, controlled trials, and prevalence studies. Qualitative studies were excluded. The keywords used were: cerebral palsy, dysphagia, gastroesophageal reflux disease, constipation, recurrent respiratory infections, and gastrostomy. SUMMARY OF THE FINDINGS: The appropriate control of the digestive system depends on the healthy functioning and integrity of the neural system. Since CP patients have structural abnormalities of the central and peripheral nervous system, they are more likely to develop eating disorders. These range from neurological immaturity to interference in the mood and capacity of caregivers. The disease has, therefore, a multifactorial etiology. The most prevalent digestive tract disorders are dysphagia, gastroesophageal reflux disease, and constipation, with consequent recurrent respiratory infections and deleterious impact on nutritional status. CONCLUSIONS: Patients with CP can have neurological abnormalities of digestive system control; therefore, digestive problems are common. The issues raised in the present study are essential for professionals within the interdisciplinary teams that treat patients with CP, concerning the importance of comprehensive anamnesis and clinical examination, such as detailed investigation of gastrointestinal disorders. Early detection of these digestive problems may lead to more efficient rehabilitation measures in order to improve patients' quality of life.

Asociación del índice de masa corporal y conductas de riesgo en el desarrollo de trastornos de la conducta alimentaria en adolescentes mexicanos

La percepción corporal y su insatisfacción se relacionan con las conductas alimentarias de riesgo (CAR), pudiendo desarrollar trastornos de la conducta alimentaria (TAC) frecuentemente identificados en los adolescentes. El objetivo fue describir la asociación del índice de masa corporal (IMC) con los hábitos y las CAR en un grupo de adolescentes. Fue un estudio transversal, descriptivo realizado con 671 adolescentes de 12 a 15 años de edad, ambos sexos. Se aplicó una encuesta validada en población mexicana que identificó las CAR para el desarrollo de los TAC. Se obtuvo el IMC, además de información sobre práctica y conocimiento del consumo de alimentos. La prevalencia promedio de las CAR fue 12%, el sobrepeso u obesidad se presentó en 48% de los participantes, 20% de ellos no desayunaba, y sólo el 16% tomaba sus alimentos sin ningún distractor (p=0.012). La variables asociadas a las CAR para el desarrollo de TAC fueron: realizar cualquier actividad simultánea al consumo de alimentos (RM:4.23, p=0.006), sobrepeso u obesidad (RM:2.59, p=0.001), comer sin compañía (RM:2.04, p=0.005), no comer frutas (RM:1.96, p=0.008) y/o leche (RM:1.79, p=0.026), ser mujer (RM:1.74 p=0.024) y no desayunar (RM:1.57, p=0.035). El consumo de alimentos que los adolescentes practicaron fue diferente del que recomendaron para estar sanos, fue menor en verduras, frutas y leguminosas, y mayor en azúcares, lípidos y bebidas gaseosas. Se concluye que existe una asociación entre el IMC y las CAR. No se encontró coherencia entre lo que los adolescentes refirieron comer y lo que ellos recomiendan, según sus conocimientos.

Association between body mass index and risk feeding behaviors to develop eating disorders in Mexican adolescents. The body self-perception and its dissatisfaction are related with the risk for developing abnormal eating behaviors (AEB), especially in eating disorders (ED) in adolescents. The objective of this study was to identify the relationship between dietary habits and the risk for AEB and their association with body mass index (BMI) in a group of adolescents in the metropolitan area of Mexico City. It was a descriptive cross-sectional study conducted with a sample of 671 adolescents, both sex, between 12 and 15 years. A validated questionnaire was used to assess the risk for developing AEB. BMI was obtained, and information from the practice and knowledge of food consumption was available. The prevalence of the risk for developing AEB in this study was 12%. It showed that 48% of participants were overweight or obese, 20% did not eat breakfast, 16% took their food without doing other activity simultaneously (p=0.012). The variables associated with the risk AEB, for developing of ED were doing any activity simultaneously with food intake (OR:4.23 p=0.006), overweight-obesity (OR:2.59 p=0001), eating without company (OR:2.04 p=0.005), not eating fruit (OR:1.96 p=0.008) or milk (OR:1.79 p=0.026), being female (OR:1.74 p= 0.024) and skipping breakfast (OR:1.57 p=0,035). Food intake differed with what themselves recommended being healthy, which was lower in vegetables, fruits, leguminous and higher in sugars, fats and soda. We conclude there is a relationship between BMI and the risk for developing AEB. There was no consistency between what adolescents say they should eat to be healthy and what they eat.

La prevención de los factores de riesgo asociados con los trastornos de la alimentación / Prevention of risk factors associated with eating disorders

Se reconoce un origen multicausal y acumulativo de diversos factores de riesgo en la aparición de un trastorno alimentario. En el presente análisis, se apoya la idea de continuar con esfuerzos de prevención universal en pacientes prepúberes.

Trastornos alimentarios del lactante y preescolar / Eating disorders in nursing and preschool children

Eating disorders among nursing and preschool children are a common cause of outpatient consultation in pediatrics and nutrition. It is essential to rule out organic causes, especially when there is nutritional involvement. Among non-organic causes there are several subtypes depending upon the trigger. Environmental and nutritional factors can be modified. Curiously, many of them are directly related to the perception of hunger and satiety the individual will develop from childhood.

Los trastornos de la alimentación en el lactante y preescolar siguen siendo un motivo frecuente de consulta en policlínicos de pediatría y nutrición infantil. Descartar causas orgánicas, sobre todo cuando existe compromiso nutricional, es de fundamental importancia. Dentro de los trastornos de origen no orgánico existen varios subtipos dependiendo de la causa desencadenante. Muchos factores involucrados tanto ambientales como nutri-cionales, son susceptibles de ser modificados. Curiosamente, muchos de ellos se relacionan directamente con la capacidad de percepción de las sensaciones de hambre y saciedad que el individuo desarrollará desde niño.

Relaciones entre los comportamientos de riesgo psicosociales y la familia en adolescentes de Suba, Bogotá / Relationships between psychosocial risk behavior and the family in adolescents' from Suba, an urban area in Bogotá

Objetivo Estimar las relaciones entre los comportamientos de riesgo de la población adolescente y la familia en torno a la estructura y la percepción de funcionalidad. Metodología Estudio observacional de corte transversal entre 12 302 adolescentes (10 a 19 años de edad), estudiantes de 12 colegios públicos de la localidad de Suba en el año 2006. Se aplicó una encuesta autodiligenciada donde se interrogó por comportamientos sexuales, adictivos, depresivos, violentos y de trastornos de conducta alimentaria. Resultados Se encontró una prevalencia de buena función familiar de 63 por ciento y de disfunción familiar severa del 7 por ciento. La disfunción severa aumentó la prevalencia de comportamientos violentos (OR de 4,1 con IC de 95 por ciento 3,4-4,7), trastornos de conducta alimentaria (OR 2,3 con IC de 95 por ciento de 1,9 - 2,8) y relaciones sexuales (OR de 2 con IC de 95 por ciento de 1,7-2,4). Por el contrario, la composición de la familia (presencia o no de ambos padres) no mostró relación con comportamientos violentos. Conclusiones La disfunción familiar se asocia a una mayor frecuencia de conductas de riesgo en los adolescentes de bajo estrato socioeconómico en Bogotá. La relación más fuerte se observa entre violencia y familia.

Objective Assessing the relationship between adolescents' high-risk behaviour and family dynamics regarding structure and perception of family functionality. Methodology A cross-sectional, observational study was carried out on a population of 12,302 adolescents ranging in age from 10 to 19 years attending 12 public schools in the urban area of Suba (Bogota). A self-assessment questionnaire was administered, focusing on sexual behaviour, addiction, depression, violent behaviour and eating disorders. Results There was 63 percent prevalence regarding good family function and 7 percent prevalence concerning severe family dysfunction; comparing these with high-risk behaviour revealed a relationship with violent behaviour (4.1 OR, 3.4-4.7 95 percentCI), eating disorders (2.3 OR, 1.9-2.8 95 percentCI) and sexual relationships (2.0 OR, 1.7-2.4 95 percentCI). Conclusions Family dysfunction was found to be more frequently associated with high-risk behaviour in adolescents from low socioeconomic strata in Bogota than that found to derive from family structure. The strongest relationship was observed between violence and family.