ABSTRACT
Objetivo: Este estudo verificou o nível de atividade física entre usuários de substâncias psicoativas. Método: Estudo transversal, realizado nos Centros de Atenção Psicossocial Álcool e Outras Drogas do município de Recife (Brasil). Participaram 160 indivíduos com idade 44.09±12.46 anos. Os participantes foram entrevistados por meio do questionário Global physical active questionnaire. Foi aplicado o teste Qui-quadrado de independência para verificar associação entre nível de atividade física e tipo de substância psicoativa utilizada, nível de instrução, raça/cor, sexo e tipo de moradia sendo aceito um p<0.05 como significativo. Resultados: Os resultados mostraram que 51.9% dos usuários de substâncias psicoativas são fisicamente inativos. Houve associação nos domínios raça/cor da pele (p=0.039) e nível de instrução (p=0.002) com relação ao nível de atividade física. Conclusão: A partir destes dados será possível estabelecer os grupos que necessitam de maior apoio para promover estímulo à prática de exercício físico.(AU)
Objetivo: En este estudio se comprobó el nivel de actividad física de los consumidores de sustancias psicoactivas. Método: Se realizó un estudio transversal en los Centros de Alcohol y Otras Drogas Psicoactivas de Recife (Brasil). Participaron 160 personas de 44.09±12.46 años. Se entrevistó a los participantes mediante el cuestionario del Global physical active questionnaire. La prueba de chi-cuadrado de independencia se aplicó para verificar la asociación entre el nivel de actividad física y el tipo de sustancia psicoactiva utilizada, el nivel de educación, la raza/color, el sexo y el tipo de vivienda siendo aceptado um valor de p<0.05 como significativo. Resultados: Los resultados mostraron que el 51.9% de los consumidores de sustancias psicoactivas son físicamente inactivos. Hubo una asociación en los dominios raza/color de piel (p=0.039) y nivel de instrucción (p=0.002) con respecto al nivel de actividad física. Conclusión: A partir de estos datos será posible establecer los grupos que necesitan más apoyo para promover la práctica del ejercicio físico.(AU)
Objective: This study checked the level of physical activity among users of psychoactive substances. Methods: A cross-sectional study was conducted at the Alcohol and Other Drugs Psychoactive Centers of Recife (Brazil). A total of 160 individuals aged 44.09±12.46 years participated. The participants were interviewed through the Global physical active questionnaire. The chi-square test of independence was applied to verify association between level of physical activity and type of psychoactive substance used, level of education, race/colour, sex and type of dwelling being accepted a p<0.05 as significant. Results: The results showed that 51.9% of psychoactive substance users are physically inactive. There was an association in the domains race/skin colour (p=0.039) and level of instruction (p=0.002) regarding the level of physical activity. Conclusion: From these data it will be possible to establish the groups that need more support to promote the practice of physical exercise.(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Substance Abuse Treatment Centers , Substance-Related Disorders , Motor Activity , Exercise , Public Health , Habits , Health Promotion , Sports Medicine , Cross-Sectional Studies , 28599 , Surveys and QuestionnairesABSTRACT
BACKGROUND: Very preterm/very low birth weight (VP/VLBW) newborns can have lifelong morbidities, as attention-deficit/hyperactivity disorder (ADHD). Clinicians have no markers to discriminate which among those individuals will develop later ADHD, based only on the clinical presentation at birth. Our aim was to develop an individualized risk calculator for ADHD in VP/VLBW newborns. METHODS: This retrospective prognostic study included a consecutive sample of all VP/VLBW children (gestational age <32 weeks and/or birth weight <1.5 kg) born between 2010 and 2012 from a clinical cohort in a Brazilian tertiary care hospital. Children were clinically assessed at 6 years of age for ADHD using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). The least absolute shrinkage and selection operator (LASSO) method was used for model-building. RESULTS: Ninety-six VP/VLBW children were assessed at 6 years of age (92% follow-up), of whom 32 (33%) were diagnosed with ADHD. The area under the ROC curve (AUC) for ADHD prediction based on seven parameters (late-onset sepsis confirmed by blood culture, necrotizing enterocolitis, neonatal seizures, periventricular leukomalacia, respiratory distress syndrome, length of hospital stay, and number of maternal ADHD symptoms) was .875 (CI, 0.800-0.942, p < .001; AUC corrected for optimism with bootstrapping: .806), a performance that is comparable to other medical risk calculators. Compared to approaches that would offer early intervention to all, or intervention to none, the risk calculator will be more useful in selecting VP/VLBW newborns, with statistically significant net benefits at cost:benefits of around 1:2 to around 10:6 (range of ADHD risk thresholds of 32%-62%, respectively). It also showed specificity for ADHD compared to other prevalent child psychopathologies. CONCLUSIONS: The risk calculator showed good performance for early identification of VP/VLBW newborns at high risk of future ADHD diagnosis. External validity in population-based samples is needed to extend clinical usefulness.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Child , Gestational Age , Humans , Infant , Infant, Extremely Premature , Infant, Newborn , Infant, Very Low Birth Weight/psychology , Retrospective StudiesABSTRACT
Objetivo: Verificar as barreiras que influenciam a não realização de atividade física no tempo livre entre usuários de substâncias psicoativas.Método: 144 indivíduos com média de idade de 44.3±12.6 anos foram entrevistados respondendo um questionário que verifica as barreiras para a prática de atividades físicas. Foi aplicado o teste Qui-quadrado de independência aceitando um p<0.05 como significativo.Resultados: Os dados mostraram que há associação entre as sentenças do questionário e o padrão de resposta dos indivíduos [x2(13)=193.88; p≤0.001]. Foi encontrada significância como barreira para prática de atividade física o cansaço físico, falta de companhia, falta de incentivo familiar e acometimento de dores leves ou mal-estar. Por outro lado, a falta de tempo, fator climático, não disponibilidade no ambiente, não disponibilidade de equipamento e falta de habilidade física foram apontados, significativamente, como não serem barreiras para a prática de atividade física em usuários de substâncias psicoativas.Conclusão: A partir destes dados será possível estabelecer estratégias mais efetivas para a promoção da prática de atividade física nesta população. (AU)
Objetivo: Verificar las barreras que influyen en los usuarios de sustancias psicoactivas para no utilizar su tiempo libre para practicar actividad física.Método: 144 personas, con edad de 44.3 ± 12.6 años, respondieron a un cuestionario sobre las barreras para la practica de actividad física. Se aplicó el test de independencia de chi-cuadrado, aceptando como significativa um valor de p<0.05.Resultados: Los datos muestran que existe asociación entre las sentencias del cuestionario y el patrón de respuesta de los individuos [x2(13)=193.88; p≤0.001]. Se consideró significativa la existencia de barreras para la práctica de actividad física como el cansancio físico, la falta de un compañero y motivación familiar, padecimiento de dolores o malestar ligeros. Por otro lado, la falta de tiempo, el factor climático, la indisponibilidad en el medio ambiente, la falta de equipos y de entrenamiento físico no fueron señalados de manera significativa como barreras para la práctica de actividad física en usuarios de sustancias psicoactivas.Conclusión: En base a estos datos, será posible establecer estrategias más efectivas para promover la práctica de actividad física en esta población. (AU)
Objective: To verify the barriers that influence the non-performance of physical activity in free time among users of psychoactive substances.Methods: 144 individuals with a mean age of 44.3±12.6 years were interviewed by answering a questionnaire that checks the barriers to physical activity. The Chi-square test of independence was applied accepting a p<0.05 as significant.Results: The data showed that there is an association between the sentences of the questionnaire and the response pattern of individuals [x2(13)=193.88; p≤0.001]. Significance was found as a barrier to physical activity the physical tiredness, lack of company, lack of family incentive and involvement of mild pain or discomfort. On the other hand, lack of time, climatic factor, non-availability in the environment, non-availability of equipment, and lack of physical ability were significantly pointed out as not being barriers to the practice of physical activity in users of psychoactive substances.Conclusion: From these data it will be possible to establish more effective strategies for the promotion of physical activity in this population. (AU)
Subject(s)
Humans , Male , Female , Young Adult , Adult , Substance-Related Disorders/prevention & control , Substance-Related Disorders/physiopathology , Mental Health Services , Exercise/psychology , Motor Activity , Surveys and QuestionnairesABSTRACT
A controversy exists on whether there is an over or underuse of medications for Attention-Deficit/Hyperactivity Disorder (ADHD). We conducted the first meta-analysis to estimate the rate of ADHD pharmacological treatment in both diagnosed and undiagnosed individuals. Based on a pre-registered protocol (CRD42018085233), we searched a broad set of electronic databases and grey literature. After screening 25,676 abstracts, we retained 36 studies including 104,305 subjects, from which 18 studies met our main analysis criteria. The pooled pharmacological treatment rates were 19.1 % and 0.9 % in school-age children/adolescents with and without ADHD, respectively. We estimated that for each individual using medication without a formal ADHD diagnosis, there are three patients with a formal diagnosis who might benefit from medication but do not receive it in the US. Our results indicate both overtreatment/misuse of medication in individuals without ADHD and pharmacological undertreatment in youths with the disorder. Our findings reinforce the need for public health policies improving education on ADHD and discussions on the benefits and limitations of ADHD medications.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Central Nervous System Stimulants , Adolescent , Attention Deficit Disorder with Hyperactivity/drug therapy , Central Nervous System Stimulants/therapeutic use , Child , Humans , Medical OveruseABSTRACT
Objective: Computerized cognitive training (CCT) as add-on treatment to stimulants for ADHD core symptoms is scarcely investigated. The purpose of this study is to assess the effect of CCT in a randomized controlled clinical trial for ADHD in children and adolescents treated with stimulants. Method: Fifty-three participants aged 6 to 13 years receiving stimulant treatment and presenting ADHD residual symptoms were randomized either to a CCT (n = 29) or to a controlled nonactive condition (n = 24) for four sessions/week during 12 weeks. The main outcome measure was inattentive symptoms assessed using the Swanson, Nolan, and Pelham-IV (SNAP-IV) Scale. Secondary outcomes include, among others, hyperactive/impulsive symptoms and cognitive tests. Results: There were neither significant group differences on ADHD-inattentive symptoms after the intervention nor on both ADHD-hyperactivity/impulsivity symptoms and cognitive measures. Conclusion: Our study does not provide evidence for the benefits of cognitive training over nonactive training on core ADHD symptoms in medicated ADHD children and adolescents.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Central Nervous System Stimulants , Adolescent , Attention Deficit Disorder with Hyperactivity/drug therapy , Central Nervous System Stimulants/therapeutic use , Child , Cognition , Humans , Neuropsychological Tests , Treatment OutcomeABSTRACT
ABSTRACT Objective: To verify the effect of recreational soccer on bone mineral density and sarcopenia in the elderly. Methods: Fourteen elderly people aged 65.9 ± 3.4 years were selected. They were separated into two groups: the intervention group and the control group; the intervention group played recreational soccer for 12 weeks on two days of the week. Assessments were performed for bone mineral density and body muscle mass before and after the intervention. For statistical analysis, the repeated measures ANOVA with Bonferroni's post hoc test was used. Results: After 12 weeks, there was a significant change in bone mineral density in the region of the total femur (p = 0.020). Analyzing the participants' sarcopenia, no significant results were found after the intervention period. Conclusion: Playing recreational soccer causes a significant improvement in the total femur and maintains bone regions in the spine, whole body, and femoral neck. Also, it promotes a removal from the threshold for sarcopenia screening in the elderly.
RESUMO Objetivo: Verificar o efeito do futebol recreativo na densidade mineral óssea e sarcopenia dos idosos. Métodos: Foram selecionados quatorze idosos com idade de 65,9±3,4 anos. Os indivíduos foram separados em dois grupos: grupo intervenção e grupo controle, o grupo intervenção praticou futebol recreativo durante 12 semanas em dois dias da semana. Foram feitas avaliações para densidade mineral óssea e massa muscular corporal no período anterior e sucessor as intervenções. Para a análise estatística, foi utilizada a anova de medidas repetidas com o post-hoc de Bonferroni. Resultados: Após 12 semanas, ocorreu alteração significativa na densidade mineral óssea na região do fêmur total (p=0,020). Já na análise da sarcopenia dos participantes não houveram resultados significativos após o período de intervenção. Conclusão: Praticar futebol recreativo provoca melhora significativa no fêmur total e manutenção dos sítios ósseos da coluna, corpo inteiro e colo do fêmur. Além disso, promove afastamento da zona limítrofe para rastreio de sarcopenia nos idosos.
ABSTRACT
INTRODUCTION: Deficits in executive functioning, especially in inhibitory control, are present in children born very premature and/or with very low birth weight (VP/VLBW) and in children with attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE: To evaluate whether ADHD imposes additional inhibitory control (IC) deficits in preschoolers born VP/VLBW. METHODS: 79 VP/VLBW (4 to 7 years) children were assessed for ADHD using the Schedule for Affective Disorders and Schizophrenia for School Aged Children - Present and Lifetime Version (K-SADS-PL). IC was measured with Conners' Kiddie Continuous Performance Test (K-CPT 2) and the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P).Results: No significant differences were found between ADHD (n = 24) and non-ADHD children (n = 55) for any of the measures (p = 0.062 to p = 0.903). Both groups had deficits in most K-CPT 2 scores compared to normative samples, indicating poor IC and inconsistent reaction times. CONCLUSIONS: ADHD does not aggravate IC deficits in VP/VLBW children. Either neuropsychological tasks and parent reports of executive functions (EFs) may not be sensitive enough to differentiate VP/VLBW preschoolers with and without ADHD, or these children's EFs are already so impaired that there is not much room for additional impairments imposed by ADHD.
Subject(s)
Attention Deficit Disorder with Hyperactivity/physiopathology , Child Behavior/physiology , Child Development/physiology , Executive Function/physiology , Infant, Extremely Premature/physiology , Infant, Very Low Birth Weight/physiology , Inhibition, Psychological , Case-Control Studies , Child , Child, Preschool , Female , Humans , MaleABSTRACT
Abstract Introduction Deficits in executive functioning, especially in inhibitory control, are present in children born very premature and/or with very low birth weight (VP/VLBW) and in children with attention-deficit/hyperactivity disorder (ADHD). Objective To evaluate whether ADHD imposes additional inhibitory control (IC) deficits in preschoolers born VP/VLBW. Methods 79 VP/VLBW (4 to 7 years) children were assessed for ADHD using the Schedule for Affective Disorders and Schizophrenia for School Aged Children - Present and Lifetime Version (K-SADS-PL). IC was measured with Conners' Kiddie Continuous Performance Test (K-CPT 2) and the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P).Results: No significant differences were found between ADHD (n = 24) and non-ADHD children (n = 55) for any of the measures (p = 0.062 to p = 0.903). Both groups had deficits in most K-CPT 2 scores compared to normative samples, indicating poor IC and inconsistent reaction times. Conclusions ADHD does not aggravate IC deficits in VP/VLBW children. Either neuropsychological tasks and parent reports of executive functions (EFs) may not be sensitive enough to differentiate VP/VLBW preschoolers with and without ADHD, or these children's EFs are already so impaired that there is not much room for additional impairments imposed by ADHD.
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Attention Deficit Disorder with Hyperactivity/physiopathology , Child Behavior/physiology , Child Development/physiology , Infant, Very Low Birth Weight/physiology , Executive Function/physiology , Infant, Extremely Premature/physiology , Inhibition, Psychological , Case-Control StudiesABSTRACT
The neurofunctional effects of Cognitive training (CT) are poorly understood. Our main objective was to assess fMRI brain activation patterns in children with ADHD who received CT as an add-on treatment to stimulant medication. We included twenty children with ADHD from a clinical trial of stimulant medication and CT (10 in medication + CT and 10 in medication + non-active training). Between-group differences were assessed in performance and in brain activation during 3 fMRI paradigms of working memory (N-back: 0-back, 1-back, 2-back, 3-back), sustained attention (Sustained Attention Task - SAT: 2 s, 5 s and 8 s delays) and inhibitory control (Go/No-Go). We found significant group x time x condition interactions in working memory (WM) and sustained attention on brain activation. In N-back, decreases were observed in the BOLD signal change from baseline to endpoint with increasing WM load in the right insula, right putamen, left thalamus and left pallidum in the CT compared to the non-active group; in SAT - increases in the BOLD signal change from baseline to endpoint with increasing delays were observed in bilateral precuneus, right insula, bilateral associative visual cortex and angular gyrus, right middle temporal, precentral, postcentral, superior frontal and middle frontal gyri in the CT compared to the non-active group. CT in ADHD was associated with changes in activation in task-relevant parietal and striato-limbic regions of sustained attention and working memory. Changes in brain activity may precede behavioral performance modifications in working memory and sustained attention, but not in inhibitory control.
Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnostic imaging , Attention Deficit Disorder with Hyperactivity/drug therapy , Brain/diagnostic imaging , Central Nervous System Stimulants/therapeutic use , Cognition , Cognitive Remediation , Magnetic Resonance Imaging , Therapy, Computer-Assisted , Attention/drug effects , Attention/physiology , Attention Deficit Disorder with Hyperactivity/physiopathology , Brain/drug effects , Brain/physiology , Child , Cognition/drug effects , Cognition/physiology , Female , Humans , Male , Memory, Short-Term/drug effects , Memory, Short-Term/physiology , Pilot ProjectsABSTRACT
BACKGROUND/OBJECTIVES: Attention-deficit hyperactivity disorder (ADHD), one of the most common neurodevelopmental disorders in childhood and adolescence, is associated with obesity in observational studies. However, it is unclear whether ADHD contributes to, results from or is merely correlated with obesity. This study evaluates the presence and direction of a causal effect between ADHD and obesity. SUBJECTS/METHODS: We performed a bidirectional two-sample Mendelian randomization using summary data from consortia of genome-wide association studies to investigate if ADHD (N = 55,374) has a causal effect on body mass index (BMI) in childhood (N = 35,668) and adulthood (N = 322,154-500,000), and vice-versa. The main analysis was performed using the inverse variance weighted (IVW) method. As sensitivity analyses, we used other Mendelian randomization methods that are more robust to horizontal pleiotropy (i.e., MR-Egger, weighted mode, and penalized weighted median estimators), as well as stratified the analysis by the putative mechanisms of genetic instruments (i.e., pathways involved or not in neurological processes). RESULTS: The IVW method indicated a positive causal effect of BMI on ADHD: ß = 0.324 (95% CI 0.198 to 0.449, p < 0.001; expressed as change in ln(odds ratio) of ADHD per each additional SD unit of BMI). IVW estimates were directionally consistent with other methods. On the other hand, we did not find consistent evidence for a causal effect of ADHD genetic liability on BMI. CONCLUSIONS: The results suggested that higher BMI increases the risk of developing ADHD, but not the other way around.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Body Mass Index , Obesity , Adult , Attention Deficit Disorder with Hyperactivity/complications , Attention Deficit Disorder with Hyperactivity/epidemiology , Child , Child, Preschool , Genome-Wide Association Study , Humans , Mendelian Randomization Analysis , Obesity/complications , Obesity/epidemiology , White PeopleABSTRACT
Abstract Objective To evaluate the accuracy of the diagnosis of fetal heart diseases obtained through ultrasound examinations performed during the prenatal period compared with the postnatal evaluation. Methods A retrospective cohort study with 96 pregnant women who were attended at the Echocardiography Service and whose deliveries occurred at the Complexo Hospitalar Santa Casa de Porto Alegre, in the state of Rio Grande do Sul, Brazil. Risk factor assessment plus sensitivity and specificity analysis were used, comparing the accuracy of the screening for congenital heart disease by means of obstetrical ultrasound and morphological evaluation and fetal echocardiography, considering p < 0.05 as significant. The present study was approved by the Research Ethics Committee of the Institution. Results The analysis of risk factors shows that 31.3% of the fetuses with congenital heart disease could be identified by anamnesis. The antepartum echocardiography demonstrated a sensitivity of 97.7%, a specificity of 88.9%, and accuracy of 93% in the diagnosis of congenital heart disease. A sensitivity of 29.3% was found for the obstetric ultrasound, of 54.3% for themorphological ultrasound, and of 97.7% for the fetal echocardiography. The fetal echocardiography detected fetal heart disease in 67.7% of the cases, the morphological ultrasound in 16.7%, and the obstetric ultrasound in 11.5% of the cases. Conclusion There is a high proportion of congenital heart disease in pregnancies with no risk factors for this outcome. Faced with the disappointing results of obstetric ultrasound for the detection of congenital heart diseases and the current unfeasibility of universal screening of congenital heart diseases through fetal echocardiography, the importance of the fetal morphological ultrasound and its performance by qualified professionals is reinforced for a more appropriate management of these pregnancies.
Resumo Objetivo Avaliar a acurácia do diagnóstico de cardiopatias congênitas obtidos por meio das ecografias realizadas durante o pré-natal comparativamente à avaliação pósnatal. Métodos Estudo de coorte retrospectivo com 96 gestantes atendidas no Serviço de Ecocardiografia cujos partos ocorreram no Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brasil. Utilizou-se a avaliação de fatores de risco e a análise de sensibilidade e especificidade, comparando-se a acurácia do rastreamento de cardiopatia congênita por meio da ecografia obstétrica, da avaliação morfológica e da ecocardiografia fetal, considerando-se como significativo um p < 0,05. O referido estudo foi aprovado pelo Comitê de Ética em Pesquisa da Instituição. Resultados A análise de fatores de risco demonstra que 31,3% dos fetos com cardiopatia congênita poderiam ser identificados pela anamnese. As ecografias anteparto possuem sensibilidade de 97,7%, especificidade de 88,9% e acurácia de 93,0% no diagnóstico da cardiopatia congênita. Ao se analisar cada tipo de ecografia separadamente, encontrou-se sensibilidade de 29,3% para a ecografia obstétrica, de 54,3% para ecografia morfológica, e de 97,7% para ecocardiografia fetal. A ecocardiografia fetal definiu a cardiopatia fetal em 67,7% dos casos, a ecografia morfológica em 16,7%, e a ecografia obstétrica em 11,5%. Conclusão Demonstra-se uma elevada proporção de cardiopatia congênita em gestações sem fatores de risco para esse desfecho. Frente aos resultados desanimadores da ecografia obstétrica para a detecção de cardiopatias congênitas e na atual inviabilidade de rastreamento universal de cardiopatias congênitas por meio da ecocardiografia fetal, reforça-se a importância da ecografia morfológica fetal e sua realização por profissionais qualificados para esse fim de forma a permitir o manejo mais adequado destas gestações.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Echocardiography , Ultrasonography, Prenatal , Heart Defects, Congenital/diagnostic imaging , Reproducibility of Results , Retrospective Studies , Cohort StudiesABSTRACT
OBJECTIVE: To evaluate the accuracy of the diagnosis of fetal heart diseases obtained through ultrasound examinations performed during the prenatal period compared with the postnatal evaluation. METHODS: A retrospective cohort study with 96 pregnant women who were attended at the Echocardiography Service and whose deliveries occurred at the Complexo Hospitalar Santa Casa de Porto Alegre, in the state of Rio Grande do Sul, Brazil. Risk factor assessment plus sensitivity and specificity analysis were used, comparing the accuracy of the screening for congenital heart disease by means of obstetrical ultrasound and morphological evaluation and fetal echocardiography, considering p < 0.05 as significant. The present study was approved by the Research Ethics Committee of the Institution. RESULTS: The analysis of risk factors shows that 31.3% of the fetuses with congenital heart disease could be identified by anamnesis. The antepartum echocardiography demonstrated a sensitivity of 97.7%, a specificity of 88.9%, and accuracy of 93% in the diagnosis of congenital heart disease. A sensitivity of 29.3% was found for the obstetric ultrasound, of 54.3% for the morphological ultrasound, and of 97.7% for the fetal echocardiography. The fetal echocardiography detected fetal heart disease in 67.7% of the cases, the morphological ultrasound in 16.7%, and the obstetric ultrasound in 11.5% of the cases. CONCLUSION: There is a high proportion of congenital heart disease in pregnancies with no risk factors for this outcome. Faced with the disappointing results of obstetric ultrasound for the detection of congenital heart diseases and the current unfeasibility of universal screening of congenital heart diseases through fetal echocardiography, the importance of the fetal morphological ultrasound and its performance by qualified professionals is reinforced for a more appropriate management of these pregnancies.
OBJETIVO: Avaliar a acurácia do diagnóstico de cardiopatias congênitas obtidos por meio das ecografias realizadas durante o pré-natal comparativamente à avaliação pós-natal. MéTODOS: Estudo de coorte retrospectivo com 96 gestantes atendidas no Serviço de Ecocardiografia cujos partos ocorreram no Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brasil. Utilizou-se a avaliação de fatores de risco e a análise de sensibilidade e especificidade, comparando-se a acurácia do rastreamento de cardiopatia congênita por meio da ecografia obstétrica, da avaliação morfológica e da ecocardiografia fetal, considerando-se como significativo um p < 0,05. O referido estudo foi aprovado pelo Comitê de Ética em Pesquisa da Instituição. RESULTADOS: A análise de fatores de risco demonstra que 31,3% dos fetos com cardiopatia congênita poderiam ser identificados pela anamnese. As ecografias anteparto possuem sensibilidade de 97,7%, especificidade de 88,9% e acurácia de 93,0% no diagnóstico da cardiopatia congênita. Ao se analisar cada tipo de ecografia separadamente, encontrou-se sensibilidade de 29,3% para a ecografia obstétrica, de 54,3% para ecografia morfológica, e de 97,7% para ecocardiografia fetal. A ecocardiografia fetal definiu a cardiopatia fetal em 67,7% dos casos, a ecografia morfológica em 16,7%, e a ecografia obstétrica em 11,5%. CONCLUSãO: Demonstra-se uma elevada proporção de cardiopatia congênita em gestações sem fatores de risco para esse desfecho. Frente aos resultados desanimadores da ecografia obstétrica para a detecção de cardiopatias congênitas e na atual inviabilidade de rastreamento universal de cardiopatias congênitas por meio da ecocardiografia fetal, reforça-se a importância da ecografia morfológica fetal e sua realização por profissionais qualificados para esse fim de forma a permitir o manejo mais adequado destas gestações.
Subject(s)
Echocardiography , Heart Defects, Congenital/diagnostic imaging , Ultrasonography, Prenatal , Cohort Studies , Female , Humans , Infant, Newborn , Pregnancy , Reproducibility of Results , Retrospective StudiesABSTRACT
Advanced glycation end products (AGEs) represent a set of molecules that contribute directly to the initiation and aggravation of diseases associated with ageing. AGEs are produced by the reaction between reducing sugars (or α-dicarbonyl compounds), proteins, and amino acid residues. Previous in vitro methods using non-enzymatic procedures described in the literature require an incubation period of 1â»3 weeks to generate AGEs. In this study, the reaction time for the formation of AGEs (48 and 3 h) was significantly reduced by adaptation of methods previously described in the literature and coupling them to the free radical generation system termed hypoxanthine/xanthine oxidase assay. The incorporation of this assay into the experimental system accelerated the production of AGEs as a result of the formation of reactive oxygen species (ROS), as shown by increased fluorescence. The capacity of different classes of chemical compounds (aminoguanidine, chlorogenic acid, rutin, and methanol extracts of Hancornia speciosa Gomes) to inhibit protein glycation by acting as scavenging agents of α-dicarbonyl species was evaluated. Aminoguanidine and, especially, rutin identified in the leaf extracts of H. speciosa Gomes showed a high capacity to act as scavengers of reactive carbonyl species RCS-trapping, resulting in the inhibition of AGEs formation.
ABSTRACT
INTRODUCTION: Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, characterized by age inappropriate and impairing levels of inattention and/or hyperactivity/impulsivity. Pharmacotherapy is an important part of the ADHD multimodal treatment. The extent to which ADHD is pharmacologically over or under treated worldwide is controversial. We aimed to estimate the pooled worldwide rate of ADHD pharmacological treatment in individuals with and without the disorder. METHOD AND ANALYSIS: We will include published or unpublished studies reporting the rates of ADHD pharmacological treatment in participants with and without ADHD of any age group. Population-based, cohort, or follow-up studies, as well as data from insurance health system and third-party reimbursements will be eligible. Searches will be performed in a large number of electronic databases, including Medline, Embase, CINAHL, Cochrane, PsycINFO, Web of Science, and Scopus. The primary outcome will be the prevalence of ADHD pharmacological treatment in individuals with ADHD and without ADHD. Two independent reviewers will perform the screening, and data extraction process. Study quality/bias will be assessed with the Newcastle-Ottawa scale by 2 independent reviewers. To test the robustness of the findings, we will perform a series of sensitivity and meta-regression analysis. Analyses will be performed with R and STATA software. ETHICS AND DISSEMINATION: No IRB approval will be necessary. The results of this systematic review and meta-analysis will be presented at international conferences and published in peer-reviewed journals. REGISTRATION AND STATUS: PROSPERO 2018 CRD42018085233.
Subject(s)
Adrenergic Uptake Inhibitors/administration & dosage , Atomoxetine Hydrochloride/administration & dosage , Attention Deficit Disorder with Hyperactivity/drug therapy , Central Nervous System Stimulants/administration & dosage , Practice Patterns, Physicians'/statistics & numerical data , Adolescent , Adult , Attention Deficit Disorder with Hyperactivity/epidemiology , Child , Child, Preschool , Humans , Prevalence , Systematic Reviews as Topic , Young AdultABSTRACT
BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. The psychostimulant methylphenidate is the most frequently used medication to treat it. Several studies have investigated the benefits of methylphenidate, showing possible favourable effects on ADHD symptoms, but the true magnitude of the effect is unknown. Concerning adverse events associated with the treatment, our systematic review of randomised clinical trials (RCTs) demonstrated no increase in serious adverse events, but a high proportion of participants suffered a range of non-serious adverse events. OBJECTIVES: To assess the adverse events associated with methylphenidate treatment for children and adolescents with ADHD in non-randomised studies. SEARCH METHODS: In January 2016, we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, 12 other databases and two trials registers. We also checked reference lists and contacted authors and pharmaceutical companies to identify additional studies. SELECTION CRITERIA: We included non-randomised study designs. These comprised comparative and non-comparative cohort studies, patient-control studies, patient reports/series and cross-sectional studies of methylphenidate administered at any dosage or formulation. We also included methylphenidate groups from RCTs assessing methylphenidate versus other interventions for ADHD as well as data from follow-up periods in RCTs. Participants had to have an ADHD diagnosis (from the 3rd to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders or the 9th or 10th edition of theInternational Classification of Diseases, with or without comorbid diagnoses. We required that at least 75% of participants had a normal intellectual capacity (intelligence quotient of more than 70 points) and were aged below 20 years. We excluded studies that used another ADHD drug as a co-intervention. DATA COLLECTION AND ANALYSIS: Fourteen review authors selected studies independently. Two review authors assessed risk of bias independently using the ROBINS-I tool for assessing risk of bias in non-randomised studies of interventions. All review authors extracted data. We defined serious adverse events according to the International Committee of Harmonization as any lethal, life-threatening or life-changing event. We considered all other adverse events to be non-serious adverse events and conducted meta-analyses of data from comparative studies. We calculated meta-analytic estimates of prevalence from non-comparative cohorts studies and synthesised data from patient reports/series qualitatively. We investigated heterogeneity by conducting subgroup analyses, and we also conducted sensitivity analyses. MAIN RESULTS: We included a total of 260 studies: 7 comparative cohort studies, 6 of which compared 968 patients who were exposed to methylphenidate to 166 controls, and 1 which assessed 1224 patients that were exposed or not exposed to methylphenidate during different time periods; 4 patient-control studies (53,192 exposed to methylphenidate and 19,906 controls); 177 non-comparative cohort studies (2,207,751 participants); 2 cross-sectional studies (96 participants) and 70 patient reports/series (206 participants). Participants' ages ranged from 3 years to 20 years. Risk of bias in the included comparative studies ranged from moderate to critical, with most studies showing critical risk of bias. We evaluated all non-comparative studies at critical risk of bias. The GRADE quality rating of the evidence was very low.Primary outcomesIn the comparative studies, methylphenidate increased the risk ratio (RR) of serious adverse events (RR 1.36, 95% confidence interval (CI) 1.17 to 1.57; 2 studies, 72,005 participants); any psychotic disorder (RR 1.36, 95% CI 1.17 to 1.57; 1 study, 71,771 participants); and arrhythmia (RR 1.61, 95% CI 1.48 to 1.74; 1 study, 1224 participants) compared to no intervention.In the non-comparative cohort studies, the proportion of participants on methylphenidate experiencing any serious adverse event was 1.20% (95% CI 0.70% to 2.00%; 50 studies, 162,422 participants). Withdrawal from methylphenidate due to any serious adverse events occurred in 1.20% (95% CI 0.60% to 2.30%; 7 studies, 1173 participants) and adverse events of unknown severity led to withdrawal in 7.30% of participants (95% CI 5.30% to 10.0%; 22 studies, 3708 participants).Secondary outcomesIn the comparative studies, methylphenidate, compared to no intervention, increased the RR of insomnia and sleep problems (RR 2.58, 95% CI 1.24 to 5.34; 3 studies, 425 participants) and decreased appetite (RR 15.06, 95% CI 2.12 to 106.83; 1 study, 335 participants).With non-comparative cohort studies, the proportion of participants on methylphenidate with any non-serious adverse events was 51.2% (95% CI 41.2% to 61.1%; 49 studies, 13,978 participants). These included difficulty falling asleep, 17.9% (95% CI 14.7% to 21.6%; 82 studies, 11,507 participants); headache, 14.4% (95% CI 11.3% to 18.3%; 90 studies, 13,469 participants); abdominal pain, 10.7% (95% CI 8.60% to 13.3%; 79 studies, 11,750 participants); and decreased appetite, 31.1% (95% CI 26.5% to 36.2%; 84 studies, 11,594 participants). Withdrawal of methylphenidate due to non-serious adverse events occurred in 6.20% (95% CI 4.80% to 7.90%; 37 studies, 7142 participants), and 16.2% were withdrawn for unknown reasons (95% CI 13.0% to 19.9%; 57 studies, 8340 participants). AUTHORS' CONCLUSIONS: Our findings suggest that methylphenidate may be associated with a number of serious adverse events as well as a large number of non-serious adverse events in children and adolescents, which often lead to withdrawal of methylphenidate. Our certainty in the evidence is very low, and accordingly, it is not possible to accurately estimate the actual risk of adverse events. It might be higher than reported here.Given the possible association between methylphenidate and the adverse events identified, it may be important to identify people who are most susceptible to adverse events. To do this we must undertake large-scale, high-quality RCTs, along with studies aimed at identifying responders and non-responders.
Subject(s)
Attention Deficit Disorder with Hyperactivity/drug therapy , Central Nervous System Stimulants/adverse effects , Methylphenidate/adverse effects , Adolescent , Central Nervous System Stimulants/therapeutic use , Child , Child, Preschool , Humans , Methylphenidate/therapeutic use , Non-Randomized Controlled Trials as Topic , Patient Dropouts/statistics & numerical data , Young AdultABSTRACT
BACKGROUND: There is little evidence in the literature on the association between methylphenidate treatment and psychotic symptoms in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE: We examine the occurrence of psychotic symptoms during methylphenidate treatment of children and adolescents with ADHD. The data arise from our two Cochrane systematic reviews on methylphenidate, reported elsewhere. METHODS: Electronic databases were searched up to January 2016 (for observational studies) and March 2017 (for randomized trials). We summarized data as risk ratios and pooled prevalences. Trial Sequential Analysis was used to control for random errors. We assessed the risk of bias and the quality of evidence according to Cochrane guidelines. RESULTS: Ten randomized trials (1103 participants), 17 non-randomized studies (76,237 participants) and 12 patient reports or series (18 patients) were identified. In the randomized trials, there was no significant difference in the risk of developing psychotic symptoms [10 of 654 (pooled prevalence, 2.5%) methylphenidate versus 1 of 508 (pooled prevalence, 1.7%) placebo patients; risk ratio, 2.07; 95% confidence interval, 0.58 to 7.35]. Nine of 10 trials had a high risk of bias, and according to the Trial Sequential Analysis, the required information size was not achieved, that is, the meta-analysis was considerably underpowered. There were 873 instances of psychotic symptoms in the non-randomized studies among 55,603 participants (pooled prevalence, 1.2%; 95% confidence interval, 0.7 to 2.4). In the comparative cohort study, methylphenidate significantly increased the risk for any psychotic disorder by 36% (risk ratio, 1.36; 95% confidence interval, 1.17 to 1.57). The overall risk of bias was rated as critical for this study. CONCLUSIONS: Because of sparse data and low quality of evidence, we cannot confirm or refute whether methylphenidate increases the risk of psychotic symptoms in children and adolescents with ADHD. This possible adverse event may affect 1.1% to 2.5%, and physicians, patients and caregivers should be aware of this to ensure proper treatment in case of occurrence during methylphenidate treatment.
ABSTRACT
CONTEXT: Although very preterm (VP), extremely preterm (EP), very low birth weight (VLBW), and extremely low birth weight (ELBW) newborns seem to have a higher risk of later attention-deficit/hyperactivity disorder (ADHD), the magnitude of the risk is not well-defined. OBJECTIVE: To systematically review and meta-analyze the risk of VP/VLBW and EP/ELBW individuals to develop a ADHD categorical diagnosis or dimensional symptomatology compared with controls with normal weight and/or birth age. DATA SOURCES: We used PsycINFO, Medline, Embase, and Cochrane databases. STUDY SELECTION: We selected cross-sectional, prospective, or retrospective studies with no time or language restriction. DATA EXTRACTION: Independent reviewers screened and extracted data using predefined standard procedures. RESULTS: In 12 studies (N = 1787), researchers relying on a categorical diagnosis showed that both VP/VLBW and EP/ELBW subjects have a higher ADHD risk (odds ratio [OR] = 3.04 higher than controls; 95% confidence interval [CI] 2.19 to 4.21). In subgroup analyses, we demonstrated that the more extreme the cases, the higher the ORs (VP/VLBW: OR = 2.25 [95% CI 1.56 to 3.26]; EP/ELBW: OR = 4.05 [95% CI 2.38 to 6.87]). We drew data from 29 studies (N = 3504) on ADHD symptomatology and found significant associations with inattention (standardized mean difference [SMD] = 1.31, 95% CI 0.66 to 1.96), hyperactivity and impulsivity (SMD = 0.74, 95% CI 0.35 to 1.13), and combined symptoms (SMD = 0.55, 95% CI 0.42 to 0.68) when compared with controls. LIMITATIONS: Heterogeneity was significantly high for all analyses involving the 3 ADHD dimensions. CONCLUSIONS: With our results, we provide evidence that VP/VLBW subjects have an increased risk of ADHD diagnosis and symptomatology compared with controls, and these findings are even stronger in the EP/ELBW group. Future researchers should address which risk factors related to prematurity or low birth weight lead to ADHD.
Subject(s)
Attention Deficit Disorder with Hyperactivity/epidemiology , Attention Deficit Disorder with Hyperactivity/etiology , Central Nervous System Stimulants/therapeutic use , Infant, Extremely Premature , Infant, Very Low Birth Weight , Attention Deficit Disorder with Hyperactivity/drug therapy , Cross-Sectional Studies , Female , Gestational Age , Humans , Infant, Newborn , Male , Neuropsychological Tests , Pregnancy , Prevalence , Prognosis , Prospective Studies , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
Abstract It is not known if competitive anxiety affects decision-making performance in athletes. This study aimed to analyze the effect of competitive anxiety on passing decision-making in young soccer players. This is a prospective study, whose sample consisted of 40 soccer athletes of the under-17 category. The Portuguese version of the Competitive State Anxiety Inventory (CSAI-2R) was filled out by athletes 45 minutes before the start of a soccer match. Decision-making was evaluated in a real game situation. The analysis and categorization of actions were based on the Game Performance Assessment Instrument. The results showed significant influence of cognitive anxiety (R² =.20; p = .001), somatic anxiety (R² = .45; p = .001) and self-confidence about the passing decision-making index (R² = .31; p = .001). It was concluded that competitive anxiety can be considered an intervening factor in decision-making of the pass of young male soccer players.Keywords: test validity, scaling, elderly, depression
Resumo Não se sabe se a ansiedade competitiva acarreta efeito no desempenho da tomada de decisão em atletas. O objetivo do estudo foi analisar o efeito da ansiedade competitiva sobre a tomada de decisão do passe em jovens atletas de futebol. Trata-se de uma investigação prospectiva, cuja amostra foi composta por 40 atletas de futebol da categoria sub-17. A versão em língua portuguesa do Competitite State Anxiety Inventory (CSAI-2R) foi preenchida 45 minutos antes do início de uma partida de futebol. A tomada de decisão foi avaliada pelos critérios do Game Performance Assessment Instrument. Os resultados apontaram influência significativa da ansiedade cognitiva (R² = .20; p = .001), da ansiedade somática (R² = .45; p = .001) e da autoconfiança sobre o índice de tomada de decisão do passe (R² = .31; p = .001). Concluiu-se que a ansiedade competitiva pode ser considerada um fator interveniente na tomada de decisão do passe de jovens atletas de futebol do sexo masculino.
Resumen No se sabe si la ansiedad competitiva genera efectos en el rendimiento de toma de decisiones en los atletas. El objetivo del estudio fue analizar el efecto de la ansiedad competitiva sobre toma de decisiones del pase en futbolistas jóvenes. Se trata de una investigación prospectiva, cuya muestra fue formada por 40 jugadores de la categoría sub-17. La versión en portugués del Competitive State Anxiety Intentory se completó 45 minutos antes del comienzo de una partida de fútbol. La toma de decisiones se evaluó mediante los criterios del instrumento de evaluación del rendimiento del juego por medio del Game Performance Assessment Instrument. Los resultados mostraron una influencia significativa de la ansiedad cognitiva (R² = .20; p = .001), de la ansiedad somática (R² = .45; p = .001) y de la autoconfianza sobre el índice de toma de decisión del pase (R² = .31; p = .001). Se concluyó que la ansiedad competitiva puede considerarse un factor que interviene en la toma de decisiones del pase de jóvenes jugadores de fútbol de sexo masculino.
Subject(s)
Humans , Male , Adolescent , Anxiety , Soccer , Athletes , Psychology, SportsABSTRACT
Background: Cognitive training has received increasing attention as a non-pharmacological approach for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents. Few studies have assessed cognitive training as add-on treatment to medication in randomized placebo controlled trials. The purpose of this preliminary study was to explore the feasibility of implementing a computerized cognitive training program for ADHD in our environment, describe its main characteristics and potential efficacy in a small pilot study. Methods: Six ADHD patients aged 10-12-years old receiving stimulants and presenting residual symptoms were enrolled in a randomized clinical trial to either a standard cognitive training program or a controlled placebo condition for 12 weeks. The primary outcome was core ADHD symptoms measured using the Swanson, Nolan and Pelham Questionnaire (SNAP-IV scale). Results: We faced higher resistance than expected to patient enrollment due to logistic issues to attend face-to-face sessions in the hospital and to fill the requirement of medication status and absence of some comorbidities. Both groups showed decrease in parent reported ADHD symptoms without statistical difference between them. In addition, improvements on neuropsychological tests were observed in both groups - mainly on trained tasks. Conclusions: This protocol revealed the need for new strategies to better assess the effectiveness of cognitive training such as the need to implement the intervention in a school environment to have an assessment with more external validity. Given the small sample size of this pilot study, definitive conclusions on the effects of cognitive training as add-on treatment to stimulants would be premature.
Subject(s)
Attention Deficit Disorder with Hyperactivity/therapy , Central Nervous System Stimulants/therapeutic use , Cognitive Remediation , Therapy, Computer-Assisted , Attention Deficit Disorder with Hyperactivity/diagnostic imaging , Attention Deficit Disorder with Hyperactivity/physiopathology , Attention Deficit Disorder with Hyperactivity/psychology , Brain/diagnostic imaging , Brain/physiopathology , Child , Clinical Protocols , Cognitive Remediation/methods , Combined Modality Therapy , Comorbidity , Feasibility Studies , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Neuropsychological Tests , Patient Selection , Pilot Projects , Psychotropic Drugs/therapeutic use , Single-Blind Method , Treatment OutcomeABSTRACT
OBJECTIVES: To study in more depth the relationship between type, dose, or duration of methylphenidate offered to children and adolescents with attention deficit hyperactivity disorder and their risks of gastrointestinal adverse events based on our Cochrane systematic review. METHODS AND FINDINGS: We use data from our review including 185 randomised clinical trials. Randomised parallel-group trials and cross-over trials reporting gastrointestinal adverse events associated with methylphenidate were included. Data were extracted and quality assessed according to Cochrane guidelines. Data were summarised as risk ratios (RR) with 95% confidence intervals (CI) using the inverse variance method. Bias risks were assessed according to domains. Trial Sequential Analysis (TSA) was used to control random errors. Eighteen parallel group trials and 43 cross-over trials reported gastrointestinal adverse events. All trials were at high risk of bias. In parallel group trials, methylphenidate decreased appetite (RR 3.66, 95% CI 2.56 to 5.23) and weight (RR 3.89, 95% CI 1.43 to 10.59). In cross-over trials, methylphenidate increased abdominal pain (RR 1.61, 95% CI 1.27 to 2.04). We found no significant differences in the risk according to type, dose, or duration of administration. The required information size was achieved in three out of four outcomes. CONCLUSION: Methylphenidate increases the risks of decreased appetite, weight loss, and abdominal pain in children and adolescents with attention deficit hyperactivity disorder. No differences in the risks of gastrointestinal adverse events according to type, dose, or duration of administration were found.
