ABSTRACT
Traffic accidents are a leading cause of death in young adults. In Brazil, traffic accidents are proportionally more prevalent among motorcyclists as compared to automobile drivers. Although numerous data indicate that individual characteristics are involved in traffic accident risk, there is no instrument in Brazil to assess motorcyclists' traffic behavior. The authors thus proposed to perform translation and cultural adaptation of the Motorcycle Rider Behavior Questionnaire (MRBQ) into Brazilian Portuguese. The translation process consisted of: two independent translations into Brazilian Portuguese; unification of the translations; back-translation into English; formal assessment of semantic equivalence; application of a summary version in a convenience sample of motorcyclists; generation of a final version; and back-translation and submission to the original author, who approved this version. The Brazilian version maintained its semantic equivalence and was accepted by the convenience sample, an important characteristic for a self-completed instrument. Further studies are necessary to evaluate the questionnaire's psychometric properties in the Brazilian cultural context.
Subject(s)
Accidents, Traffic , Motorcycles , Surveys and Questionnaires , Translations , Accidents, Traffic/prevention & control , Brazil , Cultural Characteristics , Humans , LanguageABSTRACT
O transtorno obsessivo-compulsivo (TOC) é uma doença mental grave, com graves consequências para a dinâmica familiar. Desta forma, o envolvimento dos pais parece ser determinante na resolução dos sintomas desse transtorno. O objetivo deste estudo foi avaliar a qualidade da evidência para a recomendação de terapia cognitivo-comportamental (TCC) com intervenção familiar para crianças e adolescentes com TOC. A busca sistemática foi realizada nas bases de dados MEDLINE/PubMed, seguida da análise de resumos e artigos na íntegra por dois avaliadores independentes. Posteriormente, foi realizada a análise de evidência através do sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). O tamanho de efeito da intervenção foi calculado através do d de Cohen. Foram localizados 77 artigos no PubMed e mais 12 artigos após busca cruzada de referências. Destes, sete artigos foram incluídos na revisão, segundo os seguintes critérios: ser estudo de intervenção, envolver apenas crianças e/ou adolescentes e possuir diagnóstico clínico ou estruturado de TOC. A escala Childrens Yale-Brown Obsessive Compulsive Scale (CY-BOCS) foi utilizada por todos os artigos para a avaliação de desfecho, permitindo avaliar o tamanho de efeito das intervenções não controladas (d = 1,43), que resultou em uma diferença de médias de cerca 13 pontos (IC95 por cento 11,84-14,39; p < 0,001). Por outro lado, uma alta heterogeneidade foi detectada entre os estudos (I² = 67 por cento). A TCC com intervenção familiar parece ter um efeito importante na redução dos sintomas de TOC na infância e adolescência. No entanto, os poucos estudos disponíveis não nos permitem estabelecer um grau de evidência maior do que C para essa recomendação. Novos ensaios clínicos randomizados são necessários para confirmar essa recomendação.
Obsessive-compulsive disorder (OCD) is a severe mental disorder with serious consequences to family dynamics. Therefore, parental involvement seems to be a key factor for the successful treatment of this psychiatric disorder. The aim of this study was to evaluate the level of evidence available to allow recommendation of cognitive behavioral therapy (CBT) with family intervention for the treatment of children and adolescents with OCD. The systematic search was performed on MEDLINE/PubMed, followed by analysis of abstracts and full-length articles by two independent evaluators. Subsequently, an analysis of the evidence available was conducted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The effect size of the intervention was calculated using Cohens d. We found 77 articles on PubMed, plus 12 articles via cross-reference search. Of these, seven articles were included in this review, according to the following criteria: intervention study, involving only children and/or adolescents, and a having a structured or clinical diagnosis of OCD. The Childrens Yale-Brown Obsessive Compulsive Scale (CY-BOCS) was used for outcome evaluation in all articles, thus enabling assessment of the effect size of non-controlled interventions (d = 1.43), resulting in a mean difference of 13.11 points (95 percentCI 11.84-14.39; p < 0.001). Conversely, a high heterogeneity was detected among the studies (I² = 67 percent). Family-based CBT seems to have an important effect on the reduction of OCD symptoms in children and adolescents. However, the small number of studies available do not allow us to establish an evidence level higher than C for this recommendation. New randomized clinical trials are needed to confirm this recommendation.
ABSTRACT
Objective: To investigate hematologic variables related to iron deficiency and food intake in attention-deficit/hyperactivity disorder. Method: The sample comprised 62 children and adolescents (6-15 years old) divided into three groups: Group 1: 19 (30.6 percent) patients with attention-deficit/hyperactivity disorder using methylphenidate for 3 months; Group 2: 22 (35.5 percent) patients with attention-deficit/hyperactivity disorder who were methylphenidate naïve and Group 3: 21 (33.9 percent) patients without attention-deficit/hyperactivity disorder. Serum iron, ferritin, transferrin, hemoglobin, mean corpuscular volume, red cell distribution width, mean corpuscular hemoglobin concentration, nutritional diagnostic parameters - Body Mass Index Coefficient, food surveys were evaluated among the groups. Results: The attention-deficit/hyperactivity disorder group drug naïve for methylphenidate presented the highest red cell distribution width among the three groups (p = 0.03). For all other hematologic and food survey variables, no significant differences were found among the groups. No significant correlation between dimensional measures of attention-deficit/hyperactivity disorder symptoms and ferritin levels was found in any of the three groups. Conclusion: Peripheral markers of iron status and food intake of iron do not seem to be modified in children with attention-deficit/hyperactivity disorder, but further studies assessing brain iron levels are needed to fully understand the role of iron in attention-deficit/hyperactivity disorder pathophysiology.
Objetivo: Investigar as variáveis hematológicas relacionadas à deficiência de ferro e à ingestão alimentar no transtorno de déficit de atenção/hiperatividade. Método: Sessenta e duas crianças e adolescentes (6-15 anos) divididos em três grupos: Grupo 1: 19 (30,6 por cento) pacientes com transtorno de déficit de atenção/hiperatividade com uso de metilfenidato durante três meses; Grupo 2: 22 (35,5 por cento) pacientes com transtorno de déficit de atenção/hiperatividade sem uso de medicamento; e Grupo 3: 21 (33,9 por cento) pacientes sem transtorno de déficit de atenção/hiperatividade. Ferro sérico, ferritina, transferrina, hemoglobina, volume corpuscular médio, amplitude de distribuição dos eritrócitos, concentração da hemoglobina corpuscular média, parâmetros de diagnóstico nutricional - Coeficiente de Índice de Massa Corporal, inquérito alimentar e a correlação entre os sintomas do transtorno e os níveis de ferritina foram avaliados. Resultados: O grupo com transtorno de déficit de atenção/hiperatividade não medicado com metilfenidato apresentou maior amplitude de distribuição dos eritrócitos dentre os três grupos (p = 0,03). Nas outras variáveis hematológicas e inquéritos alimentares não encontramos diferença significativa entre os grupos. Não observamos correlação entre os sintomas do transtorno de déficit de atenção/hiperatividade e ferritina. Conclusão: Marcadores periféricos do estado nutricional de ferro e a ingestão alimentar de ferro não parecem estar modificados em crianças com transtorno de déficit de atenção/hiperatividade, mas mais estudos avaliando os níveis de ferro no cérebro são necessários para compreensão plena do papel do ferro na fisiopatologia do transtorno de déficit de atenção/hiperatividade.
Subject(s)
Adolescent , Child , Female , Humans , Male , Anemia, Iron-Deficiency/blood , Attention Deficit Disorder with Hyperactivity/blood , Attention Deficit Disorder with Hyperactivity/physiopathology , Diet Surveys/statistics & numerical data , Eating/physiology , Iron, Dietary/blood , Anemia, Iron-Deficiency/diagnosis , Biomarkers/blood , Brazil , Cross-Sectional Studies , Diet Records , Dopamine Uptake Inhibitors/administration & dosage , Feeding Behavior/physiology , Iron, Dietary/administration & dosage , Methylphenidate/administration & dosage , Nutritional Status , Socioeconomic FactorsABSTRACT
OBJECTIVE: To investigate hematologic variables related to iron deficiency and food intake in attention-deficit/hyperactivity disorder. METHOD: The sample comprised 62 children and adolescents (6-15 years old) divided into three groups: Group 1: 19 (30.6%) patients with attention-deficit/hyperactivity disorder using methylphenidate for 3 months; Group 2: 22 (35.5%) patients with attention-deficit/hyperactivity disorder who were methylphenidate naive and Group 3: 21 (33.9%) patients without attention-deficit/hyperactivity disorder. Serum iron, ferritin, transferrin, hemoglobin, mean corpuscular volume, red cell distribution width, mean corpuscular hemoglobin concentration, nutritional diagnostic parameters - Body Mass Index Coefficient, food surveys were evaluated among the groups. RESULTS: The attention-deficit/hyperactivity disorder group drug naive for methylphenidate presented the highest red cell distribution width among the three groups (p = 0.03). For all other hematologic and food survey variables, no significant differences were found among the groups. No significant correlation between dimensional measures of attention-deficit/hyperactivity disorder symptoms and ferritin levels was found in any of the three groups. CONCLUSION: Peripheral markers of iron status and food intake of iron do not seem to be modified in children with attention-deficit/hyperactivity disorder, but further studies assessing brain iron levels are needed to fully understand the role of iron in attention-deficit/hyperactivity disorder pathophysiology.
Subject(s)
Anemia, Iron-Deficiency/blood , Attention Deficit Disorder with Hyperactivity/blood , Attention Deficit Disorder with Hyperactivity/physiopathology , Diet Surveys/statistics & numerical data , Eating/physiology , Iron, Dietary/blood , Adolescent , Anemia, Iron-Deficiency/diagnosis , Biomarkers/blood , Brazil , Child , Cross-Sectional Studies , Diet Records , Dopamine Uptake Inhibitors/administration & dosage , Feeding Behavior/physiology , Female , Humans , Iron, Dietary/administration & dosage , Male , Methylphenidate/administration & dosage , Nutritional Status , Socioeconomic FactorsABSTRACT
OBJECTIVE: To assess ADHD symptoms after switching from Methylphenidate Immediate-release (MPH-IR) to Methylphenidate Spheroidal Oral Drug Absorption System (MPH-SODAS) in clinically stable patients with ADHD and to identify predictors of dissatisfaction with MPH-SODAS. METHODS: This is an 8-week open clinical trial. Patients were assigned to MPH-SODAS according to their pre-study dose of MPH-IR. Assessments at baseline were conducted using the Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-IV), and the Barkley's Side Effect Rating Scale (SERS). Potentials predictors of treatment response were evaluated. RESULTS: From 62 patients, 47 completed the protocol. There was no significant change in the total score at the SNAP-IV (F (1,51.26) = 0.01; P = 0.91) and its subscales scores during the trial. Although no significant effect on the SERS total score (F (1,111.49) = 0.75; P = 0.39) was found, one adult patient with a previous cardiovascular condition presented a hemorrhagic cerebral vascular accident resulting in her obit. Overall, 46 (74.2%) patients reported to be satisfied. No factor assessed predicted dissatisfaction in univariated analyses. CONCLUSION: Results suggested that switching from MPH-IR to MPH-SODAS did not affect stabilization of ADHD symptoms in the majority of patients. MPH prescription in patients with previous cardiovascular conditions must be extremely careful. Further studies with long-acting MPH including larger samples and patients not responsive to MPH-IR are needed especially in countries outside the US.
