The effects of transcranial direct current stimulation on attention and inhibitory control of children and adolescents with attention-deficit/hyperactivity disorder (ADHD): Study protocol for a randomized, sham-controlled, triple-blind, cross-over trial.

ABSTRACT: Attention-deficit/hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention and hyperactivity/impulsivity. Despite the proven efficacy of pharmacological treatment, many individuals continue to suffer socially and academically and some experience significant side effects that negate the use psychotropic drugs. Transcranial direct current stimulation (tDCS) is a cortical neuromodulation feature that has shown positive results in the treatment of various neuropsychiatric conditions. OBJECTIVES: To investigate the effect of tDCS on the performance of children and adolescents with ADHD in the neuropsychological tests of visual attention, verbal, and inhibitory control. METHODOLOGY: Triple blind, randomized, sham-controlled, cross-over trial involving tDCS in children and adolescents with ADHD. Initial screening will be performed using Swanson, Nolan, and Pelham - IVand Wechsler intelligence scale for children fourth edition vocabulary and cube subtests. Individuals will be evaluated pre-tDCS and post-tDCS with the Wechsler intelligence scale for children fourth edition Digitus subtest, neuropsychological assessment battery second edition inhibiting responses subtest, Corsi cubes, and visual attention test-4.

The effectiveness of intervention programs in the prevention and control of obesity in infants: a systematic review.

OBJECTIVE: This study aims to conduct a literature review to evaluate the effectiveness of intervention programs in the prevention and control of obesity in children and to map the locations where the studies were carried out. METHODS: A systematic review using the PubMed / MEDLINE and LILACS databases to trace the published literature on intervention programs for prevention and control of obesity in the period of January 2004 to October 2013. The initial search was conducted using the terms "body mass index", " Intervention" and "children" or "adolescent" and only articles published in English, Spanish or Portuguese were selected. RESULTS: We found that interventions based only on advice had modest results in identifying changes in the anthropometric indicators of children and adolescents over time, although they appear to be effective in promoting positive changes in the eating habits of this population. Among the studies identified, 77.8 % were conducted in high-income countries, 22.2 % in middle to high income countries and no intervention studies were found in middle to low income countries. CONCLUSION: Intervention programs based only on counseling are effective in promoting changes in dietary patterns, but show poor results in the changes of anthropometric parameters of children and adolescents.

Objetivo: Este trabajo pretende realizar una revisión de literatura para evaluar la efectividad de programas de intervención en la prevención y en el control del exceso de peso infantil y hacer el mapeamiento de los sitios donde los estudios fueron hechos. Métodos: Estudio de revisión sistemática utilizando las bases de datos de PUBMED/MEDLINE y LILACS para rastrear la literatura publicada sobre programas de intervenciones para prevención y control de exceso de peso entre el período de enero de 2004 a octubre de 2013. La búsqueda inicial fue realizada utilizando los términos "body mass index" and "Intervention" and "children" or "adolescent" y fueron seleccionados apenas los artículos publicados en Inglés, español y portugués. Resultados: se observó que intervenciones pautadas unicamente en el aconsejamiento presentaron resultados modestos para identificar alteraciones en los indicadores antropométricos de niños y adolescentes a lo largo del tiempo, aunque parezcan ser efectivos para realizar cambios positivos en los hábitos alimentares de esa población. Entre los estudios identificados, 77.8% fueron realizados en países con renta alta, 22.2% en los países con renta media-alta y no hay estudios de intervención en países con renta media-baja y baja. Conclusión: Los programas de intervenciones basados solamente en el aconsejamiento son efectivos para promover cambios en la calidad alimentar, pero presentan insignificantes resultados en la alteración de los parámetros antropométricos de niños y adolescentes.

Iron deficiency anemia in adolescents; a literature review.

INTRODUCTION: Anemia is one of the most important nutritional deficiencies affecting various social and socioeconomic strata. It is more common in developing countries, with children and adolescents being at a significantly higher risk for the condition. OBJECTIVE: To perform a literature review on iron deficiency anemia in adolescence as a public health issue and on the risk factors that may contribute towards nutritional deficiencies, stunted growth and development in this age group, emphasizing the physiopathology and causes of anemia, the different diagnostic approaches, and its clinical characteristics, prevention and treatment. METHODOLOGY: The LILACS-BIREME, SCIELO and PUBMED databases were consulted for the study. Scientific papers published in Spanish, Portuguese or English between 2000 and 2013 on the subject of iron deficiency anemia in adolescents were selected for inclusion. A total of 102 studies published between January 1st, 2000 and June 30th, 2013 were identified and evaluated. Forty-two articles meeting the inclusion criterion (adolescents with anemia) were selected for this review. Finally, an analysis was conducted and the papers were evaluated in accordance with the study objectives. RESULTS AND DISCUSSION: The studies reviewed revealed a prevalence of iron deficiency anemia of around 20% in adolescents and described the harmful effects of anemia in this age group. CONCLUSION: Preventive action is required with respect to iron deficiency anemia. Healthcare professionals should be aware of the need for early diagnosis, prophylaxis and treatment.

Introducción: La anemia es una de las deficiencias nutricionales más importantes que afecta a varios estratos sociales y socioeconómicos. Es más frecuente en países en vías de desarrollo, estando los niños y los adolescentes en un riesgo significativamente mayor para padecer esta afección. Objetivo: Realizar una revisión bibliográfica sobre la anemia ferropénica en la adolescencia como un problema de salud pública y sobre los factores de riesgo que podrían contribuir en las deficiencias nutricionales, la detención del crecimiento y el desarrollo en este grupo de edad y poniendo el énfasis sobre la fisiopatología y las causas de la anemia, los diferentes abordajes diagnósticos y sus características clínicas, la prevención y el tratamiento. Metodología: Para este estudio, se consultaron las bases de datos LILACS-BIREME, SCIELO y PUBMED. Se seleccionaron los trabajos científicos publicados en español, portugués o inglés entre 2000 y 2013 sobre la anemia ferropénica. Se identificaron y evaluaron un total de 102 estudios publicados entre el 1º de enero de 2000 y el 30 de junio de 2013. Cuarenta y dos artículos que reunían los criterios de inclusión (adolescentes con anemia) se seleccionaron para esta revisión. Finalmente, se realizó un análisis y se evaluaron los artículos de acuerdo con los objetivos del estudio. Resultados y discusión: Los estudios revisados mostraron una prevalencia de anemia ferropénica cercana al 20 % en los adolescentes y describían los efectos deletéreos de la anemia en este grupo. Conclusión: Se requiere una acción preventiva con respecto a la anemia ferropénica. Los profesionales sanitarios deberían ser conscientes de la necesidad de un diagnóstico, profilaxis y tratamiento precoces.EL.

Metabolic syndrome and associated factors in children and adolescents of a Brazilian municipality.

BACKGROUND: the risk factors associated to metabolic syndrome (MS) have been extensively studied in adults, but in children and adolescents it is poorly explored. OBJECTIVE: To identify the prevalence of MS and associated factors in children and adolescents. METHODS: A cross-sectional study with 540 children and adolescents from 7 to 14 years of age. The socioeconomic, demographic and lifestyle data and the family history of chronic diseases were reported by the individual and/or guardian and recorded in a structured questionnaire. Biochemical tests (fasting blood glucose, triacylglycerols, reduced high-density lipoprotein, very-low-density lipoprotein, homocysteine and cysteine), an anthropometric assessment and a blood pressure measurement were performed. MS was defined according to the criteria of The National Cholesterol Education Program Adult Treatment Panel III adapted by Ferranti. A Poisson regression was used to identify the factors statistically associated with MS. RESULTS: The MS prevalence was 12.8%, in which the most frequent component was a decreased high-density lipoprotein level (58.2%), followed by hypertriglyceridemia (41.8%), elevated blood pressure (29.1%), increased waist circumference (26.7%) and hyperglycemia (7.2%). Associations between metabolic syndrome and overweight [prevalence ratio (PR): 2.2 (1.22-3.95)], father education [PR: 2.19 (1.10-4.37)], serum very low-density lipoprotein concentration [PR: 1.08 (1.04-1.11)] and concomitantly increased serum homocysteine and cysteine concentrations [PR: 2.58 (1.32-5.04)] were observed. CONCLUSIONS: The MS prevalence is high in children and adolescents and it is increased in patients with overweight, higher father education, increased serum very-low-density lipoprotein concentrations and a concomitant serum homocysteine and cysteine high levels.

Introducción: Los factores asociados al Síndrome metabólico (SM) han sido ampliamente estudiados en adultos, pero aún son poco explorado en niños y adolescentes Objetivo: Identificar la superioridad de SM y los factores asociados en niños y adolescentes. Métodos: Se trata de estudio transversal, con 540 niños de 7 a 14 años de edad. Los datos socioeconómicos, demográficos, estilo de vida e historia familiar de enfermedades crónicas fueron informados por la persona y/o responsable y registrados en cuestionario estructurado. Fueron realizadas dosificaciones bioquímicas (glicemia en ayuno, triglicérides, lipoproteína de alta densidad reducida, lipoproteína de muy baja densidad, homocisteina y cisteina), evaluación antropométrica y verificación de la presión arterial. La SM fue definida de acuerdo con los criterios del The National Cholesterol Education Program Adult Treatment Panel III adaptado por Ferranti. Se utilizó regresión de Poisson como técnica estadística para identificar los factores asociados a la SM. Resultados: La superioridad de la SM fue del 12,8%, siendo a lipoproteína de alta densidad reducida (58,2%) el componente más frecuente, seguido por la hipertrigliceridemia (41,8%), presión arterial aumentada (29,1%), circunferencia de la cintura aumentada (26,7%) e hiperglicemia (7,2%). Fue observada asociación entre SM y exceso de peso (RP: 2,2 [1,22-3,95]), escolaridad paterna (RP: 2,19 [1,10-4,37]), concentración sérica de la lipoproteína de muy baja densidad (RP: 1,08 [1,04-1,11]) y concentraciones séricas simultáneamente aumentadas de homocisteina y cisteina (RP: 2,58 [1,32-5,04]). Conclusiones: La superioridad de SM es elevada en niños y adolescentes y se encuentra aumentada en paciente con exceso de peso, mayor escolaridad paterna, concentraciones séricas aumentadas de la lipoproteína de muy baja densidad, y elevación simultánea de los niveles séricos de homocisteína y cisteína.

The prevalence of overweight and obesity in adolescents in Bahia, Brazil.

AIM: A cross-sectional study was conducted with 1,477 middle school students enrolled in the public school network in Salvador, Bahia, Brazil to assess the prevalence of overweight and obesity. METHODS: The sample was determined using a two-stage cluster sampling technique for selecting schools and classes. A posteriori error was estimated. The students were classified as overweight or obese according to the World Health Organization's 2007 classifications. They were also classified according to age, stage of sexual maturity, socioeconomic class and the presence of abdominal obesity. RESULTS: Overall, 9.3% of the students were overweight and 6.4% were obese; therefore, 15.7% of the students were considered to have excess weight (obesity + overweight), at a 95% confidence interval. Abdominal obesity was found in 12.9% of all students and in 13% of those of normal weight. An association was found between excess weight and age < 14 years (p = 0.030) and abdominal obesity (p = 0.001). CONCLUSIONS: Intervention programs should be implemented to prevent and treat obesity in childhood and adolescence. In addition, professionals working with individuals in this age group should be sensitized to this problem. The need to standardize the anthropometric indicators used in the different studies is also emphasized.

Objetivo: Un estudio transversal se llevó a cabo con 1477 estudiantes de primaria matriculados en las escuelas públicas de Salvador, Bahía, Brasil, para evaluar la prevalencia del sobrepeso y la obesidad. Métodos: La muestra se determinó por la técnica de muestreo por conglomerados en dos etapas para la selección de escuelas y clases. Más tarde, posteriori error se calculó. Los estudiantes fueron clasificados como sobrepeso u obesos de acuerdo con la clasificación de la Organización Mundial de la Salud, 2007. Ellos también fueron clasificados de acuerdo a la edad, la etapa de maduración sexual, y la presencia de obesidad abdominal. Resultados: En general, el 9,3% de los estudiantes tenían sobrepeso y el 6,4% eran obesos, por lo tanto, el 15,7% de los alumnos se considera que tienen exceso de peso (sobrepeso + obesidad), con un intervalo de confianza del 95%. De la población total estudiada el 12,9% presentaron obesidad abdominal, esta condición se observa en el 13% de su peso normal. Se encontró asociación entre el sobrepeso y la edad < 14 AÑOs (p = 0,030) y obesidad abdominal (p = 0,001). Conclusiones: Los programas de intervención deben ser implementados para prevenir y tratar la obesidad en la infancia y la adolescencia. Además, los profesionales que trabajan con las personas en este grupo de edad deben ser sensibles a este problema. La necesidad de estandarizar los indicadores antropométricos utilizados en los diferentes estudios se enfatiza también.

Atresia biliar: a experiência brasileira / Biliary atresia: the Brazilian experience

Objetivo: Avaliar as características epidemiológicas, clínicas e prognósticas de crianças com atresia biliar. Método: Dados sobre portoenterostomia, transplante hepático (TxH), idade no último seguimento e sobrevida foram coletados dos prontuários de pacientes acompanhados em seis centros no Brasil (1982-2008) e comparados em relação às décadas do procedimento cirúrgico. Resultados: Dos 513 pacientes, 76,4% foram submetidos a portoenterostomia [idade: 60,0-94,7 (82,6±32,8) dias] e 46,6% foram submetidos a TxH. Em 69% dos casos, o TxH foi realizado após a portoenterostomia, enquanto em 31% dos casos o TxH foi realizado como cirurgia primária. Os pacientes da região Nordeste foram submetidos a portoenterostomia mais tardiamente do que as crianças das regiões Sul (p = 0,008) e Sudeste (p = 0,0012), embora, mesmo nas duas últimas regiões, a idade no momento da portoenterostomia tenha sido superior ao desejável. Ao longo das décadas, houve aumento progres si vo do número de TxH realizados. A sobrevida global foi de 67,6%. A sobrevida aumentou nas últimas décadas (anos 1980 versus 90, p = 0,002; anos 1980 versus 2000, p < 0,001; anos 1990 versus 2000, p < 0,001). A sobrevida de 4 anos pós-portoenterostomia, com ou sem TxH, foi de 73,4%, inversamente correlacionada à idade no momento da portoenterostomia (80,77,7,60,5% para < 60,61-90, > 90 dias, respectivamente). Os pacientes transplantados apresentaram taxas de sobrevida mais elevadas (88,3%). A sobrevida de 4 anos com fígado nativo foi de 36,8%, inversamente correlacionada à idade no momento da portoenterostomia (54, 33,3, 26,6% para < 60,61-90, > 90 dias, respectivamente). Conclusões: Este estudo multicêntrico demonstrou que o encaminhamento tardio das crianças portadoras de atresia biliar ainda é um problema no Brasil, influenciando a sobrevida destes pacientes. Estratégias que proporcionam o encaminhamento precoce estão sendo desenvolvidas com o objetivo de reduzir a necessidade de transplante hepático nos primeiros anos de vida.

Objective: To evaluate epidemiological, clinical and prognostic characteristics of children with biliary atresia. Methods: Data regarding portoenterostomy, liver transplantation (LTx), age at last follow-up and survival were collected from the records of patients followed up in six Brazilian centers (1982-2008) and compared regarding decades of surgery. Results: Of 513 patients, 76.4% underwent portoenterostomy [age: 60-94.7 (82.6±32.8) days] and 46.6% underwent LTx. In 69% of cases, LTx followed portoenterostomy, whereas in 31% of cases LTx was performed as the primary surgery. Patients from the Northeast region underwent portoenterostomy later than infants from Southern (p = 0.008) and Southeastern (p = 0.0012) Brazil, although even in the latter two regions age at portoenterostomy was higher than desirable. Over the decades, LTx was increasingly performed. Overall survival was 67.6%. Survival increased over the decades (1980s vs. 1990s, p = 0.002; 1980s vs. 2000s, p < 0.001; 1990s vs. 2000s, p < 0.001). The 4-year post portoenterostomy survival, with or without LTx, was 73.4%, inversely correlated with age at portoenterostomy (80, 77.7, 60.5% for < 60, 61-90, > 90 days, respectively). Higher survival rates were observed among transplanted patients (88.3%). The 4-year native liver survival was 36.8%, inversely correlated with age at portoenterostomy (54, 33.3, 26.6% for < 60, 61-90, > 90 days, respectively). Conclusions: This multicenter study showed that late referral for biliary atresia is still a problem in Brazil, affecting patient survival. Strategies to enhance earlier referral are currently being developed aiming to decrease the need for liver transplantation in the first years of life.