Combining neuropsychological tests to improve the assessment of arithmetic difficulties in children with ADHD / Combinando testes neuropsicológicos para melhorar a avaliação de dificuldades aritméticas em crianças com TDAH

Abstract Objective: To compare the ways of evaluating arithmetic skills in Brazilian children with ADHD by combining three validated neuropsychological tests and determining whether they are sensitive to the methylphenidate treatment. Methods: Forty-two children (9‒12 years old) participated in the present study: 20 were children with ADHD (DSM-IV) and 22 were age-matched controls. A classification criterion was used for each test separately and one, for their combination to detect the presence of arithmetic difficulties at two time points: baseline (time 1); and when children with ADHD were taking 0.3‒0.5 mg/kg of methylphenidate (time 2). The study also assessed children's subtraction performance, combining parts of these tests. Results: Separately, the tests were only sensitive to differences between groups without medication. However, by combining the three neuropsychological tests, we observed a difference and detected a reduction in arithmetic difficulties associated with the methylphenidate treatment. The same effects were found in subtraction exercises, which require a borrowing procedure. Conclusions: The present study detected arithmetic difficulties in Brazilian children with ADHD and the effects of methylphenidate. Given this improvement in sensitivity, combining tests could be a promising alternative when working with limited samples.

Resumo Objetivo: Comparar as formas de avaliar as habilidades aritméticas em crianças brasileiras com TDAH, combinando três testes neuropsicológicos validados, e verificar se são sensíveis ao tratamento com metilfenidato. Métodos: Quarenta e duas crianças (9‒12 anos) participaram deste estudo: 20 eram crianças com TDAH (DSM-IV) e 22 eram controles pareados por idade. Usamos um critério de classificação para cada teste separadamente e outro para a combinação entre eles, visando detectar a presença de dificuldades aritméticas em dois momentos: início (tempo 1) e quando as crianças com TDAH estavam tomando 0,3‒0,5 mg/kg de metilfenidato (tempo 2). O estudo também avaliou o desempenho dessas crianças em operações de subtração, combinando partes desses testes. Resultados: Separadamente, os testes foram sensíveis apenas às diferenças entre os grupos sem medicação. Entretanto, ao combinar os três testes neuropsicológicos, foi possível observar uma diferença e detectar uma redução das dificuldades aritméticas associadas ao tratamento com metilfenidato. Os mesmos efeitos foram encontrados em exercícios de subtração que exigem o procedimento de empréstimo. Conclusões: O estudo foi capaz de detectar dificuldades aritméticas em crianças brasileiras com TDAH e os efeitos do metilfenidato. Dada essa melhora na sensibilidade, combinar testes poderia ser uma alternativa promissora ao trabalhar com amostras limitadas.

Combining neuropsychological tests to improve the assessment of arithmetic difficulties in children with ADHD.

OBJECTIVE: To compare the ways of evaluating arithmetic skills in Brazilian children with ADHD by combining three validated neuropsychological tests and determining whether they are sensitive to the methylphenidate treatment. METHODS: Forty-two children (9‒12 years old) participated in the present study: 20 were children with ADHD (DSM-IV) and 22 were age-matched controls. A classification criterion was used for each test separately and one, for their combination to detect the presence of arithmetic difficulties at two time points: baseline (time 1); and when children with ADHD were taking 0.3‒0.5 mg/kg of methylphenidate (time 2). The study also assessed children's subtraction performance, combining parts of these tests. RESULTS: Separately, the tests were only sensitive to differences between groups without medication. However, by combining the three neuropsychological tests, we observed a difference and detected a reduction in arithmetic difficulties associated with the methylphenidate treatment. The same effects were found in subtraction exercises, which require a borrowing procedure. CONCLUSIONS: The present study detected arithmetic difficulties in Brazilian children with ADHD and the effects of methylphenidate. Given this improvement in sensitivity, combining tests could be a promising alternative when working with limited samples.

Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children.

BACKGROUND: Nutrition markers may be useful for diagnosis and monitoring and, also, as additional indicators of estimating death risk. We tested the association of body composition indicators (mid-upper arm circumference and phase angle) with pediatric intensive care unit (PICU) length of stay and mortality in critically ill pediatric patients. METHODS: Data from children aged 2 months-18 years were collected, and bioelectrical impedance was performed to obtain phase angle. Severity was evaluated by scoring the Pediatric Index of Mortality. Descriptive statistics were reported for nominal variables. Receiver operating characteristic curve was used to analyze the association of phase angle with 30-day mortality and to find the best cutoff. Survival probabilities and PICU length of stay were estimated using the Kaplan-Meier method. RESULTS: We evaluated 247 children with a median age of 4.8 years whose main cause of admission was sepsis. Survival curves showed higher survival in patients with phase angle >2.8° compared with patients with phase angle ≤2.8° (P < .0001). Kaplan-Meier time-to-event analysis showed that children with lower phase angle values were more likely to remain in the PICU (hazard ratio, 1.84; P = .003). Lower survival was also observed in patients who presented mid-upper arm circumference values ≤5th percentile (P < .03). CONCLUSIONS: Mid-upper arm circumference and phase angle were associated with mortality and morbidity in critically ill children, suggesting that these parameters may be useful not only for nutrition diagnosis and monitoring, but also as an additional indicator in estimating prognosis.

Avaliação do programa de residência médica do departamento de pediatria da faculdade de medicina da Universidade de São Paulo / Assessment of the medical residency programs of the paediatrics department of the University of São Paulo medical school in light of the professional profiles of the graduates

INTRODUÇÃO: A avaliação do perfil do egresso é útil para investigar o sincronismo entre o treinamento fornecido e a demanda profissional. OBJETIVOS: Analisar, por meio de um questionário padronizado, o perfil profissional dos egressos do programa de Residência Médica (RM) de Pediatria FMUSP no período 1997-2008 e a compatibilidade entre esse perfil e a prática clínica na comunidade. MÉTODOS: Pôde-se localizar o endereço eletrônico de 297/446 egressos; 150 responderam à pesquisa, após consentimento informado. RESULTADOS: 126/150 respondentes do sexo feminino, idade média de 31,9 ± 2,8 anos, 61,3 por cento oriundas do Estado de São Paulo (SP), 64 por cento atuam profissionalmente em SP. Os egressos originários das regiões Norte, Nordeste e Centro-Oeste se estabeleceram profissionalmente em SP. A escolha da Pediatria foi relacionada a afeto pela criança, preferência de exercício profissional voltado à criança e característica generalista da especialidade. Os estágios considerados mais importantes para o exercício profissional foram na área de urgência/emergência, neonatologia, enfermarias de Pediatria geral e de especialidades pediátricas. A ampliação da RM em Pediatria para três anos foi aprovada por 72 por cento, 66 por cento destes com vistas a aumentar a exposição às especialidades pediátricas; 78 por cento se consideraram profissionalmente realizados e 22 por cento parcialmente realizados em virtude de renda mensal inferior à esperada e por não terem iniciado/concluído a pós-graduação; 54 por cento exercem função docente, principalmente em serviços públicos. As expectativas se concentram no início/término da pós-graduação, aprimoramento/reconhecimento profissional e melhoria da renda, com foco em clínica privada. CONCLUSÕES: Os egressos sugerem formação mais sólida nas especialidades pediátricas e demonstram tendência a se estabelecer em SP, não retornando ao Estado de origem.

INTRODUCTION: Graduate profile assessment is a useful means of investigating the synchronicity between training provided and professional demand. OBJECTIVES: To review, by means of a standardized questionnaire, the professional profile of graduates from the Paediatric Medical Residency program of FMUSP in the period 1997-2008 and the compatibility of that profile with medical practice in the community. METHODS: The email addresses of 297/446 graduates were located; 150 responded to the survey, following informed consent. RESULTS: 126/150 respondents were female, average age 31.9 ± 2.8 years, 61.3 percent from São Paulo state (SP), 64 percent worked professionally in SP. Graduates from the North, Northeast and Central-West regions established their careers in SP. The choice of paediatric medicine was related to affection for children, preference for working with children and the general nature of the speciality. The internships considered to be of most importance for professional practice were in the area of emergency medicine, neonatal care, general paediatric units and paediatric specialities. Extending the paediatric medical residency to three years was approved by 72 percent; 66 percent of whom wished for greater contact with paediatric specialities; 78 percent considered themselves professionally fulfilled and 22 percent partially fulfilled in virtue of earning less than expected or due to lack of academic qualification; 54 percent worked in a teaching capacity, primarily in the public sector. Future expectations related mainly to starting/completing graduate studies, professional improvement/recognition and higher earnings, with a focus on private practice. CONCLUSIONS: The graduates suggest more solid training in paediatric specialities and display a trend of settling in SP, and not returning to their home state.

Musculoskeletal pain in obese adolescents.

OBJECTIVE: To determine the prevalence of pain, musculoskeletal syndromes, orthopedic disorders and using computers and playing videogames among obese adolescents. METHODS: This was a cross-sectional study that investigated 100 consecutive obese adolescents and 100 healthy-weight controls using a confidential, self-report questionnaire covering demographic data, sports participation, painful musculoskeletal system symptoms and using computers and playing videogames. The questionnaire's test-retest reliability was tested. Physical examination covered six musculoskeletal syndromes and seven orthopedic disorders. RESULTS: The kappa index for test-retest was 0.724. Pain and musculoskeletal syndromes were equally prevalent in both groups (44 vs. 56%, p = 0.09; 12 vs. 16%, p = 0.541; respectively). Notwithstanding, orthopedic disorders (98 vs. 76%, p = 0.0001), tight quadriceps (89 vs. 44%, p = 0.0001) and genu valgum (87 vs. 24%, p = 0.0001) were significantly more prevalent in obese adolescents than in controls. Median time spent using a computer the day before, on Saturdays and on Sundays were all lower among the obese subjects (30 vs. 60 minutes, p = 0.0001; 1 vs. 60 minutes, p = 0.001; and 0 vs. 30 minutes, p = 0.02; respectively). Obese adolescents were less likely to play handheld videogames (2 vs. 11%, p = 0.003) and there was no difference in the two groups' use of full-sized videogames (p > 0.05). Comparing obese adolescents with pain to those free from pain revealed that pain was more frequent among females (59 vs. 39%, p = 0.048) and was associated with greater median time spent playing on Sundays [0 (0-720) vs. 0 (0-240) minutes, p = 0.028]. CONCLUSIONS: Obesity can cause osteoarticular system damage at the start of adolescence, particularly to the lower limbs. Programs developed specifically for obese female adolescents with musculoskeletal pain are needed.

Dor músculo-esquelética em adolescentes obesos / Musculoskeletal pain in obese adolescents

OBJETIVO: Avaliar presença de dor, síndromes músculo-esqueléticas, alterações ortopédicas e uso de computador e videogame em adolescentes obesos. MÉTODOS: Um estudo transversal avaliou 100 adolescentes consecutivos com obesidade e 100 eutróficos a partir de um questionário confidencial, autoaplicável, incluindo dados demográficos, prática esportiva, sintomas dolorosos do sistema músculo-esquelético e uso de computador e videogame. Pré-teste e reteste do questionário foram realizados. O exame físico avaliou seis síndromes músculo-esqueléticas e sete alterações ortopédicas. RESULTADOS: O índice de kappa entre pré-teste e reteste foi 0,724. Dor e síndromes músculo-esqueléticas foram igualmente prevalentes nos dois grupos (44 versus 56 por cento, p = 0,09; 12 versus 16 por cento, p = 0,541; respectivamente). Entretanto, alterações ortopédicas (98 versus 76 por cento, p = 0,0001), encurtamento de quadríceps (89 versus 44 por cento, p = 0,0001) e geno valgo (87 versus 24 por cento, p = 0,0001) foram significantemente mais evidenciados nos obesos versus controles. As medianas do tempo de uso do computador no dia anterior à pesquisa, nos sábados e domingos foram menores nos obesos (30 versus 60 minutos, p = 0,0001; 1 versus 60 minutos, p = 0,001; 0 versus 30 minutos, p = 0,02; respectivamente). Uso de minigame foi menor nos obesos (2 versus 11 por cento, p = 0,003), não havendo diferença no uso de videogame nos dois grupos (p > 0,05). Comparações entre obesos com e sem dor evidenciaram maior frequência no gênero feminino (59 versus 39 por cento, p = 0,048) e maior mediana de tempo de uso nos domingos [0 (0-720) versus 0 (0-240) minutos, p = 0,028]. CONCLUSÕES: Obesidade pode causar danos ao sistema osteoarticular no início da adolescência, principalmente nos membros inferiores. Programas específicos para adolescentes obesos do sexo feminino com dor músculo-esquelética precisam ser desenvolvidos.

OBJECTIVE: To determine the prevalence of pain, musculoskeletal syndromes, orthopedic disorders and using computers and playing videogames among obese adolescents. METHODS: This was a cross-sectional study that investigated 100 consecutive obese adolescents and 100 healthy-weight controls using a confidential, self-report questionnaire covering demographic data, sports participation, painful musculoskeletal system symptoms and using computers and playing videogames. The questionnaire’s test-retest reliability was tested. Physical examination covered six musculoskeletal syndromes and seven orthopedic disorders. RESULTS: The kappa index for test-retest was 0.724. Pain and musculoskeletal syndromes were equally prevalent in both groups (44 vs. 56 percent, p = 0.09; 12 vs. 16 percent, p = 0.541; respectively). Notwithstanding, orthopedic disorders (98 vs. 76 percent, p = 0.0001), tight quadriceps (89 vs. 44 percent, p = 0.0001) and genu valgum (87 vs. 24 percent, p = 0.0001) were significantly more prevalent in obese adolescents than in controls. Median time spent using a computer the day before, on Saturdays and on Sundays were all lower among the obese subjects (30 vs. 60 minutes, p = 0.0001; 1 vs. 60 minutes, p = 0.001; and 0 vs. 30 minutes, p = 0.02; respectively). Obese adolescents were less likely to play handheld videogames (2 vs. 11 percent, p = 0.003) and there was no difference in the two groups’ use of full-sized videogames (p > 0.05). Comparing obese adolescents with pain to those free from pain revealed that pain was more frequent among females (59 vs. 39 percent, p = 0.048) and was associated with greater median time spent playing on Sundays [0 (0-720) vs. 0 (0-240) minutes, p = 0.028]. CONCLUSIONS: Obesity can cause osteoarticular system damage at the start of adolescence, particularly to the lower limbs. Programs developed specifically for obese female adolescents with musculoskeletal pain are needed.

Oxigenoterapia domiciliar prolongada em crianças e adolescentes: uma análise do uso clínico e de custos de um programa assistencial / Long-term home oxygen therapy in children and adolescents: analysis of clinical use and costs of a home care program

OBJETIVOS: Descrever as características clínicas e laboratoriais dos pacientes em oxigenoterapia domiciliar prolongada acompanhados pelo programa de atendimento domiciliar do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, durante um período de 8 anos, e comparar os grupos com e sem hipertensão pulmonar secundária. Estimar o custo do programa utilizando concentradores versus cilindros de oxigênio arcados pela instituição. MÉTODOS: Estudo descritivo retrospectivo e de coorte dos pacientes em oxigenoterapia domiciliar prolongada, em seguimento no período de 2002 a 2009, na Unidade de Pneumologia do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. RESULTADOS: Foram estudados 165 pacientes, 53 por cento do sexo masculino, com as medianas: idade de início da oxigenoterapia - 3,6 anos; tempo de oxigenoterapia - 7 anos; e tempo de sobrevida após início da oxigenoterapia - 3,4 anos. Os principais diagnósticos foram: fibrose cística (22 por cento), displasia broncopulmonar (19 por cento) e bronquiolite obliterante (15 por cento). Dos 33 pacientes que realizaram espirometria, 70 por cento apresentavam distúrbio ventilatório obstrutivo grave. O exame ecocardiográfico foi executado em 134 pacientes; 51 por cento deles tinham hipertensão pulmonar secundária. Houve associação estatisticamente significante entre: presença de hipertensão pulmonar e necessidade de maiores fluxos de oxigênio (qui-quadrado, p = 0,011); e presença de hipertensão pulmonar e maior tempo de oxigenoterapia (Logrank, p = 0,0001). Não houve diferença estatisticamente significante entre tempo de sobrevida após início da oxigenoterapia e presença de hipertensão pulmonar. Os custos médios mensais do programa foram: US$ 7.392,93 para os concentradores e US$ 16.630,92 para cilindros. CONCLUSÕES: A oxigenoterapia domiciliar prolongada foi empregada em distintas doenças crônicas, predominantemente em lactentes e pré-escolares. Houve alta frequência de hipertensão pulmonar associada a maiores períodos de uso e fluxos de oxigênio, sem associação à sobrevida. A substituição dos cilindros por concentradores poderá reduzir custos significativamente.

OBJECTIVES: To describe the clinical and laboratory characteristics of patients on long-term home oxygen therapy followed up by the home care program of Hospital das Clínicas, School of Medicine, Universidade de São Paulo, during a period of 8 years; to compare groups with and without secondary pulmonary hypertension; and to estimate the cost of the program using oxygen concentrators versus oxygen cylinders provided by the hospital. METHODS: A descriptive, retrospective cohort study of patients on long-term home oxygen therapy followed up from 2002 to 2009 at the Unit of Pulmonology, Children's Institute, Hospital das Clínicas, School of Medicine, Universidade de São Paulo. RESULTS: We studied 165 patients, of whom 53 percent were male, with the following medians: age at the beginning of oxygen therapy - 3.6 years; duration of oxygen therapy - 7 years; and survival time after beginning of oxygen therapy - 3.4 years. The main diagnoses were: cystic fibrosis (22 percent), bronchopulmonary dysplasia (19 percent), and bronchiolitis obliterans (15 percent). Of the 33 patients who underwent spirometry, 70 percent had severe obstructive lung disease. Echocardiogram was performed in 134 patients; 51 percent of them had secondary pulmonary hypertension. There was a statistically significant association between pulmonary hypertension and need of higher oxygen flows (chi-square, p = 0.011), and between pulmonary hypertension and longer duration of oxygen therapy (Logrank, p = 0.0001). There was no statistically significant difference between survival time after the beginning of oxygen therapy and pulmonary hypertension. The average monthly costs of the program were US$ 7,392.93 for concentrators and US$ 16,630.92 for cylinders. CONCLUSIONS: Long-term home oxygen therapy was used to treat different chronic diseases, predominantly in infants and preschool children. There was a high frequency of pulmonary hypertension associated with longer periods of oxygen use and greater oxygen flow, without association with survival rate. The use of concentrators instead of cylinders may reduce costs significantly.

Quality of life of pediatric patients with lower urinary tract dysfunction and their caregivers.

The interest in quality of life (QoL) studies has increased as they are useful instruments to evaluate and compare medical care delivery and the impact of health interventions. The perception of QoL differs among individuals. Its characterization is especially difficult in the pediatric age group as each developmental stage presents specific demands. The prevalence of congenital lower urinary dysfunction is high and their management changes the daily routine of the patients and their families. In a cross-sectional study, we evaluated the QoL of 28 children and adolescents with urinary malformations and their caregivers using the Autoquestionnaire Qualité de Vie Enfant Imagé (AUQUEI) and Short-Form 36 (SF-36), respectively, and compared the results with 38 healthy control age-paired children/caregivers. Four questions were added to patients' questionnaire to evaluate issues related to their urological management. Our results show lower AUQUEI total scoring in the patients' group (p<0.0213, Fisher's exact test), who also present problems in dealing with social aspects, such as being at classroom, manifest negative feelings in relation to diurnal urinary losses but seem to be well adapted to intermittent urethral catheterization. A tendency for worse QoL scores in the patients' group caregivers was detected in the SF-36 pain and physical limitation domains.

Long-term home oxygen therapy in children and adolescents: analysis of clinical use and costs of a home care program.

OBJECTIVES: To describe the clinical and laboratory characteristics of patients on long-term home oxygen therapy followed up by the home care program of Hospital das Clínicas, School of Medicine, Universidade de São Paulo, during a period of 8 years; to compare groups with and without secondary pulmonary hypertension; and to estimate the cost of the program using oxygen concentrators vs. oxygen cylinders provided by the hospital. METHODS: A descriptive, retrospective cohort study of patients on long-term home oxygen therapy followed up from 2002 to 2009 at the Unit of Pulmonology, Children's Institute, Hospital das Clínicas, School of Medicine, Universidade de São Paulo. RESULTS: We studied 165 patients, of whom 53% were male, with the following medians: age at the beginning of oxygen therapy--3.6 years; duration of oxygen therapy--7 years; and survival time after beginning of oxygen therapy--3.4 years. The main diagnoses were: cystic fibrosis (22%), bronchopulmonary dysplasia (19%), and bronchiolitis obliterans (15%). Of the 33 patients who underwent spirometry, 70% had severe obstructive lung disease. Echocardiogram was performed in 134 patients; 51% of them had secondary pulmonary hypertension. There was a statistically significant association between pulmonary hypertension and need of higher oxygen flows (chi-square, p = 0.011), and between pulmonary hypertension and longer duration of oxygen therapy (Logrank, p = 0.0001). There was no statistically significant difference between survival time after the beginning of oxygen therapy and pulmonary hypertension. The average monthly costs of the program were US$ 7,392.93 for concentrators and US$ 16,630.92 for cylinders. CONCLUSIONS: Long-term home oxygen therapy was used to treat different chronic diseases, predominantly in infants and preschool children. There was a high frequency of pulmonary hypertension associated with longer periods of oxygen use and greater oxygen flow, without association with survival rate. The use of concentrators instead of cylinders may reduce costs significantly.

Evaluation of antibody response to the heptavalent pneumococcal conjugate vaccine in pediatric chronic kidney disease.

Pneumococcal vaccination has been recommended for immunocompromised children, including patients with chronic kidney disease. We determined pneumococcal immunoglobulin (Ig)G antibodies to serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F before and after 48 pediatric patients with chronic renal failure were administered heptavalent conjugated pneumococcal vaccine. The patients were between 1 and 9 years of age and were separated into a conservative treatment group (Group 1) and a dialysis group (Group 2). The antibody response to the vaccinal serotypes was evaluated by measuring antibody concentrations before the first dose and 60 days after the second one. Pre-vaccinal IgG concentrations > or = 0.35 microg/ml were detected for all serotypes in at least 50% of the patients in both groups. Patients from both groups showed a statistically indistinguishable behavior in terms of the medians of post-vaccination IgG levels. An "adequate" vaccine response was defined as a post-immunization level of specific pneumococcal serotype antibody > or = 0.35 microg/ml, based on the World Health Organization's (WHO) protective antibody concentration definition for pneumococcal conjugate vaccines, or on a fourfold increase over baseline for at least five of the seven antigens of the vaccine. An "adequate" vaccinal response was obtained in 100% of the patients of both groups using WHO's definition, or in 45.8% of Group 1 patients and 37.5% of Group 2 patients when the criterion was a fourfold antibody increase over baseline antibody concentrations.

A study of actinic cheilitis treatment by two low-morbidity CO2 laser vaporization one-pass protocols.

Therapeutic approaches to chronic actinic cheilitis focus on the removal or destruction of diseased epithelium. The CO(2) laser has become an important therapeutic alternative, achieving clinical resolution in around 90% of patients. Although many laser physical parameters have been reported, some are known for their low potential for scar induction without compromising the success of the results. The aim of this clinicohistological study was to compare the therapeutic responses to two low-morbidity protocols involving a single laser pass. A total of 40 patients with chronic multicentric and microscopically proven disease were randomly submitted to two conservative CO(2) laser protocols using a bilateral comparative model. The degree of histological atypia of the epithelium was determined in 26 patients both pre- and postoperatively for both protocols. Other histological phenomena were assessed in addition to this central analysis parameter. Clinical recurrence occurred in 12.5% of patients for each protocol, together with a significant reduction in the degree of epithelial atypia (p < 0.001), which was occasionally complete. However, no difference was found between the protocols (p > 0.05). Using these morphological parameters it was not possible to determine whether postoperative epithelial atypias in part of the sample were reactive or residual in nature. A few patients may show minor postoperative lesions. Due to their potential to achieve clinical and importantly microscopic resolution, the studied protocols may be used for mild through moderate dysplastic epithelium and clinically diffuse disease.

Fatores de risco associados à calcinose na dermatomiosite juvenil / Risk factors associated with calcinosis of juvenile dermatomyositis

OBJETIVO: Identificar fatores de risco associados à calcinose em crianças e adolescentes com dermatomiosite juvenil. MÉTODOS: Prontuários de 54 pacientes com dermatomiosite juvenil foram estudados. Foram avaliados dados demográficos; características clínicas: grau de força muscular (I a V do Medical Research Council), presença de comprometimentos pulmonar (distúrbio ventilatório restritivo com presença ou ausência do anticorpo anti-Jo-1), gastrointestinal (refluxo gastroesofágico) e cardíaco (pericardite e/ou miocardite); exames laboratoriais: elevação de enzimas musculares (creatinoquinase, aspartato aminotransferase, alanina aminotransferase e desidrogenase lática) e terapias utilizadas: corticoterapia isolada ou associada à cloroquina e/ou imunossupressor. Os pacientes foram divididos em dois grupos de acordo com a presença ou ausência de calcinose e foram avaliados através de análise univariada e multivariada. RESULTADOS: Calcinose foi evidenciada em 23 (43 por cento) pacientes, sendo em seis (26 por cento) antes do diagnóstico e em 17 (74 por cento) após. A análise univariada revelou que comprometimentos cardíaco (p = 0,01) e pulmonar (p = 0,02) e necessidade da utilização de um ou mais imunossupressores (metotrexato, ciclosporina A e/ou pulsoterapia com ciclofosfamida endovenosa) no tratamento da dermatomiosite juvenil (p = 0,03) foram associados com uma maior incidência de calcinose. A análise multivariada mostrou que comprometimento cardíaco (OR = 15,56; IC95 por cento 1,59-152,2) e uso de um ou mais imunossupressores (OR = 4,01; IC95 por cento 1,08-14,87) foram as únicas variáveis independentes associadas à presença de calcinose. CONCLUSÕES: O aparecimento da calcinose foi freqüente na dermatomiosite juvenil, habitualmente na evolução da doença. A calcinose foi associada aos casos mais graves, que apresentaram envolvimento cardíaco e necessitaram da utilização de imunossupressores no seu tratamento.

OBJECTIVE: To identify risk factors associated with calcinosis in children and adolescents with juvenile dermatomyositis. METHODS: A review was carried out of the medical records of 54 patients with juvenile dermatomyositis. Data were collected on demographic characteristics, clinical features: muscle strength (stages I to V of the Medical Research Council scale), pulmonary involvement (restrictive pulmonary disease with presence or absence of anti-Jo1 antibodies), gastrointestinal problems (gastroesophageal reflux) and/or heart disease (pericarditis and/or myocarditis); laboratory tests: elevated muscle enzyme levels in serum (creatine phosphokinase, aspartate aminotransferase, alanine aminotransferase and/or lactate dehydrogenase); and on the treatments given: corticoid therapy in isolation or associated with hydroxychloroquine and/or immunosuppressants. The patients were divided into two groups, depending on presence or absence of calcinosis and data were evaluated by both univariate and multivariate analyses. RESULTS: Calcinosis was identified in 23 (43 percent) patients, and in six (26 percent) patients it had emerged prior to diagnosis while in 17 (74 percent) it was post diagnosis. The univariate analysis revealed that cardiac (p = 0.01) and pulmonary (p = 0.02) involvement and the need for one or more immunosuppressor (methotrexate, cyclosporine A and/or pulse therapy with intravenous cyclophosphamide) to treat juvenile dermatomyositis (p = 0.03) were all associated with an increased incidence of calcinosis. The multivariate analysis then demonstrated that only cardiac involvement (OR = 15.56; 95 percentCI 1.59-152.2) and the use of one or more immunosuppressor (OR = 4.01; 95 percentCI 1.08-14.87) were independently associated with the presence of calcinosis. CONCLUSIONS: Calcinosis was a frequent development among these juvenile dermatomyositis cases, generally emerging as the disease progressed. Calcinosis was associated with...

Risk factors associated with calcinosis of juvenile dermatomyositis.

OBJECTIVE: To identify risk factors associated with calcinosis in children and adolescents with juvenile dermatomyositis. METHODS: A review was carried out of the medical records of 54 patients with juvenile dermatomyositis. Data were collected on demographic characteristics, clinical features: muscle strength (stages I to V of the Medical Research Council scale), pulmonary involvement (restrictive pulmonary disease with presence or absence of anti-Jo1 antibodies), gastrointestinal problems (gastroesophageal reflux) and/or heart disease (pericarditis and/or myocarditis); laboratory tests: elevated muscle enzyme levels in serum (creatine phosphokinase, aspartate aminotransferase, alanine aminotransferase and/or lactate dehydrogenase); and on the treatments given: corticoid therapy in isolation or associated with hydroxychloroquine and/or immunosuppressants. The patients were divided into two groups, depending on presence or absence of calcinosis and data were evaluated by both univariate and multivariate analyses. RESULTS: Calcinosis was identified in 23 (43%) patients, and in six (26%) patients it had emerged prior to diagnosis while in 17 (74%) it was post diagnosis. The univariate analysis revealed that cardiac (p = 0.01) and pulmonary (p = 0.02) involvement and the need for one or more immunosuppressor (methotrexate, cyclosporine A and/or pulse therapy with intravenous cyclophosphamide) to treat juvenile dermatomyositis (p = 0.03) were all associated with an increased incidence of calcinosis. The multivariate analysis then demonstrated that only cardiac involvement (OR = 15.56; 95%CI 1.59-152.2) and the use of one or more immunosuppressor (OR = 4.01; 95%CI 1.08-14.87) were independently associated with the presence of calcinosis. CONCLUSIONS: Calcinosis was a frequent development among these juvenile dermatomyositis cases, generally emerging as the disease progressed. Calcinosis was associated with the more severe cases that also had cardiac involvement and where immunosuppressors had to be included in the treatment.

Utilização do computador e de jogos eletrônicos e avaliação da ergonomia com uso do somputador em adolescentes de uma escola privada na cidade de São Paulo / Computer and eletronic games use and evaluation of ergonomy with computer use in adolescents of a private school in the city of São paulo

Objetivo: avaliar a utilização de computador e jogos eletrônicos e associar o uso destes com dados demográficos, frequência e tempo utilizado, assim como avaliar a ergonomia com o uso do computador em adolescentes. Méwtodos: um estudo transversal foi realizado em uma população de 791 adolescentes de uma escola particular da cidade de São Paulo. Noventa e um por cento pertenciam às classes socioeconômicas média e alta e 88 por cento de seis pais tinham nível universitário. A pesquisa incluiu um questionário e a avaliação da ergonomia com uso do computador. A análise estatística foi realizada com os testes de Fisher, qui-quadrado e Mann Whitney. Resultados: a média de idade foi de 14,2 +- 2,0 anos e a relação feminino:masculino foi de 1,1:1. O computador foi utilizado por 99 por cento dos alunos e 67 por cento o usaram no dia anterior à pesquisa, 58 por cento utilizaram videosgame e 30 por cento minigame/gameboy. A disponibilidade e o uso dos aparelhos foram maiores no sexo masculino (p<0,001). Os adolescentes entre 10 e 14 anos utilizaram mais o videogame e o minigame/gameboy (p<0,001) e aqueles com idades entre 15 e 18, o computador (p<0,05). Conclusões: os adolescentes utilizaram computador e jogos eletrônicos frequentemente, por tempo prolongado e todos tinham posturas inadequadas frente aos computadores, com possibilidade de dores e síndromes músculo-esqueléticas.

Pain and musculoskeletal pain syndromes in adolescents.

The presence of musculoskeletal pain was evaluated in adolescents. Pain was reported by 40% of respondents, benign joint hypermobility syndrome by 10%, myofascial syndrome by 5%, tendonitis by 2%, and fibromialgia by 1%. Logistical regression analysis indicated that sex and age were predictive of pain.

Pain and musculoskeletal pain syndromes related to computer and video game use in adolescents.

The objective of the present study was to evaluate the presence of pain and musculoskeletal pain syndromes in adolescents and associate them to computer and video game use. A cross-sectional study was performed on the entire adolescent population (n=833) of a private situated in the city of São Paulo. The research included a questionnaire and physical examination of the musculoskeletal system. Statistical analysis was carried out with Fisher, chi-square, Mann Whitney tests and logistic regression. A total of 791 adolescent was evaluated. A computer was used by 99% and video games by 58%. Pain was reported by 312 (39.4%) students: 23% complained of back pain, 9% of upper limb pain, 4% of diffuse pain and 4% of pain in the trapezium muscle. A clinical examination was carried out in 359 students, and one or more musculoskeletal pain syndromes were present in 56 students (15.6%): benign joint hypermobility syndrome in 10%, myofascial syndrome in 5%, tendonitis in 2% and fibromyalgia in 1%. In the multivariate analysis, the logistical regression showed that the independent variables in the prediction of pain were sex [odds ratio (OR): 2.19, 95% confidence interval (95% CI): 1.33-3.61] and age (OR: 1.17, 95% CI: 1.07-1.28) and that the prediction of musculoskeletal pain syndromes were sex (OR: 3.17, 95% CI: 1.69-6.22) and number of days a week using the computer (OR: 1.22, 95% CI: 1.05-1.42). However, the variations in the dependent variables by the mathematical regression models were low. Despite the frequent use of computer and video games among adolescents, this was not associated with the presence of pain and musculoskeletal pain syndromes.

Educaçäo para prevençäo de acidentes e identificaçäo dos fatores de risco no ambiente domiciliar: I. Primario ano de vida / Education to accidents prevention and identification of risk factors in home environment: I. 1st year of life

Foram entrevistadas 200 famílias que procuraram o Pronto Socorro da Criança "Prof. Pedro de Alcantara" do Hospital das Clínicas da FMUSP, trazendo crianças com menos de um ano de idade, de maio à agosto de 1986, em relaçäo aos fatores domiciliares de riscos de acidentes, relacionando-se ao gráu de instruçäo materna e classe de renda familiar. Os resultados mostraram uma ausência quase total de orientaçäo para segurança domiciliar e a existência de um grande número de fatores de risco dentro de casa