Comprehensive investigation of factor structure and gender equivalence of the Beck Depression Inventory-II among nonclinical adolescents.

The Beck Depression Inventory-II (BDI-II) is a widely used tool for rating the severity of depressive symptoms. Studies on the factor structure of the BDI-II in adolescents have yielded controversial findings. Most studies have reported an oblique two-factor model that describes the 'cognitive' and 'somatic-affective' dimensions. However, there is variation in the item composition of each factor across studies. Alternative factor structures have been proposed, including one-factor, three-factor, hierarchical, and bifactor models. Additionally, there is limited data on measurement invariance across genders. This study aimed to examine hypothetical factor structures and gender equivalence of the BDI-II in a sample of Brazilian nonclinical adolescents (N = 1,184, aged 13-18 years, 59.1% females). Cross-validation of the BDI-II was performed through exploratory (EFA) and confirmatory factor analysis (CFA). Measurement invariance was evaluated using multigroup-CFA (MG-CFA). EFA suggested an oblique two-factor model depicting "affective-cognitive" and "somatic" dimensions. CFA tested competing models for the structure of BDI-II, including the simple one- and two-factor models, a bifactor model, and the EFA model along with its corresponding bifactor model. All models demonstrated adequate and similar fitness, well-defined factors, and good reliability. Bifactor analyses indicated a robust general factor with low reliable variance in total scores attributed to multidimensionality caused by the group factors in bifactor models. MG-CFA supported invariance across gender, suggesting that the same BDI-II construct could be applied to both female and male adolescents. This study provides evidence that the BDI-II could be used as a unidimensional measure of depressive symptoms in adolescents by researchers and clinicians.

Sundown Syndrome in Older Persons: A Scoping Review.

OBJECTIVES: To map comprehensive investigations of the sundown syndrome (SS), highlighting its key definition and associated characteristics. DESIGN: Scoping review of published articles on SS in PubMed, OVID, EMBASE, Scopus, CINAHL, and Science Direct. SETTING: Post-acute and long-term health care settings. PARTICIPANTS: Older adults aged ≥60 years. MEASURES: Articles must present primary data on specific SS behavior, with explicit psychopathological and quantitative outcomes; and/or evening disruptive behavior. RESULTS: From a total number of 460 articles focusing on psychopathology and standardized outcomes of SS, 23 were retained for the final analysis (n = 1210 subjects). The mean age of participants was 63.2 years, and slightly more participants were women. The samples were recruited by convenience from long-term care facilities and tertiary outpatient clinics. The frequency of SS varied from 2% to 82%, without evident difference between genders and race/ethnicity. Generally, the sundown episode occurred during later daytime, when psychomotor alterations and cognitive disturbance manifested repeatedly. The symptomatic manifestations of SS were heterogeneous across the studies. Demographic risk factors were inconsistent. Although some authors have viewed cognitive impairment as a substantive predisposing factor to SS, others supported SS as a predictor of looming cognitive decline. The disrupted circadian rhythm was the most accepted pathophysiology. To date, clinical trials to guide the management of SS with specific pharmacologic and nonpharmacologic approaches are scant. CONCLUSIONS AND IMPLICATIONS: SS can be viewed as a cyclic delirium-like condition affecting the older population around the sunset hour that may last for a few hours. The scarcity of comprehensive studies makes it difficult to determine whether and to what extent it can represent a distinct disease, a prodromal stage of dementia, or an epiphenomenon of incipient or worsening dementia. Extensive gathering of clinical data from multiple health care settings, using uniform measurement tools, is much needed.

Epidemiology of functional gastrointestinal disorders in children and adolescents: A systematic review.

AIM: To assess the prevalence of functional gastrointestinal disorders (FGIDs) in children and adolescents. METHODS: PubMed, EMBASE, and Scopus databases were searched for original articles from inception to September 2016. The literature search was made in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For inclusion, each study had to report epidemiological data on FGIDs in children between 4 and 18 years old and contain standardized outcome based on Rome II, III or IV criteria. The overall quality of included epidemiological studies was evaluated in accordance with Loney's proposal for prevalence studies of health literature. Two reviewers assessed each study for data inclusion and extraction. Discrepancies were reconciled through discussion with seniors. RESULTS: A total of 659 articles were identified from the databases and 16 through manual search. A total of 43 articles fulfilled the eligibility criteria for full-text reading, with 26 remaining to be included in the final analysis. All studies were written in English and published between 2005 and 2016. Eight (30.8%) articles were performed in North America, five (19.2%) in Latin America, five (19.2%) in Europe, seven (27%) in Asia, and one (3.8%) in Africa. Sample size varied between 114 and 99416 subjects, totaling 132600 individuals. Fourteen (53.9%) studies recruited their target samples from schools, 11 (42.3%) from healthcare settings and the remaining one (3.8%) from online panel community. The overall FGID prevalence rates for student samples ranged from 9.9% to 29% to as high as 87% in clinical samples. Cyclic vomiting, irritable bowel syndrome and functional constipation were the most researched conditions, with a prevalence ranging from 0.2% to 6.2%, 0% to 45.1% and 0.5% to 86.9%, respectively. The qualitative appraisal revealed that most of the studies showed average or below average generalizability. CONCLUSION: The heterogeneity of the studies on FGIDs must be improved in order to allow comparison. Improvements should include appropriate sampling of representative population, comparable study setting, and consistent data collection.

Epidemiology of functional gastrointestinal disorders in infants and toddlers: A systematic review.

AIM: To assess the functional gastrointestinal disorders (FGID) prevalence in infants and toddlers. METHODS: PubMed, EMBASE, and Scopus were searched for original articles from inception to February 2016. The literature search was made in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). For inclusion, each study had to report epidemiological data of FGID on children up to 4 years old and contain standardized outcome Rome II or III criteria. The overall quality of included epidemiological studies was evaluated in accordance to Loney's proposal for prevalence studies of health literature. Two reviewers assessed each study for inclusion and extracted data. Discrepancies were reconciled through discussion. RESULTS: It was identified a total of 101 articles through the databases and two through the manual search. A total of 28 articles fulfilled the eligibility criteria. After reading the full articles, 13 of them were included in the present review. Twelve studies were written in English and one in Chinese, and published between 2004 and 2015. Eight articles (61.5%) were performed in Europe, three (23.1%) in America and two (15.4%) in Asia. Sample size varied between 45 and 9660 subjects. Cross-sectional frequency was reported in majority of studies (k = 9) and four studies prospectively followed the subjects. 27.1% to 38% of participants have met any of Rome's criteria for gastrointestinal syndromes, of those 20.8% presented two or more FGID. Infant regurgitation and functional constipation were the most common FGID, ranging from less than 1% to 25.9% and less than 1% to 31%, respectively. Most included studies were of moderate to poor data quality with respect to absence of confidential interval for prevalence rate and inadequate sampling methods. CONCLUSION: The scarcity and heterogeneity of FGID data call for the necessity of well-designed epidemiological research in different levels of pediatric practice and refinement of diagnostic.

Estudos dos casos confirmados de meningites atendidos e notificados pelo Institutos de Infectologia Emilio Ribas no periódo de 2010 a 2014 / Study of confirmed cases of meningitis reported treated at the Institute of Infectious Diseases Emilio Ribas in the period 2010 to 2014

Introdução - A meningite é um processo inflamatório das meninges, membranas que envolvem o cérebro e a medula espinhal. Sua etiologia é variada, podendo ser causada por diversos agentes infecciosos, como bactérias, vírus, parasitas e fungos, ou também por processos não infecciosos. As meningites bacterianas e virais são as mais importantes do ponto de vista de saúde pública, devido sua magnitude, capacidade de ocasionar surtos, e, no caso da meningite bacteriana, a gravidade dos casos. Objetivos - Conhecer o perfil clinico-epidemiológico dos casos atendidos e notificados de meningites pelo Instituto de Infectologia Emílio Ribas (IIER), no período de 2010 a 2014. Métodos - Estudo transversal descritivo com abordagem quantitativa dos casos confirmados de meningites notificados pelo IIER no período de 2010 a 2014, obtidos do banco de dados do Sistema de Informação de Agravos de Notificação (SINAN), contendo os registros das Fichas Individuais de Notificação e Investigação Epidemiológica de Meningites. Para informações adicionais foram utilizados o prontuário digital do Sistema de gestão hospitalar do IIER (S4SP); pesquisas no sistema digital de laudos do laboratório do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCmed) utilizado pelo IIER no período analisado e no sistema de resultados de exames (SIGWEB) do Instituto Adolfo Ltuz (IAL). Resultados ­ De 2010 a 2014 foram confirmados 494 casos de meningites notificadas pelo Serviço de Epidemiologia do IIER. Nesta casuística houve predomínio das meningites bacterianas; a doença meningocócica (DM), meningite pneumocócica (MP) e a meningite por hemófilo (MH) correspondeu a 281 (56,8%) casos confirmados; já as meningites assépticas/virais (MV) representaram a segunda maior causa com 104 (21,05%) casos. A média de idade foi de 16 anos variando de 1mês a 77 anos, a mediana esteve em 21 anos e a faixa etária com maior frequência foi a 20 a 59 anos com 244 casos (49,39%), sendo que a maioria dos casos ocorreu no sexo masculino 63,80% (n=315). Cerca de 55,47% (274) dos pacientes foram procedentes do município de São Paulo, capital do ESP. Os principais critérios diagnósticos utilizados para confirmação dos casos neste estudo foram: Reação da Cadeia de Polimerase (PCR), avaliação do quimiocitólogico do líquor (LCR) e a cultura (padrão ouro). O tempo de internação variou de 1 a 557 dias (média=18 dias, mediana=26 dias e a moda=8). Dos 494 casos confirmados, 45 evoluíram para óbito, tendo uma letalidade total de 9,11%, variando de 6,84 a 12,40% durante período estudado. Conclusões ­ As meningites bacterianas foram as mais frequentes neste estudo, sendo que as meningites virais ocuparam o segundo lugar. A maioria dos casos notificados pelo IIER são procedentes da capital do Estado. Houve predomínio do sexo masculino e da faixa etária de 20 a 59 anos. A PCR tem se mostrado um método eficaz no diagnóstico das meningites, de modo que, neste estudo, se sobressaiu a cultura. O tempo médio de internação hospitalar foi de 18 dias, a mediana de 26 dias e a moda 8 dias, tendo variado de 1 a 557 dia de internação hospitalar. A letalidade foi maior no gênero feminino com média de 10,61 % e na faixa etária dos maiores de 60 anos (20,00%)

Six-month open-label follow-up of risperidone long-acting injection use in pediatric bipolar disorder.

BACKGROUND: Recent studies suggest that risperidone long-acting injection (RLAI) may be considered for controlling mood episodes in bipolar disorder patients who have relapsed due to medication nonadherence or failure to respond to standard therapies. Currently, no study has reported the usefulness of RLAI in youths with bipolar disorder. The aim of this study was to evaluate short-term effects of RLAI in the naturalistic treatment of early-onset bipolar disorder and its role in symptomatic remission and adherence to treatment. METHOD: Nineteen early-onset bipolar disorder outpatients receiving RLAI were observed in a 6-month naturalistic study at the outpatient clinic of the Child and Adolescent Affective Disorders Program at the Institute of Psychiatry of the University of São Paulo, São Paulo, Brazil. All patients met DSM-IV criteria for bipolar disorder. Clinical response to RLAI was evaluated using the Children's Global Assessment Scale (CGAS) and Clinical Global Impressions scale (CGI) across 3 time periods: index time (T0), 8 weeks after (T1), and 24 weeks after (T2). These subjects were recruited from May 2008 to December 2009. RESULTS: Patients receiving RLAI presented considerable improvement in global functioning (CGAS: T0 = 20.6; T1 = 42.9; and T2 = 49.2) and clinical severity (CGI: T0 = 5.9; T1 = 3.9; and T2 = 3.4). Global CGI mean scores of clinical improvement were 2.2 at T1 and 2.4 at T2. There were no significant changes in laboratory measurements and weight throughout follow-up. CONCLUSIONS: RLAI was shown to be an alternative treatment for youths with bipolar disorder failing to respond to prior medication trials or with adherence problems. Further blind, randomized controlled studies are necessary to confirm these initial findings. TRIAL REGISTRATION: Sistema Nacional de Informaçoes Sobre Ética em Pesquisa Envolvendo Seres Humanos-Commisão Nacional de Ética em Pesquisa identifier: CAAE 0709.0.015.000-06.

Effect of morning exercise in sunlight on the sleep-wake cycle in adolescents

A delay in bedtime occurs in adolescence compared with childhood. However, the early waking that morning school hours impose leads to partial sleep deprivation. Although exposure to light is the most important regulator of circadian rhythm in mammals, physical exercise influences circadian synchronization. To assess the effect of morning physical exercise in sunlight on the sleep-wake cycle (SWC) in adolescents, 160 first- and second-year high-school students were exposed to classes in their usual classroom (Group C) or in a swimming pool exposed to sunlight (Group E) while physically exercising (EE; i.e., swimming) or resting (EL). At baseline, we applied Health and Sleep and Horne & Ostberg chronotype assessment questionnaires. One week later and during the intervention, we applied the Sleep Diary and Karolinska Sleepiness Scale. During the intervention we observed no changes in bedtime, time in bed and in indices of irregularity of bedtime and wake-up time. The changes observed in wake-up time (i.e., a delay in the EE group on Saturday), sleep quality (i.e., an improvement), and sleepiness (i.e., an increase) were also observed in the control group, discarding an intervention effect. We suggest that morning physical exercise in sunlight had no effect on SWC parameters, sleep quality, or daytime sleepiness, possibly because of the large irregularity in the SWC between weekdays and weekends in adolescent students as well as the low frequency and duration of exercise during the intervention. Therefore, studies that evaluate a higher frequency or duration of exercise are needed to assess its effect on the SWC in adolescents.

Effect of morning exercise in sunlight on the sleep-wake cycle in adolescents

A delay in bedtime occurs in adolescence compared with childhood. However, the early waking that morning school hours impose leads to partial sleep deprivation. Although exposure to light is the most important regulator of circadian rhythm in mammals, physical exercise influences circadian synchronization. To assess the effect of morning physical exercise in sunlight on the sleep-wake cycle (SWC) in adolescents, 160 first- and second-year high-school students were exposed to classes in their usual classroom (Group C) or in a swimming pool exposed to sunlight (Group E) while physically exercising (EE; i.e., swimming) or resting (EL). At baseline, we applied Health and Sleep and Horne & Ostberg chronotype assessment questionnaires. One week later and during the intervention, we applied the Sleep Diary and Karolinska Sleepiness Scale. During the intervention we observed no changes in bedtime, time in bed and in indices of irregularity of bedtime and wake-up time. The changes observed in wake-up time (i.e., a delay in the EE group on Saturday), sleep quality (i.e., an improvement), and sleepiness (i.e., an increase) were also observed in the control group, discarding an intervention effect. We suggest that morning physical exercise in sunlight had no effect on SWC parameters, sleep quality, or daytime sleepiness, possibly because of the large irregularity in the SWC between weekdays and weekends in adolescent students as well as the low frequency and duration of exercise during the intervention. Therefore, studies that evaluate a higher frequency or duration of exercise are needed to assess its effect on the SWC in adolescents.(AU)

Patrones de lactancia en bebés, su primer contacto con el azúcar y el dentista / Patterns of breastfeeding in infants, their first contact with the sugar and the dentist

El objetivo de esta investigación fue evaluar el patrón de lactancia, primer contacto con el azúcar y primera visita al dentista de los bebés con relación al estado socioeconómico familiar. Participaron 129 niños de 0 a 36 meses, cuyos datos fueron obtenidos por medio de un cuestionario realizado a las madres y exámenes clínicos bucales de los bebés en ambulatorios públicos y privados. La forma de lactancia más utilizada fue artificial (59%), siendo empleada desde el inicio de la vida y volviéndose más prevalente con el aumento de la edad. El primer contacto con el azúcar ocurrió principalmente después de los 3 meses de edad, sin embargo, 20% de las madres ofrecieron azúcar a sus hijos antes de los tres primeros meses de vida. El mayor número de bebés acudieron durante el primer año de vida al dentista (43%) siendo la prevención su principal motivo (65%). La prevalencia de actividad de caries para la muestra fue de 17%. Estos resultados correspondieron a madres que poseían grado escolar secundario y superior completo y recibían de 1 a 3 salarios mínimos. Conclusión: el patrón de amamantamiento en bebés es esencialmente artificial en los primeros meses de vida, lo que contribuye para que ocurra el primer contacto con el azúcar muy precozmente. La primera visita al dentista ocurre generalmente durante el primer año de vida del bebé

To analyze the pattern of feeding, first contact with sugar and first babies visit to the dentist with respect to family socioeconomic status. One hundred and twenty nine children, from 0 to 36 months, participated in the study. The data was obtained through a questionnaire conducted for their mothers and clinical oral exams of the babies in public and private outpatient departments. Results: bottle feeding was most widely used (59%), being employed since the beginning of the life and becoming more prevalent with the increasing age. The first contact with sugar occurred mostly after 3 months of life; however, 20% of mothers offered sugar for their children before the first three months of life. Most of the babies visited the dentist within their first year of life (43%) and the main reason was prevention (65%). All these results corresponded to mothers who had completed high school and higher education, as well as perceive 1 to 3 minimum wages. The pattern of breastfeeding in babies is essentially artificial in the first months of life, which contributes to appear the first contact with the sugar very early. The first visit to the dentist occurs during the first year of life of the baby

Preschool Bipolar Disorder: Brazilian children case reports.

OBJECTIVE: This study describes the clinical phenomenology and family history of preschool age onset Bipolar Disorder (BD). METHODS: Eight children and adolescents out of 118 cases (6.78%), both genders, meeting current DSM-IV criteria diagnosis of BD were described. The clinical assessment, CBCL, DICA-IV and CGAS were performed directly with each patient and their parents. RESULTS: Most (87.5%) presented classical symptoms of mania: euphoria, grandiosity, irritability, psychomotor agitation and agitated sleep or, in the same proportion, sleeplessness. Hyperactivity and increase of energy were found in all eight cases. The clinical course varied from a rapid, ultra-rapid, ultradian cycle to a continued pattern. Five out of eight children (62.5%) presented aggressiveness toward others and one deliberate self-harm. Most (87.5%) had psychiatric family history. The average number of medications used during their life was 4.5 drugs. LIMITATION: The small sample and retrospective reports of the first manic symptoms in three of the cases (cases V, VI and VII). CONCLUSION: An important incidence of classical manic features was found in very young children. The clinical course tended to be continuous, and preschool BD seems to have a strong association with affective disorder family history.

O simbólico na sessão de fonoterapia / The simbolic in a speech therapy section

Neste artigo, os autores realizaram uma breve análise de excerto de uma sessão de fonoterapia, com uma criança de 4 anos, na Clínica de Fonoaudiologia da Universidade de Ribeirão Preto, com a finalidade de estudarem, através de uma situação de brinquedo entre a criança e a estagiária, alguns conceitos relacionados à disciplina de Construção simbólica na Infância.