Repetitive low-frequency transcranial magnetic stimulation can improve sleep disorders and abnormal behavior among children on the autism spectrum / 中华物理医学与康复杂志

Objective:To observe any effect of repetitive low-frequency transcranial magnetic stimulation (rTMS) on sleep disorders and abnormal behaviors of children on the autism spectrum.Methods:Forty autistic children were randomly divided into an observation group and a control group, each of 20. Both groups were given sleep behavior training and individualized conventional rehabilitation training. Those in the observation group also received 30min of rTMS at 1Hz applied over the left dorsolateral prefrontal cortical area once a day, 5 days a week. Before and after 8 weeks of this treatment, both groups were evaluated using the Autism Behavior Checklist (ABC), the Child Autism Rating Scale (CARS) and the children′s Sleep Habit Questionnaire (CSHQ).Results:The average CARS and CSHQ scores, as well as the total ABC score of both groups increased significantly over the 8 weeks, but the average CARS and CSHQ scores, as well as the total ABC score of the observation group were then significantly better than in the control group. After the treatment, the average ABC scores for sensory ability, communication ability, motor ability, and language ability were significantly lower than before the treatment for both groups, but the observation group′s averages were then significantly better than those of the control group.Conclusions:Supplementing routine intervention with low-frequency rTMS can effectively improve the sleeping and correct the abnormal behavior patterns of autistic children.

Prevalencia de aerofagia y balanceo en caballos estabulados atados en un cubículo / Prevalence of Crib-Biting and Weaving in Stabled Horses Tie Stalls / Prevalência de aerofagia e balanceamento em cavalos estabulados atados em um cubículo

Resumen Los objetivos de este estudio fueron evaluar la prevalencia de aerofagia y balanceo en caballos estabulados atados en un cubículo e investigar la relación del género y edad con las estereotipias. Se observaron 177 caballos mestizos de silla, residentes en una escuela de equitación, de ambos géneros, de 3 a 20 años de edad, distribuidos en tres edificios y mantenidos en las mismas condiciones de manejo. Para el análisis estadístico, de acuerdo al género, los caballos fueron clasificados en 2 grupos: machos castrados (n = 110) and hembras (n = 67). De acuerdo a la edad, los caballos fueron clasificados en 2 grupos: de 3 a 7 años (n = 31) y de 8 a 20 años (n = 146). Durante 3 días consecutivos un único evaluador utilizó un día por edificio observando la presencia o ausencia de aerofagia y balanceo. Cada día fue dividido en 2 periodos de observación: desde las 7:30 a 13:00 y de 14:30 a 20:00 h. Se observaron estereotipias en el 4,5% los caballos; 3,4% de los caballos presentaba aerofagia y 1.1% balanceo. No se observaron caballos que presentaran ambas estereotipias. No se encontró asociación entre la prevalencia de estereotipias y el género o edad de los caballos. Nuestros resultados sugieren que el contacto visual y táctil con otros caballos como ocurre en caballos estabulados atados en un cubículo podría reducir el riesgo de desarrollar balanceo pero no de aerofagia.

Abstract The objectives of this study were to evaluate the prevalence of crib-biting and weaving in horses stabled in tie stalls and to investigate the relationship between gender, age, and stereotypies. One hundred and seventy-seven half-bred saddle horse residents of a riding school, of both genders and between the ages of 3 and 20, distributed in three buildings with the same management conditions, were observed. For the statistical analysis according to gender, the horses were classified into 2 groups: geldings (n = 110) and mares (n = 67). According to age, the horses were classified into 2 groups: namely, 3 to 7 years old (n = 31) and 8 to 20 years old (n = 146). During three consecutive days, a single evaluator spent one day per building observing the presence or absence of crib-biting and weaving. Each given day was divided into 2 periods of observation: from 7:30 to 13:00 and from 14:30 to 20:00. Stereotypies were observed in 4.5% of the horses, i.e., 3.4% of the horses showed crib-biting and 1.1% showed weaving. We did not find horses showing crib-biting and weaving at the same time. No association was found between the prevalence of stereotypies and either gender or age of the horses. Our results suggest that visual and tactile contact with other horses, which occurs in tie-stall housing, could reduce the risk of developing weaving in tie-stall horses but not crib-biting.

Resumo Os objetivos deste estudo foram avaliar a prevalência de aerofagia e balanceamento em cavalos estabulados atados em um cubículo e investigar a relação do gênero e idade com as estereotipagens. Se observaram 177 cavalos mestiços de sela, residentes em uma escola de equitação, de ambos gêneros, de 3 a 20 anos de idade, distribuídos em três edifícios e mantidos nas mesmas condições de manejo. Para a análise estatística, de acordo com o gênero, os cavalos foram classificados em 2 grupos: machos castrados (n = 110) e fêmeas (n = 67). De acordo com a idade, os cavalos foram classificados em 2 grupos: de 3 a 7 anos (n = 31) e de 8 a 20 anos (n = 146). Durante 3 dias consecutivos um único avaliador utilizou um dia por edifício observando a presença ou ausência de aerofagia e balanceamento. Cada dia foi dividido em 2 períodos de observação: desde as 7:30 às 13:00 e de 14:30 às 20:00 h. Se observaram estereotipagem em 4,5% os cavalos; 3,4 % dos cavalos apresentava aerofagia e 1,1 % balanceamento. Não se observaram cavalos que apresentaram ambas estereotipagens. Não se encontrou associação entre a prevalência de estereotipagens e o gênero ou idade dos cavalos. Nossos resultados sugerem que o contato visual e tátil com outros cavalos como ocorre em cavalos estabulados atados em um cubículo poderia reduzir o risco de desenvolver balanceamento mas não de aerofagia.

Emisión de Conductas de TDAH por Niños "Normales" en Opinión de Maestros Argentinos / Emission of ADHD Behaviors by "Normal" Children according to Argentinean Teachers

Resumen Según el DSM-IV un niño que emite "a menudo" seis de 18 conductas debe etiquetarse con TDAH. Los maestros generalmente reportan la frecuencia de emisión "anormal". El estudio averiguó la frecuencia de emisión de conductas del TDAH por niños "normales". Maestros de primaria (N = 113) señalaron la frecuencia (0 = nunca; 3 = muy frecuentemente) con la que un niño "normal" emite en clase las conductas del TDAH incluidas en el DSM-IV. Según el 25.7% de los maestros, los niños normales emiten frecuentemente (más de cuatro veces por hora) seis o más conductas del TDAH. Las características sociodemográficas de los maestros y variables del contexto escolar se relacionaron con la frecuencia considerada como normal. Se concluyó que las conductas del TDAH son emitidas muy frecuentemente en clase por los niños normales. El juicio sobre si dicha frecuencia es o no anormal dependerá del subgrupo al que pertenecen los maestros. Por tanto, una misma conducta puede juzgarse como anormal por un maestro y como normal por otro. Los resultados son congruentes con la aproximación psicológica a la conducta anormal que postula que cada observador juzgará como normal o anormal una conducta conforme su propio criterio, determinado por factores culturales.

Abstract According to the DSM-IV a child that "often" emits at least six of 18 behaviors should be diagnosed with ADHD. Generally teachers are the first to report the "abnormal" frequency of behaviors of their students. The study aimed at determining the frequency of emission of ADHD behaviors by a "normal" student during class hours. Elementary school teachers (N = 113) reported in a 4-point scale (0 = never; 3 = very frequently) the frequency with which a "normal" child emits in class the ADHD behaviors included in the DSM-IV. Results showed that according to 25.7% of the teachers, "normal" children emit frequently (i.e., more than four times per hour) six or more ADHD behaviors. Results also showed that the sociodemographic characteristics of the teachers and school-situational variables were related to the frequency of a beha vior that was deemed as normal. It was concluded that ADHD behaviors are emitted quite frequently by normal children du ring class hours. The judgment on whether that frequency is or not normal will depend of the subgroup to which each teacher belongs. Thus, a same behavior could be judged as normal by one teacher and as abnormal by another. The results are in accordance with the psychological approximation to abnormal behavior that states that each observer will judge a behavior as normal or as abnormal according to his/her own criteria determined by cultural standards.

Blood lead levels in a group of children: the potential risk factors and health problems / Níveis de chumbo no sangue em um grupo de crianças: possíveis fatores de risco e problemas de saúde

Abstract Objective: To investigate blood lead levels in schoolchildren in two areas of Egypt to understand the current lead pollution exposure and its risk factors, aiming to improve prevention politicies. Subjects and method: This was a cross-sectional study in children (n = 400) aged 6-12 years recruited from two areas in Egypt (industrial and urban). Blood lead levels were measured using an atomic absorption method. Detailed questionnaires on sources of lead exposure and history of school performance and any behavioral changes were obtained. Results: The mean blood lead level in the urban area of Egypt (Dokki) was 5.45 ± 3.90 µg/dL, while that in the industrial area (Helwan) was 10.37 ± 7.94 µg/dL, with a statistically significant difference between both areas (p < 0.05). In Dokki, 20% of the studied group had blood lead levels ≥ 10 µg/dL, versus 42% of those in Helwan. A significant association was found between children with abnormal behavior and those with pallor with blood lead level ≥ 10 µg/dL, when compared with those with blood lead level < 10 µg/dL (p < 0.05). Those living in Helwan area, those with bad health habits, and those living in housing with increased exposure were at a statistically significantly higher risk of having blood lead level ≥ 10 µg/dL. Conclusion: Lead remains a public health problem in Egypt. High blood lead levels were significantly associated with bad health habits and housing with increased exposure, as well as abnormal behavior and pallor.

Resumo Objetivo: Investigar os níveis de chumbo no sangue (NCSs) em crianças em idade escolar em duas áreas do Egito para entender a atual exposição à poluição por chumbo e seus fatores de risco, para melhorar as políticas de prevenção. Indivíduos e método: Este foi um estudo transversal em crianças (400) entre 6-12 anos recrutadas de duas áreas no Egito (industrial e urbana). Os NCSs foram medidos por um método de absorção atômica. Foram obtidos questionários detalhados sobre as fontes de exposição ao chumbo e o histórico de desempenho escolar e quaisquer alterações comportamentais. Resultados: O NCS na área urbana do Egito (Dokki) foi de 5,45 ± 3,90 µg/dL, ao passo que na área industrial (Helwan) foi de 10,37 ± 7,94 µg/dL, com uma diferença significativa entre ambas as áreas (p < 0,05). Na área de Dokki, 20% do grupo estudado apresentaram NCSs ≥10 µg/dL, ao passo que na área de Helwan foi 42%. Foi encontrada uma associação significativa entre as crianças com comportamento anormal e aquelas com palidez com NCS ≥ 10 µg/dL, em comparação com aquelas com NCS < 10 µg/dL (p < 0,05). Aquelas que moram na área de Helwan, aquelas com hábitos de saúde ruins e aquelas que moram em moradias com maior exposição estiveram significativamente em alto risco de apresentar NCS ≥ 10 µg/dL. Conclusão: O chumbo ainda é um problema de saúde pública no Egito. Altos NCSs foram significativamente associados a hábitos de saúde ruins e moradia com maior exposição, bem como comportamento anormal e palidez.

Conocimiento de maestros de primaria sobre el trastorno por déficit de atención e hiperactividad / Knowledge of Elementary School Teachers about the Attention Deficit Hyperactivity Disorder

El propósito del estudio fue averiguar la influencia del sexo, edad y clase social de maestros de primaria respecto del Trastorno por Déficit de Atención e Hiperactividad (TDAH), sus causas y como tratarlo. El estudio también averiguó la influencia del grado escolar y del tamaño del grupo que atendían los maestros, así como del tipo de escuela en la que trabajaban. Maestros de primaria (N = 691) señalaron si sabían qué era el TDAH y en caso afirmativo escribieron en qué consiste. También escribieron las conductas que creían emitiría en el salón de clases un niño etiquetado y cómo lo tratarían. Los resultados mostraron que en comparación con sus contrapartes, una proporción mayor de mujeres, de maestros mayores de 43 años, de clase social media, que enseñaban en 5°- 6°, que atendían grupos pequeños y de escuelas privadas dijeron saber qué es el TDAH. Estos mismos maestros consideraron que el TDHA se trata de una enfermedad orgánica, esperarían un peor comportamiento de los niños y estarían más inclinados a etiquetarlos. Los maestros dijeron que emplearían técnicas como sentar al niño etiquetado cerca de ellos para fomentar su atención y disminuir su distracción. Los resultados se discuten contrastando el punto de vista psiquiátrico y el psicológico sobre el concepto de conducta anormal.

The purpose of the study was to determine the influence of sex, age and social class of elementary school teachers on their knowledge about the attention deficit hyperactivity disorder (ADHD). The study also determined the influence of the school grade in which the teachers taught, the size of their group and the kind of school in which they worked. Elementary school teachers (N = 691) mentioned whether they knew what ADHD was and if they did, wrote down their definition of ADHD. Teachers also wrote down the specific behaviors they expected from a child with ADHD and how will they treat that child during their classes. Results showed that compared with their counterparts, a greater percentage of women, teachers older than 43 years, of middle social class, that taught in fifth and sixth grades, that had small groups and that worked in private schools said they knew what ADHD was. Those teachers considered that ADHD has an organic cause, expected children to behave worse and be willing to label their students more often than their counterparts. The majority of teachers said they would use strategies such as sitting a student with ADHD next to them to foster his/her attention and to avoid distractions. Results are discussed contrasting the psychiatric and psychological approximations to abnormal behavior.

Bem-estar de animais de produção: das necessidades animais às possibilidades humanas / Farm animal welfare: animal needs and human possibilities

O formidável aumento da produtividade animal nos últimos 50 anos, como resultado dos avanços na saúde, nutrição, genética animal e nas instalações e equipamentos, trouxeram inquestionáveis benefícios para a sociedade humana. Entretanto, algumas mudanças no alojamento, genética e forma de alimentação dos animais têm levado a questionamentos éticos relacionados ao ambiente, aos resíduos presentes nos alimentos de origem animal e à qualidade de vida dos animais envolvidos nesse processo. Dentre as espécies zootécnicas que mais têm sido afetadas com um processo de intensificação da produção, está o suíno. Por outro lado, pela sua eficiência na conversão alimentar, é uma espécie que tende a crescer em importância, o que justifica a necessidade de desenvolver conhecimentos que permitam criar esses animais com bem-estar. No Brasil e em outros países da América Latina, a produção de espécies silvestres vem aumentando em função de vários fatores como demanda por carnes exóticas e por artigos de couro diferenciados em países europeus e asiáticos. Entretanto, o conhecimento zootécnico das espécies silvestres ainda é muito precário, o que leva a uma tendência à adoção de técnicas, manejos, instalações e programas sanitários consagrados para o uso com espécies domésticas nas criações de animais silvestres. Como se pode prever, em muitos casos com consequências desastrosas. Neste trabalho abordaremos o bem-estar de algumas espécies animais silvestres criadas no Brasil e dos suínos, especialmente em relação às possibilidades de solucionar parte dos problemas de bem-estar animal através de técnicas de enriquecimento ambiental.

The huge increase in productivity in livestock production in the last 50 years, as a result of advances in health, nutrition, genetics, animal and plant and equipment, has brought unquestionable benefits to human society. However, some changes in housing, genetics and animal nutrition have led to ethical questioning, mostly of issues related to the environment, residues in food of animal origin and the quality of life of those animals involved. The pig is one of the species that have been most affected by the process of intensification of production. On the other hand, due to their high feed conversion efficiency, it is a species that tends to grow in importance, which means that there is a need to develop practices that improve the welfare of these animals. In Brazil and other Latin American countries the production of wild species is increasing due to several factors such as demand for exotic meats and leather products in different European and Asian countries. However, knowledge of wildlife under managed systems is still very poor, which leads to a tendency to adopt techniques, management, facilities and health programs developed for domestic species. As expected, in many cases this brings disastrous consequences. In this paper we discuss the welfare of some wild animals reared in Brazil and of pigs, especially regarding the possibility of improving animal welfare through environmental enrichment techniques.

A Clinical Approach for Patients with Dementia

This article provides clinical practice guidelines for primary care physicians in the assessment of dementia patients. Dementia is an acquired syndrome due to brain dysfunction, which is characterized by multiple cognitive deficits with consequent impairment in daily or occupational activities. Thus, the first and second steps in the clinical approach to dementia are the assessment of cognition and activities of daily living (ACL). The third step may be the evaluation of abnormal behaviors associated with dementia, since those symptoms are one of the main causes of caregivers' burden and can be controlled by drugs such as antipsychotics and antidepressants. Finally, as the fourth step of the evaluation, the underlying etiologies for dementia should be explored. This article describes the elemental methods of history taking and clinical examinations for dementia patients with emphasis on the assessment of 1) cognition, 2) ADL, 3) behaviors, and 4) differential diagnosis. The assessment will lead the clinician to accurate diagnosis and better management of dementia patients.

Non-convulsive partial seizure presenting with psychiatric symptoms

A 46-year-old man presented with a six-month history of recurrent episodes of abnormal behaviors characterized by agitation, anxiety, aggression, impulsion, and depression. They were not accompanied by obvious convulsions. Brain MRI demonstrated cerebromalacia from previous traumatic brain injury in both frontal and left anterior temporal lobe. Interictal EEG showed a focal seizure disorder arising from both temporal areas. Following antiepileptic medication, the abnormal behaviors disappeared. These results suggest that non-convulsive status epilepticus or a cluster of seizures could account for prolonged behavioral disturbances.