Sleep quality and bullying - prevalence in a cohort of Portuguese students.

OBJECTIVES: The involvement of adolescents in violent behaviors is becoming an important public health problem that is concerning physicians as it is associated with a decrease in adult life quality. In this context, bullying is a type of aggressive behavior that occurs repeatedly in interpersonal relationship where power imbalance exists increasing the risk of physical and psychosocial problems in all its intervenient. Prevalence of bullying in Portuguese adolescents is estimated to be ranging from 16.2 to 27.5%. Sleep disorders are a well-known problem related to bullying situations, either as a consequence or a risk factor; estimated prevalence in adolescence is 25% worldwide. In the present study we aimed to investigate the association between sleep quality and the involvement in school bullying in Portuguese adolescents in two high schools. METHODS: Data collected from a cross-sectional survey addressing questions on bullying behaviors and sleep quality was analyzed using SPSS 22.0. A two-tailed p-value of less than 0.05 was considered significant for all tests. RESULTS: We have included 171 adolescents, mean age of 14.39 ± 1.149 years, 59.6% were boys; prevalence of bullying behaviors was 28.1%. Among the students 15.2% were identified as "pure victims", 8.8% as "pure bullies", 4.1% as "bully-victims" and 71.9% as "neutrals". "Pure bullies" and "bully-victims" present higher Athens Insomina Scale (AIS) scores (p = 0.004) and higher prevalence of insomnia (p = 0.004). The prevalence of insomnia was significantly higher in the group involved in bullying behaviors comparing with the neutrals (58.3% vs 30%, p = 0.001). We verified that 65.4% of the reported bullying situations took place inside the school and 8.8% of those teachers did nothing to help the victim and in 17.5% school staff took the same attitude. CONCLUSIONS: We found a prevalence of bullying behaviors higher than the one reported in previous studies and a prevalence of insomnia of 38.0%, proving that bullying and sleep disturbances are two major problems in adolescence which may increase future risk for psychiatric symptoms, involvement in criminal activities, hyperactive, and inattentive behaviors. We verified a strong relation between insomnia and involvement in bullying situations with those who are involved reporting difficulties in sleep induction. The group of "bully-victims" was identified as potentially being the one with the most troubled adolescents since they combine characteristics of both bullies and victims. The authors conclude that there should be an investment in school-based interventions that help recognize and reduce school bullying and change lifestyle behaviors that may negatively influence adolescents' development.

Deep venous thrombosis of lower limbs in adolescents: a study in a tertiary hospital.

BACKGROUND: Venous thromboembolism (VTE) - which includes deep venous thrombosis (DVT) and pulmonary embolism (PE) - has been increasingly recognized in the pediatric population. The estimated incidence is 0.07-0.14 cases per 10,000 children. Most cases are associated with two or more risk factors. Medium and long-term complications include recurrence and post-thrombotic syndrome (PTS). OBJECTIVE: To characterize the adolescent population with the diagnosis of DVT of lower limbs in a tertiary hospital, regarding its clinical presentation, associated risk factors, treatment and outcome. METHODS: Retrospective analysis of adolescents with the diagnosis of DVT of lower limbs in our hospital for a period of 7 years. RESULTS: Eight patients were identified; seven were females; median age was 15 years. The main symptoms were local pain and edema. Left lower limb was affected in six patients. PE occurred in two cases. Positive family history of venous thromboembolism was found in five patients. Seven patients had at least two identifiable risk factors. Combined oral contraceptive pill use was the most common (seven patients). Factor V Leiden mutation was found in three patients and protein C deficiency in one. Iliac vein compression syndrome was diagnosed in one patient. The median time for discharge was 8 days. Election treatment was enoxaparin followed by warfarin, for a median period of 10.9 months. Three patients developed PTS. CONCLUSIONS: Although uncommon, VTE is an emerging reality in adolescents, particularly in females using oral contraceptive pills. Appropriated prevention strategies and treatment are required as most orientations are extrapolated from adults.

Alcohol use in adolescence: 5 years admissions at a pediatric emergency department.

Objective To characterize the profile and pattern of alcohol consumption in adolescents, admitted with acute alcoholic intoxication (AAI) at a pediatric emergency department of North Portugal. Methods Retrospective descriptive study of adolescents aged between 10 and 17 years, admitted with AAI between 2012 and 2016. The following variables were evaluated: age, gender, drinking context, quantity and type of alcohol, Glasgow Coma Scale (GCS), previous episodes, associated injuries, transport to the emergency department, other drug consumption, blood alcohol level (BAL), blood glucose level, treatment and orientation. The χ2/Fisher's exact test and t-Student test were performed (p < 0.05). Results A total of 180 adolescents with AAI presented. The majority of adolescents were older than 15 years old (71%) and 3% were younger than 14 years old. The mean age was 15.9 years [standard deviation (SD) 1.1 years] and 65% were males. The most common type of alcohol consumed was distilled drinks (60%). Recurrent alcohol use was identified in 7% and binge drinking was reported in 37% of patients. The mean BAL was 1.58 g/L (SD 0.6 g/L) and there were other drug consumptions (mainly cannabinoids) observed in 11% of patients. After emergency department discharge, 17% were followed at hospital consultation. There was no significant difference between boys and girls or between BAL and injuries or other drugs consumption. Conclusion This study confirms a high rate of alcohol use among adolescents, in particular "heavy episodic drinking", revealing an easy access to alcohol at this age. The integration of alcohol use prevention programs in community and education systems should be encouraged and implemented in every adolescent consultation.

Teenage pregnancy - a study in São Tomé and Príncipe.

Introduction The increasing number of pregnant teenagers in São Tomé and Príncipe (STP) represents a serious public health issue. The aim of this study was to characterize the population of pregnant adolescents followed in a health facility dedicated to maternal health in STP. Methods A cross-sectional survey was conducted among pregnant teenagers that attended the Mother and Child Protection Center during the first quarter of 2017. The survey contained questions on sociodemographic characteristics, sexual and risk behaviors, family, partners and health support. Results The mean age of the 51 pregnant teenagers included was 16.37 ± 0.8 years. Eight girls reported that they had planned to fall pregnant. Teenagers whose pregnancy was unplanned usually present with a previous family history of adolescent pregnancy. About 59% of girls engaged in sexual activity before 16 years of age with a mean number of sexual partners of 1.84 ± 0.88. In this study, 51% of the girls do not use any contraceptive method, usually because their partner refuses to do so. The preferred contraceptive method are condoms. Information on contraception is given mainly at school. Pregnant girls' first medical consultation was at a mean gestational age of 6 weeks. Abortion was considered by 51% of girls after pregnancy was confirmed. Conclusion Teenage pregnancy imposes health problems for the mother and child and contributes to educational and socioeconomic disadvantages. The collaboration of healthcare providers, teachers and parents is needed to enhance sexual health education. This is the first study in STP on teenage pregnancy; although the sample is small, the authors believe that the results are representative of the general population.

Immune disease expressed in liver and platelets in an adolescent: a case report.

We report a case of a 15-year-old boy with autoimmune hepatitis lacking common serologic markers and normal gammaglobulinemia associated with immune thrombocytopenia and family history of psoriasis. He presented to our department with a 4-year history of a cervical posterior lymphadenopathy and recent petechiae. Previous laboratory results 6 months before already showed hepatocellular injury. After exclusion of other causes, the diagnosis of autoimmune hepatitis was made based on clinical grounds, associated immune disorder and histological features of liver biopsy.The authors alert for this atypical presentation of autoimmune hepatitis and associated immune thrombocytopenia.

Systemic lupus erythematosus (SLE) presenting with nephrotic syndrome and membranous glomerulopathy in a 10-year-old girl.

UNLABELLED: The authors report the case of a 10-y-old girl with clinical diagnosis of systemic lupus erythematosus (SLE), made at the age of 6 y, based upon arthritis, serositis, haematological disorder and positive antinuclear antibody. The first manifestation of disease--Raynaud's phenomenon--appeared at the age of 4 y. Seven months after the diagnosis, she developed nephrotic proteinuria with haematuria. Percutaneous renal biopsy showed membranous glomerulonephritis, the least common form of lupus nephritis. CONCLUSION: Intravenous cyclophosphamide therapy associated with oral prednisolone proved effective in inducing complete remission of nephrotic syndrome.

[Group A beta-hemolytic streptococcal toxic shock]. / Choque tóxico por streptococcus beta-hemoliticus do grupo A.

In the last years has been observed an increased incidence of invasive group A beta-hemolytic streptococcal infections, including the toxic shock syndrome. The most common portal of entry is the skin and mucous membranes. The toxic shock syndrome can occurred as a rare complication of pharyngitis. The association between varicella and the use of nonsteroidal antiinflammatory drugs with necrotizing fasciitis by Streptococcus pyogenes has been discussed without reach at consensus, but some authors disapproved the use of nonsteroidal antiinflammatory drugs in this viral infection. The authors reported the clinical case of a 12 year old adolescent, that 15 days after the diagnosis of mononucleosis infectious confirmed by serology and treated with ibuprofen, was internment by streptococcal toxic shock syndrome with rhabdomyolysis, hepatitis, cellulitis of the leg, arthritis of the knee and pleural effusion. Therapeutics was made with penicillin G and clindamycin. We present this case for the severity of the clinical situation and for the questions that rise.