Correlations between childhood maltreatment, anxiety and depressive symptoms, and risk behaviors in adolescent schoolchildren.

OBJECTIVE: Childhood maltreatment is extremely harmful to health, especially in relation to development of the psychiatric disorders throughout life. The objective of this study was to describe the prevalence and types of maltreatment in a sample of adolescent schoolchildren and to investigate associations between maltreatment types and anxiety and depressive symptoms, sociodemographic variables, and risk behaviors. The study also identified which variables were the greatest predictors of anxiety and depressive symptoms. METHODS: We conducted a cross-sectional study with a sample of 654 school students aged 11 to 17 years. We collected sociodemographic data and administered the Revised Child Anxiety and Depression Scale (RCADS-47) to measure anxiety and depressive symptoms as well as the Childhood Trauma Questionnaire (CTQ) to evaluate maltreatment and adverse experiences such as abuse and negligence during childhood and adolescence. Statistical analyses were conducted to estimate correlations between sociodemographic data, anxiety, depression, and types of maltreatment. A regression analysis was also conducted to identify maltreatment types that predict psychological symptoms. RESULTS: Emotional abuse and emotional neglect were the most prevalent types of maltreatment. Statistically, emotional abuse was the maltreatment type most strongly correlated with depression and anxiety and tended to co-occur with other types of maltreatment. Additionally, emotional and sexual abuse were the greatest predictors of anxiety and depression in adolescents. CONCLUSION: The above results reinforce the findings of previous studies in terms of understanding the effects of maltreatment. They identify emotional abuse as the main predictor of depressive and anxiety symptoms.

Validation of the maximal cardiopulmonary exercise test in adolescents with major depressive disorder and comparison of cardiorespiratory fitness with sex- and age-related control values.

Endurance training has been shown to be effective in treating adolescents with major depressive disorder (MDD). To integrate endurance training into the therapeutic setting and the adolescents' daily lives, the current performance status of the adolescents should be accurately assessed. This study aims to examine adolescents with MDD concerning exhaustion criteria during a cardiopulmonary exercise test (CPET), as well as to compare the values obtained thereon with sex- and age-related control values. The study included a retrospective examination of exhaustion criteria ((i) oxygen consumption (V̇O2) plateau, (ii) peak respiratory exchange ratio (RERpeak) > 1.0, (iii) peak heart rate (HRpeak) ≥ 95% of the age-predicted maximal HR, and (iv) peak blood lactate concentration (BLCpeak) > 8.0 mmol⋅L-1) during a graded CPET on a cycle ergometer in adolescents with MDD (n = 57). Subsequently, maximal V̇O2, peak minute ventilation, V̇O2 at the first ventilatory threshold, and peak work rate of participants who met at least two of four criteria were compared with published control values using an independent-sample t-test. Thirty-three percent of the total population achieved a V̇O2 plateau and 75% a RERpeak > 1.0. The HR and BLC criteria were met by 19% and 22%, respectively. T-test results revealed significant differences between adolescents with MDD and control values for all outcomes. Adolescents with MDD achieved between 56% and 83% of control values.   Conclusions: The study shows that compared with control values, fewer adolescents with MDD achieve the exhaustion criteria on a CPET and adolescents with MDD have significantly lower cardiorespiratory fitness.   Clinical trial registration: No. U1111-1145-1854. What is Known: • It is already known that endurance training has a positive effect on depressive symptoms. What is New: • A relevant proportion of adolescents with major depressive disorder do not achieve their V̇O2max during a graded cardiopulmonary exercise test. • Adolescents with major depressive disorder have significantly lower cardiorespiratory fitness compared to sex- and age-related control values.

Correlations between childhood maltreatment, anxiety and depressive symptoms, and risk behaviors in adolescent schoolchildren

Abstract Objective Childhood maltreatment is extremely harmful to health, especially in relation to development of the psychiatric disorders throughout life. The objective of this study was to describe the prevalence and types of maltreatment in a sample of adolescent schoolchildren and to investigate associations between maltreatment types and anxiety and depressive symptoms, sociodemographic variables, and risk behaviors. The study also identified which variables were the greatest predictors of anxiety and depressive symptoms. Methods We conducted a cross-sectional study with a sample of 654 school students aged 11 to 17 years. We collected sociodemographic data and administered the Revised Child Anxiety and Depression Scale (RCADS-47) to measure anxiety and depressive symptoms as well as the Childhood Trauma Questionnaire (CTQ) to evaluate maltreatment and adverse experiences such as abuse and negligence during childhood and adolescence. Statistical analyses were conducted to estimate correlations between sociodemographic data, anxiety, depression, and types of maltreatment. A regression analysis was also conducted to identify maltreatment types that predict psychological symptoms. Results Emotional abuse and emotional neglect were the most prevalent types of maltreatment. Statistically, emotional abuse was the maltreatment type most strongly correlated with depression and anxiety and tended to co-occur with other types of maltreatment. Additionally, emotional and sexual abuse were the greatest predictors of anxiety and depression in adolescents. Conclusion The above results reinforce the findings of previous studies in terms of understanding the effects of maltreatment. They identify emotional abuse as the main predictor of depressive and anxiety symptoms.

Hsp65-producing Lactococcus lactis inhibits experimental autoimmune encephalomyelitis by preventing cell migration into spinal cord.

Multiple sclerosis is an autoimmune disease that affects the central nervous system. Because of its complexity and the difficulty to treat, searching for immunoregulatory responses that reduce the clinical signs of disease by non-aggressive mechanisms and without adverse effects is a scientific challenge. Herein we propose a protocol of oral tolerance induction that prevented and controlled MOG-induced experimental autoimmune encephalomyelitis (EAE) in C57BL/6 mice. The genetically modified strain HSP65-producing Lactococcus lactis was orally administered for 5 consecutive days either before or during disease development in mice. Both protocols of feeding HSP65 resulted in significant reduction in the clinical score of EAE. Frequencies of LAP+CD4+Foxp3- regulatory T cells were higher in spleens and inguinal lymph nodes of fed mice. In addition, intravital microscopy showed that adherence of leukocytes to venules in the spinal cord was reduced in orally treated mice. Oral treatment with HSP65-producing L.lactis prevented leukocytes to leave the secondary lymphoid organs, therefore they could not reach the central nervous system. Despite the inhibition of pathological immune response that drive EAE development, activated T cells were at normal frequencies suggesting that oral tolerance did not induce general immunosuppression, but it led to specific control of pathogenic T cells. Our results indicate a novel therapeutic strategy to prevent and control autoimmune diseases such as multiple sclerosis.

[Diagnostic Prevalence of Dental Findings in Children, Adolescents and Young Adults with Mental Disorders Compared to Healthy People - an Analysis and Estimation Based on Claims Data from 2019]. / Zahnmedizinische Diagnoseprävalenzen bei Kindern, Jugendlichen und jungen Erwachsenen mit psychischen Störungen im Vergleich zu Gesunden-Analyse und Abschätzung kassenärztlicher Abrechnungsdaten (2019).

AIM: To analyse oral health-related diagnostic prevalences in children, adolescents (KiJu), young adults with mental/behavioural disorders (PEVS) and those of the general population in Germany based on claims data. METHOD: Anonymously provided ZI (Zentralinstitut)-data sets of GKV-insured persons (0-44 years) were i. e. stratified according to gender, age groups, ICD-K00-K14 diagnosis. RESULT: No reliable oral or dental health-related information was generated from the requested data set. Regardless of the F diagnosis, according to the data set, 1.8% of all 11,854,384 KiJu-GKV-insured persons and 0.2% of 18-44-year-olds (23,348,399 GKV-insured persons) had a diagnosis related to the dental hard tissue (ICD-10 K02/K03.2). Based on available literature on the prevalence of caries in KiJu with PEVS, a mean unweighted prevalence of 51% can be assumed. According to the available literature on the prevalence of caries in KiJu with PEVS a mean unweighted prevalence of 51% can be calculated. Following this and the diagnosis prevalence of PEVS in 0- to 17-year-olds from 2017, an estimated 957.952 children with PEVS should also have a caries. CONCLUSION: The nationwide data on the prevalence of oral health-related diagnoses made by physicians in the general population and in people of the same age with PEVS are very low. Apparently, dental diagnoses are only given very rarely by general practitioners and paediatricians, among others. The existing literature as well as the clinical experience of the authors indicate that this claim data is not suitable to realistically represent the dental and oral health of the examined group of people. Thus, for networking, the improvement of health care research and the care, e. g. of subgroups of the society, is an interprofessional dental/medical, data protection-compliant central database to be driven forward.

German physicians' perceptions and views on complementary medicine in pediatric oncology: a qualitative study.

Complementary and alternative medicine (CAM) use in children with cancer has a high prevalence. If (parents of) patients bring up the topic of CAM, pediatric oncologists (POs) face considerable challenges regarding knowledge and professional behavior. In this study, we explore German POs' understanding of CAM and related attitudes as well as challenges and strategies related to CAM discussions by means of semi-structured interviews analyzed according to principles of qualitative thematic analysis with parents of children with cancer. We could conduct 14 interviews prior to theoretical saturation. The interviews had a duration of 15-82 min (M = 30.8, SD = 18.2). Professional experience in pediatric oncology was between 0.5 and 26 years (M = 13.8, SD = 7.6). Main themes identified were a heterogeneous understanding and evaluation of CAM, partly influenced by personal experiences and individual views on plausibility; the perception that CAM discussions are a possible tool for supporting parents and their children and acknowledgement of limitations regarding implementation of CAM discussions; and uncertainty and different views regarding professional duties and tasks when being confronted with CAM as a PO. Our interdisciplinary interpretation of findings with experts from (pediatric) oncology, psychology, and ethics suggests that there is need for development of a consensus on the minimal professional standards regarding addressing CAM in pediatric oncology.

Conciliação medicamentosa na admissão de pacientes transplantados renais em um hospital universitário / Medication reconciliation in the admission of kidney transplant patients to a university hospital

Introdução:O presente estudo considerou conciliações medicamentosas realizadas na admissão hospitalar de pacientes transplantados renais e intervenções farmacêuticas decorrentes desse processo.Métodos:Trata-se de um estudo transversal realizado no período de julho de 2018 a julho de 2019 no Hospital de Clínicas de Porto Alegre. Foram coletadas as características dos pacientes, as conciliações medicamentosas realizadas pelo farmacêutico clínico, as discrepâncias identificadas pelo mesmo (intencionais e não intencionais) e o resultado das intervenções. Os medicamentos foram classificados de acordo com a Anatomic Therapeutic Chemical (ATC).Resultados:Dos 719 pacientes acompanhados pelo farmacêutico clínico, 175 tiveram a conciliação medicamentosa de admissão realizada, desses, 56 apresentaram discrepâncias não intencionais. Encontramos a média de 2,2 medicamentos omissos por prescrição com desvio padrão de 1,3 medicamentos. No total, foram realizadas 122 intervenções farmacêuticas, sendo que em 61,5% houve adesão por parte da equipe médica. A classe terapêutica com maior ocorrência (43,4%) de discrepâncias não intencionais foi a que atuava sobre o aparelho cardiovascular. As variáveis observadas foram sexo, número de medicamentos nas intervenções (ambas com associação significativa com a adesão médica), idade, tempo de internação, número de medicamentos na internação e número de medicamentos de uso prévio (estas últimas sem associação significativa com a adesão médica). Conclusões:A conciliação medicamentosa previne possíveis erros de medicação, uma vez que a identificação das discrepâncias não intencionais na prescrição médica gera sinalizações que são levadas pelo farmacêutico clínico à equipe assistente, a fim garantir o uso seguro e correto dos medicamentos durante a internação hospitalar.

Introduction:This study considered medication reconciliations performed on hospital admission of kidney transplant patients and pharmaceutical interventions resulting from this process.Methods:This is a cross-sectional study carried out from July 2018 to July 2019 at Hospital de Clínicas de Porto Alegre. The characteristics of the patients, the medication reconciliations performed by the clinical pharmacist, the discrepancies identified by the same (intentional and unintentional) and the result of the interventions were collected. The drugs were classified according to the Anatomic Therapeutic Chemical (ATC). Results:Of the 719 patients monitored by the clinical pharmacist, 175 had medication reconciliation on admission performed, of which 56 had unintentional discrepancies. We found an average of 2.2 missing medications per prescription with a standard deviation of 1.3 medications. In total, 122 pharmaceutical interventions were performed, and in 61.5% there was adherence by the medical team. The therapeutic class with the highest occurrence (43.4%) of unintentional discrepancies was that which acted on the cardiovascular system. The variables observed were gender, number of medications in interventions (both with a significant association with medical adherence), age, length of stay, number of medications in hospitalization and number of medications previously used (the latter without a significant association with medical adherence).Conclusions:Medication reconciliation prevents possible medication errors, since the identification of unintentional discrepancies in the medical prescription generates signals that are taken by the clinical pharmacist to the assistant team, in order to guarantee the safe and correct use of medications during hospitalization.

How Stressful Is Examining Children with Symptoms of Child Abuse?-Measurement of Stress Appraisal (SAM) in German Physicians with Key Expertise in Pediatrics.

BACKGROUND: Pediatricians frequently feel uncertain about their ability to detect early symptoms of child abuse and how to respond in suspected cases. AIM: This study investigated the transactional stress model in German pediatricians who experienced imagination stories with a child protection scenario and another potentially stress-triggering scenario. METHODS: A two-part survey was conducted online. Each part included a different imagination story and evaluation of the Stress Appraisal Measure (SAM), as well as questions on child protection, current problematics, and suggested remedies. In total, 96 pediatricians participated. The child abuse scenario was perceived as significantly more threatening and more stressful than a medical emergency. The pediatricians declared moderate familiarity with the Child Protection Guidelines and the Federal Child Protection Act and an average confidence in their application. The greatest perceived problems were communication difficulties with parents and youth welfare services. Suggested improvements were concrete procedural directives, more training programs, better interdisciplinary networks, and greater exchange among colleagues. CONCLUSIONS: To optimize their potential in the child protection system, pediatricians need to be better supported in coping with the identified stressors in child abuse scenarios.

Is examining children and adolescents with autism spectrum disorders a challenge?-Measurement of Stress Appraisal (SAM) in German dentists with key expertise in paediatric dentistry.

OBJECTIVES: This questionnaire-based validation study investigated if the dental examination of children and adolescents with autism spectrum disorder is viewed by dentists with key expertise in paediatric dentistry as a challenge or a threat in terms of transactional stress theory. The Stress Appraisal Measure (SAM) was used for this purpose and it's feasibility and validity was examined as a first part of a multi-stage process for validation in dentistry with a sample of German dentists. It has hardly been investigated how the treatment of children and adolescents with a disorder from the autism spectrum is perceived by dentists. METHODS: An online-based survey (39 questions) plus the SAM as an add-on as well as a preceding short story of imagination on the topic (appointment for a dental check-up in a special school) were developed. Via e-mail members of the German Society of Paediatric Dentistry (DGKiZ) received a link which enabled interested members to participate. The majority of the members of the DGKiZ have additional qualifications in the treatment of children and adolescents and further training in the area of special needs care in dentistry. The data analysis was based on the SAM and its subscales. RESULTS: Out of the 1.725 members of DGKiZ 92 participants (11 male, 81 female) fully completed the questionnaire and the SAM. All in all the dentists rated their own psychological and physical stress in course of treating children and adolescents with a disorder from the autism spectrum between less and partly stressful. Although the structure of the SAM could not be fully mapped by means of a factor analysis, the different ratings "challenge" or "threat" could be comprehensibly evaluated after reading the story. The participants rated the situation from the story in general as challenging but not as threatening. Intercorrelations between the subscales of the SAM (e.g threat and centrality) of r = .56 showed that the scales are not clearly independent of one another. According to the transactional stress model, the SAM bases on, stress (perceived stressfulness) arises from appraisal processes (e.g. threat, controllable-by-self) that bring about a comparison between the requirements for the described situation and one's own possibilities in terms of a person-environment-fit. In the hierarchical regression a variance of R2 = .48 could be explained with all six subscales (appraisal processes) to predict perceived stressfulness of the SAM within a sample of dentists. CONCLUSIONS: Due to the response rate the results of the SAM are not representative for all German dentists, but it offers an insight into topics of special needs dentistry in Germany that have not yet been examined. Overall, the feasibility and validity of the SAM in the context of mapping cognitive appraisal processes and stress could be confirmed. Taking into account the result that the treatment of children and adolescents with autism spectrum disorder is seen as a challenge, it is concluded that there is a need to improve the education of dental students and graduated dentists in Germany in the field of special needs dentistry.

Self-Assessment of Knowledge on the Treatment of Children and Adolescents with Special Care Needs: Results of a Survey amongst German Dentists with Key Expertise in Paediatric Dentistry.

BACKGROUND: The treatment of children and adolescents with disabilities (CA-Dis) and psycho-emotional disorders (CA-Psy) places special demands on dentists. AIM: To explore German dentists' (with key expertise in paediatric dentistry) perception of their competence and comfort levels in dealing with these patients, and implications for access to care. METHODS: Online questionnaire surveying demographic information and self-assessment of training, knowledge, and comfort in dealing with CA-Dis and CA-Psy among 1725 members of the German Society of Paediatric Dentistry (DGKiZ). RESULTS: Ninety-two participants (11 male, 81 female) completed the questionnaire: 17.4% (n = 16) treated CA-Dis once or more a day; CA-Psy were rarely treated on a daily basis (7.6%; n = 7). In regard to CA-Dis, 62% (n = 57) rated their level of expertise as "good" or "very good"; for CA-Psy this was 40.2% (n = 37). Overall, 76.1% (n = 70), respectively, 88.0% (n = 81) of the respondents felt they had been inadequately prepared to treat CA-Dis or CA-Psy. Although the physical burden of treating CA-Psy was rated as "not at all stressful" or only "slightly stressful" by 45.7% of the participants, 31.5% rated the psychological distress as "very stressful" or "extremely stressful". The better their self-assessed expertise in treating CA-Dis was, the lower their own psychological distress was rated (r = -0.34). Training on this topic seems to have an impact on the perceived burden of treating such patients. CONCLUSIONS: A core curriculum in special care dentistry needs to be embedded in the German dental curriculum. The results permit the development of health programs for workplace health management in dentistry.

Neuroimmune circuits involved in ß-lactoglobulin-induced food allergy.

Several antigens can act as allergens eliciting IgE-mediated food allergy reactions when fed to sensitized animals. One of them is ovalbumin (OVA) which is the main allergen in egg white. Allergic mice develop aversion to OVA consumption. This aversive behavior is associated with anxiety, and it can be transferred to non-sensitized mice by injection of serum of allergic mice. However, it is yet to be determined whether altered behavior is a general component of food allergy or whether it is specific for some types of allergens. Cow's milk allergy is the most prevalent food allergy that usually begins early in life and ß-lactoglobulin (BLG) is the milk component with the highest allergenicity. In this study, we investigated behavioral and neuroimmune circuits triggered by allergic sensitization to BLG. A neuroimmune conflict between aversion and reward was observed in a model of food allergy induced by BLG intake. Mice sensitized to BLG did not present aversive behavior when BLG was used for sensitization and oral challenge. Mice allergic to BLG preferred to drink the allergen-containing solution over water even though they had high levels of specific IgE, inflammatory cells in the intestinal mucosa and significant weight loss. When sensitized to OVA and challenged with the same antigen, mice had increased levels of neuron activation in the amygdala, a brain area related to anxiety. On the other hand, when mice were sensitized to OVA and received a mixture of BLG and OVA in the oral challenge, mice preferred to drink this mixture, despite their aversion to OVA, which was associated with neuron activation in the nucleus accumbens, an area related to reward behavior. Thus, the aversive behavior observed in food allergy to OVA does not apply to all antigens and some allergens may activate the brain reward system rather than anxiety and aversion. Our study provides novel insights into the neuroimmune conflicts regarding preference and avoidance to a common antigen associated with food allergy.

Sociodemographic and clinical aspects of patients with sickle cell disease at referral centers in Salvador, Bahia / Aspectos sociodemográficos y clínicos de pacientes con enfermedad de células falciformes en centros de referencia en Salvador, Bahía / Aspectos sociodemográficos e clínicos de pacientes com doenças falciformes dos centros de referência em Salvador, Bahia

The centralization of care for patients with sickle cell diseases through the creation of reference centers through the Ministry of Health Ordinance No. 1,018/2005, enabled better monitoring of these patients. This study characterized the sociodemographic and clinical profile of patients with sickle cell diseases treated at reference centers in the city of Salvador. Women represented the largest portion of patients registered at the centers and were older and more educated than men. More than 90.0% of patients are single, demonstrating the difficulty of people with sickle cell disease to socialize due to the stigma of the disease. The most common clinical manifestations were pain crises and jaundice, and the most common complications were hospitalizations due to pain crises and blood transfusion. Associations were observed between sex and stroke, between genotype and lower limb ulcers and blood transfusion. A low percentage of patients with osteonecrosis (8.8%) was also observed, indicating possible underreporting. The low percentages of patients who use morphine and hydroxyurea point to the need to expand the offer of these drugs to reduce pain crises and improve the quality of life of patients.

La centralización de la atención a los pacientes con anemia falciforme mediante la creación de centros de referencia a través de la Ordenanza del Ministerio de Salud Nº 1.018 / 2005, permitió un mejor seguimiento de estos pacientes. Este estudio caracterizó el perfil sociodemográfico y clínico de los pacientes con drepanocitosis atendidos en centros de referencia de la ciudad de Salvador. Las mujeres representaban la mayor parte de los pacientes registrados en los centros y eran mayores y tenían más educación que los hombres. Más del 90,0% de los pacientes son solteros, lo que demuestra la dificultad de las personas con anemia falciforme para socializar debido al estigma de la enfermedad. Las manifestaciones clínicas más frecuentes fueron crisis de dolor e ictericia, y las complicaciones más frecuentes fueron hospitalizaciones por crisis de dolor y transfusión de sangre. Se observaron asociaciones entre sexo y accidente cerebrovascular, entre genotipo y úlceras de miembros inferiores y transfusión de sangre. También se observó un bajo porcentaje de pacientes con osteonecrosis (8,8%), lo que indica un posible subregistro. Los bajos porcentajes de pacientes que utilizan morfina e hidroxiurea apuntan a la necesidad de ampliar la oferta de estos fármacos para reducir las crisis de dolor y mejorar la calidad de vida de los pacientes.

A centralização do atendimento dos pacientes com doenças falciformes através da criação de centros de referência possibilitou um melhor acompanhamento desses pacientes. Este estudo caracterizou o perfil sociodemográfico e clínico dos pacientes com doenças falciformes atendidos nos centros de referência no município de Salvador. Os resultados deste estudo corroboram com a literatura e podem ajudar a melhorar os serviços oferecidos nos centros de referência pesquisados. As mulheres representaram a maior parcela dos pacientes registrados nos centros e com maior faixa etária e escolaridade do que os homens. Mais de 90,0% dos pacientes são solteiros, demonstrando a dificuldade das pessoas com doenças falciformes se socializarem devido ao estigma da doença. As manifestações clínicas mais comuns foram as crises álgicas e a icterícia e as intercorrências mais comuns foram internações devido as crises álgicas e hemotransfusão. Foram observadas associações entre sexo e acidente vascular cerebral, entre o genótipo e úlceras de membros inferiores e hemotransfusão. Também foi observado um percentual baixo de pacientes com osteonecrose indicando possível subnotificação. Os percentuais baixos de pacientes que fazem uso da morfina e hidroxiureia apontam para a necessidade de ampliar a oferta desses medicamentos para diminuir as crises álgicas e melhorar a qualidade de vida dos pacientes.

[Acute interstitial nephritis: clinical presentation and diagnosis]. / Néphrite interstitielle aiguë : quand la suspecter et quelle prise en charge ?

Acute interstitial nephritis is characterized by renal inflammation and interstitial edema. The clinical presentation is pauci-symptomatic and often non-specific. Acute interstitial nephritis typically presents with acute renal failure, alone or with fever, eosinophilia, hematuria, sterile pyuria and small range proteinuria. An early diagnosis is crucial to prevent the morbidity and mortality associated with renal function decline. The most frequent etiology of this disease is drug-induced. A kidney biopsy is not systematically required to establish the diagnosis. It should be considered in the absence of renal function improvement 5 to 7 days after withdrawal of the causal agent. Although the benefits of glucocorticoid treatment have not been proven to date, its use may be associated with a better kidney function recovery.

La néphrite interstitielle aiguë est caractérisée par une inflammation dans le compartiment interstitiel rénal. La présentation clinique est paucisymptomatique. Elle se présente généralement par une insuffisance rénale aiguë qui peut être accompagnée de fièvre, d'éosinophilie, d'hématurie, de leucocyturie stérile et de protéinurie non néphrotique. Son diagnostic précoce est crucial pour prévenir la morbi-mortalité liée au déclin de la fonction rénale. L'étiologie la plus fréquente est médicamenteuse. Le diagnostic par la ponction-biopsie rénale n'est pas systématique, mais doit être considéré en l'absence d'amélioration de la fonction rénale 5 à 7 jours après l'arrêt de la substance incriminée. Le principal traitement consiste en l'interruption du médicament incriminé et à l'administration de corticostéroïdes.

Complementary and Integrative Medicine in Pediatric Oncology - Development and Evaluation of a Blended Learning Program.

BACKGROUND: A blended learning program to promote the consultation expertise of pediatric oncologists (POs) on complementary and integrative medicine (CIM) was developed and completed by POs as part of a training program. A previous study indicated that POs in Germany were in need of information and training on CIM, and that there were no medical training offers on the subject in Germany. METHODS: Evaluation of e-learning (questionnaires) and practically oriented one-day, face-to-face workshops (questionnaires, simulation patients), the workshops were evaluated with regard to changes in quality of physician-patient interaction and with regard of the participants' feedback. RESULTS: 32 POs signed up for the program and completed the e-learning. 22 POs participated in one of the workshops. POs agreed that they had received professionally relevant content during the e-learning. The questionnaires on physician-patient interaction showed neither clear positive nor negative changes concerning the quality of interaction. The feedback from the participants on the workshop was very positive. CONCLUSION: Following the end of the blended learning program the e-learning was made available again for interested POs. 34 further applications were received for participation in this part of the training program. With around 300 POs in Germany, this shows a high demand for further training offers of this kind as well as a need for further development.

Family Aggression Screening Tool (FAST): Factor structure and psychometric properties of subscales.

BACKGROUND: The Family Aggression Screening Tool (FAST) is an instrument to screen for experiences of maltreatment using primarily pictorial representations, including direct victimisation and exposure to intimate partner violence. The initial psychometric properties of the FAST were reported in the original research in the United Kingdom. OBJECTIVE: This research aimed to replicate and to extend the evaluation of the psychometric properties of FAST in Brazil. PARTICIPANTS AND SETTING: Data consisted of 648 youth aged 11 to 17 years from public schools in Brazil. METHOD: We employed confirmatory factor analysis (CFA), exploratory factor analysis (EFA) and exploratory graphical analysis (EGA). Concurrent validity was supported by strong correlations between the FAST's emotional and physical victimisation subscales and Childhood Trauma Questionnaire (CTQ) emotional and physical abuse subscales. RESULTS: CFA resulted in a solution including second and first order factors, resembling the original structure. FAST's reliability was assessed both through internal consistency and test-retest, showing favorable coefficients. CONCLUSION: Our results suggest that FAST has good psychometric properties for the Brazilian population with respect to both its validity and reliability.

Dengue virus infection induces inflammation and oxidative stress on the heart.

OBJECTIVE: Dengue fever is one of the most important arboviral diseases in the world, and its severe forms are characterised by a broad spectrum of systemic and cardiovascular hallmarks. However, much remains to be elucidated regarding the pathogenesis triggered by Dengue virus (DENV) in the heart. Herein, we evaluated the cardiac outcomes unleashed by DENV infection and the possible mechanisms associated with these effects. METHODS: A model of an adapted DENV-3 strain was used to infect male BALB/c mice to assess haemodynamic measurements and the functional, electrophysiological, inflammatory and oxidative parameters in the heart. RESULTS: DENV-3 infection resulted in increased systemic inflammation and vascular permeability with consequent reduction of systolic blood pressure and increase in heart rate. These changes were accompanied by a decrease in the cardiac output and stroke volume, with a reduction trend in the left ventricular end-systolic and end-diastolic diameters and volumes. Also, there was a reduction trend in the calcium current density in the ventricular cardiomyocytes of DENV-3 infected mice. Indeed, DENV-3 infection led to leucocyte infiltration and production of inflammatory mediators in the heart, causing pericarditis and myocarditis. Moreover, increased reactive oxygen species generation and lipoperoxidation were also verified in the cardiac tissue of DENV-3 infected mice. CONCLUSIONS: DENV-3 infection induced a marked cardiac dysfunction, which may be associated with inflammation, oxidative stress and electrophysiological changes in the heart. These findings provide new cardiac insights into the mechanisms involved in the pathogenesis triggered by DENV, contributing to the research of new therapeutic targets for clinical practice.

Individual and interactive effects of chronic anthropogenic disturbance and rainfall on taxonomic, functional and phylogenetic composition and diversity of extrafloral nectary-bearing plants in Brazilian Caatinga.

Chronic anthropogenic disturbance (CAD) and climate change represent two of the major threats to biodiversity globally, but their combined effects are not well understood. Here we investigate the individual and interactive effects of increasing CAD and decreasing rainfall on the composition and taxonomic (TD), functional (FD) and phylogenetic diversity (PD) of plants possessing extrafloral nectaries (EFNs) in semi-arid Brazilian Caatinga. EFNs attract ants that protect plants against insect herbivore attack and are extremely prevalent in the Caatinga flora. EFN-bearing plants were censused along gradients of disturbance and rainfall in Catimbau National Park in north-eastern Brazil. We recorded a total of 2243 individuals belonging to 21 species. Taxonomic and functional composition varied along the rainfall gradient, but not along the disturbance gradient. There was a significant interaction between increasing disturbance and decreasing rainfall, with CAD leading to decreased TD, FD and PD in the most arid areas, and to increased TD, FD and PD in the wettest areas. We found a strong phylogenetic signal in the EFN traits we analysed, which explains the strong matching between patterns of FD and PD along the environmental gradients. The interactive effects of disturbance and rainfall revealed by our study indicate that the decreased rainfall forecast for Caatinga under climate change will increase the sensitivity of EFN-bearing plants to anthropogenic disturbance. This has important implications for the availability of a key food resource, which would likely have cascading effects on higher trophic levels.

[ARCHI - Development of a questionnaire on architecture of child and adolescent psychiatric facilities]. / ARCHI ­ Entwicklung eines Fragebogens zur Architektur kinder- und jugendpsychiatrischer Einrichtungen.

ARCHI - Development of a questionnaire on architecture of child and adolescent psychiatric facilities Abstract. Objective: Studies from various disciplines have pointed to a connection between the structural characteristics of hospitals, in particular psychiatric hospital wards, and various parameters in the recovery process of patients treated there. To date, however, no current studies have further investigated whether individual architectural aspects of clinical complexes are more relevant in everyday practice than others. Method: To link theory with practice in the context of this study, we developed a questionnaire to explore which architectural aspects in hospitals or utilities for child and adolescent psychiatry, psychosomatics, and psychotherapy are perceived by those working in therapy as helpful or detrimental to therapeutic treatment. We based the selection and development of several items on an extensive literary analysis and several expert rounds, and then analyzed and categorized the data acquired by those expert interviews conducted online according to Mayring. Results: The resulting categories demonstrate the aspects perceived as relevant to practice in everyday hospital life and thus form the basis for the 20 open and closed items of the questionnaire. Conclusion: The results of the expertise survey confirm the aspects found in the literature analyzed, including generosity of space, family orientation, age appropriateness, and positive atmosphere.

O uso do tempo de crianças no contexto urbano e ribeirinho na Amazônia / The use of children's time in the urban and riverside context in the Amazon / El uso del tiempo de los niños en el contexto urbano y ribereño de la Amazonía

O objetivo deste estudo foi verificar as diferenças no uso do tempo de crianças no contexto urbano e rural. Foram coletadas informações sobre o uso do tempo diário de 75 crianças (44 meninas e 31 meninos, entre cinco e 14 anos). Os instrumentos utilizados foram o Instrumento Sociodemográfico e Inventário de Rotinas. Os resultados evidenciaram diferenças estatisticamente significativas quanto ao uso do tempo, além de demonstrar diferenças contextuais entre população urbana e ribeirinha. No contexto ribeirinho, os participantes realizavam atividades como tarefas domésticas e conversa; no urbano, a categoria uso do computador sobressaiu-se. Destaca-se que os beneficiários têm importância considerável com relação à valorização da escolarização, o que pode estar relacionado às diferenças encontradas entre os beneficiários e não beneficiários. A existência de atividades citadas exclusivamente em alguns contextos permite inferir quais caminhos desenvolvimentais estão sendo seguidos por crianças moradoras de contextos culturais diferenciados.

The objective of this study was to verify the differences in the use of children's time in urban and rural contexts. Information was collected on the use of daily time of 75 children (44 girls and 31 boys, between 5 and 14 years). The instruments used were the Sociodemographic Instrument and Inventory of Routines. The results showed statistically significant differences regarding the use of time, besides showing contextual differences between urban and riverside population. In the riverside context the participants performed activities related to Housekeeping and Conversation, in comparison to the urban one in which the use category of the Computer stood out. It should be noted that the beneficiaries have considerable importance in relation to the valuation of schooling, which may be related to the differences found between beneficiaries and non-beneficiaries. The existence of activities cited exclusively in some contexts allows us to infer which developmental paths are being followed by children living in different cultural contexts.

El objetivo de este estudio fue verificar las diferencias en el uso del tiempo de los niños en el contexto urbano y rural. Se recogieron informaciones sobre el uso del tiempo diario de 75 niños (44 niñas y 31 niños, entre cinco y 14 años). Los instrumentos utilizados fueron el Instrumento Sociodemográfico e Inventario de Rutinas. Los resultados evidenciaron diferencias estadísticamente significativas en cuanto al uso del tiempo, además de mostrar diferencias contextuales entre población urbana y ribereña. En el contexto ribereño los participantes realizaban actividades relacionadas como Tareas Domésticas y Conversación, en comparación al urbano en que la categoría uso del Computador sobresalió. Se destaca que los beneficiarios tienen una importancia considerable con respecto a la valorización de la escolarización, lo que puede estar relacionado con las diferencias encontradas entre los beneficiarios y no beneficiarios. La existencia de actividades citadas exclusivamente en algunos contextos permite inferir qué caminos desarrollales están siendo seguidos por niños que viven de contextos culturales diferenciados.

The influence of Kinesio Taping on muscle fatigue in individuals with low back pain: A randomised controlled trial.

OBJECTIVE: To evaluate the effect of different taping techniques on back muscle fatigue in people with low back pain. METHODS: Sixty women with chronic non-specific low back pain were randomly assigned to four groups of 15 participants each: control (CG), Kinesio Taping (KT) with tension (KTT), KT no tension (KTNT) and Micropore® (MP), which were applied over the erector spinae muscles. The median frequency (MF) fatigue slopes of the longissimus muscle and sustained contraction time during a trunk fatigue test (Ito test), and pain using the numerical pain rating scale (NPRS) were collected at three time points: pre-treatment, three and ten days after intervention at a university laboratory. RESULTS: Significant differences were seen in the MF slopes between groups (p= 0.01, η2= 0.20), with the KTT showing a mean difference (MD = 0.31, p= 0.04) and KTNT (MD = 0.28, p= 0.04) compared with CG. Significant reductions in NPRS were seen between time points (p< 0.001, η2= 0.28), with a reduction between pre and 3 days (MD = 1.87, p< 0.001), and pre and 10 days (MD = 1.38, p< 0.001), with KTT and KTNT both showing clinically important changes. CONCLUSION: KT, with or without tension, has a tendency to reduce back muscle fatigue and reduce pain in individuals with chronic non-specific low back pain.