Characteristics of sleep in socially vulnerable adolescents.

IMPORTANCE: This study may help understand the effects of an unfavorable environment in sleep quality of adolescents. OBJECTIVE: To investigate sleep quality in socially vulnerable adolescents, correlating the results with cognitive problems and attention deficit/hyperactivity disorder, and assessing the effectiveness of sleep hygiene and an educational intervention. DESIGN: Cross-sectional and interventional study. SETTING: an educational charitable center supported by a Catholic institution, in Porto Alegre, southern Brazil. PARTICIPANTS: 125 male and female high school students. INTERVENTIONS: As first step the subjects were administered specific questionnaires, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), followed by an educational activity that was combined with an unblinded, randomized interventional study. Next, a cross-sectional study was conducted to determine the influence of cognition and ADHD on the sleep. MAIN OUTCOME AND MEASURES: Sleep was evaluated using PSQI and ESS. Cognitive assessment was based on the Wechsler Abbreviated Scale of Intelligence and ADHD by a clinical interview the Multimodal Treatment Study for ADHD (MTA-SNAP-IV). RESULTS: The average duration of sleep per night were 6 h 30 m. 80% of the sample presented sleep complains. Of these, 44% had excessive daytime sleepiness and 69.6% had poor sleep quality related to use of electronic media, environmental violence, and emotional issues. There were no significant associations between sleep problems and cognitive problems or ADHD. Sleep quality improved in 17% of the 53 students with previous sleep complains who participated in any of the two interventions. CONCLUSIONS: A high prevalence of sleep deprivation and sleep complains was found in the study sample. The interventions showed some positive effects on the improvement of sleep quality.

Behavior and EEG concordance of active and quiet sleep in preterm very low birth weight and full-term neonates at matched conceptional age.

BACKGROUND: Sleep organization in neonates is an established predictor of neurological outcome and can be evaluated through the concordance between EEG and behavioral parameters. AIMS: To evaluate the correlation between sleep stages and behavioral states in neonates. STUDY DESIGN: Longitudinal study performed in a birth-cohort of preterm low birth weight neonates. SUBJECTS: Twenty five neonates, 15 preterm (gestational age between 27 and 33 weeks) and low birth weight (800-1500g) and 10 full-term neonates that served as controls. MEASURES: All neonates were submitted to video-electroencephalography of, at least, 60 minute duration. The preterm during the first 15 days of life and, subsequently, at 38-42 weeks of conceptional age. The full-term between the 1st and 2nd days of life. The characterization of sleep stages by EEG parameters and behavioral states (based on Prechtl scale) was performed independently by previously trained researchers. RESULTS: Active sleep (AS) was the predominant sleep stage in the three groups. Preterm neonates had an increase in concordance between state 1 and quiet sleep (QS) from the 1st to the 2nd EEG (p<0.001), however in both observations it remained inferior when compared to state 2 and AS (p<0.001). Concordance between AS and state 2 was similar (p=0.567). CONCLUSIONS: Concordance between EEG and behavior is lower in QS in preterm and full-term neonates when compared to AS. Extra-uterine development of preterm neonates seems to accelerate concordance in QS. Prechtl behavior scale proved to be useful in preterm as percentage of concordance was similar in AS in the groups studied.

Consulta ginecológica da criança e do adolescente / Gynecological appointments of children and adolescents

Exame das mamas e inspeção externa da genitália devem ser considerados componentes essenciais na visita de supervisão para a saúde regular do adolescente e meninas pelo pediatra. A anamnese ginecológica inclui questões relativas ao examinador e ao paciente. Alguns achados no exame da genitália externa incluem: fusão dos lábios, hímem imperfurado, sinais de trauma e vulvovaginites. Este artigo tem como objetivo revisar estes sintomas e sinais e seus tratamentos específicos.