RESUMO
Background: Pre-school children use digital devices both at home and in kindergarten for communication. However, such technologies can also be used for creativity learning and entertainment. Technology usage might exert a negative impact on the psychosocial development of pre-school children, thus necessitating parental monitoring. Previous studies have recommended early intervention for pre-school children by decreasing the duration of digital devices, spending more time with the family, and participation in motor activities to avoid the ill effects of technology. Aim: To investigate the impact of digital device use on the behavioral and sleep scores of preschool children as perceived by parents in Saudi Arabia (SA). Method: This cross-sectional study was conducted across two regions in SA. It was ethically approved by the ethical review board of Imam Abdulrahman Bin Faisal University. The participants were randomly selected from well-baby hospital records, surveyed and interviewed to obtain data for the following measures: demographic data, technology usage, sleep disturbance scale, and behavior scale. Children with special needs or comorbidities were excluded from the study. Descriptive and multivariate regression analysis were done. Results: We recruited 288 children. Most did not attend schools (63.2%), 22.6% were in kindergarten, and 14.2% were in nursery schools. Smart phones were the most commonly used device by the children (42.4%). Most used the technology for 2-3 h/days (34%). Cartoons were the most commonly sought content (42%). The behavior scores for children aged 18-36 months showed a mean value of 5.1, 3.7, and 4.6 for surgency, negative affect, and effortful control, respectively. Children aged 3-5 years showed a mean value of 4.3, 4, and 4.7 for surgency, negative affect, and effortful control, respectively. Sleep disturbance scores for all children showed a mean value of 12.4, 3.5, 3.8, 8, 7.3, and 2.7 on disorders of initiating and maintaining sleep, sleep-breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence, and sleep hyperhidrosis, respectively. The mean total sleep score was 37. Multivariate regression analysis showed significant positive relationship between surgency and three factors namely family income of 10,000-15,000 SR (t = 1.924, p = 0.045), fathers' bachelor's degrees (t = 2.416, p = 0.16), and owning a video game device (t = 2.826, p = 0.005<0.05). Negative affect was significantly associated with fathers' diploma level of education (t = 2.042, p = 0.042). Negative significant relationship between effortful control and fathers' secondary level of education (t = -2.053, p = 0.041). There was a significant negative relationship between effortful control and owning a TV and video game device (t = -2.35, -2.855, p = 0.043, 0.005<0.05, respectively). A significant positive relationship was found between child's sleeping score (worse sleep) and watching technology between 3 and 5 h (t = 2.01, p = 0.045), and mothers' unemployment status (t = 2.468, p = 0.014). Conclusion: In conclusion, technology use is associated with a negative impact on children sleep and behavior. Owning a digital device, using tablets, screen viewing for more than 3-5 h, and watching movies were significantly associated with negative child's behavior and sleep.
RESUMO
BACKGROUND: Trifluoperazine is a long-established high potency typical antipsychotic drug used in the treatment of schizophrenia and schizophrenia-like illnesses. OBJECTIVES: To determine absolute effects of trifluoperazine for schizophrenia and schizophrenia-like illnesses compared with placebo.To critically appraise and summarise current evidence on the resource use, cost and economic evaluation of trifluoperazine compared with placebo for schizophrenia. SEARCH METHODS: Searches of the Cochrane Schizophrenia Group's register of trials (July 2012), supplemented with handsearching, reference searching, personal communication and contact with industry. Two review authors undertook a search for economic studies using the Cochrane Schizophrenia Group's Health Economic Database (CSzGHED) on the 9th April 2013. SELECTION CRITERIA: All available clinical randomised trials involving people with schizophrenia and schizophrenia-like illnesses that compare trifluoperazine with placebo. DATA COLLECTION AND ANALYSIS: Studies for the effects of interventions were reliably selected by a review team and data were doubly independently extracted to reduce bias. We only used dichotomous data, using intention-to-treat analysis when possible. Data were estimated using risk ratio (RR) with 95% confidence intervals (CI). A 'Summary of findings' table was produced, where possible, for each primary outcome using GRADE. Economic studies were searched and reliably selected by review authors (VF and SS) to provide an economic summary of available data. Where no relevant economic studies were eligible for inclusion, the economic review team valued the already-included effectiveness outcome data to provide a rudimentary economic summary. MAIN RESULTS: This review included 10 studies with a total number of 686 participants featuring in 20 different outcomes of interest. Overall, there was significant clinical improvement in clinical global state at medium term amongst people receiving trifluoperazine (3 RCTs, n = 417, RR 4.61, CI 1.54 to 13.84, low quality evidence) and significantly fewer people receiving trifluoperazine left the studies early due to relapse or worsening at medium term (2 RCTs, n = 381, RR 0.34, CI 0.23 to 0.49, low quality evidence). However, results were equivocal for leaving the study early at medium term for any reason (2 RCTs, n = 391, RR 0.80, CI 0.17 to 3.81, very low quality evidence) and due to severe adverse effects (2 RCTs, n = 391, RR 1.54, CI 0.56 to 4.24, very low quality evidence). Equivocal data were also found for intensified symptoms at medium term (2 RCTs, n = 80, RR 1.05, CI 0.54 to 2.05, very low quality evidence) and rates of agitation or distress again at medium term (1 RCT, n = 52, RR 2.00, CI 0.19 to 20.72, very low quality evidence). Comparison between low and high-dose trifluoperazine with placebo from a single study provided equivocal evidence of effects. For economic outcomes, we valued outcomes in GBP terms and presented them in additional tables; there was an estimated saving of £3488.3 in favour of trifluoperazine. However, numerous assumptions were made and these savings need to be interpreted in light of those assumptions. AUTHORS' CONCLUSIONS: Our results agree with existing evidence that compared to placebo, trifluoperazine is an effective antipsychotic for people with schizophrenia. Furthermore, our review provides supportive evidence that trifluoperazine increases the risk of extrapyramidal adverse effects. Although the effect sizes against placebo are similar to those observed with other agents, they are based on data from many small, pre-CONSORT trials with generally either a low or very low GRADE evidence that has limited implication for clinical practice. Large, independent trials are needed that adhere to the CONSORT statement to compare trifluoperazine with placebo used in the treatment of schizophrenia and schizophrenia-like illnesses.
