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1.
Int J Eat Disord ; 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32048754

RESUMO

OBJECTIVE: Eating disorders (EDs) are associated with decreased bone mineral density (BMD) and increased fracture risk. The association between BMD and fracture risk in EDs is not well elucidated. We aimed to assess BMD in an ED cohort of patients with active disease and patients in remission, and to assess the predictive value of BMD on incidence of fractures. METHOD: We included 344 female patients (median age 19, IQR 16; 24) referred to ED treatment. Later, patients were invited to follow-up including assessment of remission status and a dual-energy x-ray absorptiometry (DXA)-scan. Information on fractures was obtained through the Danish National Registry of Patients. RESULTS: Patients with current anorexia nervosa (AN) had significantly lower BMD compared to controls at lumbar spine (16% lower, p < .0001), femoral neck (18% lower, p < .0001), and total hip (23% lower, p < .0001). Recovered AN patients had higher BMD compared to those with current disease (p < .0001 for all measures), but lower BMD compared to controls at lumbar spine (p < .01) and hip (p < .001). BMD did not differ between BN patients and controls. In patients with active eating disorders not otherwise specified, BMD was lower only at the total hip (p < .005). We found no association between BMD and fracture risk. CONCLUSION: We confirm that AN is associated with low BMD, whereas BN is not. Remission is associated with higher BMD compared to patients with active AN, but a deficit remains. We found no significant association between BMD and fracture risk, challenging the benefit of the widespread use of DXA scans in young women with ED. CLINICAL TRIAL REGISTRATION: The study is registered in ClinicalTrials.gov, number NCT00267228.

2.
Int J Eat Disord ; 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31922277

RESUMO

OBJECTIVE: Malnutrition and low weight in eating disorders (EDs) are associated with increased fracture risk compared to the general population. In a cohort study, we aimed to determine fracture rates compared to age and gender matched controls (ratio 5:1), assess the impact of disease remission on fracture risk, and establish predictive factors for fractures. METHOD: Of note, 803 ED patients referred to specialized ED treatment between 1994 and 2004 were included. In 2016, data on fractures were obtained through the Danish National Registry of Patients. RESULTS: Fracture risk was increased in anorexia nervosa (AN; IRR 2.2 [CI 99%: 1.6-3.0]) but not in bulimia nervosa (BN; IRR 1.3, ns) or other specified feeding or eating disorders (OSFED; IRR 1.8, ns). IRR in the AN group were increased for vertebral fractures (IRR 3.8 [CI 99%: 1.4-10.3]), upper arm (IRR 3.0 (CI 99% 1.6-5.5) and hip (IRR 6.6 [CI 99%: 2.6-18.0]). Disease remission in AN is associated to lower fracture risk compared to active disease, but higher fracture risk compared to controls (IRR 1.7 [CI 99%: 1.1-2.7]). In regression analysis, age at debut of disease, nadir BMI and duration of disease before referral to treatment, independently predicted fracture. DISCUSSION: We confirm increased fracture risk in AN, and show significant differences in fracture risk between patients in disease remission and patients with active disease. Furthermore, we show that age at debut of disease and duration of disease before referral to treatment is positively correlated to fracture risk, whereas nadir BMI is negatively correlated to fracture risk.

3.
Cardiol Young ; : 1-8, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31928549

RESUMO

BACKGROUND: Children with complex CHD are at risk for psychopathology such as severe attention-deficit/hyperactivity disorder symptoms after congenital heart surgery. OBJECTIVE: The aim of this study was to investigate if children with Ventricular Septal Defect, Transposition of Great Arteries, or Tetralogy of Fallot have an increased occurrence of attention-deficit/hyperactivity disorder symptoms compared with the background population and to investigate differences between the three CHDs in terms of occurrence and appearance of attention-deficit/hyperactivity disorder symptoms. METHOD: A national register-based survey was conducted, including children aged 10-16 years with surgically corrected CHDs without genetic abnormalities and syndromes. The Attention-Deficit/Hyperactivity Disorder-Rating Scale questionnaires were filled in by parents and school teachers. RESULTS: In total, 159 out of 283 questionnaires were completed among children with CHDs and compared with age- and sex-matched controls. Children with CHDs had significantly increased inattention scores (p = 0.009) and total attention-deficit/hyperactivity disorder scores (p = 0.008) compared with controls. Post hoc analyses revealed that children with Tetralogy of Fallot had significantly higher inattention scores compared with children both with Ventricular Septal Defect (p = 0.043) and controls (p = 0.004). CONCLUSION: Attention-deficit/hyperactivity disorder symptoms and inattention symptoms were significantly more frequent among children aged 10-16 years with CHDs, in particular in children with corrected Tetralogy of Fallot.

4.
J Affect Disord ; 261: 58-66, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31600588

RESUMO

BACKGROUND: Postnatal depressive symptoms measured by the Edinburgh Postnatal Depression Scale (EPDS) are reported to display measurement variance regarding factor structure and the frequency of specific depressive symptoms. However, postnatal depressive symptoms measured by EPDS have not been compared between women representing three continents. METHODS: A cross-sectional study including birth cohort samples from Denmark, Vietnam and Tanzania. Women were included during pregnancy at routine care sites. Depressive symptoms were self-reported 40-90 days postpartum using the EPDS. Exploratory and confirmatory factor analyses and generalized additive regression models were performed. RESULTS: A total of N = 4,516 participated in the study (Denmark N = 2,069, Vietnam N = 1,278, Tanzania N = 1,169). Factor analyses identified three factors (anhedonia, anxiety and depression) that were almost identical in the three study populations. The only variation between countries was that the item 'self-harm' loaded differently. Women from Tanzania and Denmark were more likely to have an EPDS total score above cut-off 12 (12.6% and 6.4%), compared to women from Vietnam (1.9%) (p<0.001). A low level of education was associated with significantly more depressive symptoms after adjusting for country (p<0.001). LIMITATIONS: EPDS data was collected at a later time point in the Danish sample. CONCLUSIONS: Postnatal depressive symptoms constitute a three-factor model across cultures including the factors anhedonia, anxiety and depression. The frequency of postnatal depressive symptoms differs between high-, medium-, and low-income countries. However, clinicians should bear in mind that low-educated women worldwide are more likely to experience postnatal depressive symptoms.

5.
Dan Med J ; 66(6)2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31256773

RESUMO

INTRODUCTION: The Strengths and Difficulties Ques-tion-naire (SDQ) is a brief well-validated psychometric instrument for assessment of developmental, behavioural and emo-tional problems in children and adolescents. Versions of the questionnaire covering the 2-17-year age range are an-swered by parents and by pedagogues or teachers. Also, a self-report version can be used from the age of 11 years. The SDQ is well-accepted by informants and is increasingly preferred both internationally and in Denmark for research and evaluation purposes. The questionnaire is also well-suited for clinical use, especially in the primary sector. However, no comprehensive set of Danish norms has been available before this study. METHODS: Data from an extensive survey in a Danish municipality was used to generate national norms for SDQ scores. These norms were compared with British and Nordic population data. RESULTS: Across informants, threshold values show some variation with age and often differ between sexes. Therefore, norms are provided both with and without gender stratification. Similarities as well as differences were found between the Danish norms and materials from other countries. The differences may, to some extent, be attributable to methodological issues. CONCLUSION: We expect that the availability of Danish SDQ norms will further stimulate the use of the instrument. FUNDING: TrygFonden provided financial support for the development of Danish SDQ norms. TRIAL REGISTRATION: not relevant.


Assuntos
Sintomas Afetivos/diagnóstico , Sintomas Afetivos/epidemiologia , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/epidemiologia , Psicometria/estatística & dados numéricos , Inquéritos e Questionários , Adolescente , Sintomas Afetivos/psicologia , Criança , Transtornos do Comportamento Infantil/psicologia , Pré-Escolar , Dinamarca , Feminino , Humanos , Masculino , Valores de Referência , Autorrelato
6.
J Clin Med ; 8(6)2019 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-31212854

RESUMO

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with a complex symptomatology, and core symptoms as well as functional impairment often persist into adulthood. Recent investigations estimate the worldwide prevalence of ADHD in children and adolescents to be ~7%, which is a substantial increase compared to a decade ago. Conventional treatment most often includes pharmacotherapy with central nervous stimulants, but the number of non-responders and adverse effects call for treatment alternatives. Exercise has been suggested as a safe and low-cost adjunctive therapy for ADHD and is reported to be accompanied by positive effects on several aspects of cognitive functions in the general child population. Here we review existing evidence that exercise affects cognitive functions in children with and without ADHD and present likely neurophysiological mechanisms of action. We find well-described associations between physical activity and ADHD, as well as causal evidence in the form of small to moderate beneficial effects following acute aerobic exercise on executive functions in children with ADHD. Despite large heterogeneity, meta-analyses find small positive effects of exercise in population-based control (PBC) children, and our extracted effect sizes from long-term interventions suggest consistent positive effects in children and adolescents with ADHD. Paucity of studies probing the effect of different exercise parameters impedes finite conclusions in this regard. Large-scale clinical trials with appropriately timed exercise are needed. In summary, the existing preliminary evidence suggests that exercise can improve cognitive performance intimately linked to ADHD presentations in children with and without an ADHD diagnosis. Based on the findings from both PBC and ADHD children, we cautiously provide recommendations for parameters of exercise.

7.
Environ Res ; 176: 108533, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31229776

RESUMO

BACKGROUND: Pyrethroids and chlorpyrifos are widely used insecticides, but the potential impact of prenatal exposure on child neurodevelopment has only been addressed in few longitudinal studies. OBJECTIVES: To investigate associations between prenatal exposure to pyrethroids and chlorpyrifos and traits of ADHD in 2-4-year-old children. METHODS: Metabolites of chlorpyrifos and pyrethroids were measured in maternal urine collected at gestational week 28 among 1207 women from the Odense Child Cohort. Of these, 948 completed the Child Behavior Check List for ages 1.5-5 years (CBCL: 1½-5). Negative binomial and logistic regression models were used to estimate relative differences in ADHD problem scores (CBCL: 1½-5 subscale) expressed as the ratio of expected scores between exposure groups and the odds (OR) of scoring equal to or above the 90th percentile in relation to maternal urinary metabolite concentrations (continuous ln2-transformed or categorized into tertiles). The analyses were adjusted for maternal education level, parental psychiatric diagnosis, child age and sex. RESULTS: The chlorpyrifos metabolite, 3,5,6-trichloro-2-pyridinol (TCPY), the generic pyrethroid metabolite, 3-phenoxybenzoic acid (3-PBA), and the metabolite of trans-isomers of permethrin, cypermethrin, and cyfluthrin, trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (trans-DCCA), were detected in 90%, 94%, and 11%, respectively, of the urine samples. Each doubling in maternel 3-PBA concentration was associated with a 3% increase in the ADHD score (Ratio: 1.03 (95% CI: 1.00,1.07)) and a 13% higher odds of having a ADHD score ≥ the 90th percentile (OR: 1.13 (1.04,1.38)). Similar associations were seen for 3-PBA as categorical variable (p-trend=0.052 in negative binimoal regression, p-trend=0.007 in logistic regression). Furthermore, concurrent concentrations of 3-PBA and TCPY above their medians were associated with higher ADHD score (Ratio: 1.20 (1.04, 1.38)) and higher odds of scoring ≥ the 90th percentile (OR: 1.98 (1.26, 3.11)). Maternal trans-DCCA above the detection level increased the odds of ADHD symptoms (OR: 1.76 (1.08, 2.86)). The associations were not modified by sex. CONCLUSIONS: Prenatal exposure to pyrethroids was associated with ADHD related traits at 2-4 years of age. Considering the widespread use of pyrethroids these results are of concern.

8.
Environ Res ; 170: 398-405, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30623887

RESUMO

Bisphenol A (BPA) is a non-persistent chemical with endocrine disrupting abilities widely used in a variety of consumer products. The fetal brain is particularly sensitive to chemical exposures due to its rapid growth and complexity. Some studies have reported associationbetween maternal BPA exposure and behavior but few have assessed impact on cognitive development, and to our knowledge no studies have specifically assessed the impact on language development. We therefore assessed whether maternal urinary BPA concentration during pregnancy was associated with language development and attention-deficit and hyperactivity disorder (ADHD) symptoms in offspring aged 18-36 months in the prospective Odense Child Cohort. BPA was analyzed in 3rd trimester maternal fasting urine spot samples. Language development was addressed among 535 children using the Danish adaptation of the MacArthur-Bates Communicative Development Inventories at median age 21 months; ADHD traits were assessed by parents of 658 children using the Child Behavior Checklist for ages 1½-5 years at mean age 2.7 years. Associations were assessed using logistic regression models comparing children below the 15th percentile score for language and above the 85 percentiles score for ADHD with the other children while stratifying by sex and adjusting for maternal education, duration of breastfeeding and maternal urine phthalates. BPA was detected in 85.3% of the urine samples (median 1.2 ng/ml). Boys of mothers with BPA exposure in the highest tertile had an odds ratio of 3.70 (95% CI 1.34-10.21) of being in the lowest 15th percentile of vocabulary score compared to boys of mothers within the lowest tertile of BPA exposure after adjustment, whereas no association was found in girls. No clear dose-response relationship between maternal BPA and ADHD scores above the 85th percentile was found for either sex. Since early language development is a predictor of future reading skills and educational success, more epidemiological studies assessing BPA exposure and language skills are needed to confirm our findings.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Compostos Benzidrílicos , Exposição Ambiental/estatística & dados numéricos , Fenóis , Efeitos Tardios da Exposição Pré-Natal , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Desenvolvimento da Linguagem , Masculino , Gravidez , Estudos Prospectivos
9.
Psychol Rep ; 122(4): 1259-1296, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29958512

RESUMO

BACKGROUND: Research has pointed to secure attachment as a possible key factor of resilience in adulthood. OBJECTIVE: We aimed to investigate the role of secure attachment as a potential core feature in the properties of resilience. METHODS: We conducted a systematic review in accordance with PRISMA guidelines followed by a meta-analysis. RESULTS: Thirty-three studies were included in the review, and 10 of these, including 2305 subjects, were used for meta-analysis. The raw correlation coefficients ranged from .20 to .57, which indicated weak to moderate correlations between resilience and attachment. The synthesized correlation coefficients indicated that the correlations were significant and highly unlikely to be due to random variation. All studies are also reported on qualitatively. CONCLUSIONS: In both of our meta-analyses and in the narratively reported studies, we found that secure attachment is associated with the presence of resilience.


Assuntos
Apego ao Objeto , Resiliência Psicológica , Humanos
10.
J Clin Med ; 7(10)2018 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-30308952

RESUMO

Children with autism spectrum disorder (ASD) have a considerable use of psychotropics. Leveraging nationwide registry data, we aimed to describe the use of psychotropics among children and adolescents with ASD in Denmark. Use of melatonin and attention-deficit/hyperactivity disorder (ADHD) medication increased from 2010 to 2017, while there were limited changes in use of antidepressants and antipsychotics. Thirty percent of the identified children used psychotropics in 2017 most commonly ADHD medication (17%) and melatonin (13%). Methylphenidate, sertraline and risperidone were most often prescribed. Most children filled more than one prescription and, across drug classes, at least 38% received treatment two years after treatment initiation. Use of psychotropics followed psychiatric comorbidities. Comorbidities did not affect age at treatment initiation. Use of psychotropics varied according to age and sex with limited use in the youngest children. In summary, psychotropic drug use has increased in children with ASD mainly due to an increase in the use of ADHD medication and melatonin. In accordance with previous studies, use seems to follow comorbidities. The long treatment duration underlines the need to investigate long-term effects of psychotropic drug use in children with ASD.

11.
Autism Res ; 11(9): 1229-1238, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30265774

RESUMO

SEVERAL THEORIES HAVE ATTEMPTED TO CHARACTERISE AUTISM SPECTRUM DISORDERS (ASDS) AT THE COGNITIVE LEVEL, MOST NOTABLY: THEORY OF MIND (TOM), EXECUTIVE FUNCTION (EF), AND A LOCAL PROCESSING BIAS (LB). THE AIM OF THIS STUDY WAS TO INVESTIGATE HOW THESE COGNITIVE FUNCTIONS DEVELOP OVER TIME: The three cognitive domains (ToM, EF, and LB) were examined in a group of high-functioning children (age: 8-12, mean 10.85; IQ: 78-139, mean 105.48) with ASD and a matched group of children with neurotypical development (NTD) (IQ: 75-145, mean: 109.47), and several tasks were used within each domain to ensure the validity of the cognitive measures. Approximately 3 years later (mean age: 14.34), all children and their families were invited to participate in the follow-up (ASD, N = 21; NTD, N = 30). While the understanding of other's minds does improve from childhood to adolescence, ToM impairment persists in adolescents with ASD relative to their peers. Likewise, a development in EF was observed in the ASD group, while no significant improvement was seen in the NTD group, leading the ASD group to catch up in this domain. We did not detect any group differences at any time point regarding local bias processing (LB). Individual patterns of development were seen, but remarkably, ToM deficits were present in every child with ASD in whom we could detect any cognitive impairment at baseline, and a similar pattern was found at follow-up. These findings indicate that ToM is a persistent cognitive deficit in ASD. Autism Res 2018, 11: 1229-1238. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This was the first study to investigate the development of three well-known cognitive functions into adolescence: While the understanding of other's minds improves from childhood to adolescence, adolescents with ASD are still impaired relative to their peers. The EFs, however, seem to improve to a neurotypical level in ASD as children enter adolescence, while local processing bias seems to differentiate the groups only in early childhood.


Assuntos
Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/fisiopatologia , Disfunção Cognitiva/complicações , Disfunção Cognitiva/fisiopatologia , Adolescente , Fatores Etários , Criança , Função Executiva , Feminino , Seguimentos , Humanos , Masculino , Teoria da Mente
12.
Psychiatry Res ; 268: 419-425, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30130708

RESUMO

The Mood and Feelings Questionnaire (MFQ) was developed to measure depressive symptoms in children and adolescents. It includes a self-report and a parent-report part. This study set out to test the psychometric properties of the MFQ in a Danish population of children and adolescents.The study included a population-based sample of n = 992 individuals aged 9-17 years and n = 703 parents from five schools. The internal consistencies of both MFQ versions were excellent with high alpha coefficients. With few exceptions, correlation between items and the total score was moderate to high. Vegetative symptoms were among the lowest correlating items while cognitive symptoms were among the highest. Girls reported more depressive symptoms than boys, and reports from offspring indicated more depressive symptoms than reports from parents. There was no difference in depressive symptoms by respondents aged 9 to 11 compared to respondents aged 12 to 17 in schools where all pupils participated. However, in schools where pupils participated by choice, an increase in depressive symptoms by age was found. This study suggests that MFQ is reliable for evaluating depressive symptoms in a population of children and adolescents. Furthermore, it is of clinical relevance that parents tend to underreport depressive symptoms of their offspring.


Assuntos
Depressão/diagnóstico , Questionário de Saúde do Paciente , Testes Psicológicos/normas , Avaliação de Sintomas/normas , Adolescente , Afeto , Criança , Dinamarca , Depressão/psicologia , Emoções , Feminino , Humanos , Masculino , Pais/psicologia , Psicometria , Reprodutibilidade dos Testes , Autorrelato
13.
J Clin Endocrinol Metab ; 103(10): 3819-3827, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30060213

RESUMO

Background: Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism. In pregnancy, testosterone levels may be higher in women with PCOS compared with controls. Aims: To compare total testosterone (TT), free testosterone (FT), and sex hormone-binding globulin (SHBG) levels in third-trimester pregnant women with PCOS and controls and to establish reference ranges for TT, FT, and SHBG in PCOS and controls. Methods: The study was part of the prospective study, Odense Child Cohort. PCOS was diagnosed by questionnaires and/or patient records. Fasting blood samples were collected at gestational week 28 and plasma TT was measured by liquid chromatography-tandem mass spectrometry in women with PCOS (n = 145) and in women without PCOS (controls, n = 1341). Results: Levels of TT (mean, 2.4 vs 2.0 nmol/L) and FT (mean, 0.005 vs 0.004 nmol/L) were higher, whereas SHBG levels (mean, 447 vs 477 nmol/L) were lower in women with PCOS vs controls (all P < 0.001). Reference intervals for TT, FT, and SHBG in women with PCOS and controls were overlapping, and partitioning of reference intervals was an ambiguous decision. In multiple regression analyses, TT and FT levels were positively associated with PCOS status and BMI and inversely associated with age and parity. Offspring sex did not predict maternal TT and FT. Conclusions: TT and FT levels were higher in third-trimester pregnant women with PCOS compared with controls. Separate reference interval for FT in women with PCOS should be considered.


Assuntos
Biomarcadores/sangue , Análise Química do Sangue/normas , Síndrome do Ovário Policístico/sangue , Testosterona/sangue , Adulto , Androgênios/sangue , Estudos de Casos e Controles , Criança , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Síndrome do Ovário Policístico/fisiopatologia , Gravidez , Terceiro Trimestre da Gravidez , Prognóstico , Valores de Referência , Globulina de Ligação a Hormônio Sexual/análise
14.
Artigo em Inglês | MEDLINE | ID: mdl-29983736

RESUMO

Background: Relatively little is known about the role of maternal functioning in terms of attention deficit hyperactivity disorder (ADHD) symptoms, attachment style and resilience as predictive factors for treatment outcome when offspring are diagnosed with ADHD. Objective: To investigate whether maternal functioning is associated with treatment outcome in children with ADHD. Methods: The study formed part of a larger naturalistic observational study of children with ADHD. A battery of self-report measures was used to assess selected factors in maternal functioning at the point of referral (baseline data); adult ADHD-symptoms, adult attachment style and adult resilience. Associations between these domains and child treatment response were subsequently examined in a 1-year follow up. Results: Maternal ADHD-symptoms and degree of resilience were significantly correlated to symptom reduction in offspring diagnosed with ADHD. However, the association between maternal attachment style and child treatment response as measured by the ADHD-RS did not reach statistical significance. Conclusion: To our knowledge, this is the first study to consider potential protective factors along with risk factors in maternal functioning and the impact on child treatment outcome. The study contributes to our knowledge of the potential role of maternal functioning in treatment outcome for children with ADHD.

15.
Res Dev Disabil ; 78: 125-135, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29853334

RESUMO

BACKGROUND: ADHD is a debilitating disorder with symptoms often appearing in early childhood. To facilitate early identification, developmentally appropriate and validated assessment tools for the preschool-age are needed. AIMS: The current study aims to examine the psychometric properties of the ADHD Rating Scale (RS)-IV Preschool Version (-P) in a Danish community sample and provide national standardisation data. METHODS AND PROCEDURES: Parents (n = 916) and kindergarten teachers (n = 275) of preschool children, aged 3-5 years, completed the ADHD RS-IV-P. OUTCOMES AND RESULTS: Confirmatory factor analysis indicated that a three-factor model (inattention, hyperactivity, and impulsivity) best fit the data regardless of rater. Scales generally showed acceptable internal consistency, test-retest reliability, inter-rater reliability, and criterion validity. Boys received higher ratings on the ADHD RS-IV-P than girls and younger preschool children were rated as more inattentive than older preschool children. CONCLUSIONS AND IMPLICATIONS: Our findings support the reliability and validity of the ADHD RS-IV-P and a three-factor model of ADHD. However, high factor correlations and similarity in model fit suggest that more research is needed to clarify the organisation of ADHD symptoms in preschool children. Furthermore, the external validity of separate ADHD dimensions at this age should be examined.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Testes Psicológicos , Fatores Etários , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Pré-Escolar , Dinamarca , Análise Fatorial , Feminino , Humanos , Masculino , Pais , Psicometria , Reprodutibilidade dos Testes , Professores Escolares , Fatores Sexuais
16.
J Clin Endocrinol Metab ; 103(7): 2630-2639, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29788436

RESUMO

Context: Severe vitamin D deficiency may lead to myopathy in adults. Little is known about vitamin D and muscle strength in children. Objective: To test whether hand grip strength (HGS) in 5-year-old children is associated with serum 25-hydroxyvitamin D (S-25OHD). Design: Observational study in the population-based Odense Child Cohort, Denmark. At 5 years, anthropometrics, body fat percentage by skinfold measurements, HGS (n = 881), and S-25OHD2+3 (n = 499) were obtained. Results: Mean (SD) HGS was higher for boys compared with girls [8.76 (1.76) vs 8.1 (1.64) kg, P < 0.001]. Mean (SD) 5-year S-25OHD was 70.7 (24.5) nmol/L. HGS was directly associated with height in girls and with weight (directly) and body fat percentage (inversely) in both sexes (P < 0.01 for all). In girls, 5-year S-25OHD was associated with HGS, adjusting for height, weight, and body fat percentage [ß = 0.011 (95% CI: 0.004; 0.019), P = 0.003]. S-25OHD ≥75 nmol/L was associated with higher HGS compared with values <50 nmol/L [adjusted ß = 0.783 (95% CI: 0.325; 1.241), P = 0.001]. The odds of having myopathy (HGS <10th percentile) were reduced by approximately 70% for S-25OHD ≥50 vs <50 nmol/L [adjusted OR: 0.310 (95% CI: 0.126; 0.762), P = 0.011]. No associations were seen for boys. Pregnancy or umbilical cord S-25OHD did not associate with 5-year HGS. Conclusions: Five-year S-25OHD was independently associated with HGS and myopathy in girls but not in boys. Muscle strength may be dependent on vitamin D status even in the higher range in preschool girls. The sex difference remains unexplained.


Assuntos
Força da Mão , Doenças Musculares/etiologia , Deficiência de Vitamina D/complicações , Vitamina D/análogos & derivados , Pré-Escolar , Estudos de Coortes , Dinamarca , Feminino , Humanos , Masculino , Doenças Musculares/sangue , Estado Nutricional , Fatores Sexuais , Vitamina D/sangue , Deficiência de Vitamina D/sangue
17.
Eur Child Adolesc Psychiatry ; 27(12): 1563-1574, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29644473

RESUMO

Multicenter randomized clinical superiority single-blind trial investigated the effect of a computer training program targeting multiple cognitive functions. Seventy children with ADHD, aged 6-13, were randomized to intervention or control group. The intervention group used ACTIVATE™ for 8 weeks and both groups received treatment as usual and were assessed in regard to cognitive functions, symptoms, behavioral and functional outcome measures after 8, 12 and 24 weeks. There was no significant effect on the primary outcome, sustained attention (ß = - 0.047; CI - 0.247 to 0.153) or the secondary outcomes [parent-rated ADHD-RS, ß = - 0.037; CI (- 0.224 to 0.150); teacher-rated-ADHD-RS, ß = 0.093; CI (- 0.107 to 0.294); parent-rated-BRIEF, ß = - 0.119; CI (- 0.307 to 0.069); and teacher-rated-BRIEF, ß = 0.136; CI (- 0.048 to 0.322)]. This multicenter randomized clinical trial found no significant beneficial effects of cognitive training using the computer program ACTIVATE on the primary or secondary outcome measures in children with ADHD. Nevertheless, our study was likely underpowered to detect small to moderate changes.Trial registration ClinicalTrials.gov: NCT01752530, date of registration: December 10, 2012.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Atenção/fisiologia , Cognição/fisiologia , Terapia Cognitivo-Comportamental/métodos , Função Executiva/fisiologia , Terapia Assistida por Computador/métodos , Jogos de Vídeo , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança , Dinamarca , Feminino , Humanos , Masculino , Pais/psicologia , Método Simples-Cego , Resultado do Tratamento
18.
J Sleep Res ; 27(5): e12686, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29527757

RESUMO

This study investigated whether early signs of attention deficit hyperactivity disorder (ADHD) in toddlers aged 2-3 years are associated with disturbed sleep and activity levels. Participants were recruited from the Odense Child Cohort, and children scoring above the 93rd percentile on the ADHD scale of the Child Behaviour Checklist 1½-5 were categorised as cases and compared with age- and gender-matched normal-scoring controls. Daytime and nocturnal activity for 24 children with ADHD traits (cases) and 25 healthy controls was assessed through 7 days of actigraphy, and parents completed the Children's Sleep Habits Questionnaire (CSHQ) and the ADHD Rating Scale IV Preschool Version (ADHD-RS). Cases differed significantly on actigraphic parameters by having fewer minutes of moderate-to-vigorous physical activity (MVPA), prolonged total sleep time, fewer sleep interruptions, and increased night-to-night variability. A significant association was found between fewer minutes of MVPA and higher parent-reported motor activity on the ADHD-RS. Furthermore, increased night-to-night variability was significantly associated with higher total scores on both CSHQ and ADHD-RS. The findings show that early signs of ADHD are associated with an irregular sleep pattern and lower daytime activity, as illustrated by actigraphy. Studies investigating early ADHD risk factors could lead to a preschool ADHD risk index to help guide future early intervention.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtornos do Sono-Vigília/complicações , Estudos de Casos e Controles , Pré-Escolar , Feminino , Humanos , Masculino
19.
Neurotoxicol Teratol ; 65: 34-41, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29198963

RESUMO

BACKGROUND: Phthalates are a group of chemicals found in a variety of consumer products. They have anti-androgenic properties and human studies have reported associations between prenatal phthalate exposure and neuropsychological development in the offspring despite different cognitive tests, different ages and varying timing of exposure. OBJECTIVES: To investigate the association between prenatal phthalate exposure and language development in children aged 20-36months. METHODS: In the Odense Child Cohort, we analyzed 3rd trimester urine samples of 518 pregnant women for content of metabolites of diethyl, di-n-butyl, diisobutyl, butylbenzyl, di(2-ethylhexyl), and diisononyl phthalate, adjusted for osmolality. Language development was addressed using the Danish version of the MacArthur-Bates Communicative Development Inventories "Words and Sentences". Associations were assessed using logistic regression models comparing children below and above the 15th percentile while stratifying by sex and adjusting for maternal age and educational level. RESULTS: Phthalate metabolites were detectable in all samples although in lower levels than previous studies. Among boys, increased prenatal phthalate exposure was associated with lower scores in language development; odds ratios for vocabulary score below the 15th percentile with doubling in monoethyl phthalate, and summed di-(2-ethylhexyl) phthalate metabolites were respectively 1.24 (95% confidence interval: 1.05,1.46), and 1.33 (1.01,1.75). Similar associations were found for language complexity. No associations were found for girls. CONCLUSIONS: Our findings are notable, as adverse associations were suggested even in this low-level exposed population, with only one spot urine sample for exposure assessment and control for confounders. Lower scores in early language development are of relevance to health as this test predicts later educational success.


Assuntos
Poluentes Ambientais/toxicidade , Desenvolvimento da Linguagem , Exposição Materna/efeitos adversos , Ácidos Ftálicos/toxicidade , Efeitos Tardios da Exposição Pré-Natal/psicologia , Pré-Escolar , Estudos de Coortes , Dinamarca , Poluentes Ambientais/sangue , Poluentes Ambientais/urina , Feminino , Humanos , Masculino , Ácidos Ftálicos/sangue , Ácidos Ftálicos/urina , Gravidez , Efeitos Tardios da Exposição Pré-Natal/sangue , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/urina , Fatores Sexuais
20.
J Child Adolesc Psychopharmacol ; 27(10): 884-891, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28783382

RESUMO

OBJECTIVES: Mental illness is often accompanied by poor physical health and shorter life expectancy. Second-generation antipsychotics (SGAs) are suspected of increasing cardiovascular risk, possibly through development of metabolic syndrome (MetS), and the risk of adverse outcome is even higher if obesity or metabolic aberration starts in childhood or adolescence. METHODS: Drug-naive adolescents were recruited after contact with an outpatient Psychosis Team. Changes relative to baseline in body mass index (BMI), waist circumference (WC), blood pressure (BP), fasting blood glucose (FBG), triglycerides (TG), and high-density lipoprotein (HDL) cholesterol were determined through regular follow-ups. RESULTS: The sample included 35 SGA-naive patients aged 7-19 (mean: 15.5) with a diagnosis of psychosis. Over 12 months, the overall rate of MetS changed significantly (from 0% to 20% [p < 0.016]). There was a significant increase in BMI (18.4% [p < 0.001]), WC (14.3% [p < 0.001]), TG (25.2% [p = 0.039]), and FBG (3.6% [p = 0.038]), whereas there was a significant decrease in HDL (-11.5% [p < 0.001]). No significant change was found for BP. Compared with the 2014 Danish references BMI-for-age charts, after 12 months the participants' BMI had increased from 0.5 to 1.57 standard deviation (SD) above the 50th percentile for age and gender (p = 0.0001). CONCLUSION: To our knowledge, this is the first study to include all the aspects of MetS in a sample of drug-naive adolescents followed over the first 12 months after starting SGA treatment. A significant shift in all parameters (except BP) toward MetS was found, presumably due to SGA use. Therefore, these adolescents will need proper follow-up, consisting of not only monitoring but also preventive measures to diminish these effects of SGA use.


Assuntos
Antipsicóticos/efeitos adversos , Glicemia/efeitos dos fármacos , Índice de Massa Corporal , Transtornos Mentais/tratamento farmacológico , Síndrome Metabólica/induzido quimicamente , Adolescente , Glicemia/metabolismo , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/sangue , Transtornos Mentais/diagnóstico , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Obesidade/sangue , Obesidade/induzido quimicamente , Obesidade/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Circunferência da Cintura/efeitos dos fármacos , Circunferência da Cintura/fisiologia
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