As transformações psíquicas através do Rorschach: Juan, um adolescente e não um Don Juan! / Las transformaciones psíquicas en el Rorschach: Juan, un adolescente y no un Don Juan! / Psychic transformations through the Rorschach: Juan, an adolescent not a Don Juan!

RESUMO A adolescência é uma fase do desenvolvimento que se caracteriza pela presença de importantes transformações psíquicas que constituem a base dos processos de identidade e de identificação. No contexto social atual, a capacidade de integrar as diferenças culturais é um imperativo do ponto de vista social e emocional, não só para os adolescentes, mas para todos os que com eles se relacionam, sejam pais, professores e técnicos de saúde. Neste artigo, a autora procura realizar uma dupla análise: (1) Apresentar o trabalho psicoterapêutico realizado com Juan, um adolescente de 17 anos, durante o qual é possível observar as mudanças inerentes à construção da sua identidade e dos processos de identificação, inspirando-se num clássico literário espanhol, Don Juan; (2) A utilização do Rorschach, como instrumento de acesso privilegiado ao mundo interior do sujeito, que permite uma compreensão singular das transformações psíquicas presentes no processo de tornar-se adolescente. A utilização do Rorschach desta forma é uma abordagem inovadora para compreender os processos psíquicos envolvidos, melhorando a intervenção na clínica. No caso de Juan, foi possível ver além do seu diagnóstico clínico, lançando novos olhares sobre as suas capacidades psíquicas, favorecendo a construção de uma postura mais adulta, visível no seu desempenho académico, nas relações interpessoais e na dinâmica familiar. Esse trabalho clínico só foi possível graças aos referenciais teóricos que enfatizam os processos de comunicação e de simbolização.

RESUMEN. La adolescencia es un periodo de desarrollo que se caracteriza por la presencia de importantes transformaciones que están en la base de los procesos de identidad y de identificación. En el contexto social actual, la capacidad de integrar las diferencias culturales es un imperativo desde el punto de vista social y emocional, no solo para los adolescentes, sino para cualquier persona que tenga relación con ellos, ya sean padres, docentes y técnicos de salud. En este artículo, el autor busca realizar un doble análisis: (1) Presentar el trabajo psicoterapéutico realizado con Juan, un adolescente de 17 años, durante el cual es posible observar los cambios inherentes a la construcción de su identidad e identificación, presentada aquí con inspiración de un clásico literario español, Don Juan; (2) El empleo de la prueba de Rorschach, como instrumento de acceso privilegiado al mundo interior del sujeto, que permite una comprensión singular de las transformaciones psíquicas implicadas en el proceso de convertirse en adolescente. La utilización del Rorschach de esta manera es un enfoque innovador para comprender los procesos psíquicos involucrados, mejorando así la intervención clínica. En el caso de Juan, fue posible mirar más allá de su diagnóstico clínico, permitiendo que esta nueva lectura resalte sus habilidades psíquicas, favoreciendo la construcción de un nuevo posicionamiento, visible en su éxito académico, en las relaciones interpersonales y en su dinámica familiar. Este trabajo clínico solo fue posible dado el nuevo marco teórico que enfatiza los procesos de comunicación y simbolización.

ABSTRACT Adolescence is a stage of development that is characterized by the presence of important psychic transformations that form the base of the processes of identity and identification. In the current social context, the ability to integrate cultural differences is an imperative from a social and emotional standpoint, not only for adolescents, but anyone who has a relationship with them, be they parents, teachers and health technicians. In this article, the author seeks to carry out two-fold analysis: (1) Present the psychotherapeutic work conducted with Juan, a 17-year-old adolescent, during which it is possible to observe the changes inherent to the construction of his identity and identification, presented here with inspiration from a Spanish literary classic, Don Juan; (2) The employment of the Rorschach test, as an instrument granting privileged access to the subject's inner world, which allows for a singular understanding of the psychic transformations involved in the process of becoming an adolescent. Applying a Rorschach test in this fashion is an innovative approach to understanding the psychic underpinnings involved, thereby enhancing clinical intervention. In Juan's case, it was possible to look beyond his clinical diagnosis, shedding new light on his psychic abilities, favoring the construction of a new position, one more adult and one evidenced in improved academic performance, interpersonal relationships, and family dynamics. This clinical work was further enabled by theoretical frameworks that emphasize the processes of communication and symbolization.

Saúde e queixa escolar: registros de conserv(ação) na conduta de psicólogos / Salud y queja escolar: registros de conserv(acción) en la conducta de los psicólogos / Health and school complaint: records of conserv(action) in the conduct of psychologists

RESUMO. Este artigo expõe a temática da conduta de profissionais da psicologia no campo da saúde, diante das demandas escolares. Resulta de uma pesquisa de Mestrado, cujo objetivo principal foi, com base na Psicologia Histórico-Cultural, identificar de que forma as práticas contemporâneas da psicologia na saúde explicitam a concepção dos profissionais ante os encaminhamentos e a função da escola para a constituição da subjetividade. Para tanto, foram analisados prontuários de crianças e adolescentes entre quatro e dezessete anos, encaminhados por queixa escolar a dois serviços públicos de saúde em um município de pequeno porte do interior paulista, durante o biênio 2014-2015, e efetivadas entrevistas com as/os psicólogas/os responsáveis nos diferentes serviços. Os resultados indicaram que a atividade da/o psicóloga/o, ao receber a demanda escolar, encontra-se pouco alterada em relação às condutas que vêm sendo adotadas no país, desde os anos de 1990. As práticas aderidas consistem, em grande maioria, no atendimento clínico individual ou grupal, que não envolve o ambiente escolar. Também se mantém o perfil das crianças encaminhadas e, no contexto da ciência psicológica aplicada à saúde, um distanciamento quanto ao conhecimento das implicações da educação escolar para a aprendizagem e o desenvolvimento humano, tanto quanto a importância do acesso aos bens culturais humanos, o que pode ser decisivo para as circunstâncias e para a qualidade do processo de humanização.

RESUMEN. Este artículo expone el tema de la conducta de los profesionales de la psicología en el campo de la salud, delante de las demandas escolares. Es el resultado de una investigación de maestría, cuyo objetivo principal era, basado en la psicología histórico-cultural, identificar cómo las prácticas contemporáneas de psicologia, en la salud, hacen explícito la concepción de los profesionales delante de las derivaciones y el papel de la escuela para el constitución de subjetividad. Con este fin, se analizaron los registros de salud de niños y adolescentes entre cuatro y diecisiete años, reenviados por queja escolar a dos servicios de salud pública en una pequeña ciudad del interior de São Paulo, durante el bienio 2014-2015, y efectivadas entrevistas con los psicólogos responsables em los diferentes servicios. Los resultados indicaron que la actividad del psicólogo, al recibir la demanda escolar, cambia poco en relación a las conductas que se han adoptado en el país, desde la década de los noventa. Las prácticas adheridas consisten, en su gran mayoría, en el cuidado clínico individual o grupal, que no involucra el ambiente escolar. El perfil de los niños referidos también se mantiene y, en el contexto de la ciencia psicológica aplicada a la salud, una distancia en cuanto al conocimiento de las implicaciones de la educación escolar para el aprendizaje y el desarrollo humano, así como la importancia del acceso a los bienes culturales humanos, que puede ser decisivo para las circunstancias y la calidad del proceso de humanización.

ABSTRACT. This article exposes the theme of the conduct of psychology professionals in the field of health, in view of school demands. It results from a Master's research, mainly aimed to, based on Historical-Cultural Psychology, identify how contemporary Psychology practices in health may explain the professionals' understanding about the referrals and the role of the school in building subjectivity. To this end, medical records of children and adolescents of four to seventeen years old were analyzed. Participants had been referred due to school complaint to two public healthcare services in a small municipality in São Paulo, in the biennium 2014-2015, and participated in interviews with the responsible psychologists in the services. The results indicated that the psychologist's activity when receiving the school demand has changed a little in relation to the conducts being adopted in the country since the 1990s. The practices adopted mainly consist in individual or group clinical care, disregarding the school environment. The profile of the children referred is also maintained and, in the context of psychological science applied to health, there is a distancing regarding the knowledge of the implications of school education on human learning and development, as well as the importance of accessing human cultural assets. This could be decisive for the circumstances and the quality of the humanization process.

Sleep improvements on days with later school starts persist after 1 year in a flexible start system.

Early school times fundamentally clash with the late sleep of teenagers. This mismatch results in chronic sleep deprivation posing acute and long-term health risks and impairing students' learning. Despite immediate short-term benefits for sleep, the long-term effects of later starts remain unresolved. In a pre-post design over 1 year, we studied a unique flexible school start system, in which 10-12th grade students chose daily between an 8:00 or 8:50AM-start. Missed study time (8:00-8:50) was compensated for during gap periods or after classes. Based on 2 waves (6-9 weeks of sleep diary each), we found that students maintained their ~ 1-h-sleep gain on later days, longitudinally (n = 28) and cross-sectionally (n = 79). This gain was independent of chronotype and frequency of later starts but attenuated for boys after 1 year. Students showed persistently better sleep quality and reduced alarm-driven waking and reported psychological benefits (n = 93) like improved motivation, concentration, and study quality on later days. Nonetheless, students chose later starts only infrequently (median 2 days/week), precluding detectable sleep extensions in the flexible system overall. Reasons for not choosing late starts were the need to make up lost study time, preference for extra study time and transport issues. Whether flexible systems constitute an appealing alternative to fixed delays given possible circadian and psychological advantages warrants further investigation.

Tracking of physical activity and sedentary behavior of adolescents in different domains

This study aimed to verify the tracking of physical activity and sedentary behavior in different domains during adolescence. This longitudinal study involved 265 subjects (boys: 52.8%) with an initial mean age of 13.9 (± 1.2) years. Physical activity and sedentary behavior were verified using a questionnaire. The achievement of ≥ 150 min. week-1of moderate-to-vigorous intensity sport and/or physical exercise for ≥ 1 month was adoptedas sufficiently active. The data were collected on 2 occasions, with an average interval of 3 years. The description of the results used the relative frequency and Binary Logistic Regression was used to estimate the crude and adjusted odds ratios (95% confidence intervals). Current physical activity (adjusted odds ratios = 3.05; 95% confidence intervals: 1.77 -5.26) and sedentary behavior (adjusted odds ratios = 1.81; 95% confidence intervals: 1.03 -3.19) appear to be significantly influenced by previousbehavior, except for light-intensity physical activity. Only 12.8% of the participants remained sufficiently active for sport and/or physical exercise. Practice for at least one month of sport and/or physical exercise at baseline was a predictor of practice in the follow-up, both considering participation for at least one month (adjusted odds ratios = 2.81; 95% confidence intervals: 1.37 -5.79) and for four months (adjusted odds ratios = 2.47; 95% confidence intervals: 1.17 -5.24) in the follow-up. Beingsufficiently active at baseline increased the chance of being sufficiently active in the follow-up during adolescence. Interventions providing sufficient sport and/or physical exercise could positively influence the chances of practice in the future. For light-intensity physical activity interventions, strategies targeting adherence seem especially relevant.

Patrones de actividad física y comportamiento sedentario en adolescentes de 13 a 15 años en Paraguay / Patterns of physical activity and sedentary behaviors in adolescents aged 13 to 15 in Paraguay

Introducción: La actividad física insuficiente es uno de los principales problemas de salud pública a nivel global. Los patrones de conducta en los adolescentes, y el estilo de vida, podrían afectar su salud física y mental. Objetivos: El objetivo de este estudio fue conocer los patrones de actividad física y los comportamientos sedentarios en la población de adolescentes a nivel nacional. Materiales y métodos: Estudio cuantitativo, observacional, descriptivo de corte transverso, se aplicó el cuestionario de la Encuesta Global de Salud Escolar en adolescentes escolares del octavo y noveno grados del 3° ciclo de la Educación Escolar Básica y al 1°, 2° y 3° cursos de la Educación Media de 49 escuelas y colegios del país. En este estudio fueron incluidos 1.803 estudiantes de edades comprendidas entre 13 a 15 años. Resultados: El 27% de los adolescentes de 13 a 15 años de Paraguay son activos, siendo significativamente mayor en hombres que en mujeres (p-valor 0,000) y el 22% son inactivos con mayor frecuencia en mujeres que en hombres (p-valor 0,000). Se observo que el 33,5% de los adolescentes tenían comportamiento sedentario, el 43,4% de los adolescentes no utilizo el desplazamiento activo para asistir a la escuela. Los adolescentes que no participaron de las clases de educación física en la escuela representaron el15,6%. Conclusión: Si bien en un 27% los adolescentes de 13 a 15 años son activos, es preocupante el gran porcentaje de adolescentes inactivos y con comportamiento sedentario.

Introduction: Insufficient physical activity is one of the main public health problems globally. Teen behavior patterns and lifestyle may affect their physical and mental health. Objectives: The objective of this study was to know the patterns of physical activity and sedentary behaviors in the adolescent population nationwide. Materials and methods: A quantitative, observational, descriptive cross-sectional study, the questionnaire of the Global School Health Survey was applied in school adolescents of the eighth and ninth grades of the 3rd cycle of Basic School Education and the 1st, 2nd and 3rd year of Secondary Education in 49 schools and colleges in the country. 1,803 students aged 13 to 15 years were included in this study. Results: 27% of adolescents between the ages of 13 and 15 in Paraguay are active, being significantly higher in men than in women (p-value 0.000) and 22% are inactive more frequently in women than in men (p-value 0.000). It was observed that 33.5% of the adolescents had sedentary behavior, 43.4% of the adolescents did not use active displacement to attend school. Adolescents who did not participate in physical education classes at school accounted for 15.6%. Conclusion: Although 27% of adolescents between the ages of 13 and 15 are active, the large percentage of inactive adolescents with sedentary behavior is worrying.

Composição corporal de adolescentes pós-púberes avaliada pela absortometria radiológica de dupla energia e relações com a idade cronológica / Body composition in post-pubertal adolescents measured by dual-energy x-ray absorptiometry and relationship with chronological age

O objetivo do estudo foi analisar a composição corporal com utilização do DXA e correlacioná-la com a idade cronológica em adolescentes pós-púberes, de ambos os sexos. Participaram da pesquisa 46 adolescentes em fase pós-puberal, sendo 27 meninas (17,23±0,98) e 19 meninos (17,65±0,74) de ensino médio de uma escola estadual da Zona Sul da cidade do Rio de Janeiro. Foram realizadas uma anamnese, avaliação antropométrica e o DXA para avaliações. O teste U de Mann Whitney e o coeficiente de correlação de Spearman foram utilizados, adotando P<0,05 para significância. Verificou-se que as meninas apresentam composição corporal diferentedos meninos (P<0,05) e que com o aumento da idade elas tendem a diminuir o percentual de gordura, embora tenha sido observado um quantitativo alto de meninas com percentual de gordura elevado. Os meninos apresentaram uma tendência de aumento do percentual de gordura e da massa magra com o aumento da idade. As medidas de conteúdo e densidade mineral ósseo dentro da normalidade, com tendência de aumento com o avanço da idade cronológica. Conclui-se que os grupos masculino e feminino apresentaram comportamentos diferenciados quanto à composição corporal e os valores apresentados trazem mais um complemento à literatura a respeito de referências para a composição corporal, obtida com o DXA, em adolescentes pós-púberes.

The purpose of this study was to analyze body composition using DXA and correlate it with chronological age in post-pubertal adolescents of both genders. A total of 46 adolescents participated in the study, of which 27 were girls (17.23±0.98) and 19 boys (17.65±0.74) from a state school in the South District in the city of Rio de Janeiro. An anamnesis, anthropometric evaluation and DXA were performed for evaluations. The Mann-Whitney U test and the Spearman correlation coefficient were used, adopting P <0.05 for significance. Girls were found to have a different body composition than boys (P <0.05) and that, with increasing age, they tended to present a decrease in fat percentage, although in general a high number of girls presented a high fat level. The boys presented a tendency to increase the percentage of fat and lean mass with the increase of the age. Measurements of bone mineral content and density were considered as being within normality, with a tendency to increase with the advancing of the chronological age. Girls and boys present a different behavior regarding body composition and the values presented in this study bring an addition to the literature regarding body composition references through DXA in post-pubertal adolescents.

Nicotine Exposure during Adolescence Leads to Changes of Synaptic Plasticity and Intrinsic Excitability of Mice Insular Pyramidal Cells at Later Life.

To find satisfactory treatment for nicotine addiction, synaptic and cellular mechanisms should be investigated comprehensively. Synaptic transmission, plasticity and intrinsic excitability in various brain regions are known to be altered by acute nicotine exposure. However, it has not been addressed whether and how nicotine exposure during adolescence alters these synaptic events and intrinsic excitability in the insular cortex in adulthood. To address this question, we performed whole-cell patch-clamp recordings to examine the effects of adolescent nicotine exposure on synaptic transmission, plasticity and intrinsic excitability in layer V pyramidal neurons (PNs) of the mice insular cortex five weeks after the treatment. We found that excitatory synaptic transmission and potentiation were enhanced in these neurons. Following adolescent nicotine exposure, insular layer V PNs displayed enhanced intrinsic excitability, which was reflected in changes in relationship between current strength and spike number, inter-spike interval, spike current threshold and refractory period. In addition, spike-timing precision evaluated by standard deviation of spike timing was decreased following nicotine exposure. Our data indicate that adolescent nicotine exposure enhances synaptic transmission, plasticity and intrinsic excitability in layer V PNs of the mice insular cortex at later life, which might contribute to severe nicotine dependence in adulthood.

Ira y cyberbullying entre adolescentes: amistad, injusticia e imagen en entornos digitales / Ira e cyberbullying entre adolescentes: amizade, injustiça e imagem em ambientes digitais / Anger and cyberbullying among adolescents: friendship, injustice and image in digital environments

RESUMEN. El cyberbullying es un problema creciente, sobre todo entre la población adolescente. Este fenómeno amerita investigación científica que apunte a explicarlo en el mayor número de aspectos posibles, incluyendo las emociones. En este marco, la presente investigación se ocupa de analizar la ira en adolescentes involucrados en situaciones de cyberbullying. Se realizó un estudio con diseño cualitativo y método fenomenológico-hermenéutico, en el que se entrevistaron 31 adolescentes entre los 12 y 17 años de edad, implicados en situaciones de cyberbullying en los roles de víctimas o espectadores. Las víctimas de ciberacoso sienten ira, especialmente, cuando las agresiones provienen de parte de personas a quienes consideraban sus amigos. Esta emoción se experimenta junto con otros afectos como la tristeza y la vergüenza. Para los espectadores, la ira está asociada a situaciones de injusticia y a la percepción de que los agresores no tienen empatía hacia las víctimas. Los adolescentes reconocen los efectos negativos que el cyberbullying tiene sobre la imagen de las personas en entornos digitales. Comprender el lugar que ocupan las emociones en las agresiones mediadas por TIC es fundamental para generar conocimiento que sirva de base para el diseño e implementación de programas de intervención psicosocial del ciberacoso, y promover espacios de reflexión sobre de lo que significa la intimidad, la amistad y la confianza en la era digital.

RESUMO. O cyberbullying é um problema crescente, especialmente entre a população adolescente. Esse fenômeno merece pesquisas científicas que visam explicá-lo no maior número possível de aspectos, incluindo emoções. Dentro dessa estrutura, a presente investigação se preocupa em analisar a raiva em adolescentes envolvidos em situações de cyberbullying. Foi realizado um estudo com desenho qualitativo e método fenomenológico-hermenêutico, no qual foram entrevistados 31 adolescentes entre 12 e 17 anos de idade, envolvidos em situações de cyberbullying no papel de vítimas ou espectadores. As vítimas do cyberbullying sentem raiva, principalmente quando os ataques são de pessoas que consideram amigas. Essa emoção é experimentada junto com outros afetos, como tristeza e vergonha. Para os espectadores, a raiva está associada a situações de injustiça e à percepção de que os agressores não têm empatia pelas vítimas. Os adolescentes reconhecem os efeitos negativos que o cyberbullying tem sobre a imagem das pessoas em ambientes digitais. Compreender o lugar que as emoções ocupam nas agressões mediadas pelas TIC é essencial para gerar conhecimento que serve de base para o desenho e implementação de programas de intervenção psicossocial do cyberbullying e promover espaços de reflexão sobre o que significa intimidade, amizade e confie na era digital.

ABSTRACT. Cyberbullying is a growing problem, especially among the adolescent population. This phenomenon warrants scientific research that aims to explain it in as many aspects as possible, including emotions. In this context, this research deals with the analysis of anger in adolescents involved in cyberbullying situations. A study with qualitative design and the phenomenological-hermeneutic method was conducted, in which 31 adolescents between the ages of 12 and 17 were interviewed, involved in cyberbullying situations in the roles of victims or bystanders. Victims of cyberbullying feel angry, especially when the assaults come from people they considered their friends. This emotion is experienced along with other affections such as sadness and shame. For bystanders, anger is associated with situations of injustice and the perception that aggressors have no empathy for the victims. Adolescents recognize the negative effects that cyberbullying has on people's image in digital environments. Understanding the place of emotions in ICT-mediated aggressions is essential to generate knowledge that serves as the basis for the design and implementation of psychosocial intervention programs in cyberbullying, and to promote spaces for reflection on what intimacy, friendship, and trust mean in the digital age.

Efeitos da prática da natação sobre fatores de risco cardiovascular e aptidão física em crianças e adolescentes eutróficos e com excesso de peso / Effects of swimming on cardiovascular risk factors and physical fitness in obese and non-obese children and adolescents

Este estudo avaliou o efeito da prática de natação sobre fatores de risco cardiovascular, tradicionais e não tradicionais, e aptidão física em crianças e adolescentes em idade escolar, com e sem excesso de peso. Ao todo, 49 crianças e adolescentes entre 8 e 15 anos de idade (26 meninas) foram recrutados e submetidos a avaliações clínicas, antropométricas, laboratoriais (metabolismo energético e inflamatório), dos níveis de atividade física, aptidão cardiorrespiratória e modulação autonômica, antes e após 3, 6 e 12 meses de intervenção com prática de natação. A distribuição da gordura abdominal e espessura da camada íntima média das carótidas foram avaliadas por ultrassonografia. A função endotelial foi avaliada por meio da tonometria arterial periférica e pletismografia de oclusão venosa. A prática de natação consistiu em sessões de 50 min, realizadas duas vezes por semana, incluindo exercícios aquáticos de adaptação, flutuação, respiração e deslocamento, além das técnicas dos quatro estilos de natação. O acompanhamento ambulatorial consistiu em quatro consultas clínicas e de orientação nutricional. Os participantes foram classificados em grupos de acordo com a intervenção e o Z-escore do índice de massa corporal (Z-IMC): natação eutrófico (NEU: n = 14); natação excesso de peso (NEP: n = 20); sedentário excesso de peso (SEP: n = 15), além dos subgrupos: natação obeso (NOB: n = 10) e sedentário obeso (SOB: n = 11). Após seis meses, reduções significativas (p < 0,05) ocorreram em NEP para relação cintura/estatura (~5 %); em NOB para Z-IMC (~5 %), pressão arterial sistólica (~11 %) e diastólica (~10 %); e em NEU para pressão arterial sistólica (~6 %). Aumentos significativos (p < 0,05) ocorreram em NEP para os níveis de atividade física (~40%), distância percorrida no teste de Yoyo (~28%), intervalos RR (~7%) e modulação vagal (~19%); em NOB para o índice de hiperemia reativa (~33%). Após a intervenção, a insulinemia de NEP, que era maior em comparação a NEU na linha de base, passou a ser similar. O HDL-colesterol foi maior entre grupos com excesso de peso que praticaram natação vs. sedentários (p = 0,01). Após 12 meses de prática da natação, NOB apresentou redução significativa (p < 0,05) dos níveis de leptina (~7%) e TNFα (~15%). A quantidade de gordura intra-abdominal de NEP aproximou-se dos valores exibidos pelos eutróficos ao fim do experimento, enquanto diferenças na linha de base na espessura da carótida esquerda (maior em NEP vs. SEP) desapareceram. Conclui-se que a prática regular de natação é benéfica à saúde cardiovascular e eficaz para melhorar a composição corporal, aptidão cardiorrespiratória, modulação autonômica, pressão arterial, perfil lipídico e inflamatório de crianças e adolescentes com sobrepeso e obesidade.

This study evaluated the effect of swimming practice on cardiovascular risk factors and physical fitness in obese and non obese school age children and adolescents. A group of 49 children aged 8-15 years (26 girls) underwent anthropometric, physical activity, cardiorespiratory fitness, autonomic modulation, and laboratory (energy and inflammatory metabolism) assessments before and after 3, 6 and 12 months of swimming intervention. Abdominal fat distribution and carotid intima media thickness were evaluated by ultrasound. Endothelial function was assessed through peripheral arterial tonometry and venous occlusion plethysmography. Swimming consisted of 50-min sessions performed twice a week, including aquatic adaptation, fluctuation, breathing and displacement exercises, in addition to techniques of the four swimming styles. Outpatient follow-up consisted of four clinical consultations and nutritional counseling. Participants were classified according to intervention and z- score of body mass index (Z-BMI): eutrophic swimming (EUS: n = 14); overweight swimming (OVS: n = 20); and sedentary overweight (SEOV: n = 15), in addition to the following subgroups: obese swimming (OBS: n = 10); sedentary obese (SEOB: n = 11). After 6 months, significant reductions (p <0.05) occurred in OVS for waist to height ratio (~ 5%); OBS for Z-BMI (~5%), systolic (~11%) and diastolic (~10%) blood pressure; and in EUS for systolic (~6%). Significant increases (p <0.05) occurred in OVS for the levels of physical activity (~40%), distance covered in the Yoyo test (~28%), RR intervals (~7%) and vagal tone (~19%); and in OBS for the reactive hyperemia index (~33%). After the intervention, OVS exhibited similar insulinemia to EUS, contrarily to the greater values at baseline. The HDL-colesterol was higher among overweight group who practiced swimming vs. sedentary counterparts (p = 0.01). After 12 months of swimming, OBS showed significant reductions (p <0.05) in leptin (~7%) and TNFα (~15%). The amount of intra-abdominal fat in OVS approached the profile of eutrophic individuals, while baseline differences in the thickness of the left carotid (greater in OVS vs. SEOV) disappeared after the intervention. In conclusion, regular practice of swimming seems to be beneficial to cardiovascular health, and effective to improve body composition, cardiorespiratory fitness, autonomic modulation, blood pressure, lipid and inflammatory profile in overweight and obese children and adolescents.

Metabolic and Endocrine Changes Determined in Saliva of Adolescents Engaged in Computer Gaming.

Passion for computer games negatively affects the health level of schoolchildren. Among the approaches to monitoring the functional state of such schoolchildren, the most informative and painless is the study of the saliva. The study involved 45 children, aged 14.00 ± 0.21 years, and divided according to the contact's intensity with computer games. The following indicators of lipid peroxidation (LPO) were determined in the saliva: indicators of the antioxidant (AO) system, concentration of immunoglobulin A, and hormonal indicators. The significant increases in the catecholamine (adrenaline) level for 2.3 times and biogenic amine-serotonin for 35.5% and increase in the LPO-DC product concentration in gamers for 75.8% were revealed. The study of the schoolchildren's homeostasis peculiarities confirmed the adequacy of the use of biochemical techniques to assess the condition of children gamers. They have a prenosological condition. This is reflected in the increase in LPO intensity, failure of the protective AO system, imbalance of hormonal state, and immunity deterioration. Information on the evaluation of the LPO activity processes and the AO system condition and the degree of the balance's shift between prooxidants and antioxidants in biological substrates can be considered objective and very sensitive indicators of the general condition, activity, and improvement of the regulation and maintenance of homeostasis.

Prevalence and predictors of positive mental health among adolescents in rural Puducherry, South India.

OBJECTIVES: Most of the adult mental health disorder occurs either during childhood or adolescent stage. Assessment of positive mental health among adolescents will help in predicting the future physical and mental health outcome. Hence, this study was done to determine the prevalence and factors associated with positive mental health among adolescents in rural Puducherry. METHODS: A cross-sectional study was conducted among adolescents (10-19 years) during April and May 2018. Mental Health Continuum-Short Form (MHC-SF), a validated questionnaire was used for the assessment of positive mental health. Prevalence of positive mental health was expressed as proportion with 95% confidence interval. RESULTS: Of the total 245 adolescents interviewed, almost half of them belonged to the age group of mid-adolescence (14-16 years). Majority (66.5%) were boys and more than one third were studying in secondary class.Prevalence of positive mental health was 51.8% (95% CI: 45.6-58.1). Mother's education between primary and secondary (aPR-0.77 95% CI: 0.60-0.98), upper middle (aPR-1.74 95% CI: 1.03-2.94) and middle socioeconomic status (aPR-1.80 95% CI: 1.11-2.87) were significantly associated with positive mental health. CONCLUSION: Current study found that more than half of the rural adolescents had positive mental health. Maternal education and upper socioeconomic status were found to be significant predictors of positive mental health. Our findings on the burden and risk factors as well as protective factors of mental health can contribute to the mental health strategy in public health action.

Quality of life in parents of children and adolescents after systemic sting reactions.

INTRODUCTION AND OBJECTIVES: The study aimed at evaluating the impact of Hymenoptera venom allergy (HVA) in children and adolescents, on their parents' QoL, taking into account their socio-demographic characteristics. MATERIAL AND METHODS: The study sample consisted of 101 parents of children and adolescents aged 9-17 years, with a history of systemic reaction after insect sting who were referred for consultations in the tertiary level allergology department. The mean age of the parents was 39 years (SD=8.1; range 25-65 years); the majority were mothers (68%) and rural inhabitants (62%). QoL in parents of HVA children and adolescents was measured with the Parents of Children with Hymenoptera Venom Allergy Quality of Life Scale, a questionnaire covering 5 dimensions: anxiety, caution, limitations and discomfort, support provided to the child and feeling of safety, each measured on the scale ranging from 1 to 5. Independent predictors of QoL were estimated using the Generalized Linear Model. RESULTS: Parents of urban children and adolescents treated with venom immunotherapy (VIT) up to 3 years (B=-1.37, 95CI= (-2.22;-0.53); p=0.001) and of rural children treated for more than 3 years (B=-0.94, 95CI=(-1.55;-0.33); p=0.003) reported lower anxiety than parents studied at diagnosis. In urban parents, individuals studied at VIT beginning reported a lower feeling of safety (B=-0.63, 95CI=(-1.11;-0.15); p=0.010); those studied up to 3 years of treatment reported a higher feeling of safety (B=0.64, 95CI=(0.11;1.16); p=0.018) than those studied at diagnosis. Contrariwise, in rural parents, those studied at the beginning of immunotherapy reported a higher feeling of safety than those studied at diagnosis (B=0.51, 95CI=(0.13;0.88); p=0.008). CONCLUSIONS: The longest VIT duration in children and adolescents with HVA is related to the decreased anxiety of their parents. Parent's feeling of safety depends on the stage of treatment and place of residence.

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non- Systemic Polyarthritis, Sacroiliitis, and Enthesitis

To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non- systemic polyarthritis, sacroiliitis, or enthesitis.Methods. The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and recined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the nal recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. Thirty- nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease- modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision- making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

The age of adolescence.

Adolescence is the phase of life stretching between childhood and adulthood, and its definition has long posed a conundrum. Adolescence encompasses elements of biological growth and major social role transitions, both of which have changed in the past century. Earlier puberty has accelerated the onset of adolescence in nearly all populations, while understanding of continued growth has lifted its endpoint age well into the 20s. In parallel, delayed timing of role transitions, including completion of education, marriage, and parenthood, continue to shift popular perceptions of when adulthood begins. Arguably, the transition period from childhood to adulthood now occupies a greater portion of the life course than ever before at a time when unprecedented social forces, including marketing and digital media, are affecting health and wellbeing across these years. An expanded and more inclusive definition of adolescence is essential for developmentally appropriate framing of laws, social policies, and service systems. Rather than age 10-19 years, a definition of 10-24 years corresponds more closely to adolescent growth and popular understandings of this life phase and would facilitate extended investments across a broader range of settings.

New Approaches: Changing Lives.

Juvenile justice reform is improving the odds that at-risk youth become productive adults.

Evaluation of childhood nutrition by dietary survey and stable isotope analyses of hair and breath.

OBJECTIVES: The natural abundances of carbon, nitrogen, and sulfur stable isotopes in hair, and of carbon isotopes in breath serve as quantitative biomarkers of protein and carbohydrate sources, but applicability of isotopes for evaluating children's diet has not been demonstrated. In this study, we sought to describe the stable isotope patterns observed in the hair and breath of children and to assess dietary variations in relation to age and ethnicity, hypothesizing that these would reflect dietary differences across age and ethnic groups and would correlate with intake variables derived from a Food Frequency Questionnaire. METHODS: Data were obtained from a cross-sectional study of non-Hispanic white (N = 115) and Hispanic (N = 97) children, aged 9-16 years, in Salt Lake City, Utah. Sampling included a hair sample, breath samples (AM and PM), and a youth/adolescent food questionnaire (YAQ). Hair was analyzed for carbon (δ13 C), nitrogen (δ15 N), and sulfur (δ34 S) isotopes, and breath samples for δ13 CAM/PM of respired CO2 . RESULTS: Non-Hispanic whites had lower δ13 C, δ15 N, δ13 CAM , and δ13 CPM values than Hispanics. Hair δ13 C and δ15 N values were correlated with protein sources, particularly for non-Hispanics. Breath δ13 C values were correlated with carbohydrate sources, particularly for Hispanic students. Non-Hispanic white students reported greater intake of total protein, animal protein, dairy, and grain than Hispanic students. Hispanic students reported higher intake of carbohydrates, particularly sweetened beverages. CONCLUSION: While YAQ and stable isotope data reflected strong cultural influences in diet, no significant gender-based nor age-based differences were detected. Significant covariation between YAQ and isotopes existed and demonstrate the potential of stable isotopes for characterizing children's diet.

Maybe it is not a goal that matters: a report from a physical activity intervention in youth.

BACKGROUND: Decline in physical activity (PA), specifically in adolescents raises concerns. Setting goals and strategies are often used to increase the level of moderate-to-vigorous physical activity (MVPA), recently introducing also modern technological devices for achieving different goals. The aim of this study was to investigate the effectiveness of two different goal strategies in increasing PA of youth. It was expected that there would be positive relationships between support and goal strategy which would contribute to increase MVPA. Classmate and teacher support scales were used to evaluate support in physical education (PE) classes. Activity trackers were used to count daily steps. METHODS: Data were collected from 65 late adolescents, divided into two groups: "Goal" (group 1) and "Do your best" (group 2) set with different step goals and strategies. Differences between the terms were tested. To compare MVPA levels with the different level of support they received in girls and boys, a two-way ANOVA was used. RESULTS: There was a difference noticed in teacher support between the genders in all the two groups in favor of boys. Boys with low teacher support in group 1 indicated a higher level of MVPA. In group 2 when teacher support was high girls reported the highest level of MVPA. CONCLUSIONS: This study has shown that in terms of MVPA teacher support is more efficient than a goal strategy. The results highlight the importance of perceived teacher support for motivation in PA and pointed at PE teachers as the agents of behavior change, specifically in girls.

Padrão de consumo alimentar e prática de atividade física entre adolescentes de famí­lias em diferentes estratos sociais: Revisão sistemática de literatura e análise de dados da Pesquisa Nacional de Saúde do Escolar (PeNSE 2009, 2012 e 2015) / Food consumption pattern and physical activity level among adolescents from families in diverse social strata: Systematic literature review and analysis of data of the National School Health Survey (PeNSE 2009, 2012 and 2015) in Brazil

Introdução: Práticas alimentares inadequadas associadas a um nível de atividade física insuficiente acarretam maior risco de manifestação precoce de doenças crônicas não transmissíveis. Objetivo: Analisar padrão de consumo de determinados alimentos saudáveis e nível de atividade física de adolescentes escolares brasileiros pertencentes a famílias de diferentes estratos sociais, investigados nas três edições da Pesquisa Nacional de Saúde do Escolar (PeNSE), conduzida pelo Instituto Brasileiro de Geografia e Estatística em 2009, 2012 e 2015. Metodologia: A tese foi composta de três artigos. O primeiro artigo baseia-se em revisão sistemática da literatura para identificação de evidências sobre associação entre características socioeconômicas, nível de atividade física e frequência de consumo de alimentos entre adolescentes. Os demais artigos foram construídos a partir de análise estatística de base de dados unificada composta pelas três edições da PeNSE (2009, 2012 e 2015). O segundo artigo utilizou modelo de regressão logística multivariada para verificação da associação entre características socioeconômicas, nível de atividade física e frequência do consumo de alimentos saudáveis e não saudáveis entre adolescentes brasileiros, usando dados de amostra representativa em nível de capitais de Unidades da Federação das três edições da PeNSE 2009, 2012 e 2015. O terceiro artigo empregou modelo de regressão logística multivariada para investigação da associação entre autoavaliação do peso corporal e adoção de medidas de controle de peso em relação ao nível de atividade física e à frequência do consumo de alimentos saudáveis e não saudáveis entre adolescentes brasileiros, segundo dependência administrativa da escola (rede pública ou privada) em amostra representativa em nível de municípios capitais e grandes regiões brasileiras, a partir de dados de duas edições da PeNSE 2012 e 2015. Resultados: Os estudos analisados na revisão sistemática apontaram adoção de piores hábitos alimentares e estilo de vida sedentário entre adolescentes de menor nível socioeconômico. Em termos de análise dos dados brasileiros, no segundo artigo verificou-se que a renda familiar e o nível de escolaridade dos pais estavam associados com os hábitos alimentares e nível de atividade física entre os adolescentes. No terceiro artigo, observaram-se diferenças importantes de autoavaliação do peso corporal relacionadas ao gênero, assim como importância do ambiente escolar na determinação do nível de influência social quanto às práticas de alimentação e atividade física adotadas entre adolescentes brasileiros. Conclusão: Resultados da presente tese indicam importância de monitoramento dos fatores de risco e proteção associados às características socioeconômicas como parte das pressões às quais jovens brasileiros estão submetidos. A análise dos dados das edições da PeNSE indicou possibilidade de constituir um sistema de vigilância de fatores de risco à saúde dirigido a adolescentes, gerando evidências para avaliação e orientação de políticas destinadas aos adolescentes e escolares no país

Introduction: Inadequate dietary practices associated with insufficient physical activity lead to increased risk in early onset of non-communicable chronic diseases. Objective: To analyze food pattern and level of physical activity among Brazilian adolescents enrolled in school from families in diverse social strata, investigated in the three editions of the National School Health Survey (PeNSE), conducted by the Brazilian Institute for Geography and Statistics in 2009, 2012 and 2015. Methodology: The thesis was composed of three articles. The first article is based on systematic literature review designed to identify evidences regarding the association between socioeconomic characteristics, physical activity level and frequency of food consumption among adolescents. The following articles were constructed on statistical analysis of single dataset encompassing information on the three editions of the PeNSE (2009, 2012 and 2015). The second article used multivariate logistic regression model to verify the association between socioeconomic characteristics, physical activity level and frequency of healthy and unhealthy foods consumption among Brazilian adolescents, based on sample representative at capital of state level from three editions of PeNSE 2009, 2012 and 2015. The third article used multivariate logistic regression model to investigate the association among self-assessment of body weight and adoption of weight control measures in relation to level of physical activity and frequency of consumption of healthy and unhealthy foods among Brazilian adolescents, according to administrative dependence of school (public or private) in sample representative at the level of state capitals and Brazilian macroregions, in two editions of PeNSE 2012 and 2015. Results: The studies analyzed in the systematic review of literature indicated worst eating habits and sedentary lifestyle among adolescents with low socioeconomic status. Regarding data analysis, evidences in the second article pointed to the family income and parents' educational attainment were associated with eating habits and physical activity level among adolescents. In the third article, significant differences were observed in terms of self-assessment of body weight related to gender, as well as importance of school environment in determining the social influence on practices of food consumption and physical activity among Brazilian adolescents. Conclusion: Results of the dissertation indicate the importance of monitoring risk and protection factors related to socioeconomic characteristics which comprise pressures in Brazilian adolescents' life. The analysis of data from the three issues of the national survey on adolescents' health indicate the possibility to compose a system for monitoring health risk factors directed towards adolescents, generating evidences for assessment and guidance of public policies aimed at adolescents and schoolchildren in Brazil