O impacto do ensino público e privado na memória de crianças / The impact of public and private education on children's memory / El impacto de la educación pública y privada en la memoria de los niños

Esse estudo teve como objetivo comparar o desempenho de memória operacional e memória episódica em estudantes do ensino público e privado. A amostra foi composta por 79 crianças, com idades entre 9 e 12 anos, divididos por gênero, idade e tipo de escola. A avaliação foi realizada individualmente por meio da CMS e Raven. Para a análise dos dados, foi utilizado o teste t de Student, com nível de significância adotado de 5%. Os resultados evidenciam melhor desempenho das crianças de escola pública nas tarefas de inteligência e memória visual, enquanto os estudantes de escola particular apresentaram melhor desempenho em memória verbal e visual, corroborando com estudos que apontam diferenças em tarefas cognitivas para crianças de níveis socioeconômicos diferentes. Esses resultados fomentam a importância de mais pesquisas na área, para compreensão e melhorias no desenvolvimento cognitivo das crianças e adolescentes brasileiros. (AU)

This study aimed to compare the performance of working memory and episodic memory in students from public and private schools. A sample consisted of 79 children, aged between 9 and 12 years; divided by gender, age and type of school. The assessment was carried out individually using the CMS and Raven's test. For the data analysis student's t-test was used, the level of significance adopted was 5%. The results showed better performance by the public school children in tasks of intelligence and visual memory, while the students from private schools showed better performance in verbal and visual memory, corroborating studies that highlight differences in cognitive tasks for children with different socioeconomic levels. These results demonstrate the importance of more research in the area, aiming to better understand and improve the cognitive development of Brazilian children and adolescents. (AU)

Este estudio tuvo como objetivo comparar el rendimiento de la memoria de trabajo y la memoria episódica en estudiantes de escuelas públicas y privadas. La muestra se compuso por 79 niños, con edades comprendidas entre 9 y 12 años; divididos por género, edad y tipo de escuela. La evaluación se realizó individualmente a través de la CMS y Raven. Se utilizó la prueba t de student para el análisis de datos, el nivel de significación adoptado fue del 5%. Los resultados evidenciaron un mejor rendimiento de los niños de las escuelas públicas en tareas de inteligencia y memoria visual, mientras que los estudiantes de la escuela privada mostraron un mejor rendimiento en la memoria verbal y visual, corroborando con estudios que señalan diferencias en las tareas cognitivas para niños de diferentes niveles socioeconómicos. Estos resultados alientan la importancia de una mayor investigación en el área, para comprender y mejorar el desarrollo cognitivo de los niños y adolescentes brasileños. (AU)

Cognitive profile of children with sickle cell anemia compared to healthy controls / Perfil cognitivo de crianças com anemia falciforme, comparado com o de controles sadios

Abstract Objective: To evaluate the cognitive abilities of children and adolescents with sickle cell anemia diagnosed through neonatal screening and to compare them with healthy controls, adjusting the results to their socioeconomic status. Methods: Cognitive assessment was performed with the Wechsler WISC-III scale in 64 children and adolescents with sickle cell anemia and in 64 controls matched by gender and age, without the disease and without neurological impairment; socioeconomic status was measured by the Criterion Brasil. Results: All cognitive scores were lower in the group of patients. The mean overall IQ, Verbal IQ, and Performance IQ were, respectively, 90.95 for the group of patients and 113.97 for the controls (p < 0.001); 91.41 for the group of patients and 112.31 for the controls (p < 0.001); 92.34 for the group of patients and 113.38 for the controls (p < 0.001). Scores for processing speed, distraction resistance, and perceptual organization were also significantly lower in patients. A direct and significant correlation was detected between socioeconomic status and cognitive scores. In the multivariate analysis, for the same socioeconomic status, a child with sickle cell anemia had an average IQ of 21.2 points lower than the mean IQ observed for the controls (p < 0.001), indicating that the disease, adjusted for the socioeconomic effect, is a strong predictor of the overall IQ. Conclusion: The cognitive impairment of children with sickle cell anemia is severe and manifests even when the disease effect is adjusted to the socioeconomic status. In the authors' view, such impairment requires an early preventive approach in order to avoid this cognitive damage.

Resumo Objetivo: Avaliar os sistemas cognitivos de crianças e adolescentes com anemia falciforme provenientes de triagem neonatal e compará-las com controles sadios, ajustando-se os resultados para o nível socioeconômico. Método: A avaliação cognitiva foi feita com a escala de Wechsler WISC-III em 64 crianças e adolescentes com anemia falciforme e em 64 controles pareados por sexo e idade, sem a doença e sem comprometimento neurológico; o nível socioeconômico foi aferido pelo Critério Brasil. Resultados: Todos os escores cognitivos foram inferiores no grupo de pacientes. As médias de QI Total, QI Verbal e QI de Execução foram respectivamente 90,95 para o grupo de pacientes e 113,97 para os controles (p < 0,001); 91,41 para o grupo de pacientes e 112,31 para os controles (p < 0,001); 92,34 para o grupo de pacientes e 113,38 para os controles (p < 0,001). Os escores de velocidade de processamento, de resistência à distração e de organização perceptual foram, também, significativamente mais baixos nos pacientes. Detectou-se correlação direta e significativa entre o nível socioeconômico e os escores cognitivos. Em análise multivariada, para um mesmo nível socioeconômico, uma criança com anemia falciforme teve QI total, em média, 21,2 pontos mais baixo do que a média dos controles (p < 0,001), indicou que a doença, ajustada para o efeito socioeconômico, é forte fator preditivo do QI total. Conclusão: Os prejuízos cognitivos das crianças com anemia falciforme são intensos e se manifestam mesmo quando o efeito da doença é ajustado para o nível socioeconômico, o que, a nosso ver, requer abordagem preventiva precoce para tentar evitar tais prejuízos.

High frequency of silent brain infarcts associated with cognitive deficits in an economically disadvantaged population

OBJECTIVE: Using magnetic resonance imaging, we aimed to assess the presence of silent brain vascular lesions in a sample of apparently healthy elderly individuals who were recruited from an economically disadvantaged urban region (São Paulo, Brazil). We also wished to investigate whether the findings were associated with worse cognitive performance. METHODS: A sample of 250 elderly subjects (66-75 years) without dementia or neuropsychiatric disorders were recruited from predefined census sectors of an economically disadvantaged area of Sao Paulo and received structural magnetic resonance imaging scans and cognitive testing. A high proportion of individuals had very low levels of education (4 years or less, n=185; 21 with no formal education). RESULTS: The prevalence of at least one silent vascular-related cortical or subcortical lesion was 22.8% (95% confidence interval, 17.7-28.5), and the basal ganglia was the most frequently affected site (63.14% of cases). The subgroup with brain infarcts presented significantly lower levels of education than the subgroup with no brain lesions as well as significantly worse current performance in cognitive test domains, including memory and attention (p<0.002). CONCLUSIONS: Silent brain infarcts were present at a substantially high frequency in our elderly sample from an economically disadvantaged urban region and were significantly more prevalent in subjects with lower levels of education. Covert cerebrovascular disease significantly contributes to cognitive deficits, and in the absence of magnetic resonance imaging data, this cognitive impairment may be considered simply related to ageing. Emphatic attention should be paid to potentially deleterious effects of vascular brain lesions in poorly educated elderly individuals from economically disadvantaged environments.

Household task demands for quiet and focused behavior facilitate performance by ADHD youth / Demandas de tarefas domésticas por comportamento quieto e focado facilitam o desempenho de jovens com TDAH

ABSTRACT This study evaluated the associations among symptoms of attention-deficit/hyperactivity disorder (ADHD) and of oppositional defiant disorder (ODD) in children and adolescents’ performance in household tasks and assistance provided by caregivers. Parents of children from 6 to 14 years old with ADHD (n = 67) were interviewed with the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES) instrument. Significant correlations were found between symptoms of ODD and assistance in self-care tasks (r = −0.31; p = 0.01); symptoms of hyperactivity correlated with assistance in self-care (r = −0.30, p = 0.01); and family-care (r = −0.25, p = 0.04) tasks. Age was directly associated with the number of tasks performed by children and inversely related to the assistance provided by caregivers. A greater number of ODD symptoms resulted in more household assistance from caregivers. Characteristics of ODD symptoms, such as disobedience and hostility in the face of authority, may limit these children in accessing household tasks by their own initiative, requiring assistance from caregivers.

RESUMO Este estudo avaliou transversalmente a correlação entre sintomas de transtorno de déficit de atenção e hiperatividade (TDAH) e de oposição com desempenho de crianças e adolescentes nas tarefas domésticas e assistência disponibilizada pelos cuidadores. Pais de crianças e adolescentes com TDAH (n = 67), de 6 a 14 anos, foram entrevistados com o children helping out: responsibilities, expectations and supports (CHORES). Foram encontradas correlações significativas entre sintomas de oposição e assistência em cuidado próprio (r = -0,31; p = 0,01) e de hiperatividade com assistência em cuidado próprio (r = -0,30, p = 0,01) e em cuidado familiar (r = -0,25, p = 0,04). Idade está diretamente correlacionada ao número de tarefas desempenhadas pela criança e inversamente associada à assistência disponibilizada pelos cuidadores. Maior número de sintomas de oposição resultou em maior assistência disponibilizada. Características dos sintomas de oposição, como a desobediência e hostilidade frente às autoridades, são limitantes para que essas crianças acessem as tarefas por iniciativa própria, demandando maior assistência dos cuidadores.

The prevalence of developmental dyscalculia in Brazilian public school system / A prevalência da discalculia do desenvolvimento no sistema publico de educação brasileiro

ABSTRACT The goal of the study was to assess public school children at the end of the first stage of elementary school. We used a protocol applied concurrently with a writing test in the form of an unexpected activity in 28 public schools; 2,893 children assessed, 687 exhibited performance below 58 points, 184 were excluded due to change of address or lack of consent; 503 children subjected to a test of intellectual capacity and reading assessment and 71 considered intellectually disabled were excluded. 226 (7.8%) children, who could read, write, and had normal intellectual level, met the criteria of developmental dyscalculia (DD), 98 female and 128 male. The most influential factors in the prevalence were socioeconomic levels of the schools neighborhood, education level of parents, and being male, as demonstrated by the odds ratio and multiple logistic regression analysis. Further studies should be done so that educational policies are taken.

RESUMO Este estudo teve como objetivo avaliar crianças da rede pública no final da 1a etapa do ciclo fundamental; com um protocolo aplicado em forma de atividade surpresa em 28 escolas públicas, concomitantemente a uma prova de escrita: Das 2893 crianças avaliadas, 687 tiveram rendimento abaixo de 58 pontos, 184 foram excluídas por mudança de domicilio ou por falta de consentimento; 503 submetidas a um teste de avaliação intelectual e de leitura, 71 consideradas intelectualmente deficientes foram excluídas do estudo. 226 (7,8%) sabiam ler e escrever e intelectualmente normais, preenchendo os critérios para o diagnóstico de discalculia do desenvolvimento (DD), 98 do sexo feminino e 128 masculinos. Fatores que mais influenciaram na prevalência da DD foram os níveis socioeconômicos do bairro da escola, nível de escolaridade dos pais e sexo masculino, demonstrados pela Odds Ratio e Analise de regressão logística múltipla. Mais estudos devem ser realizados para que políticas educacionais sejam tomadas.

Practices related to late-onset sepsis in very low-birth weight preterm infants / Práticas relacionadas à sepse tardia em prematuros de muito baixo peso

OBJECTIVE: To understand the practices related to late-onset sepsis (LOS) in the centers of the Brazilian Neonatal Research Network, and to propose strategies to reduce the incidence of LOS. METHODS: This was a cross-sectional descriptive multicenter study approved by the Ethics Committee. Three questionnaires regarding hand hygiene, vascular catheters, and diagnosis/treatment of LOS were sent to the coordinator of each center. The center with the lowest incidence of LOS was compared with the others. RESULTS: All 16 centers answered the questionnaires. Regarding hand hygiene, 87% use chlorhexidine or 70% alcohol; alcohol gel is used in 100%; 80% use bedside dispensers (50% had one dispenser for every two beds); practical training occurs in 100% and theoretical training in 70% of the centers, and 37% train once a year. Catheters: 94% have a protocol, and 75% have a line insertion team. Diagnosis/treatment: complete blood count and blood culture are used in 100%, PCR in 87%, hematological scores in 75%; oxacillin and aminoglycosides is the empirical therapy in 50% of centers. Characteristics of the center with lowest incidence of LOS: stricter hand hygiene; catheter insertion and maintenance groups; use of blood culture, PCR, and hematological score for diagnosis; empirical therapy with oxacillin and aminoglycoside. CONCLUSION: The knowledge of the practices of each center allowed for the identification of aspects to be improved as a strategy to reduce LOS, including: alcohol gel use, hand hygiene training, implementation of catheter teams, and wise use of antibiotic therapy. .

OBJETIVO: Conhecer as práticas relacionadas a sepse tardia (ST) nos centros da Rede Brasileira de Pesquisas Neonatais (RBPN) e propor estratégias para redução da ST. MÉTODOS: Estudo transversal, multicêntrico da RBPN, aprovado pelo CEP. Três questionários sobre higienização das mãos, cateteres vasculares e diagnóstico/tratamento da ST foram elaborados e enviados aos coordenadores de cada centro. O centro com a menor incidência de ST foi comparado aos demais. RESULTADOS: Todos os 16 centros responderam aos questionários. Quanto à higienização das mãos: 87% usam chlorhexidine ou álcool 70%; 100% álcool gel; almotolia/leito em 80% (50% dispõem de um dispensador para cada dois leitos); Treinamento prático ocorre em 100%, teórico em 70% dos centros e 37% treinam uma vez/ano. Cateteres: 94% têm protocolo para passagem, 75% grupo de inserção. Diagnóstico/tratamento: hemograma e hemocultura são usados em 100% dos centros; PCR em 87%; 75% usam escores hematológicos; oxacilina e aminoglicosídeo são usados como terapia empírica em 50% dos centros. Características do centro com menor incidência de ST: rigorosa higienização das mãos; grupos de inserção e manutenção de cateteres; uso de hemocultura, PCR e escores hematológicos para diagnóstico da ST; tratamento empírico com oxacilina e aminoglicosídeo. CONCLUSÕES: O conhecimento das práticas de cada centro permitiu identificar aspectos a serem aprimorados como estratégia para a redução da ST incluindo: uso de álcool gel, treinamento em higienização das mãos, implantação de grupos de cateteres e uso racional de antibióticos. .

Prevalence of oral cancer self-examination among elderly people treated under Brazil's Unified Health System: household health survey / Prevalência de autoexame bucal é maior entre idosos assistidos no Sistema Único de Saúde: inquérito domiciliar

The aim of this study was to examine the prevalence of oral cancer self-examinationamong the elderly and confirm whether prevalence was higher among users of the dental services provided by Brazil's Unified Health System (SUS, acronym in Portuguese). A transversal study of elderly people aged between 65 and 74 years living in a large-sized Brazilian municipality was conducted using simple random sampling. Logistic regression was conducted and results were corrected for sample design and unequal weighting using the SPSS(r) software. The study assessed 740 individuals. A total of 492 met the inclusion criteria, of which 101 (22.4%) reported having performed an oral cancer self-examination. Prevalence was higher among users of the dental services provided by the SUS, higher-income individuals, people with higher levels of education, individuals that used a removable dental prosthesis, and people who had not experienced discomfort attributed to oral condition, and lower among people who sought regular and periodic dental treatment and individuals who did not have a drinking habit. This type of self-care should be encouraged by public health policies which respond to the needs of the elderly, with emphasis on users of private and philanthropic services, and other services outside the public health network.

Este estudo objetivou identificar a prevalência do autoexame bucal entre idosos e constatar se essa prevalência foi maior entre usuários de serviços odontológicos prestados pelo Sistema Único de Saúde (SUS). Estudo transversal conduzido a partir de amostragem probabilística complexa por conglomerados, entre idosos (65-74 anos) de um município brasileiro de grande porte populacional. Foi realizada regressão logística binária, as estimativas foram corrigidas pelo efeito de desenho e por ponderações, utilizando-se o SPSS(r). Dentre os 740 avaliados, atenderam aos critérios de inclusão 492 idosos e, destes, 101 (22,4%) relataram a prática do autoexame bucal. Esta prática foi maior entre idosos usuários dos serviços odontológicos prestados no SUS, entre aqueles com maior renda per capita, os com maior escolaridade, aqueles que utilizavam prótese dentária removível e entre os que não tiveram impactos decorrentes das desordens bucais; foi menor entre os que usaram serviços odontológicos por rotina e os que não possuíam hábito etilista. A prevalência do autoexame bucal entre idosos foi baixa e maior entre aqueles usuários do SUS. O estímulo à adesão a este autocuidado deve ser considerado nas políticas de saúde do idoso vigentes, especialmente entre usuários de serviços particulares, supletivos e filantrópicos.

ADHD inattentive symptoms mediate the relationship between intelligence and academic performance in children aged 6-14

Objective: Fluid intelligence and the behavioral problems of attention-deficit/hyperactivity disorder (ADHD) are related to academic performance, but how this association occurs is unclear. This study aimed to assess mediation and moderation models that test possible pathways of influence between these factors. Methods: Sixty-two children with ADHD and 33 age-matched, typically developing students were evaluated with Raven's Colored Progressive Matrices and the spelling and arithmetic subtests of the Brazilian School Achievement Test. Dimensional ADHD symptomatology was reported by parents. Results: Our findings suggest that fluid intelligence has a significant impact on academic tests through inattention. The inattentive dimension was the principal behavioral source of influence, also accounting for the association of hyperactive-impulsive manifestations with school achievement. This cognitive-to-behavioral influence path seems to be independent of diagnosis related group, and gender, but lower socioeconomic status might increase its strength. Conclusion: Fluid intelligence is a relevant factor in the influence of ADHD behavioral symptoms on academic performance, but its impact is indirect. Therefore, early identification of both fluid intelligence and inattentive symptoms is of the utmost importance to prevent impaired academic performance and future difficulties in functioning. .

Homicide and Klinefelter syndrome: a complex interaction

Introduction: Several studies have shown an association between homicide and sexual chromosomal abnormalities, but data are still lacking regarding Klinefelter syndrome. Methods: We retrospectively reviewed two cases of homicide perpetrators who were both diagnosed with Klinefelter syndrome on the basis of a karyotype analysis. A neurocognitive assessment was also performed (MMSE, Frontal Assessment Battery, brain CT, and electroencephalogram). Results: Numerous intermediate risk factors of homicide were shared by our two cases, including dispositional (male gender, young age, low socioeconomic status), historical (prior arrest record and past conviction for any offense), contextual (unemployment), and clinical (alcohol abuse). Conclusion: It is important that clinicians go beyond obvious risk factors, such as chromosomal abnormalities, to pinpoint other meaningful risk factors and potentially facilitate preventive approaches. .

Variables associated with cognitive, behavioral and emotional development: a cohort of schoolchildren / Variáveis associadas aos desenvolvimentos cognitivo, comportamental e emocional: uma coorte de escolares / Variables asociadas a los desarrollos cognitivo, conductual y emocional: una cohorte de escolares

This study aimed to identify possible variables associated with cognitive, behavioral and emotional development in a cohort of school children, based on biological (sex, gestational age and birth weight) and socioeconomic variables (marital status, maternal and paternal education, occupation of head of household, socioeconomic status, and number of household members). We evaluated 790 children born in a cohort of Ribeirão Preto (SP), Brazil, with 10/11 years of age. The Raven Test was used for cognitive assessment and the Strengths and Difficulties Questionnaire was utilized for emotional and behavioral assessment. By means of multivariate logistic regression analysis (CI 95%) we found that: 1) low maternal schooling was associated with behavioral and emotional problems and poor cognitive function, 2) being female was considered as a protective factor against behavioral problems and 3) low birth weight and prematurity were not associated with the outcomes investigated...

O presente trabalho objetivou identificar possíveis variáveis associadas com o desenvolvimento cognitivo, comportamental e emocional de uma coorte de crianças em idade escolar, com base em variáveis biológicas (idade, sexo e peso ao nascer) e socioeconômicas (estado civil, educação materna e paterna, ocupação do chefe de família, status socioeconômico e número de membros da família). Foram avaliadas 790 crianças nascidas em uma coorte de Ribeirão Preto (SP), Brasil, aos 10/11 anos de idade. Para a avaliação cognitiva utilizou-se o Teste de Raven e para a avaliação emocional e comportamental usou-se o Questionário de Capacidades e Dificuldades. Por meio de análise de regressão logística multivariada (IC 95%), verificou-se que: 1) baixa escolaridade materna foi associada a problemas comportamentais, emocionais e baixo desempenho cognitivo; 2) sexo feminino foi um fator de proteção contra problemas de comportamento e 3) baixo peso ao nascer e prematuridade não foram associados com as variáveis investigadas...

Este estudio objetivó identificar las posibles variables asociadas con el desarrollo cognitivo, comportamental y emocional de una cohorte de niños en edad escolar basado en variables biológicas (edad, sexo y peso al nacer) y socioeconómicas (estado civil, nivel educacional materno y paterno, ocupación del jefe del hogar, estatus socioeconómico y número de miembros de la familia). Fueron evaluados 790 niños nacidos en una cohorte de Ribeirão Preto (SP-Brasil), a los 10/11 años de edad. Para la evaluación cognitiva se utilizó el Test de Raven, y para la evaluación emocional y comportamental se usó el Cuestionario de Capacidades y Dificultades. Por medio del análisis de regresión multivariada (IC 95%) se verificó que: 1) baja escolaridad materna fue asociada a problemas comportamentales, emocionales y bajo desempeño cognitivo; 2) el sexo femenino fue un factor de protección contra problemas de comportamiento y 3) el bajo peso al nacer y la prematuridad no fueron asociados con las variables investigadas...

Impacto do aleitamento materno no coeficiente de inteligência de crianças de oito anos de idade / Impact of breastfeeding on the intelligence quotient of eight-year-old children

OBJETIVO: O objetivo deste estudo foi determinar a influência do aleitamento materno na capacidade intelectual de crianças pertencentes a uma coorte de um país em desenvolvimento, controlando para os principais fatores de confusão. MÉTODOS: Foi realizado um estudo de coorte prospectiva com todos os recém-nascidos nos hospitais de uma cidade de porte médio e acompanhou-se uma amostra aleatória destes aos 30, 90 e 180 dias de vida e aos 8 anos. No acompanhamento foram avaliados diversos aspectos da amamentação e, aos 8 anos, foi realizada avaliação da capacidade intelectual geral aplicando-se o Teste de Raven. As análises estatísticas utilizaram Teste T, ANOVA e regressão linear e logística, considerando como associações estatisticamente significativas aquelas cujo valor de p foi inferior a 0,05. RESULTADOS: Aos 8 anos 560 crianças participaram da avaliação com o Teste de Raven. A média da pontuação das crianças no teste foi de 22,56 pontos com desvio padrão de 5,93. A diferença de médias entre os grupos em aleitamento materno ou não, aos seis meses, foi de 1,33 (p = 0,008). Permaneceram associadas ao desfecho, após regressão linear e logística, a cor materna e da criança, classe socioeconômica, escolaridade e tabagismo maternos e o aleitamento materno aos 6 meses de idade (p = 0,007). CONCLUSÕES: As crianças que mamaram por seis meses ou mais tiveram melhor desempenho na avaliação intelectual geral, mesmo após ajuste para os principais fatores de confundimento.

OBJECTIVE: This study aimed to determine the influence of breastfeeding on the intellectual capacity of children from a cohort in a developing country, with a control for the main confounding factors. METHODS: A prospective cohort study was performed including all infants born in the hospitals of a medium-size city, and a random sample of these newborns was monitored at 30, 90, and 180 days of life, and at age 8 years. Several aspects of breastfeeding were assessed in the follow-up and, at 8 years, general intellectual capacity was assessed through the Raven's Colored Progressive Matrices test. The statistical analyses used Student's t-test, ANOVA, and linear regression and logistics, considering p-values less than 0.05 as statistically significant associations. RESULTS: At age 8 years, 560 children were assessed with Raven's Colored Progressive Matrices test. The average score was 22.56 points, with a standard deviation of 5.93. The difference in the averages found between the breastfed and non-breastfed groups at six months of age was 1.33 (p = 0.008). Mother's and child's skin color, social and economic class, maternal education and smoking, and breastfeeding at six months of age (p = 0.007) were still associated with the outcome. CONCLUSIONS: Children that were breastfed for six months or more had better performance in the general intellectual assessment, even after adjusting for the main confounding factors.

Risk Factor Frequency for Learning Disabilities in Low Socioeconomic Level Preschool Children in Mexico City / Frequência de fatores de risco para dificuldade de aprendizagem em pré-escolares com baixo nível socioeconômico, na Cidade do México / Frecuencia de factores de riesgo para problemas de aprendizaje en preescolares de bajo nivel socioeconómico en la Ciudad de México

The objective was to identify the frequency of risk factors for Learning Disabilities (LD) in low socioeconomic level children in Mexico City. We studied children by means of: Wechsler, Bender-Gestalt, and Human drawing tests. Average age of male subjects was 5.6±0.9 years, while that of the female group was 5.4±0.5 years. In male subjects, average Total intelligence quotient (T-IQ) score was 98±12.2 while, in the female group, this was 99±12.2. On the Bender-Gestalt test, male subjects had a mental and visual-motor average age of <1 year under chronological age. Female subjects had a mental and visual-motor age 8-7 months under the norm. On the Human drawing test, in male and female subjects, the most frequent at-risk features comprised: self-isolation in 25 por cento of subjects, shyness in 22.4 por cento, and poor internal controls in 22 por cento. In conclusion, we found a high at-risk factor frequency for LD in children of low socioeconomic strata. We highlight the importance of screening children before they attain school age.

Este estudo objetivou identificar a frequência de fatores de risco para dificuldade de aprendizagem (DA) em crianças com baixo nível socioeconômico, na Cidade do México. A escala de inteligência Wechsler, desenho da figura humana e o teste gestáltico visomotor de Bender foram utilizados. A idade média do grupo masculino foi de 5,6±0,9 anos e do grupo feminino 5,4±0,5 anos. O quociente intelectual total (QI-T) foi de 98±12 no grupo masculino e 99±12,2 no grupo feminino. No teste de Bender, os meninos apresentaram idade mental e visomotora um ano abaixo da idade cronológica, enquanto que as meninas apresentaram idade mental e visomotora 7-8 meses abaixo do normal. As características de alto risco que apresentaram maior frequência, tanto nos meninos como nas meninas, no teste do desenho de figura humana, foram: autoisolamento 25 por cento, timidez 22,4 e controle interno deficiente 22 por cento. Concluindo, alta frequência de fatores de risco para DA foi encontrada em crianças de baixo nível socioeconômico. É importante destacar a importância de se identificar pré-escolares em risco de DA.

Nuestro objetivo fue identificar la frecuencia de factores de riesgo para problemas de aprendizaje (PA) en niños de bajo nivel socioeconómico de la Ciudad de México. Se utilizaron las pruebas de inteligencia de Wechsler, Gestáltica Visuomotora de Bender y del Dibujo de la figura humana. La edad promedio en el grupo masculino fue 5,6±0,9 años, del femenino fue 5,4±0,5. En los hombres, el cociente intelectual total (CI-T) fue 98±12,2, en mujeres fue 99±12,2. En la prueba de Bender, los hombres mostraron una edad mental y visuomotora un año menor que la cronológica, las mujeres tuvieron una edad mental y visuomotora 7-8 meses por debajo de la norma. En la Prueba de la figura humana, los hombres y mujeres mostraron mayor frecuencia de: auto-aislamiento 25 por ciento, timidez 22,4 por ciento y controles internos pobres 22 por ciento. En conclusión encontramos una alta frecuencia de factores de riesgo en preescolares de bajo nivel socioeconómico, destacamos la importancia de identificar a los preescolares propensos a tener problemas de aprendizaje (PA).

Análise sociológica das políticas de saúde / Sociological analysis of health policies

Uma análise sócio-histórica da gênese de políticas de saúde na França. Os temas em debate incluem as políticas de luta contra o câncer e a Aids, e aquelas destinadas ao enfrentamento de problemas como as crianças inadaptadas ou 'anormais', com 'inteligência inferior', e os jovens 'delinquentes', usuários de drogas. Embora os estudos de caso tratem da experiência francesa, a obra traz contribuições importantes para o leitor brasileiro, principalmente por conta dos aspectos universais que podem ser apreendidos a partir da leitura.

Prevalencia de trastornos psiquiátricos en adolescentes infractores de ley: estudio caso-control / Prevalence of psychiatric disorder among juvenile offenders: case-control study

Introduction: The juvenile delinquency has grown worldwide in alarming form in the last time, a multicausality is recognized in the origin of this phenomenon, but it becomes necessary to identify the importance of each one of this causes, and its specific impact in the time. Objective: To identify individual, educational and family factors associated with criminal conduct in a sample of adolescent offenders. Method: Observational study, crossectional, of case-control. From a universe of adolescents between 12 years old and 17 years with 11 months and 30 days, offenders, imprisoned in penal or protection institutions, a convenience sample of 100 adolescents was chosen, which was equalled in gender, age range, and socioeconomic level with a control group of the same size. To both groups a battery of instruments, DISC IV, WISC-R or WAIS, and the Family History Screen, was applied. Results: During the 12 months prior to the study 64 percent of the offenders and 18 percent of the controls presented a psychiatric diagnosis. Among the offenders the most prevalent disorder were conduct disorder (46.99 percent), abuse of alcohol (26 percent) and dependence of other substances (18 percent); among the control group the most prevalent were attentional deficit disorder (5 percent) and conduct disorder (5 percent). There are statically significant differences between both groups when measuring the intellectual level of functiong, 31 percent) of the offenders were in the rank of borderline and 34 percent> of controls were classified as low average. Conclusions: Lower intellectual capacity, school failures, number of sexual partners and conduct disorder were the variables that better predicted inclusion in the group of juvenile offenders.

La delincuencia juvenil ha crecido en forma alarmante. Se reconoce en el origen del fenómeno una multicausalidad, pero se hace necesario identificar y ponderar eventuales causas y medir su impacto específico. Objetivo: Identificar prevalencias de patología psiquiátrica y variables individuales, educacionales y familiares asociadas con conductas delictivas en una muestra de adolescentes infractores de ley. Método: Estudio observacional, transversal, de caso-control. De un universo de adolescentes entre 12 y 17 años, infractores, recluidos en instituciones penales o de protección, se eligió una muestra por conveniencia de 100 sujetos y una muestra control pareada por edad y nivel socioeconómico. A ambos grupos se aplicó una batería de instrumentos, incluyendo DISC-IV, WISC-R ó WAIS, Cuestionario de Estilos de Vida y FHS. Resultados: Un 64 por ciento de los adolescentes infractores de ley y 18 por ciento de sus pares, presentaban algún diagnóstico psiquiátrico durante los doce meses previos a la entrevista. Los cuadros más prevalentes en los adolescentes infractores son trastorno disocial (46,9 por ciento), abuso de alcohol (26 por ciento) y dependencia a otras sustancias (18 por ciento). En los adolescentes no infractores son más prevalentes el déficit atencional con hieractividad (5 por ciento) y el trastorno disocial (5 por ciento). Hay diferencias estadísticamente significativas entre ambos grupos en la medición de coeficiente intelectual, un 31 por ciento) de infractores está en el rango de inteligencia limítrofe y un 34 por ciento en normal lento. Conclusiones: Menor capacidad intelectual, antecedentes de repitencia, mayor número de parejas sexuales y presencia de un trastorno disocial son las variables que mejor predicen la pertenencia al grupo de adolescentes infractores de ley.

Lenguaje e inteligencia de preescolares: análisis de su relación y factores asociados / Preschoolers language and intelligence: associated factors and relationship analysis

Background: Language and intelligence are brain superior functions and their development is vital for school and future work performance. Objective: To establish the correlation between language and intelligence, in order to identify possible factors involved in preschoolers of low socioeconomical status. Methods: Prospective and blind study that performs specific language tests, audiometry, WPSSI and pediatric-neurological examination to all children between 3-5 year-old attending a day care, belonging to families of low socioeconomical conditions at the Metropolitan Region of Chile, during 2007. Children with major diseases, explaining language difficulties (LD) were excluded. Results: 61 preschoolers, in which 22 (36 percent) LD were identified. Cognitive performance presented a normal distribution (mean 92,69 +15). There was a significant correlation between intelligence and language (p 0.002). Children with LD had lower cognitive performance, both in verbal (p 0.004) and in manual tests (p 0.0007). The family history of LD or learning difficulties and history of developmental delay were associated with a lower language performance (p 0,05 and p < 0.0000, respectively). Children of mothers with superior studies showed better scores in their cognitive potential (p 0.0079). Conclusion: Language and intelligence are significantly associated. Biological and hereditary factors were correlated with LD, whereas social factors (ex: maternal education) were associated with cognitive performance. These findings should be considered in the planification of health politics related with children development, implementing multidisciplinary strategies.

Introducción: El lenguaje y la inteligencia son funciones cerebrales superiores cuyo desarrollo es determinante para el desempeño escolar y futuro laboral. Objetivo: Establecer la correlación entre lenguaje e inteligencia, e identificar posibles factores asociados, en preescolares de nivel socio económico bajo. Metodología: Durante el año 2007 en forma prospectiva, simultánea y ciega, se aplicaron pruebas específicas de lenguaje, audiometría, WPSSI y evaluación pediátrica y neurológica completa, a todos los niños de 3 a 5 años, asistentes a un establecimiento de educación preescolar, de nivel socioeconómico bajo, de la Región Metropolitana de Chile. Se excluyeron los niños portadores de patología de base que pudiera dar cuenta de las dificultades de lenguaje (DL). Resultados: La muestra fue conformada por 61 preescolares. En 22 (36 por ciento) se identificó DL. El rendimiento cognitivo siguió una distribución normal (promedio 92,69+15). Hubo correlación significativa entre inteligencia y lenguaje (p 0,002). Los niños con DL presentaron menor rendimiento cognitivo, tanto verbal (p 0,004) como de ejecución (p 0,0007). El antecedente familiar de DL o trastornos de aprendizaje e historia de déficit del DSM se asociaron a menor rendimiento de lenguaje (p 0,05 y p < 0,0000). Los hijos de madres con educación superior mostraron mejor rendimiento en su potencial cognitivo (p 0,0079). Conclusión: El lenguaje y la inteligencia se asociaron significativamente; factores hereditarios y biológicos se correlacionaron con DL, mientras que factores sociales con el rendimiento cognitivo. Estos hallazgos debieran considerarse en las políticas de desarrollo infantil, implementando estrategias multisectoriales y multidisciplinarias.

Adult mood disorders and childhood psychological trauma / Transtornos do humor no adulto e trauma psicológico na infância

OBJECTIVE: To evaluate the association between adult mood disorders and childhood psychological trauma in a developing country. METHOD: Adults with and without mood disorders were assessed in a case-control study using the Mini International Neuropsychiatric Interview. Assessment of childhood trauma included physical and sexual abuse, frequent exposure to violence, and parental loss. RESULTS: In two independent multivariate analyses, after adjusting for potential confounding factors, we found a higher odds ratio for frequent exposure to violence in the community (p = .037) and for physical abuse by parents or caregivers during childhood/adolescence (p = .012) in the group with mood disorders than in the control group. In secondary analyses splitting the mood disorder group in two subgroups (manic episode, and major depressive episodes/ dysthymia), only manic patients showed significantly higher rates of frequent exposure to violence in the community (p = 0.01) and physical abuse during childhood (p = 0.02) than did patients in the control group. In addition, maniac patients had significantly higher rates of sexual abuse than did controls (p = .03). CONCLUSIONS: Our findings document an association between violence during childhood and adult mood disorders, especially for manic patients, in a developing country.

OBJETIVO: Avaliar a associação entre transtornos de humor no adulto e trauma psicológico na infância em um país em desenvolvimento. MÉTODO: Adultos com e sem transtorno de humor foram avaliados em um estudo de caso-controle utilizando a Mini Entrevista Neuropsiquiátrica Internacional. A avaliação de trauma infantil incluiu abuso físico e sexual, exposição freqüente à violência e perda dos pais. RESULTADOS: Em duas análises multivariadas independentes, após o ajuste para fatores potenciais de confusão, encontramos uma razão de chance mais alta de exposição freqüente à violência na comunidade (p = 0,037) e de abuso físico por pais ou cuidadores durante a infância/adolescência (p = 0,012) no grupo com transtorno de humor do que no grupo controle. Em análises secundárias, dividindo-se o grupo com transtorno de humor em dois subgrupos (episódio maníaco e episódios de depressão maior/ distimia), somente pacientes maníacos demonstraram maiores índices de exposição freqüente à violência na comunidade (p = 0,01) e abuso físico durante a infância (p = 0,02) do que os pacientes no grupo controle. Além disso, os pacientes com mania tinham índices significativamente mais altos de abuso sexual do que os controles (p = 0,03). CONCLUSÕES: Nossos achados documentam uma associação entre violência na infância e transtornos de humor na idade adulta, especialmente em pacientes com mania, em um país em desenvolvimento.

Learning difficulties in schoolchildren born with very low birth weight

OBJECTIVES: To investigate the relationship between very low birth weight and learning difficulties at school by means of a systematic review of the literature, identifying patterns of learning difficulties among these schoolchildren, possible cognitive correlations, peculiarities of the lowest birth weight ranges and any interference with outcomes by socioeconomic and/or clinical factors. SOURCES OF DATA: Bibliographic search (MEDLINE, LILACS, Excerpta Medica, reference lists of original articles, periodicals related to the subject, information from experts in the area and thesis and dissertation databases) on the keywords: prematurity/very low birth weight, learning difficulties/academic achievement/school performance, follow-up/results/cohort. SUMMARY OF THE FINDINGS: The search returned 114 articles and the 18 of these were selected as having investigated learning difficulties in schoolchildren born with very low birth weights using appropriate methodology. The academic performance of these children was observed to be inferior the whole study population was compared with those born full term. The subject most compromised was mathematics. The risk of suffering from learning difficulties increased in inverse proportion to birth weight. An association was identified between very low birth weight and cognitive compromise. CONCLUSIONS: The systematic approach corroborated the results obtained by published studies: schoolchildren born with very low birth weights exhibited increased risk of learning difficulties when compared with those born at full term. There was a predominance of children with multiple academic subjects compromised and mathematics was the most affected. Risk was observed to follow an ascending gradient as birth weight reduced. There was an association between very low birth weight and cognitive compromise.

Epidemiologia do desenvolvimento cognitivo de escolares em Jequié, Bahia, Brasil: procedimentos de avaliação e resultados gerais / Epidemiology of schoolchildren's cognitive development in Jequié, Bahia State, Brazil: assessment procedures and general results

This paper describes the methodology, applicability and utility of the Raven Progressive Matrix (Raven Test) and the Brazilian Intellectual Probe (TSI), comparing them with school achievement in a typical medium-size urban community of Northeastern Brazil. 388 schoolchildren (7-17 years old) were examined, with 371 Raven tests applied. Only 231 TSIs were completed, since 106 students were illiterate. School grades were obtained for all participants. A questionnaire evaluating school resources, and teacher profiles was answered by 200 teachers. Raven and TSI test scores were highly correlated (r = 0.53, p < 0.001), but both correlated weakly with overall school grade (r = 0.22, p < 0.001 and r = 0.12, p < 0.07 respectively). For individual school grades, the Raven scores showed statistically significant correlation with all subjects, while the Brazilian TSI presented statistically significant correlation only with geography, history and sciences. Boys' mean scores were higher than girls' for both the Raven and the TSI Tests, but for the school grades girls performed better. In general, level of cognitive development was below that expected for children in the age-group analyzed.

Alcoolismo cronico e Atrofia cortical: um estudo de seis casos / Chronic alcoholism and cortical atrophy: a study of six cases

Os autores estudaram seis casos de alcoolismo cronico com atrofia cortical decorrente, diagnosticada por meio de tomografia computadorizada. Esses pacientes estavam voluntariamente internados no Instituto Bairral de Psiquiatria de Itapira,SP,Brasil, que trabalha nos moldes de comunidade terapeutica. Apos quatro semanas de tratamento, com boa evoluçäo de cinco casos, foram aplicados o Teste de Inteligencia Näo Verbal, o G 36, de Boccalandro e o Teste de Memoria Retentiva de Paternostro. Os resultados demonstraram que 66,6 por cento ou quatro casos obtiveram escores abaixo da media em comparaçäo com a populaçäo normativa de cada teste. Os dados obtidos forma discutidos relacionando os resultados das tomografias computadorizadas, o desempenho nos testes e as características psiquiatricas e sócio-demográficas dos casos

La prueba "Matrices Coloreadas"(Escala especial): cómo evaluarla e interpretarla en nuestro medio / Colored matrices test (special scale): how to evaluate and interpret it in our milieu

La prueba Matrices Coloreadas (Escala especial) ha sido especialmente adaptada por su autor para niños de 5 a 11 años de edad. El presente artículo analiza: 1) La importancia de considerar las respuestas erróneas en la misma, desde que su probabilidad de aparición (5/6) es mayor que la de la respuesta correcta (Burnbaum, 1968; Bock, 1972); 2) La idea de consideraria como prueba con influencias "culturalmente reducidas" (Cultural reduced). Se presentan los resultados de un estudio realizado en la Argentina con 790 alumnos entre 4,0 años y 11,5 años, donde se analizan el puntaje total y el puntaje por serie. A través de un análisis de variancia múltiple se encontró que, tanto la edad como las series y la interaccción entre ambas tienen influencia estadísticamente significativa sobre las variaciones de los puntajes. Además, se presentan nuevas normas de evaluacion