Prevalence and associated factors of eating disorder symptoms in adolescents: a cross-sectional school-based study.

PURPOSE: To estimate the prevalence of eating disorder symptoms and associated factors in adolescents between 14 and 17 years old. METHODS: The data were obtained from a cross-sectional school-based study with 782 adolescents from public schools in Caxias do Sul, in Rio Grande do Sul, Brazil, in 2016. The Eating Attitudes Test (EAT-26) was used to investigate eating disorder symptoms. The chi-square test and Poisson regression with robust variance were performed to estimate the prevalence ratios and associations between the outcome and the variables of interest. RESULTS: The prevalence of eating disorder symptoms was around 56.9% among adolescents and more prevalent in females. A significant association was found between eating disorders and female gender, mothers who did not study or had an incomplete elementary school, and body image dissatisfaction. To adolescents dissatisfied with being overweight, the prevalence was more than three times higher than that observed among those who did not report such dissatisfaction. CONCLUSION: The presence of eating disorder symptoms was associated with female gender, maternal education, and body image dissatisfaction. The results show the need to identify early signs and symptoms related to changes in eating behavior and non-acceptance of their bodies in a population especially concerned with their physical appearance.

Association between the Intron 8 VNTR Polymorphism of the DAT1 Gene and Crack Cocaine Addiction.

BACKGROUND: This study aims to compare allele and genotype frequencies of a 30-bp variable number of tandem repeats (VNTR) polymorphism of the DAT1 gene, located at intron 8, between adult crack cocaine users and nonaddicted individuals. Due to its involvement in drug addiction, this gene is a good candidate for molecular studies. METHODS: A cross-sectional sample of 239 current adult crack abusers or dependents from in- and outpatient clinics and 211 control individuals was collected in Brazil. They were evaluated using ASRS, ASI-6, WAIS-III, and MINI assessments. DNA samples extracted from whole blood were genotyped for the intron 8 VNTR in DAT1. RESULTS: Logistic regression analysis was performed and controlled for gender, age, ethnicity, educational level, and comorbidities of clinical interest (generalized anxiety disorder, suicide risk, major depressive episode, and attention deficit/hyperactivity disorder). This analysis showed that the 6R6R genotype was associated with crack cocaine addiction (OR = 1.844; CI = 1.101-3.089; p = 0.020). CONCLUSIONS: Our results are consistent with the role of DAT1 in the neurobiology of drug addiction. Nevertheless, the study of other genes, environmental factors, and their interactions is also important to gain a broader understanding of this condition.

Crack cocaine users show differences in genotype frequencies of the 3' UTR variable number of tandem repeats of the dopamine transporter gene (DAT1/SLC6A3).

BACKGROUND: Due to the mechanism of action of the dopamine transporter (DAT) in drug addiction, the DAT1 gene is a potential candidate for molecular studies. This paper aims to compare the prevalence of allele and genotype frequencies created by the 3' UTR variable number of tandem repeats (VNTR) of this gene between crack cocaine users and controls. METHODS: A cross-sectional sample of 237 current adult crack cocaine abusers or dependents (DSM-IV TR criteria) from in- and outpatient clinics in southern Brazil and 205 community controls were compared. The subjects were evaluated using the Adult ADHD Self-Report Scale, the Mini-International Neuropsychiatric Interview - short version, and the Wechsler Intelligence Scale. DNA samples were genotyped for the DAT1 3' VNTR. RESULTS: Logistic regression analysis was performed to compare the frequency of the 10.10 genotype (the putative risk genotype) to those of other genotypes. A significant difference (p = 0.04, OR = 1.758, CI = 1.026-3.012) indicating an increased frequency of the 10.10 genotype in the cases (59.9%) compared to the controls (49.3%) was verified using clinical and demographic covariates. CONCLUSIONS: This is one of the first genetic association studies on crack cocaine users in the literature. The results suggest an influence of the DAT1 gene, namely the 3' VNTR 10.10 genotype. However, more analyses will confirm and clarify its contribution as a possible risk factor for crack cocaine dependence.

Cerebral palsy and developmental intellectual disability in children younger than 5 years: Findings from the GBD-WHO Rehabilitation Database 2019.

Objective: Children with developmental disabilities are associated with a high risk of poor school enrollment and educational attainment without timely and appropriate support. Epidemiological data on cerebral palsy and associated comorbidities required for policy intervention in global health are lacking. This paper set out to report the best available evidence on the global and regional prevalence of cerebral palsy (CP) and developmental intellectual disability and the associated "years lived with disability" (YLDs) among children under 5 years of age in 2019. Methods: We analyzed the collaborative 2019 Rehabilitation Database of the Global Burden of Disease (GBD) Study and World Health Organization for neurological and mental disorders available for 204 countries and territories. Point prevalence and YLDs with 95% uncertainty intervals (UI) are presented. Results: Globally, 8.1 million (7.1-9.2) or 1.2% of children under 5 years are estimated to have CP with 16.1 million (11.5-21.0) or 2.4% having intellectual disability. Over 98% resided in low-income and middle-income countries (LMICs). CP and intellectual disability accounted for 6.5% and 4.5% of the aggregate YLDs from all causes of adverse health outcomes respectively. African Region recorded the highest prevalence of CP (1.6%) while South-East Asia Region had the highest prevalence of intellectual disability. The top 10 countries accounted for 57.2% of the global prevalence of CP and 62.0% of the global prevalence of intellectual disability. Conclusion: Based on this Database, CP and intellectual disability are highly prevalent and associated with substantial YLDs among children under 5 years worldwide. Universal early detection and support services are warranted, particularly in LMICs to optimize school readiness for these children toward inclusive education as envisioned by the United Nations' Sustainable Development Goals.

Risk factors for suspected developmental delay at age 2 years in a Brazilian birth cohort.

Many children are at risk of not achieving their full potential for development. Epidemiological studies have the advantage of being able to identify a number of associated factors potentially amenable to intervention. Our purpose was to identify risk factors for suspected developmental delay (SDD) at age 2 years among all children born in the city of Pelotas, Brazil, in 2004. This study was part of the 2004 Pelotas Birth Cohort. The Battelle Screening Developmental Inventory (BSDI) was administered to cohort children at age 2 years. A hierarchical model of determination for SDD with confounder adjustment was built including maternal sociodemographic, reproductive and gestational characteristics, as well as child and environmental characteristics. Multivariable analysis was carried out using Poisson regression. Prevalence ratios (PR) and 95% confidence intervals [95% CI] were calculated. In the results, 3.3% of the 3869 children studied screened positive for SDD. After confounder control, children more likely to show SDD were: those with positive BSDI at age 12 months (PR = 5.51 [3.59, 8.47]); with 5-min Apgar <7 (PR = 3.52 [1.70, 7.27]); with mothers who had <4 years of schooling (PR = 3.35 [1.98, 5.66]); from social classes D and E (PR = 3.00 [1.45, 6.19]); with a history of gestational diabetes (PR = 2.77 [1.34, 5.75]); born <24 months after the last sibling (PR = 2.46 [1.42, 4.27]); were not told child stories in the preceding week (PR 2.28 [1.43, 3.63]); did not have children's literature at home (PR = 2.08 [1.27, 3.39]); with low birthweight (PR = 1.75 [1.00, 3.07]); were born preterm (PR = 1.74 [1.07, 2.81]); with <6 antenatal care appointments (PR = 1.70 [1.07, 2.68]); with history of hospitalisation (PR = 1.65 [1.09, 2.50]); and of male sex (PR = 1.43 [1.00, 2.04]). These risk factors may constitute potential targets for intervention by public policies and may provide help to paediatricians in preventing developmental delay.

Natural history of suspected developmental delay between 12 and 24 months of age in the 2004 Pelotas birth cohort.

AIMS: To describe the incidence and persistence of suspected developmental delay (SDD) between 12 and 24 months of age and associated factors in the 2004 Pelotas Birth Cohort. METHODS: A cohort of 4262 newborns, 3907 of whose were monitored from 12 to 24 months of life. SDD was established by Battelle Screening Developmental Inventory. The adjusted analyses were carried out using Poisson regression. Relative risks and 95% confidence intervals were calculated. RESULTS: Incidence of SDD between 12 and 24 months of age was 1.8% (95% CI: 1.4-2.3). After the adjusted analyses, the following factors increased the risk of the incidence: Apgar 5'<7, preterm delivery, low socio-economic level, intergestational interval

Global Burden of Childhood Epilepsy, Intellectual Disability, and Sensory Impairments.

BACKGROUND: Estimates of children and adolescents with disabilities worldwide are needed to inform global intervention under the disability-inclusive provisions of the Sustainable Development Goals. We sought to update the most widely reported estimate of 93 million children <15 years with disabilities from the Global Burden of Disease Study 2004. METHODS: We analyzed Global Burden of Disease Study 2017 data on the prevalence of childhood epilepsy, intellectual disability, and vision or hearing loss and on years lived with disability (YLD) derived from systematic reviews, health surveys, hospital and claims databases, cohort studies, and disease-specific registries. Point estimates of the prevalence and YLD and the 95% uncertainty intervals (UIs) around the estimates were assessed. RESULTS: Globally, 291.2 million (11.2%) of the 2.6 billion children and adolescents (95% UI: 249.9-335.4 million) were estimated to have 1 of the 4 specified disabilities in 2017. The prevalence of these disabilities increased with age from 6.1% among children aged <1 year to 13.9% among adolescents aged 15 to 19 years. A total of 275.2 million (94.5%) lived in low- and middle-income countries, predominantly in South Asia and sub-Saharan Africa. The top 10 countries accounted for 62.3% of all children and adolescents with disabilities. These disabilities accounted for 28.9 million YLD or 19.9% of the overall 145.3 million (95% UI: 106.9-189.7) YLD from all causes among children and adolescents. CONCLUSIONS: The number of children and adolescents with these 4 disabilities is far higher than the 2004 estimate, increases from infancy to adolescence, and accounts for a substantial proportion of all-cause YLD.

Brazilian study of adaptation and psychometric properties of the Coping Health Inventory for Parents.

The Coping Health Inventory for Parents (CHIP) evaluates coping patterns of parents of chronically ill children and assesses different coping strategies using three subscales. This study aimed to translate and transculturally adapt the CHIP for a Brazilian sample and investigate the preliminary psychometrics of the scale. Rating scale Rasch analysis was performed on CHIP responses, and the psychometric performance of each of the three subscales was tested. Two hundred twenty parents of individuals with health problems participated in the study, answering a sociodemographic questionnaire-the Brazilian version of the CHIP-and Folkman and Lazarus's coping questionnaire. All items exhibited good fit to the measurement model, although response categories were not used as intended and little variability on person parameter estimates was obtained. These preliminary results suggested that each construct being measured by the three subscales should be treated separately, corroborating the theoretical model of the original instrument. Suggestions to address the psychometric limitations of the instrument were made in order to improve measurement precision.

Excessive crying in infants.

OBJECTIVE: Review the literature on excessive crying in young infants, also known as infantile colic, and its effects on family dynamics, its pathophysiology, and new treatment interventions. DATA SOURCE: The literature review was carried out in the Medline, PsycINFO, LILACS, SciELO, and Cochrane Library databases, using the terms "excessive crying," and "infantile colic," as well technical books and technical reports on child development, selecting the most relevant articles on the subject, with emphasis on recent literature published in the last five years. SUMMARY OF THE FINDINGS: Excessive crying is a common symptom in the first 3 months of life and leads to approximately 20% of pediatric consultations. Different prevalence rates of excessive crying have been reported, ranging from 14% to approximately 30% in infants up to 3 months of age. There is evidence linking excessive crying early in life with adaptive problems in the preschool period, as well as with early weaning, maternal anxiety and depression, attention deficit hyperactivity disorder, and other behavioral problems. Several pathophysiological mechanisms can explain these symptoms, such as circadian rhythm alterations, central nervous system immaturity, and alterations in the intestinal microbiota. Several treatment alternatives have been described, including behavioral measures, manipulation techniques, use of medication, and acupuncture, with controversial results and effectiveness. CONCLUSION: Excessive crying in the early months is a prevalent symptom; the pediatrician's attention is necessary to understand and adequately manage the problem and offer support to exhausted parents. The prescription of drugs of questionable action and with potential side effects is not a recommended treatment, except in extreme situations. The effectiveness of dietary treatments and use of probiotics still require confirmation. There is incomplete evidence regarding alternative treatments such as manipulation techniques, acupuncture, and use of the herbal supplements and behavioral interventions.

Child development in primary care: a surveillance proposal.

OBJECTIVE: To evaluate a child development surveillance tool proposal to be used in primary care, with simultaneous use of the Denver II scale. METHODS: This was a cross-sectional study of 282 infants aged up to 36 months, enrolled in a public daycare in a countryside community in Rio Grande do Sul/Brazil. Child development was assessed using the surveillance tool and the Denver II scale. RESULTS: The prevalence of probable developmental delay was 53%; most of these cases were in the alert group and 24% had normal development, but with risk factors. At the Denver scale, the prevalence of suspected developmental delay was 32%. When risk factors and sociodemographic variables were assessed, no significant difference was observed. CONCLUSION: The evaluation of this surveillance tool resulted in objective and comparable data, which were adequate for a screening test. It is easily applicable as a screening tool, even though it was originally designed as a surveillance tool. The inclusion of risk factors to the scoring system is an innovation that allows for the identification of children with suspected delay in addition to developmental milestones, although the definition of parameters and choice of indicators should be thoroughly studied.

Early behavioral effects of lead perinatal exposure in rat pups.

Acoustic analysis of infants crying, a sensitive and selective index for measuring the effect of pre and perinatal lead exposure, may provide an early marker for central nervous system damage produced by the toxic. The present study evaluated the effects of exposure to low lead levels during perinatal and early postnatal periods on ultrasonic vocalization (USV), an early behavior of rat pups essential to their development. Non-sexually experienced females were gavaged daily with 8, 16 or 24 mg/kg of lead acetate or the control solution (1 ml/kg) for 30 days prior to breeding and until their pups were weaned. After crossover of dams, pups had been exposed to lead during pregnancy+lactation, pregnancy or lactation. The physiological variables measured on postnatal days 7 or 14 were USV, locomotion, rectal temperature, body weight and blood lead levels. Lead exposition during pregnancy+lactation, pregnancy or lactation induced a significant dose-dependent decrease of USV of 7-day-old pups. On the contrary, lead exposition during the different phases of pregnancy induced a significant dose-dependent increase of USV in 14-day-old rat pups. Blood lead levels varied from 5.7 to 36.5 microg/dl in pups. Body weight and temperature were not influenced by lead exposition. Lead-exposed 14-day-old pups were significantly more active. This study provides evidence of developmental changes in USV emission in rat pups exposed with low lead levels.

[Sensitivity, specificity and predictive value of hearing complaints]. / Sensibilidade, especificidade e valor preditivo da queixa auditiva.

This study assessed the sensitivity, specificity and predictive value of hearing complaints in outpatients attending an university ear, nose and throat clinic. A cross-sectional study was carried out in Canoas, Southern Brazil, from 1999 to 2002. Seven-hundred and ninety-five subjects who underwent the audiometric test were analyzed. The results showed that the complaint of hearing loss presented 80.9% sensitivity, 69.6% specificity and 86.5% positive predictive value and 60.4% negative predictive value. Despite its subjective character, the audiometric test can be considered a reliable diagnostic tool and should be used due to its low cost compared to the new technologies.

[Nutritional status surveillance of children in a health district in southern Brazil]. / Vigilância do estado nutricional das crianças de um distrito de saúde no Sul do Brasil.

OBJECTIVE: To investigate the nutritional status of children referred by a primary care center to the Nutritional Surveillance Program (Prá-Crescer), and to follow up children at risk in a health district of Porto Alegre. METHODS: A retrospective cohort study was conducted with 674 children, aged between 6 and 59 months, referred to the Prá-Crescer Program. Height-for-age, weight-for-height and weight-for-age indices were used to evaluate nutritional status. The cutoff points were the 3rd and 10th percentiles of the NCHS standards. The nutritional status of 391 children at nutritional risk was followed up for 12 months. The chi-square test was used to analyze associations between variables. RESULTS: Fifty-eight percent of the children had nutritional deficit. Of these, 38.1% were undernourished (< P3), and 61.9% were at nutritional risk (between P3 and P10). Height-for-age deficit was the most frequent, and the age group mostly affected was 12 to 24 months. Among those at nutritional risk, 50.1% completed the follow-up, 33.5% did not start follow-up, and 16.4% were lost to follow-up. 41.3 % recovered nutritional health, 10.2% showed some improvement, without correcting their anthropometric deficits. 39.8% did not show any improvement, and 8.7% had worsening of their deficits. Recovery of nutritional health occurred, on average, within 7.5 months. CONCLUSIONS: This study showed the importance of following up children at nutritional risk and indicates that some aspects should be improved in surveillance programs. Such improvements may reduce the number of children lost to follow-up.

[Breastfeeding of premature babies with less than 1500g: oral motor functioning and attachment]. / Amamentação de prematuros com menos de 1500 gramas: funcionamento motor-oral e apego.

BACKGROUND: Breastfeeding of premature babies. AIM: To describe breastfeeding in premature babies with very low birth weight (VLBW) and its association with the oral motor system (OMS) and with maternal-child bonding. METHOD: A cross-sectional study with 48 VLBW premature babies. An interview with the mothers, as well as the evaluation of the newborns' OMS and signs of attachment was performed. Data was submitted to a descriptive analysis and to the Fischer Test. RESULTS: Variables that showed statistical association with nutritive sucking were: child's position at breast; nipple grasping; sucking coordination between sucking, breathing and swallowing; strength and maintenance; rhythm, and level of conscious. Twelve pair situations presented signs possible bonding problems. CONCLUSION: Components of OMS are associated to the quality of feeding of premature babies. This fact suggests that the early evaluation of breastfeeding can detect difficulties that could jeopardize adequate nutrition.

[Risk factors associated with hospitalization for bronchiolitis in the post-neonatal period]. / Fatores de risco associados à hospitalização por bronquiolite aguda no período pós-neonatal.

OBJECTIVE: To investigate the relationship between socioeconomic factors, maternal characteristics, breastfeeding, and hospitalization for bronchiolitis in the post-neonatal period. METHODS: A nested case-control study with a cohort of 5,304 children born in the city of Pelotas, Brazil, was conducted. The cohort study consisted of four sub-studies with their own methods and logistics. Mothers were interviewed using a standard questionnaire during in-hospital and home visits. Cases were defined as any child aged 28 to 364 days who had been hospitalized for bronchiolitis. RESULTS: Among 5,304 cohort children, 113 (2.1%) were hospitalized for bronchiolitis. The hierarchical multivariate analysis performed using logistic regression showed the following results: family income and gestational age were inversely associated with the risk of hospitalization for bronchiolitis. Breastfeeding showed to have a protective effect; children who were breastfed for less than one month had 7 times less risk for being hospitalized for acute bronchiolitis in the first three months of life. The risk for hospitalization for bronchiolitis is 57% higher in those exposed to maternal smoking than in those non-exposed. CONCLUSIONS: Hospitalization for acute bronchiolitis is inversely associated with family income, gestational age and duration of breastfeeding and positively associated with maternal smoking. There was not an association with either parity or maternal history of asthma.

[Recent advances on attention deficit/hyperactivity disorder]. / Transtorno de déficit de atenção/hiperatividade: atualização.

OBJECTIVES: To describe the main aspects of attention deficit/hyperactivity disorder, including history, epidemiology, etiology, neurobiology, clinical features, comorbidities, diagnosis, outcome and treatment. SOURCES OF DATA: Comprehensive, non-systematic review of the literature on attention deficit/hyperactivity disorder. SUMMARY OF THE FINDINGS: Attention deficit/hyperactivity disorder has a neurobiological basis, and is highly prevalent in children and adolescents. Treatment is very efficacious, including the use of medication in most the cases. CONCLUSIONS: Pediatricians are in a privileged position to detect this disorder early and to start the initial management of less severe cases and of those not complicated by extensive comorbidities.

[Environmental influences on child mental health]. / Influências ambientais na saúde mental da criança.

OBJECTIVE: To present an up-to-date review about environmental influences on child mental health, describing major risk factors and discussing recommendations for intervention by pediatricians. SOURCES OF DATA: MEDLINE, PsycLIT and Lilacs, technical books and publications about child development and child and adolescent mental health problems and health promotion. SUMMARY OF THE FINDINGS: Children are exposed to multiple risk factors, among them high prevalence of disease, premature birth, being born from a problematic pregnancy, and living in poverty. This negative chain of events increases the risk for emotional problems. The negative effects on development and behavior result from the complex interaction between genetic, biological, psychological and environmental risk factors. The main factors influencing the mental health of children are the social and psychological environment. The cumulative risk effect is more important in determining emotional problems in children than the presence of one single stressor, regardless of its magnitude. CONCLUSION: Environmental factors play an important role in the etiology of emotional problems in childhood. An adequate clinical investigation allows pediatricians to identify risk factors for the development of mental health problems and to ensure early intervention for children at risk.

[Risk factors for accidental injuries in preschool children]. / Fatores de risco para injúrias acidentais em pré-escolares.

OBJECTIVE: To measure the main risk factors associated with the occurrence of accidental injuries in children aged 4-5 years. METHODS: The study included a prospective cohort of children whose parents filled in a diary recording accidents and injuries during a period of one-month. The children represented a systematic subsample from a population-based birth cohort in southern Brazil. The outcome was the number of reported injuries per child during one month. Multivariate analysis (Poisson regression) was used to assess confounding factors. RESULTS: The monthly frequency of accidents was 53.8%, and 48.4% of the children suffered at least one injury. Boys had 30% more injuries than girls, and white children had 70% higher incidence than non-white. Family income, parental education and maternal employment were not associated with the frequency of injuries. After adjustment of socioeconomic and environmental factors, having younger siblings was associated with a 30% higher injury rate, and living in a home made of bricks was associated with a 35% increase. The incidence of injuries appeared to be higher among children attending day-care centers and those living in periurban areas. CONCLUSIONS: Few risk factors were associated with an increased frequency of injuries. Among them, the most amenable to intervention seems to be the presence of younger siblings. Parents should become aware of children's needs for increased attention when a younger sibling is born.

Prevalence and characteristics of victims and perpetrators of bullying.

OBJECTIVE: To determine the prevalence of bullying (victims and perpetrators) in a representative sample of sixth graders from schools located in the city of Caxias do Sul, RS, Brazil and to determine possible associations with maternal education, socioeconomic level, sedentary habits, nutritional status, dissatisfaction with body image, gender, and age. METHODS: This was a school-based epidemiological study. The target population consisted of sixth graders (11-14 years). A self-administered questionnaire and anthropometric measurements of weight and height were used for the assessment of nutritional status. Bullying was assessed through the Kidscape questionnaire, and body image through the Body Shape Questionnaire. Descriptive statistics and bivariate and multivariate analyses were used. RESULTS: 1,230 schoolchildren were evaluated, and the prevalences of victims and perpetrators of bullying were 10.2% and 7.1%, respectively. Those dissatisfied with their body image were three times more likely to be victims of bullying (PR=3.24; CI=1.99- 5.28), and almost twice as likely to be aggressors (PR=1.98; CI=1.53-3.73) than those who were satisfied. Schoolchildren with sedentary habits (more than three hours a day) were 55% more likely to be victims of bullying (PR=1.55; CI=1.01- 2.36) and more than twice as likely (PR=2.42; CI=1.47-3.97) to be aggressors. Boys were more than twice as likely (PR=2.45; CI=1.42-4.24) to be aggressors. CONCLUSIONS: Body image and sedentary habits were associated with victims and perpetrators, and male gender was more prevalent among the perpetrators of bullying.