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Background: Psychiatric disorders often emerge during late adolescence/early adulthood, a period with increased susceptibility to socioenvironmental factors that coincides with incomplete parvalbumin interneuron (PVI) development. Stress during this period causes functional loss of PVIs in the ventral hippocampus (vHip), which has been associated with dopamine system overdrive. This vulnerability persists until the appearance of perineuronal nets (PNNs) around PVIs. We assessed the long-lasting effects of adolescent or adult stress on behavior, ventral tegmental area dopamine neuron activity, and the number of PVIs and their associated PNNs in the vHip. Additionally, we tested whether PNN removal in the vHip of adult rats, proposed to reset PVIs to a juvenile-like state, would recreate an adolescent-like phenotype of stress susceptibility. Methods: Male rats underwent a 10-day stress protocol during adolescence or adulthood. Three to 4 weeks poststress, we evaluated behaviors related to anxiety, sociability, and cognition, ventral tegmental area dopamine neuron activity, and the number of PV+ and PNN+ cells in the vHip. Furthermore, adult animals received intra-vHip infusion of ChABC (chondroitinase ABC) to degrade PNNs before undergoing stress. Results: Unlike adult stress, adolescent stress induced anxiety responses, reduced sociability, cognitive deficits, ventral tegmental area dopamine system overdrive, and decreased PV+ and PNN+ cells in the vHip. However, intra-vHip ChABC infusion caused the adult stress to produce changes similar to the ones observed after adolescent stress. Conclusions: Our findings underscore adolescence as a period of heightened vulnerability to the long-lasting impact of stress and highlight the protective role of PNNs against stress-induced damage in PVIs.
In this work, we aimed to go deeper into understanding perineuronal nets (PNNs), a specialized extracellular matrix that evolves and protects inhibitory neurons in the brain, specifically parvalbumin-positive interneurons (PVIs). PVIs are essential in regulating brain activity. PNNs only reach maturity in adulthood, which leaves these interneurons unprotected during early life. To investigate this vulnerability, we conducted experiments in which we exposed adolescent and adult animals to a stress protocol. We observed that adolescent animals exhibited a higher susceptibility to developing changes associated with psychiatric disorders later in life. This susceptibility may stem from the absence of PNN protection around their PVIs. To explore this possibility further, we administered an enzyme into a specific brain region, the ventral hippocampus, of adult animals to selectively remove PNNs and induce an adolescent-like state. When subjected to stress, these animals displayed abnormalities similar to those observed in animals stressed during adolescence. Our findings have significant implications, suggesting that the presence of PNN protection around PVIs may be critical for mitigating stress-related psychiatric disorders.
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ISSUE: Postpartum depressive symptoms may be more prevalent and/or severe in vulnerable populations. BACKGROUND: Postpartum depression represents a serious mental health problem associated with maternal suffering. Despite the relevance and clinical implications of investigating pain during pregnancy and the association with postpartum depression, there is limited research on this topic. AIM: We evaluated the association between pain during pregnancy and postpartum depression symptoms in adolescent and adult women. METHODS: This study included 86 pregnant women (42 adolescents aged 13 to 18 years and 44 adults aged 23 to 28 years) from Trairi region, Northeastern Brazil. The evaluation of pain intensity and postpartum depression symptoms was conducted using the validated instruments of the Pelvic Pain Assessment Form and Edinburgh Postnatal Depression Scale (EPDS), respectively. Mann-Whitney and Kruskal-Wallis tests compared depressive symptoms in relation to pain status. FINDINGS: Overall, pregnant women reporting moderate to intense pain presented more depressive symptoms, with emphasis to "deep pain with intercourse" (p = .09), "burning vaginal pain after sex" (p = .01), "pelvic pain lasting hours or days after intercourse" (p = .06), and "pain with urination" (p = .09). When stratified by age group, significant associations were found only for the adolescents. DISCUSSION: Our results suggest that women reporting pain in different daily situations have higher EPDS scores. CONCLUSION: Pain during pregnancy is associated with postpartum depression symptoms, mainly among adolescents. Adequate screening and pain management during pregnancy may improve women's quality of life.
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BACKGROUND: Colombia has high numbers of internally displaced people, forced to migrate due to the conflict. 1 in 3 displaced women undergo pregnancy during adolescence, compared to around 1 in 5 in the non-displaced population, alongside health and resource inequalities between these groups. There is limited qualitative information available from the perspectives of displaced women experiencing adolescent pregnancy. This research explores how structural violence may feature in their experiences. METHODS: Qualitative methods were used. Participants were recruited with purposive sampling, using key informants and snowball sampling technique. 14 semi-structured interviews were conducted in Ciudad Bolívar, Bogotá, involving 11 displaced women who began childbearing age 15-19 in the past 10 years, and 4 participants' mothers. Data was analysed using the theoretical framework of structural violence, and emergent themes categorised using thematic analysis. RESULTS: Pregnancy was considered advantageous in many ways, but this was contradicted by resulting disadvantages that ensued. Structural violence was embedded in life stories, manifesting in poverty and difficulties accessing reliable income, poor access to healthcare and education following pregnancy. Institutional and interpersonal discrimination confounded these challenges. CONCLUSIONS: Pregnancy during adolescence was a contradictory experience, representing both a safety net and a trap due to a complex interplay of structural and cultural violence in everyday survival. Policymakers must consider the importance of the context surrounding adolescent pregnancy and address systematic disadvantages affecting women in these positions.
The violent conflict in Colombia has left many people forced to leave their homes and become 'internally displaced'. Internally displaced women are more likely to become pregnant during their adolescence than non-displaced women. This work tries to understand more about the everyday lives of displaced women who experience adolescent pregnancy, through interviews. The interviews were analysed and results interpreted using the theory of 'structural violence'. Structural violence describes how social structures such as racism, sexism, war and poverty determine life choices, leading to suffering and inequality. The work found that pregnancy and motherhood in adolescence for displaced women was positive in many ways by bringing purpose, status and companionship. However, these women also experienced many challenges after pregnancy, such as exclusion from education and secure employment and difficulty accessing healthcare. This demonstrated that structural violence features in multiple interconnected forms in the daily lives of displaced adolescent mothers. The work urges policymakers to appreciate the complexity of context surrounding adolescent pregnancy and motherhood, and to address the structural disadvantages facing women in these situations.
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Gravidez na Adolescência , Pesquisa Qualitativa , Humanos , Feminino , Adolescente , Gravidez , Gravidez na Adolescência/psicologia , Colômbia , Adulto Jovem , Refugiados/psicologia , Violência/psicologia , Adulto , Acessibilidade aos Serviços de SaúdeRESUMO
Introduction: The PERMA model of well-being has gained prominence in the study of well-being by the Positive Psychology movement. However, the model has been little studied regarding its applicability in different populations, such as adolescents. This study sought to evaluate the psychometric properties of the PERMA-Profiler instrument for Brazilian adolescents, as well as the measurement invariance for different age groups and gender, and investigate the relation with external variables. Methods: Confirmatory Factor Analysis and Multigroup Confirmatory Factor Analysis were used to test the internal structure and invariance of the PERMA-Profiler. Reliability was determined with McDonald's Omega and composite reliability. A total of 1,197 adolescents between 11 and 19 years old from different regions of Brazil participated. Results: The results of the confirmatory factor analysis indicated that the five correlated factors model was the most appropriate, presenting good factor loadings and adequate reliability. The scale proved to be invariant for adolescents of different age groups and gender. Correlations with associated variables were significant and moderate to strong, showing positive relations between positive emotions and well-being, and negative relations with negative affects and depressive and anxiety symptoms. Discussion: These results contribute to the understanding of well-being in adolescence and highlight the importance of promoting different components of well-being for adolescents' mental health.
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PURPOSE: Sex differences play a crucial role in understanding vulnerability to opioid addiction, yet there have been limited preclinical investigations of this effect during the transition from adolescence to adulthood. The present study compared the behaviors of male and female rodents in response to fentanyl treatment and targeted molecular correlates in the striatum and medial prefrontal cortex. MATERIALS AND METHODS: Thirty adolescent C57BL/6J mice underwent a 1-week fentanyl treatment with an escalating dose. In addition to evaluating locomotor activity and anxiety-related parameters, we also assessed naloxone-induced fentanyl acute withdrawal jumps. We employed real-time quantitative PCR (qPCR) to assess overall gene expression of dopaminergic receptors (Drd1, Drd2, Drd4 and Drd5) and the µ-opioid receptor Oprm1. The levels of epigenetic base modifications including 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC) were assessed on CpG islands of relevant genes. RESULTS: Females had higher locomotor activity than males after chronic fentanyl treatment, and they exhibited higher fentanyl withdrawal jumping behavior induced by naloxone. Females also presented lower Drd4 gene expression and DNA methylation (5mC + 5hmC) in the striatum. We found that locomotor activity and fentanyl withdrawal jumps were negatively correlated with Drd4 methylation and gene expression in the striatum, respectively. CONCLUSIONS: The findings suggested that female mice displayed heightened sensitivity to the effects of fentanyl treatment during the transition from adolescence to adulthood. This effect may be associated with molecular alterations related to the Drd4 gene.
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Fentanila , Camundongos Endogâmicos C57BL , Receptores Opioides mu , Caracteres Sexuais , Animais , Fentanila/farmacologia , Masculino , Feminino , Receptores Opioides mu/genética , Receptores Opioides mu/metabolismo , Camundongos , Metilação de DNA/efeitos dos fármacos , Analgésicos Opioides/farmacologia , Corpo Estriado/metabolismo , Corpo Estriado/efeitos dos fármacos , Locomoção/efeitos dos fármacos , Córtex Pré-Frontal/efeitos dos fármacos , Córtex Pré-Frontal/metabolismo , Receptores Dopaminérgicos/genética , Receptores Dopaminérgicos/metabolismo , Naloxona/farmacologia , Comportamento Animal/efeitos dos fármacos , Síndrome de Abstinência a Substâncias/genética , Síndrome de Abstinência a Substâncias/metabolismo , Epigênese Genética/efeitos dos fármacosRESUMO
The occurrence of multiple risk behaviors among adolescents imposes challenges in the context of public policies of health, particularly in low- and middle-income countries. Evidence on the conditions leading to the exposure to and adoption of multiple risk behaviors allows the identification of vulnerable groups of adolescents, and may support the proposition of targeted strategies directed to individuals at risk. Therefore, the aim of this study was to perform a quantitative analysis to identify recent trends in the exposure to and adoption of multiple health risk behaviors among Brazilian adolescents, highlighting individual-, household-, and school-level characteristics linked to inequalities among social groups. The analysis was based on cross-sectional data from the National Student Health Survey (PeNSE), conducted by the Brazilian Institute for Geography and Statistics in 2009, 2012, 2015, and 2019. The trends in the occurrence of multiple risk behaviors among adolescents were estimated according to social strata, allowing the calculation of concentration indexes and their disaggregation into major determinants of inequalities in the exposure and adoption of risk behaviors. The analyses were conducted using a complex survey design to allow representativeness at the population level. The results showed a rise in the incidence of multiple risk behaviors among youngsters in Brazil from 2009 to 2019. Factors influencing inequalities in the exposure to multiple risk behaviors were socioeconomic status and the characteristics of the household and school environments, whilst the adoption of multiple risk behaviors was also influenced by early exposure to multiple risk behaviors. Furthermore, trends in inequalities in the exposure to and adoption of multiple risk behaviors showed an intensification from 2009 to 2019, being initially concentrated among wealthier adolescents, followed by a transition to higher incidence in the lower socioeconomic strata in 2012 and 2015, respectively. The findings underscore the role of support systems for adolescents at risk within the familial and school contexts, whereas strategies of public policies of health based on the strengthening of community ties may require improvements to tackle socioeconomic inequalities in the occurrence of risk behaviors among youngsters.
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Overweight and obesity are major public health issues worldwide, including in Mexico, particularly among adolescents. This study aimed to analyze the associations between nutritional status and impaired executive function (EF) in Mexican adolescents. A case-control study was conducted with 98 male and female adolescents, categorized into normal weight and overweight/obese groups based on body mass index. EF was assessed using the BANFE-2 test. The prevalence of overweight and obesity was 54.3%. The EF assessment revealed that 82.45% of the overweight/obese group exhibited mild-to-severe impairment, compared to only 36.58% in the normal weight group (X2 = 21.69, p < 0.0001). In the inhibitory control assessment, adolescents with overweight and obesity performed worse than their normal-weight counterparts. Specifically, females with overweight/obesity scored lower than females with normal weight on the risk-benefit processing test. The risk of severe EF impairment significantly increased with the presence of overweight/obesity (OR = 7.8, p < 0.0001). These findings indicate that EF, particularly inhibitory control and risk-benefit processing, is impaired in adolescents with overweight or obesity.
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Linalool-rich Rosewood oil (Aniba rosaeodora Ducke) is a natural compound widely used in perfumery industry. Evidence suggests that linalool exerts antidepressant and anxiolytic effects. Conversely, ethanol binge drinking (i.e., intermittent and episodic consumption) during adolescence elicits neurobehavioral alterations associated with brain damage. Here, we investigated whether linalool-rich Rosewood oil administration can improve the emotional and molecular impairments associated with ethanol binge-like exposure during adolescence in female rats. Rosewood oil was obtained by hydrodistillation and posteriorly analyzed. Adolescent female Wistar rats received four-cycles of ethanol binge-like pattern (3â¯g/kg/day, 3 days on/4 days off) and daily Rosewood oil (35â¯mg/kg, intranasally) for 28 days. Twenty-four hours after treatments, it was evaluated the impact of ethanol exposure and Rosewood oil treatment on the putative emotional impairments assessed on the splash and forced swimming tests, as well as the levels of brain-derived neurotrophic factor (BDNF), S100B, oxidative parameters, and inflammatory cytokines in prefrontal cortex and hippocampus. Results indicated that Rosewood oil intranasal administration mitigated emotional impairments induced by ethanol exposure accompanied by a marked increase in BDNF, S100B, glutathione (GSH), and antioxidant activity equivalent to Trolox (TEAC) levels in brain areas. Rosewood oil treatment also prevented the ethanol-induced increase of interleukin-1ß, interleukin-6, tumor necrosis factor α (TNF-α), and neurofilament light chain (NFL) levels. These findings provide the first evidence that Rosewood oil intranasal administration exerts protective effects against emotional and molecular impairments associated with adolescent ethanol binge-like exposure, possibly due to linalool actions triggering neurotrophic factors, rebalancing antioxidant status, and attenuating proinflammatory process.
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Monoterpenos Acíclicos , Etanol , Óleos Voláteis , Ratos Wistar , Animais , Feminino , Óleos Voláteis/farmacologia , Óleos Voláteis/isolamento & purificação , Monoterpenos Acíclicos/farmacologia , Ratos , Consumo Excessivo de Bebidas Alcoólicas/tratamento farmacológico , Antioxidantes/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Emoções/efeitos dos fármacos , Comportamento Animal/efeitos dos fármacos , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Citocinas/metabolismo , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Córtex Pré-Frontal/efeitos dos fármacos , Córtex Pré-Frontal/metabolismoRESUMO
BACKGROUND: The promotion of daily breakfast consumption and the importance of making appropriate breakfast choices have been underscored as significant public health messages. The aim of this study was to examine the relationship between breakfast frequency and life satisfaction in large and representative samples of school-going children and adolescents aged 10-17 years from 42 different countries. METHODS: This study used information from the 2017/2018 Health Behavior in School-aged Children study, comprising nationally representative samples of children and adolescents aged 10-17 years who were attending school. The total number of participants from the 42 countries included in the study was 155,451 (51.3% girls). The evaluation of breakfast consumption in this study involved a specific question: "How often do you typically have breakfast (more than a glass of milk or fruit juice)?". To measure life satisfaction, a subjective assessment scale was used in the form of a ladder, visually spanning from 0 to 10. On this scale, the topmost point (10) denotes the highest conceivable quality of life, whereas the bottom point (0) represents the worst imaginable quality of life. RESULTS: After adjusting for several covariates, the lowest estimated marginal mean of life satisfaction was identified in those participants who skipped breakfast (mean [M] = 5.6, 95% confidence interval [CI] 5.5 to 5.8). Conversely, the highest estimated marginal mean of life satisfaction was observed in those who had breakfast every day (M = 6.5, 95% CI 6.3 to 6.6). Overall, a nearly linear relationship between higher frequency of breakfast and greater life satisfaction in children and adolescents was identified (p-for-trend < 0.001). In addition, the highest estimated marginal mean of life satisfaction score was identified in those participants from Portugal who had breakfast every day (M = 7.7; 95% CI 6.9 to 8.5 points). Conversely, the lowest estimated marginal mean of life satisfaction was observed in those participants from Romania who no breakfast (M = 3.5; 95% CI 2.6 to 4.4 points). CONCLUSIONS: There is a nearly linear relationship between higher frequency of breakfast and greater life satisfaction in children and adolescents. Considering the potential health advantages associated with breakfast during this critical age phase, these findings imply the necessity for additional global efforts to promote increased breakfast consumption among children and adolescents.
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Desjejum , Comportamento Alimentar , Satisfação Pessoal , Qualidade de Vida , Humanos , Adolescente , Feminino , Criança , Estudos Transversais , Masculino , Comportamento Alimentar/psicologiaRESUMO
PURPOSE: Analyzed the associations of sedentary behavior (SB) measured by questionnaire and accelerometer, with cardiometabolic markers in adolescents. METHODS: Longitudinal study with 4 years of follow-up with adolescents from João Pessoa, Brazil. SB was measured using a questionnaire (305 adolescents: 54.5% females; age 11.7 [SD = 0.7]) and use of accelerometer (136 adolescents: 54.8% females; age 11.5 [SD = 0.7]). The cardiometabolic markers were body mass index, waist circumference, systolic and diastolic blood pressure, fasting glucose, total cholesterol, triglycerides, low-density lipoproteins and high-density lipoproteins (HDL-C), total cholesterol/HDL ratio, triglycerides/HDL ratio, and non-HDL-C. Generalized Estimating Equation analysis was used to for analyses. RESULTS: The average time in SB by the accelerometer was greater (average 8.3 [SD = 1.5], 8.8 [SD = 1.6], and 8.4 [SD = 1.9] h/d/wk) than observed in the questionnaire (on average 6.0 [SD = 4.1], 7.2 [SD = 4.9], and 6.6 [SD = 5.4] h/d/wk), in all years of the study, but without a significant increasing trend (P > .05) over time for both measures. There was a significant and positive association between SB measured by the questionnaire and SBP (ß = 0.148; 95% CI, 0.021-0.274). CONCLUSIONS: The SB generally does not seem to contribute to significant changes in cardiometabolic markers in adolescents, despite it being associated with increased systolic blood pressure levels.
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Este artículo se propone reflexionar en torno al reconocimiento de la condición jurídica de las y los adolescentes como sujeto de derechos en los procesos de atención de la salud de esta población. A partir de la autonomía progresiva y la participación directa entendidos como dos principios rectores de la Convención sobre los Derechos del Niño (CDN), se realiza un contrapunto entre las definiciones presentes en la política de salud en la adolescencia y las prácticas y sentidos puestos en juego por las/os profesionales de la salud. Las reflexiones se basan en el análisis de materiales etnográficos, producidos en una investigación realizada en la ciudad de Bahía Blanca, desde una perspectiva antropológica, centrada en la definición social de las edades. Para cerrar, se plantea una síntesis de algunos aspectos con el propósito de contribuir a la problematización de las nociones de adolescencia desde las cuales se brinda atención sanitaria de esta población. Y de favorecer el abordaje de la salud de las y los adolescentes como sujeto de derechos (AU)
This article aims to reflect on the recognition of the legal status of adolescents as subject of rights in the health care processes of this population. Starting from progressive autonomy and direct participation understood as two guiding principles of the Children's Rights Convention (CRC), a counterpoint is made between the definitions present in health policy in adolescence and the practices and meanings put into play by the health professionals. The reflections are based on the analysis of ethnographic materials, produced in an investigation carried out in the city of Bahía Blanca, from an anthropological perspective, focused on the social definition of ages. To close, a synthesis of some aspects is proposed with the purpose of contributing to the problematization of the notions of adolescence from which health care is provided to this population. And to promote the approach to adolescent health as a subject of rights (AU)
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Humanos , Masculino , Feminino , Adolescente , Comportamentos Relacionados com a Saúde/etnologia , Medicina do Adolescente , Relações Médico-Paciente , Antropologia Médica , Direito à SaúdeRESUMO
Parenting styles have been related to a series of variables that contribute positively to adulthood. The maternal and paternal parenting styles scale is a measure that presents a multidimensional structure of six correlated factors. However, the version available for Chile is extensive, with 82 items measuring this latent trait. Therefore, the aim of this study was to examine the psychometric properties of the reliability and validity of the abbreviated version of the maternal and paternal parenting styles scale using a sample of Chilean adolescents. The sample consisted of 2131 students of both the male and female sexes (51% males and 49% females) with a mean age of 15.85 years (SD = 1.37). The results of the exploratory and confirmatory factor analyses supported the six-factor correlated model, showing robust psychometric indices for both modelling approaches. In relation to the factorial invariance models, the results show factorial equivalence at the scalar invariance level for the variables of sex, age, academic achievement, and type of school. The scale showed adequate levels of reliability. This study concludes that the abbreviated version of the maternal and paternal parenting styles scale is a reliable and valid instrument for its application in Chilean adolescents.
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We assessed the association between educational aspirations and the intention to migrate among 1,446 adolescents aged 11-17 years, living in semi-urban/rural communities in Jalisco, Mexico. Analyses rely on survey data from the Family Migration and Early Life Outcomes study. The outcome variable was the intention to migrate, a three-category variable coded as no intention to migrate, intention to migrate within Mexico, and intention to migrate internationally. The main independent variable was the adolescents' educational aspirations, conceptualized as the intention to achieve higher education. Multinomial logistic regression models were used to examine associations. We found an association between educational aspirations and intentions to migrate, and it was moderated by gender. Girls with the highest educational aspirations intended to migrate internationally, while higher educational aspirations were not a driver for boys' migration intentions. The study findings have implications for education and migration policies and future research.
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Objective: To present the protocol and methods for the prospective longitudinal assessments-including clinical and digital phenotyping approaches-of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) study, which comprises Brazilian adolescents stratified at baseline by risk of developing depression or presence of depression. Method: Of 7,720 screened adolescents aged 14 to 16 years, we recruited 150 participants (75 boys, 75 girls) based on a composite risk score: 50 with low risk for developing depression (LR), 50 with high risk for developing depression (HR), and 50 with an active untreated major depressive episode (MDD). Three annual follow-up assessments were conducted, involving clinical measures (parent- and adolescent-reported questionnaires and psychiatrist assessments), active and passive data sensing via smartphones, and neurobiological measures (neuroimaging and biological material samples). Retention rates were 96% (Wave 1), 94% (Wave 2), and 88% (Wave 3), with no significant differences by sex or group (p > .05). Participants highlighted their familiarity with the research team and assessment process as a motivator for sustained engagement. Discussion: This protocol relied on novel aspects, such as the use of a WhatsApp bot, which is particularly pertinent for low- to-middle-income countries, and the collection of information from diverse sources in a longitudinal design, encompassing clinical data, self-reports, parental reports, Global Positioning System (GPS) data, and ecological momentary assessments. The study engaged adolescents over an extensive period and demonstrated the feasibility of conducting a prospective follow-up study with a risk-enriched cohort of adolescents in a middle-income country, integrating mobile technology with traditional methodologies to enhance longitudinal data collection.
This article details the study protocol and methods used in the longitudinal assessment of 150 Brazilian teenagers with depression and at risk for depression as part of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo). Over 3 years, the authors collected clinical and digital data using innovative mobile technology, including a WhatsApp bot. Most adolescents participated in all the study phases, showing feasibility of prospective follow-up in a middle-income country. This approach allowed for a deeper understanding of depression in young populations, particularly in areas where mental health research is scarce.
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The Beck Depression Inventory-II (BDI-II) is a widely used tool for rating the severity of depressive symptoms. Studies on the factor structure of the BDI-II in adolescents have yielded controversial findings. Most studies have reported an oblique two-factor model that describes the 'cognitive' and 'somatic-affective' dimensions. However, there is variation in the item composition of each factor across studies. Alternative factor structures have been proposed, including one-factor, three-factor, hierarchical, and bifactor models. Additionally, there is limited data on measurement invariance across genders. This study aimed to examine hypothetical factor structures and gender equivalence of the BDI-II in a sample of Brazilian nonclinical adolescents (N = 1,184, aged 13-18 years, 59.1% females). Cross-validation of the BDI-II was performed through exploratory (EFA) and confirmatory factor analysis (CFA). Measurement invariance was evaluated using multigroup-CFA (MG-CFA). EFA suggested an oblique two-factor model depicting "affective-cognitive" and "somatic" dimensions. CFA tested competing models for the structure of BDI-II, including the simple one- and two-factor models, a bifactor model, and the EFA model along with its corresponding bifactor model. All models demonstrated adequate and similar fitness, well-defined factors, and good reliability. Bifactor analyses indicated a robust general factor with low reliable variance in total scores attributed to multidimensionality caused by the group factors in bifactor models. MG-CFA supported invariance across gender, suggesting that the same BDI-II construct could be applied to both female and male adolescents. This study provides evidence that the BDI-II could be used as a unidimensional measure of depressive symptoms in adolescents by researchers and clinicians.
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Este escrito presenta un recorrido retrospectivo de la transición de pacientes del Hospital de Pediatría "Dr. Juan P. Garrahan", centro de referencia nacional, a centros asistenciales de adultos. Se describen sus antecedentes y se destacan dos hitos que consideramos centrales como inicio de una trayectoria hospitalaria en transición de ya 24 años: la conformación de la Unidad de Adolescencia y Transición y la creación del Comité de Transición. A continuación se describen acciones que se desarrollaron en forma transversal en toda la institución, entre ellas programas de investigación, becas de formación, realización de jornadas, publicaciones institucionales y producciones artísticas. Finalmente planteamos un horizonte para este recorrido y los desafíos para la proyección futura de la transición de pacientes (AU)
This paper presents a retrospective review of the transition of patients from the Hospital de Pediatría "Dr. Juan P. Garrahan," a national reference center, to adult care centers. It describes the background and highlights two milestones that we consider central to the beginning of a 24-year hospital transition trajectory: the creation of the Adolescence and Transition Unit and the establishment of the Transition Committee. We then describe actions developed transversally throughout the institution, including research programs, training fellowships, conferences, institutional publications, and artistic productions. Finally, we propose a vision for this journey and discuss the challenges for the future projection of patient transition (AU)
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Humanos , Adolescente , Equipe de Assistência ao Paciente , Adolescente , Transição para Assistência do Adulto/história , Transição para Assistência do Adulto/organização & administração , Hospitais Pediátricos , Doença CrônicaRESUMO
Los sobrevivientes de un trasplante alogénico de células progenitoras hematopoyéticas (TACPH) pediátrico presentan alto riesgo de padecer problemas de salud. Debido a esta vulnerabilidad, la continuidad del cuidado impacta en su pronóstico y la transición a la medicina del adulto (TMA) es un proceso clave. Objetivo: Evaluar el proceso actual de TMA de los receptores de TACPH en nuestro hospital. Métodos: Diseño: observacional retrospectivo y prospectivo. Población: todos los pacientes (p) que realizaron su TMA desde enero/2022 a marzo/2023. Instrumentos: entrevista personal; material escrito; resumen de historia clínica; escalas TRAQ 5.0 (transición), PedsQL 4.0 (CVRS) y Lansky (funcionalidad); elección de estrategias de seguimiento según complejidad y requerimientos; contacto con profesionales de adultos; entrevista telefónica luego de 6 meses posTMA; red conformada. Resultados: 36p completaron la TAM (33 presencial, 3 virtual). Edad m19 años (m6 años de seguimiento), 70% del interior del país, 58% TACPH por enfermedad maligna, 64% TACPH familiar. A la TMA: antecedente EICHc 50%, segunda enfermedad maligna 2%, compromiso órganos 75% (m2/p, r0-8, mayormente endocrinológicas, oculares y neurológicas), 94% Lansky ≥80 (r50-100), PedsQL m82 (27% ≤75), TRAQ m3.4 (r1.7- 4.8). Derivación: todos los p cubrían sus necesidades (30% en centros de alta complejidad o expertos en THA) pero 3p debieron readecuar las estrategias, 5p presentaban complicaciones en actividad o necesidad de pronta resolución. Contacto posterior: 30/33p continuaban seguimiento, 3p pudieron retomarlo, 9p nuevas complicaciones/tratamientos. Red: 20 profesionales/instituciones. Conclusiones: Se refuerza la necesidad y utilidad de un proceso de TMA tanto formal como personalizado según necesidades individuales de los pacientes con TACPH (AU)
Pediatric allogeneic hematopoietic stem cell transplant (HSCT) survivors are at high risk for health problems. Because of this vulnerability, continuity of care impacts their prognosis and transition to adult medicine (TAM) is a key process. Objective: To evaluate the current process of TAM of HSCT recipients in our hospital. Methods: A retrospective and prospective observational study was conducted. The population included all patients (p) who underwent TAM from January 2022 to March 2023. Instruments used included personal interviews, written materials, medical history summaries, the TRAQ 5.0 (transition), PedsQL 4.0 (HRQoL), and Lansky (functionality) scales. Follow-up strategies were chosen according to complexity and requirements, with contact established with adult professionals and a telephone interview conducted six months post-TAM in an established network network. Results: 36p completed TAM (33 face-to-face, 3 online). Mean age was 19 years (with a mean of 6 years of follow-up); 70% were from the provinces of the country, 58% underwent HSCT due to malignant disease, 64% had familial HSCT. At TAM: 50% had a history of GVHD, 2% had a second malignant disease, and 75% had organ involvement (mean of 2 per patient, ranging from 0 to 8, mostly endocrinological, ocular, and neurological), 94% had Lansky ≥80 (range, 50-100), mean PedsQL was 82 (27% ≤75), mean TRAQ was 3.4 (range, 1.7-4.8). Referral needs were met for all patients (30% in tertiary-level centers or with experts in allogeneic HSCT), although 3 patients had to readjust strategies, and 5 had complications requiring prompt resolution. In subsequent contact, 30 out of 33 patients continued follow-up, 3 resumed it, and 9 experienced new complications or treatments. The network included 20 healthcare providers/institutions. Conclusions: This study reinforces the need for and usefulness of a formal and personalized TAM process according to the individual needs of patients with HSCT (AU)
Assuntos
Humanos , Adolescente , Qualidade de Vida , Sobrevida , Transplante Homólogo , Fatores de Risco , Transplante de Células-Tronco Hematopoéticas , Transição para Assistência do Adulto/organização & administração , Doença Crônica , Estudos Prospectivos , Estudos Retrospectivos , Entrevista , Cooperação e Adesão ao TratamentoRESUMO
Con el advenimiento de nuevas técnicas quirúrgicas y medicaciones inmunosupresoras la sobrevida de los niños trasplantados mejoró, llegando a la adultez. La continuidad de su tratamiento requiere un proceso planificado que permita su tránsito a un sistema de salud orientado al adulto. El objeto de este trabajo es mostrar la transición a centros de adultos en una cohorte de pacientes trasplantados renales en el Hospital Garrahan, describir sus características clínicas y demográficas, su evolución, y oportunidades de mejora implementadas. Debido a cambios médicos y su abordaje desde la interdisciplina, se dividió a la población en tres periodos: era 1 (1988-1999), era 2 (2000-2009), y era 3 (2010- 2023). En la era 1, 179 adolescentes continuaron su atención médica en un centro de adultos, 212 en la era 2 y 201 en la era 3. En la era 1 el seguimiento estaba coordinado por el nefrólogo de cabecera y eran consultados los servicios de Urología, Servicio Social y Salud Mental. En la era 2, se fortaleció el trabajo en interdisciplina y aún más a partir del 2011. Surgieron centros de trasplante de adultos que recibían adolescentes y médicos dedicados a ellos en forma preferencial. En la actualidad la transición comienza a los 12 años y progresa hasta los 18. El modelo implementado es la transición directa, entre el nefrólogo pediatra y el de adultos, con varias consultas secuenciales en ambos centros. Si bien la sobrevida del paciente e injerto mejoraron, el rechazo, asociado a no adherencia, es una asignatura por mejorar (AU)
With the advent of new surgical techniques and immunosuppressive medications, the survival of transplanted children has improved, allowing them to reach adulthood. The continuity of their treatment requires a planned process that facilitates their transition to an adult-oriented healthcare system. The aim of this study was to examine the transition to adult centers in a cohort of renal transplant patients at Garrahan Hospital, describing their clinical and demographic characteristics, their evolution, and the improvement opportunities implemented. Based on medical changes and the interdisciplinary approach, the population was divided into three periods: era 1 (1988- 1999), era 2 (2000-2009), and era 3 (2010-2023). In era 1, 179 adolescents continued their medical care in an adult center, 212 in era 2, and 201 in era 3. In era 1, follow-up was coordinated by the attending nephrologist with consultations from Urology, Social Services, and Mental Health Services. In era 2, interdisciplinary work was strengthened, and even more so since 2011. Adult transplant centers were created to receive adolescents with physicians dedicated to their care on a preferential basis. Currently, the transition begins at 12 years of age and progresses up to 18. The implemented model involves direct transition between the pediatric nephrologist and the adult nephrologist, with several sequential consultations in both centers. Although patient and graft survival have improved, rejection associated with non-adherence remains an area for improvement
Assuntos
Humanos , Criança , Adolescente , Equipe de Assistência ao Paciente , Transplante de Rim , Resultado do Tratamento , Transição para Assistência do Adulto/organização & administração , Cuidado Transicional , Cooperação e Adesão ao Tratamento/psicologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Estudos Retrospectivos , Estudo ObservacionalRESUMO
OBJECTIVE: This study tried to examine the association between the frequency of family meals and excess weight using large and representative samples of children and adolescents from 43 countries. METHODS: This cross-sectional study used data from the Health Behaviour in School-aged Children (HBSC), which included nationally representative samples of children and adolescents aged 10-17 years, involving a total of 155 451 participants (mean age = 13.6 years; standard deviation [SD] = 1.6; 51.4% girls). Family meal frequency was gauged through the following question: 'How frequently do you and your family typically share meals?' The possible responses were: 'never', 'less often', 'approximately once a week', 'most days' and 'every day'. The body weight and height of the participants were self-reported and utilized to calculate body mass index (BMI). Subsequently, BMI z-scores were computed based on the International Obesity Task Force criteria, and the prevalence of excess weight was defined as +1.31 SD for boys and + 1.24 SD for girls, with obesity defined as +2.29 SD for boys and + 2.19 SD for girls. Generalized linear mixed models were conducted to examine the associations between the frequency of family meals and excess weight or obesity. RESULTS: The lowest predicted probabilities of having excess weight and obesity were observed for those participants who had family meals every day (excess weight: 34.4%, 95% confidence interval [CI] 31.4%-37.5%; obesity: 10.8%, 95% CI 9.0%-13.0%). CONCLUSIONS: A higher frequency of family meals is associated with lower odds of having excess weight and obesity in children and adolescents.
Assuntos
Índice de Massa Corporal , Comportamento Alimentar , Refeições , Obesidade Infantil , Humanos , Feminino , Masculino , Adolescente , Estudos Transversais , Criança , Obesidade Infantil/epidemiologia , Prevalência , Família , Comportamentos Relacionados com a SaúdeRESUMO
La posibilidad de la articulación conceptual de las preguntas que nos atraviesan, proviene y se sostiene de las prácticas que ejercemos, es desde mi propia clínica que voy a plantear algunas ideas que vengo pensando en relación a ¿cómo se despliegan actualmente, en el análisis de algunos adolescentes, la construcción de las diversidades sexuales y de género? A veces e presentan como oportunidades subjetivantes y otras como capturas identitarias que quedan en ocasiones adheridas a etiquetas diagnósticas. Hace tiempo que insisto en una designación que considero pertinente y que permite ubicarse en la clínica de nuestros tiempos: la de Adolescencias Complejas. No porque haya algunas que lo son y otras que no, sino como una puesta en valor de la noción de complejidad, imprescindible para comprender la clínica actual AU
The possibility of conceptual articulation of the questions that cross us comes from and is sustained by the practices that we exercise. From my own clinic, I am going to raise some ideas that I have been thinking about in relation to how they are currently deployed, in the analysis ofsome adolescents, the construction of sexual and gender diversities? Sometimes they present themselves as subjectivizing opportunities, and other times as identity captures that sometimes remain attached to diagnostic labels.For some time now I have insisted on a designation that I consider pertinent and that allows us to place ourselves in the clinic of our times: Complex Adolescence. Not because there are some that are and others that are not, but as an enhancement of the notion of complexity, essential to understand current clinical practice AU
La possibilité d'une articulation conceptuelle des questions qui nous traversent vient et est soutenue par les pratiques que nous exerçons depuis ma propre clinique, je vais évoquer quelques idées auxquelles j'ai réfléchi par rapport à la manière dont elles se déploient actuellement, dans l'analyse de certains adolescents, la construction des diversités sexuelles et de genre? Parfois, ils se présentent comme des opportunités de subjectivation, et d'autres fois comme des captures d'identité qui restent parfois attachées à des étiquettes diagnostiques.Depuis quelques temps j'insiste sur une appellation que je considère pertinente et qui permet de se situer dans la clinique de notre époque:l'Adolescence Complexe. Non pas parce qu'il y en a qui le sont et d'autres qui ne le sont pas, mais comme une valorisation de la notion de complexité, essentielle pour comprendre la pratique clinique actuelle AU
A possibilidade de articulação conceitual das questões que nos atravessam advém e é sustentada pelas práticas que exercemos. Da minha própria clínica, vou levantar algumas ideias que tenho pensado em relação à forma como são implementadas atualmente, na análise de alguns adolescentes, a construção dasdiversidades sexuais e de gênero? Às vezes apresentam-se como oportunidades subjetivantes e outras vezes como capturas de identidade que por vezes permanecem ligadas a rótulos diagnósticos.Há já algum tempo que insisto numa designação que considero pertinente e que nos permite situar-nos na clínica do nosso tempo: Adolescência Complexa. Não porque há uns que o são e outros que não o são, mas como um reforço da noção de complexidade, essencial para a compreensão da prática clínica atual AU