RESUMO
O objetivo do presente estudo foi avaliar em tomografias computadorizadas as dimensões dos tecidos periodontais supracrestais (TPSC). Cem pacientes, 600 dentes anteriores da maxila (200 incisivos centrais, 200 incisivos laterais e 200 caninos), foram avaliados. A distância média da margem gengival até a crista óssea alveolar (COA) foi de 3.25mm (95% IC: 3.20-3.30), enquanto que da junção cemento-esmalte até a COA foi de 1.77mm (95% IC: 1.72-182mm). As medidas foram significativamente diferentes entre os grupos de dentes (ANOVA, p < 0.001). A tomografia, pode representar uma importante ferramenta para a avaliação das dimensões dos TPSC.
The aim of this study was to evaluate the dimensions of the supracrestal periodontal tissues (SPT) on tomographic scans. One hundred patients, 600 maxillary anterior teeth (200 central incisors, 200 lateral incisors and 200 canines), were evaluated. The average distance from the gingival margin to the alveolar bone crest (ABC) was 3.25mm (95% CI: 3.20-3.30), while the distance from the cemento-enamel junction to ABC was 1.77mm (95% CI: 1.72-182mm). The measurements were significantly different between the tooth groups (ANOVA, p < 0.001). When properly indicated, tomography can be an important tool for assessing the dimensions of TPSCs on a case-by-case basis.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Tecidos , Periodonto , Tomografia Computadorizada de Feixe Cônico , MaxilaRESUMO
Introducción: La calidad de vida relacionada con la salud (CVRS) y los estados de ánimo son indicadores cruciales del bienestar en adolescentes, pero su relación con estudiantes de Antioquia, Colombia, no ha sido ampliamente estudiada. Objetivo: Determinar la CVRS y los estados de ánimo en escolares de Antioquia-Colombia. Materiales y métodos: Estudio transversal con 1957 escolares de 9 a 20 años. Se aplicaron mediciones de CVRS, ansiedad, depresión, hostilidad y alegría, actividad física, comportamiento sedentario, apoyo social de padres y nivel socioeconómico. Resultados: La calidad de vida alta (CVA) es más elevada en hombres, personas con alegría, estudiantes con apoyo de padres, activos físicamente y personas de nivel socioeconómico alto y medio. AL aumentar un año de edad, disminuye en un 15 % la CVA, y al aumentar la depresión, la ansiedad y el comportamiento sedentario disminuye la CVA. Además, los niveles de depresión y ansiedad son mayores en mujeres, estudiantes mayores, sin apoyo de los padres y personas sedentarias. Conclusiones: La CVRS se asocia con estados de ánimo, actividad física, comportamiento sedentario y apoyo de los padres; mientras que los estados de ánimo se asocian con el sexo, el apoyo de los padres, la CVS y el sedentarismo.
Introduction: Even though health-related quality of life (HRQL) and mood states are key indicators of the well-being of adolescents, their relationship has not been analyzed in students from Antioquia, Colombia. Objective: To determine HRQL and mood states in schoolchildren from Antioquia. Materials and methods: A cross-sectional study was conducted on 1,957 schoolchildren and adolescents aged between 9 and 20 years. Measurements of HRQL, anxiety, depression, hostility and happiness, physical activity, sedentary behavior, parental social support, and socioeconomic status were applied. Results: A high quality of life (HQL) was observed more frequently in male participants, students with parental support, physically active, and those belonging to medium and high socioeconomic status. HQL decreased 15% as their age increased by one year. Also, HQL was reduced when depression, anxiety, and sedentary behavior increased. Furthermore, depression and anxiety levels were higher in women, older students, as well as in those without parental control and with sedentary behavior. Conclusions: HRQL is associated with mood states, physical activity, sedentary behavior, and parental support. In contrast, mood states are related to gender, parental support, HQL, and sedentary lifestyle.
Introdução: A qualidade de vida relacionada à saúde (CVRS) e os estados de humor são indicadores cruciais de bem-estar em adolescentes, mas sua relação com estudantes de Antioquia, Colômbia, não foi amplamente estudada. Objetivo: Determinar a CVRS e os estados de humor em escolares de Antioquia-Colômbia. Materiais e métodos: Estudo transversal com 1.957 escolares de 9 a 20 anos. Foram aplicadas medidas de QVRS, ansiedade, depressão, hostilidade e felicidade, atividade física, comportamento sedentário, apoio social dos pais e nível socioeconômico. Resultados: A alta qualidade de vida (CVA) é maior em homens, pessoas com alegria, estudantes com apoio parental, fisicamente ativos e pessoas de nível socioeconômico alto e médio. À medida que a idade aumenta em um ano, diminui em 15% o CVA, e ao aumentar a depressão, a ansiedade e o comportamento sedentário aumentam, o CVA diminui. Além disso, os níveis de depressão e ansiedade são mais elevados nas mulheres, nos estudantes mais velhos, sem apoio dos pais e nas pessoas sedentárias. Conclusões: A QVRS está associada a estados de humor, atividade física, comportamento sedentário e apoio parental; enquanto os estados de humor estão associados ao sexo, apoio parental, CVS e estilo de vida sedentário.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Saúde , Emoções , Felicidade , HostilidadeRESUMO
Purpose: To quantify outer retina structural changes and define novel biomarkers of inherited retinal degeneration associated with biallelic mutations in RPE65 (RPE65-IRD) in patients before and after subretinal gene augmentation therapy with voretigene neparvovec (Luxturna). Methods: Application of advanced deep learning for automated retinal layer segmentation, specifically tailored for RPE65-IRD. Quantification of five novel biomarkers for the ellipsoid zone (EZ): thickness, granularity, reflectivity, and intensity. Estimation of theâ EZarea in single and volume scans was performed with optimized segmentation boundaries. The control group was age similar and without significant refractive error. Spherical equivalent refraction and ocular length were evaluated in all patients. Results: We observed significant differences in the structural analysis of EZ biomarkers in 22 patients with RPE65-IRD compared with 94 healthy controls. Relative EZ intensities were already reduced in pediatric eyes. Reductions of EZ local granularity and EZ thickness were only significant in adult eyes. Distances of the outer plexiform layer, external limiting membrane, and Bruch's membrane to EZ were reduced at all ages. EZ diameter and area were better preserved in pediatric eyes undergoing therapy with voretigene neparvovec and in patients with a milder phenotype. Conclusions: Automated quantitative analysis of biomarkers within EZ visualizes distinct structural differences in the outer retina of patients including treatment-related effects. The automated approach using deep learning strategies allows big data analysis for distinct forms of inherited retinal degeneration. Limitations include a small dataset and potential effects on OCT scans from myopia at least -5 diopters, the latter considered nonsignificant for outer retinal layers.
Assuntos
Aprendizado Profundo , Terapia Genética , Mutação , Tomografia de Coerência Óptica , cis-trans-Isomerases , Humanos , cis-trans-Isomerases/genética , Tomografia de Coerência Óptica/métodos , Masculino , Feminino , Terapia Genética/métodos , Adulto , Criança , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Degeneração Retiniana/genética , Degeneração Retiniana/terapia , Pré-Escolar , Acuidade Visual/fisiologia , Retina/diagnóstico por imagem , Retina/patologiaRESUMO
Polymorphisms in the MBL2 gene exon 1 can decrease serum levels of mannose-binding lectin (MBL), increasing the risk of infection in immunocompromised individuals. This study evaluated the association between the polymorphism in exon 1 of the MBL2 gene, genotypes, serum MBL levels, and infection in 122 patients with acute lymphoid leukemia (ALL). The MBL*A allele exhibited the highest frequency (0.37) within the study population. The MBL*D (0.32) was the predominant variant. The combined frequency of O polymorphic alleles (either B or D) was 0.63. The frequencies of the A/A, A/O and O/O genotypes were 0.13, 0.49 and 0.38, respectively. All patients exhibited consistently low levels of serum MBL, irrespective of their exon 1 genotype. Parasitic infections (n = 103), bacterial (n = 69) and viral (n = 48). A/O genotype (0.49) had higher infection rates, A/A (0.13) had lower rates, and O/O showed increased viral susceptibility (OR: 0.37; 95% CI 0.13-1.06; p = 0.05). Our findings demonstrated that the study population were MBL-deficient, regardless of their MLB2 genotype. Individuals with the A/O genotype had more infections, while those with the O/O genotype appeared more susceptible to viral infections. These findings highlight the impact of MBL levels and genetic variants on infection susceptibility in ALL patients.
Assuntos
Éxons , Predisposição Genética para Doença , Lectina de Ligação a Manose , Leucemia-Linfoma Linfoblástico de Células Precursoras , Humanos , Lectina de Ligação a Manose/genética , Lectina de Ligação a Manose/sangue , Masculino , Feminino , Éxons/genética , Adulto , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Pessoa de Meia-Idade , Adolescente , Genótipo , Adulto Jovem , Idoso , Alelos , Polimorfismo de Nucleotídeo Único , Criança , Frequência do Gene , Polimorfismo GenéticoRESUMO
Cardiorespiratory fitness is the most important variable related to health and a strong predictor of mortality. However, it is rarely used in clinics due to costs, specialized equipment, space needs, and the requirements of expert staff such as an exercise physiologist, physician, or other health professional. This work aims to validate and test the reliability of a submaximal step test to estimate VO2max of 8-to 16-year-old pediatric populations as a simple and low-cost tool for clinical practice. A cross-sectional study included 242 children and adolescents (42.1% girls) aged 8-16. Cardiorespiratory fitness was determined by a maximal incremental test on a treadmill until exhaustion. The step test entailed maintaining a steady pace of 22 steps per minute for 3 min (60 bpm), with the heart rate being recorded at the end of the test. Nutritional status was computed through BMI z-score. A multiple linear regression model validated the step test and developed a new equation to predict VO2max, including the third-minute heart rate, weight, and height. The reliability among predicted and measured VO2max was assessed by Bland-Altman analysis. The mean age was 12.5 ± 2.6; 51.6% were overweight or obese. The cardiorespiratory fitness measured as VO2max was 35.01 ± 0.58 ml·min-1·kg-1. A robust correlation was observed between the predicted VO2max from the step test and the measured VO2max (r = 0.86, p < 0.001). Bland-Altman analysis indicated statistical concordance between predicted and measured VO2max. Our findings indicate that the step test protocol is valid and reliable for estimating VO2max in children and adolescents. Furthermore, the predictive equation is suitable for application among children aged 8-16.
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Aptidão Cardiorrespiratória , Teste de Esforço , Consumo de Oxigênio , Humanos , Criança , Feminino , Masculino , Consumo de Oxigênio/fisiologia , Adolescente , Teste de Esforço/métodos , Aptidão Cardiorrespiratória/fisiologia , Estudos Transversais , Reprodutibilidade dos Testes , Frequência Cardíaca/fisiologiaRESUMO
Foreign body (FB) ingestion and aspiration are frequent causes of pediatric emergency room visits, with significant morbidity and mortality risks. This cross-sectional study analyzed 1,052 pediatric patients admitted for suspected FB events at a single institution between 2008 and 2015, including 886 cases of suspected ingestion and 166 cases of suspected aspiration. Cluster analysis identified three distinct clusters for both groups, with respiratory symptoms being predominant in clusters with worse outcomes. The respiratory clusters were associated with increased complication rates (13.0% for aspiration, 3.6% for ingestion) and all mortalities (three in aspiration and two in ingestion). In ingestion cases, Respiratory Cluster patients showed increased complications, prolonged hospital stays (mean 55.1 h), and accounted for all mortalities, a relationship not previously reported. Caregiver-reported certainty of event occurrence showed moderate sensitivity (72.5%) and low specificity (45.4%) for aspiration, and higher sensitivity (86.8%) with lower specificity (19.8%) for ingestion. Decision Curve Analysis revealed a net benefit in utilizing caregiver certainty for clinical decision-making. Confirmatory radiographic findings were commonly observed in ingestion cases (84.2%) than in aspiration cases (37.7%), likely due to the higher incidence of metal ingestions compared to mostly organic aspirations. Endoscopic management had high success rates (97.6%), and low mortality, highlighting its central role in FB treatment. These findings underscore the importance of assessing respiratory symptom severity within the broad clinical spectrum of FBs to identify patients at risk of worse clinical outcomes, which helps prioritize resources when necessary. Caregiver-reported information has been shown to be valuable in guiding diagnostic decisions.
Assuntos
Cuidadores , Corpos Estranhos , Humanos , Feminino , Masculino , Pré-Escolar , Criança , Estudos Transversais , Análise por Conglomerados , Lactente , AdolescenteRESUMO
INTRODUCTION: Tackling the inertia of growing threat of antimicrobial resistance (AMR) requires changes in how antibiotics are prescribed and utilized. The monitoring of antimicrobial prescribing in hospitals is a critical component in optimizing antibiotic use. Point prevalence surveys (PPSs) enable the surveillance of antibiotic prescribing at the patient level in small hospitals that lack the resources to establish antimicrobial stewardship programs (ASP). In this study, we analyzed antibiotic use at two public secondary care hospitals in Mexico using PPSs. METHODS: Following WHO methodology, we conducted four cross-sectional PPSs on antibiotic use in two public secondary care facilities in Mexico: two surveys in a women's specialty hospital (H1) and two in a general referral hospital (H2). We collected data from clinical records of all patients with active antibiotic prescriptions (APs) across the medical, surgical, and mixed (MIX) wards, and intensive care units (ICUs). Descriptive statistics were computed to analyze the PPSs data using Stata. RESULTS: The PPSs collected data on 127 patients, and 283 active APs. The prevalence of antibiotic use was 60.4% (H1, n = 29/48) and 70.5% (H2, n = 98/139). Antibiotics were more frequently used among patients in the MIX wards (H1: 87.5%, n = 14/16) and ICUs (H2: 90%, n = 9/10). The most frequent patient indications for antibiotic use were medical prophylaxis (H1: 51.7%, n = 15/29), community-acquired infections (H2: 42.9%, n = 42/98), and preoperative prophylaxis (H1: 27.6%, n = 8/29; H2: 23.5%, n = 23/98). The APs were mostly empirical (H1: 97%, n = 64/66; H2: 98.2%, n = 213/217), and parenterally administered (H1: 90.9%, n = 60/66; H2: 96.8%, n = 210/217). Most clinical records lacked documented post-prescription reviews (H1: 82.8%, n = 24/29; H2: 98%, n = 96/98). Preoperative prophylaxis was predominantly administered as multiple doses for more than one day. Penicillins with extended-spectrum (24.2%, n = 16/66), aminoglycosides (22.7%, n = 15/66), and first-generation cephalosporins (16.7%, n = 11/66) were the most prescribed antibiotic classes in H1, while third-generation cephalosporins (35%, n = 76/217), fluoroquinolones (14.3%, n = 31/217), and carbapenems (13.4%, n = 29/217) were the most prescribed in H2. No hospital had formally established ASP. CONCLUSIONS: This study shows high prevalence rates of antibiotic use and variations in commonly prescribed antibiotic classes in public Mexican secondary care hospitals, along with shared practices in broad-spectrum antibiotic prescription. PPS-based surveillance enables the identification of specific targets to optimize antibiotic use according to the healthcare needs of patients in each hospital and facilitates comparative evaluations across hospitals.
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Antibacterianos , Gestão de Antimicrobianos , Humanos , México/epidemiologia , Antibacterianos/uso terapêutico , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Adulto , Masculino , Prevalência , Idoso , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Atenção Secundária à Saúde/estatística & dados numéricos , Adulto Jovem , Inquéritos e Questionários , Adolescente , Prescrições de Medicamentos/estatística & dados numéricosRESUMO
INTRODUCTION: Transition clinics are conceived as programs dedicated to the active, multidimensional development of a process that addresses the medical, psychosocial, educational, and vocational needs of pediatric patients suffering from a chronic disease that will persist into adulthood. Their understanding is justified in physiological, psychological, and sociocultural terms on the basis of the differential morbidity and mortality associated with a chronic disease that begins in childhood and prevails into adulthood. MATERIALS AND METHODS: Here, we reflect on the history, structure, and impact of transition clinics in pediatrics, with an emphasis on pediatric rheumatologic diseases. Additionally, we propose comprehensive reflection as an alternative for the patient, their family, and the medical team, outlining guidelines for development, implementation, and evaluation. RESULTS: The transition of care should commence in early adolescence, considering each patient's cognitive ability as a condition for the initiation of an educational process involving introspection into the disease. Interdisciplinarity is defined as a team that addresses the clinical, physical, emotional, and social dimensions of each patient and their interaction with the environment within the framework of individualized care and family support. Despite this, the lack of evidence supporting standardized guidelines for the implementation and overall effectiveness evaluation of these interventions was highlighted. CONCLUSIONS: The transition process is considered successful when the patient is adherent and has a positive and informed perception of their healthâdisease journey. We urge the generation of evidence documenting the comprehensiveness of processes inherent to transition clinics as the foundation of necessity.
Assuntos
Doenças Reumáticas , Reumatologia , Transição para Assistência do Adulto , Humanos , Colômbia , Adolescente , Criança , Doenças Reumáticas/terapia , Pediatria , Equipe de Assistência ao Paciente , Doença CrônicaRESUMO
BACKGROUND: Interventions to promote mental health in paediatrics need to be effective, especially in crisis contexts. This systematic review proposes to compile and analyse the findings of nonpharmacological interventions conducted in samples of children and adolescents during the COVID-19 pandemic, focusing on mental health. METHODS: The research was carried out in PsycINFO, PubMed and Web of Science databases for empirical studies, including interventions in which measures of outcome variables were collected at least twice (pre and post). The studies' samples were children and adolescents up to 19 years old, and interventions were developed throughout the COVID-19 pandemic. After eligibility analyses, 16 studies were included in this review. RESULTS: Studies used different theoretical approaches, focusing on the promotion, prevention and treatment of mental health in specific contexts. Some were delivered online, in-person or in hybrid formats. Particularly, depression, the most frequently assessed outcome, demonstrated more favourable results within the interventions than other evaluated outcomes. However, due to the considerable risk of bias, the qualitative analysis of the results of many included studies should be performed with caution. CONCLUSIONS: Most of the interventions necessitate further validation, highlighting the ongoing need for research in this area. However, the emergence of interventions during crises, such as the COVID-19 pandemic, provides an opportunity to expand evidence-based mental health practices, paving the way for their application in other crisis situations. Given that mental health prevention and promotion practices can be integrated into the roles of all healthcare providers, possessing insight into the most suitable evidence-based interventions can elevate the quality of care delivered.
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COVID-19 , Promoção da Saúde , Saúde Mental , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , COVID-19/psicologia , Adolescente , Criança , Promoção da Saúde/métodos , Transtornos Mentais/terapia , Transtornos Mentais/epidemiologia , SARS-CoV-2RESUMO
INTRODUCTION: Depression is the leading cause of mental health-related illnesses and disabilities. Physical activity (PA) has been included as part of therapeutic approaches for patients with depression. This study aimed to investigate the associations between depressive symptoms and PA levels in a large representative cohort of Brazilian adults and older individuals. METHODS: Data from 58,445 Brazilian adults (68.6 % males and 31.4 % females) aged 18 years or older (42.2 ± 10 years) who participated in health screening initiatives between 2008 and 2022 at the Center for Preventive Medicine at a quaternary hospital in Sao Paulo, Brazil were analyzed. Standardized health data (anthropometric, laboratory, clinical, and behavioral) were collected. A hierarchical regression model was used to examine the associations based on the presence and absence of depressive symptoms. RESULTS: In the final model, age, gender (female), body mass index (BMI) (each kg/m2), presence of hypertension, presence of diabetes mellitus, risk of alcohol consumption, smoking status, and perceived stress were associated with higher odds of depressive symptoms. However, PA levels were associated with lower odds of depressive symptoms. CONCLUSION: The findings revealed that any level of PA was independently and significantly associated reduced risk of depressive symptoms.
Assuntos
Índice de Massa Corporal , Depressão , Exercício Físico , Humanos , Masculino , Feminino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Depressão/epidemiologia , Depressão/psicologia , Brasil/epidemiologia , Adulto Jovem , Fatores Sexuais , Idoso , Adolescente , Fatores de RiscoRESUMO
Oral mucositis (OM) is a prevalent acute adverse effect of various cancer treatments. Accurate assessment of OM is vital for effective prevention and treatment strategies. However, a lack of validated pediatric instruments for evaluating OM can lead to unreliable data, and hinder interventional and epidemiological research. This study aims to evaluate the methods used for assessing OM in pediatric oncology patients. A systematic review of four databases and a manual search yielded 113 articles. Nine different scales were identified, with the World Health Organization (WHO) scale being the most commonly used (61.9%). The Children's International Mucositis Evaluation Scale (ChIMES) was used in 7.9% of the studies. Of the 8155 pediatric patients evaluated, 47.7% had both hematological malignancies and malignant solid tumors, while 46% had solely hematological malignancies. Despite the prevalence of the WHO scale, it lacks pediatric-specific criteria. Future OM research should incorporate validated tools like ChIMES for improved pediatric assessment.
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Neoplasias , Estomatite , Humanos , Estomatite/etiologia , Estomatite/diagnóstico , Estomatite/epidemiologia , Criança , Adolescente , Neoplasias/complicações , Pré-EscolarRESUMO
The study of firearm violence in Mexico has primarily focused on homicides and trafficking. Less attention has been given to understanding how firearms affect other crimes and facilitate criminal activity beyond drug markets. By analyzing two questions, this study explores the role of firearms in extortions perpetrated in Mexico from 2012 to 2021. Questions are: What is the likelihood of reporting extortions to the police if offenders exhibited firearms? What is the likelihood of compliance with demands when offenders are armed with firearms? We obtained data from Mexico's National Crime Victimization Surveys and analyzed 2,619 extortions reported from 2012 to 2021. To explore our research questions, we ran two binary logistic regressions. Our dependent variables were dichotomous (reported to police = 1, complied with demands = 1). The independent variables were weapon types (extortions involving firearms as the reference group). We controlled for victim demographics as well as crime characteristics. Our results indicate that 40% of these extortions (n = 1,058) were perpetrated with a firearm. Fifty-two percent of extortions were perpetrated by unarmed offenders (n = 1,348) and 8% (n = 213) were perpetrated with other weapons (no firearms). Models suggest that, when compared to extortions perpetrated by unarmed offenders or those exhibiting other weapons (no firearms), victims of extortions involving firearms are less likely to report these crimes to police, mainly because of fear of reprisal. Similarly, victims are more likely to comply with demands if offenders exhibit firearms. Findings highlight the role of firearms in criminal enterprises and support the need for a comprehensive policy agenda to address firearm violence in Mexico.
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Vítimas de Crime , Armas de Fogo , Humanos , Armas de Fogo/estatística & dados numéricos , Armas de Fogo/legislação & jurisprudência , Masculino , Feminino , México , Adulto , Vítimas de Crime/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto Jovem , Adolescente , Criminosos/estatística & dados numéricos , Violência/estatística & dados numéricos , Violência com Arma de Fogo/estatística & dados numéricos , Crime/estatística & dados numéricosRESUMO
BACKGROUND: Although parasacral TENS (pTENS) has been employed in various centers, there is a lack of studies on how children with overactive bladder (OAB) respond after failing to complete pTENS sessions. This study aimed to describe and assess treatments for OAB in children who did not respond to pTENS. MATERIAL AND METHODS: This retrospective case series examined patients aged 4-17 years. Patients were given subsequent treatment options, including: behavioral therapies; oxybutynin; imipramine; a combination of oxybutynin and imipramine; parasacral percutaneous electrical nerve stimulation (PENS); or a repeat course of pTENS. Outcomes were evaluated using the Dysfunctional Voiding Scoring System (DVSS) and the Visual Analogue Scale (VAS). RESULTS: Thirty children were included, with a median age of 7 years. Patients received one or more treatments. Of these, 70% underwent monotherapy. Among them, 57% experienced complete resolution of symptoms, 28% had partial resolution and were satisfied with the results, and 14% discontinued treatment. 30% out of the whole sample continued to experience bothersome symptoms. Complete response, according to initial subsequent, was achieved in: 54% with intensified behavioral therapies, 33% with oxybutynin, and 50% with imipramine alone. The median DVSS score decreased from 7.0 to 2.0 (p=0.025), while the median VAS score increased from 80 to 100 (p<0.001). CONCLUSION: Children with OAB refractory to pTENS who received structured subsequent treatments showed partial response in all cases, with complete symptom resolution in half of the patients. More intensive urotherapy, medications, or repeat pTENS in combination with oxybutinin can be effective for managing this challenging condition.
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Ácidos Mandélicos , Estimulação Elétrica Nervosa Transcutânea , Bexiga Urinária Hiperativa , Humanos , Bexiga Urinária Hiperativa/terapia , Criança , Estimulação Elétrica Nervosa Transcutânea/métodos , Estudos Retrospectivos , Adolescente , Masculino , Feminino , Pré-Escolar , Ácidos Mandélicos/uso terapêutico , Resultado do Tratamento , Imipramina/uso terapêuticoRESUMO
The care of adolescents in reclusion has been a field of work for occupational therapists in different parts of the world. The objective of this study was to describe and analyze Brazilian occupational therapists' practices with adolescents in reclusion. Research conducted in Brazil, identifying 56 professionals, invited to answer a questionnaire (n = 43); participate in discussion groups (n = 9); and interview (n = 4). Professionals reported different visions that guide their practices, including the identification of individual skills and the profession's possibilities for social action. Occupational therapists have specificities to work in these institutions, highlighting the possibilities of acting with a focus on social change. Practices in occupational therapy can lead to social change if focused on social issues. Social occupational therapy offers theoretical and methodological elements that inform the profession. Reflections on the practice carried out, according to a critical perspective, enable a performance in occupational therapy that intends social change.
OBJECTIVE: The objective was to describe and analyze the practice of occupational therapists in custodial units of the Brazilian juvenile justice system. METHODOLOGY: Mapping and identification of occupational therapists in institutions of juvenile incarceration; questionnaire; workshops; semi-structured interviews; and synthesis meeting. RESULTS AND DISCUSSION: Forty-three professionals with diverse practices participated in this study. The collected data in the different stages of the research were analyzed based on social occupational therapy. CONCLUSION: Occupational therapy practices can lead to social change if focused on social issues. Social occupational therapy offers theoretical and methodological elements for that.
Occupational Therapy and Imprisoned Adolescents: An Analysis of Professional PracticesIntroduction: In Brazil, the number of adolescents convicted of infractions is increasing. Judicial sanctions may be imposed on this population, including imprisonment. There are occupational therapists working with these adolescents, but their practices are little recorded and debated.
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Terapia Ocupacional , Humanos , Terapia Ocupacional/métodos , Brasil , Adolescente , Masculino , Feminino , Prática Profissional , Inquéritos e Questionários , Adulto , Terapeutas Ocupacionais/psicologia , Pessoa de Meia-IdadeRESUMO
Osteosarcoma (OS) is the most frequent primary malignant bone tumor among children and adolescents, with a peak of incidence in the second decade of life. The presence of metastasis at diagnosis in OS patients significantly decreases the chances of survival and new therapy approaches are needed. The IGFBP5 gene is related to osteoblasts metabolism and some studies have pointed out a role of its low expressions in OS development and metastasis. In this study, we aimed to establish an IGFBP5 gene expression profile among metastatic and non-metastatic OS patients throughout the treatment and development of the disease. Fresh-frozen tumor samples were obtained from 40 patients admitted to treatment at the Pediatric Oncology Institute (IOP/GRAACC/UNIFESP) and divided by clinical status: metastatic or non-metastatic disease. For each patient, samples before and after chemotherapy treatment were obtained, as well as metastasis and lung tissue surrounding metastasis samples from the metastatic patients. A quantitative real-time PCR was used to investigate IGFBP5 expression. Our analyses demonstrate that non-metastatic patients presented lower IGFBP5 expression in their pre-chemotherapy samples compared with metastatic patients, suggesting that low expressions of this gene could help triggering the OS tumorigenesis but that its action alone is not sufficient to activate the metastatic process. Heterogeneity in IGFBP5 expressions within groups was also seen. We observed that IGFBP5 and two MAPK genes, a downstream pathway in the IGFBP5 axis, are differentially expressed in OS samples of non-metastatic patients. Further investigation about these genes' modulations might lead to a better understanding of metastasis development in OS.
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Neoplasias Ósseas , Regulação Neoplásica da Expressão Gênica , Proteína 5 de Ligação a Fator de Crescimento Semelhante à Insulina , Osteossarcoma , Humanos , Osteossarcoma/genética , Osteossarcoma/patologia , Proteína 5 de Ligação a Fator de Crescimento Semelhante à Insulina/genética , Proteína 5 de Ligação a Fator de Crescimento Semelhante à Insulina/metabolismo , Neoplasias Ósseas/genética , Neoplasias Ósseas/patologia , Neoplasias Ósseas/metabolismo , Feminino , Masculino , Adolescente , Criança , Carcinogênese/genética , Metástase Neoplásica , Transcriptoma , Perfilação da Expressão Gênica/métodosRESUMO
The study aimed to provide validity evidence and reliability of the Scale of Myths of Romantic Love (SMRL) in Peru among young and adult individuals. Focusing on how romantic love myths affect relationship satisfaction and their ties to interpersonal violence, sexism, and gender inequality, the methodology involved 308 participants, mainly females (75%), using the SMRL and Relationship Assessment Scale. Bayesian Confirmatory Factor Analysis (BCFA) assessed the scale's structure and reliability, complemented by descriptive statistics and correlation analyses to examine the myths' impact on intimate relationships. Results showed the SMRL's two-dimensional structure, confirming its robust psychometric properties and satisfactory internal consistency. Descriptive findings revealed a skeptical view of traditional romantic myths among participants, indicating the scale's good reliability and successful adaptation to the Peruvian context. This validation highlights how debunking romantic love myths can improve relationship dynamics and satisfaction and addresses their wider societal effects.
Assuntos
Relações Interpessoais , Amor , Psicometria , Humanos , Feminino , Peru , Masculino , Adulto , Psicometria/normas , Psicometria/instrumentação , Reprodutibilidade dos Testes , Adulto Jovem , Adolescente , Satisfação Pessoal , Inquéritos e Questionários/normas , Parceiros Sexuais/psicologia , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To explore financial toxicity (FT) experienced by the parents of children with cancer at end-of-life (EOL), including exploring differences by race and ethnicity. STUDY DESIGN: We performed secondary analysis of semistructured interviews of bereaved parents' perspectives on quality EOL care. Fifty-five interviews were conducted in California and Alabama representing 48 children (0-21 years at time of death) who died of cancer ≥6 months prior. Quotes related to FT were identified and iteratively grouped into themes without an a priori framework. RESULTS: Most participants were non-Hispanic White (30; 55%), and the most common diagnoses were noncentral nervous system solid tumors (16; 33%) and central nervous system tumors (16; 33%). Children died at a mean age of 11 and a median of 4 years prior to the interview. Almost all parents (52; 95%) discussed FT, including all Black and Hispanic parents. Parents identified transportation, housing, other basic needs, funeral costs, and medical costs as well as work disruptions as contributors to FT at EOL. Barriers to financial wellness included navigating insurance, insufficient financial support from the hospital, and long-term FT from treatment. Many parents discussed how the hospital and community served as facilitators of financial wellness. In some cases, finances prevented families from accessing nursing services and mental health support and affected EOL decisions. CONCLUSIONS: As FT affected almost all families' EOL experience, pediatric oncology programs should routinely screen for FT at EOL and ensure they have the resources to respond.
Assuntos
Luto , Neoplasias , Pais , Pesquisa Qualitativa , Assistência Terminal , Humanos , Criança , Masculino , Feminino , Pré-Escolar , Pais/psicologia , Adolescente , Lactente , Assistência Terminal/economia , Assistência Terminal/psicologia , Adulto Jovem , Adulto , Recém-Nascido , Alabama , CaliforniaRESUMO
OBJECTIVE: To provide a comprehensive overview of the epidemiologic characteristics, outcomes, and risk factors of COVID-19-related deaths in children and adolescents in Brazil. STUDY DESIGN: We conducted a population-based, retrospective cohort study that included all patients aged <18 years with laboratory-confirmed, symptomatic SARS-CoV-2 infection as registered in official Brazilian national surveillance systems for COVID-19 between February 2020 and February 2023. The primary outcome was COVID-19-related deaths. Odds ratios (ORs) of risk factors associated with death were estimated using multivariable logistic regression. RESULTS: Over a 3-year period, 2 855 704 pediatric patients with symptomatic SARS-CoV-2 infection were registered in Brazil. Of these, 59 179 (2.1%) were hospitalized, 13 844 (0.48%) were admitted to the intensive care unit, and 4943 (0.17%) received mechanical ventilation. A total of 4740 (0.17%) patients had fatal outcomes. The case fatality rate increased to 7.9% among patients who required hospitalization; 2102 (44.3%) patients who died did not receive advanced critical support. Notably, 2 (65%, 95% CI 58-71) or 3 doses (86%, 95% CI 81-89) of the vaccine provided strong protection against death. The following adjusted covariates were significantly associated with increased odds of death: age (0-4 and 11-17 years), ethnicity (Brown and Indigenous), region (Northeast or North), dyspnea, nosocomial infection, and comorbidities. Conversely, living in the South or Central-West regions, admission in the later period of the pandemic, and receiving a vaccine were all associated with protection against death. CONCLUSIONS: Our findings suggest that a complex interplay between individual factors and social inequities has shaped the impact of COVID-19 on Brazilian children and adolescents.
Assuntos
COVID-19 , Hospitalização , Humanos , COVID-19/epidemiologia , COVID-19/mortalidade , Brasil/epidemiologia , Criança , Masculino , Feminino , Pré-Escolar , Adolescente , Estudos Retrospectivos , Lactente , Fatores de Risco , Hospitalização/estatística & dados numéricos , Recém-Nascido , SARS-CoV-2 , Respiração Artificial/estatística & dados numéricosRESUMO
Adverse childhood experiences (ACEs) are associated with externalizing behaviors. Whereas some ACEs affect individual children (i.e., child-specific; e.g., failing a grade), others affect the family unit (i.e., family-wide; e.g., parent losing a job); effects of ACEs on externalizing behavior may manifest differently across groupings of ACEs. Moreover, birth order may modify the association between child-specific and family-wide ACEs and externalizing behavior due to differences in the experience of being a younger versus older sibling. This study examined the externalizing behavior of siblings in relation to their experiences of child-specific and family-wide ACEs to test the hypothesis that younger siblings are at greater risk for developing externalizing symptoms following familial ACE exposure. Participants were 61 sibling pairs (younger sibling Mage = 11.37 years, 44.1% male; older sibling Mage = 13.1 years, 52.5% male) recruited from six schools in the northeastern United States. Parents rated each child's externalizing behaviors (e.g., bullying, meanness) and retrospectively reported on each child's experience of 34 ACEs; two raters categorized ACEs as child-specific (n = 10) or family-wide (n = 24). Multilevel modeling revealed that both child-specific and family-wide ACEs were associated with increased externalizing behaviors. Birth order moderated the effect of family-wide (but not child-specific) ACEs on externalizing behaviors, independent of sex and age. Externalizing behavior was higher for younger siblings as compared with older siblings, particularly when a high number of ACEs (6+) were reported. This research should prompt future exploration of mechanistic theories of the impact of family-wide and child-specific ACEs and the role of birth order.
Assuntos
Experiências Adversas da Infância , Ordem de Nascimento , Irmãos , Humanos , Masculino , Ordem de Nascimento/psicologia , Feminino , Experiências Adversas da Infância/psicologia , Criança , Adolescente , Irmãos/psicologia , Comportamento do Adolescente/psicologia , Bullying/psicologiaRESUMO
This survey evaluated the Brazilian population's physical exercise habits and compared them with those from two decades ago. In this cross-sectional study, 432 people with epilepsy (PWE) assessed the questionnaire. Of these, 387 (age: 33 ± 10.58, 81.4 % women) completed the questionnaire. Among them, 60.5 % were involved in regular physical activities. Among those who exercise regularly, the majority (96.5 %) exercised between 2 and 5 times weekly and had been physically active for at least two years. Only 23.3 % were prohibited by their doctors from participating in physical activities. Only 10 % reported that seizures occur during exercise, and about half of them (55.8 %) believed that exercise improves or has no effect on seizure frequency. Most (79.06 %) did not or rarely believe exercise can trigger seizures. More than half (57.3 %) were not afraid to have seizures during exercise or were not afraid of injury during exercise due to a seizure (69 %). Most believed exercise improves cognition (80.9 %), depression, and anxiety (93.8 %). We visited this scenario two decades early. In our previous study, only 15 % exercised regularly, while in this survey, 58.4 % routinely exercised. Our findings also align with our initial survey, indicating a low seizure frequency during regular exercise, a belief that physical activity reduces seizure frequency, and a reduction in the fear that exercise might trigger seizures. In conclusion, our results show that after two decades, there have been several improvements in physical and sports activity participation among PWE. Implementing strategies to reduce barriers to exercise for PWE and educating them on the benefits of physical activity can help improve this scenario.