Hábitos e problemas do sono das crianças dos 2 a 10 anos

RESUMO: Enquadramento: O sono é cada vez mais reconhecido como um fator determinante na Saúde Infantil porque, quando desadequado, pode ter consequências na regulação emocional e do comportamento, nas funções cognitivas, no rendimento académico, na regulação do peso e no risco de lesões acidentais. Os hábitos e problemas do sono das crianças portuguesas não se encontram ainda bem caracterizados. Este conhecimento é importante para o desenvolvimento da investigação e para a promoção da saúde nesta área. Objetivos: Adaptar e validar o Children's Sleep Habits Questionnaire (CSHQ) para a cultura portuguesa; Caracterizar os hábitos de sono de uma amostra de crianças dos 2 aos 10 anos tendo em vista a obtenção de dados de referência; Estimar a prevalência dos problemas do sono na perspetiva dos pais; Avaliar se existem diferenças nos hábitos e problemas do sono entre as regiões de média-alta e baixa densidade populacional; Identificar potenciais consequências dos problemas do sono. Métodos: Foi realizado um estudo transversal, descritivo e correlacional. A versão portuguesa do questionário (CSHQ-PT) foi desenvolvida de acordo com as orientações previamente publicadas e validada numa amostra de 315 crianças dos 2 aos 10 anos. Para o estudo dos hábitos e problemas do sono, o CSHQ-PT foi distribuído aos pais de 2257 crianças recrutadas em 17 zonas de agrupamentos escolares (15 escolhidos de forma aleatória) das áreas da Grande Lisboa, Península de Setúbal e Alentejo, compreendendo zonas litorais e do interior, e de alta, média e baixa densidade populacional. Foram obtidos 1450 (64%) questionários válidos. Resultados: O CSHQ-PT mostrou propriedades psicométricas semelhantes às das versões de outros países e adequadas para a investigação. A avaliação dos hábitos de sono nos dias de semana mostrou que as crianças se deitam, em média, pelas 21h 44m (DP 38 min.). A necessidade da companhia dos pais para adormecer diminui com a idade, ocorrendo em 49% das crianças aos 2-3 anos e 10% aos 9-10 anos. O hábito de adormecer a ver televisão foi descrito em 15,8% das crianças. O tempo total de sono diário diminui com a idade, com uma diferença mais marcada dos 2 para os 3 anos e dos 3 para os 4 anos, quando a sesta se torna menos frequente. No fim de semana, 25% das crianças dormia pelo menos mais uma hora. As diferenças nos hábitos de sono entre regiões de média-alta e de baixa densidade populacional foram reduzidas, sem reflexo na duração média do sono. Considerando valores de referência de outros países, verificou-se que 10% das crianças estudadas tinha uma duração do sono dois desvios-padrão abaixo da média esperada para a idade. A prevalência dos problemas do sono na perspetiva dos pais foi de 10,4%, sem diferenças significativas entre classes etárias, subgrupos de nível educacional dos pais, nem entre zonas de média-alta e baixa densidade populacional. Estes problemas do sono mostraram-se associados, sobretudo, à duração do sono insuficiente, resistência em ir para a cama, dificuldade em adormecer sozinho, despertares noturnos frequentes e ocorrência de parassónias. A baixa prevalência de problemas do sono identificados pelos pais contrasta com cotações elevadas no CSHQ-PT que traduzem comportamentos-problema mais frequentes, que são bem aceites por alguns pais. O Índice de Perturbação do Sono foi mais elevado nas famílias com menor nível educacional. Em análise multivariada mostraram valor preditivo para a sonolência diurna: o tempo total de sono diário, a diferença da duração do sono noturno durante a semana e no fim de semana, a frequência de algumas parassónias e o hábito de adormecer a ver televisão. O rendimento escolar mostrou associação com os problemas do sono, que são mais frequentes nas crianças com dificuldades escolares e hiperatividade/problemas de atenção. A relação entre estas variáveis é complexa. Conclusões: Este estudo mostrou que os problemas comportamentais do sono e a privação de sono são frequentes na população estudada. Estes problemas têm consequências, uma vez que correspondem a uma frequência mais elevada de sintomas de sonolência diurna, por comparação com outros países. Perante este cenário, é muito importante reforçar a promoção de hábitos de sono saudáveis e continuar a estudar as consequências do sono desadequado nas crianças portuguesas. -----------ABSTRACT:Framework: Sleep is increasingly being recognized as important to Child Health, for inadequate sleep may impact behavioral and emotional regulation, cognitive functions, academic performance, weight regulation and the risk of accidental injuries. The sleep habits and sleep problems of Portuguese children are not well characterized. This knowledge is important to support further studies and health promotion actions. Objectives: Develop and validate a Portuguese version of the Children's Sleep Habits Questionnaire (CSHQ-PT); Characterize the sleep habits and problems in a sample of Portuguese children from the ages of 2 to 10 for future reference; Estimate the prevalence of parent-defined sleep problems; Assess whether there are differences in sleep habits and problems between regions of medium-high and low population densities; Identify potential consequences of sleep problems. Methods: We conducted a cross-sectional, descriptive and correlational study. The Portuguese version of the questionnaire (CSHQ-PT) was developed according to published guidelines and validated in a sample of 315 children from 2 to 10 years old (y.o.). In order to study sleep habits and problems we delivered the CSHQ-PT to 2257 children recruited from 17 school districts (15 were chosen randomly) in areas with low, medium and high population densities, including coastline and inland regions. 1450 (64%) valid questionnaires were obtained. Results: The CSHQ-PT demonstrated psychometric properties that were similar to the versions from other countries and adequate for research. The evaluation of sleep habits showed that on schooldays children go to bed, on average, at 21h 44m (SD 38 min.). The need of having the parent in the room at bedtime decreases with the age of the child, occurring in 49% of children with 2-3 y.o. and 10% of children between 9 and 10 y.o. The habit of going asleep while watching TV was reported in 15,8% of the children. Total sleep time diminishes with the age of the child, having a major decrease from 2 to 3 y.o. and from 3 to 4 y.o., along with less frequent naps. During the weekend, 25% of the children sleep at least one extra hour. Considering reference values from other series, we found that 10% of the children had a sleep duration two standard deviations below the mean for the age. The differences in sleep habits between regions of medium-high and low population densities are few, and there are no differences in average sleep durations. The prevalence of parent-defined sleep problems was 10.4%. There were no significant differences between age classes, parent education subgroups or between regions of medium-high and low population densities. These sleep problems were associated with insufficient sleep duration, bedtime resistance, difficulty in falling asleep alone, frequent night awakenings and the occurrence of parasomnias. The low prevalence of parent-defined sleep problems contrasts with high CSHQ scores meaning that problematic behaviors are more frequent, but acceptable to some parents. The Sleep Disturbance Score was higher in families with a lower educational level. In multivariate analysis, the following factors predicted the daytime somnolence score: total sleep time, the difference in night sleep duration between the weekend and school days, the frequency of some parasomnias and the habit of falling asleep while watching TV. School achievement showed a negative correlation with the sleep problems, which are more frequent in children with school difficulties and hyperactivity/attention problems. The relationship between these variables is complex. Conclusions: This study evidenced that behavioral sleep problems and sleep deprivation are common in our population. These sleep problems have consequences as they correspond to more symptoms of excessive daytime somnolence comparing to other countries. Therefore, we reinforce the importance of promoting healthy sleep habits and further study the consequences of inadequate sleep in Portuguese children.

Biological, behavioral, and socioeconomic factors associated with death from AIDS in Brasília, Brazil, in 2007

INTRODUCTION: In the jurisdiction of Brasília, Brazil, significant reductions in mortality rates and lethality resulting from acquired immunodeficiency syndrome (AIDS) were observed shortly after the introduction of highly active antiretroviral therapy. In recent years, however, the decline of these rates has not been as significant. Non-adherence to treatment and delayed diagnosis appear to be the main factors that increase the risk of death from AIDS. Behavioral, socioeconomic, and biological factors could also be associated with increased risk of death due to AIDS. This study aimed to identify which of these factors were associated with deaths from AIDS in Brasília. METHODS: A case-control study was undertaken using the data recorded in the Information System of Notifiable Diseases. Cases consisted of AIDS deaths occurring in 2007, residing in Brasília, and over 12 years of age. Controls consisted of AIDS patients who did not die until December 31 2007, also residing in Brasília, and over 12 years of age. For each group, frequency and proportion tables for the variables were prepared. The statistical association of each factor in isolation with the occurrence of the deaths was verified through a model of multivariate analysis using logistic regression. RESULTS: The factors that were associated with an increased risk of death were intravenous drug use, age 50 years or more, and residing in a region whose residents have low per capita income. CONCLUSIONS: We identified factors associated with death due to AIDS that can guide health planning.

The relationship between sexual and emotional promiscuity and infidelity

Dissertação de mestrado integrado em Psicologia

Infants’ behavioral and physiological profile and mother–infant interaction

This study aims to (a) identify and profile groups of infants according to their behavioral and physiological characteristics, considering their neurobehavioral organization, social withdrawal behavior, and endocrine reactivity to stress, and to (b) analyze group differences in the quality of mother–infant interaction. Ninety seven 8-week-old infants were examined using the Neonatal Behavioral Assessment Scale and the Alarm Distress Baby Scale. Cortisol levels were measured both before and after routine inoculation between 8 and 12 weeks. At 12 to 16 weeks mother–infant interaction was assessed using the Global Rating Scales of Mother–Infant Interaction. Three groups of infants were identified: (a) ‘‘withdrawn’’; (b) ‘‘extroverted’’; (c) ‘‘underaroused.’’ Differences between them were found regarding both infant and mother behaviors in the interaction and the overall quality of mother–infant interaction. The identification of behavioral and physiological profiles in infants is an important step in the study of developmental pathways.

Mother's stress, mood and emotional involvement with the infant: 3 months before and 3 months after childbirth

Adverse effects of maternal anxiety and depression are well documented, namely on the foetus/child behaviour and development, but not as much attention has been given to the mother's emotional involvement with the offspring. To study mother's prenatal and postpartum stress, mood and emotional involvement with the infant, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale and the Mother-to-Infant Bonding Scale were filled in and cortisol levels were measured, 3 months before and 3 months after childbirth, in a sample of 91 Portuguese women. From pregnancy to the postpartum period, mother's cortisol levels, anxiety and emotional involvement toward the child decrease. No significant change was observed regarding mother's depression. Mother's depression predicted a worse emotional involvement before childbirth, while mother's anxiety predicted a worse emotional involvement with the infant after childbirth. Additionally, pregnant women with a worse emotional involvement with the offspring are at risk of poorer emotional involvement with the infant and higher anxiety and depression at 3 months postpartum. It should be given more attention to mother's poor emotional involvement with the offspring during pregnancy, as it interferes with her emotional involvement with the infant and her psychological adjustment 3 months after childbirth.

Hypertensive diabetic patients: guidelines for conduct and their difficulties

OBJECTIVE: To assess the effect of blood pressure (BP) control and other cardiovascular risk factors in patients with diabetes mellitus in a referral service for the treatment of hypertension. METHODS: A retrospective study where diabetic patients (at least 2 fasting glucose levels above 126 mg/dL, use of hypoglycemic agents or insulin, or both of these) were included. They were evaluated at the first appointment (M1) and at the last appointment (M2), regarding blood pressure, body mass index (BMI), use of hypertensive drugs, glycemia, total cholesterol (TC), creatinine, and potassium. RESULTS: Of 1,032 patients studied, 146 patients with a mean age of 61.6 years had diabetes, and 27 were men (18.5%). Mean follow-up was 5.5 years. BP values were 161.6 x 99.9 mmHg in M1 and 146.3 x 89.5 mmHg in M2. In M1, 10.4% of the patients did not use medications, 50.6% used just 1 drug, 30.8% used 2 drugs, and 8.2% used 3 or more drugs. In M2, these values were 10.9%, 39%, 39.7%, and 10.4%, respectively. Diuretics were the most commonly used medication, whereas angiotensin-converting enzyme inhibitors (ACE inhibitors) were those drugs which presented greater increase when comparing M1 to M2 (24.6% and 41.7%, respectively). Only 17,1% reached the recommended goal (BP<130x85 mmhg). The other cardiovascular risk factors did not change significantly. CONCLUSION: Our data reinforce the necessity of a more aggressive approach in the treatment of these patients, despite the social and economic difficulties in adhering to treatment.

Modulation of social and emotional behaviors by glutamic acid decarboxylase (GAD) and phytoestrogens

Magdeburg, Univ., Fak. für Naturwiss., Diss., 2014

Behavioral and psychological symptoms and cognitive decline in patients with amnestic MCI and mild AD: a two-year follow-up study.

BACKGROUND: Mild cognitive impairment (MCI) has been defined as a transitional state between normal aging and dementia. In many cases, MCI represents an early stage of developing cognitive impairment. Patients diagnosed with MCI do not meet the criteria for dementia as their general intellect and everyday activities are preserved, although minor changes in instrumental activities of daily living (ADL) may occur. However, they may exhibit significant behavioral and psychological signs and symptoms (BPS), also frequently observed in patients with Alzheimer's disease (AD). Hence, we wondered to what extent specific BPS are associated with cognitive decline in participants with MCI or AD. METHODS: Our sample consisted of 164 participants, including 46 patients with amnestic (single or multi-domain) MCI and 54 patients with AD, as well as 64 control participants without cognitive disorders. Global cognitive performance, BPS, and ADL were assessed using validated clinical methods at baseline and at two-year follow-up. RESULTS: The BPS variability over the follow-up period was more pronounced in the MCI group than in patients with AD: some BPS improve, others occur newly or worsen, while others still remain unchanged. Moreover, specific changes in BPS were associated with a rapid deterioration of the global cognitive level in MCI patients. In particular, an increase of euphoria, eating disorders, and aberrant motor behavior, as well as worsened sleep quality, predicted a decline in cognitive functioning. CONCLUSIONS: Our findings confirm a higher variability of BPS over time in the MCI group than in AD patients. Moreover, our results provide evidence of associations between specific BPS and cognitive decline in the MCI group that might suggest a risk of conversion of individuals with amnestic MCI to AD.

Personality traits and behavioral and psychological symptoms in patients at an early stage of Alzheimer's disease.

OBJECTIVE: The origins of behavioral and psychological symptoms (BPS) in Alzheimer's disease (AD) are still poorly understood. Focusing on individual personality structure, we explored the relationship between premorbid personality and its changes over 5 years, and BPS in patients at an early stage of AD. METHOD: A total of 54 patients at an early stage of AD according to ICD-10 and NINCDS-ADRDA criteria and 64 control subjects were included. Family members filled in the Neuropsychiatric Inventory Questionnaire to evaluate their proxies' current BPS and the NEO Personality Inventory Revised twice, the first time to evaluate the participants' current personality and the second time to assess personality traits as they were remembered to be 5 years earlier. RESULTS: Behavioral and psychological symptoms, in particular apathy, depression, anxiety, and agitation, are frequent occurrences in early stage AD. Premorbid personality differed between AD patients and normal control, but it was not predictive of BPS in patients with AD. Personality traits clearly change in the course of beginning AD, and this change seems to develop in parallel with BPS as early signs of AD. CONCLUSIONS: Premorbid personality was not associated with BPS in early stage of AD, although complex and non-linear relationships between the two are not excluded. However, both personality and behavioral changes occur early in the course of AD, and recognizing them as possible, early warning signs of neurodegeneration may prove to be a key factor for early detection and intervention. Copyright © 2012 John Wiley & Sons, Ltd.

Cognitive and emotional effects of carotid stenosis.

PRINCIPLES: Patients with carotid artery stenosis (CAS) are at risk of ipsilateral stroke and chronic compromise of cerebral blood flow. It is under debate whether the hypo-perfusion or embolism in CAS is directly related to cognitive impairment. Alternatively, CAS may be a marker for underlying risk factors, which themselves influence cognition. We aimed to determine cognitive performance level and the emotional state of patients with CAS. We hypo-thesised that patients with high grade stenosis, bilateral stenosis, symptomatic patients and/or those with relevant risk factors would suffer impairment of their cognitive performance and emotional state. METHODS: A total of 68 patients with CAS of ≥70% were included in a prospective exploratory study design. All patients underwent structured assessment of executive functions, language, verbal and visual memory, motor speed, anxiety and depression. RESULTS: Significantly more patients with CAS showed cognitive impairments (executive functions, word production, verbal and visual memory, motor speed) and anxiety than expected in a normative sample. Bilateral and symptomatic stenosis was associated with slower processing speed. Cognitive performance and anxiety level were not influenced by the side and the degree of stenosis or the presence of collaterals. Factors associated with less co-gnitive impairment included higher education level, female gender, ambidexterity and treated hypercholesterolemia. CONCLUSIONS: Cognitive impairment and increased level of anxiety are frequent in patients with carotid stenosis. The lack of a correlation between cognitive functioning and degree of stenosis or the presence of collaterals, challenges the view that CAS per se leads to cognitive impairment.

Comparison of some behavioral and physiological feeding parameters of Triatoma infestans klug, 1834 and Mepraia spinolai porter, 1934, vectors of chagas disease in Chile

There are two vectors of Chagas disease in Chile: Triatoma infestans and Mepraia spinolai. We studied the feeding behavior of these species, looking for differences which could possibly explain the low impact of the latter species on Chagas disease. Both species used thermal cues to locate their feeding source and consumed a similar volume of blood which was inversely related to the body weight before the meal and directly related to the time between meals. The average time between bites were 6.24 and 10.74 days. The average bite of M. spinolai lasted 9.68 min, significantly shorter than the 19.46 min for T. infestans. Furthermore, while T. infestans always defecated on the host, this behavior was observed in M. spinolai in only one case of 27 (3.7%). The delay between the bites and defecation was very long in M. spinolai and short in T. infestans. These differences may affect the reduced efficiency of transmission of Chagas infection by M. spinolai.

Quality Standards for Services Promoting Mental and Emotional Wellbeing and Suicide Prevention

These standards will apply to all organisations providing mental & emotional wellbeing and suicide prevention services which are funded by the PHA.

Promoting young people's social and emotional wellbeing in secondary education.

This guidance is for all those who have a responsibility for the social and emotional wellbeing of young people in secondary education. This includes teachers, support staff, governors and professionals with public health as part of their remit working in education (including the independent sector), local authorities, the NHS and the wider public, voluntary and community sectors. It focuses on interventions to support all young people aged 11-19 who attend any education establishment. Social and emotional wellbeing includes being happy, confident and in control, with the ability to solve and cope with problems and have good relationships with other people. The six recommendations cover: strategy, the key principles and conditions, working in partnership with parents, families and young people, the curriculum, and training and professional development. They include: â?¢ Secondary education establishments should have access to the specialist skills, advice and support they require. â?¢ Practitioners should have the knowledge, understanding and skills they need to develop young peopleâ?Ts social and emotional wellbeing. â?¢ Secondary education establishments should provide a safe environment which nurtures and encourages young peopleâ?Ts sense of self-worth, reduces the threat of bullying and violence and promotes positive behaviour. â?¢ Social and emotional skills education should be tailored to the developmental needs of young people.This resource was contributed by The National Documentation Centre on Drug Use.