Reliability and convergent validity of the Childhood Anxiety Sensitivity Index in children and adolescents

OBJECTIVE: The purpose of this study was to examine the reliability and the convergent validity of the Children Anxiety Sensitivity Index (CASI) with DSM-IV anxiety disorder symptoms, by comparison with the Screen for Child Anxiety Related Emotional Disorders (SCARED), in a community sample of Brazilian children and adolescents. METHODS: Children and adolescents from five schools were selected from a larger study that aimed to assess different aspects of childhood anxiety disorders. All participants completed the CASI and the SCARED. RESULTS: This study supported the reliability of the CASI total score. Girls reported higher total anxiety sensitivity scores than boys and there were no differences in total anxiety sensitivity scores between children and adolescents. This study showed moderate to high correlations between the CASI scores with SCARED scores, all correlations coefficients being positive and significant. CONCLUSIONS: Our findings demonstrate an appropriate reliability and evidence of convergent validity in the CASI in a sample of Brazilian children and adolescents.

Diagnostic value of the tilt-table test for the assessment of syncope in children and adolescents

OBJECTIVE - To assess the diagnostic value, the characteristics, and feasibility of tilt-table testing in children and adolescents. METHODS - From August 1991 to June 1997, we retrospectively assessed 94 patients under the age of 18 years who had a history of recurring syncope and presyncope of unknown origin and who were referred for tilt-table testing. These patients were divided into 2 groups: group I (children) - 36 patients with ages ranging from 3 to 12 (mean of 9.19±2.31) years; group II (adolescents) - 58 patients with ages ranging from 13 to 18 (mean of 16.05±1.40) years. We compared the positivity rate, the type of hemodynamic response, and the time period required for the test to become positive in the 2 groups. RESULTS - The positivity rates were 41.6 % and 50% for groups I and II, respectively. The pattern of positive hemodynamic response that predominated in both groups was the mixed response. The mean time period required for the test to become positive was shorter in group I (11.0±7.23 min) than in group II (18.44±7.83 min). No patient experienced technical difficulty or complications. CONCLUSION - No difference was observed in regard to feasibility, positivity rate, and pattern of positive response for the tilt-table test in children and adolescents. Pediatric patients had earlier positive responses.

Children's play and leisure : connections with emotional competence

O jogo e o lazer são elementos importantes para o desenvolvimento das crianças. O objetivo geral desta tese foi o de investigar o modo como o jogo e o lazer estão relacionados com diferentes aspetos das competências emocional e social das crianças e jovens. Nesta tese foram investigados três aspetos do jogo: o tempo, a forma e o nível social, diferentes formas de lazer, e vários elementos chave do funcionamento sócio-emocional, através da combinação de observações naturalistas, tarefas, questionários e de um método inovador de mensuração, baseado em Identificação por Rádio-Frequência. O panorama que surge dos estudos incluídos nesta tese é que o jogo e o lazer estão relacionados com o funcionamento sócio-emocional, embora de formas distintas, e por vezes inesperadas. Os estudos no recreio revelaram que as crianças envolvem-se predominantemente no jogo de atividade física. Contudo, enquanto que uma forma de jogo de atividade física, o jogo de exercício, foi associado a melhor competência social, a outra forma, o jogo de luta-e-perseguição, foi associado à agressividade. O facto de o jogo de faz-de-conta, em estudos anteriores, ter sido maioritariamente estudado em espaços interiores, pode explicar o porquê das associações negativas encontradas entre o jogo de faz-de-conta, quer em grupo, quer solitário (nas raparigas) e a competência sócio-emocional, que contrastam com a literatura. De facto, as crianças que não conseguem juntar-se aos seus pares no jogo de exercício podem optar por esta alternativa, o que sugere que crianças socialmente competentes poderão retirar maior vantagem das oportunidades existentes, adaptando melhor os seus comportamentos de jogo. As crianças mais velhas têm geralmente mais liberdade de decisão sobre o seu tempo de lazer. Quando perguntámos às crianças mais velhas e aos adolescentes como passavam a sua semana, as atividades de ecrã destacaram-se. Contudo, as atividades de ecrã e as atividades intelectuais foram relacionadas a mais problemas de saúde mental, enquanto que as atividades desportivas foram associadas a melhor saúde mental. Concluindo, diferentes formas de jogo e de lazer podem ter diferentes funções, de uma forma positiva ou negativa, dependendo da situação em que a criança se encontra.

Crescer & saúde : desenvolvimento e comportamento dos adolescentes e jovens recém ingressados no 1º ano do ISCED de Benguela, ensino superior público

Ao abordarmos a temática “Crescer & Saúde-Desenvolvimento e Comportamento dos Adolescentes e Jovens Recém-Ingressados no ISCED de Benguela”, enfatizamos a relevância dos aspetos que constituem a sua génese, no sentido de sugerir ações que contribuam para uma educação para a saúde no âmbito do sistema educativo do ensino superior público em Benguela, e a sua promoção na formação de professores. A questão de partida do estudo foi: Qual é a situação dos adolescentes e jovens em matéria de comportamentos de saúde e seus contextos? Para responder à questão, foram desenvolvidos dois estudos: O estudo quantitativo realizado através de um questionário constituído, entre outras, por questões do Health Behaviour School Aged-Children (HBSC) (Currie, et al., 2001, Matos et al., 2002, 2010), contou com um universo estudantil distribuído por nove especialidades. Assim sendo, foi extraída uma amostra de 20% do total de indivíduos que frequentam o primeiro ano, num total de 255 estudantes. O estudo qualitativo, através de grupos focais, contou com 78 indivíduos, distribuídos entre a universidade pública e privada, e teve a finalidade de caracterizar os comportamentos sexuais e outros aspetos relacionados com a saúde nos adolescentes e jovens do 1º ano do ISCED de Benguela. Os resultados refletem a necessidade de uma educação com cariz formativo e informativo que desenvolva ações pedagógicas específicas de dimensão social, presente nas várias instâncias de socialização, através da interação social para que os jovens adquiram normas, atitudes, conhecimentos e comportamentos aceites socialmente. Esperamos que o presente sirva de ferramenta importante para melhor conhecimento dos seus comportamentos, estilo de vida, conhecimentos face ao VIH/SIDA e IST’s, comportamento de risco, saúde mental, atitudes face à diferença e às adversidades, entre outros aspetos, permitindo o exercício de uma influência positiva por parte dos trabalhadores da instituição, dos colegas, familiares e sociedade civil.

Does the provision of full day care improve the quality of life for children and their parents

This study sought to explore and examine if the provision of full day care improves the quality of life for children and their parents. Owing to the effects of the Celtic Tiger, life in Ireland has changed considerably over the past five to ten years. Because of the booming economy there are now 60.8% of women employed in the workforce. This means many changes for children, parents and families. Findings in the literature review are based on international studies. The researcher utilised both qualitative and quantitative research methodologies for the study. She interviewed 31 respondents; 27 childcare managers; 3 politicians and the chairperson of a childcare committee. Furthermore, 325 questionnaires were completed in a survey by working parents in the statutory and voluntary sectors in and around Sligo town and in two childcare facilities in Letterkenny, Co. Donegal. Babies as young as 4 months are being cared for in childcare facilities from 6.45am until 6.pm daily, 5 days per week. Some children are spending up to 11 hours per day in childcare facilities. The study has not categorically concluded that full day care is either positive or negative for children. Childcare facilities are providing good quality childcare encompassing various services; however, 25 out of 27 childcare managers reported to the researcher that they would not leave their child in full day care. Parents are finding it difficult to manage work life balance. Health dominated quality of life issues. Two hundred and thirty five (235) parents reported being stressed. The study also found that 315 working parents feel that the government is not doing enough to support working parents. On a positive note, 241 parents said they are happy in general with the quality of life for them, their family and their children. In addition, the researcher has identified a number of recommendations for future changes in policy and further study.

Comparasion of polyacrylamide gel electrophoresis (PAGE), immuno-electron microscopy (IEM) and enzyme immunoassay (EIA) for the rapid diagnosis of rotavirus infection in children

Detection of rotavirus RNA by polyacrylamide gel electrophoresis (PAGE) proved to be a highly sensitive and rapid diagnostic test. A comparison of this assay with immuno-electron microscopy (IEM) and enzyme immunoassay (EIA) in 245 faeces from children with gastroenteritis revealed complete agreement between the three assays in 238 (97.14%) samples. Among 75 samples positive in at least one of the three assays, negative results were observed in 5 (6.48%) by PAGE, in 6 (6.76%) by EIA and in none by IEM. Silver staining greatly increased the sensitivity of the PAGE assay. We conclude that although IEM remains the most sensitive and rapid rotavirus diagnostic assay, the PAGE technique has many advantages in its favour, including the non-requirement of expensive equipment, the use of only chemically defined reagents and the capacity to distinguish virus subgroup and variants and to detect non-crossreactive rotaviruses which are missed in serological assays.

Circulation flow of enteropathogenia bacteria in institutionalized children. I. An epidemiologic study

The circulation flow and maintenance of enteropathogenic bacteria were studied from May 1982 to april 1983 in a population of institutionalized children and adult staff contacts in the city of Rio de Janeiro, Brazil. Subjects were assigned to three groups; A and B, included, respectively, 105 and 46 children with diarrhea who were admitted in the institution in different periods, and group C with 82 adult contacts. Faecal cultures were positive in 35.2%, 39.1% and 19.7% of subjects of groups A, B and C, respectively. It suggests that the transmission was probably fostered by the environment because of as high as 30% of faecal contamination was found in environmental samples. Higher rate of isolation and elevated antibodies levels pointed out that Escherichia coli (EPEC) was the prevalent agent. Shigella predominated in the serological tests. These findings suggest that the institution itself may play an important role in the epidemiology and transmission of enteric infections in the community.

Patterns of serologic response to human immunodeficiency virus type 1 (HIV-1) in brazilians with different clinical forms of HIV infection

In order to investigate the IgG HIV-1 antibodies rectivity to structural components of the virus, 85 sera from infected Brazilians, comprising the total spectrum of HIV infection, were analysed by Western blot assay. The sera were confirmed as being positive to HIV with enzyme linked immuno assay (ELISA) and indirect immunofluorescence (IIF). Although the sera from patients reacted less intensively to the gag polypeptide of 55KDa, no distinctive antigen reaction patterns were observed between sera patients with different clinical forms. Because of the higher frequency of reactivity to the gag p24 in AIDS patients, the patterns of anti-HIV IgG responses are similar to those observed in their African counterparts.

Treatment-dependent loss of polyfunctional CD8+ T-cell responses in HIV-infected kidney transplant recipients is associated with herpesvirus reactivation.

Antiretroviral-therapy has dramatically changed the course of HIV infection and HIV-infected (HIV(+)) individuals are becoming more frequently eligible for solid-organ transplantation. However, only scarce data are available on how immunosuppressive (IS) strategies relate to transplantation outcome and immune function. We determined the impact of transplantation and immune-depleting treatment on CD4+ T-cell counts, HIV-, EBV-, and Cytomegalovirus (CMV)-viral loads and virus-specific T-cell immunity in a 1-year prospective cohort of 27 HIV(+) kidney transplant recipients. While the results show an increasing breadth and magnitude of the herpesvirus-specific cytotoxic T-cell (CTL) response over-time, they also revealed a significant depletion of polyfunctional virus-specific CTL in individuals receiving thymoglobulin as a lymphocyte-depleting treatment. The disappearance of polyfunctional CTL was accompanied by virologic EBV-reactivation events, directly linking the absence of specific polyfunctional CTL to viral reactivation. The data provide first insights into the immune-reserve in HIV+ infected transplant recipients and highlight new immunological effects of thymoglobulin treatment. Long-term studies will be needed to assess the clinical risk associated with thymoglobulin treatment, in particular with regards to EBV-associated lymphoproliferative diseases.

Evolutionary genomics and HIV restriction factors.

PURPOSE OF REVIEW: To provide updated insights into innate antiviral immunity and highlight prototypical evolutionary features of well characterized HIV restriction factors. RECENT FINDINGS: Recently, a new HIV restriction factor, Myxovirus resistance 2, has been discovered and the region/residue responsible for its activity identified using an evolutionary approach. Furthermore, IFI16, an innate immunity protein known to sense several viruses, has been shown to contribute to the defense to HIV-1 by causing cell death upon sensing HIV-1 DNA. SUMMARY: Restriction factors against HIV show characteristic signatures of positive selection. Different patterns of accelerated sequence evolution can distinguish antiviral strategies--offense or defence--as well as the level of specificity of the antiviral properties. Sequence analysis of primate orthologs of restriction factors serves to localize functional domains and sites responsible for antiviral action. We use recent discoveries to illustrate how evolutionary genomic analyses help identify new antiviral genes and their mechanisms of action.

Out of sight, out of mind? Educational outcomes of children with parents working abroad.

Impact of parental emigration on educational outcomes of children is theoretically ambiguous. Using novel data I collected on migration experience and its timing, family background and school performance of lower secondary pupils in Poland, I analyse the question empirically. Migration is mostly temporary in nature, with one parent engaging in employment abroad. As many as 63% of migrant parents have vocational qualifications, 29% graduated from high school, 4% have no qualifications and the remaining 4% graduated from university. Almost 18% of children are affected by parental migration. Perhaps surprisingly, estimates suggest that parental employment abroad has a positive immediate impact on a pupil’s grade. Parental education appears pivotal; children of high school graduates benefit most. Longer term effects appear more negative, however, suggesting that a prolonged migration significantly lowers a child’s grade. Interestingly, siblings’ foreign experiences exert a large, positive impact on pupils’ grades.

Detection of cytomegalovirus in urine of HIV-infected patients by DNA-DNA hybridization comparison with virus isolation, immunofluorescence and immunoperoxidase

Immunofluorescence and immunoperoxidase test directed against early viral antigens, and DNA-DNA hybridization were compared with viral isolation for their abilities to detect Cytomegalovirus (CVM) in the urine of 89 HIV infected patients. From the 100 urine samples collected, 70 were found positive by at least one method. Considering viral isolation as the "gold standard" technique, immunofluorescence and immunoperoxidase had a sensitivity of 92.3% and88% respectively, with a specificity in both cases of 95%. DNA-DNA hybridization showed a sensitivity of 90% but with lower (60%) specificity. All of the three assays were effective in detecting CVM from urine and the technical advantage of each is discussed.

Withholding antimalarials in febrile children who have a negative result for a rapid diagnostic test.

BACKGROUND: The availability of a rapid diagnostic test for malaria (RDTm) allows accurate diagnosis at all levels of health facilities. The objective of the present study was to evaluate the safety of withholding antimalarials in febrile children who have a negative test result. METHODS: We conducted a prospective 2-arm longitudinal study in areas of Tanzania that are moderately and highly endemic for malaria. Children with a history of fever were managed routinely by resident clinicians of 2 health facilities, except that no antimalarials were prescribed if the RDTm result was negative. Children were followed up at home on day 7. The main outcome was the occurrence of complications in children with negative RDTm results; children with positive RDTm results were followed up for the same outcomes for indirect comparison. RESULTS: One thousand children (median age, 24 months) were recruited. Six hundred three children (60%) had a negative RDTm result. Five hundred seventy-three (97%) of these children were cured on day 7. Forty-nine (8%) of the children with negative RDTm results spontaneously visited the dispensary before day 7, compared with 10 (3%) of the children with positive RDTm results. All children who had negative initial results had negative results again when they were tested either at spontaneous attendance or on day 7 because they were not cured clinically, except for 3 who gave positive results on days 2, 4, and 7 respectively but who did not experience any complication. Four children who had negative initial results were admitted to the hospital subsequently, all with negative results for malaria tests upon admission. Two of them died, of causes other than malaria. CONCLUSIONS: Not giving antimalarial drugs in febrile children who had a negative RDTm result was safe, even in an area highly endemic for malaria. Our study provides evidence for treatment recommendations based on parasitological diagnosis in children <5 years old.

Blastocystis hominis: occurrence in children and staff members of municipal day-care centers from Botucatu, São Paulo State, Brazil

To study the frequency of Blastocystis hominis among healthy individuals, feces were collected from 153 children and 20 staff members of some municipal day-care centers. Three separate stool specimens of each individual were processed by Lutz and Faust methods. From 173 studied individuals, 60 (34.7%) showed B. hominis, frequently in association with other intestinal parasites and/or commensals. B. hominis was found mainly in adults and children between 36 and 72 months old. All positive cases were detected only by Lutz method and the use of three stool specimens increased the positivity of the parasitological diagnostic.

Use of levosimendan as rescue therapy in children with low cardiac output syndrome.

Objective: Aim of post operative treatments after cardiac surgery is to avoid low cardiac output syndrome (LCOS). Levosimendan, a new inotrope agent, has been demonstrated in adult patient to be an effective treatment for this purpose when classical therapy is not effective. It shows a positive effect on cardiac output, with fewer adverse effects and lower mortality than with dopamine. There is very few data on its benefit in the paediatric population. The aim of this study is to evaluate the effect of levosimendan in cardiac children with LCOS.Methods: Retrospective analysis of 25 children hospitalised in our PICU after cardiac surgery that demonstrated LCOS not responding to classical catecholamine therapy and who received levosimendan as rescue. LCOS parameters like urine output, mixed venous oxygen saturation (SvO2), arterio-venous differences in CO2 (AVCO2) and plasmatic lactate were compared before therapy and at 12, 24, 48 and 72 hours after the beginning of the levosimendan infusion. We also analyzed the effect on the utilisation of amines (amine score), adverse events and mortality.Results: After the beginning of levosimendan infusion, urine output (3.1 vs 5.3ml/kg/h, p=0.003) and SVO2 (56 vs 64mmHg, p=0.001) increase significantly during first 72 hours and at the same time plasmatic lactate (2.6 vs 1.4 mmole/l, p<0.001), AVCO2 (11 vs 8 mmHg, p=0.002) and amine score (63 vs 39, p=0.007) decrease significantly. No side effects were noted during administration of levosimendan. In this group of patients, mortality was 0%.Conclusion: Levosimendan is an effective treatment in children after congenital heart surgery. Our study, with a greater sample of patient than other studies, confirms the improvement of cardiac output already shown in other paediatric studies.