Relationship between respiratory tract diseases declared by parents and socioeconomic and cultural factors

OBJETIVO: Verificar a relação entre a doença respiratória das crianças declarada pelos pais e os seguintes aspectos: instituição de ensino da criança, grau de instrução dos pais, renda per capita, classe de consumo e grupo étnico da família. MÉTODOS: Estudo descritivo com enfoque retrospectivo, por meio da análise de dados coletados de pais de uma amostra de 959 escolares entre cinco e nove anos, que residiam no distrito estudado, em São Paulo, em 2004. O levantamento das informações foi realizado por meio de instrumento de coleta de dados. As doenças respiratórias pesquisadas no conjunto foram: rinite, rinossinusite, otite, laringite, faringoamigdalite, pneumonia e asma. A associação entre doença respiratória declarada e aspectos socioeconômicos foi avaliada pelo teste do qui-quadrado. RESULTADOS: Os pais de crianças que frequentavam escolas privadas declararam significativamente mais doenças respiratórias em seus filhos, em comparação aos pais de crianças que estudavam em escolas públicas. Os pais com grau de instrução superior ou ensino médio completo declararam significativamente mais doença respiratória em seus filhos. Não houve associação entre a doença respiratória com renda per capita, classe de consumo e etnia. CONCLUSÕES: A percepção mais apurada sobre a saúde dos filhos geralmente associa-se à maior escolaridade dos pais, o que também determina melhores condições de vida. Provavelmente, por isso, os pais cujos filhos frequentavam escolas privadas e com melhor nível de escolaridade referiram mais doenças respiratórias nas crianças. Infere-se, portanto, que conquistas na percepção de saúde e, consequentemente, nas condições de saúde associam-se à melhora do nível educacional.OBJECTIVE: To determine the association between children's respiratory diseases reported by parents and the following criteria: attendance at private or public school, parents' educational level; family per capita income; household socioeconomic class, and family ethnicity. METHODS: This retrospective descriptive study analyzed data collected from questionnaires responded by the parents of 959 schoolchildren between five to nine years old, living in the district selected for the study, in São Paulo, Brazil, over 2004. Respiratory diseases reported by parents were rhinitis, rhinosinusitis, ear infections, laryngitis, pharyngitis, pneumonia, asthma and asthma-like diseases. A chi-square test was used to evaluate the association between respiratory diseases reported by parents and family socioeconomic factors. RESULTS: Parents of children in private schools reported significantly more respiratory diseases in their children than those whose children attended public schools. More respiratory diseases were reported for children whose parents finished high school or college. There were no significant differences between respiratory diseases and per capita income, socioeconomic class or ethnicity. CONCLUSIONS: A more accurate perception about the health of children is generally associated with parents' higher education, which is also expected to ensure better living conditions. This may explain why parents with a higher level of education and whose children attended private schools reported more respiratory diseases in their children. Our findings suggest that improvement of educational level is associated with more accurate health perceptions and, consequently, better health conditions

Arousal dysregulation and executive dysfunction in attention deficit hyperactivity disorder (ADHD)

Attention deficit/hyperactivity disorder (ADHD) is a heterogeneous neurodevelopmental condition, that continues to have an elusive etiological background. A number of extant models and theories have historically intended to explain the many factors contributing to ADHD behaviors. One of the most accepted hypotheses has been the executive dysfunction theory associating reduction in executive control to abnormalities in structure and operational dysfunction of dopaminergic signaling networks. Nevertheless, executive functions are not always impaired in ADHD, and the literature describes other symptoms commonly reported suggesting individuals with ADHD would appear to suffer from a more general deficit. Another existing line of research, that has gained much attention recently, establishes that ADHD would have dysregulated states of brain arousal that would account for its commonly observed cognitive deficits and behavioral symptoms, described as the state regulation theory, which has now included measures of autonomic function. This article describes some important aspects that compose and challenge these two most influential theoretical constructs, executive dysfunction and state-regulation, based on their empirical evidence, implying the need to reevaluate the norms used to classify individuals and establish ADHD diagnosis. Large number of controversial results continue to exist within the study of ADHD biological and/or performance markers, possibly due to such heterogeneity and variability within the same diagnosis. The need to resolve these issues and establish newly revised diagnostic criteria for ADHD is critical, as therapeutic success depends on having accurately identified underlying neurophysiological factors in order to appropriately address them in treatment

Clinical Experiences in Pertussis in a Population with High Vaccination Rate

Infection caused by Bordetella pertussis in young infants can lead to severe illness and death. Several countries with good pertussis vaccine coverage, above 90%, had outbreaks of this disease from 2010, including Brazil. One of the strategies to reduce the transmission of pertussis to young infants, especially below 6 months of age, is the introduction of Tdap vaccination in pregnant women between 27 and 36 weeks of gestation. Vaccination of pregnant women with Tdap is an emergency measure to reduce hospitalizations and deaths from pertussis in young infants, especially those younger than 3 months of age, which is the population group where the most frequent serious illness occurs. Passive immunity to pertussis in these newborns is temporary, lasting less than 6 months, and there is discussion in the literature of its interference with maternal immunity and immunity of young infants to other vaccines. The acquired immunity to pertussis, both by natural disease and by vaccines, is temporary, and it is known that the immune response to the acellular vaccine is smaller and less durable than the whole-cell vaccine. New strategies for pertussis control should be developed to better cope with this disease overall

No Association between Low Birth Weight and Cardiovascular Risk Factors in Early Adulthood: Evidence from São Paulo, Brazil

Background: A growing literature suggests that low birth weight increases the risk of poor health outcomes in adulthood. We tested this hypothesis among young adults living in São Paulo State, Brazil. Methods and Findings: To identify the effects of low birth weight on young adulthood outcomes, a medical assessment of 297 individuals born between 1977 and 1989 was conducted at a primary care unit in São Paulo State, Brazil. We analyzed body mass index (BMI), waist-hip ratio, blood pressure, fasting glucose and total cholesterol levels using linear and logistic regressions. Low birth was negatively associated with BMI (β = −2.0, 95% CI: −3.69, −0.27, p = 0.02), fasting glucose levels (β = −1.9, 95% CI: −3.9, −0.07, p = 0.05), waist-hip ratio (β = −0.03, 95% CI: −0.07, −0.01, p = 0.10), systolic blood pressure (β = −3.32, 95% CI: −7.60, 0.96, p = 0.12), and total cholesterol levels (β = −3.19, 95% CI: −16.43, 10.05, p = 0.636). Low birth weight was also associated with lower odds of young adults being overweight and obese, but neither association was statistically significant. Weight gain in the first 12 months of life was associated with higher adult BMI (β = 0.79, 95% CI: −0.0455, 1.623, p = 0.064) and blood pressure (β = 2.79, 95% CI: 0.22, 5.35, p = 0.034). No associations were found between low birth weight and early life (catch-up) growth. Conclusions: Low birth weight was not associated with poor health outcomes among young adults in Brazil. These results appear inconsistent with the original Barker hypothesis, but will need to be corroborated in larger samples with longer follow-ups to allow a more general evaluation of the validity of the hypothesis in low and middle income countries

Clinical Indicators of Child Development in the Capitals of Nine Brazilian States: The Influence of Regional Cultural Factors

OBJECTIVE: Evaluating the interaction between mother or caregiver and infant through the Clinical Indicators of Risks in Infant Development and investigating whether local and cultural influences during infant development affect these clinical indicators. INTRODUCTION: The Clinical Indicators of Risks in Infant Development was created in order to fully assess infants' development and the subjective relationship between the babies and their caregivers. The absence of two or more Clinical Indicators of Risks in Infant Developments suggests a possibly inadequate mental development. Given the continental size of Brazil and its accentuated cultural differences, one might question how trustworthy these indicators can be when applied to each of the geographical regions of the country. METHODS: This was a cross-sectional study with 737 infants from the capitals of 9 Brazilian states. The size of the initial sample population was based on a pilot study carried out in the cities of São Paulo and Brasília. The ages of children were grouped: 0-3 months, 4-7 months, 8-11 months and 12-18 months. The chi-square test was used together with analyses by the statistical software SPSS 13.0. RESULTS: Statistical analysis of results from the different municipalities against the total sample did not reveal any statistically significant differences. Municipalities represented were Belém (p=0.486), Brasília (p=0.371), Porto Alegre (p=0.987), Fortaleza (p=0.259), Recife (p=0.630), Salvador (0.370), São Paulo (p=0.238), Curitiba (p=0.870), and Rio de Janeiro (p= 0.06). DISCUSSION: Care for mental development should be considered a public health issue. Its evaluation and follow-up should be part of the already available mother-child assistance programs, which would then be considered to provide "full" care to children. CONCLUSIONS: Local habits and culture did not affect the results of the Clinical Indicators of Risks in Infant Development indicators. Clinical Indicators of Risks in Infant Development proved to be robust despite the specificities of each region

Early sexual development in girls

Se define como desarrollo sexual precoz en la niña a laaparición de caracteres sexuales secundarios antes delos 8 años. Existen distintos tipos de desarrollo sexualprecoz: Pubertad Precoz Central (PPC) producida porla reactivación prematura del eje hipotálamo-hipófisogonadal(HHG), Pubertad Precoz Periférica producidapor actividad ovárica autónoma independiente del ejeHHG y variantes del desarrollo sexual (pubarca y telarcaprecoz aisladas). Recientemente los avances en estudiosmoleculares y por imágenes han permitido precisarmejor su etiología.El diagnóstico se basa en el examen físico, análisis delaboratorio y estudios por imágenes que permiten diferenciarlas formas completas de sus variantes.La PPC produce alteraciones emocionales en las niñasy aceleran la maduración esquelética comprometiendola talla adulta por lo cual es necesario instituir el tratamientoadecuado.La terapéutica de elección son los análogos de GnRH quemostraron ser seguros y efectivos en las niñas con PPC.Se presenta una revisión del tema enfatizando en lasherramientas de utilidad para orientar al pediatra enel diagnóstico y realizar la pronta derivación al especialistaen endocrinología infantil para el tratamiento yseguimiento de niñas con distintos tipos de desarrollosexual precoz.The appearance of secondary sexual characteristics before the age of 8 in girls is defined as early sexual development. There are different types of early sexual development: Central Precocious Puberty (CPP) produced by the premature reactivation of the hypothalamic-pituitary-gonadal axis (HPG), Peripheral Precocious Puberty produced by autonomous ovarian activity independent of the HPG axis and variants of sexual development (premature pubarche and telarche). Recently advances in molecular studies and imaging have allowed to better define the etiology of early sexual development. The diagnosis is based on physical examination, laboratory analysis and imaging studies that allow differentiation of the complete form from their variants. CPP produces emotional alterations in girls and accelerates skeletal maturation, compromising adult height. After confirming diagnosis is necessary to institute the appropriate treatment. GnRH analogues have shown to be safe and effective in girls with CPP. A review of the topic is presented, emphasizing on the useful tools to guide the pediatrician in the diagnosis and prompt referral to pediatric endocrinologist for the treatment and monitoring of girls with different types of early sexual development.Fil: Arcari, Andrea Josefina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Gobierno de la Ciudad de Buenos Aires. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Fundación de Endocrinología Infantil. Centro de Investigaciones Endocrinológicas "Dr. César Bergada"; ArgentinaFil: Freire, Analia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Gobierno de la Ciudad de Buenos Aires. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Fundación de Endocrinología Infantil. Centro de Investigaciones Endocrinológicas "Dr. César Bergada"; ArgentinaFil: Ballerini, Maria Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Gobierno de la Ciudad de Buenos Aires. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Fundación de Endocrinología Infantil. Centro de Investigaciones Endocrinológicas "Dr. César Bergada"; ArgentinaFil: Ropelato, Maria Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Gobierno de la Ciudad de Buenos Aires. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Fundación de Endocrinología Infantil. Centro de Investigaciones Endocrinológicas "Dr. César Bergada"; ArgentinaFil: Escobar, Maria Eugenia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Gobierno de la Ciudad de Buenos Aires. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Fundación de Endocrinología Infantil. Centro de Investigaciones Endocrinológicas "Dr. César Bergada"; ArgentinaFil: Gryngarten, Mirta Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Gobierno de la Ciudad de Buenos Aires. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Fundación de Endocrinología Infantil. Centro de Investigaciones Endocrinológicas "Dr. César Bergada"; Argentin

Attachment Patterns Trigger Differential Neural Signature of Emotional Processing in Adolescents

Background: Research suggests that individuals with different attachment patterns process social information differently, especially in terms of facial emotion recognition. However, few studies have explored social information processes in adolescents. This study examined the behavioral and ERP correlates of emotional processing in adolescents with different attachment orientations (insecure attachment group and secure attachment group; IAG and SAG, respectively). This study also explored the association of these correlates to individual neuropsychological profiles. Methodology/Principal Findings We used a modified version of the dual valence task (DVT), in which participants classify stimuli (faces and words) according to emotional valence (positive or negative). Results showed that the IAG performed significantly worse than SAG on tests of executive function (EF attention, processing speed, visuospatial abilities and cognitive flexibility). In the behavioral DVT, the IAG presented lower performance and accuracy. The IAG also exhibited slower RTs for stimuli with negative valence. Compared to the SAG, the IAG showed a negative bias for faces; a larger P1 and attenuated N170 component over the right hemisphere was observed. A negative bias was also observed in the IAG for word stimuli, which was demonstrated by comparing the N170 amplitude of the IAG with the valence of the SAG. Finally, the amplitude of the N170 elicited by the facial stimuli correlated with EF in both groups (and negative valence with EF in the IAG). Conclusions/Significance: Our results suggest that individuals with different attachment patterns process key emotional information and corresponding EF differently. This is evidenced by an early modulation of ERP components’ amplitudes, which are correlated with behavioral and neuropsychological effects. In brief, attachments patterns appear to impact multiple domains, such as emotional processing and EFs

Brain signatures of moral sensitivity in adolescents with early social deprivation

The present study examined neural responses associated with moral sensitivity in adolescents with a background of early social deprivation. Using high-density electroencephalography (hdEEG), brain activity was measured during an intentional inference task, which assesses rapid moral decision-making regarding intentional or unintentional harm to people and objects.Wecompared the responses to this task in a socially deprived group (DG) with that of a control group (CG). The event-related potentials (ERPs) results showed atypical early and late frontal cortical markers associated with attribution of intentionality during moral decision-making in DG (especially regarding intentional harm to people). The source space of the hdEEG showed reduced activity for DG compared with CG in the right prefrontal cortex, bilaterally in the ventromedial prefrontal cortex (vmPFC), and right insula. Moreover, the reduced response in vmPFC for DG was predicted by higher rates of externalizing problems. These findings demonstrate the importance of the social environment in early moral development, supporting a prefrontal maturation model of social deprivation.Fil: Escobar, Maria Josefina. Universidad Católica de Chile; Chile. Universidad Diego Portales; ChileFil: Huepe, David. Universidad Diego Portales; ChileFil: Decety, Jean. University of Chicago; Estados UnidosFil: Sedeño, Lucas. Universidad Diego Portales; Chile. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; ArgentinaFil: Messow, Marie Kristin. Universidad Diego Portales; ChileFil: Báez Buitrago, Sandra Jimena. Universidad Diego Portales; Chile. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; ArgentinaFil: Rivera, Alvaro. Universidad Diego Portales; ChileFil: Canales, Andres. Universidad Diego Portales; ChileFil: Morales, Juan Pablo. Universidad Diego Portales; ChileFil: Gómez, David Maximiliano. Universidad de Chile; ChileFil: Schroeder, Johannes. Universitats Klinikum; AlemaniaFil: Manes, Facundo Francisco. Universidad Diego Portales; Chile. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; ArgentinaFil: Lopez, Vladimir. Universidad Católica de Chile; ChileFil: Ibanez Barassi, Agustin Mariano. Universidad Diego Portales; Chile. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; Argentina. Universidad Autonoma del Caribe; Colombi