Self-regulation in pediatric bipolar disorder: relationships between executive functions, emotion processing and environmental factors

Objetivos: Este estudo transversal examinou a relação entre funções executivas, processamento emocional e fatores ambientais, como componentes da autorregulação, em adolescentes com transtorno bipolar na infância e adolescência (THBIA). Métodos: 58 participantes (36 pacientes com THBIA e 22 controles), com idades entre 12-17, foram recrutados no ambulatório de transtorno de humor bipolar (PROMAN). Os participantes foram avaliados por meio da Escala de Impulsividade de Barret (BIS), Conners Continuous Performance Test (CPT-II), Wisconsin Sorting Cards Test (WCST) e questionário Adjective Checklist (ACL). As variáveis clínicas foram obtidas por meio das escalas K-SADS-PL, C-GAS, CDRS-R, YMRS e SNAP, e uma entrevista estruturada para avaliação demográfica e clínica. Resultados: Adolescentes com PBD apresentaram déficits significativos em todas as três esferas, quando comparados ao grupo controle. Além disso, o processamento emocional foi negativamente correlacionado com a inibição de respostas, atenção / memória operacional e positivamente correlacionado com a flexibilidade mental. Fatores ambientais foram negativamente correlacionados com flexibilidade mental e processamento emocional, e positivamente correlacionados com atenção / memória operacional e inibição de respostas. Conclusão: Assim, os resultados sugerem que a autorregulação seja composta por uma relação interligada entre funções executivas (inibição de respostas, memória operacional e flexibilidade mental), processamento emocional e fatores ambientais, tornando importante que planos de tratamento e intervenção incluam abordagens integradas e multifatoriaisINTRODUCTION: Gestational weight gain is an important index of the health and quality of life of women and their fetuses, especially of pregnant women with gestational diabetes mellitus (GDM). However, doubts still persist as to the influence of diet quality, physical activity (PA), and the pregestational nutritional state on total gestational weight gain in pregnant women with GDM. OBJECTIVE: To evaluate diet quality indices (DQIs) and PA levels in association with adequacy of weight gain during the pregnancy of women with GDM. METHODS: This descriptive prospective cohort study was conducted with 226 pregnant women diagnosed with GDM and under treatment at the Clínica Obstétrica do Hospital das Clínicas da Universidade de São Paulo between May 2017 and October 2018. The women included in the study were aged 18 years or older, had a single fetus, an absence of glucose intolerance prior to the pregnancy, a GDM diagnosis according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG), did not make chronic use of glucocorticoids or antiretroviral drugs for HIV viruses, and signed a free and informed consent statement. The women excluded from this study were those unable to understand and/or answer the research questionnaire items, those who missed prenatal care visits, and those with incomplete medical records. Socioeconomic, obstetric, clinical, and anthropometric data, as well as data on food consumption, PA, and lifestyle, and data on the delivery and the newborn were collected. Food consumption was assessed with the food frequency questionnaire (FFQ), diet quality was evaluated using the DQI revised and validated for Brazil (DQI-R), and PA was assessed by means of the Pregnancy Physical Activity Questionnaire (PPAQ). Weight gain was calculated by subtracting pregestational weight from the weight at the end of pregnancy and then classified as adequate weight gain (AWG), insufficient weight gain (IWG), or excessive weight gain (EWG) according to the criteria of the Institute of Medicine (IOM). A multiple multinomial regression analysis was performed for the weight gain outcome using the following data: final DQI-R score, DQI-R moderation group, total PA score, and pregestational BMI. The software used for analysis was the SPSS, version 23.0, and the significance level was set at 0.05 (p 84-135.50 METs/week; OR: 3.99; CI 95%:1.34-11.90) had a greater chance of IWG. The patients with a low final DQI-R score (27.6-50), which translates into an inadequate diet, had a greater chance of EWG (OR: 2.33; CI 95%: 1.02-5.36). Those whose PA fell in the 2nd tertile ( > 84-135.50 METs/week; OR: 3.47; CI 95%: 1.36-8.89) had the chance of EWG. The pregnant women with GDM who were obese when they got pregnant (OR: 3.20; CI 95%: 1.14-8.99; p= 0.027) had a chance of EWG. CONCLUSION: This study has shown that low PA levels may contribute towards IWG. On the other hand, a low final DQI-R score, representing inadequate food habits, low PA levels, and pregestational obesity may increase the chance of EWG in patients with GM

Review of strategies to investigate low sample return rates in remote tobacco trials: A call to action for more user-centered design research

Remote collection of biomarkers of tobacco use in clinical trials poses significant challenges. A recent meta-analysis and scoping review of the smoking cessation literature indicated that sample return rates are low and that new methods are needed to investigate the underlying causes of these low rates. In this paper we conducted a narrative review and heuristic analysis of the different human factors approaches reported to evaluate and/or improve sample return rates among 31 smoking cessation studies recently identified in the literature. We created a heuristic metric (with scores from 0 to 4) to evaluate the level of elaboration or complexity of the user-centered design strategy reported by researchers. Our review of the literature identified five types of challenges typically encountered by researchers (in that order): usability and procedural, technical (device related), sample contamination (e.g., polytobacco), psychosocial factors (e.g., digital divide), and motivational factors. Our review of strategies indicated that 35% of the studies employed user-centered design methods with the remaining studies relying on informal methods. Among the studies that employed user-centered design methods, only 6% reached a level of 3 in our user-centered design heuristic metric. None of the studies reached the highest level of complexity (i.e., 4). This review examined these findings in the context of the larger literature, discussed the need to address the role of health equity factors more directly, and concluded with a call to action to increase the application and reporting of user-centered design strategies in biomarkers research