Métodos diagnósticos para detecção do TDAH em crianças: uma mini revisão integrativa

O transtorno do Déficit de atenção e Hiperatividade (TDAH) é um distúrbio neurológico com alterações comportamentais que apresentam repercussões em diversos sistemas. O TDAH tem maior prevalência na infância sendo desafiador a percepção e o diagnóstico correto dessa alteração neurobiológica. O objetivo do trabalho é identificar os diferentes diagnósticos de TDAH em crianças e pré-adolescentes, evidenciando os seus desafios. Essa mini revisão foi de caráter descritivo, utilizou-se como método a identificação do tema, seleção da questão de pesquisa, busca na literatura através de dados eletrônicos mediante critérios de inclusão e exclusão, avaliação dos estudos, interpretação e apresentação dos resultados. O instrumento de pesquisa foi a busca de artigos nas bases de dados: PubMed (national library of Medicine and national institutes of health), BVS (Biblioteca virtual em saúde) e SciELO (Scientific Eletronic Library Online. Como resultado foi possível observar os tipos de diagnósticos de TDAH em crianças e pré-adolescentes além de comprovar os desafios de uma padronização de formas diagnósticas. Ademais, a avaliação com testes clínicos propostos pelos autores demonstrou-se bastante eficaz para o tratamento correto de crianças com TDAH, porém, o não seguimento da diretriz e a falta de metodologia dificulta o tratamento dessa alteração neurobiológica. A partir da apresentação para a comunidade científica de testes clínicos propostos pelos autores dessa mini revisão, obteve-se como conclusão suprir as carências no processo de identificação do transtorno mental, com o seguimento das diretrizes e uma necessidade de padronização pelos profissionais da saúde

O PAPEL DOS SERVIÇOS EM SAÚDE NO COMBATE À VIOLÊNCIA CONTRA AS MULHERES: UMA ANÁLISE DA ATUAÇÃO DA ATENÇÃO PRIMÁRIA À SAÚDE

The present article analyzes the possibilities of action of primary health care in its approach in cases of violence against women, aiming at an understanding of care practices at health and reception services based on the gender perspective. The statistics of violence against women increase day after day, with no expectation of a decrease, causing several damages to women victims of aggression, in the physical, psychological, social and moral spheres. Faced with the frightening numbers and the secular history of aggressions, the Maria da Penha Law was created, with the objective of protecting women against any type of violence, in view of the legal protection created, as well as the SUS Law and the policies of health have a fundamental role in this embracement. Therefore, this article aims to analyze the importance of health services in combating violence against women, analyzing the differential of the multidisciplinary approach in monitoring women victims of violence. This article used original articles found on digital data platforms, such as Google Scholar and Scielo, as a source of research, establishing the bibliographic and documentary research method. In concluding notes, the need for training health professionals was exposed for the correct approach to women victims of violence, aiming at improving, detecting and correspondingly reducing cowardly acts of violence.El presente artículo analiza las posibilidades de acción de la atención primaria de salud en su abordaje en casos de violencia contra la mujer, con el objetivo de comprender las prácticas de atención en los servicios de salud y de acogida con perspectiva de género. Las estadísticas de violencia contra la mujer aumentan día tras día, sin expectativa de disminución, provocando diversos perjuicios a las mujeres víctimas de agresiones, en el ámbito físico, psicológico, social y moral. Ante las cifras aterradoras y la historia secular de agresiones, fue creada la Ley Maria da Penha, con el objetivo de proteger a las mujeres contra cualquier tipo de violencia, teniendo en cuenta la protección legal creada, así como la Ley SUS y las políticas de la salud tienen un papel fundamental en esta adopción. Por lo tanto, este artículo tiene como objetivo analizar la importancia de los servicios de salud en el combate a la violencia contra la mujer, analizando el diferencial del abordaje multidisciplinario en el seguimiento de las mujeres víctimas de violencia. Este artículo utilizó artículos originales encontrados en plataformas de datos digitales, como Google Scholar y Scielo, como fuente de investigación, estableciendo el método de investigación bibliográfico y documental. En las notas finales, se expuso la necesidad de capacitar a los profesionales de la salud para el correcto abordaje de las mujeres víctimas de violencia, con el objetivo de mejorar, detectar y, en consecuencia, reducir los cobardes actos de violencia.O presente artigo analisa as possibilidades de atuação da atenção primária à saúde em sua abordagem nos casos de violência contra as mulheres, visando uma compreensão das práticas assistenciais aos serviços de saúde e acolhimento com base na perspectiva de gênero. As estatísticas de violência contra a mulher aumentam a dia após dia, sem expectativa de diminuição, acarretando diversos danos às mulheres vítimas de agressões, na esfera física, psicológica, social e moral. nte os números assustadores e o histórico secular de agressões, é que foi criada a Lei Maria da Penha, com o objetivo de proteger a mulher contra qualquer tipo de violência, à vista do amparo legal criado, bem como a Lei do SUS e as políticas de saúde possuem papel fundamental neste acolhimento. Logo, o presente artigo tem o intuito de analisar a importância dos serviços de saúde no combate à violência contra as mulheres, analisando o diferencial da abordagem multiprofissional no acompanhamento das mulheres vítimas de violência. O presente artigo utilizou como fonte de pesquisas artigos originais encontrados em plataformas digitais de dados, como Google Acadêmico e Scielo, estabelecendo o método de pesquisa bibliográfica e documental. Em notas conclusivas, foi exposto a necessidade de capacitação dos profissionais de saúde para a correta abordagem junto às mulheres vítimas de violência, visando o aprimoramento, a detecção e correspondente diminuição de atos covardes de violência.   O presente artigo analisa as possibilidades de atuação da atenção primária à saúde em sua abordagem nos casos de violência contra as mulheres, visando uma compreensão das práticas assistenciais aos serviços de saúde e acolhimento com base na perspectiva de gênero. As estatísticas de violência contra a mulher aumentam a dia após dia, sem expectativa de diminuição, acarretando diversos danos às mulheres vítimas de agressões, na esfera física, psicológica, social e moral. nte os números assustadores e o histórico secular de agressões, é que foi criada a Lei Maria da Penha, com o objetivo de proteger a mulher contra qualquer tipo de violência, à vista do amparo legal criado, bem como a Lei do SUS e as políticas de saúde possuem papel fundamental neste acolhimento. Logo, o presente artigo tem o intuito de analisar a importância dos serviços de saúde no combate à violência contra as mulheres, analisando o diferencial da abordagem multiprofissional no acompanhamento das mulheres vítimas de violência. O presente artigo utilizou como fonte de pesquisas artigos originais encontrados em plataformas digitais de dados, como Google Acadêmico e Scielo, estabelecendo o método de pesquisa bibliográfica e documental. Em notas conclusivas, foi exposto a necessidade de capacitação dos profissionais de saúde para a correta abordagem junto às mulheres vítimas de violência, visando o aprimoramento, a detecção e correspondente diminuição de atos covardes de violência. 

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The PLATO Mission

International audiencePLATO (PLAnetary Transits and Oscillations of stars) is ESA's M3 mission designed to detect and characterise extrasolar planets and perform asteroseismic monitoring of a large number of stars. PLATO will detect small planets (down to &lt;2 R_(Earth)) around bright stars (&lt;11 mag), including terrestrial planets in the habitable zone of solar-like stars. With the complement of radial velocity observations from the ground, planets will be characterised for their radius, mass, and age with high accuracy (5 %, 10 %, 10 % for an Earth-Sun combination respectively). PLATO will provide us with a large-scale catalogue of well-characterised small planets up to intermediate orbital periods, relevant for a meaningful comparison to planet formation theories and to better understand planet evolution. It will make possible comparative exoplanetology to place our Solar System planets in a broader context. In parallel, PLATO will study (host) stars using asteroseismology, allowing us to determine the stellar properties with high accuracy, substantially enhancing our knowledge of stellar structure and evolution. The payload instrument consists of 26 cameras with 12cm aperture each. For at least four years, the mission will perform high-precision photometric measurements. Here we review the science objectives, present PLATO's target samples and fields, provide an overview of expected core science performance as well as a description of the instrument and the mission profile at the beginning of the serial production of the flight cameras. PLATO is scheduled for a launch date end 2026. This overview therefore provides a summary of the mission to the community in preparation of the upcoming operational phases

The PLATO Mission

International audiencePLATO (PLAnetary Transits and Oscillations of stars) is ESA's M3 mission designed to detect and characterise extrasolar planets and perform asteroseismic monitoring of a large number of stars. PLATO will detect small planets (down to &lt;2 R_(Earth)) around bright stars (&lt;11 mag), including terrestrial planets in the habitable zone of solar-like stars. With the complement of radial velocity observations from the ground, planets will be characterised for their radius, mass, and age with high accuracy (5 %, 10 %, 10 % for an Earth-Sun combination respectively). PLATO will provide us with a large-scale catalogue of well-characterised small planets up to intermediate orbital periods, relevant for a meaningful comparison to planet formation theories and to better understand planet evolution. It will make possible comparative exoplanetology to place our Solar System planets in a broader context. In parallel, PLATO will study (host) stars using asteroseismology, allowing us to determine the stellar properties with high accuracy, substantially enhancing our knowledge of stellar structure and evolution. The payload instrument consists of 26 cameras with 12cm aperture each. For at least four years, the mission will perform high-precision photometric measurements. Here we review the science objectives, present PLATO's target samples and fields, provide an overview of expected core science performance as well as a description of the instrument and the mission profile at the beginning of the serial production of the flight cameras. PLATO is scheduled for a launch date end 2026. This overview therefore provides a summary of the mission to the community in preparation of the upcoming operational phases

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

International audienceAbstract Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance