Background. Emerging evidence suggests that youth with attention deficit/hyperactivity disorder (ADHD) may engage in sub-optimal health behaviors including high levels of screen time, low physical activity participation, and consumption of poor diets. These are independent risk factors for adverse health outcomes, and health-related behavior patterns established in childhood can track into adulthood. Thus, identifying and addressing dietary and physical activity habits in sub-populations of youth have important implications for health over the lifespan. The specific aims of this dissertation were to: (1) compare screen time between youth with and without ADHD and to assess its relationship to ADHD symptomatology; (2) compare participation in physical activity (PA) between adolescents with and without ADHD and to assess the relationship of PA participation to ADHD symptomatology; and (3) evaluate the association of diet quality and dietary patterns to ADHD symptomatology among youth ages 8-15 years. Methods. The aforementioned outcomes of interest were analyzed using data from the continuous National Health and Nutrition Examination Survey (NHANES) 2001-2004. These waves of NHANES included a structured DSM-IV-based interview administered to parents that identified youth with ADHD and also yielded symptom counts for hyperactivity/impulsivity and inattention. Screen time and physical activity data were obtained from questionnaires that queried the amount of time spent watching television, playing videos, or using the computer outside of school time, and also surveyed the types, frequency, and duration of PA in which youth participated. Diet quality and dietary patterns, which included consumption of sugar-sweetened beverages (SSBs), total calorie intake, and eating frequency, were obtained by a 24-hour dietary recall using the Automated Multiple Pass Method of interviewing. Linear and logistic regression models adjusted for sociodemographic factors and anxiety/depression were employed to address the specific aims. Results. The findings suggest that youth with ADHD are at the same, if not higher, risk for engaging in suboptimal health behaviors. Overall, youth participating in NHANES engaged in excessive amounts of screen time, failed to acquire sufficient physical activity, and consumed diets of poor quality. However, our findings suggest that ADHD symptomatology places youth at higher risk for sedentary behavior and poor diet quality. Relative to screen time, youth with ADHD showed a trend toward increased screen time, as did youth who took medication. ADHD symptoms were also associated with over two hours of daily TV viewing and overall increased screen time, and this was particularly true for children ages 8-11 years. Relative to physical activity, the outcomes did not differ between youth with and without ADHD, but the majority of youth did not meet the recommended guidelines of 60 minutes or more of moderate-to-vigorous PA each day. Diet quality was poor across the population of youth who participated in NHANES, and hyperactive/impulsive symptoms were associated with an even greater decrease in diet quality in both children and adolescents. In males, the presence of hyperactive/impulsive symptoms was associated with a decrease in diet quality, whereas in females, inattentive symptoms accounted for a decrease in diet quality. No differences in the other dietary patterns (i.e., SSB consumption, total energy intake, and eating frequency) were observed. Conclusions. The diagnosis of ADHD and/or its symptoms are associated with less-than-recommended levels of screen time and poor diet quality, though youth in general were found to be engaging in suboptimal sedentary, physical activity, and dietary behaviors. The mechanisms for why youth with ADHD may have increased vulnerability to poorer health behaviors are not yet well understood. The findings from this dissertation support the need for ongoing efforts to address lifestyle factors among the nation’s youth generally, but may also stimulate new hypotheses about the needs of youth with ADHD from both public health and clinical perspectives, and encourage research on the implications of ADHD symptomatology on health-related behaviors and lifestyle factors.

<p>УВОД: Нeпрaвилнa исхрaнa и нeдoвoљнa физичкa aктивнoст припaдajу групи нajзнaчajниjих здрaвствeнo-ризичних пoнaшaњa шкoлскe дeцe. Незадовољавајући трендови стања ухрањености и физичке активности деце школског узраста у Србији намећу потребу креирања и евалуације програма за унапређење исхране и физичке активности деце. Према искуствима других земаља, најефективнији програми унапређења исхране и физичке активности деце су програми који комбинују учење кроз наставни програм и утицај на родитеље или школску средину. Унапређење исхране и физичке активности у школама у Србиjи спрoвoди сe углaвнoм крoз краткотрајне кампање, промоције правилне исхране и физичке активности чији резултати нису евалуирани. У образовном систему Р. Србије не придаје се довољно значаја садржајима везаним за правилну исхрану и физичку активност у највећој мери због оптерећења наставника и ученика другим наставним предметима и садржајима. Интегрисана едукације деце и родитеља прeдстaвљa jeдaн нaчин нa кojи сe мoжe oргaнизoвaти едукација о исхрани и физичкој активности у нижим рaзрeдимa oснoвнe шкoлe, бeз дoдaтнoг oптeрeћeњa учeникa и aнгaжoвaњa нaстaвникa. ЦИЉЕВИ: Циљеви овог рада били су да се утврди да ли интегрисана едукација деце о исхрани и физичкој активности може значајно да унапреди знање и навике деце везане за исхрану и физичку активност, те стање ухрањености деце узраста 7 до 10 година. МАТЕРИЈАЛ И МЕТОДЕ: У истрaживaњу су употребљене мeтoде eкспeримeнтa сa пaрaлeлним групaмa, дескриптивна и аналитичка метода. У истраживање су укључена деца узраста 7 до 10 година из две основне школе у Сомбору. Формирање узорка вршено је по принципу једнофазног кластер узорковања. Нeзaвисне вaриjaбле истраживања биле су едукација деце о исхрани и физичкој активности и едукација родитеља о исхрани и физичкој активности. Зависне варијабле истраживања чинили су: ниво знања дeцe o прaвилнoj исхрaни и физичкoj aктивнoсти, навике у исхрани, одлике породичне исхране, физичка активност, седентарно понашање и стaњe ухрaњeнoсти дeцe. Утврђивање навика у исхрани, стања физичке активности, стања ухрањености деце и одлика породичне исхране у експерименталној групи спроведено је пре (термин Т1) и по завршетку примене едукације деце и родитеља (термин Т2). Утврђивање нивоа знања о правилној исхрани и физичкој активности спроведено је пре (термин Т1), по завршетку (термин Т2) и два месеца после примене интегрисане едукације деце и родитеља (термин Т3). Утврђивање значајних разлика између Е и К групе у терминима Т1, Т2 и Т3 вршено је применом &chi;2 теста за категоријске податке, Mann Whitney U теста за нумеричке непараметријске варијабле односно t-теста за параметријске варијабле. Утврђивање значајних разлика унутар Е и К групе у одпносу на термине Т1 и Т2 односно Т2 и Т3 вршено је применом hi2 теста за категоријске податке, Вилкоксоновог теста за упарене непараметарске податке односно t-теста упарених узорака за параметријске податке. Евалуација је извршена у односу на пол и узрасне групе деце. РЕЗУЛТАТИ: У термину Т1 узорак је чинило укупно 167 испитаника (94 испитаника у Е-експерименталној групи, а 73 испитаника у К-контролној групи), док је у термину Т2 узорак чинило 177 испитаника (92 испитаника у Е-експерименталној групи, а 85 испитаника у К-контролној групи). У термину Т2 постигнуто је значајно повећање знања деце првог разреда о улогама хране (T1=0,84; Т2=1,56; рТ1:Т2&lt;0,001), поступку прања руку (T1=0,28; Т2=1,85; рТ1:Т2&lt;0,001), пореклу производа (T2=2,12; Т3=3,10; рТ2:Т3=0,001), сезонској доступности воћа и поврћа (T1=1,58; Т2=2,66; рТ1:Т2&lt;0,001), пирамиди физичких активности (T1=0,88; Т2=3,21; рТ1:Т2&lt;0,001) и способности деце да примене стечено знање о исхрани на састављање јеловника (T1=1,14; Т2=1,98; рТ1:Т2=0,001). У Т2 постигнуто је значајно повећање знања деце другог разреда о улогама хране (T1=1,25; Т2=1,71; рТ1:Т2=0,001), прању руку (T1=0,32; Т2=1,48; рТ1:Т2&lt;0,001), пореклу производа (T1=1,89; Т2=2,92; рТ1:Т2=0,004), пирамиди исхране (T1=2,46; Т2=3,89; рТ1:Т2&lt;0,001), штетности седентарног понашања (T1=0,42; Т2=1,04; рТ1:Т2&lt;0,001) и хранљивим својствима намирница (T1=0,52; Т2=0,73; рТ1:Т2=0,002). Применa интегрисане едукације о исхрани и физичкој активности допринела је значајном унапређењу знања деце узраста 9 година о прању руку (T1=0,47;Т2=1,88;рТ1:Т2&lt;0,001), систему органа за варење (T1=0,86; Т2=1,38; рТ1:Т2=0,019), сировинама и производима (T1=1,48; Т2=2,45; рТ1:Т2=0,001)., пирамиди исхране (T1=1,89; Т2=3,18; рТ1:Т2=0,007), хранљивим својствима намирница (T1=0,57; Т2=0,78; рТ1:Т2=0,021) и штетности седентарног понашања (T1=0,06; Т2=2,03; рТ1:Т2&lt;0,001), као и унапређењу способности примене знања о исхрани на састављање једноставног оброка (T1=0,82; Т2=1,80; рТ1:Т2=0,026), јеловника (T1=1,23; Т2=2,22; рТ1:Т2&lt;0,009) и решавање проблема гојазности деце (T1=0,21; Т2=3,00; рТ1:Т2&lt;0,001). У Т2 дошло је до значајног унапређења знања деце четвртог разреда о улогама хране (T1=2,75; Т2=4,93; рТ1:Т2&lt;0,001), прању руку (T1=0,70; Т2=1,57; рТ1:Т2&lt;0,001), сезонској доступности воћа и поврћа (T1=1,04; Т2=2,57; рТ1:Т2&lt;0,001), пирамиди исхране (T1=3,08; Т2=3,69; рТ1:Т2&lt;0,001) и штетности седентарног понашања (T1=0,87; Т2=1,66; рТ1:Т2=0,023). У Т2 постигнуто је значајно унапређење знања деце узраста 7 до 10 година на нивоу памћења (р=0,040), разумевања (р&lt;0,001), примене (р&lt;0,001), анализе (р&lt;0,001), синтезе (р=0,026) и евалуације (р&lt;0,001). У Т3 значајно је опало знање на нивоу памћења (р=0,016) и разумевања (р=0,029). У обе групе испитаника дошло је до значајног повећања конзумирања поврћа (Е:р&lt; 0,001; К:р= 0,016) у термину Т2. Само у Е групи дошло је до значајног повећања конзумирања воћа (Е:р&lt; 0,001; К: р= 0,440) и млека и млечних производа (Е:р=0,005; К:р=0,916) у Т2. Значајно смањење времена проведеног у гледању телевизора (Е:р=0,005; К:р=0,782) и игрању на рачунару (Е:р=0,047; К:р=0,390) постигнуто је у експерименталној групи у Т2. Време проведено у умереним физичким активностима значајно се повећало у обе групе испитаника (Е:р&lt;0,001; К:р&lt;0,001), док је значајно повећање времена проведеног у интензивним физичким активностима утврђено само у експерименталној групи (Е:р=0,046; К:р=0,217) у Т2. после примене интегрисане едукације утврђени благи трендови промена стања ухрањености деце узраста 7 до 10 година и експерименталне и контролне групе. У Т1 утврђене су значајне разлике у слагању родитеља Е и К групе са ставом да правилна исхрана значи јести сву храну у одређеним количинама (р=0,014) и да деци треба забранити унос слаткиша и грицкалица (р=0,001), гледање телевизора и играње на рачунару (р=0,008). Значајне разлике у слагању родитеља обе групе са ставом да децу треба натерати да се баве спортом постојале су и у Т1(р=0,027) и у Т2 (р=0,016). Није утврђена статистички значајна разлика у дистрибуцији испитаника у односу на степен ухрањености у терминима Т1 и Т2 ни у Е групи (р=0.271) ни у К групи (р=0.534). ЗАКЉУЧЦИ: Применом интегрисане едукације о исхрани и физичкој активности постигнуто је значајно повећање знања деце узраста 7 година о улогама хране, поступку прања руку, пореклу производа, сезонској доступности воћа и поврћа, пирамиди физичких активности и способности деце да примене стечено знање о исхрани на састављање јеловника. Применом интегрисане едукације о исхрани и физичкој активности постигнуто је значајно повећање знања деце узраста 8 година о улогама хране, систему органа за варење, прању руку, пореклу производа, пирамиди исхране, штетности седентарног понашања и хранљивим својствима намирница, као и способности деце да примене стечено знање о исхрани на састављање јеловника. Применa интегрисане едукације о исхрани и физичкој активности допринела је значајном унапређењу знања деце узраста 9 година о прању руку, систему органа за варење, сировинама и производима, пирамиди исхране, хранљивим својствима намирница и штетности седентарног понашања. Применом интегрисане едукације постигнуто је значајно унапређење способности деце узраста 9 година да примене знање о исхрани на састављање једноставног оброка, јеловника и решавање проблема гојазности деце. Применa интегрисане едукације о исхрани и физичкој активности допринела је значајном унапређењу знања деце узраста 10 година о улогама хране, прању руку, сезонској доступности воћа и поврћа, хранљивим својствима намирница, пирамиди исхране и штетности седентарног понашања. Применом интегрисане едукације постигнуто је значајно унапређење знања деце узраста 7 до 10 година на нивоу памћења, разумевања, примене, анализе, синтезе и евалуације. Знање на нивоу памћења и разумевања нису били трајног карактера. После примене интегрисане едукације дошло је до значајног пораста уноса воћа, поврћа, млека и млечних производа у експерименталној групи деце узраста 7 до 10 година. Применом интегрисане едукације постигнуто је значајно смањење времена проведеног у гледању телевизора и игрању на рачунару код деце експерименталне групе узраста 7 до 10 година. После примене интегрисане едукације дошло је до значајног пораста времена проведеног у умереним физичким активностима у експерименталној групи деце узраста 7 до 10 година. Значајно повећање времена проведеног у интензивним физичким активностима утврђено је у експерименталној групи деце узраста 9 до 10 година. Реализација програма интегрисане едукације родитеља била је успешна у развијању свести родитеља експерименталне групе о принципима правилне исхране и штетности седентарног понашања. Примена интегрисане едукације није имала значајан ефекат на стање ухрањености деце.</p> / <p>UVOD: Nepravilna ishrana i nedovoljna fizička aktivnost pripadaju grupi najznačajnijih zdravstveno-rizičnih ponašanja školske dece. Nezadovoljavajući trendovi stanja uhranjenosti i fizičke aktivnosti dece školskog uzrasta u Srbiji nameću potrebu kreiranja i evaluacije programa za unapređenje ishrane i fizičke aktivnosti dece. Prema iskustvima drugih zemalja, najefektivniji programi unapređenja ishrane i fizičke aktivnosti dece su programi koji kombinuju učenje kroz nastavni program i uticaj na roditelje ili školsku sredinu. Unapređenje ishrane i fizičke aktivnosti u školama u Srbiji sprovodi se uglavnom kroz kratkotrajne kampanje, promocije pravilne ishrane i fizičke aktivnosti čiji rezultati nisu evaluirani. U obrazovnom sistemu R. Srbije ne pridaje se dovoljno značaja sadržajima vezanim za pravilnu ishranu i fizičku aktivnost u najvećoj meri zbog opterećenja nastavnika i učenika drugim nastavnim predmetima i sadržajima. Integrisana edukacije dece i roditelja predstavlja jedan način na koji se može organizovati edukacija o ishrani i fizičkoj aktivnosti u nižim razredima osnovne škole, bez dodatnog opterećenja učenika i angažovanja nastavnika. CILJEVI: Ciljevi ovog rada bili su da se utvrdi da li integrisana edukacija dece o ishrani i fizičkoj aktivnosti može značajno da unapredi znanje i navike dece vezane za ishranu i fizičku aktivnost, te stanje uhranjenosti dece uzrasta 7 do 10 godina. MATERIJAL I METODE: U istraživanju su upotrebljene metode eksperimenta sa paralelnim grupama, deskriptivna i analitička metoda. U istraživanje su uključena deca uzrasta 7 do 10 godina iz dve osnovne škole u Somboru. Formiranje uzorka vršeno je po principu jednofaznog klaster uzorkovanja. Nezavisne varijable istraživanja bile su edukacija dece o ishrani i fizičkoj aktivnosti i edukacija roditelja o ishrani i fizičkoj aktivnosti. Zavisne varijable istraživanja činili su: nivo znanja dece o pravilnoj ishrani i fizičkoj aktivnosti, navike u ishrani, odlike porodične ishrane, fizička aktivnost, sedentarno ponašanje i stanje uhranjenosti dece. Utvrđivanje navika u ishrani, stanja fizičke aktivnosti, stanja uhranjenosti dece i odlika porodične ishrane u eksperimentalnoj grupi sprovedeno je pre (termin T1) i po završetku primene edukacije dece i roditelja (termin T2). Utvrđivanje nivoa znanja o pravilnoj ishrani i fizičkoj aktivnosti sprovedeno je pre (termin T1), po završetku (termin T2) i dva meseca posle primene integrisane edukacije dece i roditelja (termin T3). Utvrđivanje značajnih razlika između E i K grupe u terminima T1, T2 i T3 vršeno je primenom &chi;2 testa za kategorijske podatke, Mann Whitney U testa za numeričke neparametrijske varijable odnosno t-testa za parametrijske varijable. Utvrđivanje značajnih razlika unutar E i K grupe u odpnosu na termine T1 i T2 odnosno T2 i T3 vršeno je primenom hi2 testa za kategorijske podatke, Vilkoksonovog testa za uparene neparametarske podatke odnosno t-testa uparenih uzoraka za parametrijske podatke. Evaluacija je izvršena u odnosu na pol i uzrasne grupe dece. REZULTATI: U terminu T1 uzorak je činilo ukupno 167 ispitanika (94 ispitanika u E-eksperimentalnoj grupi, a 73 ispitanika u K-kontrolnoj grupi), dok je u terminu T2 uzorak činilo 177 ispitanika (92 ispitanika u E-eksperimentalnoj grupi, a 85 ispitanika u K-kontrolnoj grupi). U terminu T2 postignuto je značajno povećanje znanja dece prvog razreda o ulogama hrane (T1=0,84; T2=1,56; rT1:T2&lt;0,001), postupku pranja ruku (T1=0,28; T2=1,85; rT1:T2&lt;0,001), poreklu proizvoda (T2=2,12; T3=3,10; rT2:T3=0,001), sezonskoj dostupnosti voća i povrća (T1=1,58; T2=2,66; rT1:T2&lt;0,001), piramidi fizičkih aktivnosti (T1=0,88; T2=3,21; rT1:T2&lt;0,001) i sposobnosti dece da primene stečeno znanje o ishrani na sastavljanje jelovnika (T1=1,14; T2=1,98; rT1:T2=0,001). U T2 postignuto je značajno povećanje znanja dece drugog razreda o ulogama hrane (T1=1,25; T2=1,71; rT1:T2=0,001), pranju ruku (T1=0,32; T2=1,48; rT1:T2&lt;0,001), poreklu proizvoda (T1=1,89; T2=2,92; rT1:T2=0,004), piramidi ishrane (T1=2,46; T2=3,89; rT1:T2&lt;0,001), štetnosti sedentarnog ponašanja (T1=0,42; T2=1,04; rT1:T2&lt;0,001) i hranljivim svojstvima namirnica (T1=0,52; T2=0,73; rT1:T2=0,002). Primena integrisane edukacije o ishrani i fizičkoj aktivnosti doprinela je značajnom unapređenju znanja dece uzrasta 9 godina o pranju ruku (T1=0,47;T2=1,88;rT1:T2&lt;0,001), sistemu organa za varenje (T1=0,86; T2=1,38; rT1:T2=0,019), sirovinama i proizvodima (T1=1,48; T2=2,45; rT1:T2=0,001)., piramidi ishrane (T1=1,89; T2=3,18; rT1:T2=0,007), hranljivim svojstvima namirnica (T1=0,57; T2=0,78; rT1:T2=0,021) i štetnosti sedentarnog ponašanja (T1=0,06; T2=2,03; rT1:T2&lt;0,001), kao i unapređenju sposobnosti primene znanja o ishrani na sastavljanje jednostavnog obroka (T1=0,82; T2=1,80; rT1:T2=0,026), jelovnika (T1=1,23; T2=2,22; rT1:T2&lt;0,009) i rešavanje problema gojaznosti dece (T1=0,21; T2=3,00; rT1:T2&lt;0,001). U T2 došlo je do značajnog unapređenja znanja dece četvrtog razreda o ulogama hrane (T1=2,75; T2=4,93; rT1:T2&lt;0,001), pranju ruku (T1=0,70; T2=1,57; rT1:T2&lt;0,001), sezonskoj dostupnosti voća i povrća (T1=1,04; T2=2,57; rT1:T2&lt;0,001), piramidi ishrane (T1=3,08; T2=3,69; rT1:T2&lt;0,001) i štetnosti sedentarnog ponašanja (T1=0,87; T2=1,66; rT1:T2=0,023). U T2 postignuto je značajno unapređenje znanja dece uzrasta 7 do 10 godina na nivou pamćenja (r=0,040), razumevanja (r&lt;0,001), primene (r&lt;0,001), analize (r&lt;0,001), sinteze (r=0,026) i evaluacije (r&lt;0,001). U T3 značajno je opalo znanje na nivou pamćenja (r=0,016) i razumevanja (r=0,029). U obe grupe ispitanika došlo je do značajnog povećanja konzumiranja povrća (E:r&lt; 0,001; K:r= 0,016) u terminu T2. Samo u E grupi došlo je do značajnog povećanja konzumiranja voća (E:r&lt; 0,001; K: r= 0,440) i mleka i mlečnih proizvoda (E:r=0,005; K:r=0,916) u T2. Značajno smanjenje vremena provedenog u gledanju televizora (E:r=0,005; K:r=0,782) i igranju na računaru (E:r=0,047; K:r=0,390) postignuto je u eksperimentalnoj grupi u T2. Vreme provedeno u umerenim fizičkim aktivnostima značajno se povećalo u obe grupe ispitanika (E:r&lt;0,001; K:r&lt;0,001), dok je značajno povećanje vremena provedenog u intenzivnim fizičkim aktivnostima utvrđeno samo u eksperimentalnoj grupi (E:r=0,046; K:r=0,217) u T2. posle primene integrisane edukacije utvrđeni blagi trendovi promena stanja uhranjenosti dece uzrasta 7 do 10 godina i eksperimentalne i kontrolne grupe. U T1 utvrđene su značajne razlike u slaganju roditelja E i K grupe sa stavom da pravilna ishrana znači jesti svu hranu u određenim količinama (r=0,014) i da deci treba zabraniti unos slatkiša i grickalica (r=0,001), gledanje televizora i igranje na računaru (r=0,008). Značajne razlike u slaganju roditelja obe grupe sa stavom da decu treba naterati da se bave sportom postojale su i u T1(r=0,027) i u T2 (r=0,016). Nije utvrđena statistički značajna razlika u distribuciji ispitanika u odnosu na stepen uhranjenosti u terminima T1 i T2 ni u E grupi (r=0.271) ni u K grupi (r=0.534). ZAKLJUČCI: Primenom integrisane edukacije o ishrani i fizičkoj aktivnosti postignuto je značajno povećanje znanja dece uzrasta 7 godina o ulogama hrane, postupku pranja ruku, poreklu proizvoda, sezonskoj dostupnosti voća i povrća, piramidi fizičkih aktivnosti i sposobnosti dece da primene stečeno znanje o ishrani na sastavljanje jelovnika. Primenom integrisane edukacije o ishrani i fizičkoj aktivnosti postignuto je značajno povećanje znanja dece uzrasta 8 godina o ulogama hrane, sistemu organa za varenje, pranju ruku, poreklu proizvoda, piramidi ishrane, štetnosti sedentarnog ponašanja i hranljivim svojstvima namirnica, kao i sposobnosti dece da primene stečeno znanje o ishrani na sastavljanje jelovnika. Primena integrisane edukacije o ishrani i fizičkoj aktivnosti doprinela je značajnom unapređenju znanja dece uzrasta 9 godina o pranju ruku, sistemu organa za varenje, sirovinama i proizvodima, piramidi ishrane, hranljivim svojstvima namirnica i štetnosti sedentarnog ponašanja. Primenom integrisane edukacije postignuto je značajno unapređenje sposobnosti dece uzrasta 9 godina da primene znanje o ishrani na sastavljanje jednostavnog obroka, jelovnika i rešavanje problema gojaznosti dece. Primena integrisane edukacije o ishrani i fizičkoj aktivnosti doprinela je značajnom unapređenju znanja dece uzrasta 10 godina o ulogama hrane, pranju ruku, sezonskoj dostupnosti voća i povrća, hranljivim svojstvima namirnica, piramidi ishrane i štetnosti sedentarnog ponašanja. Primenom integrisane edukacije postignuto je značajno unapređenje znanja dece uzrasta 7 do 10 godina na nivou pamćenja, razumevanja, primene, analize, sinteze i evaluacije. Znanje na nivou pamćenja i razumevanja nisu bili trajnog karaktera. Posle primene integrisane edukacije došlo je do značajnog porasta unosa voća, povrća, mleka i mlečnih proizvoda u eksperimentalnoj grupi dece uzrasta 7 do 10 godina. Primenom integrisane edukacije postignuto je značajno smanjenje vremena provedenog u gledanju televizora i igranju na računaru kod dece eksperimentalne grupe uzrasta 7 do 10 godina. Posle primene integrisane edukacije došlo je do značajnog porasta vremena provedenog u umerenim fizičkim aktivnostima u eksperimentalnoj grupi dece uzrasta 7 do 10 godina. Značajno povećanje vremena provedenog u intenzivnim fizičkim aktivnostima utvrđeno je u eksperimentalnoj grupi dece uzrasta 9 do 10 godina. Realizacija programa integrisane edukacije roditelja bila je uspešna u razvijanju svesti roditelja eksperimentalne grupe o principima pravilne ishrane i štetnosti sedentarnog ponašanja. Primena integrisane edukacije nije imala značajan efekat na stanje uhranjenosti dece.</p> / <p>INTRODUCTION: Improper diet and lack of physical activity belonging to the group the most significant health risks behavior of school children. Current trends in nutritional status and physical activity of schoolchildren in Serbia impose the need for creating and evaluating programs to improve nutrition and physical activity of children. According to the experience of other countries, the most effective programs for the improvement of nutrition and physical activity of children are programs that combine learning across the curriculum and the impact on parents or the school environment. Programs for improving nutrition and physical activity in schools in Serbia are usually carried out through short-term campaigns whose results are not evaluated. Contents about nutrition and physical activity are not properly represented in the curriculum for elementary schools in Serbia partly due to the workload of teachers and students in other school subjects and contents. Integrated education of children and parents may be a solution for conducting nutrition and physical activity education in primary schools without the additional burden of engaging students and teachers. AIMS: Aims of this study were to determine whether integrated education of 7 to 10 year/old children may have significant influence on children`s knowledge about nutrition and physical activity, dietary habits, physical activity, sedentary behavior, characteristics of family nutrition and children`s nutritional status. MATERIAL AND METHODS: The study used experimental methods with parallel groups, descriptive and analytical methods. The study included children aged 7 to 10 years from two primary schools in Sombor. Single-phase cluster sampling was used to form sample. Independent research variables were nutrition and physical activity program education for children and nutrition and physical activity education program for parents. Dependent research variables were the level of knowledge about proper nutrition and physical activity, dietary habits, physical activity, sedentary behavior, characteristics of family nutrition, and nutritional status of children. Determining sohrani habits, physical activity status, nutritional status of children and the quality of family nutrition in the experimental group was carried out before (the term T1) and after application of educating children and parents (a term T2). Determining the level of knowledge about proper nutrition and physical activity was carried out before (term T1) at the end (term T2) and two months after the application of the integrated education of children and parents ( term T3). Determination of significant differences between the groups E and K in terms of T1, T2 and T3 was conducted using hi2 test for categorical variables, the Mann-Whitney U test for numerical non-parametric variables and t-tests for continuous variables. Determining significant differences within the group E and K in relation to the time slots T1 and T2 or T2 and T3 was performed using hi2 test for categorical variables, the Wilcoxon test for paired data for the non-parametric variables and t-test for paired samples for parametric data. The evaluation was made in relation to gender and age groups of children. RESULTS: In the term T1 total sample included 167 subjects (94 subjects in the experimental group E, and 73 subjects in the K-control group), while in the term T2 sample consisted of 177 subjects (92 subjects in the experimental group E and 85 respondents in K-the control group). Significant increase in the knowledge of 7 year-old children in the term T2 was achieved on the roles of food (T1 = 0.84, T2 = 1.56; T1: T2 &lt;0.001), hand washing (T1 = 0.28; T2 = 1.85; T1: T2 &lt;0.001), the origin of foods (T2 = 2.12; T3 = 3.10; pT2: T3 = 0,001), the seasonal availability of fruits and vegetables (T1 = 1.58; T2 = 2.66; T1: T2 &lt;0.001), physical activity pyramid (T1 = 0.88; T2 = 3.21; T1: T2 &lt;0.001) and the ability to apply knowledge of nutrition to compose menus (T1 = 1.14; T2 = 1.98; T1: T2 = 0.001). Significant increase in knowledge of 8 year-old children was determined for the roles of the food (T1 = 1.25; T2 = 1.71; T1: T2 = 0.001), hand washing (T1 = 0.32; T2 = 1.48; T1: T2 &lt;0.001), the origin of food products (T1 = 1.89; T2 = 2.92; T1: T2 = 0.004), the food pyramid (T1 = 2.46, T2 = 3.89; T1: T2 &lt;0.001), harmfulness of sedentary behavior (T1 = 0.42, T2 = 1.04; T1: T2 &lt;0.001) and nutritional properties of foods (T1 = 0.52, T2 = 0.73; T1: T2 = 0.002). In the term T2 it was determined significant improvement of 9 year-old children`s knowledge of hand washing (T1 = 0.47, T2 = 1.88; T1: T2 &lt;0.001), digestive organ system (T1 = 0.86 ; T2 = 1.38; T1: T2 = 0.019), origins of food products (T1 =1.48; T2 = 2.45; T1: T2 = 0.001), the food pyramid (T1 = 1.89; T2 = 3 18; T1: T2 = 0.007), nutritional properties of foods (T1 = 0.57; T2 = 0.78; T1: T2 = 0.021) harmfulness of sedentary behavior (T1 = 0.06, T2 = 2.03; T1 T2 &lt;0.001), as well as improving the ability to apply knowledge of nutrition to assemble a simple meal (T1 = 0.82; T2 = 1.80; T1: T2 = 0.026), the menu for one day (T1 = 1.23; T2 = 2, 22; T1: T2 &lt;0.009) and to solve the problem of obesity in children (T1 = 0.21, T2 = 3.00; T1: T2 &lt;0.001). In the term T2 there was a significant improvement of the knowledge of 10 year-old children of the roles of food (T1=2.75; T2=4.93; T1:T2 &lt;0.001), hand washing (T1=0.70; T2=1.57; T1 T2&lt;0.001), the seasonal availability of fruits and vegetables (T1 = 1.04; T2 = 2.57; T1: T2 &lt;0.001), the food pyramid (T1 = 3.08; T2 = 3.69; T1:T2 &lt;0.001) and harmfulness of sedentary behavior (T1=0.87; T2=1.66; T1:T2 p=0.023). Significant improvement of knowledge of 7 to 10 year-old children in the term T2 was determined at the level of memory (p=0.040), understanding (p &lt;0.001), application (p&lt;0.001), analysis (p&lt;0.001), synthesis (p=.026) and evaluation (p &lt;0.001). In the term T3 there was a significant decrease of knowledge at the level of memory (p=0.016) and understanding (p= 0.029). In both groups there was a significant increase in the consumption of vegetables (E: p &lt;0.001; K: p = 0.016) in the term T2. A significant increase in the consumption of fruit (E: p &lt;0.001; K: p = 0.440) and milk and dairy products (E: p = 0.005; K: p= 0.916) at T2 was determined only in experimental group. A significant reduction in the time spent watching television (E: p = 0.005; K: p = 0.782) and playing on the computer (E p=0.047; K: p= 0.390) was achieved in the experimental group in the term T2. The time spent in moderate physical activities significantly increased in both groups (E: p &lt;0.001; P: p &lt;0.001), while the time spent in intense physical activities significantly increased only in experimental group (E: p = 0.046; K: p= 0.217) in the term T2. There were found significant differences in the agreement between parents from experimental and control group with the view that proper nutrition means eating all foods in proper quantities (p=0.014), and that children should be prohibited to consume sweets (p= 0.001), watch television and play on the computer (p = 0.008) in the term T2. Significant differences in the agreement between parents from experimental and control group with the view that children should be forced to engage in sports were found in terms T1 (p=0.027) and T2 (p=0.016). There were not found significant changes in the nutritional status of children in experimental (p=0.271) and control groups (p=0.534) in the term T2. CONCLUSIONS: Integrated nutrition and physical activity education contributed to significant increase in knowledge on health and safe food handling in 7 to 10 year-old children. Significant increase in knowledge on the roles of food was achieved in 7, 8 and 10 year-old children. Knowledge of the origin and types of food significantly increased in 7,8 and 9 year-old children. Knowledge of the seasonal availability of fruits and vegetables significantly improved in 7,9 and 10 year-old children. Significant improvement in knowledge on food pyramid, nutritional properties of foods and harmfulness of sedentary behavior was found in 8,9 and 10 year-old children. The ability to apply knowledge of nutrition to compose menus significantly improved in 7,8 and 9 year-old children. Integrated nutrition and physical activity education significantly improved 9 year-old children`s ability to apply knowledge of nutrition at solving the problem of obesity in children. Integrated nutrition and physical activity education significantly improved the knowledge of 7 to 10 year-old children at the level of memory, comprehension, application, analysis, synthesis and evaluation. Knowledge at the level of memory and understanding were not permanent. After the application of integrated nutrition and physical activity education, there was a significant increase in the intake of fruit, vegetables, milk and dairy products in the experimental group of 7 to 10 year-old children. Integrated nutrition and physical activity education contributed to significant reduction in the time spent watching television and playing on the computer in the experimental group of 7 to 10 year-old children. After the application of integrated education, there was a significant increase in the time spent in moderate to intense physical activity in the experimental group of 7 to 10 year-old children.</p>

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L'activité physique améliore la santé, mais seulement 4.8% des Canadiens atteignent le niveau recommandé. La position socio-économique est un des déterminants de l'activité physique les plus importants. Elle est associée à l’activité physique de manière transversale à l’adolescence et à l’âge adulte. Cette thèse a tenté de déterminer s'il y a une association à long terme entre la position socio-économique au début du parcours de vie et l’activité physique à l’âge adulte. S'il y en avait une, un deuxième objectif était de déterminer quel modèle théorique en épidémiologie des parcours de vie décrivait le mieux sa forme. Cette thèse comprend trois articles: une recension systématique et deux recherches originales. Dans la recension systématique, des recherches ont été faites dans Medline et EMBASE pour trouver les études ayant mesuré la position socio-économique avant l'âge de 18 ans et l'activité physique à ≥18 ans. Dans les deux recherches originales, la modélisation par équations structurelles a été utilisée pour comparer trois modèles alternatifs en épidémiologie des parcours de vie: le modèle d’accumulation de risque avec effets additifs, le modèle d’accumulation de risque avec effet déclenché et le modèle de période critique. Ces modèles ont été comparés dans deux cohortes prospectives représentatives à l'échelle nationale: la 1970 British birth cohort (n=16,571; première recherche) et l’Enquête longitudinale nationale sur les enfants et les jeunes (n=16,903; deuxième recherche). Dans la recension systématique, 10 619 articles ont été passés en revue par deux chercheurs indépendants et 42 ont été retenus. Pour le résultat «activité physique» (tous types et mesures confondus), une association significative avec la position socio-économique durant l’enfance fut trouvée dans 26/42 études (61,9%). Quand seulement l’activité physique durant les loisirs a été considérée, une association significative fut trouvée dans 21/31 études (67,7%). Dans un sous-échantillon de 21 études ayant une méthodologie plus forte, les proportions d’études ayant trouvé une association furent plus hautes : 15/21 (71,4%) pour tous les types et toutes les mesures d’activité physique et 12/15 (80%) pour l’activité physique de loisir seulement. Dans notre première recherche originale sur les données de la British birth cohort, pour la classe sociale, nous avons trouvé que le modèle d’accumulation de risque avec effets additifs s’est ajusté le mieux chez les hommes et les femmes pour l’activité physique de loisir, au travail et durant les transports. Dans notre deuxième recherche originale sur les données canadiennes sur l'activité physique de loisir, nous avons trouvé que chez les hommes, le modèle de période critique s’est ajusté le mieux aux données pour le niveau d’éducation et le revenu, alors que chez les femmes, le modèle d’accumulation de risque avec effets additifs s’est ajusté le mieux pour le revenu, tandis que le niveau d’éducation ne s’est ajusté à aucun des modèles testés. En conclusion, notre recension systématique indique que la position socio-économique au début du parcours de vie est associée à la pratique d'activité physique à l'âge adulte. Les résultats de nos deux recherches originales suggèrent un patron d’associations le mieux représenté par le modèle d’accumulation de risque avec effets additifs. / Physical activity enhances health, yet only 4.8% of adults in Canada meet the recommended level. Among the determinants of physical activity, socioeconomic position shows some of the strongest and most consistent associations. Its association is found cross-sectionally during adolescence and cross-sectionally during adulthood. This thesis aimed to determine if there is a long-lasting, life course association between socioeconomic position early in life and physical activity during adulthood. If there was one, a second goal was to determine which theoretical model in life course epidemiology best described its pattern. This thesis comprises three papers: a systematic review and two original contributions. In the systematic review, Medline and EMBASE were searched for studies that assessed socioeconomic position before age 18 years and physical activity at age ≥18 years. In the two original research papers, structural equation modeling was used to compare three competing models in life course epidemiology: the accumulation of risk model with additive effects, the accumulation of risk model with trigger effect, and the critical period model. Each of the original research paper used data from a large, nationally representative prospective cohort. In the first paper, models were compared in the 1970 British birth cohort (n=16,571). Social class was used as an indicator of socioeconomic position, and physical activity was assessed during leisure time, during transports, and at work. In the second paper, models were compared in the Canadian National Longitudinal Survey of Children and Youth (n=16,903). Education and income were used as indicators of socioeconomic position and physical activity was assessed during leisure-time only. In the systematic review, 10,619 publications were reviewed by two independent investigators and 42 were retained. For outcome "physical activity" (all types and measures), a significant association with socioeconomic position before age 18 years was found in 26/42 studies (61.9%). When the only outcome considered was leisure-time physical activity, a significant association was found in 21/31 studies (67.7%). In a subset of 21 studies with more rigorous methodology, proportions of studies finding an association were higher: 15/21 (71.4%) for all types and measures of physical activity and 12/15 (80%) for leisure-time physical activity only. In our first original research paper, using British data on social class, we found that the accumulation of risk model with additive effects fit the data best in both men and women for all three domains of physical activity studied (leisure time, transports, and work). In our second original research paper, using Canadian data on leisure-time physical activity, we found that in men, the critical period model fit the data best for education and income, while in women, the accumulation of risk model with additive effects fit the data best for income, whereas education did not fit any model. To conclude, our systematic review suggests that socioeconomic position early in life is associated with physical activity during adulthood. Results from our two original research papers indicate that the pattern of its association may be best represented by the accumulation of risk model with additive effects.

Estudos experimentais feitos em nosso laboratório comprovaram que a inalação de material particulado proveniente da queima de combustíveis fósseis utilizados em siderurgia pelos ratos adultos diminuiu a atividade motora dos animais no campo aberto. Além disso, provamos que os ratos habituaram ao ambiente desse teste, o que significa que a inalação desse tipo de material não provocou variação em termos de aprendizado simples. Uma das causas da alteração no comportamento em relação à motricidade seria o estresse oxidativo causado pelo material particulado no estriado e cerebelo desses animais. Entretanto, em nossa cidade não existem estudos que demonstrem a estreita associação entre inalação de poluentes, estresse oxidativo e alterações comportamentais. Baseados nos nossos trabalhos anteriores e na literatura, nosso objetivo foi investigar se a poluição atmosférica a nível ambiental durante as fases pré e pós-natal alteraria a memória discriminativa de curta-duração e a memória espacial. Além disso, avaliamos o papel do estresse oxidativo como o mecanismo propulsor dessas mudanças de comportamento. Para tal, ratas prenhas foram expostas ao ar filtrado e ao ar não filtrado durante os 21 dias de gestação. Ao final do período de amamentação, os machos foram separados e subdividos em 4 grupos experimentais (n=24): 1) Filtrado: nasceu e viveu em ambiente cujo ar era filtrado, 2) NFF: nasceu em ambiente cujo ar era não filtrado e viveu a partir do 21o dia do pós-natal no ambiente com ar filtrado, 3) FNF: nasceu sob ar filtrado e viveu a partir do 21o dia do pós-natal sob ar não filtrado, 4)NF: nasceu e viveu em ambiente cujo ar era não filtrado. Os animais ficaram expostos a poluição por 150 dias. Os animais foram divididos em 3 lotes: lote 1: n=6 animais por grupo; após anestesia profunda, os animais foram perfundidos com soro fisiológico seguido de paraformaldeído 4%, o encéfalo foi retirado e dissecado em córtex, hipocampo e estriado para análises histológicas por técnicas estereológicas; lote 2: n=12 ratos por grupo; aplicação dos testes comportamentais; um dia após os testes, esses animais foram eutanasiados por decapitação, o encéfalo retirado e dissecado da mesma forma citada anteriormente para análise de estresse oxidativo; lote 3: n=6 animais por grupo; os animais foram decapitados e o sangue troncular coletado para análises de elementos traço tóxicos e essenciais no sangue total. O córtex apresentou lipoperoxidação no grupo NF quando comparado aos outros grupos, assim como uma alta concentração de Cd no sangue. O grupo NFF apresentou uma maior concentração de Cu, Se e Zn no sangue em relação aos demais. Em relação à memória discriminativa de curta-duração, houve uma diminuição no grupo NF em relação aos demais grupos. No hipocampo e estriado, foi observado aumento da lipoperoxidação nos grupos FNF e NF, respectivamente, quando comparado aos outros grupos. Quanto à memória espacial, não houve diferença estatisticamente significativa entre os grupos. Primeiramente, como pudemos observar, o cada estrutura encefálica apresenta uma resposta ao estresse oxidativo. O córtex do grupo NF apresentou aumento de lipoperoxidação. Como se sabe, o Cd é feto tóxico e passa via transplacentária adsorvido ao material particulado inalado pela mãe. No caso do grupo NF, o Cd possivelmente deslocou o Zn do sítio ativo da enzima CuZn superóxido dismutase formando forma inativada da mesma. O Cd, também, forma conjugado com duas moléculas de glutationa reduzida a fim de ser excretado pela bile. Isso reduz a sua capacidade antioxidante. Esse elemento traço desloca o Fe e o Cu dos sítios ativos das suas proteínas de armazenamento, a ferritina e a ceruplasmina, respectivamente. Esses dois elementos ficam livres para catalisar a reação de Fenton cujo produto é o radical hidroxil, extremamente tóxico para o organismo. O grupo NF apresentou uma diminuição na capacidade de discriminar dois objetos diferentes. Provavelmente, o Cd agiu de forma indireta diminuindo a capacidade antioxidante da CuZn superóxido dismutase e da glutationa, além de liberar Fe e Cu e aumentar a produção de radical hidroxil. O aumento da lipoperoxidação causado pelo Cd pode ser o mecanismo responsável pela perda desse tipo de memória. Entretanto, o grupo NFF, cuja exposição à poluição foi na fase pré-natal, não apresentou aumento na lipoperoxidação. Possivelmente, a alta concentração dos elementos traço essenciais, Cu, Zn e Se aumentou a atividade das enzimas CuZn superóxidodismutase e glutationa peroxidase, respectivamente, o que evitou danos oxidativos durante o período intra-uterino. O grupo FNF apresentou aumento de lipoperoxidação no hipocampo, mas não houve diferença na memória espacial testada com o labirinto de Morris modificado. Portanto, considerando todos os achados, concluímos que, possivelmente, o aumento da lipoperoxidação causado indiretamente pelo Cd pode ser um dos mecanismos responsáveis pela perda da capacidade da memória discriminativa de curta-duração. Além disso, os elementos traço essenciais exercem uma proteção via aumento das defesas antioxidantes dos animais que nasceram em ambiente poluído e, após 21 dias de vida, foram transferidos para o ambiente com o ar filtrado, o que demonstra, provavelmente, a existência de mecanismos antioxidantes de adaptação em ambientes inóspitos como forma de proteção contra o agente agressor durante o desenvolvimento do embrião. / Experimental studies done at our laboratory demonstrated that the inhalation of residual oil fly ash by the adult rats decreased motor activity of the animals in the open-field test. Additionaly, we showed that rats which inhalated residual oil fly ash preserved its habituation capacity. In this study, oxidative stress in striatum and cerebellum might be the cause of motor activity alterations. However, there were any studies about air pollution and behavioral alterations in Porto Alegre. Based on our previous works and in the literature, our objective was to investigate if the exposure to air pollution during intrauterine and lactation periods would damage the short term discriminative and spatial memories and if the mechanisms would be dependent of oxidants. For such, female pregnant rats were exposed to the filtered air and to the non filtered air during the 21 days of gestation. At the end of the breast-feeding period, the males were separate and divided in 4 experimental groups (n =24): 1) Filtered (F): - pre and post-natal exposure until adulthood in filtered air; 2) non filtered/filtered air (NFF): pre-natal period in non-filtered air until PND21 and post-natal in filtered air until adulthood; 3) filtered air/non-filtered air (FNF): pre-natal period in filtered air until PND 21 and post-natal period in non-filtered air until adulthood; 4) non filtered air (NF): pre and post-natal periods in non-filtered air.The animals were exposed the pollution for 150 days. The animals were divided in 3 lots: lot 1: n=6 animals per group; after anesthesia, the animals were perfused with saline solution following by paraformaldehyde 4%, the brain was removed and dissected in cortex, hippocampus and striatum for histological analyses by stereological techniques; lot 2: n=12 rats per group; submitted to behavioral tests; one day after the tests, those animals were euthanized by decapitation, the brain was removed and dissected in the same way mentioned previously for oxidative stress analysis; lot 3: 6 animals per group; the animals were decapitated and the troncular blood was collected to analyze the toxic and the essential trace elements. The cortex presented lipoperoxidation in NF group when compared to other groups, as well as a high concentration of Cd in the blood. The group NFF presented higher blood concentration of Cu, Se and Zn when compared to other groups. There was a decrease in the discriminative capacity in the group NF when compared to other groups. In the hippocampus and striatum, increases of lipidperoxidation were observed in the groups FNF and NF, respectively, when compared to other groups. Spatial memory of all groups was preserved. We observed the each brain structure reacts in a different way to oxidative stress. The NF cortex group presented an increased of lipidperoxidation. In this group, there was higher Cd blood concentration, which passes through placenta and it is fetotoxic. It might be possible that Cd dislocated Zn of the active site of CuZn superóxido dismutase resulting in inactive forms of this enzyme. The Cd also depletes reduced glutathione. Moreover, Cd may dislocate the Fe and Cu from its storage proteins to react with oxygen peroxide increasing the hydroxyl radical production by Fenton reaction. The group NF presented a decrease in the capacity to discriminate two different objects. Cd may act in an indirect way reducing the antioxidant capacity of CuZn superxidodismutase and of the glutathione and increasing the hydroxyl radical production. Lipoperoxidation in NF cortex caused by the Cd may be one of the mechanisms which explain the loss of discriminative capacity. However, the group NFF, whose air pollution exposure was in the pre-natal period, did not present increase of lipidperoxidation. The higher concentrations of essential trace elements (Cu, Se and Zn) may protect this group against oxidative stress. These elements are cofactor of antioxidants enzymes, superoxidodismutase and glutathione peroxidase and increased its activities during the intra-uterine exposure to air pollution. The group FNF presented lipidperoxidation increase in the hippocampus, but there was no difference in the spatial memory tested with Morris\' maze. Therefore, considering our data, we suggested that the increase of lipidperoxidation caused indirectly by Cd, which was adsorbed in particulate matter surface, may be one of the mechanisms which explain the loss of short-term discriminative memory

Objetivo: Verificar a acurácia do Test of Infant Motor Performance (TIMP) e da ultrassonografia de crânio (USC) no diagnóstico neurológico precoce após os 10 meses de idade corrigida em recém-nascidos pré-termo (RNPT) Metodologia: Amostra não aleatória constituída por 59 RNPT (idade gestacional ao nascimento 32 semanas ou peso ao nascimento 1500 gramas) seguidos em média até os 12 meses de idade corrigida. Os resultados da USC foram agrupados em 3 intervalos: 1) de 0 a 15 dias, 2) de 16 a 30 dias e 3) de 31 a 45 dias. Os achados da USC foram classificados em normal e anormal (anormalidades moderada e grave). O TIMP foi aplicado mensalmente, do primeiro retorno após a alta hospitalar até o 4° mês de idade corrigida. As avaliações foram agrupadas em 5 intervalos, correspondentes às avaliações antes do termo, 1°, 2°, 3° e 4° meses de idade corrigida. Os resultados do TIMP foram classificados em normal (média e média baixa) ou anormal (abaixo da média e muito abaixo da média). A avaliação neurológica foi realizada em média aos 12 meses de idade corrigida, e usada como padrão-ouro. Foram calculados os valores de sensibilidade, especificidade e valores preditivos positivos (VPP) e negativos (VPN) para o TIMP e para a USC neonatal. Resultados: A paralisia cerebral foi diagnosticada em 6 crianças. Observamos que a USC apresentou alta sensibilidade (> 70%) assim como altos VPN (>88%) em todos os intervalos. Para a USC, especificidade e VPP foram baixos em todos os intervalos. A sensibilidade do TIMP foi baixa, exceto para o intervalo 0, e os VPP foram baixos em todas as idades. A escala TIMP apresentou alta especificidade (75%, 85%) no 3° e 4° meses e altos VPN (> 77%) em todos os intervalos. Conclusão: Concluímos que os RNPT com pontuação normal no 3° e 4° meses do TIMP tem grandes chances de não desenvolver PC enquanto que RNPT com anormalidades graves e persistentes à USC tem maiores chances de um prognóstico neurológico anormal / Objective: Calculate the accuracy of the Test of Infant Motor Performance (TIMP) and the cranial ultrasonography (CUS) in the neurological outcome after 10 months of corrected age of preterm infants. Methods: Non-random sample of 59 preterm newborn infants (gestational age 32weeks or birth weight1500g) were followed up to a mean of 12 months corrected age. CUS results were grouped into 3 periods: 1) from 0 to 15 days; 2) from 16 to 30 days, and 3) from 31 to 45 days of life. CUS findings were rated into two groups: normal and abnormal (moderate and severe abnormalities). TIMP was applied monthly, from the first outpatient visit after hospital discharge until four months corrected age. The evaluations were grouped into five intervals, corresponding to the assessments performed before term age, 1st, 2nd, 3rd and 4th month of corrected age. TIMP results were ranked as normal (average, low average) or abnormal (below average and far below average). A full neurological examination was performed at a mean of 12 months of corrected age, and used as gold standard. The sensitivity, specificity, positive predictive (PPV) and negative predictive (NPV) values for TIMP and CUS were calculated. Results: Cerebral palsy was diagnosed in six infants. We observed that CUS had a high sensitivity (> 70%) in all intervals as well as high NPV (>88%). For CUS, specificity and PPV were low in all intervals. TIMP sensitivity was low, except for interval 0, and PPV were low at all ages. TIMP scale showed high specificity in the 3rd and 4th month (75%, 85%) and high NPV (> 77%) at all ages. Conclusions: We conclude that preterm infants with normal score at the 3rd and 4th months of TIMP are likely to develop normally while infants with severe and persistent abnormalities in the CUS examinations are more likely to have an abnormal neurological outcome

INTRODUÇÃO: A alta prevalência da obesidade infantil em diferentes partes do planeta a posiciona como um dos principais focos de atenção da saúde pública, conhecida a associação dos seus agravos às doenças cardiovasculares e à morte prematura. O objetivo do presente trabalho foi avaliar as intervenções escolares que se utilizam das práticas em atividade física e educação nutricional na antropometria e na pressão arterial de crianças e adolescentes. MÉTODOS: Os artigos foram recuperados por buscas sistemáticas em quatorze bases de dados eletrônicas e por busca manual em listas de referências, com atualização até 30 de setembro de 2012. Dois revisores independentes avaliaram os trabalhos e extraíram os dados. Os trabalhos deveriam atender adequadamente aos seguintes critérios de elegibilidade: população dos 6 aos 18 anos de idade; intervenções comunitárias randomizadas no ambiente escolar, fundamentadas nas práticas em atividade física ou educação nutricional, ou nas duas formas combinadas; presença de grupo controle em paralelo, com seguimento concomitante; descrição de pelo menos um dos desfechos: índice de massa corporal, peso corporal e pressão arterial. A meta-análise foi desenvolvida pelo modelo de efeito randômico, com diferença padronizada entre médias pelo método de Hedges. Também foi realizada a meta-análise de regressão para identificação das fontes de heterogeneidade entre os ensaios, envolvendo as variáveis tempo e tipo de intervenção, faixa etária e qualidade. O grau de heterogeneidade entre os estudos foi verificado pelas estatísticas Q de Cochran e I2, e o viés de publicação foi avaliado subjetivamente por meio da distribuição no gráfico funnel plot. RESULTADOS: Dos 5.899 trabalhos inicialmente recuperados, 140 tiveram seus dados extraídos e 60 remanesceram para a composição das sínteses, assim subdivididas: 12 em atividade física, 8 em educação nutricional e 40 com intervenção combinada. A análise das intervenções combinadas apresentou significância estatística a favor do grupo de intervenção no índice de massa corporal, com a magnitude e variabilidade na medida do efeito em diferença padronizada de -0,14 (IC95%: -0,24 a -0,03; p=0,01; n=29471; I2= 94,4%), ao contrário dos resultados obtidos nas duas intervenções em separado, que não foram conclusivos. No desfecho peso corporal, os resultados foram significantes nas intervenções em atividade física (-0,14; IC95%: -0,27 a -0,02; I2= 7,84%) e nas combinadas (-0,65; IC95%: -1,17 a -0,13; I2= 99,3%). As análises da pressão arterial não obtiveram resultados com significância estatística. O conjunto de todas as intervenções com dados em índice de massa corporal, incluindo 55 estudos, mostrou o resultado de -0,02 (IC95%: -0,03 a 0,00; I2= 94,5%), e nenhuma das covariáveis incluídas na meta-regressão, tempo de intervenção, qualidade metodológica do estudo e faixa etária da população mostrou significância para explicar a heterogeneidade observada. A análise de subgrupos mostrou redução do efeito no estrato por tempo de intervenção curto, de até quatro meses, com estimativa de -0,04 (IC95%: -0,06 a -0,03; I2= 96,6%), e na faixa etária dos seis aos dez anos, com estimativa de -0,23 (IC95%: -0,27 a -0,19; I2= 97,9%). CONCLUSÕES: As intervenções escolares que combinaram atividade física e educação nutricional mostraram redução do índice de massa corporal, ao contrário das intervenções que se utilizaram destes elementos em separado. Os efeitos positivos estão associados aos estudos com menor tempo entre as avaliações iniciais e finais e com as faixas populacionais mais jovens. A alta heterogeneidade observada compromete a validade externa dos resultados e sugere cautela quanto à capacidade de generalização para outras populações. / INTRODUCTION: Because of its high prevalence of in different parts of the planet childhood obesity is one of the main public health issues, with obesity worsening known to be associated with cardiovascular diseases and premature death. The aim of this study was to evaluate school interventions that use physical activity and nutrition education practices in anthropometric measurements and blood pressure in children and teenagers. METHODS: The articles were retrieved via a systematic search of fourteen electronic databases and manual search through reference lists updated until September 30, 2012. Two independent reviewers assessed studies and extracted data. The papers should meet the following eligibility criteria: population aged 6 to 18 years old; randomized community interventions targeting the school environment based on physical activity or nutrition education practices, or a combination of the two approaches; placebo- controlled parallel group and concomitant monitoring; description of at least one of the outcomes: body mass index, body weight and blood pressure. Random-effects meta-analysis was used, with Hedges\'g standardized mean differences. Also, meta-analysis was performed to identify sources of heterogeneity between trials, involving the variables such as duration and type of intervention, age group and quality. The degree of heterogeneity between studies was assessed using Cochran\'s Q statistics and I2 tests, and publication bias was subjectively assessed by a funnel plot. RESULTS: Of the 5,899 papers initially retrieved, 140 were data-extracted and 60 were used in synthesis, as follows: 12 in physical activity, 8 in nutrition education and 40 in combined intervention. Analysis of the combined interventions showed that BMI was statistically more significant in the combined intervention group, with magnitude and variability in the measure of the effect size in standardized difference of (-0.14; CI95%: -0.24 to -0.03; p=0.01; n=29471; I2= 94.4%), unlike the results obtained in the two separate interventions, which were not conclusive. Regarding the body weight outcome, the results were significant for physical activity (-0.14; CI95%: -0.27 to -0.02; I2= 7.84%) and in the combined interventions (-0.65; CI95%: -1.17 to -0.13; I2= 99.3%). Blood pressure analyses did not obtain statistically significant results. The set of all interventions with BMI data (55 studies), showed the result of -0.02 (CI95%: -0.03 to 0.00; I2= 94.5%), and none of the covariates included in meta-analysis, intervention duration, methodological quality of the study and population age could explain the heterogeneity observed. Subgroup analysis showed a reduced effect in the short intervention duration stratum (up to four months), with an estimate of -0.04 (CI95%: -0.06 to -0.03; I2= 96.6%), and in the age group of 6-10 years old, with an estimate of -0.23 (CI95%: -0.27 to -0.19; I2= 97.9%). CONCLUSIONS: The school interventions that combined physical activity and nutrition education led to reduced body mass index, unlike the interventions that used these approaches separately. The positive effects are associated with studies with shorter periods of time between the initial and final evaluations and younger populations. The high heterogeneity observed jeopardizes the external validity of the results and suggests caution in generalizing these findings to other populations.

La 3,4-metilendioximetanfetamina (MDMA), una sustancia popularmente conocida como éxtasis, es una droga ilícita consumida habitualmente por adolescentes y adultos jóvenes. Además, el policonsumo es una práctica habitual entre los usuarios de la MDMA, siendo la cocaína una de las drogas más frecuentemente asociadas a esta sustancia. El objetivo del presente trabajo fue evaluar los efectos a corto y largo plazo que se producen tras la administración de la MDMA (5, 10, o 20 mg/kg) sola o en combinación con cocaína (25 mg/kg) en ratones adolescentes. En el estudio sobre el efecto agudo, observamos que ambas drogas administradas individual o simultáneamente incrementan la actividad motora. La dosis alta de MDMA disminuye de los contactos sociales en la prueba de la interacción social afectando igualmente el test de retención de la evitación pasiva. Sin embargo, sólo la co-administración de MDMA en combinación con cocaína produjo un efecto ansiolítico caracterizado por un aumento del tiempo de permanencia en los brazos abiertos del laberinto elevado en cruz. Igualmente, el análisis neuroquímico reveló que los ratones que recibieron MDMA en combinación con cocaína mostraron un incremento en el turnover de DA en el estriado, pero una disminución del de serotonina en la corteza. Los estudios de los efectos a largo plazo, realizados tres semanas después de haber finalizado un tratamiento con MDMA sola o en combinación con cocaína (2 administraciones por día durante 3 días consecutivos), mostraron que los ratones expuestos a la MDMA, sola o más cocaína, incrementaron el tiempo dedicado a las conductas sociales, aunque los que también habían recibido cocaína presentaban además conductas de amenaza. Observamos un efecto neurotóxico en los ratones tratados únicamente con 20 mg/kg de MDMA que mostraron un decremento de la concentración de DA en el estriado, no observándose este deterioro en los tratados además con cocaína. Por otra parte, mediante el condicionamiento de la preferencia de lugar (CPL) confirmamos que la MDMA posee efectos reforzantes y que esta sustancia es capaz de reinstaurar la preferencia de lugar una vez que esta se ha extinguido. La expresión y la reinstauración del CPL inducido por la MDMA dependen de la pauta de condicionamiento que condiciona los efectos neurotóxicos producidos por esta droga. Para finalizar, el tratamiento con MDMA sola o en combinación con cocaína durante la adolescencia favorece los efectos reforzantes de la MDMA durante el periodo adulto. Además, la exposición previa a la cocaína aumenta el tiempo necesario para extinguir la preferencia de lugar inducida por la MDMA. / 3,4-methylene-dioxy-methamphetamine (MDMA), commonly known as ecstasy, is an illicit recreational drug consumed by teenagers and young adults. The poly-drug pattern is the most common among those observed in MDMA users, with cocaine being a frequently associated drug. The aim of the present study was to evaluate the short- and long-term effects of exposure to MDMA (5, 10, or 20 mg/kg), alone or plus cocaine (25 mg/kg), on adolescent mice. In the acute phase, both drugs produced hyperactivity whether administered alone or concurrently. The highest MDMA dose decreased social contacts and affected the passive avoidance task. However, an anxiolytic effect, studied by means of the elevated plus maze and expressed as an increase in the time spent on the open arms, was observed only in animals treated with both cocaine and MDMA. Neurochemical analyses revealed an increase in striatal DA turnover and a decrease in serotonin cortical turnover in mice treated with MDMA plus cocaine. The studies conducted to establish long-term effects, which were performed 3 weeks after a 3-day treatment of two daily injections of MDMA alone or plus cocaine (6 administrations) during the adolescent period, showed that mice treated with MDMA alone and plus cocaine spent more time engaged in social contact, although those also treated with cocaine exhibited threat behaviors. Furthermore, we observed a neurotoxic effect in mice exposed to 20 mg/kg of MDMA, evident in a decrease in DA levels in the striatum, but this effect was not detected in mice additionally treated with cocaine. On the other hand, using the conditioned place preference (CPP), we have confirmed the rewarding effects of MDMA. In addition, we also show that MDMA can produce reinstatement of place preference after the extinction of this response. The expression and reinstatement of MDMA-induced CPP depend on the conditioning protocol, which conditions the neurotoxic effects produced by this drug. Finally, exposure during adolescence to MDMA alone or plus cocaine facilitates the rewarding effects of MDMA in adulthood. Moreover, previous experience of cocaine increases the time required to extinguish the MDMA-induced CPP.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010. / Härtill 4 uppsatser. Även tryckt utgåva.

Diese Dissertation untersucht motorische und kognitive Leistungen in der Kindheit am Beispiel des Erlernens einer sportlichen Fertigkeit. Dafür wurde eine Methode zur Messung mentaler Vorstellungen von Bewegungen bei Vorschulkindern entwickelt. Diese basiert auf dem Prinzip räumlicher Verdeckung. Es wurden damit sowohl verschiedene kognitive Leistungen wie die Wahrnehmung und Vorstellung von Bewegungen miteinander verglichen als auch in Beziehung zum Bewegungslernen gesetzt. Außerdem wurde in einer quasi-experimentellen Studie u.a. der Einfluss von Erfahrung, Geschlecht und Versuchsbedingung auf Wahrnehmungs- und Vorstellungsleistungen per Experten-Novizen-Paradigma untersucht. Es wurde geschlussfolgert, dass die Methode hinsichtlich des Geschlechts auch in jungen Jahren differenziert. Das bedeutet, dass Mädchen und Jungen im Vorschulalter möglicherweise unterschiedlich bei der Lösung der Aufgaben vorgehen. Damit kann die Methode - im Gegensatz zur Methode der Mentalen Rotation - auch für die Diagnostik von Vorstellungen von Bewegungen ab einem Alter von 4 Jahren eingesetzt werden.