A exposição da gestante a drogas de abuso tem sido motivo de preocupação mundial com relação à saúde do binômio mãe-filho. A exposição fetal ao álcool constitui-se em um dos principais fatores de risco para retardo mental, defeitos congênitos e desordens do desenvolvimento neuropsicomotor, sendo a Síndrome Fetal do Álcool e os Efeitos Fetais do Álcool um conjunto de complicações clínicas resultantes desta exposição. Vários autores encontraram associação entre exposição fetal ao álcool e sintomas psiquiátricos na infância. Este é um estudo transversal tendo como objetivo principal investigar as relações entre consumo de álcool na gestação e sintomas psiquiátricos em escolares. A amostra foi constituída de 59 pares mãe-filho. As mães responderam a um instrumento de avaliação psicopatológica na infância (CBCL), uma entrevista diagnóstica semi-estruturada (KSADS- PL) e um questionário de dados sociodemográficos e dados sobre a saúde atual e pregressa da criança. Dados referentes ao consumo de álcool na gestação foram obtidos de um estudo pregresso com os mesmos indivíduos. Foram encontradas maiores prevalências de sintomas isolados do CBCL em filhos de mães com padrão de consumo semanal de álcool na gestação, mas não maior pontuação total ou de sintomas internalizáveis ou externalizáveis. Foi encontrada maior prevalência de diagnóstico psiquiátrico atual (K-SADS-PL) nos filhos de mães com padrão de consumo semanal de álcool na gestação. Ressalta-se que novos estudos são necessários para esclarecer como outros fatores - ambientais, genéticos e psicológicos - contribuem para a gênese da psicopatologia infantil. Além disso, este estudo reforça a importância da implementação de programas nacionais de prevenção de consumo de álcool por mulheres gestantes. / Prenatal exposure to drugs of abuse has been a concern worldwide regarding mother and child health. Prenatal alcohol exposure is one of the main risk factors for mental retardation, congenital defects and neurodevelopmental disorders, namely Fetal Alcohol Syndrome and Fetal Alcohol Effects. Many authors found associations between prenatal exposure to alcohol and psychiatric symptoms in childhood. This study has a cross-sectional design and is aimed to investigate the relationships between prenatal alcohol exposure and psychiatric symptoms in school-age children Fifty-nine mothers and their children were enrolled. The mothers answered to the Child Behaviour Checklist (CBCL), a semi-structured interview (K-SADS-PL) and a general social, demographic and health questionnaire. Prenatal alcohol consumption information was obtained from a previous study on the same individuals. We found a higher prevalence of isolated CBCL symptoms among children born from mothers with prenatal weekly alcohol consumption pattern. Additionally, we found a higher prevalence of psychiatric diagnoses (K-SADS-PL) among children born from mothers with prenatal weekly alcohol consumption pattern. Those results emphasize the need for new studies to clarify how environmental, genetical and psychological factos may contribute to the genesis of childhood psychopathology. Besides, this study reinforces the importance of developing a national alcohol prevention program for pregnant women.

Introdução: Interações sociais podem afetar diretamente ritmos biológicos, independente de seu papel na organização do zeitgeber fótico. A força do zeitgeber social refere-se ao padrão rítmico das interações sociais e pode ser quantificada através da escala de ritmo social. Objetivos: Principais: 1. Adequar o instrumento de avaliação do ritmo social ao contexto de pesquisa. 2. Estudar o ritmo social em humanos. Secundários: 1. Estabecer uma versão abreviada da Escala de Ritmo Social com vistas à aplicação em pesquisa. 2. Estabelecer uma versão da Escala de Ritmo Social de 17 itens para o português angolano, para estudos transculturais. 3. Investigar a correlação entre ritmo social, fase do sono e sintomas psiquiátricos menores em trabalhadores saudáveis. Métodos: Na primeira parte do trabalho a Escala de Ritmo Social (ERS-17) foi submetida a um processo de adequação a dois contextos de pesquisa diferentes. Na segunda parte, a escala foi utilizada em um estudo clínico para avaliar a correlação entre sintomatologia psiquiátrica menor e a variável ritmo social em uma amostra saudável. Tomando como padrão-ouro a ERS-17, foram comparados escores de regularidade e quantidade de atividades de 167 sujeitos saudáveis, 25 portadores de epilepsia mioclônica juvenil e 16 portadores de transtorno depressivo, para o estabelecimento da Versão Breve. No estudo transcultural, a versão brasileira da Escala de Ritmo Social foi submetida à avaliação de 10 estudantes universitários angolanos, que analisaram o grau de clareza de cada uma das 15 sentenças do instrumento por meio da Escala Analógico-Visual de 10 cm e propuseram modificações na escala. Foi realizada revisão dos resultados para a elaboração da versão final, bem como prova de leitura e relatório final. No estudo clínico, transversal, foram avaliados 143 trabalhadores saudáveis do HCPA. Sintomas psiquiátricos menores foram avaliados pelo Self-Repport Questionnaire (SRQ-20), e ritmo social foi avaliado pela ERS-17. Exposição à luz e variáveis do sono foram avaliadas pelo Munich Choronotype Questionnaire (MCTQ). Resultados: Foi estabelecida uma versão breve de 6 itens com boa concordância com relação ao padrão-ouro k=0,51; p<0,001 e significativa correlação entre ambas: (r=0,87; p<0,001). No estudo transcultural foi estabelecida uma versão angolana que manteve uma equivalência de itens com relação à versão em português brasileiro e grau satisfatório de clareza e equivalência semântica. No estudo clínico, Quantidade de atividades correlacionou com escolaridade e tempo médio do sono e, inversamente, com (Ponto Médio do Sono) MSF e SRQ-20. Regularidade correlacionou com idade, SRQ-20 e número de dias trabalhados. SRQ-20 correlacionou inversamente com regularidade e quantidade de atividades. Conclusões: No estabelecimento da versão breve, concluiu-se que a simplificação da escala diminui a porcentagem de itens não preenchidos, o custo em material impresso e facilita a padronização. O estudo transcultural demonstrou que apesar de ser o Português o idioma oficial nos dois países, há diferenças culturais significativas que podem influenciar os resultados caso sejam ignoradas. O estudo clínico demonstrou que variáveis de ritmo social tiveram correlação inversa com sintomas psiquiátricos menores, que foram mais explicados por baixos níveis de atividade do que por baixos níveis de regularidade. / Background: Social rhythms can directly affect biological rhythms, independent of its role in organizing the photic zeitgeber. The strength of the social zeitgeber refers to the rhythmic pattern of social interactions and can be measured by Social Rhythm Metric. Objectives: Main Objectives: 1. To match the assessment tool of social rhythm to the research context. 2. To Study the social rhythm in humans. Secondary Objectives: 1. Establish an abbreviated version of the Social Rhythm Metric-17 for use in research. 2. Establish a version of the SRM-17 for the Angolan Portuguese, for cross-cultural studies. 3. To investigate the correlation between social rhythm, sleep phase and minor psychiatric symptoms in healthy workers. Methods: In the first part of this work, the Social Rhythm Metric (SRM-17) was submitted to a process of adaptation to two different research contexts. In the second part, the scale was used in a clinical study to evaluate the correlation between minor psychiatric symptomatology and the variable social rhythm in a healthy sample. Taking as gold standard SRM-17, were compared scores of regularity and amount of activities of 167 healthy subjects, 25 patients with juvenile myoclonic epilepsy and 16 patients with major depressive disorder, for establishing the Brief Version. In the cross-cultural study, the Brazilian version of the of SRM-17 was submitted to evaluation of 10 college students Angolans, who analyzed the clarity of each of the 15 sentences of the instrument through the Visual Analog Scale-10 cm and proposed modifications. Review of the results was performed for the final version, as well as proof reading and final report. In the clinical study, cross-sectional, were evaluated 143 healthy workers from HCPA. Minor psychiatric symptoms were assessed by the Self-Repport Questionnaire (SRQ-20) and social rhythm was assessed by SRM-17. Light exposure and Sleep variables wereassessed by MCTQ. Results: Was established brief version of 6 items with good agreement with respect to the gold standard (k = 0.51, p <0.001) and significant correlation between the two: (r = 0.87, p <0.001). In the transcultural study was established an angolan version that kept an equivalence of items with respect to Brazilian Portuguese version of SRM-17 and satisfactory degree of clarity and semantic equivalence. In the clinical study, number of activities correlated with schooling and average sleep time and inversely, with Midpoint of sleep (MSF) and SRQ score. Regularity correlated with age, SRQ score and number of days worked. SRQ score correlated inversely with regularity and amount of activities. Conclusions: When establishing of the short version, it was concluded that the simplification of the scale decreases the percentage of unanswered questions, the print cost, and facilitates the standardization. The transcultural study showed that, in spite of the common language in both countries, there are significant cultural differences which can inffluence the results when ignored. The clinical study showed that social rhythm variables were inversely correlated with minor psychiatric symptoms, which were explained more by lower activity levels than low levels of regularity.

Introdução: Interações sociais podem afetar diretamente ritmos biológicos, independente de seu papel na organização do zeitgeber fótico. A força do zeitgeber social refere-se ao padrão rítmico das interações sociais e pode ser quantificada através da escala de ritmo social. Objetivos: Principais: 1. Adequar o instrumento de avaliação do ritmo social ao contexto de pesquisa. 2. Estudar o ritmo social em humanos. Secundários: 1. Estabecer uma versão abreviada da Escala de Ritmo Social com vistas à aplicação em pesquisa. 2. Estabelecer uma versão da Escala de Ritmo Social de 17 itens para o português angolano, para estudos transculturais. 3. Investigar a correlação entre ritmo social, fase do sono e sintomas psiquiátricos menores em trabalhadores saudáveis. Métodos: Na primeira parte do trabalho a Escala de Ritmo Social (ERS-17) foi submetida a um processo de adequação a dois contextos de pesquisa diferentes. Na segunda parte, a escala foi utilizada em um estudo clínico para avaliar a correlação entre sintomatologia psiquiátrica menor e a variável ritmo social em uma amostra saudável. Tomando como padrão-ouro a ERS-17, foram comparados escores de regularidade e quantidade de atividades de 167 sujeitos saudáveis, 25 portadores de epilepsia mioclônica juvenil e 16 portadores de transtorno depressivo, para o estabelecimento da Versão Breve. No estudo transcultural, a versão brasileira da Escala de Ritmo Social foi submetida à avaliação de 10 estudantes universitários angolanos, que analisaram o grau de clareza de cada uma das 15 sentenças do instrumento por meio da Escala Analógico-Visual de 10 cm e propuseram modificações na escala. Foi realizada revisão dos resultados para a elaboração da versão final, bem como prova de leitura e relatório final. No estudo clínico, transversal, foram avaliados 143 trabalhadores saudáveis do HCPA. Sintomas psiquiátricos menores foram avaliados pelo Self-Repport Questionnaire (SRQ-20), e ritmo social foi avaliado pela ERS-17. Exposição à luz e variáveis do sono foram avaliadas pelo Munich Choronotype Questionnaire (MCTQ). Resultados: Foi estabelecida uma versão breve de 6 itens com boa concordância com relação ao padrão-ouro k=0,51; p<0,001 e significativa correlação entre ambas: (r=0,87; p<0,001). No estudo transcultural foi estabelecida uma versão angolana que manteve uma equivalência de itens com relação à versão em português brasileiro e grau satisfatório de clareza e equivalência semântica. No estudo clínico, Quantidade de atividades correlacionou com escolaridade e tempo médio do sono e, inversamente, com (Ponto Médio do Sono) MSF e SRQ-20. Regularidade correlacionou com idade, SRQ-20 e número de dias trabalhados. SRQ-20 correlacionou inversamente com regularidade e quantidade de atividades. Conclusões: No estabelecimento da versão breve, concluiu-se que a simplificação da escala diminui a porcentagem de itens não preenchidos, o custo em material impresso e facilita a padronização. O estudo transcultural demonstrou que apesar de ser o Português o idioma oficial nos dois países, há diferenças culturais significativas que podem influenciar os resultados caso sejam ignoradas. O estudo clínico demonstrou que variáveis de ritmo social tiveram correlação inversa com sintomas psiquiátricos menores, que foram mais explicados por baixos níveis de atividade do que por baixos níveis de regularidade. / Background: Social rhythms can directly affect biological rhythms, independent of its role in organizing the photic zeitgeber. The strength of the social zeitgeber refers to the rhythmic pattern of social interactions and can be measured by Social Rhythm Metric. Objectives: Main Objectives: 1. To match the assessment tool of social rhythm to the research context. 2. To Study the social rhythm in humans. Secondary Objectives: 1. Establish an abbreviated version of the Social Rhythm Metric-17 for use in research. 2. Establish a version of the SRM-17 for the Angolan Portuguese, for cross-cultural studies. 3. To investigate the correlation between social rhythm, sleep phase and minor psychiatric symptoms in healthy workers. Methods: In the first part of this work, the Social Rhythm Metric (SRM-17) was submitted to a process of adaptation to two different research contexts. In the second part, the scale was used in a clinical study to evaluate the correlation between minor psychiatric symptomatology and the variable social rhythm in a healthy sample. Taking as gold standard SRM-17, were compared scores of regularity and amount of activities of 167 healthy subjects, 25 patients with juvenile myoclonic epilepsy and 16 patients with major depressive disorder, for establishing the Brief Version. In the cross-cultural study, the Brazilian version of the of SRM-17 was submitted to evaluation of 10 college students Angolans, who analyzed the clarity of each of the 15 sentences of the instrument through the Visual Analog Scale-10 cm and proposed modifications. Review of the results was performed for the final version, as well as proof reading and final report. In the clinical study, cross-sectional, were evaluated 143 healthy workers from HCPA. Minor psychiatric symptoms were assessed by the Self-Repport Questionnaire (SRQ-20) and social rhythm was assessed by SRM-17. Light exposure and Sleep variables wereassessed by MCTQ. Results: Was established brief version of 6 items with good agreement with respect to the gold standard (k = 0.51, p <0.001) and significant correlation between the two: (r = 0.87, p <0.001). In the transcultural study was established an angolan version that kept an equivalence of items with respect to Brazilian Portuguese version of SRM-17 and satisfactory degree of clarity and semantic equivalence. In the clinical study, number of activities correlated with schooling and average sleep time and inversely, with Midpoint of sleep (MSF) and SRQ score. Regularity correlated with age, SRQ score and number of days worked. SRQ score correlated inversely with regularity and amount of activities. Conclusions: When establishing of the short version, it was concluded that the simplification of the scale decreases the percentage of unanswered questions, the print cost, and facilitates the standardization. The transcultural study showed that, in spite of the common language in both countries, there are significant cultural differences which can inffluence the results when ignored. The clinical study showed that social rhythm variables were inversely correlated with minor psychiatric symptoms, which were explained more by lower activity levels than low levels of regularity.

Introdução: Interações sociais podem afetar diretamente ritmos biológicos, independente de seu papel na organização do zeitgeber fótico. A força do zeitgeber social refere-se ao padrão rítmico das interações sociais e pode ser quantificada através da escala de ritmo social. Objetivos: Principais: 1. Adequar o instrumento de avaliação do ritmo social ao contexto de pesquisa. 2. Estudar o ritmo social em humanos. Secundários: 1. Estabecer uma versão abreviada da Escala de Ritmo Social com vistas à aplicação em pesquisa. 2. Estabelecer uma versão da Escala de Ritmo Social de 17 itens para o português angolano, para estudos transculturais. 3. Investigar a correlação entre ritmo social, fase do sono e sintomas psiquiátricos menores em trabalhadores saudáveis. Métodos: Na primeira parte do trabalho a Escala de Ritmo Social (ERS-17) foi submetida a um processo de adequação a dois contextos de pesquisa diferentes. Na segunda parte, a escala foi utilizada em um estudo clínico para avaliar a correlação entre sintomatologia psiquiátrica menor e a variável ritmo social em uma amostra saudável. Tomando como padrão-ouro a ERS-17, foram comparados escores de regularidade e quantidade de atividades de 167 sujeitos saudáveis, 25 portadores de epilepsia mioclônica juvenil e 16 portadores de transtorno depressivo, para o estabelecimento da Versão Breve. No estudo transcultural, a versão brasileira da Escala de Ritmo Social foi submetida à avaliação de 10 estudantes universitários angolanos, que analisaram o grau de clareza de cada uma das 15 sentenças do instrumento por meio da Escala Analógico-Visual de 10 cm e propuseram modificações na escala. Foi realizada revisão dos resultados para a elaboração da versão final, bem como prova de leitura e relatório final. No estudo clínico, transversal, foram avaliados 143 trabalhadores saudáveis do HCPA. Sintomas psiquiátricos menores foram avaliados pelo Self-Repport Questionnaire (SRQ-20), e ritmo social foi avaliado pela ERS-17. Exposição à luz e variáveis do sono foram avaliadas pelo Munich Choronotype Questionnaire (MCTQ). Resultados: Foi estabelecida uma versão breve de 6 itens com boa concordância com relação ao padrão-ouro k=0,51; p<0,001 e significativa correlação entre ambas: (r=0,87; p<0,001). No estudo transcultural foi estabelecida uma versão angolana que manteve uma equivalência de itens com relação à versão em português brasileiro e grau satisfatório de clareza e equivalência semântica. No estudo clínico, Quantidade de atividades correlacionou com escolaridade e tempo médio do sono e, inversamente, com (Ponto Médio do Sono) MSF e SRQ-20. Regularidade correlacionou com idade, SRQ-20 e número de dias trabalhados. SRQ-20 correlacionou inversamente com regularidade e quantidade de atividades. Conclusões: No estabelecimento da versão breve, concluiu-se que a simplificação da escala diminui a porcentagem de itens não preenchidos, o custo em material impresso e facilita a padronização. O estudo transcultural demonstrou que apesar de ser o Português o idioma oficial nos dois países, há diferenças culturais significativas que podem influenciar os resultados caso sejam ignoradas. O estudo clínico demonstrou que variáveis de ritmo social tiveram correlação inversa com sintomas psiquiátricos menores, que foram mais explicados por baixos níveis de atividade do que por baixos níveis de regularidade. / Background: Social rhythms can directly affect biological rhythms, independent of its role in organizing the photic zeitgeber. The strength of the social zeitgeber refers to the rhythmic pattern of social interactions and can be measured by Social Rhythm Metric. Objectives: Main Objectives: 1. To match the assessment tool of social rhythm to the research context. 2. To Study the social rhythm in humans. Secondary Objectives: 1. Establish an abbreviated version of the Social Rhythm Metric-17 for use in research. 2. Establish a version of the SRM-17 for the Angolan Portuguese, for cross-cultural studies. 3. To investigate the correlation between social rhythm, sleep phase and minor psychiatric symptoms in healthy workers. Methods: In the first part of this work, the Social Rhythm Metric (SRM-17) was submitted to a process of adaptation to two different research contexts. In the second part, the scale was used in a clinical study to evaluate the correlation between minor psychiatric symptomatology and the variable social rhythm in a healthy sample. Taking as gold standard SRM-17, were compared scores of regularity and amount of activities of 167 healthy subjects, 25 patients with juvenile myoclonic epilepsy and 16 patients with major depressive disorder, for establishing the Brief Version. In the cross-cultural study, the Brazilian version of the of SRM-17 was submitted to evaluation of 10 college students Angolans, who analyzed the clarity of each of the 15 sentences of the instrument through the Visual Analog Scale-10 cm and proposed modifications. Review of the results was performed for the final version, as well as proof reading and final report. In the clinical study, cross-sectional, were evaluated 143 healthy workers from HCPA. Minor psychiatric symptoms were assessed by the Self-Repport Questionnaire (SRQ-20) and social rhythm was assessed by SRM-17. Light exposure and Sleep variables wereassessed by MCTQ. Results: Was established brief version of 6 items with good agreement with respect to the gold standard (k = 0.51, p <0.001) and significant correlation between the two: (r = 0.87, p <0.001). In the transcultural study was established an angolan version that kept an equivalence of items with respect to Brazilian Portuguese version of SRM-17 and satisfactory degree of clarity and semantic equivalence. In the clinical study, number of activities correlated with schooling and average sleep time and inversely, with Midpoint of sleep (MSF) and SRQ score. Regularity correlated with age, SRQ score and number of days worked. SRQ score correlated inversely with regularity and amount of activities. Conclusions: When establishing of the short version, it was concluded that the simplification of the scale decreases the percentage of unanswered questions, the print cost, and facilitates the standardization. The transcultural study showed that, in spite of the common language in both countries, there are significant cultural differences which can inffluence the results when ignored. The clinical study showed that social rhythm variables were inversely correlated with minor psychiatric symptoms, which were explained more by lower activity levels than low levels of regularity.

A exposição da gestante a drogas de abuso tem sido motivo de preocupação mundial com relação à saúde do binômio mãe-filho. A exposição fetal ao álcool constitui-se em um dos principais fatores de risco para retardo mental, defeitos congênitos e desordens do desenvolvimento neuropsicomotor, sendo a Síndrome Fetal do Álcool e os Efeitos Fetais do Álcool um conjunto de complicações clínicas resultantes desta exposição. Vários autores encontraram associação entre exposição fetal ao álcool e sintomas psiquiátricos na infância. Este é um estudo transversal tendo como objetivo principal investigar as relações entre consumo de álcool na gestação e sintomas psiquiátricos em escolares. A amostra foi constituída de 59 pares mãe-filho. As mães responderam a um instrumento de avaliação psicopatológica na infância (CBCL), uma entrevista diagnóstica semi-estruturada (KSADS- PL) e um questionário de dados sociodemográficos e dados sobre a saúde atual e pregressa da criança. Dados referentes ao consumo de álcool na gestação foram obtidos de um estudo pregresso com os mesmos indivíduos. Foram encontradas maiores prevalências de sintomas isolados do CBCL em filhos de mães com padrão de consumo semanal de álcool na gestação, mas não maior pontuação total ou de sintomas internalizáveis ou externalizáveis. Foi encontrada maior prevalência de diagnóstico psiquiátrico atual (K-SADS-PL) nos filhos de mães com padrão de consumo semanal de álcool na gestação. Ressalta-se que novos estudos são necessários para esclarecer como outros fatores - ambientais, genéticos e psicológicos - contribuem para a gênese da psicopatologia infantil. Além disso, este estudo reforça a importância da implementação de programas nacionais de prevenção de consumo de álcool por mulheres gestantes. / Prenatal exposure to drugs of abuse has been a concern worldwide regarding mother and child health. Prenatal alcohol exposure is one of the main risk factors for mental retardation, congenital defects and neurodevelopmental disorders, namely Fetal Alcohol Syndrome and Fetal Alcohol Effects. Many authors found associations between prenatal exposure to alcohol and psychiatric symptoms in childhood. This study has a cross-sectional design and is aimed to investigate the relationships between prenatal alcohol exposure and psychiatric symptoms in school-age children Fifty-nine mothers and their children were enrolled. The mothers answered to the Child Behaviour Checklist (CBCL), a semi-structured interview (K-SADS-PL) and a general social, demographic and health questionnaire. Prenatal alcohol consumption information was obtained from a previous study on the same individuals. We found a higher prevalence of isolated CBCL symptoms among children born from mothers with prenatal weekly alcohol consumption pattern. Additionally, we found a higher prevalence of psychiatric diagnoses (K-SADS-PL) among children born from mothers with prenatal weekly alcohol consumption pattern. Those results emphasize the need for new studies to clarify how environmental, genetical and psychological factos may contribute to the genesis of childhood psychopathology. Besides, this study reinforces the importance of developing a national alcohol prevention program for pregnant women.

No description available.

Objectives: A meta-analysis was conducted to determine the average effect size of internalizing and externalizing symptoms after pediatric traumatic brain injury across a range of severity (mild, moderate, and severe). Two-meta-regressions were also conducted to determine the role of age at injury at time since injury on these effect sizes.Participants and Methods: 9725 titles and abstracts were collected from PubMed, PsycInfo, and Web of Science. Of these, 63 full-text articles were examined for inclusion criteria to determine eligibility for the study. To be included, the studies needed to be published prior to March 2017 in English, needed to have a control group of either orthopedically injured or typically developing peers, and required a reliable and valuable measure of internalizing and externalizing symptoms in children. Studies were excluded for non-accidental head injuries or if the sample recruited was outside the range of 2-17 years old at the time of injury. The analysis was based on 16 studies including 1083 cases of mild TBI, 184 cases of moderate TBI, 214 cases of severe TBI, and 1605 control cases.Results: Analyses revealed a large effect size for internalizing symptoms of children with mild TBI (Hedges g = -0.624, p = 0.009), a small effect size for moderate TBI (Hedges g = -0.238, p = 0.029), and a large effect size for severe TBI (Hedges g = -0.923, p < .001). These findings indicate that parents rate childrens internalizing symptoms more severely for brain injured children than for typically developing or non-brain injured peers. These children may be experiencing more severe symptoms such as anxiety and depression regardless of injury severity. For externalizing symptoms, analyses demonstrated a moderate effect size for mild TBI (Hedges g = -0.531, p = 0.003), a small effect size for moderate TBI (Hedges g = -0.257, p = 0.007), and a large effect size for severe TBI (Hedges g = -0.909, p < .001). Thus, children who experienced a TBI demonstrated externalizing symptoms including hyperactivity and impulsivity with the largest effect size associated with severe TBI. The results of the meta-regressions indicated that only injury severity was a significant predictor of symptom severity.Conclusions: Using meta-analytic methods, we found that children who experience traumatic brain injury are rated as exhibiting more severe internalizing and externalizing symptoms across levels of severity. This effect was largest for severe injury and smallest for moderate injury. Caregivers and healthcare practitioners can use this information to better screen for and treat internalizing and externalizing symptoms in children after a traumatic brain injury.

Objectives: A meta-analysis was conducted to determine the average effect size of internalizing and externalizing symptoms after pediatric traumatic brain injury across a range of severity (mild, moderate, and severe). Two-meta-regressions were also conducted to determine the role of age at injury at time since injury on these effect sizes.Participants and Methods: 9725 titles and abstracts were collected from PubMed, PsycInfo, and Web of Science. Of these, 63 full-text articles were examined for inclusion criteria to determine eligibility for the study. To be included, the studies needed to be published prior to March 2017 in English, needed to have a control group of either orthopedically injured or typically developing peers, and required a reliable and valuable measure of internalizing and externalizing symptoms in children. Studies were excluded for non-accidental head injuries or if the sample recruited was outside the range of 2-17 years old at the time of injury. The analysis was based on 16 studies including 1083 cases of mild TBI, 184 cases of moderate TBI, 214 cases of severe TBI, and 1605 control cases.Results: Analyses revealed a large effect size for internalizing symptoms of children with mild TBI (Hedges g = -0.624, p = 0.009), a small effect size for moderate TBI (Hedges g = -0.238, p = 0.029), and a large effect size for severe TBI (Hedges g = -0.923, p <<> .001). These findings indicate that parents rate childrens internalizing symptoms more severely for brain injured children than for typically developing or non-brain injured peers. These children may be experiencing more severe symptoms such as anxiety and depression regardless of injury severity. For externalizing symptoms, analyses demonstrated a moderate effect size for mild TBI (Hedges g = -0.531, p = 0.003), a small effect size for moderate TBI (Hedges g = -0.257, p = 0.007), and a large effect size for severe TBI (Hedges g = -0.909, p <<> .001). Thus, children who experienced a TBI demonstrated externalizing symptoms including hyperactivity and impulsivity with the largest effect size associated with severe TBI. The results of the meta-regressions indicated that only injury severity was a significant predictor of symptom severity.Conclusions: Using meta-analytic methods, we found that children who experience traumatic brain injury are rated as exhibiting more severe internalizing and externalizing symptoms across levels of severity. This effect was largest for severe injury and smallest for moderate injury. Caregivers and healthcare practitioners can use this information to better screen for and treat internalizing and externalizing symptoms in children after a traumatic brain injury.

Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen–Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (b 5 0.20, 95% confidence interval [CI] 5 0.07- 0.32, P 5 0.002) and at rest (b 5 0.41, 95% CI 5 0.14-0.69, P 5 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia.

no / Background Dementia is common in older people admitted to acute hospitals. There are concerns about the quality of care they receive. Behavioural and psychiatric symptoms of dementia (BPSD) seem to be particularly challenging for hospital staff. Aims To define the prevalence of BPSD and explore their clinical associations. Method Longitudinal cohort study of 230 people with dementia, aged over 70, admitted to hospital for acute medical illness, and assessed for BPSD at admission and every 4 (± 1) days until discharge. Other measures included length of stay, care quality indicators, adverse events and mortality. Results Participants were very impaired; 46% at Functional Assessment Staging Scale (FAST) stage 6d or above (doubly incontinent), 75% had BPSD, and 43% had some BPSD that were moderately/severely troubling to staff. Most common were aggression (57%), activity disturbance (44%), sleep disturbance (42%) and anxiety (35%). Conclusions We found that BPSD are very common in older people admitted to an acute hospital. Patients and staff would benefit from more specialist psychiatric support.