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The degree of academic achievement following early onset brain injury is poorly understood. Furthermore, it is unclear if academic success can be predicted by age of onset or other lesion variables (e.g., size, laterality). The purpose of the current study was to describe patterns of academic achievement in individuals with childhood-onset focal brain lesions and to determine the role of variables in the plasticity or vulnerability of the developing brain with regard to achievement. Academic achievement data were collected from 58 individuals with childhood-onset focal brain lesions. The participants' reading, spelling, and arithmetic scores, as measured by the Wide Range Achievement Test, were analyzed in relation to several neuroanatomical variables, including lesion laterality, lesion site, and lesion size. The relationship between achievement and gender, age of onset, etiology, age at testing, and time since lesion onset was also identified. As a group, achievement scores did not differ from normative data, and the majority of the sample demonstrated adequate skills in each domain. However, the frequency of deficits was larger than expected when compared to base rates, suggesting vulnerability to early insult. Achievement scores were correlated with intelligence scores, but did not differ based on lesion laterality, lesion site, age of onset, or etiology. Size of lesion was significantly correlated with reading and spelling but not with arithmetic outcomes. Gender differences were identified, with males performing significantly better on the arithmetic measure than females. The age of onset, age at testing, and time since lesion onset were not correlated with achievement scores in any domain. No interactions were found between lesion laterality and gender or lesion site and lesion laterality. An interaction between gender and lesion site was found, but the significance of the finding is unclear. The current findings provide mixed evidence for the plasticity-vulnerability debate, as many individuals were able to achieve adequate academic skills whereas others demonstrated significant impairments. Further research is needed to elucidate factors that may predict achievement outcomes in individuals with childhood-onset focal brain injury.

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In an attempt to understand girls' involvement conduct problems, this dissertation first reviews two existing theoretical approaches that provide an explanation for the development of conduct problems. Specifically, the available literature on the development and correlates of conduct problems in boys suggests the subtypes of conduct disorder represent two developmental trajectories. The adolescent-onset pathway is associated with deviant peers and few characterological problems, where as the childhood-onset pathway is associated with emotion regulation deficits, negative parenting, callous and unemotional traits, and neurological deficits. Research also suggests a gender-specific model, the delayed-onset model, for the development of conduct problems in girls. Following this theoretical review, differential predictions made by the competing theoretical models are tested in a community sample of school-aged girls and boys. Participants were 202 children (87 males and 115 females) in grades 5-9. The students ranged in age from 10 to 17 years old (M = 13.16). Similar to the total student body, the ethnic breakdown of the sample was as follows: African-American (60%), Caucasian (24%), Hispanic (6%), and Other (5%). Data was also collected from the students' parents and teachers. Results indicated that girls conduct problems did not follow either model in a consistent manner. Specifically, adolescent-onset conduct problem girls, childhood-onset conduct problem boys, and adolescentonset conduct problem boys differed from non-conduct problem children but did not differ significantly amongst themselves on study variables (e.g., deviant peer association, hyperactivity/impulsivity, emotional dysregulation, callous/unemotional traits). However, results suggest that gender-specific risk factors should be taken into account when developing theoretical models for girls' conduct problems. For example, early pubertal maturation is a particularly salient risk factor for conduct problems in girls, and pubertal development interacts with emotion regulation problems to place girls at high risk for deviant behavior. Finally, implications for prevention and intervention as well as future research are discussed.

Darbo tikslas Įvertinti pacientų, vaikystėje susirgusių pirmo tipo cukriniu diabetu (iki 15 m.), mirtingumo ir komplikacijų išsivystymo ypatumus. Darbo uždaviniai 1. Įvertinti standartizuotus mirtingumo rodiklius 1983–2005 metais. 2. Įvertinti ir palyginti standartizuotus mirtingumo rodiklius 1983–1995 m. ir 1996–2005 m. laikotarpiais. 3. Įvertinti mirties priežastis. 4. Įvertinti cukrinio diabeto komplikacijų išsivystymo ypatumus. / The aim of the study was to evaluate the characteristics of mortality and development of diabetes complications in patients with childhood-onset (under the age of 15 years) type 1 diabetes mellitus. The objectives of the study: 1. To evaluate the standardized mortality ratios in 1983–2005. 2. To evaluate and compare the standardized mortality ratios between the periods of 1983–1995 and 1996–2005. 3. To determine the causes of death. 4. To evaluate the characteristics of development of diabetes compli-cations.

Orientador: Simone Appenzeller / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T13:41:07Z (GMT). No. of bitstreams: 1 Barbosa_Renata_M.pdf: 1172344 bytes, checksum: 3fc9e9d779a4b94077d1d56223dc0d79 (MD5) Previous issue date: 2014 / Resumo: O nosso objetivo foi determinar a prevalência de atrofia hipocampal no lúpus eritematoso sistêmico juvenil (LESj) determinando a volumetria hipocampal por ressonância magnética e avaliar a possível relação entre atrofia hipocampal e fatores associados. Todos os pacientes com quatro ou mais critérios classificatórios de LES seguidos no ambulatório de reumatologia pediátrica com início da doença até aos 18 anos foram incluídos. Uma análise clínica e neurológica foi realizada de acordo com os critérios classificatórios do Colégio Americano de Reumatologia. Dados laboratoriais e de tratamento foram obtidos através da revisão criteriosa dos prontuários clínicos. Observamos que os volumes hipocampais dos nossos pacientes foram significativamente menores quando comparados aos volumes hipocampais dos nossos controles (p<0,001). A atrofia hipocampal foi identificada em 25 pacientes (34,72%) e no grupo controle 1 indivíduo (1,38%) apresentou atrofia hipocampal direita. A esclerose hipocampal esteve presente em 1(4%) paciente e o hipersinal em 13 (52%) pacientes. Em relação ao tratamento medicamentoso a atrofia hipocampal no LESj esteve associada ao uso de corticosteroides (p= 0,008), micofenolato mofetil (p=0,012), ciclosporina (p=0,018) e ciclosfosfamida (p=0,037). A idade de início da doença (p= 0,038) e dano cumulativo (p= 0,040) também se mostraram associados. Quanto à análise de dados laboratoriais, apenas o anticoagulante lúpico (p= 0,017) e a diminuição do complemento (p= 0,018) se mostraram associados. A esclerose hipocampal apresentou relação com pulso metilprednisolona no início da doença (p=0,023), ciclofosfamida (p=0,023) e com a função cognitiva organização perceptual, planejamento e praxia (p< 0,001). O hipersinal demonstrou associação com atrofia hipocampal (p=0,024), volume hipocampal direito (p=0,024), volume hipocampal esquerdo (p=0,007), no entanto a presença de hipersinal no hipocampo esquerdo apresentou associação apenas com a dose total de corticosteróides (p=0,034). Em relação aos domínios cognitivos, o raciocínio espacial apresentou uma correlação inversa com o volume hipocampal esquerdo (p=0,041; r= -0,281). A memória visográfica apresentou uma correlação direta com o volume hipocampal direito (p=0,042; r= 0,281). A velocidade de processamento associou-se com atrofia hipocampal (p=0,026). O raciocínio temporal demonstrou uma associação com atrofia hipocampal direita (p=0,015), atrofia hipocampal bilateral (p=0,012), e uma correlação inversa com o volume hipocampal direito (p=0,008; r= - 0,359) e volume hipocampal esquerdo (p=0,003; r= -0,400). A atrofia hipocampal é frequente no LESj. A idade de início da doença, tratamento medicamentoso e anticorpos antifosfolípides estão associados à sua ocorrência / Abstract: Our aimed was to determine the prevalence of hippocampal atrophy in childhood-onset SLE (cSLE) using manual magnetic resonance imaging (MRI) volumetric measurements and to evaluate the possible relationship between hippocampal atrophy and associated factors. All patients with four or more classification criteria for SLE, followed at the Pediatric Rheumatology Unit with diagnosis up to 18 years old was included. A clinical analysis and neurological evaluation was analyzed according to the American College of Rheumatology (ACR) classification criteria. Laboratory and treatment features were obtained through a review of clinical records. We observed that the hippocampal volumes of our patients were significantly smaller when compared hippocampal volumes to our controls (p <0.001). Hippocampal atrophy was identified in 25 patients (34.72%) and 1 (1.38%) control at the right hippocampus atrophy. Hippocampal sclerosis was present in 1 (4%) and increased signal in 13 (52%) patients. In relation to drug treatment in cSLE hippocampal atrophy was associated with the use of corticosteroids (p=0.008), mycophenolate mofetil (p=0.012), cyclosporine (p=0.018) e cyclophosphamide (p=0.037).The age of onset (p= 0.038) and cumulative damage (p= 0.040) were also associated. However the analysis of laboratory features, only lupus anticoagulant (p=0.017) and decreased complement (p=0.018) were associated. Hippocampal sclerosis showed relation with pulse methylprednisolone at disease onset (p=0.023), cyclophosphamide (p = 0.023) and cognitive function perceptual organization, planning and praxis (p <0.001). Increased signal showed association with hippocampal atrophy (p=0.024), right hippocampal volume (p=0.024), left hippocampal volume (p = 0.007). However presence of increased signal in the left hippocampus was associated with total corticosteroid dose (p=0.034). Considering cognitive domains, spatial reasoning showed inverse correlation with left hippocampal volume (p = 0.041, r = -0.281). Visografica memory showed a direct correlation with the right hippocampal volume (p= 0.042, r = 0.281). Processing speed is associated with hippocampal atrophy (p = 0.026). Temporal reasoning demonstrated an association with right hippocampal atrophy (p = 0.015), bilateral atrophy (p = 0.012) and inverse correlation with right hippocampal volume (p=0.008, r= -0.359) and left hippocampal volume (p = 0.003, r = -0.400). Hippocampal atrophy is prevalent in cSLE. The age of onset of disease, drug treatment and antiphospholipid antibodies are associated / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

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