Revista Paulista de Pediatria (English Edition)最新文献_第3页

Analysis of factors associated with excess weight in school children 学龄儿童超重相关因素分析

Revista Paulista de Pediatria (English Edition)

Pub Date : 2016-12-01 DOI: 10.1016/j.rppede.2016.04.005

Renata Paulino Pinto , Altacílio Aparecido Nunes , Luane Marques de Mello

Objective

To determine the prevalence of overweight and obesity in schoolchildren aged 10 to 16 years and its association with dietary and behavioral factors.

Methods

Cross-sectional study that evaluated 505 adolescents using a structured questionnaire and anthropometric data. The data was analyzed through the T Test for independent samples and Mann–Whitney Test to compare means and medians, respectively, and Chi² Test for proportions. Prevalence ratio (RP) and the 95% confidence interval was used to estimate the degree of association between variables. The logistic regression was employed to adjust the estimates to confounding factors. The significance level of 5% was considered for all analysis.

Results

Excess weight was observed in 30.9% of the schoolchildren: 18.2% of overweight and 12.7% of obesity. There was no association between weight alterations and dietary/behavioral habits in the bivariate and multivariate analyses. However, associations were observed in relation to gender. Daily consumption of sweets [PR=0.75 (0.64–0.88)] and soft drinks [PR=0.82 (0.70–0.97)] was less frequent among boys; having lunch daily was slightly more often reported by boys [OR=1.11 (1.02–1.22)]. Physical activity practice of (≥3 times/week) was more often mentioned by boys and the association measures disclosed two-fold more physical activity in this group [PR=2.04 (1.56–2.67)] when compared to girls. Approximately 30% of boys and 40% of girls stated they did not perform activities requiring energy expenditure during free periods, with boys being 32% less idle than girls [PR=0.68 (0.60–0.76)].

Conclusions

A high prevalence of both overweight and obesity was observed, as well as unhealthy habits in the study population, regardless of the presence of weight alterations. Health promotion strategies in schools should be encouraged, in order to promote healthy habits and behaviors among all students.

目的了解10 ~ 16岁学龄儿童超重和肥胖的患病率及其与饮食和行为因素的关系。方法采用结构化问卷和人体测量数据对505名青少年进行横断面研究。数据分析分别采用独立样本T检验和Mann-Whitney检验比较均值和中位数，比例采用Chi2检验。采用流行率(RP)和95%置信区间来估计变量之间的关联程度。采用逻辑回归对混杂因素的估计进行调整。所有分析均考虑显著性水平为5%。结果30.9%的小学生体重超标，其中超重18.2%，肥胖12.7%。在双变量和多变量分析中，体重变化和饮食/行为习惯之间没有关联。然而，观察到与性别有关的关联。男孩每天摄入糖果[PR=0.75(0.64-0.88)]和软饮料[PR=0.82(0.70-0.97)]的频率较低;每天吃午餐的男孩稍多一些[OR=1.11(1.02-1.22)]。男孩更常提到体力活动实践(≥3次/周)，相关测量显示该组的体力活动是女孩的两倍[PR=2.04(1.56-2.67)]。大约30%的男孩和40%的女孩表示他们在空闲时间不做需要消耗能量的活动，男孩比女孩少32%的空闲时间[PR=0.68(0.60-0.76)]。结论:在研究人群中，无论是否存在体重改变，超重和肥胖的患病率以及不健康的生活习惯都很高。应鼓励学校的健康促进战略，以便在所有学生中促进健康的习惯和行为。

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引用次数: 12

Behavior change stages related to physical activity in adolescents from Santa Catarina: prevalence and associated factors 圣卡塔琳娜州青少年身体活动相关的行为改变阶段:患病率及相关因素

Revista Paulista de Pediatria (English Edition)

Pub Date : 2016-12-01 DOI: 10.1016/j.rppede.2016.03.017

Jaqueline Aragoni da Silva, Kelly Samara da Silva, Adair da Silva Lopes, Markus Vinícius Nahas

Objective

Verify the prevalence and sociodemographic and economic factors associated with behavior change stages for habitual physical activity practice in adolescents from Santa Catarina.

Methods

Secondary analysis of a study on the Behavior of Adolescents from Santa Catarina (CompAC 2). Cross-sectional school-based study of 6,529 high-school students (males, n=2,903) from the state of Santa Catarina public education system in 2011, aged 15 to 19 years. Multinomial logistic regression (crude and adjusted) was used to measure the association.

Results

The highest and lowest prevalence rates were found in the maintenance (43.9%) and precontemplation stages (7.0%), respectively. The stages of action, preparation and contemplation showed similar results: 16.2%; 17.0% and 15.6%; respectively. Male adolescents show higher prevalence in the maintenance stage in relation to females and these show a higher prevalence in preparation, contemplation and precontemplation. All the assessed variables (gender, age, area of residence, employment status, family income, maternal education and school grade), with the exception of school shift, were associated with at least one of the stages.

Conclusions

A large proportion of adolescents are in the pre-adoption stages and most of these have the intention to start regular physical activity. With the exception of school shift, the assessed variables were associated with stages in different ways, showing different profiles in relation to sociodemographic and economic characteristics in each subgroup.

目的验证圣卡塔琳娜州青少年习惯性体育锻炼行为改变阶段的患病率及社会人口和经济因素。方法对《圣卡塔琳娜州青少年行为研究》(CompAC 2)进行二次分析。对2011年圣卡塔琳娜州公立教育系统中15 - 19岁的6529名高中生(男，n= 2903)进行横断面校本研究。采用多项逻辑回归(原始和调整)来衡量相关性。结果维持期患病率最高(43.9%)，预观期患病率最低(7.0%)。行动、准备和思考阶段的结果相似:16.2%;17.0%和15.6%;分别。男性青少年在维持阶段的患病率高于女性，在准备阶段、沉思阶段和预沉思阶段的患病率高于女性。所有被评估的变量(性别、年龄、居住地区、就业状况、家庭收入、母亲教育程度和学校年级)，除了转学外，都至少与其中一个阶段有关。结论大部分青少年处于被收养前阶段，大部分青少年有开始规律体育活动的意向。除了学校转换，评估的变量以不同的方式与阶段相关联，在每个亚组中显示出与社会人口和经济特征相关的不同概况。

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引用次数: 9

Consumption of fruits and vegetables associated with other risk behaviors among adolescents in Northeast Brazil 巴西东北部青少年食用水果和蔬菜与其他危险行为有关

Revista Paulista de Pediatria (English Edition)

Pub Date : 2016-09-01 DOI: 10.1016/j.rppede.2015.09.004

Fabiana Medeiros de Almeida Silva , Aldemir Smith-Menezes , Maria de Fátima da Silva Duarte

Objective

To determine the prevalence of consumption of fruits and vegetables and identify the association with low level of physical activity, exposure to sedentary behavior, consumption of soft drinks and overweight/obesity in adolescents.

Methods

This is a cross-sectional school-based study with a representative sample of 3992 students aged 14–19 years from the state of Sergipe, Brazil. The outcome was low consumption of fruits and vegetables (<5servings/day). Independent variables were: level of physical activity, sedentary behavior, consumption of soft drinks, and overweight/obesity. Global Student Health Survey questionnaire and body mass and height measurements were used, as well as chi-square test and crude and adjusted binary logistic regression. The significance level adopted was 5%.

Results

The prevalence of inadequate consumption of fruits and vegetables was high – 88.6% (95%CI=87.6–89.5). Higher likelihood of low consumption of fruits and vegetables was verified among boys who were exposed to sedentary behavior (OR=1.63; 95%CI=1.18–2.24), who consumed soft drinks (OR=3.04; 95%CI=2.10–4.40), with insufficiently physical activity (OR=1.98; 95%CI=1.43–2.73) and girls who consumed soft drinks (OR=1.88; 95%CI=1.43–2.47) and those with overweight/obesity (OR=1.63; 95%CI=1.19–2.23).

Conclusions

There is a need of public policies aimed at encouraging the consumption of healthy foods among adolescents.

目的确定青少年水果和蔬菜消费的流行程度，并确定其与身体活动水平低、久坐行为暴露、软饮料消费和超重/肥胖之间的关系。方法这是一项以学校为基础的横断面研究，有代表性的样本是3992名14-19岁的学生，来自巴西塞尔吉佩州。结果是水果和蔬菜的摄入量很低(每天5份)。独立变量为:体力活动水平、久坐行为、软饮料消费和超重/肥胖。采用全球学生健康调查问卷、体重和身高测量、卡方检验、粗糙和调整的二元logistic回归。采用显著性水平为5%。结果水果和蔬菜摄入不足的患病率较高，为88.6% (95%CI=87.6 ~ 89.5)。暴露于久坐行为的男孩更有可能摄入较少的水果和蔬菜(OR=1.63;95%CI= 1.18-2.24)，饮用软饮料的人(OR=3.04;95%CI= 2.10-4.40)，身体活动不足(OR=1.98;95%CI= 1.43-2.73)和饮用软饮料的女孩(OR=1.88;95%CI= 1.43-2.47)和超重/肥胖患者(OR=1.63;95% ci = 1.19 - -2.23)。结论有必要制定旨在鼓励青少年健康食品消费的公共政策。

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引用次数: 5

Influence of glycemic index and glycemic load of the diet on the risk of overweight and adiposity in childhood 饮食中血糖指数和血糖负荷对儿童超重和肥胖风险的影响

Revista Paulista de Pediatria (English Edition)

Pub Date : 2016-09-01 DOI: 10.1016/j.rppede.2015.12.009

Kellen Cristine Silva , Luciana Neri Nobre , Sofia Emanuelle de Castro Ferreira Vicente , Lidiane Lopes Moreira , Angelina do Carmo Lessa , Joel Alves Lamounier

Objective

To investigate the association between the glycemic index and the glycemic load of the diet with the risk of overweight and high adiposity in children with 5 years of age.

Methods

Cross-sectional study nested in a cohort of 232 children born and living in Diamantina (MG, Brazil). Parents and/or guardians provided the food intake data, using a semiquantitative food frequency questionnaire, past history and socioeconomic conditions. Anthropometric and fatness data were collected from the children. The dietary glycemic index and the glycemic load were calculated from the food intake. The glycemic index and glycemic load effect on overweight and adiposity in children was assessed by the Poisson regression (p<0.05).

Results

The prevalence of overweight by body mass index was 17.3%, and high adiposity was observed in 3.4% and 6.9% by triceps skinfold and subscapular skinfold, respectively. No difference was reported between the mean body mass index, triceps skinfold and subscapular skinfold according to the glycemic index and glycemic load tertiles; however, the overweight group presented a higher carbohydrate intake (p=0.04). No association was found between glycemic index and glycemic load with overweight and adiposity among the children assessed.

Conclusions

The glycemic index and glycemic load of the diet were not identified as risk factors for overweight and adiposity in this cross-sectional study.

目的探讨5岁儿童饮食中血糖指数和血糖负荷与超重和高肥胖风险的关系。方法横断面研究嵌套在232名儿童出生和生活在迪亚曼蒂纳(MG，巴西)队列。父母和/或监护人提供食物摄入数据，使用半定量食物频率问卷，过去的历史和社会经济条件。收集儿童的人体测量和肥胖数据。根据食物摄入量计算膳食血糖指数和血糖负荷。采用泊松回归评估血糖指数和血糖负荷对儿童超重和肥胖的影响(p<0.05)。结果体重指数超重的患病率为17.3%，肱三头肌皮褶和肩胛下皮褶的高肥胖率分别为3.4%和6.9%。血糖指数和血糖负荷指标与平均体重指数、肱三头肌皮褶和肩胛下皮褶无差异;然而，超重组的碳水化合物摄入量较高(p=0.04)。在被评估的儿童中，血糖指数和血糖负荷与超重和肥胖之间没有关联。结论:在这项横断面研究中，血糖指数和饮食中的血糖负荷并没有被确定为超重和肥胖的危险因素。

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引用次数: 1

Secular trends in infant mortality by age-group and avoidable components in the State of São Paulo, 1996–2012 1996-2012年<s:1>圣保罗州按年龄组和可避免因素分列的婴儿死亡率长期趋势

Revista Paulista de Pediatria (English Edition)

Pub Date : 2016-09-01 DOI: 10.1016/j.rppede.2016.03.009

Kelsy Catherina Nema Areco, Tulio Konstantyner, José Augusto de Aguiar Carrazedo Taddei

Objective

To describe trends and composition of infant mortality rate in the State of São Paulo, from 1996 to 2012.

Methods

An ecological study was conducted, based on official secondary data of births and infant deaths of residents in São Paulo, from 1996 to 2012. The infant mortality rate was calculated by the direct method and was analyzed by graphs and polynomial regression models for age groups (early neonatal, late neonatal and post-neonatal) and for groups of avoidable causes of death.

Results

The mortality rate in the State of São Paulo tended to fall, ranging from 22.5 to 11.5 per thousand live births. Half of the infant deaths occurred in the early neonatal group. The proportion of avoidable infant deaths varied from 76.0 to 68.7%. The deaths which were avoidable by adequate attention to women during pregnancy and childbirth and newborn care accounted for 54% of infant deaths throughout the period.

Conclusions

The mortality rate levels are still far from those in developed countries, which highlight the need to prioritize access and quality of healthcare services during pregnancy, childbirth and newborn care, especially in the first week of life, aiming at achieving standards of infant mortality similar to those of developed societies.

目的描述1996年至2012年圣保罗州婴儿死亡率的趋势和构成。方法基于1996 - 2012年圣保罗市居民出生和婴儿死亡的官方二级数据进行生态学研究。采用直接法计算婴儿死亡率，并采用曲线图和多项式回归模型对年龄组(新生儿早期、新生儿晚期和新生儿后期)和可避免死因组进行分析。结果圣保罗州的死亡率呈下降趋势，为每千例活产死亡22.5例至11.5例。半数婴儿死亡发生在新生儿早期组。可避免的婴儿死亡比例从76.0到68.7%不等。通过在怀孕和分娩期间对妇女给予充分关注以及新生儿护理而可以避免的死亡占整个期间婴儿死亡的54%。结论我国的婴儿死亡率水平与发达国家相比仍有较大差距，因此需要优先考虑在妊娠、分娩和新生儿护理期间，特别是生命第一周提供保健服务的机会和质量，以实现与发达社会类似的婴儿死亡率标准。

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引用次数: 5

Congenital central hypoventilation syndrome associated with Hirschsprung's Disease: case report and literature review 先天性中枢性低通气综合征与先天性巨结肠病:病例报告及文献复习

Revista Paulista de Pediatria (English Edition)

Pub Date : 2016-09-01 DOI: 10.1016/j.rppede.2015.10.009

Renata Lazari Sandoval , Carlos Moreno Zaconeta , Paulo Roberto Margotto , Maria Teresinha de Oliveira Cardoso , Evely Mirella Santos França , Cristina Touguinha Neves Medina , Talyta Matos Canó , Aline Saliba de Faria

Objective

To report the case of a newborn with recurrent episodes of apnea, diagnosed with Congenital Central hypoventilation syndrome (CCHS) associated with Hirschsprung's disease (HD), configuring Haddad syndrome.

Case description

Third child born at full-term to a non-consanguineous couple through normal delivery without complications, with appropriate weight and length for gestational age. Soon after birth he started to show bradypnea, bradycardia and cyanosis, being submitted to tracheal intubation and started empiric antibiotic therapy for suspected early neonatal sepsis. During hospitalization in the NICU, he showed difficulty to undergo extubation due to episodes of desaturation during sleep and wakefulness. He had recurrent episodes of hypoglycemia, hyperglycemia, metabolic acidosis, abdominal distension, leukocytosis, increase in C-reactive protein levels, with negative blood cultures and suspected inborn error of metabolism. At 2 months of age he was diagnosed with long-segment Hirschsprung's disease and was submitted to segment resection and colostomy through Hartmann's procedure. A genetic research was performed by polymerase chain reaction for CCHS screening, which showed the mutated allele of PHOX2B gene, confirming the diagnosis.

Comments

This is a rare genetic, autosomal dominant disease, caused by mutation in PHOX2B gene, located in chromosome band 4p12, which results in autonomic nervous system dysfunction. CCHS can also occur with Hirschsprung's disease and tumors derived from the neural crest. There is a correlation between phenotype and genotype, as well as high intrafamilial phenotypic variability. In the neonatal period it can simulate cases of sepsis and inborn errors of metabolism.

目的报告1例新生儿呼吸暂停反复发作，诊断为先天性中枢性低通气综合征(CCHS)合并先天性巨结肠病(HD)，配置Haddad综合征。病例描述:非近亲夫妇正常分娩，足月生第三个孩子，无并发症，体重和长度与胎龄相符。出生后不久，他就开始出现呼吸缓慢、心动过缓和发绀，需要气管插管，并开始经验性抗生素治疗，以怀疑早期新生儿败血症。在新生儿重症监护病房住院期间，由于睡眠和清醒时发生血饱和度过低，患者难以拔管。反复发作低血糖、高血糖、代谢性酸中毒、腹胀、白细胞增多、c反应蛋白水平升高，血培养阴性，怀疑先天性代谢错误。在2个月大时，他被诊断为长节段先天性巨结肠病，并通过Hartmann手术进行节段切除和结肠造口术。采用聚合酶链反应对CCHS筛查进行基因研究，发现PHOX2B基因等位基因突变，确诊。这是一种罕见的遗传性常染色体显性疾病，由位于染色体4p12带的PHOX2B基因突变导致自主神经系统功能障碍。先天性巨结肠综合征也可发生于先天性巨结肠病和神经嵴肿瘤。表型与基因型之间存在相关性，家族内表型具有较高的变异性。在新生儿期，它可以模拟脓毒症和先天性代谢错误的情况。

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引用次数: 13

Dental pain and associated factors in Brazilian preschoolers 巴西学龄前儿童牙痛及其相关因素

Revista Paulista de Pediatria (English Edition)

Pub Date : 2016-09-01 DOI: 10.1016/j.rppede.2016.03.002

João Gabriel Silva Souza , Andrea Maria Eleutério de Barros Lima Martins

Objective

To describe the prevalence of dental pain in Brazilian preschoolers, as well as its associated factors, considering a representative sample of that population group in Brazil.

Methods

Cross-sectional study that used the analytical data from national oral health survey (SB Brazil) carried out in 2010. A representative sample of Brazilian preschoolers aged 5 years was considered. Interviews were carried out (answered by parents/tutors), as well as clinical examinations in children. Descriptive, bivariate and mutiple analyzes were performed, described in odds ratios and 95% confidence interval (OR/95%CI).

Results

7280 preschoolers were included. Of these, 1520 (21.1%) had dental pain in the last 6 months. The chance of the occurrence of dental pain was higher among those who used dental services (1.51/1.02–2.23), with tooth decay (3.08/2.08–4.56), that self-perceveid the need for dental treatment (3.96/2.48–6.34), whose parents reported dissatisfaction by children with their teeth and mouth (1.47/1.04–2.10) and those who reported impact of oral problems on quality of life (5.76/3.90–8.49).

Conclusions

The prevalence of dental pain among Brazilian preschool children was relatively high, being associated with the use of dental services and the normative and subjective oral health status.

目的描述巴西学龄前儿童牙痛的患病率及其相关因素，考虑巴西该人群的代表性样本。方法采用2010年全国口腔健康调查(SB巴西)的分析数据进行横断面研究。研究考虑了巴西5岁学龄前儿童的代表性样本。进行了访谈(由家长/导师回答)，并对儿童进行了临床检查。采用比值比和95%置信区间(OR/95% ci)进行描述性、双变量和多重分析。结果共纳入7280名学龄前儿童。其中1520人(21.1%)在过去6个月内有过牙痛。接受牙科服务(1.51/1.02-2.23)、有蛀牙(3.08/2.08-4.56)、自我认为有需要接受牙科治疗(3.96/2.48-6.34)、父母报告子女对牙齿和口腔不满意(1.47/1.04-2.10)和报告口腔问题对生活质量有影响(5.76/3.90-8.49)的学童发生牙痛的机会较高。结论巴西学龄前儿童牙痛患病率较高，与牙科服务的使用、口腔健康的规范性和主观性有关。

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引用次数: 21

Insulin therapy in patients with cystic fibrosis in the pre-diabetes stage: a systematic review 糖尿病前期囊性纤维化患者的胰岛素治疗:一项系统综述

Revista Paulista de Pediatria (English Edition)

Pub Date : 2016-09-01 DOI: 10.1016/j.rppede.2016.03.006

Mariana Zorrón Mei Hsia Pu, Flávia Corrêa Christensen-Adad, Aline Cristina Gonçalves, Walter José Minicucci, José Dirceu Ribeiro, Antonio Fernando Ribeiro

Objective

To elucidate whether insulin is effective or not in patients with cystic fibrosis before the diabetes mellitus phase.

Data source

The study was performed according to the Prisma method between August and September 2014, using the PubMed, Embase, Lilacs and SciELO databases. Prospective studies published in English, Portuguese and Spanish from 2002 to 2014, evaluating the effect of insulin on weight parameters, body mass index and pulmonary function in patients with cystic fibrosis, with a mean age of 17.37 years before the diabetes mellitus phase were included.

Data synthesis

Eight articles were identified that included 180 patients undergoing insulin use. Sample size ranged from 4 to 54 patients, with a mean age ranging from 12.4 to 28 years. The type of follow-up, time of insulin use, the dose and implementation schedule were very heterogeneous between studies.

Conclusions

There are theoretical reasons to believe that insulin has a beneficial effect in the studied population. The different methods and populations assessed in the studies do not allow us to state whether early insulin therapy should or should not be carried out in patients with cystic fibrosis prior to the diagnosis of diabetes. Therefore, studies with larger samples and insulin use standardization are required.

目的探讨胰岛素对糖尿病前期囊性纤维化患者是否有效。数据来源研究于2014年8 - 9月采用Prisma方法进行，使用PubMed、Embase、Lilacs和SciELO数据库。纳入2002 - 2014年以英语、葡萄牙语和西班牙语发表的前瞻性研究，评估胰岛素对囊性纤维化患者体重参数、体重指数和肺功能的影响，这些患者在糖尿病期前平均年龄为17.37岁。8篇文章纳入180例使用胰岛素的患者。样本量为4 ~ 54例，平均年龄为12.4 ~ 28岁。随访的类型、胰岛素使用的时间、剂量和实施计划在研究之间存在很大差异。结论有理论上的理由相信胰岛素对研究人群有有益的作用。研究中评估的不同方法和人群不允许我们说明在诊断糖尿病之前囊性纤维化患者是否应该或不应该进行早期胰岛素治疗。因此，需要更大样本的研究和胰岛素使用标准化。

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引用次数: 5

Substance misuse and sexual function in adolescents with chronic diseases 慢性疾病青少年药物滥用与性功能的关系

Revista Paulista de Pediatria (English Edition)

Pub Date : 2016-09-01 DOI: 10.1016/j.rppede.2015.10.008

Priscila Araújo , Márcio Guilherme Nunes Carvalho , Marlon van Weelden , Benito Lourenço , Lígia Bruni Queiroz , Clovis Artur Silva

Objective

To evaluate alcohol/tobacco and/or illicit drug misuse in Chronic Diseases (CDs).

Methods

A cross-sectional study with 220 CDs adolescents and 110 healthy controls including: demographic/anthropometric data; puberty markers; modified questionnaire evaluating sexual function, alcohol/smoking/illicit drug misuse and bullying; and the physician-conducted CRAFFT (car/relax/alone/forget/friends/trouble) screen tool for substance abuse/dependence high risk.

Results

The frequencies of alcohol/tobacco and/or illicit drug use were similar in both groups (30% vs. 34%, p=0.529), likewise the frequencies of bullying (42% vs. 41%, p=0.905). Further analysis solely in CDs patients that used alcohol/tobacco/illicit drug versus those that did not use showed that the median current age [15 (11–18) vs. 14 (10–18) years, p<0.0001] and education years [9 (5–14) vs. 8 (3–12) years, p<0.0001] were significant higher in substance use group. The frequencies of Tanner 5 (p<0.0001), menarche (p<0.0001) and spermarche (p=0.001) were also significantly higher in patients with CDs that used alcohol/tobacco/illicit, likewise sexual activity (23% vs. 3%, p<0.0001). A trend of a low frequency of drug therapy was observed in patients that used substances (70% vs. 82%, p=0.051). A positive correlation was observed between CRAFFT score and current age in CD patients (p=0.005, r=+0.189) and controls (p=0.018, r=+0.226).

Conclusions

A later age was evidenced in CDs patients that reported licit/ilicit drug misuse. In CDs adolescent, substance use was more likely to have sexual intercourse. Our study reinforces that these patients should be systematically screened by pediatricians for drug related health behavioral patterns.

目的评价慢性疾病(cd)中酒精/烟草和/或非法药物滥用情况。方法采用横断面研究方法，选取220名青少年和110名健康对照者，包括人口统计学/人体测量学数据;青春期的标志;评估性功能、酗酒/吸烟/滥用非法药物和欺凌行为的改进问卷;以及医生指导的craft(汽车/放松/独处/遗忘/朋友/麻烦)药物滥用/依赖高风险筛查工具。结果两组中使用酒精/烟草和/或非法药物的频率相似(30%对34%，p=0.529)，欺凌的频率相似(42%对41%，p=0.905)。进一步分析仅使用酒精/烟草/非法药物的CDs患者与不使用酒精/烟草/非法药物的患者，结果显示，药物使用组的中位年龄[15 (11-18)vs. 14(10-18)岁，0.0001]和受教育年限[9 (5-14)vs. 8(3-12)年，0.0001]显著高于药物使用组。Tanner 5 (p<0.0001)、月经初潮(p<0.0001)和精子(p=0.001)的频率在使用酒精/烟草/类似的非法性活动的cd患者中也显着更高(23%对3%，p<0.0001)。在使用药物的患者中观察到药物治疗频率较低的趋势(70% vs 82%， p=0.051)。CD患者(p=0.005, r=+0.189)和对照组(p=0.018, r=+0.226)的craft评分与当前年龄呈正相关。结论报告合法/非法药物滥用的cd患者年龄较晚。在cd青少年中，物质使用更有可能发生性行为。我们的研究强调，儿科医生应该对这些患者进行系统的药物相关健康行为模式筛查。

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引用次数: 1

Hirschsprung's disease – Postsurgical intestinal dysmotility 先天性巨结肠病-术后肠蠕动障碍

Revista Paulista de Pediatria (English Edition)

Pub Date : 2016-09-01 DOI: 10.1016/j.rppede.2016.05.001

Mariana Tresoldi das Neves Romaneli, Antonio Fernando Ribeiro, Joaquim Murray Bustorff-Silva, Rita Barbosa de Carvalho, Elizete Aparecida Lomazi

Objective

To describe the case of an infant with Hirschsprung's disease presenting as total colonic aganglionosis, which, after surgical resection of the aganglionic segment persisted with irreversible functional intestinal obstruction; discuss the difficulties in managing this form of congenital aganglionosis and discuss a plausible pathogenetic mechanism for this case.

Case description

The diagnosis of Hirschsprung's disease presenting as total colonic aganglionosis was established in a two-month-old infant, after an episode of enterocolitis, hypovolemic shock and severe malnutrition. After colonic resection, the patient did not recover intestinal motor function that would allow enteral feeding. Postoperative examination of remnant ileum showed the presence of ganglionic plexus and a reduced number of interstitial cells of Cajal in the proximal bowel segments. At 12 months, the patient remains dependent on total parenteral nutrition.

Comments

Hirschsprung's disease presenting as total colonic aganglionosis has clinical and surgical characteristics that differentiate it from the classic forms, complicating the diagnosis and the clinical and surgical management. The postoperative course may be associated with permanent morbidity due to intestinal dysmotility. The numerical reduction or alteration of neural connections in the interstitial cells of Cajal may represent a possible physiopathological basis for the condition.

目的报告1例先天性巨结肠病患儿，表现为全结肠神经节肿大，在切除神经节段后仍存在不可逆的功能性肠梗阻;讨论在处理这种形式的先天性神经节病的困难，并讨论一个合理的发病机制，这种情况下。病例描述:一个两个月大的婴儿在发生小肠结肠炎、低血容量性休克和严重营养不良后，被诊断为先天性巨结肠病，表现为完全性结肠神经节病。结肠切除后，患者未恢复肠运动功能，无法进行肠内喂养。术后残余回肠检查显示神经节丛存在，近端肠段Cajal间质细胞数量减少。12个月时，患者仍然依赖全肠外营养。评论schsprung病表现为全结肠神经节病，其临床和外科特征与经典形式不同，使诊断和临床和手术治疗复杂化。术后过程可能与肠道运动障碍引起的永久性发病有关。Cajal间质细胞中神经连接的数量减少或改变可能是该疾病的生理病理基础。

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引用次数: 1