Impulsividad en el trastorno por déficit de atención e hiperactividad en niños después de una intervención de 8 semanas con dieta mediterránea y/o ácidos grasos omega-3: ensayo clínico aleatorizado

IntroductionThe Barratt Impulsiveness Scale (BIS) is a self-administered instrument designed to assess the personality/behavioural construct of impulsiveness. Impulsiveness has been associated with several psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD). This study assesses the progression of impulsive behaviour in children with ADHD after an 8-week dietary intervention with the Mediterranean diet and/or omega-3 fatty acid supplementation, by using a version of the 11-item BIS adapted for children (BIS-11c).MethodsThis cross-sectional study includes 60 children with ADHD from the region of Madrid, Spain. Participants were divided into 4 groups, with one control group (G1) and 3 intervention groups (Mediterranean diet [G2]; omega-3 supplementation [G3]; and Mediterranean diet plus omega-3 supplementation [G4]). A personalised Mediterranean diet was designed for members of groups 2 and 4. The BIS-11c was administered to determine the level of impulsiveness, and the KIDMED test was used to assess adherence to the Mediterranean diet.ResultsThe supplementation group showed a fairly significant decrease in the total BIS-11c (P = .049). Total cognitive score slightly decreased in the diet and supplementation groups. Only the control group showed a considerable decrease in the total motor score. Total nonplanning scores were lower in all groups after the intervention. Baseline and final BIS-11c scores were positively correlated with treatments (r > 0.9).ConclusionAn intake of 550 mg EPA fatty acid and 225 mg DHA fatty acid per day for 8 weeks is associated with less marked impulsive behaviour in children with ADHD. A Mediterranean diet may improve BIS scores, although our results are not conclusive in this population.     

Noxious family environments in relation to adult and childhood caries

BackgroundThe authors tested hypotheses that more noxious family environments are associated with poorer adult and child oral health.MethodsA community sample of married or cohabiting couples (N = 135) and their elementary school–aged children participated. Dental hygienists determined the number of decayed, missing and filled surfaces via oral examination. Subjective oral health impacts were measured by means of questionnaires completed by the parents and children. The parents completed questionnaires about interparental and parent-to-child physical aggression (for example, pushing) and emotional aggression (for example, derision), as well as harsh discipline. Observers rated the couples’ hostile behavior in laboratory interactions.ResultsThe extent of women's and men's caries experience was associated positively with their partners’ levels of overall noxious behavior toward them. The extent of children's caries experience was associated positively with the level of their mothers’ emotional aggression toward their partners.ConclusionsNoxious family environments may be implicated in compromised oral health. Future research that replicates and extends these findings can provide the foundation to translate them into preventive interventions.Practical ImplicationsNoxious family environments may help explain the limitations of routine oral health preventive strategies. Interprofessional strategies that also address the family environment ultimately may prove to be more effective than are single modality approaches.     

The status of the Glasgow Coma Scale

The Glasgow Coma Scale (GCS) was first introduced in the 1970s to provide a simple and reliable method of recording and monitoring change in the level of consciousness of head injured patients. Since its introduction, the GCS has been widely utilized in the trauma community and its use expanded beyond the original intentions of the score. In the context of traumatic injury, this paper discusses the use of the GCS as a predictor of outcome, the limitations of the GCS, the reliability of the GCS and potential alternatives through a critical review of the literature. The relevance to Australian trauma populations is also addressed.     

磁共振成像增强后静脉推注生理盐水对局部不良反应的影响效果观察

目的探讨磁共振（MRI）增强剂静脉推注后加用生理盐水冲洗以降低局部不良反应的临床效果。方法2005年5月-2006年10月,抽取行磁共振检查并需要增强患者400例,依检查登记的单、双数分成实验组和对照组各200例,实验组静脉推注增强剂后即刻推注生理盐水20ml;对照组不推注生理盐水。比较2组患者疼痛反应,组织、静脉的改变。结果实验组患者局部轻度不良反应4例占2%,无中、重度不良反应发生,对照组局部轻度不良反应36例占18%,中度4例占2%,重度1例占0.5%,2组比较差异有统计学意义（P〈0.01）。结论MRI静脉注射增强剂后立即推注生理盐水冲洗,能有效降低由于增强剂引起的局部不良反应,应视为磁共振成像增强扫描的常规辅助措施。     

Fatigue in Brazilian cancer patients, caregivers, and nursing students: a psychometric validation study of the Piper Fatigue Scale-Revised

Goals of work  The objective of this study was to validate the Piper Fatigue Scale-Revised (PFS-R) for use in Brazilian culture. Patients and methods  Translation of the PFS-R into Portuguese and validity and reliability tests were performed. Convenience samples in Brazil we as follows: 584 cancer patients (mean age 57 ± 13 years; 51.3% female); 184 caregivers (mean age 50 ± 12.7 years; 65.8% female); and 189 undergraduate nursing students (mean age 21.6 ± 2.8 years; 96.2% female); Instruments used were as follows: Brazilian PFS, Beck Depression Inventory (BDI), and Karnofsky Performance Scale (KPS). Main results  The 22 items of the Brazilian PFS loaded well (factor loading > 0.35) on three dimensions identified by factor analysis (behavioral, affective, and sensorial–psychological). These dimensions explained 65% of the variance. Internal consistency reliability was very good (Cronbach’s α ranged from 0.841 to 0.943 for the total scale and its dimensions). Cancer patients and their caregivers completed the Brazilian PFS twice for test–retest reliability and results showed good stability (Pearson’s r ≥ 0,60, p < 0,001). Correlations among the Brazilian PFS and other scales were significant, in hypothesized directions, and mostly moderate contributing to divergent (Brazilian PFS × KPS) and convergent validity (Brazilian PFS × BDI). Mild, moderate, and severe fatigue in patients were reported by 73 (12.5%), 167 (28.6%), and 83 (14.2%), respectively. Surprisingly, students had the highest mean total fatigue scores; no significant differences were observed between patients and caregivers showing poor discriminant validity. Conclusions  While the Brazilian PFS is a reliable and valid instrument to measure fatigue in Brazilian cancer patients, further work is needed to evaluate the discriminant validity of the scale in Brazil.

Pain: a review of three commonly used pain rating scales

Aims and objectives. This review aims to explore the research available relating to three commonly used pain rating scales, the Visual Analogue Scale, the Verbal Rating Scale and the Numerical Rating Scale. The review provides information needed to understand the main properties of the scales. Background. Data generated from pain‐rating scales can be easily misunderstood. This review can help clinicians to understand the main features of these tools and thus use them effectively. Method. A MedLine review via PubMed was carried out with no restriction of age of papers retrieved. Papers were examined for methodological soundness before being included. The search terms initially included pain rating scales, pain measurement, Visual Analogue Scale, VAS, Verbal Rating Scale, VRS, Numerical/numeric Rating Scale, NRS. The reference lists of retrieved articles were used to generate more papers and search terms. Only English Language papers were examined. Conclusions. All three pain‐rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. For general purposes the Numerical Rating Scale has good sensitivity and generates data that can be statistically analysed for audit purposes. Patients who seek a sensitive pain‐rating scale would probably choose this one. For simplicity patients prefer the Verbal Rating Scale, but it lacks sensitivity and the data it produces can be misunderstood. Relevance to clinical practice. In order to use pain‐rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Interpretation of the data from a pain‐rating scale is not as straightforward as it might first appear.     

Examining gender differences in emerging tobacco use using the Adolescents' Need For Smoking Scale

Aims To investigate the influence of gender on emerging tobacco use by testing for gender‐based measurement invariance of the Adolescents' Need for Smoking Scale (ANSS) and examining gender differences on each dimension across increasing levels of amount smoked. Design Cross‐sectional survey. Setting Thirteen secondary schools located in British Columbia, Canada. Participants Data from 1425 youth who reported smoking at least once in the past month. Measurements Survey questions about demographic characteristics, tobacco smoking history and need for smoking. Findings The multi‐dimensional structure of the ANSS is equivalent in boys and girls and the ANSS questions are not gender‐biased. There were no significant gender differences in the levels of physical dependence across increasing levels of amount smoked. Girls scored higher than boys on levels of emotional dependence across increasing levels of life‐time cigarette exposure. Girls also had higher scores on the social dimension of the ANSS compared to boys among those who smoked 100 or more cigarettes. Conclusions Canadian girls score higher than boys on measures of emotional dependence and social attitudes associated with tobacco smoking.