The Brazilian version of the HS-PedsQL is a valid and reliable tool to measure the overall satisfaction of parents and caregivers with the treatment of their children.

ResumoA Cognição Numérica é infl uenciada por fatores biológicos, cognitivos, educacionais e culturais. Constitui-se tanto de um sistema primário, chamado de Senso Numérico que seria inato e de abrangência universal, quanto de sistemas secundários, como o Cálculo que está implicado a realização de operações matemáticas por meio de símbolos ou palavras e o Processamento Numérico, que se divide em dois componentes, a Compreensão Numérica, que está relacionada ao entendimento de símbolos numéricos e a Produção Numérica: que inclui a leitura, escrita e contagem de números. Entretanto, os estudos que evidenciam o desenvolvimento destas funções em crianças de idade pré-escolar são escassos. Diante disso os objetivos do presente estudo foram investigar a cognição numérica em crianças brasileiras pré--escolares e demonstrar a validade de construto da ZAREKI-K (Bateria Neuropsicológica para Avaliação do Tratamento dos Números e do Cálculo para Crianças pré-escolares). Participaram da pesquisa 42 crianças, entre 5 e 6 anos de idade, de ambos os sexos, estudantes de escolas públicas de educação pré-escolar, que foram avaliadas pelos subtestes da ZAREKI-K e WISC-III. Os Resultados indicaram diferenças signifi cativas associadas à idade em que crianças de 6 anos obtiveram melhores pontuações em subtestes relacionados a Produção numérica, Compreensão numérica e Cálculo, bem como correlações moderadas a fortes entre alguns subtestes de ambos os instrumentos, demonstrando a validade de constructo da bateria. Em conclusão, foram obtidos dados normativos preliminares para a ZAREKI-K, ademais as análises sugerem tratar-se de um instrumento promissor para a avaliação da cognição numé-rica em crianças pré-escolares. Palavras

BackgroundStudies on functional magnetic resonance imaging (fMRI) have shown that adults with musculoskeletal pain syndromes tolerate smaller amount of pressure (pain) as well as differences in brain activation patterns in areas related to pain.The objective of this study was to evaluate, through fMRI, the brain activation in adolescents with idiopathic musculoskeletal pain (IMP) while performing an experimental paradigm of pain.MethodsThe study included 10 consecutive adolescents with idiopathic musculoskeletal pain (average age 16.3±1.0) and 10 healthy adolescents age-matched. fMRI exams were performed in a 3 T scanner (Magnetom Trio, Siemens) using an event-related design paradigm. Pressure stimuli were performed in the nondominant hand thumb, divided into two stages, fixed pain and variable pain.The two local Research Ethics Committees (Ethics Committee from Universidade Federal de São Paulo- Brazil, process number 0688/11, on July 1st, 2011 and Ethics Committee from Hospital Israelita Albert Einsten – Brazil, process number 1673, on October 19th, 2011) approved the study.ResultsThe idiopathic musculoskeletal pain (IMP) group showed a reduced threshold for pain (3.7 kg/cm2 versus 4.45 kg/cm2, p = 0.005). Control group presented increased bain activation when compared to IMP group in the following areas: thalamus (p = 0.00001), precentral gyrus (p = 0.0004) and middle frontal gyrus (p = 0.03). In intragroup analysis, IMP group showed greater brain activation during the unpredictable stimuli of the variable pain stage, especially in the lingual gyrus (p = 0.0001), frontal lobe (p = 0.0001), temporal gyrus (p = 0.0001) and precentral gyrus (p = 0.03), when compared to predictable stimulus of fixed pain. The same intragroup analysis with the control group showed greater activation during the unpredictable stimuli in regions of the precentral gyrus (p = 0.0001), subcallosal area (p = 0.0001), right and left occipital fusiform gyrus (p = 0.0001; (p = 0.0007), middle gyrus (p = 0.01) and precuneus p = (0.02).ConclusionAdolescents with idiopathic musculoskeletal pain (IMP) tend to request higher brain function in cognitive-emotional areas when interpreting unpredictable sensory-perceptual situations. Therefore, it is assumed that this difference in pain processing in adolescents with IMP make the subjective experience of pain something more intense and unpleasant.

OBJECTIVES:The aims of this study were to measure levels of sleep, stress, and depression, as well as health-related quality of life, and to assess the neurocognitive profiles in a sample of adolescents with idiopathic musculoskeletal pain.METHODS:Nineteen adolescents with idiopathic musculoskeletal pain and 20 age-matched healthy control subjects were evaluated regarding their levels of sleep and stress, as well as quality of life, and underwent neurocognitive testing.RESULTS:The sample groups consisted predominantly of females (84%), and the socioeconomic status did not differ between the two groups. In addition, the occurrence of depressive symptoms was similar between the two groups; specifically, 26% of the idiopathic musculoskeletal pain patients and 30% of the control subjects had scores indicative of depression. Teenagers in the group with idiopathic musculoskeletal pain reported poorer quality of life and sleep scores than those in the control group. Regarding stress, patients had worse scores than the control group; whereas 79% of the adolescents with idiopathic musculoskeletal pain met the criteria for a diagnosis of stress, only 35% of the adolescents in the control group met the criteria. In both groups, we observed scores that classified adolescents as being in the resistance phase (intermediate) and exhaustion phase (pathological) of distress. However, the idiopathic musculoskeletal pain group more frequently reported symptomatic complaints of physical and emotional distress. The neurocognitive assessment showed no significant impairments in either group.CONCLUSION:Adolescents with idiopathic musculoskeletal pain did not exhibit cognitive impairments. However, adolescents with idiopathic musculoskeletal pain did experience intermediate to advanced psychological distress and lower health-related quality of life, which may increase their risk of cognitive dysfunction in the future.

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BackgroundAdherence to treatment for chronic diseases is lower in children than in adults, less extensively studied in children and is associated with multiple related factors. The aim of this study is to perform a descriptive analysis of psycho-cognitive aspects of primary caregivers of pediatric patients with chronic rheumatic diseases, as well as socioeconomic and clinical factors, family functioning and treatment satisfaction.MethodsPrimary caregivers of 90 patients were included. Pairs (caregiver plus patient) were grouped as presenting good adherence (n = 50) or poor adherence (n = 40) according to the Morisky Adherence Test. Psycho-cognitive aspects were evaluated by Adult Self-Report and Wechsler Adult Intelligence Scale tests. For statistical comparisons, quantitative variables with normal distribution were analyzed by Student’s t test, and those with non-Gaussian distribution with the Mann Whitney test. Categorical variables were analyzed by Chi square test. A multivariate logistic regression analysis was performed to estimate the contribution of the independent variables to adherence.ResultsCompared to caregivers in the good adherence group, caregivers in the poor adherence group were more likely to be classified as clinical on the scales for attention problems and externalizing problems, which include impulsiveness and aggressiveness. They also scored higher on the depressive problem scale. In addition, the average number of children per caregiver and the mean age of caregivers and patients were significantly higher in the poor adherence group, while the proportion of caregivers with higher education was lower. The poor adherence group also included a higher incidence of pediatric patients assuming sole responsibility for managing medications. Economic status, clinical factors, treatment satisfaction, family functioning and caregiver cognitive profile were not related to adherence, except for working memory index.ConclusionOlder patients, patients as the one solely responsible for medication management, and caregivers with externalizing problems, were observed to be the most strongly associated to poor adherence. Interventions aimed at adolescent patients are needed. Also, psychological programs and interventional studies to better determine caregivers’ behavioral/emotional status, and parent-child relationships are recommended.

ResumoObjetivo: A dor musculoesquelética difusa idiopática persistente ou intermitente é definida pela presença de dor com duração de três meses ou mais, sem etiologia aparente, e tem acometido cada vez mais crianças e adolescentes. Este estudo objetivou relatar dois pacientes com dor incapacitante submetidos à abordagem e ao tratamento multiprofissional, além de discutir o tratamento conduzido, por meio de revisão da literatura atual.Descrição do caso: O primeiro caso é de uma menina com nove anos de idade, com histórico de cefaleia, dor musculoesquelética e dor abdominal há dois anos, período no qual apresentou quatro episódios de ausência de marcha, sem causas orgânicas aparentes. O segundo caso refere-se a uma adolescente de 14 anos com lombalgia diária há 14 meses de forte intensidade, com irradiação para membros inferiores, acompanhada de cefaleia, fadiga e adinamia. Ambas apresentavam exame físico normal, exceto pela presença de alodínia (caso 1) e pontos de fibromialgia (caso 2); além de exames subsidiários normais, sem justificativas orgânicas para as queixas dolorosas. Houve melhora clínica significativa após diagnóstico e tratamento diferencial por meio de abordagem multiprofissional (médico, psicólogo, fisioterapeuta e nutricionista), com retomada das atividades regulares pelas pacientes.Comentários: A atuação integrada da equipe em um curto período de tempo proporcionou às pacientes a retomada de suas atividades normais, visto que fatores emocionais, físicos e nutricionais relacionam-se à dor.Palavras-chave: dor; fibromialgia; criança; adolescente. AbstRActObjective: Persistent or intermittent diffuse idiopathic musculoskeletal pain is defined by the presence of pain over three months with no apparent etiology. The diagnosis of this condition in children and adolescents is increasing. The objective of this study was to report the cases of two patients with disabling pain that received multidisciplinary treatment and to review the current literature about this subject.Case description: The first patient is a nine-year old girl with history of headache, musculoskeletal pain and abdominal pain for two years. During this period she had four episodes of absence of gait with no apparent organic cause. The second patient is a 14-year girl with severe daily low back pain for 14 months, followed by headache and fatigue. Both patients presented a normal physical examination, except for allodynia (case 1) and fibromyalgia tender points (case 2). All tests resulted negative regarding the search for organic reasons for pain complaints. Significant clinical improvement was observed with a multidisciplinary approach offered by pediatricians, psychologists, physical therapists, and nutritionists. Both patients resumed their daily regular activities.Comments: Team integrated performance in a short-term period can provide the attenuation of pain symptoms since emotional, physical and nutritional factors are related to the pain expressed by the patients.

Normative studies of the International Affective Picture System (IAPS) have been developed in several countries, observing culturally determined differences, which seem to vary by age group and gender. Brazil has normative data for the seniors and adults; however, pediatric studies are scarce. The objective of the study was to obtain the category ratings for valence and arousal of a set of these images for Brazilian teenagers and check whether its ratings are gender related. In the study, 161 teenagers, aged 12–18 years, categorized valence and arousal dimensions of 180 pictures from the IAPS through the Self-Assessment Manikin instrument. The comparison between genders showed differences in this classification. Teenage girls attributed more valence and less arousal to pleasant images and less valence and more arousal when facing unpleasant figures compared with teenage boys. In addition, both genders expressed their emotions in different intensities but were similar in categorizing this emotionality (as pleasant, unpleasant, or neutral). The IAPS proved to be an effective tool for assessing emotional reactions because the general categorization followed an equivalent pattern observed in previous studies and validated a set of IAPS images for use properly in Brazilian teenagers.