Lifestyle and quality of life in children and adolescents during the covid-19 social distancing period

Abstract Objective To evaluate the lifestyle and quality of life in Brazilian children and adolescents during the COVID-19 social distancing period in 2020. Methods This cross-sectional study evaluated children and adolescents (2-18 years of age) and their parents, who voluntarily participated in an online survey. Snowball sampling was used to recruit participants during the first 6 months of the pandemic. A questionnaire was used to characterize the study population. The PedsQL 4.0 and the EUROHIS-QOL 8-item index were used to assess the quality of life (QoL) in children/adolescents and parents, respectively. Data were analyzed using SPSS 18.0 statistical program through the ANOVA with post hoc Bonferroni analysis, student's t test, and the generalized estimating equation. Results Mean screen time increased from 2h pre-pandemic to 5h during the pandemic (p <0.001), which was associated with a decline in PedSQL4.0 scores (from 75.7 ± 2.6 to 71.3 ± 13.7, p <0.001). Unhealthy eating habits increased from 11% to 34% and were associated with worse QoL scores compared with improved or unchanged eating habits during the pandemic (69.7 ± 13.3 vs 72.80 ± 13.4 vs 76.4 ± 12.6; p <0.001). Poor sleep quality increased from 9% to 31.7% and was associated with worse QoL scores compared to improved or unchanged sleep quality during the pandemic (67.3 ± 13.1 vs 74.5 ± 13.1 vs 76.8 ± 12.2; p <0.05). Physical exercise was associated with better PedSQL4.0 scores (77.5 ± 12.3 vs 72.5 ± 14.4; p <0.001). Children aged 2-4y old had the best QoLscores. Conclusions Pandemic-related social distancing promoted significant lifestyle changes in children and adolescents, increasing screen time, reducing physical activity, and worsening food and sleep quality, which resulted in worse QoL scores.

A Estratégia Saúde da Família e o enfrentamento à violência contra crianças e adolescentes: revisão integrativa / The Family Health Strategy and addressing violence against children and adolescents: an integrative review

Resumo Objetivou-se evidenciar na literatura científica o que se foi discutido sobre o enfrentamento à violência contra crianças e adolescentes no âmbito da Estratégia Saúde da Família. Trata-se de uma revisão integrativa da literatura, realizada nas bases de dados Medical Literatute Analysisand Retrieval System Online (Medline), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Web of Science e American Psychological Association (PsycINFO) e nestas, utilizaram-se os descritores controlados em Ciências da Saúde (DeCs) e do Medical Subject Headings (MeSH), sendo estes: "domestic violence", "child abuse", "educational technology", "primary health care" para DeCs e MeSh. Obteve-se um total de 2.403 resultados, com aplicação dos critérios de inclusão e exclusão foram analisados 15 artigos. A violência é vista como um problema de saúde pública, sendo identificada como um problema sensível a APS. Apesar da identificação de casos de violência contra crianças e adolescentes na ESF, o despreparo dos profissionais e a fragilidade na rede de enfrentamento fragmentam a assistência adequada a este público. Assim, há necessidade de fortalecimento da rede disponibilizada e incentivo a capacitação e formação dos profissionais atuantes na APS.

Abstract The scope of this study was to highlight what has been discussed about addressing violence against children and adolescents in the context of the Family Health Strategy in the scientific literature. It involved an integrative review of the literature, conducted in the Medical Literature Analysis and Retrieval System Online (Medline), Latin American and Caribbean Literature on Health Sciences (LILACS), Web of Science and American Psychological Association (PsycINFO) databases. In the survey, the controlled descriptors in Health Sciences (DeCS) and the Medical Subject Headings (MeSH) were used, including domestic violence, child abuse, educational technology and primary health care for DeCS and MeSH. A total of 2,403 results were obtained, with the application of the inclusion and exclusion criteria, and 15 articles were analyzed. Violence has been seen as a public health problem, being identified as a sensitive problem in PHC. Despite the identification of cases of violence against children and adolescents in the FHS, the lack of preparedness of professionals and the fragility in the coping network prejudice the adequate care for this public. Thus, there is a need to strengthen the network available and encourage the capacity building and training of professionals working in PHC.

Victimization and risk factors in children and adolescents admitted into outpatient protection center in northern Chile

The present study aimed to identify the proportion of victimization, types of victimization, and risk factors associated to children and adolescents who were admitted into an outpatient protection center for children and adolescents in northern Chile during the years 2016 and 2017. Secondary data from the database pertaining to the protection center was used. The sample was non-probabilistic and included 6,499 cases. The research was descriptive-comparative with a non-experimental retrospective cross-sectional design. The results showed a higher percentage of victimization by neglect, followed by witnessing domestic violence and child sexual abuse. The sociodemographic variables showed a higher percentage of victimization at the age of 6 to 9 and 14 to 17 years old, in children and adolescents who were in the first and second cycle of elementary school and were Chilean. It was found that children victimized by child sexual abuse and bullying also had a drug diagnosis record. Logistic regression analyses showed that gender, age, schooling, nationality, and a drug diagnosis record increase the probability of occurrence of certain types of victimization. The results showed the magnitude of the problem concerning victimizations experienced by children and adolescents in northern Chile and the need to generate prevention strategies for this population.

El presente estudio tuvo como objetivo identificar la proporción de victimización, tipos de victimización y factores de riesgo asociados a los niños, niñas y adolescentes que ingresaron a un Centro de Protección a la infancia en el norte de Chile durante los años 2016 y 2017. Se utilizaron datos secundarios de la base de datos del sistema de protección a la infancia. La muestra fue no probabilística e incluyó 6.499 casos. La investigación fue descriptiva-comparativa con un diseño no experimental retrospectivo de corte transversal. Los resultados mostraron un mayor porcentaje de victimización por negligencia, seguido por presenciar violencia doméstica y abuso sexual infantil. Las variables sociodemográficas mostraron un mayor porcentaje de victimización en la edad de 6 a 9 y de 14 a 17 años, en niños y adolescentes que cursaban el primer y segundo ciclo de primaria y eran chilenos. Se encontró que los niños víctimas de abuso sexual infantil y bullying también tenían un registro de diagnóstico de drogas. Los análisis de regresión logística mostraron que el género, la edad, la escolaridad, la nacionalidad y un registro de diagnóstico de drogas aumentan la probabilidad de ocurrencia de ciertos tipos de victimización. Los resultados evidencian la magnitud del problema de las victimizaciones que sufren los niños, niñas y adolescentes del norte de Chile y la necesidad de generar estrategias de prevención para esta población.

Experiências adversas na infância: um estudo com autores de agressão sexual / Experiencias infantiles adversas: un estudio con perpretadores de agresiones sexuales / Adverse childhood experiences: a study addressing the perpetrators of sexual violence

This study aimed to describe the Adverse Childhood Experiences (ACE) of perpetrators of sexual violence of children and adolescents and their relationship with the abusers' personal and situational factors (n = 30). Hence, a database composed of the transcripts of interviews was analyzed using content analysis, from which thematic categories emerged as proposed by the Adverse Childhood Experiences International Questionnaire (ACE-IQ). Physical abuse was the most frequently reported (70%). Sexual abuse was reported by almost half of the sample, which presented an increased risk in the face of the death and/or divorce of parents (RR = 4.21) and emotional neglect (RR = 3.2). In addition, the participants with higher ACE-Scores abused children more recurrently and less frequently consumed alcohol or other drugs. The interpretation of the results in light of the literature reinforces the hypothesis that the consequences of adversities during childhood are associated with a higher likelihood of becoming a victim throughout life and manifesting risky behaviors, such as aggressive sexual behavior. Future studies are suggested to apply the ACE-IQ to larger samples and implement a post-test to contribute to more effective interventions to treat this population.

Este estudio tuvo como objetivo analizar las Experiencias Adversas en la Infancia por parte de los perpetradores de agresión de niños y niñas y la asociación con factores personales y situacionales identificados. (n = 30). Para ello, se utilizó el instrumento de cribado del Cuestionario Internacional de Experiencias Adversas en la Infancia (ACE-IQ) para el análisis de los datos. El maltrato físico fue reportado con mayor frecuencia (70%) y el abuso sexual fue mencionado por casi la mitad de la muestra, con su riesgo aumentado ante la muerte y/o divorcio de los padres (RR = 4,21) y negligencia emocional (RR = 3.2). Participantes con ACE-Scores más altos han agredido repetidamente a sus víctimas y con menos necesidad de consumir alcohol y/o otras drogas. Los resultados muestran que las consecuencias de la exposición a la adversidad en la infancia están asociadas no solo a la probabilidad de convertirse en víctima a lo largo de la vida, sino también a caminos de transitar permeados por conductas de riesgo y criminalidad. Se sugiere que más estudios puedan aplicar el ACE-IQ a muestras más grandes, con la realización de una prueba posterior, lo que puede contribuir a intervenciones más efectivas al servicio de esta población.

Este estudo objetivou descrever Experiências Adversas na Infância (EAI) relatadas por autores de agressão sexual de crianças e adolescentes e sua relação com fatores pessoais e situacionais identificados (n = 30). Para tanto, utilizou-se um banco de dados formado por transcrições de entrevistas previamente realizadas, cuja análise de conteúdo considerou categorias temáticas retiradas do Adverse Childhood Experiences International Questionnaire (ACE-IQ). O abuso físico foi o mais relatado (70%) e o abuso sexual mencionado por quase metade da amostra, tendo seu risco aumentado diante da morte e/ou separação dos pais (RR = 4.21) e negligência emocional (RR = 3.2). Participantes com maiores ACE-Scores agrediram de forma mais recorrente e com menor uso de álcool e/ou outras drogas. A interpretação dos resultados à luz da literatura da área reforça a hipótese de que as consequências da exposição à adversidade na infância estão relacionadas tanto à probabilidade de tornar-se vítima ao longo da vida quanto de vir a manifestar comportamentos de risco, como a conduta sexual agressiva. Estudos posteriores poderão aplicar o ACE-IQ diretamente e em amostras maiores, com a realização de pós-teste, o que favorecerá a promoção de intervenções mais eficazes no atendimento a essa população.

Evaluation of the Biochemical, Physicochemical and Microbiological Quality of Soft Drinks Sold in Some Elementary School of Williamsville (Abidjan, Côte d’Ivoire)

The sale of soft drinks in and around primary schools is recurrent in Côte d'Ivoire. The objective of this work is to evaluate the rate of some biochemical and physicochemical parameters and the health risks related to the consumption of soft drinks. The biochemical and physicochemical parameters were determined according to the standard SOXHLET technique, that of Kjeldhal and also that described by Dubois et al in1956. Potentially pathogenic and pathogenic germs were enumerated and researched according to reference methods described by AFNOR. The moisture content of the different beverages ranged from 3.9±0.05 to 3.2±0.05, and the sugar content from 26.06±2.05 to 5.96±1.60. For the acidity, the higher value was 0.93± 0.15 (Bissap juice) and the lowest was 0.64± 0.02 (Tamarind juice). For proteins, the high value was 44.15 ± 0.11 (Milk Mint Juice) and the low value was 38.15 ± 0.11 (Ginger Juice). As for dry matter, the highest value was found in ginger juice (44.76 ±0.02) and the lowest in bissap juice (40.96 ±0.01). Soft drinks sold in Williamsville schools contain such potentially pathogenic species as Staphylococcus aureus and Bacillus cereus with a wide range of loadings in the drinks. Escherichia coli was not identified. No Salmonella was observed in the different soft drinks analyzed. The presence of potentially pathogenic germs could pose a danger to school children.

Factores asociados a la adherencia al tratamiento farmacológico del trastorno por déficit de atención e hiperactividad (TDAH): revisión preliminar / Factors associated with adherence to pharmacological treatment of attention deficit hyperactivity disorder (ADHD): preliminary review

Resumen Introducción: El tratamiento del TDAH es seguro y eficaz, pero con frecuencia existen bajos niveles de adherencia al tratamiento. En este artículo describimos factores asociados a la adherencia des critos en la literatura disponible. Métodos: Realizamos una búsqueda bibliográfica no sistemática sobre artículos recientes sobre la adherencia a la medicación en niños y adolescentes con TDAH. Resultados: Hay factores asociados al propio trastorno, al paciente, al sistema de salud, factores socio-económicos, a la medicación y al entorno que pueden reducir o aumentar la adherencia a la medicación. Algunos factores que mejoran la adhe rencia incluyen: el conocimiento sobre el TDAH, la medicación y sus beneficios y efectos adversos potenciales. Regímenes de medicación sencillos, una vez al día y de liberación prolongada. Edad del paciente menor de 12 años y sexo femenino. Menos barreras de acceso al sistema de salud. Actitud positiva y proactiva de los padres respecto al TDAH y el uso de medicación. Discusión: Se podría optimizar la adherencia y por lo tanto mejorar el pronóstico a largo plazo del TDAH reforzando estos factores que aumentan la adherencia, y reduciendo los sesgos y desconocimiento sobre el TDAH.

Abstract Introduction: ADHD treatment is safe and effective, but often, adherence to t reatment is suboptimal. We studied factors associated to adherence to treatment in ADHD described in the literature. Methods: We conducted a non-systematic bibliographic search on recent articles on medication adherence in children and adolescents with ADHD. Results: There are factors associated with the disorder itself, the patient, the health system, socio-economic factors, the medication and the environment that can reduce/improve medication adherence. Some factors that improve adherence include: knowledge about ADHD, medication and its benefits and potential adverse effects. Simple, once-daily, extended-release medication regimens. Age of the patient less than 12 years and female sex. Fewer barriers to access the health system. Positive and proactive attitude of parents regarding ADHD and the use of medication. Discussion: Adherence could be optimized and therefore the long-term prognosis of ADHD improved by reinforcingfactors that increase adherence, and reducing biases and ignorance about ADHD.

Analysis on the status and influencing factors of health care intention in transitional children and adolescents with diabetes / 中国实用护理杂志

Objective:To investigate the intention to participate in health care in transitional children and adolescents with diabetes and analyze its influencing factors.Methods:This was a cross-sectional survey study. From March to October 2021, 185 children and adolescents with diabetes were selected as research subjects by convenience sampling method from People′s Hospital Affiliated to Jiangsu University. General data questionnaire, Participation in Health Care Intention Questionnaire, Health Literacy Scale and Diabetes Self-management Scale were used to investigate, and multiple linear regression was used to analyze the influencing factors of the population′s intention to participate in health care.Results:The transitional children and adolescents with diabetes participation in health care intention total score was (124.87 ± 16.31) points, the health literacy total score was (33.70 ± 4.38) points, diabetes self-management total score was (35.11 ± 5.19) points. The regression analysis found that age, course of the disease, diabetes type, family structure modes, health literacy, and self-management ability were the main factors influencing adolescents involved in health care intention ( t values were -1.99-2.66, all P<0.05), including health literacy ability and disease management ability was positively correlated with the disease ( r = 0.250, 0.232, both P<0.01). Conclusions:The transitional children and adolenscents with diabetes have a medium level of intention to participate in health care. The transitional children and adolenscents with older age, longer disease course and nuclear family structure had higher levels of health care intention. The higher the level of health literacy and self-management, the higher the level of intention to participate in health care, medical staff should take targeted measures to improve the intention to participate in health care, promote this group to improve disease management ability and quality of life.

Interpretation of the Evidence-based Recommendations for the Treatment and Prevention of Non-specific Back Pain in Children and Adolescents by the German Society of Pediatrics and Adolescent Medicine in 2022 / 中华实用儿科临床杂志

In February 2022, the German Society of Pediatric and Adolescent Medicine published the first Evidence-based Recommendations for the Treatment and Prevention of Non-specific Back Pain in Children and Adolescents, which provides clinical evidence and recommendations for the etiology, risk factors and diagnosis of back pain in children and adolescents, and the treatment and prevention suggestions on the non-specific back pain.Although the guideline for the diagnosis and treatment of non-specific low back pain have been launched in China, a specific description of back pain in children and adolescents is lacking.With regard to increasing incidence of low back pain in children and adolescents, and differences in term of the etiology, risk factors, diagnosis and treatment of back pain between children-adolescents and adults, this article aims to interpret the guidelines to provide references and guidance for the clinical diagnosis and treatment of back pain in children and adolescents.

A study of continuous subcutaneous insulin infusion in children with type 1 diabetes mellitus / 国际儿科学杂志

Objective:To study the effect of continuous subcutaneous insulin infusion(CSII)on the emotional disorder of children and adolescents with type 1 diabetes mellitus(T1DM)and their parents.Methods:A total of 72 children and adolescents with T1DM were divided into CSII group( n=40)and multiple daily injection(MDI)group( n=32).There were 58 healthy children and adolescents with their parents selected as control group.The emotional condition of children and adolescents in T1DM group and control group was evaluated by Depression Self-rating Scale for Children(DSRS)and the Screen for Child Anxiety Related Emotional Disorders(SCARED)respectively, and Symptom Checklist-90(SCL-90)was used for evaluating the mental health of all parents. Results:The average glycated hemoglobin A1c(HbA1c)of T1DM group was at the optimal level(7.406±1.294)%.The average HbA1c of CSII group was significantly lower than that of MDI group[(7.040±1.082)% vs(7.863±1.404)%, t=2.728, P=0.008].The depression rate of children and adolescents in T1DM group increased significantly than that of control group(31.9% vs 15.5%, χ2 =4.671, P=0.031).There were statistically significant differences among CSII group, MDI group and control group(20.0% vs 46.9% vs 15.5%, χ2 =11.591, P=0.003).The depression rate of children and adolescents in MDI group increased significantly than that of CSII group and control group(all P<0.05).CSII group showed similar results as compared with control group( P>0.05).Concerning the anxiety in children and adolescents, there was no significant difference between T1DM group and control group(19.4% vs 13.8%, χ2=0.730, P=0.393), and there were no significant differences among CSII group, MDI group and control group(15.0% vs 25.0% vs 13.8%, χ2=1.994, P=0.369).The emotional disorder prevalence of parents in T1DM group was remarkably higher than that of the control group(31.9% vs 5.2%, χ2=52.927, P<0.01).The factor scores of obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, paranoia and psychotic symptoms in T1DM group were higher than that of control group( P<0.05).There were statistically significant differences among CSII group, MDI group and control group(17.5% vs 50.0% vs 5.2%, χ2=26.126, P<0.01).The emotional disorder prevalence of parents in MDI group increased significantly than that of CSII group and control group(all P<0.05).But CSII group was same as that of control group( P>0.05). Conclusion:The children and adolescents with T1DM and their parents were high-risk population of emotional disorder.CSII can reduce not only the depression in the children and adolescents with T1DM, but also emotional disorder of their parents, thus CSII can improve the mental health in families suffering from T1DM.

Research status of non-suicidal self-injury in children and adolescents / 四川精神卫生

The purpose of this paper is to review the research status on non-suicidal self-injury （NSSI） in children and adolescents， so as to provide references for the cognition and intervention of NSSI behavior in children and adolescents. NSSI behavior is an independent risk factor for suicide， which not only poses a serious threat to the mental health of children and adolescents， but also brings a great burden on families and society. This paper focuses on the epidemiology， etiology， relationship with other psychiatric disorders， and treatment of NSSI behaviors in children and adolescents.

Research progress and discipline development of mental disorders in children and adolescents / 四川精神卫生

A demand-capacity mismatch exists between the services for child and adolescent mental health and the needs of society， and the contradiction is becoming increasingly prominent. This study aims to present a thorough analysis of the current status of research in child and adolescent mental disorders and the direction of discipline development， which consists of the epidemiology， etiology and pathogenesis， diagnostic progress， treatment progress and disciplinary development in child and adolescent mental disorders. Mental disorders in children and adolescents are known to have a high prevalence rate， and the disease is most likely to continue into adulthood if it is not identified and treated in a timely manner， posing a serious burden on patients， families and society. Currently， the etiology and pathogenesis of mental disorders in children and adolescents still remain unclear due to its complexity and the numerous interrelated contributing factors such as genetics， environment， stress events and so on. And the diagnosis is limited to symptomatology and lacks objective indicators. Therapeutically， the various treatment options available have shown certain clinical effectiveness， while suboptimal treatment outcomes have been reported among some children， which require multidisciplinary comprehensive intervention. Furthermore， the research on imaging genetics， new drug-target search， wise information technology of med and brain sciences needs to be strengthened， thus providing a broader approach to better address the needs of mental health services for children and adolescents.

Content and psychological measurement index of ICF-CY-based motor function evaluation scale for children and adolescents with disabilities: a scoping review / 中国康复理论与实践

ObjectiveTo analyze the content and psychological measurement indicators of the commonly used motor function assessment tools for children and adolescents, based on the theory and method of International Classification of Function, Disability and Health-Children and Youth Version (ICF-CY). MethodsBased on the ICF-CY classification framework and coding system, four commonly used functional evaluation tools for children and adolescents were selected, and their motor function measurement methods and psychological measurement indicators were analyzed by applying ICF coding rules and matching principles. ResultsFinally, nine English articles and two Chinese articles were included, from four countries including South Korea, Spain, China and Brazil. They were mainly published in the journals of clinical medicine, neuroscience, public health, rehabilitation science and other fields from 2011 to 2021. The age of the subjects was 0 to 16 years old involving 987 subjects; the health condition included spastic cerebral palsy, neurodevelopmental disorder, etc. Among the eleven articles included, six articles used Gross Motor Function Measure (GMFM-88), two articles used Fine Motor Function Measure Scale (FMFM), two articles used Peabody Developmental Motor Scales Second Edition (PDMS-2), and two articles used Pediatric Evaluation of Disability Inventory-Functional Skills Scale (PEDI-FSS), and three articles used Pediatric Evaluation of Disability Inventory (PEDI). The measurement methods were objective evaluation, subjective evaluation, and subjective observation, etc. The number of measurements was two to six. The measurement indicators of motor function mainly involved two levels. The first was the physical activity level, including gross movement, fine movement and motor control ability. The second was the functional level of activities, mainly including activities of daily living and functional independence. ConclusionBased on ICF-CY, the evaluation of children's motor function and activity and participation was mainly divided into two levels. At the body function level, the main evaluation indicators included b730, b760, b770, etc. At the level of activities and participation, the main evaluation indicators were d410, d440, d445, etc. GMFM-88 focuses on the evaluation of children's body movement and activity functions, such as sitting, standing, lying, walking and running, mainly involving b760, d410, d455, etc. FMFM focused on autonomous movement, motor motivation and motor coordination, and was mainly used to assess the functional status of upper limbs of children with cerebral palsy aged 0 to 3 years, mainly involving b760, d155, d440, etc. PDMS-2 payed more attention to evaluating the overall motor development level and motor function status of children and adolescents, mainly involving b750, b760, d415, etc. PEDI-FSS move partition focused on children's actual motor function performance in activities of daily living, and evaluated the application and practicability of children's motor function in activities of daily living, mainly involving b760, d410, d450, etc. In terms of measurement methods, the measurement of motor function mainly included objective evaluation and subjective evaluation; the measurement of activity function mainly included objective evaluation and subjective observation. These assessment tools have established norms varies with different age groups according to the movement development. Evaluators need accept professional training before using the above assessment tools to improve the reliability, validity and adaptability of the assessment.

Clinical characteristics and treatment of spinal cord injury in children and adolescents / 中华创伤杂志(英文版)

Pediatric and adult spinal cord injuries (SCI) are distinct entities. Children and adolescents with SCI must suffer from lifelong disabilities, which is a heavy burden on patients, their families and the society. There are differences in Chinese and foreign literature reports on the incidence, injury mechanism and prognosis of SCI in children and adolescents. In addition to traumatic injuries such as car accidents and falls, the proportion of sports injuries is increasing. The most common sports injury is the backbend during dance practice. Compared with adults, children and adolescents are considered to have a greater potential for neurological improvement. The pathogenesis and treatment of pediatric SCI remains unclear. The mainstream view is that the mechanism of nerve damage in pediatric SCI include flexion, hyperextension, longitudinal distraction and ischemia. We also discuss the advantages and disadvantages of drugs such as methylprednisolone in the treatment of pediatric SCI and the indications and timing of surgery. In addition, the complications of pediatric SCI are also worthy of attention. New imaging techniques such as diffusion tensor imaging and diffusion tensor tractography may be used for diagnosis and assessment of prognosis. This article reviews the epidemiology, pathogenesis, imaging, clinical characteristics, treatment and complications of SCI in children and adolescents. Although current treatment cannot completely restore neurological function, patient quality of life can be enhanced. Continued developments and advances in the research of SCI may eventually provide a cure for children and adolescents with this kind of injury.

Influência da pandemia na rotina da equipe multiprofissional na alta hospitalar de crianças e adolescentes com condições crônicas / Influence of the pandemic on the routine of the multidisciplinary team at hospital discharge of children and adolescents with chronic conditions / Influencia de la pandemia en la rutina del equipo multidisciplinario al alta hospitalaria de niños y adolescentes con condiciones crónicas

Objetivo: identificar os desafios para o preparo da alta hospitalar de crianças e adolescentes no cenário pandêmico da Covid-19. Método: Trata-se de uma pesquisa descritiva, de caráter exploratório e abordagem qualitativa realizada com a equipe multi- disciplinar na clínica pediátrica de um Hospital Universitário localizado na Paraíba. As entrevistas foram transcritas e analisadas à luz da Análise do Conteúdo de Bardin. Re- sultados: A partir da análise dos dados foram construídos em duas categorias: Rotina da equipe multiprofissional e as medidas de biossegurança institucionalizadas e Desafios da equipe no preparo para alta de crianças e adolescentes durante a pandemia do Sars-Cov-2. Observou-se a percepção dos profissionais frente à complexidade da pandemia da Covid-19 e o direcionamento da alta hospitalar mediante as necessidades de saúde de crianças e adolescentes com condições crônicas. Conclusão: durante a pandemia, o preparo para alta hospitalar de crianças e adolescentes apresentou mudanças quanto à organização setorial frente aos procedimentos e demandas, assim como as restrições de contato desfavorecendo o apoio aos familiares. Aponta-se a necessidade de novas pesquisas relacionadas às análises frente ao processo de desospitalização, com intuito de possibilitar a reflexão em torno das problemáticas evidenciadas e elaborar uma análise do cenário para posteriores mudanças.

Objective: to identify the challenges for preparing children and adolescents for hospital discharge in the Covid-19 pandemic scenario. Method: This is a descriptive, exploratory research with a qualitative approach carried out with a multidisciplinary team at the pediatric clinic of a University Hospital located in Paraíba. The interviews were transcribed and analyzed using Bardin's Content Analysis. Results: From the analysis of the data, two categories were constructed: Routine of the multidisciplinary team and institutionalized biosecurity measures and Challenges of the team in preparing for the discharge of children and adolescents during the Sars-Cov-2 pandemic. The professionals' perception of the complexity of the Covid-19 pandemic and the direction of hospital discharge based on the health needs of children and adolescents with chronic conditions were observed. Conclusion: during the pandemic, preparation for hospital discharge of children and adolescents showed changes in terms of sectoral organization in terms of procedures and demands, as well as contact restrictions, disfavoring support for family members. It points out the need for further research related to the analysis of the process of dehospitalization, with the aim of enabling reflection on the problems highlighted and preparing an analysis of the scenario for subsequent changes.

Objetivo: identificar los desafíos para la preparación de niños y adolescentes para el alta hospitalaria en el escenario de la pandemia de Covid-19. Método: Se trata de una investigación descriptiva, exploratoria, con enfoque cualitativo, realizada con un equipo multidisciplinario en la clínica pediátrica de un Hospital Universitario ubicado en Paraíba. Las entrevistas fueron transcritas y analizadas utilizando el Análisis de Contenido de Bardin. Resultados: A partir del análisis de los datos, se construyeron dos categorías: Rutina del equipo multidisciplinario y medidas de bioseguridad institucionalizadas y Desafíos del equipo en la preparación para el alta de niños y adolescentes durante la pandemia del Sars-Cov-2. Se observó la percepción de los profesionales sobre la complejidad de la pandemia de Covid-19 y la dirección del alta hospitalaria a partir de las necesidades de salud de niños y adolescentes con condiciones crónicas. Conclusión: durante la pandemia, la preparación para el alta hospitalaria de niños y adolescentes presentó cambios en cuanto a la organización sectorial en cuanto a trámites y demandas, así como restricciones de contacto, desfavoreciendo el apoyo a los familiares. Señala la necesidad de más investigaciones relacionadas con el análisis del proceso de deshospitalización, con el objetivo de permitir la reflexión sobre los problemas destacados y preparar un análisis del escenario para los cambios posteriores.

Saúde mental infantojuvenil e experiências de profissionais da educação no contexto da suspensão de atividades escolares presenciais na pandemia de Covid-19 / Children's mental health and experiences of education professionals in the context of the suspension of classroom school activities in the Covid-19 pandemic

O objetivo geral desta dissertação foi descrever e analisar relatos de professores e coordenadores de uma escola pública municipal de Niterói-RJ sobre como eles perceberam seus alunos durante a pandemia de COVID-19 e identificar possíveis ações estratégicas de como a escola abordou a temática da saúde mental durante o período de isolamento social e suspensão das atividades escolares presenciais. Adicionalmente, analisaram-se publicações de instituições nacionais e internacionais de saúde relativas ao tema da saúde mental infantojuvenil no contexto da pandemia, com foco em suas correlações com o "fechamento" de escolas. Trata-se de uma pesquisa qualitativa de cunho exploratório na qual houve uma busca em sites oficiais de entidades como OMS/OPAS, UNICEF, FIOCRUZ, ABRASME, ABRASCO, SBP e ABP, a fim de identificar os diferentes discursos sobre a temática da saúde mental infantojuvenil. O estudo contou com a busca em sites e outros meios midiáticos de comunicação para contextualizar sócio-histórico e culturalmente o período de isolamento social no Brasil e no município em questão. Foram realizadas seis entrevistas semiestruturadas com os funcionários da referida escola, a fim de se conhecer suas vivências e experiências quanto ao ensino remoto, o ensino híbrido e a sua retomada para o presencial. Os resultados obtidos foram discursos heterogêneos em relação: à sobrecarga de trabalho; às dificuldades de adaptar-se ao ensino remoto e o acesso à plataforma digital disponibilizada pela prefeitura; à falta de acesso à internet contribuindo para uma ausência dos alunos nas aulas remotas; às ações de acolhimento entre os professores e entre professor/escola-aluno; presença aumentada de alunos com deficiência tanto nas atividades escolares propostas, quanto na demanda de pais e responsáveis durante esse período. Quanto à análise dos materiais publicados pelas instituições citadas, dentre os principais assuntos publicados, compreendendo o período de março de 2020 a janeiro de 2023, estão: dados epidemiológicos do impacto do coronavírus em crianças e adolescentes (número de casos confirmados, número de óbitos e curvatura da onda); impactos da pandemia na educação; saúde mental infantojuvenil e isolamento físico; retorno seguro às aulas e desafios de reabertura. No que se refere aos impactos na saúde mental, os documentos apontaram para: aumento da ansiedade, depressão, transtornos alimentares, insônia, enurese noturna e outros sintomas; desinteresse e perda de perspectiva ou planejamento futuro; desorganização ou surtos em casos de pessoas já em sofrimento psíquico, entre outros.

The general objective of this dissertation was to describe and analyze reports from teachers and coordinators of a municipal public school in Niterói-RJ about how they perceived their students during the COVID-pandemic19 and identify possible strategic actions of how the school addressed the theme of mental health during the period of social isolation and suspension of classroom school activities. The specific objective was to analyze publications of national and international health institutions related to the theme of children's and youth mental health in the context of the pandemic, focusing on their correlations with the "closure" of schools. This is a qualitative research of exploratory nature in which there was a search on official websites of entities such as WHO/ PAHO, UNICEF, FIOCRUZ, ABRASME, ABRASCO, SBP and ABP, in order to identify the different discourses on the theme of children's mental health. The study included the search in websites and other media of communication to contextualize socio-historical and culturally the period of social isolation in Brazil and the municipality in question. Six semi-structured interviews were conducted with the employees of that school, in order to know their experiences and experiences regarding remote education, hybrid teaching and its resumption to the classroom. The results obtained were heterogeneous discourses regarding: work overload; difficulties in adapting to remote education and access to the digital platform provided by the city hall; the lack of access to the Internet contributing to an absence of students in remote classes; the reception actions between teachers and between teacher/school-student; super presence of students with disabilities both in the proposed school activities, demand of parents and guardians during this period. As for the analysis of the materials published by the mentioned institutions, among the main published subjects, including the period from March 2020 to January 2023, are: epidemiological data on the impact of coronavirus on children and adolescents (number of confirmed cases, number of deaths and wave curvature); impacts of the pandemic on education; child and adolescent mental health and physical isolation; safe return to classes and reopening challenges. As regards mental health impacts, the documents pointed to: increased anxiety, depression, eating disorders, insomnia, nocturnal enuresis and other symptoms; disinterest and loss of perspective or future planning; disorganization or outbreaks in cases of people already in psychological distress, among others.

Saúde mental infanto-juvenil: o cuidado em municípios de pequeno porte / Children and adolescents mental health: the care in the small sized-cities / Salud mental infanto-juvenil: el atención en municipios pequeños

Resumo Esta pesquisa apresenta as estratégias de cuidado em Saúde Mental Infanto-Juvenil (SMIJ) no município de Guamiranga, localizado na região centro sul do estado do Paraná. Buscamos compreender quais as estratégias utilizadas, a partir das experiências dos Agentes Comunitários de Saúde (ACS), para identificar e acompanhar crianças que possuem demandas de cuidados em saúde mental. Dividiu-se em três momentos: acompanhamento das visitas domiciliares, um grupo focal com as ACS e a análise e sistematização dos dados a partir da Análise Institucional. Entendemos que para produzir o cuidado nesta rede complexa da SMIJ, é preciso superar a lógica da pessoalização, do especialismo e o modelo da medicalização, tensionando este modelo de cuidados para que a SMIJ se faça presente na agenda política do município. Um cuidado que precisa ser pautado na lógica da corresponsabilização e intersetorialidade, para que não fique colado na educação como o lugar responsável por essas questões.

Abstract This research presents the care strategies in Child and Adolescent Mental Health (SMIJ) in the municipality of Guamiranga, located in the south-central region of the state of Paraná. We seek to understand which strategies are used, based on the experiences of Community Health Agents (CHA), to identify and monitor children who have demands for mental health care. This research was divided into three stages: accompanying home visits, a focal group with CHAs and an analysis and data systematization utilizing Institucional Analysis. We understand that in order to produce this complex care network for CAMHC, it´s necessary to overcome the logic of personification, especialization and medicalization in the hopes that this care model for the CAMHC becomes a part of the political agenda of the city. The care needs to be based on the logic of co-responsibility and intersectoriality so that it´s not set on education as the place responsible for these issues.

Resumen Esta investigación presenta las estrategias de atención en Salud Mental Infanto-Juvenil (SMIJ) en el municipio de Guamiranga, situado en la región centro-sur del estado de Paraná. Se buscó conocer qué estrategias se utilizan, a partir de las experiencias de los Agentes Comunitarios de Salud (ACS), para identificar y acompañar a los niños que tienen demandas de atención en salud mental. Se dividió en tres momentos: el seguimiento de las visitas domiciliarias, un grupo focal con las ACS y el análisis y sistematización de los datos desde el Análisis Institucional. Entendemos que, para producir atención en esta red compleja del SMIJ, es necesario superar la lógica de la personalización, la especialización y el modelo de medicalización, tensionando ese modelo de atención para que el SMIJ esté presente en la agenda política del municipio. Una atención que debe guiarse por la lógica de la corresponsabilidad y la intersectorialidad, para no quedarse estancada en la educación como lugar responsable de estas cuestiones.

Urgencias psiquiátricas en niños y adolescentes

Introducción: Las urgencias psiquiátricas en la edad pediátrica constituyen un problema de salud pública. Objetivo: Describir las urgencias psiquiátricas y la conducta seguida, en el momento de su evaluación, en pacientes atendidos en consulta de urgencia. Métodos: Estudio observacional, descriptivo y transversal, en 340 pacientes examinados en el Hospital Pediátrico "Juan Manuel Márquez", de enero a abril de 2019. Se utilizó un instrumento validado en estudios anteriores y se realizó entrevista a pacientes y familiares. El procesamiento y análisis de los datos se realizó con el SPSS 21 y estadígrafos descriptivos. Para la comparación de frecuencias observadas y esperadas de una variable se empleó la prueba binomial, y la Ji-cuadrada, con una probabilidad de 0,5 %. Resultados: El 53,8 % de los pacientes declararon entre 15 y 19 años; 50,3 % varones. El 61,2 % presentaban antecedentes patológicos psiquiátricos y 40,3 % procedía de medios familiares problemáticos. Entre los principales motivos de consulta destacaron la conducta suicida y el consumo de sustancias psicoactivas. El 25 % de los pacientes requirió hospitalización, el resto se derivó a la atención ambulatoria. En más de 60 % se utilizaron psicofármacos. Conclusiones: Predominaron en el estudio los adolescentes, masculinos, con antecedentes patológicos personales de enfermedad psiquiátrica, procedentes de medios familiares conflictivos, con diagnóstico de trastornos del comportamiento, conducta suicida, trastornos afectivos, psicosis y trastornos adictivos; entre estos últimos, se diagnosticó la patología dual. Solo la cuarta parte requirió hospitalización y en la mayoría se usaron psicofármacos.

Introduction: Psychiatric emergencies in pediatric age constitute a public health problem. Objective: To describe the psychiatric emergencies and the behavior followed, at the time of their evaluation, in patients attended in an emergency consultation. Methods: Observational, descriptive and cross-sectional study in 340 patients examined at "Juan Manuel Márquez" Pediatric Hospital, from January to April 2019. An instrument validated in previous studies was used and interviews were conducted with patients and relatives. Data processing and analysis was performed with SPSS 21 and descriptive statistics were used. For the comparison of observed and expected frequencies of a variable, the binomial test and the Chi-square, with a probability of 0.5% were used. Results: 53.8% of patients were between 15 and 19 years old, and 50.3 % were male. 61.2 % had a psychiatric pathological history and 40.3% came from problematic family environments. Among the main reasons for consultation were suicidal behaviour and the consumption of psychoactive substances. 25% of patients required hospitalization, the rest were referred to outpatient care. Psychotropic drugs were used in more than 60%. Conclusions: In the study predominated adolescents, males, with a personal pathological history of psychiatric illness, from conflictive family environments, diagnosed with behavioral disorders, suicidal behavior, affective disorders, psychosis and addictive disorders; among the latter, dual pathology was diagnosed. Only a quarter required hospitalization and most used psychotropic drugs.

Treatment of migraine in children and adolescents. The state of the art / Tratamento da enxaqueca em crianças e adolescentes. O Estado da arte

Introduction: Headaches and migraine are common in the pediatric population, being one of the most frequent symptoms reported in practice. Additionally, it is a considerably disabling condition, which brings significant burden and impairs several aspects of a child or adolescent's life, such as mental and physical health, executive functioning, school performance. Children and adolescents with migraine have higher risk of psychiatric comorbidities and psychosocial adjustment difficulties, which, in turn, compromise even more patient's well functioning. Objective:The present article provides the clinician with a straightforward and evidence-based approach to migraine treatment in this age group. Comment: Treatment of migraine in children and adolescents requires a systematic and thorough approach. Clinicians should keep in mind the important burden migraine brings to a child's life, thus investigate, and properly manage comorbidities presented. Patient and parents' education is a meaningful part of the treatment. Moreover, non-pharmacological treatments, such as healthy lifestyle habits, behavioral interventions may also play beneficial roles. When preventive treatment is indicated, it should be tailored considering drug's profile of effectiveness and safety, as well as patient's comorbidities. Lack of evidence in this context must not translate in lack of action by the clinician, since there may be a relevant burden associated. Therefore, reasoning for the perspicacious clinician is of fundamental importance and may influence positively the outcomes.

Introdução: Dores de cabeça e enxaqueca são comuns na população pediátrica, sendo um dos sintomas mais frequentes relatados na prática. Além disso, é uma condição consideravelmente incapacitante, que traz sobrecarga significativa e prejudica diversos aspectos da vida de uma criança ou adolescente, como saúde mental e física, funcionamento executivo, desempenho escolar. Crianças e adolescentes com enxaqueca apresentam maior risco de comorbidades psiquiátricas e dificuldades de ajustamento psicossocial, o que, por sua vez, compromete ainda mais o bom funcionamento do paciente. Objetivo: O presente artigo fornece ao médico uma abordagem simples e baseada em evidências para o tratamento da enxaqueca nesta faixa etária. Comente: O tratamento da enxaqueca em crianças e adolescentes requer uma abordagem sistemática e minuciosa. Os médicos devem ter em mente o importante fardo que a enxaqueca traz à vida de uma criança, investigando e gerenciando adequadamente as comorbidades apresentadas. A educação do paciente e dos pais é uma parte significativa do tratamento. Além disso, os tratamentos não farmacológicos, como hábitos de vida saudáveis ​​e intervenções comportamentais, também podem desempenhar papéis benéficos. Quando indicado tratamento preventivo, este deve ser adaptado considerando o perfil de efetividade e segurança do medicamento, bem como as comorbidades do paciente. A falta de evidências neste contexto não deve traduzir-se em falta de ação por parte do médico, uma vez que pode haver um ónus relevante associado. Portanto, o raciocínio do clínico perspicaz é de fundamental importância e pode influenciar positivamente os resultados.

Distribution and change of poor vision among school students aged 6-19 in Hainan Province, 2013-2020 / 中国热带医学

@#Abstract: Objective　To explore the regional, age and annual characteristics of distribution and variation trend of children and adolescents with poor vision in Hainan Province, and to provide a theoretical basis for the formulation of targeted and effective prevention and treatment strategies. Methods　The eyesight monitoring data of 5 657 231 children and adolescents aged 6 to 19 from 17 cities and counties in Hainan Province from 2013 to 2020 were analyzed. Using the "Standard Logarithmic Vision Chart" (GB11533-2011) that complies with national standards for testing. Results　The rate of poor vision among children and adolescents in Hainan Province increased significantly from 2013 to 2020, and the difference between the years was statistically significant (P<0.001). The total poor vision rate in the left eye increased 10.09% (32.79% to 42.88%), and that of severe poor vision rate increased 6.68%, while that of the right eye increased 9.80% (33.11% to 42.91%) and 6.49%. The poor vision rate was significantly higher in females than in males of same year (P<0.001), but the increase pattern was the same. In 2020, there were significant differences between the same age groups in different cities and counties and between different age groups in the same city and county (P<0.001), and they all tended to increase with age. The result of analyzing the distribution characteristics of the total poor vision rate of different age groups children in the eastern (Qionghai), southern (Sanya), western (Changjiang), northern (Haikou) and central (Dingan) cities showed that the regional rate difference was small at 6-7 years old, and then increased with the increase of age. The poor vision rate of Haikou City ranked the first in all age groups, and reached the highest at 17 years old, with 76.32% and 80.89% of total poor vision rate of left and right eyes respectively. Sanya City ranked second, Qionghai ranked third. The poor vision rate of Changjiang County was lower and the growth rate was slower according to age. Conclusions　From 2013 to 2020, the total and severe poor vision rates in left and right eyes of children aged 6-19 in Hainan Province increased year by year, with the ascension range of female higher than that of male, and right eye higher than that of left eye. In the same year, the poor vision rate increase rapidly with age. It is recommended to further strengthen the daily intervention and management of key populations and special age groups to reduce the rate of low vision in children and adolescents.

Clustering of health-risk behaviors among children and adolescents in Yancheng City / 预防医学

Objective@#To investigate the clustering of health-risk behaviors and its influencing factors among children and adolescents in Yancheng City, Jiangsu Province, so as to provide insights into the prevention and control of health-risk behaviors among children and adolescents. @*Methods@#Students were randomly sampled from 4 primary schools, 4 junior high schools and 4 senior high schools in Yancheng City using a multi-stage stratified cluster random sampling method from September to December 2021. Students' demographics and 12 health-risk factors including unhealthy diet, insufficient physical activity and attempted smoking were collected using the Student's Health Status and Influencing Factors Questionnaire by Jiangsu Provincial Center for Disease Control and Prevention, and factors affecting the clustering of health-risk behaviors were identified using a multivariable linear regression model.@*Results@#A total of 2 925 valid questionnaires were recovered, and the respondents included 1 611 boys (55.08%) and 1 314 girls (44.92%). A total of 2 896 respondents were detected with health-risk behaviors, with a detection rate of 99.09%, and 2 772 respondents were detected with clustering of health-risk behaviors (93.06%). Insufficient sleep, insufficient physical activity and insufficient duration of outdoor activity were predominant patterns of clustering. The median number of health-risk behaviors was 4.00 (interquartile range, 2.00) per capita. Multivariable linear regression analysis showed that boys (β=0.232), grade (junior high school, β=0.519; senior high school, β=0.427), urban area (β=0.241), living at school (β=0.395), family structure (single parental family, β=0.188; other families, β=0.344) and father's education level of primary school and below (β=0.369) were factors affecting clustering of health-risk behavior among primary and high school students. @*Conclusions@#The detection of health-risk behaviors is high among children and adolescents in Yancheng City, and insufficient sleep, insufficient physical activity and insufficient duration of outdoor activity are predominant health-risk behaviors. Boys, junior high school and above, urban areas, living at schools, single parents, and fathers with a low educational level lead to a high degree of clustering of health-risk behaviors.