Dolor Crónico y Salud Mental en población Infanto Adolescente. Serie de casos y revisión de la literatura / Chronic pain and mental health in the child and adolescent population. Case series and literature review

El dolor crónico, es una "experiencia, sensorial y emocional desagradable persis- tente o recurrente", modulada por vulnerabilidades que interactúan en forma dinámica. Ob- jetivo: Describir vulnerabilidades de salud mental presentes en una serie de casos de dolor crónico, correlacionando estos hallazgos con la revisión de la literatura. Método: Diseño ob- servacional, descriptivo de una serie retrospectiva de 20 casos entre 8 a 15 años de edad, con dolor crónico músculo esquelético atendidos en el sistema privado y referidos desde reuma- tología a psiquiatría. Resultados: 61% fueron adolescentes y 2-3 mujeres por cada hombre. Se detectaron vulnerabilidades emocionales, comportamentales, familiares y sociales, siendo los Trastornos de Ansiedad la principal comorbilidad, lo que es concordante con la literatura. Discusión: Si bien esta revisión presenta varias limitaciones, la asociación existente entre dolor crónico infanto-juvenil y problemáticas de salud mental, plantea la necesidad de desa- rrollar mayores estudios en la temática, que orienten el abordaje multidisciplinario y atenúen el impacto negativo que éste tiene en el desarrollo.

Chronic pain is a "persistent or recurrent unpleasant sensory and emotional expe- rience" modulated by vulnerabilities that interact dynamically. Objective: To describe mental health vulnerabilities present in a series of chronic pain cases, correlating these findings with the review of the literature. Method: Observational, descriptive design of a retrospective se- ries of 20 cases between 8 and 15 years of age, with chronic musculoskeletal pain treated in the private system and referred from rheumatology to psychiatry. Results: 61% were adoles- cents and 2-3 women for every man. Emotional, behavioral, family and social vulnerabilities were detected, with Anxiety Disorders being the main comorbidity, which is consistent with the literature. Discussion: Although this review has several limitations, the existing association between chronic pain in children and adolescents and mental health problems, raises the need to develop further studies on the subject, that guide the multidisciplinary approach and attenuate the negative impact that this has on development.

Síndrome de Activación en Niños y Adolescentes Tratados con Inhibidores Selectivos de la Recaptación de Serotonina / Activation Syndrome in Children and Adolescents Treated with Selective Serotonin Reuptake Inhibitors

RESUMEN Introducción y objetivos: Los inhibidores selectivos de la recaptación de serotonina (ISRS) son medicamentos que se usan en psiquiatría de niños y adolescentes principalmente para el tratamiento de depresión, ansiedad y trastorno obsesivo compulsivo. En general, estos medicamentos son seguros y se toleran bien, pero pueden producir efectos adversos como el síndrome de activación, que si no se identifica puede afectar negativamente a la adherencia y la respuesta al tratamiento. El síndrome de activación ha recibido poca atención y existen dificultades en su reconocimiento por la falta de una definición clara y de medidas de diagnóstico objetivas y porque, además, puede confundirse con un empeoramiento del trastorno psiquiátrico de base o un viraje a manía con antidepresivos. Por todo lo anterior, es importante que los profesionales que prescriben antidepresivos a población pediátrica puedan identificar y tratar el síndrome de activación cuando se presente. El objetivo de este artículo es desarrollar una revisión narrativa del síndrome de activación en niños y adolescentes tratados con ISRS en cuanto a su definición, prevalencia, fisiopatología, factores asociados, relación con el riesgo de suicidio, las estrategias de tratamiento y las recomendaciones para la reducción del riesgo de conductas suicidas al usar antidepresivos en esta población. Métodos: Se realizó una revisión narrativa no sistemática del síndrome de activación en niños y adolescentes, la cual involucró la búsqueda de información en PubMed, Ovid, EBSCO, ProQuest y EMBASE. Se seleccionaron artículos de revisión, investigaciones prospectivas, retrospectivas, revisiones sistemáticas, metanálisis y demás artículos sobre el síndrome de activación en niños y adolescentes. La búsqueda se limitó a los estudios publicados en inglés y español que involucraran a niños y adolescentes y no se aplicaron límites en cuanto a la fecha de publicación o diseño del estudio. Resultados: Se incluyeron un total de 62 artículos, 61 de ellos en inglés. Los resultados se agruparon en los siguientes temas: definición, prevalencia, fisiopatología, factores asociados, su relación con el riesgo de suicidio, estrategias de tratamiento y recomendaciones para la reducción del riesgo de conductas suicidas al usar antidepresivos en esta población. Se encontró que el síndrome de activación hace referencia a un conjunto de síntomas consistentes en impulsividad, inquietud, aumento de la actividad, insomnio, irritabilidad, desinhibición y agitación. Hasta el momento, este síndrome está mal caracterizado en cuanto a definición, prevalencia, factores de riesgo y fisiopatología, situación que limita su reconocimiento y evaluación. Existen factores que pueden predisponer a la aparición del síndrome, como la edad, las diferencias de desarrollo cerebral en la población pediátrica, las características del paciente o del antidepresivo, los trastornos del desarrollo neurológico y las dosis y concentraciones plasmáticas de los medicamentos. Se ha considerado que el síndrome de activación puede estar relacionado con tendencias suicidas; no obstante, la evidencia que respalda dicho vínculo es contradictoria, por lo cual son necesarios más estudios. Conclusiones: El síndrome de activación con ISRS representa un efecto adverso particularmente importante en niños y adolescentes, y cuando se presenta puede causar la falta de adherencia o la suspensión del tratamiento, por lo cual se recomienda una vigilancia estricta durante el uso de estos medicamentos.

ABSTRACT Introduction and objectives: Selective serotonin reuptake inhibitors (SSRIs) are medications used in child and adolescent psychiatry mainly for the treatment of depression, anxiety and obsessive-compulsive disorder. In general, these medications are safe and well tolerated. However, they can cause adverse effects such as activation syndrome, which if not identified can negatively affect adherence and response to treatment. Activation syndrome has received little attention and can be difficult to recognize due to the lack of a clear definition and objective diagnostic measures, and also because it can be confused with a worsening of the psychiatric disorder or mania triggered by the antidepressants. For all the above, it is important that professionals who prescribe antidepressants in the pediatric population are able to identify and manage activation syndrome when it occurs. Our aim was to carry out a narrative review of activation syndrome in children and adolescents treated with SSRIs in terms of definition, prevalence, pathophysiology, associated factors, relationship with suicide risk, management strategies and recommendations for reducing the risk of suicidal behaviors when using antidepressants in this population. Methods: We performed a non-systematic narrative review of activation syndrome in children and adolescents which involved finding information in PubMed, Ovid, EBSCO, Pro-Quest and Embase. Review articles, prospective and retrospective investigations, systematic reviews, meta-analyses and other articles related to activation syndrome in children and adolescents were selected. The search was limited to studies published in English and Spanish that involved children and adolescents and no limits were applied to the publication date or study design. Results: A total of 62 articles were included, 61 of them in English. The results were grouped into the following topics: definition; prevalence; pathophysiology; associated factors; relationship with suicide risk; management strategies; and recommendations for reducing the risk of suicidal behaviors when using antidepressants in this population. Activation syndrome refers to a set of symptoms consisting of impulsiveness, restlessness, increased activity, insomnia, irritability, disinhibition and agitation. This syndrome is poorly characterized in terms of its definition, prevalence, risk factors and pathophysiology, a situation that limits its recognition and evaluation. There are many factors that predispose the development of the syndrome such as age, differences in brain development in the pediatric population, the characteristics of the patient or the antidepressant, disorders of neurological development, and the doses and plasma levels of the medications. It has been thought that activation syndrome may be related to suicidal tendencies. However, the evidence in support of this link is inconsistent and further studies are therefore necessary. Conclusions: Activation syndrome with SSRI is a particularly important adverse effect in children and adolescents and, when it occurs, can cause lack of adherence to or discontinuation of treatment. Strict vigilance is therefore recommended during the use of these medications.

«Yo tengo mi abogado¼: vínculo y participación en representación jurídica de niños / «I have my lawyer¼: Relationships and participation in the legal representation of children / «Eu tenho o meu advogado¼: Vínculo e participação na representação legal de crianças

Resumen (analítico) Este estudio buscó conocer los significados que construyen profesionales del programa Mi Abogado (Chile) sobre el vínculo y la participación infantil. Bajo un diseño cualitativo exploratorio, se realizaron entrevistas semiestructuradas y se aplicó un análisis de contenido. Los participantes señalan que se requiere conocer al niño o adolescente, reconocer su singularidad y su historia de vida. A su vez, es necesario reconstruir la confianza en el mundo adulto, para construir un vínculo significativo como base de la participación infantil. Reconocer la singularidad y reconstruir la confianza permite representarles mejor y fortalecer su agencia, facilitando su participación en los procesos que les afectan directamente. Se sugiere conocer cómo los nuevos programas construyen significados en torno a los derechos en este contexto que busca superar una perspectiva tutelar.

Abstract (analytical) This study aimed to understand the meanings developed by professional staff in the Mi Abogado Program (Chile). Using a qualitative exploratory design, semi-structured interviews were conducted with professionals and content analysis was applied. Participants highlighted a number of essential factors in their work, including that it was necessary to get to know the children and recognize their unique circumstances and life histories. At the same time, they stated that it was necessary to rebuild their trust in adults in order to form a significant relationship and enable child participation. Identification of their unique circumstances, generating trust and forming significant relationships lead to better legal representation of these children, strengthen agency and facilitate their participation in the processes that directly affect them. The authors conclude by the article by recommending further examination of how new programs are building meanings around children's rights in a context that seeks to overcome existing power imbalances.

Resumo (analítico) Este estudo buscou compreender os significados construídos pelos profissionais do Programa Mi Abogado (Chile) sobre vínculo e participação infantil. Sob um delineamento exploratório qualitativo, foram realizadas entrevistas semiestruturadas com profissionais e aplicada a análise de conteúdo das entrevistas. Os participantes destacam que é preciso conhecer à criança, reconhecer sua singularidade e sua história de vida. Ao mesmo tempo, é preciso reconstruir a confiança nos adultos, a fim de construir um vínculo significativo e possibilitar a participação infantil. Singularidade, confiança e vínculo significativo permitem uma melhor representação, fortalecem sua agência e facilitam a participação nos processos que os afetam diretamente. É relevante explorar como novos programas estão construindo significados em torno dos direitos da criança neste contexto que busca superar o enfoque tutelar.

A conduta do odontopediatra em UTI perante casos de abuso sexual infantil / The course of action of the ICU pediatric dentist towards children sexual abuse incidents

O referido trabalho visa apresentar a importância do cirurgião dentista, especialista em odontopediatria, em ambiente hospitalar, esclarecendo sinais e manifestações orais que devam despertar a atenção de um possível abuso sexual infantil, a fim de que seja feita uma notificação plausível e baseada em evidências. Esta revisão de literatura tem bibliografia baseada em artigos da Constituição Federal e artigos científicos buscados na plataforma Scientific Electronic Library Online (SciELO). A busca foi feita por meio de palavras-chave em um intervalo de 2002 a 2022, não se resumindo a um período máximo de 10 anos devido à dificuldade em encontrar referências atuais. Cerca de 29 artigos foram encontrados e após a leitura do título e resumo de cada um, 14 foram excluídos em razão de seu conteúdo não estar relacionado ao tema proposto. 15 foram lidos na íntegra. 3 manuais disponibilizados para profissionais da saúde e artigos do Estatuto da Criança e do Adolescente, bem como 1 lei municipal do Rio de Janeiro foram utilizados. Como resultado geral, foram encontradas manifestações orais e Infecções Sexuais Transmissíveis (ISTs) mais recorrentes, sinais apresentados por pacientes vítimas de abuso sexual, quais condutas obrigatórias a seguir e a importância do odontopediatra, em ambiente hospitalar, mais precisamente na Unidade de Terapia Intensiva.

This work aims to present the importance and role of the dental surgeon, specialist in pediatric dentistry, in a hospital environment, clarifying which signs, and oral manifestations should draw attention to a possible child sexual abuse, in order to make a plausible report and evidence-based. A literature review was carried out with bibliography based on articles of the Federal Constitution and scientific articles found in platform Scientific Electronic Library Online (SciELO). The search was carried out using keywords in a range from 2002 to 2022, not limited to a maximum period of 10 years due to the difficulty in finding current references. About 29 articles were found and after reading the title and abstract of each one, 14 were excluded because their content was not related to the proposed theme. 15 were read in full. 3 manuals made available to health professionals and articles from the Child and Adolescent Statute, as well as 1 municipal law of Rio de Janeiro were used. As a general result, more recurrent oral manifestations and Sexually Transmitted Infections (STIs) were found, signs presented by patients victims of sexual abuse, what mandatory conducts to follow and the importance of the pediatric dentist in a hospital environment, more precisely in the Intensive Care Unit.

Advances in treatment of acute leukemia and long-term ovarian function in children and adolescents / 国际儿科学杂志

Acute leukemia（AL）is a common hematological malignancy in children and adolescents. Chemotherapy is currently the primary treatment for AL.Alternative therapies，such as hematopoietic stem cell transplantation（HSCT），targeted therapy，and immunotherapy also offer greater hope for the survival of refractory/relapsed patients. Chemotherapeutic drugs，radiotherapy，targeted drugs and immunotherapeutic drugs are well-applied clinically，meanwhile posing threats to non-target systems. The adverse effects on the reproductive system may lead to the dilemma of infertility，thus reducing the long-term quality of life. As the survival rate of AL patients keeps increasing continuously，the influence of different treatments on the gonad function needs to be clarified. With the help of targeted fertility prevention，the patient′s quality of life can be enhanced in parallel with life span. This article aims to review the impact of AL treatment on ovarian function in female children and adolescents and provide ideas for the long-term fertility protection of leukemia patients.

Obesity status of Kazakh children and adolescents in Xinjiang agricultural and pastoral areas and its correlation with lifestyle / 中国儿童保健杂志

【Objective】 To understand the obesity status of Kazakh children and adolescents in the agricultural and pastoral areas of Xinjiang and its association with lifestyle, so as to provide reference and help for maintaining good body shape and health intervention for Kazakh children and adolescents in agricultural and pastoral areas. 【Methods】 From April to June 2022, 6 242 Kazakh children and adolescents aged 10 - 20 years were tested for obesity and surveyed by lifestyle questionnaires using stratified whole-group sampling in the farming and herding areas of Yili Kazakh Autonomous Prefecture and Altay Region, Xinjiang. χ2 test and Logistic regression analysis were used to analyze data. 【Results】 The obesity detection rate of Kazakh children and adolescents in Xinjiang farming and herding areas was 18.71%, with higher rates in boys (22.24%) compared to girls (15.12%), and the difference was statistically significant (χ2 =52.04, P<0.01). Significant differences were observed in the obesity rates based on grade level, fruit consumption frequency, screen time of television, feeling hopeful for the future, fatigue, loneliness, and sadness (χ2 =24.29, 4.61, 694.51, 7.15, 10.33, 6.51, 8.07, P<0.01). Logistic regression analysis showed that female students (OR=0.63, 95%CI: 0.56 - 0.69) and students who felt hopeful about the future (OR=0.96, 95%CI: 0.94 - 0.99) were protective factors against obesity (P<0.05); while high school and lower grades (senior high school OR=1.38, 95%CI: 1.24 - 1.57; junior high school OR=1.82, 95%CI: 1.58 - 2.06; primary school OR=2.67, 95%CI: 2.33 - 2.99), fruit consumption ≥1time/d (OR=1.07, 95%CI: 1.03 - 1.16), watching TV ≥2h/d (OR=1.07, 95%CI: 1.02 - 1.17), frequent feeling of fatigue (OR=1.07, 95%CI: 1.03 - 1.12), loneliness (OR=1.08, 95%CI: 1.02~1.19) and sadness (OR= 1.09, 95%CI: 1.04 - 1.14) of students were risk factors for the development of obesity (P<0.05). 【Conclusions】 The obesity rate of Kazakh children and adolescents in the agricultural and pastoral areas of Xinjiang is high and closely associated with lifestyle. Therefore, it is crucial to improve unhealthy lifestyles in order to reduce obesity and promote the physical and mental well-being of this population.

Status quo of overweight, obesity and elevated blood pressure among children and adolescents aged 7 - 17 years in Mengzi City / 中国儿童保健杂志

【Objective】 To analyze the association of overweight and obesity with elevated blood pressure(BP) among children and adolescents in Mengzi City, in order to provide reference for making effective interventions. 【Methods】 A total of 30 classes of students in 14 schools were selected into this study by a stratified random cluster sampling method from October 2020 to September 2021. The paticipants completed a questionnaire survey, and had their height, weight and BP measured. Logistic regression analysis was used to evaluate the association of overweight and obesity with elevated BP. 【Results】 A total of 4 015 children and adolescents aged 7 - 17 years were involved in the study. The detection rate of overweight, obesity and elevated BP was 12.53%, 10.01% and 12.38%, respectively. The detection rate of elevated BP was 9.96%, 19.48% and 25.62% in normal weight, overweight and obese groups, respectively. The risk of elevated BP in the overweight and obese groups was 2.190 times(95%CI: 1.696 - 2.926, P<0.001) and 3.243 times(95%CI: 2.501 - 4.204, P<0.001) as high as that in normal weight groups. The dietary and exercise behaviors of 1 604 adolescents were analyzed, it was found that the detection rate of obesity was significntly higher in non-boarding students(15.09%) and those who consumed fresh fruits at least once a day(13.49%)(χ2=18.012, 7.225, P<0.05), the detection rate of elevated BP was significantly higher in among those who did not consume sugary beverages(16.88%), and performed moderate-to-high intensity physical exercise of 60 minutes or more ≤ 2 days per week(16.88%)(χ2=9.403, 14.921,P<0.01). 【Conclusions】 The risk of developing hypertension increases with the high prevalence of overweight and obesity and is strongly associated with multiple factors. Therefore, it is essential to conduct effective weight control and behavioral lifestyle interventions among children and adolescents.

Application progress of predictive models in the prevention and control of myopia in children and adolescents / 国际眼科杂志(Guoji Yanke Zazhi)

In medical research,predictive models have been widely used to predict disease progression and identify high-risk populations in advance, especially in the prevention and diagnosis of chronic diseases. In ophthalmology, the predictive and diagnostic models for fundus diseases such as age-related macular degeneration and diabetic retinopathy have demonstrated expert-level accuracy. However, the application of predictive models is still in the exploratory stage as for myopia prevention and control. The establishment of a predictive model is helpful to identify the high-risk myopic children in advance, so that preventive measures such as adequate outdoor activities and reducing near work can be taken in time, which is of great significance to prevent or slow down the occurrence and development of myopia. Because the mechanism of myopia has not been fully elucidated, there are still challenges and limitations in the selection of application objects, predictors and predictive outcomes. This paper reviews the research progress of different types of myopia predictive models in order to provide reference for further development and improvement.

Efficiency of the ratio of axial length to corneal curvature radius in the evaluation of myopia in children and adolescents / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the value of the ratio of axial length to corneal radius of curvature(AL/CR)in the diagnosis of myopia in children and adolescents.METHODS: The refraction and ocular biometric parameters of 2 182 cases of children and adolescents(4 364 eyes)who initially visited the optometry clinic of the Second People's Hospital of Beihai from January 2022 to December 2023 were collected and analyzed.RESULTS: The receiver operating characteristic curve(ROC curve)showed that AL/CR had a higher area under the curve(AUC=0.925, 95%CI: 0.917-0.933)in diagnosing myopia. When AL/CR was 3.053, the Youden index was the largest. As the threshold of AL/CR decreased, the sensitivity of myopia diagnosis increased, while the specificity decreased. Compared with screening myopia, the sensitivity of AL/CR=3.053 in diagnosing myopia was low, but the specificity was high, especially in the cases of hyperopia and pre-myopia.CONCLUSION: The accuracy of AL/CR in diagnosing myopia is superior to that of axial length and average corneal curvature, with higher specificity. As the threshold of AL/CR decreases, the sensitivity of diagnosing myopia increases, but the specificity decreases. In cases of hyperopia and pre-myopia, the specificity of AL/CR in diagnosing myopia is higher than that of screening myopia.

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.

Impacto da pandemia de COVID-19 na incidência de violência sexual domiciliar contra crianças e adolescentes no Brasil / The impact of the COVID-19 pandemic on the incidence of sexual violence against children and adolescents in the home environment in Brazil

Resumo O objetivo do artigo é identificar o impacto da pandemia de COVID-19 na incidência de violência sexual de crianças e adolescentes no ambiente domiciliar no Brasil. Estudo ecológico de série temporal utilizando regressão joinpoint a partir de dados do Sistema de Informação de Agravos de Notificação, período 2009-2021. Analisaram-se frequência relativa e taxas brutas de incidência de violência sexual ocorrida na residência contra a população de 0 a 19 anos, estimando-se variação percentual anual (APC) e variação percentual anual média (AAPC), com intervalo de confiança de 95%. A frequência relativa do agravo obteve maiores valores em 2020 (69,8%) e 2021 (71,7%), com aumento de 3,1% (p = 0,001) em 2017-2021. As meninas foram mais atingidas, com elevação das taxas em 2009-2012 (APC = 44,4; p = 0,010) e 2015-2019 (APC = 16,6; p = 0,017), porém queda em 2019-2021 (APC = -17,7; p = 0,042). Todas as faixas etárias apresentaram aumento significativo até 2019, e redução após esse ano para 5-9 anos (APC = -18,6; p = 0,016), 10-14 anos (APC = -14,1; p = 0,040) e 15-19 anos (APC = -18,4; p = 0,021). A redução nas taxas de incidência desse tipo de violência pode ter sofrido influência do contexto de isolamento social na pandemia de COVID-19, que levou à subnotificação dos casos.

Abstract The scope of this article is to identify the impact of the COVID-19 pandemic on the incidence of sexual violence against children and adolescents in the home environment in Brazil. It involves an ecological time-series study using joinpoint regression based on data from the Notifiable Diseases Information System from 2009 to 2021. The relative frequency and crude incidence rates of sexual violence occurring in the home against the population group aged 0 to 19 years were analyzed, estimating the annual percentage change (APC) and average annual percentage change (AAPC), with a 95% confidence interval. The relative frequency of the problem was higher in 2020 (69.8%) and 2021 (71.7%), with an increase of 3.1% (p = 0.001) in 2017-2021. Girls were more affected, with rates rising in 2009-2012 (APC = 44.4; p = 0.010) and 2015-2019 (APC = 16.6; p=0.017) but falling in 2019-2021 (APC= -17.7; p = 0.042). All age groups showed a significant increase until 2019, and a reduction after this year for 5-9 years (APC = -18.6; p = 0.016), 10-14 years (APC = -14.1; p = 0.040) and 15-19 years (APC = -18.4; p = 0.021). The reduction in the incidence rates of this type of violence may have been influenced by the context of social isolation during the COVID-19 pandemic, which led to the underreporting of cases.

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.

Percepción de los profesionales interventores de organismos colaboradores del Servicio Mejor Niñez sobre la vulneración de los derechos de niños, niñas y adolescentes en comuna centro-sur de Chile: una mirada desde el contexto de pandemia / Perception of professional officers involved with the Childhood Improvement Service Regarding the infringement of the rights of children and adolescents in a commune in the central-south of Chile. A view from the pandemic context

Resumen El Servicio Mejor Niñez es un organismo público que tiene como objetivo garantizar la protección de derechos de niños, niñas y adolescentes al amparo de la Ley N.º 21302. En los últimos años, se ha visto cuestionado tanto por la opinión pública como por organismos internacionales, por incumplimiento de las funciones para la cual se creó. En esta línea, el objetivo de esta investigación se centró en la percepción de los profesionales interventores sobre la vulneración de derechos sobre niños, niñas y adolescentes en la zona centro-sur de Chile. Estas personas son profesionales en Psicología y Trabajo Social que durante años han trabajado en programas de protección de vulneración de derechos, y han desempeñado un rol protector en cuanto a la protección de estos derechos. Para ello, se utilizó un método cualitativo basado en un enfoque fenomenológico, a partir de entrevistas que permitieron conocer los significados y percepciones sobre su ejercicio profesional. Los resultados destacan la visión opuesta y extrema de los profesionales sobre el proceso de intervención (satisfactoria y frustrante), así como la diversidad de modelos o enfoques utilizados en el proceso, lo que parece indicar que no existe una sistematización teórica en cuanto a la intervención que cada programa utiliza. Se estableció una reflexión importante sobre la ejecución de políticas en infancia y adolescencia que buscan promover el desarrollo integral en el marco postpandemia por COVID-19, considerando que muchas personas menores de edad se vieron nuevamente expuestas a vulneraciones de derechos durante el proceso de pandemia.

Abstract The Childhood Improvement Service is a public agency whose objective is to guarantee protection of the rights of children and adolescents with respect to the enactment of Law No. 21302. This has been questioned in recent years by both public opinion and international organizations, in relation to a failure to fulfill the functions for which it was created. In this sense, the objective of this research focused on the perception of professionals involved in children's and adolescents' rights in the central-south zone of Chile. The professionals are psychologists and social workers who have worked to protect the rights circumscribing the different types of interventions and multidisciplinary approaches carried out. For this purpose, a qualitative method was used in phase with a phenomenological approach, based on interviews that allowed ascertaining the meanings and perceptions regarding their professional practice. The results highlight the opposed and extreme views of the professionals in the intervention process (satisfactory versus frustrating), as well as the diversity of models or approaches used in the process, which seems to indicate that there is no theoretical systematization regarding the intervention applied by each program. Establishing an important reflection on the implementation of policies in childhood and adolescence that seek to promote integral development in the post-Covid-19 Pandemic framework.

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.

Oral health problems and treatment seeking behaviour of school going children and adolescents in Palampur area of Kangra district in Himachal Pradesh, India

Background: Poor oral health is still a major burden for populations throughout the world, particularly in developing countries. However, it could not receive proper attention in our country. Present study was conducted mainly to investigate oral health behavior of school going children and adolescents. Methods: Cross-sectional study was conducted during March 2022 to July 2022 among 268 students aged 6 to 19 years using stratified multistage random sampling technique in Palampur, Himachal Pradesh, India. Results: Among all 268 respondents including 118 (44%) females and 150 (56%) males, 116 (43.2%) respondents were aware of oral health problems. There were 251 (93.6%) respondents not aware of good oral hygiene practices and 224 (83.6%) suffered oral problems during last one year. Only 168 (62.7%) out of 268 respondents consulted dentists. Whereas, 231 (86.2%) were scared of consulting during covid-19 lockdown. Among those who consulted, 87 (51.7%) didn’t face any problem during dental checkup and satisfaction with consultation was reported by 146 (86.9%) respondents. High cost of treatment (41.7%) fear of absence from schools (40.0%) followed by misconception that treatment was not necessary (31.0%) came out to be the most common reasons on non-consultation. Conclusions: Present study reported high prevalence of oral health problems and lack of awareness regarding good oral hygiene practices among respondents. Oral health education should be imparted among children and adolescents for adopting good hygiene practices and timely seeking dental health care.

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.

Research progress of relationship between neck circumference and cardiovascular metabolic risk in children / 中华实用儿科临床杂志

Obesity is the main risk factor of cardiovascular diseases.As the indexes of obesity evaluation, body mass index(BMI) and waist circumference are the most common methods to predict metabolic risk of cardiovascular system.Recently, neck circumference, a reliable and low-cost parameter of anthropometry, could be considered as a new indicator to evaluate childhood obesity since it is closed correlation with children′s BMI and waist circumference.Moreover, studies had shown that the increase of neck circumference had strong correlation with cardiometabolic risk, such as high blood pressure, hyperlipidemia, hyperglycaemia and hyperuricemia.This indicates that it might be the index to predict metabolic risk of cardiovascular system.Understanding and illuminating the changes of neck circumference and its relationship with obesity and metabolic disorders would have significances for preventing and identifying metabolic risks of cardiovascular system in children and adolescents.