A study on risk factors, clinical profile, spectrum of comorbidities in children with cerebral palsy and efficacy of early intervention by rehabilitation units on neurodevelopmental outcome in these children

Background: Cerebral palsy (CP) is one of the leading causes of childhood disability worldwide with the greatest burden found in developing countries. This study is undertaken as there is limited data available regarding CP children in the Andhra Pradesh region. This study was done to evaluate the clinical spectrum, risk factors, and comorbidities associated with CP that will help in better understanding of etiology and for early intervention by District early intervention centers.Methods: This is a hospital-based prospective observational study conducted over 18 months among children from 6 months to 5 years of age visiting a tertiary care hospital.Results: Among 65 enrolled children majority of the children (74%) were between 2 to 5yrs with a male-to-female ratio of 4:1. Consanguinity was observed in 33.8% and the majority were from rural areas (71%). The most frequent presenting complaint was delayed milestones (33.4%). 67.6% of subjects were born at term with the most common risk factor being birth asphyxia (27.6%). The most common type was spastic CP (87%) in whom the Developmental quotient (DQ) was severely affected (56.7%) and 32.3% of children belong to GMFCS level III. Comorbidities like feeding difficulties and GERD (47.6%), visual problems (24.8%), and hearing problems (30%) were commonly associated. At the time of enrollment, only 21.5% of children had normal nutritional status which improved to 30.7% after 12 months of follow-up.Conclusions: Efforts should be made to increase awareness among parents regarding the availability of encouraging utilization of the services to relieve the burden of disorder.

Screening of children attending well baby clinic for risk of autism using modified checklist for autism in toddlers in a pediatric tertiary care Centre in Chennai

Background: Autism spectrum disorder is a common neurodevelopmental disorder with core deficits in social communication, interaction, and restrictive/repetitive behavior. Early intervention provides opportunity for good functional outcome. The study aimed to screen children attending well baby clinic for risk of autism using modified checklist for autism in toddlers (MCHAT) questionnaire.Methods: This descriptive cross-sectional study was conducted on 302 children attending the pediatric well baby clinic. The children aged 16-30 months who met the inclusion criteria were screened for risk of autism using MCHAT.Results: 20 out of 302 children failed the MCHAT screening, 6.6% of the children were found to be at risk of autism. Boys: girls� ratio was 2:1. Advanced parental age and higher socioeconomic status were found to have significant association with the risk of autism. 70% of children in the at-risk group were first born, 70% of children who failed the MCHAT screen were from a nuclear family.Conclusions: All toddlers attending the well-baby clinic should be screened for autism by pediatricians. MCHAT is a simple easy to use validated tool to screen for autism in a busy pediatric OPD. Timely referral for comprehensive assessment and intervention can help to improve the outcome in children with autism.

Research progress on tic disorder accompanied by attention deficit hyperactive disorder in children / 中华实用儿科临床杂志

Tic disorder (TD) is a neurodevelopmental disorder characterized by sudden, rapid, repetitive, non-rhythmic motor or vocal tics at single or multiple sites.Attention deficit hyperactive disorder (ADHD) is one of the common comorbidities of TD.Early identification and intervention of inattention, hyperactivity, impulsivity, as well as comorbid ADHD in TD patients can improve its prognosis.Currently, a significant amount of research on TD accompanied by ADHD has been conducted both domestically and internationally.This article provides a systematic review and summary of the epidemiology, etiology, pathogenesis, clinical features, treatment and intervention for TD comorbid with ADHD, aiming to enrich the understanding of clinicians regarding TD comorbid with ADHD and promote its early identification and intervention.

Research progress on dental materials for preventing root caries / 口腔疾病防治

@#The high incidence and untreated rate of root caries, a common and frequently occurring oral disease with challenging treatment in elderly individuals, is the main cause of tooth loss among elderly people, as rapid development results in pulpitis and periapical periodontitis or residual crown and root, which has been regarded as one of the common chronic oral diseases seriously affecting the quality of life of elderly people. Thus, early intervention and prevention are important. Traditional dental materials for preventing root caries have been widely used in clinical practice; however, they have the disadvantages of tooth coloring, remineralization and low sterilization efficiency. A series of new dental materials for preventing root caries have gradually become a research hotspot recently, which have the advantages of promoting the mineralization of deep dental tissue, prolonging the action time and enhancing adhesion. Future caries prevention materials should be designed according to the characteristics of root surface caries and the application population and should be developed toward simplicity, high efficiency and low toxicity. This review describes current research regarding anti-caries prevention material application, serving as a theoretical underpinning for the research of root caries prevention materials, which is important for both promotion in the effective prevention of root caries and improvement in the status of oral health and the quality of life among old people.

Application of rehabilitation nursing model based on early intervention in high-risk infants with cerebral palsy / 中国现代医生

Objective To explore the application value of rehabilitation nursing model based on early intervention in high-risk infants with cerebral palsy.Methods A total of 112 high-risk infants with cerebral palsy were selected from neonatal intensive care unit of Jiaxing Maternity and Child Health Care Hospital from January to December 2022.According to the parents'wishes,they were divided into observation group and control group,56 cases in each group.The control group was adopted routine nursing mode,and the observation group was given rehabilitation nursing mode based on early intervention on the basis of routine nursing.At correction of 1 month and 3 months,general movements quality assessment method was used to evaluate central nervous system development of two groups.Results At correction of 1 month and 3 months,the normal rate of infants in observation group was significantly higher than that in control group(P<0.05).Conclusion The rehabilitation nursing model based on early intervention can promote the neurodevelopment of high-risk infants with cerebral palsy to a certain extent,and can be popularized in early clinical nursing.

Factors Influencing The Language Development of Preterm Infants and Their Intervention Strategies / 生物化学与生物物理进展

Preterm infants, born before 37 weeks of gestation, represent a significant portion of newborns globally, many of whom experiencing long-term neurodevelopmental disorders. Language development anomalies are common among preterm infants, often leading to deficits in vocabulary, grammar, phonetics, and semantics, which can persist into adolescence and adulthood. Given these complexities, these developmental challenges necessitate a deeper understanding of the influencing factors and the importance of early intervention. Biological factors such as the degree of prematurity, birth weight, and gender significantly impact language development. Specifically, shorter gestational age and lower birth weight are associated with language difficulties, manifesting in restricted vocabulary, syntax, and grammatical complexity. In addition, the severity of neonatal illnesses, including intracranial hemorrhage, hypoxic-ischemic encephalopathy, and bronchopulmonary dysplasia, critically impact cognitive and language development. Equally important, sensory systems, particularly vision and hearing, are also crucial for language acquisition, for example, retinopathy of prematurity (ROP) may increase the risk of language disorders. Environmental factors also play a vital role in language development of preterm infants. The environment within neonatal intensive care units (NICU), while important for the survival of preterm infants, can inadvertently impose sensory challenges, thereby influencing neurodevelopmental outcomes, including language skills. Beyond the NICU environment, the domestic setting and familial interactions emerge as crucial determinants. Variables such as the parental educational background and socioeconomic status substantially influence the extent and quality of language exposure, thus shaping the linguistic development of preterm infants. Addressing these challenges requires comprehensive early intervention strategies. This includes deploying a range of early evaluation tools, encompassing standardized language development scales and observational techniques, to promptly identify infants at risk of language delays. Recent advances in non-invasive brain imaging techniques, such as event-related potentials and functional magnetic resonance imaging (MRI), have opened new horizons in early detection and intervention planning, providing critical insights into the neurodevelopmental status of these infants. Intervention strategies are diverse and integrate physiological and neurological approaches, environmental modifications, and family-centric practices. Physiologically, addressing sensory impairments and nutritional needs is fundamental to fostering robust language development. This involves interventions like sensory stimulation therapies and nutritional supplements rich in essential brain-development nutrients. Additionally, environmental optimization, particularly in NICU settings, to replicate the protective conditions of womb is crucial for enhancing language learning. Strategies include controlled auditory and visual stimulation and implementing developmental care models. Furthermore, family involvement is equally important. Encouraging active parental engagement and fostering language-enriched interactions are crucial. Notably, innovative approaches such as music therapy have shown promise in enhancing auditory processing and language skills. These interventions utilize the infant brain’s neuroplasticity, combining auditory stimulation with social interaction, thereby enriching the developmental environment for preterm infants. In summary, the language development in preterm infants is shaped by an intricate interplay of biological and environmental factors, requiring a multifaceted and early intervention approach. As our understanding evolves, the integration of medical, educational, and social services will be critical in providing holistic support for the healthy development of these infants. Future research efforts should aim to elucidate the underlying mechanisms of language development in preterm infants and to refine intervention strategies to ensure more effective long-term outcomes.

Effect of Early Intervention of Yishen Huazhuo Prescription on Learning and Memory of Accelerated Aging SAMP8 Mice and Its Mechanism / 中国实验方剂学杂志

ObjectiveTo investigate the impact of early intervention with Yishen Huazhuo prescription （YHP） on the learning and memory of accelerated aging model mice， as well as its underlying mechanism. MethodForty-eight 3-month-old male SAMP8 mice were randomly assigned into four groups， including the model group， low-dose YHP group， high-dose YHP group， and donepezil group. Additionally， 24 SAMR1 mice of the same age were divided into a control group and a YHP treatment control group， each consisting of 12 mice. The YHP groups received YHP at doses of 6.24 g·kg-1 and 12.48 g·kg-1， while the donepezil group was treated with donepezil at a dose of 0.65 mg·kg-1. The model group and control groups were given physiological saline. The mice were gavaged once daily for a duration of four weeks. Spatial learning and memory abilities of mice were assessed using the Morris water maze test. Immunofluorescence staining was employed to evaluate neuronal density as well as expression levels of M1 microglial （MG） polarization marker inducible nitric oxide synthase （iNOS） and M2 MG polarization marker arginase-1 （Arg-1） in the hippocampus region. Enzyme-linked immunosorbent assay （ELISA） was used to measure serum levels of pro-inflammatory factor interleukin 1β （IL-1β） and anti-inflammatory factor transforming growth factor-β1 （TGF-β1）. Furthermore， Western blot analysis was conducted to determine expressions of amyloid β peptide1-42 （Aβ1-42） along with triggering receptor expressed on myeloid cells 2 （TREM2）/nuclear factor kappa B （NF-κB） signaling pathway-related proteins TREM2， phospho （p）-NF-κB p65， and phospho-inhibitory kappa B kinase β （IKKβ） in the hippocampus. ResultCompared with the control group， the model group exhibited a significantly prolonged escape latency （P<0.01）， a significant reduction in neuron-specific nuclear protein （NeuN） expression in the hippocampus， a significant increase in iNOS expression in MG， and a significant decrease in Arg-1 expression. The serum IL-1β content was significantly increased， while the TGF-β1 content was significantly decreased. Additionally， there was a significant decrease in TREM2 expression in the hippocampus and significant increases in p-NF-κB p65， p-IKKβ， and Aβ1-42 expressions （P<0.05， P<0.01）. However， no significant changes were observed in escape latency， times of crossing the platform， and hippocampal NeuN expression in the YHP treatment control group. Conversely， iNOS expression in MG as well as the hippocampal p-NF-κB p65， p-IKKβ， and Aβ1-42 expressions were significantly decreased. Furthermore， TREM2 expression was significantly increased （P<0.05， P<0.01）. In comparison to the model group， the low-dose YHP group showed a significantly shortened escape latency and an increased number of crossing the platform （P<0.05， P<0.01）. In the high-dose YHP group， the escape latency was significantly shortened （P<0.05）. In the low-dose YHP group， high-dose YHP group， the expression of NeuN in the hippocampus was significantly increased， the expression of iNOS in MG was significantly decreased， and the expression of Arg-l was significantly increased. The serum IL-1β content was significantly decreased， while the TGF-β1 content was significantly increased. Furthermore， the expression of TREM2 in the hippocampus was significantly increased， and the expressions of p-NF-κB p65， p-IKKβ， and Aβ1-42 were significantly decreased （P<0.01）. ConclusionEarly YHP intervention may promote the transformation of hippocampal MG from M1 to M2 by regulating the TREM2/NF-κB signaling pathway， reduce the release of neuroinflammatory factors， protect hippocampal neurons， and reduce the deposition of Aβ1-42， and finally delay the occurrence of learning and memory decline in SAMP8 mice.

Early stimulation for neuropsychomotor development in children with microcephaly: a systematic review / Estimulação precoce para o desenvolvimento neuropsicomotor de crianças com microcefalia: uma revisão sistemática

ABSTRACT Objective: To systematically review studies on the effects of early stimulation on the neuropsychomotor development of children with microcephaly. Data source: A systematic review was conducted in PubMed/MEDLINE, Virtual Health Library, and Cochrane Library databases. Studies that addressed the use of early stimulation in playful and interactive environments in children with microcephaly were included. There were no restrictions on the publication date or language of the studies. The outcomes assessed were muscle tone, social interaction, fine and gross motor skills, intelligence quotient, socioemotional and adaptive behavior of the child. The methodological quality and the scientific evidence level were assessed using the Risk of Bias in Non-randomized Studies of Interventions, the Revised Cochrane risk of bias tool for randomized trials and the Grading of Recommendations Assessment, Development and Evaluation. Data synthesis: 264 articles were identified, but only 7 met the eligibility criteria. The included studies had a total population of 125 individuals, with sample sizes ranging from 1 to 71 participants. Conclusions: The studies showed low evidence of an effect of early intervention on the outcomes muscle tone, social interaction, fine and gross motor skills, intelligence quotient, and socioemotional and adaptive behavior in children with microcephaly. However, further randomized clinical trials are needed.

RESUMO Objetivo: Revisar, de forma sistemática, estudos sobre a interferência da estimulação precoce no desenvolvimento neuropsicomotor de crianças com microcefalia. Fontes de dados: Trata-se de uma revisão sistemática realizada nas bases de dados United States National Library of Medicine/ Medical Literature Analysis and Retrieval System Online (PubMed/MEDLINE), Biblioteca Virtual em Saúde (BVS) e Cochrane Library. Foram incluídos estudos que abordassem o uso de estímulo precoce em ambientes lúdicos e interativos em crianças com microcefalia. Não foram impostas restrições quanto à data de publicação e ao idioma dos estudos. Como desfechos, avaliaram-se tônus muscular, interação social, habilidades motoras fina e grossa, quociente de inteligência, comportamento socioemocional e adaptativo da criança. A qualidade metodológica dos estudos e o nível de evidência científica foram avaliados pelo Risk of bias in non-randomized studies of interventions, Revised Cochrane risk of bias tool for randomized trials e Grading of recommendations assessment, development and evaluation. Síntese dos dados: Foram identificados 264 artigos, entretanto apenas sete atenderam aos critérios de elegibilidade. Os estudos incluídos totalizam uma população de 125 indivíduos, com amostras que variaram de um a 71 participantes. Conclusões: Os estudos demonstraram a existência de baixa evidência quanto à interferência da intervenção precoce nos desfechos tônus muscular, interação social, habilidades motoras finas e grossas, quociente de inteligência e comportamento socioemocional e adaptativo em crianças com microcefalia. No entanto, novos ensaios clínicos randomizados ainda são necessários.

The effects of the RELATo-BRAZIL Intervention Program in early-grade readers: outcomes of a pilot study / Os efeitos do Programa de Intervenção RELATo-BRAZIL em leitores iniciantes: resultados de um estudo piloto

ABSTRACT Purpose: to carry out a pilot study applying the Reading and Language Together - Brazil program (RELATo-Brazil), targeting the development of reading and oral language abilities, aiming to improve phonological awareness skills and vocabulary knowledge in the school context. Methods: 9 children of both genders, aged between 8 and 10, enrolled in the second year of elementary school at a private school in the city of Florianópolis, SC, Brazil, joined in the study. The program was applied within three phases: Phase 1 - pre-intervention, with reading and vocabulary assessment tests; Phase 2 - intervention with sessions of different types, A, B, C and Phase 3 - post-intervention, which consisted of the subjects' reassessment, using the same tests applied in Phase 1. The data were stored in Microsoft Excel spreadsheets and exported for statistical analysis in the IBM SPSS software, the 25th version. The significance level considered was p ≤ 0.05. Results: following 21 intervention sessions, a better performance among the participants was observed when comparing the results of the pre-intervention and post-intervention phases. There is a statistically considerable difference in the percentage distributions of the conceptual vocabulary fields for Furniture and utensils (p=0.028), Places (p=0.009) and Shapes and colors (p=0.047). The reading rate did not show a statistical difference, but the children performed better in reading time and accuracy after the intervention. Conclusion: the data suggest that training in phoneme awareness and oral language and linking them in the context of authentic book reading are effective strategies for improving both reading and oral language skills.

RESUMO Objetivo: realizar um estudo piloto, aplicando o programa Reading and Language Together - Brazil (RELATo-Brazil), com vistas a incentivar o desenvolvimento da leitura e da linguagem oral por meio do trabalho com as habilidades de consciência fonológica e o aprimoramento do vocabulário no contexto escolar. Métodos: participaram do estudo nove crianças, de ambos os gêneros, com idade entre 8 e 10 anos, matriculadas no terceiro ano do ensino fundamental de uma escola particular do município de Florianópolis, Santa Catarina. O programa foi aplicado em três fases: Fase 1- pré-intervenção, com provas de avaliação da leitura e vocabulário, Fase 2 - intervenção com sessões de diferentes tipos. Fase 3 - pós-intervenção, que constou da reavaliação dos sujeitos, utilizando a mesmas provas aplicadas na Fase 1. Os dados foram armazenados em planilhas do programa Microsoft Excel e exportados para análise estatística no software IBM SPSS versão 25. O nível de significância considerado foi de p≤0,05. Resultados: após 21 sessões de intervenção, constatou-se melhor desempenho dos participantes ao comparar os resultados das fases pré-intervenção e pós-intervenção. Há diferença estatisticamente significativa nas distribuições percentuais dos campos conceituais do vocabulário para Móveis e utensílios (p=0,028), Locais (p=0,009) e Formas e cores (p=0,047). A taxa de leitura não mostrou diferença estatística, porém melhor desempenho das crianças em tempo e acurácia da leitura após a intervenção. Conclusão: os dados sugerem que treinar a consciência fonêmica, a linguagem oral e a ligação entre as duas no contexto da leitura real de livros pode ser uma intervenção eficaz na leitura, além de promover competências de linguagem oral.

Dog therapy for children with zika syndrome: perceptions of mothers and professionals / Terapia con perros para niños con síndrome de zika: percepción de madres y profesionales / Terapia com cães para crianças com síndrome do zika: percepção de mães e profissionais

ABSTRACT Objective: To assess the perceptions of mothers and health professionals about the dog-assisted therapy for children with congenital Zika Virus syndrome. Method: Qualitative, descriptive-exploratory research, with six mothers of children with congenital Zika Virus syndrome and six health professionals. Data were obtained at a Brazilian Specialized rehabilitation center in Paraíba, through semi-structured interviews, between February and October 2019. The empirical material was subjected to Inductive Thematic Analysis and interpreted using the Bronfenbrenner's Bioecological Theory. Results: Dog-Assisted Therapy allowed the enhancement of skills that were previously not performed by children, such as: spontaneous hand opening, head control, improved social interaction, reduction of seizure episodes and disruption of spasticity patterns. Final considerations: Dog-Assisted Therapy was perceived as qualified, humanized and satisfactory support for the evolution of the neuropsychomotor development of children with congenital Zika Virus syndrome.

RESUMEN Objetivo: Aprehender la percepción de las madres y profesionales sobre la Terapia Asistida por Perro con niños con síndrome congénito del Virus Zika. Método: Investigación cualitativa, descriptiva-exploratoria, realizada con seis madres de niños con síndrome congénito por el virus Zika y seis profesionales de la salud. Los datos fueron recolectados en el centro brasileño de rehabilitación especializado de Paraíba, a través de entrevistas semiestructuradas entre los meses de febrero y octubre de 2019. El material empírico fue sometido al Análisis Temático Inductivo y interpretado a la luz de la Teoría Bioecológica de Bronfenbrenner. Resultados: La Terapia Asistida por Perro permitió mejorar habilidades que antes no realizaban los niños, tales como: apertura espontánea de manos, control cefálico, mejora en la interacción social, reducción de episodios convulsivos y ruptura de patrones de espasticidad. Consideraciones finales: La Terapia Asistida por Perros fue percibida como un apoyo calificado, humanizado y satisfactorio para la evolución del desarrollo neuropsicomotor de niños con síndrome congénito del Virus Zika.

RESUMO Objetivo: Apreender a percepção de mães e profissionais de saúde acerca da Terapia Assistida por Cães para crianças com síndrome congênita do Zika Vírus. Método: Pesquisa qualitativa, descritivo-exploratória, realizada com seis mães de crianças com síndrome congênita do Zika Vírus e seis profissionais de saúde. Os dados foram obtidos em um Centro Brasileiro Especializado em Reabilitação na Paraíba, por meio de entrevistas semiestruturadas, entre os meses de fevereiro e outubro de 2019. O material empírico foi submetido à Análise Temática Indutiva e interpretado à luz da Teoria Bioecológica de Bronfenbrenner. Resultados: A Terapia Assistida por Cães possibilitou o aprimoramento de habilidades antes não executadas pelas crianças, como: abertura espontânea de mãos, controle cefálico, melhoria na interação social, diminuição dos episódios convulsivos e quebra de padrões de espasticidade. Considerações finais: A Terapia Assistida por Cães foi percebida como um suporte qualificado, humanizado e satisfatório para a evolução do desenvolvimento neuropsicomotor das crianças com a síndrome congênita do Zika Vírus.

Educational intervention with nursing professionals reduces interruption of enteral nutritional support / La intervención educativa con profesionales de enfermería reduce la interrupción del soporte nutricional enteral / Intervenção educativa com profissionais de enfermagem reduz interrupção do suporte nutricional enteral

ABSTRACT Objective: To evaluate the impact of educational intervention on the occurrence of factors that interfere with the caloric-protein supply to critical and non-critical patients undergoing enteral nutritional therapy. Method: This is an intervention, a field experiment without a control group, carried out in a teaching hospital in Juiz de Fora, Minas Gerais, Brazil. Three training cycles were carried out with nursing professionals over 57 weeks, covering the same content. The data collected were divided into pre-intervention and intervention periods. Interference in caloric-protein support was analyzed based on the evaluation of days with non-conforming nutritional supply and the occurrence of factors that led to non-conformities. Results: Following interventions, there was a significant reduction (p < 0.05) in the number of non-conforming and inadequate days (nutritional supply < 80%), the frequency of occurrence of interfering factors and non-conformities caused by failure to follow the vomiting protocol. Conclusion: The educational intervention was an effective strategy to increase the quality of the therapy evaluated, especially from the fifth day of enteral nutritional therapy onwards.

RESUMEN Objetivo: Evaluar el impacto de la intervención educativa en la aparición de factores que interfieren en el aporte calórico-proteico de pacientes críticos y no críticos sometidos a terapia nutricional enteral. Método: Se trata de una intervención, un experimento de campo sin grupo de control, realizado en un hospital universitario en Juiz de Fora, Minas Gerais, Brasil. Se realizaron tres ciclos formativos con profesionales de enfermería durante 57 semanas, abarcando los mismos contenidos. Los datos recopilados se dividieron en períodos de preintervención e intervención. Se analizó la interferencia en el aporte calórico-proteico a partir de la evaluación de los días con incumplimiento de la provisión nutricional y la ocurrencia de factores que llevaron a las no conformidades. Resultados: Después de las intervenciones hubo una reducción significativa (p < 0,05) del número de días de incumplimiento e inadecuados (suministro nutricional < 80%), la frecuencia de aparición de factores de interferencia y no conformidades provocadas por la no ejecución del protocolo de vómitos. Conclusión: La intervención educativa resultó una estrategia efectiva para incrementar la calidad de la terapia evaluada, especialmente a partir del quinto día de terapia nutricional enteral.

RESUMO Objetivo: Avaliar o impacto de intervenção educativa na ocorrência de fatores que interferem na oferta calórica-proteica aos pacientes críticos e não críticos em terapia nutricional enteral. Método: Trata-se de uma intervenção, do tipo experimento de campo sem grupo controle, realizada em um hospital de ensino de Juiz de Fora, Minas Gerais, Brasil. Foram realizados 3 ciclos de capacitações com profissionais de enfermagem ao longo de 57 semanas, com abordagem dos mesmos conteúdos. Os dados coletados foram divididos em período pré-intervenção e de intervenção. A interferência no suporte calórico-proteico foi analisada a partir da avaliação dos dias com oferta nutricional não conforme e da ocorrência dos fatores que levaram às não conformidades. Resultados: Após as intervenções, houve redução significativa (p < 0,05) do número de dias não conformes e inadequados (oferta nutricional < 80%), da frequência de ocorrência dos fatores de interferência e das inconformidades ocasionadas pela não execução do protocolo de vômito. Conclusão: A intervenção educativa foi uma estratégia efetiva para aumentar a qualidade da terapêutica avaliada, especialmente a partir do quinto dia de terapia nutricional enteral.

O impacto da ausência do brincar precoce no processo do desenvolvimento psíquico do bebê / Absence of early play and its impact on the psychic development of infants / El impacto de la ausencia del juego precoz en el proceso del desarrollo psíquico del bebé / L'absence de jeux précoces et son impact dans le développement psychique des nourrissons

Resumo A pesquisa teve como objetivo estudar o impacto da ausência do brincar precoce no desenvolvimento psíquico do bebê, quando ele se encontra privado de trocas lúdicas na relação bebê-cuidadora, no contexto das creches. A correlação dos resultados dos instrumentos IRDI, MPPE e AP3 no acompanhamento longitudinal de cinco bebês, dos 8 meses de vida aos 4 anos de idade, apontou que a ausência do brincar precoce resulta no empobrecimento do brincar simbólico e entraves no processo de subjetivação da criança.

Abstract This study investigate the absence of early play, that is, the deprivation of playful exchanges with caregivers in the nursery environment, and its impact on the psychic development of infants. Results from a longitudinal study with five infants, from 8 months to 4 years of age, collected by the IRDI, MPPE and AP3 instruments showed that the absence of early play results in the impoverishment of further symbolic play and in obstacles to the child's subjectivation process.

Resumen La investigación tiene como objetivo estudiar el impacto de la ausencia del juego precoz en el desarrollo psíquico en bebés, cuando estos se encuentran privados de intercambios lúdicos en la relación bebé-cuidador/a. En el ámbito de las guarderías, la correlación de los resultados de los instrumentos IRDI, MPPE y AP3 en el acompañamiento longitudinal de cinco bebés de ocho meses a cuatro años indicó que la ausencia del juego precoz provoca empobrecimiento del juego símbolo e impedimentos en el proceso de subjetividad del niños.

Résumé Cette étude s'intéresse à l'absence de jeux précoces, c'est-à-dire à la privation d'échanges ludiques avec les soignants dans l'espace de la crèche, et à son impact dans le développement psychique des nourrissons. Les résultats d'une étude longitudinale auprès de cinq nourrissons, suivis de 8 mois à 4 ans, recueillis à l'aide des instruments IRDI, MPPE et AP3, ont montré que l'absence de jeux précoces entraîne un appauvrissement des jeux symboliques ultérieurs et des obstacles au processus de subjectivation de l'enfant.

Intervención educativa sobre salud bucal en escolares del municipio de Venezuela, Ciego de Ávila, 2018

Fundamento la salud bucal es un componente de la salud general de las personas, desarrollar acciones de promoción y prevención desde temprana edad, garantiza estilos de vida saludables. Objetivo determinar la efectividad de una estrategia de intervención educativa para mejorar el nivel de conocimientos sobre salud bucal en escolares de quinto grado. Métodos estudio pre-experimental, de intervención, del tipo antes y después, en 43 escolares del municipio de Venezuela, Ciego de Ávila, Cuba, en el período septiembre de 2018 a enero de 2019. Mediante una encuesta se identificaron las necesidades de aprendizaje. Luego se confeccionó y ejecutó la estrategia de intervención educativa con actividades teórico-prácticas y técnicas afectivo- participativas acordes con la edad d os participantes. Se utilizó como unidad de resumen el por ciento; y para el análisis estadístico, la prueba de McNemar. Resultados antes de la intervención existían conocimientos insuficientes acerca de temas como la caries dental, higiene bucal y dieta cariogénica; después de aplicada la estrategia se modificaron favorablemente los conocimientos acerca de salud bucal en general (65,1 %). La información relacionada con el tiempo de cambio del cepillo, y otros medios auxiliares para realizar la higiene bucal, resultaron los tópicos mejor asimilados (93,0 % y 90,7 % cada uno) por los infantes. Conclusiones la intervención educativa fue eficaz, lo cual se evidenció al elevarse el nivel de conocimientos sobre salud bucal en la población estudiada, como resultado de las acciones educativas realizadas.

Foundation oral health is a component of people's general health, developing promotion and prevention actions from an early age to guarantee healthy lifestyles. Objective to determine the effectiveness of an educational intervention strategy to improve the oral health knowledge level in fifth grade students. Methods pre-experimental, intervention study, of the before and after type, in 43 schoolchildren from the Venezuela municipality, Ciego de Ávila, Cuba, from September 2018 to January 2019. Learning needs were identified through a survey. The educational intervention strategy was prepared and executed with theoretical-practical activities and affective-participatory techniques according to the participants' age. The percent was used as the summary unit; and for statistical analysis, the McNemar test. Results before the intervention there was insufficient knowledge about topics such as dental caries, oral hygiene and cariogenic diet; after applying the strategy, knowledge about oral health in general was modified favorably (65.1%). The information related to the time to change the toothbrush, and other auxiliary means to perform oral hygiene, were the best assimilated topics (93.0 % and 90.7 % each) by the infants. Conclusions the educational intervention was effective; it was evidenced by raising the oral health knowledge level in the studied population, as a result of the educational actions carried out.

Autism Spectrum Disorders-A Review on The Preventive Aspects

Autism Spectrum disorder (ASD) is a neurodevelopmental disorder presenting with defects in social commu-nication skills and repetitive sensory motor behaviour. There has been increasing concern regarding this dis-order due to its increase in incidence and prevalence in recent years. Since it stays for lifelong and has no spe-cific pharmacological treatment, many studies are being conducted to find ways of preventing this disorder. Better understanding of the causative factors will lead to better development of prevention strategies. This review aims at highlighting the methods of prevention of ASD which are mostly focussed on the environmen-tal factors causing ASD as well as the ongoing researches on development of drugs and genetic modification using animal models. Some studies have shown preventive effects of factors such as nutrition supplements such as Vitamin D and folate, breastfeeding and avoiding exposure to harmful chemicals and drugs. The aim is to prevent the occurrence of the disorder and preventing the severity of symptoms wherever possible. Still more studies are needed to establish the exact association between the possible causative factors and ASD so that clinical trials can be done to establish the preventive effects in future.

Programa educativo sobre salud bucal dirigido a familias con hijos preescolares residentes en el Consejo Popular Balboa

Fundamento: la promoción de salud debe comenzar en edades tempranas del desarrollo, para que los niños adquieran estilos de vida saludables, que les resulten beneficiosos en el futuro. Objetivo: implementar un programa educativo de salud bucal, dirigido a las familias de los niños/ñas de tres a cinco años matriculados en el Programa Educa a tu hijo, de los consultorios ocho y nueve del Consejo Popular Ramón Balboa, del municipio Lajas. Métodos: se realizó un estudio de intervención, de septiembre del 2020 a julio del 2021, en la sede del Programa Educa a tu hijo, con 35 miembros de familia y 35 niños/as entre tres cinco años matriculados en dicho programa. Se analizaron las variables: conocimiento sobre higiene bucal, hábitos dietéticos y hábitos deformantes, medidas antes y después de la intervención educativa. Resultados: predominó el sexo femenino y edad de cuatro años. Los familiares tenían entre 20 y 34 años. Los principales factores de riesgo identificados fueron higiene bucal deficiente, cepillado dental incorrecto y dieta cariogénica. Antes de la intervención predominó el conocimiento regular sobre higiene bucal, un conocimiento malo sobre hábitos dietéticos y un mal nivel de conocimiento sobre hábitos deformantes. Después de la intervención se observó un mayor porcentaje de conocimiento bueno sobre higiene bucal, hábitos dietéticos y buen nivel de conocimiento sobre hábitos deformantes. Conclusiones después de aplicada la intervención educativa se evidenció una notable mejoría en los conocimientos sobre salud bucal.

Background: health promotion should begin at an early age of development, so that children acquire healthy lifestyles that will be beneficial in the future. Objective: to implement an educational oral health program, aimed at the families of children from three to five years old enrolled in the Educate your child Program, from clinics eight and nine of the Ramón Balboa neighborhood, in Lajas municipality. Methods: an intervention study was carried out, from September 2020 to July 2021, at the headquarters of the Educate your child program, with 35 family members and 35 children between three and five years old enrolled in this program. The analyzed variables were: knowledge about oral hygiene, dietary habits and deforming habits, measured before and after the educational intervention. Results: the female sex and age of four years prevailed. The relatives were between 20 and 34 years old. The main risk factors identified were poor oral hygiene, incorrect tooth brushing and cariogenic diet. Before the intervention, regular knowledge about oral hygiene, poor knowledge about dietary habits, and a poor level of knowledge about deforming habits prevailed. After the intervention, a higher percentage of good knowledge about oral hygiene, dietary habits and a good level of knowledge about deforming habits was observed. Conclusions: after applying the educational intervention, a notable improvement in knowledge about oral health was evidenced.

Intervención educativa dirigida al uso de métodos anticonceptivos en adolescentes / An educational intervention focused on the use of contraceptive methods in adolescents

El inicio de las relaciones sexuales en la adolescencia puede generar problemas de salud biopsi-cosociales, los que pueden ser más complejos sin el adecuado conocimiento acerca del uso opor-tuno de métodos anticonceptivos. La investigación tuvo el objetivo de valorar la efectividad de una intervención educativa dirigida a las conductas sexuales y reproductivas de riesgo en la adolescencia, en dos Consejos Populares del municipio de Quemado de Güines durante el perio-do 2017-2021. Se desarrolló un estudio preexperimental con una población constituida por 1501 adolescentes, de la que se seleccionó una muestra 102 individuos mediante un procedimiento no probabilístico atendiendo a criterios. En el estudio predominó: el sexo femenino (51%), aquellos con edades entre 13 y 15 años (67,7%) y los que no habían comenzado una vida sexual activa (54,9%). La intervención educativa produjo cambios estadísticamente significativos en el contexto de investigación en relación con la información sobre métodos anticonceptivos y la percepción del riesgo sobre su uso inadecuado.

The beginning of sexual relations in adolescence can generate biopsychosocial health problems, which can be more complex without adequate knowledge about the timely use of contraceptive methods. The research aimed to assess the effectiveness of an educational intervention aimed at sexual and reproductive risk behaviors in adolescents in two Popular Councils of the Quemado de Güines Hall during 2017-2021. A pre-experimental study was developed with a population of 1501 adolescents, from which a sample of 102 individuals was selected through a non-probabi-listic procedure according to criteria. The study predominated: the female gender (51%), the ages between 13 and 15 (67.7%), and those ones who had not started an active sexual life (54.9%). The educational intervention produced statistically significant changes in the research context concerning the information on contraceptive methods and the perception of risk regar-ding its inappropriate use

Ocular morbidity and co-morbidities in children attending a nodal district early intervention center in Uttar Pradesh

Purpose: To obtain epidemiological data on children with ocular morbidity attending a nodal district early intervention center (DEIC). Methods: After parental consent, we recruited children with ocular morbidity. After detailed history and clinical evaluation, along with pediatric consultation and relevant neuro?radiological and ancillary investigation, information was entered in a pretested proforma: especially looking for perinatal morbidity, including developmental delay (DD). Visual acuity (VA) was assessed by age?appropriate means by an ophthalmic assistant trained to work with children with special needs. We diligently looked for strabismus and performed dilated ophthalmoscopy. Using JASP, we summarized data as means and proportions and reported 95% CIs. We explored the association of disability percentage with possible predictor variables using regression. Results: We enrolled 320 children, with a mean age of 34.43 ± 31.35 months; two?thirds were male; one?third belonged to lower socioeconomic status (36%), with most parents being illiterate. The mean presenting VA was 1.8 logMAR for both eyes, range: 0 to 3. Sixty?one percent were hyperopic and 27% were myopic. High refractive error, (>±6D) occurred in nine; anisometropia in one; strabismus in 149, mostly esotropia; congenital cataract in 25, whereas 63 had abnormal fundus. Seventy?six received a diagnosis of cerebral visual impairment (CVI). On multivariate linear regression (MLR), younger age, presence of DD, and CVI significantly predicted a higher disability percentage. Logistic regression revealed that statutory disability is likely associated with DD (odds ratio [OR]:13.43); whereas older age was protective (OR: 0.977). Conclusion: Our study suggests that in DEIC children with ocular morbidity, younger children, and the presence of DD significantly predict both greater disability and the likelihood of statutory levels

Research progress on early speech interventions for children with cleft lip and palate / 口腔疾病防治

@#Children born with cleft lip and palate (CLP) are at high risk of disorders involving early speech production, and these problems can persist into later childhood, leading to the emergence of compensatory articulation errors. These difficulties in early vocalization directly impact the subsequent development of children's speech and vocabulary. Studies have shown that providing naturalistic interventions, such as milieu teaching and focused stimulation, for children with CLP in the first three years of life have positive impacts on the speech development of children, such as the potential to increase phonemic inventories and the percentage of correct consonants. In addition to speech and language therapists who perform systematic speech therapy, parents can be trained and supervised to deliver early speech intervention. The percentage of correct consonants can be used to assess outcome measures of speech intervention when combined with other measures, such as consonant inventory and speech intelligibility. However, much recent research in the field has focused on older children. Therefore, it must be determined if intervening during the early phase of typical speech development leads to better results. Future research should use more robust methodological designs to determine whether early speech intervention exhibits a positive impact on the speech and future physical and mental development of children with CLP.

Based on the theory of treating impotence alone with Yang Ming to explore the intervention of finger-pressing therapy on ICU-acquired weakness in critically ill children / 中国实用护理杂志

Objective:To explore the clinical feasibility of finger-pressing therapy based on the theory of treating impotence alone with Yang Ming to reduce incidence of ICU acquired weakness (ICU-AW) in critically ill children and provide a feasible nursing plan for ICU acquired asthenia in critically ill children.Methods:A quasi-experimental study was conducted. A total of 73 critically ill children were admitted to the PICU of Kunming Children′s Hospital from January 1 to April 30, 2021. According to the random number table, the subjects were divided into the observation group (37 cases) and the control group (36 cases). Children in the control group received routine PICU nursing. The children in the observation group were treated with PICU routine nursing and finger-pressing therapy based on the theory of treating impotence alone with Yang Ming. The two groups were compared in terms of limb muscle strength score (MRC-Score), incidence of ICU-AW, basic activities of life (Barthel Index, BI), limb muscle thickness.Results:After intervention, the MRC-Score of the observation group was 50 (46, 52) points, which was higher than 46 (40, 48) points of the control group, and the difference between the two groups was statistically significant ( Z=-3.70, P<0.05). The incidence of ICU-AW in the observation group was 32.43% (12/37), and the incidence of ICU-AW in the control group was 72.22% (26/36). The difference between the two groups was statistically significant ( χ2=11.58, P<0.05). The BI score of the observation group was 63 (50, 70), which was higher than 44 (40,60) of the control group, and the difference between the two groups was statistically significant ( Z=-3.94, P<0.05). The reduction degree of quadriceps femoris thickness in the observation group at D3-D1 was (-0.381 ± 0.131) cm, which was lower than (-0.762 ± 0.182) cm in the control group, and the difference between the two groups was statistically significant ( t=10.29, P<0.05). Conclusions:The application of finger-pressing therapy guided by theory of treating impotence alone with Yang Ming in the early rehabilitation of critically ill children can enhance muscle strength, prevent muscle atrophy and reduce the incidence of ICU-AW in critically ill children.

Effect of early intervention with electroacupuncture on behavior and gut microbiota in mice with post-traumatic stress disorder / 中华行为医学与脑科学杂志

Objective:To investigate the effect of early intervention with electroacupuncture (EA) on the gut microbiota in a mouse model of post-traumatic stress disorder(PTSD).Methods:Totally 32 C57BL/6 mice were randomly assigned to the following 4 groups ( n=8 for each group): Control group, EA group, PTSD group and PTSD+ EA group.After 7 days acclimation, mice in the PTSD group and PTSD+ EA group were subjected to modified single prolonged stress (mSPS). Mice in the EA group and PTSD+ EA group received EA (2/15 Hz, 1 mA, dilatational wave, 30 min/d) on "Baihui" for 7 days. Mice in the Control group and PTSD group received false stimulation (stimulated the same acupiont without electricity) for 7 days. Seven days after the last stimulation, elevated plus maze test and fear conditioning test were conducted to observe the effect of EA on PTSD-like behavior of mice. At the same time, feces of the mice were collected for gut microbiota detection by 16S rRNA sequencing.SPSS 19.0 was used for statistical analysis.One-way ANOVA was used for multiple group comparison and Bonferrani test was done for further pairwise comparision. Results:(1) There were statistically differences in the open arm activity time of the elevated plus maze test and the immobility time in contextual and cued fear conditioning test among the four groups ( F=6.93, 5.26, 14.51, all P<0.01). In the elevated plus maze test, mice in PTSD group ((60.17±15.52) s) showed significant less time in the open arms than mice in Control group((96.37±14.62) s) and PTSD+ EA group ((86.89±15.02) s) (both P<0.05). In the fear conditioning test, mice in PTSD group ((121.99±29.67) s, (130.82±29.11) s) showed significant increased immobility time both in contextual and cued fear conditioning tests than mice in Control group((74.50±26.65) s, (39.50±23.52) s) and PTSD+ EA group ((76.77±22.60) s, (102.17±3.39) s)(both P<0.05). (2) There were no significant differences among the four groups in the alpha diversity of gut microbiota ( F=0.79-2.45, all P>0.05). (3)Correlation analysis showed that 13 gut microbiotas were negatively correlated with the immobility time in contextual fear conditioning test, 2 gut microbiotas were positively correlated with it; 7 gut microbiotas were negatively correlated with the immobility time in cued fear conditioning test, 1 gut microbiota was positively correlated with it; 3 gut microbiotas were positively correlated with time spent in open arms of elevated plus maze test. Conclusion:Early intervention with EA can improve anxiety-fear like behaviors and gut microflora disorder in PTSD model mice.