Confiabilidad y validez de un cuestionario de desarrollo infantil en encuestas nacionales / Reliability and validity of a questionnaire of child development for national surveys

Resumen: Introducción: El tamizaje del desarrollo infantil en encuestas nacionales es un insumo para la formulación de po líticas públicas que contribuyan a su diagnóstico e intervención precoz, dirigidos a favorecer un de sarrollo integral y desempeño escolar exitoso hasta la adolescencia, no obstante, pocos países en La tinoamérica cuentan con esta información. Objetivo: Evaluar la confiabilidad y validez convergente de una adaptación cultural del Cuestionario de Tamizaje de Desarrollo Infantil para Encuestas en Hogares (DIEH) y describir la prevalencia de alteraciones en el desarrollo en niños de 2 meses a 5 años en Bucaramanga-Colombia. Sujetos y Método: Se realizó una evaluación de pruebas diagnósti cas. Participaron 224 niños de dos meses hasta los cinco años y sus padres o cuidadores procedentes de Bucaramanga - Colombia, entre julio y diciembre de 2016. La Escala Abreviada del Desarrollo (EAD) fue aplicada por fisioterapeutas entrenados y el DIEH, fue respondido por los padres o cui dadores. A partir del alpha de Cronbach, el Coeficiente de Correlación Intraclase (CCI) y los límites de acuerdo Bland y Altman se estableció la confiabilidad del DIEH; con el Coeficiente de Correlación de Spearman la validez convergente. Resultados: A partir del DIEH las prevalencias de rezagos y retrasos fueron 38.8% y 11.2% respectivamente; la consistencia interna osciló entre 0.23 y 0.76. La reproducibilidad registró CCI entre 0.60 y 0.92; la validez convergente fue casi perfecta (p: 0.96). Conclusiones: La adaptación cultural del DIEH mostró propiedades psicométricas aceptables, que podrían complementarse con estudios adicionales para recomendar su uso en encuestas nacionales en Latinoamérica.

Abstract Introduction: The child development screening in national surveys supports the formulation of public policies that contribute to its diagnosis and early intervention, aimed at promoting comprehensive development and successful school performance until adolescence, however, few countries in Latin America have this information. Objective: To assess the reliability and convergent validity of a cultural adaptation of the Screening Questionnaire of Child Development for Household Surveys (DIEH) and to des cribe the prevalence of developmental alterations in children aged between 2 months and 5 years in Bucaramanga-Colombia. Subjects and Method: Between July and December 2016, an evaluation of diagnostic tests was carried out in which participated 224 children aged between two months and five years and their parents or caregivers from Bucaramanga, Colombia. The Abbreviated Developmental Scale was applied by trained physiotherapists and the DIEH was answered by the parents or caregi vers. The reliability of the DIEH was established using the Cronbach's alpha, the Intraclass Correla tion Coefficient (ICC) and the Bland and Altman limits of agreement, and the convergent validity was established through the Spearman Correlation Coefficient. Results: Based on the DIEH, the pre valence of lags and delays was 38.8% and 11.2% respectively, internal consistency ranged from 0.23 to 0.76; reproducibility showed an ICC between 0.60 and 0.92; and the convergent validity was almost perfect (p: 0.96). Conclusion: The cultural adaptation of the DIEH showed acceptable psychometric properties, which could be complemented with additional studies to recommend its use in national surveys in Latin America.

Avaliação do desenvolvimento motor infantil e sua associação com a vulnerabilidade social / Evaluación del desarrollo motor infantil y su asociación con la vulnerabilidad social / Evaluation of child motor development and its association with social vulnerability

RESUMO O objetivo deste estudo foi avaliar o desenvolvimento motor de crianças de quatro a 17 meses e investigar sua associação com fatores de risco sociodemográficos. Estudo transversal, descritivo, composto por crianças de quatro a 17 meses provenientes da unidade de internação pediátrica de um hospital público de Porto Alegre (RS), clinicamente estáveis e com alta breve prevista. Para a avaliação dos fatores de risco sociodemográficos foi utilizado um questionário elaborado pelas pesquisadoras, que abordou fatores biológicos, sociais e ambientais. Para a avaliação do desenvolvimento motor foi utilizada a Alberta Infant Motor Scale na versão traduzida, adaptada e validada para a população brasileira. Para a análise estatística foi utilizado o teste t de Student e o teste qui-quadrado, com nível de significância de 5% (p≤0,05). De um total de 110 crianças avaliadas, o desempenho motor se mostrou aquém do esperado em mais da metade delas (63,6%, n=70). Houve associação estatisticamente significativa entre o desenvolvimento motor e vacinas atrasadas (p=0,005), convivência com tabagistas em casa (p=0,047) e recebimento de benefício socioeconômico (p=0,036). Conclui-se que esses fatores sociais podem estar associados a fatores de risco ao desenvolvimento motor de crianças de quatro a 17 meses.

RESUMEN El presente estudio tuvo el objetivo de evaluar el desarrollo motor de niños de 4 a 17 meses de edad e investigar su asociación con factores de riesgo sociodemográficos. Es un estudio transversal, descriptivo, en el cual participaron niños de 4 a 17 meses de la unidad de hospitalización pediátrica de un hospital público en Porto Alegre (Brasil), clínicamente estables y con la espera de recibir el alta pronto. Para la evaluación de los factores de riesgo sociodemográficos, se utilizó un cuestionario desarrollado por los investigadores, que abordó los factores biológicos, sociales y ambientales. Para la evaluación del desarrollo motor, se utilizó la Alberta Infant Motor Scale en la versión traducida, adaptada y validada para la población brasileña. En el análisis estadístico, se aplicaron la prueba t de Student y la prueba chi-cuadrado, con un nivel de significación del 5% (p≤0,05). De 110 niños evaluados, más de la mitad de ellos (63,6%, n=70) tuvieron rendimiento motor inferior a lo esperado. Hubo una asociación estadísticamente significativa entre el desarrollo motor y las vacunas tardías (p=0,005), la convivencia con fumadores en el hogar (p=0,047) y el recibimiento de beneficios socioeconómicos (p=0,036). Se concluye que estos factores sociales pueden estar asociados con factores de riesgo para el desarrollo motor de niños de 4 a 17 meses.

ABSTRACT This study aimed to evaluate the motor development of children aged four to 17 months and investigate its association with sociodemographic risk factors. This is a cross-sectional descriptive study conducted with clinically stable children aged four to 17 months from the pediatric inpatient unit of a public hospital in Porto Alegre, RS, and whose hospital discharge would happen soon. For the evaluation of sociodemographic risk factors, a questionnaire developed by the researchers was used which addressed biological, social and environmental factors. The Alberta Infant Motor Scale (AIMS), in its version translated, adapted and validated to Brazilian Portuguese, was used in the evaluation of motor development. In statistical analysis, Student's t-test and Chi-square test were used with significance level of 5% (p≤0.05) for all tests. From a total of 110 evaluated children, motor performance was lower than expected in more than half of them (63.6%, n=70). Motor development presented statistically significant associations with delayed vaccines (p=0.005), cohabitation with smokers (p=0.047), and receiving socioeconomic benefits (p=0.036). In conclusion, social factors such as delayed vaccines, cohabitation with smokers and receiving socioeconomic benefits may be associated with risk factors related to motor development of children aged four months to 17 months old.

Baja calidad de interacción madre-hijo/a en lactantes en riesgo psicosocial se asocia con riesgo de retraso del desarrollo / Low quality of mother-child interaction in infants at psychosocial risk is associated with risk of developmental delay

INTRODUCCIÓN: La infancia temprana es un período fundamental en el desarrollo de los niños y depende en gran parte de las interacciones que establecen con sus cuidadores principales. OBJETIVOS: Evaluar la asociación entre riesgo de retraso del desarrollo psicomotor (RDSM) con calidad de interacción madre-hijo/a, síntomas depresivos postparto y otros factores relacionados al cuidado y contexto, en lactantes sanos en riesgo psicosocial. PACIENTES Y MÉTODO: Estudio transversal analítico en 181 madres en riesgo psi- cosocial y sus hijo/as menores de un año, atendidas en Atención Primaria de Salud. Se determinó la presencia de riesgo de RDSM utilizando Ages & Stages Questionnaire y se estudió su asociación con calidad de interacción (CARE Index), síntomas depresivos postparto (Escala de Depresión Postparto Edimburgo) y otros factores relacionados al contexto y cuidado (cuestionario aplicado a la madre) mediante análisis bivariados y multivariados, ajustando por variables confundentes. RESULTADOS: 20% de los lactantes presentó riesgo de RDSM. Se observó un mayor riesgo de presentar riesgo de RDSM, después de ajustar por variables de control predefinidas, con: baja calidad de la interacción madre- hijo/a (OR = 2,46, p = 0,03), lactancia materna exclusiva (LME) < 6 meses (OR = 2,58, p = 0,01) y pareja no ayuda con el cuidado del niño (OR = 2,97, p = 0,03). No se observó una asociación significativa con síntomas depresivos postparto. CONCLUSIONES: En lactantes sanos en riesgo psicosocial se asocian a mayor riesgo de RDSM una baja calidad interacción madre-hijo/a, LME < 6 meses y no involucramiento del padre en el cuidado del hijo/a.

INTRODUCTION: Early childhood is a fundamental period in children's development and depends largely on their in teractions with their main caregivers. OBJECTIVES: To evaluate the association between risk of psycho motor developmental delay (PDD) with mother-child interaction quality, postpartum depressive symptoms, and other factors related to care and environment in healthy infants at psychosocial risk. PATIENS AND METHOD: Analytical cross-sectional study in 181 mothers at psychosocial risk and their children aged under one year seen in Primary Health Care. The presence of risk of PDD was deter mined using the Ages & Stages Questionnaire and its association with interaction quality (CARE In dex), postpartum depressive symptoms (Edinburgh Postpartum Depression Scale), and other factors related to environment and care (questionnaire applied to the mother) was studied through bivariate and multivariate analyses, adjusting for confusing variables. RESULTS: 20% of infants were at risk of PDD. There was an increased risk of presenting risk of PDD after adjusting for predefined control variables with: low-quality mother-child interaction (OR = 2.46, p = 0.03), exclusive breastfeeding (EBF) <6 months (OR = 2.58, p = 0.01), and partner does not help with childcare (OR = 2.97, p = 0.03). No significant association was observed with postpartum depressive symptoms. CONCLUSIONS: In healthy infants at psychosocial risk, low-quality mother-child interaction, EBF <6 months, and the non-involvement of the father in the childcare are associated with a higher risk of PDD.

Retraso del desarrollo del lenguaje en niños de 24 meses en un centro de salud en la Ciudad de Buenos Aires / Language development delay in 24-month-old children at a health care center of the City of Buenos Aires

Introducción. El retraso del desarrollo del lenguaje representa un desafío frecuente para pediatras y otros profesionales. El objetivo principal fue establecer su prevalencia en niñas y niños usuarios de un centro de salud. Población y métodos. Se evaluó el vocabulario expresivo de niñas y niños de 24 meses en un centro de salud utilizando el Inventario de Desarrollo de Habilidades Comunicativas MacArthur-Bates, versión breve (adaptación argentina). Se investigó la asociación entre el retraso del lenguaje y las características demográficas, socioeconómicas, conductuales/emocionales y de estrés parental. En aquellos con retraso expresivo, se evaluó el vocabulario receptivo y se investigaron posibles causas subyacentes (retraso cognitivo no verbal, trastornos del espectro autista, patología del oído medio e hipoacusia). Resultados. Se observó un retraso del desarrollo del lenguaje en 16 de 138 participantes (11,6%; intervalo de confianza -IC- 95%: 6,2-17%), asociado significativamente con antecedentes familiares de retraso del lenguaje, estrés parental y comportamiento problemático. El compromiso del vocabulario receptivo se identificó en 13 de 16 casos con retraso del desarrollo del lenguaje, y 7 presentaron sospecha de trastorno del espectro autista, de retraso global del desarrollo o ambas. Se observó la patología del oído medio en 5 de 9 estudiados. Los 9 participantes a los que se realizó una audiometría no presentaron resultados patológicos de acuerdo con los criterios adoptados en el presente trabajo. Conclusiones. El retraso del desarrollo del lenguaje representa un problema prevalente en nuestra población y se asoció principalmente con problemas de comportamiento y antecedentes familiares de retraso del lenguaje.

Introduction. Language development delay is a frequent challenge for pediatricians and other health care providers. The main objective of this study was to establish its prevalence among children attending a health care center. Population and methods. The expressive vocabulary of 24-month-old children attending a health care center was assessed using the Spanish-language MacArthur-Bates Communicative Development Inventories, short form (Argentine version). The association between language delay and demographic, socioeconomic, behavioral/emotional, and parental stress characteristics was analyzed. In children with expressive language delay, receptive vocabulary was assessed and possible underlying causes were studied (non-verbal cognitive delay, autistic spectrum disorders, middle ear pathology, and hearing impairment). Results. Language development delay was observed in 16 out of 138 participants (11.6%; 95% confidence interval: 6.2-17%), significantly associated with a family history of language delay, parental stress, and problem behavior. Receptive vocabulary compromise was identified in 13 out of 16 children with language development delay, and 7 were suspected of autistic spectrum disorder, overall developmental delay, or both. A middle ear pathology was observed in 5 out of 9 studied children. The 9 participants who had an audiometry did not have pathological results based on this study's criteria. Conclusions. Language development delay is a prevalent condition in our population and has been mainly associated with behavioral problems and a family history of language delay.

Avaliação do desenvolvimento neuropsicomotor de lactentes nascidos prematuros com e sem displasia broncopulmonar no primeiro ano de vida / Assessment of the neuropsychomotor development in the first year of life of premature infants with and without bronchopulmonary dysplasia

RESUMO Objetivo: Comparar o desenvolvimento neuropsicomotor de lactentes nascidos prematuramente, com e sem displasia broncopulmonar, no primeiro ano de vida. Métodos: Estudo retrospectivo, do tipo transversal, realizado no período de 1º de janeiro de 2014 a 30 de dezembro de 2015, com lactentes prematuros, com peso < 1.500g ao nascer e diagnóstico de displasia broncopulmonar, na idade corrigida de 6 e 9 meses, avaliados pelo Teste de Triagem do Desenvolvimento DENVER II. As variáveis quantitativas foram descritas em médias, medianas e desvio padrão. Para as variáveis que apresentaram distribuição normal, aplicou-se o teste t de Student; do contrário, foi aplicado o teste de Mann-Whitney, considerando significância o valor de p < 0,05. As variáveis qualitativas foram descritas em frequências e porcentagens. Utilizou-se a regressão logística com análise da razão de chances para avaliar os efeitos das outras variáveis, como fatores de risco para alterações no desenvolvimento neuropsicomotor. Resultados: Os lactentes com displasia broncopulmonar apresentaram maior atraso no desenvolvimento neuropsicomotor quando comparados àqueles sem displasia broncopulmonar (p = 0,001). Os fatores associados com maior incidência para alterações no desenvolvimento neuropsicomotor, além da displasia broncopulmonar, foram: esteroide antenatal, sexo, peso ao nascimento, escore de Apgar no quinto minuto, Score for Neonatal Acute Physiology with Perinatal Extension, tempo de oxigenoterapia, ventilação mecânica e internação. Outras variáveis também podem ter influenciado o resultado, como uso de drogas pelas mães dos lactentes com displasia broncopulmonar. Conclusão: A displasia broncopulmonar associada a outros fatores pré e pós-natais pode ser considerada fator de risco para o atraso do desenvolvimento neuropsicomotor em lactentes nascidos prematuramente e com peso inferior a 1.500g, no primeiro ano de vida.

ABSTRACT Objective: To compare the neuropsychomotor development in the first year of life of premature infants with and without bronchopulmonary dysplasia. Methods: A cross-sectional retrospective study was conducted between January 1, 2014, and December 30, 2015, with premature infants weighing < 1,500g at birth and diagnosed with bronchopulmonary dysplasia at the corrected ages of 6 and 9 months, assessed using the DENVER II Developmental Screening Test. Quantitative variables were described as the means, medians and standard deviations. Variables with normal distribution were tested using Student's t test; otherwise, the Mann-Whitney test was used, considering significance at p-value < 0.05. Qualitative variables were expressed as frequencies and percentages. Logistic regression was used with odds ratio analysis to evaluate the effects of other variables as risk factors for changes in neuropsychomotor development. Results: Infants with bronchopulmonary dysplasia showed greater developmental delay compared with those without bronchopulmonary dysplasia (p-value = 0.001). The factors associated with a higher incidence of changes in neuropsychomotor development, in addition to bronchopulmonary dysplasia, were antenatal steroid, gender, birth weight, 5-minute Apgar score, Score for Neonatal Acute Physiology-Perinatal Extension, duration of oxygen therapy, duration of mechanical ventilation and length of hospital stay. Other variables may also have influenced the result, such as drug use by mothers of infants with bronchopulmonary dysplasia. Conclusion: Bronchopulmonary dysplasia associated with other pre- and postnatal factors may be considered a risk factor for delayed neuropsychomotor development in the first year of life in premature infants born weighing less than 1,500g.

What increases the risk of dental traumatism in patients with developmental disabilities?

Abstract This study investigated risk factors for tooth injuries in individuals from a dental clinical reference service for patients with special needs in Belo Horizonte, MG, Brazil. This is a retrospective cohort study that evaluated 493 dental charts of individuals with or without tooth injuries at their first dental appointment. The dependent variable was the time of occurrence of new dental traumatic injuries and was measured in months. Gender, age, International Code of Diseases, mother's education, mouth breathing, hyperkinesis, pacifier use, thumb sucking, psychotropic drug use, tooth injuries at the first dental examination, involuntary movements, open bite, having one or more siblings and reports of seizures were the covariates. The Cox proportional hazards regression model was used to estimate the unadjusted and adjusted hazard ratios and their respective 95% confidence intervals. The average time that individuals remained free of dental traumatism was 170.78 months (95% CI, 157.89-183.66) with median of 216 months. The incidence of new events was 11.88%. The covariate associated with an increased risk of dental traumatism was a history of tooth injuries at the first dental appointment. The increase in dental trauma risk was 3.59 (95% CI, 1.94-6.65). A history of traumatic dental injury was the risk factor for the dental trauma found in this group of individuals with developmental disabilities.

Resumo Este estudo investigou os fatores de risco para traumatismo dentário em indivíduos da clínica odontológica de um serviço de referência para pacientes com necessidades especiais em Belo Horizonte, Brasil. Este é um estudo de coorte retrospectivo que avaliou 493 prontuários de indivíduos com ou sem traumatismo dentário em sua primeira consulta odontológica. A variável dependente foi o tempo de ocorrência de novas lesões traumáticas e foi mensurada em meses. Sexo, idade, Código Internacional de Doenças, educação materna, respiração bucal, hipercinese, uso de chupeta, sucção digital, uso de medicação psicotrópica, lesões dentárias no primeiro exame odontológico, movimentação involuntária, mordida aberta, ter um ou mais irmãos e relatos de convulsões foram

Procesos de atención a menores de 20 años en La Castañeda: evolución del concepto de infancia en psiquiatría / Processes of attention to children and adolescents under 20 years in La Castañeda: evolution of the concept of childhood in psychiatry

Resumen: Existe evidencia de que los niños y adolescentes pueden presentar problemas del desarrollo y trastornos psiquiátricos. Lo anterior es consecuencia del concepto de infancia y del refinamiento de las clasificaciones diagnósticas médico-psiquiátricas. Este artículo ofrece una mirada sobre los procesos de atención psiquiátrica brindados a 36 niños y adolescentes admitidos en el Manicomio La Castañeda en la primera mitad del siglo XX. Motivo de ingreso, tiempo de estancia, diagnósticos establecidos, tratamiento y motivo de egreso son algunos de los aspectos que se describen. Finalmente, se reflexiona sobre la existencia de un hospital psiquiátrico infantil, que siendo testimonio del pasado, tiene al mismo tiempo el desafío de convertirse en una institución innovadora; sitio que en el ámbito de las especialidades médicas reclama la psiquiatría infantil a favor de los menores que difícilmente pueden abogar por sí mismos.

Abstract: Today, there is evidence that shows that children and adolescents can experience developmental problems and psychiatric disorders. This was possible because of two main reasons, the evolution of the concept of infancy and the progress made in medical and psychiatric diagnostic classification. This manuscript offers a glance to early psychiatric attention in Mexico, particularly the care processes provided to 36 children and adolescents under twenty, admitted in the mental asylum La Castañeda, during the first half of the XX century. Admission causes, length of stay, diagnosis, treatment and discharge motives, are some of the aspects described in this study. Finally, it also reflects about the challenge it is for a child psychiatric hospital nowadays, with such a history, to become an innovative institution able to claim a place in the medical field in favor of those minors that can barely defend themselves.

Child development in primary care: a surveillance proposal / Desenvolvimento infantil em atenção primária: uma proposta de vigilância

Abstract Objective: To evaluate a child development surveillance tool proposal to be used in primary care, with simultaneous use of the Denver II scale. Methods: This was a cross-sectional study of 282 infants aged up to 36 months, enrolled in a public daycare in a countryside community in Rio Grande do Sul/Brazil. Child development was assessed using the surveillance tool and the Denver II scale. Results: The prevalence of probable developmental delay was 53%; most of these cases were in the alert group and 24% had normal development, but with risk factors. At the Denver scale, the prevalence of suspected developmental delay was 32%. When risk factors and sociodemographic variables were assessed, no significant difference was observed. Conclusion: The evaluation of this surveillance tool resulted in objective and comparable data, which were adequate for a screening test. It is easily applicable as a screening tool, even though it was originally designed as a surveillance tool. The inclusion of risk factors to the scoring system is an innovation that allows for the identification of children with suspected delay in addition to developmental milestones, although the definition of parameters and choice of indicators should be thoroughly studied.

Resumo Objetivo Avaliar uma proposta de um instrumento de vigilância em desenvolvimento para uso na atenção primária e a aplicação simultânea da escala de Denver II. Métodos Estudo transversal com uma amostra de 282 crianças até 36 meses da rede pública escolar, numa comunidade do RS. Foi avaliado o desenvolvimento infantil com o instrumento de vigilância proposto e o Denver II. Resultados A prevalência de provável atraso no desenvolvimento foi de 53%, a maioria desses na condição de Alerta e 24% com desenvolvimento normal, mas com fatores de risco. No Denver a prevalência foi de 32% com suspeita para o atraso no desenvolvimento. Os fatores de risco e as variáveis sociodemográficas avaliadas não apresentaram diferenças significativas. Conclusão A avaliação desse instrumento de vigilância trouxe dados objetivos e comparativos, nos moldes preconizados para um teste de triagem. É um instrumento de fácil aplicabilidade como triagem, originalmente como vigilância. A inclusão dos fatores de risco no sistema de escore é uma inovação que possibilita o aumento da identificação de crianças com suspeita de atraso além dos marcos do desenvolvimento, ainda que a definição dos parâmetros e da escolha dos indicadores deva ser melhor construída.

Desigualdades en desarrollo infantil temprano entre prestadores públicos y privados de salud y factores asociados en la Región Metropolitana de Chile / Early child development inequalities and associated factors between public and private providers at metropolitan region in Chile

El desarrollo infantil temprano es un determinante de la salud física, mental y social de poblaciones. Conocer la situación de desarrollo de base, previo a la instalación de «Chile Crece Contigo¼, es clave para efectos de su evaluación. Objetivo: Comparar el desarrollo infantil temprano y factores asociados de preescolares del sector público y del sector privado de salud en la línea de base. Pacientes y método: Una muestra de 1.045 niños de la Región Metropolitana, de 30 a 58 meses, 52% hombres, 671 del sector público y 380 del privado de salud. Se evaluaron mediante el Inventario de Desarrollo Battelle-1 y una encuesta psicosocial en sus hogares aplicada al cuidador principal. Resultados: El 14,4% del sector privado y el 30,4% de la red pública tenían desarrollo alterado. No hubo diferencias en el área adaptativa entre ambos grupos (26,3% vs 29,2%). En las áreas cognitiva (8,8% vs 12,1%), personal-social (13,2% vs 32,5%), motriz (19,2% vs 35,3%) y comunicación (19,0% vs 36,8%) las diferencias fueron estadísticamente significativas. Mediante regresión logística se determinó que, independiente del nivel socioeconómico, son factores de riesgo: Apgar < 7 (OR: 5,4; IC 95%: 1,24-23,84), tener enfermedades crónicas de la infancia (OR: 1,3; IC 95%: 1,11-1,42); protector es: hogar con recursos para el aprendizaje y juego (OR: 0,8; IC 95%: 0,76-0,89). Conclusión: Estos resultados son un aporte al conocimiento de la situación del desarrollo infantil y para relevar su importancia para las políticas sociales en pediatría.

Early child development is a population determinant of physical, mental and social health. To know the base line situation prior to the implementation of "Chile grows with you" (Chile Crece Contigo) is key to its evaluation. Objective: To compare early child development and associated factors at baseline in pre-school children from public and private health sectors. Patients and method: The sample consisted of 1045 children aged 30-58 months, 52% male, and 671 from the public and 380 from the private sector of the metropolitan region in Chile were evaluated using Battelle Developmental Inventory-1 and a household interview of primary carer. Results: Abnormal child development was found in 14.4% of children in the private sector compared to 30.4% in the public sector. There were no differences in adaptive area (26.3% vs 29.2%), but there were statistically significant differents in cognitive (8.8% vs 12.1%), social-personal (13.2% vs 32.5%), motor (19.2% vs 35.3%), and communication (19% vs 36.8%) development. The logistic regression showed that, independent of socioeconomic level, the risk factors are: Apgar < 7 (OR: 5.4; 95% CI: 1.24-23.84); having childhood chronic diseases (OR: 1.3; 95% CI: 1.11-1.42). Protective factor is: home with resources to learn and play (OR: 0.8; 95% CI: 0.76-0.89).

Asociación entre morbilidad neonatal, edad gestacional y déficit de desarrollo psicomotor en prematuros moderados y tardíos / Association between neontal morbidity, gestational age and developmental delays in moderate to late preterm children

Introducción: Existe evidencia respecto a que los niños que nacen prematuros moderados y tardíos (PMT) tendrían mayor riesgo de hospitalización, morbilidad neonatal y deficiencias del desarrollo psicomotor (DSM). Objetivo: Determinar, en PMT, la asociación entre el déficit de DSM, edad gestacional y la morbilidad neonatal. Pacientes y método: Estudio caso control anidado en una cohorte de niños nacidos PMT entre los años 2006 y 2009, en una institución privada de la Región Metropolitana. Los niños fueron evaluados con la Escala de Bayley-III de desarrollo infantil a los 8 o 18 meses de edad corregida, o a los 30 meses de edad cronológica. Retrospectivamente se revisaron los registros neonatales. Se generó un modelo de análisis de asociación multivariado para conocer el efecto de la morbilidad neonatal sobre el desarrollo alcanzado. Resultados: Se estudiaron 130 PMT, 25 casos y 105 controles. El 83,8% fue hospitalizado en el periodo neonatal. Hubo diferencias estadísticamente significativas entre casos y controles solo en relación con la edad materna y la hipoglucemia sintomática (OR cruda 3,5, OR ajustada 8,18); se encontró que las variables que afectan de forma negativa el coeficiente de desarrollo son el género masculino, la gemelaridad y la menor edad gestacional. Conclusiones: La hipoglucemia sintomática es el principal factor de riesgo de déficit del DSM, mientras que la gemelaridad, el género masculino y la edad gestacional influyen en el coeficiente de desarrollo global obtenido. Es fundamental desarrollar estrategias de prevención, pesquisa y manejo precoz de esta alteración metabólica para prevenir dificultades del DSM posteriores.

Introduction: There is evidence that children born moderate-to-late preterm (MLP) have a higher risk of hospitalisation, neonatal morbidity, and developmental delay (DD). Objective: To determine the association between DD, gestational age, and neonatal morbidity in MLP children. Patients and method: A case control study design nested in a cohort of MLP children born between 2006 and 2009 at a private hospital located in the Metropolitan area of Santiago. The children were assessed with the Bayley-III Scales of Infant Development at 8 or 18 months corrected age, or at 30 months of chronological age. Neonatal records were retrospectively reviewed. A multivariate analysis was performed to determine the effect of neonatal morbidity on development. Results: A total of 130 MLP children, 25 cases and 105 controls, were studied. Most of them (83.8%) were hospitalised during the neonatal period. Significant differences between cases and controls regarding maternal age and symptomatic hypoglycaemia were observed (crude OR 3.5, adjusted OR 8.18). It was concluded that the variables that negatively affect the rate of development are male gender, being a twin, and gestational age. Conclusions: Symptomatic hypoglycaemia is the main risk factor for DD, while being a twin, male gender, and gestational age influenced the total development rate obtained. It is essential to develop strategies for prevention, screening, and early management of this metabolic disorder to prevent future DD.

Trastornos del desarrollo en niños y adolescentes de la región de Los Ríos, Valdivia, Chile, 2006-2008 / Developmental disorders in children and adolescents of the Los Ríos region, Valdivia, Chile, 2006-2008

Objetivo: Estudiar los posibles hallazgos de factores asociados antenatales, perinatales o posnatales, tanto de la madre como del niño, que tengan relevancia significativa en la aparición de trastornos del desarrollo. Pacientes y método: Se creó una base de datos de todas las fichas clínicas de los pacientes con patología del desarrollo F80 a F90 CIE10 ingresados a la Unidad de Psiquiatría Infantil del Hospital Regional de Valdivia entre agosto de 2006 y diciembre de 2008. Total: 493 pacientes (48,7% del total de consultantes); grupo control de 32 niños sanos de consultorios de la ciudad. Se aplicó método estadístico odds ratio (95% confianza) para el análisis de algunas variables. Resultados: Destacan como factores de riesgo para desarrollar patología del desarrollo (p < 0,005, 25% de frecuencia en población consultante): la prematurez, ser de sexo masculino, tener una madre con baja escolaridad, hospitalizaciones tempranas y enfermedades médicas antes de los 3 años (todos con odds ratio significativa). Además tener una madre psiquiátrica aumenta el doble el riesgo de desarrollar trastorno del desarrollo. Conclusión: Se requiere un trabajo colaborativo interdisciplinario entre neonatólogos, obstetras, psiquiatras infantiles y la atención primaria para detectar precozmente niños en riesgo.

Objectives: To study possible findings of factors in the antenatal, perinatal or postnatal period, in the mother or the child that may have an influence on the appearance of a developmental disorder. Patients and method: A Data Base of Clinical Histories from every patient with a developmental disorder (F80-F90 ICD10) was created. The patients attended the Child Psychiatric Unit at Hospital Regional of Valdivia, Chile, from August 2006 to December 2008. Total: 493 patientes (48.7% of the total of patients consulting); Control group: 32 healthy patients. Statistical method: odds ratio (95% confidence). Results: The main risk factors for developing a developmental disorder (P < .005, 25% frequency in the consulting population) are: prematurity, male sex, mother with low education, early hospitalizations, and medical illnesses (all with a significant odds ratio). Also, having a mother with psychiatric illness doubles the risk of having a developmental disorder. Conclusion: It requires an interdisciplinary collaborative work between neonatologists, obstetricians, child psychiatrists and the primary care to detect early children at risk.

Caracterización de heridas en pacientes infantiles y juveniles con discapacidad neuro-músculo-esquelética / Characterization of wounds in children and young patients with neuro-musculoskeletal disabilities at Telethon Institute

Introducción: En la literatura existen escasas referencias a heridas en pacientes pediátricos con discapacidad, éstas son principalmente en población adulta. Para implementar medidas de prevención en pacientes infantiles y juveniles con discapacidad, es fundamental conocer sus características y factores asociados. Objetivo: Describir las características socio-demográficas y clínicas de los niños y jóvenes con discapacidad neuro-músculo-esquelética y de sus heridas, atendidos en policlínico de heridas del Instituto Teletón (IT)-Santiago. Método: Evaluación y descripción clínica de las heridas; aplicación de encuesta a pacientes/cuidadores atendidos en el policlínico, desde mayo a noviembre de 2013. Resultados: De los 34 evaluados, 55,9 por ciento son de sexo masculino, con edades entre 4,5 y 27,2 años. El diagnóstico principal corresponde a lesión medular adquirida o congénita en 79,4 por ciento de los casos. Son totalmente dependientes en transferencias y aseo genital el 50 por ciento. Se identificaron 44 heridas en total, 90,9 por ciento corresponden a úlceras por presión; grado II de profundidad en el 45 por ciento. La localización más frecuente fue tobillo-pie con 52,2 por ciento. Un 61,4 por ciento de ellas corresponde a una recidiva de episodio de herida. El 43,2 por ciento se desarrolla en el curso de una hospitalización. 29,5 por ciento de las heridas tiene contacto con elementos ortésicos o calzado no terapéutico. Se obtuvo asociación significativa entre localización y diámetro de la herida (p < 0,036). Conclusiones: En el grupo de pacientes evaluados, que en un 80 por ciento presentan lesiones medulares congénitas o adquiridas, las úlceras de mayor tamaño se concentran significativamente más en zona pelviana, y la localización de las heridas se presenta en forma casi exclusiva, en zona pelviana y tobillo-pie.

Introdution: In the literature there are few references to wounds in pediatric patients with disabilities. For prevention of wounds in pediatric population with disabilities, it is essential to know its characteristics and associated factors. Objective: Describe the socio-demographic and clinical characteristics of wounds in children and young patients with neuro-musculoskeletal disabilities in Santiago Telethon Institute. Method: Assessment and clinical description of injuries; survey application to patients/caregivers attended at Telethon Institute from May to November 2013. Results: Out of 34 patients, 55.9 percent were male, the age ranged between 4.5 and 27.2 years. The main diagnose corresponds to acquired or congenital spinal cord injury (79.4 percent). 50 percent are totally dependent on transfers and genital toilet. Overall 44 wound were identified, 90 percent of which were pressure ulcers; 45 percent classified as grade II. The most common site of injury was ankle-foot area (52.2 percent). 61.4 percent are a recurrence of pressure ulcer; 43.2 percent develops during hospitalization, 29.5 percent of wounds have contact with orthotics or footwear. Significant association was found between location and diameter of the wound (p < 0.036). Conclusions: In the group of patients evaluated, 80 percent have congenital or acquired spinal cord injuries; the greater ulcer sizes are located in the pelvic area, and the location of the wound occurs almost exclusively in the pelvic and ankle-foot area.

Severe root resorption resulting from orthodontic treatment: Prevalence and risk factors

OBJECTIVE: To assess the prevalence of severe external root resorption and its potential risk factors resulting from orthodontic treatment. METHODS: A randomly selected sample was used. It comprised conventional periapical radiographs taken in the same radiology center for maxillary and mandibular incisors before and after active orthodontic treatment of 129 patients, males and females, treated by means of the Standard Edgewise technique. Two examiners measured and defined root resorption according to the index proposed by Levander et al. The degree of external apical root resorption was registered defining resorption in four degrees of severity. To assess intra and inter-rater reproducibility, kappa coefficient was used. Chi-square test was used to assess the relationship between the amount of root resorption and patient's sex, dental arch (maxillary or mandibular), treatment with or without extractions, treatment duration, root apex stage (open or closed), root shape, as well as overjet and overbite at treatment onset. RESULTS: Maxillary central incisors had the highest percentage of severe root resorption, followed by maxillary lateral incisors and mandibular lateral incisors. Out of 959 teeth, 28 (2.9%) presented severe root resorption. The following risk factors were observed: anterior maxillary teeth, overjet greater than or equal to 5 mm at treatment onset, treatment with extractions, prolonged therapy, and degree of apex formation at treatment onset. CONCLUSION: This study showed that care must be taken in orthodontic treatment involving extractions, great retraction of maxillary incisors, prolonged therapy, and/or completely formed apex at orthodontic treatment onset. .

OBJETIVO: avaliar a prevalência de reabsorções radiculares externas severas e identificar prováveis fatores de risco decorrentes do tratamento ortodôntico. MÉTODOS: utilizou-se uma amostra selecionada aleatoriamente, composta de radiografias periapicais de incisivos superiores e inferiores, obtidas no mesmo centro radiológico, de pré- e pós-tratamento ortodôntico ativo, de 129 pacientes, de ambos os sexos, tratados por meio da técnica Edgewise Standard. Dois examinadores mensuraram e definiram a reabsorção radicular de acordo com índice proposto por Levander et al., e o grau de reabsorção foi registrado, definindo a reabsorção em quatro graus de severidade. Para avaliar a reprodutibilidade intra- e interexaminadores, adotou-se o índice de coeficiente kappa ponderado. O teste chi-quadrado (χ2) foi adotado para avaliar a relação entre a quantidade de reabsorção radicular e o sexo dos pacientes, arcada dentária (superior ou inferior), tratamentos com ou sem extrações, duração do tratamento, forma radicular, estágio do ápice radicular (aberto ou fechado), overjet e overbite no início do tratamento. RESULTADOS: os incisivos centrais superiores apresentaram a maior porcentagem de reabsorção radicular severa, seguidos dos incisivos laterais superiores e dos incisivos laterais inferiores. Entre 959 dentes avaliados, 28 (2,9%) apresentaram reabsorção radicular severa. Os fatores de risco relacionados foram: dentes localizados na região anterossuperior, overjet maior ou igual a 5mm ao início do tratamento, tratamentos envolvendo extrações dentárias, tempo prolongado de terapia e formação radicular completa à época do início do tratamento ortodôntico. CONCLUSÃO: o estudo demonstrou que cuidados devem ser tomados em tratamentos ortodônticos envolvendo extrações, com grande retração de incisivos superiores, tratamentos prolongados e/ou ápice radicular completamente formado no início da terapia ortodôntica. .

Monitoreo de los indicadores del Programa "Chile Crece Contigo" 2008-2011 / Monitoring indicators of the program "Chile Grows with you" 2008-2011

Objective: To monitor coverage and outcomes associated with the activities of the integrated protection system for early childhood Chile Grows with You (CHCC), which includes the comprehensive psychosocial development of children between 18 months and 3 years old, in each of the 29 Health Services of the country, as well as the changes observed after 4 years. Material and Method: Database analysis of all local public networks in the country between 2008 and 2011 was performed. The application of the test regarding psychomotor development, prevalence of development delay and risk, participation of mothers in educational workshops, home visits and recovery rate of deficient children by age were studied. Median and observed changes of each indicator were analyzed developing a ranking based on the results observed. Results: Approximately 75% of children were evaluated, with a prevalence of delay or risk of about 5% and a rate of recovery close to 50%. The participation of mothers in educational workshops increased from 7.6 to 11.0% (p <0.001) and home visits to developmentally delayed children increased 6 times between 2009 and 2011 (p <0.001). Most changes were positive, although the prevalence of developmentally delayed children under 2 years slightly increased (0.6%), and the recovery of 3 year olds decreased (-14.4%). A great variability was observed among the Health Services. Conclusions: There are some positive results in relation to psychomotor development, with significant regional differences. A lower than expected deficit rate regarding psychomotor development was observed, which implies the need to further analyze the instrument used or the conditions of application.

Objetivo: Monitorear la cobertura y resultados de las principales actividades planificadas en el subsistema de protección social Chile Crece Contigo (CHCC) en relación al desarrollo psicosocial integral en niños de 18 meses y 3 años, en cada una de los 29 Servicios de Salud del país y los cambios observados en 4 años. Material y Método: Análisis de bases de datos de todos los establecimientos de la Red Pública del país, 2008 y 2011. Se estudió: aplicación del test de desarrollo psicomotor, prevalencia de retraso y riesgo del desarrollo, participación de madres en talleres educativos, visitas domiciliarias integrales y tasa de recuperación de niños con déficit según edad. Se analizó mediana y cambio observado de cada indicador por servicios de salud y se elaboró un ranking en función de los resultados observados. Resultados: Aproximadamente el 75% de los niños fueron evaluados, con una prevalencia de retraso o riesgo del orden de 5% y tasa de recuperación cercana al 50%. La participación de madres en talleres educativos aumentó de 7,6 a 11,0% (p < 0,001) y las visitas domiciliarias en niños con rezago 6 veces entre el 2009 y 2011 (p < 0,001). La mayor parte de los cambios fueron positivos, aunque aumentó levemente la prevalencia de rezago en menores de 2 años (0,6%) y disminuyó la recuperación de niños de 3 años (-14,4%). Destaca amplia variabilidad entre servicios de salud. Conclusiones: Existen algunos resultados positivos en relación al desarrollo psicomotor, con importantes diferencias regionales. Destaca una tasa de déficit del desarrollo psicomotor menor a lo esperado, lo que implica la necesidad de revisar el instrumento utilizado o las condiciones de aplicación.

Fatores de risco para o desenvolvimento de criancas atendidas em Unidades de Saude da Familia, ao final do primeiro ano de vida: aspectos sociodemograficos e de saude mental materna / Risk factors for impaired development in children attended at family health units at the end of the first year of life: socio-demographic aspects and maternal mental health

O objetivo deste artigo é verificar fatores de risco e proteção para o desenvolvimento de crianças de 1 ano, atendidas em unidades de saúde da família. Estudo transversal com 65 crianças de aproximadamente 1 ano, atendidas em duas Unidades de Saúde da Família, e suas respectivas mães. Avaliou-se o desenvolvimento através de um teste de screening para rastreamento de risco. As mães responderam a uma entrevista e ao SRQ-20 para identificar indicadores de transtorno mental comum (TMC). Realizou-se análise descritiva dos dados e procedeu-se a análise estatística inferencial. Estavam em risco para o desenvolvimento global 43,1% das crianças e as áreas mais afetadas foram linguagem e motricidade fina; 44,6% das mães pontuaram para indicativo de transtorno mental comum, quando a criança tinha 1 ano. Na análise bivariada, depressão referida, tabagismo, infecções na gravidez, TMC após o nascimento e trabalhar fora associaram-se significativamente com o desenvolvimento da criança. Após os ajustes, apenas TMC apresentou-se como fator de risco e trabalhar fora fator de proteção. Para aumentar as chances de sucesso de programas direcionados a crianças com risco para o desenvolvimento em unidades de saúde parece importante ter dois focos: a estimulação da criança e a saúde mental materna.

The scope of this article is to evaluate risk and protection factors for the development of 1-year-olds assisted at family health care units. It is a cross-sectional study involving 65 children of approximately 1 year of age and their mothers attended at two family health care units. The development was assessed using a developmental screening test (Denver II). The mothers filled out the SRQ-20 questionnaire to identify common mental disorder (CMD) indicators. After data collection, descriptive and inferential statistical analysis was performed. Global development was at risk in 43.1% of the children evaluated, and the most affected areas were language and fine motor development; 44.6% of mothers had results indicative of CMD when the child was 1 year of age. In bivariate analysis, reported depression, smoking, infections in pregnancy, CMD after birth and working outside the home were significantly associated with the children's development. After full statistical analysis, CMD was revealed as being a risk factor, and working away from home as being a protection factor. In order to increase the chances of success of programs targeted for children at health care units and avoiding the risk of impaired development, it is important to focus on two aspects: children's stimulation and maternal mental health. .

Risk of developmental delay of children aged between two and 24 months and its association with the quality of family stimulus / Riesgo de retardo en el desarrollo de ninos de dos a 24 meses y su asociacion con la calidad del estimulo familiar / Risco de atraso no desenvolvimento de criancas de dois a 24 meses e sua associacao com a qualidade do estimulo familiar

OBJECTIVE: To analyze the association between neurodevelopment and the family environment resources of children from the coverage area of a Basic Health Unit (BHU) of Belo Horizonte, Brazil, using a tool based on the Integrated Management of Childhood Illness (IMCI) strategy. METHODS: Cross-sectional study with a non-probabilistic sample involving 298 children aged between 2-24 months old, who attended a BHU in 2010. The assessment of child development and family resources made at the BHU lasted, in average, 45 minutes and included two tests - an adaptation of the Handbook for Monitoring Child Development in the Context of IMCI and an adapted version of the Family Environment Resource (FER) inventary. The nonparametric tests of Kruskal-Wallis and Mann-Whitney were used for the statistical analysis. RESULTS: The sample included 291 assessments, with 18.2% of children between 18 and 24 months old, 53.6% male gender, and 91.4% who did not attend day care centers. According to IMCI, 31.7% of the children were in the risk group for developmental delay. The total average score in FER was 38.0 points. Although it has been found an association between the IMCI outcome and the total FER score, all groups had low scores in the family environment assessment. CONCLUSIONS: The data indicate the need for childhood development screening in the primary health care and for early intervention programs aimed at this age group. .

OBJETIVO: Analizar la asociación entre el desarrollo neuropsicomotor y los recursos del ambiente familiar de niños de dos a 24 meses del área de alcance de una Unidad Básica de Salud (UBS) de Belo Horizonte, utilizando instrumento basado en la estrategia Atención Integral de las Enfermedades Prevalentes en la Infancia (AIDPI). MÉTODOS: Estudio transversal con muestra no probabilística, del que participaron 298 niños de dos a 24 meses y que frecuentaban una UBS de Belo Horizonte, en 2010. La evaluación del desarrollo infantil y de los recursos familiares realizada en la UBS tuvo duración mediana de 45 minutos e incluyó la aplicación de dos pruebas - una adaptación del Manual para Vigilancia del Desarrollo Infantil en el Contexto de AIDPI y una versión adaptada del Inventario de Recursos del Ambiente Familiar (RAF). En el análisis estadístico, se utilizaron las pruebas no paramétricas de Kruskal-Wallis y de Mann-Whitney. RESULTADOS: La muestra contuvo 291 evaluaciones, siendo más grandes los porcentajes de niños de 18 a 24 meses (18,2%), del sexo masculino (53,6%) y que no frecuentaban guardería (91,4%). Los resultados obtenidos con la AIDPI demostraron que el 31,7% de los niños estaban en un grupo de riesgo para el retardo en el desarrollo. En el Inventario de RAF, la puntuación total mediana fue de 38,0 puntos. Aunque haya habido asociación del resultado de AIDPI con la puntuación total obtenida en el Inventario de RAF, todos los grupos presentaron baja puntuación en la evaluación del ambiente familiar. CONCLUSIONES: Los datos apuntan a la necesidad de rastreo del desarrollo infantil en la atención básica y de programas de intervención temprana dirigidos a esa franja de edad. .

OBJETIVO: Analisar a associação entre o desenvolvimento neuropsicomotor e os recursos do ambiente familiar de crianças da área de abrangência de uma Unidade Básica de Saúde (UBS) de Belo Horizonte, utilizando instrumento baseado na estratégia Atenção Integral das Doenças Prevalentes na Infância (AIDPI). MÉTODOS: Estudo transversal com amostra não probabilística, do qual participaram 298 crianças de dois a 24 meses que frequentavam uma UBS de Belo Horizonte, em 2010. A avaliação do desenvolvimento infantil e dos recursos familiares feita na UBS teve duração média de 45 minutos e incluiu a aplicação de dois testes - uma adaptação do Manual para Vigilância do Desenvolvimento Infantil no Contexto da AIDPI e uma versão adaptada do Inventário de Recursos do Ambiente Familiar (RAF). Na análise estatística, utilizaram-se os testes não paramétricos de Kruskal-Wallis e de Mann-Whitney. RESULTADOS: A amostra conteve 291 avaliações, sendo maiores as porcentagens de crianças de 18 a 24 meses (18,2%), do sexo masculino (53,6%) e que não frequentavam creche (91,4%). Os resultados obtidos com a AIDPI demonstraram que 31,7% das crianças estavam em um grupo de risco para o atraso no desenvolvimento. No Inventário RAF, a pontuação total média foi de 38,0 pontos. Embora tenha havido associação do resultado da AIDPI com a pontuação total obtida no Inventário RAF, todos os grupos apresentaram baixa pontuação na avaliação do ambiente familiar. CONCLUSÕES: Os dados apontam para a necessidade de triagem do desenvolvimento infantil na atenção básica e de programas de intervenção precoce voltados para essa faixa etária. .

Prevalencia de estereotipias en pacientes sin enfermedades crónicas / Prevalence of stereotypies in patients without chronic diseases

Introducción: Las estereotipias han sido descritas en niños con trastornos del desarrollo pero su prevalencia y características en niños con desarrollo madurativo normal no es conocida. Objetivo: Estimar la prevalencia de estereotipias en niños sin enfermedades crónicas y describir sus características clínicas y epidemiológicas Pacientes y Métodos: Estudio de corte transversal. Se aplicó una encuesta a madres de niños recién nacidos hasta niños de 12 años que concurrieron a los consultorios externos con muestreo consecutivo y no aleatori-zado. La encuesta fue analizada previamente en un subgrupo de madres. Resultados: Se completaron 406 encuestas, en el 57 por ciento se refirieron estereotipias y las más frecuentes fueron chuparse los dedos (21,8 por ciento) y comerse las uñas (20 por ciento). El análisis multivariado identificó mayor probabilidad de presentar estereotipias en niños con antecedentes de esterotipia en los padres, situaciones de estrés y madres mayores de 35 años. Conclusión: Las estereotipias tienen una elevada prevalencia en los niños y son más frecuentes en niños con antecedentes familiares de estereotipias, situaciones de estrés y en niños con madres de mayor edad.

Background: Stereotypies have been described in children with developmental disorders but their prevalence and characteristics in developmentally normal children is unknown. Objective: To estimate the prevalence of stereotypies in children without chronic diseases and describe their clinical and epidemiological characteristics. Patients and Methods: A Cross-sectional study was performed. Mothers of children aged from birth to 12 years, who attended the outpatient clinic, answered survey questions. Results: 406 surveys were completed; stereotypies were observed in 57 percent of patients, among the most frequent, finger sucking (21.8 percent) and nail biting (20 percent). A multivariate analysis identified that stereotypies are more likely in children with a history of stereotypy in parents, under stressful environments, and with mothers over 35 years old. Conclusion: Stereo-typies showed a high prevalence in this study, most frequently in those children under stressful environments, mothers older than 35 years, and affected parents.

A endogamia explicaria a elevada prevalência de deficiências em populações do Nordeste brasileiro? / Could endogamy explain the higher prevalence of disabilities in the population of the Brazilian Northeast?

Apesar da inexatidão conceitual e de métodos de aferição, a OMS estima que cerca de 10% da população mundial apresente alguma forma de deficiência. Com a finalidade de investigar a prevalência e a etiologia das deficiências e verificar se elas estariam associadas à endogamia, foi realizado um estudo epidemiológico transversal com uso do método do informante envolvendo cinco municípios do Estado do Rio Grande do Norte, no Nordeste brasileiro; nos quais foram estimadas frequências de casamentos consanguíneos que variam de 9 a 32%. A prevalência média estimada para deficiências nos cinco municípios amostrados foi de 4,53%, obtida por meio de entrevistas envolvendo 37,87% de uma população de 39.054 habitantes. Em média, 25% dos casais consanguíneos e 12% dos não consanguíneos apresentaram um ou mais filhos com alguma deficiência. A elevada prevalência de pessoas com deficiência no Nordeste brasileiro pode ter associação com a manutenção da tradição de casamentos consanguíneos nessas populações e parte dessas deficiências pode ser causada por doenças genéticas.

Despite conceptual inaccuracies and methods of measurement, the WHO estimates that about 10% of the world population has some form of disability. In order to investigate the prevalence and etiology of disabilities and to evaluate if they could be associated with inbreeding, a cross-sectional epidemiological study was conducted using the informant method in five communities of the state Rio Grande do Norte in the Brazilian Northeast, in which consanguineous marriages frequencies varied between 9 and 32%. The average prevalence of disabilities in the five sampled communities was 4.53%, obtained by interviews that involved 37.87% of a population of 39,054 inhabitants. On average, 25% of consanguineous and 12% of non-consanguineous couples had one or more children with disabilities. The increased rate of individuals with disabilities in the Brazilian Northeast could be associated with the maintenance of the tradition of consanguineous marriages in these populations and some of these disabilities may be caused by genetic disorders.