Chronic neutropenia in childhood: experience of a tertiary center

Abstract Objective: To assess the prevalence of chronic neutropenia (CN) and the clinical profile of patients with CN aged up to 18 years, followed in the pediatric hematology, rheumatology, or immunology outpatient clinic of a tertiary medical center from May 1, 2018, to 30 April 2019. Methods: Retrospective observational study carried out by collecting data from the patient's medical charts. CN was defined as absolute neutrophil count (ANC) below 1.5 × 109/L lasting over three months. Autoimmune neutropenia (AIN) was defined by clinical criteria and an over twofold increase in ANC after glucocorticoid stimulation. AIN was considered secondary when associated with autoimmune or immunoregulatory disorders. Wilcoxon and Fisher's exact tests were used to compare variables; the significance level was 5 %. Results: A total of 1,039 patients were evaluated; 217 (20 %) presented CN. Twenty-one (2 %) had AIN, classified as primary in 57 % of the cases. The average age at the onset of symptoms was 38.6 months. During follow-up, patients had 4.2 infections on average; frequency was higher among patients with secondary AIN (p = 003). Isolated neutropenia occurred in 43 % of the patients with AIN. Neutropenia resolved in eight (38 %) of the 21 patients with AIN within 19.6 months on average. Eight patients with secondary AIN met the criteria for Inborn Errors of Immunity. Conclusion: AIN prevalence was 2 %. Most cases were first evaluated by a pediatric immunologist or rheumatologist rather than a pediatric hematologist. This study highlights the need for a multidisciplinary approach involving a pediatric immunologist, rheumatologist, and hematologist.

Especialización o diversificación en el desarrollo deportivo: Una revisión integrativa / Specialization or Diversification in Sports Development: An Integrative Review / Especialização ou diversificação no desenvolvimento esportivo: uma revisão integrativa

Resumen Objetivo: Explorar y discutir literatura científica teórica y práctica para comparar la diversificación y la especialización deportivas tempranas como un enfoque deportivo y educativo. Métodos: Se realizó una revisión sistemática siguiendo las pautas PRISMA, se incluyó un total de 61 estudios. Resultados: Entrenadores, padres e hijos consideran que la mejor forma de desarrollar el talento deportivo y alcanzar la élite en el deporte es participar en una sola disciplina y hacerlo lo antes posible para lograr la especialización y las máximas habilidades técnicas, físicas y psicológicas. Los caminos de especialización deportiva pueden conducir a una situación física, social y mental que comprometa su desarrollo integral. Conclusión: Se puede plantear, en primer lugar, la diversificación deportiva en edades tempranas y luego la especialización; una vez alcanzadas las bases de la fuerza, el acondicionamiento y el entrenamiento neuromuscular, así como una maduración psicomotora específica, para que su rendimiento deportivo y su salud no se vean comprometidos en el mediano o largo plazo. Es necesario considerar que pocos niños logran obtener un lugar en los deportes de élite, por lo que, para muchos de ellos, la educación en torno al deporte será la base para el ejercicio de su ciudadanía como personas activas.

Abstract Purpose: To explore and discuss theoretical and practical scientific literature to compare sports diversification and early sports specialization as a sport and educational approach. Methods: A systematic review was conducted following PRISMA guidelines, and 61 studies were included. Results: Coaches, parents, and children consider that the best way to develop sports talent and enter the elite in sports is to practice a single discipline as early as possible to achieve specialization and maximum technical skills and physical and psychological conditions. Sports specialization paths may lead to a physical, social, and mental state that compromises their integral development. Conclusion: Sports diversification should be considered first at an early age and, afterward, the specialization once the bases of strength, conditioning, neuromuscular training, and a specific psychomotor maturation have been achieved, so that sports performance and health are not compromised in the medium or long term. It is necessary to consider that few children enter elite sports, so for many of them, sports education will be the basis for exercising their citizenship as active people.

Resumo Objetivos: Explorar e discutir literatura científica teórica e prática para comparar a diversificação e especialização esportiva precoce como uma abordagem esportiva e educacional. Métodos: uma revisão sistemática foi realizada seguindo as diretrizes do PRISMA, um total de 61 estudos foram incluídos Resultados: Treinadores, pais e crianças acreditam que a melhor maneira de desenvolver talentos esportivos e ingressar na elite do esporte é participar de uma única disciplina e fazer o mais cedo possível para alcançar a especialização e o máximo de habilidades técnicas, físicas e psicológicas. Os caminhos da especialização esportiva podem levar a uma situação física, social e mental que comprometa seu desenvolvimento integral. Conclusão: Primeiro, a diversificação esportiva pode ser considerada em uma idade precoce e depois a especialização, uma vez que os princípios básicos de força, condicionamento e treinamento neuromuscular tenham sido alcançados, bem como a maturação psicomotora específica para que seu desempenho esportivo e saúde não sejam comprometidos a médio ou longo prazo. É necessário considerar que poucas crianças conseguem obter um lugar nos esportes de elite, de modo que, para muitas delas, a educação em torno do esporte será a base para o exercício de sua cidadania como pessoas ativas.

Asociación del índice de masa corporal con la insatisfacción corporal en escolares / Association of body mass index with body dissatisfaction in schoolchildren

Introducción: La malnutrición por exceso causa sobrepeso y obesidad, siendo un problema de salud pública, que se ha presentado en los primeros años de vida. Investigaciones realizadas han informado la existencia de insatisfacción corporal relacionada con el peso, debido a los estándares de belleza establecidos en la sociedad. Objetivo: asociar el índice de masa corporal con la insatisfacción corporal y percepción de la imagen corporal de los escolares. Materiales y métodos: estudio transversal con 610 escolares. El estado nutricional se clasificó según el puntaje z del IMC. Para determinar la insatisfacción corporal y la percepción de la imagen corporal, se aplicó una escala de imagen corporal infantil de siete fotografías, con un valor del 1 al 7 de acuerdo con el tamaño creciente, y el rango final del IMC. Se calculó la diferencia entre la figura que los participantes consideraron ideal y la forma corporal percibida. Resultados: el 47,3% presentaron sobrepeso y obesidad. La insatisfacción corporal fue mayor en las niñas con sobrepeso y obesidad (p = 0,013). El IMC correlacionó con la insatisfacción corporal (rho(608) = 0,480; p < 0,001) y la percepción de la imagen corporal (rho(608) = 0,433; p < 0,001). Conclusiones: El IMC se relacionó positivamente con la insatisfacción corporal y la percepción de la imagen corporal; esto podría elevar el riesgo de presentar trastornos alimentarios, contribuir al mantenimiento del exceso de peso corporal, al no percibirse con exceso de peso, es menos probable que realicen acciones para controlarlo(AU)

Introduction: Excessive malnutrition causes overweight and obesity, being a public health problem, which has occurred in the first years of life. Research has reported the existence of body dissatisfaction related to weight, due to beauty standards established in society. Objective: to associate the BMI with body dissatisfaction and body image perception of schoolchildren. Materials and methods: cross-sectional study of 610 schoolchildren. Nutritional status was classified according to the BMI z score. To determine body dissatisfaction and body image perception, a child body image scale of seven photographs was applied, with a value of 1 to 7 according to the increasing size, and the final range of the BMI. The difference between the figure that participants considered ideal, and the perceived body shape was calculated. Results: 47.3% were overweight and obese. Body dissatisfaction was higher in overweight and obese girls (p = 0.013). BMI correlated with body dissatisfaction (rho(608) = 0.480; p < 0.001) and body image perception (rho(608) = 0.433; p < 0.001). Conclusions: BMI was positively related to body dissatisfaction and body image perception; this could increase the risk of developing eating disorders, contribute to the maintenance of excess body weight, as it is not perceived with excess weight, are less likely to take actions to control it(AU)

Indicadores tempranos de dispraxia verbal en el inicio tardío: orientaciones para la intervención / Early indicators of childhood apraxia of speech in late talkers: general guidelines to intervention

Resumen Introducción : La población de niños que comienzan con lentitud el desarrollo del lenguaje varía amplia mente, tanto en su perfil inicial como en la respuesta a la intervención. En este sentido, existe un grupo de niños, denominados hablantes tardíos, que continúan mostrando dificultades persistentes en el lenguaje. Al gunos de estos niños muestran signos compatibles con la dispraxia verbal, y que se ponen de manifiesto a lo largo de la intervención. Método : En este trabajo presentamos la diferente respuesta a la intervención de dos perfiles de hablante tardío. Concretamente, se aplicó el programa Target Word©, del centro Hanen, que conjuga la técnica de la estimulación focalizada con la orientación a padres so bre estrategias que promueven el desarrollo del lenguaje. Resultados : Gran parte de la sintomatología mostrada en uno de los dos casos, que experimentó un progreso pobre, coincide con las descripciones retrospectivas de niños posteriormente diagnosticados con dispraxia y pueden considerarse indicadores tempranos del trastor no: ininteligibilidad, inventario consonántico reducido o dificultades en la repetición de palabras. Discusión : La diferente respuesta a la intervención contribuye a la toma de decisiones diagnósticas y a la aplicación temprana de estrategias específicas para la mejora de las habilidades de aprendizaje del habla me diante la incorporación de los principios del aprendizaje motor. Los escasos estudios de intervención en casos de sospecha de dispraxia verbal en la infancia temprana ofrecen resultados prometedores en diversos indicadores de evaluación del habla, y proporcionan a los profesio nales una información valiosa en la que fundamentar la intervención en esta población.

Abstract Introduction : The population of children with slow emergence of language development varies widely, both in their initial profile and in their response to interven tion. In this sense, there is a group of late talkers who continue to show persistent language difficulties, in some cases exhibiting signs compatible with verbal dyspraxia. Method : In this paper we present the different response to intervention of two profiles of late talk ers. Specifically, the Target Word© program (Hanen Centre) was implemented, which is addressed to late-talking children and their families. It combines the technique of focused stimulation with guidance to parents on strategies that stimulate global language development. Results : Much of the symptomatology shown in one case of poor progress coincides with retrospective de scriptions of children subsequently diagnosed with dyspraxia and can be considered early indicators of the disorder: unintelligibility, reduced consonant inventory or difficulties in word repetition. Discussion : The different response to intervention contributes to diagnostic decision making and the early implementation of specific strategies directed to improve speech learning skills by incorporating motor learning principles. The few studies of intervention in suspected verbal dyspraxia in early childhood offer promising re sults on a variety of speech assessment indicators, and provide practitioners with valuable information with which to support the intervention in this population.

Use of neutropenic diet in the nutritional care of pediatric cancer patients with neutropenia: a scoping review

Abstract Objective: to carry out a scoping review with the purpose of mapping the scientific evidence on the use of the neutropenic diet in neutropenic pediatric cancer patients. Source of data: The scoping review protocol was prepared in accordance with the PRISMA-ScR and the checklist before the literature search was performed. Articles on nutritional management in adults or on the treatment of other diseases, and articles that were not in Portuguese or English and published before the year 2000, were excluded. Data were extracted based on the Cochrane Consumer and Communication Review Group form. Summary of the findings: Three hundred and forty scientific articles were identified, with the final sample of this review consisting of nine studies. Although the neutropenic diet has been part of the nutritional management of pediatric cancer patients for more than 20 years, there is still great variation in the criteria for indicating use and starting and discontinuing it, as well as in the nutritional composition of the diet. Furthermore, there is no consensus on the impact of using a neutropenic diet on different clinical and nutritional outcomes. Conclusion: In the absence of guidelines that standardize the use of a neutropenic diet in pediatric patients with neutropenia, there are heterogeneous approaches reported in the literature, even within the same institution. The available literature presents an absence of evidence on the use, viability, and effectiveness of the neutropenic diet in oncological children with neutropenia. More studies are needed to identify the real impact of the neutropenic diet on clinical and nutritional outcomes.

Transgenerational transmission of eating habits

Abstract Objective To investigate the relationship between the biopsychosocial environment and eating habits and behaviors that lead to the selection and consumption of certain food from the earliest stages of life. To clarify whether there is an interaction between genetic and epigenetic factors, and how they shape eating habits. Data source A narrative review based on research in PubMed and Web of Science electronic databases was carried out over the last 10 years, searching the title and summary fields using the keywords Children OR adolescents Feeding Behavior eating OR Dietary Habits OR Eating Behavior OR Eating Habits OR Children obesity. Data synthesis The generational transmission of eating habits is related to the home, community, and school environments, mainly during the first years of life, and can exert the modulation of habits during all stages of life. During childhood, the family's role in consolidating eating habits is very broad and ranges from choosing foods to prioritizing family meals, including the lifestyle. Conclusions Eating habits are transmitted from parents to children in different ways: environmental, emotional, social, and educational. In cases of obesity, a greater association of genetic influence can be observed.

Marketing and child feeding

Abstract Objective To carry out a narrative review on the use of marketing strategies in child nutrition, as well as potential implications for health professionals and children. Data source Searches were carried out on the PubMed, SciELO, and Google platforms, using the terms "child nutrition" or "industrialized baby food" or "infant formula" or "breast milk" or "breastfeeding" and "marketing", with original articles, review articles, institutional reports, institutional position documents and websites considered relevant to the topic being analyzed. Data synthesis Children's food marketing started with the industrialization of food and the resulting actions aimed at increasing sales and meeting commercial interests. Since its inception to the present, infant formulas have been the most widely used products, which has impacted breastfeeding practices. International and national institutions, that care for children's health, are searching for strategies to limit the abusive marketing of industrialized children's foods. Marketing strategies interfere with medical knowledge and actions, potentially influencing the guidance provided by pediatricians to families, and finally, compromising healthy eating practices at a critical period in life, with possible long-term effects. Conclusions Health professionals, especially pediatricians, must provide the best care for children and families, and need to maintain the search for quality scientific information, not influenced by conflicts of interest. Updated and critical knowledge on the part of healthcare professionals can curb marketing strategies that aim to influence their actions.

What causes obesity in children and adolescents?

Abstract Objective To present the different aspects that may be involved in the genesis and maintenance of obesity in children and adolescents. Data source Narrative review of articles published in the PubMed, Scielo, Lilacs, Scopus and Google Scholar databases, using the search terms: overweight, obesity, pre-conception, prenatal, infants, schoolchildren, children, and adolescents. The search was conducted in studies written in Portuguese, English and Spanish, including narrative, integrative or systematic reviews, meta-analyses, cross-sectional, case-control and cohort studies, published between 2003 and 2023. Data synthesis A total of 598 studies were initially screened and 60 of them, which showed the main biopsychosocial aspects related to greater risks of excessive adiposity in the pediatric age, were included in the review. The data were presented taking into account the incidence of risk factors and their consequences in six periods: pre-conception, pre-natal, infant, preschool, school age, and adolescence. Conclusions The causal factors described in the scientific literature that have been shown to be related to obesity in childhood and adolescence are presented.

Characteristics of acute chikungunya virus infection in children: an epidemiological study in the Department of Caaguazú, Paraguay

Introduction: The rapid transmission and severe symptoms associated with acute chikungunya virus (CHIKV) infection in children make it a highly concerning health issue. Objective: This study aimed to describe the characteristics of acute chikungunya virus infection in children from the Department of Caaguazú, Paraguay. Material and Methods: A retrospective observational study was conducted in the Department of Caaguazú, Paraguay, in 2023, with all patients who came to the Regional Hospital within 5 days of developing characteristic symptoms of acute CHIKV infection and tested positive for the virus by RT-PCR. Patients with Dengue or Zika infections were excluded. We collected data on clinical characteristics using a standardized case record form and created an electronic dataset for analysis. Results: A total of 461 children were included in the study. 51.6% were women. Cases were divided into groups based on pediatric age: infants (0-23 months, n=88, 19.1%), preschoolers (2-5 years, n=115, 24.9%), schoolchildren (6-11 years, n=163, 35.4%), and adolescents (12-17 years and 11 months, n=95, 20.6%). Schoolchildren and adolescents experienced a higher prevalence of myalgia (64.6%) and arthralgia (63.7%). Vomiting (89%), headache (89.4%), and retro-orbital pain (95%) were more common in preschoolers, schoolchildren, and adolescents, while rash (39.5%) and petechiae (18.5%) were more prevalent in infants. Four children died during the study period. Conclusion: The 2023 CHIKV virus epidemic in Paraguay had different clinical presentations depending on the age of the affected children, with fatal outcomes occurring in a small percentage of cases.

Introducción: La rápida transmisión y los síntomas graves asociados con la infección aguda por el virus de la chikungunya (CHIKV) en niños lo convierten en un problema de salud altamente preocupante. Objetivo: Este estudio tuvo como objetivo describir las características de la infección aguda por el virus de la chikungunya en niños del Departamento de Caaguazú, Paraguay. Materiales y métodos: Un estudio retrospectivo fue realizado en el Departamento de Caaguazú, Paraguay, en 2023, con todos los pacientes que acudieron al Hospital Regional dentro de los 5 días posteriores al desarrollo de síntomas característicos de la infección aguda por CHIKV y que dieron positivo para el virus mediante RT-PCR. Pacientes con infecciones por Dengue o Zika fueron excluidos. Se recogieron datos sobre las características clínicas mediante un formulario normalizado de registro de casos y se creó un conjunto de datos electrónicos para su análisis. Resultados: Se incluyeron en el estudio un total de 461 niños. 51,6% eran mujeres. Los casos se dividieron en grupos según la edad pediátrica: lactantes (0-23 meses, n=88, 19,1 %), preescolares (2-5 años, n=115, 24,9%), escolares (6-11 años, n=163, 35.4%), and adolescentes (12-17 años and 11 meses, n=95, 20.6 %). La mialgia (64,6%) y la artralgia (63.7%) fueron más prevalentes en escolares y adolescentes. El vómito (89%), la cefalea (89,4%) y el dolor retroorbitario (95%) fueron más comunes en preescolares, escolares y adolescentes, mientras que la erupción cutánea (39,5%) y las petequias (18,5%) fueron más prevalentes en lactantes. Cuatro niños fallecieron durante el período de estudio. Conclusión: La epidemia de virus de la CHIKV de 2023 en Paraguay tuvo diferentes presentaciones clínicas dependiendo de la edad de los niños afectados, con resultados fatales ocurriendo en un pequeño porcentaje de casos.

Implementación de intervenciones que aborden las experiencias adversas en la infancia en atención primaria: una revisión exploratoria

Introducción: La vivencia de experiencias adversas en la infancia (EAI) se asocia a mayor riesgo de presentar conductas de riesgo y enfermedades crónicas a largo plazo. A nivel mundial, se han comenzado a pesquisar y abordar en las atenciones de salud. Sin embargo, en Chile aún no existe una sugerencia a nivel nacional para incorporarlo. El fin de este artículo es proveer de información y recomendaciones a la práctica clínica. Métodos: Se realizó una revisión exploratoria en PubMed, LILACS y PsycInfo usando el marco metodológico del Joanna Briggs Institute para identificar la literatura disponible sobre implementación de intervenciones en detección y abordaje de EAI dentro de un sistema de salud, con foco en atención infantil ambulatoria. Resultados: Se encontraron 34 estudios atingentes al tema, los que muestran que implementar mecanismos de detección y abordaje de EAI es factible y aceptable, tanto para el personal de salud como para los usuarios, pero debe ser realizado dentro de un modelo de cuidado que incorpore a las familias y comunidad, además de trabajar con los equipos en capacitación, gestión del cambio, implementación y evaluación. Conclusiones: La Atención Primaria de Salud (APS) resulta ser un lugar privilegiado para su implementación dada la cercanía y relación de confianza que se establece con las familias. Este estudio muestra que es posible implementar un modelo de detección y abordaje de EAI en APS, lo que resulta crucial dentro de su rol preventivo-promocional si se quiere generar un impacto en la salud de niños, niñas y adolescentes ahora y en el futuro.

Introduction: Adverse childhood experiences (ACEs) are associated with an increased risk of developing risky health behaviors and chronic diseases in the long term. Screening for ACEs is beginning to be implemented worldwide in healthcare settings due to their known impact on present and future health. However, in Chile, there are no recommendations to incorporate ACEs screening into usual care. Methods: A scoping review was conducted using the Joanna Briggs Institute methodological framework to identify available literature on the implementation of interventions aimed at the detection and management of ACEs within a health system, specifically pediatric primary care. The search included PubMed, LILACS, and PsycInfo databases. Results: A total of 34 studies were included. They show that screening for ACEs is feasible and acceptable for both health care providers and users. However, it must be implemented as a part of a model of care that considers families and communities, besides working with health teams in training, change management, implementation, and evaluation. Conclusions: Primary Health Care (PHC) is a privileged setting for screening implementation because of the longitudinal and trust relationships established with families. This study concludes that it is possible to implement a model for detecting and managing ACEs in PHC, which will be crucial for its promotional and preventive role if there is a desire to generate an impact on infant and adolescent health now and in the future.

Food patterns associated with overweight in 7-11-year old children: machine-learning approach / Padrões alimentares associados ao excesso de peso em crianças de 7 a 11 anos: abordagem de aprendizado de máquina

Abstract Longitudinal study, whose objective was to present a better strategy and statistical methods, and demonstrate its use with the data across the 2013-2015 period in schoolchildren aged 7 to 11 years, covered with the same food questionnaire (WebCAAFE) survey in Florianopolis, southern Brazil. Six meals/snacks and 32 foods/beverages yielded 192 possible combinations denominated meal/snack-Specific Food/beverage item (MSFIs). LASSO algorithm (LASSO-logistic regression) was used to determine the MSFIs predictive of overweight/obesity, and then binary (logistic) regression was used to further analyze a subset of these variables. Late breakfast, lunch and dinner were all associated with increased overweight/obesity risk, as was an anticipated lunch. Time-of-day or meal-tagged food/beverage intake result in large number of variables whose predictive patterns regarding weight status can be analyzed by machine learning such as LASSO, which in turn may identify the patterns not amenable to other popular statistical methods such as binary logistic regression.

Resumo Estudo longitudinal cujo objetivo foi apresentar melhores estratégia e métodos estatísticos e demonstrar sua utilização com os dados do período 2013-2015 em escolares de 7 a 11 anos, contemplados com o mesmo questionário alimentar (WebCAAFE) em Florianópolis, Sul do Brasil. Seis refeições/lanches e 32 alimentos/bebidas resultaram em 192 combinações possíveis denominadas item refeição/lanche-alimentos/bebidas específicos (MSFIs). O algoritmo LASSO (LASSO-regressão logística) foi usado para determinar os MSFIs preditivos de sobrepeso/obesidade e, em seguida, a regressão binária (logística) foi usada para analisar um subconjunto dessas variáveis. Café da manhã, almoço e jantar tardios foram todos associados ao aumento do risco de sobrepeso/obesidade, assim como um almoço antecipado. O consumo de alimentos/bebidas marcados na hora do dia ou na refeição resulta em um grande número de variáveis ​​cujos padrões preditivos em relação ao status do peso podem ser analisados ​​por LASSO. Essa análise pode identificar os padrões não passíveis de outros métodos estatísticos populares, como a regressão logística binária.

Stress level and quality of life following pediatric cataract surgery / Avaliação do nível de estresse e de qualidade de vida em crianças submetidas à cirurgia de catarata

ABSTRACT Purpose: To evaluate the quality of life and stress level related to visual function following pediatric cataract surgery in a Brazilian public hospital. Methods: This prospective study analyzed children aged 6-14 years old who underwent cataract surgery. The Childhood Stress Scale and Children's Visual Function Questionnaire (CVFQ) were used to assess stress levels and quality of life, respectively. Both instruments were applied by two psychologists before and after the surgery. Eye examination was performed by two ophthalmologists. Preoperative and postoperative data were compared. Results: In total, 23 children (32 eyes) were enrolled in the study, of which 9 had bilateral cataracts. The average age group at the time of surgery was 9.65 ± 2.26 (6-14) years old. One month after the surgery, the spherical equivalent was -0.90 ± 1.66D, and the corrected distance visual acuity was 0.13 ± 0.10 (0-0.3) LogMAR in bilateral cases and 0.50 ± 0.39 (0-1.3) LogMAR in unilateral cases (p<0.01). According to the Childhood Stress Scale, 77.7% of the bilateral cases and 57.1% of the unilateral cases had stable stress levels, and 34.7% of the children improved their stress level. The analysis of the CVFQ was based on scores for general health, general vision health, competence, personality, and treatment. After cataract surgery, 78.2% of the patients had improved or maintained CVFQ scores in the general health domain; 82.6%, general vision health; 95.6%, competence; 56.5%, personality; and 78.2%, treatment. Conclusion: Pediatric cataract surgery improves the visual function and the quality of life even in patients undergoing surgical procedures, without increasing the stress levels.

RESUMO Objetivo: Avaliar a qualidade de vida e o nível de estresse relacionada à função visual após a cirurgia de catarata pediátrica em um hospital público brasileiro. Métodos: Estudo prospectivo em crianças de seis a 14 anos submetidas à cirurgia de catarata. A Escala de Stresse Infantil e o Questionário de Função Visual em Crianças foram usados para avaliar o nível de estresse e a qualidade de vida, respectivamente. Ambos os instrumentos foram aplicados por duas psicólogas antes e após a cirurgia. O exame oftalmológico foi realizado por dois oftalmologistas. Os dados coletados no pré e pós-operatório foram comparados. Resultados: Vinte e três crianças (32 olhos) foram incluídas no estudo, nove delas apresentavam catarata bilateral. A média de idade na cirurgia foi de 9,65±2,26 (6 a 14) anos. Um mês após a cirurgia, o equivalente esférico foi de -0,90 ± 1,66D e a acuidade visual corrigida a distância foi de 0,13 ± 0,10 (0-0,3) LogMAR em casos bilaterais e 0,50 ± 0,39 (0-1,3) LogMAR em casos unilaterais (p<0.01). De acordo com a Escala de Stresse Infantil, 77,7% dos casos de catarata bilaterais, e 57,1% dos casos unilaterais mantiveram o nível de estresse e 34,7% das crianças melhoraram o nível de estresse. A análise do Questionário de Função Visual em Crianças foi baseada em pontuações para saúde geral, saúde geral da visão, competência, personalidade e tratamento. Após a cirurgia de catarata, 78,2% dos pacientes melhoraram ou mantiveram o escore do Questionário de Função Visual em Crianças na saúde geral, 82,6% na saúde geral da visão, 95,6% na competência, 56,5% na personalidade e 78,2% no tratamento. Conclusão: A cirurgia de catarata pediátrica melhora a função visual e a qualidade de vida em pacientes submetidos a procedimento cirúrgico, sem aumentar o nível de estresse.

Geographical and gender differences in the development of motor skills in preschool children / Diferenças geográficas e de género no desenvolvimento das capacidades motoras das crianças em idade pré-escolar

ABSTRACT Motor development during childhood is fundamental for acquiring advanced perceptual and cognitive skills, playing a pivotal role in personal development and skill acquisition later in life. This study aims to investigate differences in the motor skills of children between the ages of 3 to 5, based on their geographic location (urban or rural) and gender. A cohort of 94 Portuguese children between the ages of 3 and 5 years old (comprising 48 boys and 46 girls) were selected for a study. Data collection was conducted within 8 different schools, and motor skills were assessed utilizing the MOBAK-KG test. It was observed that children from urban areas outperformed those from rural areas in motor skills related to body and object control. On the contrary, girls' motor skills did not show significant differences according to their geographical location. Although the geographical environment influences children's motor development, other factors, such as socio-economic and cultural factors, may have a greater impact on girls. These findings emphasise the significance of focusing on the motor development of girls and examining how cultural and gender expectations can impact their motor skills.

RESUMO O desenvolvimento motor durante a infância é fundamental para a aquisição de competências perceptivas e cognitivas avançadas, desempenhando um papel fulcral no desenvolvimento pessoal e na aquisição de competências mais tarde na vida. Este estudo tem como objetivo investigar as diferenças nas capacidades motoras de crianças entre os 3 e os 5 anos de idade, com base na sua localização geográfica (urbana ou rural) e género. Foi selecionada para o estudo uma coorte de 94 crianças portuguesas com idades compreendidas entre os 3 e os 5 anos (48 meninos e 46 meninas). A recolha de dados foi efectuada em 8 escolas diferentes e as capacidades motoras foram avaliadas utilizando o teste MOBAK-KG. Verificou-se que as crianças das zonas urbanas superavam as das zonas rurais nas capacidades motoras relacionadas com o controlo do corpo e dos objectos. Pelo contrário, as capacidades motoras das raparigas não apresentaram diferenças significativas em função da sua localização geográfica. Embora o ambiente geográfico influencie o desenvolvimento motor das crianças, outros factores, tais como os factores socioeconómicos e culturais, podem ter um maior impacto nas raparigas. Estes resultados sublinham a importância de nos concentrarmos no desenvolvimento motor das raparigas e de examinarmos a forma como as expectativas culturais e de género podem ter impacto nas suas capacidades motoras.

Prática Pedagógica, Contextos Físicos e Sociais: Implicações Para a Inclusão / Pedagogical Practice, Physical and Social Contexts: Implications for the Inclusion

RESUMO: Este estudo compara os contextos físicos, sociais e a prática pedagógica da Educação Infantil com a do Ensino Fundamental e levanta suas respectivas implicações para a inclusão das crianças. Participaram desta pesquisa dois estudantes com deficiência matriculados no último ano da Educação Infantil, comparados com outros dois estudantes com deficiência do Ensino Fundamental. Configura-se uma pesquisa descritiva de cunho quantitativo. O método baseou-se na etologia. Os resultados indicam que, na Educação Infantil, houve altos índices de interação social, variabilidade na utilização de espaços, maior tempo em atividades corporais e o direcionamento da prática pedagógica voltada à interação. Já no Ensino Fundamental, os alunos apresentaram relativo grau de autonomia, mas ainda muito condicionado ao conteúdo.

ABSTRACT: This study compares the physical and social contexts and the pedagogical practice of Early Childhood Education with that of Elementary Education and raises their respective implications for the inclusion of children. Two students with disabilities enrolled in the last grade of the Early Childhood Education participated in this research, in comparison with two other students with disabilities in Elementary School. It is a descriptive investigation of quantitative nature. The method was based on the ethology. The results indicate that in Early Childhood Education there were high levels of social interaction, variability in the use of spaces, more time dedicated to physical activities and orientation of the pedagogical practice centered on interaction. In Elementary School, students had a relative degree of autonomy, but still highly conditioned to the content.

Relação entre a Ficha de Observação do Desenvolvimento Mental da Criança de Helena Antipoff e a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) / Relationship between Helena Antipoff's Mental Development of a Child Observation Form and The International Classification of Functioning, Disability and Health (ICF)

RESUMO: No início do século XX, intensificaram-se as pesquisas relacionadas ao desenvolvimento infantil. Helena Antipoff (1892-1974) foi uma pesquisadora e professora que dedicou seus estudos a esse tema, principalmente no que se refere ao desenvolvimento das crianças nomeadas na época como "anormais". Um dos instrumentos elaborados por ela foi a Ficha de Observação do Desenvolvimento Mental da Criança, em 1939. A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), proposta pela Organização Mundial de Saúde (OMS), sugere uma avaliação da condição do sujeito baseada nos aspectos biológicos, psíquicos e sociais, em contraposição a uma avaliação baseada somente no critério da doença ou da incapacidade. Assim sendo, o objetivo deste estudo foi resgatar a Ficha de Observação proposta por Helena Antipoff e compará-la à CIF, utilizando os guias recomendados por Alarcos Cieza e colaboradores. Os resultados apontam que a maioria dos itens da ficha puderam ser codificados e relacionados à CIF, pois os itens da ficha de Antipoff buscam também avaliar, de forma associada, funções do corpo, atividade e participação, podendo ser utilizados como instrumento de avaliação prévia da criança, devendo, ainda, serem atualizados com uma nomenclatura mais atual, baseada na nomenclatura empregada na CIF.

ABSTRACT: At the beginning of the 20th century, research related to child development were intensified. Helena Antipoff (1892-1974) was one of the researchers and professors who dedicated her studies to this topic, especially with regard to the development of children known at the time as "abnormal". One of the instruments that she developed was the Mental Development of a Child Observation Form, in 1939. The International Classification of Functioning, Disability and Health (ICF) proposed by the World Health Organization (WHO), proposes an assessment of the subject's condition based on in biological, psychological and social aspects, as opposed to an evaluation based only on the criterion of illness or disability. Thus, the objective of this study was to retrieve the Observation Form proposed by Helena Antipoff and compare it to the ICF, using the guides proposed by Alarcos Cieza e collaborators. The results show that most of the items on the form could be coded and related to the ICF, as the items on Antipoff's form also seek to evaluate, in an associated way, body functions, activity and participation, which can be used as a tool for prior assessment of the child and should also be updated with a most current nomenclature based on the nomenclature used in the ICF.

Problematização sobre o Transtorno Disruptivo da Desregulação do Humor / Problematization about Disruptive Mood Dysregulation Disorder / Problématisation du Trouble Disruptif avec Dysrégulation émotionnelle / Problematización del Trastorno de Desregulación Disruptiva del Estado de Ánimo

Este artigo se propõe a delinear, historicamente, o diagnóstico clínico do Transtorno Disruptivo da Desregulação do Humor (TDDH). Com base no método genealógico, essa categoria diagnóstica é desnaturalizada e recontextualizada em sua origem. Analisa-se o conceito de desregulação do humor a partir da escala CBCL (Childhood Behaviour Checklist), sua identificação como um transtorno bipolar da infância, posterior transformação no diagnóstico de TDDH e subsequente crítica deste, com a proposta de englobar os sintomas de desregulação do humor na infância, no diagnóstico de transtorno opositor-desafiante. Como alternativa, o artigo sugere que o humor irritadiço na infância é um estado afetivo primário, constituindo-se, assim, em uma predisposição orgânica primária. Já a regulação emocional é uma construção adaptativa, que se modela ao longo da vida, gerando apresentações subjetivas diversas.

Resumos This article historically outlines the clinical diagnosis of disruptive mood dysregulation disorder (DMDD). Based on the genealogical method, this diagnostic category is denaturalized and recontextualized in its origin. The concept of mood dysregulation is analyzed from the Childhood Behavior Checklist scale (CBCL), its identification as a childhood bipolar disorder, subsequent transformation in the diagnosis of DMDD and subsequent criticism of it, with the proposal of encompassing the symptoms of mood dysregulation humor in childhood into the diagnosis of oppositional defiant disorder. As an alternative, the article suggests that irritable mood in childhood is a primary affective state, thus, constituting a primary organic predisposition. Emotional regulation, on the other hand, is an adaptive construction, which is modeled throughout life, generating diverse subjective presentations.

Cet article retrace l'historique du diagnostic clinique du trouble disruptif avec dysrégulation émotionnelle (TDDE). Basée sur la méthode généalogique, cette catégorie diagnostique est dénaturalisée et recontextualisée dans ses origines. Le concept de dysrégulation émotionnelle est analysé à partir de l'échelle CBCL (Childhood Behavior Checklist), de son identification en tant que trouble bipolaire de l'enfance, de sa transformation ultérieure en diagnostic de TDDE et de sa critique ultérieure, avec la proposition d'inclure les symptômes de dysrégulation émotionnelle dans l'enfance dans le diagnostic du trouble oppositionnel avec provocation. Comme alternative, l'article suggère que l'humeur irritable dans l'enfance est un état affectif primaire, constituant ainsi une prédisposition organique primaire. La régulation émotionnelle, quant à elle, est une construction adaptative qui est modelée tout au long de la vie, générant diverses présentations subjectives.

Este artículo describe historicamente el diagnóstico clínico del trastorno de desregulación disruptiva del estado de ánimo (TDDEA). Con base en el método genealógico, esta categoria diagnostica se desnaturaliza y recontextualiza en su origen. Se analiza el concepto de desregulación del estado de ánimo a partir de la escala CBCL (Childhood Behavior Checklist), su identificación como trastorno bipolar pediátrico, posterior transformación en el diagnóstico de TDDEA y posterior crítica al mismo, con la propuesta de englobar los síntomas de desregulación del estado de ánimo en el diagnóstico de trastorno negativista desafiante. Como alternativa, se sugiere que el estado de ánimo de irritabilidad en la infancia es un estado afectivo primario, constituyendo una predisposición orgánica primaria. La regulación emocional, por su parte, es una construcción adaptativa, que se modela a lo largo de la vida, generando diversas presentaciones subjetivas.

Psychometric properties and reliability of the Brazilian version of Parent Attitudes about Childhood Vaccine (PACV-BR) / Propriedades psicométricas e confiabilidade da versão brasileira do Parent Attitudes about Childhood Vaccine (PACV-BR)

ABSTRACT Objective: To evaluate the psychometric properties and reliability of the Brazilian version of the tool Parent Attitudes about Childhood Vaccine (PACV-BR). Methods: The sample included 110 parents of children up to two years old served by Family Health Basic Units. The tool's internal consistency and factor validity were respectively assessed by Cronbach's alpha and exploratory factor analysis (EFA). The test-retest reliability was assessed by the intraclass correlation coefficient (ICC). Results: The EFA results indicated a proper structural adequacy of the PACV-BR (15 items and two factors). The reliability generated Cronbach's alpha values between 0.715 and 0.854 for the items, of 0.918 for the tool as a whole, of 0.877 for factor 1 and of 0.825 for factor 2, in addition to an ICC of 0.984. Conclusions: The PACV-BR showed evidence of construct validity and reliability.

RESUMO Objetivo: Avaliar as propriedades psicométricas e a confiabilidade da versão brasileira do instrumento Parent Attitudes about Childhood Vaccine (PACV-BR). Métodos: A amostra incluiu 110 pais de crianças de até dois anos atendidas em Unidades Básicas de Saúde da Família. A consistência interna e a validade fatorial do instrumento foram avaliadas, respectivamente, pelo alfa de Cronbach e pela análise fatorial exploratória (EFA). A confiabilidade teste-reteste foi avaliada pelo coeficiente de correlação intraclasse (ICC). Resultados: Os resultados da AFE indicaram adequação estrutural do PACV-BR (15 itens e dois fatores). A confiabilidade indicou valores de alfa de Cronbach entre 0,715 e 0,854 para os itens, de 0,918 para o instrumento como um todo, de 0,877 para o fator 1 e de 0,825 para o fator 2, além de ICC de 0,984. Conclusões: O PACV-BR apresentou evidências de validade de construto e confiabilidade.

Terapia oromotora: Estudio de un modelo educativo para cuidadores primarios / Oral-motor therapy: Study of a distance learning educational model for primary caregivers / Terapia motora oral: estudo de um modelo de ensino à distância para cuidadores primários

Los trastornos alimentarios y de deglución afectan considerablemente la calidad de vida de niños y niñas con discapacidades neuromotoras. La pandemia de COVID-19 agravó estos desafíos al limitar el acceso a la atención en salud. Este estudio evaluó un modelo educativo de aprendizaje a distancia en terapia oral-motora, dirigido a personas cuidadoras de niños y niñas con discapacidades neuromotoras en Mérida, México. Participaron incialmente treinta personas cuidadoras de niños y niñas entre 2 y 12 años de edad con trastornos alimentarios y de deglución, quienes recibían atención en siete instituciones. 23 participantes completaron el programa. Se usó un diseño cuasiexperimental de prueba pre y post. El programa incluyó sesiones teóricas y prácticas. Los resultados mostraron mejoras significativas en el conocimiento teórico y en las competencias prácticas, con niveles de competencia superiores al 80%. Aun así, se reconocen limitaciones del estudio como el tamaño de la muestra y la ausencia de un grupo de control. Abordar estas limitaciones en investigaciones futuras fortalecerá la evidencia sobre la efectividad de este enfoque innovador centrado en la persona cuidadora, crucial para gestionar trastornos alimentarios y de deglución de manera efectiva y mejorar la calidad de vida de niños y niñas con discapacidades neuromotoras.

Eating and swallowing disorders are prevalent among children with neuromotor disabilities, significantly impacting their overall quality of life. The COVID-19 pandemic exacerbated the challenges by restricting access to health care, underscoring the necessity for innovative solutions with caregiver involvement. This study investigated the effectiveness of a distance learning educational model in oral-motor therapy for primary caregivers of children with neuromotor impairments in Mérida, Mexico. The quasiexperimental pretest-posttest design included thirty primary caregivers of children aged 2 to 12 with feeding and swallowing disorders from seven institutions. Twenty-three participants completed the program. The program encompassed theoretical sessions on various aspects of oral motor therapy and practical sessions focusing on hands on training. Results revealed substantial enhancements in theoretical knowledge and practical competencies among caregivers, with competence levels exceeding 80% in all evaluated activities. Despite these positive outcomes, the study acknowledges limitations such as a small sample size and the absence of a control group. Addressing these constraints through future research endeavors will bolster the evidence supporting the effectiveness of this innovative caregivercentric approach. Ultimately, integrating caregivers into the care team is imperative for improving the quality of life for children with neuromotor disabilities and effectively managing eating and swallowing disorders.

Os distúrbios da alimentação e da deglutição afetam significativamente a qualidade de vida das crianças com deficiências neuromotoras. A pandemia da COVID-19 exacerbou esses desafios desafios, sendo que limitou o acesso ao atendimento. Este estudo avaliou um modelo educacional de ensino à distância sobre terapia oral-motora, orientado a cuidadores primários de crianças com deficiências neuromotoras em Mérida, México. Trinta cuida- dores de crianças de 2 a 12 anos de idade com distúrbios de alimentação e deglutição de sete instituições participaram, sendo que 23 deles concluíram o programa. Um estudo quase experimental de préteste-pós-teste foi realizado. O programa incluiu sessões teóricas e práticas. Os resultados mostraram melhorias significativas no conhecimento teórico e nas competências práticas, com níveis de competência acima de 80%. Contudo, são reconhecidas algumas limitações do estudo, como o pequeno tamanho da amostra e a falta de um grupo de controle. A abordagem dessas limitações em pesquisas futuras fortalecerá as evidências respeito da eficácia dessa abordagem inovadora centrada no cuidador, crucial para melhorar a qualidade de vida das crianças com deficiências neuromotoras e gerenciar os distúrbios de alimentação e deglutição de forma eficaz.

Childhood-onset systemic lupus erythematosus (cSLE) and malignancy: a nationwide multicentre series review

Abstract Background Increased malignancy frequency is well documented in adult-systemic lupus erythematosus (SLE), but with limited reports in childhood-onset SLE (cSLE) series. We explored the frequency of malignancy associated with cSLE, describing clinical and demographic characteristics, disease activity and cumulative damage, by the time of malignancy diagnosis. Method A retrospective case-notes review, in a nationwide cohort from 27 Pediatric Rheumatology centres, with descriptive biopsy-proven malignancy, disease activity/damage accrual, and immunosuppressive treatment were compiled in each participating centre, using a standard protocol. Results Of the 1757 cSLE cases in the updated cohort, 12 (0.7%) developed malignancy with median time 10 years after cSLE diagnosis. There were 91% females, median age at cSLE diagnosis 12 years, median age at malignancy diagnosis 23 years. Of all diagnosed malignancies, 11 were single-site, and a single case with concomitant multiple sites; four had haematological (0.22%) and 8 solid malignancy (0.45%). Median (min-max) SLEDAI-2 K scores were 9 (0-38), median (min-max) SLICC/ACR-DI (SDI) score were 1 (1-5) Histopathology defined 1 Hodgkin's lymphoma, 2 non-Hodgkin's lymphoma, 1 acute lymphoblastic leukaemia; 4 gastrointestinal carcinoma, 1 squamous cell carcinoma of the tongue and 1 anal carcinoma; 1 had sigmoid adenocarcinoma and 1 stomach carcinoid; 3 had genital malignancy, being 1 vulvae, 1 cervix and 1 vulvae and cervix carcinomas; 1 had central nervous system oligodendroglioma; and 1 testicle germ cell teratoma. Conclusion Estimated malignancy frequency of 0.7% was reported during cSLE follow up in a multicentric series. Median disease activity and cumulative damage scores, by the time of malignancy diagnoses, were high; considering that reported in adult series.