Brazilian children's quality of life during the COVID-19 pandemic: analysis of contextual factors and dimensions / Qualidade de vida de crianças brasileiras durante a pandemia de COVID-19: análise de fatores e dimensões contextuais

ABSTRACT Objective: The aim of this study was to investigate the contextual factors associated with the quality of life (QOL) of Brazilian children aged 0-12 years during the strict period of social isolation. Methods: This observational cross-sectional study was conducted between July and September 2020 using an online questionnaire on QOL-related family factors and the Pediatric Quality of Life Inventory (PedsQL™). Results were analyzed by multinomial logistic regression analysis. Results: The sample had 849 children, mostly from the South Region of Brazil (75%), white (83%), with typical development (79%), sedentary (68%), using screen (85%) for >3 h/day (44%). Their mothers were their main caregivers (90%). The following variables were significantly associated with high scores of QOL: typical health status (OR 2.38; 95%CI 1.60-3.55; screen time ≤2 h/day (OR 1.62; 95%CI 1.17-2.24); social distancing considered as "easy" (OR 1.67; 95%CI 1.20-2.32), and stimulation of the child by the family (OR 1.93; 95%CI 1.08-3.45). Conclusions: This study indicates that the family context can influence children's QOL, especially during the COVID-19 pandemic and home environment reorganization.

RESUMO Objetivo: Investigar os fatores contextuais associados à qualidade de vida (QV) de crianças brasileiras de zero a 12 anos, em momento de ápice de distanciamento social. Métodos: Estudo observacional, transversal, online, de julho a setembro de 2020, com questionário sobre fatores do contexto familiar associados à QV e Inventário Pediátrico sobre QV — PedsQL™. A análise dos dados foi feita por de regressão logística multinomial. Resultados: A amostra foi de 849 crianças, na maioria da Região Sul (75%), brancas (83%), com desenvolvimento típico (79%), sedentárias (68%), com uso de telas (85%) em tempo >3h/dia (44%). As mães eram as cuidadoras principais (90%). Foram significativamente associadas a escores mais elevados de QV: a condição de saúde típica (odds ratio — OR 2,38; intervalo de confiança de 95% — IC95% 1,60-3,55), o tempo de tela ≤2h/dia (OR 1,62; IC95% 1,17-2,24), o distanciamento social considerado "fácil" (OR 1,67; IC95% 1,20-2,32) e a família afirmar estimular a criança (OR 1,93; IC95% 1,08-3,45). Conclusões: Este estudo mostra que o contexto familiar pode influenciar a QV de crianças, especialmente no período de pandemia e de reorganização do ambiente domiciliar.

Clinical, epidemiological, and care profile of hospitalized patients with retinoblastoma in Brazil

ABSTRACT Purpose: To describe the epidemiological and clinical profile of hospitalized patients with retinoblastoma in Brazil. Methods: Using data from the Hospital Cancer Registry of the Instituto Nacional de Câncer, patients with the morphological codes of retinoblastoma who were diagnosed between 2000 to 2018, aged 0-19 years, and followed up in registered hospitals (analytical cases) were selected. The relative and absolute frequencies of demographic, clinical, diagnostic, therapeutic, and outcome variables were described. Hospital performance indicators were calculated and compared between hospitals qualified and not qualified to treat pediatric oncology cases and between hospitals with different case volumes (<20, 20-75, >75 cases). Results: Of the 2,269 identified analytical cases from 86 institutions, 48% were from the Southeast, 54% were male, and 66% were aged <4 years. The proportion of missing data (NA) was too high for several variables. Approximately 84% of the patients were from the public health system, 40% had a positive family history, and 88% had unilateral involvement. The first treatment included surgery in 58.3% of the patients (NA=2), Approximately 36.6% of these patients achieved complete remission, 10.8% achieved partial remission, and 12.7% died (NA=59%). Hospital performance indicators were within the target in >90% of the patients. The median time between the first appointment and diagnosis (6 days, interquartile range [IQR] 1-14) was significantly lower and the median time to death was longer (343 days, IQR, 212-539) in high-volume hospitals (>75 cases) than in medium- and low-volume hospitals. Conclusions: Despite the high proportion of missing data, we found that the delay in diagnosis is due to prehospital factors. Additionally, there is a need for educational programs for healthcare professionals and families that emphasize early identification and referral to specialized centers. Future studies should focus on the impact of Hospital Cancer Registry data completeness on outcomes, causes of delay in diagnosis, regional inequalities, and barriers to accessing specialized services.

Habilidades ejecutivas: actualización, cambio entre conjuntos mentales e inhibición en niños no mapuche urbanos, mapuche urbanos y mapuche rurales de La Araucanía, Chile

Las habilidades cognitivas de los niños varían conforme a los contextos de desarrollo cultural en los que se desenvuelven. Asumiendo la variabilidad cultural, este estudio tuvo por objetivo comparar las habilidades ejecutivas en 110 niños, entre 9 y 11 años, pertenecientes a tres grupos: no mapuche urbanos, mapuche urbanos y mapuche rurales, de comunas de la región de La Araucanía, Chile. Se usó un diseño descriptivo y correlacional para contrastar el desempeño de los niños en las variables de interés. La batería de instrumentos estuvo formada por tres pruebas que evaluaron: actualización, cambio entre conjuntos mentales e inhibición, respectivamente. Los resultados indican que no hubo diferencias estadísticamente significativas en actualización y cambio entre conjuntos mentales, pero sí hubo significancia estadística para las diferencias en inhibición; siendo los niños no mapuche quienes tuvieron mayor inhibición respecto de los otros dos grupos. Se discuten los hallazgos según la hipótesis de que el desarrollo de habilidades se relaciona con las prácticas cotidianas, demandas y características sociodemográficas de los contextos en los que los niños se desarrollan.

As habilidades cognitivas das crianças variam conforme os contextos de desenvolvimento cultural em que elas se desenvolvem. Partindo do pressuposto da variabilidade cultural, este estudo teve como objetivo comparar as habilidades executivas de 110 crianças, com idades entre 9 e 11 anos, pertencentes a três grupos: não mapuche urbanas, mapuche urbanas e mapuche rurais, de municípios da região de La Araucanía, Chile. Foi utilizado um desenho descritivo e correlacional para comparar o desempenho das crianças nas variáveis de interesse. A bateria de instrumentos foi composta por três testes que avaliaram: atualização, mudança entre conjuntos mentais e inibição, respectivamente. Os resultados indicam que não houve diferença estatisticamente significativa em atualização e mudança entre conjuntos mentais, mas houve significância estatística para as diferenças em inibição, com as crianças não mapuches apresentando maior inibição do que os outros dois grupos. Os resultados são discutidos de acordo com a hipótese de que o desenvolvimento de habilidades está relacionado às práticas cotidianas, demandas e características sociodemográficas dos contextos em que as crianças se desenvolvem.

Children's cognitive abilities differ according to the cultural development settings in which they are raised. Assuming cultural variability, this study compared the executive functions in 110 children, aged 9 to 11 years, belonging to three groups: urban non-Mapuche, urban Mapuche, and rural Mapuche, from communes in the Araucanía region, Chile. A descriptive and correlational design was used to contrast children's performance on the variables of interest. The battery of instruments comprised three tests that assessed updating, set-shifting, and inhibition, respectively. The results indicate no statistically significant differences in updating and set-shifting, but there was a statistical significance for differences in inhibition, with non-Mapuche children having greater inhibition than the other two groups. The findings are discussed according to the hypothesis that skill development is related to the daily practices, demands, and sociodemographic characteristics of the settings in which children are raised.

Spinal anesthesia in children: an educational review / Anestesia raquídea en niños: una revisión educativa

Abstract Despite the well-known benefits of spinal anesthesia (SA), this technique remains underutilized among pediatric anesthesiologists. According to the data from the Pediatric Regional Anesthesia Network, SA accounted for less than 5% of all neuraxial techniques. Some of the factors for underutilization of SA include: Limited duration, unfamiliarity with the technique in younger children, and surgeon preference for general anesthesia. The safe and successful use of SA in children involves recognition of anatomical and physiological differences between adults and children owing to differences in bony structures, spinal cord growth and cerebrospinal fluid physiology. Reports on successful use of SA in children for various surgeries have increased. This educational review summarizes what is known about SA in children, reviews the literature from the last decade and provides suggestions for development of SA in children. Technical considerations, role of ultrasound, guidance on dosing, physiological effects, unexplained aspects of the mechanism of action and combined caudal/SA are discussed.

Resumen A pesar de los beneficios bien conocidos de la anestesia raquídea (AR), esta técnica sigue siendo subutilizada entre los anestesiólogos pediátricos. De acuerdo con los datos de la Red Regional de Anestesia Pediátrica, la AR representó menos del 5% de todas las técnicas neuroaxiales. Algunos de los factores a los que se atribuye dicha subutilización son: su duración limitada, la falta de familiaridad con la técnica en niños de menor edad, y la preferencia del anestesiólogo por la anestesia general. El uso seguro y exitoso de la AR en niños implica el claro conocimiento de las diferencias anatómicas y fisiológicas entre adultos y niños, en virtud de las diferencias en las estructuras óseas, el crecimiento de la médula espinal y la fisiología del líquido cefalorraquídeo. Los reportes sobre el uso exitoso de la AR en niños para diferentes cirugías ha aumentado. La presente revisión educativa resumen la información conocida sobre AR en niños, revisiones de la literatura de la última década y ofrece sugerencias para el desarrollo de la AR en población pediátrica. Se discuten consideraciones técnicas, el papel de la ecografía, orientación sobre la dosificación, los efectos fisiológicos, aspectos no explicados del mecanismo de acción y la combinación de anestesia raquídea/caudal.

Tratamiento funcional de las fracturas diafisarias de pierna en edad pediátrica: Cohorte única prospectiva y consecutiva de casos

Introducción: Las fracturas de tibia son lesiones frecuentes. En los niños existe una mayor capacidad de curación debido al mayor grosor y mejor vascularización que presenta su periostio. Como resultado, la mayoría pueden tratarse de manera exitosa de forma no quirúrgica. Está descrito el tratamiento funcional para estas fracturas, siguiendo los principios desarrollados por Sarmiento. Dada la falta de evidencia actual acerca del tratamiento funcional en este grupo etario, realizamos el análisis del mismo mediante una serie de casos tratados siguiendo este método. Materiales y métodos: Se incluyeron pacientes que cumplieron con los criterios de inclusión y exclusión, tratados mediante tratamiento funcional siguiendo los principios desarrollados por Sarmiento. Se evaluaron clínica y radiográficamente. Se evaluó la técnica registrando tiempos para cada período en este grupo etario, así como la satisfacción con el tratamiento de los pacientes y padres y/o tutores. Todas las complicaciones relacionadas fueron documentadas. Resultados: Evaluamos un total de 15 pacientes, con al menos 6 meses de seguimiento. La edad promedio fue de 11.7 años. Todas las fracturas consolidaron, el tiempo promedio hasta la consolidación fue de 7.6 semanas. El período agudo de 3.4 semanas y el período funcional de 4.2 semanas promedio respectivamente. Todas las fracturas consolidaron con una reducción aceptable. Existió un 100% de satisfacción tanto de los pacientes como de los padres ó tutores con el tratamiento implementado. Dos pacientes presentaron complicaciones menores. Conclusión: El tratamiento funcional para las fracturas de pierna en niños entre 10 y 15 años es una técnica segura, reproducible, con buenos resultados funcionales, que le permite tanto a los pacientes y a sus cuidadores gran independencia durante el período de curación.

Introduction: Tibial fractures are frequent injuries. In children there is a greater healing capacity due to the greater thickness and better vascularization of their periosteum. As a result, most of them can be successfully treated non-surgically. Functional treatment for these fractures is described, following the principles developed by Sarmiento. Given the lack of current evidence on functional treatment in this age group, we analyzed a series of cases treated following this method. Materials and methods: We included patients who met the inclusion and exclusion criteria, treated by functional treatment following the principles developed by Sarmiento. They were evaluated clinically and radiographically. The technique was evaluated by recording times for each period in this age group, as well as the satisfaction with the treatment of the patients and parents and/or guardians. All related complications were documented. Results: We evaluated a total of 15 patients, with at least 6 months of follow-up. The average age was 11.7 years. All fractures consolidated, the average time to consolidation was 7.6 weeks. The acute period of 3.4 weeks and the functional period of 4.2 weeks average respectively. All fractures healed with acceptable reduction. There was 100% satisfaction of both patients and parents or guardians with the treatment implemented. Two patients presented minor complications. Conclusion: Functional treatment for leg fractures in children between 10 and 15 years of age is a safe, reproducible technique, with good functional results, which allows both patients and their caregivers great independence during the healing period.

Introdução: As fracturas da tíbia são lesões comuns. Nas crianças existe uma maior capacidade de cicatrização devido à maior espessura e melhor vascularização do periósteo. Como resultado, a maioria pode ser tratada com sucesso de forma não cirúrgica. É descrito o tratamento funcional destas fracturas, seguindo os princípios desenvolvidos por Sarmiento. Dada a falta de evidência atual sobre o tratamento funcional neste grupo etário, procedeu-se à análise de uma série de casos tratados por este método. Material e métodos: Foram incluídos pacientes que preencheram os critérios de inclusão e exclusão, tratados por tratamento funcional seguindo os princípios desenvolvidos por Sarmiento. Foram avaliados clínica e radiograficamente. A técnica foi avaliada através do registro dos tempos para cada período nessa faixa etária, bem como a satisfação com o tratamento por parte dos pacientes e dos pais e/ou responsáveis. Todas as complicações relacionadas foram documentadas. Resultados: Avaliámos um total de 15 doentes, com pelo menos 6 meses de seguimento. A idade média foi de 11,7 anos. Todas as fracturas cicatrizaram, sendo o tempo médio de cicatrização de 7,6 semanas. O período agudo foi de 3,4 semanas e o período funcional de 4,2 semanas, em média, respetivamente. Todas as fracturas foram curadas com uma redução aceitável. Os doentes e os pais/encarregados de educação ficaram 100% satisfeitos com o tratamento efectuado. Dois doentes tiveram complicações ligeiras. Conclusão: O tratamento funcional das fracturas da perna em crianças com idades compreendidas entre os 10 e os 15 anos é uma técnica segura, reprodutível e com bons resultados funcionais, que permite aos doentes e aos seus cuidadores uma grande independência durante o período de cura.

Características del síndrome inflamatorio multisistémico asociado a COVID-19 en niños atendidos en un hospital peruano, 2020-2022 / Characteristics of COVID-19-associated multisystemic inflammatory syndrome in children treated in a Peruvian hospital, 2020-2022

RESUMEN El propósito del estudio fue describir las características del síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-C) en los primeros tres años de pandemia en niños de un hospital pediátrico del Perú. Se realizó un estudio observacional, descriptivo con datos de 73 pacientes y se describieron las características clínicas, laboratoriales, tratamiento y complicaciones según la ola de la pandemia y si tuvieron shock. La mediana de edad fue 6 años, las manifestaciones gastrointestinales y mucocutáneas fueron frecuentes en las tres olas. El fenotipo similar a enfermedad de Kawasaki se presentó en 34 (46,6%) pacientes y 21 (28,8%) pacientes desarrollaron shock. El tratamiento más usado fue la inmunoglobulina (95,9%), ácido acetil salicílico (94,5%) y corticoide (86,3%). Cinco (7%) pacientes tuvieron aneurisma coronario y 17 (23,3%) ingresaron a la unidad de cuidados intensivos (UCI). Los pacientes con shock tuvieron mayor alteración laboratorial y necesidad de ventilación mecánica. En conclusión, el SIM-C ha disminuido en los primeros tres años de pandemia posiblemente por la vacunación de COVID-19 en niños.

ABSTRACT This study aimed to describe the characteristics of multisystemic inflammatory syndrome associated with COVID-19 (MIS-C) in the first three years of the pandemic in children in a pediatric hospital in Peru. We conducted an observational, descriptive study with data from 73 patients and described the clinical and laboratory characteristics, treatment and complications according to the wave of the pandemic and whether they had shock. The median age was 6 years, gastrointestinal and mucocutaneous manifestations were frequent in the three waves. Kawasaki disease-like phenotype was present in 34 (46.6%) patients and 21 (28.8%) patients developed shock. The most commonly used treatment was immunoglobulin (95.9%), followed by acetylsalicylic acid (94.5%) and corticosteroid (86.3%). Five (7%) patients had coronary aneurysm and 17 (23.3%) were admitted to the intensive care unit (ICU). Patients with shock had greater laboratorial alteration and need for mechanical ventilation. In conclusion, MIS-C has decreased in the first three years of the pandemic, possibly due to COVID-19 vaccination in children.

Factores asociados a la duración de la lactancia materna en niños menores de 2 años en el Perú 2021-2022

Introducción: La duración de la lactancia materna es crucial para la salud infantil, sin embargo, la prevalencia ha disminuido en los últimos años, situando a los niños en una población de riesgo. Objetivo: Determinar los factores asociados a la duración de la lactancia materna en niños menores de 2 años en el Perú 2021-2022. Metodología: Estudio analítico transversal, a través del análisis secundario de datos de la Encuesta Demográfica y de Salud Familiar (ENDES) del año 2021 y 2022. El tamaño muestral fue de 4951 niños/niñas con sus respectivas madres. Se evaluaron factores infantiles y maternos utilizando el Estadístico F corregida para el análisis bivariado con una significancia estadística p<0,05 y un intervalo de confianza al 95%. Finalmente, para medir la asociación se calculó la razón de prevalencia cruda (RPc) y la razón de prevalencia ajustada (RPa) mediante la Regresión de Poisson con varianza robusta. Resultados: El 85,3% tuvo una duración de 0-6 meses y solo el 14,7% tiene una duración hasta los 23 meses. El no contacto piel a piel precoz bebe-madre (p <0,01) (RPa 1,19) y el consumo de bebidas diferentes a la leche materna los primeros 3 días de nacido (p <0,01) (RPa 0,66) se asociaron con una duración hasta los 6 meses de lactancia materna. Las madres adolescentes tuvieron un 30,7% de duración de lactancia materna de 6 meses (p<0,01) (RPa 2,49), por el contrario, el lugar de residencia rural, el grado no superior y un menor ingreso económico permiten una lactancia materna por más de 6 meses. Discusión: Los resultados asocian no recibir contacto piel a piel precoz bebe-madre, edad materna igual o menor de 18 años, grado superior, lugar de residencia urbano y mayor ingreso económico con una menor duración de lactancia materna en niños menores de 2 años.

Introduction: The duration of breastfeeding is crucial for child health; however, the prevalence has decreased in recent years, placing children in a population at risk. Objective: To determine the factors associated with the duration of breastfeeding in children under 2 years of age in Peru 2021-2022. Methodology: Cross-sectional analytical study, through the secondary analysis of data from the Demographic and Family Health Survey (ENDES) of 2021 and 2022. The sample size was 4951 children with their respective mothers. Infant and maternal factors were evaluated using the F-statistic corrected for bivariate analysis with a statistical significance of p<0.05 and a 95% confidence interval. Finally, to measure the association, the crude prevalence ratio (cPR) and the adjusted prevalence ratio (aPR) were calculated using Poisson regression with robust variance. Results: 85.3% had a duration of 0-6 months and only 14.7% had a duration of up to 23 months. Early baby-mother skin-to-skin non-contact (p <0.01) (aPR 1.19) and consumption of beverages other than breast milk in the first 3 days of birth (p <0.01) (aPR 0.66) were associated with a duration of breastfeeding up to 6 months. Adolescent mothers had a 30.7% duration of breastfeeding of 6 months (p<0.01) (aPR 2.49), on the contrary, the place of rural residence, the non-higher grade and a lower economic income allow breastfeeding for more than 6 months. Discussion: The results were associated with not receiving early skin-to-skin contact between the baby and the mother, maternal age equal to or less than 18 years, higher grade, urban place of residence and higher economic income with a shorter duration of breastfeeding in children under 2 years of age.

La salud infantil y el ambiente. Exposición a pesticidas de poblaciones vulnerables

Los pesticidas son un grupo de compuestos químicos que tienen diferentes acciones, insecticidas, fungicidas, herbicidas, rodenticidas. Luego de su aplicación el proceso de degradacion es lento. Pueden permanecer en el suelo y en las aguas subterráneas, contaminando el agua. El cambio climático transforma el proceso de degradación de los compuestos químicos, por la alteración de la composición del suelo, produciendo alteraciones en el ecosistema y la biodiversidad.El impacto de los pesticidas sobre la salud humana es un desafío por el gran potencial de daño que tienen. Desde el año 2004, se introduce en Paraguay las semillas geneticamente modificadas, acompañado de un gran incremento de las areas de cultivo y la utilizacion de pesticidas.Con el objetivo de revisar el estado del conocimiento actual sobre los efectos de estas sustancias quimicas, sobre los diferentes organos y sistemas en las poblaciones pediatricas y embarazadas, se realizo una revision descriptiva, abarcando las principales base de datos disponibles.Como objetivo secundario, considerando la extension de areas de cultivo en Paraguay, describir los resutlados de los estudios realizados en el pais. Los resultados de los estudios revisados muestran asociacion entre afectacion de diferentes organos, sistemas, de estas poblaciones y la exposcion ambiental, de las aguas y los alimentos. Algunos de estos resultados se replican en los realizados en las zonas de cultivo del pais.

Pesticides, such as insecticides, fungicides, herbicides, and rodenticides, are a group of chemical compounds that have different actions. After their application, the degradation process is slow. They can remain in the soil and groundwater, contaminating the water. Climate change transforms the process of degradation of chemical compounds, by altering soil composition, producing alterations in the ecosystem and biodiversity. The impact of pesticides on human health is challenging because of the great potential for harm they have. Since 2004, genetically modified seeds have been introduced in Paraguay, accompanied by a great increase in cultivation areas and pesticide use. To review the current state of knowledge about the effects of these chemical substances on the different organs and systems in pediatric and pregnant populations, a descriptive review was carried out, utilizing the main available databases. As a secondary objective, considering the extension of cultivation areas in Paraguay, we also described the results of studies carried out in the country. The results of the reviewed studies show an association between the involvement of different organ systems in these populations and environmental exposure, water, and food. Some of these results are replicated in those carried out in the country's growing areas.

Conocimiento, actitud y práctica sobre salud oral en niños de 6 a 12 años de una escuela de Capiatá, Paraguay

Introducción: La salud bucal en niños es esencial para su desarrollo, habla, nutrición y autoestima. Además, previene problemas odontológicos graves en la edad adulta y evita costosos tratamientos futuros. Objetivo: Determinar el nivel de conocimiento, actitud y práctica sobre salud oral en niños de 6 a 12 años de una escuela del área metropolitana de Asunción. Resultado: Participaron 202 niños, donde el 51,0% correspondió al sexo masculino, con edad media de 9 ± 4,24 años. El 55% de los niños presentó gingivitis. El 35,6% posee caries en dientes primarios mientras que el 48,9% presenta caries en dientes permanentes. El 98,02% de los participantes respondió correctamente la pregunta sobre alimentos perjudiciales para los dientes. Sobre la práctica de higiene bucal, en la mayoría de los niños la enseñanza de la técnica de cepillado estuvo a cargo de los padres, sin embargo, reportan que estos no siempre los controlan. Conclusión: Los niños tuvieron buen conocimiento, actitud positiva y prácticas adecuadas de higiene bucal, sin embargo, la mitad de ellos presentaba caries en dientes permanentes. Se sugiere que la falta de supervisión diaria por parte de los padres en la técnica de cepillado podría ser un factor contribuyente.

Introduction: Oral health is crucial for children's development, speech, nutrition, and self-esteem. Maintaining good oral health during childhood prevents serious dental issues in adulthood and reduces the need for costly treatments later on. Objective: To assess the knowledge level, attitudes, and practices regarding oral health among children aged 6 to 12 years at a school located in the metropolitan area of Asunción. Results: A total of 202 children participated in the study, of whom 51.0% were male, with a mean age of 9 years (SD = 4.24 years). Approximately 55% of the children had gingivitis. Primary teeth cavities were present in 35.6% of the participants, while 48.9% had cavities in their permanent teeth. Regarding dietary knowledge, 98.02% of the participants correctly identified foods harmful to dental health. Most children learned brushing techniques from their parents; however, consistent parental supervision was reportedly lacking. Conclusion: Despite demonstrating good knowledge and generally adequate oral hygiene practices, nearly half of the children had cavities in their permanent teeth. The data suggest that the lack of regular parental supervision of brushing techniques could be a significant contributing factor to dental caries.

Factores sociales y culturales relacionados al estado nutricional en menores de 2 años ecuatorianos / Social and cultural factors related to nutritional status in Ecuadorian children under 2 years of age

Resumen La desnutrición infantil constituye un desafío de gran importancia en el ámbito de la salud pública. El objetivo de la investigación fue evaluar la influencia de los factores sociales y culturales en el estado nutricional en niños menores ecuatorianos de 2 años, en la ciudad de Portoviejo, Provincia de Manabí, durante el año 2023. Se realizó una investigación prospectiva, descriptiva, transversal y observacional. La población pediátrica incluyó 169 menores de dos años, cuyas madres proporcionaron los datos pertinentes. Los factores sociales predominantes fue el nivel educativo del cuidador del niño comprendida entre 7 a 12 años de estudios con la presencia de casos de desnutrición crónica en un 83,9%; además, la limitada contribución financiera del progenitor para la alimentación del infante con casos de desnutrición aguda en un 88,6%. Dentro de los factores culturales, se encontró que los niños con esquema de vacunación incompleto presentaban desnutrición crónica con un 88,7%, la falta de los controles prenatales, al igual que la inasistencia al primer control prenatal antes del quinto mes con casos de desnutrición aguda en un 95,5%; además, se evidenció que la estimulación para la ingesta de alimentos y la falta de práctica de la lactancia materna exclusiva con la presencia de desnutrición crónica en los menores, con un 98,4% y un 96,8%, respectivamente. En este entorno, el estado nutricional de mayor tendencia fue la desnutrición crónica con un 34,3%. Además, se identificó una asociación significativa de relación de dependencia (p<0,05) entre los factores sociales, culturales y el estado nutricional.

Abstract Child malnutrition constitutes a challenge of great importance in the field of public health. The objective of the research was to evaluate the influence of social and cultural factors on the nutritional status in Ecuadorian children under 2 years of age in the city of Portoviejo, Province of Manabí, during the year 2023. A prospective, descriptive, crooss-sectional and observational research was carried. The pediatric population included 169 children under two years of age, whose mothers provided the relevant data. The predominant social factors were the educational level of the child's caregiver, ranging from 7 to 12 years of education, with the presence of cases of chronic malnutrition in 83.9%; in addition, the limited financial contribution of the parent to feeding the infant with cases of acute malnutrition in 88.6%. Within the cultural factors, it was found that children with an incomplete vaccination presented chronic malnutrition with 88.7%, the lack of prenatal check-ups, as well as non-attendance at the first prenatal check-up before the fifth month with cases of malnutrition acute in 95.5%; Furthermore, it was evidenced that the stimulation of food intake and the lack of practice of exclusive breastfeeding with the presence of chronic malnutrition in minors, with 98.4% and 96.8%, respectively. In this environment, the most trending nutritional status was chronic malnutrition with 34.3%. In addition, a significant association of dependency relationship (p<0.05) was identified between social and cultural factors and nutritional status.

Mental health difficulties and related factors in Chinese children and adolescents during the COVID-19 pandemic: a cross-sectional study

Abstract Objective: To examine the mental health status and related factors in children and adolescents, and to assess age groups and sexes differences in factors influencing mental health. Methods: This cross-sectional study was performed on Chinese children aged 6-18 years from November 2021 to January 2022. Mental health difficulties were accessed by the Strengths and Difficulties Questionnaire. Multivariate logistic regression was used to analyze factors associated with mental health status. Multiple linear regression was used to evaluate factors associated with the scores of the Strengths and Difficulties Questionnaire. Results: The prevalence of mental health difficulties was 12.98% (n =1348). Age (OR, 0.909, [95%CI, 0.830-0.996]), sex (OR, 1.424, [95%CI, 1.033-1.963]) and screen time on weekdays ("≥2" h/d vs "< 1" h/d: OR, 2.001, [95%CI, 1.300-3.080]) were related factors for mental health difficulties. For children (year ≤ 12), the strongest related factor for mental health difficulties was screen time on weekdays ("≥ 2" h/d vs "< 1" h/d: OR, 1.821 [95%CI, 1.203-2.755]). The risk of mental health difficulties in females with ≥ 2 h/d screen time on weekends was 3.420 times higher than those with < 1 h/d (OR, 3.420, [95%CI, 1.923-6.081]). Conclusion: The prevalence of mental health difficulties among children and adolescents was relatively high. The lower age, female sex and excessive screen time were associated with a higher risk of mental health difficulties. The factors influencing mental health varied by different age groups and sexes. Thus, specific measures for different age groups and sexes should be adopted to mitigate the impact.

Key clinical predictors in the diagnosis of ovarian torsion in children

Abstract Objective: Ovarian torsion (OT) represents a severe gynecological emergency in female pediatric patients, necessitating immediate surgical intervention to prevent ovarian ischemia and preserve fertility. Prompt diagnosis is, therefore, paramount. This retrospective study set out to assess the utility of combined clinical, ultrasound, and laboratory features in diagnosing OT. Methods: The authors included 326 female pediatric patients aged under 14 years who underwent surgical confirmation of OT over a five-year period. Logistic regression analysis was employed to pinpoint factors linked with OT, and the authors compared clinical presentation, laboratory results, and ultrasound characteristics between patients with OT (OT group) and without OT (N-OT group). The authors conducted receiver operating characteristic (ROC) curve analysis to gauge the predictive capacity of the combined features. Results: Among 326, OTwas confirmed in 24.23 % (79 cases) of the patients. The OT group had a higher incidence of prenatal ovarian masses than the N-OT (22 cases versus 7 cases) (p < 0.0001). Similarly, the authors observed significant differences in the presence of lower abdominal pain, suspected torsion on transabdominal ultrasound, and a high neutrophil-lymphocyte ratio (NLR > 3) between the OTand non-OT groups (p < 0.05). Furthermore, when these parameters were combined, the resulting area under the curve (AUC) was 0.868, demonstrating their potential utility in OT diagnosis. Conclusion: This study demonstrates a prediction model integrating clinical, laboratory, and ultrasound findings that can support the preoperative diagnosis of ovarian torsion, thereby enhancing diagnostic precision and improving patient management. Future prospective studies should concentrate on developing clinical predictive models for OTin pediatric patients.

Atenção infantil na rede de cuidados à pessoa com deficiência no Brasil: um estudo multicêntrico / Children's health care in the care network for people with disabilities in Brazil: a multicenter study

Resumo Objetivou-se identificar fatores associados à atenção à saúde infantil na atenção primária à saúde (APS), na perspectiva das ações preconizadas pela Rede de Cuidados à Pessoa Deficiência (RCPCD), quanto à identificação precoce de deficiências e acompanhamento do desenvolvimento infantil. Trata-se de estudo transversal, multicêntrico, realizado em oito estados brasileiros. A coleta de dados envolveu a aplicação de questionário estruturado com profissionais de saúde de nível superior atuantes na APS, com amostra aleatória estratificada por estado e município. Foram realizadas regressões de Poisson com variância robusta para duas variáveis resposta. Entre os 1.488 trabalhadores que compuseram a amostra final, 63,6% realizam ações de identificação precoce de deficiências e 49% efetuam acompanhamento do desenvolvimento infantil. As equipes de Saúde da Família (eSF) identificam e acompanham mais do que as equipes do modelo tradicional, e os Núcleos Ampliados de Saúde da Família e Atenção Básica realizam mais ações de acompanhamento do que essas equipes. Conclui-se que os fatores mais associados com a identificação e o acompanhamento de crianças com deficiências na APS foram aqueles relativos à formação profissional, à eSF e ao conhecimento de normativas relativas à RCPCD.

Abstract The aim of this study was to identify factors associated with early identification of disabilities and developmental follow-up of children in primary health care (PHC) services under the Care Network for People with Disabilities (RCPCD). We conducted a cross-sectional study using data from a multicenter study undertaken in eight states. The data were collected using a structured questionnaire answered by PHC professionals with degree-level qualifications selected using random sampling and stratified by state and municipality. Poisson regression with robust variance was performed for the two outcomes. Of the 1,488 workers in the final sample, 63.6% performed early identification of disabilities and 49% provided developmental follow-up. Family health teams performed early identification of disabilities and follow-up more than traditional model teams, and expanded family health teams provided developmental follow-up more than both these teams. The factors that showed the strongest association with identification and developmental follow-up were profession, working in a family health team and knowledge of the RCPCD.

Spatial clusters and social inequities in COVID-19 vaccine coverage among children in Brazil / Aglomerados espaciais e desigualdades sociais na cobertura vacinal contra COVID-19 em crianças no Brasil

Abstract This study examined the spatial distribution and social inequalities in COVID-19 vaccine coverage among children aged 5-11 in Brazil. First and second dose vaccine coverage was calculated for all Brazilian municipalities and analyzed by geographic region and deciles based on human development index (HDI-M) and expected years of schooling at 18 years of age. Multilevel models were used to determine the variance partition coefficient, and bivariate local Moran's I statistic was used to assess spatial association. Results showed significant differences in vaccine coverage rates among Brazilian municipalities, with lower coverage in the North and Midwest regions. Municipalities with lower HDI and expected years of schooling had consistently lower vaccine coverage rates. Bivariate clustering analysis identified extensive concentrations of municipalities in the Northern and Northeastern regions with low vaccine coverage and low human development, while some clusters of municipalities in the Southeast and South regions with low coverage were located in areas with high HDI-M. These findings highlight the persistent municipal-level inequalities in vaccine coverage among children in Brazil and the need for targeted interventions to improve vaccine access and coverage in underserved areas.

Resumo O estudo analisou a distribuição espacial e as desigualdades sociais na cobertura vacinal para COVID-19 entre crianças de 5 a 11 anos no Brasil. As coberturas vacinais foram calculadas para os municípios brasileiros e analisadas por região geográfica e decis com base no Índice de Desenvolvimento Humano (IDH-M) e expectativa de escolaridade aos 18 anos. Modelos multiníveis foram usados ​​para determinar o coeficiente de partição da variância, e a estatística local bivariada de Moran I foi usada para avaliar a associação espacial. Os resultados mostraram diferenças significativas nas taxas de cobertura vacinal entre os municípios, com menor cobertura nas regiões Norte e Centro-Oeste. Municípios com menor IDH e anos de escolaridade esperados apresentaram menores taxas de cobertura vacinal. A análise de agrupamento bivariado identificou extensas concentrações de municípios nas regiões Norte e Nordeste com baixa cobertura vacinal e baixo desenvolvimento humano, enquanto alguns aglomerados de municípios nas regiões Sudeste e Sul com baixa cobertura localizavam-se em áreas com alto IDH-M. Essas descobertas destacam as desigualdades persistentes em nível municipal na cobertura vacinal entre crianças e a necessidade de intervenções para melhorar o acesso e a cobertura vacinal em áreas mais vulneráveis.

Prevalencia de anomalías dentomaxilares y necesidad de tratamiento de ortodoncia en niñas/os de 6 años en cinco comunas de Chile. Estudio Preliminar

Objetivo: Determinar la prevalencia de las anomalías dentomaxilares (ADM) y necesidad de tratamiento de ortodoncia en escolares de 6 años en cinco comunas en Chile. Material y método: Estudio de corte transversal, observacional y descriptivo. La muestra fue de 1102 escolares. Se realizaron exámenes clínicos aplicando la Guía de Referencia Clínica a Ortodoncia para Servicios Públicos de Salud, para determinar la prevalencia de las ADM y necesidad de tratamiento de ortodoncia. El análisis estadístico utilizó el programa STATA®, considerando estadísticamente significativo p 0.05. Resultados: 1102 escolares de 6 años fueron examinados, 48,8% niñas y 51,2% niños. La prevalencia de niño/as con anomalías dentomaxilares fue 59.1%. Las tres más prevalentes fueron: apiñamiento dentario o rotaciones (21,6%), resalte aumentado (17,6%) y overbite aumentado (15,9%). La necesidad de tratamiento de ortodoncia encontrada fue de 34,7% con evidente necesidad y un 25,3% con leve necesidad. Conclusión: Se evidencia la necesidad de incluir en las políticas públicas de salud oral, estrategias de diagnóstico y tratamiento temprano de ADM por su alta prevalencia.

Objective: To determine the prevalence of dento-maxillary anomalies (DMA) and the orthodontic treatment need in 6-year-old schoolchildren in five areas of Chile. Material and method: Cross-sectional, observational and descriptive study. The sample consisted of 1102 6-year-old schoolchildren. Clinical examinations were carried out applying the Clinical Reference Guide for Orthodontics in Public Health Services, to determine the prevalence of DMA and the need for orthodontic treatment. Statistical analysis used the STATA® program, considering p ≤ 0.05 statistically significant. Results: 1102 6-year-old children were examined, 48.8% were girls and 51.2% boys. The prevalence of children with DMA was 59.1%. The three most prevalent were: dental crowding or rotations (21.6%), increased overjet (17.6%), and increased overbite (15.9%). The orthodontic treatment need was 34.7% of patients with great need and 25.3% with moderate need. Conclusion: The need to include early diagnosis and treatment strategies for DMA in public oral health policies is evident due to its high prevalence.

Sistema de actividades físico-deportivas para desarrollar habilidades motrices básicas en niños con dislexia

La dislexia es un trastorno del aprendizaje que afecta la capacidad de los niños para leer, escribir y procesar información de manera adecuada, tradicionalmente se ha creído que en contexto escolar son los psicopedagogos los encargados de lidiar con este trastorno y tratar de mejorarlo. Sin embargo, se ha demostrado que las actividades físicas pueden, de forma consciente y organizada, contribuir de modo significativo a tratar esta condición. Es por ello que el objetivo de este trabajo fue proponer un sistema de actividades físico-deportivas para contribuir al tratamiento de la dislexia en alumnos de la escuela unidocente "Francisco de Orellana", en Paztaza, Ecuador. Para lograr este propósito, se utilizaron métodos empíricos tales como la observación, la encuesta, la entrevista, además de diferentes pruebas que se aplicaron para determinar la veracidad de la condición disléxica. Después de corroborar las dificultades encontradas en el diagnóstico y de las potencialidades consultadas en los referentes teóricos sobre el tema, se elaboró un sistema de actividades físico-deportivas que se incluyeron en las sesiones de trabajo del profesor de Educación Física y tuvieron el apoyo de los profesores, directivos y padres, así como un satisfactorio nivel de aceptación práctica, lo que influyó significativamente en el mejoramiento de las dificultades en el aprendizaje de estos alumnos y la relación con sus compañeros de clase.

A dislexia é um distúrbio de aprendizagem que afeta a capacidade das crianças de ler, escrever e processar informações de maneira adequada. Tradicionalmente, acredita-se que, no contexto escolar, os psicólogos educacionais são os responsáveis ​​​​por lidar com esse distúrbio e tentar melhorá-lo. Contudo, foi demonstrado que as atividades físicas podem, de forma consciente e organizada, contribuir significativamente para o tratamento desta condição. Por isso o objetivo deste trabalho foi propor um sistema de atividades físico-esportivas para contribuir no tratamento da dislexia em alunos da escola monoprofessora "Francisco de Orellana", em Paztaza, Equador. Para atingir este objetivo, foram utilizados métodos empíricos como observação, inquérito, entrevista, bem como diversos testes que foram aplicados para determinar a veracidade da condição disléxica. Após corroborar as dificuldades encontradas no diagnóstico e as potencialidades consultadas nos referenciais teóricos sobre o tema, foi desenvolvido um sistema de atividades físico-esportivas que foram incluídas nas sessões de trabalho do professor de Educação Física e contaram com o apoio dos professores, diretores e pais, bem como um nível satisfatório de aceitação prática, o que influenciou significativamente na melhora das dificuldades de aprendizagem desses alunos e no relacionamento com os colegas.

Dyslexia is a learning disorder that affects children's ability to read, write and process information appropriately. It has traditionally been believed that in the school context, educational psychologists are in charge of dealing with this disorder and trying to improve it. However, it has been shown that physical activities can, in a conscious and organized way, contribute significantly to treating this condition. That is why the objective of this work was to propose a system of physical-sports activities to contribute to the treatment of dyslexia in students of the "Francisco de Orellana" single-teacher school, in Paztaza, Ecuador. To achieve this purpose, empirical methods such as observation, survey, interview, as well as different tests that were applied to determine the veracity of the dyslexic condition were used. After corroborating the difficulties found in the diagnosis and the potential consulted in the theoretical references on the subject, a system of physical-sports activities was developed that were included in the work sessions of the Physical Education teacher and had the support of the teachers, directors and parents, as well as a satisfactory level of practical acceptance, which significantly influenced the improvement of these students' learning difficulties and their relationships with their classmates.

Adoecimento crônico Infantil: das marcas do corpo às marcas simbólicas / Childhood chronic illness: from body marks to symbolic marks / Enfermedad crónica Infantil: de las marcas corporales a las marcas simbólicas

Introdução: O adoecimento crônico e a hospitalização trazem para o universo infantil vivências que são ameaçadoras tanto do ponto de vista físico quanto psíquico. Adoecer é uma experiência complexa, disruptiva e traumática, que acarreta sobrecarga emocional para as crianças e seus familiares. Objetivo: compreender o cenário do adoecimento infantil e a hospitalização, articulando as marcas do corpo às marcas simbólicas. Método: Trata-se de uma pesquisa qualitativa, exploratória de ordem teórico-clínica no campo da psicanálise. Resultado: O processo de adoecimento crônico coloca o sujeito em um drama subjetivo com necessidade de elaborar lutos e lidar com a ferida narcísica e, até mesmo pensar a morte de frente. O hospital ganha contornos simbólicos para além do espaço de tratamento da doença e seus sintomas: lugar em que a doença insiste em se dar a ver e permanecer. Conclusão: O adoecimento envolve componentes para além das dimensões biológica, cognitiva e emocional, sendo atravessado por questões subjetivas e simbólicas que norteiam a forma como o sujeito lidará com seu corpo adoecido, portanto implica reflexões acerca da criança como protagonista de seu processo e a escuta do sujeito em sua dimensão simbólica. (AU)

Introduction: Chronic illness and hospitalization bring experiences to children that are threatening from both a physical and psychological point of view. Falling ill is a complex, disruptive and traumatic experience, which causes emotional overload for children and their families. Objective: to understand the scenario of childhood illness and hospitalization, linking body marks to symbolic marks.Method: This is qualitative, exploratory theoretical-clinical research in the field of psychoanalysis. Result: The process of chronic illness places the subject in a subjective drama with the need to mourn and deal with the narcissistic wound and even think about death in the face. The hospital gains symbolic contours beyond the space for treating the disease and its symptoms: a place where the disease insists on showing itself and remaining. Conclusion: Illness involves components beyond the biological, cognitive and emotional dimensions, being crossed by subjective and symbolic issues that guide the way the subject will deal with their ill body, therefore implying reflections on the child as the protagonist of their process and listening of the subject in its symbolic dimension. (AU)

Introducción: Las enfermedades crónicas y la hospitalización traen a los niños experiencias amenazantes tanto desde el punto de vista físico como psicológico. Enfermar es una experiencia compleja, perturbadora y traumática, que provoca una sobrecarga emocional en los niños y sus familias. Objetivo: comprender el escenario de la enfermedad y la hospitalización infantil, vinculando las marcas corporales con las marcas simbólicas. Método: Se trata de una investigación teórico-clínica exploratoria, cualitativa, en el campo del psicoanálisis. Resultado: El proceso de enfermedad crónica sitúa al sujeto en un drama subjetivo con la necesidad de llorar y lidiar con la herida narcisista e incluso pensar en la muerte en elrostro. El hospital gana contornos simbólicos más allá del espacio de tratamiento de la enfermedad y sus síntomas: un lugar donde la enfermedad insiste en mostrarse y permanecer. Conclusión: La enfermedad involucra componentes más allá de las dimensiones biológica, cognitiva y emocional, siendo atravesada por cuestiones subjetivas y simbólicas que orientan la forma en que el sujeto afrontará su cuerpo enfermo, implicando por tanto reflexiones sobre el niño como protagonista de su proceso y escucha del sujeto en su dimensión simbólica. (AU)

Gingivitis espongiótica. Manejo clínico no quirúrgico. Reporte de un caso / Spongiotic gingivitis. Non-surgical clinical management. Report of a case

Objetivo: La gingivitis espongiótica es una patología benigna poco común y una entidad clínica patológica poco frecuente que los odontólogos pueden observar durante la atención odontológica. Es importante conocer la misma para poder diagnosticarla adecuadamente, describir sus características clínicas y elaborar un plan para su tratamiento. El objetivo de este artículo es presentar un caso clínico de esta patología poco conocida, describir sus características y su manejo clínico. Caso clínico: Un niño de 7 años que ingresó derivado por su odontólogo a la cátedra de Estomatología de la Facultad de Odontología de la Universidad Nacional de Córdoba, Argentina, presentaba en la encía libre e insertada del maxilar superior una lesión con ausencia de sintomatología y evolución crónica, benigna y con cambios estéticos notorios. Se deriva a la cátedra de Periodoncia para realizar un tratamiento interdisciplinario. Tuvo una respuesta favorable al tratamiento de la lesión, y se realizó un seguimiento periódico de la misma evitando la técnica quirúrgica convencional para su tratamiento.(AU)

Aim: Spongiotic gingivitis is a rare benign pathology and a rare clinical pathological entity that dentists can observe during dental care. It is important to know it to be able to properly diagnose it, describe its clinical characteristics and develop a plan for its treatment. The aim of this article is to present a clinical case of this little-known pathology and describe its characteristics as well as its clinical management. Clinical case: A 7-yeard-old child who was referred by his dentist to the Department of Stomatology of the Faculty of Dentistry of the National University of Córdoba, Argentina, presented a lesion in the free and inserted gingiva of the upper jaw, with absence of symptoms and chronic, benign evolution with notable aesthetic changes. He is referred to the Periodontics department to perform interdisciplinary treatment. He had a favorable response to the treatment of the lesion, and a periodic follow-up was carried out, avoiding the conventional surgical technique for its treatment.(AU)

Diabetic cystopathy due to detrusor muscle dysfunction in a child with type ? diabetes mellitus

The word diabetic cystopathy (DC) refers to lower urinary symptoms due to diabetic neuromyopathy and is common in adults while very unusual in children with diabetes mellitus. This case report seeks to delineate a distinctive case concerning a 9-year-old boy who was diagnosed with DC due to detrusor muscle dysfunction confirmed by urodynamic studies, induced by type 1 diabetes mellitus of four years duration. DC should be considered in children with long standing urinary symptoms without urinary tract infection in type 1 diabetes mellitus even if it is rare condition.

Magnetic resonance imaging findings in acute febrile encephalopathy in children

Background: This prospective observational study aims to study magnetic resonance imaging (MRI) findings in the setting of acute febrile encephalopathy in children between 1 month to 18 year of age group.Methods: This study was conducted in patients of acute febrile encephalopathy admitted in pediatric intensive care unit (PICU) at tertiary care centre during January 2019 to December 2019 in age group one month to 18 years. 32 patients satisfied the inclusion criteria.Results: Of the 32 patients included in the study MRI was done in 28 patients. MRI brain was normal in 17 patients and abnormalities were found in 11 patients. Majority findings were cerebral enema and restricted diffusion 3 (10.5%). Other findings were T2 hyperintensity and FLAIR hyperintensity lesion in basal ganglia and thalami region 2 (7%), T2 and FLAIR hyperintensity hippocampal lesion in hippocampus 2 (7%), haemorrhagic lesion 1 (3.5%).Conclusions: Acute febrile encephalopathy is a life-threatening condition. It is important to identify the possible aetiology for directing specific treatment. Amongst others MRI is one modality that has the potential to identify possible aetiology. Paediatric intensive care physicians are not always updated regarding utility of MRI and its findings in acute febrile encephalopathy. The main reason being non-inclusion of this subject in curriculum. This study was intended to understand all the possible MRI findings in acute febrile encephalopathy, correlate it with clinical findings and ultimately aid in management of these cases.