¿Cuál es el efecto de las intervenciones implementadas en APS por profesionales de la salud para prevenir la violencia escolar?: síntesis rápida de evidencia / What is the effect of interventions implemented in PHC by health professionals to prevent school violence?: rapid evidence synthesis

ANTECEDENTES Y OBJETIVO En el contexto del retorno escolar luego de la suspensión de clases por la pandemia por COVID-19, el Departamento de Salud Mental, Gabinete MINSAL y el Ministerio de Educación, establecieron una mesa de trabajo para hacer frente al aumento de hechos de violencia escolar ocurridos con el retorno presencial a clases desde marzo de 2022. En este contexto el Departamento de Salud Mental de la Subsecretaría de Salud Pública se solicitó el desarrollo de una síntesis rápida de evidencia con el objetivo de conocer la efectividad de las medidas implementadas desde el sector salud para prevenir la violencia escolar. METODOLOGÍA Para la elaboración de esta síntesis rápida de evidencia, el equipo formuló estrategias de búsqueda que fueron utilizadas en 7 bases de datos pertinentes al tema estudiado. Así mismo se recuperaron documentos que fueron filtrados por criterios según tema y tipo de documento, enfocados en revisiones sistemáticas y sus estudios primarios. RESULTADOS Se trabajó con 4 revisiones sistemáticas, de las cuales se recuperaron los siguientes resultados: -No es posible establecer el efecto de las estrategias conductuales en la población escolar, en comparación con el cuidado usual sobre la victimización, la agresión y el apego en la escuela debido a que la certeza en la evidencia existente es muy baja. -No es posible establecer el efecto de la consulta escolar psiquiátrica en la población escolar en comparación con el cuidado usual sobre la victimización. -No es posible establecer el efecto de las estrategias conductuales en población escolar conflictiva, en comparación con el cuidado usual sobre la agresión. -El balance costo-beneficio es favorable para las intervenciones que tienen como objetivo prevenir el abuso escolar. -La medición de resultados de las intervenciones incluidas son a corto plazo, por lo que estos resultados podrían no ser válidos si las mediciones consideran el tiempo para adoptar las nuevas conductas. -En Chile existen programas y asociaciones entre escuelas y centros de salud que favorecerían la implementación de programas desde el sector salud.

Variabilidad en el patrón de consumo de alimentos en una población de preescolares de Asunción, de nivel socioeconómico alto y su relación con el estado nutricional / The variability in feeding patterns of pre-schoolers living in Asunción, from families with high socioeconomic status and the relation with their nutritional status

Introducción: La diversidad alimentaria constituye una medida cualitativa del consumo de alimentos, tiene una asociación positiva con la calidad de la dieta y es un factor importante para alcanzar los requerimientos nutricionales. Objetivo: Evaluar la variabilidad en el patrón de consumo de los alimentos de niños pre escolares residentes en Asunción, de condición socioeconómica alta y su relación con el estado nutricional. Metodología: Diseño observacional, trasversal, cualitativo. Se realizó la evaluación de niños prescolares de 2-6 años de nivel socio económico alto de Asunción, de setiembre a octubre de 2014 mediante medición antropométrica y con dos encuestas: una de datos demográficos y otra con la lista de todos los alimentos disponibles en el mercado, mediante entrevista directa. Se evaluó estado nutricional y su relación con la diversidad alimentaria. Se utilizó medidas de frecuencia y el programa Anthro 3.2 de la Organización Mundial de la Salud. Resultados: Se estudiaron 67 niños, con predominó del sexo femenino. El 89,5 % de madres tuvo estudios terciarios concluidos. Se encontraban eutróficos (63% de los niños) y 31,5 % con malnutrición por exceso (sobrepeso y obesidad) Un 19% presentó riesgo de talla baja y el 1,5% talla baja. Se hallaron un total de 172 tipos de alimentos que se distribuyeron en 9 grupos, la media de número de alimentos consumidos por los niños pre escolares fue de 69,19 (IC 95%: 63,79- 74,59). El rango mínimo fue de 28 alimentos y el máximo 126 alimentos. No se encontró diferencias significativas con el Índice de Masa Corporal y la diversidad alimentaria; sin embargo la relación fue estadísticamente significativa entre diversidad de la alimentación y la talla alta. Conclusión: Se constató que existe poca variabilidad en el consumo de alimentos de niños pre escolares sin restricción socio económica. Se encontró relación significativa entre diversidad Alimentaria y la talla del niño

Introduction: Food diversity can be used to measure the quality of the feeding habits. It has a positive association with diet quality and constitutes an important factor to reach the nutritional requirements. Objectives: Assess the variability in feeding patterns of pre-schoolers living in Asunción, from families with high socioeconomic status and the relation with their nutritional status. Methodology: Observational, transversal in time, qualitative study. The researchers evaluated children from 2-6 years of age, from families with high socioeconomic status living in Asunción, from September to October of 2014, using antromopetric measures and two questionnaires applied in direct interview format: the first one with demographic data and the second one with a list of locally available food. The nutritional status and its relation with food diversity were assessed, measuring frequency. World's Health Organization's Software Anthro 3.2 was used for anthropometric evaluation. Results: In total, 67 children were included in the study, mainly female. 89,5% of the patient's mother had concluded tertiary education. 63% of patients were well-nourished and 31,5% had excess weight (overweight and obese). 19% were in risk of stumpting and 1,5% were in the range of stumpting. A total of 172 food varieties were found, distributed in 9 groups, the mean quantity of food varieties consumed by children was of 69,19 (CI: 95%, 63,79-74,59), ranging from 28 to 126 food varieties. Significant differences were not found in Body Mass Index and food diversity; but a statistically significant relation was found between food diversity and height. Conclusion: Low variability in feeding patterns was found in children with high socioeconomic status. There was a significant relation between food diversity and the child's height

Melanocitosis dérmica adquirida en la mano de un paciente pediátrico / Acquired dermal melanocytosis on the hand of a pediatric patient

Resumen Introducción: Las melanocitosis dérmicas son un grupo de enfermedades dermatológicas pigmentarias asociadas con la proliferación melanocítica. Se clasifican con base en su número y localización profunda a nivel de la dermis; pueden ser congénitas o adquiridas. Caso clínico: Paciente de sexo masculino de 11 años de edad, sin antecedentes de importancia para el padecimiento actual. Inicio con mácula oscura en la palma de la mano izquierda hace 5 años, asintomática, de crecimiento paulatino. A la exploración física, se detectó dermatosis que afectaba la palma izquierda, cara palmar de las falanges proximales del tercer y cuarto dedos, caracterizada por la presencia de mácula grisácea negruzca, bordes difusos e irregulares, no infiltrada ni indurada. En la dermatoscopia se detectó un patrón de pigmento de tono gris acero con áreas de color café, y con evidencia de puntos blanquecinos dentro de estas. En la histopatología se identificaron células fusiformes, con núcleo grande y la presencia de pigmento melánico en su interior, con distribución perivascular y entremezclados con las fibras de colágeno en la dermis superficial y media. Con base en las características clínicas e histopatológicas de la lesión, se concluyó melanocitosis dérmica adquirida de la mano como el diagnóstico definitivo. Conclusiones: Los reportes de casos de melanocitosis dérmica adquiridas atípicas son infrecuentes. La melanocitosis dérmica de la mano es una variante de estas enfermedades, de la que existen menos de 10 casos. Se presenta el primer caso reportado en Latinoamérica hasta el momento, con el objetivo de ampliar el conocimiento de sus características clínico-histológicas y dermatoscópicas.

Abstract Background: Dermal melanocytosis is a group of pigmentary dermatological diseases associated with melanocytic proliferation, which are classified based on their number and depth at the level of the dermis; they may be congenital or acquired. Case report: An 11-year-old male patient with no history of importance for the current condition started 5 years ago with a dark macula in the left hand palm, which was asymptomatic but grew gradually. On physical examination, dermatoses affecting the left palm, palmar face of proximal phalanges of the third, fourth and fifth fingers, characterized by the presence of blackish greyish macula, diffuse and irregular edges, not infiltrated or indurated were detected. The dermatoscopy identified a pattern of pigment with a greyish-brown tone with brown areas, showing whitish spots inside. In the histopathology, the presence of spindle cells was observed in the superficial and middle dermis, with a large nucleus and the presence of a melanic pigment inside, with perivascular distribution and intermingled with the collagen fibres. Based on the clinical characteristics and the histopathological findings, acquired dermal melanocytosis of the hand was concluded as the final diagnosis. Conclusions: Case reports of atypical acquired dermal melanocytosis are infrequent. Dermal melanocytosis of the hand is a rare variant of these diseases, of which less than 10 cases have been reported. At present, this case of dermal melanocytosis is the first reported in Latin America with the aim to extend the knowledge of its clinical-histological and dermatoscopic characteristics.

Effectiveness Of Vision Screening Program Conducted By Preschool Teachers

@#Vision impairment when undetected early can affect the social and mental development of a child. Early detection of visual impairment can provide better prognosis and can be conducted through vision screening at pre-school. Vision screening performed using pre-school teachers would allow cost and time savings while providing greater access to perform this screening. The objective of this study was to determine the effectiveness of vision screening conducted by pre-school teachers. A total of sixty pre-school teachers from KEMAS Tabika’s and Taska’s in the Klang Valley were randomly selected and divided into two groups i.e. a Study Group and a Control Group. The Study Group was given participative and handson vision screening training whereas the Control Group was only given brief verbal instructions on conducting the screening. Each of these pre-school teachers was asked to conduct vision screening on 15 pre-school children aged 4 to 6 years old. Trained optometrists then repeated the vision screening on the same children. The results showed that there was a higher validity in the vision screening findings from the Study Group (sensitivity = 79%, specificity = 95%) compared to the Control Group (sensitivity = 26%, specificity = 95%). The level of agreement concurrence between the pre-school teachers in the Study Group and the optometrist was high for all tests (AC1 ≥ 0.89). In conclusion, the vision screening program conducted by pre-school teachers was effective but needed proper training for the screeners. This program is seen to be able to empower pre-school teachers using vison screening techniques to allow them to identify pre-school children with vision impairment who would then require further examination and management by an eye-care professional. This program would be able to reduce the prevalence of vision impairment among pre-school children in Malaysia in the long term.

Comparison of Role of Different Doses of Rectal Paracetamol with Rectal Diclofenac as Pre-emptive Analgesics for Postoperative Pain Relief in Paediatric Surgeries.

Background: Post operative pain is a major concern in children particularly in developing countries were opioids are not freely available. Use of opioids is associated with side effects increasing patient discomfort and delaying patient discharge from hospital. We conducted a study comparing the use of different doses of rectal paracetamol with rectal diclofenac when used as pre-emptive analgesics on postoperative pain and recovery in paediatric patients considering the relative risk of diclofenac to increase bleeding in surgeries like tonsillectomy, cleft lip and cleft palate. Methods: Study groups included 20 patients in each. Group P40 receiving 40 mg/kg rectal paracetamol, Group P20 receiving 20 mg/kg rectal paracetamol, Group D receiving rectal diclofenac 1 mg/kg. Pain scoring was done by TPPPS (Toddler Pre-schooler postoperative pain scale) time to first need of analgesia and total dose of analgesia was noted. The rates of recovery were evaluated by using “Modified Steward Coma Scale”at 5 and 10 minutes after extubation. Results: Time of first demand of analgesic was delayed in Group-P40 as compared to Group-D and Group-P20 and difference was statically significant. TPPPS of the three studied groups varied significantly at different time intervals in favour of Group-P40. Total duration of analgesia in Group- P40 was (646±9.94) min Group- D (501±10.63) min and in Group-P20 (294±23.17) min Total analgesic requirement was also low in Group P40 and the difference between groups was significant. Conclusion: Pre-emptive high dose rectal paracetamol appears to be more effective than rectal diclofenac sodium suppository for postoperative analgesia in children without additional risk of bleeding in surgeries like tonsillectomy and cleft lip and cleft palate repair. Hence, high dose rectal paracetamol can be used as an alternative to diclofenac sodium due to higher risks of bleeding with diclofenac sodium in surgeries with increased risk of bleeding.

Estudio preliminar del impacto socioeconómico sobre los puntajes de una batería multidimensional de aptitudes en niños preescolares / A preliminary study on the socioeconomic impact on the scores of a set of multidimensional aptitude tests in pre-school children

El presente estudio explora las relaciones entre nivel socioeconómico, género y tipo de centro educativo preescolar y el desempeño cognitivo de niños preescolares (N = 323) de Lima (Perú), con una prueba multidimensional de aptitudes. Con la aplicación de la técnica multivariada de análisis de perfiles se hallaron diferencias estadísticamente significativas y de moderada magnitud del efecto en los puntajes cognitivos, debidas a la ubicación del centro educativo; no se detectaron diferencias que se atribuyan al género y al tipo de centro. Se trabajó en base a tres hipótesis: La primera es la hipótesis de igualdad de niveles, en la que se examinan las diferencias que en promedio existen entre los dos grupos. La segunda es la hipótesis de igualdad de la dispersión, que examina si las variables de respuesta (puntajes en las subescalas) tienen la misma respuesta en promedio. Y la tercera, la hipótesis de paralelismo, que prueba si el patrón de elevaciones en el perfil es similar entre los dos grupos. Los resultados fueron evaluados con respecto a la consistencia interna y a la definición del nivel socioeconómico (ubicación geográfica). Se discuten las diferencias halladas en el aspecto socioeconómico y relacionándolas con la bibliografía sobre el tema y la utilidad de la batería multidimensional de aptitudes para niños preescolares. Es importante destacar que el estudio reporta información normativa acerca del desempeño de los niños preescolares, en lo que respecta al género y ubicación de los centros educativos y su carácter correlacional y la magnitud del efecto de los resultados.

The present study explores the relationship between socioeconomic level, gender and type of pre-school education center, and cognitive development in 323 pre-schoolers in Lima (Perú), using a multidimensional aptitude test. By applying the multivariate technique, we found statistical significant differences and medium size effects on the cognitive scores due to the educational center location, whereas gender and type of educational center differences were not found. The results were considered taking into account reliability levels and also according to the definition of socioeconomic levels. The differences found are discussed based on other articles as well as on the usefulness of the multidimensional aptitude tests for pre-schoolers. The sample consisted of 323 children of 5 years old, 167 boys and 156 girls, who go to both private and public pre-schools in a district of Lima. The proportion of public pre-school students (67.2%) was double the amount of private pre-school students (32.8%). Moreover, the private pre-schools had been recently formed (4 to 5 years before) and had children from families with a medium or medium to low socioeconomic level. In order to assess general and relevant aspects of pre-school learning, we applied a pre-school diagnostic test (De la Cruz, 1991), which can be used at a pre-school level (4-5 year-olds). This test contains the following areas: Verbal concepts, Quantitative concepts and Auditive memory, Visual perceptual aptitude and Visual-motor coordination. It is a potentia test because the time varies from one student to another so as to allow every child to answer every item. Furthermore, it is also a maximum performance test because the student tries to obtain the best possible score. We contacted several educational centers (private and public) from three different districts in Lima which accepted to participate in this study. The time of application of the test varied considering: individual skills, the number of children in the collective application, the presence of a teacher's aide for the collective application, and the attitude and motivation of the students. We used MANOVA to analyze profiles, a post hoc univariate contrast, and effect size estimations such as Cohen's d. Our study was based on three hypotheses: The first hypothesis was on the equality of levels (variability between subjects) that explores the differences that exist between both groups separately. As a result, we found no correlation between test performance and gender or school location. However, when considering type of school (public or private), we did find significant differences in one scale: Auditive memory, which was higher in public schools. The second hypothesis was the equality of dispersion (within-group differences), to identify if the answer variables have the same answers on average. We found similarities regarding school conditions (public or private); but there were small differences between gender and school location. The third hypothesis was regarding parallelism, which tests whether the pattern of elevations on the profile is similar between the two groups or not. We did not find important statistical dispersions and the effect size was small. The results coincide with other studies on the correlation between gender and socioeconomic level, and cognitive development. Among some of the limitations of our study, we list the following: for example, we used the school location to determine the children's socioeconomic level. Therefore, there were also extreme scores (outliers), which could vary the central tendency estimations and the dispersion. However, they were not trimmed, since in a previous unreported analysis without these data, researchers found only minimum changes. We also had occasional difficulties in applying the tests, due to the children's disposition to participate as well as their reaction concerning the test situation, which could have added random error on the results. However, we presume their negative reactivity was reduced because of the playful manner in which the tests were presented. The results of our research shed normative information regarding the performance of preschoolers due to gender and location of their educational centers. It is important to emphasize correlations as well as effect size of the results so as not to reach erroneous conclusions.

Self-Esteem of the Schooler of Families in Poverty / 아동간호학회지

The Purpose of this study was to identify factors that influence the self-esteem of the schooler of families in poverty. A descriptive, correlational, and cross-sectional study design was used. The data were collected from February to March, 2001. Convenient sampling was done from 194 subjects living in Jeju Do, but 167 subjects among these were used for the study analysis. Hierarchical Stepwise Regression was used to identify significant factors. The results of this study were as follows: In general, self-esteem status of the schooler in poor families was relatively poor. In stepwise regression analysis, self-esteem status was significantly influenced by emotional home environment, duration of poverty and frequency of parent-child tactics. These variables explained 26.8% of the variance of schooler's self-esteem. Conclusively, it is recommended that nursing intervention programs for schooler in poor family should be a focus to enhance the economic context as well as family effect.

The needs for sex knowledge in the late schooler / 아동간호학회지

The goal of this research was to provide the basic data of sexual education for late schooler by finding out what they want to know about sex, or to see, if any, its relevancy between female and male students and between each grade. The sample for this research was a total of 453 students in 4th, 5th and 6th grade from 12 different classes at two elementary schools which were located in C city and in B province. The children were requested to write down three points on what they want to know or to learn most about sex, and their answers were put through two analytical stages in order to classify and to examine. The followings are the conclusions from the data. 1. The female cluster took 44.2% out of the whole sample, and there were 151 students per each grade. The specific girl ratios for each grade were 42.4%, 50.3% and 39.7% respectively. 2. It was noted that a total of 1,195 questions were gathered from the students writings, 45% of the questions was raised by the female students. The 4th grade students raised 432questions (43.8% by the girl) while the 5th. and the 6th grade students raised 387 (53.2% by the girl) and 376 questions (42.3% by the girl) respectively. The average number of questions per students was 2.6 while the female students raised 2.8 questions which was more than the average 2.5 questions by male students. It was the 4th grade female student cluster, which raised the most question (3.0) while the 6th grade male students raised the least question (2.4) in average. 3. The questions raised by the children could be divided into seven categories of the knowledge need on sex. They were Reproduction (310 questions, 25.9%), Sexual Culture (230, 19.2%), Concept of sex (125, 18.0%), Changes of Puberty (172, 14.4%), Sexual Health (119, 10.0%), Anatomy and Physiology of Reproductive System (78, 6.5%) and Sexual Tendency and behavior (71, 5.9%). 4.'Reproduction'was the most frequently raised questions not only by both sex groups but also by the 5th grade students. Both sexes in the 4th grade showed the highest interest in Sexual Culture while it was Changes in Puberty for the both sexes in the 6th grade. The knowledge need on sex of the children indicated what they understand sexuality. They apprehended sex as sex, gender and sexuality in an inclusive way. They showed a major interest in the biological sex and the sexual activities. It seems that the children managed to understand clearly the meaning of gender, furthermore, they even pointed out that the streotyped sex role, patrimonial system and the sexual discrimination were unreasonable. The students possessed not only the least but also the most negative understanding in regard of sexuality. Two suggestions were made from the above conclusions for the practical sex education as well as its research. 1. For the practice: The sex education for the elementary upper grade school student should be relevant with their cognitive characteristics, also it should be more specific on the reproductive organs of both sexes, the actual scenes of the pregnancy and child delivery procedures. The gender concept should be added to the biological sex education, which will lead them to understand the unreasonableness of today's male-superior phenomenon and correct them. It is also necessary to develop educational programs for this age group so as to help them to understand sex in the sense of sexuality as well. 2. For the research: It is not easy to draw out a through conclusion since this study was carried out as one-time data collection. Yet it is undeniably helpful for the sex education if we can understand what the children want to know about sex, how much they know about it by conducting deep-interview researches through a small number of sample.