Temporalidade no estabelecimento do vínculo parento-filial em adoções malsucedidas / Temporality in establishing the parent-child bond in unsuccessful adoptions / Temporalidad en el establecimiento del vínculo padre-hijo en adopciones fallidas

Este estudo é parte de uma ampla investigação sobre a vivência do processo de adoção malsucedida de crianças e adolescentes sob a perspectiva dos adotantes. Foi realizada uma pesquisa qualitativa, com base em entrevistas semiestruturadas com 11 sujeitos independentes, nove mulheres e dois homens, moradores de diferentes estados do Brasil, que vivenciaram adoções malsucedidas. Buscamos analisar as percepções dos adotantes relacionadas à temporalidade no estabelecimento do vínculo parento-filial nessas adoções. A temporalidade da gestação simbólica foi vivenciada pelos participantes de diferentes formas, podendo ser afetada pela lentidão no processo administrativo e/ou por fantasias e idealizações referentes à origem da criança/adolescente. Tanto a demora quanto a tentativa de agilização do processo de adoção são fatores que podem gerar ansiedade na experiência da gestação simbólica e que não serão amparados no tempo cronológico, afetando o estabelecimento do vínculo parento-filial. Ressaltamos a relevância do cuidado nos períodos iniciais de construção do vínculo parento-filial, considerando a temporalidade particular de cada caso e a história pregressa da criança/adolescente, aspecto que influencia o sucesso do processo de adoção.(AU)

This study is part of a broad investigation about the experience of the unsuccessful adoption process of children and adolescents from the perspective of the adopters. Qualitative research was carried out, based on semi-structured interviews with 11 independent subjects, nine women and two men, living in different states of Brazil, who experienced unsuccessful adoptions. We seek to analyze the perceptions of adopters related to the temporality in establishing the parent-child bond in these adoptions. The temporality of the symbolic gestation was experienced by the participants in different ways, which can be affected by the slowness of the administrative process and/or by fantasies and idealizations regarding the origin of the child/adolescent. Both the delay and the attempt to speed up the adoption process are factors that can generate anxiety in the experience of symbolic gestation and that will not be supported in chronological time, affecting the establishment of the parent-child bond. The relevance of care stands out in the initial periods of parent-child bond construction considering the particular temporality of each case and the child's/adolescent's past history, aspect that influences the success of the adoption process.(AU)

Este estudio es parte de una extensa investigación sobre la experiencia del proceso fallido de adopción de niños y adolescentes desde la perspectiva de los adoptantes. Se realizó una investigación cualitativa a partir de entrevistas semiestructuradas con 11 sujetos independientes, nueve mujeres y dos hombres, residentes en diferentes estados de Brasil, que experimentaron adopciones fallidas. En este trabajo se analizan las percepciones de los adoptantes relacionadas con la temporalidad en el establecimiento del vínculo padre-hijo en adopciones fallidas. La temporalidad del embarazo simbólico fue vivida por los participantes de diferentes formas, las cuales pueden verse afectadas por la lentitud del proceso administrativo y por fantasías e idealizaciones sobre el origen del niño/adolescente. Tanto la demora como el intento de agilizar el proceso de adopción pueden generar ansiedad por la vivencia del embarazo simbólico y que no serán sustentados en el tiempo cronológico, lo que afecta establecer este vínculo. Se enfatiza la relevancia del cuidado en los períodos iniciales de construcción del vínculo considerando la temporalidad particular de cada caso y la historia pasada del niño/adolescente, un aspecto que influye en el éxito del proceso de adopción.(AU)

Estado nutricional población pediátrica y funcionalidad familiar en una unidad educativa ecuatoriana / Pediatric population nutritional status and family functionality in an Ecuadorian educa-tional unit

El estado de la funcionalidad de la familia influye en la calidad nutricional de sus miembros. El objetivo del presente estudio fue describir el estado nutricional de población pediátrica y la funcionalidad familiar en una unidad educativa pública en la provincia Cotopaxi, Ecuador, durante 2020. Se desarrolló una investigación descriptiva transversal, en la que participaron 179 familias de alumnos con edades entre 5 y 19 años, cuyos padres o tutores legales aportaron los datos de interés. La población pediátrica estuvo conformada por 91 niños/as de 5 a 9 años y 88 adolescentes de 10 a 19 años. El 54,7% correspondió al sexo femenino. En este contexto predominó el estado nutricional normal en los menores de edad y las familias funcionales (57%). La funcionalidad familiar se asoció significativamente con el grupo etario y el estado nutricional atendiendo a la talla/edad. Sin embargo, esa variable resultó independiente con respecto al estado nutricional según IMC/edad.

The state of family functionality influences the nutritional quality of its members. This study aimed to describe the nutritional status of the pediatric population and family functionality in a public educational unit in the Cotopaxi province, Ecuador, during 2020. A cross-sectional descriptive research was developed. The population was constituted by 179 families of students aged between 5 and 19 years old, whose parents or legal guardians provided the data of interest. The pediatric population consisted of 91 children from 5 to 9 years old and 88 adolescents from 10 to 19 years old. 54.7% corresponded to the female sex. In this context, normal nutritional status prevailed in minors and functional families (57%). Family functionality was significantly associated with age group and nutritional status according to height/age. However, this variable was independent with respect to nutritional status according to BMI/age

Valoración de la mejoría clínica en niños y adolescentes con trastornos psiquiátricos: una evaluación de múltiples perspectivas con HoNOSCA / Measure of clinical improvement in children and adolescents with psychiatric disorders: an evaluation of multiple perspectives with HoNOSCA

INTRODUCCIÓN La evaluación rutinaria de variables de resultado ayuda en la toma de decisiones, la asignación de recursos y el diseño de políticas en salud. La evaluación rutinaria de variables de resultado en el entorno hospitalario para niños y adolescentes con trastornos psiquiátricos sigue siendo limitada. La Health of the Nation Outcome Scales for Children and Adolescents, HoNOSCA, que recientemente se ha traducido al español y al catalán, permite la evaluación de resultados en esta población desde la perspectiva de pacientes, padres o tutores legales y clínicos. Este instrumento mide 13 áreas de salud y funcionamiento psicosocial. OBJETIVOS Evaluar variables de resultado en salud mental entre pacientes jóvenes de hospital de día de psiquiatría desde estas tres perspectivas usando Health of the Nation Outcome Scales for Children and Adolescents. MÉTODOS Reclutamos pacientes pediátricos (18 años o menos) con cualquier trastorno psiquiátrico en el hospital de día de la unidad de psiquiatría y psicología juvenil del Hospital Salut Mental Parc Taulí (Sabadell, Cataluña, España). Obtuvimos puntuaciones de Health of the Nation Outcome Scales for Children and Adolescents desde la perspectiva de pacientes, sus padres o tutores legales y clínicos, al ingreso y al alta. RESULTADOS Reclutamos 99 pacientes entre enero de 2015 y diciembre de 2017; once se perdieron durante el seguimiento. Entre los 88 restantes, encontramos una mejora significativa en las puntuaciones de Health of the Nation Outcome Scales for Children and Adolescents desde el ingreso hasta el alta. El acuerdo en las puntuaciones de esta escala entre los diferentes evaluadores fue débil al inicio, pero mejor al alta. En general, los pacientes y los padres o tutores legales reportaron puntuaciones más bajas de Health of the Nation Outcome Scales for Children and Adolescents (mejor estado de salud) al ingreso en comparación con los profesionales de la salud. Al alta, las puntuaciones fueron homogéneas desde las tres perspectivas. CONCLUSIONES La Health of the Nation Outcome Scales for Children and Adolescents permite la evaluación rutinaria de variables de resultado en salud mental en el entorno de hospital de día de psiquiatría desde la perspectiva de los pacientes, sus padres o tutores legales y los profesionales de la salud.

INTRODUCTION Routine outcome assessment is helpful to inform decision-making, resource allocation, and health policy design. Routine outcome assessment in the hospital setting for children and adolescents with psychiatric disorders remains limited. The clinical instrument HoNOSCA (Health of the Nation Outcome Scales for Children and Adolescents), which has recently become available in Spanish and Catalan, allows outcome assessment in this population from the perspective of patients, their parents or legal guardians, and clinicians. HoNOSCA measures 13 areas of health and psychosocial functioning. OBJECTIVES The aim of this study was to assess mental health outcomes in psychiatric day hospital pediatric patients from three perspectives (patient, par-ent/legal guardian, clinician), using the Spanish and Catalan versions of HoNOSCA. METHODS We recruited patients up to 18 years old with any psychiatric disorder at the day unit of the Salut Mental Parc Taulí Hospital Universitari (Sabadell, Catalonia, Spain). We obtained admission and discharge HoNOSCA scores for the patients, their parents or legal guardians, and their clinicians. RESULTS We recruited 99 patients over the study period (January 2015 to December 2017), 11 of which were lost to follow-up. Among the remaining 88, we found significant improvement in HoNOSCA scores from admission to discharge. Agreement between the HoNOSCA scores for the three different groups of evaluators (patients, parents/legal guardians, and clinicians) was weak at admission but better at discharge. In general, evaluations from patients and their parents or legal guardians had lower HoNOSCA scores (indicating a better mental health status) at admis-sion compared to those from clinicians. At discharge, however, the scores were more homogenous across the three groups of stakeholders. CONCLUSIONS Use of HoNOSCA allows for routine evaluation of mental health outcomes in the psychiatric day hospital setting from the perspective of pa-tients, their parents or legal guardians, and clinicians.

Conhecimento de responsáveis sobre traumatismo dentário em crianças / Knowledge of parents regarding dental trauma in children

Objetivo: identificar o conhecimento de pais/responsáveis sobre como proceder em caso de traumatismo dentário. Método: pesquisa com desenho observacional descritivo realizada por meio de questionários impressos entregues a 80 pais/responsáveis por crianças atendidas nas disciplinas de Clínica Infantil e Ortodontia I e II da Faculdade Avantis. A análise dos dados foi realizada de forma descritiva e com os testes Qui-Quadrado e Exato de Fisher. Resultados: a prevalência de pais que nunca receberam orientações sobre como porceder perante um traumatismo dentário foi de 75%, associando-se às respostas das perguntas: se saberiam como acondicionar o dente (p=0,001) e se já presenciaram alguma situação de trauma dental (p=0,047). As variáveis socioeconômicas escolaridade e renda e a autopercepção sobre o que fazer em uma situação de traumatismo dentário não se associaram a ter recebido informação sobre como proceder perante um traumatismo dentário, segundo o autorrelato dos responsáveis. A maioria dos pais das crianças nunca receberam informações e não sabem como proceder em caso de um possível traumatismo dentário. Conclusão: ter recebido informação sobre como proceder diante de um traumatismo dentário está associado a já ter presenciado situação de traumatismo dentário e a saber como acondicionar o dente para levar no dentista. (AU)

Objective: to identify the knowledge of parents/ guardians on how to proceed in the event of dental trauma. Method: observational descriptive study performed using printed questionnaires applied to 80 parents/guardians of children assisted in the classes of Children's Clinic and Orthodontics I and II at Faculdade Avantis. The data were analyzed descriptively and with chi-square and Fisher's exact tests. Results: the prevalence of parents who had never received instructions on how to deal with dental trauma was 75%, which was associated with the answers to the questions: "Would you know how to prepare the tooth?" (p = 0.001) and "Have you ever experienced any dental trauma situation?" (p = 0.047). Socioeconomic variables including education and income, and the self-perception on the procedures in case of dental trauma were not associated with having received information about how to proceed in a dental trauma situation according to the self-report of parents/guardians. Most parents had never received information and did not know how to deal with a potential dental trauma. Conclusion:having received information on how to deal with dental trauma is associated with having experienced a dental trauma situation and with how to prepare the tooth to take it to the dentist. (AU)

Students' dietary habits, food service satisfaction, and attitude toward school meals enhance meal consumption in school food service

BACKGROUND/OBJECTIVES: This study aimed to compare student consumption of school meals by school level, to identify the influencing factors of school meal consumption, and to assess improvement needs of school food service among students. SUBJECTS/METHODS: A total of 1,441 elementary, middle, and high school students attending 58 schools in Gyeonggi-do, South Korea participated in the survey in 2015. A questionnaire and informed consent forms for students and legal guardians were sent home and completed responses were returned to the researcher. RESULTS: Approximately 58% of the students perceived the portion sizes of school meals as appropriate and 76.1% consumed almost all or all of the meals served. More elementary and middle school students than high school students consumed almost all or all of the meals (P < 0.001). A regression analysis revealed that the students with a higher dietary behavior score (P < 0.001), higher satisfaction with food service (P < 0.001), a higher environmental protection practice score (P < 0.05), and more positive attitudes toward school meals (P < 0.01) consumed significantly more meals. The provision of foods that taste good and reflecting student opinions on menus were the most important factors for increasing school meal consumption. CONCLUSIONS: To increase consumption of school meals, food service staff should provide students with quality meals and engage students in school food service. Nutrition education that emphasizes healthy eating behaviors and cafeteria environment modification that applies strategies based on behavioral economics can encourage students to consume more school meals.

Pediatric Asthma Control and Communication Instrument: translation into Portuguese and cross-cultural adaptation for use in Brazil / Pediatric Asthma Control and Communication Instrument: tradução e adaptação transcultural para a língua portuguesa falada no Brasil

ABSTRACT Objective: To translate the Pediatric Asthma Control and Communication Instrument (PACCI) to Portuguese and adapt it for use in Brazil, ensuring the cultural validity of the content and semantic equivalence of the target version. Methods: The Brazilian Portuguese-language version of the PACCI was developed according to the most commonly used methodology, which included the following steps: translation; synthesis of the translation; review by the author of the original questionnaire; back-translation; synthesis of the back-translation; review by a native external researcher who is a native speaker of English; approval of the author of the original questionnaire; review by a specialist in Portuguese; review by a multidisciplinary committee of experts to determine the agreement of the items, considering the clarity of each and its appropriateness in the cultural context; cognitive debriefing; and development of the final version. The cognitive debriefing involved 31 parents/legal guardians of children 1-21 years of age with a clinical diagnosis of asthma, as defined by the Global Initiative for Asthma, with the objective of determining the comprehensibility and clarity of the items for the target population. Results: The multidisciplinary committee of experts indicated that the items on the questionnaire were clear and comprehensible, with kappa values above 0.61, indicating substantial agreement. In the cognitive debriefing, the parents/legal guardians presented no difficulties in understanding any of the items (agreement > 0.90); therefore, no further changes were needed. Conclusions: The translation and cross-cultural adaptation of the PACCI for use in Brazil were successful.

RESUMO Objetivo: Realizar a tradução e a adaptação transcultural do Pediatric Asthma Control and Communication Instrument (PACCI) para o contexto da população brasileira, e assegurar a validade de conteúdo e equivalência semântica da versão adaptada. Métodos: A versão do PACCI para a língua portuguesa falada no Brasil foi desenvolvida de acordo com a metodologia mais comumente utilizada, que incluiu as seguintes etapas: tradução; síntese da tradução; revisão de um pesquisador nativo de língua inglesa; tradução reversa; síntese da tradução reversa; revisão de um pesquisador nativo de língua inglesa; apreciação do autor do questionário original; revisão por especialista em língua portuguesa; revisão do comitê multiprofissional de especialistas para verificar a concordância dos itens, considerando a clareza e a adequação dos itens ao contexto cultural; desdobramento cognitivo; e desenvolvimento da versão final. O desdobramento cognitivo foi realizado com 31 pais/responsáveis por crianças e adolescentes de 1-21 anos, com diagnóstico clínico de asma de acordo com a Global Initiative for Asthma, com o objetivo de verificar a compreensão e a clareza dos itens na população-alvo. Resultados: O comitê multiprofissional de especialistas indicou que os itens do questionário se apresentaram claros e compreensíveis, com valores de kappa superiores a 0,61, indicando concordância substancial. Considerando o procedimento de desdobramento cognitivo, os pais/responsáveis não apresentaram dificuldades de compreensão (concordância > 0,90) não havendo necessidade de modificações da versão final em português. Conclusões: O PACCI apresenta-se adequadamente traduzido e transculturalmente adaptado para uso na população brasileira.

Critique of Mental Health Welfare Law in Korea : Focusing on Involuntary Hospitalization Criteria / 신경정신의학

Under new mental health and welfare law, involuntary admission is allowed only for persons with mental illness based on the narrowed criteria of mental illness when they meet both need for treatment and danger to themselves and others. These stringent danger criteria along with narrowed definition of mental illness may prevent timely intervention for people with acute psychosis. It is claimed that the danger criteria is essential to keep up with international (UN, WHO) principles for legislation of mental health acts and laws of advanced countries. The international principles, however, do not necessarily call for stringent danger criteria for involuntary hospitalization. Danger criteria are not also prerequisites for involuntary hospitalization in many advanced countries. In countries with strict danger criteria, complementary measures seem to be taken for the drawback of danger criteria. As for the involuntary hospitalization by legal guardians, the complicated qualification for legal guardians may hinder prompt admission. The required number of legal guardians also needs to be changed from two to one person. Even in the situation where involuntary hospitalization is deemed urgent, there is no way to transport the patients to the hospital for assessment or temporary admission unless the police judges the patients to be dangerous to themselves or others. Outpatient treatment order can be an alternative to involuntary admission. However, it is rarely used since the order cannot be applied to those who do not have history of admission due to danger. For voluntary admission, status conversion to involuntary admission needs to be allowed in case of aggravation of symptoms to meet involuntary admission criteria. In addition, informal admission needs to be introduced to avoid unnecessary formal procedures for patients admitting voluntarily to open ward. In view of all these issues with new mental health and welfare law, entire revision of new mental health law is urgent to balance the rights to proper treatments and protection of human rights of persons with mental disorder.

A didactic approach to presenting verbal and visual information to children participating in research protocols: the comic book informed assent

OBJECTIVE: When children participate in research protocols, consent (by a parent or legal guardian) and assent (by the children) must be given. Understanding research protocols can be challenging for an adult and even more difficult for a child. The aim of this study was to describe the development of a comic book created to facilitate children's understanding of informed assent with clear and simple language. METHODS: Five researchers with scores above seven according to the Fehring criteria developed the comic book, avoiding the use of technical terminology. Twenty children between 7 and 12 years old, and enrolled in a larger study, responded using a Likert scale and questions about the clarity of texts and illustrations. The final version met National Health System Resolutions (Resoluções do Conselho Nacional da Saúde - CNS n° 196/1996 and 466/2012). RESULTS: The comic book assent presents a short story containing information about a real study: the invitation to participate, objectives, methods, instruments, procedures, risks, benefits, and the researchers' contact information. Most of the participants answered that they perceived the content of the text to be "Excellent" (40%) and "Very good" (40%), and the illustrations were perceived as "Excellent" (45%) and "Very good" (55%). CONCLUSION: The construction of a simple and clear model of informed assent is possible, and this model should be used in experiments with children.

Proteção e escuta no espaço do conselho tutelar: relações com a judicialização da vida / Protection and listening within the tutelary council space: relations with the judicialization of life / Protección y escucha en el espacio del consejo tutelar: relaciones con la judicialización de la vida

O artigo busca pensar como se dá a institucionalização de algumas práticas que entrelaçam escuta e proteção a partir de uma intervenção realizada em conselhos tutelares (CTs). As análises procuram questionar práticas instituídas sobre a proteção de crianças e adolescentes no referido estabelecimento. Na rotina do conselho tutelar, são frequentes os usos que se faz da escuta como arte do especialista e como uma técnica para apontar verdades. A escuta, tomada como um saber poder, acaba por tomar o judiciário como espaço mais capacitado para gerir as condutas, seja normalizando os modos de vida, seja sendo convocado quando esta vida escapa à moral instituída. De tais problematizações surgem alguns questionamentos que conduzem a presente escrita. Aqui dois em destaque: como são escutadas as diferenças que se instalam no espaço de atendimento? Como se dão as práticas de escuta e proteção em meio aos processos de judicialização que atravessam o CT?

The article tries to think about how the institutionalization of some practices that intertwine listening and protection occurs through an intervention carried out in tutelary councils. The analyses seek to question established practices about the protection of children and adolescents in these establishments. Usually, in the routine of the tutelary council, the listening is used as the art of the specialist and as a technique that points out truths. Taken as a knowing power, the listening ends up considering the judiciary as the most capable place to manage the conduct, or normalizing the ways of life, or being summoned when this life escapes the established morality. From such problematizations arise some questions that lead to this writing. Here two are highlighted: How are the differences, that are installed in the service space, listened to? How are the practices of listening and protection in the midst of the processes of judicialization that cross the tutelary board?

El artículo busca pensar como se da la institucionalización de algunas prácticas que entrelazan escucha y protección a partir de una intervención realizada en consejos tutelares (CTs). Los análisis buscan cuestionar prácticas instituídas sobre la protección de niños y adolescentes en el referido establecimiento. En la rutina del consejo tutelar, lo más frecuente son los usos que se hacen de la escucha como arte del especialista y como una técnica para señalar verdades. La escucha, tomada como un saber poder, acaba por tomar al judiciario como espacio más capacitado para gestionar las conductas, sea normalizando los modos de vida, sea siendo convocado cuando esta vida escapa a la moral instituida. De tales problematizaciones surgen algunos cuestionamientos que conducen al presente texto. Aqui, dos en destaque: ¿cómo son escuchadas las diferencias que se instalan en el espacio de atención? ¿Cómo se dan las prácticas de escucha y protección en medio a los procesos de judicialización que atraviesan el CT?

Conselho tutelar não se escreve com maiúscula / Tutelary council must not be written with capital letters / Consejo tutelar no se escribe con mayúscula

Dentre as disputas em torno da lei "Estatuto da Criança e do Adolescente" está a luta por descriminalizar algumas situações provindas da pobreza, retirando-as do Poder Judiciário e destinando-as a outros serviços de assistência e de reivindicação de garantia de direitos. Uma proposta que busca produzir deslocamentos com a implantação do conselho tutelar: uma governamentalização da pobreza que dá visibilidade à conjugação dos dispositivos de poder da soberania e da segurança. Embora pensadas para desjudicializar, as práticas do conselho tutelar têm lhe associado ao âmbito da Justiça, ao olhar punitivo presente em uma sociedade que se estrutura pela perspectiva jurídica, distanciando-se da maior parte dos prestadores de serviços, o que é visível, inclusive, na escrita dos textos, ao ser diferenciado dos órgãos e estabelecimentos do Poder Executivo por ser referido com o uso de letras maiúsculas, "Conselho Tutelar", como querem os órgãos do Poder Judiciário

Among the disputes around the law "Child and Adolescent Statute" is the struggle for the decriminalization of some situations arising from poverty, taking them off the Judiciary Power, and destining them to other kind of assistance services, or to services that claim for the rights guaranty. This is a proposal that seeks to produce displacements with the implantation of the tutelary council: a governamentalization of poverty that turns visible the conjugation of power devices of sovereign and security. Although initially proposed to dejudicialize, the practices of the tutelary council have associated it to the juridical sphere, to the punitive approach present in a society that structures itself through the juridical perspective, distancing itself from the bigger part of the service providers; this is visible even in the writing of the texts, when it is referred in a different way in relation to the Executive Power organisms, using capital letters: "Conselho Tutelar", as demanded by the Judiciary Power organisms

Entre las disputas en torno de la ley "Estatuto del Niño y del Adolescente" está la lucha por descriminalizar algunas situaciones provenientes de la pobreza, retirándolas del Poder Judiciario y destinándolas a otros servicios de asistencia y de reivindicación de la garantía de derechos. Una propuesta que busca producir desplazamientos con la implantación del consejo tutelar: una gubernamentalidad de la pobreza que da visibilidad a la conjugación de los dispositivos de poder soberano y de seguridad. Aun cuanto fuera propuesto para desjudicializar, las prácticas del consejo tutelar lo han asociado al ámbito de la justicia, a la mirada punitiva presente en una sociedad que se estructura por la perspectiva jurídica, distanciándolo de la mayor parte de los prestadores de servicios, lo que es visible inclusive en la escritura de los textos, al ser referido de forma diferenciada de los órganos y establecimientos del Poder Ejecutivo, con el uso letras mayúsculas: "Consejo Tutelar", como quieren los organismos del Poder Judiciario

Salud bucal en pacientes con síndrome de Down según actitud de sus tutores legales / Oral health in patients with Down syndrome according to the attitude of their legal tutors

Se realizó un estudio descriptivo y transversal de las 41 familias que tienen miembros con síndrome de Down, pertenecientes al área de salud del Policlínico Julián Grimau de Santiago de Cuba, desde enero de 2015 hasta igual mes de 2016, para evaluar la actitud de los tutores legales de estos pacientes, según variables de interés para la investigación. En la serie predominaron las familias no receptivas, cuyos hijos presentaron mayor porcentaje de enfermedad bucal (92,3), así como los afectados que se encontraban bajo la tutela de familiares con una actitud no salutogénica ante la salud bucal (88,8 por ciento). A pesar de que los tutores tenían un nivel de conocimiento adecuado, más de la mitad poseían una actitud no salutogénica. Se recomienda elaborar un proyecto educativo dirigido a estas personas, y hacerlo extensivo a otras áreas de salud del territorio, lo cual posibilitará la formación temprana de hábitos relacionados con el cepillado dental y el cuidado de la higiene bucal

A descriptive and cross-sectional study of the 21 families that have members with Down syndrome, belonging to the health area of Julián Grimau García Polyclinic in Santiago de Cuba, was carried out from January, 2015 to the same month in 2016, to evaluate the attitude of the legal tutors of these patients, according to variables of interest for the investigation. In the series there was a prevalence of non receptive families, whose children presented higher percentage of oral disease (92.3), as well as those affected whose tutors had a non healthy attitude when facing the oral health (88.8 percent). Although the tutors had an appropriate level of knowledge, more than half possessed a non healthy attitude. It is recommended to elaborate an educational project directed to these people, and make it extensive to other health areas of the territory, which will facilitate the early training of habits related to dental brushing and care of oral hygiene

Dementia and legal determination of capacity / Demência e avaliação de interdição judicial

ABSTRACT One of the consequences of dementia is the possibility of a guardianship proceeding that will deprive patients of legal capacity in taking decisions and managing their own assets. Objective To assess the legal capacity and guardianship proceedings in patients diagnosed with dementia. Methods Ninety-seven patients diagnosed with dementia and seen at a tertiary hospital were evaluated. Results Of these 97 patients, 60 (62%) were female. The mean age of the patients was 77.9 years; average schooling was 5.5 years. The main diagnosis was Alzheimer’s disease (73%): 16 patients were at a mild stage, eight at a moderate stage and 73 at an advanced stage of dementia. Only 28 patients had been legally declared incapable. Conclusion The large numbers of patients at an advanced stage of dementia, and the relatively few patients legally declared incapable show that legal issues in dementia are problematic.

RESUMO Uma das consequências das demências é a possibilidade da interdição judicial do paciente, retirando-lhe a capacidade jurídica da prática de decisões e administração de bens. Objetivo Avaliar a existência de capacidade jurídica e da interdição judicial em pacientes com diagnóstico de demência. Métodos Foram entrevistados 97 pacientes com diagnóstico prévio de demência atendidos no ambulatório de neurologia do comportamento de um hospital terciário. Resultados Dos 97 pacientes, 60 (62%) eram mulheres. A média de idade dos pacientes foi de 77,9 anos, e de escolaridade foi de 5,5 anos. O principal diagnóstico foi de doença de Alzheimer: 16 estavam em estágio leve, 8 em estágio moderado e 73 em estágio avançado da demência. Somente 28 pacientes apresentavam interdição judicial. Conclusão O elevado número de pacientes em estágio avançado de demência e reduzido número de pacientes com interdição indicou dificuldades em relação às questões legais da demência.

Autonomia e indivíduos sem a capacidade para consentir: o caso dos menores de idade / Autonomy and individuals without the capacity to consent: the case of minors / Autonomía e individuos sin la capacidad para consentir: el caso de los menores de edad

A Declaração Universal sobre Bioética e Direitos Humanos (2005) contemplou a autonomia com três artigos entre seus 15 princípios: autonomia e responsabilidade individual (artigo 5º); consentimento (artigo 6º); indivíduos sem a capacidade para consentir (artigo 7º). Diante da complexidade do tema, este trabalho analisa o artigo 7º da Declaração, com foco especificamente na questão das crianças. Por causa da ausência de competência para que crianças consintam de maneira livre e autônoma, essa autorização é repassada aos responsáveis legais, geralmente pais ou familiares. A inexistência de dispositivos legais que legitimem a decisão dos menores abre espaço para atuação paternalista de profissionais e dos responsáveis legais, que agem visando ao beneficio da criança, a partir de perspectivas próprias. A bioética é responsável por estimular a discussão sobre as possíveis formas e mecanismos de proteção real dos menores de idade, considerados legalmente incapazes de fornecer o próprio consentimento.

The Universal Declaration on Bioethics and Human Rights (2005) contemplated autonomy in three articles among its 15 principles: autonomy and individual responsibility (article 5); consent (article 6); and, persons without the capacity to consent (article 7). In view of the complexity of the mater, this paper analyzes Article 7 of the Declaration, specifically focusing on children. Because of children's lack of competence to freely and autonomously provide their consent, this authorization is passed on to their legal guardians, usually parents or relatives. The absence of legal provisions to legitimize the decision of minors leaves room for paternalistic actions by professionals and legal representatives, who act, based on their own perspectives, for the benefit of children. Bioethics is responsible for stimulating a discussion on possible ways and mechanisms for the real protection of minors, legally regarded as unable to provide their own consent.

La Declaración Universal sobre Bioética y Derechos Humanos (2005) incluyó a la autonomía, con tres articulos, entre sus 15 principios: autonomía y responsabilidad individual (articulo 5); consentimiento (articulo 6); y personas sin capacidad para consentir (articulo 7). Frente a la complejidad del tema, este trabajo analiza el articulo 7 de la Declaración, centrándose específicamente en la cuestión de los niños. Debido a la ausencia de competencia para que los niños presten consentimiento de manera libre y autónoma, esta autorización es desplazada a sus responsables legales, generalmente los padres o familiares. La inexistencia de dispositivos legales que legitimen la decisión de los menores, abre espacio para acciones paternalistas de parte de los profesionales y de los representantes legales, quienes actúan en beneficio de los niños desde sus propias perspectivas. La bioética es responsable de estimular la discusión sobre las posibles formas y mecanismos de protección real de los menores de edad, considerados legalmente como incapaces de proporcionar su propio consentimiento.

Asthma treatment in children and adolescents in an urban area in southern Brazil: popular myths and features / Mitos populares e características do tratamento da asma em crianças e adolescentes de zona urbana do sul do Brasil

Objective: To describe the frequency of popular myths about and features of asthma treatment in children and adolescents in an urban area in southern Brazil. Methods: The parents or legal guardians of public school students (8-16 years of age) completed a specific questionnaire regarding their understanding of asthma, asthma control, and treatment characteristics. The sample included parents or legal guardians of students with asthma (n = 127) and healthy controls (n = 124). Results: The study involved 251 parents or legal guardians, of whom 127 (68.5%) were the mothers and 130 (51.8%) were White. The mean age of these participants was 38.47 ± 12.07 years. Of the participants in the asthma and control groups, 37 (29.1%) and 26 (21.0%), respectively, reported being afraid of using asthma medications, whereas 61 (48%) and 56 (45.2%), respectively, believed that using a metered dose inhaler can lead to drug dependence. However, only 17 (13.4%) and 17 (13.7%) of the participants in the asthma and control groups, respectively, reported being afraid of using oral corticosteroids. In the asthma group, 55 students (43.3%) were diagnosed with uncontrolled asthma, only 41 (32.3%) had a prescription or written treatment plan, and 38 (29.9%) used asthma medications regularly. Conclusions: Popular myths about asthma treatment were common in our sample, as were uncontrolled asthma and inappropriate asthma management. Further studies in this field should be conducted in other developing countries, as should evaluations of pediatric asthma treatment programs in public health systems.

Objetivo: Descrever a frequência de mitos populares e as características do tratamento em asma em crianças e adolescentes em uma amostra urbana no sul do Brasil. Métodos: Foi aplicado um questionário específico, contendo perguntas sobre entendimento da doença, controle da asma e características do tratamento a pais/responsáveis de escolares da rede pública (8-16 anos de idade) com diagnóstico de asma (n = 127) e de controles saudáveis (n = 124). Resultados: Participaram do estudo 251 pais/responsáveis, com predomínio de mães como acompanhantes dos escolares (n = 127; 68,5%) e de etnia caucasiana (n = 130; 51,8%), com média de idade de 38,47 ± 12,07 anos. Sobre os mitos, 37 (29,1%) dos participantes do grupo asma e 26 (21,0%) dos do grupo controle relataram possuir receio de utilizar medicamentos para asma, e 61 (48%) e 56 (45,2%), respectivamente, acreditam que os inaladores pressurizados podem levar a dependência ao fármaco. No entanto, apenas 17 (13,4%) dos participantes do grupo asma e 17 (13,7%) dos do grupo controle relataram ter receio de utilizar corticoide oral. A ausência de controle da asma foi detectada em 55 (43,3%) dos escolares no grupo asma, apenas 41 (32,3%) possuíam uma receita ou um plano por escrito de como tratar da asma e 38 (29,9%) fazia uso contínuo de medicamentos para a doença. Conclusões: A presença de mitos populares sobre o tratamento da asma, a falta de controle da doença e seu manejo inadequado mostraram ser elevados nesta amostra. Nossos achados apontam para a necessidade de novos estudos nesse campo em países em desenvolvimento e de uma avaliação dos programas de manejo da asma pediátrica na saúde pública.

What are the boundaries of legal guardianship in Alzheimer's disease? An evidence-based update in the context of the Brazilian Civil Code

The Brazilian Civil Code, which came into force in 2002, established a functional criterion for guardianship proceedings and introduced the concept of “limited guardianship,” applied to cases in which incapacity to exercise civil rights is partial. With population aging and the growth in the number of older people with cognitive impairments, such as Alzheimer’s disease (AD), the need to invoke legal remedies against elder abuse increased; however, difficulties in assessing capacity still lead to a majority of decisions in favor of plenary guardianship. The present article compiled data on capacity in AD subjects. The varying degrees of decision-making impairment at different stages of AD might be compatible with limited guardianship in milder cases of the disease.

Evaluation of a preventive educational program for malocclusions: 7-year study

Abstract This study aimed at evaluating the Protocol for the Prevention of Malocclusions (PPM), established in the preventive educational program developed by the Public Infant Oral Health Program of the State University of Londrina (PIOHP-UEL). Guardians of three-year-olds or older, maintaining nutritive (bottle) and/or non-nutritive (pacifier and finger) sucking habits, attended meetings designed to alert and guide them to eliminating these habits from their children. PPM patient records (2006-2013) were assessed and the data were described and evaluated by the Chi-square test, with a 5% significance level. Results 506 of the 802 guardians/children referred to the PPM joined. As for the children, the most frequently assessed habits were: bottle (56.1%), bottle and pacifier (18.4%), finger (11.9%), bottle and finger (7.1%), pacifier (5.7%), pacifier and finger (0.6%), and bottle/pacifier/finger (0.2%). After parent participation in the meetings, 335 (66.2%) children abandoned their habits. There was a statistical difference between type of oral habit and time to abandonment (p = 0.0001). However, those with only one habit abandoned it more easily (72.6%) than those with two or more associated habits (48.1%) (p = 0.042). Presence or absence of breastfeeding and parents' level of education had no significant effect on habit abandonment. Conclusion PPM was an important tool for spreading knowledge to guardians, greatly contributing to the abandonment of deleterious oral habits. Bottle sucking warrants special attention - mentioned by 81.8% of parents - either alone or associated with other habits. Thus, educational actions to implement the children's approach to oral health are fundamental to making behavioral changes and promoting education of healthy habits, thereby keeping malocclusions from developing.

Parental influence on children's answers to an oral-health-related quality of life questionnaire

Abstract The aim of the study was to evaluate parental influence on children's answers to an oral health-related quality of life (OHRQoL) questionnaire. A cross-sectional study was conducted with a non-probabilistic sample of 84 pairs of 5-year-olds and parents/guardians. The participants were selected from a primary family healthcare center in Campina Grande, Brazil. First, the children and parents answered respective versions of the Scale of Oral Health Outcomes for Five-Year-Old Children (SOHO-5). Seven days later, the children answered their version of the SOHO-5, without the presence of their parents/guardians, and underwent a clinical exam of dental caries, traumatic dental injury and malocclusion, by a previously calibrated researcher. Statistical analysis involved a comparison of mean scores and the calculation of the intraclass correlation coefficient (ICC). Poisson regression models were used to associate the variables (α = 5%). No significant differences were found between the mean SOHO-5 scores of the children when alone or accompanied by parents/guardians (p > 0.05). The ICC between the answers of the children alone or accompanied was 0.84. White spot (PR = 6.32; 95%CI: 1.36 - 29.40) and cavitated lesions (PR = 9.81; 95%CI: 3.22 - 29.85) had an impact on OHRQoL, according to the children's self-report, whereas cavitated lesions (PR = 90.52; 95%CI: 13.26 - 617.74) and anterior open bite (PR = 1.95; 95%IC: 1.07 - 3.53) remained on the final model, according to the parents' version of the SOHO-5. In conclusion, parents did not influence the children's responses, and dental caries are the oral health problem exerting the greatest impact on the children's OHRQoL.

But is this Really the 'Parent' or 'Guardian'? Practical Strategies for Consent to Child Research in South Africa

Research ethics committees (RECs) in South Africa may require consent from a parent or legal guardian for child research. In instances where an REC determines that parental or guardianship consent is required; how far should researchers go to establish if the accompanying adult is in fact the parent or guardian? Should researchers accept disclosures at face value; probe assertions that are made; or even call for supporting documentation? In this article we set out the facts research staff should possess; propose key questions they could ask; and recommend practical steps for uncertain cases. We recognise that a parental/guardianship consent strategy may not be appropriate in all instances; but do not debate that issue in this article. This article is confined to practical advice for researchers wishing to implement a parental or guardianship consent approach

A ótica dos conselheiros tutelares sobre a ação da rede para a garantia da proteção integral a crianças e adolescentes em situação de violência sexual / Guardianship Councilors’ views on the effectiveness of the existing network in providing full protection to children and teenagers in situations of sexual violence

Resumo O artigo objetivou conhecer a ótica dos conselheiros tutelares sobre as principais dificuldades de atuação e mobilização da rede para garantir a proteção integral de crianças e adolescentes em situação de abuso e exploração sexual no município do Rio de Janeiro. O estudo qualitativo, a partir da análise temática de 12 entrevistas (individuais e grupos focais), reconstituiu o cenário desenhado pelos conselheiros e os limites percebidos de sua atuação. Os resultados apontam como problemas percebidos a insuficiência de instituições para atendimento especializado, profissionais despreparados, morosidade, falta de comunicação e de articulação interinstitucionais para garantir as medidas de proteção necessárias aos casos.

Abstract This article aimed to ascertain the point of view of Guardianship Councilors about the main difficulties of operation and mobilization faced by the Guardianship Councils network in ensuring full protection to children and teenagers in a situation of sexual abuse and exploitation in the municipality of Rio de Janeiro. The qualitative study, based on thematic analysis of 12 interviews (with individuals and as focus groups), reconstituted the scenario reported by the Councilors and the limitations that they experienced on their sphere of activity. The results indicate the following problems perceived: (i) insufficiency of institutions for specialized care; (ii) professionals without the necessary training/experience; (iii) delays; and (iv) lack of communication and coordination between institutions able to ensure the necessary protection measures for the cases concerned.

Percepção e orientação de condutas de conselheiros tutelares sobre práticas sexuais de menores de 18 anos / Perception and conduct's guidance of the guardianship board's members on sexual practices of the under 18 years old

A abertura política do Brasil à democracia promoveu uma série de mudanças legislativas e de organização do Estado. Na área da infância e adolescência, após a promulgação do Estatuto da Criança e do Adolescente (ECA), foram criados conselhos de nível federal, estadual e municipal, com o objetivo de promover e defender os direitos dessa população específica. Também foram formados os Conselhos Tutelares compostos por membros da sociedade civil, diretamente eleitos pela população, com a função de informar e promover esses direitos localmente. Utilizando a metodologia qualitativa-quantitativa do Discurso do Sujeito Coletivo, a pesquisa analisou a percepção e opinião dos conselheiros tutelares a respeito de situações que envolvem a prática sexual voluntária heterossexual e homossexual de adolescentes da faixa etária de 12 a 17 anos. Os dados foram colhidos com o uso de questionários semiestruturados para autopreenchimento, apresentados em visita técnica aos membros dos 44 Conselhos Tutelares do município de São Paulo. Além do perfil social e familiar, foram coletadas opiniões dos conselheiros quanto à autonomia dos adolescentes e suas noções de desrespeito legal, além de sugestões de orientação de condutas frente a três casos hipotéticos de prática sexual realizada por adolescentes. Responderam à pesquisa 80 (36,4 por cento ) conselheiros de um total de 220, de 29 (65,9 por cento ) dos 44 Conselhos Tutelares da cidade. Observou-se que apresentaram tendência a reproduzir os modelos tradicionais negativos da sociedade brasileira no julgamento da prática sexual de adolescentes, avaliando sua ocorrência pela ótica moral e de opinião de familiares e outros adultos

The political opening to democracy in Brazil promoted a series of changes of legislation and state organization. Concerning to the childhood and adolescence, after the promulgation of the Estatuto da Criança e do Adolescente (Statute for Children and Adolescents), councils were created at federal, state and municipal level, to promote and defend the rights of this specific group. The Conselhos Tutelares (Tutelary Councils) were also created, composed by civil society members, directly elected by the population, to inform and promote these rights locally. Using qualitative and qualitative-quantitative methodologies of the Discurso do Sujeito Coletivo (Discourse of the Collective Subject), the research analyzed the perception and the opinion of councilors regarding to situations involving heterosexual and homosexual voluntary sexual practices, among teenagers from 12 to 17 years old. Data were collected with semi-structured questionnaires for self-fulfillment, presented in technical visits to members of the 44 Tutelary Councils in São Paulo city. Beyond the social and family profile, opinions on the autonomy of adolescents and their notions of legal disrespect were collected and also the suggestions to orientation of conducts, facing three hypothetical cases of sexual practice performed by adolescents. The research was answered by 80 (36,4 per cent ) counselors from a total of 220, of 29 (65,9 per cent ) Tutelary Councils from the 44 placed in the city