Rehabilitation using neurodevelopmental and sensory integration therapy approaches in an 8-month-old infant with self-gratification behavior: A case report

Self-gratification behavior is a normal behavior in infants or children and is usually misdiagnosed with dystonic development delays, repeated movement disorders, or even epilepsy. This case report aims to share our clinical experience in managing a child with self-gratification disorder through physical therapy techniques. An 8-month-old female infant presents with concerns related to poor social interaction, reduced play, irritable behavior, frequent crossing, and stiffness in the legs which she started showing at 3 months of age. She was earlier diagnosed with dystonic developmental delay and referred for a thorough development and sensory assessment. Rehabilitation with sensory integration and neurodevelopmental techniques was delivered to the child. Ages and Stages Questionnaire, Denver’s score, and Sensory profile were assessed at 8–9 months, 9–10 months, and 10–11 months to monitor prognosis. There was a significant improvement in self-gratification habits and improved attention in the child. Self-gratification behavior is a normal behavior in infants or children and is usually misdiagnosed. Treatment mainly constitutes neurodevelopment, sensory integration techniques, and parent education.

Incidence & factors influencing maternal near miss events in tertiary hospitals of Maharashtra, India

Background & objectives: Government of India (GoI) released operational guidelines for maternal near miss-review (MNM-R) in 2014 for use by programme managers of public health system to assist them for conducting MNM-R. The objective of the present study was to review the incidence and factors influencing MNM events in two tertiary hospitals of Maharashtra, India, as per the operational guidelines of the GoI released in 2014 and identify delays based on three-delay model to prevent such events in future. Methods: This prospective observational study was conducted in two tertiary hospitals of Maharashtra, from July 2018 to November 2020. All women during pregnancy, childbirth or postpartum upto 42 days meeting the eligibility criteria of MNM as per the 2014 GoI guidelines were included as cases (n=228), interviewed and discussed during the monthly MNM meetings at these hospitals. Results: The incidence of MNM was 11/1000 live births; the ratio of MNM to maternal deaths was 1.2:1. Leading causes of MNM were haemorrhage (36.4%) and hypertensive disorders of pregnancy (30.3%). Haemorrhage was maximum (70.6%) in abortion and ectopic pregnancies. Majority of the women (80.2%) were anaemic, of whom 32.4 per cent had severe anaemia. Eighty six per cent of women included in the study had MNM events at the time of admission and 81 per cent were referred from lower facilities. Level one and two delays were reported by 52.6 and 32.5 per cent of women, respectively. Level three delay at referral centres and at tertiary hospitals was reported by 69.7 and 48.2 per cent of women, respectively. Interpretation & conclusions: The findings of this study suggest that MNM-R should be undertaken at all tertiary hospitals in India as per GoI guidelines to identify gaps based on three-delay model. These hospitals should implement interventions as per the identified gaps with emphasis on strengthening the infrastructure, facilities and manpower at the first-referral units.

Professor FU Wen-bin's experience in treating "five delays and five weaknesses" in children with yang-oriented approach / 中国针灸

Professor FU Wen-bin, based on the concept of the "yang-oriented approach", identifies "yang deficiency with excess yin" as the underlying pathological mechanism of "five delays and five weaknesses" in children. He recommends a treatment model that included acupuncture, moxibustion, and rehabilitation, integrating various therapeutic methods of acupuncture, refined moxibustion, and auricular point sticking. Specific acupoints along the conception vessel, governor vessel, and bladder meridian, as well as related acupoints with tonifying effects on spleen and kidney, are selected to achieve the therapeutic goal of "promoting yang and nourishing yang simultaneously".

Evaluación del impacto de la pandemia COVID-19 en el diagnóstico y tratamiento de pacientes con cáncer de mama tratadas en Clínica Alemana de Santiago / Evaluation of the impact of the COVID-19 pandemic in the diagnosis and treatment of breats cancer patients at Clínica Alemana de Santiago

Resumen Introducción: Debido a la pandemia COVID-19 se ha visto un retraso en diagnósticos de en-fermedades oncológicas, cambio de tratamientos y aumento en mortalidad. Objetivo: Evaluar efectos de la pandemia en pacientes de Clínica Alemana de Santiago con diagnóstico reciente de cáncer de mama, comparadas con igual periodo año 2019. Materiales y Método: Estudio cuantitativo, retrospectivo, tipo descriptivo. Período 1 de abril - 31 de julio de 2020 comparado con igual periodo de año 2019. Revisión de nuestra base de datos, comparando motivo de consulta, estadio y tratamiento. Análisis estadístico con programa STATA, test T student y test exacto de Fisher. Consideramos significativo p < 0,05. Resultados: Total 156 pacientes, 70 (44,87%) consultaron en periodo señalado año 2020 versus 86 (55,13%) en 2019 (p = 0,1). Edad promedio 55 años versus 58 (p = 0,38). Consulta por nódulo palpable de mama, 25 versus 29 (p = 0,86). Hubo diferencias en pacientes que consultaron por antece-dentes familiares de cáncer de mama, 0 versus 6 (p = 0,033), y en pacientes con antecedente personal de cáncer de mama, 0 versus 6 (p = 0,033). Consulta por control imagenológico fue 39 versus 53 (p = 0,5). En época de pandemia hubo más tumores Her 2, 11 versus 2 (p = 0,006). Por estadios, no hubo diferencia. Por tratamiento indicado, cirugía fue de 49 pacientes versus 71 (p = 0,85). Hormonoterapia neoadyuvante 7 versus 1 (p = 0,058). Conclusiones: En periodo de pandemia hubo menor consulta por cáncer de mama. La mayoría por control imagenológico y lesiones palpables, sin diferencia en estos grupos entre ambos periodos. Hubo menos cirugías y más tratamientos con hormonoterapia neoadyuvante.

Introduction: Due to SARS-CoV-2 pandemic there has been a delay in oncological diagnosis and treatments potentially increasing mortality. Aim: To evaluate the effects of the pandemic in patients treated in Clinica Alemana with recent diagnosis of breast cancer, comparing the reason of consultation, stage and treatment to a similar time frame in 2019. Materials and Method: This is a retrospective, descriptive and quantitative study. Analyzing patients registry from April 1st to July 31st, 2020 compared with same time frame of 2019. Retrospective analysis of our database searching for reason of consultation, stage and treatment. Data analysis using STATA, T student test and Fisher exact test, considering significant a p < 0.05. Results: N156, 70 (44.87%) consultations in the 2020-time frame versus 86 (55.13%) in 2019 (p = 0.1). Mean age 55 years versus 58 (p = 0.38). Palpable tumor 25 versus 29 (p = 0.86). There was a difference in patients consulting due to personal breast oncological background, 0 versus 6 (p = 0.033) or familiar breast oncological background 0 versus 6 (p = 0.033). Breast images control 39 versus 53 (p = 0.5). In Pandemic more Her 2 tumors were diagnosed 11 versus 2 (p = 0.006). No differences in stages were observed. Upfront surgical treatment in 49 versus 71 patients (p = 0.85) and neoadjuvant hormonal treatment 7 versus 1 (p = 0.058). Conclusion: In the pandemic time frame there were less consultations due to breast cancer. The majority of the patients came because of a palpable tumor or breast image control without a significant difference compared with a similar time frame in previous year. There were less surgeries and more neoadjuvant hormonal treatments.

Motor intervention effectiveness on children daily routine, motor, health, and psychosocial parameters / Eficácia da intervenção motora na rotina diária, e em parâmetros motores, de saúde e psicossocial de crianças

ABSTRACT For children with motor delays, the intervention effectiveness regarding children's routine, overall self-perceptions, and engagement in the lessons, have been understudied. Furthermore, specific sex differences still lack evidence. This study examines the effectiveness of mastery Climate (MC) motor intervention on girls' and boys' daily routine, motor performance, BMI, self-perceptions, and engagement, and the sex differences across these variables. Children with motor delays were randomly assigned to MC Group or Comparison Group. We assessed children's routine at home; perceived competence, social acceptance, and global self-worth; BMI; motor skills; and qualitative engagement in the lesson. Results show girls and boys increased the playtime, motor scores, perceptions of cognitive and motor competence, social acceptance, global self-worth, and engagement with success in the lessons; and, decreased TV time and free play, changing tasks, distraction, and conflicts in the lesson. In conclusion the MC intervention was effective in fostering girl's and boys' achievement.

RESUMO Para crianças com atrasos motores, a eficácia da intervenção motora em relação à rotina, autoconceito e engajamento tem sido pouco estudada. Diferenças específicas de sexo ainda carecem de evidências. Este estudo examina a eficácia da intervenção motora com o Clima para a Maestria (MC) na rotina diária de meninas e meninos, e no desempenho motor, IMC, autoconceito e engajamento; e, as diferenças entre sexo nessas variáveis. Crianças com atrasos motores foram alocadas aleatoriamente no Grupo MC ou Grupo de Comparação. Avaliamos a rotina em casa, competência percebida, aceitação social e autoestima global, IMC, habilidades motoras, e engajamento na aula. Os resultados mostraram que meninas e meninos aumentaram o tempo de brincar e os escores motores, as percepções de competência cognitiva e motora, a aceitação social, o autovalor global e o engajamento com sucesso; e diminuíram o tempo assistindo TV, e as brincadeiras livres, o mudar a tarefa, e as distrações e os conflitos na aula. Conclui-ise que a intervenção MC foi eficaz em promover o desempenho de meninas e meninos.

Association between delayed diagnosis and breast cancer in advanced clinical stage at the time of consultation in four oncology centers in Medellin- Colombia, 2017. Cross-sectional study / Asociación entre retraso en el diagnóstico y estadio clínico avanzado de cáncer de mama al momento de la consulta en cuatro centros oncológicos de medellín, colombia, 2017. estudio de corte transversal

RESUMEN Objetivo: establecer la asociación entre el retraso en el diagnóstico de cáncer de mama con un estadio clínico avanzado y explorar factores que influyen en dicho retraso. Materiales y métodos: estudio de corte transversal con mujeres mayores de 18 años con cáncer de mama que consultaron en cuatro centros oncológicos de Medellín, Colombia, en 2017. Se usó el Breast Cancer Delay Questionnaire que incluye variables sociodemográficas, clínicas y de tiempos de atención. Se estimó el odds ratio (OR) crudo y ajustado por medio de una regresión logística con el estadio clínico avanzado como desenlace y el retraso diagnóstico como exposición. Resultados: se incluyeron 242 pacientes. La mediana del tiempo entre identificar el problema y la biopsia diagnóstica fue 104,5 días; entre identificar el problema y la primera consulta médica, 20 días, y de la primera consulta a la biopsia diagnóstica fue de 53 días. El 52,1 % se diagnosticó en estadio avanzado. Hubo asociación del retraso diagnóstico con estadio clínico avanzado (OR = 2,15; IC 95 %: 1,21-3,79). Se encontró que la edad mayor a 40 años es un factor protector contra una lesión avanzada (OR = 0,35; IC 95 %: 0,14-0,83). El retraso diagnóstico se asoció con estar afiliada al régimen subsidiado por el Estado (OR = 9,67; IC 95 %: 2,76-33,9) y tener edad mayor a 40 años (OR = 2,75; IC 95 %: 1,16-6,53). Conclusión: se requieren intervenciones educativas en las pacientes para adherir a los programas de tamización temprana o la consulta oportuna al identificar un signo o síntoma, para lograr un diagnóstico en estadios tempranos de la enfermedad. Además, se requieren estudios prospectivos para determinar los factores relacionados con la demora en recibir el tratamiento una vez diagnosticado el cáncer de seno y evaluar las intervenciones destinadas a disminuir las dilaciones en la atención de este cáncer.

ABSTRACT Objective: To determine the association between delayed diagnosis and advanced clinical stage breast cancer, and to explore the factors that influence this delay. Materials and methods: Cross-sectional study of women over 18 years of age with breast cancer who attended 4 oncology centers in Medellín, Colombia, in 2017. The "Breast Cancer Delay Questionnaire" which includes sociodemographic and clinical variables as well as time intervals was used. Crude and adjusted odds ratio (OR) were estimated, using advanced clinical stage as outcome and delayed diagnosis as exposure. Results: 242 patients were included. The median time interval between the identification of the problem and the diagnostic biopsy was 104.5 days; between the identification of the problem and the first medical visit, 20 days; and between the first visit and the diagnostic biopsy, 53 days. Of all the cases, 52.1 % were diagnosed at an advanced stage. An association was found between delayed diagnosis and advanced clinical stage (OR = 2.15 95 % CI 1.21-3.79). Age above 40 was found to be a protective factor against having an advanced-stage lesion (OR = 0.35; 95 % CI: 0.14-0.83). Delayed diagnosis was associated with affiliation to the government subsidized health system (OR = 9.67; 95 % CI 2.76- 33.9) and age over 40 years (OR = 2.75; 95 % CI: 1.16-6.53). Conclusion: Patient education is required in order to ensure adherence to early screening programs or timely consultation whenever a sign or symptom is identified, thus allowing diagnosis at an early stage of the disease. Moreover, prospective studies are needed in order to identify factors associated with delays in treatment after the diagnosis of breast cancer, and to assess interventions designed to reduce delays in the care of this form of cancer.

Morbidity profile of children from birth to 18 years of age referred for intervention to the district early intervention centre in a District Hospital, Andhra Pradesh

Background: The 揅hild Health Screening and Early Intervention Services� program aims at early detection and management of the four dimensions prevalent in children-defects at birth, diseases in children, deficiency conditions, and developmental delays, including disabilities. Objective: The objective of the study was to assess the morbidity profile of children from birth to 18 years of age screened in the district early intervention center (DEIC). Methods: A record-based descriptive study was done in the DEIC in Chittoor, Andhra Pradesh. The data were retrieved for 1-year from April 2017 to March 2018 into the excel sheet, and the combined master sheet was prepared for analysis. The analysis was done with SPSS 21.0 Version. Results: A total of 10571 children were screened and referred to the DEIC during the period. Out of them, 5679 (53.7%) were male and 4892 (46.3%) were female. Among all the four types of morbidities screened, majority 4847 (45.9%) were having the childhood diseases, 4177 (39.5%) had developmental delays including disabilities, 1067 (10.1%) had different deficiencies, and 361 (3.4%) had birth defects. Among the adolescent health issues, 119 (1.1%) were screened and sent for the early intervention to the district hospital. Conclusions: A huge number of children were screened and referred to the DEIC every year for intervention. The health sector has to focus more on the resources like workforce, training of peripheral health workers at regular intervals about the different morbidities screened, that would help in identifying the morbidities at the earliest possible time and receive the intervention at the best center.

Socio-demographics and clinical characteristics affecting pre-hospital delays in acute stroke patients: A 6-year registry study from a Malaysian stroke hospital

@#Background and objectives: The cumulative time spent without medical intervention in acute stroke patients may affect clinical outcomes. As the onset-to-arrival time to the hospital is crucial for effective treatment interventions, this study aimed to explore the factors associated with pre-hospital delays amongst acute stroke patients. Methods: We explored 932 patients data retrieved from the National Neurology Registry of Seberang Jaya Hospital between January 2013 and December 2018. Data on patient demographics and stroke manifestations were analysed using descriptive, univariate and multivariate logistic regressions. Results: Most patients were men (62.9%) with an average age of 62 years old. In the final multivariate regression model, pre-hospital delay was significantly lower among Chinese patients (aOR=0.6, 95% CI 0.4–0.9, p=0.016) and those using hospital ambulance (aOR=0.4, 95% CI 0.3–0.7, p<0.001), but higher among patients with lacunar infarcts (aOR=2.5, 95% CI 1.4–3.3; p<0.001). Conclusions: Demographic characteristic (ethnicity) and stroke manifestations, particularly stroke subtypes, and mode of transport were mainly associated with pre-hospital delays among acute stroke patients.

Frecuencia y determinantes del retraso en el diagnóstico de cáncer infantil en Argentina / Frequency and determinants of the delay in the diagnosis of cancer in children, in Argentina

En Argentina, la mortalidad por cáncer infantil es mayor que en países más desarrollados, siendo el diagnóstico tardío una de las posibles causas. Nuestro objetivo fue determinar la frecuencia de obstáculos al diagnóstico enfrentados por las familias de niños con cáncer asistidas por un Organismo No Gubernamental, y algunos factores demográficos, institucionales y médicos asociados. Se realizó un análisis retrospectivo observacional y cuantitativo del recorrido diagnóstico de los niños con cáncer asistidos por la Fundación N.D. Flexer, Argentina, entre el 1/1/2011 y el 31/12/2015. El resultado primario fue la presencia de obstáculos para acceder al diagnóstico. Se consideró que existió un obstáculo cuando tuvieron lugar consultas no orientativas, demora familiar, demora institucional, autoderivación y/o más de 30 días entre la aparición de síntomas y el diagnóstico. La frecuencia dentro de cada categoría se contrastó mediante la prueba de χ2. La influencia de distintas variables se evaluó mediante una regresión logística multivariada. De 1818 familias incluidas, 63.5% enfrentaron algún tipo de obstáculos. Resultaron moduladores negativos el diagnóstico antes del año, de tumor renal y la concurrencia a un hospital público de la Ciudad de Buenos Aires o de capital provincial como centro de primer contacto (todos p < 0.0001). Resultaron moduladores positivos el diagnóstico de tumor óseo (p = 0.009) y los centros de atención primaria (p < 0.0001) y consultorios particulares (p = 0.001) como centros de primer contacto. El principal factor no biológico asociado a la frecuencia de obstáculos al diagnóstico de cáncer infantil fue el tipo de centro de primer contacto.

In Argentina, mortality from childhood cancer is higher than in more developed countries, with late diagnosis being one of the possible causes. Our objective was to determine the frequency of barriers to diagnosis faced by families assisted by a Non-Governmental Organization, and some associated demographic, institutional and medical factors. A retrospective observational and quantitative analysis of the diagnosis pathway of children with cancer assisted by the N.D. Flexer Foundation, Argentina, between 1/1/2011 and 12/31/2015 was carried out. The primary outcome was the presence of barriers to diagnosis. It was considered that there was a barrier when there were consultations without diagnostic suspicion, family delay, institutional delay, self-derivation and/ or more than 30 days between the onset of symptoms and diagnosis. The frequency of barriers within each category was contrasted by the χ2 test. A multivariate logistic regression was used to examine its association with relevant variables. Among the 1818 families included, 63.5% faced delays/ barriers to diagnosis. Negative modulators were diagnosis at age younger than 1-year, renal tumor and first attention at a public hospital of the City of Buenos Aires or a provincial capital hospital (all p < 0.0001). Positive modulators were the diagnosis of bone tumor (p = 0.009) and first attention at a primary healthcare center (p< 0.0001) or private doctor's office (p= 0.001). The main non-biological factor associated with the possibility of facing barriers to diagnosis was the type of first contact-health institution.

A longitudinal study of near-miss and maternal mortality at a tertiary centre in rural Uttarakhand: addressing the fourth delay

Background: India is a signatory of the sustainable development goals and is committed to reduce the maternal mortality ratio to less than 70 per lakh live births. Review of maternal deaths and near miss cases is a very important step towards achieving this aim.Methods: A prospective observational study was carried out in a tertiary care centre in rural Uttarakhand for a period of one and half year using WHO criteria for maternal near-miss, in an attempt to assess the quality of obstetric care in the region and to identify the possible delays leading to this.Results: Haemorrhage was the most common cause leading to severe maternal outcome, followed by early pregnancy complications and hypertensive disorders of pregnancy. The mortality index was 15% and maternal near miss to mortality ratio was 7:1. We could identify some type of delay in at least 70% of near miss and mortality cases. Although delay in seeking healthcare was the most common, lack of community participation was identified as an important fourth delay.Conclusions: For substantive reduction of maternal mortality in this region of Uttarakhand, the main action needed is strengthening of primary health care, educating the patients regarding warning signs of pregnancy and strengthening the social status of women in society, increasing community support in women health care.

Why tuberculosis patients under revised national tuberculosis control programme delay in health-care seeking? A mixed-methods research from Wardha District, Maharashtra

Background: Timely treatment of tuberculosis is imperative for its control. This can get delayed due to delay in care seeking, diagnosis or treatment initiation. Objectives: The study aims to find out the magnitude of delays in care seeking, diagnosis or treatment initiation, and understand the reasons behind these delays in Wardha district of Maharashtra, India. Methods: A mixed methods study was conducted among 275 patients selected from those enrolled under Revised National Tuberculosis Control Programme in 2014. We collected information regarding the duration of delays and generated a free list of reasons for delays in care seeking and diagnosis. The free list items were then subjected to pile sorting. Two-dimensional scaling and hierarchical clustering analysis were performed to identify the various domains of reasons for delays. Results: The median delay in initial care seeking and diagnosis was 10 days each, and that for treatment initiation was 2 days. The domains identified for delay in care seeking were negligence toward health, health conditions, facility-related issues, and household and social reasons. The domains identified for delay in diagnosis were system-related reasons; and patient-related reasons, each of them further having two subdomains. Conclusions: Interventions for reducing the knowledge gap and stigma, increasing the accessibility of services, active case finding; capacity building of providers, quality assured sputum microscopy, and communication skills will help reduce these delays.

The time required to diagnose and treat lung cancer in Delhi, India: an updated experience of a public referral center

Background: Delays that postpone the evaluation and management of malignancy may lead to considerable morbidity. The primary objective of this study was to assess the time required to diagnose and treat lung cancer at an Indian public referral center that predominantly serves lower-income patients. Methods: A review of patients diagnosed with lung cancer between January 2008 and December 2016 was completed. We computed the median time intervals and inter-quartile ranges between symptom onset, definitive diagnostic investigation, confirmed histologic diagnosis, and chemotherapy initiation. Median intervals were correlated with baseline demographics and disease characteristics using Kruskal-Wallis test. Results: One thousand, three hundred and-seventy patients were selected. A majority (94.5%) with non-small cell lung cancer were diagnosed with advanced disease. After developing symptoms, patients required 101 [56­168] days to undergo a definitive diagnostic study, 107 [60­173] days to confirm a diagnosis, and 126 [85­196.8] days to initiate treatment. Patients who were previously treated for tuberculosis required more time to receive chemotherapy compared to those who were not (187 [134­261.5] days vs. 113 [75­180] days, p < 0.0001). A specialty Lung Cancer Clinic was implemented in 2012, and the mean referrals per month increased nearly four-fold (p < 0.0001), but the time required to administer treatment was not shortened. Conclusion: Among lower-income Indian patients, the most prominent delays occur prior to diagnosis. Efforts should be directed toward encouraging physicians to maintain a high index of clinical suspicion and educating patients to report concerning symptoms as early as possible.

The importance of encouraging child development

@#Quality child growth and development are important tools in assisting today's children to become the adults of the future. Hence, developmental delays in young children have an impact not only on a child's abilities to learn new skills, but also in the opportunities of the greater community or society. In this regard, parents and caregivers are the most well-equipped to prevent the child from experiencing developmental delays. Children will learn to trust the person who sensitively interacts with them and this trust provides a foundation for future learning, growth, and development. This paper looks at the importance of encouraging child development through the parents or guardians of children, since they are inevitably linked to a child's learning, and they know their own children better than anyone else. Parents and guardians who do not have the skills required to monitor and encourage the development of young children can and should be trained by professionals. This research reveals that training parents and guardians to use the Developmental Surveillance and Promotion Manual in monitoring and encouraging development of young children is a very important way to prevent future developmental delays.

Família como promotora do desenvolvimento de crianças que apresentam atrasos / Family as a promoter of the development of children with delays

Este estudo faz uma revisão teórica para compreender a família como um ambiente promotor do desenvolvimento humano. A família corresponde ao principal contexto de inter-relações da criança. A qualidade do ambiente familiar e das relações neste contexto conduz a evolução do desenvolvimento infantil. O bebê, ao chegar ao ambiente familiar, exige mudanças estruturais, e, quando esta criança apresenta atrasos em seu desenvolvimento, o modo como a família enfrenta esta realidade pode propiciar risco à vida da criança. Programas de Intervenção Precoce buscam entender o desenvolvimento infantil a partir de uma visão multidimensional, ou seja, mudar o foco somente na criança e no seu déficit, passando a considerar: família, comunidade e trabalho em equipe interdisciplinar.(AU)

This paper makes a theoretical revision to understand the family as an environment that promotes human development. The family corresponds to the main context of a child's interrelationships. In this way, the quality of the family environment and the relationships established in this context directs the evolution of child's development. A baby, when arriving to a familiar environment, demands structural changes, and when this child presents delays in its development, the way the family faces this reality can propitiate risk to the development of the child and the whole family. Early Intervention Programs seek to understand child development from a multidimensional perspective, changing the focus to be only on the child and his / her deficit, to consider three main characteristics: family, community and interdisciplinary teamwork.(AU)

Analysis of Risk Factors for Developmental Delay in Preterm Infants Using Screening Test / 대한소아신경학회지

PURPOSE: The purpose of this study was to identify the risk factors for developmental delays in preterm infants. METHODS: We studied 151 preterm infants admitted to the neonatal intensive care unit (NICU) at the Hallym University Kangnam Sacred Heart Hospital from January 2013 to November 2016. After discharge, the infants were evaluated by a pediatric neurologist via the developmental screening test K-ASQ:SE II, which consists of five domains: communication (CC), gross motor (GM), fine motor (FM), problem solving (PS), and social-emotional (SE). The subjects were divided into a normal group and an abnormal group (abnormal results on at least one of the five domains). Several variables were compared between the two groups and risk factors for developmental delays were analyzed. RESULTS: Several factors, such as birth weight (BW), gestational age (GA), Apgar score at 1 and 5 min (AS1, AS5), hospital days (HDs), respiratory distress syndrome (RDS), chronic lung diseases, intraventricular hemorrhage (IVH), early sepsis, retinopathy of prematurity (ROP), and history of management of invasive ventilators, dexamethasone, anti-hypotensive, were significantly different between the normal and abnormal groups. BW was a risk factor for developmental delay according to the binary logistic regression analysis. On individual domain analysis, risk factors were lower GA for domains CC and FM, lower AS1 for GM domain, lower BW for PS domain, and longer HDs for SE domain. CONCLUSION: In preterm infants, regular developmental screening especially follow-up observation, is important for early detection of developmental delay, considering the risk factors, such as GA (≤30 weeks), BW (≤1,500 g), low AS1, and long HDs, which may be helpful in the early diagnosis of developmental delay.

Determinantes para o cumprimento de prazo e preço em obras da educação: uma análise nos municípios capixabas / Determinantes del plazo y precio en obras de educación: un análisis en los municipios de Espírito Santo / Determinants for compliance with budget and deadline in constructions for education purposes: an analisys of cities in Espírito Santo

Resumo Objetiva-se com este estudo analisar os determinantes que contribuem para explicar o cumprimento dos prazos e preços em obras do setor de educação nos municípios capixabas. Tem como norteadora a revisão de literatura dos tópicos relativos à eficiência na alocação dos recursos públicos e estudos anteriores. Os determinantes foram classificados em cinco dimensões. Os resultados indicaram que, quanto ao cumprimento de prazo, são determinantes: as modalidades de licitação concorrência pública e convite, o tipo de serviço executado de reforma, o número de habitantes, o governante reeleito e o partido do prefeito igual ao do presidente. Quanto ao cumprimento de preço: a modalidade convite, o número de habitantes e o partido do prefeito igual ao do presidente. Este estudo contribui para a identificação de características que podem auxiliar no aumento da eficiência na alocação dos recursos públicos.

Resumen Este estudio tiene como objetivo analizar los factores determinantes que influyen en el cumplimiento de plazos y precios en las obras en el sector educacional, dentro de los municipios de Espírito Santo. Toma como guía la revisión de literatura de los temas relacionados con la asignación eficiente de los recursos públicos y estúdios anteriores. Los factores determinantes se clasificaron en cinco dimensiones. Los resultados indicaron que, para cumplimiento de plazos, son determinantes: procedimientos de licitación de concurso público por invitación, el tipo de servicio realizado como reforma, el número de habitantes, el gobernador reelecto y el partido político del alcalde al ser el mismo del presidente. Los factores que influyen en cuanto al cumplimiento de precios son: los procedimientos de licitación por invitación, el número de habitantes y la adherencia al mismo partido político del alcalde y del presidente. Este estudio contribuye a la identificación de características que pueden ayudar a aumentar la asignación eficiente de los recursos públicos.

Abstract This article aims to identify characteristics that contribute to reducing the probability of delays and overpayment related to the construction of schools and other types of Education facilities in municipalities of Espírito Santo. The article carries out a literature review of the topics related to the efficient allocation of public resource and previous studies. The characteristics were then classified in five dimensions. Results indicate that the following variables contribute to avoid or reduce delays: type of bidding process, type of service, number of inhabitants, mayors in their second term and their party. Regarding overpayments, the significant characteristics were type of bidding process, number of inhabitants and the mayor's party. This study contributes to the discussion on how public spending could be more efficient.

Development and effect evaluation of nurse-led emergency cerebral ischemia-reperfusion procedure / 中华护理杂志

Objective To optimize the cerebral ischemia-reperfusion process for acute ischemic stroke patients,so as to reduce the time of in-hospital delays.Methods A multi-disciplinary management team was established to design the flowchart of the cerebral ischemia-reperfusion process for acute ischemic stroke patients.By applying Healthcare Failure Mode and Effect(HFMEA) management mode,intervention was conducted and its effect was analyzed.Results After implementation of the HFMEA intervention,the door to needle time(DNT)was reduced from 88 (42,140) minutes to 45 (37,59) minutes(P＜0.001);the ratio of patients with the DNT＜60 minutes increased from 20％ to 87.7％(P＜0.001);the door to cerebral ischemia-reperfusion time was shortened from 207(169,227) minutes to 165(155,185) minutes (P＜O.05).There was no significant difference in the incidence and mortality of symptomatic cerebral hemorrhage between before and after intervention (P＞0.05).Conclusion Utilization of HFMEA to optimize the emergency cerebral ischemia-reperfusion process can effectively reduce the in-hospital delays of acute ischemic stroke patients.

Funciones sensoriales en niños menores de 3 años diagnosticados con trastorno del espectro autista (TEA) / Sensory processing in toddlers diagnosed with autism spectrum disorder (ASD)

Las dificultades de procesamiento sensorial en niños con Trastorno del Espectro Autista (TEA) están ampliamente descritos en la literatura principalmente mediante el uso de encuestas a padres y observaciones. Con menor frecuencia se han descrito las dificultades de procesamiento sensorial en niños menores de 3 años de edad que han sido posteriormente diagnosticados con TEA. Este estudio retrospectivo está basado en 84 niños (28 diagnosticados con TEA, 28 con retraso en el desarrollo, y 28 niños con desarrollo típico) entre 18 y 36 meses de edad que asistieron a un programa de intervención temprana y cuyos padres completaron el cuestionario Infant Toddler Sensory Profile (Dunn & Daniels, 2002). Los resultados obtenidos en esta encuesta revelan que los niños menores de edad con TEA muestran un patrón específico de procesamiento sensorial en comparación con niños con otros retrasos en el desarrollo.

Sensory processing difficulties of children with Autism Spectrum Disorder (ASD) are extensively described in the literature using parent surveys and observations. The sensory processing difficulties of children under 3 years of age who are later diagnosed with ASD have seldom been described. This retrospective study is based on 84 children (28 diagnosed with ASD, 28 with developmental disabilities, and 28 typically developing children) between 18 and 36 months of age attending an early intervention program and whose parents completed the Infant Toddler Sensory Profile questionnaire (Dunn & Daniels, 2002). The results obtained in this survey reveals that toddlers with ASD exhibit a distinct pattern of sensory processing as compared to children with other developmental delays.

Demoras en el proceso de atención de pacientes con cáncer de mama en dos hospitales públicos de la provincia de Santa Fe / Delays in the process of care of patients with breast cancer in two public hospitals in the province of Santa Fe

INTRODUCCIÓN: el retraso en el inicio de untratamiento efectivo del cáncer de mama reduce la tasa desupervivencia y está asociado a estadios más avanzados aldiagnóstico y a la necesidad de tratamientos más agresivos ycostosos. OBJETIVOS: Describir la trayectoria de la atención médicade mujeres con diagnóstico de cáncer de mama desde la apariciónde un signo o síntoma hasta la finalización del tratamiento.MÉTODOS: Se realizó un estudio descriptivo retrospectivo, quecombinó técnicas cuantitativas y cualitativas. Se estimaron lostiempos utilizados en cada etapa del proceso de atención de cáncerde mama en mujeres diagnosticadas y/o tratadas durante 2012 endos hospitales de la provincia de Santa Fe. RESULTADOS: Se incluyóa 62 pacientes en la muestra. El 20,3% obtuvo su diagnósticodentro del mes posterior a la mamografía y/o ecografía, y sólola mitad fue operada dentro del mes posterior al diagnóstico. El60% de las pacientes con necesidad de quimioterapia adyuvantey el 72,4% con necesidad de radioterapia tras la cirugía tuvierondemoras mayores a 60 días. Ninguna de las pacientes en estadio IVcomenzó el tratamiento antes de los 30 días. CONCLUSIONES: Si secompara con los parámetros establecidos en la guía del ProgramaNacional de Cáncer de Mama, hay demoras en todas las etapas. Esnecesario establecer estrategias que reduzcan los tiempos para laconfirmación diagnóstica en mujeres con sospecha, así como lostiempos de tratamiento en pacientes con cáncer confirmado.

INTRODUCTION: the delay to start an effectivetreatment for breast cancer reduces survival rate and is associatedto advanced stages at diagnosis and to the need for moreaggressive and costly treatments. OBJECTIVES: To describe thehealth care path of women with diagnosis of breast cancersince the first sign or symptom until the end of the treatment.METHODS: A retrospective descriptive study was performed,combining quantitative and qualitative techniques. It estimatedthe time used in each stage of the health care process amongwomen with breast cancer, diagnosed and/or treated during2012 in two hospitals of the province of Santa Fe, Argentina.RESULTS: A total of 62 patients were included in the sample.Of them, 20.3% received her diagnosis within 30 days of themammogram and/or ultrasound and 50% were operatedwithin one month of the diagnosis. There were delays of morethan 60 days in 60% and 72.4% of the patients who had toundergo adjuvant chemotherapy and radiotherapy, respectively.None of the patients with stage IV began the treatment withinthe first 30 days. CONCLUSIONS: Compared to the guidelinesof the National Program of Breast Cancer, there are delaysat all stages. It is necessary to develop strategies to shortenthe time for diagnosis confirmation in women with suspectedbreast cancer and for the access to treatment in patients withcancer confirmed.

Pontualidade do professor: atribuições causais de alunos em sala / Teacher's punctuality: causal attributions by students in class / Puntualidad del maestro: atribuciones causales de estudiantes en clase

A literatura sobre serviços educacionais tende a focar o engajamento e desempenho dos estudantes, que frequentemente depende de seu manejo do tempo. Mas como os alunos reagem quando o professor chega atrasado para a aula? Baseado no modelo de atribuição de Weiner, este trabalho investigou o efeito do atraso do professor nas reações emocionais, incômodo e julgamento de aceitabilidade de 232 estudantes de ensino médio. Um cenário de desenho fatorial 2 (atraso vs pontualidade do aluno) x 2 (causa interna vs externa para o atraso do professor) mostrou que causas externas foram mais aceitáveis e menos incômodas que causas internas. Esses resultados foram independentes da pontualidade ou atraso do próprio aluno. São discutidas implicações para as primeiras impressões influenciadas pela pontualidade em sala no contexto de interações de alunos e professores.

The literature on educational services tends to focus on students' engagement and performance, which frequently depends of their time management. But how do students react when teacher gets late in class? Based on Weiner's attribution model, this article investigated the effects of teacher's delay on 232 high school students' emotional reactions, annoyance, and judgments of acceptability. A scenario of factorial design two (student's delay vs punctuality) X two (internal vs external cause for teacher's delay) showed that external causes were more acceptable and less annoying than internal causes. These results were independent of student's own delay or punctuality. Implications for how first impressions are influenced by punctuality in class are discussed in the context of students' and teachers' interactions.

La literatura sobre los servicios educativos tiende a centrarse en el compromiso y desempeño de los estudiantes, a menudo dependiendo de su manejo del tiempo. Pero ¿cómo reaccionan los estudiantes cuando el profesor llega tarde a clase? Basándose en el modelo atribucional de Weiner, este estudio investigó el efecto del atraso del maestro en las reacciones emocionales, incomodidad y aceptabilidad de 232 estudiantes de secundaria. Un escenario de diseño factorial 2 (retraso vs puntualidad del estudiante) x 2 (causa interna vs externa para el del maestro) mostró que las causas externas fueron más aceptables y menos incómodas que las causas internas. Estos resultados fueron independientes de la puntualidad o retraso del proprio estudiante. Se discuten las implicaciones para las primeras impresiones influenciadas por la puntualidad en classe en el contexto de interacciones de estudiantes y maestros.