Development of physical fitness through simulation exercises for ski racers aged 13-14. Non-randomized quasi-experimental study / Desarrollo de la condición física mediante ejercicios de simulación para corredores de esquí de 13-14 años. Estudio cuasi-experimental no aleatorizado

Abstract Introduction: In recent decades, the level of skiing performance in Russia has decreased significantly. This has necessitated problems with the preparation of athletes for competitions and the training process. Objective: To analyze the effects of simulation training tools on the physical condition of ski racers aged 13-14 years. Methods: Quasi-experimental, non-randomized study. 40 cross-country skiers aged 13-14 years belonging to the Korshik Village sports school (Russia) were assigned to a control (n = 20) and experimental (n = 20) group. Classes in the control group were conducted according to the usual training plan and in the experimental group simulation exercises were used. The control tests included pull-ups, squats, two-legged long jump, simulated 100-meter climbing and a 500-meter running test. Results: The control group showed no significant improvements (p > 0.05), while the experimental group reported significant improvements in pull-ups (22.2%; p< 0.05), squat (5.9%; p< 0.05), two-legged long jump (6.8%; p< 0.05), 100-meter climbing simulation (7.8%; p< 0.05) and 500-meter run (4.2 %, p <0.05). Conclusion: If, in the preparatory period, a series of simulation exercises are included in the training program for skiers aged 13-14 years, the level of physical fitness of athletes will improve significantly.

Resumen Introducción: En las últimas décadas, el nivel de rendimiento del esquí en Rusia ha disminuido significativamente. Esto plantea nuevos desafíos en la preparación de los atletas para las competiciones y el proceso de entrenamiento. Objetivo: Analizar los efectos de las herramientas de entrenamiento por simulación sobre la condición física de corredores de esquí de entre 13 y 14 años. Métodos: Estudio cuasiexperimental, no aleatorizado. 40 esquiadores de fondo de entre 13 y 14 años pertenecientes a la escuela deportiva Korshik Village (Rusia) fueron asignados a un grupo control (n=20) y experimental (n=20). Las clases en el grupo de control se llevaron a cabo según el plan de entrenamiento habitual y en el grupo experimental se utilizaron ejercicios de simulación. Las pruebas de control incluyen dominadas, sentadillas, salto de longitud con dos piernas, escalada simulada de 100 metros y una prueba de carrera de 500 metros. Resultados: El grupo control no presentó mejoras significativas (p>0,05), mientras que el grupo experimental reportó mejoras significativas en dominadas (22,2%; p<0,05), sentadilla (5,9%; p<0,05), salto de longitud a dos piernas (6,8%; p<0,05), simulación de escalada de 100 metros (7,8%; p<0,05) y carrera de 500 metros (4,2%; p<0,05). Conclusión: Si en el periodo preparatorio se incluye una serie de ejercicios de simulación en el programa de entrenamiento para esquiadores de 13-14 años, el nivel de condición física de los deportistas mejorará significativamente.

Rol del fisioterapeuta y del fonoaudiólogo en la educación inicial y preescolar de niños en Colombia / Role of the physiotherapist and speech therapist in the initial and preschool education of children in Colombia

Resumen Introducción: los fisioterapeutas y fonoaudiólogos como profesionales de la salud generan impacto en el rol educativo realizando acciones dentro de sus competencias de detección temprana y oportuna de las alteraciones que se presentan frecuentemente en educación inicial y preescolar a nivel de los procesos motores y comunicativos. Objetivo: realizar una reflexión sobre el rol del fisioterapeuta y el fonoaudiólogo en la educación inicial y preescolar de niños en Colombia. Reflexión: es necesaria la inclusión de los fisioterapeutas y los fonoaudiólogos en el sector educativo, formando grupos interdisciplinares en conjunto con los docentes, familias, e instituciones educativas con el fin de impactar positivamente en el bienestar comunicativo y desarrollo motor de la población que se encuentra en educación inicial y preescolar. Conclusión: se resalta la importancia de incluir a los fisioterapeutas y fonoaudiólogos en el equipo interdisciplinar en el sector educativo, con el fin de abordar de manera temprana las dificultades que puedan generarse a nivel comunicativo y en el desarrollo motor.

Abstract Introduction: Health professionals such as physiotherapists and speech therapists, within their competences, generate an impact on the educational role by carrying out early and opportune detection actions of the alterations that frequently occur in initial and preschool education at the level of motor and communication processes. Objective: To make a reflection on the role of the physiotherapist and speech therapist in the initial and preschool education of children in Colombia. Reflection: It is important to highlight and recognize the importance of including physiotherapists and speech therapists in the education sector in such a way that it can impact the population that is in initial and preschool education, forming interdisciplinary groups together with teachers, families, and schools, to impact the communicative well-being and motor development. Conclusion: When making the reflection, the importance of including physiotherapists and speech therapists in the interdisciplinary team of the educational sector is highlighted, to approach the difficulties that may be generated at the communicative level and in motor development in an early stage.

Fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática / Intervening factors in the management of nursing care for children hospitalized with rheumatic heart disease / Factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática

Objetivo: analisar os fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo descritivo-exploratório com abordagem qualitativa, que utilizou a Teoria Fundamentada em Dados e o Interacionismo Simbólico, respectivamente, como referencial metodológico e teórico. A coleta de dados foi realizada em uma instituição especializada em atendimento cardiológico, no munícipio do Rio de Janeiro. Foram entrevistados 19 profissionais de enfermagem através de um roteiro semiestruturado. Resultado: emergiram os seguintes fatores intervenientes na prática da gerência do cuidado: condição socioeconômica da família, comportamento da criança, condições de trabalho, comunicação ineficaz, educação permanente, trabalho em equipe e experiência profissional. Conclusão: os resultados apontam para a necessidade de proposição de estratégias de ação e interação que facilitem a prática gerencial de cuidado à criança com cardiopatia reumática e sua família face aos fatores intervenientes identificados.

Objective: to analyze the factors involved in the management of nursing care for children hospitalized with rheumatic heart disease. Method: this is a descriptive-exploratory study with a qualitative approach, which used Data-Based Theory and Symbolic Interactionism, respectively, as methodological, and theoretical references. Data was collected in an institution specializing in cardiac care in the city of Rio de Janeiro. Nineteen nursing professionals were interviewed using a semi-structured script. Result: the following intervening factors in the practice of care management emerged: the family's socioeconomic status, the child's behavior, working conditions, ineffective communication, continuing education, teamwork, and professional experience. Conclusion: the results point to the need to propose strategies for action and interaction that facilitate management practice in caring for children with rheumatic heart disease and their families, given the intervening factors identified.

Objetivo: analizar los factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio descriptivo-exploratorio con enfoque cualitativo, cuyos marcos metodológico y teórico fueron la Teoría Fundamentada y el Interaccionismo Simbólico, respectivamente. La recolección de datos se realizó en una institución especializada en atención cardiológica, en la ciudad de Río de Janeiro. Fueron entrevistados 19 profesionales de enfermería mediante un cuestionario semiestructurado. Resultado: surgieron los siguientes factores intervinientes en la práctica de la gestión del cuidado: condición socioeconómica de la familia, comportamiento del niño, condiciones de trabajo, comunicación ineficaz, educación continua, trabajo en equipo y experiencia profesional. Conclusión: los resultados indican que es necesario proponer estrategias de acción e interacción que faciliten la práctica de la gestión del cuidado al niño con cardiopatía reumática y a sus familiares, con respecto a los factores intervinientes identificados.

Efetividade de um filme na ansiedade e medo de crianças em idade escolar submetidas a cirurgia / Effectiveness of an educational video in reducing anxiety and fear in school-aged children undergoing surgery / Eficacia de una película sobre la ansiedad y el miedo en escolares sometidos a cirugía

Resumo Enquadramento: A hospitalização e a cirurgia são consideradas pela criança como eventos ameaçadores e com repercussões no seu comportamento, nomeadamente ansiedade e medo. Objetivo: Avaliar a efetividade de um filme preparatório para procedimentos a realizar antes de uma cirurgia de ambulatório visando a redução da ansiedade e medo. Metodologia: Estudo randomizado, controlado, envolvendo 60 crianças (6-14 anos), submetidas a cirurgia de ambulatório. O grupo de intervenção visualizou um filme no período pré-operatório e o grupo de controlo recebeu os cuidados habituais. A efetividade do filme foi medida através da escala de ansiedade Children's Anxiety Meter-State e o medo pela escala Children's Fear Scale. Resultados: Não se observaram diferenças significativas (p > 0,05) entre o grupo de intervenção que visualizou o filme e o grupo de controlo que seguiu os cuidados pré-operatórios habituais. Conclusão: Importa avaliar de forma precisa se os custos envolvidos nesta intervenção compensam os benefícios. Sugere-se mais investigação nesta área, ajustando outros programas que se revelem mais efetivos neste contexto.

Abstract Background: Children often perceive hospitalization and surgery as threatening events that can lead to feelings of anxiety and fear. These feelings may affect their behaviors. Objective: To evaluate the effectiveness of an educational video in reducing anxiety and fear before outpatient surgery. Methodology: A randomized controlled study was conducted with 60 children (6 - 14 years old) undergoing outpatient surgery. The intervention group watched an educational video during the preoperative period, while the control group received standard preoperative care. The effectiveness of the video was measured using the Children's Anxiety Meter-State scale, and fear was measured using the Children's Fear Scale. Results: No significant differences (p > 0.05) were found between the intervention group that watched the video and the control group that received standard preoperative care. Conclusion: An accurate assessment of whether the costs of this intervention outweigh the benefits is essential. Further research is recommended, particularly in adapting other programs that have proven more effective in this context.

Resumen Marco contextual: La hospitalización y la intervención quirúrgica son percibidas por el niño como acontecimientos amenazantes que repercuten en su comportamiento, concretamente en la ansiedad y el miedo. Objetivo: Evaluar la eficacia de una película preparatoria para los procedimientos que deben realizarse antes de la cirugía ambulatoria con el fin de reducir la ansiedad y el miedo. Metodología: Estudio aleatorizado y controlado en el que participaron 60 niños (de 6 a 14 años) sometidos a cirugía ambulatoria. El grupo de intervención vio una película en el periodo preoperatorio y el grupo de control recibió los cuidados habituales. La eficacia de la película se midió con la escala Children's Anxiety Meter-State y el miedo con la Children's Fear Scale. Resultados: No hubo diferencias significativas (p > 0,05) entre el grupo de intervención que vio la película y el grupo de control que siguió los cuidados preoperatorios habituales. Conclusión: Es importante evaluar con precisión si los costes de esta intervención compensan los beneficios. Se sugiere seguir investigando en este ámbito, ajustando otros programas que resulten más eficaces en este contexto.

Enlisting toddler cooperation through structure and autonomy support: The amplifying role of suboptimal relationship mutuality.

Regular repair of normative mother-toddler conflict is required for relational health; yet, we still need improved delineation of regulation strategies that can promote child cooperation. Contemporary conceptualizations of positive parenting propose that structure and autonomy support each facilitate children's optimal engagement; however, toddler studies rarely address their joint impact and conditional moderation. This observational study examined both dimensions in predicting cooperation among 106 U.S. 30-month-olds and their primarily European-American mothers during a demanding request situation. We also assessed mutuality, an indicator of mother-child relationship quality, from two situations with minimized power differentials to explore whether it moderated associations. Regression analyses confirmed the unique and additive impact of both maternal behavioral dimensions in predicting toddler cooperation and also an interaction effect such that the positive association between maternal autonomy support and toddlers' level of cooperation was accentuated depending on the dyads' mutuality. Results suggest that maternal structure and autonomy support may serve as effective approaches for enlisting or maintaining child cooperation during hierarchical negotiations, and that suboptimal relationship mutuality magnifies toddlers' responses to maternal levels of autonomy support. Findings are likely relevant to parenting programs that advance mother-child relational health during the transition from infancy to early childhood.

Para el bienestar de la relación se requiere una regular reparación del conflicto normativo entre madre­niño pequeñito; aun así, necesitamos mejorados delineamientos de las estrategias de regulación que puedan promover la cooperación del niño. Las conceptualizaciones contemporáneas de una crianza positiva proponen que tanto el apoyo de la estructura como de la autonomía facilitan por su parte la participación óptima de los niños; sin embargo, los estudios sobre niños pequeñitos raramente abordan su impacto conjunto y la moderación condicional. Este estudio observacional examinó ambas dimensiones en cuanto a predecir la cooperación entre 106 niños de 30 meses de edad, de Estados Unidos, y sus primariamente euroamericanas mamás durante una pedida situación exigente. También evaluamos la mutualidad, un indicador de la calidad de la relación madre­niño, a partir de dos situaciones con diferenciales de poder minimizados para explorar si la ésta moderaba las asociaciones. Los análisis de regresión confirmaron el singular y agregado impacto de ambas dimensiones del comportamiento materno para predecir la cooperación del niño pequeñito y también un efecto de interacción de manera que la asociación positiva entre el apoyo de autonomía materna y el nivel de cooperación de los niños pequeñitos se acentuó dependiendo de la mutualidad de las díadas. Los resultados sugieren que el apoyo de estructura y autonomía materno pudiera servir como acercamiento efectivo para conseguir y mantener la cooperación del niño durante negociaciones jerárquicas y que la mutualidad subóptima de la relación ensancha las respuestas de los niños pequeñitos a los niveles maternos de apoyo de autonomía. Las recomendaciones son probablemente relevantes para programas de crianza que llevan adelante el bienestar de la relación madre­niño durante la transición de la infancia a la niñez. Consistent with self­determination theory, maternal structuring and autonomy­supportive strategies made unique contributions to positively predicting toddler cooperation suggesting they may serve as effective and joint approaches for enlisting or maintaining cooperation during difficult request situations. As caregiver structuring is likely needed for many toddlers to accomplish multifaceted tasks, its positive association with cooperation was not altered by dyadic mutuality, an indicator of mother­child relationship history. Suboptimal relationship mutuality magnified the positive association between autonomy support and cooperation suggesting that mothers from dyads with low mutuality should be aware that their toddlers' cooperation may be especially sensitive to varying levels of autonomy support.

Declines in coastal macrozooplankton communities within a recent climate and ocean tipping point in the Tropical South Atlantic.

This study investigated whether variations in climate and ocean drivers on global, regional, and local scales affected macrozooplankton communities in a coastal protected area in Tamandaré Bay (northeastern Brazil). For this purpose, bimonthly field campaigns were carried out from June 2013 to August 2019. A significant tipping point (point of change, p < 0.001), with an abrupt increase in SST, was detected in the TSA (Tropical South Atlantic) index. This indicates the existence of a climate regime shift in the Tropical South Atlantic during the 2015/16 El Niño (EN) event. Extreme rainfall events were observed in Tamandaré Bay after this EN event, in 2017, 2018, and in 2019 (and more recently, in 2022). This extreme rainfall led to low-salinity events, increased variability in salinity, and significantly lower abundances in the period after the strong EN event, for socioeconomically relevant penaeid shrimp postlarvae and several other zooplankton groups (e.g., copepods, appendicularians, anomuran hermit crab larvae, and chaetognaths). We found a significant relationship between SSTs in the TSA region and penaeid shrimp recruitment in the study area, located leewards of the TSA index area. The decline in shrimp postlarvae and other macrozooplankton may be due to a combination of factors, such as climate and ocean shifts (atmospheric easterly waves disturbances, winds, precipitation, salinity) and possibly increasing marine pollution (related to extreme rainfall events, that convey macro- and microplastics, and pollutants from the continent). Cnidarian medusae and fish eggs were among the few "winners" of this ecosystem regime shift. Changes in climate, ocean, macrozooplankton, and shrimp postlarvae abundance evidence a relevant climate, ocean and ecosystem regime shift in this region with a tipping point during 2015/16 "Godzilla" El Niño. Possible future consequences in the context of persistent warming in the TSA region and the currently ongoing record strength 2023/24 EN event are discussed.

Dynamics of meteorological and hydrological drought: The impact of groundwater and El Niño events on forest fires in the Amazon.

Over recent decades, anthropogenic forest fires have significantly altered vegetation dynamics in the Amazon region. While human activities primarily initiate these fires, their escalation is intricately linked to climatic conditions, particularly droughts induced by the warm El Niño phase. This study investigates the impact of meteorological and hydrological drought on forest fires in the Amazon, focusing on the role of groundwater and El Niño events. Utilizing comprehensive drought indicators at various soil depths and standardized precipitation indexes, the research spans from 2004 to 2016, revealing a consistent decrease in humidity conditions across surface soil moisture, root zone soil moisture, and groundwater storage levels. With its slower response to precipitation changes, groundwater emerges as a crucial factor influencing hydrological drought patterns in the Amazon. The spatial distribution of drought conditions is explored, highlighting areas with lower humidity concentrations in the northeast and a correlation between forest fires and positive rates of change in burned area fraction during El Niño events. Notably, the study underscores the substantial increase in burned area during the 2015-2016, characterized by a very strong El Niño. This nuanced understanding of groundwater dynamics and its interplay with El Niño events provides critical insights for developing a tailored fire risk index in the ecologically significant and vulnerable Amazon basin, subsidizing strategies for mitigating fire risk and enhancing preparedness.

Venipuncture in pediatric emergency department by using Koala Attachment Distraction method: Randomized clinical trial.

OBJECTIVE: To assess, compare and relate the toddler's pain and anxiety during venipuncture by using either the Koala Attachment Distraction method or the physical restraint method and to evaluate the level of anxiety perceived by the companions in both groups. METHOD: Randomised, single-blind, controlled clinical trial in two arms (control and intervention group) conducted in the paediatric emergency department of a tertiary university hospital. The study variables were pain and stress of the child and anxiety perceived by the accompanying persons in both groups at the time before and during the technique. The pain rating scale Face, Leg, Activity, Cry, Consolability; the Groningen stress scale and the STAI questionnaire were used. RESULTS: A total of 113 participants aged 3 to 4 years participated in the trial (n=113). 50% (55) were girls, mean total age 3.83±0.59 years and accompanying persons 37.17±6.96. During the technique the mean pain in control and intervention groups was 5.64±3.30 and 3.87±3.01; stress, 3.25±1.22 and 2.67±1.24, respectively. No statistically significant differences were found in the assessment of anxiety between the groups. CONCLUSIONS: Patients who underwent the Koala Attachment Distraction method venipuncture show a lower level of pain and anxiety than those who received physical restraint, and the anxiety perceived by the companion is similar in both groups.

Temporal variability of spatial patterns of correlations between summer rainfall and the Oceanic Niño Index in the Pampean region.

The Argentinean Pampean region is essential for global food security, known for its extensive production of soybeans, corn, and wheat. The November to January (NDJ) trimester is critical for rainfed summer crops, as precipitation during this period directly affects soil moisture and crop yields. The El Niño-Southern Oscillation (ENSO), particularly its Oceanic Niño Index (ONI), plays a crucial role in influencing precipitation patterns in this region. This study investigates the spatial correlation between the ONI and NDJ precipitation from 1990 to 2021 sing a 20-year sliding window approach. We conducted Pearson correlation and cluster analyses to identify regions with consistent ONI-precipitation relationships. Our findings reveal notable temporal variability, with a general decrease in correlation strength since the window 1995-2014. This decline is likely driven by changes in ENSO dynamics and the influence of other climate variability modes, highlighting the need to consider factors modulating the ONI-precipitation relationship. Notably, the addition of the strong 2015 El Niño, which exhibited inconsistent precipitation behaviour compared to previous strong El Niño events such as 1997, contributed to this weakening. While the 1997 El Niño brought widespread positive rainfall anomalies, the 2015 event was marked by weaker and even negative precipitation anomalies in part of the region. This difference mirrors similar patterns reported in other parts of South America, such as Ecuador and Coastal Peru, and may be linked to a poleward shift in the jet streams during the 2015/2016 El Niño. The results underscore the complexity of ENSO's impact on regional climate and highlight the need for adaptive agricultural planning. By enhancing the understanding of ONI-precipitation dynamics, this study aims to improve long-term climate predictions and support sustainable agricultural practices in the Pampean region.

Fingerprints of El Niño Southern Oscillation on global and regional oceanic chlorophyll-a timeseries (1997-2022).

With the advancement of present-day ocean color satellites, the spatiotemporal variations of oceanic Chlorophyll-a (Chl-a) concentration, a proxy for phytoplankton population, can be monitored at regional and global scales. Estimating long-term changes in Chl-a concentration, however, is mainly constrained by the limited availability of ocean color data and the significant influence of climate oscillations like the El Niño Southern Oscillation (ENSO). In this study, we investigate the influence of ENSO on regional and global Chl-a timeseries using two ocean color datasets spanning from September 1997 to December 2022. Our analysis found that global Chl-a concentration exhibits a significant increasing trend over the study period. Most of the increasing trends are detected in the Southern Hemisphere and high-latitudinal regions, including the Southern Ocean. In light-limited regions like the Southern Ocean, enhanced Chl-a concentration shows a strong positive correlation with warming sea surface temperature (SST). Conversely, most oceans in the Northern Hemisphere exhibit decreasing trends, which are highly correlated with warming SST and ENSO phases. Additionally, we identify distinctive fingerprints of four extreme ENSO events: two extreme El Niño events (1997-1998 and 2015-2016) and two triple La Niña events (1998-2001 and 2020-2022) in these timeseries. Furthermore, empirical orthogonal function analysis reveals that the dominant mode of interannual Chl-a variability is associated with an ENSO-like pattern, accounting for about 13 % of the total variability. Intriguingly, this principal mode is highly correlated with the phases of ENSO (R = -0.87) and Pacific Decadal Oscillation (R = -0.90) on an interannual scale. This study underscores the significance of assessing the impacts of ENSO on long-term Chl-a trend estimation.

Temporal and spatial variation patterns of chlorophyll a in marine ranching under global interannual events.

Marine ecosystems are facing numerous environmental challenges due to global climate change. In response to these challenges, the establishment and growth of marine ranching has emerged as a pivotal solution. Chlorophyll a concentration (Chla) is recognized as a valuable indicator for the ecological assessment of marine ranching. This study focused on the spatiotemporal distribution of Chla and its response to environmental factors according to the dataset in the marine ranching area of Haizhou Bay (Lianyungang, Jiangsu, China) from 2003 to 2022. The results showed that Chla had a significant cycle of summer > spring > autumn and was distributed evenly in the central area of the marine ranching. During interannual changes, Chla patches were centered in the central region during 2014, 2015, and 2016. The Chla patches predominantly focused on the eastern area in 2018-2019, shifting to the western area in 2020-2021. The generalized additive model (GAM) indicated that salinity, depth, temperature, biological oxygen demand (BOD5) and SiO3--Si were the main environmental factors affecting Chla during spring, summer and autumn. However, during El Niño events, salinity, depth, temperature, BOD5 and transparency became the main environmental factors. We concluded that salinity, depth and temperature consistently played a crucial role in determining Chla under various climate conditions, and SiO3--Si and transparency will no longer be an environmental factor limiting Chla. In addition, The effect of interannual variability on upwelling and vertical mixing of water layers may potentially alter the spatial distribution pattern of Chla. These findings can offer ideas into predicting the variation of Chla in marine ranching under global interannual events in the future. Furthermore, this can contribute to the comprehensive assessment of ecological benefits and the in-depth construction of marine ranching. Ultimately, it can provide essential data and scientific references for offshore ecological environment assessment and ecosystem restoration.

Behavioural responses of a trans-hemispheric migrant to climate oscillation.

Large-scale climatic fluctuations, such as the El Niño-Southern Oscillation, can have dramatic effects on ocean ecosystem productivity. Many mobile species breeding in temperate or higher latitudes escape the extremes of seasonal climate variation through long-distance, even trans-global migration, but how they deal with, or are affected by, such longer phased climate fluctuations is less understood. To investigate how a long-lived migratory species might respond to such periodic environmental change we collected and analysed a 13 year biologging dataset for a trans-equatorial migrant, the Manx shearwater (Puffinus puffinus). Our primary finding was that in El Niño years, non-breeding birds were at more northerly (lower) latitudes than in La Niña years, a response attributable to individual flexibility in migratory destinations. Daily time spent foraging varied in concert with this latitudinal shift, with birds foraging less in El Niño years. Secondarily, we found that in subsequent breeding, a hemisphere away, El Niño years saw a reduction in foraging time and chick provisioning rates: effects that could not be attributed to conditions at their breeding grounds in the North Atlantic. Thus, in a highly migratory animal, individuals may adjust to fluctuating non-breeding conditions but still experience cascading carry over effects on subsequent behaviour.

Los estudios por imágenes en la evaluación del niño con estridor / Imaging studies in evaluating children with stridor

El estridor es un síntoma de obstrucción de la vía aérea superior y puede ser resultado de causas congénitas o adquiridas. El diagnóstico suele ser clínico. Si es necesaria una investigación adicional para el diagnóstico diferencial, la endoscopia es el método de elección en la mayoría de los casos. Los estudios por imágenes son complementarios a la endoscopia. Permiten evaluar la patología laríngea y traqueobronquial, las compresiones extrínsecas de la vía aérea por tumores o malformaciones vasculares y definir la localización, extensión y características de una lesión. Son útiles en casos de duda diagnóstica y cuando la endoscopia no está disponible. Es fundamental comprender la anatomía y fisiopatología del tracto respiratorio, y ser conscientes de las indicaciones y limitaciones de los exámenes complementarios para el diagnóstico adecuado. Se describen las diferentes modalidades de imágenes disponibles para evaluar el estridor en pediatría y se discuten sus ventajas.

Stridor is a symptom of upper airway obstruction and may result from congenital or acquired causes. The diagnosis is usually clinical. If further investigation is necessary for differential diagnosis, endoscopy is the method of choice in most cases. Imaging studies are complementary to endoscopy. They allow evaluation of laryngeal and tracheobronchial pathology and extrinsic airway compressions due to tumors or vascular malformations and define a lesion's location, extent, and characteristics. They are helpful in cases of diagnostic doubt and when endoscopy is unavailable. It is essential to understand the anatomy and pathophysiology of the respiratory tract and to be aware of the indications and limitations of complementary examinations for proper diagnosis. The different imaging modalities available to evaluate stridor in pediatrics are described, and their advantages are discussed.

Dificultades alimentarias en la infancia: una revisión narrativa / Feeding difficulties in childhood: A narrative review

Se estima que entre el 25 % y el 40 % de los niños sanos presentan algún síntoma de dificultad alimentaria (DA) durante su crecimiento y desarrollo, y muchas veces no son adecuadamente diagnosticadas. El propósito de este trabajo consistió en realizar una revisión narrativa que reuniera la información disponible sobre las dificultades alimentarias. Se desarrollaron algoritmos de evaluación y abordaje a partir de la evidencia en la literatura. La mayoría de los problemas de alimentación en los niños pequeños (selectividad alimentaria, falta de apetito, miedo a la alimentación) a menudo coexisten y es necesario evaluar el riesgo clínico para planificar una intervención individualizada. Contar con definiciones estandarizadas y terminología común para abordar estas dificultades de manera adecuada y multidisciplinaria es uno de los caminos para optimizar su tratamiento. Involucrar a los diferentes profesionales de la salud y a los padres es fundamental para abordar las dificultades alimentarias.

It has been estimated that between 25% and 40% of healthy children show symptoms of feeding difficulties (FDs) during their growth and development; many times, these are not adequately diagnosed. The objective of this study was to conduct a narrative review that collected the available information on fee ding difficulties. Assessment and management algorithms were developed based on the bibliographic evidence. Most feeding problems in young children (feeding selectivity, loss of appetite, fear of feeding) are often con current, and a clinical risk assessment is necessary to plan an individualized intervention. Having standardized definitions and common terms to address these difficulties in an appropriate and multidisciplinary manner is one of the ways to optimize their treatment. The involvement of different health care providers and parents is critical to address feeding difficulties.

Prevalencia de urticaria crónica: un estudio en población pediátrica de un hospital general / Prevalence of chronic urticaria: A study in the pediatric population of a general hospital

Introducción. La urticaria crónica es una afección inflamatoria de la piel caracterizada por presencia de habones evanescentes y/o angioedema, que ocurren durante un período ≥ 6 semanas. Objetivo. Determinar la prevalencia de esta enfermedad y describir características clínicas en niños y adolescentes menores de 19 años de un hospital general. Población y métodos. Estudio corte transversal, realizado entre el 2015 y el 2020, en una población de niños y adolescentes de un sistema de salud privado. Resultados. Se revisaron 1567 historias clínicas de pacientes con urticaria atendidos durante el período de estudio. Se identificaron 36 pacientes con urticaria crónica; se estableció una prevalencia del 0,16 % (IC95% 0,11-0,22). Conclusión. La prevalencia de urticaria crónica en niños y adolescentes fue del 0,16 %. Se observó mayor frecuencia en el sexo femenino y adolescentes.

Introduction. Chronic urticaria is an inflammatory skin condition characterized by the presence of evanescent wheals or angioedema that last for ≥ 6 weeks. Objective. To determine the prevalence of urticaria and describe its clinical characteristics in children and adolescents under 19 years of age in a general hospital. Population and methods. This was a cross-sectional study carried out between 2015 and 2020 in a population of children and adolescents seen at a private healthcare facility. Results. A total of 1567 medical records of patients with urticaria seen during the study period were reviewed. Thirty-six patients with chronic urticaria were identified; the prevalence was 0.16% (95% CI: 0.11­0.22). Conclusion. The prevalence of chronic urticaria in children and adolescents was 0.16%. A higher frequency was observed among girls and adolescents.

Patrones de alimentación perceptiva durante la primera infancia en conglomerados urbanos. Argentina, 2018-19 / Responsive feeding patterns during early childhood in urban areas. Argentina, 2018­2019

Introducción. La calidad de la alimentación implica tanto la cantidad y calidad de los alimentos que se ofrecen como la forma en que se ofrecen, el entorno y las respuestas de quien los ofrece. El objetivo de este trabajo fue identificar patrones de comportamiento relacionados a la alimentación perceptiva en niños entre 6 y 23 meses de áreas urbanas de la Argentina en 2018-19. Población y métodos. Análisis secundario de datos de la 2da Encuesta Nacional de Nutrición y Salud 2018-19, de una muestra probabilística polietápica de localidades urbanas de 5000 habitantes y más de Argentina. Se realizó análisis descriptivo y análisis de componentes principales para identificar los patrones de alimentación perceptiva en 4379 niños y niñas de 6 a 23 meses. Resultados. Se identificaron cinco patrones de alimentación perceptiva, las dos primeras dimensiones explicaron el 71,1 % de la inercia (p = 0,013). El patrón donde prevalecía la posibilidad de experimentación, la autonomía, la interacción y la ausencia de pantallas, premios y distracciones se asoció a niños/as mayores de 12 meses, de las regiones del centro y sur (Cuyo, Pampeana, Gran Buenos Aires y Patagonia), mientras que el patrón relacionado con menor autonomía, experimentación y autorregulación correspondió a las regiones Noroeste y Noreste, y a niños/as entre 6 y 11 meses. Conclusión. Se evidencian prácticas de alimentación perceptiva que se corresponden con patrones diferenciados entre sí, asociados a diferentes etapas y a la región donde viven los niños/as.

Introduction. Dietary quality involves both the quantity and quality of food offered, the way and the setting in which it is offered, and the responses of the person offering it. The objective of this study was to identify behavioral patterns related to responsive feeding in children aged 6 to 23 months in urban areas from Argentina in 2018­2019. Population and methods. Secondary analysis based on data from the second National Survey on Nutrition and Health of 2018­2019 conducted in a multistage probability sample from urban areas of 5000 inhabitants or more in Argentina. A descriptive analysis and a principal component analysis were performed to identify responsive feeding patterns in 4379 children aged 6 to 23 months. Results. Five responsive feeding patterns were identified; the first 2 dimensions explained 71.1% of inertia (p = 0.013). The pattern with a prevailing possibility of experimentation, autonomy, interaction, and the absence of screens, rewards and distractions was associated with children older than 12 months from the central and south regions (Cuyo, Pampa, Greater Buenos Aires, and Patagonia), whereas the pattern related to a lower autonomy, experimentation, and self-regulation corresponded to children aged 6 to 11 months from the Northwest and Northeast regions. Conclusion. There is evidence of responsive feeding practices that correspond to distinguishable patterns, associated with different stages of life and with the region where the children live

Evaluación funcional de niños, niñas y adolescentes con diagnóstico de trastorno del espectro autista en Argentina: estudio multicéntrico TEA-CIFunciona / Functional assessment of children and adolescents with autism spectrum disorder in Argentina: ICF-ASD multicenter study

Introducción. El trastorno del espectro autista (TEA) se caracteriza por dificultades de comunicación social y comportamientos repetitivos y estereotipados. Además de la categoría diagnóstica, las actividades que los niños, niñas y adolescentes (NNyA) pueden realizar y la participación social son los aspectos principales por considerar desde el marco de la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF), propuesta por la Organización Mundial de la Salud, para describir los estados de salud. En una investigación previa, elaboramos la primera versión de una herramienta pediátrica basada en la CIF llamada TEA-CIFunciona para evaluación funcional de NNyA con diagnóstico de TEA, que permitió captar características funcionales adaptadas a nuestro contexto cultural. Se propuso como objetivo posterior aplicar TEA-CIFunciona en formato multicéntrico para evaluar NNyA de diferentes regiones, revisar y actualizar la herramienta, e identificar barreras y facilitadores. Población y métodos. Se administró TEA-CIFunciona versión 1.0 a NNyA con diagnóstico confirmado de TEA (según criterios del DSM-5), menores de 16 años, en seguimiento en cinco centros de atención pediátrica del país. Resultados. Se obtuvo la versión 2.0 de TEA-CIFunciona con 34 categorías (10 funciones corporales, 15 actividades y participación, y 9 factores ambientales). Se elaboró el perfil funcional de la muestra completa (n = 308). Conclusiones. La versión actualizada de TEA-CIFunciona contribuye a estandarizar y a sistematizar la obtención de información necesaria para adecuar el seguimiento de los NNyA con TEA a nivel nacional. Además, permite identificar barreras por superar y facilitadores para generalizar

Introduction. Autism spectrum disorder (ASD) is characterized by difficulties in social communication and repetitive and stereotyped behaviors. In addition to the diagnostic category, the activities performed by children and adolescents and their social involvement are the main aspects to be considered according to the International Classification of Functioning, Disability, and Health (ICF) proposed by the World Health Organization to describe health status. In a previous study, we developed the first version of a pediatric tool based on the ICF called ICF-ASD for the functional assessment of children and adolescents with ASD to capture functional characteristics adapted to our cultural setting. Our subsequent objective was to apply the ICF-ASD in a multicenter format to assess children and adolescents from different regions, review, and update it, and identify barriers and facilitators. Population and methods. The ICF-ASD version 1.0 was administered to children and adolescents younger than 16 years with a confirmed diagnosis of ASD (as per DSM-5 criteria), who were receiving follow-up at 5 children's health centers across Argentina. Results. Version 2.0 of the ICF-ASD was obtained, which included 34 categories (10 under body function, 15 under activities and participation, and 9 under environmental factors). A functional profile was developed for the whole sample (n = 308). Conclusions. The updated version of the ICF-ASD helps to standardize and systematize the collection of necessary data for an adequate follow-up of children and adolescents with ASD at a national level. It also allows to identify barriers to overcome and facilitators to be generalized

Relationship between video game addiction and bladder/bowel dysfunction in children / Relación entre la adicción a los videojuegos y la disfunción vesical o intestinal en niños

Abstract Introduction. Video games have a strong influence on children and adolescents. Video game addiction has negative effects on children's health. Objective. To determine the relationship between video game addiction and bladder/bowel dysfunction in children. Materials and methods. Three hundred sixty-three children and their mothers who met the inclusion criteria constituted the sample of this correlational study. The data were collected using a descriptive information form, the Video Game Addiction Scale for Children, and the Childhood Bladder and Bowel Dysfunction Questionnaire. Results. We found that 72.5% of the children were nine years old and 27.5% were ten years old; 50.4% were males and 49.6% were female. While 4.7% of the children who participated in the study were underweight, 19.6% were overweight, and 17.9% were obese. The mean Video Game Addiction Scale for Children score was 50.77 ± 16.17, whereas the mean Childhood Bladder and Bowel Dysfunction Questionnaire score was 29.98 ± 8.90. The ratio of children with a mean Video Game Addiction Scale for Children scores equal to or greater than 90 was 0.8% (n = 3). We found that 3.6% (n = 13) of the children had urinary/fecal incontinence while playing video games. There was a weak positive relationship between the dimensions of the Video Game Addiction Scale for Children scores, the Childhood Bladder and Bowel Dysfunction Questionnaire scores, and children's bladder and bowel function (r = 0.220; p < 0.05). Conclusions. There is a correlation between children's video game addiction level and their bladder and bowel dysfunction grade. Higher video game addiction levels correspond to higher bladder and bowel dysfunction.

Resumen Introducción. Los videojuegos tienen una fuerte influencia en los niños y adolescentes. La adicción a ellos tiene efectos perjudiciales para la salud de los niños. Objetivo. Determinar la relación entre la adicción a los videojuegos y la disfunción vesical o intestinal en niños. Materiales y métodos. Los 373 niños y sus madres que cumplieron con los criterios de inclusión constituyeron la muestra de este estudio descriptivo y correlacional. Los datos se recopilaron mediante un formulario de información descriptiva, la Video Game Addiction Scale for Children y el Childhood Bladder and Bowel Dysfunction Questionnaire. Resultados. El 72,5 % de los niños tenía nueve años y, el 27,5 %, diez; el 50,4 % eran hombres y el 49,6 %, mujeres. El 4,7 % de los estudiantes que participaron en el estudio tenían bajo peso, el 19,6 % presentaba sobrepeso y el 17,9 % tenía obesidad. Se constató que las puntuaciones medias de las escalas fueron 50,77 ± 16,17 para la Video Game Addiction Scale for Children y 29,98 ± 8,90 para el Childhood Bladder and Bowel Dysfunction Questionnaire. La proporción de niños con una puntuación de 90 o superior en la dicha escala fue del 0,8 % (n = 3). Se encontró que el 3,6 % (n = 13) de los niños tenía incontinencia urinario-fecal mientras jugaba videojuegos. Se reveló que había una correlación positiva débil entre las dimensiones de las dos escalas evaluadas, y la función de la vejiga y el intestino (p < 0,05). Conclusiones. El grado de adicción a los videojuegos de los niños está correlacionado con su grado de disfunción vesical o intestinal: entre mayor sea la adicción, mayor es la disfunción.

Clinical and epidemiological factors related to mortality due to septic shock in a pediatric intensive care unit.

INTRODUCTION: Septic shock is a potentially life-threatening condition. The aim of this study was to identify clinical and epidemiological factors associated with mortality in pediatric patients admitted to a pediatric intensive care unit (PICU) with septic shock. MATERIALS AND METHODS: A retrospective comparative case series study was conducted with children aged 1 month to 14 years with septic shock from 2018 to 2020 in a PICU in Lima, Peru. Patients were divided into deceased and survivor groups based on their condition at discharge from the PICU. The influence of each variable on mortality was assessed using a logistic regression model. RESULTS: A total of 174 patients were included in the study, with 51 (29.3%) fatalities. Deceased patients, compared to survivors, were older, had a higher incidence of oncological disease (31.4% vs. 14.6%; p = 0.011), more frequently presented with hemoglobin ≤ 9 g/dL (44% vs. 28%; p = 0.043), lactate > 2 mmol/L (70% vs. 44%; p = 0.002), platelets ≤ 150 (×103)/µL (77% vs. 42%; p < 0.001), and pH ≤ 7.1 (31% vs. 6%; p < 0.001). In the logistic regression model, factors related to mortality were having a pH ≤ 7.1 (odds ratio [OR] = 8.95; 95% confidence interval [CI]: 2.52-31.75) and platelets ≤ 150 (×103)/µL (OR = 3.89; 95% CI: 1.40-10.84). CONCLUSIONS: Factors associated with mortality in pediatric patients with septic shock were a pH ≤ 7.1 and platelets ≤ 150 (×103)/µL in the assessments conducted upon admission to the PICU.

INTRODUCCIÓN: El shock séptico es una condición potencialmente mortal. El objetivo del estudio fue identificar factores clínicos y epidemiológicos relacionados con la mortalidad en pacientes que ingresaron por shock séptico a una Unidad de Cuidados Intensivos Pediátricos (UCIP). MÉTODOS: Estudio retrospectivo tipo serie de casos comparativos con niños de 1 mes a 14 años hospitalizados por shock séptico del 2018 al 2020 en una UCIP de Lima en Perú. Los pacientes fueron divididos en fallecidos y vivos según su condición al alta de la Unidad. La influencia de cada variable sobre la mortalidad fue evaluada mediante un modelo de regresión logística. RESULTADOS: Ingresaron 174 pacientes al estudio, fallecieron 51 (29.3%). Los fallecidos en comparación con los vivos fueron de mayor edad, tuvieron más casos oncológicos (31.4% vs. 14.6%; p = 0.011), presentaron con mayor frecuencia hemoglobina ≤ 9 g/dL (44% vs. 28%; p = 0.043), lactato > 2 mmol/L (70% vs. 44%; p = 0.002), plaquetas ≤ 150 (×103)/µL (77% vs. 42%; p < 0.001) y pH ≤ 7,1 (31% vs. 6%; p < 0.001). En la regresión logística ajustada los factores que se relacionaron con la mortalidad fueron tener un pH ≤ 7,1 (OR = 8.95; IC 95%: 2.52 a 31.75) y plaquetas ≤ 150 (×103)/µL (OR = 3.89; IC 95%: 1.40 a 10.84). CONCLUSIONES: Los factores relacionados con la mortalidad en pacientes hospitalizados por shock séptico fueron tener un pH ≤ 7.1 y plaquetas ≤ 150 (×103)/µL en los controles realizados al ingreso de la UCIP.

Unraveling the role of the western North Pacific circulation anomaly in modulating Indian summer monsoon rainfall variability beyond ENSO.

The Indian summer monsoon (ISM) rainfall interannual variability is known to be strongly linked to the El-Niño-Southern Oscillation (ENSO). This linear relationship is the primary factor in controlling the interannual variation in ISM precipitation. However, there are many outlier cases, and such deviations pose significant challenges in seasonal prediction over this region. Here we show that such challenges can be attributed to anomalous atmospheric pressure patterns in the Western North Pacific (WNP) region. The anticyclonic circulation anomaly over WNP region causes the easterly wind toward the Indian subcontinent, leading to positive precipitation anomalies with stronger low-level moist convergence, while the cyclonic circulation decreases ISM precipitation. The linear baroclinic model simulation results further support that the WNP circulation pattern can serve as an independent factor for forecasting precipitation over India. The WNP circulation anomaly play the crucial role generating ISM precipitation particularly for July and September. Our study suggests that the role of the WNP circulation anomaly should be carefully considered as the secondary prevailing mechanism on the subseasonal timescale during the boreal summer in addition to the ENSO signal.