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

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

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

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

Key clinical predictors in the diagnosis of ovarian torsion in children

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Surgical treatment for severe pediatric tracheobronchomalacia: the 20-year experience of a single center

Abstract Objective: In children with tracheobronchomalacia, surgical management should be reserved for the most severe cases and be specific to the type and location of tracheobronchomalacia. The goal of this study is to describe the presentation and outcomes of children with severe tracheobronchomalacia undergoing surgery. Methods: Retrospective case series of 20 children operated for severe tracheobronchomalacia at a tertiary hospital from 2003 to 2023. Data were collected on symptoms age at diagnosis, associated comorbidities, previous surgery, age at surgery, operative approach, time of follow-up, and outcome. Surgical success was defined as symptom improvement. Results: The most frequent symptoms of severe tracheobronchomalacia were stridor (50 %), cyanosis (50 %), and recurrent respiratory infections (45 %). All patients had one or more underlying conditions, most commonly esophageal atresia (40 %) and prematurity (35 %). Bronchoscopy were performed in all patients. Based on etiology, patients underwent the following procedures: anterior aortopexy (n = 15/75 %), posterior tracheopexy (n = 4/20 %), and/or posterior descending aortopexy (n = 4/20 %). Three patients underwent anterior aortopexy and posterior tracheopexy procedures. After a median follow-up of 12 months, 16 patients (80 %) had improvement in respiratory symptoms. Decannulation was achieved in three (37.5 %) out of eight patients with previous tracheotomy. The presence of dying spells at diagnosis was associated with surgical failure. Conclusions: Isolated or combined surgical procedures improved respiratory symptoms in 80 % of children with severe tracheobronchomalacia. The choice of procedure should be individualized and guided by etiology: anterior aortopexy for anterior compression, posterior tracheopexy for membranous intrusion, and posterior descending aortopexy for left bronchus obstruction.

Effect of recorded mother's voice on emergence delirium in pediatric patients: a systematic review with meta-analysis

Abstract Objective: Emergence delirium is a common complication in children. Recorded mother's voice, as a non-pharmacological measure, is increasingly used to prevent the emergence of delirium in pediatric patients, but sufficient evidence is still needed to prove its efficacy. Methods: Embase, PubMed, Cochrane Library, Web of Science, CINAHL, and Sinomed databases were searched for randomized controlled trials exploring the efficacy of recorded mother's voice in preventing the emergence of delirium in pediatric patients undergoing general anesthesia. The original data were pooled for the meta-analysis with Review Manager 5.4.1. This study was conducted based on the Cochrane Review Methods. Results: Eight studies with 724 children were included in the analysis. Recorded mother's voice reduced the incidence of emergence delirium when compared with either no voice (RR: 0.45; [95 % CI, 0.34 - 0.61]; p < 0.01; I2 = 7 %) or stranger's voice (RR: 0.51; [95 % CI, 0.28 - 0.91]; p = 0.02; I2 = 38 %) without increasing other untoward reactions. In addition, it shortened the post-anesthesia care unit stay time when compared with no voice (MD = -5.64; [95 % CI, -8.43 to -2.58]; p < 0.01, I2 = 0 %), but not stranger's voice (MD = -1.23; [95 % CI, -3.08 to 0.63]; p = 0.19, I2 = 0 %). It also shortened the extubation time and reduced the incidence of postoperative rescue analgesia. Conclusion: The current analysis indicated that recorded mother's voices could reduce the incidence of emergency delirium, shorten post-anesthesia care unit stay time and extubation time, and decrease the incidence of postoperative rescue analgesia in children.