The context and development of the early relational health screen.

Early relational experiences are key drivers for developing social emotional capacities, educational achievement, mental health, physical health, and overall wellbeing. The child health sectors are committed to promotion, prevention, and early intervention that optimize children's health and development, often employing evidence-based screening as foundational practices. Despite a variety of validated parent-infant observational assessment tools, few are practical within busy practice settings, acceptable with all racial and ethnic groups and ready for universal adoption. In response to this need, a team of clinicians, early childhood educators, researchers and infant mental health specialists collaborated to develop and test a novel video-based, dyadic relational screening and monitoring tool, the Early Relational Health Screen (ERHS). This tool uniquely focuses on the early parent-child relationship (6-24 months), within the construct of early relational health (ERH). Initial testing demonstrated that the ERHS is a valid, reliable, feasible, and useful screening and monitoring tool for clinical applications. The ERHS was further developed within a population-based, prospective research study and adapted with brief video feedback for parents in the home visiting and child health sectors. The ERHS and its adaptations appear to advance ERH and equity within the transforming child health and public health care systems of today.

Las tempranas experiencias de relaciones afectivas son clave para desarrollar las capacidades socioemocionales, para los logros educativos, la salud mental, la salud física y el bienestar en general. Los sectores de salud infantil están comprometidos a promover, prevenir e intervenir a tiempo para que la salud de los niños y su desarrollo sean óptimos, a menudo empleando examinaciones basadas en la evidencia como prácticas fundamentales. A pesar de la variedad de válidas herramientas para la evaluación con base en la observación progenitor-infante, pocas son prácticas dentro del ocupado campo de la práctica, aceptables con todos los grupos raciales y étnicos, y pocas están listas para ser adoptadas en forma generalizada. Como respuesta a esta necesidad, un equipo formado por clínicos profesionales, educadores de la temprana niñez, investigadores y especialistas de la salud mental infantil colaboraron para desarrollar y probar una herramienta novedosa basada en videos, con el fin de examinar y darle seguimiento a la relación de la díada, el Examen del Bienestar de la Temprana Relación (ERHS). Esta herramienta de manera única se enfoca en la temprana relación progenitor-niño (6-24 meses), dentro del marco del temprano bienestar de la relación. La examinación inicial demostró que ERHS es una herramienta de examinación y seguimiento válida, confiable, posible y útil para la aplicación clínica. Entonces ERHS se desarrolló dentro de un estudio de investigación de probabilidades, con base en la población, y se adaptó con breves respuestas en video para progenitores en los sectores de visitas a casa y salud infantil. ERHS y sus adaptaciones parecen avanzar el temprano bienestar de la relación (ERH) y la equidad dentro de los sistemas de salud infantil y cuidado de salud pública en transformación hoy día.

Les expériences relationnelles sont des moteurs essentiels pour le développement des capacités socio-émotionnelles, la réussite scolaire, la santé mentale, la santé physique et le bien-être général. Les secteurs de la santé de l'enfant sont dédiés à la promotion, à la prévention et à l'intervention précoce qui optimisent la santé des enfants et leur développement, en employant souvent des dépistages fondés sur des données probantes en tant que pratiques fondamentales. En dépit d'une variété d'outils d'évaluation observationnelle parent-bébé validés, peu de ces outils sont pratique au sein d'un cabinet de pratique très occupé et peu sont acceptables pour tous groupes raciaux et éthiques ainsi que prêts pour une adoption universelle. Pour répondre à ce besoin une équipe de cliniciens, d'éducateurs de la petite enfance, de chercheurs et de spécialistes de la santé mentale du nourrisson ont collaboré afin de développer et de tester un outil innovateur et basé sur la vidéo de dépistage relationnel dyadique et de suivi, le Dépistage de Santé Relationnelle Précoce (en anglais Early Relational Health Screen dont nous gardons l'abréviation ici, ERHS). Cet outil se concentre uniquement sur la relation précoce parent-enfant (6-24 mois), dans le cadre de la construction de la santé relationnelle précoce. Les essais ont montré que l'ERHS est un outil de dépistage et de suivi valide, fiable, réalisable et utile pour les applications cliniques. L'ERHS a été plus profondément développé au sein d'une étude de recherches de prospection, basées sur certaines populations, et adapté avec de brefs commentaires vidéo pour les parents dans les secteurs des visites à domicile et de la santé de l'enfant. L'ERHS et ses adaptations semblent faire progresser la Santé Relationnelle Précoce et l'équité au sein des transformation de la santé de l'enfant et des systèmes de santé publique d'aujourd'hui.

A hermeneutic study of integrating psychotherapist competence in postnatal Child Health Care: Parents' perspectives.

A child's emotional and social development depends on the parents' provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents' experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists' technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified.

El desarrollo emocional y social del niño depende de que los padres le brinden un apoyo óptimo. Muchos progenitores con aflicciones perinatales experimentan dificultades al aprender a dominar la crianza y buscan ayuda de profesionales dentro del cuidado de salud de primera instancia. En Estocolmo, se inició un proyecto clínico en el que sicoterapeutas sicodinámicos ofrecieron consultas a corto plazo en los Centros de Salud Infantil. Este estudio exploró cualitativamente las experiencias de aflicciones perinatales de los padres y las de recibir ayuda del cuerpo de enfermería y terapeutas del proyecto. Método: Se entrevistaron trece progenitores y sus respuestas se analizaron con un método hermenéutico. Resultados: Se concretaron tres temas principales: la accesibilidad a ayuda sicológica con detección de problemas emocionales, las experiencias de terapia en los Centros de Salud Infantil, así como las técnicas de los terapeutas. A los progenitores se les agrupó también en tres designados Tipos Ideales: el inseguro, el progenitor en crisis, el progenitor con problemas sicológicos a lo largo de la vida. Conclusión: los progenitores se enfrentaron con obstáculos al tratar de encontrar ayuda sicológica dentro del cuidado de salud de primera instancia; los sicoterapeutas con una perspectiva familiar integral y aquellos que podían oscilar entre fomentar la percepción y las intervenciones de apoyo fueron especialmente apreciados; se identificaron categorías de pacientes que se beneficiaron del fomento de la percepción y del apoyo, respectivamente.

Le développement émotionnel et social d'un enfant dépend du soutien optimal qu'offrent les parents. Beaucoup de parents avec une détresse périnatale font l'expérience de difficultés quant à la gestion du parentage et cherchent l'aide de professionnels au sein des soins de santé primaires. Un projet clinique a été lancé à Stockholm, en Suède, au sein duquel des psychothérapeutes psychodynamiques ont offert des consultations à court terme dans les Centres de Santé de l'Enfant. Cette étude a exploré de manière qualitative les expériences de détresse périnatale des parents et l'aide qu'ils ont reçue de la part des infirmières/infirmiers et des thérapeutes dans ce projet. Méthode: Treize parents ont passé un entretien, et leurs réponses ont été analysées au moyen d'une méthode herméneutique. Résultats : Trois thèmes principaux ont émergé, l'accès à l'aide psychologique et la détection de problèmes émotionnels, les expériences de thérapie au Centre de Santé de l'Enfant, et la technique des thérapeutes. Les parents ont aussi été regroupés en trois soi-disant Types Parfaits: les insécures, les parents en crise et les parents avec des problèmes psychologiques de longue haleine. Conclusion: Les parents ont fait l'expérience d'obstacles dans l'accès au soin psychologique au sein des soins de santé primaires. Les psychothérapeutes ayant une perspective familiale holistique et ceux qui sont arrivés à osciller entre une promotion de perspicacité et des interventions de soutien ont été généralement appréciés. Les catégories de patients qui ont respectivement bénéficié de perspicacité et de soutien ont été identifiées.

Infant illness severity and family adjustment in the aftermath of NICU hospitalization.

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants' medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider-patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.

Hasta un 15% de progenitores tiene un infante que pasará un tiempo en una Unidad de Cuidado Intensivo Neonatal (NICU). Después de la salida, los progenitores deben cuidar de un infante médicamente débil y preocuparse por su desarrollo. El presente estudio examinó cómo la severidad de la enfermedad del infante se asocia con la adaptabilidad familiar. Los participantes eran progenitores con infantes que habían salido de la Unidad de Cuidado Intensivo Neonatal entre 6 meses y 3 años antes de participar en el estudio (N = 199). Por medio de una encuesta electrónica tipo Qualtrics, los progenitores reportaron el historial médico de su infante, el estrés de la crianza, la carga familiar, el funcionamiento como pareja y el acceso a recursos. Los análisis de regresión de variables múltiples revelaron que asuntos médicos más severos del infante durante la hospitalización (v.g. período más largo de hospitalización, más aparatos médicos) se asociaban con mayor carga familiar, aunque no así con estrés o el funcionamiento como pareja. Los asuntos de salud infantil posteriores a la hospitalización (v.g. diagnóstico médico, más médicos especialistas) se asociaron con mayor estrés, un más pobre funcionamiento como pareja y mayor carga familiar. Menos tiempo para los progenitores se asoció con un aumento en el estrés y un más pobre funcionamiento como pareja. De modo sorprendente, los progenitores de infantes que habían sido hospitalizados otra vez reportaron menos estrés y mejor funcionamiento como pareja, pero mayor carga familiar. Las intervenciones con enfoque familiar que incorporan educación sicológica acerca de la comunicación entre proveedor y paciente, apoyo a la propia pareja y el cuidado propio pudieran ser eficaces para prevenir la secuela sicosocial entre familias.

Jusqu'à 15% des parents ont un bébé qui passera du temps en Unité Néonatale de Soins Intensifs. A la sortie de l'hôpital les parents peuvent se retrouver à prendre soin d'un bébé fragile du point de vue médical et s'inquiéter de son développement. Cette étude a examiné comment la sévérité de la maladie du bébé est liée à l'ajustement de la famille. Les participants ont inclu des parents avec des bébés étant sortis de l'Unité Néonatale de Soins Intensifs 6 mois à trois ans avant la participation à l'étude (N = 199). Au travers d'un questionnaire Qualtrics en ligne, les parents ont fait état de l'histoire médicale des bébés, du stress de parentage, du poids sur la famille, du fonctionnement du couple et de l'accès aux ressources. Des analyses de régression multivariables ont révélé que les problèmes médicaux du bébé durant l'hospitalisation les plus graves (i.e. durée plus longue du séjour, plus de dispositifs médicaux) étaient liés à un poids sur la famille plus fort, mais pas au stress ni n'affectait le fonctionnement du couple. Les problèmes de santé du bébé après l'hospitalisation (soit un diagnostic médical, plus de spécialistes médicaux) étaient liés à un stress plus élevé, à un fonctionnement du couple moins bon, et à un poids sur la famille plus fort. Moins de temps pour les parents était lié à un stress supplémentaire et à un fonctionnement du couple moins bon. Avec surprise, les parents de bébés qui étaient réhospitalisés ont fait état de moins de stress et d'un meilleur fonctionnement de couple, mais d'un poids plus fort sur la famille. Les interventions centrées sur la famille qui incorporent une psychoéducation sur la communication médecin-parent, le soutien du partenaire et le soin de soi peut s'avérer efficace afin d'éviter des séquelles psychosociales négatives chez les familles.

Factors associated with the health and cognition of 6-year-old to 8-year-old children in KwaZulu-Natal, South Africa.

OBJECTIVE: To investigate 6-year-old to 8-year-old children's health, nutritional status and cognitive development in a predominantly rural area of KwaZulu-Natal, South Africa. METHODS: Cohort study of 1383 children investigating the association of demographic variables (area of residence, sex, pre-school education, HIV status, height for age and haemoglobin level) and family variables (socioeconomic status, maternal and paternal level of education), with children's cognitive performance. The latter was measured using the Grover-Counter Scale of Cognitive Development and subtests of the Kaufman Assessment Battery for Children, second edition (KABC-II). General linear models were used to determine the effect of these predictors. RESULTS: Area of residence and height-for-age were the statistically significant factors affecting cognitive test scores, regardless of attending pre-school. Paternal level of education was also significantly associated with the cognitive test scores of the children for all three cognitive test results, whereas HIV status, sex and their socioeconomic status were not. CONCLUSION: Children with low cognitive scores tended to be stunted (low height-for-age scores), lacked pre-school education and were younger. Area of residence and their parents' educational level also influenced their cognition.

Exposure-response relationship of neighbourhood sanitation and children's diarrhoea.

OBJECTIVES: To assess the association of neighbourhood sanitation coverage with under-five children's diarrhoeal morbidity and to evaluate its exposure-response relationship. METHODS: We used the Demographic and Health Surveys (DHS) of 29 developing countries in sub-Saharan Africa and South Asia, conducted between 2010 and 2014. The primary outcome was two-week incidence of diarrhoea in children under 5 years of age (N = 269014). We conducted three-level logistic regression analyses and applied cubic splines to assess the trend between neighbourhood-level coverage of improved household sanitation and diarrhoeal morbidity. RESULTS: A significant association between neighbourhood-level coverage of improved household sanitation and diarrhoeal morbidity (OR [95% CI] = 0.68 [0.62-0.76]) was found. Exposure-relationship analyses results showed improved sanitation coverage threshold at 0.6. We found marginal degree of association (OR [95% CI] = 0.82 [0.77-0.87]) below the threshold, which, beyond the threshold, sharply increased to OR of 0.44 (95% CI: 0.29-0.67) at sanitation coverage of 1 (i.e. neighbourhood-wide use of improved household sanitation). Similar exposure-response trends were identified for urban and rural subgroups. CONCLUSIONS: Our findings suggest that neighbourhood sanitation plays a key role in reducing diarrhoeal diseases and that increase in sanitation coverage may only have minimal impact on diarrhoeal illness, unless sufficiently high coverage is achieved.

Multistakeholder partnerships with the Democratic Peoples' Republic of Korea to improve childhood immunisation: A perspective from global health equity and political determinants of health equity.

OBJECTIVE: To examine the current partnerships to improve the childhood immunisation programme in the Democratic Peoples' Republic of Korea (DPRK) in the context of the political determinants of health equity. METHODS: A literature search was conducted to identify public health collaborations with the DPRK government. Based on the amount of publicly accessible data and a shared approach in health system strengthening among the partners in immunisation programmes, the search focused on these partnerships. RESULTS: The efforts by WHO, UNICEF, GAVI and IVI with the DPRK government improved the delivery of childhood vaccines (e.g. pentavalent vaccines, inactivated polio vaccine, two-dose measles vaccine and Japanese encephalitis vaccine) and strengthened the DPRK health system by equipping health centres, and training all levels of public health personnel for VPD surveillance and immunisation service delivery. CONCLUSION: The VPD-focused programmatic activities in the DPRK have improved the delivery of childhood immunisation and have created dialogue and contact with the people of the DPRK. These efforts are likely to ameliorate the political isolation of the people of the DPRK and potentially improve global health equity.

Policy challenges facing integrated community case management in Sub-Saharan Africa.

OBJECTIVE: To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. METHODS: Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions. RESULTS: Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change. CONCLUSIONS: iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies.

[How to measure the migration status of the child and young population? Studies on health and inequalities in health in Europe]. / ¿Cómo medir el estatus migratorio de la población infantil y juvenil? Estudios sobre salud y desigualdades en salud en Europa.

OBJECTIVE: To analyse how the migration status of the child and young population is measured in the scientific literature on health and social inequalities in health in Europe. METHOD: A systematic search of the literature published in Spanish, English and French between 2007 and 2017 in PubMed and Social Sciences Citation Index was carried out. The included studies analysed health and social inequalities in health of a population under 18 years old according to its migration origin in Europe. The variables used to measure the migration status were described. RESULTS: 50 articles were included. Twenty studies analysed perinatal health, eleven mental health, nine dental health, and ten studies other variables. The main variables to define migration status were the country of birth (32 studies), either of the child, the mother, or one of the parents, and sometimes in a complementary way. Less frequent was the use of nationality (15 studies), of the child, or of the parents, especially the mother. Migration status is referred to in very different ways, not always comparable and sometimes the variable used is not clearly explained. CONCLUSIONS: There is a great diversity of ways to measure migration status in the child and young population. A better definition and consensus is needed to improve the temporal and geographical comparability of knowledge in this area, which will help to design public policies aimed at reducing social inequalities in health from childhood.

Etiology and outcome of febrile children coming from the tropics.

INTRODUCTION: International travelers have grown significantly over last years, as well as imported diseases from tropical areas. Information in pediatric population is scarce. We describe demographic and clinical characteristics of febrile children coming from the tropics. METHODS: Retrospective review of patients under 18 years old, presenting at a tertiary hospital and surrounding primary health care centers between July 2002 and July 2018 with a stay in a tropical region during the previous year. Patients were selected from microbiological charts of thick smears for malaria or dengue serologies. RESULTS: 188 patients were studied: 52.7% were born in Spain with a median age of 3.0 years old (IQR 1.5-8.0). Main regions of stay were Sub-Saharan Africa (54.8%) and Latin America (29.8%), mostly for visiting their friends and relatives (56.3%), followed by recent arrival migrants (32.4%). Only 34% of travelers attended pre-travel consultation. More than 80% of these febrile children attended directly the Emergency Room. The most frequent diagnoses were febrile syndrome without source (56.4%), respiratory condition (15.4%) and acute diarrhea (11.7%). Around a half (52.1%) were managed as outpatients, but 46.2% were hospitalized and 7.4% were admitted to Intensive Care Unit. No specific diagnosis was achieved in 24% of cases. However, 29.7% were diagnosed with malaria. CONCLUSION: Children with fever coming from tropical areas were at risk of severe infectious diseases. Malaria was diagnosed in one out of four and 7% required admission in PICU. This information emphasizes the need of reinforcing training about tropical diseases among first line physicians.

Human rights in the Horn of Africa: an index of child and maternal health.

OBJECTIVE: To construct a territorial measure and classification of child and maternal health in the countries of the Horn of Africa based on the 2030 Agenda for Sustainable Development adopted by all United Nations Member States in 2015. METHOD: The design of our index includes the variables child and maternal health defined in the Sustainable Development Goals (SDGs) to enable territorial ranking of the countries. For this purpose, we used Pena's distance method for 2017. RESULTS: The results indicate a relatively high territorial disparity in maternal health between the countries of the Horn of Africa according to the differing values of the SDGs variables of child and maternal health. CONCLUSIONS: We propose a territorial classification in the countries of the Horn of Africa. We believe that the most striking differences between countries relate to basic variables of maternal health such as being attended by skilled health personnel.

Etiology and outcome of febrile children coming from the tropics.

INTRODUCTION: International travelers have grown significantly over last years, as well as imported diseases from tropical areas. Information in pediatric population is scarce. We describe demographic and clinical characteristics of febrile children coming from the tropics. METHODS: Retrospective review of patients under 18 years old, presenting at a tertiary hospital and surrounding primary health care centers between July 2002 and July 2018 with a stay in a tropical region during the previous year. Patients were selected from microbiological charts of thick smears for malaria or dengue serologies. RESULTS: 188 patients were studied: 52.7% were born in Spain with a median age of 3.0 years old (IQR 1.5-8.0). Main regions of stay were Sub-Saharan Africa (54.8%) and Latin America (29.8%), mostly for visiting their friends and relatives (56.3%), followed by recent arrival migrants (32.4%). Only 34% of travelers attended pre-travel consultation. More than 80% of these febrile children attended directly the Emergency Room. The most frequent diagnoses were febrile syndrome without source (56.4%), respiratory condition (15.4%) and acute diarrhea (11.7%). Around a half (52.1%) were managed as outpatients, but 46.2% were hospitalized and 7.4% were admitted to Intensive Care Unit. No specific diagnosis was achieved in 24% of cases. However, 29.7% were diagnosed with malaria. CONCLUSION: Children with fever coming from tropical areas were at risk of severe infectious diseases. Malaria was diagnosed in one out of four and 7% required admission in PICU. This information emphasizes the need of reinforcing training about tropical diseases among first line physicians.

[Assessment of nutritional status, and habits and food preferences in a child-youth population (7 to 16 years) of the Community of Madrid]. / Valoración del estado nutricional y de hábitos y preferencias alimentarias en una población infanto-juvenil (7 a 16 años) de la Comunidad de Madrid.

INTRODUCTION: Background: the prevalence of overweight and obesity in childhood and adolescence in Spain is alarming. The high consumption of processed products of low nutritional quality but high caloric density, together with sedentary lifestyle, are two of the main causes. Objective: to know the nutritional status of a population of children and adolescents, and some of their eating habits, tastes and preferences, and physical activity practice. Methods: a cross-sectional descriptive study based on an anthropometric assessment and a survey on food habits and lifestyle in 1,939 schoolchildren between seven and 16 years of school age in the Community of Madrid. Updated indexes such as the body mass index (BMI) adapted according to the Cole cut-off points and the waist-height index (CTI), which have a high correlation with infant adiposity, are used. Results: the rates of overweight and obesity are high in both children and adolescents. It should be noted that abdominal obesity according to ICT represents a greater percentage than global obesity diagnosed with BMI (overweight + total obesity according to BMI: 27.23%, and according to ICT: 35.17%). The sedentariness is high (25.12%), as well as the consumption of highly caloric products, but of low nutritional value mainly at breakfast, mid-morning and snack. Conclusions: the prevalence of overweight and obesity is high, especially at the abdominal level, probably associated with the increasing consumption of ultra-processed products and the high rates of sedentary lifestyle. The conclusion is the need to develop programs to prevent obesity and nutritional education.

INTRODUCCIÓN: Introducción: la prevalencia de sobrepeso y obesidad en la infancia y adolescencia en España es alarmante. El alto consumo de productos procesados de baja calidad nutricional pero alta densidad calórica, junto al sedentarismo, son dos de las principales causas. Objetivos: conocer la condición nutricional de una población de niños y adolescentes, y algunos de sus hábitos alimentarios, gustos y preferencias y práctica de actividad física. Métodos: estudio descriptivo transversal basado en una valoración antropométrica y encuesta sobre hábitos alimentarios y estilo de vida a 1.939 escolares de entre siete y 16 años de centros escolares de la Comunidad de Madrid. Se emplean índices actualizados como el índice de masa corporal (IMC) adaptado según los puntos de corte de cole y el índice cintura-talla (ICT), que presentan alta correlación con la adiposidad infantil. Resultados: las tasas de sobrepeso y obesidad son elevadas tanto en población infantil como adolescente. Cabe destacar que la obesidad abdominal según ICT representa un mayor porcentaje que la obesidad global diagnosticada con el IMC (sobrepeso + obesidad total según IMC: 27,23%; y según ICT: 35,17%). El sedentarismo es elevado (25,12%), así como el consumo de productos altamente calóricos pero de bajo valor nutricional tanto en desayuno como en media mañana y merienda. Conclusión: la prevalencia de sobrepeso y obesidad es elevada, sobre todo a nivel abdominal, probablemente asociada al creciente consumo de productos ultraprocesados y a las altas tasas de sedentarismo. Se concluye la necesidad de desarrollar programas de prevención de obesidad y educación nutricional.

[Health and determinants of health in second generations of international immigrants: Social inequalities in health since childhood?] / Salud y determinantes sociales de la salud en hijos e hijas de personas inmigrantes internacionales: ¿desigualdades sociales en salud desde la infancia?

OBJECTIVE: To analyse the social inequalities in health between children and youth population of an immigrant origin from low-income countries and those of native origin in the Basque Country. METHOD: Cross-sectional descriptive study using data from the Basque Country Health Survey 2013. Variables of health, behaviours and life conditions were used as the outcome variables. Prevalence ratios were calculated using robust Poisson models. RESULTS: The children with immigrant parents had poorer self-rated health, a higher prevalence of obesity, spent more hours in sedentary activities and lived in households with greater economic difficulties. The differences persisted even after adjusting for social class and educational level of parents. CONCLUSIONS: A migrant background is a highly relevant axis of health inequalities and has an influence beyond a generation. Given this reality, it is necessary to implement effective and suitable measures to ensure life with good health conditions and to reduce social inequalities in health, not only in childhood but through the entire life cycle.

Internações na infância por doenças do aparelho respiratório no Brasil de 2013 a 2022 / Hospitalizaciones infantiles por enfermedades del sistema respiratorio en Brasil de 2013 a 2022 / Hospitalizations during childhood due to respiratory system diseases in Brazil from 2013 to 2022

Introdução: As doenças do sistema respiratório se mostram como uma das causas mais preocupantes de internações hospitalares no país. Nessa perspectiva, o perfil das internações por doenças respiratórias em crianças permite observar os parâmetros desta problemática, fornecendo um conhecimento amplo acerca do processo saúde e doença nessa população. Objetivo: Analisar o perfil epidemiológico das internações hospitalares por causas do aparelho respiratório em crianças de 0 a 9 anos no Brasil e regiões, entre os anos de 2013 e 2022. Metodologia: Trata-se de um estudo ecológico, realizado no Brasil, a partir de dados secundários do Sistema de Informações Hospitalares. A população escolhida para este estudo foram crianças de 0 a 9 anos deidade. Os dados foram coletados em 26 de novembro de 2022. As variáveis dependentes do estudo são as internações de crianças de 0 a 9 anos por doenças do aparelho respiratório no Brasil e suas regiões. Já, como variáveis independentes, tem-se o tempo, do período de janeiro de 2013 a setembro de 2022, regiões e faixa etária. Resultados: Há uma tendência de queda das internações por causa respiratória até o ano de 2016, seguido de um crescimento gradativo até 2019. Entretanto, em 2020, a taxa de hospitalização reduziu drasticamente em todas as localidades. As regiões Sul, Norte e Centro-Oeste permaneceram com taxas maiores que o Brasil em todo o período estudado. A internação em menores de 1 ano representa o maior quantitativo de internações sendo a pneumonia a causa mais prevalente. Conclusões: As taxas de internação infantil por doenças respiratórias representam importante preocupação para saúde pública. Assim, destaca-se a relevância da efetividade da Atenção Primária à Saúde, que possui grande impacto no desfecho dos adoecimentos em crianças, especialmente das doenças respiratórias (AU).

Introduction: Respiratory system diseases are one of the most worrying causes of hospital admissions in the country. From this perspective, the profile of hospitalizations for respiratory diseases in children allows us to notice the parameters of this problem, providing a broad understanding of the health and disease process in this population.Objective: To analyze the epidemiological profile of hospital admissions due to respiratory causes in children aged 0 to 9 in Brazil and its regions between 2013 and 2022. Methodology: This is an ecological study held in Brazil using secondary data from the Hospital Information System. The population chosen for this study consisted of children aged 0 to 9. Data were collected on November 26, 2022. The dependent variables of this study are hospitalizations of children aged 0 to 9 due to respiratory diseases in Brazil and its regions. The independent variables are time, from January 2013 to September 2022, regions, and age group.Results: There was a downward trend in hospitalizations due to respiratory causes until 2016, followed by a gradual increase until 2019. Nonetheless, in 2020, the hospitalization rate fell dramatically in all locations. The South, North and Mid-West regions remained with higher rates than Brazil throughout the studied period. Hospitalization of children under 1 year old represents the largest number of admissions, with pneumonia being Revista Ciência Plural. 2024; 10(1): e31414 3the most prevalent cause.Conclusions: Hospitalization rates during childhood due to respiratory diseases represent a major public health concern. Thus, one can highlight the importance of the effectiveness of Primary Health Care, which has a major impact on the outcome of illnesses in children, especially respiratory diseases (AU).

Introducción: Las enfermedades del sistema respiratorio son una de lascausas más preocupantes de hospitalizaciones en el país. Desde esta perspectiva, el perfil de hospitalizaciones por enfermedades respiratorias en niños permite observar los parámetros de este problema, proporcionando una amplia comprensión del proceso de salud y enfermedad en esta población.Objetivo: Analizar el perfil epidemiológico de las internaciones por causas respiratorias en niños de 0 a 9 años en Brasil y sus regiones entre 2013 y 2022. Metodología: Se trata de un estudio ecológico conducido en Brasil a partir de datos secundarios del Sistema de Información Hospitalaria. La población elegida para este estudio fueron los niños de 0 a 9 años. Los datos se recogieron el 26 de noviembre de 2022. Las variables dependientes del estudio son las hospitalizaciones de niños de 0 a 9 años por enfermedades respiratorias en Brasil y sus regiones. Las variables independientes son el tiempo, de enero de 2013 a septiembre de 2022, las regiones y la franja etaria.Resultados: Se nota una tendencia a la baja de las hospitalizaciones por causas respiratorias hasta 2016, seguida de un aumento gradual hasta 2019. Sin embargo, en 2020, la tasa de hospitalización cayó drásticamente en todas las localidades. Las regiones Sur, Norte y Medio Oeste se mantuvieron con tasas másaltas que Brasil durante todo el período estudiado. Las hospitalizaciones en niños menores de 1 año representan el mayor número de internaciones, siendo la neumonía la causa más prevalente.Conclusiones: Las tasas de hospitalización infantil por enfermedades respiratorias representan un importante problema de salud pública. Así, se subraya la importancia de la eficacia de la Atención Primaria de Salud, que tiene un gran impacto en el resultado de las enfermedades en los niños, especialmente las respiratorias (AU).

Cuidado domiciliar da criança em uso de traqueostomia: perspectiva dos cuidadores no contexto amazônico / Home care for children using a tracheostomy: caregivers' perspective in the amazon context / Atención domiciliaria a niños con traqueostomía: la perspectiva de los cuidadores en el contexto amazónico

RESUMO Objetivo: descrever a percepção dos cuidadores de crianças traqueostomizadas sobre os desafios no processo de alta para o domicílio no contexto amazônico. Método: estudo descritivo, qualitativo, realizado com 16 cuidadores de crianças traqueostomizadas que vivenciaram a desospitalização, em um Hospital Infantil de Rio Branco - Acre - Brasil. Amostragem definida por saturação, dados coletados com roteiro semiestruturado de agosto a dezembro de 2021, submetidos à Análise de Conteúdo de Bardin. Resultados: a análise resultou em quatro categorias: (1) sentimentos vivenciados com o uso do dispositivo traqueal; (2) cuidados rotineiros com a traqueostomia que os cuidadores julgam importantes; (3) dúvidas e relatos sobre a aspiração traqueal; e (4) condutas diante de intercorrências nas crianças em uso de traqueostomia. Considerações finais: o temor em aprender a técnica de aspiração traqueal e da alta hospitalar reforça a necessidade de educação precoce e contínua dos cuidadores, com foco no atendimento de rotina e de emergência para as crianças traqueostomizadas.

ABSTRACT Objective: To describe caregivers' perception of tracheostomized children about the challenges in discharge to their homes in the Amazonian context. Method: A descriptive, qualitative study was conducted with 16 caregivers of tracheostomized children who experienced dehospitalization in a children's hospital in Rio Branco - Acre - Brazil. Saturation-defined sampling, data collected with a semi-structured script from August to December 2021, submitted to Bardin Content Analysis. Results: the analysis resulted in four categories: (1) feelings experienced with the use of the tracheal device; (2) routine tracheostomy care that caregivers consider important; (3) questions and reports about tracheal aspiration; and (4) conduct in the face of complications in children using tracheostomy. Final remarks: the fear of learning the tracheal aspiration technique and of being discharged from the hospital reinforces the need for early and continuous education for caregivers, focusing on routine and emergency care for tracheostomized children.

RESUMEN Objetivo: describir la percepción de los cuidadores de niños traqueostomizados sobre los desafíos del alta domiciliaria en el contexto amazónico. Material y método: estudio descriptivo, cualitativo, realizado con 16 cuidadores de niños traqueostomizados que pasaron por la experiencia de des-hospitalización en un Hospital Infantil de Rio Branco - Acre - Brasil. Muestreo definido por saturación, datos recogidos mediante guion semiestructurado de agosto a diciembre de 2021, sometidos al Análisis de Contenido de Bardin. Resultados: el análisis dio lugar a cuatro categorías: (1) sentimientos experimentados con el uso del dispositivo traqueal; (2) cuidados rutinarios con la traqueostomía que los cuidadores consideran importantes; (3) dudas e informes sobre la aspiración traqueal; y (4) comportamiento en caso de complicaciones en niños que utilizan una traqueostomía. Consideraciones finales: el miedo a aprender la técnica de aspiración traqueal y a recibir el alta hospitalaria refuerza la necesidad de una formación precoz y continuada de los cuidadores, centrada en los cuidados rutinarios y de urgencia de los niños traqueostomizados.

Perspectivas sobre as necessidades essenciais das crianças na primeira infância no contexto da pandemia da COVID-19: uma revisão integrativa / Perspectivas sobre las necesidades esenciales de los niños en la primera infancia en el contexto de la pandemia de COVID-19: Una revisión integradora / Perspectives on the essential needs of children in early childhood in the context of the COVID-19 pandemic: an integrative review

RESUMO Objetivo O presente estudo objetiva identificar as perspectivas científicas sobre as implicações da pandemia da COVID-19 na primeira infância, focando nas necessidades essenciais da criança. Método Foi realizada uma revisão integrativa da literatura, que incluiu cinco bases de dados. O processo envolveu a identificação do problema, o desenvolvimento de uma pergunta orientadora, pesquisa na literatura, análise dos dados e síntese dos resultados. Foram incluídos artigos originais que envolviam crianças com menos de seis anos, publicados entre 2020 e 2022. A análise foi conduzida tendo como referencial teórico as necessidades essenciais da criança. Resultados Foram examinados 22 artigos. Os resultados indicaram um aumento na sobrecarga e no estresse parental. As crianças apresentaram alterações comportamentais, perturbações no padrão do sono, uso mais frequente de mídias digitais e diminuição de atividades realizadas ao ar livre. Fatores protetores, relacionados ao vínculo familiar, cuidado e acolhimento da criança, foram identificados. O fechamento de creches e escolas distanciou os cuidadores dos profissionais da educação e de outros pais, mas sua reabertura trouxe maior apoio às famílias. Necessidades de relacionamentos contínuos de apoio, experiências adequadas ao desenvolvimento e comunidades solidárias foram mais evidenciadas. No entanto, foram encontrados menos aspectos relacionados à proteção física e ao estabelecimento de limites. Experiências sobre diferenças individuais não foram identificadas. Conclusão A pesquisa científica revelou vulnerabilidades substanciais e potencialidades no cuidado à saúde da criança durante a pandemia de COVID-19. Esses resultados sugerem impactos significativos no bem-estar e no desenvolvimento infantil, implicando na necessidade de ações específicas por parte da enfermagem no contexto da Atenção Primária à Saúde.

RESUMEN Objetivo Identificar el conocimiento científico acerca de las implicaciones de la pandemia de COVID-19 en la primera infancia desde la perspectiva de las necesidades esenciales de los niños. Método Se realizó una revisión integrativa de la literatura en cinco bases de datos, que incluye la identificación del problema, la formulación de una pregunta orientadora, la búsqueda de la literatura, el análisis de los datos y una síntesis de los resultados. Se incluyeron artículos originales que trataban sobre niños menores de seis años y que fueron publicados entre los años 2020-2022. A. El análisis se llevó a cabo utilizando el marco teórico de las necesidades esenciales de los niños. Resultados Se analizaron 22 artículos. Se observó una sobrecarga y un incremento del estrés en los padres. Los niños mostraron cambios en su comportamiento y patrones de sueño, un mayor uso de medios digitales y una menor participación en actividades al aire libre. Se identificaron factores de protección relacionados con el vínculo familiar, el cuidado y recibimiento del niño. El cierre de guarderías y escuelas aisló a los cuidadores de los profesionales de la educación y de otros padres, aunque la reapertura proporcionó un mayor apoyo a las familias. Las necesidades más evidentes fueron las de relaciones de apoyo contínuas, experiencias apropiadas para el desarrollo y comunidades de apoyo. Hubo menos énfasis en aspectos de protección física y establecimiento de límites. No se identificaron experiencias respecto a diferencias individuales. Conclusión El conocimiento científico destaca vulnerabilidades y aspectos positivos significativos en la atención de la salud infantil que sugieren un impacto en el bienestar y desarrollo de los niños, con repercusiones para el desempeño de los profesionales de enfermería en el ámbito de la atención primaria de salud.

ABSTRACT Objective Identify scientific knowledge regarding the implications of the COVID-19 pandemic on early childhood, specifically from the perspective of children's essential needs. Method An integrative literature review was conducted on five databases. The review process involved identifying a research problem, creating a guiding question, performing a literature search, analyzing data, and synthesizing the results. The review included original articles about children under six, published between 2020 and 2022. The theoretical framework of the child's essential needs was used for analysis. Results A total of 22 articles were analyzed. Findings indicated an increase in parental overload and stress levels. The children exhibited behavioral changes, sleep pattern disorders, increased digital media use, and reduced outdoor participation. Protective factors related to the familial bond, child care, and child reception were identified. Closure of daycare centers and schools resulted in a distance between the caregiver, the education professionals, and the fellow parents. In contrast, the reopening of those places brought added support to families. The needs, such as ongoing supportive relationships, developmentally appropriate experiences, and supportive communities, were more highlighted. Physical protection and setting boundaries were less prominent aspects. No experiences examining individual differences were identified. Conclusion The scientific knowledge points to significant vulnerabilities and certain potentialities in child health care during the COVID-19 pandemic. Those results suggest considerable impacts on child well-being and development and imply significant implications for nursing practices in Primary Health Care.

Perfil epidemiológico de internações por doenças infecciosas e bacterianas em menores de 5 anos, de 2017 a 2021 / Perfil epidemiológico de las hospitalizaciones por enfermedades infecciosas y bacterianas más prevalentes en niños menores de 5 años, de 2017 a 2021 / Epidemiological profile of hospitalizations for the most prevalent infectious and bacterial diseases in children under 5 years, from2017 to 2021

Introdução:A internação representa um impacto considerável na vida de qualquer pessoa, podendo tomar proporções ainda maiores quando se trata de uma criança. A impossibilidade de realizar sua rotina, como brincar e ir à escola, faz com que a internação infantil assuma um contexto marcante.Dito isso, nota-se que grande parte dessas internações é evitável, sendo denominadasde Internações por Condições Sensíveis à Atenção Primária. Dessa forma, o atendimento ambulatorial de qualidade poderia resolver a maioria das enfermidades infantis, evitando esse desfecho.Objetivo:Elaborar um perfil epidemiológico de internações por doenças infecciosas e bacterianas mais prevalentes em menores de 5 anos, de 2017 a 2021, no Brasil. Metodologia:A pesquisa em questão se trata de um estudo ecológico de série temporal,elaborado através de informações coletadas por vias secundárias.Os dados foram coletados na plataforma DataSUS e no Sistema de Informação Hospitalar. Posteriormente, os dados foram processados e armazenados no aplicativo Microsoft Excel®, onde foram tratados e selecionados de acordo com sua relevância para a pesquisa. Resultados:Constata-se que a faixa etária situadaabaixo do primeiro ano de vidaapresenta um grau de hospitalização superior ao dascrianças que vãodo primeiro ao quarto ano completo.Quanto àfrequência relativa, depreende-se que diarreia e gastroenterite de origem infecciosa presumível apresentaram o maior índice de prevalência em relação às demais patologias, com o maior número chegando a 23,8% no ano de 2017 e o menor situando-se na faixa de 13,22% em 2020. Conclusões: Apesar do avanço na Atenção Primária à Saúde e da cobertura pré-natal, a assistência ainda é deficitária, sendo necessários mais investimentos na área e o fomento de políticas públicas que abranjam essa população (AU).

Introduction: Hospitalization represents a considerable impact on the life of any person, and can even take on even greater proportions when it comes to a child. The impossibility of realizing their routine, such as playing and going to school, means that hospitalization during childhood takes ona remarkable context. That said, it is noted that mostofthese hospitalizations are avoidable,and are called Ambulatory Care Sensitive Conditions. Thus, quality ambulatory care could solve most childhood illnesses, avoiding this outcome.Objective:To elaborate an epidemiological profile of hospitalizations for the most prevalent infectious and bacterial diseases in children under 5 years of age,from 2017 to 2021,in Brazil. Methodology: The research in question is an ecological study of time series, elaborated through information collected through secondary data sources. Data were collected from the DataSUS platform and the Hospital Information System. Subsequently, data were processed and stored in Microsoft Excel® application, where they were managedand selected according to their relevance to the research. Results:It is observed that the age group below the first year of life presents a higher degree of hospitalization thanthat of children ranging from the first to the fourth year. As for the relative frequency, it can be seen that diarrhea and gastroenteritis of presumable infectious origin had the highest prevalence rate compared to other pathologies, with the highest number reaching 23.8% in 2017 and the lowest being in the range of 13.22% in 2020. Conclusions: Despite the advances in Primary Health Care and prenatal coverage, assistance is still deficient, requiring more investments in the area and the promotion of public policies that cover this population (AU).

Introducción: La hospitalización representa un impacto considerable en la vida de cualquier persona, quepuede adquirir proporciones aún mayores cuando se trata de un niño. La imposibilidadde realizar su rutina, como jugar e ir al colegio, hace que la hospitalización infantiltengaun contexto notable. Dicho esto, cabe señalar que una gran parte de estas hospitalizaciones son evitables, denominándose Hospitalizaciones por Condiciones Sensibles a la Atención Ambulatoria. Así pues, una atención ambulatoria de calidad podría resolver la mayoría de las enfermedades infantiles, evitando este desenlace. Objetivo: Elaborar un perfil epidemiológico de las hospitalizaciones por enfermedades infecciosas y bacterianas más prevalentes en niños menores de 5 años, de 2017 a 2021, en Brasil. Metodología: La investigación en cuestión es un estudio ecológico de series temporales, elaborado a partir de información recogida por vías secundarias. Los datos se recogieron de la plataforma DataSUS y del Sistema de Información Hospitalaria. Posteriormente, los datos se procesaron y almacenaron en la aplicación Microsoft Excel®, donde se trataron y seleccionaron en función de su relevancia para la investigación. Resultados: Se observa que el grupo de edad inferior al primer año de vida presenta un mayor grado de hospitalización que los niños del primero al cuarto año completo. En cuanto a la frecuencia relativa, se puede inferirque la diarreay lagastroenteritis presumible origen infeccioso tuvieron la tasa de prevalencia más alta en relación con las demáspatologías, siendola cifra más alto el 23,8% en 2017 y lamás bajael rango del 13,22% en el 2020. Conclusiones: A pesar de los avances en la Atención Primariade Salud y en la cobertura prenatal, la asistencia aún es deficiente, por lo que se requieren mayoresinversiones en el área y la promoción de políticas públicas que cubran a esta población (AU).

[Parent-reported Health-Related Quality of Life in Spanish pre-schoolers: Psychometric properties of the Kiddy-KINDL-R]. / Calidad de vida relacionada con la salud informada por los padres en preescolares españoles: propiedades psicométricas del Kiddy-KINDL-R.

INTRODUCTION: Although several tools have been developed to assess general HRQoL in children, parental reports are required to supplement this information, especially in very young children. The parents version of the Kiddy-KINDL-R was developed to assess HRQoL in children aged 3 to 7 years through the reports of their parents or legal guardians. OBJECTIVE: The aim of this study was to validate the parents version of the Kiddy-KINDL-R questionnaire and assess its psychometric properties in a sample of Spanish preschool-aged children. METHOD: Cross-sectional study in 283 parents or legal guardians of children aged 3 to 6 years that completed the Kiddy-KINDL-R questionnaire and an additional scale to assess anxiety problems. We performed confirmatory factor analysis to assess whether the original Kiddy-KINDL-R version fit the Spanish data; we assessed internal consistency by means of the ordinal alpha and the discriminant validity by means of the Preschool Anxiety Scale. RESULTS: Although the original six-factor model showed a good fit, we propose a model consisting of 22 items and the same 6 factors for the Spanish version. The reliability was excellent, and the internal consistency values were adequate. Our results showed significant negative correlations between the Kiddy-KINDL-R and the external anxiety measure, which was evidence of discriminant validity. CONCLUSION: We demonstrated that the Spanish version of the Kiddy-KINDL-R had good psychometric properties and that this questionnaire is an adequate assessment tool that could be useful in clinical practice.

Learning difficulties in school children: health and education professionals' perceptions / Dificultades de aprendizaje en escolares: percepciones de los profesionales de la salud y la educación / Dificuldade de aprendizagem de crianças escolares: percepções dos profissionais da saúde e da educação

ABSTRACT Objectives: to understand health and education professionals' perceptions regarding children's learning difficulties in public schools. Methods: qualitative research, of the participatory action type, linked to Paulo Freire's Research Itinerary. Forty-five professionals participated, through interviews and a Virtual Culture Circle. The analysis was developed through careful reading, reflection and interpretation of highlighted topics. Results: professionals discussed the (in)visibility of learning difficulties, strategies and resources in the educational sector and the search for solutions in the health sector. It was found that the production of complaints related to school learning is attributed predominantly as an individual problem of children or their family, exempting the educational institution from this process. Final Considerations: greater investment in professional training and development policies is urgently needed to facilitate coordination between sectors, with a view to overcoming outdated pedagogical and health models.

RESUMEN Objetivos: comprender las percepciones de los profesionales de la salud y la educación sobre las dificultades de aprendizaje de los niños en las escuelas públicas. Métodos: investigación cualitativa, del tipo acción participativa, vinculada al Itinerario de Investigación de Paulo Freire. Participaron 45 profesionales, a través de entrevistas y un Círculo Virtual de Cultura. El análisis se desarrolló a través de una atenta lectura, reflexión e interpretación de los temas destacados. Resultados: los profesionales discutieron la (in)visibilidad de las dificultades de aprendizaje, las estrategias y los recursos en el sector educativo y la búsqueda de soluciones en el sector salud. Se encontró que la producción de quejas relacionadas con el aprendizaje escolar se atribuye predominantemente como un problema individual del niño o de su familia, eximiendo a la institución educativa de este proceso. Consideraciones Finales: urge una mayor inversión en políticas de formación y desarrollo profesional para facilitar la coordinación entre sectores, con miras a superar modelos pedagógicos y sanitarios obsoletos.

RESUMO Objetivos: conhecer as percepções dos profissionais da saúde e da educação acerca da dificuldade de aprendizagem de crianças da rede pública de ensino. Métodos: pesquisa qualitativa, do tipo ação participante, articulada ao Itinerário de Pesquisa de Paulo Freire. Participaram 45 profissionais, por meio de entrevistas e um Círculo de Cultura Virtual. A análise desenvolveu-se na leitura cuidadosa, reflexão e interpretação dos temas destacados. Resultados: os profissionais dialogaram sobre a (in)visibilidade da dificuldade de aprendizagem, as estratégias e os recursos do setor educacional e a busca por resolutividade no setor saúde. Verificou-se que a produção das queixas relacionadas à aprendizagem escolar está atribuída predominantemente como problema individual da criança ou de sua família, isentando a instituição educacional desse processo. Considerações Finais: é premente maior investimento em políticas de formação e aperfeiçoamento dos profissionais para propiciar a articulação entre os setores, com vistas a superar modelos pedagógicos e de saúde ultrapassados.

Incidence of childhood cancer in Latin America and the Caribbean: coverage, patterns, and time trends / Incidencia del cáncer infantil en América Latina y el Caribe: cobertura de los registros, patrones y tendencias a lo largo del tiempo / Incidência de câncer infantil na América Latina e no Caribe: cobertura, padrões e tendências temporais

ABSTRACT Objective. To provide a comprehensive overview of geographical patterns (2001-2010) and time trends (1993-2012) of cancer incidence in children aged 0-19 years in Latin America and the Caribbean (LAC) and interpret the findings in the context of global patterns. Methods. Geographical variations in 2001-2010 and incidence trends over 1993-2012 in the population of LAC younger than 20 years were described using the database of the third volume of the International Incidence of Childhood Cancer study containing comparable data. Age-specific incidence per million person-years (ASR) was calculated for population subgroups and age-standardized (WSR) using the world standard population. Results. Overall, 36 744 unique cases were included in this study. In 2001-2010 the overall WSR in age 0-14 years was 132.6. The most frequent were leukemia (WSR 48.7), central nervous system neoplasms (WSR 23.0), and lymphoma (WSR 16.6). The overall ASR in age group 15-19 years was 152.3 with lymphoma ranking first (ASR 30.2). Incidence was higher in males than in females, and higher in South America than in Central America and the Caribbean. Compared with global data LAC incidence was lower overall, except for leukemia and lymphoma at age 0-14 years and the other and unspecified tumors at any age. Overall incidence at age 0-19 years increased by 1.0% per year (95% CI [0.6, 1.3]) over 1993-2012. The included registries covered 16% of population aged 0-14 years and 10% of population aged 15-19 years. Conclusions. The observed patterns provide a baseline to assess the status and evolution of childhood cancer occurrence in the region. Extended and sustained support of cancer registration is required to improve representativeness and timeliness of data for childhood cancer control in LAC.

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RESUMO Objetivo. Apresentar uma visão abrangente dos padrões geográficos (2001 a 2010) e das tendências temporais (1993 a 2012) da incidência de câncer em crianças e jovens de 0 a 19 anos na América Latina e no Caribe (ALC) e interpretar os resultados no contexto de padrões mundiais. Métodos. Foram descritas variações geográficas de 2001 a 2010 e tendências de incidência de 1993 a 2012 na população com menos de 20 anos da ALC usando informações comparáveis da base de dados do terceiro volume do estudo International Incidence of Childhood Cancer. Foram calculadas taxas de incidência específica por idade por milhão de pessoas-ano (ASR, na sigla em inglês) para subgrupos populacionais e taxas padronizadas por idade usando a população padrão mundial (WSR, na sigla em inglês). Resultados. No total, foram incluídos 36 744 casos únicos. No período de 2001 a 2010, a WSR para todos os tumores combinados na faixa etária de 0 a 14 anos foi de 132,6. Os diagnósticos mais frequentes foram leucemia (WSR de 48,7), neoplasias do sistema nervoso central (WSR de 23,0) e linfoma (WSR de 16,6). A ASR para todos os tumores combinados na faixa etária de 15 a 19 anos foi de 152,3, e a maior taxa foi a de linfoma (ASR de 30,2). A incidência foi maior no sexo masculino do que no sexo feminino e maior na América do Sul do que na América Central e no Caribe. De modo geral, em comparação com as estimativas mundiais, a incidência na ALC foi menor, exceto para leucemia e linfoma entre 0 e 14 anos e para outros tumores e tumores não especificados em qualquer idade. A taxa de incidência na faixa etária de 0 a 19 anos aumentou em 1,0% ao ano (IC de 95% [0,6, 1,3]) entre 1993 e 2012. Os registros incluídos cobriam 16% da população de 0 a 14 anos e 10% da população de 15 a 19 anos. Conclusões. Os padrões observados servem de referência para avaliar o status e a evolução da ocorrência de câncer infantil na região. É necessário garantir um apoio ampliado e consistente aos registros de câncer para aprimorar a representatividade e a disponibilidade das informações em tempo adequado para o controle do câncer infantil na ALC.