Perfil de crianças e adolescentes dependentes de tecnologia em um hospital pediátrico do Sul do país / Perfil de niños e adolescentes dependientes de tecnología en un hospital pediátrico de referencia del sur del país / Profile of technology-dependent children and adolescents in a referral pediatric hospital in the south of the country

Resumo Objetivo identificar o perfil de crianças e adolescentes dependentes de tecnologia de um hospital de referência pediátrica do sul do país. Método estudo descritivo, com abordagem quantitativa. A coleta de dados ocorreu por meio da análise de prontuários, entre janeiro de 2016 e dezembro de 2019, armazenados em planilha Microsoft Excel para a análise estatística descritiva. Um projeto aprovado pelo Comitê de Ética sob o parecer 5.115.194. Resultados prevaleceu o sexo masculino (50,8%), em idade pré-escolar (30,8%), proveniente da Grande Florianópolis (60,1%). Os diagnósticos mais frequentes foram relacionados à prematuridade/período neonatal, anomalias congênitas/defeitos genéticos, doenças neurológicas e/ou neuromusculares, correspondendo a 37%, 33,2% e 18,5%. Os dispositivos tecnológicos mais utilizados foram gastrostomia (56,3%) e traqueostomia (36,6%). A utilização de medicamentos contínuos se deu em 93,4% e 49,2% utilizavam quatro ou mais medicamentos. As mães foram as principais cuidadoras (80,9%). Ocorreram 31 óbitos no período. Conclusão e implicação para a prática este grupo apresenta grande demanda de cuidados decorrentes do diagnóstico principal, dos dispositivos tecnológicos, das medicações e das possíveis complicações. A identificação do perfil das crianças e adolescentes dependentes de tecnologia contribuiu para ampliar a visibilidade de uma população que está em constante crescimento e, assim, prestar uma assistência integral, de acordo com suas especificidades e reais necessidades.

Resumen Objetivo identificar el perfil de niños y adolescentes dependientes de tecnología atendidos en un hospital de referência pediátrica del sur del país. Método estudio descriptivo con enfoque cuantitativo. La recolección de datos ocurrió através del análisis de las historias clínicas, desde enero de 2016 hasta diciembre de 2019, almacenadas en una hoja de cálculo de Microsoft Excel para el análisis estadístico descriptivo. El proyecto fue aprobado por el Comité de Ética bajo el parecer 5.115.194. Resultados predominaron varones (50,8%), en período de desarrollo preescolar (30,8%), la región más frecuentada de la Gran Florianópolis (60,1%). Los diagnósticos más frecuentes estuvieron relacionados con prematuridad/el período neonatal, anomalías congénitas/defectos genéticos, enfermedades neurológicas y/o neuromusculares, correspondiendo al 37%, 33,2% y 18,5%, respectivamente. Los dispositivos tecnológicos más utilizados fueron la gastrostomía (56,3%) y la traqueotomía (36,6%). El uso de medicación continua ocurrió en el 93,4% y el 49,2% utilizó cuatro o más medicamentos. Las madres fueron las principales cuidadoras en 80,9% de los casos, ocurriendo 31 óbitos en el período. Conclusión e implicación para la práctica este grupo tiene una alta demanda de atención debido al diagnóstico principal, dispositivos tecnológicos, medicamentos y posibles complicaciones. Identificar el perfil de niños y adolescentes dependientes de tecnología contribuye a aumentar la visibilidad de una población en constante crecimiento y, por lo tanto, calificar la asistencia, de acuerdo com sus especificidades y reales necesidades.

Abstract Objective to identify the profile of technology-dependent children and adolescents at a pediatric referral hospital in southern Brazil. Method a descriptive study with a quantitative approach. Data was collected by analyzing medical records between January 2016 and December 2019 and stored in a Microsoft Excel spreadsheet for descriptive statistical analysis. The project was approved by the Ethics Committee under protocol number 5.115.194. Results: The prevalence was male (50.8%), pre-school age (30.8%), from Greater Florianópolis (60.1%). The most frequent diagnoses were related to prematurity/neonatal period, congenital anomalies/genetic defects, and neurological and/or neuromuscular diseases, corresponding to 37%, 33.2%, and 18.5%. The most commonly used technological devices were gastrostomy (56.3%) and tracheostomy (36.6%). 93.4% used continuous medication and 49.2% used four or more medications. Mothers were the main caregivers (80.9%). There were 31 deaths during the period. Conclusion and implications for practice this group has a high demand for care due to the main diagnosis, technological devices, medications, and possible complications. Identifying the profile of technology-dependent children and adolescents has helped to increase the visibility of a population that is constantly growing and thus provides comprehensive care according to their specific needs.

Effect of a community-based child health counselling intervention on health-seeking behaviours, complementary feeding and nutritional condition among children aged 6-23 months in rural China: A pre- and post-comparison study.

In China, the prevalence of undernutrition among children under 5 years of age has declined significantly during recent decades. However, noticeable gaps exist between rural and urban areas. Since 2012, a government-funded nutrition programme, Ying Yang Bao (YYB; soybean powder-based iron-rich supplement) programme, has been implemented in poor rural areas to decrease the risk of developing anaemia among children aged 6-23 months, but there are still inadequate health care awareness, feeding knowledge and skills among caregivers. From June 2018 to December 2020, a child health counselling intervention was delivered through a home visit based on the YYB programme in Liangshan. Child health messages were given by trained village child health assistants while distributing YYB. Surveys were conducted before and after the intervention to analyse changes in child health check-up frequency, complementary feeding practice and prevalence of undernutrition. After the intervention, the proportion of children who had regular health check-ups, who were vaccinated and who met the minimum YYB consumption significantly increased from 26.0%, 81.6%, and 67.8% to 59.7%, 95.0%, and 79.2%. Increased rates of IYCF indicators (introduction of solid, semisolid, or soft foods, minimum dietary diversity and consumption of iron-rich or iron-fortified foods) were observed after the intervention. The prevalence of stunting, underweight, wasting, and anaemia significantly decreased from 26.3% to 10.8%, 13.4% to 8.7%, 14.0% to 10.5%, and 52.1% to 43.9%. This intervention can be well integrated into the YYB programme with less additional resources. Children in resource-limited areas will benefit more from a comprehensive nutritional package, including food supplements and child health education.

Improving child tuberculosis contact identification and screening in Lesotho: Results from a mixed-methods cluster-randomized implementation science study.

BACKGROUND: Child tuberculosis (TB) contact management is recommended for preventing TB in children but its implementation is suboptimal in high TB/HIV-burden settings. The PREVENT Study was a mixed-methods, clustered-randomized implementation study that evaluated the effectiveness and acceptability of a community-based intervention (CBI) to improve child TB contact management in Lesotho, a high TB burden country. METHODS: Ten health facilities were randomized to CBI or standard of care (SOC). CBI holistically addressed the complex provider-, patient-, and caregiver-related barriers to prevention of childhood TB. Routine TB program data were abstracted from TB registers and cards for all adult TB patients aged >18 years registered during the study period, and their child contacts. Primary outcome was yield (number) of child contacts identified and screened per adult TB patient. Generalized linear mixed models tested for differences between study arms. CBI acceptability was assessed via semi-structured in-depth interviews with a purposively selected sample of 20 healthcare providers and 28 caregivers. Qualitative data were used to explain and confirm quantitative results. We used thematic analysis to analyze the data. RESULTS: From 01/2017-06/2018, 973 adult TB patients were recorded, 490 at CBI and 483 at SOC health facilities; 64% male, 68% HIV-positive. At CBI and SOC health facilities, 216 and 164 child contacts were identified, respectively (p = 0.16). Screening proportions (94% vs. 62%, p = 0.13) were similar; contact yield per TB case (0.40 vs. 0.20, p = 0.08) was higher at CBI than SOC health facilities, respectively. CBI was acceptable to caregivers and healthcare providers. CONCLUSION: Identification and screening for TB child contacts were similar across study arms but yield was marginally higher at CBI compared with SOC health facilities. CBI scale-up may enhance the ability to reach and engage child TB contacts, contributing to efforts to improve TB prevention among children.

"You Will Not Mourn Your Children": Spirituality and Child Health in Ibadan Urban Markets.

The urban Ibadan market is not only important for its economic value, but also for its representation of the worldview of the Yoruba people of South-Western Nigeria. Yoruba urban markets are adorned with different spiritualists who also earn their livelihood in the market space. Hence, through the employment of observations and in-depth interviews, the study examines how spirituality shapes child health and mothers' health seeking behaviours in Ibadan urban markets.

Integrated Management of Childhood Illnesses implementation-related factors at 18 Colombian cities.

BACKGROUND: Integrated Management of Childhood Illnesses (IMCI) is a strategy developed by the World Health Organization (WHO) and UNICEF in 1992. It was deployed as an integrated approach to improve children's health in the world. This strategy is divided into three components: organizational, clinical, and communitarian. If the Integrated Management of Childhood Illnesses implementation-related factors in low- and middle-income countries are known, the likelihood of decreasing infant morbidity and mortality rates could be increased. This work aimed to identify, from the clinical component of the strategy, the implementation-related factors to Integrated Management of Childhood Illnesses at 18 Colombian cities. METHODS: A quantitative cross-sectional study was performed with a secondary analysis of databases of a study conducted in Colombia by the Public Health group of Universidad de Los Andes in 2016. An Integrated Care Index was calculated as a dependent variable and descriptive bivariate and multivariate analyses to find the relationship between this index and the relevant variables from literature. RESULTS: Information was obtained from 165 medical appointments made by nurses, general practitioners, and pediatricians. Health access is given mainly in the urban area, in the first level care and outpatient context. Essential medicines availability, necessary supplies, second-level care, medical appointment periods longer than 30 min, and care to the child under 30 months are often related to higher rates of Integrated Care Index. CONCLUSION: Health care provided to children under five remains incomplete because it does not present the basic minimums for the adequate IMCI's implementation in the country. It is necessary to provide integrated care that provides medicine availability and essential supplies that reduce access barriers and improve the system's fragmentation.

Breastfeeding and child survival from 0 to 5 years in Côte d'Ivoire.

BACKGROUND: One of the main objectives of health policy-makers is to promote children's growth, development, and survival. The current research evaluates the impact of breastfeeding on infant survival and highlights the major socio-economic determinants of child survival from 0 to 5 years old in Côte d'Ivoire. METHODS: This study uses Probit estimation to evaluate the impact of the type of breastfeeding on the survival of children aged from 0 to 5 years old. The main socio-economic determinants of child survival were identified and analyzed. The sample of the study covers 7776 children under 5 years old drawn from the Côte d'Ivoire Demographic Health Surveys and the Multiple Indicators cluster survey of 2012. RESULTS: A child is more likely to survive when immediate exclusive breastfeeding was practiced for up to 6 months. The probability of survival increases significantly when the mother lives in a healthy environment, when she has at least a primary school education, and when she plays a leading role in caring for the children. Likewise, when she better controls the market of some breast milk supplement and she chooses the best milk formula to complete feeding for her baby, the child's chances of survival increase significantly. CONCLUSION: Health policy-makers must strengthen programs to promote exclusive breastfeeding up to 6 months through social campaigns. It should also strengthen the capacity of health workers (midwives, nurses, doctors, etc.) to better guide and provide training to mothers and young women about childbearing age to allow them to practice exclusive breastfeeding for up to 6 months. It is only after 6 months that they have to complete infant feeding by providing some semi-solid food rich in vitamins, proteins, and minerals. Taking into account the time constraint when they are engaged in economic activity, they must choose the best formula milk to supplement breastfeeding. It is also important to educate women to improve hygiene in their housing, in their neighborhood and in their community in order to promote the welfare and health of their children.

Use of antibiotics in the health care unit: 2015 Pelotas Birth Cohort.

OBJECTIVE: To estimate the use of the first dose of antibiotics in the health care unit in children from the 2015 Pelotas Birth Cohort at 24 months. METHODS: A total of 4,014 children were monitored. We used descriptive statistics and Poisson regression to analyze the association between socioeconomic and demographic variables, participation in daycare units, in the activities of the Pastoral da Criança and in the Primeira Infância Melhor program, low birth weight, hospitalization between 12 and 24 months, place of medical appointment, prevalence of medical appointment in the last 30 days, prescription of antibiotics, and administration of the first dose in the health care unit. RESULTS: A total of 1,044 children had medical appointments in the last 30 days, of which 45% were prescribed antibiotics and only 10.5% were administered the first dose of this medication in the health care unit. Children with brown, yellow or indigenous skin color were administered 2.5 times more antibiotics than white children. Children whose mothers had 12 years or more of education were administered 83.0% fewer antibiotics than those whose mothers had up to 4 years of education. Among those who were hospitalized for 12 to 24 months, the use of antibiotics was almost four times higher than among those who were not. Among the children served by the Brazilian Unified Health System (SUS), only 15.3% were administered the first dose of antibiotic in the health care unit. When compared with children served by private health care or health plan, administration of the first dose in the SUS was 76.0% higher. CONCLUSIONS: Despite the efforts related to the Pastoral da Criança campaign "Antibiotic: first dose immediately," adherence to the provision of antibiotics in the health care unit is still low. Strategies are necessary and urgent so children have access to the first dose of antibiotics in the health care unit.

Preteen children's health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups.

BACKGROUND: Assessing disparities in health-related quality of Life (HRQoL) is important as a part of health-related disparities in the society. The aim of this study was to explore HRQoL among 12-year-olds in Sweden in terms of differences between years 2005 and 2009 and disparities related to sociodemographic background. METHODS: During the school years 2005 and 2009, a total of 18,325 sixth grade students in Sweden were invited to a celiac disease screening study; 13,279 agreed to participate. Jointly with the celiac screening, the children answered a questionnaire that included EuroQol 5 Dimensions-youth (EQ-5D-Y) and their parents responded to separate questionnaires about their own and their child's country of birth, family structure, their employment status, occupation, and education. In total 11,009 child-parent questionnaires were collected. Logistic regression was used to study differences in HRQoL between 2005 and 2009, and between various sociodemographic subgroups. RESULTS: Compared with 2005, children in 2009 reported more pain (OR: 1.20, 95% CI: 1.1-1.3) and more mood problems (OR: 1.35, 95% CI: 1.2-1.5). In general, girls reported more pain and mood problems and had more disparities than boys. There were no significant differences based on parents' occupation, however, children of parents with low or medium education levels reported less "mood problems" than those of parents with high education levels (OR: 0.65, 95% CI: 0.46-0.92) and (OR: 0.84, 95% CI: 0.73-0.96), respectively. A slight variation was seen in HRQoL between children with different migration background. Girls living in small municipalities reported more pain (OR: 1.51, 95% CI: 1.14-2.01), and problems performing usual activities (OR: 3.77, 95% CI: 2.08-6.84), compared to girls living in large municipalities. In addition, children living with two parents had less mood problems than children living in other family constellations. CONCLUSION: More children reported pain and mood problems in 2009 compared with 2005. To study future trends, health outcomes among children in Sweden should continue to be reported periodically. More efforts should be invested to increase the awareness of health-related disparities as highlighted in this study especially for girls living in small municipalities and children of parents with high education level.

Use of antibiotics in the health care unit: 2015 Pelotas Birth Cohort / Uso de antibióticos no local do atendimento: Coorte de Nascimentos de Pelotas de 2015

ABSTRACT OBJECTIVE To estimate the use of the first dose of antibiotics in the health care unit in children from the 2015 Pelotas Birth Cohort at 24 months. METHODS A total of 4,014 children were monitored. We used descriptive statistics and Poisson regression to analyze the association between socioeconomic and demographic variables, participation in daycare units, in the activities of the Pastoral da Criança and in the Primeira Infância Melhor program, low birth weight, hospitalization between 12 and 24 months, place of medical appointment, prevalence of medical appointment in the last 30 days, prescription of antibiotics, and administration of the first dose in the health care unit. RESULTS A total of 1,044 children had medical appointments in the last 30 days, of which 45% were prescribed antibiotics and only 10.5% were administered the first dose of this medication in the health care unit. Children with brown, yellow or indigenous skin color were administered 2.5 times more antibiotics than white children. Children whose mothers had 12 years or more of education were administered 83.0% fewer antibiotics than those whose mothers had up to 4 years of education. Among those who were hospitalized for 12 to 24 months, the use of antibiotics was almost four times higher than among those who were not. Among the children served by the Brazilian Unified Health System (SUS), only 15.3% were administered the first dose of antibiotic in the health care unit. When compared with children served by private health care or health plan, administration of the first dose in the SUS was 76.0% higher. CONCLUSIONS Despite the efforts related to the Pastoral da Criança campaign "Antibiotic: first dose immediately," adherence to the provision of antibiotics in the health care unit is still low. Strategies are necessary and urgent so children have access to the first dose of antibiotics in the health care unit.

RESUMO OBJETIVO Estimar o uso da primeira dose do antibiótico no local de atendimento nas crianças da Coorte de Nascimentos de Pelotas de 2015 aos 24 meses. MÉTODOS Foram acompanhadas 4.014 crianças. A associação entre variáveis socioeconômicas e demográficas, participação em creche, nas ações da Pastoral da Criança e no programa Primeira Infância Melhor, baixo peso ao nascer, internação entre 12 e 24 meses, local da consulta, prevalência de consulta nos últimos 30 dias, prescrição de antibióticos e recebimento da primeira dose no local de atendimento foi analisada por meio de estatística descritiva e regressão de Poisson. RESULTADOS Tiveram consulta nos últimos 30 dias 1.044 crianças, das quais 45% receberam prescrição de antibiótico e apenas 10,5% receberam a primeira dose dessa medicação no local de atendimento. Crianças de cor da pele parda, amarela ou indígena tiveram um uso de antibiótico 2,5 vezes maior que o das brancas. Já as crianças cujas mães tinham 12 anos ou mais de escolaridade usaram 83,0% menos antibióticos que aquelas cujas mães tinham até quatro anos de estudo. Entre aquelas que foram internadas entre 12 e 24 meses, o uso de antibiótico foi quase quatro vezes maior do que entre as que não foram. Entre as crianças atendidas pelo Sistema Único de Saúde (SUS), apenas 15,3% receberam a primeira dose do antibiótico no local de atendimento. Quando comparado com o de crianças atendidas por financiamento particular ou convênio, o recebimento da primeira dose no SUS chegou a ser 76,0% superior. CONCLUSÕES Apesar dos esforços relacionados à campanha da Pastoral da Criança "Antibiótico: primeira dose imediata", ainda é baixa a adesão ao fornecimento de antibióticos no local de atendimento. Estratégias são necessárias e urgentes para que as crianças tenham acesso à primeira dose de antibióticos no local de atendimento.

Childhood health and education outcomes following early term induction for large-for-gestational age: A population-based record linkage study.

INTRODUCTION: There is debate about optimal management of pregnancies with a large-for-gestational age baby. A recent randomized controlled trial reported that early term induction of labor reduced cesarean section rates and infant morbidity. However, long term childhood outcomes have not been assessed. The aim of this study was to assess maternal, neonatal and child health and education outcomes for large-for-gestational age babies induced at 37-38 weeks' gestation. MATERIAL AND METHODS: Population-based record linkage study of term (37+ weeks), cephalic-presenting singleton pregnancies with a large-for-gestational age baby in New South Wales, Australia, 2002-2006. Linked birth, hospital, mortality and education data were used with at least 9 years follow up from birth. Exposure was induction of labor at 37-38 weeks, compared to expectant management (spontaneous birth at ≥37 weeks and planned births at ≥39 weeks). Relative risks and 95% confidence intervals were estimated using Modified Poisson regression with robust variance. RESULTS: Among 10 174 eligible pregnancies, 412 (4.0%) had an induction at 37-38 weeks. Women in the induction group were less likely to have a cesarean section (RR: 0.65, 95% CI: 0.51-0.82). Infants had higher rates of: low Apgar scores, birth trauma, neonatal jaundice and phototherapy use, and admission to special care nursery or neonatal intensive care than their expectantly managed counterparts. As children, they had higher rates of hospital admission (RR: 1.16, 95% CI: 1.04-1.30) and special needs (RR: 1.98, 95% CI: 1.12-3.50). However, by age 8 there was no difference in overall literacy and numeracy achievement. CONCLUSIONS: Although women who had an early term labor induction with large-for-gestational age were less likely to have a cesarean section, the increased risk of neonatal morbidities and additional healthcare utilization suggests the need for caution in early induction of large-for-gestational age babies before 39 weeks' gestation.

Maternal and child characteristics and health practices affecting under-five mortality: A matched case control study in Gamo Gofa Zone, Southern Ethiopia.

BACKGROUND: Though Ethiopia has shown a considerable improvement in reducing under-five mortality rate since 1990, many children still continue to die prematurely. Mixed results have been reported about determinants of under-five mortality. Besides, there is paucity of mortality studies in the current study site. Therefore, this study was conducted to assess maternal and child health related predictors of under-five mortality in Southern Ethiopia. METHODS: A matched case control study was conducted in 2014 in Arba Minch Town and Arba Minch Zuria District of Gamo Gofa Zone, Southern Ethiopia. Conditional logistic regression was employed to identify the predictors of under-five mortality. Sampling weight was applied to account for the non-proportional allocation of sample to different clusters. Based on the Mosley & Chen's analytical framework for under-five and infant mortalities, the predictors were organized in to three groups: 1) personal illness control, 2) child feeding and newborn care and 3) other maternal and child related factors. RESULTS: Among personal illness control related factors: lack of post-natal care, immunization status of the child and lack of Vitamin A supplementation were significantly associated with higher rate of under-five mortality. Not breastfeeding and delaying first bath at least for 24 hours were child feeding and newborn care related factors which were found to be significantly associated with under-five mortality. Among other maternal and child related factors, shorter previous birth interval, history of death of index child's older sibling, being multiple birth and live birth after the index child were significantly associated with under-five mortality. CONCLUSIONS: In order to maintain reduction of under-five mortality during the Sustainable Development Goals era, strengthening of maternal and child health interventions, such as post-natal care, family planning, immunization, supplementation of Vitamin A for children older than six months, breastfeeding and delaying of first bath after delivery at least for 24 hours are recommended.

[From recommendations to practice: eight years of challenges for children's health in primary care services in the interior of São Paulo State, Brazil]. / Do preconizado à prática: oito anos de desafios para a saúde da criança em serviços de atenção primária no interior de São Paulo, Brasil.

This article aims to identify changes in indicators for the organization of children's health services in primary care in the State of São Paulo, Brazil. An evaluative study was conducted with three series of cross-sectional evaluations with participation by 81 services, involving 32 municipalities (counties) in the central-west region of the state, who answered the Quali AB questionnaire in 2007, 2010, and 2014. The analysis used 74 children's health indicators and 7 services indicators. Comparison of the indicators evidenced changes in the organization of children's healthcare, with an improvement in the majority of the indicators in 2010 and maintenance or worsening in 2014, compared to 2007. In conclusion, children's health policy recommendations have not been fully realized in the organization of the supply of comprehensive care, although relevant issues such as childhood obesity and violence have been addressed by a few services.

O presente artigo tem por objetivo identificar mudanças nos indicadores de organização da atenção à saúde da criança em serviços de atenção primária do Estado de São Paulo, Brasil. Pesquisa avaliativa desenvolvida por três séries de avaliações transversais com a participação de 81 serviços, envolvendo 32 municípios do centro-oeste paulista, que responderam ao instrumento Quali AB nos anos de 2007, 2010 e 2014. A análise utilizou 74 indicadores de saúde da criança e 7 de caracterização dos serviços. A comparação dos indicadores evidenciou mudanças na organização de ações de saúde da criança, com melhora da maioria dos indicadores em 2010 e manutenção, ou piora, em 2014, em relação a 2007. Conclui-se que os avanços preconizados pelas políticas de atenção à saúde da criança não têm se efetivado plenamente na organização da oferta da atenção integral, ainda que temas relevantes como obesidade infantil e violência sejam abordados em um pequeno número de serviços.

El objetivo del presente artículo es identificar cambios en los indicadores de organización de la atención a la salud infantil en los servicios de atención primaria del estado de São Paulo, Brasil. Se trata de una investigación evaluativa, desarrollada por tres series de evaluaciones transversales con la participación de 81 servicios, involucrando a 32 municipios del centro-oeste paulista, que respondieron al instrumento Quali AB durante los años de 2007, 2010 y 2014. El análisis utilizó 74 indicadores de salud infantil y 7 de caracterización de los servicios. La comparación de los indicadores evidenció cambios en la organización de acciones de salud infantil, con una mejora de la mayoría de los indicadores en 2010 y un mantenimiento, o empeoramiento, en 2014, comparándolo con 2007. Se concluye que los avances preconizados por las políticas de atención a la salud infantil no se han hecho efectivos plenamente en la organización de la oferta de atención integral, aunque algunos temas relevantes como la obesidad infantil y la violencia sean abordados en un pequeño número de servicios de atención primaria.

Do preconizado à prática: oito anos de desafios para a saúde da criança em serviços de atenção primária no interior de São Paulo, Brasil / From recommendations to practice: eight years of challenges for children's health in primary care services in the interior of São Paulo State, Brazil / De lo preconizado a la práctica: ocho años de desafíos para la salud infantil en los servicios de atención primaria en la zona interior de São Paulo, Brasil

O presente artigo tem por objetivo identificar mudanças nos indicadores de organização da atenção à saúde da criança em serviços de atenção primária do Estado de São Paulo, Brasil. Pesquisa avaliativa desenvolvida por três séries de avaliações transversais com a participação de 81 serviços, envolvendo 32 municípios do centro-oeste paulista, que responderam ao instrumento Quali AB nos anos de 2007, 2010 e 2014. A análise utilizou 74 indicadores de saúde da criança e 7 de caracterização dos serviços. A comparação dos indicadores evidenciou mudanças na organização de ações de saúde da criança, com melhora da maioria dos indicadores em 2010 e manutenção, ou piora, em 2014, em relação a 2007. Conclui-se que os avanços preconizados pelas políticas de atenção à saúde da criança não têm se efetivado plenamente na organização da oferta da atenção integral, ainda que temas relevantes como obesidade infantil e violência sejam abordados em um pequeno número de serviços.

This article aims to identify changes in indicators for the organization of children's health services in primary care in the State of São Paulo, Brazil. An evaluative study was conducted with three series of cross-sectional evaluations with participation by 81 services, involving 32 municipalities (counties) in the central-west region of the state, who answered the Quali AB questionnaire in 2007, 2010, and 2014. The analysis used 74 children's health indicators and 7 services indicators. Comparison of the indicators evidenced changes in the organization of children's healthcare, with an improvement in the majority of the indicators in 2010 and maintenance or worsening in 2014, compared to 2007. In conclusion, children's health policy recommendations have not been fully realized in the organization of the supply of comprehensive care, although relevant issues such as childhood obesity and violence have been addressed by a few services.

El objetivo del presente artículo es identificar cambios en los indicadores de organización de la atención a la salud infantil en los servicios de atención primaria del estado de São Paulo, Brasil. Se trata de una investigación evaluativa, desarrollada por tres series de evaluaciones transversales con la participación de 81 servicios, involucrando a 32 municipios del centro-oeste paulista, que respondieron al instrumento Quali AB durante los años de 2007, 2010 y 2014. El análisis utilizó 74 indicadores de salud infantil y 7 de caracterización de los servicios. La comparación de los indicadores evidenció cambios en la organización de acciones de salud infantil, con una mejora de la mayoría de los indicadores en 2010 y un mantenimiento, o empeoramiento, en 2014, comparándolo con 2007. Se concluye que los avances preconizados por las políticas de atención a la salud infantil no se han hecho efectivos plenamente en la organización de la oferta de atención integral, aunque algunos temas relevantes como la obesidad infantil y la violencia sean abordados en un pequeño número de servicios de atención primaria.

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014.

BACKGROUND: Reducing child mortality was one of the Millennium Development Goals. In the current Sustainable Development Goals era, achieving equity is prioritized as a major aim. OBJECTIVE: This study aims to provide a comprehensive and updated picture of inequalities in child health intervention coverage and child health outcomes by wealth status, as well as their trends between 2000 and 2014. METHODS: Using data from Demographic Health Surveys and Multiple Indicator Cluster Surveys, we adopted three measures of inequality, including one absolute inequality indicator and two relative inequality indicators, to estimate the level and trends of inequalities in three child health outcome variables and 17 intervention coverages in 88 developing countries. RESULTS: While improvements in child health outcomes and coverage of interventions have been observed between 2000 and 2014, large inequalities remain. There was a high level of variation between countries' progress toward reducing child health inequalities, with some countries significantly improving, some deteriorating, and some remaining statistically unchanged. Among child health interventions, the least equitable one was access to improved sanitation (The absolute difference in coverages between the richest quintile and the poorest quintile reached 49.5% [42.7, 56.2]), followed by access to improved water (34.1% [29.5, 38.6]), and skilled birth attendant (SBA) (34.1% [28.8, 39.4]). The most equitable intervention coverage was insecticide-treated bed net for children (1.0% [-3.9, 5.9]), followed by oral rehydration therapy for diarrhea ((8.0% [5.2, 10.8]), and vitamin A supplement (8.4% [5.1, 11.7]). These findings were robust to various inequality measurements. CONCLUSIONS: Although child health outcomes and coverage of interventions have improved largely over the study period for almost all wealth quintiles, insufficient progress was made in reducing child health inequalities between the poorest and richest wealth quintiles. Future efforts should focus on reaching the poorest children by increasing investments toward expanding the coverage of interventions in resource-limited settings.

Forty years of research concerning children and youth in Greenland: a mapping review.

OBJECTIVE: This study undertakes a mapping review of mainly concerning children and youth in Greenland in the period 1976-2016 and reflects on how the research has been conducted and knowledge thereby created about children and youth in Greenland, as well as how the research has been developed over time. DESIGN: 16 online databases; five journals; publication lists originating from seven organisations and ten prominent researchers; and local network and references were used in the search and subsequently screened through the scoping criteria. 342 publications were included, encompassing knowledge based on empirical research on children and youth in Greenland within the broader field of psychology. RESULTS: The majority of studies, 71%, were conducted through quantitative methods. The qualitative research is represented in 22% of the studies and participatory and action-orientated research is represented in 7% of the studies. The most prominent themes in research concerning children and youth in Greenland were physical problems, which were found in 38% of the studies. CONCLUSIONS: The result reflects a consistent objectivity and quantitative methodology in health research in Greenland since 1991.The health research thus represents a united research community with a shared methodological research approach, while the local participatory action research projects all appear differentiated. While health research covers a spectrum of psychology related objectives, the methodology traditions reveal a specific kind of knowledge, which has come to determine how the mental health of the Greenlandic children is perceived. We believe that more qualitative and locally grounded approaches need to be organised in order to produce a more nuanced knowledge of the Greenlandic children and youth.

Multiple Threats to Child Health from Fossil Fuel Combustion: Impacts of Air Pollution and Climate Change.

BACKGROUND: Approaches to estimating and addressing the risk to children from fossil fuel combustion have been fragmented, tending to focus either on the toxic air emissions or on climate change. Yet developing children, and especially poor children, now bear a disproportionate burden of disease from both environmental pollution and climate change due to fossil fuel combustion. OBJECTIVE: This commentary summarizes the robust scientific evidence regarding the multiple current and projected health impacts of fossil fuel combustion on the young to make the case for a holistic, child-centered energy and climate policy that addresses the full array of physical and psychosocial stressors resulting from fossil fuel pollution. DISCUSSION: The data summarized here show that by sharply reducing our dependence on fossil fuels we would achieve highly significant health and economic benefits for our children and their future. These benefits would occur immediately and also play out over the life course and potentially across generations. CONCLUSION: Going beyond the powerful scientific and economic arguments for urgent action to reduce the burning of fossil fuels is the strong moral imperative to protect our most vulnerable populations. Citation: Perera FP. 2017. Multiple threats to child health from fossil fuel combustion: impacts of air pollution and climate change. Environ Health Perspect 125:141-148; http://dx.doi.org/10.1289/EHP299.

Maternal Micronutrient Supplementation and Long Term Health Impact in Children in Rural Bangladesh.

BACKGROUND: Limited data is available on the role of prenatal nutritional status on the health of school-age children. We aimed to determine the impact of maternal micronutrient supplementation on the health status of Bangladeshi children. METHODS: Children (8.6-9.6 years; n = 540) were enrolled from a longitudinal mother-child cohort, where mothers were supplemented daily with either 30mg iron and 400µg folic acid (Fe30F), or 60mg iron and 400µg folic acid (Fe60F), or Fe30F including 15 micronutrients (MM), in rural Matlab. Blood was collected from children to determine the concentration of hemoglobin (Hb) and several micronutrients. Anthropometric and Hb data from these children were also available at 4.5 years of age and mothers at gestational week (GW) 14 and 30. RESULTS: MM supplementation significantly improved (p≤0.05) body mass index-for-age z-score (BAZ), but not Hb levels, in 9 years old children compared to the Fe30F group. MM supplementation also reduced markers of inflammation (p≤0.05). About 28%, 35% and 23% of the women were found to be anemic at GW14, GW30 and both time points, respectively. The prevalence of anemia was 5% and 15% in 4.5 and 9 years old children, respectively. The adjusted odds of having anemia in 9 year old children was 3-fold higher if their mothers were anemic at both GW14 and GW30 [Odds Ratio (OR) = 3.05; 95% Confidence Interval (CI) 1.42, 6.14, P = 0.002] or even higher if they were also anemic at 4.5 years of age [OR = 5.92; 95% CI 2.64, 13.25; P<0.001]. CONCLUSION: Maternal micronutrient supplementation imparted beneficial effects on child health. Anemia during pregnancy and early childhood are important risk factors for the occurrence of anemia in school-age children.

Psychopharmacological Prescriptions in Children and Adolescents in Germany.

BACKGROUND: In view of the well-known increase in prescriptions of stimulants for children and adolescents over the last 20 years, it is important to study trends in the prevalence and incidence of the use of other psychotropic drugs by this age group as well, to enable an early response to potential problems in the current care situation. METHODS: We used nationwide data from German statutory health insurance funds (Allgemeine Ortskrankenkasse [AOK], all insurees; Techniker Kranken - kasse [TK], a 50% randomized sample) concerning all insurees aged 0-17 years (5.0 million people in 2012) to study trends in the prevalence and incidence of psychotropic medication use as well as initially prescribing medical specialties over the period 2004-2012, both for the overall group of psychotropic drugs and for selected subgroups of drugs. RESULTS: From 2004 to 2012, the prevalence of psychotropic drug prescriptions (not including herbal and homeopathic substances) for children and adolescents rose from 19.6 to 27.1 per 1000 individuals. Marked rises were seen for stimulants (10.5 to 19.1 per 1000) and antipsychotic drugs (2.3 to 3.1 per 1000), while the prevalence of antidepressant prescriptions remained constant at about 2 per 1000. The rates of new prescriptions from 2006 to 2012 were generally constant or decreasing; for the overall group of (non-herbal, nonhomeopathic) psychotropic drugs, the rate of new prescriptions fell from 9.9 to 8.7 per 1000. There was a trend toward the issuance of new prescriptions by medical specialists, rather than by family physicians and pediatricians. CONCLUSION: The observed increased prevalence of psychotropic drug use among children and adolescents appears to be due not to an increased rate of initial prescriptions for these drugs, but rather to a rise in the number of patients who, once having received such drugs, were given further prescriptions for them in the years that followed.