Eficacia y seguridad de un compuesto de ácidos grasos hiperoxigenados en la mejora de la microcirculación de la púrpura fulminante en pacientes pediátricos con sepsis: estudio piloto / Efficacy and safety of a hyperoxygenated fatty acid compound in improving the microcirculation of purpura fulminans in paediatric patients with sepsis: a pilot study

Introducción La púrpura fulminante (PF) es una complicación grave de la sepsis resultado de un conjunto de alteraciones caracterizadas por el desarrollo de lesiones hemorrágicas equimóticas y necrosis de la piel. Objetivo Analizar la eficacia y la seguridad de la aplicación tópica de un compuesto de ácidos grasos hiperoxigenados (AGHO) en la microcirculación de la PF en pacientes pediátricos afectados de sepsis. Material y métodos Se llevó a cabo un estudio prospectivo cuasiexperimental pretest-posttest de un solo grupo en una Unidad de Cuidados Intensivos Pediátrica (UCIP). Se incluyeron en el estudio pacientes con PF de 0 a 18 años. Para evaluar la efectividad del producto objeto de evaluación en la microcirculación de las lesiones por PF se determinaron los valores de oximetría somática antes y después de la aplicación de AGHO cada 4h durante los 3 primeros días de ingreso de los pacientes. Resultados Se reclutaron 4 pacientes, con una mediana de edad de 98 meses. Las lesiones purpúricas que se midieron estaban ubicadas, sobre todo, en ambos pies y manos y, en 2 pacientes, también en los maléolos laterales y gemelos de ambas extremidades inferiores. Se obtuvieron un total de 225 mediciones, observando unas puntuaciones medias preintervención de 71,17±15,65% versus los 73,68±14,83% postintervención. Se objetivó significación estadística (p<0,001) al comparar las mediciones pre- y postintervención. Conclusiones La aplicación precoz y continuada de AGHO en el manejo de la PF por sepsis es una práctica eficaz y segura en los casos de población pediátrica analizada. En más de la mitad de los episodios analizados se objetivó un aumento de microcirculación tisular tras la aplicación de los AGHO, sin eventos adversos. (AU)

Introduction Purpura fulminans (PF) is a serious complication of sepsis resulting from a set of alterations characterised by the development of ecchymotic haemorrhagic lesions and skin necrosis. Aim To analyse the efficacy and safety of the topical application of HOFA compound, in the cutaneous microcirculation of PF lesions in paediatric patients affected by sepsis. Material and methods A prospective quasi-experimental pre-test/post-test single-group conducted in a Paediatric Intensive Care Unit of a third level hospital was performed. Paediatric patients aged 0-18 years with sepsis were included. Somatic oximetry values were measured before and after application of HOFAs every 4hours over the first three days of the patients’ hospitalisation. Patient's socio-demographic and clinical variables and somatic oximetry by placing a sensor for measuring tissue perfusion on the area with PF were determined. Results Four patients were recruited, with a median age of 98 months. The purpuric lesions measured were mainly located on both feet and hands and, in two patients, also on the lateral malleoli and calves of both lower extremities. A total of 225 measurements were obtained, with mean pre-intervention scores of 71.17±15.65% versus 73.68±14.83% post-intervention. Statistical significance (p<0.001) was observed upon comparison of the pre- and post-intervention measurements. Conclusions Early and continued application of HOFAs in the management of sepsis-induced PF is an effective and safe practice in the cases analysed. In more than half of the episodes analysed, an increase in tissue microcirculation was observed after the application of HOFAs, with no adverse events. (AU)

A quality improvement approach to improving recognition of Maori tamariki (children) and assessing barriers to culturally responsive care in a paediatric ward setting.

BACKGROUND: Health inequity persists in Aotearoa (New Zealand) and internationally amongst most indigenous peoples. To address these health inequities, countries need to contend with the ramifications of entrenched historical, cultural and systemic failures. Within Aotearoa part of the solution to rectifying persistent health inequities lies in shifting everyday healthcare practices towards a more culturally responsive, patient-centred approach that utilises Maori knowledge and principles. Although the need for culturally responsive services in healthcare settings is clearly evident, most practitioners struggle with the challenge of creating a culturally safe environment. Further to these challenges, there are issues related to accurate recognition of ethnicity within the time constraints of an overwrought hospital environment. Within this environment, the correct identification of ethnicity is a fundamental step in the process of moving towards culturally responsive and more inclusive care. METHOD: The research was concerned with indigenous Maori patients being consistently and correctly identified so that they might receive culturally appropriate interaction and treatment. The research specifically focused on the impact of introducing a customised sticker prompt on the front cover of clinical notes of Maori tamariki (children) to assist with correct ethnicity identification. Surveys were conducted on the paediatric ward over a 3-week period, prior to and during the intervention to evaluate the effect of the customised stickers. This study sought to (1) assess the efficacy of a sticker to improve recognition of Maori tamariki (children), (2) examine key barriers to identifying ethnicity and (3) identify wider impacts of a sticker prompt on clinical practice. RESULTS: Results showed wide ranging positive impacts on clinical practice and culturally responsive care. Sixty-four per cent of participants indicated that the stickers were a useful tool to improve identification of Maori tamariki. Respondents reported increased accuracy of identifying patients by ethnicity, as well as improved awareness of existing ethnicity documentation, and increased engagement regarding cultural needs and ethnicity. CONCLUSIONS: This study identified that sticker prompts are a useful tool for healthcare workers to improve recognition and awareness of ethnicity and to increase dialogue around cultural needs. The stickers led to increased consideration of the wider elements of holistic wellbeing and therefore improved culturally responsive care for Maori tamariki.

Spiritualité

Les soins palliatifs chez les patients pédiatriques atteints de cancer représentent une approche fondamentale dans les soins médicaux visant à améliorer la qualité de vie de l'enfant affecté et de sa famille tout au long du processus de la maladie. Ces soins sont axés sur le soulagement de la souffrance physique, émotionnelle et spirituelle qui accompagne la lutte contre le cancer chez les enfants. Il est essentiel de comprendre que les soins palliatifs ne se limitent pas aux derniers moments de la vie du patient, mais englobent la période allant du diagnostic à la possibilité d'une guérison ou à la transition vers des soins en fin de vie dans les cas terminaux. L'objectif principal de cette approche globale est de garantir que l'enfant et sa famille reçoivent le soutien nécessaire pour faire face aux défis qui se posent dans ce parcours difficile. Dans ce contexte, l'Initiative mondiale contre le cancer infantile, promue par l'Organisation panaméricaine de la santé (OPS), joue un rôle essentiel en fournissant une série de modules éducatifs sur les soins palliatifs pédiatriques destinés aux mères, aux pères et aux aidants. Ces modules contiennent des informations précieuses et essentielles pour offrir les meilleurs soins possibles aux enfants atteints de cancer et à leurs proches. En plus d'aborder les aspects généraux de ce que sont les soins palliatifs pédiatriques et comment les aborder, ces ressources éducatives abordent également des questions clés telles que la personne responsable de la fourniture de ces soins, à qui ils sont destinés et comment ils peuvent bénéficier à la fois au patient et aux personnes impliquées dans les soins. Dans ce module, le sujet de la spiritualité est abordé, y compris ce qu'elle est, comment son développement se produit, comment la nourrir chez l'enfant, pourquoi s'engager dans des pratiques spirituelles est important, et comment ces pratiques peuvent être menées avec des enfants.

Spirituality

The goal of palliative care in pediatric cancer patients is to improve the well-being of the patient and their family throughout the illness, as well as reduce physical, emotional and spiritual suffering. Within the framework of the Global Initiative against Childhood Cancer, PAHO offers a series of modules on pediatric palliative care for mothers, fathers and caregivers. Each one contains essential information to be able to provide the best care and satisfy the needs derived from the disease that affect both the patient and their loved ones. This module addresses the topic of spirituality: what is it? What does its development consist of? How to develop it with the minor? Why is it important to carry out spiritual practices? Or how can you carry out spiritual practices with minors?

Uptake of pediatric patient-reported outcome and experience measures and challenges associated with their implementation in Alberta: a mixed-methods study.

BACKGROUND: Implementing Patient-reported Outcome Measures (PROMs) and Patient-reported Experience Measures (PREMs) is an effective way to deliver patient- and family-centered care (PFCC). Although Alberta Health Services (AHS) is Canada's largest and fully integrated health system, PROMs and PREMs are yet to be routinely integrated into the pediatric healthcare system. This study addresses this gap by investigating the current uptake, barriers, and enablers for integrating PROMs and PREMs in Alberta's pediatric healthcare system. METHODS: Pediatric clinicians and academic researchers with experience using PROMs and PREMs were invited to complete a quantitative survey. Additionally, key stakeholders were qualitatively interviewed to understand current challenges in implementing pediatric PROMs and PREMs within AHS. Quantitative data gathered from 22 participants were descriptively analyzed, and qualitative data from 14 participants were thematically analyzed. RESULTS: Participants identified 33 PROMs and 6 PREMs showing diversity in the types of pediatric PROMs and PREMs currently being used in Alberta and their mode of administration. The qualitatively identified challenges were associated with patients, family caregivers, and clinicians. The absence of system-level support, such as integration within electronic medical records, is considered a significant system-level challenge. CONCLUSIONS: The significant variation in the types of PROMs and PREMs used, the rationale for their use, and their mode of administration demonstrate the diverse and sporadic use of these measures in Alberta. These findings highlight the need for province-wide uniform implementation of pediatric PROMs and PREMs in Alberta. Our results could benefit healthcare organizations in developing evidence-based PROM and PREM implementation strategies in pediatrics.

Colostrum Feeding among Newborns Visiting the Outpatient Department of Pediatrics of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Colostrum is the thick yellowish breast milk that is produced during the first 3-5 days of childbirth. Feeding colostrum protects the newborn from various diseases, thus promoting the overall well-being of the newborn. The objective of this study was to find out the prevalence of colostrum feeding among newborns visiting the Department of Pediatrics in a tertiary care centre. Methods: A descriptive cross-sectional study was done among infants presenting to the Department of Pediatrics in a tertiary care centre. Ethical approval was taken from the Institutional Review Committee (Reference number: 2078/079/107). The duration of study was six month from 12 February 2022 to 12 August 2022. A pre-designed questionnaire was used for face-to-face interviews. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 350 newborns, colostrum was fed to 305 (87.14%) (83.63-90.65, 95% Confidence Interval) newborns. A total of 180 (59.02%) were breastfed within 1 hour of delivery. Conclusions: The prevalence of colostrum feeding was higher in our study than in other studies done in similar settings. Keywords: colostrum; exclusive breastfeeding; newborns; prevalence.

Inappropriate supplementation of Vitamin D can result in toxicity: a crosssectional study of paediatrics population.

OBJECTIVE: To evaluate children with suspected or definite hypervitaminosis D with respect to prevalence, clinical manifestations and pharmacological aspects. METHODS: The retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, and comprised medical records from January 1 to December 31, 2018, of children aged <18 years with 25-hydroxyvitamin D levels >50ng/ml. Clinical and pharmacological data was retrieved. Data was analysed using SPSS 23. RESULTS: Of the 118,149 subjects visiting the clinical laboratory during the study period, children tested for serum 25-hydroxyvitamin D levels were 16,316(13.8%) who had a median age of 9.78 years (interquartile range: 10.2 years). Children who registered for consultation were 2720(16.6%), and, out of them, 602(22%) had serum 25-hydroxyvitamin D >50ng/ml. The median 25-hydroxyvitamin D levels and age were 70.1ng/ml (interquartile range: 100ng/ml) and 3.1 years (interquartile range: 17.93 years), respectively, and 345(57.3%) of them were boys. Children supplemented with vitamin D were 197(33.1%) and 193(97.9%) of them were prescribed by physicians. Mega-doses were taken by 68(34.17%), while the remaining had used various combinations in syrup or tablet forms. Commonly prescribed mega-doses were 600,000IU 30((44.1%) and 200,000IU 31(45.5%) injections of vitamin D. The primary indications were pains/aches in 51(25.8%) cases, developmental delay 50(25.3%), and vitamin D deficiency 49(24.8%). The main symptoms of hypervitaminosis D or toxicity were abdominal pain 27(13.7%) and constipation 31(15.7%). CONCLUSIONS: Children should be given vitamin D supplements with caution as prolonged supplementation and repeated mega-doses can result in toxicity which may cause serious consequences.

Pediatrics, Students, Allied Health and COVID-19.

This second issue of JORH for 2023 considers research relating to (1) pediatrics, (2) students, (3) various allied health professions and their related practices, and lastly, (4) COVID-19. An additional reminder is also provided to readers on the call for papers regarding a future issue on "Religion, Spirituality, Suicide, and its Prevention", as well as a new call for papers with respect to "Spiritual Care for People with Parkinson's Disease and their Caregivers".

Recommendations to improve recruitment and retention of underrepresented in medicine trainees in neonatal-perinatal medicine.

Physicians who identify as Black, Latinx, American Indian, Pacific Islander, and certain Asian subgroups represent racial and ethnic populations that are underrepresented in medicine (URM). While the proportion of URM pediatric trainees has remained unchanged, that of Neonatal-Perinatal Medicine (NPM) fellows has decreased. Informed by the medical literature and our lived experiences, we compiled and developed a list of recommendations to support NPM fellowship programs in the recruitment, retention, and promotion of URM trainees. We describe ten recommendations that address 1) creating a culture of inclusivity and psychological safety, 2) the critical appraisal of recruitment practices and climate, and 3) an inclusive and holistic fellowship application process. The first two themes lay the foundation, while the final theme spotlights our recommendations for URM recruitment. Each recommendation is a step towards improvement in recruitment and inclusion at a program.

Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

A experiência intersubjetiva na ludoterapia humanista sob uma perspectiva fenomenológica / The intersubjective experience in humanistic play therapy from the standpoint of phenomenology / La experiencia intersubjetiva en la ludoterapia humanista desde una perspectiva fenomenológica

Esta pesquisa qualitativa objetivou compreender, fenomenologicamente, a experiência vivida por psicoterapeutas e crianças no acontecer clínico da ludoterapia humanista. Foram realizados 26 encontros dialógicos individuais com nove psicoterapeutas e sete crianças, registrados pela pesquisadora na forma de Narrativas Compreensivas que incluíram suas impressões impactadas subjetivamente pelas falas e expressões corporais dos participantes. A análise fenomenológica culminou com a escrita de uma Narrativa Síntese. Os resultados indicam que a relação psicoterapêutica é percebida como: facilitadora do crescimento psicológico da criança; intensificadora do fluxo de mudanças ao dinamizar os processos pessoais infantis; geradora de motivação na criança para a relação interpessoal, a partir do envolvimento subjetivo do terapeuta; potencializadora da tomada de consciência com base na corporeidade; propiciadora da integração de experiências por meio do brincar; reveladora das singularidades individuais, catalisando o desenvolvimento; e, por fim, benéfica à atualização de significados e sentidos da experiência pessoal e relacional. Evidenciou-se, entre os psicoterapeutas, uma concepção da ludoterapia humanista que prioriza a compreensão dirigida ao estilo próprio de cada cliente em relação aos modos de sentir e expressar-se no mundo e à estruturação do processo psicoterapêutico a partir do relacionamento com a criança. Concluiu-se, assim, que a experiência desse tipo de relação interpessoal facilita a constituição na criança de singularidades que imprimem um sentido existencial próprio ao seu mundo de relações e historicidade. A relevância do processo psicoterapêutico para o crescimento psicológico da criança apresentou-se também pelo seu caráter psicoprofilático, reverberado no encadeamento de processos associados à experiência pessoal dela.(AU)

This qualitative research aimed to understand, phenomenologically, the lived experience of psychotherapists and children in the clinical event of humanistic play therapy. A total of 26 individual dialogical encounters were held with nine psychotherapists and seven children, registered in the form of Comprehensive Narratives by the researcher, which included her subjectively impacted impressions about the participants' speeches and body expressions. The phenomenological analysis culminated in a Synthesis Narrative. The results demonstrate that the psychotherapeutic relationship is perceived as: facilitating the child's psychological growth; intensifying the flow of change by streamlining children's personal processes; generating motivation for the child to get involved with interpersonal relationship, based on the subjective involvement of the therapist; potentiating awareness raising based on the corporeality; enabling the integration of experiences by playing; revealing the uniqueness, catalyzing development; and, finally, benefiting the updating of meanings and senses of personal and relational experience. A conception of humanistic play therapy became evident among the psychotherapists, which prioritizes the understanding directed to the own way of each client regarding how to feel and express themselves in the world and the structuring of the psychotherapeutic process based on the relationship with the child. Thus, it was concluded that the experience of this interpersonal relationship facilitates the constitution in the child of singularities that bring their own existential meaning to their world of relationships and historicity. The relevance of the psychotherapeutic process for the child's psychological growth was also shown by the psycho-prophylactic character reverberated in the processes associated with the child's personal experience.(AU)

Esta investigación cualitativa tuvo por objetivo comprender, fenomenológicamente, la experiencia vivida por psicoterapeutas y niños en ludoterapia de orientación humanista. La investigadora desarrolló 26 conversaciones dialógicas individuales con nueve psicoterapeutas y siete niños, registradas como narrativas comprensivas que incluyeron sus impresiones impactadas subjetivamente por los discursos y expresiones corporales de los participantes. El análisis fenomenológico culminó con una síntesis narrativa. Los resultados demuestran que la relación psicoterapéutica se percibe como facilitadora del crecimiento psicológico del niño; intensificadora del flujo de cambio, optimizando su procesos personales; generadora de motivación para que el niño se involucre en la relación interpersonal a partir del envolvimiento subjetivo del terapeuta; potenciadora de la toma de conciencia a partir de la corporeidad; propiciadora de la integración de las experiencias por medio del juego; reveladora de singularidades individuales al catalizar el desarrollo; y beneficiosa para actualizar los significados y sentidos de la experiencia personal e relacional. Entre los psicoterapeutas se hizo evidente una concepción de ludoterapia humanista que prima por comprender la forma propia del cliente de sentirse y expresarse y la estructuración del proceso psicoterapéutico a partir de la relación con el niño. Se concluyó que la vivencia de este tipo de relación facilita la constitución en el niño de singularidades que le aportan un sentido existencial a su mundo de relación e historicidad. La relevancia del proceso psicoterapéutico para el crecimiento psicológico también se mostró por su carácter psicoprofiláctico, que reverberó en la cadena de procesos asociados con la experiencia personal del niño.(AU)

Percepções de familiares sobre uma rede de cuidados de saúde mental infantojuvenil / Family perceptions about a children's mental health network / Percepciones familiares sobre una red de atención de salud mental infantojuvenil

Este artigo pretende conhecer como a rede de cuidados em saúde tem se operacionalizado a partir da percepção de familiares de crianças com demanda de cuidado em saúde mental (SM). Foram realizados dois grupos focais, um com familiares da Atenção Básica (AB) e outro com familiares do Centro de Atenção Psicossocial Infantojuvenil (CAPSij), totalizando 15 participantes. Seguiu-se com a análise lexical do tipo classificação hierárquica descendente, com o auxílio do software R Interface, a fim de análises multidimensionais de textos e questionários (IRaMuTeQ), resultando em cinco classes: A Pílula Mágica; Forças e Fraquezas dos serviços; Procurando por ajuda; Aceitando o diagnóstico da criança e Onde procurei ajuda. Os resultados apontam para dificuldades presentes na AB em identificar e manejar situações de Saúde Mental Infantojuvenil (SMIJ), por meio de uma lógica ainda medicalizante. Ressalta-se que a escola é apresentada como lugar de destaque na produção da demanda por cuidado e a família ainda é pouco convocada à construção das ações. Conclui-se, então, que avanços ainda são necessários para operacionalização de um cuidado pautado nas diretrizes da política de SMIJ.(AU)

This article aims to know how the healthcare network has been operationalized from the perception of family members of children with demand for mental health care (MH). Two focus groups were held, one with family members from Primary Care (PC) and the other with family members from the Child Psychosocial Care Center (CAPSij), totaling 15 participants. A lexical analysis of the descending hierarchical classification type was performed with the help of the software R Interface for multidimensional analyzes of texts and questionnaires (IRAMUTEQ), resulting in five classes: The Magic Pill; Strengths and Weaknesses of services; Looking for help; Accepting the child's diagnosis; and Where did I look for help. The results point to difficulties present in PC in identifying and managing situations of mental health in children and adolescents (MHCA), with a medicalization logic. Note that the school is presented as a prominent place in producing the demand for care, and the family is still not very much involved in the actions. It is, thus, concluded that advances are still needed for operationalization of care guided by MHCA policy guidelines.(AU)

Este artículo tuvo por objetivo conocer cómo opera una red asistencial a partir de la percepción de familiares de niños con demanda de atención en salud mental (SM). Se realizaron dos grupos focales, uno con familiares de Atención Primaria (AP) y otro con familiares del Centro de Atención Psicosocial Infantojuvenil (CAPSij), totalizando 15 participantes. Se realizó análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), lo que resultó en cinco clases: "La píldora mágica"; "Fortalezas y debilidades de los servicios"; "En busca de ayuda"; "Aceptar el diagnóstico del niño" y "¿Dónde busqué ayuda?". Los resultados apuntan las dificultades presentes en AP para identificar y manejar situaciones de salud mental infantojuvenil (SMIJ) mediante una lógica aún medicalizante. La escuela tiene un lugar destacado en la producción de la demanda de cuidados y la familia aún no está muy involucrada en la construcción de acciones. Se concluye que se necesitan avances para ofertar una atención guiada por lineamientos de la política del SMIJ.(AU)

Percepção sobre o cuidado à perda gestacional: estudo qualitativo com casais brasileiros / Perceptions on pregnancy loss care: a qualitative study with brazilian couples / Percepción sobre la atención a la pérdida del embarazo: estudio cualitativo con parejas brasileñas

Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)

This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)

Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)

A nutrição no transtorno do espectro autista: benefícios de intervenções dietéticas na infância / Nutrition in autism spectrum disorder benefits of dietary interventions in childhood / Nutrición en el trastorno del espectro autista: beneficios de las intervenciones dietéticas en la infância

Objetivo: Conduzir uma revisão de literatura com foco na busca de intervenções nutricionais em pacientes pediátricos que apresentam transtorno do espectro autista (TEA). Método: Tratase de uma revisão narrativa realizada entre dezembro de 2022 a janeiro de 2023 nas bases de dados eletrônicas: nas bases de dados MEDLINE, SCIENCE DIRECT, PUBMED, SCIELO, LILACS e Google Acadêmico por meio dos descritores de assunto: transtorno do espectro autista, TEA, autismo, nutrição, terapia nutricional, pediatria, criança, adolescente. Resultados: O uso de dietas contendo nutrientes específicos, além da utilização de suplementos nutricionais, como vitaminas, minerais, ácidos graxos ômega-3 são abordados de forma fornecer evidências atualizadas sobre sua utilização. Conclusão: o uso de intervenções nutricionais pode melhorar algumas questões observadas em pacientes pediátricos com TEA e propiciar uma vida com maior qualidade, garantindo que as necessidades nutricionais da criança sejam atingidas para a promoção do crescimento e desenvolvimento.

Objective: To conduct a literature review focusing on the search for nutritional interventions in pediatric patients with autism spectrum disorder (ASD). Method: This is a narrative review conducted between December 2022 and January 2023 in the electronic databases: in the databases MEDLINE, SCIENCE DIRECT, PUBMED, SCIELO, LILACS and Google Scholar through the subject descriptors: autism spectrum disorder, ASD, autism, nutrition, nutritional therapy, pediatrics, child, adolescent. Results: The use of diets containing specific nutrients, in addition to the use of nutritional supplements such as vitamins, minerals, omega-3 fatty acids are addressed in order to provide updated evidence on their use. Conclusion: the use of nutritional interventions can improve some issues observed in pediatric patients with ASD and provide a higher quality of life, ensuring that the nutritional needs of the child are met to promote growth and development.

Objetivo: Realizar una revisión bibliográfica centrada en la búsqueda de intervenciones nutricionales en pacientes pediátricos con trastorno del espectro autista (TEA). Método: Se trata de una revisión narrativa realizada entre diciembre de 2022 y enero de 2023 en las bases de datos electrónicas: en las bases de datos MEDLINE, SCIENCE DIRECT, PUBMED, SCIELO, LILACS y Google Scholar a través de los descriptores temáticos: trastorno del espectro autista, TEA, autismo, nutrición, terapia nutricional, pediatría, niño, adolescente. Resultados: Se aborda el uso de dietas que contienen nutrientes específicos, además del uso de suplementos nutricionales como vitaminas, minerales, ácidos grasos omega-3 con el fin de proporcionar evidencia actualizada sobre su uso. Conclusión: el uso de intervenciones nutricionales puede mejorar algunos problemas observados en pacientes pediátricos con TEA y proporcionar una mayor calidad de vida, asegurando que se satisfagan las necesidades nutricionales del niño para promover el crecimiento y el desarrollo.

Inspiratory Muscle Rehabilitation Training in Pediatrics: What Is the Evidence?

Pulmonary rehabilitation is typically used for reducing respiratory symptoms and improving fitness and quality of life for patients with chronic lung disease. However, it is rarely prescribed and may be underused in pediatric conditions. Pulmonary rehabilitation can include inspiratory muscle training that improves the strength and endurance of the respiratory muscles. The purpose of this narrative review is to summarize the current literature related to inspiratory muscle rehabilitation training (IMRT) in healthy and diseased pediatric populations. This review highlights the different methods of IMRT and their effects on respiratory musculature in children. Available literature demonstrates that IMRT can improve respiratory muscle strength and endurance, perceived dyspnea and exertion, maximum voluntary ventilation, and exercise performance in the pediatric population. These mechanistic changes help explain improvements in symptomology and clinical outcomes with IMRT and highlight our evolving understanding of the role of IMRT in pediatric patients. There remains considerable heterogeneity in the literature related to the type of training utilized, training protocols, duration of the training, use of control versus placebo, and reported outcome measures. There is a need to test and refine different IMRT protocols, conduct larger randomized controlled trials, and include patient-centered clinical outcomes to help improve the evidence base and support the use of IMRT in patient care.

Expression of LncRNA-BCYRN1 in pediatric asthma and related factors of disease induction.

The study aimed to investigate the expression of lncRNA-BCYRN1 in serum of pediatric asthma patients and the related factors of disease induction. For this purpose, a total of 95 patients were randomly selected from the outpatient department of pediatrics of a hospital affiliated with the medical university from October 2018 to October 2019, including 25 intermittent episodes, 25 mild persistent episodes, 20 moderate persistent episodes, and 20 severe persistent episodes. In addition, serum samples from 30 healthy control children were selected for comparison. The expression levels of lncRNA-BCYRN1 and the inflammatory factors IL-4, IL-12, IL-37, 25-(OH)D in serum were detected by real-time quantitative fluorescence PCR(qrt-PCR), and the influence of the expression of lncRNA-BCYRN1 on the prognosis of children and its correlation with the expression of TNF-a and IgE were analyzed. Results: the expression of LncRNA BCYRN1 was positively correlated with the expression of TNF-α and IgE (r=0.712, 0.748, all P<0.001). Serum IL-4 levels in each group were 21.06±2.93pg/ml, 23.88±3.91pg/ ml, 25.85±4.02pg/ml, and 17.74±1.77pg/ml, respectively. Serum IL-4 levels in each group were higher than those in the normal control group, and the difference was statistically significant (P<0.001). The levels of IL-12, IL-37 and 25-(OH)D in all the affected groups were decreased compared with the normal control group, while the serum levels of IL-37 were negatively correlated with IL-4 and positively correlated with IL-12 and 25-(OH)D. Conclusion: serum IL-4 level of children in the disease group was increased, indicating hyperexpression of Th2 cell function, and serum IL-12 and IL-37 levels were decreased, suggesting decreased Th1 cell function, indicating Th1/Th2 imbalance in children with asthma. The low serum vitamin D level of children in the disease group was negatively correlated with serum IL-4 level and positively correlated with IL-12 and IL-37 levels, which may be the trigger factor of inflammation in asthmatic diseases and should be supplemented in clinical treatment. The expression level of lncRNA-BCYRN1 is related to the severity of pediatric asthma, which can be used as a prognostic indicator and has a certain effect on the prognosis of clinical pediatric asthma.

Espiritualidade

O objetivo dos cuidados paliativos em pacientes pediátricos com câncer é melhorar o bem-estar do paciente e de sua família ao longo da doença, bem como reduzir o sofrimento físico, emocional e espiritual. No âmbito da Iniciativa Global contra o Câncer Infantil, OPAS oferece uma série de módulos sobre cuidados paliativos pediátricos para mães, pais e cuidadores. Cada um contém informações essenciais para poder prestar o melhor atendimento e atender às necessidades decorrentes da doença que afetam tanto o paciente quanto seus entes queridos. A espiritualidade é a forma como nos relacionamos com nós mesmos, com as outras pessoas e com o que é sagrado, seja deus, o cosmos, a natureza ou qualquer ser superior. Adultos e crianças buscam o significado da finitude. a espiritualidade se expressa através das crenças, valores, tradições e práticas. Os cuidados espirituais fazem parte da atenção global e dos cuidados paliativos pediátricos. Este módulo 7 aborda o tema da espiritualidade : o que é? Em que consiste o seu desenvolvimento? Como desenvolvê - la com o menor? Por que é importante realizar práticas espirituais? Ou como as práticas espirituais podem ser realizadas com menores?

Guía clínica para la atención pediátrica de tuberculosis y coinfección TB-VIH. 2ª. ed. / Clinical guideline for pediatric care of tuberculosis and TB-HIV coinfection. 2nd. ed

El Salvador está implementando la estrategia «Fin de la TB¼, que abarca un conjunto de intervenciones que pueden adaptarse plenamente a nivel nacional. Cuenta con diez componentes organizados en tres pilares y cuatro principios fundamentales; requiere la rectoría del SNIS, coordinación sólida con las organizaciones de la sociedad civil y las comunidades, un enfoque basado en derechos humanos, ética y equidad, y la adaptación nacional de la estrategia y las metas. La presente guía unifica conocimientos sobre la enfermedad y criterios de diagnóstico, tratamiento de la TB y la coinfección TB-VIH, para aplicar las medidas de prevención de la TB dentro de los establecimientos del Sistema Nacional Integrado de Salud (SNIS)

El Salvador is implementing the "End TB" strategy, which encompasses a set of interventions that can be fully adapted at the national level. It has ten components organized into three pillars and four fundamental principles; It requires leadership of the SNIS, solid coordination with civil society organizations and communities, an approach based on human rights, ethics and equity, and the national adaptation of the strategy and goals. This guide unifies knowledge about the disease and diagnostic criteria, treatment of TB and TB-HIV coinfection, to apply TB prevention measures within the establishments of the National Integrated Health System (SNIS)