Tiempo de cuidado familiar en la carga de trabajo doméstico y sus efectos en la salud del niño / Family Care Time within Domestic Workloads and its Effects on Child Health

Introducción: El bienestar de los niños depende de un cuidado integral. Es la madre junto a la familia quienes desempeñan un rol importante en el cuidado integral de sus hijos, por lo que el tiempo que le dedican es fundamental. Objetivo: Identificar los efectos del tiempo de cuidado familiar en la carga de trabajo doméstico sobre la salud del niño. Métodos: Estudio cuantitativo, observacional, transversal con diseño ex post facto, realizado en Acomayo, Distrito Chinchao, Provincia Huánuco, Perú, durante enero-diciembre del 2019. Población de 180 madres, muestra de 54 sujetos seleccionados con muestreo aleatorio simple. Se aplicaron: cuestionario de características generales de la madre, ficha de evaluación del estado nutricional del niño, ficha de tamizaje de hemoglobina y ficha de análisis documental de los episodios de enfermedades de los niños, validados y fiabilizados. Se utilizaron frecuencias absolutas y porcentajes, las hipótesis se comprobaron mediante la prueba chi cuadrado para p 0,05. Resultados: Del total de la muestra, 55,55 por ciento disponía de tiempo insuficiente para el cuidado familiar, 42,59 por ciento tenía un tiempo ajustado. Hubo desnutrición aguda en 48,14 por ciento y anemia leve en 46,29 por ciento. Se identificó presencia de al menos un episodio de enfermedad diarreica aguda en 37,03 por ciento, infección respiratoria aguda en 38,88 por ciento y parasitosis en 35,18 por ciento. Conclusiones: El tiempo insuficiente para el cuidado familiar en las cargas de trabajo doméstico tiene efectos desfavorables en la salud infantil, evidenciado con la presencia de desnutrición aguda, anemia, enfermedades diarreicas agudas, infecciones respiratorias agudas. y parasitosis en los niños estudiados (p ≤ 0,05)(AU)

Introduction: The well-being of children depends on comprehensive care. It is the mother, together with the family, who plays an important role in the comprehensive care of their children; therefore, the time they dedicate to such task is essential. Objective: To identify the effects of family care time within domestic workloads on child health. Methods: Quantitative, observational and cross-sectional study, with ex post facto design, carried out, from January to December 2019, in Acomayo, Chinchao District, Huánuco Province, Peru. The population was 180 mothers, while the sample was 54 subjects chosen with simple random sampling. The following instruments, validated and made reliable, were applied: a questionnaire on the mother's general characteristics, an assessing card for the child's nutritional status, a hemoglobin screening card, document analysis card for the children's illness episodes. Absolute frequencies and percentages were used < the hypotheses were verified using the chi-square test for P ≤ 0.05. Results: Of the whole sample, 55.55 percent had insufficient time for family care, while 42.59 percent had an adjusted time. There was acute malnutrition in 48.14 percent and mild anemia in 46.29 percent. The presence of at least one episode of acute diarrheal disease was identified in 37.03 percent; for acute respiratory infection, in 38.88 percent; and for parasitosis, in 35.18 percent. Conclusions: Insufficient family care time within the domestic workloads has unfavorable effects on child health, evidenced by the presence of acute malnutrition, anemia, acute diarrheal diseases, acute respiratory infections and parasitosis in the children studied (P ≤ 0.05)(AU)

A service evaluation of parent adherence with dysphagia management therapy guidelines: reports from family carers supporting children with complex needs in Greece.

Purpose: Many children with complex needs exhibit eating, drinking, and/or swallowing disorders (dysphagia). These children often have associated learning needs, and require assistance from carers for daily tasks such as eating and drinking. The aim of this study was to identify which strategies to manage dysphagia were challenging for family carers, and reasons for any non-adherence.Method: In this service evaluation researchers observed carers during mealtimes, and investigated carer opinions of strategies used to minimise the risks of dysphagia. Eight children with complex needs aged 3.4-7.5 years and their primary family caregiver participated.Results: Adherence with speech and language pathologists' dysphagia recommendations overall was over 50% in all but one case. For specific strategies, the highest adherence was observed for diet modifications of foods (89%), communication during the mealtime (83%), amount of food to present (81%), and the pacing of fluids and foods (81%). Lower levels of adherence were identified in relation to postural management (58%), environmental changes (58%), utensils (56%), and preparatory strategies (49%).Conclusions: Adherence with use of strategies to support mealtimes was over 50% in all but one case. Findings suggest that support is essential to promote safe mealtimes, reduce family carers' stress and increase knowledge, confidence, and adherence in implementing dysphagia guidelines in the family home. Implications for rehabilitationDifficulties with eating, drinking and swallowing (dysphagia) can impact on the parent-child mealtime experience.Mealtime strategies as recommended by a speech-language pathologist can support children who have difficulties eating, drinking, and swallowing.Some strategies to support eating, drinking, and swallowing are easier for carers to adhere to than others.

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels.

Optimal care for children and adolescents with type 1 diabetes is well described in guidelines, such as those of the International Society for Pediatric and Adolescent Diabetes. High-income countries can usually provide this, but the cost of this care is generally prohibitive for lower-income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower-income countries work toward establishing guidelines-based care, it is helpful to describe the levels of care that are potentially affordable, cost-effective, and result in substantially improved clinical outcomes. We have developed a levels of care concept with three tiers: "minimal care," "intermediate care," and "comprehensive (guidelines-based) care." Each tier contains levels, which describe insulin and blood glucose monitoring regimens, requirements for hemoglobin A1c (HbA1c) testing, complications screening, diabetes education, and multidisciplinary care. The literature provides various examples at each tier, including from countries where the life for a child and the changing diabetes in children programs have assisted local diabetes centres to introduce intermediate care. Intra-clinic mean HbA1c levels range from 12.0% to 14.0% (108-130 mmol/mol) for the most basic level of minimal care, 8.0% to 9.5% (64-80 mmol/mol) for intermediate care, and 6.9% to 8.5% (52-69 mmol/mol) for comprehensive care. Countries with sufficient resources should provide comprehensive care, working to ensure that it is accessible by all in need, and that resulting HbA1c levels correspond with international recommendations. All other countries should provide Intermediate care, while working toward the provision of comprehensive care.

Nurses' contributions to good practices in child care: an integrative literature review.

OBJECTIVE: to identify scientific evidence on the contribution of nurses' work to good practices in child care in the Brazilian literature. METHOD: integrative review of the literature, carried out in Latin American and Caribbean in Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), Brazilian Nursing Database (BDENF), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scientific Electronic Library Online (SCIELO) database, from 2008 to 2018. RESULTS: 14 complete studies were selected for interpretative analysis. Two categories allowed responding to the initial questioning of the study, namely: Nurses' contributions in child care; and Limits for the nurse's role in child care. CONCLUSION: evidences show the importance of nurses in child care for the promotion of comprehensive care for children and their families. However, there are socioeconomic, cultural, institutional and technical factors that hinder the nurses' performance in this setting.

Impacts 2 years after a scalable early childhood development intervention to increase psychosocial stimulation in the home: A follow-up of a cluster randomised controlled trial in Colombia.

BACKGROUND: Poor early childhood development (ECD) in low- and middle-income countries is a major concern. There are calls to universalise access to ECD interventions through integrating them into existing government services but little evidence on the medium- or long-term effects of such scalable models. We previously showed that a psychosocial stimulation (PS) intervention integrated into a cash transfer programme improved Colombian children's cognition, receptive language, and home stimulation. In this follow-up study, we assessed the medium-term impacts of the intervention, 2 years after it ended, on children's cognition, language, school readiness, executive function, and behaviour. METHODS AND FINDINGS: Study participants were 1,419 children aged 12-24 months at baseline from beneficiary households of the cash transfer programme, living in 96 Colombian towns. The original cluster randomised controlled trial (2009-2011) randomly allocated the towns to control (N = 24, n = 349), PS (N = 24, n = 357), multiple micronutrient (MN) supplementation (N = 24, n = 354), and combined PS and MN (N = 24, n = 359). Interventions lasted 18 months. In this study (26 September 2013 to 11 January 2014), we assessed impacts on cognition, language, school readiness, executive function, and behaviour 2 years after intervention, at ages 4.5-5.5 years. Testers, but not participants, were blinded to treatment allocation. Analysis was on an intent-to-treat basis. We reassessed 88.5% of the children in the original study (n = 1,256). Factor analysis of test scores yielded 2 factors: cognitive (cognition, language, school readiness, executive function) and behavioural. We found no effect of the interventions after 2 years on the cognitive factor (PS: -0.031 SD, 95% CI -0.229-0.167; MN: -0.042 SD, 95% CI -0.249-0.164; PS and MN: -0.111 SD, 95% CI -0.311-0.089), the behavioural factor (PS: 0.013 SD, 95% CI -0.172-0.198; MN: 0.071 SD, 95% CI -0.115-0.258; PS and MN: 0.062 SD, 95% CI -0.115-0.239), or home stimulation. Study limitations include that behavioural development was measured through maternal report and that very small effects may have been missed, despite the large sample size. CONCLUSIONS: We found no evidence that a scalable PS intervention benefited children's development 2 years after it ended. It is possible that the initial effects on child development were too small to be sustained or that the lack of continued impact on home stimulation contributed to fade out. Both are likely related to compromises in implementation when going to scale and suggest one should not extrapolate from medium-term effects of small efficacy trials to scalable interventions. Understanding the salient differences between small efficacy trials and scaled-up versions will be key to making ECD interventions effective tools for policymakers. TRIAL REGISTRATION: ISRCTN18991160.

Nurses' contributions to good practices in child care: an integrative literature review / Contribuciones de los enfermeros para buenas prácticas en la puericultura: revisión integrativa de la literatura / Contribuições do enfermeiro para boas práticas na puericultura: revisão integrativa da literatura

ABSTRACT Objective: to identify scientific evidence on the contribution of nurses' work to good practices in child care in the Brazilian literature. Method: integrative review of the literature, carried out in Latin American and Caribbean in Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), Brazilian Nursing Database (BDENF), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scientific Electronic Library Online (SCIELO) database, from 2008 to 2018. Results: 14 complete studies were selected for interpretative analysis. Two categories allowed responding to the initial questioning of the study, namely: Nurses' contributions in child care; and Limits for the nurse's role in child care. Conclusion: evidences show the importance of nurses in child care for the promotion of comprehensive care for children and their families. However, there are socioeconomic, cultural, institutional and technical factors that hinder the nurses' performance in this setting.

RESUMEN Objetivo: identificar en la literatura brasileña las evidencias científicas sobre la contribución del trabajo del enfermero a buenas prácticas en la puericultura. Método: revisión integrativa de la literatura, realizada en las bases de datos Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), Base de Dados de Enfermagem (BDENF), Cumulative Index to Nursing and Allied, en la base de datos bibliográfica de Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) (CINAHL) y Scientific Eletronic Library Online (SCIELO), en el período de 2008 a 2018. Resultados: se seleccionaron 14 estudios completos para análisis interpretativo. Dos categorías permitieron responder al cuestionamiento inicial del estudio, a saber: Contribuciones del enfermero en la puericultura y Límites para la actuación del enfermero en la puericultura. Conclusión: las evidencias apuntan la importancia del enfermero en la puericultura para la promoción de un cuidado integral a los niños y sus familias. Sin embargo, existen factores socioeconómicos, culturales, institucionales y técnicos que dificultan la actuación del enfermero en ese escenario.

RESUMO Objetivo: identificar na literatura brasileira as evidências científicas sobre a contribuição do trabalho do enfermeiro para boas práticas na puericultura. Método: revisão integrativa da literatura, realizada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Literatura Internacional em Ciências da Saúde (MEDLINE), Base de Dados de Enfermagem (BDENF), Cumulative Index to Nursing and Allied Health Literature (CINAHL) e Scientific Eletronic Library Online (SCIELO), no período de 2008 a 2018. Resultados: foram selecionados 14 estudos completos para análise interpretativa. Duas categorias permitiram responder ao questionamento inicial do estudo, a saber: Contribuições do enfermeiro na puericultura; e Limites para a atuação do enfermeiro na puericultura. Conclusão: as evidências apontam a importância do enfermeiro na puericultura para a promoção de um cuidado integral às crianças e suas famílias. Contudo, existem fatores socioeconômicos, culturais, institucionais e técnicos que dificultam a atuação do enfermeiro nesse cenário.

Historia de la Puericultura en Cuba / History of Puericulture in Cuba

En la Edad Media los niños eran tratados como adultos pequeños. A partir del Renacimiento surge mayor interés en la infancia. En 1722 aparece el término Pediatría en la Europa Central, y en 1865, por primera vez, es acuñado el término Puericultura por Alfred Pierre Caron, profesor en la Universidad de París. Realizar consultas de Puericultura en la primera mitad del siglo XX en Cuba era prácticamente un lujo. Con el sistema único de salud y cobertura total de la atención primaria a partir de 1959, se lograron establecer consultas de Pediatría (1960) y Puericultura (1963) en los policlínicos. El nuevo enfoque de la práctica médica preventivo-curativa influyó en el desarrollo de la Puericultura, con programas como: Atención integral al niño y la mujer, la normación de las especialidades, la reducción de la mortalidad infantil, la medición de indicadores de salud en la población cubana de 0 a 19 años, la dispensarización de niños y adolescentes, Puericultura prenatal, así como la evaluación de Hospitales y policlínicos Amigos de la madre y el niño. En 2004 fue creado un grupo multidisciplinario para el rescate de la calidad de las consultas de Puericultura, y se inauguró el Centro de Referencia Nacional de Puericultura en el año 2007, con funciones docentes, de investigación, asistenciales-metodológicas y administrativas. Sorprende la búsqueda de cómo se introdujo en Cuba la Puericultura, a través de Infomed e Internet, visitas a bibliotecas especializadas y la Oficina del Historiador del Ministerio de Salud Pública(AU)

In the Middle Age, children were treated as small adults. As of Renassaince, more interest on childhood was aroused. In 1722, the term Pediatrics appears in Central Europe, and in 1865 for the first time the term Puericulture was coined by Alfred Pierre Caron, professor at the University of Paris. The puericulture service in Cuba in the first half of the 20th century was a sort of luxury. After 1959, the unique health system and the total coverage of primary health care managed to set pediatric (1960) and puericulture (1963) services in polyclinics. The new approach to the preventive-healing medical practice had an impact on the development of puericulture with programs such as comprehensive care to the child and the woman, the standardization of specialties, the reduction of infant mortality, the evaluation of health indicators in the Cuban 0-19 years old population, the classification of the health conditions of children and adolescents, prenatal puericulture as well as the evaluation of Friends of the mother and the child hospitals and polyclinics. In 2004, a multidisciplinary group was created to rescue the quality of the puericultural service and the National Center of Reference of Puericulture was opened up in 2007 which carries out teaching, research, assistance-methodological and administrative functions. The information search through Infomed and Internet, visits to specialized libraries and to the office of the historian of the Ministry of Public Health about how puericulture was introduced in Cuba shows surprising aspects(AU)

Improving feeding and growth of HIV-positive children through nutrition training of frontline health workers in Tanga, Tanzania.

BACKGROUND: Nutrition training can boost competence of health workers to improve children's feeding practices. In this way, child undernutrition can be ameliorated in general populations. However, evidence is lacking on efficacy of such interventions among Human Immunodeficiency Virus (HIV)-positive children. We aimed to examine the efficacy of a nutrition training intervention to improve midlevel providers' (MLPs) nutrition knowledge and feeding practices and the nutrition statuses of HIV-positive children in Tanga, Tanzania. METHODS: This cluster-randomized controlled trial was conducted in 16 out of 32 care and treatment centers (CTCs) in Tanga. Eight CTCs were assigned to the intervention arm and a total of 16 MLPs received nutrition training and provided nutrition counseling and care to caregivers of HIV-positive children. A total of 776 pairs of HIV-positive children and their caregivers were recruited, of whom 397 were in the intervention arm. Data were analyzed using instrumental variable random effects regression with panel data to examine the efficacy of the intervention on nutrition status through feeding practices. RESULTS: Mean nutrition knowledge scores were higher post-training compared to pre-training among MLPs (37.1 vs. 23.5, p < 0.001). A mean increment weight gain of 300 g was also observed at follow-up compared to baseline among children of the intervention arm. Feeding frequency and dietary diversity improved following the intervention and a 6 months follow-up (p < 0.001). An increase in each unit of feeding frequency and dietary diversity were associated with a 0.15-unit and a 0.16-unit respectively decrease in the child underweight (p < 0.001). CONCLUSIONS: Nutrition training improved nutrition knowledge among MLPs caring for HIV-positive children attending CTCs in Tanga, Tanzania. Caregivers' feeding practices also improved, which in turn led to a modest weight gain among HIV-positive children. To sustain weight gain, efforts should be made to also improve households' food security and caregivers' education in addition to inservice nutrition trainings. The protocol was registered on 15/02/2013, before the recruitment at ISRCTN trial registry with the trial registration number: ISRCTN65346364.

Sección de Gastroenterología Infantil del Hospital Universitario Gregorio Marañón / Pediatric Gastroenterology section of the Hospital Universitario Gregorio Marañón

La Sección de Gastroenterología, Hepatología y Nutrición Infantil del Hospital Materno Infantil del HGU Gregorio Marañón se dedica a la atención integral del paciente pediátrico con patología digestiva y con especial dedicación a la nutrición del niño enfermo en diferentes situaciones especiales (enfermedades oncohematológicas, niños con cardiopatías congénitas, enfermedades neuromusculares, postoperatorio de diferentes patologías quirúrgicas, enfermedades del riñón, enfermedades metabólicas, etc.). Dentro de las actividades asistenciales de la sección cabe destacar el seguimiento de diferentes patologías digestivas crónicas, como la enfermedad celíaca, la dedicación especial con novedosos proyectos asistenciales y de investigación en la enfermedad inflamatoria intestinal, así como la asistencia en enfermedades crónicas del hígado y páncreas, entre otras. En esta Sección se han desarrollado nuevas técnicas diagnósticas y se han fortalecido la aplicación de otras exploraciones complementarias complejas en el estudio de enfermedades digestivas, convirtiéndose en centro de referencia de algunas de ellas como sucede en el caso de trastornos de motilidad digestiva o el estudio de la microbiota intestinal. En este artículo se refleja la estructura de la unidad junto con una revisión de su actividad asistencial en patologías digestivas cada vez más complejas, la elaboración de las tareas docentes realizadas en nuestro centro y para otras entidades con gran difusión de las mismas, así como la importante labor de investigación clínica con participación en diferentes líneas de investigación (AU)

The Paediatric Gastroenterology, Hepatology and Nutrition Section of Maternal and Child Hospital HGU Gregorio Maranon is dedicated to comprehensive care of pediatric patients with digestive diseases with special attention to the nutrition of the sick child in different special situations (oncohaemathologic diseases, complex heart diseases, neuropaediatric diseases, postoperative of different surgical diseases, kidney diseases, metabolíc diseases…). Within the humanitarian assistance activities of the Section include monitoring of different chronic digestive diseases, such as celiac disease, special dedication to innovative care projects and research in inflammatory bowel disease, and such as assistance in chronic diseases of the liver and pancreas, among others. On the other hand, in our section we have developed new diagnostic techniques and strengthened the implementation of other complex complementary examinations in the study of digestive diseases, becoming a reference center for some of them as happens in the case of motility disorders and research of microbiome. In this article, the structure of the Section is reflected along with a review of their daily work in increasingly complex digestive diseases, as well as educational activities in our center and to other entities with widely distributed thereof, as well as the important work of clinical research with participation in different lines of research (AU)

Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services.

BACKGROUND: Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. OBJECTIVES: The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to:1. describe the impact of such strategies on childcare service staff knowledge, skills or attitudes;2. describe the cost or cost-effectiveness of such strategies;3. describe any adverse effects of such strategies on childcare services, service staff or children;4. examine the effect of such strategies on child diet, physical activity or weight status. SEARCH METHODS: We searched the following electronic databases on 3 August 2015: the Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, ERIC, CINAHL and SCOPUS. We also searched reference lists of included trials, handsearched two international implementation science journals and searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). SELECTION CRITERIA: We included any study (randomised or non-randomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. DATA COLLECTION AND ANALYSIS: The review authors independently screened abstracts and titles, extracted trial data and assessed risk of bias in pairs; we resolved discrepancies via consensus. Heterogeneity across studies precluded pooling of data and undertaking quantitative assessment via meta-analysis. However, we narratively synthesised the trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). MAIN RESULTS: We identified 10 trials as eligible and included them in the review. The trials sought to improve the implementation of policies and practices targeting healthy eating (two trials), physical activity (two trials) or both healthy eating and physical activity (six trials). Collectively the implementation strategies tested in the 10 trials included educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing. A total of 1053 childcare services participated across all trials. Of the 10 trials, eight examined implementation strategies versus a usual practice control and two compared alternative implementation strategies. There was considerable study heterogeneity. We judged all studies as having high risk of bias for at least one domain.It is uncertain whether the strategies tested improved the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention. No intervention improved the implementation of all policies and practices targeted by the implementation strategies relative to a comparison group. Of the eight trials that compared an implementation strategy to usual practice or a no intervention control, however, seven reported improvements in the implementation of at least one of the targeted policies or practices relative to control. For these trials the effect on the primary implementation outcome was as follows: among the three trials that reported score-based measures of implementation the scores ranged from 1 to 5.1; across four trials reporting the proportion of staff or services implementing a specific policy or practice this ranged from 0% to 9.5%; and in three trials reporting the time (per day or week) staff or services spent implementing a policy or practice this ranged from 4.3 minutes to 7.7 minutes. The review findings also indicate that is it uncertain whether such interventions improve childcare service staff knowledge or attitudes (two trials), child physical activity (two trials), child weight status (two trials) or child diet (one trial). None of the included trials reported on the cost or cost-effectiveness of the intervention. One trial assessed the adverse effects of a physical activity intervention and found no difference in rates of child injury between groups. For all review outcomes, we rated the quality of the evidence as very low. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used in this review. AUTHORS' CONCLUSIONS: Current research provides weak and inconsistent evidence of the effectiveness of such strategies in improving the implementation of policies and practices, childcare service staff knowledge or attitudes, or child diet, physical activity or weight status. Further research in the field is required.

Imagen musculoesquelética en la urgencia pediátrica. Lo esencial a través de tres escenarios clínicos / Musculoskeletal imaging in pediatric emergencies: the basics through three clinical scenarios

La patología musculoesquelética pediátrica representa un alto porcentaje de los estudios solicitados al radiólogo de guardia. Al tratarse de huesos y articulaciones inmaduros, en constante crecimiento y remodelación, presentan peculiaridades fisiológicas y anatómicas propias que condicionan la necesidad de un abordaje específico para la edad pediátrica. Mediante tres escenarios clínicos (cojera, fracturas e infecciones osteoarticulares) hemos querido resumir y transmitir los conceptos esenciales de la radiología musculoesquelética en la urgencia pediátrica (AU)

A high percentage of the pediatric imaging studies requested during calls are related to musculoskeletal disease. Since bones and joints in children are immature, constantly growing and remodeling, they have physiological and anatomical peculiarities that make it necessary to use an approach specific for pediatric patients. In this article, we use three clinical scenarios (limping, fractures, and musculoskeletal infections) to summarize and transmit the concepts that are essential in emergency musculoskeletal imaging in children (AU)

Programa de protección de madres adolescentes de niños hospitalizados "Cuidando a las cuidadoras". Primeros dos años de experiencia / Protection program for teen mothers of hospitalized children "Caring for caregivers". First two years of experience

Introducción: "Cuidando a las cuidadoras" consiste en un programa interdisciplinario e intersectorial que brinda desde el año 2013 atención integral a las madres de niños hospitalizadas protegiendo sus derechos. Objetivos: describir un programa de protección de adolescentes que aproxima al sistema de salud a las madres de niños hospitalizados. Método: diseño: observacional, descriptivo. Período: 1 de marzo de 2013 al 1 de marzo de 2015. Criterios de inclusión: madres y/o cuidadoras menores de 19 años de los niños hospitalizados en cuidados moderados del CHPR. Se indagaron variables sociodemográficas, características del embarazo, conocimientos sobre el cuidado del hijo, hábitos de autocuidado. Resultados: se entrevistaron 208 madres y 2 cuidadoras hospitalizadas con sus niños. 195 no controladas en salud. Rango de edad: 14-19 años. Todas solteras y 11 conviviendo con su pareja. Nivel educativo: 150 terminaron primaria, 22 hasta tercer año de secundaria, abandono: 45 primaria, 128 secundaria. Se derivaron 180 cuidadoras al servicio de salud sexual y reproductiva. Las adolescentes decidieron iniciar medidas anticonceptivas en 110 casos. En 26 casos se logró la cobertura odontológica. En 21 se realizó consulta con oftalmología. En 26 se logró realizar conexión con programas socioeducativos logrando reinserción a nivel educativo. Todas las cuidadoras fueron controladas en salud, se les brindó el carnet de control de adolescentes y se realizó la contrarreferencia al primer nivel de atención. Discusión: ésta es la primera experiencia de abordaje de atención a la salud de cuidadoras de niños hospitalizados. Se detectó gran vulnerabilidad en las adolescentes incluidas, logrando un acercamiento a los servicios de salud y educativos.

Introduction: "Caring for the caregivers" is an interdisciplinary and intersectorial program offered since 2013, which offers comprehensive care to mothers of hospitalized children by protecting their rights. Objective: To describe a protection program for teenagers that aims to bring teenage mothers of hospitalized children into the health system. Method: Design: observational, descriptive study. Period: 1/3/2013 - 1/3/2015. Inclusion criteria: mothers and / or caregivers under 19 years old. Results: 208 mothers and 2 caregivers hospitalized with their children were interviewed. 195 of them had no regular control or follow-up in the health system. Age range: 14-19 years. All of them were single and 11 lived with a partner. Education level: 150 had completed primary school, 22 had completed the third year of secondary school. Dropouts: 45 primary school, 128 secondary school. 180 caregivers were referred to the sexual and reproductive health service. 110 teenagers decided to adopt contraceptive methods. In 26 cases the dental coverage was achieved. 21 teenagers consulted ophthalmologists. In 26 cases, it was possible to refer them to existing social programs to help them resume education. All caregivers were controlled as to their health condition, they received their health card and tests were recorded in the first level of care. Discussion: This is the first experience to address the health services provision for caregivers of hospitalized children. Great vulnerability was identified in the adolescents included in the study, and it was possible to include them both in the health and education systems.

Alimentación de las pacientes durante la etapa de puerperio atendidas en el hospital básico Shushufindi / Food intake patients during puerperium tretaed at the basic hospital Shushufindi

Fundamentos: Algunas creencias y costumbres relacionadas con la alimentación en mujeres indígenas pueden ocasionar problemas en el embarazo y post-parto. Objetivo: El objetivo de esta investigación es conocer la relación entre alimentación, creencias y costumbres asociadas al puerperio en mujeres indígenas atendidas en el Hospital Básico Shushufindi. Métodos: Se realizó una encuesta para determinar las características culturales y costumbres alimentarias que mantenían durante su puerperio, así como los alimentos más consumidos. Resultados/Conclusión: Entre los principales resultados se observó que las pacientes mantenían malos hábitos alimenticios durante esta etapa, debido a las costumbres y creencias que han venido adquiriendo en sus hogares, y que traen consigo altos índices de anemia acompañados de problemas digestivos, que las obliga a consumir suplementos nutricionales (AU)

Background: Some believes and used in native women, related to food practices may lead to health problems during pregnancy and post-partum. Objective: The objective of this investigation is to know the relationship between food, beliefs, and custom associated with the puerperium in indigenous women who attended in the Hospital Basico Shushufindi. Methods: We realized a survey to determine the cultural characteristics and food customs that they maintain during the puerperium, just like the food most consumed. Results/Conclusions: Between the principal results we observed that the patients maintained bad food habits during this stage, due to the customs and beliefs that they had acquired in their houses, and they bring high rates of anemia accompanied by digestive problems, forcing them to consume nutritional supplements (AU)

Hospitalización a domicilio. Una alternativa asistencial / Hospital at home. A care alternative

La hospitalización a domicilio (HADO) supone una alternativa asistencial capaz de dispensar asistencia médica de rango hospitalario a los pacientes en sus domicilios, cuando ya no precisan de la infraestructura hospitalaria. Proporciona una atención integral al enfermo de determinadas patologías crónicas y agudas y permiten a los niños enfermos permanecer en el domicilio, rodeados de sus familiares y en su entorno. En otros países la hospitalización a domicilio está ampliamente desarrollada en adultos y en el ámbito pediátrico. En España, aunque es una realidad creciente, resulta aún insuficiente y precisa un mayor desarrollo para proporcionar una atención adecuada de los niños enfermos en sus domicilios (AU)

Hospital at Home (HaH) is a care alternative capable of providing hospital range medical care to patients in their homes when they do not require the hospital infrastructure. It provides comprehensive care to the patient with certain chronic and acute conditions and permits ill children to remain at home, surrounded by their family and environment. In other countries, hospital at home is widely developed in adults and in the pediatric setting. In Spain, although in is growing at present, greater development to provide adequate care of ill children in their homes is still insufficient and precise (AU)

A population-based study of how children are exposed to saliva in KwaZulu-Natal Province, South Africa: implications for the spread of saliva-borne pathogens to children.

OBJECTIVES: In sub-Saharan Africa, many viral infections, including Epstein-Barr virus, cytomegalovirus, Kaposi's sarcoma-associated herpesvirus and hepatitis B are acquired in childhood. While saliva is an important transmission conduit for these viruses, little is known about how saliva is passed to African children. We endeavoured to identify the range and determinants of acts by which African children are exposed to saliva. METHODS: To identify the range of acts by which African children are exposed to saliva, we conducted focus groups, semi-structured interviews and participant observations in an urban and a rural community in South Africa. To measure the prevalence and determinants of the identified acts, we administered a questionnaire to a population-based sample of caregivers. RESULTS: We identified 12 caregiving practices that expose a child's oral-respiratory mucosa, cutaneous surfaces or anal-rectal mucosa to saliva. Several acts were heretofore not described in the contemporary literature (e.g., caregiver inserting finger lubricated with saliva into child's rectum to relieve constipation). Among 896 participants in the population-based survey, many of the acts were commonly practised by all respondent types (mothers, fathers, grandmothers and siblings). The most common were premastication of food, sharing sweets and premastication of medicinal plants that are spit onto a child's body. CONCLUSIONS: African children are exposed to saliva through a variety of acts, practised by a variety of caregivers, with no single predominant practice. This diversity poses challenges for epidemiologic work seeking to identify specific saliva-passing practices that transmit viruses. Most acts could be replaced by other actions and are theoretically preventable.

Asthma knowledge and behaviours among mothers of asthmatic children in Aseer, south-west Saudi Arabia.

Mothers of children with bronchial asthma consecutively admitted to Aseer central hospital, Saudi Arabia (n = 171), were interviewed using a questionnaire based on the Chicago Community Asthma Survey to study their knowledge and behaviours concerning bronchial asthma. The least known information among mothers was the complications of bronchial asthma. Breathing exercises during asthma attacks were the least practised behaviour. In a multivariate analysis, significant risk factors for poor knowledge and behaviours among mothers were female sex of the child, illiterate mother and young age of mother (< 30 years). More education is needed to help the mothers of asthmatic children to acquire the necessary knowledge and practices to care for their children.

Recomendaciones para los cuidados respiratorios del niño y adolescente con enfermedades neuromusculares / Respiratory care for the children and adolescents with neuromuscular diseases

El compromiso del sistema respiratorio repercute directamente en la morbimortalidad de niños y adolescentes con enfermedades neuromusculares (ENM). Un enfoque integral que incluya la aproximación a un diagnostico neurológico específico, evaluación funcional respiratoria, de los trastornos respiratorios de sueño, comorbilidades y afecciones secundarias, permiten orientar a el tipo, grado y pronóstico respiratorio; además de otorgar herramientas objetivas para modificar la historia natural de la enfermedad. Utilizar criterios estrictos de selección, una mirada interdisciplinaria y actividades complementarias de rehabilitación; que incorporen en forma programática la ventilación no invasiva domiciliaria, protocolos de tos asistida y métodos para aumentar la capacidad máxima de insuflación, cambia la evolución, disminuye la morbimortalidad y evita la traqueostomía, en una alta proporción de niños y adolescentes portadores de ENM.

Child health promotion and protection among Mexican mothers.

For numerous reasons, children of Mexican descent experience many health disparities. One strategy for addressing these disparities is to increase health promotion and protection behaviors that mothers use with their preschool children. Limited literature is available on such practices used by mothers of Mexican descent with their healthy preschool children. This study explored child health promotion and protection practices used by mothers of Mexican descent. A naturalistic design, guided by Spradley's ethnographic interview techniques, was selected for this study. The sample included 9 Mexican-descent mothers from an urban U.S. community with healthy preschool children. Despite significant challenges, participants promoted and protected the health of their preschool children by al cuidado (taking care) and by being al pendiente (being mindful) of balancing the health of their children's bodies, minds, and souls. Understanding these mothers' approaches allows the creation of culturally sensitive health programs that can build on existing maternal strengths.

Children's wishes: holistic revelations in art.

Expressions of children who have life-threatening illnesses are revealed in their art that provides a way for adults to know how they are experiencing their world. The language of children is unsophisticated; however, they speak meaningfully through their drawings. Children use symbols and images to represent elements in circumstances they are trying to understand. The purpose of this article is to show how the drawings of children with life-threatening illnesses who had special wishes fulfilled reveal meaning that translates into holistic practices.

How do parents of children with juvenile idiopathic arthritis (JIA) perceive their therapies?

BACKGROUND: Complementary and alternative medical (CAM) therapies are commonly used by pediatric patients with chronic medical conditions. Little is known about parents' perceptions of these therapies. This study describes the views of parents of patients with juvenile idiopathic arthritis (JIA) regarding conventional and CAM therapies. METHODS: Parents of children with JIA seen at a pediatric rheumatology clinic were surveyed between June 1 and July 31, 2007. Questionnaires asked about patients' use of over 75 therapies in the past 30 days, their perceived helpfulness (0 = not helpful; 3 = very helpful), perceived side effects (0 = none; 3 = severe), and whether each therapy would be recommended to other patients with JIA (Yes, No, Not sure). RESULTS: Questionnaires were returned by 52/76 (68%) parents; patients' average age was 10.9 years and 87% were Caucasian. Medications were used by 45 (88%) patients; heat (67%) and extra rest (54%) were also commonly used. CAM therapies were used by 48 (92%), e.g., massage (54%), vitamins and other supplements (54%), avoiding foods that worsened pain (35%) and stress management techniques (33%). Among the therapies rated by 3 or more parents, those that scored 2.5 or higher on helpfulness were: biologic medications, methotrexate, naproxen, wheelchairs, orthotics, heat, vitamins C and D, music, support groups and prayer. CAM therapies had 0 median side effects and parents would recommend many of them to other families. CONCLUSION: JIA patients use diverse therapies. Parents report that many CAM therapies are helpful and would recommend them to other parents. These data can be used in counseling patients and guiding future research.