Safety of Antiretroviral Therapy in the Treatment of HIV/AIDS in Children: Systematic Review and Meta-analysis.

The safety of using different antiretroviral therapies (ART) in pediatric HIV/AIDS patients is not well-established. Therefore, this study aimed to assess the safety of ART in children. A systematic review of randomized clinical trials (RCTs) was conducted to assess the safety of ART used by pediatric patients living with HIV/AIDS. The electronic search was conducted in PubMed and Scopus, in addition to a manual search. Studies were included if they assessed the safety of ART compared to placebo or another ART. Direct and indirect meta-analyses were conducted regarding safety outcomes. The systematic review included 21 RCTs. The studies included more than 5500 participants, and age ranged from 3 months to 18 years. The drugs evaluated were nucleoside reverse transcriptase inhibitors (NRTI); non-NRTI; and protease inhibitors. The predominant route of infection was vertical. Direct meta-analyses were performed for the outcomes sleep disorders, hepatobiliary disorders, respiratory disorders, hypertransaminasemia, neutropenia, hospitalization, and death. For these outcomes, no statistically significant differences were found. Indirect meta-analyses were performed for the outcomes anemia, gastrointestinal disorders, liver disorders, severe adverse events (AE), AE that led to changes in treatment, fever, and skin manifestations. However, no statistically significant differences were found for these outcomes. In this study, non-significant differences were detected in the safety of different ART used in pediatric individuals. The choice of appropriate therapy should be based on its efficacy and the individual characteristics of each patient.

Impact of child restraint policies on child occupant fatalities and injuries in Chile and its regions: An interrupted time-series study.

OBJECTIVES: We assessed the effectiveness of the child restraint legislation (CRL) introduced in Chile in December 2005 and the National Decree enacted in February 2007, which regulated the technical characteristics of child restraint devices with the goal of reducing child occupant fatalities and severe injuries nationally and within Chile's regions. METHODS: An interrupted time-series design was used to measure the effect of CRL and the National Decree on two dependent variables-number of child occupant deaths in traffic collisions and number of child occupants severely injured in traffic collisions per vehicle fleet from 2002 to 2014 (police data). Our analyses compared the incidence of these outcomes in the post-intervention period (2006 to 2014) with the period prior to these interventions (2002-2005) nationally and by region, controlling for several confounders. RESULTS: Nationally, the child restraint policies were associated with a 39.3% (95% CI: 4.7; 73.9) reduction in child occupant fatalities, but no significant decrease was observed in child severe injuries. These interventions were associated with a 75.3% (95% CI: 15.6; 135.1) reduction in the rate of child occupant fatalities in the southern regions, and a 32.9% (95% CI: 1.1; 67.0) reduction in the rate of children severely injured in the northern regions. CONCLUSION: In the short term, the CRL and the National Decree were associated with fewer child occupant fatalities, at the national level and in the southern regions, and severely injured child occupants in traffic collisions in Chile's northern regions. These results demonstrate a limited temporal and territorial impact. This suggests that to effectively protect vulnerable populations across all territories, efforts should be expanded more consistently and sustained over time.

Are child passenger fatalities and child passenger severe injuries equally affected by child restraint legislation? The case of Chile.

The objective of this study is to determine the contribution of Chile's 2005 child restraint legislation to the reduction of child passenger fatalities and severe injuries. We analysed motor vehicle injury and fatality data from Chile's National Road Safety Commission of the Ministry of Transport from 2000 to 2012 to determine the effect of Chile's 2005 mandatory child restraint legislation. Using interrupted time-series Poisson regression models, we assessed the effect of the law on two dependent variables: (1) number of child fatalities in car and (2) number of children severely injured. The independent variable was the 2005 enactment of Chile's mandatory child restraint legislation. Coefficients from the interrupted time-series Poisson regression models indicate that Chile's enactment of child restraint legislation in 2005 is significantly associated with a total of 35% reduction in child passenger severely injured but only three years after its enactment, and significant associations between this policy and child fatalities were less evident.

Parental awareness and perception for correct use of child restraint systems and airbags in Brazil.

OBJECTIVE: The objective of this study was to obtain information about the current knowledge and habits of parents who transport children in cars in Brazil. METHODS: A cross-sectional survey was conducted using specifically designed self-report questionnaires to parents of children attending a private pediatric office in a town in southwest Brazil. Data were collected regarding children's age, gender, height, and weight and possession of an automobile child restraint system (CRS), its type, frequency and adequacy of use, and reasons for not possessing or not using the devices. Parents were asked whether their cars were equipped with airbags and about the use of the restraints in seats with airbags. RESULTS: We interviewed parents of 293 children transported in cars who met the criteria for use of a CRS. Children were younger than 1 year in 15.3% of the cases, between 1 and 4 years in 38.6%, and older than 4 in 46.1%. Cars were equipped with CRS in 78.5% of the cases, but in only 58% of the cases was the device proper for child's age and adequately installed in the seat. Among owners of the devices, 84.3% reported that they always used it. Reasons for infrequency were forgetting the device at home or in another car (6.4%), the child disliking the device (3.2%), or the false impression that the child was grown enough not to use it (3.2%)l 87.1% did not justify why they did not always use the CRS. Considering type of CRS, correct installation of the seat, and frequency of use, only 44.4% of children under 1 year, 69.9% of those 1 to 4 years, and 52.6% over age 4 were protected. Only 28.6% of the parents knew that children should never be positioned in a seat with active airbags. CONCLUSION: Considering appropriateness for age, correctness of installation (in the back seat in the correct orientation), and frequency of use, only 50.85% (149/293) of the children were reported as always protected with a CRS. Children between 1 and 4 years were more likely to always use a CRS in this Brazilian survey. We were also able to identify an important gap in the knowledge about airbags among parents. Further efforts are needed to correct those distortions.

Prevalence and characteristics of child victims in motor vehicle collisions in Panama.

OBJECTIVE: Fatalities from motor vehicle collisions are one of the leading causes of death among children in developed countries. Previous publications have shown that the rate is approximately 4 times higher in Latin American countries. We aimed to determine the prevalence and characteristics of child victims of motor vehicle collisions in Panama and to compare them with data from a more developed country. In this study, Spain was the country chosen for such comparison. METHODS: A descriptive and retrospective study on the prevalence and characteristics of child victims from motor vehicle collisions that occurred from 2005 to 2012 in Panama was performed. To carry out this study, the records pertaining to victims of motor vehicle collisions in Panama were obtained from the National Institute of Statistics and Census and the Spanish data were obtained from the Road Accident Report. The variables analyzed were age, sex, number of victims, number of injuries, number of fatalities, and type of motor vehicle collision. RESULTS: The child mortality rate in Panama by motor vehicle collisions during the evaluated time period ranged from 2.11 to 3.63, whereas mortality rates in Spain ranged from 0.6 to 1.9, making rates in Panama 3 to 4 times higher than the rates observed in Spain. Children under 5 years old were the group with the highest number of fatalities in Panama. CONCLUSIONS: In Panama, a lack of specific legislation on the use of child restraints (car seats) as well as a lack of information and awareness campaigns could be responsible for the high toll of child victims associated with motor vehicle collisions.

Effects of LATCH versus Available Seatbelt Installation of Rear Facing Child Restraint Systems on Head Injury Criteria for 6 Month Old Infants in Rear End Collisions.

OBJECTIVE: The Lower Anchor and Tethers for CHildren (LATCH) system was introduced in vehicles made after September 1, 2002 and intended to make installation of rear and forward-facing child safety seats easier. Due to the lack of rear impact testing of RFCRS required per the Federal Motor Vehicle Safety Standards (FMVSS), the purpose of this study was to explore the effects, if any, of installation method of RFCRS on the performance of commonly purchased makes and models of RFCRS. Specifically, we hypothesize that in a 48 km/h (29.8 MPH) rear-end collision, installation of RFCRS using the LATCH system will result in higher Head Injury Criteria (HIC) values when compared to using the available lap/shoulder seatbelt (Emergency Locking Retractor - ELR or Automatic Locking Retractor - ALR). METHODS: The test matrix included 36 rear impact sled tests conducted using 3 installation methods on 3 models of RFCRS: the Graco SnugRide® with and without the base, the Britax Chaperone with base-mounted anti-rebound bar, and the Evenflo Tribute®, a model of convertible rearward/forward facing restraint system used in the rearward facing mode. The seats were installed using the LATCH system, ELR lap/shoulder belts, or ALR lap/shoulder belts in seating positions 4 and 6 on a vehicle buck mounted to the sled test base. The infant seat and 6 month old CRABI anthropometric test device (ATD) installation methods were in accordance with standards set forth in the National Highway Traffic Safety Administration's (NHTSA) FMVSS No. 213, Child Restraint Systems. All tests were conducted on pneumatic controlled acceleration sled (HYGE, Inc., PA, USA) at 48 km/h. RESULTS: Installation of infant seat type RFCRS using the LATCH system resulted in higher HIC15 values when compared to using the available lap/shoulder seatbelt (ELR or ALR). The mean HIC15 values were most severe when infant seat type RFCRS were installed using LATCH (Graco SnugRide® HIC15 = 394 and Britax Chaperone HIC15 = 133) compared to using either ELR lap/shoulder belts (Graco SnugRide® HIC15 = 218 and Britax Chaperone HIC15 = 65) or ALR lap/shoulder belts (Graco SnugRide® HIC15 = 194 and Britax Chaperone HIC15 = 78). The installation method did not result in a statistically significant difference in HIC for the convertible type RFCRS (Evenflo Tribute®). In many of the tests, the ATD's head struck the seatback in which the RFCRS was installed. These head strikes resulted in the higher HIC15 scores recorded throughout the testing. CONCLUSIONS: The results of this study suggest that LATCH does not offer equal protection to lap/shoulder belts from head injuries in rear impacts when used with infant seat type RFCRS.

Erros de utilização de assentos de segurança infantil por menores de 4 anos / Child safety seat usage errors in under-4s

Objetivo: Analisar erros de utilização de assentos de segurança infantil por crianças matriculadas em creches e fatores relacionados. Métodos: Estudo observacional transversal de coleta de dados prospectiva e eixo analítico retrospectivo. Resultados: Um total de 42,7% das crianças apresentava erros de utilização. O modelo de regressão logística evidenciou maiores chances de erros na presença de duas ou mais crianças no veículo (odds ratio = 5,10, p = 0,007) e menores níveis de escolaridade e renda dos pais (renda e escolaridade médias: odds ratio = 7,00, p = 0,003; renda e escolaridade baixas: odds ratio = 3,40, p = 0,03). Conclusão: Os dados são coerentes com publicações internacionais.

Objective: To analyze child safety seat usage errors among children enrolled at daycare. Methods: This was a cross-sectional, observational study with prospective data collection and a retrospective analytical axis. Results: Overall, 42.7% of the children studied were in incorrectly used seats. A logistic regression model showed that the likelihood of usage errors was higher if there were two or more children in the vehicle (odds ratio = 5.10, p = 0.007) and was dependent on parents' educational level and income (medium income and educational level: odds ratio = 7.00, p = 0.003; low income and educational level: odds ratio = 3.40, p = 0.03). Conclusion: The results of this study are in line with findings reported in international publications.

Erros de utilização de assentos de segurança infantil por menores de 4 anos / Child safety seat usage errors in under-4s

OBJETIVO: Analisar erros de utilização de assentos de segurança infantil por crianças matriculadas em creches e fatores relacionados. MÉTODOS: Estudo observacional transversal de coleta de dados prospectiva e eixo analítico retrospectivo. RESULTADOS: Um total de 42,7% das crianças apresentava erros de utilização. O modelo de regressão logística evidenciou maiores chances de erros na presença de duas ou mais crianças no veículo (odds ratio = 5,10, p = 0,007) e menores níveis de escolaridade e renda dos pais (renda e escolaridade médias: odds ratio = 7,00, p = 0,003; renda e escolaridade baixas: odds ratio = 3,40, p = 0,03). CONCLUSÃO: Os dados são coerentes com publicações internacionais.

OBJECTIVE: To analyze child safety seat usage errors among children enrolled at daycare. METHODS: This was a cross-sectional, observational study with prospective data collection and a retrospective analytical axis. RESULTS: Overall, 42.7% of the children studied were in incorrectly used seats. A logistic regression model showed that the likelihood of usage errors was higher if there were two or more children in the vehicle (odds ratio = 5.10, p = 0.007) and was dependent on parents' educational level and income (medium income and educational level: odds ratio = 7.00, p = 0.003; low income and educational level: odds ratio = 3.40, p = 0.03). CONCLUSION: The results of this study are in line with findings reported in international publications.