Thoracoabdominal rebalancing is not superior to manual hyperinflation to increase the amount of pulmonary secretion removed in preterm newborns: A randomized crossover trial.

Background and Aims: Respiratory physical therapy is recommended to prevent complications of accumulated secretion in mechanical ventilated infants, but no consensus about the best technique is available. Aims: To evaluate the effects of manual hyperinflation maneuver (MHM) and thoracoabdominal rebalancing method (TRM) in preterm newborns (PTNB) for bronchial hygiene. Methods: Single-blind randomized crossover trial with intention-to-treat analysis was carried out with 24 PTNB (<37 weeks of gestation) under invasive ventilatory support via orotracheal cannula received both interventions (MHM and TRM) with an interval of 4 h, followed by tracheal suctioning. The primary outcome was the amount of pulmonary secretion, while secondary outcomes were the response of the autonomous (heart rate, respiratory rate [RR], tidal volume [TV], and oxygen saturation [SpO2]), motor (classification of general movements), and regulatory (pain and respiratory discomfort) systems pre and postintervention. Results: Although the amount of secretion was not different after the MHM and TRM interventions (0.10 and 0.09 g, respectively, p = 0.47), a difference was observed in the increase of SpO2 (p ≤ 0.001), and in the decrease of RR (p ≤ 0.001) for TRM. The poor repertoire pattern was predominant (23 PTNB), and it did not alter after interventions. Pain was not observed during interventions, the respiratory discomfort decreased after both interventions (p = 0.50). Conclusion: The amount of secretion removed was similar after MHM and TRM and both maneuvers did not negatively alter the response of the autonomous, motor, and regulatory systems.

Screening for Autism Spectrum Disorder in Premature Subjects Hospitalized in a Neonatal Intensive Care Unit.

Considering that the average age for diagnosis of autism spectrum disorder (ASD) is 4-5 years, testing screening methods for ASD risk in early infancy is a public health priority. This study aims to identify the risks for development of ASD in children born prematurely and hospitalized in a neonatal intensive care unit (NICU) and explore the association with pre-, peri- and postnatal factors. Methods: The children's families were contacted by telephone when their child was between 18 and 24 months of age, to apply the Modified Checklist for Autism in Toddlers (M-CHAT). The sample consisted of 40 children (57.5% boys). M-CHAT screening revealed that 50% of the sample showed early signs of ASD. Although the frequency of delayed development was higher in boys, this difference was not statistically significant between the sexes (p = 0.11). Assessment of the association between perinatal conditions and early signs of autism in children hospitalized in an NICU exhibited no correlation between the factors analyzed (birth weight and type of delivery). The findings indicate a high risk of ASD in premature children, demonstrating no associations with gestational and neonatal variables or the hospitalization conditions of the NICUs investigated.

Linking quality of life questionnaires for asthma to the International Classification of Functioning.

OBJECTIVE: To link the content of the most common quality of life instruments for children with asthma to the International Classification of Functioning, Disability and Health (ICF). METHODS: The study was conducted in two stages. The first involved a review of the literature to select quality of life questionnaires and in the second, two independent reviewers identified questionnaire items, and categories corresponding to the ICF, according to approved methodology. The degree of agreement was calculated using the kappa coefficient. RESULTS: Two questionnaires were selected: the Pediatric Asthma Quality of Life (PAQLQ) and Pediatric Quality of Life Asthma Module (PedsQL-Asthma), self and proxy versions. The degree of agreement was strong for all the instruments: PAQLQ (k = 0.624), PedsQL- Asthma self (k = 0.610), and PedsQL-Asthma proxy (k = 0.673). A total of 114 concepts were identified in the 77 items. Thirty-five different ICF categories were linked, 16 (45.7%) related "body function," 13 (37.1%) "activity and participation," and 6 (17.1%) "environmental factors." Two items (1.7%) could not be linked because they represent personal factors or are not covered by the ICF. CONCLUSION: The categories linked to the PAQLQ contained primarily "body function" and "activity and participation," but not "environmental factors." Those linked to the PedsQL-Asthma versions encompass three of the four ICF components, where the highest content frequency was associated with "body function," followed by "environmental factors" and "activities and participation."

Factors Associated with the Detection of Childhood and Adolescent Cancer in Primary Health Care: A Prospective Cross-Sectional Study.

BACKGROUND: The treatment of childhood cancer has achieved important advances evidencing a significant increase in overall survival; however, the diagnosis of these cases still seems late. Among the main causes for the delay in diagnosis are the issues related to the health system and the first professional who performs the care. The objective of this study is to evaluate the knowledge of primary care physicians and nurses about the most common signs and symptoms of pediatric cancers, as well as the factors related to the obtained scores. METHODS: This is a prospective cross-sectional study, developed in municipalities in the northeastern region of Brazil. Fifty-one professionals (physicians and nurses) were interviewed through a questionnaire structured as a quiz game about knowledge, training and attitudes regarding the signs and symptoms of childhood cancer. Multiple linear regression analysis was used to evaluate the effect of professional characteristics on the number of correct answers on the implemented questionnaire on knowledge of childhood and adolescent cancer. RESULTS: In the bivariate analysis, the results indicated that the type of employment relationship influences the number of correct answers in the questionnaire used. However, when adjusted for covariates, only the professional category, which means being a medical professional, showed a significant effect on the number of correct answers (ß=-7.50, p=0.001). CONCLUSION: The type of employment relationship of medical professionals and nurses working in primary care had an influence on the number of correct answers for knowledge of childhood and adolescent cancer, but only the professional category (physician) was associated with the highest number when controlled by covariables, thereby justifying the need to improve the curricular training of nurses and greater investments in primary health care for continuing health education that includes infant and adolescent oncology.

Educação postural em escolares: existe diferença na aprendizagem entre escolas públicas e privadas? / Educación postural en escolares: ¿hay alguna diferencia en el aprendizaje entre escuelas públicas y privadas? / Postural education in schoolchildren: is there a difference in learning between public and private schools?

Objetivo: Comparar o antes e o depois de uma ação de educação postural sobre o conhecimento relativo ao modo de transportar o material escolar, o modo de se sentar e a posição ao dormir de escolares da rede pública e privada do município de Santa Cruz (RN), Brasil. Métodos: A amostra foi composta por 200 escolares do 1º ao 5º ano, e a ação, de três atividades: palestra sobre hábitos posturais, peça teatral e paródia educativa. Para comparação antes e após as intervenções, foi aplicado um questionário com figuras ilustrativas das diversas posições que poderiam ser adotadas pelo escolar. Na análise estatística, utilizou-se o teste de Mcnemar (??0,05). Resultados: Apenas os alunos da escola privada obtiveram aumento significativo no número de respostas corretas em todas as variáveis observadas: 16% em relação ao transporte do material escolar [55 (67,9%) versus 68 (83,9%)]; 27,5% no modo de sentar [48 (60%) versus 70 (87,5%); ?2=1,905; p<0,001]; e aumento de 18,2% no número de acertos quanto à posição ao dormir [55 (71,4%) versus 69 (89,6%); ?2=0,349; p=0,007]. Conclusão: Esta intervenção de educação postural foi eficaz no aumento do conhecimento dos escolares da rede privada. Entretanto, para a rede pública, as abordagens educacionais utilizadas neste estudo parecem não ter produzido efeito.

Objetivo: Comparar el antes y el después de una acción de educación postural sobre el conocimiento relativo con el modo de cargar los útiles escolares, sentarse y posición de dormir de estudiantes de la red pública y privada en el municipio de Santa Cruz (RN). Métodos: la muestra fue compuesta por 200 estudiantes de 1º a 5º grado, y la acción de tres actividades: una palestra sobre hábitos posturales, obra de teatro y la parodia educativa. Para la comparación antes y después de la intervención, fue aplicado un cuestionario con figuras ilustrativas de las distintas posiciones que podrían ser adoptadas por los estudiantes. En el análisis estadístico, se utilizó el teste de McNemar (??0,05). Resultados: sólo los estudiantes de escuela privada tuvieron un aumento significativo en el número de respuestas correctas en todas las variables observadas: 16% en relación con el transporte del material escolar [55 (67,9%) frente a 68 (83,9%)]; 27 5%, para sentarse [48 (60%) frente a 70 (87,5%), ?2=1,905, p<0,001]; y el 18,2% de aumento en el número de aciertos en relación a la posición de dormir [55 (71,4%) frente a 69 (89,6%), ?2=0,349, p=0,007]. Conclusión: La presente intervención de educación postural fue eficaz para aumentar el conocimiento de los estudiantes de las escuelas privadas. Sin embargo, para las públicas, los abordajes educacionales utilizados parecen haber producido ningún efecto.

Objective: To compare a posture education measure on the knowledge related to the way students carry their school supplies, sit in the desk and their sleeping position at public and private schools in Santa Cruz/RN. Methods: The sample consisted of 200 students from the 1st to the 5th grades and three activities: a lecture on postural habits; a play and an educational parody. For a comparison before and after the interventions, we applied a questionnaire with illustrative figures of the various positions that could be adopted by the school. In the statistical analysis we used the McNemar test (??0.05). Results: Only private school students had a significant increase in the number of correct answers in all the observed variables: 16% regarding the way they carried school supplies [55 (67.9%) versus 68 (83.9%)], 27.5% concerned to the way they sit [48 (60%) versus 70 (87.5%), ?2=1.905, p<0.001] and an increase of 18.2% in the number of correct answers related to the sleeping position [55 (71.4%) versus 69 (89.6%), ?2=0.349, p=0.007]. Conclusion: This postural education intervention was effective in increasing the students? knowledge from private schools. However, for public school students, the educational approaches used in this study did not seem to have produced effects.