Willingness of Brazilian caregivers in having their children and adolescents vaccinated against Covid-19.

BACKGROUND: The vaccination of children and adolescents for the prevention of Covid-19 is important to:decrease in deaths and hospitalizations, prevent multisystem inflammatory syndrome, avoid long-term complications and decrease the suspension of on-site classes. Despite of these benefits, some studies have shown that some caregivers are still hesitancy. METHODS: This is a voluntary and anonymous online survey conducted from November 17 to December 14, 2021, in Brazil, through a free-of-charge platform with a link provided on social networks. A bivariate analysis was conducted with the independent variables, with vaccine hesitancy as the outcome variable, and a multivariate logistic model was used to calculated adjusted odds ratios. RESULTS: The sample included 15,297 respondents. Approximately 13.3 % (2,028) of the caregivers were hesitant to vaccinate their children and adolescents against Covid-19 in at least one age group. The vaccination hesitanty rate of caregivers of children aged 0-4 years, 5-11 years and adolescents were 16 %, 13 %, 15 %, respectively. The principal factors associated with vaccine hesitancy were the following: belief that they need to wait longer, belief that children that had natural infection doesn't need to vaccinate and belief that vaccine has long term adverse effects. INTERPRETATION: The present study showed that the willingness of caregivers to have their children and adolescents vaccinated in Brazil is high compared to data from adult and pediatric international studies. This study provides a profile of the hesitant caregivers considering their perspectives and beliefs regarding vaccines that can help the elaboration of strategies to increase vaccine adherence.

Clinical features, electroencephalogram, and biomarkers in pediatric sepsis-associated encephalopathy.

To date, no specific diagnostic criteria for sepsis-associated encephalopathy (SAE) have been established. We studied 33 pediatric patients with sepsis prospectively and evaluated the level of consciousness, the presence of delirium, electroencephalographic (EEG) findings, and plasma levels of neuron-specific enolase and S100-calcium-binding protein-B. A presumptive diagnosis of SAE was primarily considered in the presence of a decreased level of consciousness and/or delirium (clinical criteria), but specific EEG abnormalities were also considered (EEG criteria). The time course of the biomarkers was compared between groups with and without clinical or EEG criteria. The Functional Status Scale (FSS) was assessed at admission, discharge, and 3-6 months post-discharge. Clinical criteria were identified in 75.8% of patients, EEG criteria in 26.9%, both in 23.1%, and none in 23.1%. Biomarkers did not differ between groups. Three patients had an abnormal FSS at discharge, but no one on follow-up. A definitive diagnostic pattern for SAE remained unclear. Clinical criteria should be the basis for diagnosis, but sedation may be a significant confounder, also affecting EEG interpretation. The role of biomarkers requires a better definition. The diagnosis of SAE in pediatric patients remains a major challenge. New consensual diagnostic definitions and mainly prognostic studies are needed.

Perinatal stress and methylation of the NR3C1 gene in newborns: systematic review.

Adverse experiences in the perinatal period have been associated with the methylation of the human glucocorticoid receptor gene (NR3C1) and long-term diseases. We conducted a systematic review on the association between adversities in the perinatal period and DNA methylation in the 1 F region of the NR3C1 gene in newborns. We explored the MEDLINE, Web of Science, Scopus, Scielo, and Lilacs databases without time or language limitations. Two independent reviewers performed the selection of articles and data extraction. A third participated in the methodological quality assessment and consensus meetings at all stages. Finally, ten studies were selected. Methodological quality was considered moderate in six and low in four. Methylation changes were reported in 41 of the 47 CpG sites of exon 1 F. Six studies addressed maternal conditions during pregnancy: two reported methylation changes at the same sites (CpG 10, 13, 20, 21 and 47), and four at one or more sites from CpG 35 to 39. Four studies addressed neonatal parameters and morbidities: methylation changes at the same sites 4, 8, 10, 16, 25, and 35 were reported in two. Hypermethylation associated with stressful conditions prevailed. Hypomethylation was more often associated with protective conditions (maternal-foetal attachment during pregnancy, breast milk intake, higher birth weight or Apgar). In conclusion, methylation changes in several sites of the 1 F region of the NR3C1 gene in newborns and very young infants were associated with perinatal stress, but more robust and comparable results are needed to corroborate site-specific associations.