Evolución de la salud mental infanto-juvenil en Catalunya en el contexto de la pandemia por la COVID-19 durante el curso escolar 2020-2021 / Trends in child and adolescent mental health in Catalonia in the context of the covid-19 pandemic during the 2020-2021 school year

Introducción: La pandemia por SARS-CoV-2 ha tenido un alto impacto en la salud física y psicológica de la población. Nuestro objetivo fue evaluar la salud mental infanto-juvenil de una cohorte poblacional a lo largo del curso 2020-2021. Métodos: Estudio longitudinal y prospectivo de una cohorte de niños escolarizados entre 5 y 14años en Cataluña entre septiembre de 2020 y julio de 2021. Los participantes fueron seleccionados de forma aleatoria y seguidos por el pediatra de referencia en la atención primaria. La evaluación del riesgo de psicopatología fue realizada a través del Strengths and Difficulties Questionnaire (SDQ), contestada por un tutor legal del niño. Fueron recogidas también variables sociodemográficas y de salud del individuo y su núcleo de convivencia. Los datos fueron recogidos mediante una encuesta on-line a través de la plataforma RedCap al inicio del curso y al final de cada trimestre (4cortes). Resultados: Al inicio del curso escolar el 9,8% de los alumnos fueron casos probables de psicopatología, frente al 6,2% de final de curso. La percepción del nivel de preocupación de los niños por su salud y la de su familia se relacionó con presentar psicopatología, especialmente al inicio del curso, mientras que la percepción de un buen ambiente familiar se relacionó en todo momento con menor riesgo. Ninguna variable relacionada con la COVID-19 se asoció con resultado alterado del SDQ. Conclusiones: A lo largo del curso escolar 2020-2021 el porcentaje de niños con probabilidad de presentar psicopatología mejoró, y pasó del 9,8% al 6,2%. (AU)

Introduction: The SARS-CoV-2 pandemic has had a great impact on the physical and psychological health of the population. The aim of our study was to assess child and adolescent mental health in a cohort throughout the 2020-2021 school year. Methods: We conducted a longitudinal prospective study in a cohort of children aged 5 to 14 years in Catalonia, Spain, from September 2020 to July 2021. Participants were randomly selected and followed up by their primary care paediatricians. The risk of mental health problems was assessed with the Strengths and Difficulties Questionnaire (SDQ), completed by one of the legal guardians of the child. In addition, we obtained information on the sociodemographic and health characteristics of the participants and their nuclear families. We collected the data by means of an online survey through the REDCap platform at the beginning of the academic year and at the end of each term (4 time points). ResultsAt the beginning of the school year, 9.8% of participants were cases of probable psychopathology compared to 6.2% at the end of the year. The perceived level of worry of the children for their own health and the health of their families was associated with the presence of psychopathology, especially at the beginning of the year, while the perception of a good family atmosphere was consistently associated with a decreased risk. No variable related to COVID-19 was associated with abnormal results in the SDQ. Conclusions: During the 2020-2021 school year, the percentage of children with probable psychopathology decreased from 9.8% to 6.2%. (AU)

[Trends in child and adolescent mental health in Catalonia in the context of the covid-19 pandemic during the 2020-2021 school year]. / Evolución de la salud mental infanto-juvenil en Catalunya en el contexto de la pandemia por la COVID-19 durante el curso escolar 2020-2021.

Introduction: The SARS-CoV-2 pandemic has had a great impact on the physical and psychological health of the population. The aim of our study was to assess child and adolescent mental health in a cohort throughout the 2020-2021 school year. Methods: We conducted a longitudinal prospective study in a cohort of children aged 5 to 14 years in Catalonia, Spain, from September 2020 to July 2021. Participants were randomly selected and followed up by their primary care paediatricians. The risk of mental health problems was assessed with the Strengths and Difficulties Questionnaire (SDQ), completed by one of the legal guardians of the child. In addition, we obtained information on the sociodemographic and health characteristics of the participants and their nuclear families. We collected the data by means of an online survey through the REDCap platform at the beginning of the academic year and at the end of each term (4 time points). Results: At the beginning of the school year, 9.8% of participants were cases of probable psychopathology compared to 6.2% at the end of the year. The perceived level of worry of the children for their own health and the health of their families was associated with the presence of psychopathology, especially at the beginning of the year, while the perception of a good family atmosphere was consistently associated with a decreased risk. No variable related to COVID-19 was associated with abnormal results in the SDQ. Conclusions: During the 2020-2021 school year, the percentage of children with probable psychopathology decreased from 9.8% to 6.2%.

Trends in child and adolescent mental health in Catalonia in the context of the COVID-19 pandemic during the 2020-2021 school year.

INTRODUCTION: The SARS-CoV-2 pandemic has had a great impact on the physical and psychological health of the population. The aim of this study was to evaluate child and adolescent mental health in a population cohort along the 2020-2021 school year. METHODS: This was a prospective longitudinal study of a cohort of children from 5-14 years of age in Catalonia, Spain, performed from September 2020 to July 2021. The participants were randomly selected and accompanied by their primary care paediatrician. Evaluation of risk of psychopathology was performed using the Strengths and Difficulties Questionnaire (SDQ) carried out by one of the legal guardians of the child. We also collected sociodemographic and health variables of the participants and their nuclear family. Data were collected by an online survey through the RedCap platform at the beginning of the academic year and at the end of each trimester (4 cuts). RESULTS: At the beginning of the school year, 9.8% of the patients were probable cases of psychopathology compared to 6.2% at the end of the year. The perception of the level of preoccupation of the children for their health and that of their family was related to presenting psychopathology, especially at the beginning of the year, with the perception of a good family atmosphere being always related to lower risk. No variable related to COVID-19 was associated with an altered SDQ result. CONCLUSIONS: Along the 2020-2021 school year, the percentage of children with a probability of presenting psychopathology decreased from 9.8% to 6.2%.

Expresión clínica de la COVID-19 en pediatría de atención primaria: estudio COVIDPAP / COVID-19 clinical features in primary care: COVIDPAP study

Objetivos: En España, las pruebas diagnósticas de COVID-19 en atención primaria estuvieron disponibles desde mayo de 2020. Previamente la mayoría de los estudios describían pacientes hospitalarios: la fiebre y la tos eran los síntomas más frecuentes. Interesaba conocer la expresión clínica de la COVID-19 pediátrica en la comunidad. Métodos: Estudio descriptivo analítico observacional de casos pediátricos (0-14 años) de 255 pediatras de atención primaria españoles, del 12/5/2020 al 30/4/2021. Los diagnósticos se determinaron por PCR, test rápido de detección de antígeno o serología IgG positiva. Resultados: Se incluyeron 10.021 niños, 48,4% mujeres, con una edad media de 8,04±4,17 años. Se detectó la infección por búsqueda de contactos (70,9%) o síntomas compatibles (18,8%). El hogar familiar fue la principal fuente de contagio (64,9%), seguido por los colegios (10%) o de origen desconocido (9,9%). No hubo diferencias significativas en la incidencia entre temporadas vacacionales o lectivas. El 43,2% fueron asintomáticos. Los síntomas más frecuentemente encontrados fueron rinorrea en menores de 2 años, fiebre entre 3 y 8 años y cefalea en mayores de 9 años. Se describen exhaustivamente los síntomas y signos observados por edad. Se hospitalizaron a 8 pacientes, uno con un síndrome inflamatorio multisistémico. No hubo fallecimientos. Conclusiones: La COVID-19 es una enfermedad leve con un gran número de casos asintomáticos, con pocas hospitalizaciones y fallecimientos. El lugar principal de transmisión es el domicilio y el cierre de colegios debería ser el último recurso para controlar la pandemia. No se pudo describir un cuadro clínico característico de la enfermedad. (AU)

Objectives: In Spain, the tools to diagnose COVID-19 were available in primary care from May 2020. Previously most studies described inpatients, and fever and cough were the most frequent symptoms. This study aims to define the clinical picture of the pediatric COVID-19 in the community. Methods: A descriptive and analytical observational study was performed including pediatric cases (0-14y) from 255 pediatricians, proportionally distributed to its population, from primary health centers in Spain, from 12th May 2020 to 30th April 2021. Diagnostics were made by PCR detection of viral RNA, rapid antigen detection test or positive IgG serology. Results: There were 10,021 positive children included, 48.4% women, mean age 8,04±4.17 years. Infection was detected due to contact tracing (70.9%), compatible symptoms (18.8%). Household was the main source of transmission (64.9%), followed by school setting (10%) or unknown (9.9%). We did not find any significant differences in the incidence between holidays and school terms. 43.2% of the children were asymptomatic. Most frequent symptoms are rhinorrhea in <2y, fever in 3-8y and headache in >9y. An exhaustive description of objective and subjective symptoms by age is made. 18 patients were hospitalized, one with multisystem inflammatory syndrome in children. There were no deaths. Conclusions: Pediatric COVID-19 is a mild disease, with a large number of asymptomatic cases, with very few hospital admissions and deaths. The main setting for transmission is the household, and school closures should be a last resource measure during the COVID-19 pandemic. A specific clinical picture of pediatric COVID-19 was not found. (AU)

COVID-19 clinical features in primary care: COVIDPAP study.

OBJECTIVES: In Spain, the tools to diagnose COVID-19 were available in primary care from May 2020. Previously most studies described inpatients or patients in A&E departments, and fever and cough were the most frequent symptoms. This study aims to define the clinical picture of the pediatric COVID-19 in the community. METHODS: A descriptive and analytical observational study was performed including pediatric cases (0-14years) from 255 pediatricians, proportionally distributed to its population, from primary health centers in Spain, from 12th May 2020 to 30th April 2021. Diagnostics were made by PCR detection of viral RNA, rapid antigen detection test or positive IgG serology. RESULTS: There were 10,021 positive children included, 48.4% women, mean age 8,04±4.17years. Infection was detected due to contact tracing (70.9%), compatible symptoms (18.8%). Household was the main source of transmission (64.9%), followed by school setting (10%) or unknown (9.9%). We did not find any significant differences in the incidence between holidays and school terms. 43.2% of the children were asymptomatic. Most frequent symptoms are rhinorrhea in <2years, fever in 3-8years and headache in >9years. An exhaustive description of objective and subjective symptoms by age is made. 18 patients were hospitalized, one with multisystem inflammatory syndrome in children. There were no deaths. CONCLUSIONS: pediatric COVID-19 is a mild disease, with a large number of asymptomatic cases, with very few hospital admissions and deaths. The main setting for transmission is the household, and school closures should be a last resource measure during the COVID-19 pandemic. A specific clinical picture of pediatric COVID-19 was not found.

Informe anual de los editores de Anales de Pediatría / Annual report of Anales de Pediatría editors

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[COVID-19 clinical features in primary care: COVIDPAP study]. / Expresión clínica de la COVID-19 en pediatría de atención primaria: estudio COVIDPAP.

Objectives: In Spain, the tools to diagnose COVID-19 were available in primary care from May 2020. Previously most studies described inpatients, and fever and cough were the most frequent symptoms. This study aims to define the clinical picture of the pediatric COVID-19 in the community. Methods: A descriptive and analytical observational study was performed including pediatric cases (0-14y) from 255 pediatricians, proportionally distributed to its population, from primary health centers in Spain, from 12th May 2020 to 30th April 2021. Diagnostics were made by PCR detection of viral RNA, rapid antigen detection test or positive IgG serology. Results: There were 10,021 positive children included, 48.4% women, mean age 8,04 ± 4.17 years. Infection was detected due to contact tracing (70.9%), compatible symptoms (18.8%). Household was the main source of transmission (64.9%), followed by school setting (10%) or unknown (9.9%). We did not find any significant differences in the incidence between holidays and school terms. 43.2% of the children were asymptomatic. Most frequent symptoms are rhinorrhea in < 2 y, fever in 3-8 y and headache in > 9 y. An exhaustive description of objective and subjective symptoms by age is made. 18 patients were hospitalized, one with multisystem inflammatory syndrome in children. There were no deaths. Conclusions: Pediatric COVID-19 is a mild disease, with a large number of asymptomatic cases, with very few hospital admissions and deaths. The main setting for transmission is the household, and school closures should be a last resource measure during the COVID-19 pandemic. A specific clinical picture of pediatric COVID-19 was not found.

Translation to Spanish and validation of a scale for the observation of breastfeeding: The Bristol Breastfeeding Assessment Tool.

INTRODUCTION: The observation of a feeding by a professional is important to strengthen breastfeeding. The Bristol Breastfeeding Assessment Tool (BBAT) was translated into Spanish and validated. MATERIAL AND METHODS: Translation and back-translation of the original scale was done. Six pediatricians and six pediatric nurses collaborated. At the newborn's first visit, a feeding was observed and the pediatrician and nurse scored the BBAT scale independently. The nurse also scored the LATCH Breastfeeding Assessment (LATCH) and each mother filled out the Breastfeeding Self-Efficacy Scale (BSES-SF). Mothers were appointed a week later and the nurse re-scored the BBAT. RESULTS: A total of 62 mothers participated. There was good internal consisitency for the BBAT (Cronbach's alpha = 0.83 in the assessment made by the nurses and Cronbach's alpha = 0.79 in the assessment made by the pediatricians). Inter-rater consistency showed an intra-class correlation coefficient of 0.91, while for the test-retest was 0.67. Concurrent validity with the BSES-SF scale was good and with the LATCH scale very good. The factor analysis showed the one-dimensional character of the scale and a good homogeneity of the 4 items (positioning = 0.771, attachment = 0.852, sucking = 0.856 and swallowing = 0.679). CONCLUSIONS: The scale obtained in Spanish shows good reliability and validity. The BBAT is an easy-to-use tool that allows breastfeeding assessment and determines the aspects that need to be improved.

Capacidad predictiva para la lactancia y determinación del mejor punto de corte de la escala BSES-SF / Predictive capacity for breastfeeding and determination of the best cut-off point for the breastfeeding self-efficacy scale-short form

Introducción: El instrumento utilizado habitualmente para valorar la autoeficacia de la lactancia materna (LM) es la breastfeeding self-efficacy scale-short form (BSES-SF). Este estudio valora la relación entre la puntuación de la BSES-SF y el riesgo de abandono de la lactancia. También se determina el punto de corte en la puntuación de la escala que optimiza la detección de este riesgo desde la atención primaria. Métodos: Análisis secundario de datos del estudio Lactancia y Desarrollo Infantil (LAyDI). Ensayo de cohorte única realizado a través de la red de investigación de pediatras de atención primaria (PAPenRed). Cada especialista reclutó un recién nacido cada mes durante un año. Se siguió la cohorte durante 24 meses. Las madres respondieron la BSES-SF en la primera visita. Se recogieron datos generales de el embarazo y el parto y se valoró la LM (suplementada o exclusiva) hasta los seis meses. Resultados: n = 1.845. El área bajo la curva ROC para la LM exclusiva fue al primer mes de 0,79 (0,77 a 0,82) y al segundo mes de 0,760 (0,734 a 0,786). Para los cuatro y seis meses, así como para cualquier edad en las madres que dan LM suplementada, el área bajo la curva fue menor de 0,75 y su capacidad predictiva no se consideró adecuada. Para una sensibilidad del 80% en la detección de las mujeres en riesgo de abandono de la lactancia, la puntuación de corte fue 58. Conclusiones: Las madres que en atención primaria presenten una puntuación en la BSES-SF por debajo de 58 tienen riesgo de abandono de la LM exclusiva antes de los dos meses.(AU)

Introduction: The most widely used tool for assessing breastfeeding self-efficacy is the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). This study asses the relationship between the BSES-SF score and the risk of breastfeeding (BF) cessation and determine the cut-off point in the scale score that optimizes detection of this risk in primary health care pediatric consultations. Methods: Secondary data analysis of the LAyDI study. It is a cohort study. It was carried out through a research network of primary care pediatricians (PAPenRed). A newborn was recruited every month for one year by 210 pediatricians. The cohort was followed for 24 months. Mothers responded to the BSES-SF at the first visit. General pregnancy and delivery data were collected and assessed to determine whether breastfeeding was exclusive or supplemented during the first six months. Results: n = 1,845. The area under the ROC curve for the exclusive BF was 0.790 (0.765-0.815) the first month and 0.760 (0.734-0.786) the second month. For four and six months, as well as for any age in mothers who give supplemented BF, the Area Under the Curve was less than 0.75 and its predictive capacity was not considered to be good. For a sensitivity of 80% in detecting mothers at risk of BF cessation with the BSES-SF, the cut-off score was 58. Conclusions: Mothers with a BSES-SF score below 58 points in primary health care, are at risk of early withdrawal of exclusive BF within two months.(AU)

Predictive capacity for breastfeeding and determination of the best cut-off point for the breastfeeding self-efficacy scale-short form.

INTRODUCTION: The most widely used tool for assessing breastfeeding self-efficacy is the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). This study assesses the relationship between the BSES-SF score and the risk of breastfeeding (BF) cessation and determines the cut-off point in the scale score that optimizes detection of this risk in primary health care pediatric consultations. METHODS: Secondary data analysis of the LAyDI study. Cohort study carried out through a research network of primary care pediatricians (PAPenRed). A newborn was recruited every month for one year by 210 pediatricians. The cohort was followed for 24 months. Mothers responded to the BSES-SF at the first visit. General pregnancy and delivery data were collected and assessed to determine whether breastfeeding was exclusive or supplemented during the first 6 months. RESULTS: N = 1845. The Area Under the ROC Curve for the exclusive BF was 0.790 (0.765-0.815) the first month and 0.760 (0.734-0.786) the second month. For 4 and 6 months, as well as for any age in mothers who give supplemented BF, the Area Under the Curve was less than 0.75 and its predictive capacity was not considered to be good. For a sensitivity of 80% in detecting mothers at risk of BF cessation with the BSES-SF, the cut-off score was 58. CONCLUSIONS: Mothers with a BSES-SF score below 58 points in primary health care, are at risk of early withdrawal of exclusive BF within two months.

Child Care Center Hand Hygiene Programs' Cost-Effectiveness in Preventing Respiratory Infections.

BACKGROUND: We previously demonstrated that a hand hygiene program, including hand sanitizer and educational measures, for day care center (DCC) staff, children, and parents was more effective than a soap-and-water program, with initial observation, in preventing respiratory infections (RIs) in children attending DCCs. We analyzed the cost-effectiveness of these programs in preventing RIs. METHODS: A cluster, randomized, controlled and open study of 911 children aged 0 to 3 years, attending 24 DCCs in Almeria. Two intervention groups of DCC-families performed educational measures and hand hygiene, one with soap-and-water (SWG) and another with hand sanitizer (HSG). The control group (CG) followed usual hand-washing procedures. RI episodes, including symptoms, treatments, medical contacts, complementary analyses, and DCC absenteeism days, were reported by parents. A Bayesian cost-effectiveness model was developed. RESULTS: There were 5201 RI episodes registered. The adjusted mean societal costs of RIs per child per study period were CG: €522.25 (95% confidence interval [CI]: 437.10 to 622.46); HSG: €374.53 (95% CI: 314.90 to 443.07); SWG: €494.51 (95% CI: 419.21 to 585.27). The indirect costs constituted between 35.7% to 43.6% of the total costs. Children belonging to the HSG had an average of 1.39 fewer RI episodes than the CG and 0.93 less than the SWG. It represents a saving of societal cost mean per child per study period of €147.72 and €119.15, respectively. The HSG intervention was dominant versus SWG and CG. CONCLUSIONS: Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents are more effective and cost less than a program with soap and water and initial observation in children attending DCCs.

State of child and adolescent mental health during the first wave of the COVID-19 pandemic and at the beginning of the 2020-2021 school year.

INTRODUCTION: The aim of this project was to evaluate the psychopathological impact of home confinement and school closing between March and September 2020 on the mental health of Catalonian children. METHODS: PEDSAME study: first cross-sectional section (beginning of the school year) and retrospective data (lockdown), carried out through the network of Primary Care pediatricians in the Catalan population between 5 and 14 years (included) from 09/14/2020 to 10/30/2020 in a random sample. Data were collected with an online survey through the RedCap platform at the beginning of the school year. The main variable was the result of the Strengths and Difficulties Questionnaire answered by parents to assess the risk of psychopathology, in addition to other related variable. RESULTS: The results obtained at the beginning of the school year show that 9.8% of the patients were probable cases of psychopathology. The most affected group were those between 5 and 8 years. The perception of the children's level of concern for their health and that of their family was a risk factor for presenting psychopathology, while the good family environment was a protective factor. Emotional and behavioral symptoms, sleep disorders and problematic use of screens were detected more frequently during confinement than at the beginning of the school year. CONCLUSIONS: Confinement and the absence of schooling for 6 months had a negative impact on the mental health of the child-adolescent population who showed worse indicators than the previous year.

Estado de la salud mental infantojuvenil durante la primera ola de la pandemia de la COVID-19 y en el inicio del curso escolar 2020-2021 / State of child and adolescent mental health during the first wave of the COVID-19 pandemic and at the beginning of the 2020–2021 school year

Introducción: El objetivo de este proyecto fue evaluar el impacto psicopatológico del confinamiento domiciliario y cierre escolar entre marzo y septiembre 2020 en la población pediátrica catalana. Métodos: Estudio PEDSAME: primer corte transversal (inicio de curso escolar) y datos retrospectivos (periodo de confinamiento), realizado a través de la red de pediatras de atención primaria en población catalana entre 5 y 14 años (incluidos) del 14/09/2020 al 30/10/2020 en una muestra aleatoria. Los datos fueron recogidos con una encuesta on line a través de la plataforma RedCap al inicio del curso. La variable principal fue el resultado del cuestionario Strengths and Difficulties Questionnaire contestado por los progenitores para evaluar el riesgo de psicopatología, además de otras variables relacionadas. Resultados: Los resultados obtenidos al inicio del curso escolar mostraron que el 9,8% de los pacientes eran casos probables de psicopatología. La franja más afectada fue la de los 5 a 8 años. La percepción del nivel de preocupación de los niños por su salud y la de su familia fue un factor de riesgo de presentar psicopatología, mientras que el buen ambiente familiar resultó protector. Durante el confinamiento se detectaron con mayor frecuencia síntomas emocionales, de conducta, trastornos del sueño y uso problemático de pantallas respecto al inicio del curso escolar. Conclusiones: El confinamiento y la ausencia de escolarización durante 6 meses supusieron un impacto negativo en la salud mental de la población infantojuvenil, con peores indicadores que el curso anterior. (AU)

Introduction: The aim of this project was to evaluate the psychopathological impact of home confinement and school closing between March and September 2020 on the mental health of Catalonian children. Methods: PEDSAME study: first cross-sectional section (beginning of the school year) and retrospective data (lockdown), carried out through the network of Primary Care pediatricians in the Catalan population between 5 and 14 years (included) from 09/14/2020 to 10/30/2020 in a random sample. Data were collected with an online survey through the RedCap platform at the beginning of the school year. The main variable was the result of the Strengths and Difficulties Questionnaire answered by parents to assess the risk of psychopathology, in addition to other related variable. Results: The results obtained at the beginning of the school year show that 9.8% of the patients were probable cases of psychopathology. The most affected group were those between 5 and 8 years. The perception of the children's level of concern for their health and that of their family was a risk factor for presenting psychopathology, while the good family environment was a protective factor. Emotional and behavioral symptoms, sleep disorders and problematic use of screens were detected more frequently during confinement than at the beginning of the school year. Conclusions: Confinement and the absence of schooling for 6 months had a negative impact on the mental health of the child–adolescent population who showed worse indicators than the previous year. (AU)

[State of child and adolescent mental health during the first wave of the COVID-19 pandemic and at the beginning of the 2020-2021 school year]. / Estado de la salud mental infantojuvenil durante la primera ola de la pandemia de la COVID-19 y en el inicio del curso escolar 2020-2021.

INTRODUCTION: The aim of this project was to evaluate the psychopathological impact of home confinement and school closing between March and September 2020 on the mental health of Catalonian children. METHODS: PEDSAME study: first cross-sectional section (beginning of the school year) and retrospective data (lockdown), carried out through the network of Primary Care pediatricians in the Catalan population between 5 and 14 years (included) from 09/14/2020 to 10/30/2020 in a random sample. Data were collected with an online survey through the RedCap platform at the beginning of the school year. The main variable was the result of the Strengths and Difficulties Questionnaire answered by parents to assess the risk of psychopathology, in addition to other related variable. RESULTS: The results obtained at the beginning of the school year show that 9.8% of the patients were probable cases of psychopathology. The most affected group were those between 5 and 8 years. The perception of the children's level of concern for their health and that of their family was a risk factor for presenting psychopathology, while the good family environment was a protective factor. Emotional and behavioral symptoms, sleep disorders and problematic use of screens were detected more frequently during confinement than at the beginning of the school year. CONCLUSIONS: Confinement and the absence of schooling for 6 months had a negative impact on the mental health of the child-adolescent population who showed worse indicators than the previous year.

Anales de Pediatría: tomamos el relevo / Anales de Pediatría: We take over

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