High-risk children and social isolation: the importance of family functioning.

High-risk newborns are exposed to neonatal conditions such as prematurity, very low birth weight, and congenital malformations that can affect development and behavior. Coronavirus disease 2019 (COVID-19) restraint and control measures have been identified as important stressor events and cumulative risk factors for behavioral changes in these children. This study examined social isolation-related factors that contribute to internalizing and externalizing behavior problems in children already at risk for neurodevelopmental disorders. This cross-sectional, multicenter study included 113 children (18 months to 9 years) who were followed in reference services for neonatal follow-up in tertiary units of the public health system in the city of Rio de Janeiro, Brazil. Behavior was assessed using the child behavior checklist, and a structured questionnaire was used to assess sociodemographic aspects. In the bivariate analysis, prematurity was associated with externalizing problems and change in eating habits with internalizing problems. The logistic model indicated that both parents having completed high school and both sharing care of the child were protective factors for behavioral problems; however, reports of sleep problems and living with another child were risk factors. In conclusion, the study identified internalizing and externalizing behavior problems related to prematurity and aspects of family structure and routine in children at risk. The findings confirm the importance of family functioning for child health and family-centered interventions.

Delayed childhood neurodevelopment and neurosensory alterations in the second year of life in a prospective cohort of ZIKV-exposed children.

We report neurodevelopmental outcomes in 216 infants followed since the time of PCR-confirmed maternal Zika virus (ZIKV) infection in pregnancy during the Rio de Janeiro epidemic of 2015-2016 (refs. 1,2). Neurodevelopment was assessed by Bayley Scales of Infant and Toddler Development, third edition (Bayley-III; cognitive, language and motor domains) in 146 children and through neurodevelopment questionnaires/neurological examinations in 70 remaining children. Complete eye exams (n = 137) and hearing assessments (n = 114) were also performed. Below-average neurodevelopment and/or abnormal eye or hearing assessments were noted in 31.5% of children between 7 and 32 months of age. Among children assessed by Bayley-III, 12% scored below -2 s.d. (score <70; a score of 100 ± 2 s.d. is the range) in at least one domain; and 28% scored between -1 and -2 s.d. in any domain (scores <85-70). Language function was most affected, with 35% of 146 children below average. Improved neurodevelopmental outcomes were noted in female children, term babies, children with normal eye exams and maternal infection later in pregnancy (P = 0.01). We noted resolution of microcephaly with normal neurodevelopment in two of eight children, development of secondary microcephaly in two other children and autism spectrum disorder in three previously healthy children in the second year of life.

Cognitive performance of premature infants: association between bronchopulmonary dysplasia and cognitive skills. Cross-sectional study.

CONTEXT AND OBJECTIVE:: Children born prematurely often have worse cognitive performance than those born at term regarding skills such as memory, attention and processing speed. Bronchopulmonary dysplasia may compromise cognitive development. The aims here were: a) To describe the cognitive performance of preterm infants with very low birth weight; b) To investigate its association with bronchopul-monary dysplasia adjusted for sociodemographic, neonatal and post-neonatal factors. DESIGN AND SETTING:: Cross-sectional study developed in a public tertiary-care hospital. METHODS:: To evaluate cognition among 112 children, we applied an intelligence scale (Wechsler scale). The average scores for children with and without bronchopulmonary dysplasia were compared across the fve domains of the scale. Associations with bronchopulmonary dysplasia were investigated for domains that showed signifcant diferences between the two groups. Associations between exposure and outcome were estimated via multivariate logistic regression. RESULTS:: There were no diferences in averages for the full-scale intelligence quotient, verbal intelligence quotient, performance intelligence quotient and general language composite domains. The processing speed quotient was the only domain that presented a signifcant diference between the two groups (P = 0.02). Among the children with bronchopulmonary dysplasia, low full-scale intelligence quotient was observed in 28.1%. In the multivariate analysis, bronchopulmonary dysplasia (odds ratio: 3.1; 95conf-dence interval: 1.1-8.7) remained associated with the outcome of processing speed quotient. CONCLUSION:: Bronchopulmonary dysplasia was an independent risk factor for alteration of the processing speed quotient.

Cognitive performance of premature infants: association between bronchopulmonary dysplasia and cognitive skills. Cross-sectional study / Desempenho cognitivo de prematuros: associação da displasia broncopulmonar com as habilidades cognitivas. Estudo transversal

ABSTRACT CONTEXT AND OBJECTIVE: Children born prematurely often have worse cognitive performance than those born at term regarding skills such as memory, attention and processing speed. Bronchopulmonary dysplasia may compromise cognitive development. The aims here were: a) To describe the cognitive performance of preterm infants with very low birth weight; b) To investigate its association with bronchopul-monary dysplasia adjusted for sociodemographic, neonatal and post-neonatal factors. DESIGN AND SETTING: Cross-sectional study developed in a public tertiary-care hospital. METHODS: To evaluate cognition among 112 children, we applied an intelligence scale (Wechsler scale). The average scores for children with and without bronchopulmonary dysplasia were compared across the fve domains of the scale. Associations with bronchopulmonary dysplasia were investigated for domains that showed signifcant diferences between the two groups. Associations between exposure and outcome were estimated via multivariate logistic regression. RESULTS: There were no diferences in averages for the full-scale intelligence quotient, verbal intelligence quotient, performance intelligence quotient and general language composite domains. The processing speed quotient was the only domain that presented a signifcant diference between the two groups (P = 0.02). Among the children with bronchopulmonary dysplasia, low full-scale intelligence quotient was observed in 28.1%. In the multivariate analysis, bronchopulmonary dysplasia (odds ratio: 3.1; 95conf-dence interval: 1.1-8.7) remained associated with the outcome of processing speed quotient. CONCLUSION: Bronchopulmonary dysplasia was an independent risk factor for alteration of the processing speed quotient.

RESUMO CONTEXTO E OBJETIVO: Crianças nascidas prematuras com frequência apresentam pior desempenho cognitivoque as nascidas a termo em habilidades como memória, atenção, velocidade de processamento. A displasia broncopulmonar pode comprometer o desenvolvimento cognitivo. Os objetivos aqui foram: a) Descrever o desempenho cognitivo de crianças nascidas prematuras com muito baixo peso; b) Investigar sua associação com a displasia broncopulmonar ajustada para fatores sócio-demográfcos, neonatais e pós-neonatais. TIPO DE ESTUDO E LOCAL: Estudo transversal desenvolvido em hospital público de cuidados terciários. MÉTODOS: Para a avaliação cognitiva de 112 crianças, aplicamos a escala de inteligência (Wechsler scale). Foram comparadas as médias dos escores das crianças com e sem displasia broncopulmonar nos cinco domínios da escala. A associação com a displasia broncopulmonar foi investigada para os domínios que apresentaram diferença signifcativa entre os dois grupos. A associação entre a exposição e o desfecho foi estimada por regressão logística multivariada. RESULTADOS: Não houve diferença entre as médias dos domínios do quociente de inteligência total, quociente de inteligência verbal, quociente de inteligência de execução e composto de linguagem geral. O quociente de velocidade de processamento foi o único domínio que apresentou diferença signifcativa entre os dois grupos (P = 0,02). Entre as crianças com displasia broncopulmonar, quociente de inteligência total baixo ocorreu em 28,1%. Na análise multivariada, a displasia broncopulmonar (odds ratio: 3,1; intervalo de confança: 1,1-8,7) permaneceu associada ao desfecho quociente de velocidade de processamento. CONCLUSÃO: A displasia broncopulmonar foi um fator de risco independente para alteração no quociente de velocidade de processamento.

Early hematopoietic stem cell transplantation in a patient with severe mucopolysaccharidosis II: A 7 years follow-up.

Mucopolysaccharidosis type II (MPS II - Hunter syndrome) is an X-linked lysosomal storage disorder caused by a deficiency in the enzyme iduronate-2 sulfatase (I2S), leading to the accumulation of the glycosaminoglycans, affecting multiple organs and systems. Enzyme replacement therapy does not cross the blood brain barrier, limiting results in neurological forms of the disease. Another option of treatment for severe MPS, hematopoietic stem cell transplantation (HSCT) has become the treatment of choice for the severe form of MPS type I, since it can preserve neurocognition when performed early in the course of the disease. To date, only few studies have examined the long-term outcomes of HSCT in patients with MPS II. We describe the seven-year follow-up of a prenatally diagnosed MPS II boy with positive family history of severe MPS form, submitted to HSCT with umbilical cord blood cells at 70 days of age. Engraftment after 30 days revealed mixed chimerism with 79% donor cells; after 7 years engraftment remains at 80%. I2S activity 30 days post-transplant was low in plasma and normal in leukocytes and the same pattern is observed to date. At age 7 years growth charts are normal and he is very healthy, although mild signs of dysostosis multiplex are present, as well as hearing loss. The neuropsychological evaluation (Wechsler Intelligence Scale for Children - Fourth Edition - WISC-IV), disclosed an IQ of 47. Despite this low measured IQ, the patient continues to show improvements in cognitive, language and motor skills, being quite functional. We believe that HSCT is a therapeutic option for MPS II patients with the severe phenotype, as it could preserve neurocognition or even halt neurodegeneration, provided strict selection criteria are followed.

Functional complementation of Leishmania (Leishmania) amazonensis AP endonuclease gene (lamap) in Escherichia coli mutant strains challenged with DNA damage agents.

During its life cycle Leishmania spp. face several stress conditions that can cause DNA damages. Base Excision Repair plays an important role in DNA maintenance and it is one of the most conserved mechanisms in all living organisms. DNA repair in trypanosomatids has been reported only for Old World Leishmania species. Here the AP endonuclease from Leishmania (L.) amazonensis was cloned, expressed in Escherichia coli mutants defective on the DNA repair machinery, that were submitted to different stress conditions, showing ability to survive in comparison to the triple null mutant parental strain BW535. Phylogenetic and multiple sequence analyses also confirmed that LAMAP belongs to the AP endonuclease class of proteins.

Functional complementation of Leishmania (Leishmania) amazonensis AP endonuclease gene (lamap) in Escherichia coli mutant strains challenged with DNA damage agents

During its life cycle Leishmania spp. face several stress conditions that can cause DNA damages. Base Excision Repair plays an important role in DNA maintenance and it is one of the most conserved mechanisms in all living organisms. DNA repair in trypanosomatids has been reported only for Old World Leishmania species. Here the AP endonuclease from Leishmania (L.) amazonensis was cloned, expressed in Escherichia coli mutants defective on the DNA repair machinery, that were submitted to different stress conditions, showing ability to survive in comparison to the triple null mutant parental strain BW535. Phylogenetic and multiple sequence analyses also confirmed that LAMAP belongs to the AP endonuclease class of proteins.

Mental performance of very low birth weight preterm infants: assessment of stability in the first two years of life and factors associated with mental performance.

The aim of this study was to investigate the stability of mental performance of very low birth weight premature infants during the first two years of life, and to identify factors associated with mental performance.The study included 109 children. The Mental Scale of Bayley Scales of Infant Development - Second Edition was administered at 6, 12 and 18-24 months of corrected age. The stability of the scores between assessments was verified by the analysis of variance for repeated measures.The association of the major social and neonatal characteristics with mental development was confirmed using multivariate analysis by linear regression, considering the following outcomes: mental development indices at 6 months, 12 months and between 18-24 months of corrected age. The mean Mental Developmental Index (MDI) was 83.4 (SD: 12.4) at 6 months, 86.4 (SD: 13.9) at 12 months, and 73.4 (SD: 14.5) at 18-24 months. A significant decrease in the mental developmental index (13 points) at 18-24 month corrected age was observed. The Mental development index did not show stability during the first two years of life in this population of preterm infants, except for children with neonatal pneumonia whose performance was unsatisfactory in all assessments. Among the risk factors investigated only male gender and neonatal pneumonia were associated with outcomes.

Desempenho mental de bebês pré-termo de muito baixo peso ao nascer: avaliação da estabilidade nos dois primeiros anos de vida e fatores associados ao desempenho mental / Mental performance of very low birth weight preterm infants: assessment of stability in the first two years of life and factors associated with mental performance

O objetivo do estudo foi investigar a estabilidade do desempenho mental de bebês prematuros de muito baixo peso ao nascer ao longo dos dois primeiros anos de vida e identificar os fatores associados ao seu desempenho mental. Estudo de coorte com 109 crianças. A Escala Mental da Bayley Scales of Infant Development - Second Edition foi aplicada aos 6, aos 12 e entre 18-24 meses de idade corrigida. A estabilidade dos escores entre as avaliações foi investigada através de análise de variância para medidas repetidas. A associação entre as características neonatais e sociais no desenvolvimento mental foi verificada por análise multivariada através de regressão linear, considerando como desfechos os Índices de Desenvolvimento Mental aos 6 meses, 12 meses e entre 18-24 meses de idade corrigida. A média do Índice de Desenvolvimento Mental aos 6 meses foi 83,4 (DP: 12,4), aos 12 meses foi 86,4 (DP: 13,9) e aos 18-24 meses foi 73,4 (DP: 14,5). Observou-se uma diminuição significativa de 13 pontos no escore aos 18-24 meses de idade corrigida. O Índice de Desenvolvimento Mental não apresentou estabilidade ao longo dos dois primeiros anos de vida nesta população de prematuros, exceto para as crianças que tiveram pneumonia neonatal, cujo desempenho foi insatisfatório em todas as avaliações. Dos fatores de risco investigados, apenas o sexo masculino e a pneumonia neonatal estiveram associados aos desfechos.

The aim of this study was to investigate the stability of mental performance of very low birth weight premature infants during the first two years of life, and to identify factors associated with mental performance.The study included 109 children. The Mental Scale of Bayley Scales of Infant Development - Second Edition was administered at 6, 12 and 18-24 months of corrected age. The stability of the scores between assessments was verified by the analysis of variance for repeated measures.The association of the major social and neonatal characteristics with mental development was confirmed using multivariate analysis by linear regression, considering the following outcomes: mental development indices at 6 months, 12 months and between 18-24 months of corrected age. The mean Mental Developmental Index (MDI) was 83.4 (SD: 12.4) at 6 months, 86.4 (SD: 13.9) at 12 months, and 73.4 (SD: 14.5) at 18-24 months. A significant decrease in the mental developmental index (13 points) at 18-24 month corrected age was observed. The Mental development index did not show stability during the first two years of life in this population of preterm infants, except for children with neonatal pneumonia whose performance was unsatisfactory in all assessments. Among the risk factors investigated only male gender and neonatal pneumonia were associated with outcomes.

Anticoncepção na adolescência: revisão da literatura / Contraception in adolescence: literature review

It is worrisome to the public health the fact that adolescents are the portion of the population which has increased the fertility rate in recent years. This article aims to identify the reasons in the literature why adolescents are still presenting risk behavior despite of being informed about contraceptive methods. Two computerized databases were consulted: LILACS (Latino-American and Caribbean Health Sciences Literature) and MEDLINE (International Database for Medical Literature). It has been found 128 articles, from which 16 were chosen to fit more to the proposed research. After analyzing the article, the discussion was based on the main issues addressed by the studies: the level of knowledge of adolescents about contraceptives, the age of first sexual intercourse, the most used contraceptive method, the factors related to the no using of contraceptives, the use of methods related to the sex of the adolescent and the use of drugs related to the contraception. The research enabled to note the complexity of the factors that determine the behavior of young people about contraception. The data indicated can help to develop ways of dealing with adolescents and create different strategies to achieve healthy behaviors. There is also a need to develop educational strategies that address the matter in multiplies dimensions.

É preocupante para a saúde pública o fato de os adolescentes serem a parcela da população que apresenta maior taxa de fecundidade nos últimos anos. Foi realizada uma pesquisa bibliográfica a fim de identificar os motivos pelos quais os adolescentes continuam apresentando comportamento de risco apesar de serem informados sobre os métodos contraceptivos. Duas bases de dados informatizadas foram consultadas: LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e MEDLINE (Literatura Internacional em Ciências da Saúde). Foram encontrados 128 artigos, dos quais 16 foram escolhidos por serem textos compreendidos entre os anos de 2003 e 2008 que mais se adequaram à proposta da pesquisa. Após a análise dos artigos, a discussão foi baseada em cima dos principais temas abordados pelos estudos: o nível de conhecimentos dos adolescentes quanto aos métodos anticoncepcionais, a idade da primeira relação sexual, o método mais utilizado, os fatores relacionados ao não uso de métodos anticoncepcionais, o uso dos métodos relacionado ao sexo do adolescente e o uso de drogas relacionado à anticoncepção. A pesquisa permitiu notar que o conhecimento não é o ponto chave da mudança de comportamento em relação ao sexo seguro entre os adolescentes. Os adolescentes tendem a usar contraceptivos com mais consistência quando a idade de início da atividade sexual é maior. Entre os métodos contraceptivos mais utilizados pelos adolescentes estão a pílula, o condon. Além disso, os pais têm influência significativa sobre o comportamento dos filhos, podendo contribuir para a redução da taxa de gravidez. A não utilização dos métodos contraceptivos está relacionada a relação sexual não esperada, o custo, a satisfação, a possível ocorrência de efeitos colaterais e atitudes do parceiro, bem como o uso de álcool e drogas está fortemente associado ao sexo inseguro...

Concurrent validity and reliability of the Alberta Infant Motor Scale in premature infants.

OBJECTIVE: To verify the concurrent validity and interobserver reliability of the Alberta Infant Motor Scale (AIMS) in premature infants followed-up at the outpatient clinic of Instituto Fernandes Figueira, Fundação Oswaldo Cruz (IFF/Fiocruz), in Rio de Janeiro, Brazil. METHODS: A total of 88 premature infants were enrolled at the follow-up clinic at IFF/Fiocruz, between February and December of 2006. For the concurrent validity study, 46 infants were assessed at either 6 (n = 26) or 12 (n = 20) months' corrected age using the AIMS and the second edition of the Bayley Scales of Infant Development, by two different observers, and applying Pearson's correlation coefficient to analyze the results. For the reliability study, 42 infants between 0 and 18 months were assessed using the Alberta Infant Motor Scale, by two different observers and the results analyzed using the intraclass correlation coefficient. RESULTS: The concurrent validity study found a high level of correlation between the two scales (r = 0.95) and one that was statistically significant (p < 0.01) for the entire population of infants, with higher values at 12 months (r = 0.89) than at 6 months (r = 0.74). The interobserver reliability study found satisfactory intraclass correlation coefficients at all ages tested, varying from 0.76 to 0.99. CONCLUSIONS: The AIMS is a valid and reliable instrument for the evaluation of motor development in high-risk infants within the Brazilian public health system.

Validade concorrente e confiabilidade da Alberta Infant Motor Scale em lactentes nascidos prematuros / Concurrent validity and reliability of the Alberta Infant Motor Scale in premature infants

OBJETIVO: Verificar a validade concorrente e a confiabilidade interobservador da Alberta Infant Motor Scale (AIMS) em lactentes prematuros acompanhados no ambulatório de seguimento do Instituto Fernandes Figueira, Fundação Oswaldo Cruz (IFF/Fiocruz). MÉTODOS: Foram avaliados 88 lactentes nascidos prematuros no ambulatório de seguimento do IFF/Fiocruz entre fevereiro e dezembro de 2006. No estudo de validade concorrente, 46 lactentes com 6 (n = 26) ou 12 (n = 20) meses de idade corrigida foram avaliados pela AIMS e pela escala motora da Bayley Scales of Infant Development, 2ª edição, por dois observadores diferentes, utilizando-se o coeficiente de correlação de Pearson para análise dos resultados. No estudo de confiabilidade, 42 lactentes entre 0 e 18 meses foram avaliados pela AIMS por dois observadores diferentes, utilizando-se o intraclass correlation coefficient (ICC) para análise dos resultados. RESULTADOS: No estudo de validade concorrente, a correlação encontrada entre as duas escalas foi alta (r = 0,95) e estatisticamente significativa (p < 0,01) na população total de lactentes, alcançando valores mais altos aos 12 meses (r = 0,89) do que aos 6 meses (r = 0,74). A confiabilidade interobservador apresentou valores satisfatórios de ICC em todas as idades avaliadas, variando de 0,76 a 0,99. CONCLUSÃO: A AIMS é uma escala válida e confiável para ser utilizada na avaliação do desenvolvimento motor de lactentes de risco na população da rede pública de saúde brasileira.

OBJECTIVE: To verify the concurrent validity and interobserver reliability of the Alberta Infant Motor Scale (AIMS) in premature infants followed-up at the outpatient clinic of Instituto Fernandes Figueira, Fundação Oswaldo Cruz (IFF/Fiocruz), in Rio de Janeiro, Brazil. METHODS: A total of 88 premature infants were enrolled at the follow-up clinic at IFF/Fiocruz, between February and December of 2006. For the concurrent validity study, 46 infants were assessed at either 6 (n = 26) or 12 (n = 20) months' corrected age using the AIMS and the second edition of the Bayley Scales of Infant Development, by two different observers, and applying Pearson's correlation coefficient to analyze the results. For the reliability study, 42 infants between 0 and 18 months were assessed using the Alberta Infant Motor Scale, by two different observers and the results analyzed using the intraclass correlation coefficient. RESULTS: The concurrent validity study found a high level of correlation between the two scales (r = 0.95) and one that was statistically significant (p < 0.01) for the entire population of infants, with higher values at 12 months (r = 0.89) than at 6 months (r = 0.74). The interobserver reliability study found satisfactory intraclass correlation coefficients at all ages tested, varying from 0.76 to 0.99. CONCLUSIONS: The AIMS is a valid and reliable instrument for the evaluation of motor development in high-risk infants within the Brazilian public health system.

Implantaçäo de um programa de conservaçäo auditiva em uma indústria de bebidas / Implantation of a hearing conservation programme in a drink industry

Os objetivos deste trabalho foram verificar a condição auditiva de 46 funcionários de uma indústria de bebidas da cidade de Santa Maria, RS e implantar um programa de conservação auditiva (PCA). Efetuaram-se medição do nível de ruído no local de trabalho, anamnese, palestra, avaliação audiológica e recomendações à direção da empresa. Abordou-se a importância da audição, os danos causados pelo ruído à saúde e especialmente à audição e a conscientização sobre o uso efetivo do EPI. Concluiu-se que existe PAIR instalada em 41,30 por cento dos indivíduos estudados e que há necessidade de conscientizar a direção da empresa e os funcionários sobre a importância da continuidade do PCA. Recomendou-se a redução do ruído na fonte.