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Nature ; 577(7789): 170, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31911692
Adv Exp Med Biol ; 1232: 77-83, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893397


Instantaneous orthostatic hypotension (INOH) is one of the main types of orthostatic dysregulation in children and adolescents. In patients with INOH arterial pressure drops considerably after active standing and is slow to recover. We investigated changes in cerebral oxygenation in the bilateral prefrontal cortex during an active standing test in juvenile INOH patients to evaluate changes in cerebral oxygen metabolism. We enrolled 82 INOH patients (mean age 13.8 ± 2.2 years, 52 mild and 30 severe patients) at Nihon University Itabashi Hospital from October 2013 to April 2018. We measured cerebral oxygenated hemoglobin, deoxygenated hemoglobin, and total hemoglobin levels in the bilateral prefrontal cortex using near-infrared spectroscopy during an active standing test. In severe INOH patients, cerebral oxygenation of the right prefrontal cortex remained constant when blood pressure dropped; however, de-oxy-Hb significantly increased. These findings confirm that there is asymmetrical autoregulation between the right and left prefrontal cortex.

Circulación Cerebrovascular , Hipotensión Ortostática , Adolescente , Circulación Cerebrovascular/fisiología , Niño , Homeostasis , Humanos , Hipotensión Ortostática/fisiopatología , Oxihemoglobinas , Espectroscopía Infrarroja Corta
Urology ; 135: 137-138, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31895676
FP Essent ; 488: 11-15, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31894950


Circumcision is the surgical removal of some or all of the foreskin (ie, prepuce) of the penis. Among high-resource countries, the United States is the only country in which the majority of newborns are circumcised for nonreligious reasons. The rate of circumcision in the United States has been decreasing. Circumcised males have a lower risk of urinary tract infections, penile cancer, and several sexually transmitted infections. The benefit of circumcision is greater for males with certain urologic conditions, such as isolated hydronephrosis, vesicoureteral reflux, and ureteropelvic junction obstruction. Complications develop in approximately 1 of every 200 procedures. The American Academy of Pediatrics and the American Academy of Family Physicians recommend continued access to circumcision on an elective basis and conclude that the benefits outweigh the risks. However, they do not endorse routine neonatal circumcision. Local anesthesia should be used to decrease pain during the procedure. Three devices commonly are used. Each has risks and benefits, and no one device has been proven to be superior to another.

Circuncisión Masculina , Neoplasias del Pene , Enfermedades de Transmisión Sexual , Infecciones Urinarias , Niño , Humanos , Lactante , Recién Nacido , Masculino , Neoplasias del Pene/prevención & control , Enfermedades de Transmisión Sexual/prevención & control , Estados Unidos , Obstrucción Ureteral , Infecciones Urinarias/prevención & control
FP Essent ; 488: 16-20, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31894951


In children, inguinal hernias, hydroceles, and cryptorchidism typically are associated with a patent processus vaginalis. Inguinal hernias occur in 3.5%-5% of full-term newborns and 9%-11% of premature newborns. Inguinal hernias are characterized by an intermittent mass in the groin that may be reducible or incarcerated. Incarcerated hernias usually are painful, can cause vomiting, and require prompt intervention. The definitive treatment is surgery, and urgency depends on symptoms and ability to reduce the hernia. Hydrocele is an accumulation of serous fluid in the tunica vaginalis around the testicle that presents as a painless, fluctuant mass. Most hydroceles resolve spontaneously by age 1 year. Cryptorchidism occurs when one or both testes do not migrate to the scrotum. The diagnosis is made via history and physical examination. Spontaneous descent of the testis may occur before age 6 months but referral to a surgical subspecialist is indicated if descent does not occur.

Criptorquidismo , Hernia Inguinal , Hidrocele Testicular , Niño , Humanos , Lactante , Recién Nacido , Masculino
FP Essent ; 488: 21-24, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31894952


Toilet training is a developmental task that typically can be accomplished without medical intervention. Parent counseling about it can begin approximately at the 18- to 24-month well child visit. Guidelines from the American Academy of Pediatrics recommend beginning toilet training when the child shows signs of readiness, but typically not before age 2 years; praising success using positive terms; avoiding punishment, shaming, or force; and making training positive, nonthreatening, and natural. Nocturnal enuresis is defined as urinary incontinence that occurs at night during sleep in children 5 years or older for 3 consecutive months. It is common, affecting 5%-10% of 7-year-old children in the United States. Nonpharmacologic management includes behavioral interventions (eg, limiting fluid intake before bedtime, waking the child at night to attempt to urinate, lifting the sleeping child onto the toilet and then waking him or her to urinate, bladder training to increase bladder capacity, or instituting a reward system). Bed alarms are the first-line intervention but typically are not reimbursed by health insurance. Pharmacotherapy includes desmopressin, tricyclic antidepressants, and anticholinergics. The combination of a bed alarm with pharmacotherapy can be considered as initial management or after an unsuccessful initial intervention.

Enuresis Nocturna , Control de Esfínteres , Antidepresivos Tricíclicos , Terapia Conductista , Niño , Preescolar , Desamino Arginina Vasopresina , Femenino , Humanos , Lactante , Masculino , Enuresis Nocturna/terapia
FP Essent ; 488: 25-34, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31894953


Acute urinary tract infection (UTI) is among the most common bacterial infections in infants and children. Diagnosis requires evidence of infection and the presence of at least 50,000 colony-forming units (CFU)/mL of a pathogen cultured from an appropriately collected urine specimen. Febrile UTIs (ie, temperature 38°C [100.4°F] or greater) are most common during the first two years of life. Risk factors for UTI in febrile female infants are white race, age younger than 12 months, temperature 39°C (102.2°F) or greater, fever lasting 2 days or more, and absence of another source of infection. For febrile male infants, risk factors include being uncircumcised. If circumcised, risk factors include nonblack race, temperature 39°C (102.2°F) or greater, fever for more than 24 hours, and absence of another source of infection. Antibiotic treatment should be continued for 7 to 14 days. Renal and bladder ultrasonography is indicated for infants ages 2 to 24 months with a febrile UTI. If ultrasonography results are abnormal, a voiding cystourethrogram (VCUG) is indicated. VCUG also is indicated for children with recurrence of febrile UTI to identify vesicoureteral reflux and/or other anatomic findings associated with recurrent UTI. Recent studies have shown a statistically significant benefit of continuous antibiotic prophylaxis for prevention of recurrent UTI.

Infecciones Urinarias , Reflujo Vesicoureteral , Profilaxis Antibiótica , Niño , Preescolar , Femenino , Fiebre , Humanos , Lactante , Masculino , Factores de Riesgo
Oral Maxillofac Surg Clin North Am ; 32(1): 117-134, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31699581


Temporomandibular joint (TMJ) arthritis impacts mandibular growth and development. This can result in skeletal deformity, such as facial asymmetry and/or malocclusion asymmetry. This article reviews the unique properties of TMJ and dentofacial growth and development in the setting of juvenile idiopathic arthritis (JIA). Specific orthopedic/orthodontic and surgical management of children with JIA and TMJ arthritis is discussed. The importance of interdisciplinary collaboration is highlighted.

Artritis Juvenil/complicaciones , Deformidades Dentofaciales , Maloclusión , Procedimientos Quirúrgicos Ortognáticos/métodos , Trastornos de la Articulación Temporomandibular/complicaciones , Articulación Temporomandibular/patología , Niño , Humanos , Desarrollo Maxilofacial
Am J Clin Hypn ; 62(1-2): 60-73, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265372


This article examines the spatial and social nature of human relationships with children and adolescents in clinical hypnosis. Beginning with the unique way in which the phenomenon of rapport is intrinsic to the therapeutic uses of hypnosis and is distinct among other therapies, the stage is set for the importance of relational hypnosis. Through the use of case vignettes that illustrate developmental imperatives, relationship factors influencing the clinical interaction are demonstrated in practice. These include transference and countertransference, safety, embodiment, novelty, creativity, respect, trust, equality, being with, loving responses, synchronicity, and empathy. Hypnotic relating exists in a framework through which absorption in play and imagination evokes the child's resources and suggestions are made. In this receptive stance the personalized suggestions lead to an environment for positive change.

Hipnosis , Imaginación , Adolescente , Niño , Desarrollo Infantil , Preescolar , Femenino , Humanos , Masculino , Relaciones Profesional-Paciente , Alianza Terapéutica
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1048000


Objetivo: discutir as vivências dos profissionais no cuidado em rede intersetorial voltado à criança e adolescente e suas articulações/trabalho no território. Método: pesquisa qualitativa, exploratório-descritivo, desenvolvida com 26 trabalhadores da rede intersetorial, em um município do Rio Grande do Sul, entre os meses de maio a junho de 2014. Os instrumentos utilizados para a coleta de dados foram entrevistas semiestruturadas com os depoimentos gravados e, posteriormente, transcritos na íntegra. Resultados: o profissional possui uma vivência de rede intersetorial, entendendo que esta rede deve partir de premissas como a interdisciplinaridade e o trabalho em conjunto. Que a rede de cuidado deve transpor serviços de saúde, ampliando olhares para projetos sociais e de inclusão. Conclusão: o território pode ser incorporado como um espaço de cuidado, de relações sociais e de modos de vida, sendo espaço também de vínculos entre profissionais e usuários

Objective: to discuss the experiences of professionals of the intersectoral care network focused on children and adolescents and their connections / work in the territory. Method: This qualitative study exploratory-descriptive, that included 26 intersectoral network workers in a city of Rio Grande do Sul state, Brazil between the months of May and June 2014. Data collection was conducted through a semistructured interview during which the testimonies were recorded and subsequently transcribed in full. Results: The professional has an experience of intersectoral network, which is based on the premises of interdisciplinarity and working together. The care network must be more than just health services, including social and community spaces, social and inclusion projects. Conclusion: The territory can be understood as a space of care, social relations and ways of life, also offering space for links between professionals and users of services

Objetivo: discutir las experiencias de los profesionales acerca de la red de atención direccionada a los niños y adolescentes y sus articulaciones / trabajo en el territorio. Método: investigación cualitativa, exploratoriodescriptivo, desarrollada con 26 trabajadores de la red intersectorial entre los meses de mayo hasta junio de 2014 en una ciudad en Rio Grande do Sul. La recolección de datos fue realizada por medio de entrevista semiestructurado, con los testimonios grabados y posteriormente transcritos en su totalidad. Resultados: el profesional tiene una experiencia de red intersectorial, la comprensión de que la red de premisas como la interdisciplinariedad y el trabajo en conjunto. La red de cuidado debe pasar a los servicios de salud, la ampliación de las miradas para proyectos sociales e inclusión. Conclusión: El territorio puede ser incorporado como un espacio de atención, las relaciones sociales y formas de vida también el espacio y las relaciones entre los profesionales y los usuarios

Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Salud del Niño , Colaboración Intersectorial , Personal de Salud/organización & administración , Salud del Adolescente , Investigación Cualitativa , Atención a la Salud Mental
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1048054


Objetivo: compreender a contribuição da consulta de enfermagem para a educação em saúde dos familiares de crianças em tratamento quimioterápico ambulatorial. Método: pesquisa de campo de abordagem qualitativa, realizada no interior do estado de São Paulo com 15 famílias atendidas na consulta de enfermagem, por meio de entrevista semiestruturada. Os dados foram analisados com a técnica de análise de conteúdo. Resultados: identificou-se uma categoria temática central "A consulta de enfermagem como ferramenta para o empoderamento dos pais", subsidiada pelos seguintes núcleos de sentido: fundamental, apoio, acolhimento, relação de confiança e vínculo, aprendizado e segurança. Conclusão: a consulta de enfermagem foi revelada como um espaço que proporciona o empoderamento da família por meio da aquisição do conhecimento sobre o diagnóstico, o tratamento e a forma de lidar com a criança oncológica, o que possibilita aos pais maior segurança para cuidarem do filho

Objective: to understand the contribution of the nursing consultation to the health education of the relatives of children undergoing outpatient chemotherapy. Method: a qualitative field survey was carried out at in a town in the State of Sao Paulo with 15 families seen at the nursing consultation. Data collection was performed through a semi-structured interview and analyzed through content analysis technique. Results: a central thematic category was identified: "The nursing consultation as a tool for empowering the parents", supported by the nuclei of meaning: fundamental, support, reception, trust and bonding, learning and confidence. Conclusion: the nursing consultation was revealed as a moment for providing empowerment for the child's family through knowledge acquisition regarding the diagnosis, treatment and way of coping with the oncological child, which provides the parents with greater confidence to care for their child

Objetivo: comprender la contribución de la consulta de enfermería para la educación en salud de familiares de niños en tratamiento ambulatorio de quimioterapia. Método: estudio de campo de enfoque cualitativo, realizado en el interior de São Paulo, con 15 familias atendidas en consulta de enfermería, por medio de entrevista semiestructurada. Los datos fueron analizados con la técnica de análisis de contenido. Resultados: se identificó una categoría temática central "La consulta de enfermería como herramienta para empoderamiento de los padres", auxiliada por los siguientes núcleos de sentido: fundamental, apoyo, acogida, relación de confianza y vínculo, aprendizaje y seguridad. Conclusión: la consulta de enfermería fue revelada como un espacio que proporciona el empoderamiento de la familia por medio de adquisición de conocimiento sobre el diagnóstico, el tratamiento y la forma de tratar con el niño oncológico, lo que les propicia a los padres mayor seguridad para cuidar del hijo

Humanos , Masculino , Niño , Adulto , Padres/educación , Enfermería de Consulta , Oncología Médica/educación , Relaciones Profesional-Familia , Familia , Salud del Niño , Investigación Cualitativa , Atención Ambulatoria
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1047782


Objetivo: desvelar a produção acerca da assistência de enfermagem prestada às crianças/adolescentes vítimas de violência. Método: trata-se de uma revisão sistematizada realizada com consulta nas bases de dados: LILACS, Scielo e BDENF. Foram selecionados 19 artigos para compor este trabalho. A análise de dados deu-se por meio da proposta de Mendes, Silveira e Galvão. Resultados: os dados foram discutidos através dos tópicos: despreparo dos profissionais frente aos casos de violência infantil; sentimentos dos profissionais envolvidos no cuidado à criança/adolescente vítima de violência; notificação, protocolos e rotinas na assistência à criança/ adolescente vítima de violência; estratégias de assistência à criança/adolescente vítima de violência. Conclusão: os profissionais de enfermagem não se sentem preparados para atuarem frente aos casos de violência infantil. Identificou-se a necessidade de protocolos assistenciais que respaldem a assistência profissional. Ademais, é importante o fortalecimento da rede de atenção intersetorial que garanta a assistência adequada às vítimas e suas famílias

Objective: to explore the literature regarding the nursing care provided to children/adolescents victims of violence. Method: it consists of a systematic review performed on databases such as, LILACS, Scielo and BDENF. 19 articles have been selected to compose this study. The data analysis was developed throughout Mendes, Silveira and Galvão's proposal. Results: the data discussion occurred throughout the following topics: professional unpreparedness to deal with cases of child violence; the feelings of professionals involved on the care provided to a child/adolescent victim of violence; notification, protocols and routines regarding the assistance of children/adolescents victims of violence. Conclusion: nursing professionals do not feel prepared to deal with situations of children violence. It was identified the need of protocols that support the nursing assistance. Furthermore, it is important to enhance the intersectoral attention network in order to ensure the appropriate care to the victims and their families

Objetivo: desvelar la producción acerca de la asistencia de enfermería a los niños/adolescentes víctimas de violencia. Método: se trata de una revisión sistematizada realizada con consulta en las bases de datos: LILACS, Scielo y BDENF. Se seleccionaron 19 artículos para componer este trabajo. El análisis de datos se dio através de la propuesta de Mendes, Silveira y Galvão. Resultados: los datos fueron discutidos através de los tópicos: despreparo de los profesionales frente a los casos de violencia infantil; sentimientos de los profesionales envolvidos en el cuidado al niño/ adolescente víctima de violencia; notificación, protocolos y rutinas en la asistencia al niño/adolescente víctima de violencia; estrategias de asistencia al niño/adolescente víctima de violencia. Conclusión: los profesionales de enfermería no se sienten preparados para actuar frente a los casos de violencia infantil. Se identificó la necesidad de protocolos asistenciales que soporten la asistencia profesional. Además, es importante el fortalecimiento de la red de atención intersectorial que promueva la asistencia adecuada a las víctimas y sus familia

Humanos , Masculino , Femenino , Niño , Adolescente , Maltrato a los Niños/psicología , Violencia Doméstica , Atención de Enfermería , Maltrato a los Niños/terapia , Salud del Niño , Salud del Adolescente , Exposición a la Violencia
Gut ; 69(1): 32-41, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-30979718


INTRODUCTION: The optimal trial design for assessing novel therapies in paediatric IBD (PIBD) is a subject of intense ongoing global discussions and debate among the different stakeholders. However, there is a consensus that the current situation in which most medications used in children with IBD are prescribed as off-label without sufficient paediatric data is unacceptable. Shortening the time lag between adult and paediatric approval of drugs is of the upmost importance. In this position paper we aimed to provide guidance from the global clinical research network (Pediatric Inflammatory Bowel Disease Network, PIBDnet) for designing clinical trials in PIBD in order to facilitate drug approval for children. METHODS: A writing group has been established by PIBDnet and topics were assigned to different members. After an iterative process of revisions among the writing group and one face-to-face meeting, all statements have reached consensus of >80% as defined a priori. Next, all core members of PIBDnet voted on the statements, reaching consensus of >80% on all statements. Comments from the members were incorporated in the text. RESULTS: The commentary includes 18 statements for guiding data extrapolation from adults, eligibility criteria to PIBD trials, use of placebo, dosing, endpoints and recommendations for feasible trials. Controversial issues have been highlighted in the text. CONCLUSION: The viewpoints expressed in this paper could assist planning clinical trials in PIBD which are both of high quality and ethical, while remaining pragmatic.

Ensayos Clínicos como Asunto/métodos , Fármacos Gastrointestinales/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Factores de Edad , Productos Biológicos/administración & dosificación , Productos Biológicos/uso terapéutico , Niño , Ensayos Clínicos como Asunto/normas , Relación Dosis-Respuesta a Droga , Aprobación de Drogas/métodos , Fármacos Gastrointestinales/administración & dosificación , Humanos , Selección de Paciente , Proyectos de Investigación , Índice de Severidad de la Enfermedad , Resultado del Tratamiento