Prediction of visceral leishmaniasis incidence using the Seasonal Autoregressive Integrated Moving Average model (SARIMA) in the state of Maranhão, Brazil / Previsão da incidência da leishmaniose visceral usando o modelo de média móvel integrado autorregressivo sazonal (SARIMA) no Maranhão, Brasil

Abstract Visceral leishmaniasis (VL) is an infectious disease predominant in countries located in the tropics. The prediction of occurrence of infectious diseases through epidemiologic modeling has revealed to be an important tool in the understanding of its occurrence dynamic. The objective of this study was to develop a forecasting model for the incidence of VL in Maranhão using the Seasonal Autoregressive Integrated Moving Average model (SARIMA). We collected monthly data regarding VL cases from the National Disease Notification System (SINAN) corresponding to the period between 2001 and 2018. The Box-Jenkins method was applied in order to adjust a SARIMA prediction model for VL general incidence and by sex (male or female) for the period between January 2019 and December 2013. For 216 months of this time series, 10,431 cases of VL were notified in Maranhão, with an average of 579 cases per year. With regard to age range, there was a higher incidence among the pediatric public (0 to 14 years of age). There was a predominance in male cases, 6437 (61.71%). The Box-Pierce test figures for overall, male and female genders supported by the results of the Ljung-Box test suggest that the autocorrelations of residual values act as white noise. Regarding monthly occurrences in general and by gender, the SARIMA models (2,0,0) (2,0,0), (0,1,1) (0,1,1) and (0,1,1) (2, 0, 0) were the ones that mostly adjusted to the data respectively. The model SARIMA has proven to be an adequate tool for predicting and analyzing the trends in VL incidence in Maranhão. The time variation determination and its prediction are decisive in providing guidance in health measure intervention.

Resumo A leishmaniose visceral (LV) é uma doença de natureza infecciosa, predominante em países de zonas tropicais. A predição de ocorrência de doenças infecciosas através da modelagem epidemiológica tem se revelado uma importante ferramenta no entendimento de sua dinâmica de ocorrência. O objetivo deste estudo foi desenvolver um modelo de previsão da incidência da LV no Maranhão usando o modelo de Média Móvel Integrada Autocorrelacionada Sazonal (SARIMA). Foram coletados os dados mensais de casos de LV através do Sistema de Informação de Agravos de Notificação (SINAN) correspondentes ao período de 2001 a 2018. O método de Box-Jenkins foi aplicado para ajustar um modelo de predição SARIMA para incidência geral e por sexo (masculino e feminino) de LV para o período de janeiro de 2019 a dezembro de 2023. Durante o período de 216 meses dessa série temporal, foram registrados 10.431 casos de LV no Maranhão, com uma média de 579 casos por ano. Em relação à faixa etária, houve maior registro no público pediátrico (0 a 14 anos). Houve predominância do sexo masculino, com 6437 casos (61,71%). Os valores do teste de Box-Pierce para incidência geral, sexo masculino e feminino reforçados pelos resultados do teste Ljung-Box sugerem que as autocorrelações de resíduos apresentam um comportamento de ruído branco. Para incidência mensal geral e por sexo masculino e feminino, os modelos SARIMA (2,0,0) (2,0,0), (0,1,1) (0,1,1) e (0,1,1) (2, 0, 0) foram os que mais se ajustaram aos dados, respectivamente. O modelo SARIMA se mostrou uma ferramenta adequada de previsão e análise da tendência de incidência da LV no Maranhão. A determinação da variação temporal e sua predição são determinantes no norteamento de medidas de intervenção em saúde.

Influência do tempo de internação hospitalar sobre a variabilidade da frequência cardíaca pediátrica por meio de método linear / Influence of hospital stay on the variability of pediatric heart rate by linear method / Influencia de la estancia hospitalaria en la variabilidad de la frecuencia cardiaca pediátrica por método lineal

INTRODUÇÃO: A imobilização prolongada acarreta prejuízos sistêmicos que repercute diretamente em maiores agravos aos pacientes, dentre eles se encontra a redução da VFC, indicativo de maior morbimortalidade clínica. OBJETIVO: Analisar se o tempo de internação hospitalar influencia a modulação autonômica da frequência cardíaca em pacientes pediátricos. METODOLOGIA: Estudo longitudinal, quantitativo e prospectivo, realizado em uma enfermaria pediátrica. A amostra foi de pacientes entre 4 a 11 anos, ambos gêneros, internados dentro das primeiras 48 horas. A coleta iniciou após a assinatura do TCLE pelo responsável, seguida do colhimento dos dados pessoais e clínicos dos pacientes seguida da coleta da VFC, repetida no último dia de internação. A captação da VFC foi realizada pelo monitor Polar RS800CX. Os dados foram transferidos e passados por uma análise matemática no programa Kubios HRV2.2. Por fim, os dados foram tabulados e analisados pelo Microsoft Excel 2013 e software BioEstat® 5.3 respectivamente. RESULTADOS: Os valores lineares no domínio do tempo obtiveram média pré (IRR=644,7 com P=0,42; RMSSD= 46,1 com P=0,017 e SDNN=43,5 com P=0,017) e pós (IRR=656,3; RMSSD=34,8; SDNN=35,38) e no domínio da frequência média pré (LF=41,9 com P=0,013; HF=58,0 com P=0,013; LF/HF=1,03 com P=0,04) e pós (LF=52,2; HF=47,7; LF/HF=3,56). A correlação de Pearson na análise tanto de RMSSD pós x tempo de internação, quanto SDNN pós x tempo de internação demonstraram R=0,55 e R=0,59 respectivamente. CONCLUSÃO: Foi observado que o tempo de internação exerce influência negativa sobre a modulação autonômica da frequência cardíaca em pacientes pediátricos.

INTRODUCTION: Prolonged immobilization causes systemic damage that has a direct impact on greater harm to patients, among which is the reduction in HRV, indicative of greater clinical morbidity and mortality. OBJECTIVE: To analyze whether the length of hospital stay influences the autonomic modulation of heart rate in pediatric patients. METHODOLOGY: Longitudinal, quantitative and prospective study, carried out in a pediatric ward. The sample consisted of patients between 4 and 11 years old, both genders, hospitalized within the first 48 hours. The collection began after the signature of the TCLE by the guardian, followed by the collection of the patients' personal and clinical data, followed by the HRV collection, repeated on the last day of hospitalization. HRV capture was performed by the Polar RS800CX monitor. The data were transferred and passed through a mathematical analysis in the Kubios HRV2.2 program. Finally, data were tabulated and analyzed using Microsoft Excel 2013 and BioEstat® 5.3 software, respectively. RESULTS: Linear values in the time domain obtained mean pre (IRR=644.7 with P=0.42; RMSSD=46.1 with P=0.017 and SDNN=43.5 with P=0.017) and post (IRR=656.3; RMSSD=34.8; SDNN=35.38) and in the pre mean frequency domain (LF=41.9 with P=0.013; HF=58.0 with P=0.013; LF/HF=1,03 with P=0.04) and powders (LF=52.2; HF=47.7; LF/HF=3.56). Pearson's correlation in the analysis of both the RMSSD post x length of stay and the SDNN post x length of stay showed R=0.55 and R=0.59 respectively. CONCLUSION: It was observed that the length of stay has a negative influence on the autonomic modulation of heart rate in pediatric patients.

INTRODUCCIÓN: La inmovilización prolongada provoca daños sistémicos que repercuten directamente en un mayor perjuicio para los pacientes, entre los que se encuentra la disminución de la VFC, indicativa de una mayor morbimortalidad clínica. OBJETIVO: Analizar si la duración de la estancia hospitalaria influye en la modulación autonómica de la frecuencia cardiaca en pacientes pediátricos. METODOLOGÍA: Estudio longitudinal, cuantitativo y prospectivo, realizado en una planta de pediatría. La muestra consistió en pacientes entre 4 y 11 años, de ambos sexos, hospitalizados dentro de las primeras 48 horas. La recogida se inició tras la firma del TCLE por el tutor, seguida de la recogida de los datos personales y clínicos de los pacientes, seguida de la recogida de la VFC, repetida el último día de hospitalización. La captura de la VFC se realizó con el monitor Polar RS800CX. Los datos se transfirieron y pasaron por un análisis matemático en el programa Kubios HRV2.2. Finalmente, los datos fueron tabulados y analizados utilizando Microsoft Excel 2013 y el software BioEstat® 5.3, respectivamente. RESULTADOS: Se obtuvieron valores lineales en el dominio temporal medios pre (TIR=644,7 con P=0,42; RMSSD=46,1 con P=0,017 y SDNN=43,5 con P=0,017) y post (TIR=656,3; RMSSD=34. 8; SDNN=35,38) y en el dominio de la frecuencia media pre (LF=41,9 con P=0,013; HF=58,0 con P=0,013; LF/HF=1,03 con P=0,04) y polvos (LF=52,2; HF=47,7; LF/HF=3,56). La correlación de Pearson en el análisis tanto de la RMSSD post x duración de la estancia como de la SDNN post x duración de la estancia mostró R=0,55 y R=0,59 respectivamente. CONCLUSIÓN: Se observó que la duración de la estancia influye negativamente en la modulación autonómica de la frecuencia cardíaca en pacientes pediátricos.

Assistance to families of children with Autism Spectrum Disorders: Perceptions of the multiprofessional team / Assistência às famílias de crianças com Transtornos do Espectro Autista: percepções da equipe multiprofissional / Asistencia a familias de niños con Trastornos del Espectro Autista: percepciones del equipo multidisciplinario

Abstract Objective: to synthesize the care provided by health professionals, at different care levels, to the families of children with Autism Spectrum Disorders. Method: a qualitative study, based on the Family-Centered Care philosophical theoretical framework and developed with 22 professionals from three multidisciplinary teams from the Health Care Network of a municipality in the state of Mato Grosso do Sul, Brazil. The data were collected through two focus groups with each team, organized with the support of the Atlas.ti 8 Qualitative Data Analysis® software and submitted to Thematic Content Analysis. Results: the findings show actions centered on specific situations, especially on the demands and needs arising from the child's care and atypical behavior. Influencing factors for family care, such as work overload and little professional experience, show the weakness of multiprofessional care and the invisibility of the family as a care unit. Conclusion: the need is highlighted to review functioning of the network for the multiprofessional care of children and their families and how such network is organized. It is recommended to offer permanent education actions that contribute to the qualification of multiprofessional teams in the care of families of children in the autism spectrum.

Resumo Objetivo: sintetizar o cuidado prestado por profissionais de saúde, nos diferentes níveis de atenção, às famílias de crianças com Transtornos do Espectro Autista. Método: estudo qualitativo, baseado no referencial teórico filosófico do Cuidado Centrado na Família, desenvolvido com 22 profissionais de três equipes multidisciplinares de serviços da Rede de Atenção à Saúde de um município do estado de Mato Grosso do Sul, Brasil. Os dados foram coletados por meio de dois grupos focais com cada equipe, organizados com apoio do software Atlas.ti 8 Qualitative Data Analysis e submetidos à Análise Temática de Conteúdo. Resultados: as descobertas mostram ações centradas em situações pontuais, principalmente nas demandas e necessidades advindas do cuidado da criança e de seu comportamento atípico. Fatores influenciadores para o cuidado à família, como a sobrecarga de trabalho e a pouca experiência profissional, evidenciam a fragilidade da assistência multiprofissional e a invisibilidade da família enquanto unidade de cuidado. Conclusão: destaca-se a necessidade de rever o funcionamento e modo como a rede para o cuidado multiprofissional da criança e sua família está organizada. Recomenda-se a oferta de ações de educação permanente que contribuam com a qualificação das equipes multiprofissionais no cuidado às famílias de crianças no espectro do autismo.

Resumen Objetivo: resumir la atención que brindan los profesionales de la salud, en los diferentes niveles de atención, a las familias de niños con Trastornos del Espectro Autista. Método: estudio cualitativo, basado en el marco teórico filosófico de la Atención Centrada en la Familia, desarrollado con 22 profesionales de tres equipos multidisciplinarios de servicios de la Red de Atención de la Salud en un municipio del estado de Mato Grosso do Sul, Brasil. Los datos fueron recolectados a través de dos grupos focales con cada equipo y organizados con la ayuda del software Atlas.ti 8 Qualitative Data Analysis ® y sometidos al Análisis de Contenido Temático. Resultados: los hallazgos muestran acciones enfocadas en situaciones específicas, principalmente en las demandas y necesidades que genera el cuidado del niño y su comportamiento atípico. Factores que influyen en la atención a la familia, como la sobrecarga de trabajo y la poca experiencia profesional, revelan las falencias que tiene la asistencia multidisciplinaria y la invisibilidad de la familia como unidad de atención. Conclusión: es necesario examinar el funcionamiento y la forma en que está organizada la red para la atención multidisciplinaria de los niños y sus familias. Se recomienda implementar acciones de educación continua que contribuyan a la capacitación de los equipos multidisciplinarios para la atención a las familias de niños con espectro autista.

El cuidado de niños y adolescentes negros con problemas de salud mental en la interseccionalidad entre género y raza / The care provided to black-skinned children and adolescents with mental health problems in the intersection between gender and race / O cuidado de crianças e adolescentes negros com problemas de saúde mental na interseccionalidade entre gênero e raça

Objetivo: caracterizar el perfil sociofamiliar de niños y adolescentes negros con problemas de salud mental y describir desde un enfoque interseccional quién es responsable de su cuidado. Método: estudio exploratorio descriptivo de enfoque cualitativo, llevado a cabo en un Centro de Atención Psicosocial Infantil y Juvenil de la región norte del municipio de São Paulo. La recolección de datos se realizó con 47 familiares de niños y adolescentes negros, con el soporte de un guion con variables predefinidas, sometidas a análisis estadístico. Resultados: se realizaron 49 entrevistas, 95,5% con mujeres, con edad promedio de 39 años, 88,6% madres, 85,7% negras. La renta familiar procede del salario para el 100% de los cuidadores hombres y el 59% de las mujeres. Entre las cuidadoras negras, 25% tienen casa propia y, entre las pardas, 46,2%. Del total de cuidadores, el 10% vive en casas ocupadas, el 20% vive en viviendas cedidas, el 35% tiene casa propia y el 35% alquila. La red de contención social es mayor entre los blancos (16,7%), seguidos por los pardos (3,8%) y está ausente entre los negros (0%). Conclusión: las responsables por el cuidado de niños y e adolescentes negros atendidos en el CAPSij, son, casi en su totalidad mujeres, "madres o abuelas" negras (o mulatas), con acceso desigual a educación, trabajo y vivienda, derechos sociales constitucionales en Brasil.

Objective: to characterize the sociofamily profile of black-skinned children and adolescents with mental health problems and to intersectionally describe who assumes responsibility for their care. Method: a descriptive and exploratory study with a quantitative approach, developed in the Psychosocial Care Center for Children and Adolescents from the North region of the municipality of São Paulo. The data were collected from 47 family members of black-skinned children and adolescents, using a script with predefined variables submitted to statistical analysis. Results: a total of 49 interviews were conducted: 95.5% women with a mean age of 39 years old, 88.6% mothers and 85.7% black-skinned. Family income comes from wages for all the male caregivers and for 59% of the women. Among the black-skinned female caregivers, 25% live in their own house, whereas this percentage is 46.2% among the brown-skinned ones. Of all the caregivers, 10% have a job, 20% live in transferred properties, 35% in houses of their own and 35% in rented places. The social support network is larger among white-skinned people (16.7%), followed by brown-skinned (3.8%), and absent among black-skinned individuals (0%). Conclusion: those responsible for the care of black-skinned children and adolescents monitored by the CAPS-IJ are almost entirely women, black-skinned (black or brown) "mothers or grandmothers", with unequal access to education, work and housing, constitutional social rights in Brazil.

Objetivo: caracterizar o perfil sociofamiliar de crianças e adolescentes negros com problemas de saúde mental e descrever interseccionalmente quem se responsabiliza por seus cuidados. Método: estudo descritivo exploratório de abordagem quantitativa, desenvolvido em um Centro de Atenção Psicossocial Infantojuvenil da região norte do município de São Paulo. Os dados foram coletados com 47 familiares de crianças e adolescentes negros, utilizando um roteiro com variáveis pré-definidas, submetidas à análise estatística. Resultados: foram realizadas 49 entrevistas, sendo 95,5% com mulheres, média de idade de 39 anos, 88,6% mães, 85,7% negras. A renda familiar é proveniente de salário, para 100% dos cuidadores homens e para 59% das mulheres. Dentre as cuidadoras pretas, 25% possuem casa própria, sendo que, dentre as pardas, 46,2%. Do total de cuidadores, 10% vivem em condições de ocupação, 20% habitam moradias cedidas, 35% casas próprias e 35% alugadas. A rede social de suporte é maior entre os brancos (16,7%), seguido pelos pardos (3,8%) e ausente entre os pretos (0%). Conclusão: as responsáveis pelo cuidado de crianças e adolescentes negros acompanhados pelo CAPSij, são na quase totalidade mulheres, "mães ou avós" negras (pretas ou pardas), com acesso desigual à educação, trabalho e moradia, direitos sociais constitucionais no Brasil.

Factores promotores y amenazadores de Esperanza en cuidadores de niños con condiciones crónicas / Factors that promote and threaten Hope in caregivers of children with chronic conditions / Fatores promotores e ameaçadores da Esperança em cuidadores de crianças com condições crônicas

Objetivo: identificar los factores que promueven y amenazan la Esperanza en cuidadores familiares de niños de 2 a 3 años con condiciones crónicas. Método: estudio cualitativo, incluyendo 46 cuidadores familiares de niños con condición crónica de 2 a 3 años, egresados de dos Unidades de Cuidados Intensivos Neonatales. La recolección de datos ocurrió mediante entrevistas semiestructuradas guiadas por el Modelo de Intervención en Ayuda Mutua Promotora de Esperanza. Los datos fueron sometidos a análisis temático deductivo. Resultados: se identificaron como factores promotores de la Esperanza: la experiencia compartida con los miembros de la red social de apoyo; la relación con el niño; mejoría clínica del niño; espiritualidad; orientación positiva para el futuro. Se identificaron como factores amenazadores de la Esperanza: relaciones conflictivas y incredulidad con relación al niño por parte de personas cercanas; incertidumbres sobre el futuro; inseguridades sobre la capacidad de cuidar al niño. Conclusión: los factores amenazadores de Esperanza generaron sufrimiento, dolor, angustia, ansiedad y soledad en los cuidadores. Los factores promotores de Esperanza generaron consuelo, motivación, fuerza y alegría. Los hallazgos permiten a los enfermeros reconocer las fortalezas y debilidades de los cuidadores y promover la adopción de comportamientos que promuevan la Esperanza en los cuidadores de niños con condiciones crónicas.

Objective: to identify the factors that promote and threaten Hope in family caregivers of 2- to 3-year-old children with chronic conditions. Method: qualitative study with 46 family caregivers of children between 2 and 3 years old with a chronic condition, discharged from two Neonatal Intensive Care Units. Data was collected through semi-structured interviews guided by the Model for Intervention in Mutual Help Promoter of Hope. Data were submitted to deductive thematic analysis. Results: the following were identified as factors that promote Hope: The experience shared with members of the social support network; The relationship with the child; Clinical improvement of the child; Spirituality; Positive guidance for the future. The following were identified as factors that threaten Hope: Conflictual relationships and discredit of the child by close people; Uncertainties about the future; Insecurities about the ability to care for the child. Conclusion: the threatening factors of Hope generated suffering, pain, anguish, anxiety, and loneliness in caregivers. The promoting factors of Hope generated comfort, motivation, strength and joy. The findings allow Nurses to recognize the strengths and weaknesses of caregivers and adopt behaviors that promote Hope in caregivers of children with chronic conditions.

Objetivo: identificar quais são os fatores promotores e ameaçadores da Esperança em cuidadores familiares de crianças de 2 a 3 anos com condições crônicas. Método: estudo qualitativo, incluindo 46 cuidadores familiares de crianças com condição crônica de 2 a 3 anos egressas de duas Unidades de Terapia Intensiva Neonatal. A coleta de dados se deu por meio de entrevista semiestruturada orientada pelo Modelo de Intervenção em Ajuda Mútua Promotor de Esperança. Os dados foram submetidos à análise temática dedutiva. Resultados: foram identificados como fatores promotores da Esperança: A experiência compartilhada com membros da rede de apoio social; A relação com a criança; Melhora clínica da criança; Espiritualidade; Orientação positiva para o futuro. Foram identificados como fatores ameaçadores da Esperança: Relações conflituosas e descrença da criança por pessoas próximas; Incertezas sobre o futuro; Inseguranças sobre a capacidade de prestar os cuidados à criança. Conclusão: os fatores ameaçadores da Esperança geraram sofrimento, dor, angústia, ansiedade e solidão nos cuidadores. Os fatores promotores da Esperança geraram conforto, motivação, força e alegria. Os achados possibilitam que Enfermeiros reconheçam as potencialidades e fragilidades dos cuidadores e promovam a adoção de comportamentos promotores de Esperança em cuidadores de crianças com condições crônicas.

Vida tras un trasplante renal pediátrico / Life after a pediatric kidney transplant

Introducción y objetivos: Actualmente no hay duda de que un trasplante renal con buena función es el mejor tratamiento que podemos ofrecer a un niño con insuficiencia renal severa, mejorando su crecimiento, su desarrollo y su actividad en general. Pero hay pocos trabajos que sigan a estos pacientes a lo largo de los años para conocer cómo es su vida de adultos, sus logros y si hay dificultades que han podido derivarse de su enfermedad. Este ha sido el objetivo del presente trabajo. Material y métodos: Hemos recogido la evolución de 287 pacientes que recibieron al menos un trasplante renal en edad pediátrica en nuestra unidad, analizando no solo la supervivencia de los injertos y receptores sino, fundamentalmente, su calidad de vida actual. Resultados: En un periodo de 40años (1979-2019) se realizaron 345 trasplantes renales en 287 receptores pediátricos, con una tasa de retrasplantes antes de cumplir la mayoría de edad del 16,7%. La supervivencia, tanto de los pacientes como de los injertos, ha mejorado notablemente en los últimos 20años. La supervivencia de los pacientes trasplantados en el periodo de 1979 a 1996 a los 10, 20 y 25años de la intervención fue del 83, del 76 y del 65%, respectivamente, y del 94 y del 82% a los 10 y 20años, respectivamente, en los trasplantados en el periodo de 1997 a 2019. La supervivencia del injerto en el periodo de 1979 a 1996 a los 10 y 20años fue del 39 y del 18%, aumentando en el segundo periodo al 68 y al 34%, respectivamente. La supervivencia del primer injerto con donante vivo a los 5 y 10años fue del 94 y del 89%. Actualmente son adultos 150 de estos pacientes. De ellos, el 32% tienen pareja estable y el 6,6% tienen hijos. El nivel de formación es menor que el de la población general, y muchos de ellos tienen otras comorbilidades. (AU)

Introduction and objectives: There is currently no doubt that a kidney transplant with good function is the best treatment we can offer a child with severe kidney failure, improving their growth, development and life in general. But there are few works that follow these patients over the years to find out what their life is like as adults, their achievements and if there are any difficulties that may have arisen from their illness. That has been the objective of this work. Material and methods: We have collected the evolution of 287 patients who received at least one kidney transplant in pediatric age, analyzing not only the survival of grafts and recipients but, fundamentally, their current quality of life. Results: Over a 40-year period (1979-2019), 345 kidney transplants were performed in 287 pediatric recipients, with a rate of retransplantation before reaching the age of majority of 16.7%. Survival, both of patients and grafts, has improved remarkably in the last 20years. The survival of transplanted patients in the period from 1979 to 1996 at 10, 20 and 25years after the intervention was 83%, 76% and 65% respectively, and 94% and 82% at 10 and 20years respectively in those transplanted in the period from 1997 to 2019. Graft survival in the period from 1979 to 1996 at 10 and 20years was 39% and 18%, increasing in the second period to 68% and 34% respectively. Survival of the first living donor graft at 5 and 10years was 94% and 89%.Currently 150 of these patients are adults. Of these, 32% have a stable partner and 6.6% have children. The level of training is lower than that of the general population and many of them have other comorbidities.(AU)

Lei Geral de Proteção de Dados e o controle social da saúde / General Data Protection Law and the social control of health

A proteção dos dados pessoais é um tema crucial para o controle social da saúde nesses tempos de capitalismo de vigilância em que há uma troca constante da privacidade dos indivíduos por serviços. Os capítulos dessa publicação são fruto de autores especialistas e convidados que participaram do Seminário online e gratuito intitulado "LGPD na Saúde: o CNS como articulador dos interesses da sociedade brasileira em Defesa da Vida", realizado em 2021. O evento foi promovido pelo Conselho Nacional de Saúde e nove mesas redondas conformaram três eixos de discussão: Acesso Universal à Saúde na Sociedade da Informação; Governo, Transformação Digital, Cidadania e o Controle Social da Saúde e Aspectos da Saúde Digital e da Ética em Pesquisa à Luz da LGPD. Enfim, esta coletânea visa contribuir com o cenário da governança das informações em saúde e a literacia dos atores do controle social na transição digital da saúde, suas práticas e tecnologias emergentes associadas.

Motivación y actividad física de los padres e índice de masa corporal de futbolistas infantiles / Motivation and physical activity of parents and body mass index of children footballers

El objetivo de este estudio fue comprobar si existe relación entre la motivación y la actividad física de los padres con la actividad física, el deseo y consumo alimentario y el índice de masa corporal de los hijos deportistas. Para ello, se llevó a cabo una revisión médica a 176 jugadores de fútbol (170 niños y 6 niñas; media de edad M=7.3 DT=.16) pertenecientes a la Escuela Municipal de Fútbol de Arahal (Sevilla); y de las categorías alevín (33 jugadores), benjamín (49), prebenjamín (44) e iniciación (50). Se calculó el índice de masa corporal a los infantes y luego se pidió a sus padres que completaran un cuestionario de motivación de padres, el cuestionario ad-hoc sobre la alimentación de los hijos, y que respondieran preguntas sobre su propia actividad física y la de sus hijos. Se realizaron análisis descriptivo, correlacional, comparativo, regresión y discriminante. Los resultados mostraron que la actividad física de los padres predecía un índice de masa corporal normal en los hijos, mientras que el mayor número de horas dedicadas a actividad extraescolares no deportivas (condición conductual) y el consumo excesivo de alimentos, mayor deseo de ingesta (condición cognitiva) por parte de los hijos se asociaron con sobrepeso u obesidad. Ambos resultados se produjeron independientemente del tipo de motivación que los padres presentaran sobre la práctica deportiva de sus hijos. (AU)

The im of this study was to check if there is a relationship between parental motivation and physical activity with physical activity, food desire and consumption and the body mass index of their sporting children. For this purpose, a medical check-up was carried out on 176 football players (170 boys and 6 girls; mean age M=7.3 SD=.16) belonging to the Municipal Football School of Arahal (Seville); and of the categories alevín (33 players), benjamín (49), prebenjamín (44) and iniciación (50). The children's body mass index was calculated and then their parents were asked to complete a parental motivation questionnaire, the ad-hoc questionnaire on their children's diet, and to answer questions about their own and their children's physical activity. Descriptive, correlational, comparative, regression and discriminant analyses were performed. Results showed that parental physical activity predicted normal body mass index in children, while more hours spent in non-sport extracurricular activity (behavioural condition) and excessive food consumption, higher food craving (cognitive condition) by children were associated with overweight or obesity. Both results were independent of the type of motivation parents had about their children's sport practice. (AU)

Protocolo de tratamiento con polietilenglicol 3350 con electrolitos para el estreñimiento en el niño crítico / Protocol for treatment of constipation with polyethylene glycol 3350 plus electrolytes in critically ill children

Introducción y objetivos: Ningún estudio ha analizado la efectividad del tratamiento del estreñimiento en niños críticamente enfermos. El objetivo de este estudio fue evaluar la implementación, la eficacia y la seguridad de un protocolo de tratamiento con polietilenglicol 3350 con electrolitos (PEG 3350+E) para el estreñimiento en niños en estado crítico. Métodos: Estudio prospectivo unicéntrico, incluyendo niños que ingresaron en cuidados intensivos pediátricos durante más de 72h y que desarrollaron estreñimiento. Se excluyeron los niños con trastornos o afecciones gastrointestinales previas. Los pacientes fueron tratados con enemas rectales o con PEG 3350+E oral a criterio del médico tratante. Se compararon variables clínicas, demográficas y efectos secundarios (diarrea, distensión abdominal y desequilibrio electrolítico). Resultados: Se estudiaron 56 pacientes de 48,2±11,9 meses de edad, siendo el 55,4% varones. Cuarenta y cuatro pacientes (78,6%) fueron tratados con PEG 3350+E y 12 pacientes (21,4%) con enemas rectales. El porcentaje de efectividad del PEG 3350+E (79,5%) fue mayor que el de los enemas (58,3%), pero la diferencia no fue estadísticamente significativa (p=0,151). No existieron diferencias significativas en ninguno de los efectos secundarios entre los 2 grupos. El PEG 3350+E fue más efectivo en los niños menores de 2 años (100%) que en los mayores de esa edad (65,4%), p<0,01, sin diferencias significativas en la aparición de efectos secundarios. Conclusiones: El tratamiento del estreñimiento en los niños en estado crítico con PEG 3350+E es eficaz y tiene pocos efectos secundarios, incluso en niños menores de 2 años. (AU)

Introduction and objectives: No studies have analysed the effectiveness of treatment for constipation in critically ill children. The aim of this study was to assess the implementation, efficacy and safety of a treatment protocol using polyethylene glycol 3350 with electrolytes (PEG 3350+E) for constipation in critically ill children. Methods: We conducted a single-centre prospective study in children admitted to the paediatric intensive care unit for a minimum of 72h and who developed constipation. Children with previous gastrointestinal disorders or diseases were excluded. The patients were treated with rectal enemas or with the oral PEG 3350+E protocol at the discretion of the treating physician. We compared clinical and demographic variables as well as adverse events (diarrhoea, abdominal distension and electrolyte imbalances). Results: The sample included 56 patients with a mean age of 48.2±11.9 months, of who 55.4% were male. Forty-four patients (78.6%) were treated with PEG 3350+E and 12 (21.4%) with rectal enemas. The proportion of patients who responded well to treatment was greater in the PEG 3350+E group (79.5%) compared to the enema group (58.3%), but the difference was not statistically significant (P=.151). There were no significant differences between the groups in any of the adverse effects. Treatment with PEG 3350+E was more effective in children aged less than 2 years (100%) compared to older children (100% vs. 65.4%; P<.01), with no significant differences in the development of adverse events. Conclusions: The PEG 3350+E treatment protocol for constipation in critically ill children was effective and associated with few adverse events, even in children aged less than 2 years. (AU)

Quality of life in children with food allergies, psychiatric symptoms, and caregiving burden of their mothers

Objective: The present study aimed to evaluate the quality of life in children with food allergies, the accompanying depression and anxiety disorders, and caregiving burden of their mothers. Material and Methods: A total of 168 children with food allergy visiting our clinic and their mothers were included in the study group. The control group included 152 children who visited the healthy child follow-up clinic of our hospital and their mothers. Studying mothers’ opinions, the Food Allergy Quality of Life Questionnaire Parent Form (FAQLQ-PF) was used for evaluating children, and the Beck’s Depression Inventory, Beck’s Anxiety Inventory, Temperament Evaluation of Memphis, Pisa, Paris, San Diego Auto-questionnaire, and Zarit Caregiver Burden Scales were used for evaluating mothers. Results: No differences were noticed between the study and control group regarding mean age and gender distribution (P > 0.05). In the study, the FAQLQ-PF total and subscale scores of children with food allergies were determined according to the opinions of their mothers, and scores tended to increase with age (P < 0.0001). In addition, it was determined that mothers of children with food allergies had higher levels of anxiety, depression, and caregiving burden than mothers of the control group (P < 0.0001). Conclusion: In order to develop a multidisciplinary approach for children with food allergies, we conceived as appropriate to inform their families about the difficulties of caregiving and psychosocial disorders that could develop over time. They also must be informed to take preventive measures as well as the medical aspects of their children’s disease (AU)

Does the severity of atopic dermatitis change with allergic sensitization? Is it real or a myth?

Objective: Atopic dermatitis (AD) is a chronic inflammatory skin disease that can occur at any age. This study aimed to evaluate the impact of food allergy on disease severity as well as clinical/laboratory findings in children with AD. Methods: Clinical and laboratory data of AD patients evaluated for food allergy between January 2021 and December 2022 were examined retrospectively. Results: Of the 52 patients evaluated, 32 (61.5%) were males, with a median age of 6 months (2–118 months). Among them, 26 (50%) had food allergies (FA) and five (9.6%) had inhalant allergen sensitivity. No significant difference in AD severity was observed between patients with and without FA. However, the FA group showed higher serum lactate dehydrogenase (LDH) levels (343.3 ± 81.5 U/L vs 297.7 ± 77.4 U/L; P = 0.011) and lower red cell distribution width (RDW). Inhalant allergen sensitivity was associated with higher AD severity. Conclusion: While guidelines recommend investigating food allergies in moderate to severe AD, this study found no significant difference in the relationship between AD severity and the presence of FA. However, inhalant allergen sensitivity was linked to increased AD severity. Therefore, a comprehensive patient history should include an evaluation of food allergies in children with AD, regardless of disease severity. Elimination and provocation tests related to suspected food items should be performed, and allergenic foods should be removed from the diet if they are found to contribute to the allergy (AU)

Somatic mutation spectrum of a Chinese cohort of pediatrics with vascular malformations.

BACKGROUND: Somatic mutations of cancer driver genes are found to be responsible for vascular malformations with clinical manifestations ranging from cutaneous birthmarks to life-threatening systemic anomalies. Till now, only a limited number of cases and mutations were reported in Chinese population. The purpose of this study was to describe the somatic mutation spectrum of a cohort of Chinese pediatrics with vascular malformations. METHODS: Pediatrics diagnosed with various vascular malformations were collected between May 2019 and October 2020 from Beijing Children's Hospital. Genomic DNA of skin lesion of each patient was extracted and sequenced by whole-exome sequencing to identify pathogenic somatic mutations. Mutations with variant allele frequency less than 5% were validated by ultra-deep sequencing. RESULTS: A total of 67 pediatrics (33 males, 34 females, age range: 0.1-14.8 years) were analyzed. Exome sequencing identified somatic mutations of corresponding genes in 53 patients, yielding a molecular diagnosis rate of 79.1%. Among 29 PIK3CA mutations, 17 were well-known hotspot p.E542K, p.E545K and p.H1047R/L. Non-hotspot mutations were prevalent in patients with PIK3CA-related overgrowth spectrum, accounting for 50.0% (11/22) of detected mutations. The hotspot GNAQ p.R183Q and TEK p.L914F mutations were responsible for the majority of port-wine stain/Sturge-Weber syndrome and venous malformation, respectively. In addition, we identified a novel AKT1 p.Q79K mutation in Proteus syndrome and MAP3K3 p.E387D mutation in verrucous venous malformation. CONCLUSIONS: The somatic mutation spectrum of vascular malformations in Chinese population is similar to that reported in other populations, but non-hotspot PIK3CA mutations may also be prevalent. Molecular diagnosis may help the clinical diagnosis, treatment and management of these pediatric patients with vascular malformations.

[Epidemiological characteristics and analysis of related infection risk factors for influenza in Anhui Province from 2013 to 2021].

Objective: Analysis of the characteristics of influenza epidemic in Anhui Province and quantification of the impact of different factors on influenza occurrence, providing scientific basis for better influenza prevention and control. Methods: Descriptive analysis and factor analysis were conducted on influenza-like illness (ILI) cases and RT-PCR results in Anhui Province from 2013 to 2021 using data from China's Influenza Monitoring Information System. Results: The percentage of influenza-like illness (ILI%) of sentinel hospitals in Anhui Province from April 1, 2013 to March 31, 2021 was 3.80% (1 209 142/31 779 987), showing an overall increasing trend, with a relatively high proportion in 2017-2018 at 4.30% (191 148/4 448 211). The proportion of ILI cases in infants and young children aged 0-4 years was a relatively high at 54.14% (654 676/1 209 142), and the highest ILI% was observed in Fuyang City, Anhui Province (6.25%, 236 863/3 788 863). Laboratory monitoring results showed that the positive rate of ILI cases in sentinel hospitals in 8 influenza monitoring years was 16.38% (34 868/212 912), showing an increasing trend year by year, with a relatively proportion in 2017-2018 at 26.19% (6 936/26 488). The detection rate of school-age children aged 5-14 years was a relativelyhigh at 28.81% (13 869/48 144), and the positive rate was a relatively high in Wuhu City among the 16 cities, reaching 22.01% (2 693/122 237). Influenza activity showed a single peak in winter-spring and alternating double peaks in winter-spring and summer, with different subtypes alternating, and A (H3N2) was the dominant subtype in summer. The results of a multiple logistic regression model showed that the positive rate was higher in 2017-2018, among children aged 5-14 years, in winter, and in southern Anhui. Conclusions: Influenza epidemic in Anhui Province has a clear seasonal pattern, and the ILI% and detection rate have shown an upward trend from 2013 to 2021. Therefore, it is suggested to ensure vaccine supply before the winter-spring influenza season arrives, and to strengthen vaccine uptake and health education to avoid the risk of infection during the peak period of influenza.

Child Death in a Resource-Limited Setting: A Simulation Case for Pediatric Residents to Prepare for Global Health Electives.

Introduction: Pediatric residents are increasingly pursuing global health electives. Differences in cultural norms and management around pediatric deaths in resource-limited settings can be emotionally overwhelming for residents. Educational resources are needed to better equip them for handling these stressful situations. We developed a predeparture simulation child death case to prepare pediatric residents for their global health elective. Methods: The simulation module included a clinical case followed by a multidisciplinary structured debriefing. The case featured a 5-year-old, malnourished child in hypovolemic shock who clinically deteriorates and dies. After obtaining a history and performing a physical examination, residents were expected to diagnose severe malnutrition, treat hypovolemic shock, and decide how far to extend resuscitation with the limited resources. Upon returning from abroad, residents were invited to complete a survey on the utility of the simulation case module in preparing for their elective. Results: Twenty-nine residents participated in the simulation case module, and 18 completed the survey. Seventeen agreed or strongly agreed that the simulation module was a useful tool for preparation (Mdn = 4.5 on a 5-point Likert scale). Residents reflected that the simulation module helped manage expectations and provided them with an understanding of the cross-cultural differences in managing pediatric deaths in a resource-limited setting. Discussion: Pediatric residents trained in resource-rich countries do not encounter death often. Postgraduate training programs could consider simulations like this one to prepare such residents for cross-cultural differences in managing pediatric deaths and build resiliency to operate in resource-limited settings.

Epidemiological characteristics of crashes and pattern of motorcycle injuries presenting to hospitals in Kisumu City, Kenya: a cross-sectional study.

Introduction: motorcycle injuries comprise considerable morbidity, disability and mortality of road traffic casualties. The study aimed to assess the pattern and characteristics of motorcycle crash injuries that sought care at the Emergency Departments in Tier III hospitals in Kisumu City during a six-month period from May to November 2019. Methods: this was a cross-sectional study of all motorcycle injury patients presenting to three tier III public and private hospitals in Kisumu City. Using a structured questionnaire, data were collected on human and injury characteristics. Multiple logistic regression model was used to determine the predictors of fatality. Statistical significance was set at p<0.05. Results: a total of 1073 of motorcycle crash injury patients sought and obtained care at the hospitals. The majority (73.6%) were males. Seventy-three cases resulted in death (case-fatality rate of 6.80%. The age range was 2-84 years, with a mean of 29.6 years (± SD 12.19). Majority, (43.3%) were aged 21-30 years. Most of the crashes occurred during the daytime (79.1%). Of all motorcycle riders and pillion passengers 30.6% wore helmets at the time of the crash. Head injuries (43.6%) were the most common. Injury seventy scores (ISS) ranged from 1 to 51. Glasgow comma scale <3, un-helmeted patients and major trauma (ISS > 16), significantly influenced mortality (P< 0.001). Conclusion: these findings confirmed and strengthened the documented substantial morbidity, mortality that motorcycle crashes place on individuals and society, contribute to the body of literature on motorcycle injuries and potentially assist in policy decisions on motorcycle transport safety.

A pattern of antibiotic drug resistance of Salmonella Typhi and Salmonella Paratyphi among children with enteric fever in a tertiary care hospital in Lahore, Pakistan.

AIM: To establish the pattern of antibiotic resistance and assess the frequency of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Salmonella Typhi and Salmonella Paratyphi among children with enteric fever. METHODS: This cross-sectional study was carried out in the Department of Pediatrics, Sharif Medical City Hospital, Lahore, from July 2020 to January 2021. The study involved patients aged between 0 to 15 years who attended our outpatient department or were admitted to the ward with the suspicion of typhoid fever. A convenience sample of patients with blood cultures positive for S. Typhi and S. Paratyphi was enrolled. RESULTS: Of the 105 participants, 70 (66.7%) were male. The mean age was 8.48±4.18 years, and the most affected age group was 6-10 years (n=46, 43.8%). Among the cultured organisms, 95 (90.5%) isolates were S. Typhi and 10 (9.5%) were S. Paratyphi A. Antibiotic resistance was highest against ampicillin (n=91, 86.7%), and all of the isolates were sensitive to imipenem and meropenem. Twenty-three (21.9%) cultured organisms were MDR and 54 (56.8%) were XDR. CONCLUSION: An alarming antibiotic drug resistance pattern was observed among children with enteric fever in Lahore. The lowest resistance was noted for azithromycin, meropenem, and imipenem. Our findings warrant the immediate implementation of tailored antibiotic stewardship and infection control strategies.

Prevalence of sleep disorder diagnoses and sleep medication prescriptions in individuals with ADHD across the lifespan: a Swedish nationwide register-based study.

BACKGROUND: Consistent evidence suggests a strong association between attention-deficit/hyperactivity disorder (ADHD) and subjectively reported sleep problems. However, the prevalence of clinically ascertained sleep disorder diagnoses and sleep medication prescriptions in individuals with ADHD remains unclear. OBJECTIVE: To determine the rates of sleep disorder diagnoses and sleep medication prescriptions in children, adolescents and adults with ADHD. METHODS: We linked Swedish national registers to create a cohort of individuals born 1945-2008. We estimated the absolute and relative risks (using logistic regression models) of different sleep disorder diagnoses and medication prescriptions in individuals with and without ADHD. The analyses were performed across five different age groups: children (5-11 years), adolescents (12-17 years), young adults (18-30 years), middle-aged adults (31-45 years) and older adults (46-60 years). FINDINGS: Among individuals with ADHD (N=145 490, 2.25% of the cohort), 7.5% had a sleep disorder diagnosis and 47.5% had been prescribed sleep medication. Individuals with ADHD, across all age groups, had a statistically significantly increased risk of having any sleep disorder diagnosis (ORrange=6.4-16.1) and any sleep medication prescription (ORrange=12.0-129.4) compared with individuals without ADHD. While rates of sleep disorders were highest in older adults, the relative risks were highest in youth. CONCLUSIONS: Individuals with ADHD have a substantially increased risk of sleep disorder diagnoses and sleep medication prescriptions, from childhood into older adulthood. CLINICAL IMPLICATIONS: More clinical efforts are needed to tackle impairing sleep problems in individuals with ADHD via systematic sleep assessment, appropriate diagnosis, and pharmacological and non-pharmacological interventions. Sleep medication use should be informed by sleep disorder diagnosis.

Infant and Young Child Feeding practices up to 23 months in Namuno District, Cabo Delgado, Mozambique.

BACKGROUND: Inadequate breastfeeding and complementary feeding practices are key determinants of child malnutrition and impact one-third of the under-five mortality rate worldwide. The district of Namuno in Cabo Delgado (Mozambique) has been long registering a high prevalence of acute malnutrition. To date, no data exists about Infant and Young Child Feeding (IYCF) practices in the area. The current pilot study explores the feeding practices among children aged 0-23 months in Namuno and sets out its main drivers. METHODS: This cross-sectional study was realized between August and September 2019 and drew on questionnaires for mothers/caregivers of children aged 0 to 23 months. We computed IYCF indicators and correlated them with mothers'/caregivers' school attendance, delivery setting, and distance between home and the place where livelihood activities took place (workplace), using univariate and multivariate (age-adjusted) logistic regression analysis. RESULTS: The survey was data derived from a sample of 632 mothers/caregivers. 62% of 0-23-month-old children received colostrum whilst only 31% of 0-5 months babies were on exclusive breastfeeding (EBF). Among 6-23 months old children, 17% consumed foods and beverages from at least five out of eight defined food groups, 31% received a minimum frequency of meals, and 23% had a minimum acceptable diet. Data revealed a positive correlation between early initiation of breastfeeding and delivery in a maternity ward (OR 6.9, CI 3.2-16.1, p-value < 0.001). No difference in the IYCF indicators between female and male babies was detected. CONCLUSIONS: In the Namuno district, IYCF practices did not fulfill WHO/UNICEF's indicators and recommendations. This suggests that efforts should be focused on EBF-enabling interventions to improve children's dietary consumption patterns.

Performance evaluation of two multiplex qualitative RT-PCR assays for detection of respiratory infection in paediatric population.

INTRODUCTION: Acute respiratory infection (ARI) contributes to significant mortality and morbidity worldwide and is usually caused by a wide range of respiratory pathogens. This study aims to describe the performance of QIAstat-Dx® Respiratory Panel V2 (RP) and RespiFinder® 2SMART assays for respiratory pathogens detection. MATERIALS AND METHODS: A total of 110 nasopharyngeal swabs (NPS) were collected from children aged one month to 12 years old who were admitted with ARI in UKMMC during a one-year period. The two qPCR assays were conducted in parallel. RESULTS: Ninety-seven samples (88.2%) were positive by QIAstat-Dx RP and 86 (78.2%) by RespiFinder assay. The overall agreement on both assays was substantial (kappa value: 0.769) with excellent concordance rate of 96.95%. Using both assays, hRV/EV, INF A/H1N1 and RSV were the most common pathogens detected. Influenza A/H1N1 infection was significantly seen higher in older children (age group > 60 months old) (53.3%, p-value < 0.05). Meanwhile, RSV and hRV/EV infection were seen among below one-year-old children. Co-infections by two to four pathogens were detected in 17 (17.5%) samples by QIAstat-Dx RP and 12 (14%) samples by RespiFinder, mainly involving hRV/EV. Bacterial detection was observed only in 5 (4.5%) and 6 (5.4%) samples by QIAstat-Dx RP and RespiFinder, respectively, with Mycoplasma pneumoniae the most common detected. CONCLUSION: The overall performance of the two qPCR assays was comparable and showed excellent agreement. Both detected various clinically important respiratory pathogens in a single test with simultaneous multiple infection detection. The use of qPCR as a routine diagnostic test can improve diagnosis and management.