Chilean reference of length at birth.

BACKGROUND: To generate a reference of length at birth (LB) according to sex and gestational age (GA) of the Chilean population. METHODS: This cross-sectional observational study used public pooled Chilean newborn (NB) population data registered by the Civil Registry and Identification Service in Chile from 2000 to 2016. Multiple births, entries without information for LB, GA, and sex, and birth lengths <-4SD and > 4SD, were excluded. After applying the selection and randomization criteria, the final sample was made up of 5 010 963 NB (2 560 310 boys; 2 450 653 girls). Length at birth centiles by sex and GA (24-42 weeks) were calculated using the GAMLSS method and then compared with the INTERGROWTH-21st standard. RESULTS: Girls had a lower LB than boys. For most GA and in both sexes, the absolute and percentage differences of percentiles as compared with INTERGROWTH-21st were lower than 1 cm and 1%, respectively. CONCLUSIONS: We present a reference for LB by sex and GA in the Chilean population, developed following updated methodological criteria for neonatal anthropometry, which is acceptably consistent with the INTERGROWTH-21st standard. The reference we propose may be used in clinical and epidemiological studies to identify either Chilean individuals or populations, respectively, at higher risk of perinatal and infant adverse events related to LB.

Intervención cognitivo conductual para promover la adhesión al tratamiento médico, recursos psicológicos y calidad de vida en pacientes pediátricos con hemodiálisis en México / Cognitive behavioral intervention to promote adherence to medical treatment, psychological resources, and quality of life in pediatric hemodialysis patients in Mexico

La Enfermedad Renal Crónica [ERC] es un problema de salud pública a nivel mundial. En México, en el año 2018 murieron 13.845 personas por estacausa. El incremento en el riesgo de mortalidad está asociado a la falta de apego al tratamiento. En pacientes pediátricos, una parte importante delmanejo de la enfermedad recae en el cuidador primario. El propósito de la presente investigación fue evaluar la eficacia de una intervención cognitivoconductual para mejorar la adhesión al tratamiento y la calidad de vida, así como promover recursos psicológicos en pacientes pediátricos con ERCen tratamiento de hemodiálisis y al mismo tiempo disminuir la carga en sus cuidadores primarios. El estudio empleó un diseño mixto, longitudinal, queincluyó pre-test, una intervención cognitivo conductual de ocho sesiones en el que se utilizó un manual, una evaluación post-test y un seguimiento a losdos meses. Participaron 5 pacientes pediátricos entre 12 y 17 años de edad y sus cuidadores primarios que asistían a un hospital público de la ciudadde Morelia, Michoacán, en México. Los resultados cuantitativos mostraron una mejora en la adhesión terapéutica, en la calidad de vida global y en losrecursos psicológicos de los pacientes, así como una disminución de la carga en los cuidadores primarios. Los hallazgos cualitativos mostraron que lospacientes lograron entender su padecimiento, expresaron sus emociones respecto a la enfermedad y reconocieron el apoyo de su cuidador primario.Se concluye que el tratamiento cognitivo conductual es una propuesta de intervención eficaz para mejorar las variables de estudio. (AU)

Cognitive behavioral intervention to promote adherence to medical treatment, psychological resources, and quality of life in pediatric hemodialysispatients in Mexico. Chronic Kidney Disease [CKD] is a public health problem worldwide. In Mexico, in 2018 13,845 people died from this cause.The increased risk of mortality is associated with the lack of adherence to treatment. In pediatric patients, an important part of disease managementfall on the primary caregiver. The purpose of the present investigation was to evaluate the efficacy of a cognitive behavioral intervention to improveadherence to treatment and quality of life, as well as to promote psychological resources in pediatric patients with CKD undergoing hemodialysistreatment and at the same time reduce the burden on their primary caregivers. The study used a mixed longitudinal design, with a pretest measurement, an 8-session cognitive-behavioral intervention using a manual, a post-test, and a 2-month follow-up test. Five pediatric patients between 12 and 17 years of age and their primary caregivers who attended a public hospital in the city of Morelia, Michoacán, in Mexico participated. The quantitative results showed an improvement in the therapeutic adherence, in the global quality of life and in the psychological resources of the patients,as well as a decrease in the burden on the primary caregivers. Qualitative findings showed that patients understood their condition, expressed theiremotions about the disease, and recognized the support of their primary caregiver. It is concluded that cognitive behavioral treatment is an effectiveintervention proposal to improve the study variables. (AU)

Birth Size and Maternal, Social, and Environmental Factors in the Province of Jujuy, Argentina.

INTRODUCTION: birth size is affected by diverse maternal, environmental, social, and economic factors. AIM: analyze the relationships between birth size-shown by the indicators small for gestational age (SGA) and large for gestational age (LGA)-and maternal, social, and environmental factors in the Argentine province of Jujuy, located in the Andean foothills. METHODS: data was obtained from 49,185 mother-newborn pairs recorded in the Jujuy Perinatal Information System (SIP) between 2009 and 2014, including the following: newborn and maternal weight, length/height, and body mass index (BMI); gestational age and maternal age; mother's educational level, nutritional status, marital status and birth interval; planned pregnancy; geographic-linguistic origin of surnames; altitudinal place of birth; and unsatisfied basic needs (UBN). The dataset was split into two groups, SGA and LGA, and compared with adequate for gestational age (AGA). Bivariate analysis (ANOVA) and general lineal modeling (GLM) with multinomial distribution were employed. RESULTS: for SGA newborns, risk factors were altitude (1.43 [1.12-1.82]), preterm birth (5.33 [4.17-6.82]), older maternal age (1.59 [1.24-2.05]), and primiparous mothers (1.88 [1.06-3.34]). For LGA newborns, the risk factors were female sex (2.72 [5.51-2.95]), overweight (1.33 [1.22-2.46]) and obesity (1.85 [1.66-2.07]). CONCLUSIONS: the distribution of birth size and the factors related to its variability in Jujuy are found to be strongly conditioned by provincial terrain and the clinal variation due to its Andean location.

Adherencia al tratamiento en infantes con insuficiencia renal crónica: inclusión del psicólogo al equipo interdisciplinario / Adherence to treatment in children with Chronic Renal Failure: inclusion of the psychologist to the interdisciplinary team

Resumen La enfermedad renal crónica (ERC) constituye una de las principales causas de mortalidad a nivel mundial. Se calcula que en México existen alrededor de 140.000 pacientes con este padecimiento. El presente trabajo tuvo como objetivo comprender los factores que facilitan e inhiben la adherencia al tratamiento de los pacientes pediátricos con ERC, dando énfasis en el abordaje interdisciplinario y en la inclusión del/la psicólogo/a para favorecer la atención integral de los pacientes. Se realizó un estudio descriptivo de tipo cualitativo, por medio de la técnica de entrevista con análisis por categorías. Participaron cuatro profesionales: un médico, una enfermera, una nutrióloga y una psicóloga del Hospital Infantil y de la Clínica de Hemodiálisis Galeno en Morelia, Michoacán, México. Los resultados mostraron la importancia del acompañamiento psicológico al paciente para la aceptación del diagnóstico, el manejo emocional, la adherencia al tratamiento y apoyo social, en especial con su cuidador/a primario. Finalmente, se propone un modelo de atención al paciente con ERC desde un enfoque interdisciplinario.

Abstract Chronic Kidney Disease (CKD) is one of the main causes of mortality worldwide. In Mexico there are around 140,000 patients with this condition. The aim of this research was understand the factors that facilitate and inhibit the adherence to treatment of pediatric patients with CKD, with interdisciplinary approach and the inclusion of the psychologist to promote comprehensive patient care. A descriptive qualitative study was carried out by the interview technique with analysis by categories. Four professionals participated: a doctor, a nurse, a nutritionist and a psychologist of the Children's Hospital and of Galeno Hemodialysis Clinic in Morelia, Michoacán, Mexico. The results showed the importance of psychological support to the patient for the acceptance of the diagnosis, emotional management, adherence to treatment and social support, especially with their primary caregiver. Finally, a model of CKD patient care is proposed from an interdisciplinary approach.

Geographic altitude and prevalence of underweight, stunting and wasting in newborns with the INTERGROWTH-21st standard / Altitude geográfica e prevalência de recém-nascidos abaixo do peso, com baixa estatura e emaciação de acordo com o padrão INTERGROWTH-21st

Abstract Objective: To assess the prevalence and risks of underweight, stunting and wasting by gestational age in newborns of the Jujuy Province, Argentina at different altitude levels. Methods: Live newborns (n = 48,656) born from 2009-2014 in public facilities with a gestational age between 24+0 to 42+6 weeks. Phenotypes of underweight (<P3 weight/age), stunting (<P3 length/age) and wasting (<P3 body mass index/age) were calculated using Intergrowth-21st standards. Risk factors were maternal age, education, body mass index, parity, diabetes, hypertension, preeclampsia, tuberculosis, prematurity, and congenital malformations. Data were grouped by the geographic altitude: ≥2.000 or <2.000 m.a.s.l. Chi-squared test and a multivariate logistic regression analysis were performed to estimate the risk of the phenotypes associated with an altitudinal level ≥2.000 m.a.s.l. Results: The prevalence of underweight, stunting and wasting were 1.27%, 3.39% and 4.68%, respectively, and significantly higher at >2.000 m.a.s.l. Maternal age, body mass index >35 kg/m2, hypertension, congenital malformations, and prematurity were more strongly associated with underweight rather than stunting or wasting at ≥2.000 m.a.s.l. Conclusions: Underweight, stunting, and wasting risks were higher at a higher altitude, and were associated with recognized maternal and fetal conditions. The use of those three phenotypes will help prioritize preventive interventions and focus the management of fetal undernutrition.

Resumo Objetivo: Avaliar a prevalência e os riscos de recém-nascidos abaixo do peso, baixa estatura e emaciação por idade gestacional da Província de Jujuy, Argentina, em diferentes níveis de altitude. Métodos: Recém-nascidos vivos (n = 48.656) nascidos entre 2009 e 2014 em instalações públicas entre 24+0-42+6 semanas de idade gestacional. Os fenótipos de abaixo do peso (< P3 peso/idade), baixa estatura (< P3 comprimento/idade) e emaciação (< P3 índice de massa corporal/idade) foram calculados com os padrões do INTERGROWTH-21st. Os fatores de risco foram idade materna, escolaridade, índice de massa corporal, paridade, diabetes, hipertensão, pré-eclâmpsia, tuberculose, prematuridade e malformações congênitas. Os dados foram agrupados pela altitude geográfica: ≥ 2.000 ou < 2.000 m.a.s.l. O teste qui-quadrado e a análise de regressão logística multivariada foram feitos para estimar o risco dos fenótipos associados ao nível de altitude ≥ 2.000 m.a.s.l. Resultados: A prevalência de abaixo do peso, baixa estatura e emaciação foi de 1,27%, 3,39% e 4,68%, respectivamente, significativamente maiores em > 2.000 m.a.s.l. A idade materna, índice de massa corporal > 35 kg/m2, hipertensão, malformações congênitas e prematuridade foram mais fortemente associados a abaixo do peso e não a baixa estatura ou emaciação em ≥ 2.000 m.a.s.l. Conclusões: Os riscos de abaixo do peso, baixa estatura e emaciação foram maiores em altitude mais elevada e foram associados a condições maternas e fetais reconhecidas. O uso desses três fenótipos ajudará a priorizar as intervenções preventivas e focar no manejo da desnutrição fetal.

Geographic altitude and prevalence of underweight, stunting and wasting in newborns with the INTERGROWTH-21st standard.

OBJECTIVE: To assess the prevalence and risks of underweight, stunting and wasting by gestational age in newborns of the Jujuy Province, Argentina at different altitude levels. METHODS: Live newborns (n=48,656) born from 2009-2014 in public facilities with a gestational age between 24+0 to 42+6 weeks. Phenotypes of underweight (2.000m.a.s.l. Maternal age, body mass index >35kg/m2, hypertension, congenital malformations, and prematurity were more strongly associated with underweight rather than stunting or wasting at ≥2.000m.a.s.l. CONCLUSIONS: Underweight, stunting, and wasting risks were higher at a higher altitude, and were associated with recognized maternal and fetal conditions. The use of those three phenotypes will help prioritize preventive interventions and focus the management of fetal undernutrition.