Indicadores de qualidade da atenção a usuários com diabetes na Atenção Primária à Saúde do Brasil: 2012 e 2018 / Quality indicators of care for users with diabetes in Primary Health Care in Brazil: 2012 and 2018 / Indicadores de calidad de la atención a usuarios con diabetes en Atención Primaria de Salud en Brasil: 2012 y 2018

Introdução: Diabetes mellitus (DM) é uma doença crônica, não transmissível, cuja prevalência tem aumentado mundialmente. Seu manejo adequado na Atenção Primária à Saúde (APS) pode reduzir suas complicações e as internações por condições sensíveis à atenção primária. Objetivo: Comparar indicadores de qualidade da atenção a pessoas com diabetes atendidas na rede básica de saúde do Brasil e suas diferenças por região. Métodos: Com delineamento transversal, utilizaram-se dados dos Ciclos I e III do Programa de Melhoria do Acesso e da Qualidade (PMAQ). Os desfechos foram indicadores sintéticos, operacionalizados a partir de 24 variáveis: i) acesso; ii) disponibilidade de insumos e equipamentos em condições de uso; iii) disponibilidade de medicamentos em quantidade suficiente; iv) organização e gestão; v) cuidado clínico; e vi) relato de cuidado adequado. Foram calculadas as diferenças em pontos percentuais (p.p.) dos indicadores entre 2012 e 2018, e os dados foram estratificados por região. Resultados: No geral, houve uma melhora no cuidado à pessoa com DM na APS do Brasil e regiões entre as equipes participantes do PMAQ, entre 2012 e 2018. As prevalências de acesso, disponibilidade de insumos/equipamentos, medicamentos, oferta, organização e gestão apresentaram aumento de, no mínimo, 10 p.p. no período de 6 anos, mas podem melhorar. Conclusões: Considerando que a ocorrência de DM está aumentando no país, faz-se necessário maior investimento na estrutura dos serviços e em programas de educação permanente dos profissionais de saúde.

Introduction: Diabetes Mellitus (DM) is a non-communicable chronic disease whose prevalence has been increasing worldwide. Its adequate management in Primary Health Care (PHC) can reduce complications and hospitalizations for conditions sensitive to primary care. Objective: To compare quality indicators for the care of people with diabetes treated in the basic health network in Brazil and their differences by region. Methods: With a cross-sectional design, data from Cycles I and III of the PMAQ were used. The outcomes were synthetic indicators, operationalized from 24 variables: i) access; ii) availability of supplies and equipment in usable conditions; iii) availability of medications in sufficient quantities; iv) organization and management; v) clinical care; and vi ) report of adequate care. Differences in percentage points (p.p.) of the indicators between 2012 and 2018 were calculated, and the data were stratified by region. Results: Overall, there was an improvement in the care of people with DM in PHC in Brazil and regions among the teams participating in PMAQ, between 2012 and 2018. The prevalence of access, availability of supplies/equipment, medications, demand, organization, and management showed an increase of at least 10 p.p. within six years, but they can improve. Conclusions: Considering that the occurrence of DM is increasing in the country, greater investment is necessary in the structure of services and in continuing education programs for health professionals.

La Diabetes Mellitus es una enfermedad crónica no transmisible cuya prevalencia ha aumentado en todo el mundo. Su manejo adecuado en la Atención Primaria puede reducir sus complicaciones y las hospitalizaciones por afecciones sensibles a la Atención Primaria. Objetivo: comparar indicadores de calidad de la atención a personas con diabetes atendidas en la red básica de salud de Brasil y sus diferencias por región. Métodos: Con delineamiento transversal, se utilizaron datos de los Ciclos I y III del PMAQ. Los defectos fueron indicadores sintéticos, operacionalizados a partir de 24 variables: i) acceso, ii) disponibilidad de insumos y equipos en condiciones utilizables, iii) disponibilidad de medicamentos en cantidad suficiente, iv) organización y gestión, v) atención clínica y vi) reporte de atención adecuada. Se calcularon las diferencias en puntos porcentuales (p.p.) de los indicadores entre 2012 y 2018, y los datos se estratificaron por regiones. Resultados: En general, hubo una mejora en la atención a las personas con DM en APS en Brasil y regiones entre los equipos participantes en el PMAQ entre 2012 y 2018. La prevalencia del acceso, la disponibilidad de insumos/equipos, los medicamentos, el suministro, la organización y la gestión mostraron un aumento de al menos 10 p.p. en el periodo de seis años, pero pueden mejorar. Conclusiones: Considerando que la ocurrencia de DM está aumentando en el país, es necesario invertir más en la estructura de los servicios y en programas de educación continuada para los profesionales de salud.

Impacto do exercício físico sobre o desempenho sexual / Impact of physical exercise on sexual performance

O desempenho sexual humano é influenciado por uma variedade de fatores biopsicossociais e a prática regular de exercícios pode trazer efeitos benéficos sobre a saúde física e emocional e prevenir disfunções sexuais. Este artigo tem como objetivo analisar a influência do exercício físico no desempenho sexual humano. Para a população feminina, exercitar-se tem efeitos positivos sobre a função sexual pela melhora na excitação sexual em decorrência do aumento na atividade do sistema nervoso simpático e fatores endócrinos. Praticantes de exercícios regulares apresentam melhor função sexual e vascularização clitoriana e menor sofrimento sexual, em comparação com mulheres sedentárias, sendo os benefícios mediados por determinantes biológicos e psicológicos. Para a população masculina, níveis mais altos de atividade física estão associados à melhora da função erétil e ao controle da ejaculação, pelo aumento da consciência interoceptiva e melhor equilíbrio simpático-vagal durante essa atividade, mediados por vias psicológicas e fisiológicas. As evidências sugerem que níveis moderados a altos (mas não excessivos) de atividade física beneficia a saúde sexual, caracterizando uma estratégia não farmacológica para a promoção do bem-estar sexual. A relação entre exercício físico e desempenho sexual reforça a importância de incorporar atividades físicas regulares como parte de um estilo de vida saudável, visando não apenas a saúde geral, mas também o bem-estar sexual. Com a crescente prevalência de disfunções sexuais, o exercício físico emerge como intervenção preventiva e terapêutica promissora, enfatizando a necessidade de mais estudos para explorar plenamente o potencial dessa intervenção.

Preparing the soil: Adjusting the metabolic health of patients with chronic wounds and musculoskeletal diseases.

In recent years, systemic inflammation has emerged as a pivotal player in the development and progression of various degenerative diseases. This complex, chronic inflammatory state, often undetected, can have far-reaching consequences for the body's physiology. At the molecular level, markers such as C-reactive protein, cytokines and other inflammatory mediators serve as indicators of systemic inflammation and often act as predictors of numerous musculoskeletal diseases and even certain forms of cancer. The concept of 'meta-inflammation', specifically referring to metabolically triggered inflammation, allows healthcare professionals to understand inflammatory responses in patients with metabolic syndrome. Driven by nutrient excess and the expansion of adipose tissue, meta-inflammation is closely associated with insulin resistance, further propagating the metabolic dysfunction observed in many Western societies. Wound persistence, on the other hand, exacerbates the detrimental effects of prolonged inflammation at the local level. Acute inflammation is a beneficial and essential process for wound healing and infection control. However, when inflammation fails to resolve, it can impede the healing process, leading to chronic wounds, excessive scarring and even the activation of fibrotic pathways. This approach significantly reduces the efficacy of regenerative biological therapies. Our review focuses on the vital role of proteins, vitamins and minerals in collagen synthesis and cell proliferation for tissue healing. We also examine hormonal influences on regeneration, noting the negative effects of imbalances, and emphasize glucose regulation's importance in creating a stable environment for chronic wound healing.

Bioinformatic Analysis from a Descriptive Profile of miRNAs in Chronic Migraine.

Chronic migraines have been described chiefly only from a clinical perspective. However, searching for reliable molecular markers has allowed for the discovery of the expression of different genes mainly associated with inflammation, neuro-vascularization, and pain-related pathways. The interest in microRNAs (miRs) that can regulate the expression of these genes has gained significant relevance since multiple miRs could play a key role in regulating these events. In this study, miRs were searched in samples from patients with chronic migraine, and the inclusion criteria were carefully reviewed. Different bioinformatic tools, such as miRbase, targetscan, miRPath, tissue atlas, and miR2Disease, were used to analyze the samples. Our findings revealed that some of the miRs were expressed more (miR-197, miR-101, miR-92a, miR-375, and miR-146b) and less (miR-133a/b, miR-134, miR-195, and miR-340) than others. We concluded that, during chronic migraine, common pathways, such as inflammation, vascularization, neurodevelopment, nociceptive pain, and pharmacological resistance, were associated with this disease.

Impact of chronic illness caused by chikungunya fever on quality of life and functionality.

BACKGROUND: Chikungunya fever compromises the functionality and quality of life in the affected individuals, even one year after the acute phase of the disease. Chronically affected people experience direct impairment in performing daily activities, along with a risk of developing other morbidities. BACKGROUND: ◼ Even after a year, chikungunya fever-affected people experience damage to their physical and mental health. BACKGROUND: ◼ Positive screening for depression risk was 13.5 times more likely in chronically affected. BACKGROUND: ◼ Patients with chronic chikungunya fever had a 76 times higher risk of walking impairments. OBJECTIVE: To evaluate the impact of chronic illness caused by chikungunya fever on the quality of life and functionality of affected individuals. METHODS: A cross-sectional and comparative study was conducted in which two groups were investigated: a Chikungunya Group comprising 25 patients with chronic fever screened after 1 year of illness via a telephonic survey, and a Healthy Group comprising 25 healthy individuals matched for sex and age by face-to-face interview. The Stanford HAQ 20-Item Disability Scale (HAQ) and the Short Form Health Survey (SF-12) questionnaires were administered to both groups. Generalized Linear Models, Pearson χ2 tests, and odds ratios were used to evaluate the test results. RESULTS: Significant differences in functional capacity and quality of life were observed between the Chikungunya and Healthy Groups. The chance of some impairment in functionality was also much higher in the Chikungunya Group in four of the HAQ categories, especially in the "walking" category (adjusted OR= 109.40). Further, the Chikungunya Group had a higher chance of presenting a below-average score in the mental component summary of the SF-12 (adjusted OR= 16.20) and of being positive in depression risk screening (adjusted OR= 34.57). CONCLUSION: Even one year after the acute phase, chikungunya fever can compromise the functionality and quality of life in affected individuals, with direct impairment in performing daily activities. Studies and therapeutic plans for chikungunya fever should consider the long-term impacts of this disease.

Long COVID: a new disease?

The definition of quaternary prevention as the set of interventions that avoids or mitigates the consequences of unnecessary or excessive activity of medical interventionism and the health system. The definition of a new disease is a complex process that involves the identification, characterization and description of a medical condition that has not been previously recognized or documented. Since mid-2020, the term chronic COVID/long COVID has been used to describe the presence of signs and symptoms after an acute SARS-CoV-2 infection, with multiple terminologies and definitions in international literature. Post-infectious syndromes, myalgia encephalomyelitis and fibromyalgia, are some of the diseases that have similarities with chronic COVID. This article presents an analysis relating the concepts of new disease and quaternary prevention with chronic COVID and other diseases described in the literature.

Se define prevención cuaternaria como el conjunto de intervenciones que evita o atenúa las consecuencias de la actividad innecesaria o excesiva del intervencionismo médico y del sistema sanitario. La definición de una nueva enfermedad es un proceso complejo que involucra la identificación, caracterización y descripción de un cuadro clínico que no ha sido previamente reconocida o documentada. Desde mediados del año 2020 se utiliza el término COVID crónico/long COVID para describir la presencia de signos y síntomas luego de una infección aguda por SARS-CoV-2, con múltiples terminologías y definiciones en la literatura internacional. Los síndromes posinfecciosos, la encefalomielitis mialgia y la fibromialgia, son algunas de las enfermedades que tienen similitudes con el COVID crónico. En este artículo se presenta un análisis relacionando los conceptos de nueva enfermedad y prevención cuaternaria con el COVID crónico y otras enfermedades descritas en la literatura.

Prognostic value of the duke activity Status Index Questionnaire in predicting mortality in patients with chronic heart failure: 36-month follow-up study.

BACKGROUND: The Duke Activity Status Index (DASI) questionnaire has been the focus of numerous investigations - its discriminative and prognostic capacity has been continuously explored, supporting its use in the clinical setting, specifically during rehabilitation in patients with chronic heart failure (CHF).However, studies exploring optimal DASI questionnaire threshold scores are limited. OBJECTIVE: To investigate optimal DASI questionnaire thresholds values in predicting mortality in a CHF cohort and assess mortality rates based on the DASI questionnaire using a thresholds values obtained. METHODOLOGY: This is a prospective cohort study with a 36-month follow-up in patients with CHF. All patients completed a clinical assessment, followed by DASI questionnaire, pulmonary function, and echocardiography. The Receiver Operating Characteristic (ROC) curve analysis was used to discriminate the DASI questionnaire score in determining the risk of mortality. For survival analysis, the Kaplan-Meier model was used to explore the impact of ≤/>23 points on mortality occurring during the 36-month follow-up. RESULTS: One hundred and twenty-four patients were included, the majority being elderly men. Kaplan Meier analysis revealed that ≤/> 23 was a strong predictor of CHF mortality over a 36-month follow-up. CONCLUSION: A score of ≤/>23 presents good discriminatory capacity to predict mortality risk in 36 months in patients with CHF, especially in those with reduced or mildly reduced ejection fraction. Age, ejection fraction, DASI questionnaire score and use of digoxin are risk factors that influence mortality in this population.

Healing of leprosy-associated chronic plantar wounds with a novel biomembrane containing latex proteins from Calotropis procera.

Pre-clinical assays demonstrated that a 1% polyvinyl alcohol biomembrane containing latex proteins (10%) from the medicinal plant Calotropis procera was biocompatible and stimulated healing of incisional and excisional wounds in murine models, and the mechanistic aspects were established. The efficacy of the biomembrane (BioMemCpLP) to promote healing of chronic ulcers in leprosy patients was investigated. The study started with 28 volunteers. Five were excluded later due to different disconformities. Ulcers from 15 patients were continuously treated with BioMemCpLP for 56 days. Five patients were treated only with silver sulfadiazine and three patients received plain hydrocolloid wound dressings with high absorption capacity. In all cases, wound dressings were renewed three times a week for 56 days and ulcers were evaluated weekly for contraction and healing progress. The extent of the healed area in the ulcers treated with BioMemCpLP was greater than in the control groups. Approximately 88% of ulcers treated with BioMemCpLP were fully healed before day 56, against 6% in both control groups. This result was not correlated with age/gender, duration or location of ulcers, deformity or whether or not the patient was cured of leprosy. The results showed that BioMemCpLP was beneficial for treatment of ulcers suffered by leprosy patients without noticeable side effects.

Dissimilar Trypanosoma cruzi genotype-specific serological profile assessed by Chagas-Flow ATE IgG1 upon benznidazole etiological treatment of chronic Chagas disease.

The present study aimed to verify the impact of etiological treatment on the genotype-specific serological diagnosis of chronic Chagas disease patients (CH), using the Chagas-Flow ATE IgG1 methodology. For this purpose, a total of 92 serum samples from CH, categorized as Not Treated (NT, n = 32) and Benznidazole-Treated (Bz-T, n = 60), were tested at Study Baseline and 5Years Follow-up. At Study Baseline, all patients have the diagnosis of Chagas disease confirmed by Chagas-Flow ATE IgG1, using the set of attributes ("antigen/serum dilution/cut-off"; "EVI/250/30%"). The genotype-specific serodiagnosis at Study Baseline demonstrated that 96% of patients (44/46) presented a serological profile compatible with TcII genotype infection. At 5Years Follow-up monitoring, NT and Bz-T presented no changes in anti-EVI IgG1 reactivity. However, significant differences were detected in the genotype-specific IgG1 reactivity for Bz-T. The most outstanding shift comprised the anti-amastigote TcVI/(AVI), anti-amastigote TcII/(AII) and anti-epimastigote TcVI/(EVI) reactivities. Regardless no changes in the genotype-specific serology of NT (TcI = 6%; TcII = 94%), distinct T. cruzi genotype-specific sero-classification was detected for Bz-T samples at 5Years Follow-up (TcII = 100%) as compared to Baseline (TcII = 97%; TcVI = 3%). The anti-trypomastigote TcI/(TI) was the attribute accountable for the change in genotype-specific sero-classification. In conclusion, our findings of dissimilar T. cruzi genotype-specific serology upon Bz-treatment re-emphasize the relevance of accomplishing the genotype-specific serodiagnosis during clinical pos-therapeutic management of chronic Chagas disease patients.

[Intercultural characterization of the empathetic physician: Experiences of chronic patients of the chilean public health system]. / Caracterización intercultural del médico empático: Experiencias de pacientes crónicos del sistema público de salud chileno.

BACKGROUND: Empathy is a fundamental element of the physician-patient relationship for treatment and therapeutic adherence that has had to face significant changes due to the migrations of the health system in Chile. AIM: Characterize the empathetic physicians according to the perceptions of chronic patients during the encounter with national and foreign doctors in the public health system in the Maule Region. METHODS: Qualitative study of exploratory-descriptive type. Twenty chronic patients from public health services in the Maule region were interviewed remotely using the free listing technique. A thematic processual qualitative analysis of the content and a descriptive quantitative analysis were carried out where the frequency and salience of the Smith index assisted by the Anthropac 4.98 software were obtained. RESULTS: Seven categories of empathetic care were identified in the physicians-patient relationship: Affectivity (37%), Communication (19%), Attention (13%), Respect (12%), Research (9%), Knowledge (5%) and Efficiency (5%). CONCLUSIONS: The affective and psychoemotional aspects were more valued than the cognitive aspects of empathetic care. No differences were observed in assessing the empathetic care of patients seen by Chilean physicians and those treated by foreign physicians.

Vitamin D treatment distinctly modulates cytokine production by peripheral blood mononuclear cells among patients with chronic cardiac and indeterminate clinical forms of Chagas disease.

INTRODUCTION: Chagas disease is caused by the protozoan Trypanosoma cruzi and is clinically divided into acute and chronic phases. Chronic Chagas cardiomyopathy is the most studied manifestation of the disease. Vitamin D deficiency has been suggested as a risk factor for cardiovascular disease. No studies demonstrate the action of this hormone in the cells of patients with chronic Chagas heart disease. OBJECTIVE: To evaluate the in vitro immunomodulatory effect of vitamin D on peripheral blood mononuclear cells of patients with the different chronic clinical forms of Chagas disease. Evaluating vitamin D's in vitro effect on blood cells by producing cytokines. METHODS: Thirteen patients of the undetermined form (IND), 13 of the mild cardiac form (CARD1) and 14 of the severe cardiac form (CARD2) of Chagas disease, and 12 with idiopathic heart disease (CARDid) were included. The cells obtained from peripheral blood were treated in vitro with vitamin D (1 × 10-7 M) for 24 h and cytokines were dosed in the culture supernatant. RESULTS: Although it was not possible to demonstrate statistically significant differences between the groups studied, our data showed that the cells treated with vitamin D modify (p < .05) the production of interferon-γ (IFN-γ) (decrease in IND), tumor necrosis factor-α (TNF-α) (decreased in CARD1 and CARDid), interleukin (IL)-6 (increased in all groups), and IL-10 (decreased in CARD1, CARD2, and CARDid) when compared to untreated cells. CONCLUSION: In vitro treatment with vitamin D distinctly modulated the production of cytokines by mononuclear cells of peripheral blood among patients with chronic and indeterminate cardiac clinical forms of Chagas disease.

[Early integration of palliative care; implications for people with chronic diseases]. / Integración temprana de cuidados paliativos; implicancias para personas con enfermedades crónicas.

INTRODUCTION: Globally, there is a growing number of population with noncommunicable and aging diseases that are eligible for palliative care. OBJECTIVE: To analyze when palliative care should be integrated in people with non-oncological chronic diseases and the implications of its implementation. METHODOLOGY: Review of scientific literature in the Web of Science, PubMed and CINAHL databases, using the descriptors palliative care, chronic diseases, and benefits. RESULTS: 28 scientific articles were selected, identifying four categories: palliative care for all; early integration of palliative care; strategies for implementation; benefits of palliative care integration. CONCLUSIONS: Palliative care is a strategy of care for all people with complex chronic pathologies, which should be integrated early, in an active, multidimensional and safe way, under the wing of a trained and coordinated health team at different levels of care.

Treatment of Chronic Haemophilic Synovitis with PRP: Clinical and In Vitro Studies.

Intra-articular blood, iron and hemosiderin, hydroxyl radical cytokines, and neo-angiogenesis cause synovial inflammation, which leads to cartilage and joint damage. Platelet-rich plasma (PRP) inhibits most of the mediators that produce and maintain synovitis. We compile here our work showing the clinical effectiveness of intra-articular PRP injections and their potential role in stopping articular cartilage damage due to bleeding and its possible repair. A total of 116 joints, including knees (63%), elbows (19.8%), and ankles (17.2%), were treated with intra-articular injections of PRP. Moreover, we also show here the number of extracellular DNA traps (ETs) and the PRP effect in the synovial fluid of patients at the time of treatment and six months after. Clinically, it is demonstrated that PRP is effective in reducing bleeding episodes (p < 0.001) and pain (p < 0.0001) and improving the hemophilia joint health score (HJHS) (p < 0.001) at one year of follow-up. Furthermore, our results demonstrate that PRP inhibits ET formation in vitro and reconstitutes the immune system's cellular components in the synovial fluid of patients after treatment. We conclude that PRP can be considered an effective, safe, and easy treatment for hemophilic synovitis.

A Multi-Epitope Protein for High-Performance Serodiagnosis of Chronic Chagas Disease in ELISA and Lateral Flow Platforms.

We developed a protein to rapidly and accurately diagnose Chagas disease, a life-threatening illness identified by the WHO as a critical worldwide public health risk. Limitations in present day serological tests are complicating the current health situation and contributing to most infected persons being unaware of their condition and therefore untreated. To improve diagnostic testing, we developed an immunological mimic of the etiological agent, Trypanosoma cruzi, by combining ten pathogen-specific epitopes within the beta-barrel protein structure of Thermal Green Protein. The resulting multi-epitope protein, DxCruziV3, displayed high specificity and sensitivity as the antibody capture reagent in an ELISA platform with an analytical sensitivity that exceeds WHO recommendations. Within an immunochromatographic platform, DxCruziV3 showed excellent performance for the point of application diagnosis in a region endemic for multiple diseases, the municipality of Barcelos in the state of Amazonas, Brazil. In total, 167 individuals were rapidly tested using whole blood from a finger stick. As recommended by the Brazilian Ministry of Health, venous blood samples were laboratory tested by conventional assays for comparison. Test results suggest utilizing DxCruziV3 in different assay platforms can confidently diagnose chronic infections by T. cruzi. Rapid and more accurate results will benefit everyone but will have the most noticeable impact in resource-limited rural areas where the disease is endemic.

Heart Failure Care Facilitators and Barriers in Rural Haiti: A Qualitative Study.

Background: Heart failure (HF) is a leading cause of hospitalizations in Haiti. However, few patients return for outpatient care. The factors contributing to chronic HF care access are poorly understood. Objective: The purpose of this study is to investigate the facilitators and barriers to accessing care for chronic HF from the patients' perspectives. Methods: We conducted a qualitative descriptive study of 13 patients with HF participating in three group interviews and one individual interview. We recruited patients after discharge from a nongovernmental organization-supported academic hospital in rural Haiti. We employed thematic analysis using emergent coding and categorized themes using the socioecological model. Findings: Facilitators of chronic care included participants' knowledge about the importance of treatment for HF and engagement with health systems to manage symptoms. Social support networks helped participants access clinics. Participants reported low cost of care at this subsidized hospital, good medication accessibility, and trust in the healthcare system. Participants expressedstrong spiritual beliefs, with the view that the healthcare system is an extension of God's influence. Barriers to chronic care included misconceptions about the importance of adherence to medications when symptoms improve and remembering follow-up appointments. Unexpectedly, participants believed they should take their HF medications with food and that food insecurity resulted in missed doses. Lack of social support networks limited clinic access. The nonhealthcare costs associated with clinic visits were prohibitive for many participants. Participants expressed low satisfaction regarding the clinic experience. A barrier to healthcare was the belief that heart disease caused by mystical and supernatural spirits is incurable. Conclusions: We identified several facilitators and barriers to chronic HF care with meaningful implications for HF management in rural Haiti. Future interventions to improve chronic HF care should emphasize addressing misconceptions about HF management and fostering patient support systems for visit and medication adherence. Leveraging local spiritual beliefs may also promote care engagement.

[Sleep in chronic neuropediatric diseases]. / Sueño en enfermedades neuropediátricas crónicas.

The prevalence of sleep disorders (SD) is notoriously increased in children with chronic neurological disease, with a negative bidirectional link that aggravates their symptomatology and has a negative impact on the quality of life of the child and their families. Identifying and recognizing this association is key for the child neurologist since the treatment of SD significantly improves daytime symptomatology in neurodevelopmental disorders, epilepsy, primary headaches, cerebral palsy and neuromuscular diseases.

La prevalencia de los trastornos del sueño (TS) se incrementa notoriamente en niños con enfermedad neurológica crónica, con un vínculo bidireccional negativo que agrava su sintomatología y repercute negativamente en la calidad de vida del niño y su familia. Identificar y reconocer dicha asociación es clave para el neuropediatra, ya que el tratamiento del TS mejora significativamente la sintomatología diurna de los trastornos del neurodesarrollo, epilepsia, cefaleas primarias, parálisis cerebral y enfermedades neuromusculares.