O conhecimento das fases do desenvolvimento da linguagem infantil é de suma importância para a identificação precoce de suas alterações. Como o pediatra é o profissional que acompanha o desenvolvimento infantil, desde o nascimento da criança, cabe a ele acompanhar todas as fases do desenvolvimento - tanto global quanto da linguagem - além de orientar a família, realizar a identificação do problema de linguagem e o encaminhamento precoce do que não está dentro do desenvolvimento típico para que - o quanto antes - possa ser feita a intervenção. O objetivo principal deste trabalho foi verificar o conhecimento dos pediatras sobreo desenvolvimento da linguagem infantil antes e depois do acesso a um site específico sobre o tema. O objetivo secundário foi avaliar e analisar se o site acrescentou algum conhecimento aos profissionais, que pudesse ser utilizado e aplicado em suas rotinas. Participaram deste estudo 17 pediatras da Secretaria Municipal de Saúde do Município da cidade de Bauru (interior do Estado de São Paulo), sendo que a coleta de dados ocorreu em seus locais de trabalho (ambulatório ou pronto-socorro). Os profissionais foram convidados a preencher três questionários - um sobre perfil profissional e os outros dois avaliativos sobre o conteúdo do mesmo, com perguntas objetivas, antes e após a visualização do website. Para cada questionário, foram fornecidos até 30 minutos para preenchimento por meio manuscrito. Quanto ao perfil profissional, a média de idade dos pediatras foi de 48 anos, prevalência do sexo feminino, a média da carga horária semanal foi de 54 horas e 30 minutos e o local de trabalho com maior prevalência foi o pronto atendimento público. Em relação ao desempenho dos pediatras somente foi possível comparar o resultado pré e pós-visualização. Do questionário sobre aquisição e desenvolvimento da linguagem infantil, a questão que os pediatras apresentaram maior grau de acerto (82,35%) foi a que relacionava a idade da criança com o surgimento das primeiras palavras e o fator de risco que os pediatras mais elencaram que interfere no desenvolvimento e geram alterações na linguagem infantil foi a falta de estímulos. Os resultados pré e pós-visualização do blog somente foram possíveis de serem comparados em 24% da amostra (seis pediatras), pois a maioria dos pediatras só respondeu o questionário pré-visualização. Nesta comparação, as questões que apresentaram acertos com mudanças estatisticamente significantes foram as questões que se referiam a idade de aquisição dos fonemas e ao período em que a criança consegue contar uma história para o adulto. Concluindo, os resultados desta pesquisa mostraram que os pediatras que fizeram parte da amostra possuem uma visão global da linguagem e que há uma grande dificuldade quanto à adesão de participação em pesquisas mesmo que esta seja por meio de recursos digitais e não necessitando ser realizada no ambiente de trabalho. / The knowledge about the stages of the child language development is of paramount importance for the early identification of its changes. As the pediatrician is the professional who accompanies the child development from birth, it is up to him to follow all the stages of development - both global and language - in addition to guiding the family, carring the language problem identification and early referral about what is not within the typical development, so as soon as possible the intervention can be made. This paper aimed to verify pediatricians knowledge about child language development before and after the access to a specific site on the topic. The secondary objective was to evaluate and analyze if the site have added some knowledge to the professionals, that could be used and applied to their daily routines. Seventeen pediatricians of the Municipal Health Department of the Municipality of Bauru (state of São Paulo) participated of this study, and the data collection took place in their workspaces (outpatient or emergency room). The professionals were asked to complete three questionnaires - one about professional profile and two others evaluating its content, containing objective questions before and after viewing the website. It was provided 30 minutes to fill each questionnaire by hand. On the professional profile, the average age of pediatricians was 48 years, prevalence of women, the average weekly working hours was 54 hours and 30 minutes, and the workplace with the highest prevalence was the emergency public service. On the pediatricians performance, it was only possible comparing the pre and post view results. On the child language acquisition and development questionnaire, the question pediatricians had higher rightness degree (82.35%) was the one relating the child\'s age with the emergence of the first words, and according to the pediatricians, the risk factor that most interfere on development and generate changes in children\'s language was the lack of stimuli. Preview and post view results could only be compared with 24% of the sample (six pediatricians) since most pediatricians only answered the preview questionnaire. On this comparison, the questions presenting hits with statistically significant changes were those referred to the age of acquisition of phonemes and the period in which the child can tell a story to the adult. These data demonstrated and concluded that pediatricians have a global view of language and that there is a great difficulty on the participation of the accession in research even if it is through digital resources and do not need to be performed in the workplace.

O conhecimento das fases do desenvolvimento da linguagem infantil é de suma importância para a identificação precoce de suas alterações. Como o pediatra é o profissional que acompanha o desenvolvimento infantil, desde o nascimento da criança, cabe a ele acompanhar todas as fases do desenvolvimento - tanto global quanto da linguagem - além de orientar a família, realizar a identificação do problema de linguagem e o encaminhamento precoce do que não está dentro do desenvolvimento típico para que - o quanto antes - possa ser feita a intervenção. O objetivo principal deste trabalho foi verificar o conhecimento dos pediatras sobreo desenvolvimento da linguagem infantil antes e depois do acesso a um site específico sobre o tema. O objetivo secundário foi avaliar e analisar se o site acrescentou algum conhecimento aos profissionais, que pudesse ser utilizado e aplicado em suas rotinas. Participaram deste estudo 17 pediatras da Secretaria Municipal de Saúde do Município da cidade de Bauru (interior do Estado de São Paulo), sendo que a coleta de dados ocorreu em seus locais de trabalho (ambulatório ou pronto-socorro). Os profissionais foram convidados a preencher três questionários - um sobre perfil profissional e os outros dois avaliativos sobre o conteúdo do mesmo, com perguntas objetivas, antes e após a visualização do website. Para cada questionário, foram fornecidos até 30 minutos para preenchimento por meio manuscrito. Quanto ao perfil profissional, a média de idade dos pediatras foi de 48 anos, prevalência do sexo feminino, a média da carga horária semanal foi de 54 horas e 30 minutos e o local de trabalho com maior prevalência foi o pronto atendimento público. Em relação ao desempenho dos pediatras somente foi possível comparar o resultado pré e pós-visualização. Do questionário sobre aquisição e desenvolvimento da linguagem infantil, a questão que os pediatras apresentaram maior grau de acerto (82,35%) foi a que relacionava a idade da criança com o surgimento das primeiras palavras e o fator de risco que os pediatras mais elencaram que interfere no desenvolvimento e geram alterações na linguagem infantil foi a falta de estímulos. Os resultados pré e pós-visualização do blog somente foram possíveis de serem comparados em 24% da amostra (seis pediatras), pois a maioria dos pediatras só respondeu o questionário pré-visualização. Nesta comparação, as questões que apresentaram acertos com mudanças estatisticamente significantes foram as questões que se referiam a idade de aquisição dos fonemas e ao período em que a criança consegue contar uma história para o adulto. Concluindo, os resultados desta pesquisa mostraram que os pediatras que fizeram parte da amostra possuem uma visão global da linguagem e que há uma grande dificuldade quanto à adesão de participação em pesquisas mesmo que esta seja por meio de recursos digitais e não necessitando ser realizada no ambiente de trabalho. / The knowledge about the stages of the child language development is of paramount importance for the early identification of its changes. As the pediatrician is the professional who accompanies the child development from birth, it is up to him to follow all the stages of development - both global and language - in addition to guiding the family, carring the language problem identification and early referral about what is not within the typical development, so as soon as possible the intervention can be made. This paper aimed to verify pediatricians knowledge about child language development before and after the access to a specific site on the topic. The secondary objective was to evaluate and analyze if the site have added some knowledge to the professionals, that could be used and applied to their daily routines. Seventeen pediatricians of the Municipal Health Department of the Municipality of Bauru (state of São Paulo) participated of this study, and the data collection took place in their workspaces (outpatient or emergency room). The professionals were asked to complete three questionnaires - one about professional profile and two others evaluating its content, containing objective questions before and after viewing the website. It was provided 30 minutes to fill each questionnaire by hand. On the professional profile, the average age of pediatricians was 48 years, prevalence of women, the average weekly working hours was 54 hours and 30 minutes, and the workplace with the highest prevalence was the emergency public service. On the pediatricians performance, it was only possible comparing the pre and post view results. On the child language acquisition and development questionnaire, the question pediatricians had higher rightness degree (82.35%) was the one relating the child\'s age with the emergence of the first words, and according to the pediatricians, the risk factor that most interfere on development and generate changes in children\'s language was the lack of stimuli. Preview and post view results could only be compared with 24% of the sample (six pediatricians) since most pediatricians only answered the preview questionnaire. On this comparison, the questions presenting hits with statistically significant changes were those referred to the age of acquisition of phonemes and the period in which the child can tell a story to the adult. These data demonstrated and concluded that pediatricians have a global view of language and that there is a great difficulty on the participation of the accession in research even if it is through digital resources and do not need to be performed in the workplace.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / A infecÃÃo hospitalar à atualmente a mais freqÃente e importante causa de Ãbito de pacientes internados em unidades de terapia intensiva pediÃtrica. Para conhecer a dimensÃo desse problema em um Hospital PediÃtrico que possui um atendimento terciÃrio localizado no CearÃ, foi realizado um estudo de coorte prospectivo de todas as crianÃas internadas na UTIP no perÃodo de 01 de agosto de 2007 a 31 de janeiro de 2008. Uma coorte de 66 pacientes foi seguida da internaÃÃo a alta ou Ãbito. Ao todo 18 variÃveis do paciente e hospitalares foram pesquisadas em cada membro da coorte. Os testes estatÃsticos utilizados foram: Mann-Whitney e o teste exato de FISCHERâS, o cÃlculo do risco relativo com os respectivos intervalos de confianÃa. Em seguida procedeu-se a anÃlise multivariada com transformaÃÃo para regressÃo logÃstica dos fatores mais significativos (p<0,05). Ao final, um fator foi selecionado como preditor independente da infecÃÃo hospitalar: intubaÃÃo orotraqueal (OR=2,29, IC95%=1,38 a 3,82). A incidÃncia de infecÃÃo hospitalar foi de 54,6% (35IH/64pacientes). As bactÃrias mais prevalentes dos casos confirmados foram os bacilos gram-negativos (73,3%). A internaÃÃo dos pacientes com infecÃÃo hospitalar foi de 2,9 vezes superior a internaÃÃo dos pacientes nÃo acometido. A probabilidade de Ãbito global esperado foi de 13% e a observada foi de 43,9%. Este estudo poderà ser Ãtil para futuras estratÃgias com vistas a diminuir a morbimortalidade por infecÃÃo hospitalar.

Background: Caring for a child with a chronic health condition is often associated with high levels of anxiety, depression and stress (Burton et al., 2003). Demanding caring duties, a lack of time and social isolation create barriers for carers accessing mental health support. The internet may be useful way for carers to access psychological supports but to date no research has explored this. Aims: To identify common difficulties which carers face and adapt a pre-existing computerised CBT (cCBT) based course to reduce carer stress. To determine the feasibility of providing mental health support to carers through an online course and assess its potential effectiveness and accessibility. Methods: Focus groups and questionnaires completed by hospice staff provided information regarding common stressors encountered by carers. Thematic analysis (Braun and Clarke, 2006) was used to identify topics which were then used to adapt a pre-existing cCBT course which consisted of 6 primary modules and additional online materials/modules plus the offer of weekly email support for 6 weeks from a support worker to encourage use. A single arm feasibility trial of the tailored cCBT was conducted using carers of children with chronic conditions recruited through advertisements and local hospice staff. Participants were provided with access to the cCBT course for 6 weeks and received weekly personalised support emails. Self-report measures of anxiety, depression and daily functioning were measures at baseline and at post-treatment. Questionnaires administered online explored participant satisfaction and course use which were then analysed. Results: 19 hospice workers were recruited to complete questionnaires regarding common difficulties faced by carers. Several themes emerged from thematic analysis of the data including: physical and interpersonal difficulties, external pressures, time constraints, limited support, responding to the child’s illness and difficulties accessing appropriate care for their child. 29 carers were recruited to trial the online course, with 55.6% recruited through social media. 12 (30.8%) carers logged onto the course and 6 (15.4%) completed follow-up measures at 8 weeks post intervention. Of the participants that started the course only 2 (18.2%) completed all 6 course modules. Exploratory analyses showed no statistically significant differences in depression, anxiety or functional impairment. However, results indicated a general reduction in clinically significant anxiety symptoms and functional impairment. Satisfaction questionnaires completed by carers post-intervention indicated a high level of satisfaction with the course. Qualitative results showed that participants valued the email support they received and the flexibility that an online approach provided. Some carers still struggled to find time to complete the course and suggestions were made to amend the course to enable it to be accessed offline and on portable devices. Conclusion: Computerised courses may be an acceptable way of offering mental health support to some carers. Difficulties in retention and recruiting suggest that further adaptations to the course are needed to improve engagement (i.e. delivering the course via apps, or moving to stand alone course topics rather than a recommended course). Alternative methods of delivering psychological support should be explored to avoid excluding those who do not have internet access.

Two-thirds of UK mothers begin breastfeeding, but many soon stop. Although breastfeeding benefits health, infant feeding is influenced by social and attitudinal factors. Study one prospectively investigated the attitudes and experiences of 514 women. Past experience predicted which multiparae would stop by six weeks. Manual social class and considering bottle feeding did so for primiparae. Perceived insufficient milk was the commonest reason for stopping. Study two, a randomised trial of support from breastfeeding counsellors, recruited 720 women. At four months, 46.1% (143/310) intervention and 42.3% (131/310) control women breastfed (Chi\(^2\)=0.942, P=0.33); 73.9% (229/310) vs 79.4% (246/310) gave bottle feeds (Chi\(^2\)=2.60, P=0.11). Survival analysis confirmed that differences between intervention and control women's partial and full breastfeeding duration were not significant (P=0.45 and 0.15 respectively.) Significantly fewer intervention women felt they had insufficient milk. Qualitative analysis of women’s comments revealed they wanted better information, practical help with positioning, effective advice, encouragement and their feelings acknowledged. Women valued counselling, but their feeding behaviour changed little, which may reflect the strength of social influences and that not all mothers contacted the counsellors postnatally. Practical support in the early postnatal period is important. Counselling may increase women's confidence in breastfeeding and producing enough milk.

Successful implementation of the American Academy of Pediatrics evidence-based practice guidelines for ADHD management in primary care settings is challenging. Despite widespread use of these guidelines and the adoption of strategies to overcome barriers to care, no research has looked at how providers spend their time in managing ADHD and how this relates to the feasibility of practice guidelines in community settings. The present study aimed to assess pediatricians’ self-reported experiences in using the AAP guidelines for ADHD management and barriers to using an evidence-based approach, especially related to time demands. Five pediatricians from five pediatric primary care settings were interviewed on their experiences in ADHD management. Time demands was shown to be related to on-site behavioral health services and innovative scheduling strategies. Implications for primary care practice and future research are discussed.

El presente plan de negocios presenta el proyecto de aplicativo móvil Dr. Kids cuyo centro de operaciones será en el distrito de Pueblo Libre ubicado en la ciudad de Lima (Perú). Este proyecto consiste en brindar el servicio médico pediátrico domiciliario a través de la solicitud de citas mediante un aplicativo móvil y nace de la insatisfacción percibida en cuanto a los servicios de salud se refiere – tiempo de espera, atención administrativa y trato del personal médico principalmente – y a la disponibilidad de tiempo de los padres o apoderados de los niños y/o adolescentes para acudir a un centro médico ya sea privado o estatal. A través de este servicio se pretende brindar un servicio de calidad; eficiente; seguro e inmediato. Adicionalmente se beneficiará a los pacientes un seguimiento sobre su estado de salud y controles médicos si así lo amerite; es decir un negocio orientado al cliente y a la solución de su problema: En cuanto a la rentabilidad del negocio, podemos afirmar que según los datos obtenidos del plan financiero este negocio es rentable ya que presenta una TIR de 62.60%: y un VAN de: S/. 168,932.64 soles siendo el periodo de recuperación de 3 años 5 meses. / This business plan presents the project of mobile application Dr. Kids whose center of operations will be in the district of Pueblo Libre located in the city of Lima (Peru). This project consists of providing home pediatric medical service through the application of appointments through a mobile application and is born from the perceived dissatisfaction with regard to health services - waiting time, administrative attention and treatment of medical personnel mainly - and the availability of time for parents or guardians of children and / or adolescents to go to a private or state medical center. Through this service we aim to provide a quality service; efficient; safe and immediate. In addition, patients will benefit from a follow-up on their health status and medical check-ups if warranted; that is, a business oriented to the client and to the solution of his problem: As for the profitability of the business, we can say that according to the data obtained from the financial plan this business is profitable since it has an IRR of 62.60%: and a NPV of: S/. 168,932.64 soles being the recovery period of 3 year 5 months. / Trabajo de investigación

Nasal sprays used for the treatment of cold and allergy symptoms use same device and formulation in children and adults. Owing to the obvious differences in nasal cavity dimensions between adults and children, the performance of nasal sprays products in children needs to be critically assessed. In an effort to evaluate the deposition patterns of nasal sprays administered to children, a nasal cast based on MRI images obtained from a 12-year-old child’s nasal cavity was developed using 3D printing technology. Glycerin-water mixtures providing sprays with a range of plume angles (26° - 62°), along with three additional commercial nasal sprays, were investigated by actuating the device into the cast under controlled conditions. Following spray administration, the cast was disassembled and subjected to image analysis followed by quantification of formulation deposition in each section of the cast using both chemical and image analysis. The results showed that nasal sprays impacted entirely in the anterior region of the 12-year-old child’s nasal cavity and limited amount of spray entered the turbinate region – the effect site for most topical drugs. Additional experiments were conducted to measure the deposition patterns of nasal sprays in the presence of a mucus layer on the surface of the nasal cast. In an effort to make the nasal deposition studies more relevant to human nasal conditions, the mucus coated nasal cast was tilted in order to induce a physical movement of the mucus layer from the anterior region to the nasopharynx. The presence of mucus did not result in a significant increase in the turbinate region deposition but tilting of the mucus coated nasal cast resulted in 20% - 40% deposition in the turbinate region, improving the posterior region deposition of sprays. Even with the enhanced posterior movement nearly 60% of the spray formulations remained in the anterior region, a site with poor absorption characteristics. The computational fluid dynamic simulations evaluated the impact of multiple parameters including plume angle, droplet diameter and administration conditions on the deposition of nasal sprays in the 12-year-old child’s nasal cavity. The simulations showed significant anterior deposition for all plume angles (10° – 50°) and droplet diameters (30 µm – 400 µm) tested, similar to the observations from the in vitro experiments. An additional parameter, the direction of nasal spray actuation in the nasal cavity, was identified as a critical factor improving the turbinate region deposition of sprays in the 12-year-old child’s nasal cavity in spite of the narrow nasal valve region.

The pediatric intensive care unit (PICU) has been described as a stressful place for parents of critically ill children. Research to date has examined parents’ needs and stressors with a child in PICU. There is a paucity of research examining the experience for parents of a child who is transferred from the PICU to the hospital ward. Open-ended interviews were conducted with 10 parents within 24-48 hours after transfer from a PICU to a hospital ward at a children’s hospital in Canada to understand this experience. Parents revealed that the experience involved a search for comfort through transitions as expressed through the themes of: ‘being a parent with a critically ill child is exhausting’, ‘being kept in the know’, ‘feeling supported by others’, and ‘being transferred’. The findings from this study can help nurses and other health professionals working with parents to support them through the transition from PICU. Recommendations are made for the inclusion of family-centered care practices to assist parents through transitions.

Objectives: 1) Evaluate the risk of atherosclerosis in rheumatic disease compared to healthy controls; 2) Assess the lipid profile of children with systemic lupus erythematosus (SLE) at presentation before treatment with corticosteroids; 3) Compare the lipid profiles of children with juvenile dermatomyositis (JDM), systemic juvenile idiopathic arthritis (SJIA), and SLE; 4) Evaluate the extent of early atherosclerosis in children with JDM, SJIA, and SLE; 5) Investigate the progression of early markers of atherosclerosis in children with SLE. Methods. The methods include a systematic review, a cross sectional study of serum lipid levels of a cohort of children with SLE, an analysis of the first time point of a prospective study of cardiovascular disease risk factors and vascular function measures of a cohort of children with JDM, and SJIA, and SLE and a longitudinal study of vascular function measures of a prospective study of a cohort of children with SLE. Results. Our systematic review demonstrated that carotid intima media thickness (CIMT), a surrogate marker of early atherosclerosis, was significantly increased in rheumatic disease populations. We found that newly diagnosed children with SLE before corticosteroid treatment exhibited a pattern of dyslipoproteinemia of increased triglycerides and depressed HDL-cholesterol. When we measured the lipid profiles in children with the rheumatic diseases of JDM, SJIA, and SLE, one third of children had at least one abnormal lipid value. The most common abnormalities were found for total cholesterol and triglyceride levels and most often in children with JDM. One quarter of all patients were found to have insulin resistance. Lastly, when we considered the effects of treatment in children with SLE, we found that improvement in CIMT was possible and it correlated with a higher cumulative dose of prednisone over the study period. Conclusions. Early markers of atherosclerosis in pediatric rheumatic disease are important for determining the risk of these children in developing heart disease as young adults. Chronic inflammation plays a significant role and should be considered an important predictor of premature atherosclerosis.