Avaliação do desenvolvimento neuropsicomotor em crianças na rede básica de saúde utilizando o teste de Denver II: identificação de fatores de risco materno

Alterations in the neuropsychomotor development of children are not rare and can manifest themselves with varying intensity at different stages of their development. In this context, maternal risk factors may contribute to the appearance of these alterations. A number of studies have reported that neuropsychomotor development diagnosis is not an easy task, especially in the basic public health network. Diagnosis requires effective, low-cost, and easy - to-apply procedures. The Denver Developmental Screening Test, first published in 1967, is currently used in several countries. It has been revised and renamed as the Denver II Test and meets the aforementioned criteria. Accordingly, the aim of this study was to apply the Denver II Test in order to verify the prevalence of suspected neuropsychomotor development delay in children between the ages of 0 and 12 months and correlate it with the following maternal risk factors: family income, schooling, age at pregnancy, drug use during pregnancy, gestational age, gestational problems, type of delivery and the desire to have children. For data collection, performed during the first 6 months of 2004, a clinical assessment was made of 398 children selected by pediatricians and the nursing team of each public health unit. Later, the parents or guardians were asked to complete a structured questionnaire to determine possible risk indicators of neuropsychomotor development delay. Finally the Denver II Developmental Screening Test (DDST) was applied. The data were analyzed together, using Statistical Package for Social Science (SPSS) software, version 6.1. The confidence interval was set at 95%. The Denver II Test yielded normal and questionable results. This suggests compromised neuropsychomotor development in the children examined and deserves further investigation. The correlation of the results with preestablished maternal risk variables (family income, mother s schooling, age at pregnancy, drug use during the pregnancy and gestational age) was strongly significant. The other maternal risk variables (gestational problems, type of delivery and desire to have children) were not significant. Using an adjusted logistic regression model, we obtained the estimate of the greater likelihood of a child having suspected neuropsychomotor development delay: a mother with _75 4 years of schooling, chronological age less than 20 years and a drug user during pregnancy. This study produced two manuscripts, one published in Acta Cirúrgica Brasileira , in which an analysis was performed of children with suspected neuropsychomotor development delay in the city of Natal, Brazil. The other paper (to be published) analyzed the magnitude of the independent variable maternal schooling associated to neuropsychomotor development delay, every 3 months during the first twelve months of life of the children selected.. The results of the present study reinforce the multifactorial characteristic of development and the cumulative effect of maternal risk factors, and show the need for a regional policy that promotes low-cost programs for the community, involving children at risk of neuropsychomotor development delay. Moreover, they suggest the need for better qualified health professionals in terms of monitoring child development. This was an inter- and multidisciplinary study with the integrated participation of doctors, nurses, nursing assistants and professionals from other areas, such as statisticians and information technology professionals, who met all the requirements of the Postgraduate Program in Health Sciences of the Federal University of Rio Grande do Norte

Identificação de crianças e adolescentes com suspeita de câncer: uma proposta de intervenção

Unlike adult cancer, where cells usually originate from epithelial tissue and is linked to environmental factors, malignant tumors in childhood are mostly of embryonic origin and have a phase of rapid proliferation. When not started chemotherapy at this stage, the tumor increases in size, reducing their growth rate, thus reducing the response to chemotherapy. Childhood cancer is in Brazil, the second cause of mortality among children and adolescents from one to nineteen. His impact on the ranking of diseases becomes significantly important to public health since the first issue is related to accidents and violence. Many children are still sent to the centers of high complexity for cancer treatment with advanced stage disease. The delay in referral to diagnosis can be family, or the difficulty of access to the health sector, or the characteristics of the disease and lack of health staff regarding theme of childhood cancer. Before this problem, we aimed to assess the performance of health teams in the identification of child and adolescent symptoms of cancer in primary care, through the action research methodology, which includes the teaching-learning, seminars, describing the actions of the group and discussing the activities after the training. This study involved thirty-seven health professionals who provide care for children and adolescents in the USF Felipe Shrimp II, the Support Center for Children with Cancer and the pediatric hospital UFRN during the period from March to December 2010. The data were analyzed simultaneously to evaluate actions, following the direction of the analysis of ideas Freires, having as theoretical reference the primary health care. The diagnosis of current reality, as knowledge of the health team targeted for early identification of signs and symptoms raised through questioning, presented as generative themes: resistance to change, awareness of the need for apprehension of knowledge; prior knowledge through the media, fragmentation of the healthcare network, interfering with the operation of the reference and counter, the stigma of death, among others. The selected themes enabled the choice of content for the preparation of four seminars, such as implementation of collective action for discussion problematical. The teaching-learning process has allowed the study participants awareness of the problem and work through the knowledge acquired by interfering in decreasing the time interval between the identification of signs and symptoms of cancer and early specialist treatment. Their difficulties we are faced with a diagnosis of terminal cancer and associated with delayed access to laboratory tests and imaging necessary for the diagnosis of neoplasms. Thus, we find that when the team is consciously involved in the education process from identification of the problem situation, there may be significant changes in daily activities through awareness of being. However, we also realize that acquisition of knowledge and interest of the team are not enough, since to be efficiency of our service, we need an organization of cancer care network operating in the state of Rio Grande do Norte

Síndrome metabólica e fatores de risco relacionados em crianças e adolescentes com excesso de peso na cidade do Natal

Nas últimas décadas, houve grande aumento da prevalência de obesidade, inclusive na faixa etária pediátrica. Com isso, aumentou o número de crianças e adolescentes afetados por síndrome metabólica (SM), diabetes tipo 2 (DM2) e doenças cardiovasculares (DCV), doenças anteriormente consideradas quase exclusivas de adultos. Os objetivos do estudo foram identificar e correlacionar marcadores antropométricos (IMC- índice de massa corpórea, CA- circunferência abdominal, RCQ- razão cintura/quadril, RCArazão cintura altura e PSE- prega subescapular), PAS e PAD- pressão arterial sistólica e diastólica, respectivamente, e laboratoriais (CT- colesterol total, HDL, LDL, TGL- triglicérides, I/G- razão insulina glicose, HOMA- homeostatic model assessment for insulin resistance) de risco para o desenvolvimento de SM e observar a sua prevalência em crianças e adolescentes com excesso de peso. Foi conduzido estudo transversal, em amostra aleatória, de conveniência, onde foram avaliadas 60 crianças e adolescentes com excesso de peso, atendidas no ambulatório de endocrinologia pediátrica do Hospital de Pediatria da Universidade Federal do Rio Grande do Norte (UFRN) com idade mínima e máxima de 7 e 15 anos, de maio de 2009 a abril de 2010. Foram admitidos os indivíduos que apresentavam sobrepeso (IMC P > 85 e < 95) ou obesidade (IMC P > 95) (CDC, 2000) e história familiar positiva para DM2 em parentes de primeiro ou segundo grau ou algum dos sinais de resistência insulínica (acantose, hipertensão arterial, dislipidemia, síndrome de ovários policísticos). 2 O componente individual para SM mais prevalente foi o percentil da CA ≥ 90 (58,3%), seguido de HDL ≤ 40 mg/dl (36,6%). Na regressão linear simples, observaram-se as variações para mais nos parâmetros laboratoriais e de PA para cada unidade de aumento de IMC, CA, RCA, RCQ e PSE, sendo significantes as seguintes correlações: CA com TGL, HOMA IR, I/G, PAS e PAD; RCQ com TGL, HOMA, I/G, LDL e glicemia; RCA com TGL; PSE com TGL, HOMA-IR, I/G e PAS; e IMC com HOMA IR, I/G, PAS e PAD. De acordo com os critérios da IDF (Federação Internacional de Diabetes International Diabetes Federation) 2007, o diagnóstico de SM foi encontrado em seis indivíduos (10%). Do total, oito (13,3%), estavam em situação de sobrepeso e 52 (86,6%), obesos. As evidências de correlação CA e RCQ, medidas de obesidade centrípeta, com vários marcadores como TGL e HOMA, já sabidamente relacionados à SM, chamam atenção para a necessidade de utilização dessas medidas de forma mais rotineira na prática pediátrica, por serem de fácil obtenção, baixo custo e método não invasivo. Os valores de CA, RCQ, RCA e PSE, quando elevados devem justificar maior detalhamento na avaliação laboratorial de possível resistência insulínica. É importante a identificação de crianças e adolescentes que preencham os requisitos para o diagnóstico da SM, pois são indivíduos de maior risco metabólico e devem ser adequadamente acompanhados.

Efeitos da deficiência de vitamina A na função pulmonar de crianças após infecção respiratória viral

Conselho Nacional de Desenvolvimento Científico e Tecnológico

A leitura de literatura na escola: por uma educação emocional de crianças na educação infantil

This dissertation examines the contributions of juvenile literature reading for the problematization of the emotional experiences and conflicts of children at infant education. Its importance consists in providing useful information for the pedagogic work orientated to literature reading at the initial series of basic education, in order to increase the teacher s ability to explore the literary text from its instigating and enriching nature in view of the child s emotional experiences and conflicts. It is methodologically based on the principles of the qualitative research, what characterizes it as a case study. The research focused a level V-infant education class with 28 students in 5-6 age group, at a public school of Natal, State of Rio Grande do Norte (Brazil). The used resources were: audio recording, field diary, and interviews. Seventeen classes were carried out and they consisted in reading sessions of classic and contemporaneous tales, fables, and legends which used different didactic strategies. These sessions were developed in accordance with the reading experience through scaffolding instructions as it was described by Graves & Graves. The theoretical references were the studies of Amarilha (1997/ 2006), Bettelheim (2004), Coelho (1987/2000), Damásio (2005), Del Nero (2003), Eco (1994/2006), Held (1980), Iser (1996), Jauss (2002), Stierle (2002), Wallon (2007), Telles (2006), Yunes (2003), and Zilberman (1987). The analyses showed that literary reading in class is a special environment for inclusion of the reader s subjectivity; as well as the inclusion of their emotional experiences and their conflicts within the story by way of helping children think and become suitable for dealing with their inner feelings. The literary reading is presented as an experiential and formative activity which helps children understand their emotions through a process of identification, exteriorization, and catharsis; what implies that the esthetic experience from the text makes possible the reader s self-knowledge and increases the perception of his inner feelings and objective reality so that this reader has emotional capital to deal with life difficulties. It is important to highlight that the discussions carried out in the class represented a field of sharing experiences through which each reader had the chance to present their experience of life to the others, including their sorrows and sufferings, in order to help them to develop best strategies to deal with the social environment

Análise crítica dos produtos de mobilidade sentada - cadeiras de rodas - utilizados por crianças e adolescentes com paralisia cerebral em Natal/RN e outros municípios do Rio Grande do Norte

The objective of this work is to critically analyze the seated mobility adaptive equipment, wheelchair, used by non-ambulatory children/adolescents diagnosed with cerebral palsy of the quadriplegy type with ages in between 0-18 years old in the municipal city of Natal/RN and of other ones in the state of Rio Grande do Norte. This study is characterized as descriptive as it took into consideration the individualized conditions of each child/adolescent and of their home environment, and also evaluates the condition of the used seated mobility devices such as wheelchairs or strollers. Thirty three (33) subjects which had a wheelchair prescribed by a healthcare professional specialist in adaptive equipment within the past 3 years were selected. A questionnaire was applied through a phone with the patient s primary care giver or parents. The results obtained showed that all the equipment being used had an anatomical seat and back and the tilt system mechanism and even though most of the patients required small individual adjustments upon receiving the wheelchair in order to accommodate to the patients characteristics. From the point of view of the caregiver/parents interviewed, 97% described satisfied with the equipment and report assistance with mobility (97%), comfort (82%) and good posture (82%) as the main positive aspects from the equipment. The results also describe the aspects related to the maintenance, time used and activities developed that were reported by the patients. The conclusion therefore is that in order to select the equipment to meet the needs of the consumer it is necessary that: an appropriate wheelchair prescription takes place, the up-to-date knowledge of equipment available in the market, the appropriate use of the resources from the concession programs of the government that purchase equipment and the establishment of link in between the manufacturers, patients and the caregivers

A constituição da identidade em crianças vítimas de abuso sexual

Subject s identity is constituted in the relation with the other, which is characterized by dialeticity, and is configured as an identification and/or recognize movement, and strangeness and/or distance. In social interactions, people with whom subject relates himself assign meanings to him and, from these, the subject will ressignify, producing sense about himself. In other words, is through these interactions that subjects organizes themselves, recognize what is yours, and acquire the sense about themselves. It can be highlighted, too, the social-historic context s importance in the self-constitution process, whereas, from this, the subject produces particular forms of perception about reality charged with cultural meaning. Thus, the self-conception, the manners of thinking, of being, of relates, of take position against experiences, coming from values internalization, roles and related, are permeated by the manner witch the others relates themselves with the subject. However, when the relation with the other happens to be in a violent way, like in children sexual abuse, there are implications in the subjects constitution, whereas violates his physical and psychological integrities, as well as the rights of dignity, respect and even healthy physical, psychological and sexual developments. Therefore, this work aims to investigate how the identity process is constituted in children victims of sexual abuse. As specific aims the research proposes: 1) to characterize the relations between child and abuser, before and after the abuse act; 2) to identify images that the subjects, abuse victims, have about themselves and; 3) to identify the features of subject s relation with their own body. Toward this aims, procedures involving drawings, painting, collage, photography, activities with cardboard, colored pens, glue and tissue snips. The research took place at the Social Assistance Specialized Reference Center, where there is the treatment of children who suffered of rights violation, which includes sexual abuse. The research subjects were 3 girl children, between 6 and 10 years old, victims of sexual abuse. The corpus analyses was done through Thematic Content Analysis, structured in three meaning nucleus: 1) self-reference without the explicit attendance of other s discourse; 2) self-reference with the explicit attendance of other s discourse; 3) The other abuser. The analysis indicates that children, research subjects, have deteriorated images about themselves, about their bodies, which is consistent with the studies in the children and adolescents sexual violence field. In the other hand, were identified, too, self-references with positive values in the cases with mention about their way-of-being, which can be read as important to subject s development. About the other s discourse towards the subjects, were identified positive observations and found that these can contribute to subject s self-image reorganization. The contribution of negative comments, on the other hand, was showed in a more clear and incisive form in subject s constitution. There is, yet, an overvaluation of the other s discourse, so the meanings attributed toward them by the other are internalized, overshadowing the self-appreciation. To conclude, it can be highlighted that the need of psychological accompaniment of the children victims of sexual abuse, based on the possibility of this trauma experience elaboration, trying to overcome, as well as can be expected that this research s results contributes to the practices of professionals who work with subjects who have their rights violated

Concepções e práticas dos profissionais que atuam na educação infantil diante da violência doméstica contra crianças de zero a cinco anos

El estudio presenta el problema de la violencia doméstica contra los niños de hasta cinco años en el contexto de los centros municipales de Educación Infantil (CMEI) en la ciudad de Natal-RN. Constituye un análisis bajo el enfoque teórico y metodológico de carácter cualitativo, en vista de la totalidad, con la asunción de la violencia doméstica contra los niños en su guía sociales, legales, históricos y culturales con el tema. Tiene como objetivo investigar si los profesionales que trabajan en Educación Infantil son capaces de identificar las posibles situaciones de violencia doméstica contra los niños que están bajo su responsabilidad, e incluso si, en los casos de los casos sospechosos o reales de la identidad de saber que las referencias deben ser adoptadas. La ruta entre el conocimiento y el método establecido implica el análisis conceptual de la infancia, la educación infantil y violencia doméstica contra los niños, además de la realización de grupos focales con los participantes de la encuesta con sus registros en un diario de campo. Perciben a sí mismos para el estudio de las contradicciones en la lucha contra la violencia doméstica contra los niños. Incluso con los conocimientos teóricos sobre el tema, los profesionales no pueden dar referencias adecuadas para proteger a los niños y detener la violencia. Nos encontramos con que las condiciones objetivas del trabajo de los profesionales que trabajan en CMEI, asociados con poco conocimiento sobre el tema, no contribuyen a las referencias. Llegamos a la conclusión de que es necesario la participación de la Secretaría Municipal de Educación, sin olvidar que todas las acciones tienen limitaciones como la violencia doméstica contra los niños también se relaciona con problemas estructurales de la sociabilidad capitalista.

Processo de cuidar de crianças hospitalizadas com câncer

The objective was to understand the process of care in the perception of hospitalized children with cancer. This is a descriptive study of qualitative approach. Data were collected between the months of October 2013 and January 2014, through photographic records and semi-structured interview consisting of questions relating to the identification of age, sex, diagnosis and length of stay and a script of questions related to the recorded pictures. Eight children were included aged between six and twelve who were admitted to a pediatric oncology sector, located in the city of Natal / RN. The criteria used in the sample were: being hospitalized for cancer treatment; and present favorable physical conditions for carrying out the data collection. For the treatment of collected material was used content analysis, thematic modality. The study followed the ethical and legal principles governing scientific research with human beings and took place with the approval of the project by the Ethics and Research Committee of the Northern League Riograndense against Cancer, with opinion registered under number 329 015 and CAAE 16097613.9.0000.5293. According to the results it was found that, for the child, the care happens through technical activities, such as making procedures and the use of personal protective equipment, as well as through the dialogic relationship, which favors the establishment of confidence in care professional. Caring also means developing activities that promote well-being, the fun and the social and cognitive development, highlighting thus the playful, during hospitalization, as an auxiliary tool in the care process. During hospitalization, the child identifies two individuals responsible for their care, accompanying family and professional, and nursing professionals the most cited in moments of care. , Also of note, the promotion of care, in the perception of the child related to the infrastructure of the institution, environmental cleaning, personal hygiene, the medicalization and the food. It is concluded that care understood by the child, whilst still maintaining relations with the biomedical model, points to a new perspective that should consider the biological, social and psychological of acquiring cancer without unlink them of the development child. 9 Moreover, we see the child as an active social actor in this process, and therefore needs to be heard and answered their needs