The right of children and adolescents to a healthy environment. A diagnosis from Latin America and the Caribbean

Healthy environment: unresolved debts that affect childhood and adolescenceIn this new edition, we point out the right of children and adolescents to live in a healthy environment with emphasis on adequate access to drinking water and sanitation, including diagnosis as well as policy perspective. It is our contribution to the challenges set out by the Millennium Development Goals and the Convention on the Rights of the Child.

Age and gender differences in health-related quality of life of children and adolescents in Europe: a multilevel analysis

OBJECTIVES: To determine age and gender differences in health-related quality of life (HRQOL) in children and adolescents across 12 European countries using a newly developed HRQOL measure (KIDSCREEN). METHODS: The KIDSCREEN-52 questionnaire was filled in by 21,590 children and adolescents aged 8-18 from 12 countries. We used multilevel regression analyses to model the hierarchical structure of the data. In addition, effect sizes were computed to test for gender differences within each age group. RESULTS: Children generally showed better HRQOL than adolescents (P < 0.001). While boys and girls had similar HRQOL at young age, girls' HRQOL declined more than boys' (P < 0.001) with increasing age, depending on the HRQOL scale. There was significant variation between countries both at the youngest age and for age trajectories. CONCLUSIONS: For the first time, gender and age differences in children's and adolescents' HRQOL across Europe were assessed using a comprehensive and standardised instrument. Gender and age differences exist for most HRQOL scales. Differences in HRQOL across Europe point to the importance of national contexts for youth's well-being.

The Care and Shelter of Children and Adolescents in Brazil: Expressions of Social Issues

The future of Brazilian children who have the protection offered by familial bonds is threatened by social inequities that force them to seek shelter and grow up in shelters. According to the Institute of Applied Economic Research, an estimated 20,000 children and adolescents are served by institutions. The majority of these children are afro-descendent males between the ages of seven and fifteen years old. Of those researched, 87.6% have families (58.2% receive visits from their families, 22.7% are rarely visited by their families and 5.8 are legally prohibited from contacting or being by their families). The percentage of children and adolescents “without families” or with “missing families” is 11.3%. There is no information available for 2% of the children and adolescents residing in shelters. The principle factors that necessitate the placement of Brazilian children in institutions that provide care and shelter include poverty (including children forced to work, sell drugs or beg, for example); domestic violence; chemical dependence of parents or guardians; homelessness; death or parents or guardian; imprisonment of their parents; and sexual abuse committed by their parents or guardians. The issue of abandoned children and adolescents and their care and shelter in the Brazilian context expresses a perverse violation of Child and Adolescent Rights.

Reactivity to Accelerometer Measurement of Children and Adolescents

PURPOSE: Awareness of being monitored can influence participants' habitual physical activity (PA) behavior. This reactivity effect may threaten the validity of PA assessment. Reports on reactivity when measuring the PA of children and adolescents have been inconsistent. The aim of this study was to investigate whether PA outcomes measured by accelerometer devices differ from measurement day to measurement day and whether the day of the week and the day on which measurement started influence these differences. METHODS: Accelerometer data (counts per minute [cpm]) of children and adolescents (n = 2081) pooled from eight studies in Switzerland with at least 10 h of daily valid recording were investigated for effects of measurement day, day of the week, and start day using mixed linear regression. RESULTS: The first measurement day was the most active day. Counts per minute were significantly higher than on the second to the sixth day, but not on the seventh day. Differences in the age-adjusted means between the first and consecutive days ranged from 23 to 45 cpm (3.6%-7.1%). In preschoolchildren, the differences almost reached 10%. The start day significantly influenced PA outcome measures. CONCLUSIONS: Reactivity to accelerometer measurement of PA is likely to be present to an extent of approximately 5% on the first day and may introduce a relevant bias to accelerometer-based studies. In preschoolchildren, the effects are larger than those in elementary and secondary schoolchildren. As the day of the week and the start day significantly influence PA estimates, researchers should plan for at least one familiarization day in school-age children and randomly assign start days.

Self-injury in a residential treatment population of children and adolescents

Objectives. The aim of this study was to describe the relationship between child-abuse and self-injury among children and adolescents living in a residential treatment center in a large urban area. ^ Methods. A retrospective study was conducted through a chart review of the residents who were placed at the center from 2003-2006. A total of 35 cases (with at least one documented incident of self-injury during placement at the residential treatment center) were age/gender matched with 35 controls (without at least one documented incident of self-injury during placement at the residential treatment center). ^ Results. In this study, the case subjects were far more likely to be victims of sexual abuse than were the controls (74.3% vs. 25.7%, respectively). Self-harm was found to be 9.5 times as frequent in the group that was exposed to sexual abuse in the source population (OR = 9.500 with a 95% CI = 2.292, 84.111). The difference was statistically significant (McNemar's test, x2 = 12.190 with 1 df. The two-tailed P value equals 0.0005). ^ Conclusion. These findings suggest that school-age and early-adolescent children who have a history of sexual abuse may engage in a variety of self-harming behaviors. Clinicians should consider a history of sexual abuse when working with self-harming children. ^

Systematic review of interventions designed to reduce screen time in children and adolescents

This descriptive systematic review describes intervention trials for children and youth that targeted screen time (ST) as a way to prevent or control obesity and measured ST, and at least one of the following: physical activity, dietary intake, and adiposity. Both “hands-on” (e.g., video games) and “hands free” (e.g., television viewing) ST were included. Published, completed intervention trials (k=12), not-yet-published, completed trials (k=6), and in-progress trials (k=11) were identified through searches of electronic databases, including trial registries and bibliographies of eligible study reports. Study characteristics of the 29 identified trials were coded and presented in evidence tables. Considerable attention was paid to the type of ST addressed, measures used, and the type of interventions. Based on the number of in-progress and not-yet-published trials, the number of completed, published reports will double in the next three years. Most of the studies were funded by federal sources. General populations, not restricted by race, gender, or weight status, were targets of most interventions with children ages 9-12 yeas as the modal age group. Most trials used randomized control trials in which the majority of control or comparison group received an intervention. The mean number of participants was 242.8 (SD=314.7) and interventions were delivered over an average of 10.5 months and consisted of approximately 16 sessions, with a total time of about eight hours. The majority of completed trials evaluate each of the four constructs, however, most studies have more than one measure to assess each construct (e.g., BMI and tricep skinfold thickness to evaluate adiposity) and rarely did studies use the same measures. This is likely why the majority of studies produced at least one significant intervention effect on each outcome that was assessed. The four major outcomes should be evaluated in all interventions attempting to reduce screen time in order to determine the mechanisms involved that may contribute to obesity. More importantly researchers should work together to determine the best measures to evaluate the four main constructs to allow studies to be compared. Another area for consensus is the definition of ST. ^

PICTOAPRENDE: Design and evaluation of a tool that contributes to the personal autonomy of children and youth diagnosed with autism spectrum disorder in Ecuador

This paper presents the development and evaluation of PICTOAPRENDE, which is an interactive software designed to improve oral communication. Additionally, it contributes to the development of children and youth who are diagnosed with autism spectrum disorder (ASD) in Ecuador. To fulfill this purpose initially analyzes the intervention area where the general characteristics of people with ASD and their status in Ecuador is described. Statistical techniques used for this evaluation constitutes the basis of this study. A section that presents the development of research-based cognitive and social parameters of the area of intervention is also shown. Finally, the algorithms to obtain the measurements and experimental results along with the analysis of them are presented.

Living with pain: the experience of children and adolescents in palliative care

A qualitative study was conducted with semi-structured interviews with the aim of understanding the experience of children and adolescents under palliative care when managing pain daily and how they describe the intensity, quality and location of pain. We used Piaget’s theory of cognitive development as a theoretical framework and oral history as a methodological framework. We found four themes: describing pain; seeking a life closer to normality, despite pain and disease; using a variety of alternatives for pain control; and living with damaged physical appearance. Although pain is a limiting factor in the lives of children and adolescents, we found that they faced their daily pain and still had a life beyond pain and illness. In addition, we highlight the relevance of nurses’ understanding that effective management of pain in children is essential for a normal life and less suffering.

Topographic aspects of photic driving in the electroencephalogram of children and adolescents

The electroencephalogram amplitude spectra at 11 fixed frequencies of intermittent photic stimulation of 3 to 24 Hz were combined into driving "profiles" for 14 scalp points in 8 male and 7 female normal subjects aged 9 to 17 years. The driving response varied over frequency and was detected in 70 to 100% of cases in the occipital areas (maximum) and in 27 to 77% of cases in the frontal areas (minimum) using as a criterion peak amplitude 20% higher than those of the neighbors. Each subject responded, on average, to 9.7 ± 1.15 intermittent photic stimulation frequencies in the right occipital area and to 6.8 ± 1.97 frequencies in the right frontal area. Most of the driving responses (in relation to the previous background) were significant according to the spectral F-test (a = 0.05), which also detected changes in some cases of low amplitude responses not revealed by the peak criterion. The profiles had two maxima in the alpha and theta bands in all leads. The latter was not present in the background spectra in the posterior areas and was less pronounced in the anterior ones. The weight of the profile theta maximum increased towards the frontal areas where the two maxima were similar, while the profile amplitudes decreased. The profiles repeated the shape of the background spectra, except for the theta band. The interhemispheric correlation between profiles was high. The theta driving detected in all areas recorded suggests a generalized influence of the theta generators in prepubertal and pubertal subjects.

Flow rate, pH and calcium concentration of saliva of children and adolescents with type 1 diabetes mellitus

Alterations in salivary parameters may increase the caries risk in diabetic children, but, contradictory data on this issue have been reported. The aims of this study were to compare salivary parameters (flow rate, pH and calcium concentration) between healthy and type 1 diabetes mellitus (T1DM) individuals. The sample consisted of 7- to 18-year-old individuals divided into two groups: 30 subjects with T1DM (group A) and 30 healthy control subjects (group B). Fasting glucose levels were determined. Unstimulated and stimulated saliva was collected. The pH of unstimulated saliva was measured with paper strips and an electrode. Calcium concentrations in stimulated saliva were determined with a selective electrode. Group A individuals had inadequate blood glucose control (HbA1C >9%), with means ± SD unstimulated salivary flow rate of 0.15 ± 0.1 mL/min compared to 0.36 ± 0.2 mL/min for group B (P < 0.01). Stimulated salivary flow rate was similar by both groups and above 2.0 mL/min. Saliva pH was 6.0 ± 0.8 for group A and significantly different from 7.0 ± 0.6 for group B (P < 0.01). Salivary calcium was 14.7 ± 8.1 mg/L for group A and significantly higher than 9.9 ± 6.4 mg/L for group B (P < 0.01). Except for elevated calcium concentrations in saliva, salivary parameters favoring caries such as low saliva pH and unstimulated salivary flow rate were observed in T1DM individuals.

The Nutritional Status of Children and Adolescents with HIV/AIDS on Antiretroviral Therapy

The objective of this cross-sectional study was to assess the nutritional status of children and adolescents with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) receiving highly active antiretroviral therapy (HAART). One hundred and eighteen subjects aged 6-19 years attending an outpatient clinic in Sao Paulo city were involved in the study. The following anthropometric measurements were assessed: weight, height, waist circumference and triceps and subscapular skinfold thickness. One (0.9%) adolescent was diagnosed with abdominal obesity based on waist circumference measurement; three (2.5%) adolescents were obese based on subscapular skinfold thickness. According to the body mass index, the population studied was mainly eutrophic. The prevalence of fat redistribution, a characteristic of patients with HIV/AIDS under HAART, was low. We advise the development of further studies to assess the nutritional status of children and adolescents with HIV/AIDS using anthropometric measurements as well as computed tomography to detect fat redistribution.

Clinical and microbiological studies of children and adolescents receiving orthodontic treatment

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Perception-action and adaptation in postural control of children and adolescents with cerebral palsy

The aim of this study was to examine the coupling between visual information and body sway and the adaptation in this coupling of individuals with cerebral palsy (CP). Fifteen children with and 15 without CP. 6-15 years old, were required to stand upright inside of a moving room. All children first performed two trials with no movement of the room and eyes open or closed, then four trials in which the room oscillated at 0.2 or 0.5 Hz (peak velocity of 0.6 cm/s), one trial in which the room oscillated at 0.2 Hz (peak velocity of 3.5 cm/s), and finally two other trials in which the room oscillated again at 0.2 Hz (peak velocity of 0.6 cm/s). Participants with CP coupled body sway to visual information provided by the moving room, comparable to the coupling of participants without CP. However, participants with CP exhibited larger body sway in maintaining upright position and more variable sway when body sway was induced by visual manipulation. They showed adaptive sensory motor coupling, e.g. down-weighting visual influence when a larger stimulus was provided, but not with the same magnitude as typically developing participants. This indicates that participants with CP have less capability of adaptation. (C) 2011 Published by Elsevier Ltd.

Changes in periodontal conditions of children and adolescents from Araraquara, Brazil: 1995-1998.

The aim of this study was to compare the periodontal conditions in 7-15-year-olds from Araraquara, SP, Brazil in 1998 with data from 1995. A systematic random sample was drawn from the population of children and adolescents enrolled in all public schools in 1998. The survey was conducted by trained examiners using the CPITN and WHO diagnostic criteria. Results showed an increase in the percentage of students of all ages with healthy periodontal conditions (from 14% in 1995 to 33% in 1998; p < 0.01). An increase in the mean number of healthy sextants (from 3.2 to 4.4; p < 0.0001), a decrease in the mean number of bleeding sextants (from 2.5 to 1.2; p < 0.0001) and no difference in the mean number of sextants with calculus were also observed. At the age of 15, 54% of the students had 5-6 healthy sextants in 1998 compared to 19% in 1995 (p < 0.01). Despite the improvement observed in the periodontal conditions, efforts must be increased in order to achieve the WHO goal for the year 2010 of no more than one sextant affected by bleeding or calculus at the age of 15.

Rights of children and adolescents with disabilities

Rights of children and adolescents with disabilities Until not long ago, children with disabilities were made fun of, hidden away and, all too often, the victims of violence. Fortunately, this state of affairs has improved thanks to changes in the way disability is viewed and to the ratification, by 23 countries in the region, of the Convention on the Rights of Persons with Disabilities (CRPD).