Jornal de pediatria最新文献_第10页

Profiles of suicide attempted in children and adolescents 儿童和青少年自杀未遂的概况。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-04-11 DOI: 10.1016/j.jped.2024.01.007

Alicia Ortega-Narváez , Diana Marcela Muñoz-Manquillo , Claudia Patricia Guzmán-Lopez , Ginna Cabra-Bautista

Objective

Suicide attempt (SA) is the strongest predictive variable for completed suicide. The Department of Cauca in Colombia has an SA rate higher than the national average, but the factors are unknown. The objective was to identify the profiles of SA in children and adolescents of Cauca.

Methods

Cross-sectional study, which included all SA (Event-356) records from the SIVIGILA platform in children under 18 years of age between 2016 and 2019. The authors described the variables and multiple correspondence analysis (MCA) with the Burt method, according to the completeness of the data to establish the possible SA profiles using STATA 15.1, and R. The Ethics Committee at Universidad del Cauca approved it.

Results

The study found 977 SA during this period, 72.4% female, 97.1% adolescent, 74.4% mestizo, 19.3% indigenous, 45.3% resided in municipalities exposed to the armed conflict, 32.3% expressed ideation and previous attempts, and 15.5% prior attempts. The MCA included 810 SA and identified three profiles: “Classic”, which had mestizo adolescents with a history of prior SA, mental illness, or psychoactive substance use problems; “Related to the armed conflict”, which included female adolescents with a first SA and residents in municipalities exposed to the armed conflict; “Ethnic” represented by male indigenous, with housing in a rural area.

Conclusion

The SA profiles found in Cauca were “Classic”, “Related to the armed conflict”, and “Ethnic”; these can be considered to implement prevention strategies from a cross-cultural, mental health, and gender perspective, with the presence of the state in the territories.

目的自杀未遂（SA）是预测完成自杀的最强变量。哥伦比亚考卡省的自杀未遂率高于全国平均水平，但原因不明。该研究旨在确定考卡省儿童和青少年的自杀未遂概况。研究方法横断面研究，纳入了 SIVIGILA 平台中 2016 年至 2019 年间 18 岁以下儿童的所有自杀未遂（事件-356）记录。作者使用 STATA 15.1 和 R 软件，根据数据的完整性对变量进行了描述，并使用伯特方法进行了多重对应分析（MCA），以确定可能的 SA 剖面。结果研究发现，在此期间有 977 名 SA，72.4% 为女性，97.1% 为青少年，74.4% 为混血人，19.3% 为土著人，45.3% 居住在受武装冲突影响的城市，32.3% 表达了意念和先前的企图，15.5% 有过企图。心理分析包括 810 名南澳大利亚人，并确定了三种特征："传统型 "是指曾有过自伤史、精神疾病或精神活性物质使用问题的混血青少年；"与武装冲突有关型 "是指首次自伤的女性青少年和武装冲突城市的居民；"少数民族型 "是指居住在农村地区的男性土著人。结论在考卡省发现的 SA 特征是 "典型"、"与武装冲突有关 "和 "种族"；这些特征可以考虑从跨文化、心理健康和性别的角度实施预防战略，同时国家在这些地区的存在。

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引用次数: 0

Bioelectrical impedance phase angle and nutritional status in children with intestinal failure on prolonged parenteral nutrition 长期肠外营养的肠功能衰竭儿童的生物电阻抗相位角和营养状况。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-04-10 DOI: 10.1016/j.jped.2023.12.006

Objective

To compare the phase angle (PhA) through bioelectrical impedance (BIA) of children with intestinal failure (IF) using prolonged parenteral nutrition (PN) followed by an Intestinal Rehabilitation Program, with a control group.

Methods

Children under 10 years of age with IF using prolonged PN for >60 days (study group) were included. The control group consisted of healthy children without chronic pathologies, matched by sex and age. Anthropometric parameters evaluated were: weight, height, weight/age z-score (W/A), height/age z-score (H/A), BMI, BMI/A z-score, arm circumference, triceps skinfold, subscapular skinfold, mid-arm muscle circumference. BIA parameters were resistance (R), reactance (Xc), and phase angle (PhA).

Results

Twenty-eight children were included in the study group, median (IQR) age was 11 (8–27) months, 53.6 % were male. In the control group, 28 children were included, median (IQR) age was 12.5 (8–24.7) months, 50 % were male. Children from the study group had W/A z-scores and H/A z-scores significantly lower than controls. There was no significant difference between PhA in the study group and controls, [median (IQR) 4.3° (3.8;4.6) vs 4.0° (3.8;5.4) respectively, p = 0.980]. Prematurity was significantly higher in the study group than in the controls, but there was no significant correlation between gestational age at birth and PhA of the children from the study group.

Conclusion

Children with IF using prolonged PN showed lower W/A and H/A compared to the control group, but without significant difference between the PhA of children with IF compared to controls.

目的通过生物电阻抗（BIA）比较肠道功能衰竭（IF）患儿和对照组的相位角（PhA）。方法纳入 10 岁以下肠道功能衰竭患儿（研究组），研究组患儿使用长期肠外营养（PN）并接受肠道康复计划 60 天。对照组由无慢性病的健康儿童组成，性别和年龄相匹配。评估的人体测量参数包括：体重、身高、体重/年龄 Z 值（W/A）、身高/年龄 Z 值（H/A）、体重指数（BMI）、体重指数/年龄 Z 值、臂围、肱三头肌皮褶、肩胛下皮褶、中臂肌围。BIA 参数为阻力（R）、电抗（Xc）和相位角（PhA）。结果研究组有 28 名儿童，年龄中位数（IQR）为 11（8-27）个月，53.6% 为男性。对照组有 28 名儿童，年龄中位数（IQR）为 12.5（8-24.7）个月，50% 为男性。研究组儿童的 W/A z 分数和 H/A z 分数明显低于对照组。研究组和对照组的 PhA 没有明显差异[中位数（IQR）分别为 4.3° (3.8;4.6) vs 4.0° (3.8;5.4)，P = 0.980]。研究组的早产率明显高于对照组，但研究组患儿的出生胎龄与 PhA 之间无明显相关性。结论与对照组相比，使用长期 PN 的 IF 患儿的 W/A 和 H/A 较低，但与对照组相比，IF 患儿的 PhA 无明显差异。

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引用次数: 0

High-fidelity simulation versus case-based discussion for training undergraduate medical students in pediatric emergencies: a quasi-experimental study 高仿真模拟与基于病例讨论的儿科急诊培训：一项准实验研究。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-04-09 DOI: 10.1016/j.jped.2024.03.007

Nathalia Veiga Moliterno , Vitor Barreto Paravidino , Jaqueline Rodrigues Robaina , Fernanda Lima-Setta , Antônio José Ledo Alves da Cunha , Arnaldo Prata-Barbosa , Maria Clara de Magalhães-Barbosa

Objective

To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students.

Methods

33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge's g.

Results

Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20).

Conclusion

HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.

方法33名医学生被分配到两种教学方法中：高仿真模拟（HFS，n = 18）或病例讨论（CBD，n = 15）。在干预前后进行了自信心和知识测试，并通过混合效应模型估算了高仿真模拟对两种结果的影响。干预后进行了客观结构化临床考试活动，两名独立评分员使用特定的模拟检查表来评估临床推理、沟通、态度和领导力。采用线性回归和逻辑回归估算了 HFS 对这些结果的影响。结果随着时间的推移，两组的自信心（HFS 59.1 × 93.6，p < 0.001；CDB 50.5 × 88.2，p < 0.001）和知识得分（HFS 45.1 × 63.2，p = 0.001；CDB 43.5 × 56.7，p 值 < 0.01），但在这两项测试中没有观察到组间差异（根据学生排名调整的混合效应模型中的组*时间效应）（分别为 p = 0.6565 和 p = 0.3331）。HFS组的模拟检查表得分高于CBD组，在所有领域都有较大的效应量（Hedges g 1.15至2.20）。结论HFS在培养儿科急诊护理本科医学生的临床推理能力、沟通能力、态度和领导力方面优于CBD，但在自信心和理论知识方面未观察到显著差异。

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引用次数: 0

Direct costs for outpatient excess body weight treatment in Brazilian children and adolescents attending a public children's hospital 在一家公立儿童医院就诊的巴西儿童和青少年门诊治疗体重超标的直接费用

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-04-09 DOI: 10.1016/j.jped.2024.03.005

Aline Denise Hanauer , Zaíne Glaci Durte Corrêa , Gleci Blazius , Rodolfo Coelho Prates , Marco Fabio Mastroeni

Objective

To estimate the direct costs of treating excess body weight in children and adolescents attending a public children's hospital.

Methods

This study analyzed the costs of the disease within the Brazilian Unified Health System (SUS) for 2,221 patients with excess body weight using a microcosting approach. The costs included operational expenses, consultations, and laboratory and imaging tests obtained from medical records for the period from 2009 to 2019. Healthcare expenses were obtained from the Table of Procedures, Medications, Orthoses/Prostheses, and Special Materials of SUS and from the hospital's finance department.

Results

Medical consultations accounted for 50.6% (R$703,503.00) of the total cost (R$1,388,449.40) of treatment over the period investigated. The cost of treating excess body weight was 11.8 times higher for children aged 5–18 years compared to children aged 2–5 years over the same period. Additionally, the cost of treating obesity was approximately 4.0 and 6.3 times higher than the cost of treating overweight children aged 2–5 and 5–18 years, respectively.

Conclusion

The average annual cost of treating excess body weight was R$138,845.00. Weight status and age influenced the cost of treating this disease, with higher costs being observed for individuals with obesity and children over 5 years of age. Additionally, the important deficit in reimbursement by SUS and the small number of other health professionals highlight the need for restructuring this treatment model to ensure its effectiveness, including a substantial increase in government investment.

估算公立儿童医院治疗儿童和青少年体重超标的直接成本。本研究采用微观成本计算方法，分析了巴西统一卫生系统（SUS）内2221名体重超标患者的疾病成本。成本包括从病历中获取的 2009 年至 2019 年期间的业务费用、咨询费用、实验室和影像检查费用。医疗费用来自 SUS 的手术、药物、矫形器/假肢和特殊材料表以及医院财务部门。在调查期间，医疗咨询费用占治疗总费用（1,388,449.40 雷亚尔）的 50.6%（703,503.00 雷亚尔）。同期，5-18 岁儿童治疗体重超标的费用是 2-5 岁儿童的 11.8 倍。此外，治疗肥胖症的费用分别比治疗 2-5 岁和 5-18 岁超重儿童的费用高出约 4.0 倍和 6.3 倍。治疗体重超标的年平均费用为 138,845.00 雷亚尔。体重状况和年龄影响了该疾病的治疗费用，肥胖症患者和 5 岁以上儿童的治疗费用更高。此外，单一保健系统的报销额度严重不足，其他保健专业人员的人数也很少，这突出表明有必要对这一治疗模式进行重组，以确保其有效性，包括大幅增加政府投资。

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引用次数: 0

Clinical significance and different strategies for re-elevation of plasma EBV-DNA during treatment in pediatric EBV-associated hemophagocytic lymphohistiocytosis 小儿 EBV 相关性嗜血细胞淋巴组织细胞增多症治疗期间血浆 EBV-DNA 再升高的临床意义和不同策略。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-04-08 DOI: 10.1016/j.jped.2024.03.006

Objective

Monitoring the disease status of Epstein–Barr virus (EBV)–related hemophagocytic lymphohistiocytosis (HLH) patients is crucial. This study aimed to investigate the different strategies and outcomes of patients with EBV-HLH and re-elevated EBV-DNA.

Method

A retrospective analysis was conducted on 20 patients diagnosed with EBV-HLH. Clinical features, laboratory tests, treatments, plasma EBV-DNA levels, and outcomes were assessed. Three cases were highlighted for detailed analysis.

Results

Nine of the 20 patients had a re-elevation of EBV-DNA during treatment, and 55.5 % (5/9) experienced relapses. Patients with persistently positive plasma EBV-DNA (n = 4) and those with re-elevated EBV-DNA after conversion (n = 9) showed a significantly higher relapse rate compared to those with persistently negative EBV-HLH (n = 7) (p < 0.05). Among the highlighted cases, Case 1 exhibited plasma EBV-DNA re-elevation after four weeks of treatment without relapse, maintaining stability with the original treatment regimen, and eventually, his plasma EBV-DNA turned negative. In Case 2, plasma EBV-DNA was elevated again with a recurrence of HLH after L-DEP. Consequently, she underwent allogeneic hematopoietic stem cell transplantation and eventually achieved complete remission (CR) with negative plasma EBV-DNA. Case 3 experienced plasma EBV-DNA re-elevation after L-DEP but remained in CR, discontinuing chemotherapy without relapse.

Conclusion

The re-elevation of plasma EBV-DNA during EBV-HLH treatment poses challenges in determining disease status and treatment strategies. Optimal management decisions require a combination of the level of elevated EBV-DNA, the intensity of hyperinflammation, and the patient's immune function.

目的监测与爱泼斯坦-巴氏病毒（EBV）相关的嗜血细胞淋巴组织细胞增多症（HLH）患者的疾病状态至关重要。本研究旨在探讨EBV-HLH和EBV-DNA再次升高患者的不同策略和预后。方法对20例确诊为EBV-HLH的患者进行回顾性分析。对临床特征、实验室检查、治疗方法、血浆 EBV-DNA 水平和疗效进行了评估。结果 20 例患者中有 9 例在治疗期间 EBV-DNA 再次升高，55.5%（5/9）的患者复发。血浆 EBV-DNA 持续阳性的患者（4 例）和转阴后 EBV-DNA 再次升高的患者（9 例）的复发率明显高于 EBV-HLH 持续阴性的患者（7 例）（p < 0.05）。在重点病例中，病例 1 在治疗 4 周后出现血浆 EBV-DNA 再次升高，但未复发，在原治疗方案下保持稳定，最终血浆 EBV-DNA 转阴。在病例 2 中，血浆 EBV-DNA 再次升高，L-DEP 后 HLH 复发。因此，她接受了异基因造血干细胞移植，最终在血浆 EBV-DNA 阴性的情况下获得了完全缓解（CR）。结论 EBV-HLH 治疗期间血浆 EBV-DNA 的再次升高给确定疾病状态和治疗策略带来了挑战。最佳治疗决策需要结合 EBV-DNA 升高的水平、高炎症强度和患者的免疫功能。

{"title":"Clinical significance and different strategies for re-elevation of plasma EBV-DNA during treatment in pediatric EBV-associated hemophagocytic lymphohistiocytosis","authors":"","doi":"10.1016/j.jped.2024.03.006","DOIUrl":"10.1016/j.jped.2024.03.006","url":null,"abstract":"<div><h3>Objective</h3><p>Monitoring the disease status of Epstein–Barr virus (EBV)–related hemophagocytic lymphohistiocytosis (HLH) patients is crucial. This study aimed to investigate the different strategies and outcomes of patients with EBV-HLH and re-elevated EBV-DNA.</p></div><div><h3>Method</h3><p>A retrospective analysis was conducted on 20 patients diagnosed with EBV-HLH. Clinical features, laboratory tests, treatments, plasma EBV-DNA levels, and outcomes were assessed. Three cases were highlighted for detailed analysis.</p></div><div><h3>Results</h3><p>Nine of the 20 patients had a re-elevation of EBV-DNA during treatment, and 55.5 % (5/9) experienced relapses. Patients with persistently positive plasma EBV-DNA (<em>n</em> = 4) and those with re-elevated EBV-DNA after conversion (<em>n</em> = 9) showed a significantly higher relapse rate compared to those with persistently negative EBV-HLH (<em>n</em> = 7) (<em>p</em> < 0.05). Among the highlighted cases, Case 1 exhibited plasma EBV-DNA re-elevation after four weeks of treatment without relapse, maintaining stability with the original treatment regimen, and eventually, his plasma EBV-DNA turned negative. In Case 2, plasma EBV-DNA was elevated again with a recurrence of HLH after L-DEP. Consequently, she underwent allogeneic hematopoietic stem cell transplantation and eventually achieved complete remission (CR) with negative plasma EBV-DNA. Case 3 experienced plasma EBV-DNA re-elevation after L-DEP but remained in CR, discontinuing chemotherapy without relapse.</p></div><div><h3>Conclusion</h3><p>The re-elevation of plasma EBV-DNA during EBV-HLH treatment poses challenges in determining disease status and treatment strategies. Optimal management decisions require a combination of the level of elevated EBV-DNA, the intensity of hyperinflammation, and the patient's immune function.</p></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"100 5","pages":"Pages 505-511"},"PeriodicalIF":2.8,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0021755724000366/pdfft?md5=5a2c04ff71b7e6b5898a3f3f732bd68b&pid=1-s2.0-S0021755724000366-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Vitamin D status in children 儿童的维生素 D 状态。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-04-08 DOI: 10.1016/j.jped.2024.04.001

Roger Bouillon, Leen Antonio, Nick Narinx

引用次数: 0

Key clinical predictors in the diagnosis of ovarian torsion in children 诊断儿童卵巢扭转的主要临床预测指标

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-04-03 DOI: 10.1016/j.jped.2024.01.006

Sai Chen, Zhigang Gao, Yunzhong Qian, Qingjiang Chen

Objective

Ovarian torsion (OT) represents a severe gynecological emergency in female pediatric patients, necessitating immediate surgical intervention to prevent ovarian ischemia and preserve fertility. Prompt diagnosis is, therefore, paramount. This retrospective study set out to assess the utility of combined clinical, ultrasound, and laboratory features in diagnosing OT.

Methods

The authors included 326 female pediatric patients aged under 14 years who underwent surgical confirmation of OT over a five-year period. Logistic regression analysis was employed to pinpoint factors linked with OT, and the authors compared clinical presentation, laboratory results, and ultrasound characteristics between patients with OT (OT group) and without OT (N-OT group). The authors conducted receiver operating characteristic (ROC) curve analysis to gauge the predictive capacity of the combined features.

Results

Among 326, OT was confirmed in 24.23 % (79 cases) of the patients. The OT group had a higher incidence of prenatal ovarian masses than the N-OT (22 cases versus 7 cases) (p < 0.0001). Similarly, the authors observed significant differences in the presence of lower abdominal pain, suspected torsion on transabdominal ultrasound, and a high neutrophil-lymphocyte ratio (NLR > 3) between the OT and non-OT groups (p ˂ 0.05). Furthermore, when these parameters were combined, the resulting area under the curve (AUC) was 0.868, demonstrating their potential utility in OT diagnosis.

Conclusion

This study demonstrates a prediction model integrating clinical, laboratory, and ultrasound findings that can support the preoperative diagnosis of ovarian torsion, thereby enhancing diagnostic precision and improving patient management. Future prospective studies should concentrate on developing clinical predictive models for OT in pediatric patients.

卵巢扭转（OT）是女性儿科患者的一种严重妇科急症，需要立即进行手术治疗，以防止卵巢缺血并保留生育能力。因此，及时诊断至关重要。这项回顾性研究旨在评估综合临床、超声波和实验室特征在诊断 OT 中的实用性。作者纳入了 326 名 14 岁以下的儿科女性患者，她们在五年内接受了 OT 手术确诊。作者采用逻辑回归分析找出了与OT相关的因素，并比较了OT患者（OT组）和无OT患者（N-OT组）的临床表现、实验室结果和超声波特征。作者进行了接收器操作特征（ROC）曲线分析，以衡量综合特征的预测能力。在 326 例患者中，有 24.23% 的患者（79 例）确诊为 OT。OT 组产前卵巢肿块的发生率高于 N-OT（22 例对 7 例）（< 0.0001）。同样，作者观察到 OT 组和非 OT 组在出现下腹痛、经腹超声疑似扭转以及中性粒细胞-淋巴细胞比率高（NLR > 3）方面存在显著差异（P ˂0.05）。此外，如果将这些参数结合在一起，得出的曲线下面积（AUC）为 0.868，证明了它们在 OT 诊断中的潜在作用。这项研究展示了一个整合了临床、实验室和超声检查结果的预测模型，该模型可支持卵巢扭转的术前诊断，从而提高诊断精确度并改善患者管理。未来的前瞻性研究应致力于开发儿科患者卵巢扭转的临床预测模型。

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引用次数: 0

Substance use and adolescent mental health during the COVID-19 pandemic in Brazil: a longitudinal approach 巴西 COVID-19 大流行期间的药物使用和青少年心理健康：一种纵向方法

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-04-03 DOI: 10.1016/j.jped.2024.01.005

Rodrigo Garcia-Cerde, Gabriela A. Wagner, Juliana Y. Valente, Zila M. Sanchez

Objective

To describe the changes in alcohol and drug use by Brazilian adolescents during the COVID-19 pandemic (April-August 2021), and to analyze the relationship between alcohol use changes and psychiatric symptomatology.

Methods

A secondary analysis with a longitudinal approach was performed with data from a cluster-randomized controlled trial, conducted in 73 public middle schools in three Brazilian cities, to evaluate the effectiveness of a drug use prevention program. The sample included 535 students (61% girls; M_age = 15.2 years). Data were collected pre-intervention (February-March 2019), after 9 months (November-December 2019), and after 26 months (April-August 2021), when the students were in their first year of high school. The authors analyzed drug use prevalence (alcohol, binge drinking, tobacco, inhalants, marijuana, cocaine, and crack) in a lifetime, past year, and past month periods, and the association between alcohol use change subsamples with psychiatric symptoms. Logistic regressions were adjusted by sex, age, socioeconomic status, city, and group (control and intervention).

Results

The present findings suggest that the COVID-19 pandemic led to a decrease in past-year substance use and in past-month substance use frequency, despite the gradually increased (but decelerating) prevalence of lifetime use. However, some adolescents initiated, maintained, or increased the frequency of their alcohol use. Mainly, they were more likely to present behavioral problems, as well as symptoms of inattentive hyperactivity, and peer and emotional problems.

Conclusions

Despite the extensive decline in substance use during the pandemic period, these results suggest an association between previous mental health conditions and behavioral risk factors, leading to increased alcohol consumption and behavioral disorders manifestations.

描述在COVID-19大流行期间（2021年4月至8月）巴西青少年饮酒和吸毒的变化，并分析饮酒变化与精神症状之间的关系。在巴西三个城市的 73 所公立中学开展了一项分组随机对照试验，对数据进行了纵向二次分析，以评估预防吸毒计划的有效性。样本包括 535 名学生（61% 为女生；= 15.2 岁）。数据分别在干预前（2019 年 2 月至 3 月）、9 个月后（2019 年 11 月至 12 月）和 26 个月后（2021 年 4 月至 8 月）收集，当时学生正在读高一。作者分析了终生、过去一年和过去一个月的药物使用流行率（酒精、酗酒、烟草、吸入剂、大麻、可卡因和快克），以及酒精使用变化子样本与精神症状之间的关联。逻辑回归根据性别、年龄、社会经济地位、城市和组别（对照组和干预组）进行了调整。本研究结果表明，COVID-19 大流行导致过去一年药物使用率和过去一个月药物使用频率下降，尽管终生药物使用率逐渐上升（但速度减慢）。然而，一些青少年开始、维持或增加了饮酒频率。主要表现为，他们更有可能出现行为问题、注意力不集中多动症状以及同伴和情感问题。尽管大流行期间药物使用量大幅下降，但这些结果表明，以前的精神健康状况与行为风险因素之间存在关联，从而导致饮酒量增加和行为失常表现。

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引用次数: 0

Inborn errors of immunity and its clinical significance in children with lymphoma in China: a single-center study 中国淋巴瘤患儿的先天性免疫错误及其临床意义：一项单中心研究。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-03-25 DOI: 10.1016/j.jped.2024.02.002

Chao Yang , Nan Li , Meng Zhang , Shuang Huang , Ling Jin , Shu-Guang Liu , Chun-Ju Zhou , Zhi-Gang Li , Yan-Long Duan

Objective

To investigate the incidence, clinical and genetic characteristics of pediatric lymphoma patients of China with inborn errors of immunity (IEI)-related gene mutations, which have not been fully studied.

Method

From Jan. 2020 to Mar. 2023, IEI-related genetic mutations were retrospectively explored in 108 children with lymphomas admitted to Beijing Children's Hospital by NGS. Genetic rule and clinical characteristics as well as treatment outcomes were compared between patients with or without IEI-related gene mutations.

Results

A total of 17 patients (15.7 %) harbored IEI-associated mutations, including 4 cases with X-linked lymphoproliferative syndrome (XLP), 3 cases had mutations in tumor necrosis factor receptor superfamily 13B (TNFRSF13B), 2 cases with Activated p110 syndrome (APDS). Patients with IEI all had alteration of immunocompetence with decreased levels of immunoglobulin and lymphocyte subsets. Recurrent infection existed in 41.2 % of patients. The 18-month event-free survival (EFS) and the overall response rate (ORR) of patients with IEI are significantly lower than those without IEI (33.86% vs. 73.26 %, p = 0.011; 52.94% vs. 87.91 %, p = 0.002, respectively). In addition, patients with IEI had a higher progression disease (PD) rate of 23.5 % than those without IEI of 4.4 % (p = 0.006).

Conclusion

The present study demonstrated that IEI-associated lymphomas were much more common than originally appreciated in pediatric lymphomas, and those were insensitive to treatment and more likely to progress or relapse. The genomic analysis and a thorough review of the medical history of IEI can be used to distinguish them from pediatric lymphomas without IEI, which are beneficial for the early diagnosis and direct intervention.

目的研究中国小儿淋巴瘤患者先天性免疫错误（IEI）相关基因突变的发生率、临床和遗传学特征：方法：2020 年 1 月至 2023 年 3 月，通过 NGS 对北京儿童医院收治的 108 例淋巴瘤患儿的先天性免疫错误（IEI）相关基因突变进行回顾性研究。比较了有无IEI相关基因突变患者的遗传规律、临床特征以及治疗效果：结果：共有 17 例患者（15.7%）携带 IEI 相关基因突变，其中 4 例患有 X 连锁淋巴细胞增生综合征（XLP），3 例患有肿瘤坏死因子受体超家族 13B（TNFRSF13B）基因突变，2 例患有活化 p110 综合征（APDS）。所有 IEI 患者的免疫能力都发生了改变，免疫球蛋白和淋巴细胞亚群水平下降。41.2%的患者存在复发性感染。IEI 患者的 18 个月无事件生存期（EFS）和总反应率（ORR）明显低于无 IEI 患者（分别为 33.86% 对 73.26%，P = 0.011；52.94% 对 87.91%，P = 0.002）。此外，IEI患者的疾病进展率（PD）为23.5%，高于无IEI患者的4.4%（P = 0.006）：本研究表明，IEI相关淋巴瘤在小儿淋巴瘤中的发病率远高于最初的认识，而且这些淋巴瘤对治疗不敏感，更容易进展或复发。通过基因组分析和全面回顾病史，可将IEI相关淋巴瘤与无IEI相关淋巴瘤区分开来，有利于早期诊断和直接干预。

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引用次数: 0

Nutritional status and age at menarche in Amazonian students 亚马逊学生的营养状况和初潮年龄。

IF 3.3 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-03-21 DOI: 10.1016/j.jped.2024.03.002

Kettyuscia Coelho e Oliveira , José Cardoso Neto , Davi C. Aragon , Sonir R. Antonini

Objectives

Age at menarche (MA) is a proxy for biological maturation and a parameter of socioeconomic changes. Worldwide, anticipation of menarche is associated with nutritional transition and excess weight. The objective of this study was to evaluate the MA in Amazonian students and its association with nutritional status, ethnicity, and socioeconomic level.

Methods

Cross-sectional study with 1,017 students aged 6 to 17 living in the city of Manaus, Brazil. MA was analyzed by status quo and recall; its association with body mass index (BMI), race, socioeconomic status, and adult height was examined.

Results

559 (51.9%) participants had already experienced menarche. In 91.7%, menarche occurred between 10 and 14 years of age; the mean age at the onset of menarche was 11.9 years. Overweight (11.6 years) and obese (11.4 years) participants reached menarche earlier than those with normal weight (12 years) and lean (12.7 years) participants. The associations between MA and nutritional status showed that overweight and obesity are risk factors for the early occurrence of menarche. MA was not associated with socioeconomic status/parental education or race. However, excess weight was associated with earlier MA in all races and social classes. The adult height was slightly lower in girls with menarche before 12 years old (157.9 vs 159.4 cm).

Conclusion

Regardless of socioeconomic level or ethnicity, excess weight was associated with earlier menarche in Amazonian students.

目的：初潮年龄（MA）是生理成熟的代表，也是社会经济变化的一个参数。在世界范围内，月经初潮的预期与营养过渡和体重超标有关。本研究旨在评估亚马逊学生的初潮年龄及其与营养状况、种族和社会经济水平的关系：方法：对巴西玛瑙斯市 1 017 名 6 至 17 岁的学生进行横断面研究。结果：559 人（占 51.9%）的体重指数（BMI）与种族、社会经济地位和成人身高有关：559名参与者（51.9%）已经初潮。其中 91.7% 的人月经初潮发生在 10-14 岁之间；月经初潮的平均年龄为 11.9 岁。超重（11.6 岁）和肥胖（11.4 岁）的受试者比体重正常（12 岁）和瘦弱（12.7 岁）的受试者更早初潮。月经初潮与营养状况之间的关系表明，超重和肥胖是导致月经初潮提前的风险因素。月经初潮与社会经济地位/父母教育程度或种族无关。然而，在所有种族和社会阶层中，超重与月经初潮提前有关。12岁前初潮的女孩成年身高略低（157.9厘米对159.4厘米）：结论：无论社会经济水平或种族如何，体重超标都与亚马逊学生月经初潮提前有关。

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