Pediatric office practice

UNIFESP-EPM Departamento de PediatriaUFRGS Faculdade de Medicina Departamento de Pediatria e PuericulturaUNIFESP, EPM, Depto. de PediatriaSciEL

Care needs of children with disabilities – Use of the Pediatric Evaluation of Disability Inventory

AbstractObjectiveTo describe the care needs reported by caregivers of children with disabilities going through the school inclusion process using the Pediatric Evaluation of Disability Inventory.MethodsCross-sectional study with 181 children aged 7–10 years with physical or mental disabilities, undergoing the inclusion process in elementary school in 2007. Location: 31 schools of the Regional Education Board–District of Penha, East Side the city of São Paulo. The children's care needs according to the caregivers were assessed in three areas–self-care, mobility and social function, using the Pediatric Evaluation of Disability Inventory, according to the following score: 5, Independent; 4, Supervision; 3, Minimum Assistance; 2, Moderate Assistance; 1, Maximum Assistance and 0, Total Assistance. For statistical analysis, we used Student's t-test and analysis of variance (ANOVA), with p<0.05 being statistically significant.ResultsThe lower means, with statistically significant differences, were observed for the items related to social function (55.8–72.0), followed by self-care functions (56.0–96.5); for all types of disabilities, except for children with physical disabilities, who had lower means for self-care (56.0) and mobility (63.8).ConclusionsSocial function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention

Necessidades de assistência à criança com deficiência – Uso do Inventário de Avaliação Pediátrica de Incapacidade

ResumoObjetivoDescrever as necessidades de assistência referidas por cuidadores de crianças com deficiência em processo de inclusão escolar, por meio do Inventário de Avaliação Pediátrica de Incapacidade.MétodosEstudo transversal com 181 crianças de 7‐10 anos com deficiências físicas ou mentais, que se encontravam em processo de inclusão escolar no ciclo Fundamental I, em 2007. Local: 31 escolas da Diretoria Regional de Ensino – Distrito Penha, Zona Leste do Município de São Paulo. Foram avaliadas as necessidades de assistência do cuidador da criança em três áreas – autocuidado, mobilidade e função social, por meio do Inventário de Avaliação Pediátrica de Incapacidade, segundo a seguinte pontuação: 5 Independente, 4 Supervisão, 3 Assistência mínima, 2 Assistência moderada, 1 Assistência máxima e 0 Assistência total. Para análise estatística, usou‐se o teste t de Student e análise de variância (Anova) e foi significativo p<0,05.ResultadosAs menores médias, com diferença estatística, foram observadas para os itens relacionados à função social (55,8‐72), seguidas das funções de autocuidado (56‐96,5) para todos os tipos de deficiência, com exceção das crianças com deficiência física que apresentaram menores médias para autocuidado (56) e mobilidade (63,8).ConclusõesA função social foi a área referida como a que necessita de maior assistência do cuidador e o Inventário de Avaliação Pediátrica de Incapacidade é um instrumento que pode contribuir para identificar essas necessidades e para o desenvolvimento de uma intervenção mais dirigida.AbstractObjectiveTo describe the care needs reported by caregivers of children with disabilities going through the school inclusion process using the Pediatric Evaluation of Disability Inventory.MethodsCross‐sectional study with 181 children aged 7 to 10 years with physical or mental disabilities, undergoing the inclusion process in Elementary school in 2007. Location: 31 schools of the Regional Education Board ‐ District of Penha, East Side the city of São Paulo. The children's care needs according to the caregivers were assessed in three areas ‐ self‐care, mobility and social function, using the Pediatric Evaluation of Disability Inventory, according to the following score: 5, Independent; 4, Supervision; 3, Minimum Assistance; 2, Moderate Assistance; 1, Maximum Assistance and 0, Total Assistance. For statistical analysis, we used Student's t‐test and analysis of variance (ANOVA), with p<0.05 being statistically significant.ResultsThe lower means, with statistically significant differences, were observed for the items related to social function (55.8 to 72.0), followed by self‐care functions (56.0 to 96.5); for all types of disabilities, except for children with physical disabilities, who had lower means for self‐care (56.0) and mobility (63.8).ConclusionsSocial function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention

Childcare and children's healthcare: historical factors and challenges

This paper reviews the history of puericulture and attention to children's health in Brazil and establishes relationships between this history and the concept of childhood at different times and within different sociocultural contexts, and between this history and the way in which the Brazilian healthcare system has been organized. The characteristics of the Brazilian educational process, the state's role in healthcare, the creation of the national health system and the creation of the children's and adolescent's laws are highlighted as determinants of healthcare that consider children and their families as subjects under the law. These important achievements within Brazilian society have stimulated changes in clinical practice and, especially, in childcare. Today, the state no longer has a controlling role over families' childcare through regulation of individuals' conduct. Rather, childcare is undertaken scientifically, through a multiprofessional team in partnership with families and communities.This paper reviews the history of puericulture and attention to children’s health in Brazil and establishes relationships between this history and the concept of childhood at different times and within different sociocultural contexts, and between this history and the way in which the Brazilian healthcare system has been organized. The characteristics of the Brazilian educational process, the state’s role in healthcare, the creation of the national health system and the creation of the children’s and adolescent’s laws are highlighted as determinants of healthcare that consider children and their families as subjects under the law. These important achievements within Brazilian society have stimulated changes in clinical practice and, especially, in childcare. Today, the state no longer has a controlling role over families’ childcare through regulation of individuals’ conduct. Rather, child care is undertaken scientifically, through a multiprofessional team in partnership with families and communities

Functional skills of children with deficiencies in school inclusion: barriers to effective inclusion

The scope of this article is to describe the disabilities of students in the process of inclusion by means of the PEDI - Pediatric Evaluation of Disability Inventory. A cross-sectional analysis was conducted. The population studied included 181 students (7-10 years old) from 31 public schools in São Paulo. Using a questionnaire applied to the caregiver, 197 activities were evaluated in the areas of self-care, mobility and social function. In accordance with the PEDI, differences (p < 0.05) in student performance were observed between grades in the scales of self-care (average of 77.8% in the 1st grade and 95.2% in the 4th grade) and mobility (average of 90% in the 1st grade and 99.8% in the 4th grade); social function had the lowest averages, except for those with physical disabilities, in which the most affected area was mobility (average of 62.7%). The PEDI enabled the identification of disabilities per group and individual disability, which may constitute an important tool for targeted intervention and follow-up at school.O objetivo deste artigo é descrever as incapacidades de alunos em processo de inclusão por meio do PEDI (Inventário de Avaliação Pediátrica de Incapacidades). Estudo transversal analítico. População: 181 alunos (7-10 anos) de 31 escolas municipais de São Paulo. Por meio de questionário aplicado ao cuidador, foram avaliadas 197 atividades nas áreas de autocuidado, mobilidade e função social. Diferenças (p < 0,05) no desempenho dos alunos, segundo o PEDI, foram observadas entre as séries nas escalas de autocuidado (média de 77,8% na 1ª série e de 95,2% na 4ª série) e mobilidade (média de 90,0% na 1ª série e 99,8% na 4ª série); a função social apresentou as menores médias, exceção ao grupo com deficiência física, cuja área mais afetada foi a mobilidade (média de 62,7%). O PEDI permitiu a identificação de incapacidades por grupo de deficiências e individual, podendo constituir instrumento importante para intervenção direcionada e acompanhamento na escola.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaSciEL

Educação continuada em desenvolvimento infantil para profissionais da atenção primária em saúde: estudo prospectivo do tipo antes-e-depois

CONTEXT AND OBJECTIVE:Children's developmental disorders are often identified late by healthcare professionals working in primary care. The aim of this study was to assess the impact of a continuing education program on child development, on the knowledge and practices of these professionals.DESIGN AND SETTING:Prospective single-cohort study (before-and-after study), conducted in the city of Belém, Pará , Brazil.METHODS:Two hundred and twenty-one professionals working in primary healthcare (82.2%) participated in a continuing education program on child development and were assessed before and after implementation of the program through tests on their knowledge of child development, consisting of 19 questions for physicians and 14 for nurses, and questionnaires on their professional practices.RESULTS:One to three years after the program, the mean number of correct answers in the tests had increased from 11.5 to 14.3 among physicians in the Healthy Family Program (Programa Família Saudável, PFS); 13.0 to 14.3 among physicians in Municipal Health Units (Unidades Municipais de Saúde, UMS); 8.3 to 10.0 among PFS nurses; and 7.8 to 9.4 among UMS nurses. In interviews with mothers attended by these professionals before the program, only 21.7% reported that they were asked about their children's development, 24.7% reported that the professional asked about or observed their children's development and 11.1% received advice on how to stimulate them. After the program, these percentages increased to 34.5%, 54.2% and 30.3%, respectively.CONCLUSIONS:Professionals who participated in the program showed improved performance regarding child development knowledge and practices.CONTEXTO E OBJETIVO:Alterações do desenvolvimento em crianças frequentemente têm sido tardiamente identificadas por profissionais de saúde que atuam na atenção básica. O objetivo deste estudo foi avaliar o impacto de um programa de educação permanente sobre desenvolvimento infantil nos conhecimentos e práticas desses profissionais.TIPO DE ESTUDO E LOCAL:Estudo de coorte única prospectivo (antes-e-depois), realizado no município de Belém, Pará, Brasil.MÉTODOS:221 (82,2%) profissionais da rede básica de saúde que participaram do programa de educação permanente sobre desenvolvimento infantil foram avaliados antes e após a implantação do programa, através de testes sobre seus conhecimentos em desenvolvimento infantil com 19 questões para médicos e 14 para enfermeiros, e questionários sobre sua prática profissional.RESULTADOS:Um a três anos após o programa, a média de perguntas certas dos testes aumentou de 11,5 para 14,3 entre os médicos do Programa da Família Saudável (PFS); 13,0 para 14,3 entre os médicos de Unidades Municipais de Saúde (UMS); 8,3 para 10,0 entre os enfermeiros de PFS e 7,8 para 9,4 entre os enfermeiros de UMS. Nas entrevistas com mães atendidas por esses profissionais, verificou-se que, antes do programa, apenas 21,7% informaram que foram indagadas sobre o desenvolvimento dos seus filhos, 24,7% relataram que o profissional perguntou ou observou o desenvolvimento da sua criança e 11,1% receberam orientação sobre como estimulá-las; após o programa, esses percentuais aumentaram para 34,5%, 54,2% e 30,3%, respectivamente.CONCLUSÃO:Profissionais que participaram do programa apresentaram melhor desempenho quanto aos conhecimentos e práticas sobre desenvolvimento infantil.Universidade Federal do Pará School of MedicineUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of PediatricsUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPM, Department of PediatricsUNIFESP, EPMSciEL

Nonfatal accidents among adolescents students in the city of Belém, Pará, Brazil

OBJECTIVE: Study the frequency of nonfatal accidents among adolescent students in the city of Belém, Pará, Brazil. METHODS: This cross-sectional study enrolled a probabilistic sample of 2,828 adolescent students, aged 17 and 18 years old, chosen in clusters obtained in multiple stages. Students were in their final year of high school, in public and private schools of the city of Belém, during the year 2000. Data was collected through a self-administered semi-structured questionnaire. Statistical analysis to compare the categorical variables between the two groups used the chi-square calculated by the Epitable of Epi-Info 6.01. RESULTS: The students' mean age was 17.7 years; 60% were female; 82% studied in public schools; 61% lived with both parents; and 23% with only one of their parents. The occurrence of at least one accident was reported by 1,987 (70%) adolescents. The most frequent types were: falls (35%), contact with sharp glass, knife, sword and dagger (30%), contact with heat and hot substances (22%), transport accidents (20%) and bite by dogs and other mammals (18%). Accidents were more frequent among males (78%) than females (65%), and among students of private schools (77%) than those of public schools (69%). One third of the accidents led the adolescents to healthcare services and, of these, 9% were hospitalized. CONCLUSIONS: A high accident rate was seen among adolescent students, confirming the vulnerability of this age group. Better social conditions, here represented by attendance of private schools, did not confer protection against accidents in this population.OBJETIVO: Verificar a ocorrência de acidentes não fatais em adolescentes escolares do município de Belém, Pará. MÉTODOS: Estudo transversal. Amostra probabilística por conglomerados obtida em múltiplos estágios, que incluiu 2.828 adolescentes escolares, com idades entre 17 e 18 anos, matriculados na terceira série do ensino médio de escolas públicas e privadas de Belém, no ano 2000. Coleta de dados: questionário semi-estruturado de autopreenchimento. Análise estatística: comparação das variáveis categóricas por teste do qui-quadrado, calculado pelo programa Epitable, do Epi-Info 6.01. RESULTADOS: A média de idade dos escolares foi 17,7 anos, sendo 60% meninas, 82% estudavam na rede pública, 61% residiam com pai e mãe e 23% com apenas um dos genitores. A ocorrência de pelo menos um acidente foi relatada por 1.987 (70%) adolescentes. Os mais freqüentes foram: quedas (35%), contato com vidro, faca, espada e punhal (30%), contato com fonte de calor ou substâncias quentes (22%), acidentes de transporte (20%) e mordeduras por cão ou outros mamíferos (18%). A ocorrência foi maior no sexo masculino (78%) do que no feminino (65%) e entre estudantes da rede privada (77%) em comparação aos da rede pública (69%). Um terço dos acidentes levou os adolescentes à procura do serviço de saúde e, destes, 9% foram hospitalizados. CONCLUSÕES: Verificou-se elevada ocorrência de acidentes em adolescentes escolares, confirmando a vulnerabilidade desta faixa etária. Concluiu-se que a melhor condição social, aqui representada pela procedência da escola privada, não conferiu proteção a esses escolares.Universidade do Estado do Pará Disciplina de PediatriaUniversidade Federal de São Paulo (UNIFESP) Departamento de Pediatria Disciplina de Pediatria Geral e ComunitáriaUNIFESP Departamento de Clínica Disciplina de Medicina Baseada em EvidênciasUNIFESP, Depto. de Pediatria Disciplina de Pediatria Geral e ComunitáriaUNIFESP, Depto. de Clínica Disciplina de Medicina Baseada em EvidênciasSciEL