The present study suggests a link between overweight/obesity and altered sleep quality due to compromised non-rapid eye movement sleep, an indirect marker of sleep quality. There was also a link between slow-wave sleep duration and insulin resistance. We must find a strategy to provide adequate slow-wave sleep duration to reduce the obesity epidemic at young ages. Further research is needed.
Health-Related Quality of Life (HRQL) can be used to measure the impact of Sickle Cell Disease (SCD) on the child and their family and is generally reduced. No research has yet measured HRQL in Portuguese pediatric SCD patients. Objectives: (1) Describe and compare HRQL of children with SCD reported by them and their parents; (2) Compare with a pediatric population with no SCD; (3) Find predictive factors of HRQL in SCD children. Methods: Descriptive, case-control study that included sixty-eight children and adolescents with SCD (aged 3 to 18 years) and their parents. Control group—children with no SCD, matched by age, gender and ethnic background. HRQL was assessed using the multidimensional self-report PedsQL® 4.0 Generic Scales. Summary scores for overall HRQL and subscale scores for physical, emotional, social and school functioning were compared within groups (children-parents) and with the control group. Clinical and socio-demographic variables were analyzed to find predictive factors of HRQL in pediatric SCD patients. Results: Children with SCD and their parents had significantly lower overall and all subdomains of HRQL, compared with the control group. Children with SCD also rated lower when compared with their parents (only significant for social functioning), with low to moderate correlations. Children and parent reports declined with increasing age. Higher pain frequency was associated with worse total and psychosocial domains of HRQL. The number of hospitalizations was a predictor of worse school score, and female gender was a predictor of worse emotional score. Conclusions: SCD significantly affects children’s HRQL. Parents can provide a good proxy report, although both evaluations are beneficial. Disease status, like number of hospitalizations and frequency of pain, influences HRQL. Interventions in SCD should consider improvements in HRQL as an important outcome.
Worldwide, vaccinations are the most common source of iatrogenic pain during childhood. Increasing attention is being given to minimising vaccination pain due to accumulating evidence of acute and long-term negative sequelae. These include the distress experienced by the child and those accompanying them, dissatisfaction with healthcare delivery, the development of needle phobias and subsequent noncompliance with vaccinations (1). In 2015, the World Health Organization (WHO) issued its first position statement on vaccination pain and recommended a variety of evidence-based and feasible interventions for global implementation. Pain mitigation was identified as part of good immunisation practice (2).We undertook the first study to benchmark analgesic practices in Lisbon, Portugal. We randomly invited two of the six academic health centres affiliated with our hospital that vaccinated children to participate. Nurses involved in immunisation completed a structured questionnaire, including demographic information, analgesic interventions and child reactions. Caregivers provided informed consent.The questionnaire was completed for a random sample of children seen over a sixmonth period, and we included 87 children (54% female) aged from two months to 14 years (mean 4.4 years) who received 144 intramuscular vaccine injections. Just over three-quarters (76%) of the children received more than one injection. The results are summarised in Table 1. The injections were administered without prior aspiration in 27.7% of cases, and 32.0% of the injections were performed with the children in the supine position. We gave 81 injections to children who were aged 18 months or less and the evidencebased pain strategies used during the injections included: pacifier (62.8%), breastfeeding (16.0%) and sucrose (7.4%). In the older children, 30.1% were informed about the procedure ahead of time and distraction techniques were used in 40.2% of the procedures.Topical anaesthetics were never used. We found that 43% of all the children cried and 19% of the older children were cooperative.The data from this study highlight the suboptimal uptake of research evidence and opportunities for improvement in vaccination pain mitigation for different areas. These include the injection technique, such as not aspirating; physical interventions like positioning the child upright or breastfeeding; pharmacologic interventions such as topical anaesthetics and psychological interventions like distraction techniques.Despite the small sample, the results were consistent with the results of North American surveys about vaccination pain management practices.(3) The observed nonsystematic use of effective analgesic strategies highlights the need for educational programmes aimed at healthcare providers and families to provide them with the tools and training to implement optimal pain mitigation strategies effectively and improve the vaccination experience. To this end, we have begun working with our hospitalaffiliated health centres to incorporate evidencebased int...
Background: Patients with sickle cell disease (SCD) suffer from recurrent painful vaso-occlusive episodes with a significant impact on their quality of life. The aim of this study was to perform a multidimensional assessment of pain in Portuguese children and adolescents with SCD. Methods: Subjects were children and adolescents and their parents recruited from the outpatient pediatric hematology clinic in a Portuguese Hospital. Pain frequency and a broader multidimensional evaluation was performed using the Pediatric Pain Questionnaire (PedsQL) (that includes Visual Analog Scales, color indicators, qualitative descriptors of pain [open question] and body diagram) and a structured questionnaire (PQ2), that included a term list of the Adolescent Pediatric Pain Tool, among other questions. Results: Included 60 children and adolescents (36 boys and 24 girls) with a mean age of 11±4.0 years (range, 5 to 18). The majority of children (83.1%) reported no present pain and 57.6% reported pain last month, with several degrees of pain intensity. Abdomen, thorax, and limbs were the most frequent localizations. Red was the color most chosen to describe “severe pain,” whereas blue and green were more used to describe “no pain.” The number of pain descriptors is different using an open-ended question (2.1±1.5) than a given list of terms (15.3±8.1). The most frequent terms used in the open question were “strong/very strong,” “hurts a lot,” “makes cry,” and “horrible.” Parents used similar pain descriptors. “Makes cry,” “horrible,” “tiring,” “unbearable,” and “uncomfortable” were the most frequent terms chosen in the PQ2. Pain interfered variably with daily activities for most of the patients. Conclusion: Pain experienced in SCD has a broad range of intensity levels, localization, and frequency. There are a number of pain descriptors and socio-emotional factors related to the pain experience. A comprehensive multidimensional assessment that includes both child’s and parents’ perspective seem to be the most adequate strategy to assess pain.
SummaryA tuberculoma is a rare form of presentation of tuberculosis (TB) in children. We describe the case of a 13-year-old girl, with 3 weeks of progressive tiredness and asthenia and a 48 h fever and cough. Physical examination revealed diminished pulmonary sounds in the left lower hemithorax. A chest radiograph showed an oval hypotransparency image in this location. The TB skin test was anergic and sputum was negative for acid-fast bacilli (AFB). The thoracic CT revealed a cystic mass in the left lower half hemithorax, compressing the adjacent pulmonary lobe, with double non-calcificated membrane. The exeresis of the pulmonary mass was performed and the anatomopathological study revealed a tuberculoma with AFB. TB treatment was established with a favourable clinical and radiological evolution. TB is a prevalent disease around the world. In this case, due to the mass dimensions and adjacent-organ compression, surgery was essential for a favourable clinical evolution. BACKGROUND
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