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OBJECTIVE: To evaluate a fast-track triage model in an integrated community specialty clinic to reduce the age of diagnosis for patients with autism spectrum disorder (ASD). STUDY DESIGN: A retrospective chart review was performed for patients seen in an integrated community specialty pediatric practice using a fast-track screening and triage model. The percentage of ASD diagnoses, age at diagnosis, and time from referral to diagnosis were evaluated. The fast-track triage model was compared with national and statewide estimates of median age of first evaluation and diagnosis. RESULTS: From January 1, 2020, through December 31, 2021, 189 children with a mean (SD) age of 32.2 (12.4) months were screened in the integrated community specialty. Of these, 82 (43.4%) children were referred through the fast-track triage for further evaluation in the developmental and behavioral pediatrics (DBP) department, where 62 (75.6%) were given a primary diagnosis of ASD. Average wait time from referral to diagnosis using the fast-track triage model was 6 months. Mean (SD) age at diagnosis was 37.7 (13.5) months. The median age of diagnosis by the fast-track triage model was 33 months compared with the national and state median ages of diagnosis at 49 and 59 months, respectively. CONCLUSIONS: With the known workforce shortage in fellowship-trained developmental behavioral pediatricians, the fast-track triage model is feasible and maintains quality of care while resulting in more timely diagnosis, and reducing burden on DBP by screening out cases who did not require further multidisciplinary DBP evaluation as they were appropriately managed by other areas.

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Objective: The principal aim of this randomized clinical trial (RCT) was to test the effectiveness in the prevention of Early Childhood Caries (ECC) through an educational intervention program with the use of a printed guide for pediatricians and parents both designed by pediatric dentists. Materials and methods: After ethical approval, the first step was to design the educational guides, which were based on the information obtained from a focus group with pediatricians (n = 3), phone interviews with mothers to toddlers' (n = 7), and the best evidence available about children's oral health. For the RCT, 309 parents with their 10-12 months old children were randomly allocated to either the intervention or the control group. Parents in the intervention group received oral health education from the pediatricians supported by the printed guides. Parents in both groups received an oral health kit with a toothbrush and toothpaste at the first visit as well as at each 6-month follow-up visit. After 18 months the children were evaluated using ICDAS criteria. Results: At baseline, data were available from 309 children (49.8% girls). The mean age of the children was of 10.8 months (SD = 0.8) and 69.3% had not had their teeth brushed with toothpaste. After 18 months, a total of 28 (22%) children in the intervention group and 44 (24%) in the control group were clinically examined. Regarding the number of tooth surfaces with caries lesions, the children in the intervention group had a mean of 6.50 (SD = 6.58) surfaces, while the children in the control group had a mean of 5.43 (SD = 4.74) surfaces with caries lesions. This difference was not significant (p = 0.460). Conclusion: The RCT showed no effectiveness in caries-progression control. Despite this result, this study managed to identify barriers that do not allow pediatricians from offering parents adequate oral health recommendations. With this learning, it is possible to work on collaborative programs with pediatricians that over time likely will increase dental health by controlling for ECC.

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La fecundidad adolescente en Cuba es elevada y muestra resistencia a su reducción en los últimos años a pesar de las acciones realizadas. Para promover una sexualidad responsable en los adolescentes, se requiere de un diferente y particular accionar de los pediatras. El objetivo de esta colaboración es aportar elementos que sensibilicen e involucren a los pediatras cubanos para que ofrezcan orientación a los adolescentes sobre el ejercicio de una sexualidad plena, libre y responsable, que contribuya a la reducción de la fecundidad y al cuidado integral de la salud sexual y reproductiva. El método utilizado fue la revisión de las legislaciones vigentes y las recomendaciones de varias sociedades internacionales de pediatría, respecto a la función e importancia de la especialidad en la prevención del embarazo adolescente. Se destacan las ventajas del pediatra para la prevención de la fecundidad adolescente, se explican las habilidades que deben adquirir para informar y orientar a los adolescentes, se analizan las barreras que debe favorecer el acceso del adolescente a la prevención de la fecundidad y se exponen las recomendaciones específicas para su actuación Se concluye que los pediatras cubanos pueden contribuir a la reducción de la fecundidad y mejorar el cuidado integral de la salud sexual y reproductiva de los adolescentes(AU)

Adolescent fertility in Cuba is high and shows resistance to its reduction in recent years despite the actions taken. To promote responsible sexuality in adolescents, a different and particular action of pediatricians is required. The objective of this collaboration is to provide elements that sensitize and involve Cuban pediatricians to offer guidance to adolescents on the exercise of a full, free and responsible sexuality, which contributes to the reduction of fertility and comprehensive care of sexual and reproductive health. The method used was the review of current legislation and the recommendations of several international pediatric societies, regarding the role and importance of the specialty in the prevention of adolescent pregnancy. The advantages of the pediatrician for the prevention of adolescent fertility are highlighted, the skills they must acquire to inform and guide adolescents are explained, the barriers that the pediatrician must face to favor the access of adolescents to prevent fertility are analyzed, and the specific recommendations for the action of the pediatrician in the prevention of adolescent fertility are exposed. It is concluded that Cuban pediatricians can contribute to the reduction of fertility and improve the comprehensive care of sexual and reproductive health of adolescents(AU)

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El presente trabajo tiene como finalidad relatar la historia de la fundación de primigenios hospitales en Valencia y el ejercicio de la medicina entre los siglos XV-XXL. Metodología: se investigó en textos, documentos y entrevistas la secuencia de un proceso histórico, de las actividades cumplidas por médicos en Carabobo. En 1422 la medicina se concebía con características, mágico-religiosas y empírica donde piaches, curanderos, y barberos, sin estudios, la ejercieron hasta el siglo XVI. Luego médicos cirujanos de guerra, connacionales y extranjeros intentaron mejorar el ejercicio. El emperador Carlos I, de España, en 1541 decretó la creación de hospitales en América; edificándose en 1670 el hospital San Antonio de Padua, años después (1874) le cambian el nombre por hospital de Caridad, por decreto del General Guzmán Blanco. en 1890 se creó la Clínica de los Niños pobres. en 1897 se funda el hospital civil y en 1898 el hospital San Roque. El Hospital Central de Valencia, se construye durante el gobierno del presidente López Contreras, y los niños eran atendidos por médicos generales. Fue inaugurado en 1949 y se envió a un grupo de médicos a especializarse en el extranjero, y trajeron médicos de otras latitudes para ejercer y formar especialistas. Es larga la lista de médicos que atendieron a la infancia en Valencia desde principios del siglo XIX, y numerosos los pediatras que desde finales del siglo XIX y hasta el XXI, ejercieron la pediatría y formaron los pediatrasque el país requería(AU)

The purpose of this paper is to recount the history of the foundation of hospitals in Valencia and the practice of pediatric medicine between the XV and XXI centuries. Methodology: It was investigated in texts, documents, and interviews the sequence of a historical process, of the activities carried out by doctors in Carabobo. In 1422, medicine was conceived with magical-religious and empirical characteristics where piaches, healers, and barbers, without studies, practiced it until the 16th century. Then war surgeons, compatriots and foreigners tried to improve the practice. emperor Carlos I of Spain, in 1541, decreed the creation of hospitals in America; the San Antonio de Padua hospital was built in 1670, years later (1874) they changed its name to Hospital la Caridad, by decree of General Guzmán Blanco. In 1890 the clinic for Poor children was created. In 1897 the civil hospital was founded and in 1898 the San Roque hospital. The Central Hospital of Valencia was built during the government of president López Contreras, and the children were cared for by general practitioners. It was inaugurated in 1949 and a group of doctors was sent abroad to specialize, and they brought doctors from other latitudes to practice and train specialists. The list of doctors who attended children in Valencia since the beginning of the 19th century is long, and there are many pediatricians who, from the end of the 19th century to the 21st, practiced pediatrics and trained the pediatricians that the country required(AU)

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ABSTRACT Objective: To assess personal, professional, medical, and scientific educational characteristics and issues reported by pediatricians. Methods: Cross-sectional study based on an online survey including 614 pediatricians who graduated in the last 15 years at a University Pediatric Department in Brazil. Results: The response rate was 331/614(54%). The majority were females (82%), the median age was 33 years (27-40) and median years of pediatric practice was 5 (1-13). High workload (>60 hours/week) occurred in 25% and 47% earned ≥15 minimum wages/month. The most work-related issues reported were long working hours, poor social life and a sedentary lifestyle (>50%). Pediatricians were further divided into two groups, according to years of pediatric clinical practice: group 1 (≤5 years) and group 2 (>5 years). The median of overall satisfaction with pediatric residency [8(0-10) vs. 9 (4-10); p=0.002] was significantly reduced in group 1. The frequencies of workload >60 hours, work on pediatric ward and pediatric intensive care were significantly higher in the first group (p<0.05). Regarding main issues related to clinical practice in the last year, long working hours (73 vs. 53%; p<0.001), poor social life (75 vs. 62%; p=0.018) and harassment (23 vs. 4%; p=0.003) were significantly higher in the first group. Conclusions: Very early career pediatricians (≤5 years) reported higher workload, lower income, work-related issues and different location of pediatric practice compared to early career pediatricians (>5 years). The overall satisfaction with pediatric residency was good, however, reduced in very early career pediatricians.

RESUMO Objetivo: Avaliar características e problemas pessoais, profissionais, médicos e de educação científica reportados por pediatras. Métodos: Estudo transversal com base em uma pesquisa online, incluindo 614 pediatras formados nos últimos 15 anos no Departamento de Pediatria de uma universidade brasileira. Resultados: A taxa de resposta foi de 331/614 (54%). A maioria dos participantes era do sexo feminino (82%), a mediana de idade foi de 33 anos (27-40 anos) e a mediana de tempo de prática pediátrica foi de 5 anos (1-13). Jornada de trabalho elevada (>60 horas/semana) foi relatada por 25% dos entrevistados e 47% recebiam ≥15 salários mínimos/mês. Os problemas relacionados ao trabalho mais frequentes foram jornadas longas de trabalho, vida social insatisfatória e sedentarismo (>50%). Os pediatras foram divididos em dois grupos de acordo com os anos de prática clínica pediátrica: grupo 1 (≤5 anos) e grupo 2 (>5 anos). A mediana de satisfação geral com a residência pediátrica [8 (0-10) versus 9 (4-10); p=0,002] foi significativamente menor no grupo 1. As frequências de jornada de trabalho >60 horas, trabalho na enfermaria pediátrica e na terapia intensiva pediátrica foram significativamente maiores no primeiro grupo (p<0,05). Quanto aos principais problemas relacionados à prática clínica no ano anterior, jornadas longas de trabalho (73 versus 53%; p<0,001), vida social insatisfatória (75 versus 62%; p=0,018) e assédio (23 versus 4%; p=0,003) foram significativamente mais elevados no grupo 1. Conclusões: Pediatras em início de carreira (≤5 anos) relataram maior jornada de trabalho, menor renda, problemas relacionados ao trabalho e diferentes locais de trabalho em comparação com pediatras mais experientes (>5 anos). A satisfação geral com a residência pediátrica foi boa, porém menor em pediatras do primeiro grupo.

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BACKGROUND: In April 2017 the Mexican Asthma Guidelines (GUIMA) were published. Before the launch, physicians' knowledge was explored related to key issues of the guideline. METHODS: A SurveyMonkey® survey was sent out to board-certified physicians of 5 medical specialties treating asthma. Replies were analyzed per specialty against the GUIMA evidence-based recommendations. We present the treatment part here. RESULTS: A total of 364 allergists (ALLERG), 161 pulmonologists (PULM), 34 ENTs, 239 pediatricians (PED) and 62 general practitioners (GPs) replied to the survey and 247-83-14-135-37 respectively finished it. Spirometry is not routinely indicated when asthma is very probable by ALLERG 54%, PULM 47%, ENT 39%, PED 65%, GP 64%. A fictitious case proposed to the physicians with intermittent asthma was erroneously treated with ICS by ALLERG 9%, PULM 11%, ENT 28%, PED 10%, GP 11%. The mild persistent case received mistakenly ICS-LABA by ALLERG 25%, PULM 26%, ENT 33%, PED 27%, GP 23%. The first-line option for moderate persistent asthma was ICS(median dose) instead of ICS(low)+LABA for ALLERG 29%, PULM 25%, ENT 17%, PED 27%, GP 23% and in severe asthma maintenance treatment PULM20%, ALLERG-ENT-PED-GP 22-34% failed to indicate LABA. Concerning the guidelines' recommendation to use one inhaler for maintenance & rescue in moderate-to-severe asthma, PULM45%, ALLERG-ENT-PED-GP 56-80% (p < 0.00001), erroneously indicated ICS-salmeterol could be used, instead of ICS-formoterol. Oral ß2 or theophylline are no longer recommended, but PULM 37% and ALLERG-ENT-PED-GP 42-62% (p < 0.01) still indicate their use. In severe asthma 61-73% of physicians consider adding LTRA to the treatment; only PULM38%, OTHERS12-25% consider adding tiotropium (p < 0.001) and 3-17% consider adding omalizumab, both guideline recommended add-ons. As for asthma in pregnancy, most surveyed are not aware budesonide is the 1st line option ICS. Finally, 81-97% of the group-members recognized allergen immunotherapy, as a viable add-on, in line with GINA/GEMA/GUIMA recommendations. CONCLUSIONS: An online survey could detect knowledge-gaps related to asthma treatment. Interestingly, surveyed physicians tended to over-treat the milder asthma cases, thus clearly leaving room for cost-savings. Caution should be taken in the promotion of the SMART (single-maintenance-and-reliever-treatment) approach, which can only be done with ICS-formoterol. Many physicians opt for other combinations not apt for this approach. Among all surveyed specialties there is ample room for improvement in mild and severe asthma management.

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Introducción. El síndrome de Down (SD) es un trastorno genético frecuente. Las familias de los niños con SD en general no reciben suficiente información al momento del diagnóstico. El objetivo de este estudio fue evaluar las experiencias de las madres de niños con SD al momento que le dieron el diagnóstico y la comunicación que brindaron los profesionales de la salud. Población y métodos. Se incluyeron madres de niños con síndrome de Down. Se evaluaron sus experiencias con la información del diagnóstico y las actitudes de los profesionales, mediante una entrevista semiestructurada. Resultados. La muestra fue 43 madres. Se diagnosticó SD durante el control prenatal en ocho niños y en 35 después del nacimiento. Dieciocho madres recibieron el diagnóstico en la clínica pediátrica, y a 16 les informaron en la maternidad. Más de la mitad de las madres recibieron la primera información sobre el diagnóstico de su hijo del pediatra. Solo cinco de las 43 madres habían recibido información detallada. De 32 madres, 23 dijeron que percibieron una actitud negativa. La mayoría de los informes del diagnóstico a las familias, duraron menos de cinco minutos. Conclusiones. Las madres de niños con SD desean recibir más información sobre el SD de parte de los profesionales de la salud. Además, desean que esta información se brinde de manera comprensiva y sensible. Los profesionales de la salud, en especial los pediatras, necesitan dedicar el tiempo suficiente para conversar con la familia sobre el SD y los desafíos que presenta.

Introduction. Down's syndrome (DS) is a common genetic disorder. The families of children with DS generally do not receive sufficient information at the time of the diagnosis. They are dissatisfied with the manner of healthcare professionals. The objective was to evaluate the experiences of mothers of children with DS at the time of the diagnosis and the communicative attitudes of healthcare professionals. Population and methods. Mothers who had children with Down syndrome were included. The experiences of the mothers at the time of diagnosis and the attitudes of the healthcare professionals were evaluated by a semistructured interview. Results. The study sample was 43 mothers. Eight children had been diagnosed with DS prenatally, and 35 had been diagnosed postnatally. Eighteen of the mothers had received the diagnosis in a pediatric clinic, and 16 had been told of the diagnosis in an obstetric clinic. More than half the mothers had received the first information about their child's diagnosis from a pediatrician. Only five of the 43 mothers had received detailed information. Twenty-three of 32 mothers said that they were met with a negative attitude. Generally, the time put aside to inform the families about the diagnosis was less than 5 min. Conclusions. Mothers of DS children want more information about DS from healthcare professionals. Furthermore, they want this information to be delivered in a supportive and sensitive manner. Healthcare professionals, especially pediatricians need to allocate sufficient time to discuss DS and its challenges with the family.

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INTRODUCTION: Down's syndrome (DS) is a common genetic disorder. The families of children with DS generally do not receive sufficient information at the time of the diagnosis. They are dissatisfied with the manner of healthcare professionals. The objective was to evaluate the experiences of mothers of children with DS at the time of the diagnosis and the communicative attitudes of healthcare professionals. POPULATION AND METHODS: Mothers who had children with Down syndrome were included. The experiences of the mothers at the time of diagnosis and the attitudes of the healthcare professionals were evaluated by a semistructured interview. RESULTS: The study sample was 43 mothers. Eight children had been diagnosed with DS prenatally, and 35 had been diagnosed postnatally. Eighteen of the mothers had received the diagnosis in a pediatric clinic, and 16 had been told of the diagnosis in an obstetric clinic. More than half the mothers had received the first information about their child's diagnosis from a pediatrician. Only five of the 43 mothers had received detailed information. Twenty-three of 32 mothers said that they were met with a negative attitude. Generally, the time put aside to inform the families about the diagnosis was less than 5 min. CONCLUSIONS: Mothers of DS children want more information about DS from healthcare professionals. Furthermore, they want this information to be delivered in a supportive and sensitive manner. Healthcare professionals, especially pediatricians need to allocate sufficient time to discuss DS and its challenges with the family.

Introducción. El síndrome de Down (SD) es un trastorno genético frecuente. Las familias de los niños con SD en general no reciben suficiente información al momento del diagnóstico. El objetivo de este estudio fue evaluar las experiencias de las madres de niños con SD al momento que le dieron el diagnóstico y la comunicación que brindaron los profesionales de la salud. Población y métodos. Se incluyeron madres de niños con síndrome de Down. Se evaluaron sus experiencias con la información del diagnóstico y las actitudes de los profesionales, mediante una entrevista semiestructurada. Resultados. La muestra fue 43 madres. Se diagnosticó SD durante el control prenatal en ocho niños y en 35 después del nacimiento. Dieciocho madres recibieron el diagnóstico en la clínica pediátrica, y a 16 les informaron en la maternidad. Más de la mitad de las madres recibieron la primera información sobre el diagnóstico de su hijo del pediatra. Solo cinco de las 43 madres habían recibido información detallada. De 32 madres, 23 dijeron que percibieron una actitud negativa. La mayoría de los informes del diagnóstico a las familias, duraron menos de cinco minutos. Conclusiones. Las madres de niños con SD desean recibir más información sobre el SD de parte de los profesionales de la salud. Además, desean que esta información se brinde de manera comprensiva y sensible. Los profesionales de la salud, en especial los pediatras, necesitan dedicar el tiempo suficiente para conversar con la familia sobre el SD y los desafíos que presenta.

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O emprego de agonistas adrenérgicos dos receptores a2 traz benefícios na Anestesiologia clínica, em especial a dexmedetomidina, por seu aspecto farmacológico e alta especificidade. Contudo, suas vantagens e desvantagens devem ser melhor elucidadas por meio de estudos clínicos tanto na Medicina Humana quanto na Veterinária. Dentro da Medicina Veterinária, a realização de pequenos procedimentos, principalmente em felinos, requer sedação intensa ou mesmo anestesia geral, o que prolonga o tempo de recuperação do paciente, exige maior monitoramento e envolve maior incidência de efeitos colaterais. Portanto, o desenvolvimento de protocolos de sedação que permitam a realização destes procedimentos sem a necessidade de anestesia geral mostra-se viável, como já se faz presente na Medicina em pacientes pediátricos. O desenvolvimento de protocolos seguros, de rápida duração e que apresentem antídotos se faz necessário, especialmente em felinos cujo manejo envolve maior estresse e contenção. A presente revisão aborda o uso dos agonistas adrenérgicos dos receptores a2, em especial a dexmedetomidina, em gatos hígidos para a realização de pequenos procedimentos, o mecanismo de ação, bem como a possibilidade de reversibilidade farmacológica destes fármacos na espécie.

The use of the a2 adrenergic agonists has benefits in clinical anesthesiology, especially dexmedetomidine, because of its pharmacological aspect and high specificity. However, its advantages and disadvantages should be better elucidated through clinical studies in both Human and Veterinary Medicine. Within Veterinary Medicine, small procedures, especially in cats, require intense sedation or even general anesthesia, which prolongs the patient's recovery time, requires greater monitoring and involves a higher incidence of side effects. Therefore, the development of sedation protocols that allow the performance of these procedures without the need for general anesthesia is feasible, as is already present in human pediatric patients. The development of safe, fast and antidepressant protocols is necessary, especially in cats whose management involves greater stress and containment. The present review addresses the use of a2, adrenergic agonists, especially dexmedetomidine, in healthy cats to perform small procedures, the mechanism of action, as well as the possibility of pharmacological reversibility of these drugs in the specie.

El empleo de agonistas adrenérgicos de los receptores a2 trae beneficios en la Anestesiología clínica, en particular la dexmedetomidina, por su aspecto farmacológico y alta especificidad. Sin embargo, sus ventajas y desventajas deben ser mejor elucidadas por medio de estudios clínicos tanto en la Medicina Humana y en la Veterinaria. En la Medicina Veterinaria, la realización de pequenos procedimientos, principalmente en felinos, requiere sedación intensa o incluso anestesia general, lo que prolonga el tiempo de recuperación del paciente, exige mayor monitoreo e involucra mayor incidencia de efectos colaterales. Por lo tanto, el desarrollo de protocolos de sedación que permitan la realización de estos procedimientos sin la necesidad de anestesia general se muestra viable, como ya se hace presente en la Medicina en pacientes pediátricos. El desarrollo de protocolos seguros, de rápida duración y que presenten antídotos se hace necesario, especialmente en felinos cuyo manejo involucra mayor estrés y contención. La presente revisión aborda el uso de los agonistas adrenérgicos de los receptores a2, en particular la dexmedetomidina, en gatos hígidos para la realización de pequenos procedimientos, el mecanismo de acción, así como la posibilidad de reversibilidad farmacológica de estos fármacos en la especie.

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O emprego de agonistas adrenérgicos dos receptores a2 traz benefícios na Anestesiologia clínica, em especial a dexmedetomidina, por seu aspecto farmacológico e alta especificidade. Contudo, suas vantagens e desvantagens devem ser melhor elucidadas por meio de estudos clínicos tanto na Medicina Humana quanto na Veterinária. Dentro da Medicina Veterinária, a realização de pequenos procedimentos, principalmente em felinos, requer sedação intensa ou mesmo anestesia geral, o que prolonga o tempo de recuperação do paciente, exige maior monitoramento e envolve maior incidência de efeitos colaterais. Portanto, o desenvolvimento de protocolos de sedação que permitam a realização destes procedimentos sem a necessidade de anestesia geral mostra-se viável, como já se faz presente na Medicina em pacientes pediátricos. O desenvolvimento de protocolos seguros, de rápida duração e que apresentem antídotos se faz necessário, especialmente em felinos cujo manejo envolve maior estresse e contenção. A presente revisão aborda o uso dos agonistas adrenérgicos dos receptores a2, em especial a dexmedetomidina, em gatos hígidos para a realização de pequenos procedimentos, o mecanismo de ação, bem como a possibilidade de reversibilidade farmacológica destes fármacos na espécie.(AU)

The use of the a2 adrenergic agonists has benefits in clinical anesthesiology, especially dexmedetomidine, because of its pharmacological aspect and high specificity. However, its advantages and disadvantages should be better elucidated through clinical studies in both Human and Veterinary Medicine. Within Veterinary Medicine, small procedures, especially in cats, require intense sedation or even general anesthesia, which prolongs the patient's recovery time, requires greater monitoring and involves a higher incidence of side effects. Therefore, the development of sedation protocols that allow the performance of these procedures without the need for general anesthesia is feasible, as is already present in human pediatric patients. The development of safe, fast and antidepressant protocols is necessary, especially in cats whose management involves greater stress and containment. The present review addresses the use of a2, adrenergic agonists, especially dexmedetomidine, in healthy cats to perform small procedures, the mechanism of action, as well as the possibility of pharmacological reversibility of these drugs in the specie.(AU)

El empleo de agonistas adrenérgicos de los receptores a2 trae beneficios en la Anestesiología clínica, en particular la dexmedetomidina, por su aspecto farmacológico y alta especificidad. Sin embargo, sus ventajas y desventajas deben ser mejor elucidadas por medio de estudios clínicos tanto en la Medicina Humana y en la Veterinaria. En la Medicina Veterinaria, la realización de pequenos procedimientos, principalmente en felinos, requiere sedación intensa o incluso anestesia general, lo que prolonga el tiempo de recuperación del paciente, exige mayor monitoreo e involucra mayor incidencia de efectos colaterales. Por lo tanto, el desarrollo de protocolos de sedación que permitan la realización de estos procedimientos sin la necesidad de anestesia general se muestra viable, como ya se hace presente en la Medicina en pacientes pediátricos. El desarrollo de protocolos seguros, de rápida duración y que presenten antídotos se hace necesario, especialmente en felinos cuyo manejo involucra mayor estrés y contención. La presente revisión aborda el uso de los agonistas adrenérgicos de los receptores a2, en particular la dexmedetomidina, en gatos hígidos para la realización de pequenos procedimientos, el mecanismo de acción, así como la posibilidad de reversibilidad farmacológica de estos fármacos en la especie.(AU)

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Venezuela atraviesa una emergencia humanitaria compleja de acuerdo a la Organización de Naciones Unidas, la cual es el resultado de una combinación de inestabilidad política, conflictos y violencia, desigualdades sociales y una pobreza subyacente. El impacto de esta situación en las condiciones de vida de la población, en especial, de la infancia, ha sido registrado por organizaciones internacionales y nacionales no gubernamentales ante el silencio cómplice del Estado. Se revisan los indicadores que permiten evaluar el grado de bienestar de la población infantil venezolana en cuanto a nivel de pobreza, nutrición y seguridad alimentaria, salud, educación y otros determinantes sociales. Conclusión: Como consecuencia de la emergencia humanitaria compleja, la infancia venezolana está amenazada por el incremento de la pobreza, a partir de la cual, se ha generado un aumento de todas las formas de desnutrición e inseguridad alimentaria, un incremento de la mortalidad materna, neonatal e infantil, la aparición de enfermedades prevenibles por vacunas y aquellas transmitidas por artrópodos, un grave deterioro del sistema educativo y la obligación de muchas familias a migrar para sobrevivir. El pediatra cumple un papel fundamental en la atención de niños, niñas y adolescentes al identificar factores de riesgo, denunciar la violación de sus derechos y aglutinar esfuerzos para garantizar su bienesta(AU)

Venezuela through a complex humanitarian emergency, according to the Organization of United Nations, which is the result of a combination of political instability, conflicts and violence, social inequality and underlying poverty. The impact of this situation on the living conditions of the population, especially children, has been registered by national non-governmental and international organizations to silence an accomplice of the State. Reviews of the indicators that allow evaluating the degree of welfare of the Venezuelan child population in terms of level of poverty, nutrition and food security, health, education and other social determinants. Conclusion: As result of the complex humanitarian emergency, Venezuelan children is threatened by the increase in poverty, from which it has generated an increase in all forms of malnutrition and food insecurity, an increase of the maternal, neonatal and child mortality, the emergence of diseases preventable by vaccines and those transmitted by arthropods, a serious deterioration of the educational system and the obligation of many families to migrate to survive. The pediatrician has an important role in the care of children and adolescents to identify risk factors denounce the violation of their rights and unite efforts to ensure their well-being(AU)

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El objetivo fue describir opiniones, prácticas y conocimientos de pediatras sobre prevención de lesiones no intencionales (LNI) Metodología: estudio descriptivo y analítico por encuesta anónima y auto-administrada a pediatras, en Mendoza, en 2015. Resultados: N: 210. La edad media de los pediatras fue 44, 55 años, 65, 2% mujeres. Doscientos (95, 22%) realizan prevención de lesiones, 76% lo hace en la mayoría de las consultas, usando método verbal principalmente. El 94, 29% (198) opinaron que la prevención mejora la seguridad en el hogar y 185 (88, 1%) que debiera hacerse en todas las consultas. Entre pediatras con menos de 10 años de antigüedad (N= 84), el 79, 6% respondió correctamente sobre sillitas, ahogamiento, andador y caídas; entre los de mayor antigüedad (N= 126) hubo 61, 9% de respuestas correctas (p= 0, 007) Conclusiones: Los pediatras son conscientes de su rol en prevención de LNI, refieren realizar actividades de prevención y conocen sobre el tema, sobre todo los más jóvenes.

Introduction: The objective of this study was to address the pediatrician's opinions, practices and knowledge on the prevention of unintentional injuries. Design: descriptive and analytical study by anonymous and self-administered survey to pediatricians, in Mendoza, in 2015. Results: N: 210. The mean age of pediatricians was 44.55 years old, 65.2% were women. 200 (95.22%) performed injury prevention, 76% did it in most of the visits, using verbal method mainly. 198 (94.29%) believed that prevention improves home safety and 185 (88.1%) should be done in all consultations. There were 79.6% correct answers among pediatricians less than 10 years' seniority (N= 84) about child car restraint system, drowning, baby walker use and falls; among the oldest (N= 126) there were 61.9% of correct answers (p= 0.007) Conclusions: Pediatricians are aware of their role in injury prevention, realized prevention activities and knew about the subject, especially the younger ones.

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INTRODUCTION: The objective of this study was to address the pediatrician's opinions, practices and knowledge on the prevention of unintentional injuries. DESIGN: descriptive and analytical study by anonymous and self-administered survey to pediatricians, in Mendoza, in 2015. RESULTS: N: 210. The mean age of pediatricians was 44.55 years old, 65.2% were women. 200 (95.22%) performed injury prevention, 76% did it in most of the visits, using verbal method mainly. 198 (94.29%) believed that prevention improves home safety and 185 (88.1%) should be done in all consultations. There were 79.6% correct answers among pediatricians less than 10 years` seniority (N= 84) about child car restraint system, drowning, baby walker use and falls; among the oldest (N= 126) there were 61.9% of correct answers (p= 0.007). CONCLUSIONS: Pediatricians are aware of their role in injury prevention, realized prevention activities and knew about the subject, especially the younger ones.

INTRODUCCIÓN: El objetivo fue describir opiniones, prácticas y conocimientos de pediatras sobre prevención de lesiones no intencionales (LNI). METODOLOGÍA: estudio descriptivo y analítico por encuesta anónima y auto-administrada a pediatras, en Mendoza, en 2015. RESULTADOS: N: 210. La edad media de los pediatras fue 44,55 años, 65,2% mujeres. Doscientos (95,22%) realizan prevención de lesiones, 76% lo hace en la mayoría de las consultas, usando método verbal principalmente. El 94,29% (198) opinaron que la prevención mejora la seguridad en el hogar y 185 (88,1%) que debiera hacerse en todas las consultas. Entre pediatras con menos de 10 años de antigüedad (N= 84), el 79,6% respondió correctamente sobre sillitas, ahogamiento, andador y caídas; entre los de mayor antigüedad (N= 126) hubo 61,9% de respuestas correctas (p= 0,007). CONCLUSIONES: Los pediatras son conscientes de su rol en prevención de LNI, refieren realizar actividades de prevención y conocen sobre el tema, sobre todo los más jóvenes.

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Angel Arturo Aballí Arellano es considerado como uno de los pediatras más importante de la historia de la medicina cubana, hasta el punto que resulta prácticamente imposible acometer la historia de esta disciplina en nuestro país, sin el estudio profundo de su vida y obra, toda ella dirigida a la defensa de los intereses de la nueva generación, al estado de salud de la niñez, y a luchar por los recursos requeridos para su atención, bienestar y felicidad. Dedicó estudios a las enfermedades diarreicas, a la desnutrición y a la tuberculosis. Para estos fines inauguró el Dispensario Antituberculoso para Niños ¨Calmette¨; el Preventorio ¨Grancher¨ para Lactantes, una sala destinada para niños tuberculosos en el Hospital La Esperanza, y más tarde el Hospital Infantil Antituberculoso, que ostenta hoy su nombre, convertido al triunfo de la Revolución en Hospital Pediátrico General (AU).

Angel Arturo Aballí Arellano is considered one of the most important pediatricians of the Cuban medicine history, up to the point that it is almost impossible to write the history of this discipline in our country without deeply studying his life and work, all of it devoted to the defense of the new generations interests, the childhood health status, and to struggle for obtaining the resources required for their attention, welfare and happiness. He studied diarrheic diseases, malnutrition and tuberculosis. With this aim he inaugurated the Anti-tuberculosis Dispensary for Children Calmette, the Grancvher Preventer for Nursing Infants, a ward for tuberculous children at the hospital La Esperanza and later the Infantile Antituberculous Hospital that today is named after him and after the triumph of the revolution became a General Pediatric Hospital (AU).

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OBJECTIVE: To evaluate the potential impact of a concussion management education program on community-practicing pediatricians. STUDY DESIGN: We prospectively surveyed 210 pediatricians before and 18 months after participation in an evidence-based, concussion education program. Pediatricians were part of a network of 38 clinically integrated practices in metro-Atlanta. Participation was mandatory for at least 1 pediatrician in each practice. We assessed pediatricians' self-reported concussion knowledge, use of guidelines, and comfort level, as well as self-reported referral patterns for computed tomography (CT) and/or emergency department (ED) evaluation of children who sustained concussion. RESULTS: Based on responses from 120 pediatricians participating in the 2 surveys and intervention (response rate, 57.1%), the program had significant positive effects from pre- to postintervention on knowledge of concussions (-0.26 to 0.56 on -3 to +1 scale; P < .001), guideline use (0.73-.06 on 0-6 scale; P < .01), and comfort level in managing concussions (3.76-4.16 on 1-5 scale; P < .01). Posteducation, pediatricians were significantly less likely to self-report referral for CT (1.64-1.07; P < .001) and CT/ED (4.73-3.97; P < .01), but not ED referral alone (3.07-3.09; P = ns). CONCLUSIONS: Adoption of a multifaceted, evidence-based, education program translated into a positive modification of self-reported practice behavior for youth concussion case management. Given the surging demand for community-based youth concussion care, this program can serve as a model for improving the quality of pediatric concussion management.

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The field of pediatrics in Europe is characterized by the diversities, variations, and heterogeneities of child health care services provided in 53 European countries with more than 200 million children below 18 years of age. Managing the health care of infants, children, and adolescents in Europe requires balancing clinical aims, research findings, and socioeconomic goals within a typical environment characterized by cultural and economic complexity and large disparity in availability, affordability, and accessibility of pediatric care. Since its foundation in 1976, the European Paediatric Association-Union of National European Paediatric Societies and Associations has worked to improve both medical care of all children and cooperation of their caretakers in Europe. Such a report has been conceived in the strong belief that broadening of the intellectual basis of the European Paediatric Association-Union of National European Paediatric Societies and Associations and creating a multidisciplinary society will be necessary to reduce fragmentation of pediatrics and tackle the legal, economic, and organizational challenges of child health care in Europe.

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Abstract Objective: To analyze the perception of pediatric guidelines by mothers at the time of consultation in private offices, in order to know how they assimilate, process and use the information received from the pediatricians. Methods: Data collection was carried out by a questionnaire sent to participants by a total of 200 mothers from a virtual community in social networks participated in the research. The answers were transcribed using the Discourse of the Collective Subject method. The analyses were supported by the research qualitative perspective, from the viewpoint of the social representation theory. Results: Three categories were obtained through data analysis: (1) assessing the pediatric guidelines, (2) confronting theory and practice and (3) developing a critical view of the pediatric guidelines. These categories have elucidated that the level of knowledge of pediatric issues by mothers and their ability to use them when making decisions about the care of their babies, have a direct association between following or not the pediatric guidelines. Conclusions: The mother's decision on following the pediatrician's recommendations depends on two main factors: (a) certification of the updated and proven recommendations, according to the official health agencies; (b) support and recognition by the pediatrician of the maternal empowerment during the follow-up process. The mothers' practice of accessing knowledge through social networks hinders the pediatric monitoring.

Resumo Objetivo: Analisar a percepção das orientações pediátricas pelas mães na ocasião do atendimento em consultórios particulares, para conhecer de que maneira assimilam, processam e usam as informações recebidas de seu pediatra. Métodos: A coleta de dados foi feita por questionário enviado às participantes. Participaram da pesquisa 200 mães de uma comunidade virtual nas redes sociais. As respostas foram transcritas por meio do método do discurso do sujeito coletivo. As análises foram respaldadas na perspectiva qualitativa de pesquisa, sob a ótica da teoria das representações sociais. Resultados: Obtiveram-se três categorias por meio da análise de dados: (1) avaliação das orientações pediátricas, (2) confronto da teoria e prática e (3) desenvolvimento de um olhar crítico acerca das orientações pediátricas. Tais categorias elucidaram que o nível de conhecimento de temas pediátricos por parte das mães e a sua capacidade de usá-los na tomada de decisões sobre os cuidados dos seus bebês apresentam uma relação direta entre seguir ou não as orientações pediátricas. Conclusões: A decisão das mães quanto a seguir as recomendações do pediatra depende de dois fatores principais: (a) certificação das recomendações atualizadas e comprovadas, de acordo com os órgãos oficiais de saúde; (b) apoio e reconhecimento por parte do pediatra do papel materno durante o processo de acompanhamento. A prática do acesso ao conhecimento das mães por meio de redes sociais dificulta o acompanhamento pediátrico.

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