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Introduction: Neurofibromatosis type 1 (NF1) is one of the most common autosomal dominant genetic disorders. Some clinical manifestations are present at birth, while some develop during childhood, and others can occur at any age. Given the early age at which patients develop clinical features, diagnosis is often made during childhood. The most prevalent features of NF1 are café au lait spots, dermal and plexiform neurofibromas, and learning disability. A variety of skeletal problems may be seen in NF1, including scoliosis, short stature, and pseudoarthrosis. Reduced skeletal bone mass has been documented to be a common phenomenon in children and adults with NF1. Decreased serum 25-hydroxyvitamin D (vitamin D) levels have been noted in adults and children with NF1 and have been reported to be inversely correlated with the number of dermal neurofibromas in adults. However, the actual correlation of vitamin D level to bone density and dermal neurofibroma number in children with NF1 remains unclear. Objectives: The primary objective of this study was to evaluate vitamin D levels among children and adolescents with NF1. The secondary objective was to describe the levels of vitamin D among children and adolescents with NF1, to verify in which age group there is a higher frequency of vitamin D alterations, and to explore vitamin D level correlations between age, gender, sun exposure, number of neurofibromas, and number of plexiform neurofibromas. Methods: This was an observational, cross-sectional, hospital-based study. We obtained a convenience sample of individuals with confirmed diagnosis of NF1 from patients attending the Medical Genetics Service of the IPPMG-UFRJ and Santa Casa de Misericórdia of Rio de Janeiro over a 24-month period. We evaluated vitamin D levels in blood samples of patients with NF1 by a chemiluminescent immunoassay method, and we correlated the results with gender, age, number of neurofibromas, number of plexiform neurofibromas, and satisfactory sun exposure. Results: Of the 55 patients, 28 (50.9%) were female and 27 (49.1%) were male. Patient ages ranged from a minimum of 1.2 to a maximum of 19.6 years (mean age 10.95 years) and the median was 11.11 years. Median and mean body mass index (BMI; z score) were -0.09 (minimum value -1.63 and maximum of 4.62) and 0.16, respectively. The mean value of vitamin D was 30.82 ng/mL (±12.31) and the median was 29 ng/mL (minimum value of 10.40 ng/mL and maximum of 79.19 ng/mL). Conclusions: The levels of vitamin D did not differ according to gender, age group, or the presence or number of cutaneous neurofibromas. Among patients with adequate sun exposure, there was a higher incidence of sufficient serum vitamin D levels. Patients with cutaneous neurofibromas in the 0 to 11 age group had a greater tendency to vitamin D sufficiency in relation to patients aged 11 to 19 years. [ABSTRACT FROM AUTHOR]

Background. The Health in Action Program was established in Brazil in 2010 to address the critical issues of health and nutrition among vulnerable children in the northeast and southeast regions of the country. By offering school-based nutrition education and increased access to nutritious foods from school gardens, the program has benefited more than 200,000 children aged 6 through 14 years in 430 schools and an additional 670,000 family and community members. The program is now expanding to reach an additional 260,000 students in 570 schools. Objective. The purpose of this study was to perform a Program Impact Pathways (PIP) analysis to identify Critical Quality Control Points (CCPs) and a suite of impact indicators in order to better understand and illustrate the impact of the program. Methods. The analyses of the PIP and the suite of impact indicators were conducted in collaboration with INMED Brasil's program management and evaluation team and the international evaluation team of INMED Partnerships for Children. INMED presented the results at a seven-country Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13-14 September 2013, hosted by the Mondelez International Foundation, where it received feedback from evaluation experts. Results. The PIP analysis enabled INMED to clarify the goals of the program, understand the ways in which program activities lead to stated goals, identify CCPs to monitor, and select achievable impact indicators, including changes in diet, physical activity, and knowledge, attitudes, and behaviors, as well as body mass index. Conclusions. While the program had previously demonstrated benefits through internal impact evaluation, the PIP Healthy Lifestyles Program Evaluation Workshop led to the identification of potential improvements in program processes and activities, as well as corresponding evaluation methodologies. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effectiveness of two screening methods (imitanciometry screening and questionnaire) to identify children at risk for conductive hearing loss, comparing this data with complete audiologic evaluation. Methods Of 507 children aged between three and six, 111 completed all procedures. The observational methods used were: imitanciometry screening, a questionnaire to identify risk factors for hearing loss and complete audiologic evaluation. Results obtained in the first two instruments were compared with results from complete audiologic evaluation (gold standard). From these comparisons, sensitivity and specificity, accuracy, positive and negative predictive values, and odds ratio were determined for the two screening methods and for the combination of both methods. Results The two methods applied in series (questionnaire and after imitanciometry screening) showed a greater odds ratio and better correlation between sensitivity and proportion of false-positives (ROC curve). Conclusion Combining the two tests in series improved screening accuracy. This combination was the best tool for identifying children at risk for conductive hearing loss. [ABSTRACT FROM AUTHOR]

Background. Diarrhea is a major cause of death in children in developing countries. However, in Brazil, diarrhea-related morbidity and mortality have declined over the past decades. Objective. To explore community perspectives in Brazil on changes in health related to diarrhea and factors that may have contributed to these changes. Methods. This qualitative study included 12 focus group sessions held with 50 mothers and 42 grandmothers in the state of Ceará. Results. Most grandmothers reported having lost at least one child to diarrhea, and all participants had witnessed children dying from diarrhea in the past. The participants saw a clear decline in diarrhea over the past 20 years. They felt that this was due to social, economic, and cultural progress. The participants also considered government-supported outreach programs very important for health improvement. Conclusions. Knowledge of diarrhea and its causes in the community is broad, but many traditional beliefs about the illness still prevail. The Brazilian experience is an example of the critical effect that policies to promote income redistribution and universal access to education, health, water supply, and sanitation services may have on the reduction of undernutrition and diarrhea among children. [ABSTRACT FROM AUTHOR]

Provides information on the context of the musical play of children. Significance of play to the lives of children; Cultural variations in the participation of children in musical plays; Popularity of circle song and game "Bambu" among children in Brazil.