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Background/Objectives: Digital parenting programs using smartphone apps can support families in positive parenting and require evaluations of their effects, mainly in low- and middle-income countries with caregivers experiencing psychosocial vulnerabilities. The study evaluated the “Born Learning” digital parenting program on improving parenting practices, child prosocial behavior, and reducing the children’s externalizing behavior problems. Additionally, participants’ satisfaction and engagement with the program were evaluated. Methods: Brazilian primary caregivers of 3- to 6-year-old children totaling 91, participated in the “Born Learning” program and pre-, post-intervention, and five-month follow-up evaluations. Results: Most participants received cash transfers (64%) and reported some level of food insecurity (78%). The parenting coercive practices decreased from pre- to post-intervention, with maintenance in follow-up. Satisfaction with the role of parenting increased, and child conduct behavior problems decreased from pre-intervention to follow-up. Most participants found the program content very interesting and engaged adequately with the program strategies, such as messages and videos. Conclusions: The digital parenting program can support caregivers by enhancing parenting and decreasing child behavior problems, highlighting the potential for broader implementation in similar contexts.

Los prohombres son personas excepcionales por sus hechos, integridad y desprendimiento social; porque destacan combativa e innovadoramente entre sus pares, con quienes se identifican sin interés individual y aportando sin descanso por su bienestar. Su enfoque humanista y fe en el porvenir social es su marca. Gamaniel Blanco Murillo fue de aquella estirpe, entre sus muchas virtudes se obligó a ejercer la docencia. Como pocos la sintió un fundamento esencial en la vida de los pueblos y como pocos la entendió en toda su profundidad y extensión. Como docente educó en las aulas, la escuela, el taller industrial, el sindicato y la misma comunidad de ciudadanos. Distantes quizá de su posición ideológica y política, este prohombre pasqueño dejó un legado de vida pleno y solidario que trasciende a su época; que aún hoy es un ejemplo a seguir. El estudio del Gamaniel Blanco educador se alcanza a través de su fraterno amigo Augusto Mateú Cueva y su discípulo Víctor Mazzi Trujillo.

Introduction Tuberculosis (TB) is the seventh leading cause of death. Spinal involvement represents less than 1 % of cases. Objective To investigate our state frequency of Pott disease, to typify its profile and to identify guidelines for similar regions. Methods Verify all TB admissions during 1996 – 2014 period (19 years) in main state hospitals. Medical records review of all cases with spinal involvement. Frankel and GATA classifications. Data from last national census. Literature review. Results 14 cases: 8 males/6 females. Average age: 35.4 years (3.8 - 63). Follow-up: 2.8 years (1 month – 15 years); an immediate postoperative death. Seven patients came from low TB burden departments. Initial symptoms: neurological impairment 9, pure axial and/or radicular pain 4 and pure spine deformity 1 patient. Initial Frankel: E 5 cases, D2, C 2 and A 5 patients. Localization: Thoracic, 5; Thoraco-lumbar, 6; Lumbar, 1; Multiple 2 patients. Ethnic distribution: 5 Caucasian, 5 natives, 3 creoles, 1 mestizo. According to GATA classification: 1 Type IB lesion; 4 Type II; 8 Type III; 1 unclassifiable case. Native patients had more severe neurological hospital admission profile and GATA lesions. Twelve patients were operated on with 10 instrumentations. At follow-up: 8 asymptomatic cases, 4 deceased and 2 cases with moderate symptoms. Five cases improved neurological status; no worsening was found. Of 11 survivors operated cases 5 had residual spine deformity. No difference existed among double instrumentation, isolated posterior one or no instrumentation.

OBJETIVO: La espondilolistesis ístmica del adulto se puede tratar con reparación del defecto, descompresión (sola o con fusión), fusión circunferencial, y reducción con fijación posterior. El objetivo de este trabajo es valorar los resultados a medio plazo de la descompresión y fusión in situ en pacientes operados por un solo cirujano. MÉTODO: Criterios de Inclusión: 1) Espondilolistesis Ístmica L5-S1. 2) Operados en madurez esquelética. 3) Laminoartrectomía de L5 con Artrodesis posterolateral instrumentada sin reducción. 4) Más de 3 años de seguimiento. 5) Ausencia de pseudoartrosis al seguimiento. 6) Valoración funcional y radiológica por observador independiente. Comparación de datos con bibliografía. Análisis estadístico con t - test, Chi cuadrado y ANOVA. RESULTADOS: 16 pacientes (12 ♀/4 ♂) evaluados. Edad promedio: 40,6 años (17 - 66); seguimiento promedio: 10.3 años (3.3 - 18). Deslizamiento promedio: 42,9%. Nueve presentaban dolor radicular, 3 dolor lumbar y 4 dolor lumborradicular. Score del dolor (SRS) preoperatorio promedio: 1.38, sin diferencias entre bajo y alto grado (p=0.887). 15/16 mejoraron (score final promedio: 4.44). 13/16 retornaron a su actividad previa (81%). Hubo 2 infecciones; no hubo complicaciones neurológicas. Los parámetros espinopélvicos finales, comparados con la literatura no mostraron diferencias estadísticas. La comparación entre listesis de bajo y alto grado en la serie no mostró diferencia significativa en dichos parámetros, ni en tiempo de seguimiento, niveles artrodesados, síntomas ni retorno al trabajo. CONCLUSIÓN: La descompresión y fusión posterolateral instrumentada in situ permite un 80% de buenos resultados en la espondilolistesis ístmica lumbosacra del adulto sin importar el grado.OBJETIVO: A espondilolistese ístmica dos adultos pode ser tratada com reparo do defeito, descompressão (isolada ou com fusão), fusão circunferencial e redução com fixação posterior. O objetivo foi avaliar os resultados a médio prazo da descompressão e fusão in situ em pacientes submetidos a tratamento cirúrgico por um só cirurgião. MÉTODO: Critérios de inclusão: 1) Espondilolistese ístmica L5-S1. 2) Cirurgia depois da maturidade esquelética. 3) Lâmino-artrectomia e artrodese póstero-lateral instrumentada em L5 sem redução. 4) Mais de três anos de acompanhamento. 5) Ausência de pseudoartrose no acompanhamento. 6) Avaliação funcional e radiológica por observadores independentes. Comparação com a literatura. Análise estatística por teste "t", qui quadrado e ANOVA. RESULTADOS: Foram avaliados 16 pacientes (12 ♀ e 4 ♂). Média de idade: 40,6 anos (17-66), acompanhamento médio: 10,3 anos (3,3-18). Média do deslizamento: 42,9%. Nove tinham dor radicular, 3 lombar, 4 dor radicular e lombar. Pontuação de dor pré-operatória média (segundo SRS): 1,38, sem diferenças entre baixo e alto grau (p=0,887). Quinze em 16 pacientes tiveram melhora dos sintomas (pontuação final média: 4,44). Treze em 16 pacientes retornaram à atividade anterior (81%). Houve duas infecções, mas nenhuma complicação neurológica. Os parâmetros espino-pélvicos no final do acompanhamento não apresentaram diferenças estatísticas em relação com os valores encontrados na literatura. A comparação entre deslizamentos de baixo e alto grau da série não mostrou diferença significante nesses parâmetros nem em tempo de acompanhamento, níveis com artrodese, sintomas ou retorno ao trabalho. CONCLUSÃO: A descompressão póstero-lateral e fusão instrumentada in situ permitem 80% de bons resultados na espondilolistese ístmica lombossacral em adultos, independentemente do grau de deslizamento.OBJECTIVE: Adult isthmic spondylolisthesis can be treated with direct repair of the defect, decompression (alone or with posterolateral fusion), circumferential fusion, and reduction with posterior fixation. The aim of this work is to assess the mid-term results of decompression and in situ fusion among patients undergoing surgical treatment with the same surgeon. METHOD: Inclusion criteria: 1) L5-S1 Isthmic spondylolisthesis. 2) Surgery performed after skeletal maturity. 3) L5 laminectomy and arthrectomy with posterolateral instrumented fusion without reduction. 4) Follow-up greater than 3 years. 5) No pseudoarthrosis at follow-up. 6) Functional and radiological assessment by independent observers; literature review and data comparison; statistical analysis with t-test, chi-squared and ANOVA. RESULTS: 16 patients were evaluated (12 ♀/4 ♂). Mean age: 40.6 years (17-66); mean follow-up: 10.3 years (3.3-18). Average slip: 42.9%. Nine patients had radicular pain, 3 back pain and 4 both. Mean preoperative SRS pain score: 1.38 with no differences between low and high degree (p=0.887). Fifteen of 16 patients had improvement of symptoms (mean final score: 4.44). Thirteen of 16 patients returned to previous activity (81%). There were 2 infections, but no neurologic complications. The spino-pelvic parameters at the end of the follow-up showed no statistical differences compared with the values found in literature. The comparison between low and high degree listhesis in our series showed no significant difference in these parameters or in the follow-up period, fused levels, symptoms or return to work. CONCLUSION: The posterolateral decompression and instrumented fusion in situ allow 80% of good results in lumbosacral isthmic spondylolisthesis in adults regardless of the degree of slip.

OBJETIVO: Determinar si la gravedad del trauma en lesiones toracolumbosacras mayores estables permite decidir la selección del tipo de ortesis en un tratamiento ortopédico. MÉTODOS: Estudio Retrospectivo de casos 12/1990 - 12/2006 (16 años). Criterios de Selección: 1) Seguimiento mínimo: 2 años. 2) Estudios radiológicos convencionales completos. 3) Ausencia de Litigio. 4) Tratamiento ortésico con TLSO a medida para los traumas de alta energía cinética y con ortesis prefabricadas para los de baja energía. 5) Tratamiento efectuado o supervisado por el autor Sénior. Evaluación por observadores independientes de Parámetros Geométricos (ángulo de Cobb sagital, cifosis vertebral, grado de colapso vertebral) pretratamiento y seguimiento en Rx simple, y Parámetros Funcionales (Dolor según SRS, Índice de Oswestry, Retorno a la Actividad Previa). Subdivisión de los diferentes tipos de fracturas (según AO y Denis) en Alta (Grupo A) y Baja Energía [Grupo B] de acuerdo con la energía cinética del trauma. Comparación de Parámetros Geométricos con Grupo Control. Análisis Estadístico: chi cuadrado y t-test de Student. RESULTADOS: 41 pacientes (44 fracturas] tratados (23 mujeres/18 varones), con 25 fracturas Grupo "A", y 19 Grupo "B". Edad promedio: 46 años (12 - 83). Seguimiento promedio: 4,5 años (2.2 - 15.5). Localización predominante: T11 - L2. Tipos Predominantes: tipo A (AO) o por compresión y por estallido. No hubo diferencias significativas en las mediciones efectuadas en cada grupo pretratamiento y al seguimiento. La única diferencia significativa entre grupos fue en la cifosis vertebral inicial tanto en general como según la clasificación AO entre los tipos A de alta y baja energía. La comparación al seguimiento de los parámetros geométricos entre grupo control y grupos A y B así como entre grupo control y cada tipo (AO/Denis) subdivididos en alta o baja energía, arrojó siempre diferencias significativas. Los parámetros funcionales al seguimiento mostraron siempre puntuaciones promedio buenas, con variaciones significativas entre grupos A y B. El retorno a la actividad previa fue del 90,6%, sin diferencias entre trabajadores de esfuerzo físico y de escritorio. CONCLUSIONES: Es posible lograr un Resultado Clínico Funcional satisfactorio a mediano plazo en las lesiones toracolumbosacras mayores estables seleccionando el tipo de ortesis según que el trauma sea de alta o baja energía cinética. Los resultados clínicos funcionales parecen ser mejores en los casos de Trauma de Alta Energía. Sin embargo, este tratamiento no mejora ni empeora los parámetros radiológicos sagitales.OBJETIVO: Determinar se a gravidade do trauma toraco-lombo-sacro estável permite decidir o tipo de órteses na seleção do tratamento ortopédico. MÉTODOS: Estudo retrospectivo (16 anos). Critérios de inclusão: 1) Seguimento mínimo: 2 anos. 2) Estudos radiológicos convencionais completos. 3) Ausência de litígio. 4) Tratamento com TLSO feito à medida para trauma de alta energia cinética e órteses pré-fabricadas para trauma de baixa energia. 5) Tratamentos realizados ou supervisionados pelo autor sênior. Avaliação por observadores independentes de parâmetros geométricos (Cobb sagital, cifose da vértebra, grau de colapso vertebral anterior) iniciais e ao seguimento, e parâmetros funcionais (dor de acordo com a SRS, índice de Oswestry, retorno à atividade anterior). Subdivisão de diferentes tipos de fraturas (AO e Denis) proporcional à energia cinética do trauma, em (grupo A) alta energia e (grupo B) baixa energia. Comparação com o grupo de controle. Análise estatística: qui quadrado e teste tStudent. RESULTADOS: Estudos até 41 pacientes (44 fraturas, 23 mulheres/18 homens), 25 fraturas grupo "A" e 19 grupo "B". Média de idade: 46 anos (12-83). Seguimento médio: 4,5 anos (2,2 -15,5). Localização predominante: T11 - L2. Tipos predominantes: Tipo A (AO) ou por compressão e estalido. Não houve nenhuma diferença significativa entre medições iniciais e seguimento. A única diferença significativa entre os grupos foi a cifose inicial da coluna vertebral. Sempre houve dife renças na comparação dos parâmetros geométricos do grupo controle e os grupos A e B, e entre o grupo controle e cada tipo (AO/Denis) subdividido em alta ou baixa energia. As pontuações dos parâmetros funcionais finais sempre foram boas, com variações significativas entre os grupos A e B. CONCLUSÕES: É possível um bom resultado funcional em lesões toraco-lombo-sacrais estáveis, selecionando o tipo de órteses de acordo com a energia cinética do trauma. Esses resultados parecem ser melhores em traumas de alta energia tratados com dispositivos ortopédicos feitos à medida. No entanto, o tratamento ortésico diferenciado de acordo com a energia do trauma não altera os parâmetros radiológicos sagitais.OBJECTIVE: To determine whether the severity of stable thoraco-lumbo-sacral trauma is useful for deciding the selection of brace type in orthopedic treatment. METHODS: Retrospective study (16 years length). Inclusion criteria: 1) Minimum follow-up: 2 years. 2) Complete conventional radiologic studies. 3) no litigation. 4) TLSO custom-made treatment for high kinetic energy trauma and pre-fabricated orthoses for low energy one. 5) Treatment performed or supervised by the senior author. Evaluation by independent observers of geometric Parameters (sagittal Cobb, vertebral kyphosis, anterior vertebral collapse) initially and at follow-up, and Functional Parameters (SRS pain scale, Oswestry Index, Return to Previous Activity). Subdivision of different fractures types (of AO and Denis classifications) in High (group A) and Low Energy (group b) according to the amount of kinetic energy of trauma. Comparison with a control group. Statistical analysis: chi square and Student t-test. RESULTS: Forty-one patients were studied (44 fractures, 23 females/18 males), 25 fractures group A and 19 group b. Average age: 46 years (12 - 83). Average follow-up: 4.5 years (2.2 - 15.5). Predominant location: T11 - L2. Predominant types: Type A (AO) or compression and burst. There were no significant differences between initial and follow-up measurements. The only significant difference between groups was in the initial vertebral kyphosis. However, there were always differences when comparing the geometric Parameters between control group and groups A and b, and between control group and each type (AO/Denis) subdivided into high or low energy. The final functional parameters scores were always good, with significant variations between groups A and b. CONCLUSIONS: A satisfactory functional result in stable thoraco-lumbo-sacral injuries is possible by selecting the type of brace according to the kinetic energy involved. Results appear to be better in High Energy Trauma treated with custom-made orthosis. However, the orthotic treatment according to trauma energy does not change the sagittal radiographic parameters.

ABSTRACT Objective: Spastic cerebral palsy (sCP) is a cause of early onset scoliosis, although there are no data on its prevalence. Our objective was to determine the prevalence of early onset neuromuscular spinal deformities (SD) in severely compromised children with sCP. Methods: Cross-sectional quantitative, observational, exploratory, and descriptive study. Review of clinical records. Inclusion criteria: age 2 to 5 years, sCP, level V of the GMFCS, residents in our province. X-ray blind reading by 2 observers. The Student t test was used for parametric data and the chi-square test for non-parametric data. Level of statistical significance: p < 0.05. Results: Thirty-eight cases of 158 registered were included. Average age: 3 years 7 months (2 years – 5 years 2 months). Sex: 21 male/17 female. The predominant etiologies were perinatal: 21 (55.3%), and the prevalent nutritional status was eutrophic: 28 cases (73.7%). SD was very frequent: 32 patients (84.2%) without statistical differences between sexes; there were 20 kyphoscoliosis, 1 lordoscoliosis, 6 scoliosis, 5 hyperkyphosis. Mean angular values: 23.9° (10°- 50°) for the frontal plane deformities and 58° (9°- 92º) for the sagittal deformities. Seventeen patients (44.7%) had average pelvic obliquity of 15° (2°- 30°) without differences in patients with and without SD. There was no association between SD and etiology, digestive disorders, seizures, nutritional status, hip excentration, or limb deformities. Conclusions: The prevalence of SD in children up to 5 years old with severe sCP is high: 84.2% (32/38 cases). The orthopedic profile is children with sCP of any etiology at GMFCS level V, with multiple disabilities and independently of associated limb deformities. Level of evidence I; Diagnostic Studies - Investigating a Diagnostic Test: Testing of previously developed diagnostic criteria on consecutive patients (with universally applied reference “gold” standard).

ABSTRACT Objective: Selective dorsal rhizotomy (SDR) used for spasticity treatment could worsen or develop spinal deformities. Our goal is to describe spinal deformities seen in patients with cerebral palsy (CP) after being treated by SDR. Methods: Retrospective study of patients operated on (SDR) between January/1999 and June/2012. Inclusion criteria: spinal Rx before SDR surgery, spinography, and assessment at follow-up. We evaluated several factors emphasizing level and type of SDR approach, spinal deformity and its treatment, final Risser, and follow-up duration. Results: We found 7 patients (6 males): mean age at SDR 7.56 years (4.08-11.16). Mean follow-up: 6.64 years (2.16-13), final age: 14.32 years (7.5-19). No patient had previous deformity. GMFCS: 2 patients level IV, 2 level III, 3 level II. Initial walking status: 2 community walkers, 2 household walkers, 2 functional walkers, 1 not ambulant, at the follow-up, 3 patients improved, and 4 kept their status. We found 4 TL/L laminotomies, 2 L/LS laminectomies, and 1 thoracic laminectomy. Six spinal deformities were observed: 2 sagittal, 3 mixed, and 1 scoliosis. There was no association among the type of deformity, final gait status, topographic type, GMFCS, age, or SDR approach. Three patients had surgery indication for spinal deformity at skeletal maturity, while those patients with smaller deformities were still immature (Risser 0 to 2/3) although with progressive curves. Conclusions: After SDR, patients should be periodically evaluated until they reach Risser 5. The development of a deformity does not compromise functional results but adds morbidity because it may require surgical treatment.