This paper aims to improve the diagnosis of syncope and transient loss of consciousness (TLOC) in children. Diagnostic problems stem, first, from some causes spanning various disciplines, e.g.... Show moreThis paper aims to improve the diagnosis of syncope and transient loss of consciousness (TLOC) in children. Diagnostic problems stem, first, from some causes spanning various disciplines, e.g. cardiology, neurology and psychiatry, while the most common cause, vasovagal syncope, is not embraced by any specialty. Second, clinical variability is huge with overlapping signs and symptoms. Third, the approach to TLOC/syncope of the European Society of Cardiology (ESC) is underused in childcare. We explain the ESC guidelines using an additional paediatric literature review. Classification of TLOC and syncope is hierarchic and based on history taking. Loss of consciousness (LOC) is defined using three features: abnormal motor control including falling, reduced responsiveness and amnesia. Adding a < 5 min duration and spontaneous recovery defines TLOC. TLOC simplifies diagnosis by excluding long LOC (e.g. some trauma, intoxications and hypoglycaemia) and focussing on syncope, tonic-clonic seizures and functional TLOC. Syncope, i.e. TLOC due to cerebral hypoperfusion, is divided into reflex syncope (mostly vasovagal), orthostatic hypotension (mostly initial orthostatic hypotension in adolescents) and cardiac syncope (arrhythmias and structural cardiac disorders). The initial investigation comprises history taking, physical examination and ECG; the value of orthostatic blood pressure measurement is unproven in children but probably low. When this fails to yield a diagnosis, cardiac risk factors are assessed; important clues are supine syncope, syncope during exercise, early death in relatives and ECG abnormalities.Conclusions: In adults, the application of the ESC guidelines reduced the number of absent diagnoses and costs; we hope this also holds for children. Show less
1887/26094 Chile has embarked on a road that must lead to the reduction of inequality gaps for the population. A public policy called Chile Growths With You has focused on an increase in the... Show more1887/26094 Chile has embarked on a road that must lead to the reduction of inequality gaps for the population. A public policy called Chile Growths With You has focused on an increase in the breadth of coverage of non-maternal care through childcare centers to provide equal opportunities in early childhood and onwards. This dissertation focuses on the quality of the early childcare environment in Chile and the role of ethnicity and socio-economic inequality. Ninety-five mother-child dyads were followed in their first year of life to examine changes in the attachment relationship and quality of the home environment, dependent on type of care (maternal care versus center daycare) and ethnicity (Mapuche versus non-Mapuche). Our results show that differences in quality of the home environment between the two ethnic groups are very small and that Mapuche families are distinguished from the majority group by lower income and lower maternal education. Fulltime daycare has no negative consequences for the attachment relationship and the quality of the home environment. Moreover, a positive change in attachment security was found but only for Mapuche children who attended daycare. Show less
