[Spanish translation and validation of the Neuromuscular Module of the Pediatric Quality of Life Inventory (PedsQL): evaluation of the quality of life perceived by 5-7 years old children with neuromuscular disorders and by their parents]. / Traducción y validación al español del módulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL): evaluación de la calidad de vida autopercibida por niños de 5-7 años con enfermedades neuromusculares y sus padres.

INTRODUCTION: The recent advances in the therapies for some neuromuscular disorders imply a better prognosis. As a consequence, health-related quality of life has emerged as a core outcome. It is particularly important to know both the self-perceived health-related quality of life by children, as soon as possible, as well as the parental perception. Therefore, it is essential to have valid and specific scales for proper assessment. AIM: To assess the validity and reliability of the Spanish version of Pediatric Quality of Life Inventory (PedsQL) Neuromuscular Module for self-perceived and parent perceived quality of life of children aged 5-7 with neuromuscular disorders. SUBJECTS AND METHODS: Cross-cultural validity of the Spanish version was carried out with the permission of the Mapi-Research-Trust. Subsequently, a test-retest was administered to 27 children aged 5-7 and 37 parents in order to evaluate internal consistency, intra-observer reliability and construct validity. RESULTS: The Cronbach alpha coefficient showed good internal consistency for children and was rated as excellent by parents. Furthermore, the intra-observer correlation indicated an excellent reliability for both. Construct validity analysis suggested that a new scale structure with more dimensions might be more adequate. Moreover, said structure will also explain a greater percentage of variability. CONCLUSION: The Spanish version of PedsQL Neuromuscular Module for the self-perceived and parent-perceived quality of life of children aged 5-7 showed good internal consistency and reliability.

TITLE: Traducción y validación al español del módulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL): evaluación de la calidad de vida autopercibida por niños de 5-7 años con enfermedades neuromusculares y sus padres.Introducción. Los recientes avances en el abordaje terapéutico de las enfermedades neuromusculares pediátricas han permitido un mejor pronóstico y, en consecuencia, surge la necesidad de medir la calidad de vida relacionada con la salud como parte de un abordaje integral. Es importante disponer de instrumentos válidos y específicos para su correcta valoración que contemplen la calidad de vida relacionada con la salud tanto autopercibida por los niños como por los padres. Objetivo. Evaluar la validez y la fiabilidad de la versión española del módulo neuromuscular de la Pediatric Quality of Life Inventory (PedsQL) para la medición de la calidad de vida autopercibida por niños de 5 a 7 años con enfermedades neuromusculares y la de sus padres. Sujetos y métodos. Con autorización de Mapi-Research-Trust, se procedió a la adaptación transcultural de la versión española de la escala. Posteriormente, se realizó un test-retest a 27 niños de 5 a 7 años y a 37 padres para evaluar la consistencia interna, la fiabilidad y la validez de constructo. Resultados. El coeficiente alfa de Cronbach mostró una consistencia interna buena para los niños y excelente para los padres. La correlación intraobservador indicó una excelente fiabilidad para ambos. La validez de constructo sugirió que una estructura de más dimensiones podría ser más adecuada y explicaría un mayor porcentaje de variabilidad. Conclusiones. La versión española del módulo neuromuscular de la PedsQL para evaluar calidad de vida de niños de 5 a 7 años con enfermedades neuromusculares y de sus padres tiene buena consistencia interna y fiabilidad.

[Spanish translation and validation of the Neuromuscular Module of the Pediatric Quality of Life Inventory (PedsQL): evaluation of the quality of life perceived by 8-18 years old children with neuromuscular diseases and by their parents]. / Traduccion y validacion al español del modulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL): evaluacion de la calidad de vida autopercibida por niños de 8-18 años con enfermedades neuromusculares y sus padres.

INTRODUCTION: The quality of life related to health of children with pediatric neuromuscular diseases is studied from the perspective of self-perception and parent-perception. It is therefore essential to dispose valid scales such as Pediatric Quality of Life inventory (PedsQL) Neuromuscular Module for its correct assessment. AIM: To assess the validity and reliability of the Spanish version of PedsQL Neuromuscular Module for self-perceived and parent-perceived quality of life of children aged 8-18 with neuromuscular disorders. SUBJECTS AND METHODS: The cognitive validity of the Spanish version of PedsQL was carried out with Mapi Research Trust permission. Subsequently, a test-retest was performed with 90 children volunteers with neuromuscular diseases, 50 aged 8-12 and 40 aged 13-18, and 85 of those children's parents. This allowed an evaluation of PedsQL intra-observer concordance and internal consistency. Finally, construct validity was evaluated through factor analysis. RESULTS: The Cronbach alpha and all correlation intra-observer coefficients were higher than 0.8, indicating excellent validity and reliability and a higher internal consistency. The construct validity analysis suggested that a new construct with more might be a better fit than three and it will be able to explain a higher percentage of variability. CONCLUSIONS: The Spanish version of PedsQL Neuromuscular Module for self-perceived and parent-perceived quality of life of children aged 8-18 presented excellent validity and reliability.

TITLE: Traduccion y validacion al español del modulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL): evaluacion de la calidad de vida autopercibida por niños de 8-18 años con enfermedades neuromusculares y sus padres.Introduccion. La calidad de vida relacionada con la salud de los niños con enfermedades neuromusculares pediatricas se estudia desde la perspectiva de la autopercepcion y la percepcion de sus padres. Por ello, es esencial disponer de instrumentos validos, como el modulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL), para su correcta valoracion. Objetivo. Evaluar la validez y fiabilidad de la version española del modulo neuromuscular de la PedsQL para la medicion de la calidad de vida autopercibida por niños de 8-18 años con enfermedades neuromusculares y por sus padres. Sujetos y metodos. Una vez autorizados por Mapi Research Trust, se procedio a la validacion cognitiva de la version española del modulo neuromuscular. Posteriormente, se realizo un test-retest a 90 niños, de los cuales 50 tenian entre 8 y 12 años y 40 tenian entre 13 y 18 años, y a 85 padres de dichos niños, lo que permitio evaluar la consistencia interna, la fiabilidad y la validez de constructo. Resultados. El coeficiente alfa de Cronbach y todos los de correlacion interclase mostraron valores superiores a 0,8, lo que indica una consistencia y una fiabilidad excelentes. La validez de constructo sugirio que una estructura de mas dimensiones podria ajustarse mejor que una de tres y explicaria un mayor porcentaje de variabilidad. Conclusiones. La version española del modulo neuromuscular de la PedsQL para la autopercepcion de la calidad de vida de ni­ños de 8-18 años con enfermedades neuromusculares y percibida por sus padres presenta una excelente validez y fiabilidad.

Obstructive sleep apnea syndrome and growth failure.

Obstructive sleep apnea syndrome is a common problem among children and is recognized as a cause of significant medical morbidity. Since the 1980s, it has been suggested that obstructive sleep apnea syndrome is a risk factor for growth failure in children. In many cases, it has been shown that growth failure is reversible once the obstructive sleep apnea syndrome is resolved. The objectives of this study were to analyze and compare growth failure prevalence in a Mediterranean population of children with obstructive sleep apnea syndrome and healthy children matched in age and sex, and to assess the effectiveness of tonsillectomy and adenoidectomy in resolving growth retardation. We compared 172 children with obstructive sleep apnea syndrome (apnea-hypopnea index ≥ 3) who had undergone tonsillectomy and adenoidectomy with 172 healthy controls in terms of key anthropometric parameters. Most of the criteria used for growth failure were higher to a statistically significant degree in the study group vs the control group: height-for-age ≤ 3rd percentile (7.56% vs 2.91%; p = 0.044), weight-for-age ≤ 5th percentile (9.30% vs 2.33%; p = 0.005), weight-for-age ≤ 3rd percentile (8.14% vs 2.33%; p = 0.013) and height and/or weight for-age ≤ 5th percentile (13.95% vs 5.81%; p = 0.009). The height-for-age ≤ 5th percentile was almost at the limit of statistical significance (8.72% for the study group vs 4.65% for the control group; p = 0.097). At one-year post-surgery follow-up, 10 of 15 children with height-for-age ≤ 5th percentile had achieved catch-up growth (66.6%), and 14 of 24 children with height- and/or weight-for-age ≤ 5th percentile had normalized growth (58.33%). For children with failure to thrive or who have growth failure, physicians should consider the possibility of obstructive sleep apnea. A significant number of children with obstructive sleep apnea concurrent with growth failure could benefit from tonsillectomy and adenoidectomy to recover and normalize their growth rate.

Higher cost of single incision laparoscopic cholecystectomy due to longer operating time. A study of opportunity cost based on meta-analysis.

BACKGROUND: We aimed to calculate the opportunity cost of the operating time to demonstrate that single incision laparoscopic cholecystectomy (SILC) is more expensive than classic laparoscopic cholecystectomy (CLC). METHODS: We identified studies comparing use of both techniques during the period 2008-2016, and to calculate the opportunity cost, we performed another search in the same period of time with an economic evaluation of classic laparoscopy. We performed a meta-analysis of the items selected in the first review considering the cost of surgery and surgical time, and we analyzed their differences. We subsequently calculated the opportunity cost of these time differences based on the design of a cost/time variable using the data from the second literature review. RESULTS: Twenty-seven articles were selected from the first review: 26 for operating time (3.138 patients) and 3 for the cost of surgery (831 patients), and 3 articles from the second review. Both echniques have similar operating costs. Single incision laparoscopy surgery takes longer (16.90min) to perform (p <0.00001) and this difference represents an opportunity cost of 755.97 € (cost/time unit factor of 44.73 €/min). CONCLUSIONS: SILC costs the same as CLC, but the surgery takes longer to perform, and this difference involves an opportunity cost that increases the total cost of SILC. The value of the opportunity cost of the operating time can vary the total cost of a surgical technique and it should be included in the economic evaluation to support the decision to adopt a new surgical technique.

[Spanish translation and validation of the neuromuscular module of the Pediatric Quality of Life Inventory (PedsQL): evaluation of the quality of life perceived by the parents of 2-4-year-old children with neuromuscular diseases]. / Traduccion y validacion al español del modulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL): evaluacion de la calidad de vida percibida por padres de niños de 2-4 años con enfermedades neuromusculares.

INTRODUCTION: Paediatric neuromuscular disorders, which negatively impact on children's health-related quality of life (HRQoL), are a frequent cause of parental consultation with a physiotherapist. Parents' stress overload triggers a poor perception of their children's HRQoL. For this reason, it is essential to have psychometrically sound instrument to measure parent's perceptions such as the Pediatric Quality of Life Inventory (PedsQL) Neuromuscular Module. AIM: To assess the validity and reliability of the Spanish version of PedsQL Neuromuscular Module for parent perceived quality of life of children aged 2-4 with neuromuscular disorders. SUBJECTS AND METHODS: The cognitive validity of the Spanish version of PedsQL was carried out with Mapi Research Trust permission. Subsequently, a test-retest was performed with 42 parent volunteers of children aged 2-4 with paediatric neuromuscular disorders. This allowed an evaluation of PedsQL intra-observer concordance and internal consistency. Finally, construct validity was evaluated through factor analysis. RESULTS: The Cronbach alpha and all correlation intra-observer coefficients were higher than 0.8, indicating excellent validity and reliability. The construct validity analysis presented 63.5% variability and such analysis suggested that a seven-dimension construct might be a better fit than three. CONCLUSIONS: The Spanish version of PedsQL Neuromuscular Module for parent perceived quality of life of children aged 2-4 presented excellent validity and reliability.

TITLE: Traduccion y validacion al español del modulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL): evaluacion de la calidad de vida percibida por padres de niños de 2-4 años con enfermedades neuromusculares.Introduccion. Las enfermedades neuromusculares pediatricas, que repercuten negativamente en la calidad de vida relacionada con la salud de los niños, son causa frecuente de consulta de los padres al fisioterapeuta. La sobrecarga de los padres desencadena una baja percepcion de dicha calidad de vida. Por ello, es esencial disponer de instrumentos validos, como el modulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL) para su correcta valoracion. Objetivo. Evaluar la validez y fiabilidad de la version española del modulo neuromuscular de la PedsQL para la medicion de la calidad de vida percibida por padres de niños de 2-4 años con enfermedades neuromusculares. Sujetos y metodos. Una vez autorizados por Mapi Research Trust, se procedio a la validacion cognitiva de la version española del modulo neuromuscular. Posteriormente, se realizo un test-retest a 42 padres voluntarios de niños de 2-4 años con enfermedades neuromusculares, que permitio evaluar la consistencia interna y la concordancia intraobservador. Finalmente, la validez de constructo fue evaluada con un analisis factorial. Resultados. El coeficiente alfa de Cronbach y todos los de correlacion intercalase mostraron valores superiores a 0,8, lo que indica una consistencia y una fiabilidad excelentes. La validez de constructo explico un 63,5% de la variabilidad y sugirio que una estructura de siete dimensiones podria ajustarse mejor que una de tres. Conclusiones. La version española del modulo neuromuscular de la PedsQL para la percepcion de la calidad de vida por los padres de niños de 2-4 años con enfermedades neuromusculares presenta una excelente validez y fiabilidad.

[Translation and validation of the Individualised Neuromuscular Quality of Life scale for the Spanish population: quality of life assessment for persons with neuromuscular diseases]. / Traduccion y validacion de la escala Individualized Neuromuscular Quality of Life para la poblacion española: evaluacion de la calidad de vida para personas afectas de enfermedades neuromusculares.

INTRODUCTION: The Individualized Neuromuscular Quality of Life (INQoL) is a questionnaire that evaluates the quality of life related to the health of adults with neuromuscular diseases. AIM: To validate and analyze the reliability of the Spanish version of the INQoL scale as an instrument for measuring quality of life related to health in individuals with neuromuscular diseases. PATIENTS AND METHODS: A translation-back translation of the INQoL in the Spanish population is performed and, subsequently, for the analysis of reliability, two measurements are carried out; test retest, with 50 patients aged between 19 and 67 years. In this way we assess the intraobserver concordance and assess the internal consistency of the scale. RESULTS: The study of the reliability of the intraobserver concordance index has a value of excellent in seven of the ten subdimensions as well as in the total score of the quality of life. It has a value of good in two and of moderate in one subdimension. The analysis of Cronbach's alpha for the subdimensions of the INQoL has a value of excellent (> 0.818) in seven of them, as well as in the total score of the quality of life related to health (0.928), a value of good internal consistency in three of the subdimensions, and of moderate in one. CONCLUSIONS: The Spanish version of the INQoL is a valid and reliable instrument as a tool for measuring quality of life in adult patients with neuromuscular diseases.

TITLE: Traduccion y validacion de la escala Individualized Neuromuscular Quality of Life para la poblacion española: evaluacion de la calidad de vida para personas afectas de enfermedades neuromusculares.Introduccion. La escala Individualized Neuromuscular Quality of Life (INQoL) es un cuestionario que valora la calidad de vida relacionada con la salud de personas adultas con enfermedades neuromusculares. Objetivo. Validar y analizar la fiabilidad de la version española de la INQoL, como instrumento de medicion de la calidad de vida relacionada con la salud en individuos con enfermedades neuromusculares. Pacientes y metodos. Se realiza una traduccion-retrotraduccion de la INQoL en la poblacion española y, posteriormente, para el analisis de fiabilidad se llevan a cabo dos mediciones, test-retest, a 50 pacientes de 19 a 67 años. De este modo se evalua la concordancia intraobservador y se evalua la consistencia interna de la escala. Resultados. El estudio de la fiabilidad del indice de concordancia intraobservador tiene un valor de excelente en siete de las diez subdimensiones y en la puntuacion total de la calidad de vida; de buena, en dos; y de moderada, en una. El analisis del alfa de Cronbach para las subdimensiones de la INQoL tiene un valor de excelente (> 0,818) en siete de ellas, asi como en la puntuacion total de la calidad de vida relacionada con la salud (0,928), un valor de buena consistencia interna en tres de las subdimensiones y de moderada en una. Conclusiones. La version española de la INQoL es un instrumento valido y fiable como herramienta de medicion de la calidad de vida en individuos adultos con enfermedades neuromusculares.

[Evolution of functional capacity, assessed with the Egen Klassifikation scale, in the Spanish population with spinal muscular atrophy or Duchenne muscular dystrophy. A three year longitudinal study]. / Evolucion de la capacidad funcional valorada con la escala Egen Klassifikation en personas afectas de atrofia muscular espinal o distrofia muscular de Duchenne de la poblacion española: estudio longitudinal de tres años.

INTRODUCTION: Spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD) are two neuromuscular diseases which evolve with a progressive loss of muscle strength and, therefore, the loss of functional capacity. The valuation measurement scales are used to understand better and to quantify this involution as well as making treatment to anticipate problems and improve the quality of life of people suffering from these diseases. AIM: To study the changes in the functional capacity of a group of patients with SMA and DMD, over a period of three years. PATIENTS AND METHODS: Nineteen individuals of the Spanish population affected with SMA and DMD, which were assessed with the Egen Klassifikation scale twice, with a time interval of three years. RESULTS: The results show a decrease in the functional capacity of these persons during this time period, with a significant difference in the total amount of the scale (p = 0.003). All scale items showed lower valuations after three years, reaching statistical significance during the assessment, containing the ability to move his hands and coughing. CONCLUSION: The functional capacity of patients with SMA and DMD decreases significantly within three years.

TITLE: Evolucion de la capacidad funcional valorada con la escala Egen Klassifikation en personas afectas de atrofia muscular espinal o distrofia muscular de Duchenne de la poblacion española: estudio longitudinal de tres años.Introduccion. La atrofia muscular espinal (AME) y la distrofia muscular de Duchenne (DMD) son dos enfermedades neuromusculares que evolucionan con perdida progresiva de la fuerza muscular y, en consecuencia, perdida de la capacidad funcional. La valoracion con escalas de medicion permite conocer mejor y cuantificar esta involucion, asi como tomar decisiones terapeuticas para anticiparse a los problemas y mejorar la calidad de vida de las personas afectas de estas patologias. Objetivo. Estudiar los cambios de la capacidad funcional de un grupo de pacientes con AME y DMD en un periodo de tres años. Pacientes y metodos. Diecinueve personas de la poblacion española afectas de AME o DMD, a las que se valoro con la escala Egen Klassifikation en dos ocasiones, en un periodo de tres años. Resultados. Los resultados obtenidos reflejan una disminucion de la capacidad funcional de estas personas durante este periodo de tiempo, con una diferencia significativa en la suma total de la escala (p = 0,003). Todos los items de la escala tuvieron valoraciones inferiores despues de tres años, y se llego a la significacion estadistica en la valoracion de la capacidad de mover las manos y de toser. Conclusion. La capacidad funcional de los pacientes con AME y DMD disminuye de forma significativa en tres años.

Validation of the Spanish version of the Urogenital Distress Inventory short form and Incontinence Impact Questionnaire short form for women between the ages of 18 and 65.

BACKGROUND AND OBJECTIVE: To analyze the reliability of the Spanish version of the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact Questionnaire short form (IIQ-7) questionnaires for assessing the presence of urinary incontinence, the degree of impairment and the impact on quality of life for Spanish women between the ages of 18 and 65. PATIENTS AND METHODS: A total of 150 women were enrolled throughout Spain and were administered the UDI-6 and IIQ-7 questionnaires in 2 registries performed with a 15-day interval. The ICIQ-short form, in its Spanish version, was used as the gold standard. RESULTS: In the reliability analysis of the UDI-6, an internal consistency of 0.973 and an intraclass correlation of 0.974 were achieved, with a 95% CI between 0.964 and 0.981. For the IIQ-7, the internal consistency was 0.984 and the intraclass correlation was 0.985, with a 95% CI between 0.985 and 0.977. For both questionnaires, the kappa values for each item ranged from 0.717 to 0.876. CONCLUSIONS: The Spanish version of the UDI-6 and IIQ-7 questionnaires reliably and consistently assess the urogenital symptoms and their impact on the quality of life of Spanish women between 18 and 65 years of age.

The impact of high level basketball competition, calcium intake, menses, and hormone levels in adolescent bone density: a three-year follow-up.

AIM: The main goal of the present work is to establish the positive influence high-impact physical exercise, specifically high-level basketball, on bone acquisition in adolescent female and verify if the long-term exposure to such programs is the major modifiable factor explaining bone acquisition during adolescence. METHODS: A prospective cohort study comparing the development of bone mass in the lumbar spine, proximal femur and distal radius was carried out over a three-year period in two groups of adolescents: elite basketball players and age-matched controls. Baseline hormone levels and bone remodelling were evaluated. Bone mass, hours of physical exercise, diet, unhealthy habits, anthropometry and menstrual cycle were assessed at baseline and yearly. Differences in acquisition of bone mass were assessed by two-way repeated measures analysis of variance (ANOVA). RESULTS: Elite basketball training and competition appears to increase bone mass in girls aged 14-18 years. The most pronounced benefits were observed in lumbar spine and proximal femur, sites most directly involved in the exercise and subjected to greatest impact. CONCLUSION: The intensive basketball training and competition in adolescent females increases bone mass in the lumbar spine and femur, skeletal sites submitted to high impact in this sport. No significant gain in bone mass was observed in age-matched, normally active, controls.

[Neurocognitive and behavioral disturbances after adenotonsillectomy in obstructive sleep apnea syndrome]. / Alteraciones cognitivas y conductuales tras adenoamigdalectomía en el síndrome de apnea del sueño.

INTRODUCTION: Adenotonsillectomy is an effective treatment for sleep-disordered breathing in children, but its ability to resolve neurocognitive issues, is not clear. OBJECTIVE: To analyze the outcomes of cognitive and behavioral disorders after one year of adenotonsillectomy. METHOD: We studied the behavioral and cognitive abnormalities in 45 children with obstructive sleep apnea and 30 healthy controls, aged 3 to 13 years. Psychological tests were performed in both groups at baseline and at 12 months. RESULTS: Preoperatively, all cognitive and behavioral disturbances were higher in the study group than in the control group: attention in 46.7% of cases in the study group versus 20% in the control group (P=.016), anxiety 60.9% versus 40.9% (not significant); memory 55.6% versus 36.7% (P=.019), spatial structuring 64.4% versus 36.7% (P=.017), hyperactivity 42.9% versus 12.5% (P=.016), and attention deficit 46.4% versus 8.3% (P=.003). After one year we observed more disturbances in all variables in the study group. However, significant differences remained only in spatial structure (31.3% versus 3.3%, P=.017), and attention deficit (40.5% versus 16.7%, P=.031). The percentages of patients that improved in one year were not significantly different between both groups. CONCLUSION: Behavioral and cognitive disturbances in children with sleep apnea were partially resolved following adenotonsillectomy. Improvements in the cognitive and behavioral variables did not differ significantly from those the normal evolution of the individual, and were independent of the resolution of respiratory disorders.

Treadmill interventions with partial body weight support in children under six years of age at risk of neuromotor delay: a report of a Cochrane systematic review and meta-analysis.

UNLABELLED: Delayed motor development may occur in children with Down syndrome, cerebral palsy or children born preterm, which in turn may limit the child's opportunities to explore the environment. Neurophysiologic and early intervention literature suggests that task-specific training facilitates motor development. Treadmill intervention is a good example of locomotor task-specific training. AIM: The aim of this paper was to assess the effectiveness of treadmill intervention on locomotor motor development in pre-ambulatory infants and children under six years of age who are at risk for neuromotor delay. DESIGN: A Cochrane systematic review with meta-analysis. METHODS: We employed a comprehensive search strategy. We included randomised, quasi-randomised and controlled clinical trials that evaluated the effect of treadmill intervention in children up to six years of age with delays in gait development or the attainment of independent walking or who were at risk of neuromotor delay. We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, Science Citation Index, PEDro, CPCI-S and LILACS; and also ICTRP, ClinicalTrials.gov, mRCT and CenterWatch. Four authors independently extracted the data using standardized forms. RESULTS: We included five studies, which reported on treadmill intervention in 139 children. Of the 139 children, 73 were allocated to treadmill intervention groups. The studies varied in the type of population studied, the type of comparison, the time of evaluation and the parameters assessed. Due to the diversity of the studies, we were only able to use data from three studies in meta-analyses and these were limited to two outcomes: age of onset of independent walking and gross motor function. Evidence suggested that treadmill intervention could lead to earlier onset of independent walking when compared to no treadmill intervention (effect estimate -1.47; 95% CI: -2.97, 0.03), though these trials studied two different populations: Down syndrome and children at risk of neuromotor disabilities. Children with Down syndrome seemed to benefit while it was not clear if this was the case for children at high risk of neuromotor disabilities. Two other studies, both in children with Down syndrome, compared different types of treadmill intervention (high versus low intensity training). Both were inconclusive regarding the impact of these different protocols on the age at which children started to walk. There is insufficient evidence to determine whether treadmill intervention improves gross motor function (effect estimate 0.88; 95% CI: -4.54, 6.30). CONCLUSION: The current review provided only limited evidence of the efficacy of treadmill intervention in children up to six years of age. Few studies have assessed treadmill interventions in young children using an appropriate control group. The available evidence indicates that treadmill intervention may accelerate the development of independent walking in children with Down syndrome. Further research is needed to confirm this and should also address whether intensive treadmill intervention can accelerate walking onset in young children with cerebral palsy and high risk infants, and whether treadmill intervention has a general effect on gross motor development in the various subgroups of young children at risk for developmental delay.

Reducing errors in the management of hyperbilirubinaemia: validating a software application.

OBJECTIVE: To verify the usefulness and reliability of a software tool we developed to help to apply the American Academy of Pediatrics (AAP) Guidelines 2004 on hyperbilirubinaemia according to the infant's age in hours and their clinical risk factors. DESIGN: Randomised, cross-over, controlled trial with 20 simulated clinical cases comparing the "manual" application of the guidelines with our software application. PARTICIPANTS: Fifteen doctors (eight final-year residents and seven consultants) from two hospitals in Spain. MAIN OUTCOME MEASURES: Major errors (defined a priori as any deviation from the AAP guidelines that involve a risk of morbidity or mortality for the patient), minor errors (those that cause discomfort and/or, in extremely rare cases, morbidity) and time spent. RESULTS: Fifteen doctors each managed 20 simulated cases, half by using the guidelines alone and half using the software tool. Without the software application, 42 "minor" errors were made. With it, only 25 errors were made. "Major" errors also decreased from 10 to 2 with the software. As a group, the residents benefited most; they made an average of 1.8 errors fewer per 10 cases. Use of the software reduced the time taken by the residents to resolve the cases, although the mean reduction in time was not significant for the group of consultants. CONCLUSIONS: The use of simulated clinical cases revealed many errors in the routine management of hyperbilirubinaemia. The software helped clinicians make fewer errors and saved time for residents, but not consultants.