RESUMO
PURPOSE: In this 6-year study we identified factors associated with spontaneous vertebral body reshaping in glucocorticoid (GC)-treated children with leukemia, rheumatic disorders, and nephrotic syndrome. METHODS: Subjects were 79 children (mean age 7.4 years) who had vertebral fracture (VF) evaluation on lateral spine radiographs at least 1 year after VF detection. VF were graded using the modified Genant semiquantitative method and fracture burden for individuals was quantified using the spinal deformity index (SDI; sum of grades from T4 to L4). RESULTS: Sixty-five children (82.3%) underwent complete vertebral body reshaping (median time from VF detection to complete reshaping 1.3 years by Cox proportional hazard modeling). Of 237 VF, the majority (83.1%) ultimately reshaped, with 87.2% reshaping in the thoracic region vs 70.7% in the lumbar region (P = .004). Cox models showed that (1) every g/m2 increase in GC exposure in the first year after VF detection was associated with a 19% decline in the probability of reshaping; (2) each unit increase in the SDI at the time of VF detection was associated with a 19% decline in the probability of reshaping [hazard ratio (HR) = 0.81; 95% confidence interval (CI) = 0.71, 0.92; P = .001]; (3) each additional VF present at the time of VF detection reduced reshaping by 25% (HR = 0.75; 95% CI = 0.62, 0.90; P = .002); and (4) each higher grade of VF severity decreased reshaping by 65% (HR = 0.35; 95% CI = 0.21, 0.57; P < .001). CONCLUSION: After experiencing a VF, children with higher GC exposure, higher SDI, more severe fractures, or lumbar VF were at increased risk for persistent vertebral deformity.
Assuntos
Fraturas Ósseas , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Criança , Humanos , Glucocorticoides/efeitos adversos , Corpo Vertebral , Densidade Óssea , Fraturas Ósseas/induzido quimicamente , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/induzido quimicamente , Fraturas por Osteoporose/induzido quimicamenteRESUMO
Children with chronic medical conditions face many challenges when considering sport participation. Compared with their healthy counterparts, they are often discouraged from physical activity or sports participation because of real or perceived limitations imposed by their condition. Prescribed exercise should be based on the demands of the sport, the effect of the disease on performance, and the potential for exercise-induced acute or chronic worsening of the illness or disability. This article will focus on several examples of chronic medical conditions and the clinician's role in providing advice about sport participation.
Assuntos
Doença Crônica/terapia , Pessoas com Deficiência , Exercício Físico , Promoção da Saúde/métodos , Artrite Juvenil/fisiopatologia , Artrite Juvenil/terapia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Espectro Autista/fisiopatologia , Transtorno do Espectro Autista/terapia , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/terapia , Criança , Fibrose Cística/fisiopatologia , Fibrose Cística/terapia , Epilepsia/fisiopatologia , Epilepsia/terapia , Hemofilia A/fisiopatologia , Hemofilia A/terapia , Humanos , Doenças Neuromusculares/fisiopatologia , Doenças Neuromusculares/terapia , Traço Falciforme/fisiopatologia , Traço Falciforme/terapia , Medicina EsportivaRESUMO
Physical activity and participation in sports are important for the well being of children and youth and should be encouraged by health care providers. Individuals with chronic diseases are often less active, which can have a negative impact on their health. This article will review the effects of exercise on a few chronic medical conditions including juvenile arthritis, cystic fibrosis, and hypertension. The clinician's role in providing advice about sport participation will also be addressed.