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INTRODUCTION: Cerebral palsy (CP) is one of the leading causes of childhood disability globally with a high burden in low-income and middle-income countries (LMICs). Preliminary findings from the global LMIC CP Register (GLM CPR) suggest that the majority of CP in LMICs are due to potentially preventable causes. Such data are lacking in the Latin American region. Generating comparable epidemiological data on CP from this region could enable translational research and services towards early diagnosis and early intervention. We aim to establish a Latin American multicountry network and online data repository of CP called Latin American Cerebral Palsy Register (LATAM-CPR). METHODS AND ANALYSIS: The LATAM-CPR will be modelled after the GLM CPR and will support new and emerging Latin American CP registers following a harmonised protocol adapted from the GLM CPR and piloted in Argentina (ie, Argentine Register of Cerebral Palsy). Both population-based and institution-based surveillance mechanisms will be adopted for registration of children with CP aged less than 18 years to the participating CP registers. The data collection form of the LATAM-CPR will include risk factors, clinical profile, rehabilitation, socioeconomical status of children with CP. Descriptive data on the epidemiology of CP from each participating country will be reported, country-specific and regional data will be compared. ETHICS AND DISSEMINATION: Individual CP registers have applied ethics approval from respective national human research ethics committees (HREC) and/or institutional review boards prior to the establishment and inclusion into the LATAM-CPR. Ethical approval for LATAM-CPR has already been obtained from the HREC in the two countries that started (Argentina and Mexico). Findings will be disseminated and will be made publicly available through peer-reviewed publications, conference presentations and social media communications.
Subject(s)
Cerebral Palsy , Disabled Persons , Child , Humans , Latin America/epidemiology , Cerebral Palsy/rehabilitation , Data Collection , Developing CountriesABSTRACT
Introduction: Motor compromise characterizes cerebral palsy (CP), and is often associated with intellectual disability (ID). Standardized classification systems have been developed to describe the functions of people with CP. The aim was to functionally characterize children and adolescents aged 0 to 18 years with CP in Argentina and to investigate the association between motor compromise (GMFCS), ID and functional classifications. Methods: Cross-sectional study. Data were collected through family interviews and medical records review. Individuals with CP were included. Data were collected from 19 institutions in different cities of Argentina. Fisher's test and odds ratio [IC95%] were used for data analysis, with significance <0.05. Results: 182 children and adolescents with CP participated. According to GMFCS classification, level V prevailed with 36.3%. Those with more severe motor compromise (GMFCS IV-V) were 72 [25.4;206.0] times and 13 [5.9;28.2] times more likely to present a severe level of MACS and CFCS, respectively. But they were 34 [7.9;146.0] times more likely to have a mild to moderate level of EDACS. Those with DI were 10 [5.1;20.5] times more likely to have severe GMFCS, 6 [3.4;13.2] times more likely to have severe MACS and 4 [2.0;7.8] times more likely to have severe CFCS. On the contrary, they are 4 [1.9;9.5] times more likely to present a mild-moderate EDACS level. Conclusion: the level of GMFCS and the presence of DI influence general functionality and increase severity in engagement, manual and communication skills.
Introducción: El compromiso motor caracteriza la parálisis cerebral (PC), y suele asociarse a la discapacidad intelectual (DI). Se han desarrollado sistemas de clasificación estandarizados para describir las funciones de personas con PC. Objetivo: caracterizar funcionalmente a niños, niñas y adolescentes de 0 a 18 años con PC de Argentina e indagar la asociación entre el compromiso motor (GMFCS), la DI y las clasificaciones funcionales. Métodos: Estudio transversal. Se recolectaron datos a través de entrevistas a las familias y revisión de historias clínicas. Se incluyeron personas con PC. Los datos se recolectaron de 19 instituciones de distintas ciudades de Argentina. Resultados: participaron 182 niños, niñas y adolescentes con PC. Según clasificación GMFCS prevaleció el nivel V con 36,3%. Quienes presentan compromiso motor más severo (GMFCS IV-V), tienen 72 [25,4;206,0] veces y 13 [5,9;28,2] veces más chances de presentar un nivel severo de MACS y CFCS respectivamente. Pero, presentaron 34 [7,9;146,0] veces más chances de un nivel leve a moderado de EDACS. Quienes presentaron DI tuvieron 10 [5,1;20,5] veces más chances de presentar un nivel severo GMFCS, 6 [3,4;13,2] veces más chances un nivel severo MACS y 4 [2,0;7,8] veces más chances de un nivel severo CFCS. Por el contrario, tienen 4 [1,9;9,5] veces más chances de presentar un nivel leve-moderado EDACS. Conclusión: el nivel de GMFCS y la presencia de DI influyen en la funcionalidad general y aumentan la severidad en el compromiso, habilidades manuales y de comunicación.
Subject(s)
Cerebral Palsy , Intellectual Disability , Motor Disorders , Child , Humans , Adolescent , Argentina , Activities of Daily LivingABSTRACT
To analyze growth patterns of children with CP between countries; to examine differences in growth; and to assess the fit of growth charts. Cross-sectional study in children with CP from 2 to 19 years old, 399 from Argentina and 400 from Germany. Growth measures were converted into z-scores and compared to WHO reference and US CP growth charts. Generalized Linear Model was used to analyze the growth expressed as mean z-scores. 799 children. Mean age 9 years (± 4). Compared to the WHO reference, the decrease in Height z-scores (HAZ) with age in Argentina (- 0.144/year) was double that in Germany (- 0.073/year). For children in GMFCS IV-V, BMI z-scores (BMIZ) decreased with age (- 0.102/year). Using the US CP charts, both countries showed decreasing HAZ with age, in Argentina (- 0.066/year) and in Germany (- 0.032/year). BMIZ increased more among children with feeding tubes (0.062/year), similar in both countries. Argentinian children with oral feeding decrease their Weight z-score (WAZ) by - 0.553 compared to their peers. With WHO charts BMIZ presented an excellent fit for GMFCS I-III. HAZ presents a poor fit to growth references. BMIZ and WAZ presented a good fit to US CP Charts. Growth differences due to ethnicity also act in children with CP, and are related to motor impairment, age and feeding modality, possibly reflecting differences in environment or health care.
Subject(s)
Cerebral Palsy , Humans , Child , Adolescent , Child, Preschool , Young Adult , Adult , Cerebral Palsy/epidemiology , Argentina/epidemiology , Cross-Sectional Studies , Child Development , Germany/epidemiologyABSTRACT
AIM: To validate a novel equation to estimate weight from mid-upper arm circumference (MUAC) among children with cerebral palsy (CP) in rural Bangladesh. METHOD: Children with CP aged 2 to 18 years registered in the Bangladesh CP Register were randomly selected. Data on sociodemographics, Gross Motor Function Classification System level, and anthropometric measurements were extracted. Bland-Altman plots with a 95% agreement limit and Lin's concordance correlation coefficient with 95% confidence intervals (CI) were reported to measure agreement between observed and estimated weight. Percentage error was used to determinate the method's accuracy. RESULTS: There were 497 participants with a mean age at assessment of 9 years (SD 4 years 11 months) (47.7% female). Lin's concordance correlation coefficient between the observed and estimated weights was 0.90 (95% CI 0.89-0.92). Bland-Altman plots showed a reasonable accuracy of the equation in the study cohort. The mean percentage error of the equation was 5.04%. The average difference between observed and estimated weights was -1.02 kg (SD 5.1). The differences between observed and estimated weights were significantly greater among children with weight-for-age, height-for-age, or BMI-for-age z-scores less than or equal to -4. INTERPRETATION: It is possible to predict the weight of children with CP from MUAC with sufficient accuracy. The equation can be used for populations in low-resources and low- and middle-income countries. WHAT THIS PAPER ADDS: The equations predict the weight of children with cerebral palsy from their mid-upper arm circumference reasonably accurately. The difference between observed and estimated weights ranged between 0 kg and ± 5 kg in 81.5% of children. Sex and Gross Motor Function Classification System level did not affect the accuracy of the equations. The equations were less accurate for estimating the weight of severely undernourished children.
Subject(s)
Cerebral Palsy , Child Nutrition Disorders , Humans , Child , Female , Male , Anthropometry , Rural Population , BangladeshABSTRACT
To compare growth patterns during infancy, childhood and adolescence in children with unilateral and bilateral cerebral palsy (CP) phenotype and to assess the association with gross motor impairment, dysphagia and gestational age. We retrospectively studied 389 children with CP from a single center population in Munich, Germany. 1536 measurements of height and weight were tabulated and z-scored from 6 to 180 months of age. Generalized linear mixed model were used to examine the association between growth, GMFCS, dysphagia and gestational age by CP phenotype. Children with unilateral CP tend to grow similarly to their typically developed peers. In the main effect model, bilateral CP phenotype was significantly associated with decreased mean z-scores for height (ß [95% CI] - 0.953 [- 1.145, - 0.761], p < 0.001), weight (- 0.999 [- 1.176, - 0.807], p < 0.001) and BMI (ß [95% CI] - 0.437 [- 0.799, - 0.075]), compared with unilateral CP phenotype. This association remained significant in the interaction models. The height-for-age z-scores, weight-for-age decreased z-scores and BMI-for-age z-scores of children with bilateral CP and GMFCS III-V or dysphagia decreased more significantly than those of children with unilateral CP. Preterm birth was not significantly associated with decreased growth in height, weight and BMI. Reduced growth in children with bilateral CP was strongly associated with moderate to severe impairment in gross motor function (GMFCS III-V) and dysphagia.
Subject(s)
Adolescent Development , Cerebral Palsy/complications , Child Development , Deglutition Disorders/etiology , Deglutition , Growth Disorders/etiology , Motor Activity , Motor Disorders/etiology , Adolescent , Age Factors , Body Height , Body Mass Index , Cerebral Palsy/diagnosis , Cerebral Palsy/physiopathology , Child , Child, Preschool , Deglutition Disorders/diagnosis , Deglutition Disorders/physiopathology , Female , Germany , Gestational Age , Growth Disorders/diagnosis , Growth Disorders/physiopathology , Humans , Infant , Male , Motor Disorders/diagnosis , Motor Disorders/physiopathology , Retrospective Studies , Risk Assessment , Risk Factors , Weight GainABSTRACT
The COVID-19 pandemic is pronounced as a turning point in our professional health practice, from which new opportunities will arise with which we must promote the rights of children and people with disabilities.
La pandemia del COVID-19 se pronuncia como un punto de inflexión en nuestra práctica profesional en salud, a partir de la cual nuevas oportunidades surgirán con las que debemos promover los derechos de niños, niñas y personas con discapacidad.
Subject(s)
Human Rights , Child , HumansABSTRACT
OBJETIVO: Desarrollar ecuaciones y software para estimar peso usando medidas de segmentos corporales en niños con parálisis cerebral (PC). MÉTODO: Este fue un estudio transversal. Se incluyeron niños y adolescentes con PC de ambos sexos de 2 a 19 años de cinco ciudades de Argentina. Se recolectó el peso, la circunferencia media del brazo (CMB) y covariables clínicas. Se desarrollaron modelos de regresión lineal con el peso como variable dependiente y las medidas de los segmentos corporales como predictores, y se compararon para R2 , R2 ajustado y la raíz cuadrada media del error. RESULTADOS: En total, se incluyeron 381 niños y adolescentes con diagnóstico confirmado de PC (edad media 10 años y 5 meses [DE 4 años 9 meses], rango de 2 a 19 años; 231 hombres, 150 mujeres). La función motora gruesa basada en el Sistema de clasificación de función motora gruesa (GMFCS) fue la siguiente: nivel I, 59; II, 55; III, 59; IV, 69; V, 139. Se analizó la interacción entre el peso y otras variables como CMB, sexo, GMFCS y edad. El coeficiente de correlación de concordancia entre el peso estimado y el observado fue de 0,94 (IC 95%: 0,93-0,95). A partir de los resultados de las ecuaciones, se desarrolló una herramienta de software gratuita, denominada Calculador de Peso PC. INTERPRETACIÓN: El peso de los niños con parálisis cerebral se puede predecir utilizando CMB, GMFCS y edad. Calculador de Peso PC se puede utilizar en la práctica clínica cuando no se puede obtener el peso directo.
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AIM: To develop equations and software to estimate weight using segmental measures for children with cerebral palsy (CP). METHOD: This was a cross-sectional study. Children and adolescents with CP of both sexes from 2 to 19 years old from five cities in Argentina were included. Weight, mid-upper arm circumference (MUAC), and clinical covariables were collected. Linear regression models with weight as the dependent variable and body segment lengths as predictors were developed and compared for R2 , adjusted R2 , and the root mean square of the error. RESULTS: In total, 381 children and adolescents (mean age 10y 5mo [SD 4y 9mo], range 2-19y; 231 males, 150 females) with a confirmed diagnosis of CP were included. Gross motor function based on the Gross Motor Function Classification System (GMFCS) was as follows: level I, 59; II, 55; III, 59; IV, 69; V, 139. The interaction between weight and other variables such as MUAC, sex, GMFCS, and age was analysed. The concordance correlation coefficient between estimated and observed weight was 0.94 (95% CI 0.93-0.95). From the results of the equations, a free software tool, named Weight Calculator CP, was developed. INTERPRETATION: Weight in children with CP can be predicted using MUAC, GMFCS, and age. Weight Calculator CP can be used in clinical practice when direct weight cannot be obtained. What this paper adds Equations can be used to estimate weight in children with cerebral palsy via body segments. Weight can be estimated according to age and gross motor function. The average difference between estimated and observed weights was 119g.
Subject(s)
Body Weight/physiology , Cerebral Palsy/physiopathology , Software , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , MaleABSTRACT
OBJETIVO: Describir el estado nutricional de niños con parálisis cerebral (PC) en centros de rehabilitación y terapéuticos de Argentina, y analizar el riesgo de desnutrición en relación su nivel según el sistema de la clasificación de la función motora gruesa (GMFCS). MÉTODO: Este fue un estudio transversal con datos recolectados de 321 niños (196 varones, 125 mujeres) con PC de 2 a 19 años (edad media 9 años 3 meses, DE 4 años) de 17 centros de rehabilitación y terapéuticos en cinco provincias argentinas. El estado nutricional se definió con puntajes z según peso, talla e índice de masa corporal para la edad utilizando patrones de crecimiento de la Organización Mundial de la Salud. Se utilizó Odds ratio para evaluar la asociación entre el nivel GMFCS y el estado nutricional. RESULTADOS: De los niños con PC estudiados, 52.4% tenían nivel IV y V de GMFCS. En cuanto al estado nutricional, 41,7% eran normales, 19,0% tenían desnutrición moderada, 33,9% desnutrición severa, 2,5 % sobrepeso, y 2,8% obesidad. En comparación con los niños con niveles I-III de GMFCS, los niños con niveles IV y V de GMFCS presentaron 4 veces más probabilidades de presentar desnutrición moderada y 14 veces más probabilidades de tener desnutrición severa. INTERPRETACIÓN: Existe una alta prevalencia de desnutrición asociada a la PC (niveles IV y V de GMFCS) entre niños de centros de rehabilitación y terapéuticos en Argentina. El riesgo de desnutrición severa aumenta cuando aumenta el compromiso motor.
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OBJETIVO: Describir el crecimiento en estatura, estimar la edad pico del estirón, la velocidad de crecimiento en dicho punto, la talla final adulta esperada y los patrones diferenciales en una muestra poblacional de ambos sexos. SUJETOS Y MÉTODO: Se realizó un estudio transversal recabando prospectivamente datos demográficos, clínicos y antropométricos en sujetos sanos de ambos sexos, entre 2015 y 2016. Se calcularon los percentiles para la estatura mediante el método LMS (sesgo, mediana y coeficiente de variabilidad) y luego se ajustaron dichos valores utilizando el modelo 1 de Preece-Baines. RESULTADOS: Se evaluaron 861 sujetos, edades 2 - 18 años, 377 varones y 484 mujeres. La edad estimada al pico del estirón (h0) fue de 13,6 años en los niños y de 11,0 años en las niñas, con una velocidad de crecimiento lineal en ese punto (V2) de 6,4 cm/año para ambos sexos. La estatura adulta media esperada (hj) se estimó en 173,7 cm en los chicos y en 160,0 cm en las chicas. CONCLUSIONES: El modelo 1 de Preece-Baines permitió estimar satisfactoriamente la edad pico del estirón, la velocidad de crecimiento en dicho punto y la talla final adulta esperada.
OBJECTIVE: Based on a sample of children and adolescents of both genders, our objective is to des cribe height growth, estimate the peak age at growth spurt, growth rate at this point, the final adult height expected, and differential patterns SUBJECTS AND METHOD: A cross-sectional study was conduc ted using demographic, clinical, and anthropometric data collected prospectively from children and adolescents of both sexes between 2015 and 2016. Height percentiles were calculated using the LMS (skewness, median, and coefficient of variation) method and then adjusted using the Preece-Baines model 1. RESULTS: We evaluated 861 participants (484 girls, 377 boys), aged between 2 and 18 years. The estimated peak age at growth spurt (he) was 13.6 years in boys and 11.0 years in girls, with a peak growth rate (V2) at this point of 6.4 cm/year for both sexes. The mean expected adult height (h1) was 173.7 cm in boys and 160.0 cm in girls. CONCLUSIONS: Preece-Baines model 1 provides satisfactory estimates for the peak age at growth spurt, peak growth rate at this point, and final expected adult height.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Body Height/physiology , Child Development/physiology , Adolescent Development/physiology , Growth Charts , Argentina , Reference Values , Sex Factors , Cross-Sectional Studies , Prospective Studies , Models, StatisticalABSTRACT
Introduction: In the context of the COVID-19 pandemic, WHO published considerations regarding people with disabilities. The aim of this work was to know if these considerations can be fulfilled and if there are differences in their fulfillment between age groups. Method: Descriptive study aimed at people with disabilities in Argentina. A survey was conducted about the four WHO recommendations for this population in online mode, between the 28th and 39th days of preventive and compulsory social isolation. Statistical analysis was according to the nature of the variables, X2 with Fisher's correction was used to determine the differences between groups. Results: 309 surveys were collected from 18 provinces of Argentina. 230(74.4%[69.1-79.1]) were answered by caregivers and 79(25.5%[20.7-30.7]) by people with disabilities. Persons with disabilities were 138(44.7%[39.0-50.4]) children and adolescents and 171(55.3%[49.5-60.9]) adults and older adults. People with disabilities were able to comply with the WHO recommendations regarding reducing exposure to COVID-19 and to be prepared in case of contracting it. There were difficulties in the number of caregivers needed, since 266(66.6%[61.0-71.8]) have this possibility, and difficulties in 55(32.1%[25.1-39.6]) adults and older adults that do not carry out educational-therapeutic activities. There are feelings of anxiety, distress, or depression in people with disabilities and their caregivers. Conclusion: In Argentina, it is possible to comply with the WHO recommendations to avoid exposure to the virus and to be prepared in case of infection. Challenges remain to be solved in terms of accompanying people with disabilities in their physical and mental health.
Introducción: En el contexto de la pandemia del COVID-19 la OMS publicó consideraciones relativas a las personas con discapacidad. El objetivo del trabajo fue conocer si estas consideraciones pueden cumplirse y si existen diferencias en su cumplimiento entre grupos etarios. Método: Estudio descriptivo dirigido a personas con discapacidad de Argentina. Se realizó una encuesta sobre las cuatro recomendaciones de la OMS para esta población en modalidad online, entre los días 28° y 39° del aislamiento social preventivo y obligatorio. El análisis estadístico fue según naturaleza de las variables, para determinar las diferencias entre grupos se usó X2 con corrección de Fisher. Resultados: Se recolectaron 309 encuestas de 18 provincias de Argentina. 230(74,4%[69,1-79,1]) fueron respondidas por cuidadores y 79(25,5%[20,7-30,7]) por personas con discapacidad. Las personas con discapacidad fueron 138(44,7%[39,0-50,4]) niños, niñas y adolescentes y 171(55,3%[49,5-60,9]) adultos y adultos mayores. Las personas con discapacidad pudieron cumplir con las recomendaciones de la OMS en cuanto a disminuir la exposición a COVID-19 y estar preparados en caso de contraerlo. Hubo dificultades en la cantidad de cuidadores necesarios, ya que 266(66,6%[61,0-71,8]) tiene esta posibilidad, y en que 55(32,1%[25,1-39,6]) adultos y adultos mayores no realizan actividades educativas-terapéuticas. Existen sentimientos de ansiedad, angustia o depresión en personas con discapacidad y sus cuidadores. Conclusión: En Argentina se está pudiendo cumplir con las recomendaciones de la OMS para evitar la exposición al virus y estar preparados en caso de contagio. Quedan desafíos por resolver en cuanto al acompañamiento de las personas con discapacidad en su salud física y mental.
Subject(s)
Coronavirus Infections/epidemiology , Disabled Persons , Patient Compliance , Pneumonia, Viral/epidemiology , Argentina/epidemiology , Betacoronavirus , COVID-19 , Communicable Disease Control/methods , Coronavirus Infections/prevention & control , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Social Isolation , World Health OrganizationABSTRACT
Introduction: Classification systems are internationally used tools to characterize the functions of children and young people with cerebral palsy (CP), for clinical and research use. The aim of this study was to characterize the different classification systems available and describe the usefulness of each of the classifications, describing their use in clinical practice. Methods: An exhaustive bibliographic revision was performed using the Cochrane Database, MEDLINE, LILACS y Google Scholar databases. The search period was from 1997 to 2019 using key words. Classification systems were included that focused on functions and body structures, considered the International Classification of Functioning, Disability and Health, were validated and in English and Spanish. The quality of the works was assessed according to the AGREE reporting checklist. Results: Six classification systems were found for children with CP regarding their functions and body structures. Each of the systems focuses on a specific function or skill, which are: gross motor function, manual skills, communication functions, eating and drinking skills, MRIs, and visual functions. Main conclusion: All systems have been validated, standardized and used internationally. They serve to more fully describe the functional levels and body structure of children with CP both at the clinical, population and research levels.
Introducción: Los sistemas de clasificaciones son herramientas de uso internacional para caracterizar las funciones de los niños y jóvenes con parálisis cerebral (PC), para el uso clínico y de investigación. El objetivo de este estudio fue caracterizar los distintos sistemas de clasificación disponibles y describir la utilidad de cada una de las clasificaciones, describiendo su uso en la práctica clínica. Métodos: se realizó una búsqueda bibliográfica exhaustiva utilizando las bases de datos de Cochrane Database, MEDLINE, LILACS y Google Académico. El período de búsqueda fue desde 1997 hasta el 2019 mediante palabras claves. Se incluyeron sistemas de clasificación que se centraran en funciones y estructuras corporales, consideren la Clasificación internacional del funcionamiento, de la discapacidad y de la salud, estén validados y en idioma inglés y en español. La calidad de los trabajos fue valorada de acuerdo al AGREE reporting checklist. Resultados: Se encontraron seis sistemas de clasificación destinado a personas con PC sobre sus funciones y estructuras corporales. Cada uno de los sistemas se centra en una función o habilidad específica, que son: función motora gruesa, habilidades manuales, funciones de la comunicación, habilidades para comer y beber, resonancias magnéticas nuclear y funciones visuales. Conclusión principal: Todos los sistemas han sido validados, estandarizados y utilizados de forma internacional. Sirven para describir de forma más completa los niveles funcionales y de estructuras corporales de las personas con PC tanto a nivel clínico, poblacional e investigaciones.
Subject(s)
Cerebral Palsy , Adolescent , Child , Communication , Humans , Magnetic Resonance ImagingABSTRACT
AIM: To describe the nutritional status of children with cerebral palsy (CP) from rehabilitation and therapeutic centers in Argentina, and to analyze their risk of undernutrition based on their Gross Motor Function Classification System (GMFCS) level. METHOD: This was a cross-sectional study with data collected from 321 children (196 males, 125 females) with CP age 2 to 19 years (mean age 9y 3mo, SD 4y 5mo) from 17 rehabilitation and therapeutic centers in five Argentine provinces. Nutritional status was defined by height, weight, and body mass index for age z-scores using World Health Organization growth charts. Odds ratios were used to evaluate the association between GMFCS level and nutritional status. RESULTS: Of the children with CP studied, 52.4% were in GMFCS levels IV and V. Regarding the nutritional status, 41.7% were normal, 19.0% had moderate undernutrition, 33.9% severe undernutrition, 2.5% overweight, and 2.8% obese. When compared to those in GMFCS levels I to III, the odds of children in GMFCS levels IV and V having moderate undernutrition are four times greater and the odds of having severe undernutrition are 14 times greater. INTERPRETATION: There is a high prevalence of undernutrition associated with CP (GMFCS levels IV and V) among children in rehabilitation and therapeutic centers in Argentina. Risk of severe undernutrition increases with increased motor compromises.
Subject(s)
Cerebral Palsy/complications , Cerebral Palsy/physiopathology , Child Nutritional Physiological Phenomena , Malnutrition/etiology , Nutritional Status , Rehabilitation Centers/statistics & numerical data , Adolescent , Adult , Argentina/epidemiology , Cerebral Palsy/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Malnutrition/epidemiology , Neurological Rehabilitation , Risk , Severity of Illness Index , Young AdultABSTRACT
OBJECTIVE: Based on a sample of children and adolescents of both genders, our objective is to des cribe height growth, estimate the peak age at growth spurt, growth rate at this point, the final adult height expected, and differential patterns Subjects and Method: A cross-sectional study was conduc ted using demographic, clinical, and anthropometric data collected prospectively from children and adolescents of both sexes between 2015 and 2016. Height percentiles were calculated using the LMS (skewness, median, and coefficient of variation) method and then adjusted using the Preece-Baines model 1. RESULTS: We evaluated 861 participants (484 girls, 377 boys), aged between 2 and 18 years. The estimated peak age at growth spurt (he) was 13.6 years in boys and 11.0 years in girls, with a peak growth rate (V2) at this point of 6.4 cm/year for both sexes. The mean expected adult height (h1) was 173.7 cm in boys and 160.0 cm in girls. CONCLUSIONS: Preece-Baines model 1 provides satisfactory estimates for the peak age at growth spurt, peak growth rate at this point, and final expected adult height.
Subject(s)
Adolescent Development/physiology , Body Height/physiology , Child Development/physiology , Growth Charts , Adolescent , Argentina , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Models, Statistical , Prospective Studies , Reference Values , Sex FactorsABSTRACT
Introducción: la disfagia requiere una modificación de la consistencia de los alimentos que resulta difícil de explicar a pacientes y cuidadores. Métodos: se desarrolló y validó un atlas para explicar las consistencias mediante un cuestionario de escala Likert y una encuesta Delphi. Se evaluó acuerdo y confiabilidad del instrumento (80% mínimo). El atlas se realizó en lengua española. Resultados: en la evaluación se obtuvo un acuerdo del 93,3% (IC 95%: 63,7-100%). En la validación se obtuvo un acuerdo del 97,5% e índice kappa de 0,96 (IC 95%: 0,93-0,99; p = 0,016). Conclusión: el atlas es un instrumento válido que puede ser utilizado por los profesionales de la salud
Introduction: dysphagia requires texture-modified foods and thickened liquids, which is difficult to explain to patients and caregivers. Methods: an atlas has been developed and validated to explain the consistencies using the Likert scale questionnaire and the Delphi survey. The agreement and reliability of the tool were evaluated, with a minimum of 80%. The atlas was developed in Spanish. Results: an agreement of 93.3% (95% CI: 63.7-100%) was obtained during the evaluation and a value of 97.5% and a Kappa index of 0.96 (95% CI: 0.93-0.99; p = 0.016] were obtained during the validation processes. Conclusion: the atlas is a new valid tool that can be used by health professionals
Subject(s)
Humans , Deglutition Disorders/diet therapy , Food Analysis/methods , Nutrition Therapy/methods , Food Quality , Food Handling/methods , Cross-Sectional StudiesABSTRACT
INTRODUCTION: dysphagia requires texture-modified foods and thickened liquids, which is difficult to explain to patients and caregivers. METHODS: an atlas has been developed and validated to explain the consistencies using the Likert scale questionnaire and the Delphi survey. The agreement and reliability of the tool were evaluated, with a minimum of 80%. The atlas was developed in Spanish. RESULTS: an agreement of 93.3% (95% CI: 63.7-100%) was obtained during the evaluation and a value of 97.5% and a Kappa index of 0.96 (95% CI: 0.93-0.99; p = 0.016] were obtained during the validation processes. CONCLUSION: the atlas is a new valid tool that can be used by health professionals.
Subject(s)
Deglutition Disorders/therapy , Food , Photography , Atlases as Topic , Food/classification , Humans , Reproducibility of ResultsABSTRACT
Introduction: The definition of cerebral palsy (CP) has been difficult over the years mainly because of the large number of manifestations and concomitant diseases that can occur, taking unique characteristics in each subject that suffers. Method: This work seeks to reconstruct the historical course of cerebral palsy in order to relate it to the current challenges that arise in the area of public health for its approach. For this, a bibliographic review work was carried out in digital databases based on keywords. A literature search was performed using the data bases of MEDLINE (PubMed), SCOPUS, LILACS and Google Scholar. Texts were included in both English and Spanish. Results: It describes in the work different definitions that the PC takes from the nineteenth century to its current international definition agreed in 2005. More than 150 years took a long time to establish a definition demonstrating the complexity involved. The contributions of the International Classification of Functionality and Health (CIF) currently bring new challenges in the treatment. Conclusions: Knowing the history of the PC definition by relating it to changes in the disability paradigm allows us to analyze the complexity of the situation and calls for reflection on our health practices.
Introducción: La definición de la parálisis cerebral (PC) ha sido dificultosa a lo largo de los años principalmente por el gran número de manifestaciones y enfermedades concomitantes que puede presentar, tomando características únicas en cada sujeto que la padece. Método: Este trabajo buscó reconstruir el recorrido histórico de la parálisis cerebral para poder relacionarlo a los desafíos actuales que se presentan en el área de la salud pública para su abordaje. Para esto se llevó a cabo un trabajo de revisión bibliográfica en bases de datos digitales a partir de palabras clave. Se realizó una búsqueda bibliográfica utilizando las bases de dato de MEDLINE (PubMed), SCOPUS, LILACS y Google Scholar. Se incluyeron textos tanto en inglés como en español. Resultados: Se describen en el trabajo a distintas definiciones que toma la PC desde el siglo XIX hasta su actual definición internacional consensuada en 2005. Pasaron más de 150 años para establecerse una definición demostrando la complejidad que conlleva. Los aportes de la Clasificación Internacional de Funcionalidad y Salud (CIF) traen aparejados en la actualidad nuevos desafíos en el tratamiento.Conclusiones: Conocer la historia de la definición de la PC relacionándola con los cambios de paradigma de la discapacidad permite analizar la complejidad de la situación, y llama a la reflexión sobre nuestras prácticas de sanitarias. Conclusiones: Conocer la historia de la definición de la PC relacionándola con los cambios de paradigma de la discapacidad permite analizar la complejidad de la situación, y llama a la reflexión sobre nuestras prácticas de sanitarias.
Subject(s)
Cerebral Palsy/history , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Terminology as TopicABSTRACT
Introduction: Weight and height are essential information to assess growth and nutritional status in pediatrics. The determination of them by direct method is difficult in hospitalized patients. The objective was to analyze the correlation between weight and mid arm circumference (MAC), and between height and knee height (KH) of children and teenagers so it can be used to asses growth and nutritional status in hospitalized children. Population and methods: An observational, descriptive and cross-sectional study was carried out. We included children and teenagers of both gender of 2 and 19 years old. To establish the correlation, the correlation coefficient r and determination R2 were calculated with a significance of p <0.05, plotting the correlation. The MedCalc V12.5.0.0 software was used to analyze the data. Results: Data from 861 subjects were collected. 484 females (56.2% CI95% 52.8-59.5), and 377 males (43.8% CI 95% 40.4-47.2) aged between 2 and 19 years. A correlation was obtained between the KH and the height of r = 0.98 for both sexes, (R2 = 0.96 females and R2 = 0.97 in males), p <0.001. The MAC showed a correlation with the weight of r = 0.92 (R2 = 0.76) in males and r = 0.87 (R2 = 0.85) in females, both with p <0.001. Conclusions: Body segments KH and MAC have a high correlation with height and weight, respectively. That is why we propose to use them for the assessment of growth and nutritional status in hospitalized children with functional limitations.
Introducción: El peso y la talla son datos esenciales para la valoración del crecimiento y estado nutricional en pediatría. La determinación por método directo resulta difícil en pacientes hospitalizados. El objetivo fue analizar la correlación entre el peso y la circunferencia media de brazo (CMB), y entre la talla y la altura talón rodilla (ATR) de niños y adolescentes para su uso en la valoración nutricional y de crecimiento en niños y adolescentes hospitalizados. Población y métodos: Se realizó un estudio observacional, descriptivo y transversal. Se incluyeron, niños, niñas y adolescentes de ambos sexos de 2 y 19 años. Para establecer la correlación se calculó el coeficiente de correlación r y de determinación R2 con una significación de p<0,05, graficando la correlación. Para el análisis de los datos se utilizó el software MedCalc V12.5.0.0. Resultados: Se recolectaron datos de 861 sujetos. 484 femeninos (56.2% IC95%52,8-59,5), y 377 masculinos (43.8% IC95%40,4-47,2) con edades entre 2 y 19 años. Se obtuvo una correlación entre la ATR y la talla de r=0.98 para ambos sexos, (R2=0.96 mujeres y R2=0.97 en varones), p<0.001. La CMB demostró una correlación con el peso de r=0.92 (R2=0.76) en varones y de r=0.87 (R2=0.85) en mujeres, ambas con p<0.001. Conclusiones: Los segmentos corporales ATR y CMB presentan una alta correlación con la talla y peso, respectivamente. Es por esto que proponemos utilizar los mismos para la valoración del crecimiento y estado nutricional en niños hospitalizados con limitaciones funcionales.
