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AIM: To evaluate the methodological quality of studies that analysed the relationship between accessibility to emergency services and infant mortality. METHODS: A systematic review with meta-analysis, registered on the international prospective register of systematic reviews (PROSPERO) platform under code CRD42021279854. Medline/Pubmed, Embase, SciElo, Lilacs, Scopus and web of science electronic databases were searched between November 2021 and May 2024, without language or publication time restriction. We included observational studies that compared the infant mortality outcome with the different distances travelled or travel time to health services in a paediatric emergency. Thus, we excluded studies with primary outcomes present in the pre- and perinatal periods, as well as distances or travel time to obstetric emergency units. We used the grade to assess the methodological quality of the studies and the Newcastle-Ottawa scale for the risk of bias, in addition to performing a meta-analysis. RESULTS: The evidence quality on infant mortality was moderate for four studies and low for three studies. The meta-analysis showed that children who travelled more than 5 km to the emergency service had a 28% increase in the chance of dying (P = 0.002), as well as those travelling for more than 40 min increased by 45% (P < 0.001). CONCLUSIONS: There was a relationship between the increase in geographic accessibility distance and travel time with the increase in infant mortality. However, the studies still showed moderate to low methodological quality.
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Resumo Introdução Alterações neurológicas em crianças com síndrome congênita do vírus Zika (SCZ) repercutem em atrasos no desenvolvimento e deformidades, levando à necessidade da assistência aos serviços de reabilitação. Objetivo Analisar a acessibilidade geográfica de crianças com SCZ na Região Metropolitana do Recife (RMR) e compará-la com a otimizada (distância mais próxima entre a residência da criança e o serviço). Método Estudo descritivo, incluindo 51 crianças com SCZ que residiam na RMR. Utilizaram-se questionários semiestruturados com dados sociodemográficos, econômicos e informações dos serviços de reabilitação utilizados pela criança. Elaboraram-se mapas de distribuição espacial e fluxos pelo Sistema de Informação Geográfica QGis e análises descritivas do perfil da amostra, usando SPSS 20.0. Resultados A maioria era de crianças que viviam em locais de vulnerabilidade, considerando a renda como indicador. Quanto à acessibilidade, os serviços de reabilitação estavam concentrados na cidade do Recife, levando 37,3% das crianças a percorrer acima de 15 km até os serviços. Verificou-se que numa acessibilidade otimizada, 52,9% percorreriam entre 1 e 5 km. Conclusão Uma reorganização dos serviços para garantir maior facilidade de acessibilidade a essas crianças é necessária e imprescindível para garantia de melhor acompanhamento e assistência dessas famílias em longo prazo.
Abstract Background Neurological changes in children with congenital zika virus syndrome (CZS) have delays in development and deformities, leading to the need care for rehabilitation services Objective This study aims to analyze the geographical accessibility of children with CZS in the Metropolitan Region of Recife (RMR), and to compare such with the optimized (closest distance between the child's residence and the service). Method It is a descriptive study, including 51 CZS who resided in the RMR. The instruments used were semi structured questionnaire with sociodemographic data, economic and information from the centers attended by the child. Spatial distribution maps and flows were prepared by the Geographic Information System-QGis and descriptive analyzes of the sample profile, using SPSS 20.0. Results The majority were children who lived in locales of socioeconomic vulnerability. As for the accessibility, it was noted that the rehabilitation services which received these children were concentrated in the city of Recife, leading 37.3% of children to travel over 15 km to services. However, the optimal accessibility, 52,9% would be between 1 and 5 km. Conclusion A reorganization of these services to facilitate accessibility to these children, as well as a follow-up towards better tending to these families in the long term.
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Humanos , Lactante , Preescolar , Rehabilitación , Rehabilitación Neurológica , Virus Zika , Vulnerabilidad Social , Accesibilidad a los Servicios de Salud , Anomalías Congénitas , Determinantes Sociales de la Salud , MicrocefaliaRESUMEN
Abstract Introduction: The quality of life (QoL) of schoolchildren with cerebral palsy (CP) should be evaluated considering the functional variability of the child with CP with an extended view on functionality in the school context and the determinants of QoL. Objective: to evaluate the school participation and the QoL of schoolchildren with CP in Recife's municipal public network, as well as to analyze the influence of GMFCS levels and motor performance on these variables in the study population. Method: This is an exploratory observational study whose evaluation model was structured based on the International Classification of Functioning, Disability and Health (CIF). Children with CP were classified in the Gross Motor Function Classification System (GMFCS) and evaluated according to Gross Motor Function Measure-88 (GMFM-88). The School Function Assessment (SFA) and the Quality of Life Questionnaire for Cerebral Palsy (CPQOL-Caregiver) were answered by teachers and mothers, respectively. Results: In the study population, the higher the GMFCS level, the lower the participation and the lower the independence in school activities, aspects that add to the QoL construct, mainly with less functionality, less emotional well-being and self-esteem, and lower family health. Conclusion: GMFCS levels and motor performance of schoolchildren with CP can affect school participation and QoL, and it is important to consider each child's individual and contextual factors. These results can help the development of functional, care, inclusion and pedagogical strategies for students with CP.
Resumo Introdução: A qualidade de vida (QV) do escolar com paralisia cerebral (PC) deve ser avaliada considerando a variabilidade funcional da criança com PC com olhar ampliado sobre a funcionalidade no contexto escolar e os determinantes da QV. Objetivo: avaliar a participação escolar e a QV de escolares com PC da rede pública municipal do Recife, bem como analisar a influência dos níveis do GMFCS e do desempenho motor sobre essas variáveis na população estudada. Método: Trata-se de um estudo observacional exploratório cujo modelo de avaliação foi estruturado com base na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). As crianças com PC foram classificadas no Sistema de Classificação da Função Motora Grossa (GMFCS) e avaliadas segundo o Gross Motor Function Measure-88 (GMFM-88). O School Function Assessment (SFA) e o Questionário de Qualidade de Vida da Paralisia Cerebral (CPQOL-Cuidador) foram respondidos por professores e mães, respectivamente. Resultados: Na população estudada, quanto maior o nível do GMFCS, menor a participação e menor a independência nas atividades escolares, aspectos que se somam ao constructo de QV, principalmente, com a menor funcionalidade, o menor bem-estar emocional e autoestima e a menor saúde familiar. Conclusão: Os níveis de GMFCS e o desempenho motor de escolares com PC podem repercutir na participação escolar e na QV, sendo importante considerar fatores individuais e contextuais de cada criança. Esses resultados podem auxiliar o desenvolvimento de estratégias funcionais, assistenciais, inclusivas e pedagógicas aos escolares com PC.
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Objective: To evaluate the short-term effect of two hydrokinesiotherapy protocols on muscle tone and stress levels in children with SCZ. Method: A crossover, randomized, blinded study with children with microcephaly/SCZ between 3-36 months of age. Was evaluated by the Modified Tardieu Scale(EMT), analyzing the degree of muscle tone and the range of articular movement(ROM); the level of stress, through a visual analogue scale of faces ranging from a state without stress(1) to intense stress(4). Two hydrocinesotherapy protocols(PI and PII) were applied in a restricted aquatic environment, for 15 minutes with water temperature at 37ºC. Results: Twelve children participated in the study (mean age in months: 23.9+3.97), 58.7% female. After PI, we observed a reduction in the degree of tone of the extensor muscles of the elbow(p = 0.03) and knee(p = 0.04); in PII, there were no significant changes in the degree of tone. There were no significant changes in the level of stress in PI and PII, however 83.3% were without stress or mild stress before the interventions. Conclusions: Protocol I reduced the degree of muscle tone in the short term when compared to PII. It is emphasized that the protocols applied are of low cost, and can be a viable non-pharmacological technique option in the therapeutic follow-up of these children. It should be noted that the physiotherapist's experience should guide the choice of the appropriate protocol for the therapeutic objective of each child and the advantage of being a technique easily replicable in a therapeutic and home environment.
Objective: To evaluate the short-term effect of two hydrokinesiotherapy protocols on muscle tone and stress levels in children with SCZ. Method: A crossover, randomized, blinded study with children with microcephaly/SCZ between 3-36 months of age. Was evaluated by the Modified Tardieu Scale(EMT), analyzing the degree of muscle tone and the range of articular movement(ROM); the level of stress, through a visual analogue scale of faces ranging from a state without stress(1) to intense stress(4). Two hydrocinesotherapy protocols(PI and PII) were applied in a restricted aquatic environment, for 15 minutes with water temperature at 37ºC. Results: Twelve children participated in the study (mean age in months: 23.9+3.97), 58.7% female. After PI, we observed a reduction in the degree of tone of the extensor muscles of the elbow(p = 0.03) and knee(p = 0.04); in PII, there were no significant changes in the degree of tone. There were no significant changes in the level of stress in PI and PII, however 83.3% were without stress or mild stress before the interventions. Conclusions: Protocol I reduced the degree of muscle tone in the short term when compared to PII. It is emphasized that the protocols applied are of low cost, and can be a viable non-pharmacological technique option in the therapeutic follow-up of these children. It should be noted that the physiotherapist's experience should guide the choice of the appropriate protocol for the therapeutic objective of each child and the advantage of being a technique easily replicable in a therapeutic and home environment.