RESUMO
Birds living in developed areas contend with numerous stressors, including human disturbance and light, noise, and air pollution. COVID-19 pandemic lockdowns presented a unique opportunity to disentangle these effects during a period of reduced human activity. We launched a community science project in spring 2020 to explore drivers of site use by and detection of common birds in cities under lockdown in the U.S. Pacific Northwest. Our goals were twofold: (1) consider how intensity of urbanization, canopy cover, and availability of bird feeders and bird baths influenced avian habitat use; and (2) quantify how daily changes in weather, air pollution, and human mobility influenced detection of birds. We analyzed 6,640 surveys from 367 volunteers at 429 monitoring sites using occupancy models for 46 study species. Neither land cover nor canopy cover influenced site use by 50% of study species, suggesting that backyard birds may have used a wider range of habitats during lockdowns. Human mobility affected detection of 76% of study species, suggesting that birds exhibited species-specific behavioral responses to day-to-day changes in human activity beginning shortly after initial lockdown restrictions were implemented. Our study also showcases how existing community science platforms can be leveraged to support local monitoring efforts.
Assuntos
Biodiversidade , COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Ecossistema , Humanos , PandemiasRESUMO
BACKGROUND: To help implement behavior change interventions (BCIs) it is important to be able to characterize their key components and determine their effectiveness. PURPOSE: This study assessed and compared the components of BCIs in terms of intervention functions identified using the Behaviour Change Wheel Framework (BCW) and in terms of their specific behavior change techniques (BCTs) identified using the BCT TaxonomyV1, across six behavioral domains and the association of these with cost-effectiveness. METHODS: BCIs in 251 studies targeting smoking, diet, exercise, sexual health, alcohol and multiple health behaviors, were specified in terms of their intervention functions and their BCTs, grouped into 16 categories. Associations with cost-effectiveness measured in terms of incremental cost-effectiveness ratio (ICER) upper and lower estimates were determined using regression analysis. RESULTS: The most prevalent functions were increasing knowledge through education (72.1%) and imparting skills through training (74.9%). The most prevalent BCT groupings were shaping knowledge (86.5%), changing behavioral antecedents (53.0%), supporting self-regulation (47.7%), and providing social support (44.6%). Intervention functions associated with better cost-effectiveness were those based on training (ßlow = -15044.3; p = .002), persuasion (ßlow = -19384.9; p = .001; ßupp = -25947.6; p < .001) and restriction (ßupp = -32286.1; p = .019), and with lower cost-effectiveness were those based on environmental restructuring (ß = 15023.9low; p = .033). BCT groupings associated with better cost-effectiveness were goals and planning (ßlow = -8537.3; p = .019 and ßupp = -12416.9; p = .037) and comparison of behavior (ßlow = -13561.9, p = .047 and ßupp = -30650.2; p = .006). Those associated with lower cost-effectiveness were natural consequences (ßlow = 7729.4; p = .033) and reward and threat (ßlow = 20106.7; p = .004). CONCLUSIONS: BCIs that focused on training, persuasion and restriction may be more cost-effective, as may those that encourage goal setting and comparison of behaviors with others.
Assuntos
Terapia Comportamental , Comportamentos Relacionados com a Saúde , Exercício Físico , Humanos , FumarRESUMO
Estimates of species abundance are critical to understand population processes and to assess and select management actions. However, capturing and marking individuals for abundance estimation, while providing robust information, can be economically and logistically prohibitive, particularly for species with cryptic behavior. Camera traps can be used to collect data at temporal and spatial scales necessary for estimating abundance, but the use of camera traps comes with limitations when target species are not uniquely identifiable (i.e., "unmarked"). Abundance estimation is particularly useful in the management of invasive species, with herpetofauna being recognized as some of the most pervasive and detrimental invasive vertebrate species. However, the use of camera traps for these taxa presents additional challenges with relevancy across multiple taxa. It is often necessary to use lures to attract animals in order to obtain sufficient observations, yet lure attraction can influence species' landscape use and potentially induce bias in abundance estimators. We investigated these challenges and assessed the feasibility of obtaining reliable abundance estimates using camera-trapping data on a population of invasive brown treesnakes (Boiga irregularis) in Guam. Data were collected using camera traps in an enclosed area where snakes were subject to high-intensity capture-recapture effort, resulting in presumed abundance of 116 snakes (density = 23/ha). We then applied spatial count, random encounter and staying time, space to event, and instantaneous sampling estimators to photo-capture data to estimate abundance and compared estimates to our presumed abundance. We found that all estimators for unmarked populations performed poorly, with inaccurate or imprecise abundance estimates that limit their usefulness for management in this system. We further investigated the sensitivity of these estimators to the use of lures (i.e., violating the assumption that animal behavior is unchanged by sampling) and camera density in a simulation study. Increasing the effective distances of a lure (i.e., lure attraction) and camera density both resulted in biased abundance estimates. Each estimator rarely recovered truth or suffered from convergence issues. Our results indicate that, when limited to unmarked estimators and the use of lures, camera traps alone are unlikely to produce abundance estimates with utility for brown treesnake management.
Assuntos
Espécies Introduzidas , Animais , Humanos , Densidade DemográficaRESUMO
A 38-year-old white rhinoceros bull (Ceratotherium simum) was treated with phenylbutazone over a period of four years for chronic osteoarthritic and neuropathic pain of the thoracic limbs. Initially the lameness was sporadic and responded well to phenylbutazone (4 mg/kg PO SID). The lameness increased in severity during the winter months. Four years after treatment was initiated, there was an increase in the severity and incidence of the lameness. Analgesia was augmented by the addition of non-conventional analgesic drugs. Pentosan polysulfate was administered IM at 3 mg/kg once a week for two treatments and thereafter monthly when possible. Gabapentin was used at 8 mg/kg but produced ataxia and anorexia. The dose was reduced to 4-5 mg/kg PO SID. Amantadine (3 mg/kg PO BID) was added to the multimodal analgesia and produced a significant improvement in the clinical lameness. Chronic inflammation was monitored using both automated and manual fibrinogen methods. Eventually the rhinoceros was euthanized on humane grounds when treatment was unable to produce suitable clinical relief.
Assuntos
Analgesia , Dor Crônica , Amantadina/uso terapêutico , Analgesia/veterinária , Animais , Bovinos , Dor Crônica/veterinária , Eutanásia Animal , Gabapentina/uso terapêutico , Masculino , Poliéster Sulfúrico de Pentosana , Perissodáctilos , FenilbutazonaRESUMO
BACKGROUND: Sitting time is associated with adverse physical and mental health outcomes, and premature mortality. Office workers sit for prolonged periods, so are at particular risk. Scientific advances in public health threats are predominantly communicated to the public through media reports. AIMS: This study aimed to examine office workers' impromptu responses to media coverage of scientific evidence related to the health risks of sedentary behaviour. METHODS: Semi-structured interviews were run with 26 office workers (mean age 35 years), recruited from four organizations in southern England. Within the interview, each participant provided a 'think-aloud' narrative as they read three real-world news reports relating to sedentary behaviour. Thematic analysis was conducted on verbatim transcripts. RESULTS: Three themes were extracted from the data: gauging the personal relevance of the news reports; questioning their trustworthiness and challenging the feasibility of proposed sitting-reduction strategies. Participants voiced scepticism about the applicability of the reports to their personal circumstances, and the validity of the reports and the scientific evidence underpinning them. CONCLUSIONS: Researchers, press officers and journalists should emphasise the ways in which participants in research studies represent the broader population of office workers, and offer greater transparency in reporting study methods, when reporting scientific advances in sedentary behaviour.
Assuntos
Meios de Comunicação de Massa , Saúde Ocupacional , Postura Sentada , Adulto , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Comportamento Sedentário , Local de TrabalhoRESUMO
BACKGROUND: To identify, using a longitudinal data set, parental and childhood correlates of adult television (TV) viewing time at 32-year follow-up. METHOD: Data were derived from the 1970 British Cohort Study, a longitudinal observational study of 17â 248 British people born in a single week of 1970. The present analyses incorporated data from the age 10 and 42-year surveys. When participants were aged 10â years, their mothers provided information on how often participants watched TV and played sports (never/sometimes/often), and parents' own occupation, as well as height and weight. A health visitor objectively assessed participants' height and weight at age 10. Thirty-two years later, when participants were aged 42â years, they reported their daily TV viewing hours (none/0≤1/1<3/3<5/≥5), physical activity and health status. Associations between putative childhood and parental correlates and adult TV viewing time were investigated using logistic regression. RESULTS: Valid data at both time points were available for 6188 participants. Logistic regression models showed that those who reported 'often' watching TV at baseline were significantly more likely to watch >3â h/days of TV at follow-up (OR 1.42, 95% CI 1.21 to 1.65), as were those whose father was from a lower socio-occupational class (intermediate, routine/manual) compared with managerial (OR 1.55, 95% CI 1.14 to 2.11; OR 2.05, 95% CI 1.47 to 2.87). Body mass index (BMI) at age 10 was inversely associated with high TV in adulthood (per unit increase; OR 0.93, 95% CI 0.90 to 0.96) although fathers BMI when the child was aged 10 was positively associated with high TV in adulthood (per unit increase; OR 1.04, 95% CI 1.02 to 1.06). CONCLUSIONS: Findings suggest that childhood TV viewing time tracks into adulthood. Parents' health behaviours and social position appear to be associated with their children's viewing habits, which may have important implications for the direction of future policy and practice. Specifically, findings support the case for early life interventions, particularly on socioeconomic inequalities, as a way of preventing sedentary behaviour in later life.
Assuntos
Saúde da Família , Comportamentos Relacionados com a Saúde , Obesidade/etiologia , Comportamento Sedentário , Esportes/estatística & dados numéricos , Televisão , Adulto , Índice de Massa Corporal , Criança , Pai/estatística & dados numéricos , Feminino , Seguimentos , Previsões , Nível de Saúde , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Mães/estatística & dados numéricos , Classe Social , Fatores de Tempo , Reino UnidoRESUMO
This study compared serum cholecalciferol and 25-hydroxyvitamin D (25(OH)D) concentrations over four weeks in healthy, non-pregnant, non-lactating females aged 18-40 years, who were randomized to oral cholecalciferol 5000 international units (IU) daily for 28 days or a single dose of 150 000 IU. The study was conducted in Rochester, MN in March and April of 2010. We found no difference in mean 25(OH)D between treatment groups on study day 0 or day 28 (P=0.14 and 0.28, respectively). The daily group had 11 more days of detectable serum cholecalciferol than the single-dose group (P<0.001). There was no difference observed in cholecalciferol area under the curve (AUC28) between groups (P=0.49). However, the single-dose group had a significantly greater mean 25(OH)D AUC28 compared with the daily group (P<0.001).
Assuntos
Colecalciferol/administração & dosagem , Colecalciferol/farmacocinética , Suplementos Nutricionais , Adolescente , Adulto , Área Sob a Curva , Colecalciferol/sangue , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Lactação , Adulto JovemRESUMO
STUDY DESIGN: Multi-centre, retrospective self-report postal survey. OBJECTIVES: To characterise spinal cord injured (SCI) individuals with a stoma, their stoma management and outcomes, to identify sources of information and support for decision making and to explore the impact of a stoma on life satisfaction. SETTING: Five UK spinal cord injury centres. METHODS: A study-specific questionnaire accompanied by self-concept, life satisfaction and mood measures, and three simple rating scales for satisfaction, impact and restriction on life were sent to all known ostomates at five participating centres. RESULTS: Respondents were 92 individuals, mean age 56 years, mean duration of injury 26 years, 91% with colostomy. Multiple sources of information were utilised in deciding on surgery; discussion with other SCI ostomates was important. Duration of bowel care, faecal incontinence, bowel-related autonomic dysreflexia, dietary manipulation and laxative use were all significantly reduced following surgery. Rectal mucous discharge was the most common and bothersome post-stoma problem. Satisfaction with stoma was high; provision of sufficient information preoperatively was important, those with ileostomy were more dependent and less satisfied. Life satisfaction and physical self-concept were both lower in this sample than in previously reported samples of SCI individuals without reported bowel difficulties or stoma. CONCLUSION: The findings of this study of self-selected respondents with a stoma for bowel management after SCI emphasised the benefits of stoma in selected individuals and the importance of timely intervention, the complexity of the associated decision-making and of preoperative counselling. The impact of bowel dysfunction on physical self-concept warrants investigation.
Assuntos
Colostomia , Ileostomia , Qualidade de Vida , Traumatismos da Medula Espinal/cirurgia , Estomas Cirúrgicos , Colostomia/psicologia , Feminino , Humanos , Ileostomia/psicologia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Consuming a healthy diet in pregnancy has the potential to improve obstetric outcome, including minimising the risk of macrosomia. Effective promotion of dietary change depends on identifying and targeting determinants of gestational diet. The present study aimed to model psychological predictors of intentions to reduce intake of high-fat and high-sugar foods, and increase fruit and vegetable consumption, among pregnant women. METHODS: One hundred and three pregnant women completed questionnaire measures of intentions to modify the consumption of the target foods, current intake, perceived vulnerability to and severity of adverse outcomes of unhealthful consumption of these foods (i.e. 'threat'), benefits of dietary change to mother and baby, barriers to dietary changes, and social approval for dietary change ('subjective norms'). A cross-sectional design was used. Logistic regression analyses were undertaken to model dietary change intentions. RESULTS: Participants who reported excessive current intake of high-fat and high-sugar foods were more likely to intend to reduce the intake of these foods. Perceived benefits for mother and baby enhanced intentions to eat more fruit and vegetables and eat less high-fat, and marginally significantly increased high-sugar reduction intentions. There were no effects of threat, barriers or subjective norms. CONCLUSIONS: Lack of effects for barriers, threat and subjective norms may indicate that pregnant women discount barriers to health-promoting behaviour, understand the threat posed by unhealthy eating and perceive social approval from others. Dietary change interventions for pregnant women should emphasise likely positive outcomes for both mother and child.
Assuntos
Dieta/psicologia , Intenção , Fenômenos Fisiológicos da Nutrição Materna , Adulto , Estudos Transversais , Carboidratos da Dieta/administração & dosagem , Gorduras na Dieta/administração & dosagem , Ingestão de Alimentos/psicologia , Feminino , Idade Gestacional , Promoção da Saúde , Humanos , Modelos Logísticos , Gravidez , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Disability scales do not enable the transmission of concise, meaningful and daily function description for clinical purposes. STUDY DESIGN: Cross-sectional statistical analysis of 328 patients' Spinal Cord Independence Measure (SCIM) III item scores (SIS). OBJECTIVE: To develop a concise and clinically interpretable data-based characterization of daily task accomplishment for patients with spinal cord lesions (SCLs). SETTING: Multi-center study at 13 spinal units in 6 countries. METHODS: Patients were grouped into clusters characterized by smaller differences between the patients' SIS within the clusters than between their centers, using the k-medoides algorithm. The number of clusters (k) was chosen according to the percent of SIS variation they explained and the clinical distinction between them. RESULTS: Analysis showed that k=8 SIS clusters offer a good description of the patient population. The eight functional clusters were designated as A-H, each cluster (grade) representing a combination of task accomplishments. Higher grades were usually (but not always) associated with patients implementing more difficult tasks. Throughout rehabilitation, the patients' functional grade improved and the distribution of patients with similar functional grades within the total SCIM III score deciles remained stable. CONCLUSIONS: A new classification based on SIS clusters enables a concise description of overall functioning and task accomplishment distribution in patients with SCL. A software tool is used to identify the patients' functional grade. Findings support the stability and utility of the grades for characterizing the patients' functional status.
Assuntos
Atividades Cotidianas/classificação , Avaliação da Deficiência , Traumatismos da Medula Espinal/reabilitação , Adulto , Idoso , Algoritmos , Estudos Transversais , Incontinência Fecal/etiologia , Incontinência Fecal/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quadriplegia/etiologia , Quadriplegia/reabilitação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicaçõesRESUMO
The most common injury in rugby resulting in spinal cord injury (SCI) is cervical facet dislocation. We report on the outcome of a series of 57 patients with acute SCI and facet dislocation sustained when playing rugby and treated by reduction between 1988 and 2000 in Conradie Hospital, Cape Town. A total of 32 patients were completely paralysed at the time of reduction. Of these 32, eight were reduced within four hours of injury and five of them made a full recovery. Of the remaining 24 who were reduced after four hours of injury, none made a full recovery and only one made a partial recovery that was useful. Our results suggest that low-velocity trauma causing SCI, such as might occur in a rugby accident, presents an opportunity for secondary prevention of permanent SCI. In these cases the permanent damage appears to result from secondary injury, rather than primary mechanical spinal cord damage. In common with other central nervous system injuries where ischaemia determines the outcome, the time from injury to reduction, and hence reperfusion, is probably important. In order to prevent permanent neurological damage after rugby injuries, cervical facet dislocations should probably be reduced within four hours of injury.
Assuntos
Vértebras Cervicais , Futebol Americano/lesões , Luxações Articulares/cirurgia , Traumatismos da Medula Espinal/cirurgia , Adolescente , Adulto , Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Excessive pregnancy weight gain is associated with adverse maternal and child health outcomes. Intervention developers have assumed that adopting a healthier diet and increasing physical activity in pregnancy can limit weight gain, but evaluations of such interventions have yielded mixed results. Recent reviews of this literature have not identified defining characteristics of effective interventions. We systematically reviewed 10 published controlled trials of interventions that aimed to reduce gestational weight gain through changes in diet or physical activity. Characteristics of the sample, intervention content and delivery, and methodology were categorized. Meta-analysis showed that, overall, diet and physical activity change was effective in reducing gestational weight gain, but there was considerable heterogeneity in outcomes. Our analysis points to sample characteristics and aspects of intervention design, content, delivery and evaluation which differ between studies and may explain variation in effectiveness. Failure to evaluate changes in behaviour or its psychological determinants, and under-reporting of intervention content, may obscure identification of the processes by which weight change is effected. This limits our ability to discern active intervention ingredients. We suggest that behaviour-based gestational weight gain reduction interventions be more systematically designed, evaluated and reported to build on insights from behavioural science.
Assuntos
Dieta , Atividade Motora , Gravidez , Aumento de Peso , Terapia Comportamental , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Obesidade/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
STUDY DESIGN: Multicenter international cohort study. OBJECTIVE: The objective of this study was to establish target values for Spinal Cord Independence Measure (SCIM) III scoring in rehabilitation for clinically complete spinal cord lesion (SCL) neurological levels. SETTING: In total, 13 spinal cord units in six countries from North America, Europe and the Middle East were taken. METHODS: Total SCIM III scores and gain at discharge from rehabilitation were calculated for SCL levels in 128 patients with American Spinal Injury Association Impairment Scale (AIS) grade A on admission to rehabilitation. RESULTS: Median, quartiles, mean and s.d., values of discharge SCIM III scores and SCIM III gain for the various SCL levels are presented. Total SCIM III scores and gain were significantly correlated with the SCL level (r=0.730, r=0.579, P<0.001). CONCLUSIONS: Calculated discharge SCIM III scores can be used as target values for functional achievements at various neurological levels in patients after AIS A SCL. They are generally, but not always, inversely correlated with SCL level.
Assuntos
Avaliação da Deficiência , Avaliação de Resultados em Cuidados de Saúde/métodos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico , Adulto , Europa (Continente) , Humanos , Cooperação Internacional , Pessoa de Meia-Idade , Oriente Médio , Exame Neurológico , América do Norte , Recuperação de Função Fisiológica/fisiologia , Reprodutibilidade dos Testes , Traumatismos da Medula Espinal/reabilitação , Adulto JovemRESUMO
STUDY DESIGN: A multi-center international cohort study. OBJECTIVE: To evaluate the reliability and validity of the third version of the Spinal Cord Independence Measure (SCIM III), separately for patients with traumatic spinal cord lesions (SCLs). SETTING: A total of 13 spinal cord units in six countries from North America, Europe and the Middle-East. METHODS: SCIM III and Functional Independence Measure (FIM) were assessed for 261 patients with traumatic SCLs, on admission to rehabilitation and before discharge, by two raters. Conventional statistical measures were used to evaluate the SCIM III reliability and validity. RESULTS: In almost all SCIM III tasks, the total agreement between the paired raters was >80%. The κ coefficients were all >0.6 and statistically significant. Pearson's coefficients of the correlations between the paired raters were >0.9, the mean differences between raters were nonsignificant and the intraclass correlation coefficients (ICCs) were ≥ 0.95. Cronbach's α values for the entire SCIM III scale were 0.833-0.835. FIM and SCIM III total scores were correlated (r=0.84, P<0.001). SCIM III was more responsive to changes than FIM. In all subscales, SCIM III identified more changes in function than FIM, and in 3 of the 4 subscales, differences in responsiveness were statistically significant (P<0.02). CONCLUSION: The results confirm the reliability and validity of SCIM III for patients with traumatic SCLs in a number of countries.
Assuntos
Avaliação da Deficiência , Avaliação de Resultados em Cuidados de Saúde/métodos , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/reabilitação , Inquéritos e Questionários/normas , Atividades Cotidianas/classificação , Adulto , Estudos de Coortes , Feminino , Humanos , Vida Independente/normas , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Yolk coelomitis as a result of pre-ovulatory follicular stasis is a common disorder in captive reptiles, especially in captive lizards of various genera. The clinical signs are generally fairly non-specific and diagnosis is based on clinical signs together with most of the common diagnostic modalities. The condition is most likely a husbandry and environment-related reproductive disorder. It has not been reported in wild free-living specimens. This report describes the clinical presentation and post mortem lesions in a white-throated monitor lizard that died during treatment for non-specific clinical signs related to a severe yolk coelomitis.
Assuntos
Gema de Ovo/patologia , Lagartos , Animais , Animais de Zoológico , Evolução Fatal , FemininoRESUMO
OBJECTIVE: To characterize parents' perception of back-transport of very-low-birth-weight (VLBW) infants from a regional referral neonatal intensive care unit (RR-NICU) to a community hospital (CH) for convalescent care. STUDY DESIGN: Mixed methods utilizing parental interview and medical record review. RESULT: Overall, 20% of parents selected the CH to which their child was transferred. Less than half of the parents wanted the transfer. Psychological comfort with the RR-NICU was the most frequently reported reason for opposing transfer. At the time of home discharge, most parents were satisfied with the transfer and felt prepared to care for their infant at home. CONCLUSION: Parents want their infants closer to home, but are worried about the unknown. They are willing to forfeit autonomy in decision-making regarding the site of convalescent care. Parents need better preparation for transfer. Including them in an advisory group that reviews transfer policies could ameliorate the transition.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Recém-Nascido de muito Baixo Peso , Pais , Satisfação do Paciente , Encaminhamento e Consulta , Feminino , Hospitais Comunitários , Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Entrevistas como Assunto , Masculino , Transferência de PacientesRESUMO
OBJECTIVES: To evaluate the relationship between fetal Doppler parameters, biophysical profile score (BPP) and neurodevelopmental delay at 2 years of corrected age in infants who had been growth-restricted in utero. METHODS: This was a prospective observational study including 113 pregnancies complicated by intrauterine growth restriction (IUGR) (abdominal circumference<5th percentile and elevated umbilical artery (UA) pulsatility index). The relationships of UA, middle cerebral artery and ductus venosus (DV) Doppler features, BPP, birth acidemia (artery pH<7.0+/or base deficit>12), gestational age at delivery, birth weight and neonatal morbidity (i.e. bronchopulmonary dysplasia, >Grade 2 intraventricular hemorrhage, or necrotizing enterocolitis) with a 2-year neurodevelopmental delay were evaluated. Best Beginnings Developmental Screen, Bayley Scale of Infant Development II (BSID) and Clinical Adaptive/Clinical Linguistic Auditory Milestone Stage were used. BSID<70, cerebral palsy, abnormal tone, hearing loss and/or blindness defined neurodevelopmental delay. RESULTS: Seventy-two of the 113 pregnancies completed assessment; there were 10 stillbirths, 19 neonatal deaths, three infant deaths and nine pregnancies with no follow-up. Twenty fetuses (27.8%) had UA reversed end-diastolic velocity (REDV), 34 (47.2%) abnormal DV Doppler features and 31 (43.1%) an abnormal BPP. Median gestational age at delivery and birth weight were 30.4 weeks and 933 g, respectively. Twelve infants had acidemia and 28 neonatal morbidity. There were 38 (52.8%) infants with neurodevelopmental delay, including 37 (51.4%) with abnormal tone, 20 (27.8%) with speech delay, 23 (31.9%) with an abnormal neurological examination, eight (11.1%) with a hearing deficit and six (8.3%) with cerebral palsy. Gestational age at delivery was associated with cerebral palsy (r2=0.52, P<0.0001; 92% sensitivity and 83% specificity for delivery at <27 weeks). UA-REDV was associated with global delay (r2=0.31, P=0.006) and birth weight with neurodevelopmental delay (r2=0.54, P<0.0001; 82% sensitivity and 64% specificity for BW<922 g). CONCLUSIONS: Although UA-REDV is an independent contributor to poor neurodevelopment in IUGR no such effect could be demonstrated for abnormal venous Doppler findings or BPP. Gestational age and birth weight remain the predominant factors for poor neurodevelopment in growth-restricted infants.
Assuntos
Deficiências do Desenvolvimento/etiologia , Retardo do Crescimento Fetal/diagnóstico por imagem , Insuficiência Placentária/diagnóstico por imagem , Artérias Umbilicais/diagnóstico por imagem , Adolescente , Adulto , Cegueira/embriologia , Velocidade do Fluxo Sanguíneo/fisiologia , Paralisia Cerebral/embriologia , Pré-Escolar , Feminino , Monitorização Fetal , Perda Auditiva/embriologia , Humanos , Lactente , Recém-Nascido , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal , Adulto JovemRESUMO
PURPOSE: To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability and validity in a multi-center cohort study. METHOD: Four hundred and twenty-five patients with spinal cord lesions from 13 spinal cord units in six countries from three continents were assessed with SCIM III and the Functional Independence measure (FIM) on admission to rehabilitation and before discharge. RESULTS: Total agreement between raters was above 80% in most SCIM III tasks, and all kappa coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.9, and intraclass correlation coefficients were above 0.94. Cronbach's alpha was above 0.7. The coefficient of Pearson correlation between FIM and SCIM III was 0.790 (P<0.01). SCIM III was more responsive to changes than FIM in the subscales of Respiration and sphincter management and Mobility indoors and outdoors. CONCLUSIONS: The results support the reliability and validity of SCIM III in a multi-cultural setup. Despite several limitations of the study, the results indicate that SCIM III is an efficient measure for functional assessment of SCL patients and can be safely used for clinical and research trials, including international multi-center studies.