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1.
Klin Padiatr ; 231(6): 304-312, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31724139

RESUMO

BACKGROUND: Physiotherapy, including vibration-assisted therapy, has been proven to be effective for patients with ataxic cerebral palsy. Herewith, we studied the effect of a functional, goal-oriented interval rehabilitation program, including vibration-assisted home-training on the motor function of children with congenital ataxias. PATIENTS: 45 children (mean age 7.7 years, SD 4.70) with ataxia, having received a 6-month home-based side-alternating vibration-assisted therapy combined with intensive, goal-oriented, functional rehabilitation intervals, were included in the study, classified according to the progressive or non-progressive ataxia character. METHOD: Retrospective analysis of the prospectively collected data of the registry of the Cologne rehabilitation program "Auf die Beine". Motor abilities have been assessed prior to the intervention (M0), after 6 months of home-training (M6) as well as in a follow-up 6 months later (M12). We performed a gait analysis, a 1-minute walking test (1-MWT), and the Gross Motor Function Measure (GMFM-66). RESULTS: The GMFM-66 improvement (M6-M0 vs. M12-M6) was statistically significant with median improvement of 2.4 points (non-progressive) and 2.9 points (progressive) respectively, and clinically relevant. The 1-MWT improvement was statistically significant and clinically relevant for non-progressive ataxia. CONCLUSION: The intensive training, including vibration-assisted therapy significantly improved the motor function of children with ataxia. Six months later the skills were preserved in children with progressive ataxia and could be further developed in non-progressive forms.


Assuntos
Ataxia/reabilitação , Paralisia Cerebral/reabilitação , Modalidades de Fisioterapia , Vibração/uso terapêutico , Criança , Feminino , Humanos , Masculino , Destreza Motora , Estudos Retrospectivos , Resultado do Tratamento
2.
Med Decis Making ; 39(7): 781-795, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31423892

RESUMO

Background. Inappropriate prescribing of antibiotics, which is common in pediatric care, is a key driver of antimicrobial resistance. To mitigate the development of resistance, antibiotic stewardship programs often suggest the inclusion of feedback targeted at individual providers. Empirically, however, it is not well understood how feedback affects individual physicians' antibiotic prescribing decisions. Also, the question of how physicians' characteristics, such as clinical experience, relate to antibiotic prescribing decisions and to responses to feedback is largely unexplored. Objective. To analyze the causal effect of descriptive expert feedback (and individual characteristics) on physicians' antibiotic prescribing decisions in pediatrics. Design. We employed a randomized, controlled framed field experiment, in which German pediatricians (n=73) decided on the length of first-line antibiotic treatment for routine pediatric cases. In the intervention group (n=39), pediatricians received descriptive feedback in form of an expert benchmark, which allowed them to compare their own prescribing decisions with expert recommendations. The recommendations were elicited in a survey of pediatric department directors (n=20), who stated the length of antibiotic therapies they would choose for the routine cases. Pediatricians' characteristics were elicited in a comprehensive questionnaire. Results. Providing pediatricians with expert feedback significantly reduced the length of antibiotic therapies by 10% on average. Also, the deviation of pediatricians' decisions from experts' recommendations significantly decreased. Antibiotic therapy decisions were significantly related to pediatricians' clinical experience, risk attitudes, and personality traits. The effect of feedback was significantly associated with physicians' experience. Conclusion. Our results indicate that descriptive expert feedback can be an effective means to guide pediatricians, especially those who are inexperienced, toward more appropriate antibiotic prescribing. Therefore, it seems to be suitable for inclusion in antibiotic stewardship programs.

3.
Child Obes ; 15(7): 476-484, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31274333

RESUMO

Background: Obesity was often associated with low high-density lipoprotein (HDL) cholesterol concentration, which is an established cardiovascular risk factor. Objectives: To evaluate the association of HDL-cholesterol concentration with fat and muscle mass in children and adolescents. Methods: Data of the National Health and Nutrition Examination Survey (1999-2004) were used to estimate fat and muscle mass by dual-energy X-ray absorptiometry (DXA) of the participants who had also an examination of their lipid profiles. Fat mass was assessed by DXA-determined fat mass index (FMI). Muscle mass was operationalized by appendicular lean mass index (LMI). Low HDL-cholesterol concentration was defined as <40 mg/dL. Results: For the evaluation of the association of HDL-cholesterol concentration with FMI and LMI Z-scores, the data of 6288 children and adolescents (age 8-19 years) (2535 females) were eligible. In the study population, the prevalence of low HDL-cholesterol concentration increased with rising FMI and appendicular LMI Z-scores. Conclusions: The study results suggested that there is a counterintuitive, inverse association of muscle mass and HDL-cholesterol concentration.

4.
J Nutr ; 149(10): 1863-1868, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31204786

RESUMO

BACKGROUND: Densitometrically measured lean body mass (LBM) is often used to quantify skeletal muscle mass in children with cerebral palsy (CP). Since LBM depends on the individual's height, the evaluation of $\frac{{{\rm{LBM}}}}{{heigh{t^2}}}\ $ (lean BMI) is often recommended. However, LBM includes not only skeletal muscle mass but also the mass of skin, internal organs, tendons, and other components. This limitation applies to a far lesser extent to the appendicular lean mass index (LMIapp). OBJECTIVES: The aim of the study was to evaluate skeletal muscle mass in children with CP using total lean BMI (LMItot) and LMIapp. METHODS: The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation program. In total, 329 children with CP [148 females; Gross Motor Function Classification Scale (GMFCS) I, 32 children; GMFCS II, 73 children; GMFCS III, 133 children; GMFCS IV, 78 children; and GMFCS V, 13 children] were eligible for analysis. The mean age was 12.3 ± 2.75 y. Pediatric reference centiles for age-adjusted LMIapp were generated using data from NHANES 1999-2004. Low skeletal muscle mass was defined as a z score for DXA determined LMItot and LMIapp less than or equal to -2.0. RESULTS: The z scores for LMIapp were significantly lower than LMItot in children with CP, GMFCS levels II-V (P < 0.001), with the exception of GMFCS level I (P = 0.121), where no significant difference was found. The prevalence of low LMItot (16.1%; 95% CI: 16.1, 20.1%) was significantly lower (P < 0.001) than the prevalence of LMIapp (42.2%; 95% CI: 36.9, 47.9%) in the study population. CONCLUSIONS: The prevalence of low skeletal muscle mass in children with CP might be underestimated by LMItot. LMIapp is more suitable for the evaluation of skeletal muscle mass in children with CP.

5.
Dev Neurorehabil ; : 1-9, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31177878

RESUMO

Background: Children with cerebral palsy (CP) show age-driven development and individual fluctuations in walking capacity. Aim: 1. To precisely quantify 1MWT changes in children with CP, GMFCS level 1 and 2, generating 1MWT percentiles, depicting expected development over 6 months; 2. to assess the effect of a 6-month rehabilitation using whole-body vibration (WBV). Methods: Retrospective data analysis in 210 children with CP, GMFCS 1 and 2 who received standardized rehabilitation (DRKS00011331). 1MWT was assessed before (M0) and after treatment (M6), and at a 6-month follow-up (M12). Centiles were created using the lambda-mu-sigma method. Cohen's d was used to assess effect size. Results: We created 1MWT percentiles using data of all 210 children (M0 data). A small treatment effect size (d = 0.46) was found (M6 and M12 data). Conclusions: Using the generated centiles clinicians may monitor 1MWT changes over 6 months. Combining WBV and conventional physiotherapy may improve 1MWT in children with CP. Abbreviations: 1MWT: One-Minute Walk Test; 6MWT: Six-Minute Walk Test; CP: Cerebral palsy; ES: effect size; GMFCS: Gross Motor Function Classification System; GMFM-66: Gross Motor Function Measure 66; LOESS: Locally Estimated Scatterplot Smoothing; LMS: lambda-mu-sigma; SD: standard deviation; WBV: whole-body-vibration.

6.
Acta Paediatr ; 108(11): 1972-1977, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31074050

RESUMO

AIM: Hearing loss in infants is often diagnosed late, despite universal screening programmes. Risk factors of hearing impairment in high-risk neonates, identified from population-based studies, can inform policy around targeted screening. Our aim was to determine the prevalence and the risk factors of hearing loss in a high-risk neonatal population. METHODS: This was a retrospective cohort study of neonates hospitalised at the University Hospital Cologne, Germany from January 2009 to December 2014 and were part of the newborn hearing screening programme. Multivariable regression analyses using the lasso approach was performed. RESULTS: Data were available for 4512 (43% female) neonates with a mean gestational age at birth of 35.5 weeks. The prevalence of hearing loss was 1.6%, and 42 (0.9%) neonates had permanent hearing loss. Craniofacial anomalies, hyperbilirubinaemia requiring exchange transfusion, oxygen supplementation after 36 weeks of gestation and hydrops fetalis showed associations with permanent hearing loss. CONCLUSION: Our findings of risk factors for hearing loss were consistent with other studies. However, some commonly demonstrated risk factors such as perinatal infections, meningitis, sepsis and ototoxic drugs did not show significant associations in our cohort. Targeted screening based on risk factors may help early identification of hearing loss in neonates.

7.
J Child Health Care ; 23(3): 343-357, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31132868

RESUMO

Children's rights to autonomy of choice are differently expressed throughout Europe. We explored differences regarding expressions of respect for children's autonomy throughout Europe, using the procedure of human papillomavirus (HPV) vaccination offer as indicator. We used a mixed methods approach, utilizing an expert survey within the frame of "Models of Child Health Appraised" (MOCHA), among all 30 European Union (EU) and European Economic Area states. A questionnaire was designed using vignettes regarding the vaccine provision. Thirty MOCHA country agents were invited to respond from June 2017 to April 2018. In total, 28 country agents responded. We studied the following themes: (i) provision of informed consent, (ii) parental and medical paternalism, (iii) relevance of the child's chronological age or maturity, and (iv) vaccination programs targeting boys. These are being handled differently across the region. We explored associations of these implemented practices with the national vaccine coverage rate across Europe. We used the processes of HPV vaccination to study child's autonomy, the paradigm change toward libertarian paternalism and issues of sex-equity. Interestingly, greater respect for children's autonomy tends to be associated with medium or high vaccination coverage rates and lower respect with lower rates. Respect and empowerment seem to have practical as well as moral benefits. Identifying and transferring the most suitable ethical approaches is crucial and should be strengthened.

8.
Eur J Pediatr ; 178(6): 811-822, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30877384

RESUMO

The purpose of this study was to create growth-percentiles for Caucasian children with cerebral palsy (CP). The studied parameters were height and age. In a retrospective analysis, we converted measurements collected in our center to create disorder-specific percentiles of normative data. Patients were stratified due to sex (male and female) and to mobility levels using the gross motor function classification system (GMFCS) (A = walking; GMFCS I-III, B = non walking; GMFCS IV-V) into four groups. In total, 2363 measurements in patients 0-18 years were collected. The mean age for group "Am" was 6.8 years (n = 862), group "Bm" 7.6 years (n = 563), group "Af" 7.7 years (n = 600), and group "Bf" 8.2 years (n = 366). The created percentiles for all groups were below the reference percentiles for healthy Caucasian children (KiGGS). The median curve for children with GMFCS levels I-III is slightly above the 3rd percentile, whereas the 50th percentile for GMFCS levels IV-V is mostly below the 3rd KiGGS centile.Conclusion: In conclusion, children with cerebral palsy are smaller than healthy children. The difference between 50th percentile of CP patients compared to healthy children supports the need for the use of disorder-specific growth charts. Those charts can help clinicians differentiate growth disorders in patients with CP. What is Known: • Children with cerebral palsy are shorter than healthy children and height is influenced by level of ambulation. • Currently, only reference percentiles of American children with mixed ethical backgrounds are available to evaluate growth. What is New: • This paper presents disorder-specific reference percentiles for longitudinal growth of Caucasian children with cerebral palsy depending on motor function. • These percentiles allow to asses longitudinal growth in children with cerebral palsy to detect other additional diseases impairing growth.


Assuntos
Paralisia Cerebral/fisiopatologia , Desenvolvimento Infantil , Gráficos de Crescimento , Caminhada , Adolescente , Adulto , Estatura , Estudos de Casos e Controles , Criança , Pré-Escolar , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
9.
Dev Med Child Neurol ; 61(10): 1168-1174, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30927269

RESUMO

AIM: To evaluate the diagnostic performance of anthropometric indicators to identify undernutrition in children with cerebral palsy (CP). METHOD: The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation program. Undernutrition was defined as a z-score for dual-energy X-ray absorptiometry (DXA) determined body fat percentage less or equal to -2.0. The cut-off values for body mass index (BMI) of the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), and the cut-off values for BMI and height for age of the Robert Koch Institut (RKI) were evaluated. RESULTS: In total, 329 children with CP (181 males, 148 females, Gross Motor Function Classification System levels I-V) were eligible for analysis. The mean age was 12 years 4 months (SD 2y 9mo). The BMI cut-off values showed the following sensitivities and specificities: WHO, sensitivity of 0.474 (95% confidence interval [CI] 0.244-0.711), specificity of 0.897 (95% CI: 0.857-0.928); CDC, sensitivity of 0.632 (95% CI: 0.384-0.837), specificity of 0.819 (95% CI: 0.772-0.861); RKI, sensitivity of 0.789 (95% CI: 0.544-0.939), specificity of 0.732 (95% CI: 0.679-0.781); and for height for age, sensitivity of 0.263 (95% CI: 0.091-0.512), specificity of 0.668 (95% CI: 0.612-0.720). INTERPRETATION: BMI had a high specificity but very low sensitivity in identifying undernutrition in children with CP. Z-scores for height for age had even lower specificity and sensitivity and seemed not to be appropriate for predicting undernutrition in children with CP. WHAT THIS PAPER ADDS: Body mass index (BMI) z-scores had a high specificity but very low sensitivity in identifying undernutrition in children with cerebral palsy (CP). Height z-scores were not appropriate for predicting undernutrition in children with CP. Undernutrition assessed by BMI was overestimated in children with CP versus when assessed by dual-energy X-ray absorptiometry (DXA).


Assuntos
Paralisia Cerebral/complicações , Transtornos da Nutrição Infantil/diagnóstico , Antropometria , Índice de Massa Corporal , Criança , Transtornos da Nutrição Infantil/complicações , Feminino , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade
10.
Artigo em Alemão | MEDLINE | ID: mdl-30820615

RESUMO

Vaccination recommendations of public health institutes and personal decisions to get vaccinated cannot be grounded on scientific evidence alone. If and under what conditions vaccinations should take place can only be decided for concrete contexts and accompanied by justification processes applying ethical norms and values.This paper offers a normative framework for vaccination ethics. It reflects the principles and argumentation of individual and social ethics and discusses public health ethical tools available in the literature. The specific challenges of autonomous and health literate behavior from a justice perspective are examined. Also discussed is the position of the German Standing Committee on Vaccination (STIKO).


Assuntos
Sarampo/prevenção & controle , Princípios Morais , Autonomia Pessoal , Justiça Social , Vacinação/ética , Alemanha , Saúde Pública
11.
J Clin Densitom ; 2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-30827819

RESUMO

BACKGROUND: Body fat percentage (BF%), fat mass index (FMI), and lean body mass index (LBMI) are often used to evaluate the nutritional status of children. Until now, no pediatric FMI reference centiles are applicable for GE Healthcare Lunar DXA systems. The aim of the study was to generate age-specific BF%, FMI, and LBMI references centiles for GE Healthcare Lunar DXA systems. METHODOLOGY: Published values from the National Health and Nutrition Examination Survey 1999-2004 (age 8-20 years) were used to generate the reference centiles for the non-Hispanic black, non-Hispanic white, and Mexican American NHANES population. The LMS and LMSP methods were used to generate the reference centiles. RESULTS: Data of 2433 non-Hispanic black children (972 females), 2026 non-Hispanic white children (873 females), and 2547 Mexican American children (1010 females) were eligible. CONCLUSIONS: We presented age-specific reference centiles for BF%, FMI, and LBMI for children and adolescents which were ethnicity specific (non-Hispanic black, non-Hispanic white, and Mexican American) and directly applicable to Prodigy and iDXA GE Healthcare Lunar systems with software version 14.0. We proposed the use of BF%, FMI, and LBMI together to evaluate nutritional status in children.

12.
Inquiry ; 56: 46958019833869, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30845863

RESUMO

To adopt and implement innovative good practices across the European Union requires developing policies for different political and constitutional contexts. Health policies are mostly decided by national political processes at different levels. To attain effective advice for policy making and good practice exchange, one has to take different models of governance for health into account. We aimed to explore which concepts of governance research are relevant for implementing child health policies in a European Union context. We argue that taking into account the insights of good intersectoral and multilevel governance in research and practice is essential and promising for future analyses. These governance concepts help to understand what actors and institutions are potentially of relevance for developing and implementing child-centric health care approaches not only within health care but also outside health care. The framework we developed has the potential to advise on and thus support effectively the spreading and implementation of good practices of child-centric health policy approaches across the European Union. With this heuristic framework, the variety of relevant stakeholders and institutions can better be mapped and taken into account in implementation processes. Also, the normative side-particularly stressing values that make governance "good governance"-is to be taken into account.


Assuntos
Saúde da Criança , Política de Saúde , Heurística , Formulação de Políticas , Atenção Primária à Saúde , Criança , Tomada de Decisões , União Europeia , Humanos , Política
13.
Anthropol Anz ; 76(1): 15-28, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30648187

RESUMO

Growth references are used worldwide. The objective of monitoring growth of apparently healthy children is to identify treatable diseases early. Children with compromised growth, e.g. due to genetic disease, are assessed and compared to common growth references based on healthy children. But children with genetic diseases often fulfil the most referral criteria for further evaluation already due to their underlying disease. So, only the height deflection criteria (excessive decrease in height Z-score over time) seem reasonable in these children. But it is unclear whether one should expect these children to follow the standard growth references. The aim of the study was to develop a tool for evaluating the applicability of common growth standards for growth monitoring of children with specific genetic disease. We introduced the percentile parallelism test (PPT). This novel test assesses whether a height deflection is to be expected due to the underlying specific genetic disease, or if it is a sign of an additional disease. For illustration, the PPT was applied to a cohort of boys (n = 28, age 2-16 years) with osteogenesis imperfecta type IV. Boys with osteogenesis imperfecta showed a significant (p = 0.001) higher variability of their age specific height distribution than their healthy peers. Therefore, the commonly proposed cutoffs for the height deflection criteria had to be adjusted by the factor of 1.342 (95%CI 1.337-1.347). The PPT might improve the growth monitoring of children with genetic diseases, preventing them from unnecessary diagnostics.


Assuntos
Estatura , Gráficos de Crescimento , Osteogênese Imperfeita , Índice de Massa Corporal , Peso Corporal , Criança , Humanos , Masculino , Osteogênese Imperfeita/complicações
14.
J Eval Clin Pract ; 25(1): 78-87, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30028064

RESUMO

RATIONALE, AIMS, AND OBJECTIVES: Children with cerebral palsy (CP) can show an increase in gross motor function until the age of 9 to 10 years under the standard of care. Additionally, the motor development can have large individual fluctuations. Therefore, in clinical setting, it is not trivial to estimate the effect of an additional therapeutic intervention at this age interval. The study aim was to develop a method which allows quantification of the gross motor function changes over 6 months of the individual child with CP. METHOD: The present study was a single center retrospective analysis. Data were collected in children with CP who participated in a rehabilitation program between 2006 and 2016. The gross motor function of the children was measured with the Gross Motor Function Measurement (GMFM-66). Reference centiles for the GMFM-66 were created with data before starting the rehabilitation program. The variability of the evolution of the GMFM-66 was assessed with data at the start and the end of a 6-month observational phase of standard of care. RESULTS: In total, the GMFM-66 data of 919 children before starting the rehabilitation program were available (age 6.49 ± 2.49 years, GMFCS-level I-V). For 515 study participants (6.76 ± 2.30 years, GMFCS-level I-V), data were also available at the start and the end of a 6-month observational phase. CONCLUSIONS: The presented method helps to guide the clinician to track the individual patient's gross motor development and assess the additional effect of an additionally applied intervention while taking into account the expected progression of gross motor function under standard of care.


Assuntos
Paralisia Cerebral , Desenvolvimento Infantil , Monitorização Fisiológica/métodos , Destreza Motora , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/terapia , Criança , Pré-Escolar , Avaliação da Deficiência , Progressão da Doença , Feminino , Alemanha , Humanos , Masculino , /normas , Modalidades de Fisioterapia , Estudos Retrospectivos , Índice de Gravidade de Doença
15.
Acta Paediatr ; 108(2): 245-252, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29953663

RESUMO

AIM: This study assessed the cost consciousness of nurses and physicians in German neonatal intensive care units (NICUs) and identified factors affecting cost consciousness. METHODS: This study on cost consciousness was part of the German Safety4NICU study, a cross-sectional survey conducted from 2015 to 2016. All 224 German NICUs were invited to take part in the survey, and written consent was obtained from the leading physicians and nurses. The various professions were addressed via specific questionnaires. The cost survey tool identified the participants' responsibility and their desired focus on cost consciousness. RESULTS: Of the 1406 nurses and 496 physicians from 84 NICUs, 64.4% of the nurses and 62.5% of the physicians agreed that they shared responsibility for controlling costs. The computed score to define the overall cost consciousness level was 4.47. We identified a significantly positive association between cost consciousness, longer total clinical work experience and a decreased number of NICU intensive care beds. Increased cost consciousness was found in both men and physicians. Other hospital characteristics did not have an effect. CONCLUSION: Neonatology is a medical speciality where the tension between economics and the benefit of patients is extremely high. We found a moderate level of cost consciousness among NICU physicians and nurses.

16.
Gesundheitswesen ; 81(7): e121-e126, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28697522

RESUMO

INTRODUCTION: Childhood immunisation against seasonal influenza promises to reduce the burden of disease through herd immunity. The option of intranasal vaccination seemed to offer a more acceptable vaccination for children, as they are perceived to be less invasive. Yet, intranasal vaccines have been recently proven not to be as effective as presumed. In Germany, contradictory recommendations of the Standing Committee on Vaccination (STIKO) first, to use and then, in October 2016, not use these vaccines have been issued for the 2016-2017 season, whereas recommendations not to use them were already issued in the USA (CDC, ACIP). This controversy spurs the discussion of immunisation programmes for children again. Despite studies discussing the effectiveness of a comprehensive immunisation programme targeting children also in the German and wider European context, an accompanying ethical discussion is missing. METHODOLOGY: We discuss several policy options from different key ethical perspectives that are widely used in public health: if seasonal influenza vaccination should be intensively offered to or even made mandatory for children to decrease the societal burden of the disease. RESULTS: Various ethical perspectives reflect the question how to balance individual autonomy, personal benefit and population benefit differently. DISCUSSION: A convincing justification for suggestions on immunisation policies has to balance norms anchored in different ethical theories. There are good reasons to offer immunisation programmes against seasonal influenza to children, using a voluntary, possibly incentive-based approach.


Assuntos
Vacinas contra Influenza , Influenza Humana , Criança , Efeitos Psicossociais da Doença , Alemanha , Humanos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Estações do Ano , Vacinação/ética
17.
Pediatr Obes ; 14(2): e12494, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30590878

RESUMO

BACKGROUND: Waist circumference (WC) and z scores of body mass index (BMI) are commonly used to predict childhood obesity, although BMI and WC have a limited sensitivity. OBJECTIVES: To generate an artificial neural network (ANN), using the input parameters age, height, weight, and WC, to predict excess body fat in children. METHODS: As part of the National Health and Nutrition Examination Survey (NHANES) study, in the years 1999 to 2004, the body fat percentage of randomly selected Americans from 8 to 19 years were measured using whole-body dual energy X-ray absorptiometry (DXA) scans. Excess body fat was defined as a body fat percentage ≥ 85th centile. RESULTS: The data of 1999 children (856 female) were eligible. In females, the sensitivity of the BMI, WC, and ANN approaches to predict excess body fat were 0.751 (95% CI, 0.730-0.771), 0.523 (0.487-0.559), and 0.782 (0.754-0.810), respectively. In males, the sensitivity of the BMI, WC, and ANN approaches to predict excess body fat were 0.721 (95% CI, 0.699-0.743), 0.572 (0.549-0.594), and 0.795 (0.768-0.821). CONCLUSIONS: Only in boys, the diagnostic performance in identifying excess body fat was better by using an ANN than by applying BMI and WC z scores. In girls, the ANN and BMI z scores performed comparable and significantly better than WC z scores.


Assuntos
Absorciometria de Fóton/métodos , Tecido Adiposo/diagnóstico por imagem , Obesidade Pediátrica/diagnóstico , Adolescente , Índice de Massa Corporal , Peso Corporal , Criança , Feminino , Humanos , Masculino , Inquéritos Nutricionais , Autoimagem , Sensibilidade e Especificidade , Circunferência da Cintura , Adulto Jovem
18.
Arch. argent. pediatr ; 116(3): 401-408, jun. 2018. ilus, tab
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1038425

RESUMO

Los cambios del nuevo Código Civil y Comercial de la Argentina impulsa el desarrollo de la autonomía en niños y adolescentes. En este trabajo, estructuramos un modelo que describe la autonomía en la atención de la salud infantil. Hicimos un análisis bibliográfico enfocado en I) concepto de autonomía relacionado con el valor absoluto del individuo autónomo y II) el proceso de desarrollo de toma idónea de decisiones en función de la edad. Resumimos nuestros hallazgos mediante el desarrollo de un modelo conceptual en el niño, el pediatra y los padres. La relación pediatra-niño se fundamenta en formas de orientación y cooperación con diversos niveles de actividad y pasividad. La autoridad de los padres influye sobre el grado de autonomía en función del nivel de respeto e igualdad moral del niño. Al aplicar el modelo para facilitar el diálogo entre pediatras, niños, padres y otros, se considerarán las circunstancias contextuales, existenciales, conceptuales y socio-éticas.


The changes initiated by the new National Civil and Commercial Code in Argentina underline the pediatric task to empower children's and adolescents' developing autonomy. In this paper, we have framed a model describing autonomy in child healthcare. We carried out a literature review focusing on i) the concept of autonomy referring to the absolute value of the autonomous individual, and ii) the age-driven process of competent decisionmaking development. We summarized our findings developing a conceptual model that includes the child, the pediatrician and the parents. The pediatrician-child relationship is based on different forms of guidance and cooperation, resulting in varying levels of activity and passivity. Parental authority influences the extent of autonomy, based on the level of respect of the child's moral equality. Contextual, existential, conceptual, and social-ethical conditions shall be considered when applying the model to facilitate dialogue between pediatricians, children, parents and other actors.


Assuntos
Humanos , Criança , Adolescente , Pediatria , Saúde da Criança , Adolescente , Autonomia Pessoal
19.
Arch Argent Pediatr ; 116(3): e401-e408, 2018 06 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29756714

RESUMO

The changes initiated by the new National Civil and Commercial Code in Argentina underline the pediatric task to empower children's and adolescents' developing autonomy. In this paper, we have framed a model describing autonomy in child healthcare. We carried out a literature review focusing on i) the concept of autonomy referring to the absolute value of the autonomous individual, and ii) the age-driven process of competent decisionmaking development. We summarized our findings developing a conceptual model that includes the child, the pediatrician and the parents. The pediatricianchild relationship is based on different forms of guidance and cooperation, resulting in varying levels of activity and passivity. Parental authority influences the extent of autonomy, based on the level of respect of the child's moral equality. Contextual, existential, conceptual, and socialethical conditions shall be considered when applying the model to facilitate dialogue between pediatricians, children, parents and other actors.


Assuntos
Tomada de Decisões , Assistência à Saúde/organização & administração , Autonomia Pessoal , Adolescente , Argentina , Criança , Serviços de Saúde da Criança/ética , Serviços de Saúde da Criança/organização & administração , Assistência à Saúde/ética , Humanos , Modelos Teóricos , Relações Pais-Filho , Pais , Pediatras/ética , Pediatras/organização & administração , Pediatria/ética , Pediatria/organização & administração , Relações Médico-Paciente
20.
Dev Med Child Neurol ; 60(7): 680-686, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29512149

RESUMO

AIM: To assess the diagnostic performance of body mass index (BMI) cut-off values according to recommendations of the World Health Organization (WHO), the World Obesity Federation (WOF), and the German Society for Adiposity (DAG) to identify excess body fat in children with cerebral palsy (CP). METHOD: The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation programme. Excess body fat was defined as a body fat percentage above the 85th centile assessed by dual-energy X-ray absorptiometry. RESULTS: In total, 329 children (181 males, 148 females) with CP were eligible for analysis. The mean age was 12 years 4 months (standard deviation 2y 9mo). The BMI cut-off values for 'overweight' according to the WHO, WOF, and DAG showed the following sensitivities and specificities for the prediction of excess body fat in our population: WHO: sensitivity 0.768 (95% confidence interval [CI] 0.636-0.870), specificity 0.894 (95% CI 0.851-0.928); WOF: sensitivity 0.696 (95% CI 0.559-0.812), specificity 0.934 (95% CI 0.898-0.960); DAG: sensitivity 0.411 (95% CI 0.281-0.550), specificity 0.993 (95% CI 0.974-0.999). INTERPRETATION: Body mass index showed high specificity, but low sensitivity in children with CP. Thus, 'normal-weight obese' children with CP were overlooked, when assessing excess body fat only using BMI. WHAT THIS PAPER ADDS: Excess body fat in children with cerebral palsy (CP) is less common than previously reported. Body mass index (BMI) had high specificity but low sensitivity in detecting excess body fat in children with CP. BMI evaluation criteria of the German Society for Adiposity could be improved in children with CP.


Assuntos
Tecido Adiposo/patologia , Índice de Massa Corporal , Paralisia Cerebral/diagnóstico , Obesidade/diagnóstico , Sobrepeso/diagnóstico , Absorciometria de Fóton , Adiposidade , Adolescente , Paralisia Cerebral/epidemiologia , Criança , Feminino , Humanos , Masculino , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Estudos Retrospectivos , Sensibilidade e Especificidade
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