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Rev. latinoam. cienc. soc. niñez juv ; 17(2): 127-147, jul.-dic. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1043046


Resumen (analítico) La investigación tiene como objetivo identificar los principales problemas de acceso a los servicios de salud de niños y niñas con diversidad funcional en América Latina. Se trata de una revisión sistemática. Se desarrollaron estrategias detalladas para la búsqueda individual en Health, Redalyc, Medline y SciELO entre mayo y junio de 2018. Se incluyeron artículos originales publicados entre enero 2013- julio 2018 en portugués, inglés o español. Se realizaron análisis descriptivos para la categorización de los estudios. Se identificaron 9 artículos, todos transversales de diseño descriptivo. A partir de los resultados obtenidos, quedó evidente que las dificultades de acceso a los servicios de salud están asociadas a la mayor vulnerabilidad a factores demográficos, socioeconómicos, siendo necesario traspasar las barreras existentes a través de la creación y efectividad de políticas públicas que garanticen acceso a la salud.

Abstract (analytical) The research aims to identify the main problems in terms of access to health services for children with disabilities in Latin America. This is a systematic review that involved detailed individual search strategies for Bireme, Redalyc, Medline and SciELO between May and June 2018. Original articles that were published between January 2013 and July 2018 in Portuguese, English and Spanish were reviewed. Descriptive analysis was categorized out to categorize the studies that were reviewed. A total of 9 articles were identified, all with a cross-cutting descriptive design. From the results obtained, it was evident that the difficulties involved in access to health services for this population are associated with greater vulnerability in terms of demographic and socioeconomic factors. It is necessary to overcome existing barriers through the creation and implementation of public policies that guarantee access to health.

Resumo (analítico) A investigação tem como objetivo identificar os principais problemas de acesso aos serviços de saúde de crianças com diversidade funcional na América Latina. Se trata de uma revisão sistemática, onde foram desenvolvidas estratégias detalhadas de busca individual para Bireme, Redalyc, Medline e SciELO entre maio e junho de 2018. Foram incluídos artigos originais publicados entre janeiro de 2013 a julho de 2018 nos idiomas português, inglês ou espanhol. Foram feitas análises descritivas para a categorização dos estudos. Foram identificados 9 artigos, todos transversais de desenho descritivo. A partir dos resultados obtidos, ficou evidente que as dificuldades de acesso aos serviços de saúde estão associadas a maior vulnerabilidade aos fatores demográficos e socioeconômicos sendo necessário traspassar as barreiras existentes através da criação e efetivação de políticas públicas que garantam acesso à saúde.

Saúde da Criança , Crianças com Deficiência
J Law Med ; 26(4): 874-895, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31682365


Internationally, profoundly disabled children have received growth attenuation treatment to allow their parents to continue to care for them as they mature into adulthood. This article considers how the Family Court of Australia might approach this topic. It assumes that parents wishing to attenuate the linear growth of their child require an order from the Family Court under its welfare jurisdiction. This assumption is made because of the parents' conflict of interests; the treatment's irreversible nature; and the fact that it is sought for non-Gillick competent children. This article highlights the view that there are concerns about how the Court, given its adversarial nature and current approach to medical decisions, will determine whether this treatment is in a child's best interests. It concludes that a federally funded interdisciplinary administrative panel is better positioned to assess and decide each application on a case-by-case basis.

Crianças com Deficiência , Seguridade Social/legislação & jurisprudência , Adulto , Austrália , Criança , Tomada de Decisões , Humanos , Pais
J Indian Soc Pedod Prev Dent ; 37(3): 237-244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31584022


Background: The purpose of the present study was to resolve whether caregiving for a child with disability influences the physical and mental health of the caregivers and whether stress is related to the quality of life of the caregivers. Methods: The Parental Stress Scale questionnaire for the assessment of parental stress and the Short Form-12 version 2 questionnaire for the assessment of physical and mental health quality of life were distributed among 69 parents of developmentally disabled children and 137 parents of healthy children (control group). Various sociodemographic factors were also included. Results: A significant difference was seen between the two groups in terms of employment, presence of disabled sibling, smoking, and physical activity. Parents of developmentally disabled children had significantly higher stress levels and worse mental health-related quality of life. Overall physical health quality of life was similar between cases and controls. Stress had a negative correlation with both mental and physical health quality of life of the parents. Conclusion: Stress related to raising a child with disability negatively influences the parental quality of life. Stress management aiming at its prevention and reduction might be significant aspects of intervention for the improvement of the quality of life of the caregivers.

Crianças com Deficiência , Cuidadores , Estudos de Casos e Controles , Criança , Humanos , Pais , Qualidade de Vida , Estresse Psicológico , Inquéritos e Questionários
Pediatr Phys Ther ; 31(4): 360-368, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568384


PURPOSE: Children who use manual wheelchairs encounter pain and injury risks to the upper body. Current literature does not describe how propulsion pattern and physiotherapeutic training methodologies impact response to treatment. METHODS: This study assesses the effect of community-based intensive physical and occupational therapy on functional outcomes over a 7-week period in pediatric manual wheelchair users. RESULTS: Key results include significant joint and musculotendon kinematic differences at the shoulder, improved speed and propulsion effectiveness, and changed propulsion pattern. CONCLUSIONS: Statistics also revealed that propulsion pattern was a predictor of response to therapy, as was weekly therapeutic duration, wheelchair-specific focus by the therapists, and stretching.

Fenômenos Biomecânicos/fisiologia , Crianças com Deficiência/reabilitação , Terapia Ocupacional/métodos , Modalidades de Fisioterapia , Disrafismo Espinal/reabilitação , Cadeiras de Rodas , Adolescente , Criança , Feminino , Humanos , Masculino , Resultado do Tratamento
Pediatr Phys Ther ; 31(4): 370-372, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568386


The outbreak of Zika in Brazil almost 3 years ago had harmful medical, financial, and social consequences for children and their families. It also significantly increased the statistics of Brazilian children with disabilities being followed up in rehabilitation centers. Actions promoting the use of the International Classification of Functioning, Disability and Health (ICF) framework are encouraged in view of the complex health needs identified in this population, which cover all areas of functioning, and gain special relevance when it comes to a vulnerable context. This perspective article discusses the challenges related to the implementation of the ICF in rehabilitation services for children with congenital syndrome.

Avaliação da Deficiência , Crianças com Deficiência/reabilitação , Microcefalia/reabilitação , Reabilitação/classificação , Reabilitação/métodos , Infecção por Zika virus/reabilitação , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
Prensa méd. argent ; 105(9 especial): 487-494, oct 2019.
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1046230


The relevance of this research is based on the fact that delayed psychoverbal development is very common is very common in modern children. The problems caused by delayed psychoverbal development accompany many pathologies connected with the development of the nervous system. Therefore, the issues of providing help and training to such children are becoming increasingly relevant both in Russian and foreign pedagogy. The article looks at some aspects of the vocal training technology used in work with children who have delays in psychoverbal development in order to improve the level of their cognitive and communicative skills, develop their thinking, speech, memory and empathy and overcome psychological difficulties. Research methods include theoretical works by Russian psychologists and a pedagogical experiment in vocal training of children with health problems.

Humanos , Pré-Escolar , Criança , Ensino de Recuperação , Deficiências do Desenvolvimento/terapia , Criança Excepcional/educação , Inquéritos e Questionários , Crianças com Deficiência/reabilitação , Transtornos do Desenvolvimento da Linguagem/terapia , Musicoterapia
Prensa méd. argent ; 105(9 especial): 628-633, oct 2019.
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1046836


The article reveals the features of the study and development of the tempo-rhythmic speech components of children with disabilities as exemplified by preschool children with a stutter. The article describes the course and methods of an ascertaining experiment to identify the initial state of the tempo-rhythmic speech components of children with stuttering. Games and tasks, with the help which it is possible to determine the state of the tempo and rhythm of children's speech, are offered and the obtained results are described. The stages of correctional work with children on the development of the tempo-rhythmic speech components of children with stuttering are given.

Humanos , Pré-Escolar , Criança , Fala , Fonoterapia/métodos , Gagueira/etiologia , Tempo , Métodos Epidemiológicos , Crianças com Deficiência/reabilitação , Jogos Experimentais
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1368-1375, out.-dez. 2019. il
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1021865


Objective: The study's main purpose has been to analyze the Brazilian scientific productions that used the Pediatric Evaluation of Disability Inventory (PEDI) in investigations focused on children diagnosed with disabilities. Methods: It is an integrative literature review which was carried out from July to August 2017 in the following data sources: MEDLINE (PubMed), Virtual Health Library (VHL) and Web of Science, in English, Portuguese and Spanish languages. Results: The use of PEDI contributed to the identification of individual disabilities and the most impaired functions in children, providing data that allows the planning of interventions for parents, professionals, and caregivers. Furthermore, it has revealed the benefits of physical activities for functional performance, as well as the effects of the guidelines transmitted by health professionals to children with developmental disorders. Conclusion: PEDI has been proved to be relevant as it contributes with evidence to the evolution of the child with disabilities, identifies the commitments and allows the redirection of the actions of professionals and caregivers

Objetivo: Analisar as produções científicas brasileiras que utilizaram o Inventário de Avaliação Pediátrica de Incapacidade (PEDI) em estudos voltados para crianças diagnosticadas com deficiência. Metodologia: Trata-se de revisão integrativa da literatura, realizada entre julho e agosto de 2017 nas seguintes fontes: MEDLINE (PubMed), Biblioteca virtual em saúde (BVS) e Web of sience nos idiomas inglês, português e espanhol. Resultados: A utilização do PEDI contribuiu para identificação de incapacidades individuais e das funções mais comprometidas em crianças, fornece dados que permitem o planejamento de intervenções para pais, profissionais e cuidadores. Além disso, permitiu revelar os benefícios das atividades físicas para o desempenho funcional assim como os efeitos das orientações realizadas por profissionais de saúde para crianças com desvios de desenvolvimento. Conclusão: O PEDI têm-se mostrado relevante por contribuir com evidências sobre a evolução da criança com incapacidades, identificar os comprometimentos e permitir redirecionamento das ações de profissionais e cuidadores

Objetivo: Analizar las producciones científicas brasileñas que utilizaron el Inventario deEvaluación Pediátrica de Discapacidad en estudios centrados en niños diagnosticados con discapacidad. Método: Se trata de una revisión integradora de la literatura, efectuada entre julio y agosto de 2017 en las siguientes fuentes: MEDLINE (PubMed), Biblioteca Virtual en Salud (BVS) y Web of Science enlos idiomas inglés, portugués y español. Resultados: La utilización del PEDI contribuyó a la identificación de discapacidades individuales y de las funciones más comprometidas en niños, suministra datos que permiten la planificación de intervenciones redireccionando las acciones de padres, profesionales y cuidadores, además de haber permitido revelar los beneficios de las actividades físicas para el desempeño funcional, así como los efectos de las orientaciones transmitidas por profesionales de salud para niños con desviaciones de desarrollo. Conclusión: El PEDI se ha mostrado relevante por contribuir con evidencias sobre la evolución del niño con discapacidades, identificar los compromisos y permitir la redirección de las acciones de profesionales y cuidadores

Humanos , Criança , Crianças com Deficiência/reabilitação , Crianças com Deficiência/estatística & dados numéricos , Equipamentos e Provisões/normas , Reabilitação/tendências
Artigo em Inglês | MEDLINE | ID: mdl-31480233


Schools are salient locations for children with disabilities to accrue physical activity (PA) and to diminish sedentary time (ST). We examined seasonal variation in accelerometer-assessed PA and ST among children with disabilities during the school day in three school settings (physical education (PE) lessons, recess and lunchtime). Children (n = 270) from 13 special schools for those with five disability types (visual impairments, hearing impairments, physical disabilities, intellectual disabilities (ID), and social development problems) participated. Their PA and ST were assessed during three winter and three summer school days using accelerometry. Linear mixed models were performed to determine seasonal variation in the proportion of time they spent in moderate-to-vigorous physical activity (MVPA) and ST in the three settings. On average, the children spent 4.5% (18.6 min) and 4.0% (15.6 min) in MVPA at school during winter and summer days, respectively. They were more physically active during winter (especially during recess and lunchtime), but there were no seasonal differences for ST. Thus, children's year-round engagement in PA needs to be promoted, especially during summer.

Acelerometria/estatística & dados numéricos , Crianças com Deficiência/estatística & dados numéricos , Exercício , Comportamento Sedentário , Adolescente , Criança , Crianças com Deficiência/classificação , Feminino , Hong Kong , Humanos , Masculino , Instituições Acadêmicas , Estações do Ano
Artigo em Inglês | MEDLINE | ID: mdl-31470512


Background: The aims of this study were to determine the prevalence of deliberate self-harm (DSH) and to compare the risk of self-harm in Chinese children with different types and severity of disabilities. Methods: Participants were 1300 children aged 6-17 years in Beijing, China; 650 children with disabilities and 650 healthy peers matched on age, gender and residence district. Questionnaires were completed anonymously by parents or children if the age or disability made it necessary. The associations between the disability type, severity and DSH were examined using the Chi-square testing and logistic regression models. Results: Children with a single disability or multiple disabilities had statistically higher rates of DSH than children without disabilities (15.6% and 39.7% compared to 10.9%). The prevalence of DSH was associated with the severity of disability, being 36.2% among children with level 1 (the most severe) disability, 19.8% among children with level 2 disability, and 9.2% among children with level 3 + 4 disability. The multivariable odds ratio (OR) of DSH among children with any disability was statistically higher than that among children without a disability (OR = 2.40; 95% CI = 1.71, 3.36; p < 0.05). Children with multiple disabilities (OR = 6.89; 95% CI: 4.24-11.20) and level 1 severity of disability (OR = 6.11; 95% CI: 3.91-9.56) had the highest risk of DSH. Conclusions: This study clearly demonstrated associations between the severity and type of disability and DSH. This finding highlights the importance of DSH in children with disabilities, and underlines the importance of the prevention of DSH among a vulnerable pediatric population in China.

Crianças com Deficiência/psicologia , Comportamento Autodestrutivo/epidemiologia , Adolescente , Adulto , Pequim/epidemiologia , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Criança , Feminino , Nível de Saúde , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Prevalência , Fatores de Risco , Inquéritos e Questionários
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(9): 941-943, 2019 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-31474078


From September 2017 to February 2018, 650 disabled children and adolescents aged 6-to 17-year-old in Beijing were matched 1∶1 to those in normal physical condition with same age, gender and place of residence. All children and adolescents were investigated for self-injury status in the last year to understand the difference of self-injury incidence between groups. Multivariate unconditional logistic regression model was applied for exploring relevant factors of self-injury of children and adolescents. This study found that the disability, insufficient sleep, difficulty falling asleep, and sleeping late were associated with self-injury of children and adolescents.

Crianças com Deficiência , Comportamento Autodestrutivo , Adolescente , Pequim/epidemiologia , Criança , Estudos Transversais , Crianças com Deficiência/estatística & dados numéricos , Humanos , Modelos Logísticos , Comportamento Autodestrutivo/epidemiologia , Sono
Rev. logop. foniatr. audiol. (Ed. impr.) ; 39(3): 115-128, jul.-sept. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-ET1-3786


Introduction: children with severe to profound sensorineural hearing loss and prelingual onset of deafness exhibit less linguistic skills and poorer academic achievements when compared with their hearing peers. Recent studies show that cochlear implants may promote language development in this paediatric population, although phonological development does not always follow the patterns attested for typically developing children. Aim and method: the present study aims at describing the phonetic properties of segments and the phonological processes produced by 18 deaf Portuguese children with more than 2.0 years of implant use, divided into two groups according of their hearing age (A=2.10-4.04 and B=5.04-7.03) For this purpose, we used a formal articulation test validated for the Portuguese population. Results: results show that Group B, with a higher hearing age, exhibit a consonant repertoire more complete than Group A, whose hearing age was lower. Syllable and segmental difficulties tend to persist over a long period of time, even after 4 years of implant experience (i.e. hearing age). Discussion: the children's consonant repertoire of plosives and fricatives seems to take longer to establish in deaf children with cochlear implants than in their Portuguese hearing peer; other phonological patterns found in the data show an immature phonological development (e.g. syllable omission and onset deletion); these results match the ones reported for other languages in other studies on cochlear implanted children

Introducción: los niños con un nivel de hipoacusia neurosensitiva entre intensa y profunda, y en fases iniciales de sordera prelocutiva presentan conocimientos lingüísticos y resultados académicos inferiores en relación con otros niños de su misma edad con un cuadro auditivo normal. Estudios recientes muestran que los implantes cocleares pueden promover el desarrollo lingüístico de este segmento pediátrico, aun cuando el desarrollo fonológico no siempre siga la progresión estándar que se observa en niños con una evolución prototípica. Objetivo y metodología: este estudio tiene como objetivo describir las propiedades de los segmentos fonéticos y de las pautas fonológicas producidos por 18 niños sordos portugueses con más de 2 años de experiencia con el implante coclear, divididos en dos cohortes en función del tiempo que han utilizado este tipo de implantes (A = 2.10-4.04 y B = 5.04-7.03). Con este propósito nos hemos servido de una prueba de articulación formal validada para hablantes portugueses. Resultados: los resultados muestran que el grupo B, con mayor edad auditiva, presenta un repertorio de consonantes más completo que el grupo A. Las dificultades en la producción de sílabas y segmentos suelen persistir durante un largo período de tiempo, incluso después de los 4 años de experiencia con el implante, es decir, con 4 años de edad auditiva. Discusión: al parecer, el repertorio de consonantes obstruyentes (oclusivas y fricativas) tarda más tiempo en establecerse en niños sordos con implantes cocleares que en niños con audición normal. Los datos obtenidos revelan, además, pautas propias de un desarrollo fonológico inmaduro (p. ej., omisión total de sílabas y omisión de ataques silábicos); los resultados coinciden así con los que arrojan varios estudios sobre niños de otras lenguas que llevan también implante coclear

Humanos , Surdez/complicações , Transtorno Fonológico/fisiopatologia , Implantes Cocleares/estatística & dados numéricos , Transtornos do Desenvolvimento da Linguagem/reabilitação , Portugal , Transtorno Fonológico/reabilitação , Surdez/reabilitação , Crianças com Deficiência
Res Nurs Health ; 42(5): 334-348, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31418465


Well siblings of chronically ill children experience family disruptions that profoundly affect them. Previous research focusing on well siblings' experiences has often produced inconsistent findings, likely the result of varying study designs and samples. The purposes of this synthesis research study were twofold: (a) to assess the applicability of existing grounded theory of sibling response to a child's cancer to a wider range of childhood conditions; and (b) to refine the existing theory to reflect the experiences of the broader sample. Data for the synthesis came from a National Institute of Nursing Research-funded mixed-methods synthesis examining the intersection of childhood chronic illness and family life. The current analysis was based on well sibling results extracted from 78 research reports published between 2000 and 2014. An existing grounded theory, Creating a Tenuous Balance (CTB), was discovered at the outset of analysis and used as the primary framework for coding and synthesizing results. The focus of most studies was siblings' responses to 14 chronic conditions, with cancer being the most often studied. Results reflected siblings' perspectives of their experiences as well as perspectives of parents and the ill child. The analysis substantiated all four patterns of sibling behavior included in CTB, with the patterns of adapting to changes in personal and family life, and handling strong emotions being especially challenging aspects of the sibling experience. Moreover, the results expanded several aspects of CTB. The analysis provided evidence of the applicability of the theory to a varied group of chronic conditions and enabled us to identify important areas for developing interventions to support siblings.

Adaptação Psicológica , Doença Crônica/psicologia , Crianças com Deficiência/psicologia , Voluntários Saudáveis/psicologia , Neoplasias/psicologia , Qualidade de Vida/psicologia , Irmãos/psicologia , Adolescente , Criança , Feminino , Humanos , Masculino
Artigo em Inglês | MEDLINE | ID: mdl-31416123


As a result of various barriers, several pediatric populations are at risk for poor oral health, including children with disabilities and children from under-represented populations, such as Latinos. To this end, this study aimed to better understand the factors that affect the oral health experiences of 32 Latino parents/caregivers from 18 families (n = 8 with a typically developing child and n = 10 with a child with Autism). Using a qualitative descriptive methodology, each family was interviewed twice. Interviews were audio-recorded, transcribed verbatim, and coded thematically to identify the individual, social, systemic, and culturally rooted factors contributing to oral health disparities in the families. The three themes that arose were "Why would I want to start trouble?": Latino parents' dissatisfaction with dental treatments, costs, and fear of the dentist and health care providers because of their ethnic minority status as key factors inhibiting receipt of dental care; "We have to put our children first": prioritizing the oral care activities of their children over their own individual oral care needs; and "We always keep baking soda around": familial and cultural influences on oral care habits. Understanding the oral health beliefs and experiences of Latino parents and caregivers of children with and without autism is critical for developing targeted prevention and intervention programs and reducing oral health disparities.

Transtorno Autístico/psicologia , Cuidadores/psicologia , Assistência Odontológica/psicologia , Crianças com Deficiência/psicologia , Hispano-Americanos/psicologia , Saúde Bucal , Pais/psicologia , Adulto , Atitude Frente a Saúde , Criança , Grupos Étnicos/psicologia , Feminino , Humanos , Los Angeles , Masculino , Grupos Minoritários/psicologia
BMC Public Health ; 19(1): 1133, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31420030


BACKGROUND: Approximately one billion children experience violence every year. Violence against children is an urgent global public health concern and violation of children's rights. It is also a risk factor for serious negative health and social outcomes and is therefore addressed within the Sustainable Development Goals (SDGs). Children with disabilities, who make up one in 20 children worldwide, are particularly vulnerable to violence although good quality data are lacking on causes and means of prevention of violence against children with disabilities. Key challenges exist in the measurement of disability and violence, which in part explains the dearth in evidence. IMPROVING RESEARCH ON VIOLENCE AGAINST CHILDREN WITH DISABILITIES: This paper provides guidance on how to conduct good quality, ethical, and inclusive research on violence against children with disabilities, particularly in low-income settings. The lack of an international agreed 'gold standard' frustrates efforts to measure violence across settings and time. Careful consideration must be given to the design of survey tools. Qualitative and participatory research methods also offer important opportunities to explore children's subjective understanding and experiences of violence. Challenges also exist around the measurement of disability. Disability may be measured by asking directly about disability, through self-reported functioning, or through the presence of impairments or health conditions. These approaches have strengths and limitations and should build on what children are able to do and include appropriate adaptations for specific impairments where necessary. Ethical research also requires adherence to ethical guidelines and approvals, obtaining informed consent, appropriate child protection responses, and careful consideration of interviewer-related issues including their selection, training, and welfare. Key methodological gaps remain - how to include children with severe communication challenges in research; how to respond in instances of weak child protection systems; designing sampling procedures that adequately represent children with disabilities in large-scale violence surveys; and determining how best to ask about violence safely in large-scale surveys and monitoring data. This paper further advocates for the dissemination of research results in inclusive and accessible formats. CONCLUSION: With careful planning, challenges in collecting data on disability and violence can be overcome to generate evidence in this neglected area.

Crianças com Deficiência , Ética em Pesquisa , Projetos de Pesquisa , Sujeitos da Pesquisa , Violência/ética , Criança , Humanos , Pobreza/ética
Artigo em Inglês | MEDLINE | ID: mdl-31443294


The study aimed to develop and evaluate a multicomponent school and home based physical activity (PA) intervention in children in grades 3-7 (aged 8-13 years) and determine the psychological variables that influence PA; 10 × 1 h school-based training sessions, a home-based activity program and 4 × 1 h lifestyle workshops for parents. PA was assessed at an intervention and nearby control school using accelerometers and self-report at 3-time points: baseline, post intervention and 10-week follow-up. Self-efficacy, self-management strategies, enjoyment, perceived barriers to PA, outcome-expectancy and social support were evaluated. The study showed 73% of the children with complete data sets at the intervention school (n = 27) did not increase device measured moderate to vigorous PA (MVPA) in the after-school period (3 p.m. to 6 p.m.) or over the whole day or during school break time immediately following the intervention or at follow-up, as compared to 70% of children with complete data sets at the control school (n = 35; p > 0.05 for all). Overall, 59% of boys attained more than double the recommended 120 min of MVPA each day compared to 42% of girls (p = 0.013). At the baseline, children's self-reported PA in the intervention school positively correlated with: outcome expectancy (R = 0.240, p = 0.015), enjoyment (R = 0.339, p < 0.001), self-efficacy (R = 0.399, p < 0.001), self-management (R = 0.617, p < 0.001), social support at home (R = 0.406, p < 0.001), and social support at school (R = 0.407, p < 0.001). Similar relationships were observed after the intervention and at follow-up. Focus groups with the children, parents and interviews with teachers identified areas for improvement of the intervention. In conclusion, while the multifaceted approach to improve PA was ineffective over the time span of the study, important predictors of PA in this sample of disadvantaged children were identified.

Crianças com Deficiência/psicologia , Exercício/psicologia , Nível de Saúde , Serviços de Saúde Escolar/organização & administração , Autoeficácia , Apoio Social , Populações Vulneráveis/psicologia , Adolescente , Austrália , Criança , Feminino , Humanos , Masculino , Projetos Piloto
Health Serv Res ; 54(5): 1007-1015, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31388994


OBJECTIVE: To examine the impact of a Medicaid-serving pediatric accountable care organization (ACO) on health service use by children who qualify for Medicaid by virtue of a disability under the "aged, blind, and disabled" (ABD) eligibility criteria. DATA SOURCES/STUDY SETTING: We evaluated a 2013 Ohio policy change that effectively moved ABD Medicaid children into an ACO model of care using Ohio Medicaid administrative claims data for years 2011-2016. STUDY DESIGN: We used a difference-in-difference design to examine changes in patterns of health care service use by ABD-enrolled children before and after enrolling in an ACO compared with ABD-enrolled children enrolled in non-ACO managed care plans. DATA COLLECTION/EXTRACTION METHODS: We identified 17 356 children who resided in 34 of 88 counties as the ACO "intervention" group and 47 026 ABD-enrolled children who resided outside of the ACO region as non-ACO controls. PRINCIPAL FINDINGS: Being part of the ACO increased adolescent preventative service and decreased use of ADHD medications as compared to similar children in non-ACO capitated managed care plans. Relative home health service use decreased for children in the ACO. CONCLUSIONS: Our overall results indicate that being part of an ACO may improve quality in certain areas, such as adolescent well-child visits, though there may be room for improvement in other areas considered important by patients and their families such as home health service.

Organizações de Assistência Responsáveis/normas , Crianças com Deficiência/reabilitação , Hospitais Pediátricos/estatística & dados numéricos , Hospitais Pediátricos/normas , Programas de Assistência Gerenciada/normas , Medicaid/normas , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Organizações de Assistência Responsáveis/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Crianças com Deficiência/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Programas de Assistência Gerenciada/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Ohio , Estados Unidos
Soins Pediatr Pueric ; 40(309): 44-46, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31331602


Teleconsultations facilitating access to care, offer undeniable added value to the digital care pathway of children with multiple disabilities. This innovation transforms and enhances practices and collaboration methods between healthcare, medico-social and private practice professionals. An interview with Monique Bredillot, general care coordinator for CESAP, the committee for studies, education and care for people with multiple disabilities.

Serviços de Saúde da Criança/organização & administração , Crianças com Deficiência , Acesso aos Serviços de Saúde , Consulta Remota , Criança , Humanos