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1.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31949000

RESUMO

BACKGROUND: Material hardship has been associated with adverse health care use patterns for children with special health care needs (CSHCN). In this study, we assessed if resilience factors were associated with lower emergency department (ED) visits and unmet health care needs and if they buffered associations between material hardship and health care use for CSHCN and children without special health care needs. METHODS: A cross-sectional study using the 2016 National Survey of Children's Health, restricted to low-income participants (<200% federal poverty level). Separately, for CSHCN and children without special health care needs, weighted logistic regression was used to measure associations between material hardship, 2 resilience factors (family resilience and neighborhood cohesion), and 2 measures of use. Moderation was assessed using interaction terms. Mediation was assessed using structural equation models. RESULTS: The sample consisted of 11 543 children (weighted: n = 28 465 581); 26% were CSHCN. Material hardship was associated with higher odds of ED visits and unmet health care needs for all children. Resilience factors were associated with lower odds of unmet health care needs for CSHCN (family resilience adjusted odds ratio: 0.58; 95% confidence interval: 0.36-0.94; neighborhood cohesion adjusted odds ratio: 0.53; 95% confidence interval: 0.32-0.88). For CSHCN, lower material hardship mediated associations between resilience factors and unmet health care needs. Neighborhood cohesion moderated the association between material hardship and ED visits (interaction term: P = .02). CONCLUSIONS: Among low-income CSHCN, resilience factors may buffer the effects of material hardship on health care use. Future research should evaluate how resilience factors can be incorporated into programs to support CSHCN.


Assuntos
Crianças com Deficiência , Serviço Hospitalar de Emergência/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Pobreza/psicologia , Resiliência Psicológica , Adolescente , Criança , Pré-Escolar , Intervalos de Confiança , Estudos Transversais , Crianças com Deficiência/estatística & dados numéricos , Família/psicologia , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Razão de Chances , Características de Residência , Fatores de Risco
2.
Disabil Health J ; 13(1): 100798, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31076227

RESUMO

BACKGROUND: Hearing difficulties (HD) affect a sizable minority of children in the United States and can have a significant impact on child development. Children with HD may face barriers around language development, communication abilities, learning, and social interactions, which in turn can affect multiple aspects of their lives. OBJECTIVE/HYPOTHESIS: Little is known about the extent to which children with HD have access to a system of care and we hypothesize that this population may experience significant unmet needs. METHODS: In this cross-sectional study, using bivariate and multivariable regression models, we analyzed data from the 2009/2010 National Survey of Children with Special Health Care Needs (NS-CSHCN). Selected survey items were used to assess health and healthcare characteristics of CSHCN with some level of HD (n = 2,315) compared to those without HD (n = 37,851). The study sample included 40,242 CSHCN aged 0-17 years, whose caregivers responded to the survey. RESULTS: Approximately 694,000 CSHCN in the U.S. were reported to have any level of HD, representing 6.3% of the CSHCN population. Compared to CSHCN without HD, those with HD were less likely to have access to a medical home, community services, or have adequate health insurance. CONCLUSIONS: Significant deficits in medical home access, adequate insurance, and accessibility of community-based services are evident for CSHCN with HD. Families having knowledge of how and when to access community services and partner with providers in their child's health care is important for the overall health and wellbeing of this subpopulation of CSHCN.


Assuntos
Crianças com Deficiência , Acesso aos Serviços de Saúde , Serviços de Saúde para Pessoas com Deficiência , Disparidades em Assistência à Saúde , Perda Auditiva , Qualidade da Assistência à Saúde , Adolescente , Cuidadores , Criança , Pré-Escolar , Serviços de Saúde Comunitária , Estudos Transversais , Assistência à Saúde/normas , Crianças com Deficiência/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde para Pessoas com Deficiência/normas , Perda Auditiva/epidemiologia , Humanos , Lactente , Recém-Nascido , Seguro Saúde , Masculino , Assistência Centrada no Paciente , Inquéritos e Questionários , Estados Unidos
3.
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

RESUMO

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


Assuntos
Humanos , Criança , Crianças com Deficiência/reabilitação , Crianças com Deficiência/estatística & dados numéricos , Equipamentos e Provisões/normas , Reabilitação/tendências
4.
Artigo em Inglês | MEDLINE | ID: mdl-31480233

RESUMO

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.


Assuntos
Acelerometria/estatística & dados numéricos , Crianças com Deficiência/estatística & dados numéricos , Exercício Físico , Comportamento Sedentário , Adolescente , Criança , Crianças com Deficiência/classificação , Feminino , Hong Kong , Humanos , Masculino , Instituições Acadêmicas , Estações do Ano
5.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(9): 941-943, 2019 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-31474078

RESUMO

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.


Assuntos
Crianças com Deficiência , Comportamento Autodestrutivo , Adolescente , Pequim/epidemiologia , Criança , Estudos Transversais , Crianças com Deficiência/estatística & dados numéricos , Humanos , Modelos Logísticos , Comportamento Autodestrutivo/epidemiologia , Sono
6.
Health Serv Res ; 54(5): 1007-1015, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31388994

RESUMO

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.


Assuntos
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
7.
Nurs Child Young People ; 31(3): 38-46, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31468865

RESUMO

Research and advances in technology have enabled children and young people with life-limiting conditions to live longer. To maintain their well-being and quality of life many of these children usually require some form of intravenous access for treatment. Children's nurses should have the skills and training to ensure they are competent to practise using totally implanted central venous access devices such as portacaths (ports). This article addresses the care and management of these ports in children and the wide variation in practice that exists in the UK, and makes recommendations for practice.


Assuntos
Dispositivos de Acesso Vascular/tendências , Administração Intravenosa/instrumentação , Adolescente , Criança , Crianças com Deficiência/reabilitação , Crianças com Deficiência/estatística & dados numéricos , Desenho de Equipamento/normas , Humanos , Qualidade de Vida/psicologia , Reino Unido , Dispositivos de Acesso Vascular/efeitos adversos
8.
BMC Infect Dis ; 19(1): 549, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226951

RESUMO

BACKGROUND: Intestinal parasitic infections are still common in low-income countries including Ethiopia, particularly in children due to low-quality drinking water, poor personal and environmental sanitation. Disabled individuals are excluded from most academic, economic, social and cultural opportunities, they are among the poorest and most marginalized of the whole world's people. The aim of this study was to assess the prevalence of intestinal parasitic infections and associated factors among mentally disabled and non-disabled students at primary schools in Bahir Dar city, Amhara regional state, Ethiopia, 2018. METHODS: A school-based Comparative cross-sectional study design was conducted from November 1-30, 2018. A total of 418 study participants, 104 mentally disabled and 314 non-disabled students were recruited through a simple random sampling technique. The collected data were coded, entered and cleaned with EpiData version 3.1 and analyzed using SPSS version 23. Multivariable logistic regression was conducted to identify factors associated with intestinal parasitic infections. The adjusted odds ratio with a 95% Confidence interval at a 5% level of significance was used to measure the strength of association. RESULTS: The mean age of study participants was 14.05 ± 3.66 and 11.96 ± 2.94 for mentally disabled students and non-disabled students. Prevalence of parasitic infection was 56.70% (n = 59) for mentally disabled students whereas 41.10%(n = 129) for non-disabled students. Unclean fingernails [AOR = 2.42; 1.40,4.17], health checkups [AOR = 1.87;1.16,3.02], hand washing with water only [AOR = 2.48; 1.49,4.12], cooking and sanitation source of water [AOR = 4.40;2.32,8.36], Grade [ (1-4)] [AOR = 2.27;1.41,3.67], sex [AOR = 1.64;1.03,2.63] and Family size> = 7 [AOR = 2.74;1.25,5.99] were variables which showed statistically significant association with intestinal parasitic infections. CONCLUSION: The prevalence of intestinal parasitic infection was higher among mentally disabled students than non-disabled students. Unclean fingernails, health checkups, hand washing habits, source of water, family size, sex and Grade of students have had a statistically significant association with intestinal parasitic infections. Periodic medicinal treatment was needed twice a year for mentally disabled and once a year for non-disabled students.


Assuntos
Crianças com Deficiência/estatística & dados numéricos , Enteropatias Parasitárias/epidemiologia , Pessoas com Deficiência Mental/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Criança , Estudos Transversais , Crianças com Deficiência/psicologia , Etiópia/epidemiologia , Feminino , Humanos , Higiene , Masculino , Áreas de Pobreza , Prevalência , Fatores de Risco , Estudantes/psicologia
9.
BMC Public Health ; 19(1): 748, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196050

RESUMO

BACKGROUND: Universal childhood vaccination programmes form a core component of child health policies in most countries, including the UK. Achieving high coverage rates of vaccines is critical for establishing 'herd immunity' and preventing disease outbreaks. Evidence from the UK has identified several groups of children who are at risk of not being fully immunised. Our aim was to determine whether children with intellectual disabilities constitute one such group. METHODS: Secondary analysis of parental report data on child vaccination collected in the UK's Millennium Cohort Study when the children were 9 months, 3 years, 5 years and 14 years old. RESULTS: With one exception (MMR coverage at age 5) vaccination coverage rates were lower for children with intellectual disabilities (when compared to children without intellectual disability) for all vaccinations at all ages. Complete coverage rates were significantly lower for children with intellectual disabilities at ages 9 months (unadjusted PRR non-vaccination = 2.03 (1.14-3.60), p < 0.05) and 3 years (unadjusted PRR = 2.16 (1.06-4.43), p < 0.05), but not at age 5 years (unadjusted PRR = 1.91 (0.67-5.49)). HPV vaccination was lower (but not significantly so) at age 14 (PRR = 1.83 (0.99-3.37), p = 0.054). Adjusting PRRs for between group differences in family socio-economic position and other factors associated with coverage reduced the strength of association between intellectual disability and coverage at all ages. However, incomplete vaccination remained significantly elevated for children with intellectual disabilities at ages 9 months and 3 years. There were no statistically significant differences between parents of children with/without intellectual disability regarding the reasons given for non-vaccination. CONCLUSIONS: Children with intellectual disabilities in the UK are at increased risk of vaccine preventable diseases. This may jeopardise their own health, the health of younger siblings and may also compromise herd immunity.


Assuntos
Crianças com Deficiência/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Reino Unido/epidemiologia
10.
Braz Oral Res ; 32: e117, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30892372

RESUMO

The oral health status of children with special health care needs (SHCN) can affect their quality of life wich domains of the Brazilian version of the Early Childohood Oral Health Impact Scale (B-ECOHIS). A cross-sectional study was conducted in children with SHCN (aged 1 to 9 years), who underwent an oral examination for the assessment of dental caries severity. Parents/caregivers answered two questionnaires, one on oral health-related quality of life (OHRQoL) - B-ECOHIS, and one on socioeconomic characteristics. Statistical analyses were performed using the Kolmogorov-Smirnov test, Mann-Whitney U-test, Poisson regression, Point-biserial correlation coefficient, and Cronbach's alpha. A total of 128 children participated in the study and OHRQoL was affected in 68.75% of them. The function domain in the Child Impact Section (CIS) had a higher mean value. Caries severity was associated with worse quality of life (p=0.001). Severe dental caries was associated with a negative impact on the OHRQoL of disabled children and of their families. The impact of untreated dental caries and severity of dental caries was associated with the CIS domains (except for the self-image/social interaction domain).


Assuntos
Cuidadores , Cárie Dentária/epidemiologia , Crianças com Deficiência/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Qualidade de Vida , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Índice CPO , Feminino , Humanos , Lactente , Masculino , Índice de Gravidade de Doença , Fatores Socioeconômicos , Estatísticas não Paramétricas , Inquéritos e Questionários
11.
Matern Child Health J ; 23(7): 919-924, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30617441

RESUMO

Introduction Children with special health care needs (CSHCN) are a high risk population with complex medical issues and needs. It is challenging to care for them in a busy, pediatric practice without understanding how many exist and how best to allocate resources. EMRs can be adapted to develop registries and stratify patients to promote population health management. Methods Adaptations were made to the EMR in September 2013 to capture CSHCN and the associated risk level during well-child visits prospectively. All physicians were trained on the definition of CSHCN and on risk stratification levels 1, 2, 3A and 3B. An analysis using one-way ANOVA for children ages 0-21, seen between September 1, 2011 and August 31, 2015, who were identified and stratified after September 2013, was conducted to determine utilization patterns on hospital admissions, emergency department (ED), subspecialty, and primary care visits. Results A total of 4687 CSHCN were identified during the study period. Of the CSHCN, 45% were Level 1, 41% Level 2, 7% 3A and 7% 3B. There were significant differences in utilization across the tiers of CSHCN with the highest level of stratification (3B) demonstrating the most hospital admissions and primary care visits. Level 3B and level 3A (unstable) had significantly more ED visits. Additionally, as tiers increased from level 1 to 3B there was an increase in subspecialty provider utilization (p < 0.0001). Discussion The EMR adaptations developed for CSHCN identified the expected number of CSHCN and predicted utilization patterns across primary, subspecialty, ED and in-patient care.


Assuntos
Crianças com Deficiência/estatística & dados numéricos , Assistência Centrada no Paciente/métodos , Medição de Risco/métodos , Adolescente , Análise de Variância , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , New York , Atenção Primária à Saúde/métodos , Medição de Risco/tendências , Inquéritos e Questionários
12.
Matern Child Health J ; 23(7): 951-960, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30673999

RESUMO

Objectives Caregivers of children with autism spectrum disorder (ASD) experience stress at greater rates than caregivers of other children with developmental conditions. Little is known about how families from different racial and ethnic backgrounds report family impact beyond individual stressors associated with caregiving. This paper aims to examine differences in family impact variables among caregivers of ASD children from different racial/ethnic backgrounds. Methods Using data from the 2005-2006 and 2009-2010 National Survey of Children with Special Health Care Needs, this retrospective, cross-sectional study examined family impact among caregivers of children with ASD. Family impact was defined as financial impact, time spent caregiving, and work impact variables and evaluated in five racial/ethnicity groups: white, non-Hispanic; any race, English-speaking Hispanic; any race, Spanish-speaking Hispanic; black, non-Hispanic; and other race, non-Hispanic respondents (n = 5115). Multivariate logistic regression was used to analyze the association of race and ethnicity with family impact variables while controlling for child and family covariates. Results Significant differences were found between race/ethnicity groups of caregivers on financial spending of more than $500 per year on care and providing more than 11 h a week on direct child care. No significant differences were observed in job impact variables between race/ethnicity groups. Conclusions for Practice Racial/ethnic differences exist in providing and spending more on direct care, but they do not necessarily represent disparities. More research is needed to fully understand if family impact is affected by cultural differences in care provided for children with ASD.


Assuntos
Transtorno do Espectro Autista/complicações , Crianças com Deficiência/estatística & dados numéricos , Grupos Étnicos/psicologia , Transtorno do Espectro Autista/psicologia , Criança , Grupos de Populações Continentais/estatística & dados numéricos , Efeitos Psicossociais da Doença , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores Socioeconômicos , Inquéritos e Questionários
13.
J Neuroeng Rehabil ; 16(1): 9, 2019 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-30642361

RESUMO

BACKGROUND: Even though typically developing youth are already at risk for physical inactivity, youth with spina bifida may be even at higher risk as a consequence of their reduced mobility. No objective data is available for youth with spina bifida who use a manual wheelchair, so the seriousness of the problem is unknown. The purpose of this observational study was to quantify physical activity in wheelchair-using youth with spina bifida and evaluate the intensity of activities. METHODS: Fifty-three children and adolescents (5-19 years) with spina bifida who use a manual wheelchair for daily life, long distances or sports were included. To assess time spent in several types of activities VitaMove data of 34 participants were used and were presented as time spent sedentary and time spent physically active. This was compared to reference data of typically developing youth. To assess time spent in several intensities Actiheart data of 36 participants were used. The intensities were categorized according to the American College of Sports Medicine, ranging from very light intensity to near to maximal intensity. Data of 25 participants were used to combine type of activity and intensity. RESULTS: Children and adolescents with spina bifida who use a manual wheelchair were more sedentary (94.3% versus 78.0% per 24 h, p < 0.000) and less physically active (5.0% versus 12.2% per 24 h, p < 0.000) compared to typically developing peers. Physical activity during weekend days was worse compared to school days; 19% met the Guidelines of Physical Activity during school days and 8% during weekend days. The intensities per activity varied extensively between participants. CONCLUSIONS: Children and adolescents with spina bifida who use a manual wheelchair are less physically active and more sedentary than typically developing youth. The physical activity levels on school days seem to be more favorable than the physical activity levels on a weekend day. The low levels of physical activity need our attention in pediatric rehabilitation practice. The different intensities during activities indicate the importance of individually tailored assessments and interventions.


Assuntos
Crianças com Deficiência/estatística & dados numéricos , Exercício Físico , Disrafismo Espinal , Cadeiras de Rodas , Adolescente , Criança , Feminino , Humanos , Masculino
14.
Artigo em Inglês | MEDLINE | ID: mdl-30621091

RESUMO

Two important challenges in research on bullying are to have reliable tools to measure traditional bullying and discriminatory bullying related to special educational needs (SEN), and to learn more about their prevalence. We present the validations of two instruments to measure bullying (European Bullying Intervention Project Questionnaire, EBIPQ) and discriminatory bullying with respect to SEN (EBIPQ⁻Special Education Needs Discrimination version, henceforth EBIPQ-SEND). A total of 17,309 teenagers from Ecuador took part in the study (M = 14.76, SD = 1.65; 49.9% male). The item response theory analyses evidenced accuracy and quality of the measures. The confirmatory factor analyses of the EBIPQ and the EBIPQ-SEND revealed the same two-factor structure-aggression and victimization-regardless of gender, showing optimal fit indexes. We present the results of the prevalence according to the roles of participation in traditional bullying and discriminatory bullying around SEN. Significant gender and age differences were observed for involvement in both phenomena. We also discuss the advantages of applying the EBIPQ and the EBIPQ-SEND to evaluate and diagnose harassment and discriminatory harassment around SEN.


Assuntos
Bullying/estatística & dados numéricos , Vítimas de Crime/estatística & dados numéricos , Crianças com Deficiência/estatística & dados numéricos , Educação Especial , Inquéritos e Questionários/normas , Adolescente , Fatores Etários , Agressão , Bullying/psicologia , Vítimas de Crime/psicologia , Crianças com Deficiência/psicologia , Equador/epidemiologia , Análise Fatorial , Feminino , Humanos , Masculino , Prevalência , Psicometria , Fatores Sexuais
15.
Public Health ; 167: 55-61, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30639804

RESUMO

OBJECTIVES: The purpose of this study was to examine the prevalence of food insufficiency, a more severe form of food insecurity, across levels of special healthcare needs among a nationally representative sample of children in the United States. The study also investigates whether medical home access serves as a possible protective mechanism against food hardship. STUDY DESIGN: The study involves analysis of nationally representative cross-sectional data. METHODS: The data used are the 2016 National Survey of Children's Health, a cross-sectional nationally representative sample of the US children (N = 48,709). Descriptive analyses and logistic regression analysis are used to estimate food insufficiency and its correlates by complexity of children's special healthcare needs. RESULTS: Analysis showed that children with more complex special healthcare needs experienced roughly twice the rate of food insufficiency compared with children with no special healthcare needs or children with less complex healthcare needs. Multivariate analysis indicated that children with more complex healthcare needs face an increased risk of food insufficiency net of demographic and economic characteristics. Interaction models revealed that medical home access protects children with medical complexity from food insufficiency. CONCLUSIONS: These findings document significantly elevated risk of food insufficiency among families with a child facing more complex special healthcare needs. Interventions in healthcare settings could include referrals to resources already in place to combat hunger such as food bank agencies and other resources that might help at-risk families obtain assistance through programs such as the Supplemental Nutrition Assistance Program and Women, Infants, and Children.


Assuntos
Crianças com Deficiência/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estados Unidos
16.
Dev Neurorehabil ; 22(5): 359-364, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30307382

RESUMO

Globally, overweight and obesity (OW/OB) levels are high among children, with rates surpassing the adult population. With such high pediatric OW/OB rates, it is imperative that risk factors are identified and explored. Thus, Davison and Birch developed an adapted framework, based on Bronfenbrenner's Ecological Systems Theory, which identifies and categorizes the factors in a child's life that put them at risk for OW/OB. While a socioecological perspective has been a useful tool for examining risk factors in typically developing pediatric populations, this holistic approach has not yet been applied to populations of children with disabilities, who are at an even higher risk of OW/OB than their typically developing peers. This commentary, therefore, explores Bronfenbrenner's Ecological Framework as applied to OW/OB by Davison and Birch, and critically examines its application to children with disabilities.


Assuntos
Crianças com Deficiência/estatística & dados numéricos , Ecossistema , Obesidade Pediátrica/epidemiologia , Adulto , Criança , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco
17.
Death Stud ; 43(4): 248-259, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29757103

RESUMO

Drawing on national, longitudinal Adoption and Foster Care Analysis, and Reporting System data (2005-2015), demographic, health, foster care, and geographic characteristics of decedents (N = 3653) aged 1-17 years were examined. On average, decedents were 6 years old, the highest proportion died as infants, and experienced significant trauma in their short lives either through maltreatment or exposure to parental substance use. A noted increase in Medicaid coverage among decedents over time suggests critical access to concurrent treatment and hospice care, but this is unavailable to children with private insurance. This study has policy implications related to the 2010 Affordable Care Act.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Mortalidade da Criança , Criança Acolhida/estatística & dados numéricos , Crianças com Deficiência/estatística & dados numéricos , Cuidados no Lar de Adoção/estatística & dados numéricos , Mortalidade Infantil , Medicaid/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Estados Unidos
18.
Dev Med Child Neurol ; 61(5): 593-600, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30417338

RESUMO

AIM: Since cross-sectional trends of 8-year-old cerebral palsy (CP) birth prevalence based on record review were stable from 1985 to 2002 in Metropolitan Atlanta, we examined birth cohort trends using administrative data sets promptly. METHOD: Among 755 433 live births from 1996 to 2009 in South Carolina, 2080 received CP diagnosis by age 4 years from linked Medicaid claims with International Classification of Diseases, Ninth Revision codes 343.X (contributing 1061 [51%] unique cases), hospital discharge data (57 [3%] unique cases), and Department of Disabilities and Special Needs program (64 [3%] unique cases). Trends were assessed using negative binominal regression. RESULTS: Including 3.7 percent of cases who died before age 4 years, CP prevalence per 1000 live births decreased significantly from 3.6 in 1996 to 2.1 in 2006 (-3.0% average annual change; 95% confidence interval -4.4 to -1.6). The overall prevalence was 2.8 per 1000 live births, 46.0 per 1000 very-low-birthweight (VLBW) live births, and 53.0 per 1000 VLBW 1-year survivors. Disparities and downward trends persisted across subgroups with higher rates among non-Hispanic black infants than non-Hispanic white and among males compared to females. INTERPRETATION: Downward CP prevalence rates and persistent disparities remain in South Carolina. Further research should validate this methodology, including early deaths, and develop broad surveillance systems to inform clinical practices and etiology. WHAT THIS PAPER ADDS: Birth cohort cerebral palsy (CP) prevalence decreased in South Carolina from 1996 to 2009. CP prevalence was higher in very-low-birthweight infants, non-Hispanic blacks, and males. Three administrative data sets captured 2080 patients with CP in South Carolina. Medicaid claims contributed 51% of unique cases of CP to the cohort. CP diagnoses included 76 patients who died before age 4 years.


Assuntos
Paralisia Cerebral/epidemiologia , Crianças com Deficiência/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Peso ao Nascer , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido de muito Baixo Peso , Masculino , Prevalência , Fatores Sexuais , South Carolina/epidemiologia , Estados Unidos
19.
Br J Sociol ; 70(2): 502-525, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29667166

RESUMO

Childhood disability has been largely overlooked in social stratification and life course research. As a result, we know remarkably little about mechanisms behind well-documented disability differentials in educational outcomes. This study investigates educational transitions of disabled youth using data from the Longitudinal Study of Young People in England. We draw on social stratification literature on primary and secondary effects as well as that on stigma and labelling in order to explain disabled young people's educational outcomes. We find that disability differentials in transition rates to full-time academic upper secondary education and to university are largely the result of primary effects, reflected in differences in school performance between disabled and non-disabled young people. However, we also find evidence for secondary effects, with similarly achieving disabled young people less likely to pursue full-time academic upper secondary education compared to their non-disabled peers. We examine the extent to which these effects can be explained by disabled youth's suppressed educational expectations as well as their experiences of being bullied at school, which we link to the stigma experienced by disabled young people and their families. We find that educational expectations play an important role at crucial transitions in the English school system, while the effect of bullying is considerably smaller. By drawing attention to different social processes contributing to disability differentials in attainment, our study moves beyond medical models that implicitly assume a naturalized association of disability with poor educational outcomes, and demonstrates the parallels of disability with other ascriptive inequalities.


Assuntos
Crianças com Deficiência , Escolaridade , Adolescente , Bullying , Crianças com Deficiência/psicologia , Crianças com Deficiência/estatística & dados numéricos , Inglaterra , Feminino , Humanos , Estudos Longitudinais , Masculino , Instituições Acadêmicas , Estigma Social , Universidades
20.
Arch Dis Child Fetal Neonatal Ed ; 104(3): F285-F292, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29997167

RESUMO

OBJECTIVE: To assess the impact of hypothermic neural rescue for perinatal asphyxia at birth on healthcare costs of survivors aged 6-7 years, and to quantify the relationship between costs and overall disability levels. DESIGN: 6-7 years follow-up of surviving children from the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) trial. SETTING: Community study including a single parental questionnaire to collect information on children's healthcare resource use. PATIENTS: 130 UK children (63 in the control group, 67 in the hypothermia group) whose parents consented and returned the questionnaire. INTERVENTIONS: Intensive care with cooling of the body to 33.5°C for 72 hours or intensive care alone. MAIN OUTCOME MEASURES: Healthcare resource usage and costs over the preceding 6 months. RESULTS: At 6-7 years, mean (SE) healthcare costs per child were £1543 (£361) in the hypothermia group and £2549 (£812) in the control group, giving a saving of -£1005 (95% CI -£2734 to £724). Greater levels of overall disability were associated with progressively higher costs, and more parents in the hypothermia group were employed (64% vs 47%). Results were sensitive to outlying observations. CONCLUSIONS: Cost results although not significant favoured moderate hypothermia and so complement the clinical results of the TOBY Children study. Estimates were however sensitive to the care requirements of two seriously ill children in the control group. A quantification of the relationship between costs and levels of disability experienced will be useful to healthcare professionals, policy makers and health economists contemplating the long-term economic consequences of perinatal asphyxia and hypothermic neural rescue. TRIAL REGISTRATION NUMBER: This study reports on the follow-up of the TOBY clinical trial: ClinicalTrials. gov number NCT01092637.


Assuntos
Asfixia Neonatal/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Hipotermia Induzida/métodos , Hipóxia-Isquemia Encefálica/terapia , Asfixia Neonatal/complicações , Deficiências do Desenvolvimento/economia , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/prevenção & controle , Crianças com Deficiência/estatística & dados numéricos , Feminino , Seguimentos , Recursos em Saúde/economia , Humanos , Hipóxia-Isquemia Encefálica/complicações , Recém-Nascido , Inteligência , Masculino , Psicometria
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