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1.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593284

RESUMO

Preterm delivery in Sweden constitutes 5.7 % of all deliveries, which is among the lowest rates in the world. There has not been any increase in the proportion of iatrogenic preterm deliveries during the last decades.The main hypothesis concerning the causality of preterm delivery is still that of the ascending infection from the vagina to the uterus and inflammation resulting in contractions, rupture of membranes and delivery. The mechanisms behind parturition at term are still elusive and this is also true for preterm delivery. The genetic contribution to preterm delivery is about 25-30 %. The first genes that are associated with preterm delivery and gestational duration have recently been published. Huge progress has been made in care of preterm born infants. Sweden has among the lowest rates of mortality and morbidity in the world, especially in the lowest gestational weeks. New modes of care, family-centered care and hospital-assisted home care, have empowered the parents and reduced the cost for care.


Assuntos
Nascimento Prematuro , Corioamnionite , Deficiências do Desenvolvimento/epidemiologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Gravidez , Resultado da Gravidez , Nascimento Prematuro/economia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Fatores de Risco , Suécia/epidemiologia
2.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31558576

RESUMO

OBJECTIVES: To study the national prevalence of 10 developmental disabilities in US children aged 3 to 17 years and explore changes over time by associated demographic and socioeconomic characteristics, using the National Health Interview Survey. METHODS: Data come from the 2009 to 2017 National Health Interview Survey, a nationally representative survey of the civilian noninstitutionalized population. Parents reported physician or other health care professional diagnoses of attention-deficit/hyperactivity disorder; autism spectrum disorder; blindness; cerebral palsy; moderate to profound hearing loss; learning disability; intellectual disability; seizures; stuttering or stammering; and other developmental delays. Weighted percentages for each of the selected developmental disabilities and any developmental disability were calculated and stratified by demographic and socioeconomic characteristics. RESULTS: From 2009 to 2011 and 2015 to 2017, there were overall significant increases in the prevalence of any developmental disability (16.2%-17.8%, P < .001), attention-deficit/hyperactivity disorder (8.5%-9.5%, P < .01), autism spectrum disorder (1.1%-2.5%, P < .001), and intellectual disability (0.9%-1.2%, P < .05), but a significant decrease for any other developmental delay (4.7%-4.1%, P < .05). The prevalence of any developmental disability increased among boys, older children, non-Hispanic white and Hispanic children, children with private insurance only, children with birth weight ≥2500 g, and children living in urban areas and with less-educated mothers. CONCLUSIONS: The prevalence of developmental disability among US children aged 3 to 17 years increased between 2009 and 2017. Changes by demographic and socioeconomic subgroups may be related to improvements in awareness and access to health care.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Adolescente , Fatores Etários , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Cegueira/epidemiologia , Paralisia Cerebral/epidemiologia , Criança , Pré-Escolar , Escolaridade , Feminino , Perda Auditiva/epidemiologia , Humanos , Cobertura do Seguro/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Masculino , Dinâmica Populacional , Prevalência , Convulsões/epidemiologia , Fatores Sexuais , Fatores Socioeconômicos , Gagueira/epidemiologia , Estados Unidos/epidemiologia
3.
Res Dev Disabil ; 94: 103495, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31499380

RESUMO

BACKGROUND: Research evidence from studies in North America on the relationships between family-centered practices, parents' self-efficacy beliefs, parenting confidence and competence beliefs, and parents' psychological well-being was used to confirm or disconfirm the same relationships in two studies in Spain. AIMS: The aim of Study 1 was to determine if results from studies in North America could be replicated in Spain and the aim of Study 2 was to determine if results from Study 1 could be replicated with a second sample of families in Spain. METHODS AND PROCEDURES: A survey including the study measures was used to obtain data needed to evaluate the relationships among the variables of interest. The participants were 105 family members in Study 1 and 310 family members in Study 2 recruited from nine early childhood intervention programs. Structural equation modeling was used to test the direct and indirect effects of the study variables on parents' well-being. OUTCOMES AND RESULTS: Results showed that family-centered practices were directly related to both self-efficacy beliefs and parenting beliefs, and indirectly related to parents' psychological well-being mediated by belief appraisals. CONCLUSION AND IMPLICATIONS: The pattern of results was similar to those reported in other studies of family-centered practices. Results indicated that the use of family-centered practices can have positive effects on parent well-being beyond that associated with different types of belief appraisals.


Assuntos
Deficiências do Desenvolvimento , Crianças com Deficiência , Saúde da Família , Saúde Mental , Pais/psicologia , Reabilitação Psiquiátrica , Adulto , Pré-Escolar , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/psicologia , Crianças com Deficiência/psicologia , Crianças com Deficiência/reabilitação , Feminino , Humanos , Masculino , Poder Familiar/psicologia , Reabilitação Psiquiátrica/métodos , Reabilitação Psiquiátrica/psicologia , Sistemas de Apoio Psicossocial , Autoeficácia , Espanha/epidemiologia
4.
PLoS Med ; 16(9): e1002920, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31560687

RESUMO

BACKGROUND: Approximately 250 million (43%) children under the age of 5 years in low- and middle-income countries (LMICs) are failing to meet their developmental potential. Risk factors are recognised to contribute to this loss of human potential. Expanding understanding of the risks that lead to poor outcomes and which protective factors contribute to resilience in children may be critical to improving disparities. METHODS AND FINDINGS: The Drakenstein Child Health Study is a population-based birth cohort in the Western Cape, South Africa. Pregnant women were enrolled between 20 and 28 weeks' gestation from two community clinics from 2012 to 2015; sociodemographic and psychosocial data were collected antenatally. Mothers and children were followed through birth until 2 years of age. Developmental assessments were conducted by trained assessors blinded to background, using the Bayley-III Scales of Infant and Toddler Development (BSID-III), validated for use in South Africa, at 24 months of age. The study assessed all available children at 24 months; however, some children were not able to attend, because of loss to follow-up or unavailability of a caregiver or child at the correct age. Of 1,143 live births, 1,002 were in follow-up at 24 months, and a total of 734 children (73%) had developmental assessments, of which 354 (48.2%) were girls. This sample was characterised by low household employment (n = 183; 24.9%) and household income (n = 287; 39.1% earning 1 domain affected, and 75 (10.2%) had delay in all domains. Bivariate and multivariable analyses revealed several factors that were associated with developmental outcomes. These included protective factors (maternal education, higher birth weight, and socioeconomic status) and risk factors (maternal anaemia in pregnancy, depression or lifetime intimate partner violence, and maternal HIV infection). Boys consistently performed worse than girls (in cognition [ß = -0.74; 95% CI -1.46 to -0.03, p = 0.042], receptive language [ß = -1.10; 95% CI -1.70 to -0.49, p < 0.001], expressive language [ß = -1.65; 95% CI -2.46 to -0.84, p < 0.001], and fine motor [ß = -0.70; 95% CI -1.20 to -0.20, p = 0.006] scales). There was evidence that child sex interacted with risk and protective factors including birth weight, maternal anaemia in pregnancy, and socioeconomic factors. Important limitations of the study include attrition of sample from birth to assessment age and missing data in some exposure areas from those assessed. CONCLUSIONS: This study provides reliable developmental data from a sub-Saharan African setting in a well-characterised sample of mother-child dyads. Our findings highlight not only the important protective effects of maternal education, birth weight, and socioeconomic status for developmental outcomes but also sex differences in developmental outcomes and key risk and protective factors for each group.


Assuntos
Comportamento Infantil , Desenvolvimento Infantil , Deficiências do Desenvolvimento/epidemiologia , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Fatores Etários , Peso ao Nascer , Pré-Escolar , Deficiências do Desenvolvimento/fisiopatologia , Deficiências do Desenvolvimento/prevenção & controle , Deficiências do Desenvolvimento/psicologia , Escolaridade , Feminino , Humanos , Masculino , Saúde Materna , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores Sexuais , África do Sul/epidemiologia
5.
Early Hum Dev ; 136: 60-69, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31377564

RESUMO

BACKGROUND: In 1989-1991, a population-based cohort of every Missouri birth weighing < 1500 g was identified over a 16-month period. Infants born moderately low birth weight (MLBW, 1500-2499 g) and normal birth weight (NBW, ≥ 2500 g), were matched to < 1500 g infants by delivery date, race, maternal age, and residence. AIMS: To compare outcomes of extremely low birth weight (ELBW, < 1000 g), very low birth weight (VLBW, 1000-1499 g), and MLBW, to NBW infants at age 10. STUDY DESIGN: A population-based cohort and matched case-control study OUTCOME MEASURES: A Child Health and Development Questionnaire developed for this study collected social, medical, educational and special services history. The Conners' Parent Rating Scale-Revised was also completed by parents/caregivers. RESULTS: As birth weight declined, the prevalence of adverse outcomes increased. Children in all LBW groups were more likely than NBW children to have problems in speech and language, vision, fine and gross motor tasks, illnesses, attention, school performance, and increased requirements for therapy and accommodation. Repetition of a grade was three times higher for MLBW children and over three times higher for the other LBW groups. CONCLUSION: In this statewide population-based study, controlling for child's sex, mother's age, race, residence, education, marital status, Medicaid assistance, and smoking or alcohol use during pregnancy, failed to eliminate the strong effect of decreasing birth weight. Problems were most frequent in ELBW, however, VLBW and MLBW also had many significantly greater problems than NBW children. All LBW groups of children experienced greater adverse health and developmental outcomes resulting in significant habilitation and educational challenges.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Sucesso Acadêmico , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Criança , Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Masculino , Idade Materna , Missouri , Fatores Socioeconômicos
6.
Early Hum Dev ; 137: 104830, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31374454

RESUMO

OBJECTIVE: Many children with omphalocele experience morbidity in early life, which could affect long-term outcomes. We determined parent-reported outcomes in school-aged children treated for minor or giant omphalocele. STUDY DESIGN: We sent paper questionnaires to the parents of all children treated for omphalocele in 2000-2012. Giant omphalocele was defined as defect diameter ≥ 5 cm with liver protruding. Motor function (MABC-2 Checklist) was compared with Dutch reference data; cognition (PedsPCF), health status (PedsQL), quality of life (DUX-25) and behavior (Strengths and Difficulties Questionnaire; SDQ) were compared with those of controls (two per child) matched for age, gender and maternal education level. Possible predictors of cognition and behavior were evaluated using linear regression analyses. RESULTS: Of 54 eligible participants, 31 (57%) returned the questionnaires. MABC-2 Checklist scores were normal for 21/26 (81%) children. Cognition, health status, quality of life and behavior were similar to scores of matched controls. One quarter (26%) of children with omphalocele scored ≤ - 1 standard deviation on the PedsPCF, compared with 9% of matched controls (p = 0.07). Giant omphalocele and presence of multiple congenital anomalies (MCA) were most prominently associated with lower PedsPCF scores (giant omphalocele: ß -22.11 (95% CI: -43.65 to -0.57); MCA -23.58 (-40.02 to -7.13)), although not significantly after correction for multiple testing. CONCLUSIONS: Parent-reported outcomes of children with omphalocele at school age are reassuring. Children with an isolated, minor omphalocele do not need extensive long-term follow-up of daily functioning. Those with a giant omphalocele or MCA might be at risk for delayed cognitive functioning at school age; we recommend long-term follow-up to offer timely intervention.


Assuntos
Desenvolvimento Infantil , Deficiências do Desenvolvimento/epidemiologia , Nível de Saúde , Hérnia Umbilical/reabilitação , Adolescente , Criança , Cognição , Feminino , Hérnia Umbilical/epidemiologia , Humanos , Masculino , Destreza Motora , Pais/psicologia , Qualidade de Vida , Inquéritos e Questionários
7.
Comput Methods Programs Biomed ; 178: 145-153, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31416543

RESUMO

BACKGROUND: Southern Illinois University School of Medicine (SIUSOM) collects large amounts of data every day. SIUSOM and other similar healthcare systems are always looking for better ways to use the data to understand and address population level problems. The purpose of this study is to analyze the administrative dataset for pediatric patients served by Southern Illinois University School of Medicine (SIUSOM) to uncover patterns that correlate specific demographic information to diagnoses of pediatric diseases. The study uses a cross-sectional database of medical billing information for all pediatric patients served by SIUSOM between June 2013 and December 2016. The dataset consists of about 980.9K clinical visits for 65.4K unique patients and includes patient demographic identifiers such as their sex, date of birth, race, anonymous zipcode and primary and secondary insurance plan as well as the related pediatric diagnosis codes. The goal is to find unknown correlations in this database. METHOD: We proposed a two step methodology to derive unknown correlations in SIUSOM administrative database. First, Class association rule mining was used as a well-established data mining method to generate hypothesis and derive associations of the form D → M, where D is diagnosis code of a pediatric disease and M is a patient demographic identifier (age,sex, anonymous zipcode, insurance plan, or race). The resulting associations were pruned and filtered using measures such as lift, odds ratio, relative risk, and confidence. The final associations were selected by a pediatric doctor based on their clinical significance. Second,each association rule in the final set was further validated and adjusted odds ratios were obtained using multiple logistic regression. RESULTS: Several associations were found correlating specific patients' residential zip codes with the diagnosis codes for viral hepatitis carrier, exposure to communicable diseases, screening for mental and developmental disorder in childhood, history allergy to medications, disturbance of emotions specific to childhood, and acute sinusitis. In addition, the results show that African American patients are more likely to be screened for mental and developmental disorders compared to White patients for SIUSOM pediatric population (Odds Ratio (OR):3.56, 95% Confidence Interval (CI):[3.29,3.85]). CONCLUSION: Class association rule mining is an effective method for detecting signals in a large patient administrative database and generating hypotheses which correlate patients' demographics with diagnosis of pediatric diseases. A post processing of the hypotheses generated by this method is necessary to prune spurious associations and select a set of clinically relevant hypotheses.


Assuntos
Mineração de Dados/métodos , Pediatria/organização & administração , Adolescente , Algoritmos , Criança , Pré-Escolar , Doenças Transmissíveis/epidemiologia , Estudos Transversais , Interpretação Estatística de Dados , Bases de Dados Factuais , Deficiências do Desenvolvimento/epidemiologia , Grupos Étnicos , Feminino , Hepatite/epidemiologia , Humanos , Illinois/epidemiologia , Lactente , Recém-Nascido , Masculino , Transtornos Mentais/epidemiologia , Análise de Regressão , Características de Residência , Estudos Retrospectivos
8.
Ital J Pediatr ; 45(1): 87, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331363

RESUMO

BACKGROUND: The purpose of this study was to analyze the growth status and to identify the risk factors that influence the catch-up growth of preterm infants after discharge and to provide evidence for feeding strategies and the need for further research. METHODS: A descriptive correlational analysis was applied. The sample consisted of 309 preterm infants and their caregivers selected from June to August 2017 from five women's and children's hospitals. Self-designed questionnaires based on knowledge, attitude and practice and the Health Belief Model (HBM) were used to measure the catch-up growth status of preterm infants after discharge. Logistic regression was used to determine the risk factors for the catch-up growth of preterm infants. RESULTS: The results showed that of 309 preterm infants, only 14 (4.5%) were underweight, and 52 (17.4%) did not meet the criteria for catch-up growth at 12 months of actual age. The logistic regression analysis showed that gestational age, regular health care, caregivers' educational background, mothers' daily contact with the baby, monthly average family income, the addition of a breast milk supplement, and daily milk volume were risk factors that affected the catch-up growth of preterm infants after discharge. CONCLUSIONS: The rate of catch-up growth of preterm infants is still not high. We should pay much more attention to preterm infants of small gestational age and guide their child care on a regular basis to detect and correct risk factors in a timely fashion, especially those involving lower daily milk volume, lower degree of culture and family economic difficulties. Second, we suggest that the government publish relevant policy that appropriately increases the length of maternity leave for preterm mothers. Future studies should have larger sample sizes and explore other important factors influencing the catch-up growth of preterm infants.


Assuntos
Desenvolvimento Infantil , Deficiências do Desenvolvimento/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Recém-Nascido Prematuro , China/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Alta do Paciente , Fatores de Risco , Inquéritos e Questionários
9.
PLoS One ; 14(7): e0220044, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31339925

RESUMO

Late-onset sepsis is frequently seen in preterm infants and is associated with poor neurodevelopmental outcome. White matter damage is proposed as substrate of poor outcome, with contributing factors as regional hypoxia and effects of cytokines on oligodendrocytes. We investigated the relation between cerebral oxygenation during (suspected) late-onset sepsis and neurodevelopmental outcome. Prospective cohort study, including preterm infants (gestational age <32 weeks and/or birthweight <1500 grams) with (suspected) late-onset sepsis underwent NIRS registration during the first 72 hours of suspected late-onset sepsis. At two years corrected age neurodevelopment was scored using the Bayley Scales of Infant Development-II. Thirty-two infants were included. Twenty-seven infants were identified with proven late-onset sepsis and five infants had clinical sepsis without positive blood culture. In this study, late-onset sepsis was predominantly caused by coagulase negative staphylococci (CoNS) (72%). All NIRS values were within normal limits. No association was found between NIRS and impaired neurodevelopmental outcome (n = 4) at corrected age two years: composite cognitive score 105 (80-115), composite motor score 103 (82-118) (median and range). In this pilot study, late-onset sepsis (predominantly caused by CoNS with a relatively mild clinical course), was not associated with aberrant NIRS values, nor with impaired neurodevelopmental outcome. Further research might establish our findings and elucidate effects of other micro-organisms on cerebral perfusion.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Recém-Nascido , Recém-Nascido Prematuro , Sepse Neonatal/diagnóstico por imagem , Espectroscopia de Luz Próxima ao Infravermelho/normas , Desenvolvimento Infantil , Feminino , Humanos , Masculino , Sepse Neonatal/epidemiologia , Sepse Neonatal/microbiologia , Projetos Piloto , Valor Preditivo dos Testes , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia
10.
Rev Chil Pediatr ; 90(3): 260-266, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31344185

RESUMO

INTRODUCTION: Early childhood is a fundamental period in children's development and depends largely on their in teractions with their main caregivers. OBJECTIVES: To evaluate the association between risk of psycho motor developmental delay (PDD) with mother-child interaction quality, postpartum depressive symptoms, and other factors related to care and environment in healthy infants at psychosocial risk. PATIENTS AND METHOD: Analytical cross-sectional study in 181 mothers at psychosocial risk and their children aged under one year seen in Primary Health Care. The presence of risk of PDD was deter mined using the Ages & Stages Questionnaire and its association with interaction quality (CARE In dex), postpartum depressive symptoms (Edinburgh Postpartum Depression Scale), and other factors related to environment and care (questionnaire applied to the mother) was studied through bivariate and multivariate analyses, adjusting for confusing variables. RESULTS: 20% of infants were at risk of PDD. There was an increased risk of presenting risk of PDD after adjusting for predefined control variables with: low-quality mother-child interaction (OR = 2.46, p = 0.03), exclusive breastfeeding (EBF) <6 months (OR = 2.58, p = 0.01), and partner does not help with childcare (OR = 2.97, p = 0.03). No significant association was observed with postpartum depressive symptoms. CONCLUSIONS: In healthy infants at psychosocial risk, low-quality mother-child interaction, EBF <6 months, and the non-involvement of the father in the childcare are associated with a higher risk of PDD.


Assuntos
Depressão Pós-Parto/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Relações Mãe-Filho/psicologia , Mães/psicologia , Adolescente , Adulto , Aleitamento Materno/estatística & dados numéricos , Desenvolvimento Infantil , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Adulto Jovem
11.
PLoS One ; 14(6): e0215804, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220086

RESUMO

BACKGROUND: Attention to research and planning are increasingly being devoted to newcomer health, but the needs of newcomers with disabilities remain largely unknown. This information is difficult to determine since population-level data are rarely available on newcomers or on people with intellectual and developmental disabilities (IDD), although in Ontario, Canada these databases are accessible. This study compared the prevalence of IDD among first generation adult newcomers to adult non-newcomers in Ontario, and assessed how having IDD affected the health profile and health service use of newcomers. METHODS: This population-based retrospective cohort study of adults aged 19-65 in 2010 used linked health and social services administrative data. Prevalence of IDD among newcomers (n = 1,649,633) and non-newcomers (n = 6,880,196) was compared. Among newcomers, those with IDD (n = 2,830) and without IDD (n = 1,646,803) were compared in terms of health conditions, and community and hospital service use. RESULTS: Prevalence of IDD was lower in newcomers than non-newcomers (171.6 versus 898.3 per 100,000 adults, p<0.0001). Among newcomers, those with IDD were more likely than those without IDD to have comorbid physical health disorders, non-psychotic, psychotic and substance use disorders. Newcomers with IDD were also more likely to have psychiatry visits, and frequent emergency department visits and hospitalizations. CONCLUSION: First generation adult newcomers have lower rates of IDD than non-newcomers. How much of this difference is attributable to admission policies that exclude people expected to be high health service users versus how much is attributable to our methodological approach is unknown. Finding more medical and psychiatric comorbidity, and more health service use among newcomers with IDD compared to newcomers without IDD is consistent with patterns observed in adults with IDD more generally. To inform polices that support newcomers with IDD future research should investigate reasons for the prevalence finding, barriers and facilitators to timely health care access, and pathways to care.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Adulto , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Prevalência , Estudos Retrospectivos , Adulto Jovem
12.
PLoS Negl Trop Dis ; 13(6): e0007494, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31226111

RESUMO

BACKGROUND: Soil-transmitted helminth (STH) infections remain highly endemic across the Philippines, and are believed to be important contributors to delayed cognitive development of school-aged children. Identification of communities where children are at risk of functional illiteracy is important for the attainment of Sustainable Development Goals target for literacy. We aimed to quantify the associations between the spatial variation of STH infections and functional literacy indicators adjusting for other important contributors, and identify priority areas in the Philippines in need of interventions. METHODOLOGY/PRINCIPAL FINDINGS: We used data from 11,313 school-aged children on functional literacy indicators collected in 2008. Nested fixed-effects multinomial regression models were built to determine associations between STH endemicity and geographical distribution of functional literacy, adjusting for demographics, household level variables, and the prevalence of malaria. Bayesian multinomial geostatistical models were built to geographically predict the prevalence of each level of functional literacy. The number of school-aged children belonging to each of the functional literacy indicator classes was forecast for 2017. We estimated 4.20% of functional illiteracy burden among school-aged children in Mindanao might be averted by preventing T. trichiura infections. Areas predicted with the highest prevalence of functional illiteracy were observed in localised areas of the eastern region of the Visayas, and the south-eastern portion of Mindanao. CONCLUSIONS/SIGNIFICANCE: The study demonstrates significant geographical variation in burden of functional illiteracy in school-aged children associated with STH infections suggesting that targeted helminth control could potentially promote the development of cognitive function of school-aged children in the Philippines. The benefits of a spatially targeted strategy should be tested by future studies.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Doenças Endêmicas , Helmintíase/complicações , Helmintíase/epidemiologia , Enteropatias Parasitárias/complicações , Enteropatias Parasitárias/epidemiologia , Alfabetização/estatística & dados numéricos , Topografia Médica , Adolescente , Criança , Feminino , Humanos , Masculino , Filipinas/epidemiologia , Prevalência , Análise Espacial , Inquéritos e Questionários , Adulto Jovem
13.
Matern Child Health J ; 23(9): 1213-1219, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31209617

RESUMO

The effects of place on human health and development have been extensively studied in recent years in the adult and adolescent populations, but minimal research has addressed neighborhood effects in early childhood. This analysis of the National Survey of Children's Health 2011/2012 cross-sectional survey examined relationships between risk for developmental disability in early childhood and neighborhood characteristics in a nationally-representative sample of children ages 0-5 years. Parents reported on their child's development using a well-validated parent report screening tool for developmental problems (the Parent's Evaluation of Developmental Status tool), and neighborhood and family characteristics. Multinomial logistic regression analyses were conducted for each of three neighborhood variables: physical disorder, safety, and isolation. After controlling for parental and child characteristics, the three neighborhood variables were each significantly associated with moderate (but not severe) risk versus low to no risk for developmental disabilities. When all neighborhood characteristics were included simultaneously in the same model, only physical disorder remained statistically significant [OR 1.44 (95% CI 1.09-1.91)], though modestly attenuated. These results suggest that neighborhoods may have effects on early childhood development, after controlling for individual child, parental, and family characteristics.


Assuntos
Desenvolvimento Infantil , Deficiências do Desenvolvimento/epidemiologia , Características de Residência/estatística & dados numéricos , Adulto , Pré-Escolar , Estudos Transversais , Feminino , Mapeamento Geográfico , Humanos , Lactente , Masculino , Inquéritos e Questionários
14.
J Pediatr Surg ; 54(9): 1771-1777, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31196668

RESUMO

OBJECTIVE: To determine the prevalence and identify risk factors of autism spectrum disorders (ASDs) and neurodevelopmental delays in giant omphalocele (GO) survivors. MATERIALS AND METHODS: The study cohort consists of 47 GO survivors enrolled in our follow-up program between 07/2004 and 12/2015. All patients underwent assessments at 2 years of age or older. Outcomes were assessed by either the Bayley Scales of Infant Development II (prior 2006) or III (after 2006), or the Wechsler Preschool and Primary Scale of Intelligence (children older than 4 years). ASD diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders IV (prior to 2014) or 5 criteria. RESULTS: The prevalence of ASD in GO children is 16 times higher than the general population (P = 0.0002). ASD patients were more likely to be diagnosed with neurodevelopmental and neurofunctional delays, language disorders, and genetic abnormalities (P < 0.01). While 53.2% of GO children scored within the average range for all developmental domains, 19.1% scored within the mildly delayed and 27.7% in the severe delayed range in at least one domain. Prolonged respiratory support, pulmonary hypertension, gastroesophageal reflux disease, feeding problems, prolonged hospitalization, abnormal BAER hearing screen, presence of delayed motor coordination, and hypotonicity were associated with delayed scores (P < 0.05). CONCLUSIONS: There is a significant rate of ASD in GO survivors. Neurodevelopmental delays, language delays, and genetic abnormalities were strongly associated with ASD. Neurological impairments were present in nearly half of GO children. Surrogate markers of disease severity were associated with below average neurodevelopmental scores. Level of evidence Level IV.


Assuntos
Transtorno do Espectro Autista , Deficiências do Desenvolvimento , Hérnia Umbilical , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/epidemiologia , Hérnia Umbilical/complicações , Hérnia Umbilical/epidemiologia , Humanos , Prevalência , Fatores de Risco
15.
J Pediatr Endocrinol Metab ; 32(7): 667-674, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31150357

RESUMO

Background Obesity with developmental disability/intellectual disability (DD/ID) is the most common association in syndromic obesity. Genomic analysis studies have allowed the decipherment of disease aetiology, both in cases of syndromic obesity as well as in cases of isolated or syndromic DD/ID. However, more data are needed to further elucidate the link between the two. The aim of this pangenomic study was to use single nucleotide polymorphism (SNP) array technology to determine the copy number variant (CNV) type and frequency associated with both obesity and DD/ID. Methods Thirty-six patients were recruited from the Clinical Emergency Hospital for Children, in Cluj-Napoca, Romania during the period 2015-2017. The main inclusion criterion was a diagnosis that included both obesity and DD/ID. Genomic analysis via SNP array technology was performed. Results Out of the 36 patients, 12 (33%) presented CNVs with a higher degree of pathogenicity (A group) and 24 (66%) presented benign CNVs (B group). The SNP array results for the A group were as follows: pathogenic CNVs in 8/12 patients (67%); variants of unknown significance (VOUS) in 2/12 patients (16%); and uniparental disomy (UPD) in 2/12 patients (16%). Conclusions Some of these CNVs have already been observed in patients with both obesity and DD/ID, but the others were noticed only in DD/ID patients and have not been described until now in association with obesity.


Assuntos
Biomarcadores/análise , Aberrações Cromossômicas , Deficiências do Desenvolvimento/genética , Genômica/métodos , Deficiência Intelectual/genética , Obesidade Pediátrica/genética , Polimorfismo de Nucleotídeo Único , Adolescente , Criança , Pré-Escolar , Variações do Número de Cópias de DNA , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/patologia , Feminino , Seguimentos , Testes Genéticos , Humanos , Lactente , Deficiência Intelectual/complicações , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/patologia , Masculino , Análise em Microsséries , Obesidade Pediátrica/complicações , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/patologia , Prognóstico , Romênia/epidemiologia
16.
BMC Neurol ; 19(1): 108, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146703

RESUMO

BACKGROUND: The study is intended to fill the knowledge gap about the neuropsychology and neuromotor developmental outcomes, and identify the perinatal risk factors for late preterm infants (LPIs 34~36 weeks GA) born with uncomplicated vaginal birth at the age of 24 to 30 months. METHODS: The parents/guardians of 102 late preterm infants and 153 term infants, from 14 community health centers participated in this study. The Modified Checklist for Autism in Toddlers (M-CHAT) questionnaire, the Chinese version of Gesell Development Diagnosis Scale (GDDS), and the Sensory Integration Schedule (SIS), a neurological examination for motor disorders (MD) were carried out. Infants screening positive to the M-CHAT were referred to specialist autism clinics. RESULTS: Forty-six LPIs (45.1%) scored low in GDDS. Nine LPIs (8.8%) scored positive on M-Chat. 8.8% of LPIs (9 out of 102) were diagnosed MD (p <  0.05). Compared with their full-term peers, LPIs had statistically lower scores in GDDS and the Child Sensory Integration Checklist. LPIs who had positive results on M-CHAT showed unbalanced abilities in every part of GDDS. Risk factors of twin pregnancies, pregnancy induced hypertension and premature rupture of membranes had negative correlation with GDDS (all p <  0.05). Birth weight and gestational age were positively correlated with GDDS. CONCLUSIONS: LPIs shall be given special attention as compared to normal deliveries, as they are at increased risk of neurodevelopment impairment, despite being born with no major problems. Some perinatal factors such as twin pregnancies, and pregnancy induced hypertension etc. have negative effects on their neurodevelopment. Regular neurodevelopmental follow- up and early intervention can benefit their long term outcomes.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/etiologia , Recém-Nascido Prematuro , Nascimento Prematuro , Pré-Escolar , China , Feminino , Idade Gestacional , Humanos , Masculino , Exame Neurológico , Inquéritos e Questionários
17.
J Consult Clin Psychol ; 87(6): 551-562, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31120274

RESUMO

OBJECTIVE: This study examines the effect of a home visiting intervention on maternal alcohol use, problematic drinking, and the association of home visiting and alcohol use on children's behavioral, cognitive, and health outcomes at 5 time points over 5 years. METHOD: We analyzed 5,099 observations of 1,236 mothers and their children from pregnancy to 5 years postbirth, within a longitudinal cluster-randomized trial evaluating the effect of a home visiting intervention on mothers in Cape Town, South Africa. Paraprofessional home visitors coached mothers on coping with multiple risk factors, including a brief, 1-visit intervention on alcohol prevention in pregnancy. We assessed changes in maternal drinking over time in relation to the intervention, and then examined the impact of these drinking patterns on child outcomes over five years. RESULTS: Drinking increased over the 5 years postbirth, but it was significantly lower in the intervention condition. Compared with abstinence, mothers' problematic drinking was associated with decreased child weight (-0.21 z-units) at all assessments, increased child aggressive behavior (3 to 7 additional symptoms), and decreased child performance on an executive functioning measure (the silly sounds task; odds ratio = .34) at 3 and 5 years. The intervention's effect was associated with increased child aggression (0.25 to 0.75 of 1 additional symptom), but the intervention appeared to decrease the effect of problem drinking on children's aggressive acts and executive functioning. CONCLUSION: These findings support the need for sustained interventions to reduce alcohol use, especially for mothers who exhibit problematic drinking. Maternal drinking influences children's health and development over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Visita Domiciliar/estatística & dados numéricos , Mães/estatística & dados numéricos , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adulto , Pré-Escolar , Análise por Conglomerados , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Gravidez , África do Sul/epidemiologia
18.
Congenit Heart Dis ; 14(5): 797-802, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31112369

RESUMO

OBJECTIVE: Neurodevelopmental impairment is common after surgery for congenital heart disease (CHD) in infancy. While neurodevelopmental follow-up of high-risk patients has increased, the referral patterns for ancillary services following initial evaluation have not been reported. The aim of this study is to describe the rates and patterns of referral at the initial visit to our outcomes clinic of patients who underwent surgery for CHD during infancy. OUTCOMES MEASURES: The Cardiac Developmental Outcomes Program clinic at Texas Children's Hospital provides routine longitudinal follow-up with developmental pediatricians and child psychologists for children who required surgery for CHD within the first 3 months of life. Demographic, diagnostic, and clinical data, including prior receipt of intervention and referral patterns at initial presentation, were abstracted from our database. RESULTS: Between April 2013 and May 2017, 244 infants under 12 months of age presented for initial evaluation at a mean age of 7 ± 1.3 months. At presentation, 31% (76/244) were referred for either therapeutic intervention (early intervention or private therapies), ancillary medical services, or both. Referral rates for low-risk (STAT 1-3) and high-risk (STAT 4-5) infants were similar (28 vs. 33%, P = .48). Referrals were more common in: Hispanic white infants (P = .012), infants with non-cardiac congenital anomalies (P = .001), history of gastrostomy tube placement (P < .001), and infants with prior therapy (P = .043). Infants of non-English speaking parents were three times more likely to be referred (95% CI = 1.5, 6.4; P = .002). CONCLUSIONS: At the time of presentation, nearly 1 in 3 infants required referral. Referral patterns did not vary by traditional risk stratification. Sociodemographic factors and co-morbid medical conditions increased the likelihood of referral. This supports the need for routine follow-up for all post-surgical infants regardless of level of surgical complexity. Further research into the completion of referrals and long-term referral patterns is needed.


Assuntos
Desenvolvimento Infantil , Deficiências do Desenvolvimento/etiologia , Sistemas de Informação em Saúde/estatística & dados numéricos , Cardiopatias Congênitas/complicações , Encaminhamento e Consulta/estatística & dados numéricos , Medição de Risco/métodos , Procedimentos Cirúrgicos Cardíacos , Pré-Escolar , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/psicologia , Feminino , Seguimentos , Cardiopatias Congênitas/cirurgia , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Texas/epidemiologia
19.
Fukushima J Med Sci ; 65(1): 1-5, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30996215

RESUMO

The present adjunct study of the Japan Environment and Children's Study (JECS) aimed to determine the occurrence of developmental disorders in Fukushima Prefecture, which was exposed to low-dose radiation. At two medical institutions in Fukushima City, we enrolled 339 pregnant women from September 2013 through May 31, 2014, who delivered 335 neonates (174 male, including one set of twins) between November 4, 2013 and November 11, 2014. The parents of four neonates declined to participate in the present study and one neonate died. Therefore, 334 families agreed to participate in additional surveys until March 2017. Child Behavior Checklists (CBCL) were mailed to all 334 families during the month of their infant's second birthday and we received 236 responses (response rate, 70%). All responses were below the 69th percentile in the CBCL, and no responses indicated significant problem behaviors. Boys tended to have higher values for items associated with developmental problems, but symptoms of autism were not evident. The mental health of the mothers indicated in the previous study might not have influenced the children. Autism spectrum disorder (ASD) is not obvious by the age of three years and thus it might become apparent as the children grow older.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Terremotos , Acidente Nuclear de Fukushima , Centrais Nucleares , Transtorno do Espectro Autista/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Japão/epidemiologia , Masculino , Saúde Mental
20.
J Appl Res Intellect Disabil ; 32(4): 967-980, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30941865

RESUMO

BACKGROUND: Comorbid conditions are very common in children and adults with autism spectrum disorder (ASD) and can affect school performance, adaptive skills and peer relationships. Comorbid conditions place strain on the family as well as the individual with ASD. This project aimed to determine the affect of comorbid conditions over and above child and family characteristics. METHODS: The present authors examined 3,055 cases of children with ASD who had varying numbers of comorbid conditions (i.e., ADHD, depression, anxiety or behaviour problems). RESULTS: Multiple comorbid conditions did have a unique impact on difficulties accessing services. A greater number of comorbid conditions impacted daily activity participation, but not a family's receipt of mental health care or respite, work changes or number of weekly hours dedicated to caring for a child with ASD. CONCLUSIONS: Families, practitioners, paraprofessionals and educators of children with autism should address comorbid conditions to ensure both child and family well-being.


Assuntos
Ansiedade , Transtornos de Deficit da Atenção e do Comportamento Disruptivo , Transtorno do Espectro Autista , Efeitos Psicossociais da Doença , Depressão , Deficiências do Desenvolvimento , Família , Acesso aos Serviços de Saúde/estatística & dados numéricos , Adolescente , Ansiedade/epidemiologia , Ansiedade/reabilitação , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/epidemiologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/reabilitação , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/reabilitação , Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Comorbidade , Depressão/epidemiologia , Depressão/reabilitação , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/reabilitação , Feminino , Humanos , Masculino , Serviços de Saúde Mental/estatística & dados numéricos
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