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1.
Codas ; 31(4): e20180177, 2019 Aug 22.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31460569

RESUMO

PURPOSE: This study aimed to present findings on language, behavior, and neurodevelopment in a girl diagnosed with Angelman Syndrome, evaluated when she was three and eight years old. METHODS: The following evaluation instruments were used: Observation of Communication Behavior, Early Language Milestone (ELM) Scale, and Denver Developmental Screening Test, 2nd edition (DDST-II). RESULTS: In this case report, presence of AS phenotype signals such as wide mouth and wide-spaced teeth, tongue thrusting, strabismus, up slanting palpebral fissures, and sialorrhea are verified. Expressive and receptive deficits were verified in the language assessment, with the absence of orality and loss of comprehension with very similar performances in both evaluations. The ELM and DDST-II tests indicated severe impairment of all abilities evaluated at both three and eight years of age. Performance was quite similar in both evaluations in all areas of child development. Little progress was observed over time despite the great therapeutic and educational investment. CONCLUSION: The presence of a complex scenario such as AS demands high complexity clinical needs, a situation that is worsened due to scarcity of therapeutic resources that could minimize the harmful impacts of AS and culminate in increased quality of life for the AS population and their families.


Assuntos
Síndrome de Angelman/reabilitação , Transtornos do Neurodesenvolvimento/reabilitação , Síndrome de Angelman/diagnóstico , Síndrome de Angelman/psicologia , Criança , Desenvolvimento Infantil , Comunicação , Feminino , Humanos , Desenvolvimento da Linguagem , Testes de Linguagem , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/psicologia , Testes Neuropsicológicos , Desempenho Psicomotor
2.
Soins Pediatr Pueric ; 40(309): 22-26, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31331597

RESUMO

In intensive care units, the priority is to provide the care and treatments essential for the child's survival. However, the psychological aspect must not be ignored. The sensory-motor approach contributes to the provision of high-quality care in this context. It enables individualised care to be delivered in an environment optimising the child's resources.


Assuntos
Desenvolvimento Infantil , Criança Hospitalizada/psicologia , Unidades de Terapia Intensiva , Criança , Humanos , Qualidade da Assistência à Saúde
3.
Medicine (Baltimore) ; 98(28): e16414, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305457

RESUMO

The gestational weight gain is determined by food habits, environmental and genetic factors.The aims of this paper were to establish relationships between maternal gene polymorphisms (patatin-like phospholipase domain-containing protein 3 rs738409 [PNPLA3 rs738409], glucokinase regulatory protein rs780094 [GCKR rs780094], and guanine nucleotide-binding protein rs5443 [GNB3 rs5443]) and mothers' gestational weight gain, but also neonatal outcomes (birth weight, length, and ponderal index [PI]).We performed a cross-sectional study in a sample of 158 mothers and their product of conception' in an Obstetrics-Gynecology Clinic from Romania. We divided the pregnant women according to the Institute of Medicine recommendations into 3 subgroups: (1) insufficient gestational weight gain; (2) normal gestational weight gain; and (3) excessive gestational weight gain.The gestational weight gain among pregnant women included in this study was classified as insufficient (10.1%), normal (31%), and excessive (58.9%). We found a tendency towards statistical significance for mothers that were overweight or obese before pregnancy to present an excessive gestational weight gain as compared to the normal weight ones. Similarly, we identified a tendency for statistical significance regarding the association between the variant genotype of GNB3 rs5443 and excessive gestational weight gain. We noticed differences that tended to be statistical significant concerning aspartate aminotransferase values between the 3 subgroups, mothers with excessive gestational weight gain having higher values than mothers with normal gestational weight gain (median, IQR: 22.89[17.53; 31.59] for mothers with excessive gestational weight gain versus 22.71[18.58; 27.37] for mothers with normal gestational weight gain). In mothers with excessive gestational weight gain, we found a significant association between the variant genotype of PNPLA3 rs738409 polymorphism and neonatal PI noticing a decrease of this index in case of newborns from mothers carrying the variant genotype.Excessive gestational weight gain was noticed in pregnant women that were obese and overweight before pregnancy. We found a positive association between the variant genotype of GNB3 rs5443 polymorphism and excessive gestational weight gain. Similarly, the presence of variant genotype of PNPLA3 rs738409 in mothers was associated with a lower PI in their newborns. Our study pointed out the most important factors that influence gestational weight gain and related birth outcomes.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Desenvolvimento Infantil , Ganho de Peso na Gestação/genética , Proteínas Heterotriméricas de Ligação ao GTP/genética , Lipase/genética , Proteínas de Membrana/genética , Adolescente , Adulto , Peso ao Nascer , Estatura , Estudos Transversais , Feminino , Estudos de Associação Genética , Humanos , Recém-Nascido , Sobrepeso/genética , Polimorfismo de Nucleotídeo Único , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/genética , Adulto Jovem
4.
Medicine (Baltimore) ; 98(28): e16424, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305461

RESUMO

Although the changes in DNA methylation are assumed to be due to the association between adverse intrauterine conditions and adult metabolic health, evidence from human studies is rare. Little is known about the changes in DNA methylation present at birth that affect metabolic profiles in childhood. Previous studies have shown that the melanocortin 4 receptor (MC4R) and hepatocyte nuclear factor 4 alpha (HNF4α) genes are associated with obesity and metabolic disorders. Thus, we investigated the associations of the DNA methylation statuses of MC4R and HNF4α in cord blood with metabolic profiles in childhood.We collected data from 90 children 7 to 9 years of age included in the Ewha Birth & Growth Cohort Study in Korea. DNA methylation was analyzed by pyrosequencing. The children were split into 2 groups according to the cutoff triglyceride (TG) levels (<110 and ≥110 mg/dL).The methylation statuses of MC4R and HNF4α at birth were significantly associated with the TG level in childhood (P < .05). It was interesting to note that the methylation statuses of MC4R and HNF4α in cord blood were significantly decreased, whereas childhood body mass index was significantly increased, in children with high TG levels compared with children with low TG levels (P < .05).Our findings show that the methylation statuses of MC4R and HNF4α at birth are associated with metabolic profiles in childhood. These epigenetic modifications occurring in early life may contribute to subsequent metabolic-related disorders. Thus, we suggest that DNA methylation status in cord blood may be predictive of the risk of developing metabolic syndrome.


Assuntos
Metilação de DNA , Fator 4 Nuclear de Hepatócito/genética , Regiões Promotoras Genéticas , Receptor Tipo 4 de Melanocortina/genética , Triglicerídeos/sangue , Índice de Massa Corporal , Criança , Desenvolvimento Infantil , Ilhas de CpG , Epigênese Genética , Feminino , Sangue Fetal/metabolismo , Seguimentos , Fator 4 Nuclear de Hepatócito/metabolismo , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Receptor Tipo 4 de Melanocortina/metabolismo
5.
Epidemiol Health ; 41: e2019035, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31319652

RESUMO

OBJECTIVES: Child development is a significant issue in global public health, and maternal mental health (MMH) can have a remarkable effect on children's development of communication skills. We aimed to investigate the association between MMH and communication skills in a sample of Iranian children. METHODS: This study was conducted in Shiraz, Iran during 2016. In total, 640 mothers who lived in Shiraz and were registered in the Fars Birth Cohort (FBC) study were invited to attend the FBC clinic with their children. A trained physician evaluated MMH using the General Health Questionnaire (GHQ). Additionally, a trained nurse assessed the children's communication development status using the Ages and Stages Questionnaire for 60-month old children. RESULTS: The majority of the mothers were homemakers (82.8%) and had high school diplomas (38.9%). The mothers' mean age was 33.7±4.6 years. Seventy-nine (12.3%) children had delayed communication skills, but no significant association was found between children's communication skills and the mothers' total GHQ score (p=0.43). In total, 493 mothers (77.0%) had abnormal somatic symptoms, 497 (77.7%) had abnormal anxiety/insomnia, 337 (52.7%) had social dysfunction, and 232 (36.3%) suffered from depression. Logistic regression indicated that after adjusting for confounders, the odds of delayed communication skills were 3-fold higher among the children of mothers with abnormal somatic symptoms than among other children (p=0.01). CONCLUSIONS: The study results confirmed that MMH had a significant impact on children's communication skills. Moreover, maternal abnormal somatic symptoms exerted the strongest impact on the development of communication skills in 5-yearold children.


Assuntos
Desenvolvimento Infantil , Comunicação , Transtornos Mentais/epidemiologia , Mães/psicologia , Adulto , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Mães/estatística & dados numéricos , Inquéritos e Questionários
6.
Washington, D. C.; PAHO; 2019-07-15.
em Inglês | PAHO-IRIS | ID: phr-51366

RESUMO

[Foreword]. Early childhood development (ECD) – including the physical (or motor), communication, cognitive and social - emotional capacities – is indivisible from the child survival, health and education agendas and represents one of the important stages for breaking the intergenerational cycles of poverty and for promoting sustainable development. Development during the early years lays the critical foundations for health, learning and behaviour across the life course… Investment in early childhood programmes is essential because ECD programmes and interventions can provide a “good and fair start” to children and help to modify distressing socio-economic and gender-related inequities. There is strong evidence regarding interventions that can address the causal factors and reduce the burden of poor child development… The health sector in countries has the capacity to play a unique role in the field of ECD because the most important window of opportunity for ensuring optimal development and preventing risk of long-term damage is from pregnancy through the first five years of life – especially from birth to three years of age... For some countries, ECD is currently not systematically incorporated into initiatives to promote and protect maternal and child health. Moreover, families are often not prepared or aware of the critical role they can play in promoting cognitive and socio-emotional development in the early years. To address this gap, WHO, PAHO/WHO and UNICEF have collaborated closely to strengthen their advocacy and technical support to regions and countries and have extended partnership to national leaders and governments, development agencies, researchers, academics, non-governmental organizations, professional associations, media and advocacy groups. We have also developed the present evidence-based set of materials to help international staff, national governments and their partners promote Care for Child Development within all relevant programme activities of the health sector, with the emerging involvement of education, social protection, rehabilitation and other ECD partners.


Assuntos
Cuidado da Criança , Desenvolvimento Infantil , Saúde Pública , Setor de Assistência à Saúde , América Latina , Região do Caribe
7.
Lima; Perú. Ministerio de Salud; 20190600. 37 p. tab, ilus.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1005180

RESUMO

Contribuir a la conservación de la salud de la población infantil y prevenir precoz y oportunamente la morbilidad, discapacidad y mortalidad mediante la detección de alteraciones metabólicas, auditivas y visuales en la etapa neonatal, favoreciendo el adecuado desarrollo infantil temprano en el país.


Assuntos
Desenvolvimento Infantil , Triagem Neonatal , Normas Técnicas , Serviços de Saúde da Criança
8.
Rev. neurol. (Ed. impr.) ; 68(12): 503-509, 16 jun., 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-180477

RESUMO

Introducción. Los prematuros tardíos constituyen actualmente el 70% de los nacimientos prematuros. Presentan mayor comorbilidad, incluyendo las alteraciones del neurodesarrollo, que pueden no manifestarse hasta la escolarización. Objetivo. Identificar dificultades en el desarrollo neurológico a los dos años de edad. Sujetos y métodos. Se valoró el desarrollo psicomotor a los dos años de los prematuros tardíos y del grupo control a término nacidos en nuestro centro entre enero y septiembre del año 2014 mediante la escala de Brunet-Lézine revisada y el cuestionario de edades y etapas para la detección de trastornos del neurodesarrollo Ages & Stages Questionnaires (ASQ-3). Resultados. Se incluyó a 88 niños. Los prematuros tardíos presentaron puntuaciones inferiores en el lenguaje y el desarrollo postural. Las niñas obtuvieron resultados superiores en la edad de desarrollo global, la coordinación oculomotriz, el lenguaje y la sociabilidad. El cuestionario ASQ-3 detectó las diferencias en comunicación y socioindividuales. Se identificaron como factores de riesgo para presentar alteración del desarrollo la prematuridad, para alteración del lenguaje, y el sexo masculino, para menor edad de desarrollo y alteración del lenguaje. La correlación entre la valoración del lenguaje con la escala de Brunet-Lézine revisada y el cuestionario ASQ-3 fue buena, con un coeficiente de correlación de Pearson de 0,7 (p < 0,001), lo que nuestra la utilidad del cuestionario. Conclusiones. Los prematuros tardíos presentan menor desarrollo del lenguaje a los dos años. La prematuridad y el sexo masculino son factores de riesgo para presentar alteración. La valoración del lenguaje con el cuestionario ASQ-3 puede ser útil para detectar alteraciones


Introduction. Late preterm infants currently constitute 70% of preterm infant births. They present greater comorbidity, including neurodevelopment disorders, which may not manifest until the school age. Aim. To identify the existence of difficulties in the neurodevelopment at the age of two years. Subjects and methods. The psychomotor development was performed at two years of age in late preterm infants and term control group born at our center between January and September 2014, with Brunet-Lezine Revised test and Ages & Stages Questionnaires (ASQ-3) questionnaire. Results. 88 children were included. Late preterm infants had lower scores in the language area and postural developmental. Girls achieved better results than males at global developmental age, oculo-motor coordination, language area and sociability. The ASQ-3 questionnaire detected differences in communication and socio-individual. Prematurity and male sex were identified as an independent risk factor to present a developmental disorder, prematurity for language impairment and male sex for younger developmental age and language impairment. The correlation between language assessment with the Brunet-Lezine Revised test and the ASQ-3 questionnaire was good, with a Pearson correlation coefficient of 0.7 (p < 0.001), showing the usefulness of the questionnaire. Conclusions. Late preterm infants have a lower developmental age in the language area at two years. Prematurity and male sex are risk factors for developmental disorder. Language assessment with the ASQ-3 questionnaire may be a useful tool to detect disorders and intervene early


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Recém-Nascido Prematuro/fisiologia , Desenvolvimento Infantil/fisiologia , Desempenho Psicomotor/fisiologia , Deficiências do Desenvolvimento/diagnóstico , Seguimentos , Idade Gestacional , Fatores de Risco , Estudos de Casos e Controles
9.
BMC Public Health ; 19(Suppl 4): 541, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196019

RESUMO

BACKGROUND: Socioeconomic factors and nutritional status have been associated with childhood cognitive development. However, previous Malaysian studies had been conducted with small populations and had inconsistent results. Thus, this present study aims to determine the association between socioeconomic and nutritional status with cognitive performance in a nationally representative sample of Malaysian children. METHODS: A total of 2406 Malaysian children aged 5 to 12 years, who had participated in the South East Asian Nutrition Surveys (SEANUTS), were included in this study. Cognitive performance [non-verbal intelligence quotient (IQ)] was measured using Raven's Progressive Matrices, while socioeconomic characteristics were determined using parent-report questionnaires. Body mass index (BMI) was calculated using measured weight and height, while BMI-for-age Z-score (BAZ) and height-for-age Z-score (HAZ) were determined using WHO 2007 growth reference. RESULTS: Overall, about a third (35.0%) of the children had above average non-verbal IQ (high average: 110-119; superior: ≥120 and above), while only 12.2% were categorized as having low/borderline IQ (< 80). Children with severe obesity (BAZ > 3SD), children from very low household income families and children whose parents had only up to primary level education had the highest prevalence of low/borderline non-verbal IQ, compared to their non-obese and higher socioeconomic counterparts. Parental lack of education was associated with low/borderline/below average IQ [paternal, OR = 2.38 (95%CI 1.22, 4.62); maternal, OR = 2.64 (95%CI 1.32, 5.30)]. Children from the lowest income group were twice as likely to have low/borderline/below average IQ [OR = 2.01 (95%CI 1.16, 3.49)]. Children with severe obesity were twice as likely to have poor non-verbal IQ than children with normal BMI [OR = 2.28 (95%CI 1.23, 4.24)]. CONCLUSIONS: Children from disadvantaged backgrounds (that is those from very low income families and those whose parents had primary education or lower) and children with severe obesity are more likely to have poor non-verbal IQ. Further studies to investigate the social and environmental factors linked to cognitive performance will provide deeper insights into the measures that can be taken to improve the cognitive performance of Malaysian children.


Assuntos
Transtornos Cognitivos/epidemiologia , Obesidade Mórbida/psicologia , Pobreza/psicologia , Classe Social , Índice de Massa Corporal , Criança , Desenvolvimento Infantil , Pré-Escolar , Cognição , Transtornos Cognitivos/etiologia , Feminino , Humanos , Renda , Testes de Inteligência/estatística & dados numéricos , Malásia/epidemiologia , Masculino , Inquéritos Nutricionais , Estado Nutricional , Obesidade Mórbida/epidemiologia , Pais , Prevalência , Inquéritos e Questionários
11.
Rev. bras. ciênc. mov ; 27(2): 82-96, abr.-jun.2019.
Artigo em Português | LILACS | ID: biblio-1009179

RESUMO

O presente estudo teve como objetivo analisar a influência da Psicomotricidade Relacional nas relações afetivas entre crianças durante aulas de educação física de uma turma da Educação Infantil. Vários teóricos subsidiaram a construção deste trabalho, tais como Lapierre, Aucouturier, Le Boulch, Negrine, dentre outros. Tais autores fundamentam a ideia de que o jogo simbólico e espontâneo contribui para as interações entre as crianças e destas com o estagiário/professor, a partir das quais emergem os conflitos inconscientes que poderão ser trabalhados na mediação pedagógica. Tal investigação, de cunho qualitativo, teve como participantes alunos de uma turma de segundo período da Educação Infantil em uma escola da rede pública de ensino do Distrito Federal. Foi utilizada como instrumento de pesquisa a observação participante. Os resultados indicam que o uso de objetos dispostos durante as sessões/aulas conjuntamente com a mediação pedagógica relacional do estagiário/professor oportunizaram as crianças a expressão de sentimentos não manifestos anteriormente, tanto na relação entre elas quanto com o estagiário e a professora de sala. Através da linguagem corporal e verbal foram desencadeadas pulsões agressivas reprimidas, expressão de domínio, dependência fusional, dentre outras. Os problemas afetivosrelacionais das crianças receberam suporte e acolhimento nas sessões/aulas, contribuindo para que elas pudessem caminhar ao encontro da resolução dos seus conflitos inconscientes. Conclui-se que a prática de intervenções psicomotoras propulsoras de relações afetivas contribuiu para as crianças tanto no sentido do desenvolvimento integral quanto na formação pessoal, além de ter permitido também que fosse explorada a dimensão do prazer de brincar, que é uma prática pouco explorada pelos professores. Por fim, possibilitou compreender aspectos importantes da função do professor diante da criança e a liberdade que deve ser dada a ela para a expressão dos seus conteúdos psíquicos que são um dos fatores que determinam os processos de socialização....(AU)


The aim of the present study is to analyze the influence of relational psychomotricity on affective relationships among children during physical education classes in Early Childhood Education. Several authors subsidized the construction of this work, such as Lapierre, Aucouturier, Le Boulch, Negrine, among others. These authors base the idea that the spontaneous and symbolic play contributes to the interactions between the children and between them and the trainee / teacher, from which emerges the unconscious conflicts that can be worked in pedagogical mediation. This qualitative research was carried out with students from a second period of Early Childhood Education in a public school system in the Federal District. Participant observation was the methodological tool. The results indicate that the use of objects arranged during the sessions together with the pedagogical relational mediation of the trainee / teacher lead the children to express feelings that were not manifest previously, both in the relationship between them and with the trainee and the classroom teacher. Through the body and verbal language were triggered repressed aggressive drive, expressions of domination, fusional dependence, among others. The affective-relational problems of the children received support and acceptance in the sessions, so that they could afford to the resolution of their unconscious conflicts. It was concluded that the practice of psychomotor interventions that fostered affective relationships contributed to the children both in the sense of integral development and in personal formation, and also allowed them to explore the dimension of play pleasure, which is a practice hardly explored by the teachers. Finally, it was possible to understand important aspects of the teacher's role in face of the child and the freedom that should be given to her for the expression of their psychic contents that are one of the factors that determine the processes of socialization....(AU)


Assuntos
Humanos , Pré-Escolar , Educação Física e Treinamento , Socialização , Desenvolvimento Infantil
12.
Nursing ; 49(6): 50-55, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31124856

RESUMO

Characterized by aggressive or violent behaviors, reactive attachment disorder (RAD) affects children who have been repeatedly exposed to traumatic experiences. This article discusses the underlying causes of RAD and provides insight on therapies and interventions.


Assuntos
Transtorno Reativo de Vinculação na Infância/enfermagem , Desenvolvimento Infantil , Criança Acolhida/psicologia , Pré-Escolar , Humanos , Lactente , Transtorno Reativo de Vinculação na Infância/etiologia , Fatores de Risco
13.
Semin Pediatr Surg ; 28(2): 118-121, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31072460

RESUMO

After a diagnosis of omphalocele during pregnancy, questions regarding long-term prognosis are of primary importance for parents. It is imperative that their questions are answered with substantiated data to promote confident decisions for their children. They frequently express concerns regarding long-term survival, quality of life, need for more operations, feeding issues, motor and cognitive development, cosmesis, and the unique difficulties of giant omphaloceles. The available outcome studies that address these questions are discussed.


Assuntos
Hérnia Umbilical/complicações , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/terapia , Criança , Desenvolvimento Infantil , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Dor Crônica/terapia , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/terapia , Hérnia Umbilical/diagnóstico , Hérnia Umbilical/fisiopatologia , Hérnia Umbilical/cirurgia , Herniorrafia , Humanos , Lactente , Recém-Nascido , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/etiologia , Transtornos do Neurodesenvolvimento/terapia , Prognóstico , Qualidade de Vida , Resultado do Tratamento
14.
J Glob Health ; 9(1): 010431, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31131103

RESUMO

Background: Undernutrition impairs child development outcomes and growth. In this follow-up study of an open cluster-randomized intervention trial we examined the effects of an education package delivered to mothers in rural Uganda on their children's development, growth and gut microbiota at 36 months of age. Methods: The parental trial included 511 mother-child pairs recruited when the children were 6-8 months. In that trial, a nutrition, stimulation and hygiene education was delivered to mothers in the intervention group while the control group received routine health care. A follow-up sample of 155 pairs (intervention n = 77, control n = 78) were re-enrolled when the children were 24 months. Developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development (BSID-III) composite scores for cognitive (primary endpoint), language and motor development. Development outcomes were also evaluated using the Ages and Stages Questionnaire (ASQ) and the Mullen Scales of Early Learning (MSEL). Other outcomes included growth and gut microbiota composition. Results: The demographic characteristics were not different (P > 0.05) between the intervention and control groups and similar to those of the parental study. The intervention group had higher BSID-III scores than controls, with mean difference 10.13 (95% confidence interval (CI): 3.31-17.05, P = 0.002); 7.59 (1.62-13.66, P = 0.01); 9.00 (2.92-15.40, P = 0.005), for cognitive, language and motor composite scores, respectively. An improvement in the intervention compared to the control group was obtained for both the ASQ and the MSEL scores. The mean difference in height-for-age z-score was higher in the intervention compared to the control group: 0.50 (0.25-0.75, P = 0.0001). Gut microbiota composition did not differ significantly between the two study groups. Conclusions: The maternal education intervention had positive effects on child development and growth at three years, but did not alter gut microbiota composition. This intervention may be applicable in other low-resource settings. Trial registration: ClinicalTrials.gov registration number NCT02098031.


Assuntos
Desenvolvimento Infantil , Microbioma Gastrointestinal , Mães/educação , População Rural , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , População Rural/estatística & dados numéricos , Uganda
15.
BMC Public Health ; 19(1): 641, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31132997

RESUMO

BACKGROUND: Child health, nutrition, and responsive stimulation interventions have been developed to improve child survival, growth and development outcomes in low- and middle-income countries. Nevertheless, research on integrated implementation approaches to deliver and promote uptake of these interventions is needed, particularly in sub-Saharan Africa. METHODS/DESIGN: We will conduct a cluster-randomized controlled trial of a supply-side community health worker (CHW) delivered child health, nutrition, and responsive stimulation intervention alone and in combination with a demand-side conditional cash transfer (CCT) intervention to promote antenatal care and child growth monitoring attendance in rural Morogoro region, Tanzania. Twelve village clusters will be randomly assigned to one of the three trial arms: (1) CHW, (2) CHW + CCT, or (3) Control. Mothers (or another primary caregiver) residing in study villages are eligible for trial enrollment if they are currently pregnant or have a child < 1 year of age at the time of enrollment. For the duration of the trial, CHWs will visit households once every 4-6 weeks to deliver the intervention package and CCTs will be provided for documented antenatal care and routine child health and growth monitoring clinic visits. Participants will be followed-up at 9 months (midline) and 18 months (endline) post-randomization. The primary outcomes of the trial are child development assessed by the Bayley Scales of Infant and Toddler Development (BSID-III) and child height-for-age z-score. Secondary outcomes include a range of maternal, child and household outcomes. DISCUSSION: This trial will provide evidence on the effect of CHWs and conditional cash transfers on child growth and development. The results of the trial may be generalizable to similar settings in sub-Saharan Africa. TRIAL REGISTRATION: ISRCTN10323949 , Retrospectively registered on October 3, 2017.


Assuntos
Desenvolvimento Infantil , Agentes Comunitários de Saúde , Promoção da Saúde/organização & administração , População Rural , Pré-Escolar , Feminino , Apoio Financeiro , Promoção da Saúde/métodos , Humanos , Lactente , Masculino , Estado Nutricional , Gravidez , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Tanzânia
16.
Lancet ; 393(10189): 2416-2427, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-31104833

RESUMO

BACKGROUND: X-linked hypophosphataemia in children is characterised by elevated serum concentrations of fibroblast growth factor 23 (FGF23), hypophosphataemia, rickets, lower extremity bowing, and growth impairment. We compared the efficacy and safety of continuing conventional therapy, consisting of oral phosphate and active vitamin D, versus switching to burosumab, a fully human monoclonal antibody against FGF23, in paediatric X-linked hypophosphataemia. METHODS: In this randomised, active-controlled, open-label, phase 3 trial at 16 clinical sites, we enrolled children with X-linked hypophosphataemia aged 1-12 years. Key eligibility criteria were a total Thacher rickets severity score of at least 2·0, fasting serum phosphorus lower than 0·97 mmol/L (3·0 mg/dL), confirmed PHEX (phosphate-regulating endopeptidase homolog, X-linked) mutation or variant of unknown significance in the patient or a family member with appropriate X-linked dominant inheritance, and receipt of conventional therapy for at least 6 consecutive months for children younger than 3 years or at least 12 consecutive months for children older than 3 years. Eligible patients were randomly assigned (1:1) to receive either subcutaneous burosumab starting at 0·8 mg/kg every 2 weeks (burosumab group) or conventional therapy prescribed by investigators (conventional therapy group). Both interventions lasted 64 weeks. The primary endpoint was change in rickets severity at week 40, assessed by the Radiographic Global Impression of Change global score. All patients who received at least one dose of treatment were included in the primary and safety analyses. The trial is registered with ClinicalTrials.gov, number NCT02915705. FINDINGS: Recruitment took place between Aug 3, 2016, and May 8, 2017. Of 122 patients assessed, 61 were enrolled. Of these, 32 (18 girls, 14 boys) were randomly assigned to continue receiving conventional therapy and 29 (16 girls, 13 boys) to receive burosumab. For the primary endpoint at week 40, patients in the burosumab group had significantly greater improvement in Radiographic Global Impression of Change global score than did patients in the conventional therapy group (least squares mean +1·9 [SE 0·1] with burosumab vs +0·8 [0·1] with conventional therapy; difference 1·1, 95% CI 0·8-1·5; p<0·0001). Treatment-emergent adverse events considered possibly, probably, or definitely related to treatment by the investigator occurred more frequently with burosumab (17 [59%] of 29 patients in the burosumab group vs seven [22%] of 32 patients in the conventional therapy group). Three serious adverse events occurred in each group, all considered unrelated to treatment and resolved. INTERPRETATION: Significantly greater clinical improvements were shown in rickets severity, growth, and biochemistries among children with X-linked hypophosphataemia treated with burosumab compared with those continuing conventional therapy. FUNDING: Ultragenyx Pharmaceutical and Kyowa Kirin International.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Raquitismo Hipofosfatêmico Familiar/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Estatura , Criança , Desenvolvimento Infantil , Pré-Escolar , Raquitismo Hipofosfatêmico Familiar/diagnóstico , Feminino , Humanos , Lactente , Masculino , Índice de Gravidade de Doença , Resultado do Tratamento
17.
BMC Public Health ; 19(1): 576, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092239

RESUMO

BACKGROUND: Humanitarian crises present major threats to the wellbeing of children. These threats include risks of violence, abduction and abuse, emotional distress and the disruption of development. Humanitarian response efforts frequently address these threats through psychosocial programming. Systematic reviews have demonstrated the weak evidence-base regarding the impact of such interventions. This analysis assesses the impact of Child Friendly Spaces (CFS), one such commonly implemented intervention after humanitarian emergencies. METHODS: We completed baseline and endline (three-six months post-baseline) assessments regarding protection concerns, psychosocial wellbeing, developmental assets and community resources for a total of 1010 children and 1312 carers in catchment areas for interventions with humanitarian populations in Ethiopia, Uganda, Iraq, Jordan, and Nepal. We estimated intervention effect-sizes with Cohen's d for difference in mean difference scores between attenders and non-attenders - who proved comparable on baseline measures - by site. We then pooled findings for a meta-analysis summarizing overall impacts across domains. RESULTS: Amongst children aged 6-11, significant intervention impacts were observed through site-level analysis for protection concerns (Ethiopia, Cohen's d = 0.48, 95% CI 0.08-0.88), psychosocial wellbeing (Ethiopia, d = 0.51, 95% CI 0.10-0.91; and Uganda, d = 0.21, 95% CI 0.02-0.40), and developmental assets (Uganda, d = 0.37, 95% CI 0.15-0.59; and Iraq, d = 0.86, 95% CI 0.18-1.54). Pooled analyses for this age group found impacts of intervention to be significant only for psychosocial wellbeing (d = 0.18, 95% CI 0.03-0.33). Among children aged 12-17, site-level analysis indicated intervention impact for protection concerns in one site (Iraq, d = 0.58, 95% CI 0.07-1.09), with pooled analysis indicating no significant impacts. CONCLUSION: CFS can provide - albeit inconsistently - a protective and promotive environment for younger children. CFS show no impact with older children and in connecting children and carers with wider community resources. A major reappraisal of programming approaches and quality assurance mechanisms is required.


Assuntos
Altruísmo , Bem-Estar da Criança , Saúde Mental , África Oriental , Criança , Desenvolvimento Infantil , Feminino , Humanos , Masculino , Oriente Médio , Nepal , Psicologia da Criança , Nações Unidas , Violência
18.
Cochrane Database Syst Rev ; 5: CD012611, 2019 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046132

RESUMO

BACKGROUND: One nutritional intervention advocated to prevent malnutrition among children is lipid-based nutrient supplements (LNS). LNS provide a range of vitamins and minerals, but unlike most other micronutrient supplements, LNS also provide energy, protein and essential fatty acids. Alternative recipes and formulations to LNS include fortified blended foods (FBF), which are foods fortified with vitamins and minerals, and micronutrient powders (MNP), which are a combination of vitamins and minerals, OBJECTIVES: To assess the effects and safety of preventive LNS given with complementary foods on health, nutrition and developmental outcomes of non-hospitalised infants and children six to 23 months of age, and whether or not they are more effective than other foods (including FBF or MNP).This review did not assess the effects of LNS as supplementary foods or therapeutic foods in the management of moderate and severe acute malnutrition. SEARCH METHODS: In October 2018, we searched CENTRAL, MEDLINE, Embase, 21 other databases and two trials registers for relevant studies. We also checked the reference lists of included studies and relevant reviews and contacted the authors of studies and other experts in the area for any ongoing and unpublished studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs that evaluated the impact of LNS plus complementary foods given at point-of-use (for any dose, frequency, duration) to non-hospitalised infants and young children aged six to 23 months in stable or emergency settings and compared to no intervention, other supplementary foods (i.e. FBF), nutrition counselling or multiple micronutrient supplements or powders for point-of-use fortification of complementary foods. DATA COLLECTION AND ANALYSIS: Two review authors independently screened studies for relevance and, for those studies included in the review, extracted data, assessed risk of bias and rated the quality of the evidence using the GRADE approach. We carried out statistical analysis using Review Manager software. We used a random-effects meta-analysis for combining data as the interventions differed significantly. We set out the main findings of the review in 'Summary of findings' tables,. MAIN RESULTS: Our search identified a total of 8124 records, from which we included 17 studies (54 papers) with 23,200 children in the review. The included studies reported on one or more of the pre-specified primary outcomes, and five studies included multiple comparison groups.Overall, the majority of trials were at low risk of bias for random sequence generation, allocation concealment, blinding of outcome assessment, incomplete outcome data, selective reporting and other sources of bias, but at high risk of bias for blinding of participants and personnel due to the nature of the intervention. Using the GRADE approach, we judged the quality of the evidence for most outcomes as low or moderate.LNS+complementary feeding compared with no intervention Thirteen studies compared LNS plus complementary feeding with no intervention. LNS plus complementary feeding reduced the prevalence of moderate stunting by 7% (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.88 to 0.98; nine studies, 13,372 participants; moderate-quality evidence), severe stunting by 15% (RR 0.85, 95% CI 0.74 to 0.98; five studies, 6151 participants; moderate-quality evidence), moderate wasting by 18% (RR 0.82, 95% CI 0.74 to 0.91; eight studies; 13,172 participants; moderate-quality evidence), moderate underweight by 15% (RR 0.85, 95% CI 0.80 to 0.91; eight studies, 13,073 participants; moderate-quality evidence), and anaemia by 21% (RR 0.79, 95% CI 0.69 to 0.90; five studies, 2332 participants; low-quality evidence). There was no impact of LNS plus complementary feeding on severe wasting (RR 1.27, 95% CI 0.66 to 2.46; three studies, 2329 participants) and severe underweight (RR 0.78, 95%CI 0.54 to 1.13; two studies, 1729 participants). Adverse effects did not differ between the groups (RR 0.86, 95% CI 0.74 to 1.01; three studies, 3382 participants).LNS+complementary feeding compared with FBF Five studies compared LNS plus complementary feeding with other FBF, including corn soy blend and UNIMIX. We pooled four of the five studies in meta-analyses and found that, when compared to other FBF, LNS plus complementary feeding significantly reduced the prevalence of moderate stunting (RR 0.89, 95% CI 0.82 to 0.97; three studies, 2828 participants; moderate-quality evidence), moderate wasting (RR 0.79, 95% CI 0.65 to 0.97; two studies, 2290 participants; moderate-quality evidence), and moderate underweight (RR 0.81, 95% CI 0.73 to 0.91; two studies, 2280 participants; moderate-quality evidence). We found no difference between LNS plus complementary feeding and FBF for severe stunting (RR 0.41, 95% CI 0.12 to 1.42; two studies, 729 participants; low-quality evidence), severe wasting (RR 0.64, 95% CI 0.19 to 2.81; two studies, 735 participants; moderate-quality evidence), and severe underweight (RR 1.23, 95% CI 0.67 to 2.25; one study, 173 participants; low-quality evidence).LNS+complementary feeding compared with MNP Four studies compared LNS plus complementary feeding with MNP. We pooled data from three of the four studies in meta-analyses and found that compared to MNP, LNS plus complementary feeding significantly reduced the prevalence of moderate underweight (RR 0.88, 95% CI 0.78 to 0.99; two studies, 2004 participants; moderate-quality evidence) and anaemia (RR 0.38, 95% CI 0.21 to 0.68; two studies, 557 participants; low-quality evidence). There was no difference between LNS plus complementary feeding and MNP for moderate stunting (RR 0.92, 95% CI 0.82 to 1.02; three studies, 2365 participants) and moderate wasting (RR 0.97, 95% CI 0.77 to 1.23; two studies, 2004 participants). AUTHORS' CONCLUSIONS: The findings of this review suggest that LNS plus complementary feeding compared to no intervention is effective at improving growth outcomes and anaemia without adverse effects among children aged six to 23 months in low- and middle-income countries (LMIC) in Asia and Africa, and more effective if provided over a longer duration of time (over 12 months). Limited evidence also suggests that LNS plus complementary feeding is more effective than FBF and MNP at improving growth outcomes.


Assuntos
Desenvolvimento Infantil/fisiologia , Gorduras na Dieta/administração & dosagem , Fenômenos Fisiológicos da Nutrição do Lactente , Estado Nutricional , Pré-Escolar , Suplementos Nutricionais , Alimentos Formulados , Alimentos Fortificados , Humanos , Lactente
19.
BMC Health Serv Res ; 19(1): 267, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035985

RESUMO

BACKGROUND: The child health record booklet (CHRB) is a powerful tool for screening children under five and for education of caregivers by health workers. The objective of the present study was to assess the knowledge and utilization of CHRB by mothers and health workers in child growth monitoring and promotion (GMP) in the East Mamprusi Municipal, Northern region, Ghana. METHODS: A descriptive cross-sectional study was conducted among mothers attending child welfare clinics (CWC) and health workers providing GMP at CWC. Observational checklists were used to assess 73 CHRB on the completeness and correctness of growth charts. Mothers and health workers' knowledge on essential components of CHRB were assessed with a questionnaire. RESULTS: Weight measurements were correctly recorded in all booklets analyzed. Even though a greater proportion (70.7%) of health workers exhibited high knowledge scores on the interpretation of the essential components of the CHRB,most of the charts analyzed were not completely filled (72.6%) but rather correctly filled (74.0%). Mean knowedge score (3.4 ± 1.3) on growth charting was low among mothers who attend GMP. Work overload (26.1%), inadequate supply of CHRB (26.1%) and vaccine shortages (18.7%) were concerns raised by health workers on the effective usage of the CHRB. CONCLUSION: Knowledge scores on the child health record booklets among health workers and mothers in this part of northern Ghana were high but charting of growth of children was sub-optimal among health workers.


Assuntos
Desenvolvimento Infantil , Saúde da Criança/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Mães/educação , Folhetos , Adulto , Lista de Checagem , Saúde da Criança/normas , Pré-Escolar , Estudos Transversais , Feminino , Gana , Humanos , Lactente , Masculino , Programas de Rastreamento , Inquéritos e Questionários
20.
Environ Sci Pollut Res Int ; 26(18): 18267-18290, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31041704

RESUMO

Exposure to pesticides is a major factor in the cause of dysfunction in the nervous system and neurodevelopment disorders in children at critical periods of great vulnerability. The aim of this study was to review scientific evidence published on neurodevelopmental effects of prenatal and postnatal exposure to organophosphate pesticides (OPs) in different stages, including neonates, infants, toddlers, preschool children, and school-age children. Full-text articles published in PubMed, Scopus, and ISI databases between 1973 and 2019 were reviewed and the scientific evidence was evaluated. Results: Fifty studies were eligible for inclusion in this quantitative synthesis. Fifteen of these papers evaluated the effects on neonates and infants, 18 on the effects on toddlers and preschool children, and 24 the effects on school-age children. Considerable evidence suggests that prenatal exposure to OPs contributes to child neurodevelopment disorders in all stages, whereas data about the effects of postnatal exposure are limited. Therefore, the available evidence supports the theory that sensitive time-windows occur prenatally rather than postnatally. Although 45 out of the total 50 selected articles found an association between OP exposure and child neurodevelopment, some of the evidence is controversial. A standardized methodology is needed to enable the comparison of the results in several studies, and further research studies are needed to warrant firmer conclusions. A systematic review of this evidence should be performed continuously to update the state of knowledge regarding neurodevelopmental effects associated with OP exposure.


Assuntos
Poluentes Ambientais/toxicidade , Sistema Nervoso/efeitos dos fármacos , Organofosfatos/toxicidade , Praguicidas/toxicidade , Adolescente , Criança , Desenvolvimento Infantil/efeitos dos fármacos , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Sistema Nervoso/crescimento & desenvolvimento , Praguicidas/farmacologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal
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