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1.
JAMA Netw Open ; 3(6): e207728, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32543699

RESUMO

Importance: The prevalence of asthma in US children with various developmental disabilities and delays is unclear, including how estimates vary by ethnic group. Objective: To report asthma prevalence estimates by various disability categories and developmental delays in a diverse sample of the US pediatric population. Design, Setting, and Participants: This population-based cross-sectional study encompassed a total of 71 811 families with children or adolescents aged 0 to 17 years (hereinafter referred to as children) who participated in the 2016 and 2017 National Survey of Children's Health. Data were collected from June 10, 2016, to February 10, 2017, for the 2016 survey and from August 10, 2017, to February 10, 2018, for the 2017 survey. Data were analyzed from September 20, 2019, to April 5, 2020. Exposures: Developmental disability, including attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, seizure, intellectual and/or learning disability, and vision, hearing, and/or speech delay. Delay was defined as not meeting growth milestones with unknown cause. Main Outcomes and Measures: Weighted asthma prevalence estimates and 95% CIs were generated for children with and without disabilities. Results: A total of 71 811 participants (mean [SE] age, 8.6 [0.1] years; 36 800 boys [51.1%; 95% CI, 50.2%-52.0%]; 50 219 non-Hispanic white [51.4%; 95% CI, 50.6%-52.3%]) were included in our final analytical sample, of whom 5687 (7.9%; 95% CI, 7.5%-8.4%) had asthma and 11 426 (15.3%; 95% CI, 14.7%-16.0%) had at least 1 disability. Overall asthma prevalence estimates were 10 percentage points higher in children with a disability (16.1%; 95% CI, 14.3%-17.8%) vs children without a disability (6.5%; 95% CI, 6.0%-6.9%). The odds of asthma were significantly higher in children with a disability (odds ratio [OR], 2.77; 95% CI, 2.39-3.21) or delay (OR, 2.22; 95% CI, 1.78-2.77) vs typically growing children. Adjusted models remained significant for all disability categories (overall adjusted OR, 2.21; 95% CI, 1.87-2.62). Subgroup analyses showed ethnic minorities had a higher prevalence of concurrent asthma and developmental disabilities vs non-Hispanic whites (19.8% [95% CI, 16.6%-23.0%] vs 12.6% [95% CI, 11.1%-14.0%]; P < .001). Conclusions and Relevance: These results suggest that US children with various developmental disabilities or delay may have higher odds for developing asthma vs their typically developing peers. These findings support asthma screening in pediatric health care settings among patients with developmental disabilities and delays, particularly among those from ethnic minority backgrounds. In addition, very young children with asthma should be screened for disabilities and delays, because temporality cannot be determined by the current data source and analytical approach.


Assuntos
Asma/complicações , Asma/epidemiologia , Transtornos do Neurodesenvolvimento/complicações , Transtornos do Neurodesenvolvimento/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Estados Unidos/epidemiologia
2.
Complement Ther Clin Pract ; 39: 101098, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32379640

RESUMO

BACKGROUND AND PURPOSE: Parents of children with obsessive-compulsive disorder (OCD) report significant emotional and socio-occupational impacts. There is, however, currently insufficient support for these parents. This study examined a mindfulness-based intervention for parents of OCD-affected children, investigating its feasibility and impact on parental ability to tolerate their child's OCD-related distress, in addition to exploring potential indirect effects. MATERIALS AND METHODS: Parents of OCD-affected children (n = 39) completed an eight-week baseline observation period followed by eight, weekly manualized mindfulness-based intervention group sessions. Measures of parental tolerance of child distress, dispositional mindfulness, family accommodation, family functioning, and OCD symptom severity were collected. RESULTS: In comparison to the baseline observation period, parental tolerance of child distress and dispositional mindfulness significantly improved following mindfulness training. No other temporal differences were observed. Parents reported high satisfaction. CONCLUSION: Mindfulness-based skills training for parents of OCD-affected youth appears to be feasible and to significantly increase tolerance related to the child's distress. CLINICAL TRIAL REGISTRATION NUMBER: NCT03212703.


Assuntos
Adaptação Psicológica , Cuidadores/psicologia , Atenção Plena , Transtornos do Neurodesenvolvimento , Transtorno Obsessivo-Compulsivo , Pais/psicologia , Angústia Psicológica , Adolescente , Adulto , Idoso , Criança , Emoções , Família/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Neurodesenvolvimento/complicações , Transtorno Obsessivo-Compulsivo/complicações , Resiliência Psicológica , Adulto Jovem
3.
BMC Med Genet ; 21(1): 59, 2020 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-32209057

RESUMO

BACKGROUND: Intellectual disability (ID) is both a clinically diverse and genetically heterogeneous group of disorder, with an onset of cognitive impairment before the age of 18 years. ID is characterized by significant limitations in intellectual functioning and adaptive behaviour. The identification of genetic variants causing ID and neurodevelopmental disorders using whole-exome sequencing (WES) has proven to be successful. So far more than 1222 primary and 1127 candidate genes are associated with ID. METHODS: To determine pathogenic variants causative of ID in three unrelated consanguineous Pakistani families, we used a combination of WES, homozygosity-by-descent mapping, de-deoxy sequencing and bioinformatics analysis. RESULTS: Rare pathogenic single nucleotide variants identified by WES which passed our filtering strategy were confirmed by traditional Sanger sequencing and segregation analysis. Novel and deleterious variants in VPS53, GLB1, and MLC1, genes previously associated with variable neurodevelopmental anomalies, were found to segregate with the disease in the three families. CONCLUSIONS: This study expands our knowledge on the molecular basis of ID as well as the clinical heterogeneity associated to different rare genetic causes of neurodevelopmental disorders. This genetic study could also provide additional knowledge to help genetic assessment as well as clinical and social management of ID in Pakistani families.


Assuntos
Consanguinidade , Deficiência Intelectual/genética , Proteínas de Membrana/genética , Polimorfismo Genético , Proteínas de Transporte Vesicular/genética , beta-Galactosidase/genética , Criança , Pré-Escolar , Família , Feminino , Genes Recessivos/genética , Heterogeneidade Genética , Testes Genéticos , Homozigoto , Humanos , Deficiência Intelectual/complicações , Deficiência Intelectual/patologia , Masculino , Transtornos do Neurodesenvolvimento/complicações , Transtornos do Neurodesenvolvimento/genética , Transtornos do Neurodesenvolvimento/patologia , Paquistão/epidemiologia , Linhagem , Sequenciamento Completo do Exoma
4.
Pediatr Surg Int ; 36(5): 591-596, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32198620

RESUMO

AIM OF THE STUDY: Liver retraction during laparoscopic fundoplication is important for obtaining an optimal space. Several methods have been developed, but the risks and benefits are unclear. We compared three different approaches and evaluated their safety and utility. METHODS: Forty-three neurologically impaired patients who underwent laparoscopic fundoplication between 2005 and 2018 were classified into three groups: A, snake retractor method, n = 18; B, crural suture method, n = 13; C, needle grasper method, n = 12. Patients' characteristics and outcomes were reviewed. MAIN RESULTS: The liver retraction time was significantly shorter in group C than in A or B (p < 0.05). The operative times were shorter in groups B and C than in A. There were no significant differences in the liver enzyme levels. The liver enzyme levels increased temporarily but improved within a week. The C-reactive protein levels were significantly lower in group B than in A or C (p < 0.05). CONCLUSIONS: The most convenient method was the needle grasper method, as the other two approaches create conflict with the operator's forceps. The crural suture method damages the liver less, but requires higher surgical skill levels. It is important to select the appropriate method according to the operator's skill and the patient's size and deformity.


Assuntos
Refluxo Gastroesofágico/cirurgia , Laparoscopia/métodos , Fígado/cirurgia , Transtornos do Neurodesenvolvimento/complicações , Técnicas de Sutura , Adolescente , Adulto , Criança , Feminino , Fundoplicatura/métodos , Refluxo Gastroesofágico/complicações , Humanos , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Adulto Jovem
5.
J Pediatr Surg ; 55(5): 848-851, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32085915

RESUMO

PURPOSE: We sought to describe long-term outcomes of infants with severe surgical necrotizing enterocolitis (NEC). METHODS: Data were collected on infants with surgical NEC (2009-2018). Severe surgical NEC was defined by extensive bowel loss with residual bowel length <30 cm, and "NEC totalis" was identified per operative report. Post-operative management and long-term outcomes were assessed, including enteral autonomy, severe neurodevelopmental disability, and educational attainment. RESULTS: Of 268 infants with surgical NEC, 41 (15%) had severe surgical NEC, and 14/41 were identified as "NEC totalis". Zero severe NEC vs. 8 (57%) "NEC totalis" patients were placed on comfort measures following initial surgery (p < 0.001). Twenty-five patients (93%) with severe NEC survived vs 3/6 with "NEC totalis" (p < 0.001). The 28 survivors (68%) were followed for a median (IQR) duration of 8(4,10) years. Nine (32%) with severe NEC were weaned from parenteral nutrition. Eight (29%) had ≥1 marker for severe neurodevelopmental disability, and 11/16(69%) (7-16 years) were attending school at last follow-up. CONCLUSION: Long-term survival is excellent following initial discharge, and achievement of enteral autonomy is feasible in patients with severe surgical NEC. The majority of patients who survive do not have severe neurodevelopmental disability and participate in school. Given current survivals and outcomes, focus on measured residual bowel length may be more appropriate than the subjective term "NEC-totalis." TYPE OF STUDY: Prognosis Study. LEVEL OF EVIDENCE: Level II.


Assuntos
Enterocolite Necrosante/cirurgia , Adolescente , Criança , Enterocolite Necrosante/complicações , Enterocolite Necrosante/mortalidade , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido , Recém-Nascido Prematuro , Masculino , Transtornos do Neurodesenvolvimento/complicações , Nutrição Parenteral , Prognóstico , Taxa de Sobrevida
6.
Dev Neuropsychol ; 45(1): 1-16, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31914808

RESUMO

Relationships between neurodevelopmental functioning and hemodynamic changes in the prefrontal cortex (PFC) were contrasted between children with prenatal alcohol exposure (PAE) and children who differed relative to their history of PAE and the presence of other neurodevelopmental impairment. For all groups, deoxygenated hemoglobin (HBR) levels in the medial PFC area were negatively related to externalizing problems and levels in the medial and right lateral PFC were positively related to errors on a cognitive inhibition task. Hemodynamic changes in the medial and right lateral PFC of children with PAE demonstrated stronger relationships to aspects of executive functioning relative to contrast groups.


Assuntos
Transtornos do Espectro Alcoólico Fetal/patologia , Transtornos do Neurodesenvolvimento/complicações , Córtex Pré-Frontal/irrigação sanguínea , Efeitos Tardios da Exposição Pré-Natal/psicologia , Adolescente , Criança , Pré-Escolar , Feminino , Hemodinâmica , Humanos , Masculino , Gravidez
7.
Trials ; 21(1): 44, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915035

RESUMO

BACKGROUND: An increasing number of children are suffering from brain damage-related visual processing dysfunctions (VPD). There is currently a lack of evidence-based intervention methods that can be used early in development. We developed a visual intervention protocol suitable from 1 year of age. The protocol is structured, comprehensive and individually adaptive, and is paired with quantitative outcome assessments. Our aim is to investigate the effectiveness of this first visual intervention program for young children with (a risk of) VPD. METHODS: This is a single-blind, placebo-controlled trial that is embedded within standard clinical care. The study population consists of 100 children born very or extremely preterm (< 30 weeks) at 1 year of corrected age (CA), of whom 50% are expected to have VPD. First, children undergo a visual screening at 1 year CA. If they are classified as being at risk of VPD, they are referred to standard care, which involves an ophthalmic and visual function assessment and a (newly developed) visual intervention program. This program consists of a general protocol (standardized and similar for all children) and a supplement protocol (adapted to the specific needs of the child). Children are randomly allocated to an intervention group (starting upon inclusion at 1 year CA) or a control group (postponed: starting at 2 years CA). The control group will receive a placebo treatment. The effectiveness of early visual intervention will be examined with follow-up visual and neurocognitive assessments after 1 year (upon completion of the direct intervention) and after 2 years (upon completion of the postponed intervention). DISCUSSION: Through this randomized controlled trial we will establish the effectiveness of a new and early visual intervention program. Combining a general and supplement protocol enables both structured comparisons between participants and groups, and custom habilitation that is tailored to a child's specific needs. The design ensures that all included children will benefit from participation by advancing the age at which they start receiving an intervention. We expect results to be applicable to the overall population of children with (a risk of) VPD early in life. TRIAL REGISTRATION: Netherlands Trial Register: NTR6952. Registered 19 January 2018.


Assuntos
Transtornos do Neurodesenvolvimento/complicações , Transtornos da Percepção/prevenção & controle , Nascimento Prematuro/fisiopatologia , Transtornos da Visão/prevenção & controle , Percepção Visual/fisiologia , Encéfalo/fisiopatologia , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Cognição , Feminino , Seguimentos , Humanos , Lactente , Masculino , Países Baixos , Transtornos do Neurodesenvolvimento/fisiopatologia , Transtornos da Percepção/diagnóstico , Transtornos da Percepção/etiologia , Transtornos da Percepção/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologia
8.
Expert Opin Pharmacother ; 20(18): 2257-2271, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31638842

RESUMO

Introduction: Sleep disturbances are highly prevalent in children with neurodevelopmental disabilities. Without appropriate treatment, sleep disorders can become chronic and last for many years. However, there are no sleep medications approved by the United States Food and Drug Administration and only one has been approved by the European Medicines Agency for pediatric insomnia; thus, most medications are prescribed off-label.Areas covered: In this narrative review, the authors highlight and summarize the most common drugs and supplements used for the treatment of sleep problems in children with neurodevelopmental disabilities. Recommendations are formulated regarding the use of melatonin and melatonin receptor agonists, sedating antidepressants, antipsychotics, antihistamines, gabapentin, clonidine and orexin receptor antagonists, and benzodiazepines and hypnotic benzodiazepine receptor agonists.Expert opinion: The choice of pharmacological agents and their dosage should be individualized taking into consideration multiple factors, including the severity and type of sleep problem and the associated neurological pathology. Melatonin is widely used and safe in children with neurodevelopmental conditions. Gabapentin, clonidine, trazodone, and mirtazapine hold promise but require further study. Supplements (iron, vitamin D, and 5-hydroxytryptophan) might be helpful. Due to the lack of clinical data, there is still uncertainty concerning dosing regimens and tolerability.


Assuntos
Transtornos do Neurodesenvolvimento/tratamento farmacológico , Transtornos do Sono-Vigília/tratamento farmacológico , Sono/efeitos dos fármacos , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Criança , Suplementos Nutricionais , Humanos , Hipnóticos e Sedativos/uso terapêutico , Melatonina/uso terapêutico , Transtornos do Neurodesenvolvimento/complicações , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico
9.
Neurology ; 93(17): e1597-e1604, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31594858

RESUMO

OBJECTIVE: We performed a prospective, cross-sectional analysis of neurodevelopmental concerns and psychosocial adjustment in relation to DMD mutations in young steroid-naive boys with dystrophinopathy. METHODS: We evaluated 196 steroid-naive boys with dystrophinopathy who were enrolled in the Finding the Optimal Regimen for Duchenne Muscular Dystrophy trial. The neurodevelopmental concerns and psychosocial adjustment challenges were analyzed in relation to DMD mutation. A parent or legal guardian reported neurodevelopmental concerns in 4 domains (speech, learning and attentional difficulties, and autism spectrum disorder [ASD]) and completed the Personal Adjustment and Role Skills Scale to assess psychosocial adjustment. We also assessed whether boys of DMD carrier mothers were more vulnerable to speech delay and learning difficulties. RESULTS: We found that 39% of boys were reported to have speech delay with a mean age of speaking at 28 months (range 7-66 months). Learning difficulties were reported in 28% of participants. Inattentive-overactive and oppositional-defiant behavior was reported in 8% and 5% of participants, respectively. Psychosocial adjustment challenges were reported in 4% of participants. An ASD diagnosis was reported in 3 participants. Speech delay and learning difficulties were more common in boys with mutations downstream of DMD exon 45. Neurodevelopmental concerns were not associated with DMD deletion, duplication, or point mutation subtype. Boys of DMD carrier mothers did not have longer speech delay or more learning difficulties. CONCLUSION: Our data support evidence for a relationship between neurodevelopmental concerns and DMD mutation. A longitudinal assessment of developmental trajectory is necessary to evaluate how specific DMD mutations affect brain function.


Assuntos
Distrofina/genética , Distrofia Muscular de Duchenne/complicações , Distrofia Muscular de Duchenne/genética , Mutação , Transtornos do Neurodesenvolvimento/complicações , Transtornos do Neurodesenvolvimento/genética , Criança , Pré-Escolar , Estudos Transversais , Método Duplo-Cego , Humanos , Masculino , Distrofia Muscular de Duchenne/tratamento farmacológico , Distrofia Muscular de Duchenne/psicologia , Transtornos do Neurodesenvolvimento/psicologia , Fármacos Neuromusculares/uso terapêutico , Esteroides/uso terapêutico
10.
An. psicol ; 35(3): 389-396, oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-190026

RESUMO

El déficit de vitamina D durante el embarazo tiene un impacto negativo en la salud materno-infantil. OBJETIVO: Evaluar el efecto del estado de vitamina D durante el embarazo sobre el neurodesarrollo del niño. Selección de estudios: Se realizó una búsqueda de la literatura científica publicada en PubMed/MEDLINE, Scopus y Cochrane hasta enero del 2018. Se seleccionaron los estudios que relacionaban el estado de la vitamina D durante el embarazo con algún dominio del neurodesarrollo del niño (mental, motor, lenguaje, cociente intelectual y comportamiento). La calidad de los estudios incluidos se evaluó a través de la escala Newcastle-Ottawa. RESULTADOS: De los 164 estudios encontrados en la búsqueda, once estudios cumplieron los criterios y fueron considerados diez de alta calidad metodológica y uno de moderada. La revisión sistemática mostró que niveles prenatales de vitamina D <50 nmol/L se asocian frecuentemente a un peor desarrollo mental, motor y del lenguaje de sus hijos en comparación con las madres con concentraciones ≥ 50 nmol/L. CONCLUSIÓN: Aunque existe poca evidencia científica que corrobore la relación entre la deficiencia de vitamina D prenatal y su impacto en el neurodesarrollo de los hijos, los datos actuales sugieren un perjuicio sobre el desarrollo mental, motor y del lenguaje del niño


BACKGROUND: A deficiency of vitamin D during pregnancy has a negative impact on the health of the mother and the child. OBJECTIVE: To evaluate the effect of vitamin D status during pregnancy on the neurodevelopment of children. Selection of studies: We explored studies that linked the maternal status of vitamin D with neurodevelopment in the infant. The selected studies were identified through a systematic review of the scientific literature published in PubMed/MEDLINE, Scopus and Cochrane until January 2018. The quality of the included studies was carried out through the Newcastle-Ottawa scale. RESULTS: 164 studies were identified and reviewed for selection. At the end of this review, 11 studies were included, all of high methodological quality. This systematic review shows that prenatal vitamin D levels <50 nmol/L are associated with worse mental, motor and language development of their children compared with pregnant women with good vitamin D status. CONCLUSION: There is still little scientific evidence to corroborate the relationship between prenatal vitamin D deficiency and its impact on the neurodevelopment of children, although current data suggest a detrimental effect on the child's mental, motor and language development


Assuntos
Humanos , Masculino , Feminino , Gravidez , Criança , Vitamina D/administração & dosagem , Transtornos do Neurodesenvolvimento/complicações , Desenvolvimento Infantil/fisiologia , Estado Nutricional , Desenvolvimento da Linguagem , Vitamina D/metabolismo , Deficiência de Vitamina D/metabolismo , Transtornos do Neurodesenvolvimento/psicologia , Saúde Materno-Infantil , Fenômenos Fisiológicos da Nutrição Pré-Natal , Nutrição Pré-Natal , Deficiência de Vitamina D
11.
Psychiatr Danub ; 31(Suppl 3): 455-461, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488772

RESUMO

Complex disability is very difficult to manage. It usually subtends very serious clinical pictures, because it affect several body systems, or because it is associated with intellectual disability and behavioral disorders. Often affected patients are unable to communicate their basic needs. All these factors combine to make the management of these patients very complex, and those who care for them realize how important it is to find a way to detect their state and to identify their potential capabilities. Developing appropriate rehabilitation programs for these patients requires additional effort and an assessment capacity that is as objective as possible. Few scales cited in the literature are capable of evaluating these aspects in patients with complex disabilities, among them the Barthel Index (Mahoney & Barthel 1965) and the Vineland Adaptive Behavior scale II (Sparrow et al. 2005). The majority of these scales often tend to depict the data regarding the disease to a degree of severity that precludes adequate individual rehabilitation program development. There is a dire need for a more appropriate instrument, an observational grid that is capable of identifying the potential of this patient population and evaluate the effectiveness of rehabilitation interventions provided. The aim of the study is to evaluate the efficacy of rehabilitation interventions in a group of patients with IQ <32 (determined by the Vineland II scale) using an evaluation tool created ad hoc called D-Rubrics, designed with the intent to identify "micro-differences" between baseline (T0) and post-rehabilitation (T1). The goal is part of a more long term-term objective which involves developing an effective assessment tool for patients with complex disabilities. Such an assessment tool should be practical, easy to administer and useful in both clinical and research settings.


Assuntos
Transtornos do Neurodesenvolvimento/reabilitação , Reabilitação/normas , Humanos , Deficiência Intelectual/complicações , Deficiência Intelectual/reabilitação , Transtornos do Neurodesenvolvimento/complicações , Avaliação de Resultados em Cuidados de Saúde
12.
S Afr Med J ; 109(7): 526-534, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31266581

RESUMO

BACKGROUND: Alcohol use in South Africa (SA) is increasing. The World Health Organization (WHO) states that SA is the third-largest drinking population in Africa, with the highest rate of fetal alcohol syndrome in the world. Internationally, parental drinking during childhood is a risk factor for poor child mental health, behavioural problems and weaker educational outcomes in middle childhood. However, parental alcohol use in Africa is under-researched, and much of the literature on maternal alcohol consumption is restricted to clinical and pregnancy samples. OBJECTIVES: To investigate alcohol use and hazardous drinking (HD) among mothers/primary caregivers of children aged 7 - 11 years in a rural SA cohort. We explored risk factors for drinking and the association between HD and child behaviour/cognition. METHODS: The primary outcome measure was the WHO Alcohol Use Disorder Identification Test (AUDIT) using the standardised cut-off for HD (≥8). Secondary measures were the Patient Health Questionnaire Depression Scale (PHQ-9), Patient Health Questionnaire General Anxiety Disorder Scale (GAD-7), Parenting Stress Index, short form (PSI-36), Child Behaviour Checklist (CBCL, parent reported), Kaufman Developmental Assessment Battery (KABC-II) for child cognition, and Neuropsychological Assessment Battery, 2nd edition, subtests (NEPSY-II) for executive function. We compared characteristics of those drinking/not drinking, using χ2 tests, and modelled outcomes on parenting stress, cognitive outcomes and CBCL scores for children using logistic regression analysis. We grouped mothers/caregivers engaged in HD to examine its effect on parent/child outcomes using t-tests to test for significant differences. RESULTS: Of 1 505 women (1 266 mothers and 239 caregivers) with 1 536 children, 12% reported consuming alcohol and 3% reported HD. Higher maternal/caregiver age (31 - 40 years, adjusted odds ratio (aOR) 0.57 (95% confidence interval (CI) 0.4 - 0.9); >41 years, aOR 0.30 (95% CI 0.2 - 0.5)), education (matriculation, aOR 0.49 (95% CI 0.3 - 0.9); post matriculation, aOR 0.30 (95% CI 0.1 - 0.6)), and a stable relationship with the father (aOR 0.6 (95% CI 0.4 - 1.0)) were associated with no alcohol use. Food insecurity increased the odds of alcohol use (aOR 1.52 (95% CI 1.1 - 2.1)), while parental mental health (parenting stress, anxiety) and child mental health problems were associated with approximately double the odds of consuming alcohol in univariate analysis. Children of HD mothers/caregivers had higher mean scores for psychological problems (CBCL total score: no HD (mean 45.0) v. HD (mean 48.9); p=0.029) and lower cognitive scores (KABC Learning Scale: no HD (mean 14.3) v. HD (mean 12.8); p=0.017). CONCLUSIONS: While HD rates were low, maternal/caregiver alcohol use negatively impacted on parenting and children's behavioural/cognitive outcomes. International evidence suggests that integrated approaches engaging parents and families may be more effective for parent-child outcomes than individual psychiatric or medical care for the parent on their own.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Transtornos do Comportamento Infantil/epidemiologia , Transtornos Cognitivos/epidemiologia , Mães/psicologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Ansiedade/psicologia , Cuidadores/psicologia , Criança , Estudos de Coortes , Feminino , Abastecimento de Alimentos , Infecções por HIV/complicações , Humanos , Masculino , Saúde Mental , Transtornos do Neurodesenvolvimento/complicações , Testes Neuropsicológicos , Poder Familiar/psicologia , População Rural , África do Sul/epidemiologia , Estresse Psicológico/etiologia , Inquéritos e Questionários
14.
Sleep Med Rev ; 46: 54-63, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31060029

RESUMO

Sleep problems are prevalent in people with rare genetic neurodevelopmental disorders (RGND) and, in some cases, RGNDs are associated with specific forms of sleep disturbance that appear relatively unique. Although a notable amount of research has focused on behavioral intervention for sleep problems in people with higher incidence developmental disorders, research focused on potentially modifiable learning and environmental factors for people with RGND has received less attention. This review summarizes empirical evidence from studies providing behavioral interventions for sleep problems in RGND. A systematic search identified nine studies for inclusion. Studies were coded to extract data on participant characteristics, intervention components, dependent variables, research rigor and intervention effects. Study rigor was then evaluated using an established criteria and effects were classified as positive, neutral or mixed. Seven of the nine studies demonstrated positive treatment effects and two mixed results. In most studies, treatment consisted of multiple intervention components and were implemented by parents in the home. However, only three studies met criteria for an adequate level of rigor, thus greatly limiting certainty of conclusions. This review identifies current intervention practices and potential foci for future research.


Assuntos
Terapia Comportamental , Transtornos do Neurodesenvolvimento/genética , Doenças Raras/genética , Higiene do Sono/fisiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Humanos , Transtornos do Neurodesenvolvimento/complicações , Doenças Raras/complicações
16.
Indian J Pediatr ; 86(9): 777-783, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31020592

RESUMO

OBJECTIVES: To document the prevalence of hypovitaminosis-D in children with intellectual and movement disorders and to identify the risk factors in vitamin D deficient children. METHODS: This is a cross-sectional study on 90 children with neurodevelopmental disabilities. The prevalence of hypovitaminosis-D and the risk factors such as sun exposure, age-appropriate mobility, diet, skin color and anti-epileptic medications were examined in children with cognitive disorders and movement disorders. RESULTS: The mean serum vitamin D level in children with cognitive disability (n = 46) was found to be 26.7 ± 16.3 ng/L and in the children with movement disability (n = 44) it was 27.9 ± 10.5 ng/L. Though the risk factors were found in greater numbers in children in the deficient group (vitamin D < 30 ng/L), the difference between the two groups was not significant. Of the 90 children, 86 (95.5%) had at least one sign of vitamin D deficiency. Lowest levels of vitamin D were seen in autistic spectrum disorder and learning disabilities in the Cognitive Disability group and hemiplegia in the Movement Disability group. CONCLUSIONS: The prevalence of vitamin D deficiency in children with neurodevelopmental disabilities was 72.2%, with 76.1% in the cognitive disability group and 68.2% in the movement disability group. The risk factors were more common in vitamin D deficient children.


Assuntos
Transtornos dos Movimentos/congênito , Transtornos dos Movimentos/complicações , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia , Transtorno Autístico/complicações , Criança , Pré-Escolar , Estudos Transversais , Dieta , Crianças com Deficiência , Feminino , Humanos , Lactente , Deficiências da Aprendizagem/complicações , Masculino , Transtornos do Neurodesenvolvimento/complicações , Prevalência , Fatores de Risco , Vitamina D/sangue , Deficiência de Vitamina D/sangue
17.
Ginekol Pol ; 90(3): 148-153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30950004

RESUMO

OBJECTIVES: To estimate the prevalence, associated anomalies, and postnatal outcomes in infants prenatally diagnosed with ventriculomegaly. MATERIAL AND METHODS: All cases of ventriculomegaly that were examined and treated by the 1st Department of Obstet- rics and Gynecology, at the Medical University of Warsaw, from August 2007 until November 2017 were included in this study. Ultrasound data, and information on perinatal outcomes and long-term postnatal follow up were retrospectively collected by a standardised telephone survey. Ventriculomegaly was diagnosed when the atrial width of the lateral ventri- cles was ≥ 10 mm. The cases analyzed were divided into two subgroups: isolated ventriculomegaly (IVM) and non-isolated ventriculomegaly (NIVM). Neurodevelopmental complications were differentiated as either moderate or severe and were compared within each group and between groups. RESULTS: There were 118 cases of prenatally diagnosed ventriculomegaly. Complete follow up records were collected for 54 cases (45.8%). IVM was diagnosed in 29/54 (53.7%) cases, while NIVM was diagnosed in the remaining 25 (46.3%). The mean ventricular width for IVM was 16.93 mm (range 10.0 mm-73.0 mm) and 14.08 mm (range 9.0 mm-27.1 mm) for NIVM (p = 0.28). The mean gestational age at delivery for the IVM cases was 36 + 4 weeks and in the NIVM group 33 + 4 weeks (p = 0.022). Mild VM (10-12 mm) was diagnosed in 22/54 cases (40.7%), moderate VM (13-15 mm) in 12/54 (22.3%) and severe (≥ 15 mm) in 20/54 (37%). Among the infants with IVM the rate of severe medical complications was 29.6% (8/28) and for NIVM 667% (8/12) (p = 0.041). Less severe medical conditions affected 6/28 of the infants with IVM (21.4%) vs 9/12 NIVM cases (75%) (p = 0.012). CONCLUSIONS: In terms of prenatal diagnosis, treatment of ventriculomegaly remains challenging due to a lack of specific prognostic factors and the significant risk of neurodevelopmental disorders. Nevertheless, isolated ventriculomegaly has significantly better long-term outcomes compared with non-isolated ventriculomegaly. In our material, the rate of severe neurodevelopmental disorders in the non-isolated ventriculomegaly cases was associated with a 52% rate of adverse perinatal outcomes. On the other hand, less severe medical conditions occurred in 21.4% of the infants with IVM and in 75% of the NIVM cases. Furthermore, obstetrical data suggest that the risks of premature delivery and caesarean section are significantly higher in cases of non-isolated ventriculomegaly.


Assuntos
Doenças Fetais , Hidrocefalia , Adulto , Cesárea/estatística & dados numéricos , Pré-Escolar , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/epidemiologia , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Hidrocefalia/complicações , Hidrocefalia/diagnóstico , Hidrocefalia/epidemiologia , Lactente , Masculino , Pessoa de Meia-Idade , Transtornos do Neurodesenvolvimento/complicações , Transtornos do Neurodesenvolvimento/epidemiologia , Polônia , Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal , Adulto Jovem
18.
PLoS One ; 14(3): e0214290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30913240

RESUMO

INTRODUCTION: Cerebral Visual Impairment (CVI) is the most common cause of visual impairment in children in the developed world and appears to be more prevalent in children with additional support needs (ASN). There is an urgent need for routine screening for CVI, particularly in children with ASN, however, current screening questionnaires for CVI have limited validation. The aim of this study was to evaluate two screening tools: the Five Questions and the CVI Questionnaire. Additionally, the distribution of CVI across neurodevelopmental disorders is unknown. This too was investigated. METHODS: An online survey was completed by 535 parents. The survey was advertised via social media, CVI websites and parent email systems of four schools. The survey comprised of the Five Questions, the CVI Questionnaire and additional questions regarding the child's diagnoses. Whether or not a child had a diagnosis of CVI and/or additional neurodevelopmental disorders was based on parental report. RESULTS: Based on parent reports, both the screening tools accurately screened for CVI diagnoses in children. The Five Questions and the CVI Questionnaire have construct validity (as determined through factor analysis), high internal consistency (as determined by Cronbach's alpha) and convergent validity (as determined by correlation analysis of the raw scores of each questionnaire). This study also highlights that among children with neurodevelopmental disorders, a large proportion have parent-reported CVI (23%-39%) and potential CVI (6.59-22.53%; as identified by the questionnaires). CONCLUSION: The current study demonstrates that the Five Questions and CVI Questionnaire have good convergent validity, internal consistency and a reliable factor structure and may therefore be suitable as screening tools. The study also highlights that reported or potential CVI is evident in a large proportion of children with neurodevelopmental disorders.


Assuntos
Encefalopatias/diagnóstico , Programas de Rastreamento/métodos , Transtornos da Visão/diagnóstico , Adolescente , Encefalopatias/complicações , Criança , Pré-Escolar , Feminino , Humanos , Modelos Logísticos , Masculino , Transtornos do Neurodesenvolvimento/complicações , Transtornos do Neurodesenvolvimento/diagnóstico , Sensibilidade e Especificidade , Mídias Sociais , Inquéritos e Questionários , Transtornos da Visão/complicações
19.
Clin Dysmorphol ; 28(3): 114-119, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30921090

RESUMO

The objective of our study was to use an established cohort of boys to investigate common patterns of malformations in those with hypospadias. We performed a retrospective review of the phenotype of participants in the Deciphering Developmental Disorders Study with neurodevelopmental delay and an 'Abnormality of the genital system'. This group was divided into two subgroups: those with hypospadias and without hypospadias. Associated phenotypes of the two subgroups were compared and analysed. Of the 166 Deciphering Developmental Disorders participants with hypospadias and neurodevelopmental delay, 47 (28%) had cardiovascular and 40 (24%) had structural brain abnormalities. The rate of cardiovascular abnormalities in those with neurodevelopmental delay and genital abnormalities other than hypospadias (N = 645) was lower at 19% (P = 0.001). In addition, structural brain malformations were higher at 24% in the hypospadias group versus 15% in the group without hypospadias (P = 0.002). The constellation of these features occured at a higher rate in the hypospadias group versus the no hypospadias group (P = 0.038). In summary, this is the first study to indicate that cardiovascular and brain abnormalities are frequently encountered in association with hypospadias in children with neurodevelopmental disorders. Not only do these associations provide insight into the underlying aetiology but also they highlight the multisystem involvement in conditions with hypospadias.


Assuntos
Hipospadia/complicações , Hipospadia/fisiopatologia , Transtornos do Neurodesenvolvimento/fisiopatologia , Encéfalo/anormalidades , Anormalidades Cardiovasculares/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Transtornos do Neurodesenvolvimento/complicações , Transtornos do Neurodesenvolvimento/etiologia , Fenótipo , Estudos Retrospectivos , Anormalidades Urogenitais/complicações
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