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[PMID]:29215834
[Au] Autor:Maisel D
[Ti] Título:A United Response: Programs in Israel and Jersey City, N.J., shift the paradigm of the community's role in medical response and disaster preparedness.
[So] Source:JEMS;42(2):54-8, 2017 02.
[Is] ISSN:0197-2510
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Desastres
Serviços Médicos de Emergência/organização & administração
Voluntários
[Mh] Termos MeSH secundário: Planejamento em Saúde Comunitária
Comparação Transcultural
Planejamento em Desastres
Serviços Médicos de Emergência/recursos humanos
Seres Humanos
Israel
Modelos Organizacionais
New Jersey
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE


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[PMID]:27774585
[Au] Autor:Del Brutto OH; Mera RM; Atahualpa Project Investigators
[Ad] Endereço:School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador.
[Ti] Título:The importance of people compliance (social desirability bias) in the assessment of epilepsy prevalence in rural areas of developing countries. Results of the Atahualpa Project.
[So] Source:Epilepsia;57(12):e221-e224, 2016 12.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Epilepsy is a major health issue in rural areas of developing countries. However, heterogeneity of epilepsy prevalence in different studies precludes assessment of the magnitude of the problem. Using similar protocols, two population-based surveys were conducted 12 years apart (2003 and 2015) in a rural Ecuadorian village (Atahualpa). The only difference was a higher people compliance with interviewers during the second survey. Epilepsy prevalence in the 2003 survey was 13.5 per 1,000 (18/1,332) in villagers aged ≥20 years. This rate increased to 26.8 per 1,000 (41/1,530) in the 2015 survey. Thirty-three persons with epilepsy detected during the second survey lived in the village in 2003; six of them had seizures starting after 2003. Of the remaining 27 cases, 13 (48%) denied their problem during the first survey. Further interview revealed that denial was related to lack of confidence with unacquainted field personnel. Social Desirability Scale-17 scores were lower in those who admitted having epilepsy than in those who denied their condition (p = 0.048). Lack of confidence with interviewers and a social desirability bias account for a sizable proportion of epilepsy denial in the study population, and may explain heterogeneity of epilepsy prevalence reported in studies conducted in poor rural settings.
[Mh] Termos MeSH primário: Epilepsia/epidemiologia
Epilepsia/psicologia
Cooperação do Paciente
População Rural
Desejabilidade Social
[Mh] Termos MeSH secundário: Adulto
Planejamento em Saúde Comunitária
Estudos Transversais
Países em Desenvolvimento
Equador/epidemiologia
Feminino
Inquéritos Epidemiológicos
Seres Humanos
Estudos Longitudinais
Masculino
Prevalência
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180107
[Lr] Data última revisão:
180107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13594


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[PMID]:27779314
[Au] Autor:Jacquier D; Newman CJ
[Ad] Endereço:Paediatric Neurology and Neurorehabilitation Unit, Department of Paediatrics, University Hospital of Lausanne, Lausanne, Switzerland.
[Ti] Título:Co-sleeping in school-aged children with a motor disability: a comparative population-based study.
[So] Source:Dev Med Child Neurol;59(4):420-426, 2017 04.
[Is] ISSN:1469-8749
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: To determine the prevalence and determinants of co-sleeping in school-aged children with a motor disability compared with the school-aged general population. METHOD: A questionnaire on demographic characteristics and co-sleeping habits, along with the Sleep Disturbance Scale for Children (SDSC), was sent to parents of children aged between 4 years and 18 years followed in our tertiary paediatric neurorehabilitation clinic, and to school-aged children in a representative sample of state schools. RESULT: We analysed responses for 245 children with motor disability (142 males, 103 females; mean age 10y 6mo, standard deviation [SD] 3y 10mo, range 4-18y) and 2891 of the general population (1484 males, 1497 females; mean age [SD] 9y 6mo [3y 5mo], range 4-18y) (response rates 37% and 26% respectively). Cerebral palsy was the most common diagnosis among children with motor disability. Weekly co-sleeping was significantly more common in children with motor disability than in the general population (11.8% vs 7.9% respectively, p=0.032). Special care of the child with motor disability at night, mainly addressing epilepsy, was reported as a cause of co-sleeping by two-thirds of parents. Factors associated with co-sleeping in the motor disability group were age, housing crowding, severe visual impairment, and pathological sleep according to the SDSC. INTERPRETATION: Co-sleeping is common among children with motor disability. It is influenced by personal and medical factors, as well as the requirements for special care at night. Therefore, health professionals should explore sleeping arrangements in families of children with motor disability.
[Mh] Termos MeSH primário: Dissonias/epidemiologia
Hábitos
Transtornos dos Movimentos/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Distribuição por Idade
Criança
Pré-Escolar
Planejamento em Saúde Comunitária
Estudos Transversais
Dissonias/psicologia
Feminino
Seres Humanos
Masculino
Pais/psicologia
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1705
[Cu] Atualização por classe:171209
[Lr] Data última revisão:
171209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1111/dmcn.13300


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[PMID]:29021355
[Au] Autor:Yu AYX; Rogers E; Wang M; Sajobi TT; Coutts SB; Menon BK; Hill MD; Smith EE
[Ad] Endereço:From the Department of Clinical Neurosciences (A.Y.X.Y., M.W., T.T.S., S.B.C., B.K.M., M.D.H., E.E.S.), Department of Community Health Sciences (A.Y.X.Y., T.T.S., S.B.C., B.K.M., M.D.H., E.E.S.), Department of Radiology (S.B.C., B.K.M., M.D.H., E.E.S.), and Hotchkiss Brain Institute (T.T.S., S.B.C.,
[Ti] Título:Population-based study of home-time by stroke type and correlation with modified Rankin score.
[So] Source:Neurology;89(19):1970-1976, 2017 Nov 07.
[Is] ISSN:1526-632X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To describe home-time, stratified by stroke type, in a complete population and to determine its correlation with modified Rankin Scale (mRS) scores. METHODS: We used linked administrative data to derive home-time in all patients admitted for a cerebrovascular event in Alberta, Canada, between 2012 and 2016. Home-time is the number of days spent outside a health institution in the first 90 days after index hospitalization. We used negative binomial regression, adjusted for age, sex, Charlson comorbidity index, and hospital location, to determine the association between home-time and stroke type. In 552 patients enrolled in 4 acute ischemic stroke clinical trials, we used multivariable ordinal logistic regression analysis to determine the association between home-time and mRS score at 90 days. RESULTS: Among 15,644 patients (n = 10,428 with ischemic stroke, n = 1,415 with intracerebral hemorrhage, n = 760 with subarachnoid hemorrhage, n = 3,041 with TIA), patients with TIA have the longest home-time, almost triple the number of days at home compared to patients with intracerebral hemorrhage (incidence rate ratio 2.85, 95% confidence interval [CI] 2.58-3.15). Among clinical trial ischemic stroke patients, longer home-time was associated with a lower mRS score at 90 days (adjusted common odds ratio 1.04, 95% CI 1.04-1.05). CONCLUSIONS: We showed that home-time is an objective and graded indicator that is correlated with disability after stroke. It is obtainable from administrative data, applicable to different stroke types, and a valuable outcome indicator in population-based health services research.
[Mh] Termos MeSH primário: Hemorragia Cerebral/epidemiologia
Acidente Vascular Cerebral/diagnóstico
Acidente Vascular Cerebral/epidemiologia
Hemorragia Subaracnóidea/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Algoritmos
Canadá/epidemiologia
Planejamento em Saúde Comunitária
Feminino
Fibrinolíticos/uso terapêutico
Seres Humanos
Masculino
Meia-Idade
Análise de Regressão
Estudos Retrospectivos
Acidente Vascular Cerebral/tratamento farmacológico
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Fibrinolytic Agents)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171115
[Lr] Data última revisão:
171115
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171013
[St] Status:MEDLINE
[do] DOI:10.1212/WNL.0000000000004631


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[PMID]:28978659
[Au] Autor:Nurmonen HJ; Huttunen T; Huttunen J; Kurki MI; Helin K; Koivisto T; von Und Zu Fraunberg M; Jääskeläinen JE; Lindgren AE
[Ad] Endereço:From Neurosurgery (H.J.N.), School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio; Neurosurgery of NeuroCenter (T.H., J.H., K.H., T.K., M.v.u.z.F., J.E.J. A.E.L.), Kuopio University Hospital, Finland; and Broad Institute (M.I.K.), Bosto
[Ti] Título:Polycystic kidney disease among 4,436 intracranial aneurysm patients from a defined population.
[So] Source:Neurology;89(18):1852-1859, 2017 Oct 31.
[Is] ISSN:1526-632X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To define the association of autosomal dominant polycystic kidney disease (ADPKD) with the characteristics of aneurysmal subarachnoid hemorrhage (aSAH) and unruptured intracranial aneurysm (IA) disease. METHODS: We fused data from the Kuopio Intracranial Aneurysm database (n = 4,436 IA patients) and Finnish nationwide registries into a population-based series of 53 IA patients with ADPKD to compare the aneurysm- and patient-specific characteristics of IA disease in ADPKD and in the general IA population, and to identify risks for de novo IA formation. RESULTS: In total, there were 33 patients with ADPKD with aSAH and 20 patients with ADPKD with unruptured IAs. The median size of ruptured IAs in ADPKD was significantly smaller than in the general population (6.00 vs 8.00 mm) and the proportion of small ruptured IAs was significantly higher (31% vs 18%). Median age at aSAH was 42.8 years, 10 years younger than in the general IA population. Multiple IAs were present in 45% of patients with ADPKD compared to 28% in the general IA population. Cumulative risk of de novo IA formation was 1.3% per patient-year (vs 0.2% in the general IA population). Hazard for de novo aneurysm formation was significantly elevated in patients with ADPKD (Cox regression hazard ratio 7.7, 95% confidence interval 2.8-20; < 0.0005). CONCLUSIONS: Subarachnoid hemorrhage occurs at younger age and from smaller IAs in patients with ADPKD and risk for de novo IAs is higher than in the general Eastern Finnish population. ADPKD should be considered as an indicator for long-term angiographic follow-up in patients with diagnosed IAs.
[Mh] Termos MeSH primário: Aneurisma Intracraniano/epidemiologia
Doenças Renais Policísticas/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Área Programática (Saúde)
Planejamento em Saúde Comunitária
Bases de Dados Factuais
Feminino
Finlândia/epidemiologia
Seguimentos
Seres Humanos
Incidência
Aneurisma Intracraniano/complicações
Aneurisma Intracraniano/diagnóstico por imagem
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Doenças Renais Policísticas/complicações
Doenças Renais Policísticas/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171006
[St] Status:MEDLINE
[do] DOI:10.1212/WNL.0000000000004597


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[PMID]:28969391
[Au] Autor:Lantz M; Sieurin J; Sjölander A; Waldenlind E; Sjöstrand C; Wirdefeldt K
[Ad] Endereço:Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
[Ti] Título:Migraine and risk of stroke: a national population-based twin study.
[So] Source:Brain;140(10):2653-2662, 2017 Oct 01.
[Is] ISSN:1460-2156
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Numerous studies have indicated an increased risk for stroke in patients with migraine, especially migraine with aura; however, many studies used self-reported migraine and only a few controlled for familial factors. We aimed to investigate migraine as a risk factor for stroke in a Swedish population-based twin cohort, and whether familial factors contribute to an increased risk. The study population included twins without prior cerebrovascular disease who answered a headache questionnaire during 1998 and 2002 for twins born 1935-58 and during 2005-06 for twins born between 1959 and 1985. Migraine with and without aura and probable migraine was defined by an algorithm mapping on to clinical diagnostic criteria according to the International Classification of Headache Disorders. Stroke diagnoses were obtained from the national patient and cause of death registers. Twins were followed longitudinally, by linkage of national registers, from date of interview until date of first stroke, death, or end of study on 31 Dec 2014. In total, 8635 twins had any migraineous headache, whereof 3553 had migraine with aura and 5082 had non-aura migraineous headache (including migraine without aura and probable migraine), and 44 769 twins had no migraine. During a mean follow-up time of 11.9 years we observed 1297 incident cases of stroke. The Cox proportional hazards model with attained age as underlying time scale was used to estimate hazard ratios with 95% confidence intervals for stroke including ischaemic and haemorrhagic subtypes related to migraine with aura, non-aura migraineous headache, and any migraineous headache. Analyses were adjusted for gender and cardiovascular risk factors. Where appropriate; within-pair analyses were performed to control for confounding by familial factors. The age- and gender-adjusted hazard ratio for stroke related to migraine with aura was 1.27 (95% confidence interval 1.00-1.62), P = 0.05, and 1.07 (95% confidence interval 0.91-1.26), P = 0.39 related to any migraineous headache. Multivariable adjusted analyses showed similar results. When stratified by gender and attained age of ≤50 or >50 years, the estimated hazard ratio for stroke was higher in twins younger than 50 years and in females; however, non-significant. In the within-pair analysis, the hazard ratio for stroke related to migraine with aura was attenuated [hazard ratio 1.09 (95% confidence interval 0.81-1.46), P = 0.59]. In conclusion, we observed no increased stroke risk related to migraine overall but there was a modestly increased risk for stroke related to migraine with aura, and within-pair analyses suggested that familial factors might contribute to this association.
[Mh] Termos MeSH primário: Transtornos de Enxaqueca/epidemiologia
Transtornos de Enxaqueca/genética
Acidente Vascular Cerebral/epidemiologia
Acidente Vascular Cerebral/genética
[Mh] Termos MeSH secundário: Adulto
Idoso
Algoritmos
Planejamento em Saúde Comunitária
Feminino
Seres Humanos
Masculino
Meia-Idade
Fatores de Risco
Acidente Vascular Cerebral/diagnóstico
Suécia/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; TWIN STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171004
[St] Status:MEDLINE
[do] DOI:10.1093/brain/awx223


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[PMID]:28967231
[Au] Autor:Jystad KP; Strand KM; Bjellmo S; Lydersen S; Klungsöyr K; Stoknes M; Skranes J; Andersen GL; Vik T
[Ad] Endereço:Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
[Ti] Título:Congenital anomalies and the severity of impairments for cerebral palsy.
[So] Source:Dev Med Child Neurol;59(11):1174-1180, 2017 Nov.
[Is] ISSN:1469-8749
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: To study the prevalence of congenital anomalies among children with cerebral palsy (CP) born at term or late preterm, and if CP subtypes and clinical manifestations differ between children with and without congenital anomalies. METHOD: This was a cross-sectional study using data from the Cerebral Palsy Register of Norway and the Medical Birth Registry of Norway. All children with congenital CP born at and later than 34 weeks' gestation in Norway from 1999 to 2009 were included. Anomalies were classified according to the European Surveillance of Congenital Anomalies classification guidelines. Groups were compared using Fisher's exact test, Kruskal-Wallis test, and the Mann-Whitney U test. RESULTS: Among 685 children with CP, 169 (25%) had a congenital anomaly; 125 within the central nervous system. Spastic bilateral CP was more prevalent in children with anomalies (42%) than in children without (34%; p=0.011). Children with anomalies less frequently had low Apgar scores (p<0.001), but more often had severe limitations in gross- and fine-motor function, speech impairments, epilepsy, severe vision, and hearing impairments than children without anomalies (p<0.03). INTERPRETATION: Although children with CP and anomalies had low Apgar scores less frequently, they had more severe limitations in motor function and more associated problems than children with CP without anomalies. WHAT THIS PAPER ADDS: One in four children with cerebral palsy (CP) born at term or late preterm has a congenital anomaly. The added value of neuroimaging to detect central nervous system anomalies in children with CP. Children with anomalies have more severe motor impairments. More severe clinical manifestations are not explained by perinatal complications as indicated by low Apgar scores.
[Mh] Termos MeSH primário: Paralisia Cerebral/complicações
Paralisia Cerebral/epidemiologia
Malformações do Sistema Nervoso/complicações
Malformações do Sistema Nervoso/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Criança
Estudos de Coortes
Planejamento em Saúde Comunitária
Estudos Transversais
Feminino
Lateralidade Funcional
Idade Gestacional
Seres Humanos
Masculino
Noruega
Razão de Chances
Fatores de Risco
Índice de Gravidade de Doença
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171003
[St] Status:MEDLINE
[do] DOI:10.1111/dmcn.13552


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[PMID]:28931645
[Au] Autor:Thormann A; Sørensen PS; Koch-Henriksen N; Laursen B; Magyari M
[Ad] Endereço:From the Danish Multiple Sclerosis Center (A.T., P.S.S., M.M.), Department of Neurology, University of Copenhagen, Rigshospitalet; The Danish Multiple Sclerosis Registry (A.T., N.K.-H., M.M.), Department of Neurology, Rigshospitalet, Copenhagen; Department of Clinical Epidemiology (N.K.-H.), Clinica
[Ti] Título:Comorbidity in multiple sclerosis is associated with diagnostic delays and increased mortality.
[So] Source:Neurology;89(16):1668-1675, 2017 Oct 17.
[Is] ISSN:1526-632X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS. METHODS: We conducted a population-based, nationwide cohort study including all incident MS cases in Denmark with first MS symptom between 1980 and 2005. To investigate the time of diagnosis, we compared individuals with and without chronic comorbidity using multinomial logistic regression. To investigate mortality, we used Cox regression with time-dependent covariates, following study participants from clinical MS onset until endpoint (death) or to the end of the study, censuring at emigration. RESULTS: We identified 8,947 individuals with clinical onset of MS between 1980 and 2005. In the study of time of diagnosis, we found statistically significant odds ratios for longer diagnostic delays with cerebrovascular comorbidity (2.01 [1.44-2.80]; <0.0005), cardiovascular comorbidity (4.04 [2.78-5.87]; <0.0005), lung comorbidity (1.93 [1.42-2.62]; <0.0005), diabetes comorbidity (1.78 [1.04-3.06]; 0.035), and cancer comorbidity (2.10 [1.20-3.67]; 0.009). In the mortality study, we found higher hazard ratios with psychiatric comorbidity (2.42 [1.67-3.01]; <0.0005), cerebrovascular comorbidity (2.47 [2.05-2.79]; <0.0005), cardiovascular comorbidity (1.68 [1.39-2.03]; <0.0005), lung comorbidity (1.23 [1.01-1.50]; 0.036), diabetes comorbidity (1.39 [1.05-1.85]; 0.021), cancer comorbidity (3.51 [2.94-4.19]; <0.0005), and Parkinson disease comorbidity (2.85 [1.34-6.06]; 0.007). CONCLUSIONS: An increased awareness of both the necessity of neurologic evaluation of new neurologic symptoms in persons with preexisting chronic disease and of optimum treatment of comorbidity in MS is critical.
[Mh] Termos MeSH primário: Diagnóstico Tardio/mortalidade
Esclerose Múltipla
[Mh] Termos MeSH secundário: Adulto
Doenças Autoimunes/epidemiologia
Doenças Cardiovasculares/epidemiologia
Transtornos Cerebrovasculares/epidemiologia
Estudos de Coortes
Planejamento em Saúde Comunitária
Comorbidade
Dinamarca/epidemiologia
Feminino
Seres Humanos
Nefropatias/epidemiologia
Modelos Logísticos
Masculino
Meia-Idade
Transtornos do Humor/epidemiologia
Esclerose Múltipla/diagnóstico
Esclerose Múltipla/epidemiologia
Esclerose Múltipla/mortalidade
Neoplasias/epidemiologia
Exame Neurológico
Doença de Parkinson/epidemiologia
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171024
[Lr] Data última revisão:
171024
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170922
[St] Status:MEDLINE
[do] DOI:10.1212/WNL.0000000000004508


  9 / 4805 MEDLINE  
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[PMID]:28877337
[Au] Autor:Benfer KA; Weir KA; Ware RS; Davies PSW; Arvedson J; Boyd RN; Bell KL
[Ad] Endereço:Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.
[Ti] Título:Parent-reported indicators for detecting feeding and swallowing difficulties and undernutrition in preschool-aged children with cerebral palsy.
[So] Source:Dev Med Child Neurol;59(11):1181-1187, 2017 Nov.
[Is] ISSN:1469-8749
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: To determine the most accurate parent-reported indicators for detecting (1) feeding/swallowing difficulties and (2) undernutrition in preschool-aged children with cerebral palsy (CP). METHOD: This was a longitudinal, population-based study, involving 179 children with CP, aged 18 to 60 months (mean 34.1mo [SD 11.9] at entry, 111 males, 68 females [Gross Motor Function Classification System level I, 84; II, 23; III, 28; IV, 18; V, 26], 423 data points). Feeding/swallowing difficulties were determined by the Dysphagia Disorders Survey and 16 signs suggestive of pharyngeal phase impairment. Undernutrition was indicated by height-weight and skinfold composite z-scores less than -2. Primary parent-reported indicators included mealtime duration, mealtime stress, concern about growth, and respiratory problems. Other indicators were derived from a parent feeding questionnaire, including 'significant difficulty eating and drinking'. Data were analysed using multilevel mixed-effects regression and diagnostic statistics. RESULTS: Primary parent-reported indicators associated with feeding/swallowing were 'moderate-severe parent stress' (odds ratio [OR]=3.2 [95% confidence interval {CI} 1.3-7.8]; p<0.01), 'moderate-severe concern regarding growth' (OR=4.5 [95% CI 1.7-11.9]; p<0.01), and 'any respiratory condition' (OR=1.8 [95% CI 1.4-5.8]; p<0.01). The indicator associated with undernutrition was 'moderate-severe concern regarding growth' (height-weight OR=13.5 [95% CI 3.0-61.3]; p<0.01; skinfold OR=19.1 [95% CI 3.7-98.9]; p<0.01). 'Significant difficulty eating and drinking' was most sensitive/specific for feeding outcome (sensitivity=58.6%, specificity=100.0%), and 'parent concern regarding growth' for undernutrition (sensitivity=77.8%, specificity=77.0%). INTERPRETATION: Parent-reported indicators are feasible for detecting feeding and swallowing difficulties and undernutrition in children with CP, but need formal validation. WHAT THIS PAPER ADDS: Parent-reported indicators can detect feeding/swallowing difficulties and undernutrition in children with cerebral palsy. Most accurate screening questions were 0-10 scales for 'difficulty eating' and 'difficulty drinking'. Supplementation of these scales with additional indicators would improve detection.
[Mh] Termos MeSH primário: Paralisia Cerebral/complicações
Transtornos de Deglutição/diagnóstico
Transtornos de Deglutição/etiologia
Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico
Transtornos da Alimentação e da Ingestão de Alimentos/etiologia
Desnutrição/diagnóstico
Desnutrição/etiologia
Pais/psicologia
[Mh] Termos MeSH secundário: Índice de Massa Corporal
Paralisia Cerebral/psicologia
Pré-Escolar
Estudos de Coortes
Planejamento em Saúde Comunitária
Estudos Transversais
Feminino
Seres Humanos
Lactente
Masculino
Índice de Gravidade de Doença
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170907
[St] Status:MEDLINE
[do] DOI:10.1111/dmcn.13498


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[PMID]:28838189
[Au] Autor:Menning L; Garg G; Pokharel D; Thrush E; Farrell M; Kodio FK; Veira CL; Wanyoike S; Malik S; Patel M; Rosenbauer O
[Ad] Endereço:World Health Organization.
[Ti] Título:Communications, Immunization, and Polio Vaccines: Lessons From a Global Perspective on Generating Political Will, Informing Decision-Making and Planning, and Engaging Local Support.
[So] Source:J Infect Dis;216(suppl_1):S24-S32, 2017 Jul 01.
[Is] ISSN:1537-6613
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The requirements under objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018-to introduce at least 1 dose of inactivated poliomyelitis vaccine (IPV); withdraw oral poliomyelitis vaccine (OPV), starting with the type 2 component; and strengthen routine immunization programs-set an ambitious series of targets for countries. Effective implementation of IPV introduction and the switch from trivalent OPV (containing types 1, 2, and 3 poliovirus) to bivalent OPV (containing types 1 and 3 poliovirus) called for intense global communications and coordination on an unprecedented scale from 2014 to 2016, involving global public health technical agencies and donors, vaccine manufacturers, World Health Organization and United Nations Children's Fund regional offices, and national governments. At the outset, the new program requirements were perceived as challenging to communicate, difficult to understand, unrealistic in terms of timelines, and potentially infeasible for logistical implementation. In this context, a number of core areas of work for communications were established: (1) generating awareness and political commitment via global communications and advocacy; (2) informing national decision-making, planning, and implementation; and (3) in-country program communications and capacity building, to ensure acceptance of IPV and continued uptake of OPV. Central to the communications function in driving progress for objective 2 was its ability to generate a meaningful policy dialogue about polio vaccines and routine immunization at multiple levels. This included efforts to facilitate stakeholder engagement and ownership, strengthen coordination at all levels, and ensure an iterative process of feedback and learning. This article provides an overview of the global efforts and challenges in successfully implementing the communications activities to support objective 2. Lessons from the achievements by countries and partners will likely be drawn upon when all OPVs are completely withdrawn after polio eradication, but also may offer a useful model for other global health initiatives.
[Mh] Termos MeSH primário: Erradicação de Doenças
Programas de Imunização
Poliomielite/prevenção & controle
Vacina Antipólio de Vírus Inativado/administração & dosagem
Vacina Antipólio Oral/administração & dosagem
[Mh] Termos MeSH secundário: Planejamento em Saúde Comunitária
Tomada de Decisões Gerenciais
Erradicação de Doenças/métodos
Erradicação de Doenças/organização & administração
Saúde Global
Seres Humanos
Programas de Imunização/métodos
Programas de Imunização/organização & administração
Vacina Antipólio de Vírus Inativado/provisão & distribuição
Vacina Antipólio Oral/provisão & distribuição
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Poliovirus Vaccine, Inactivated); 0 (Poliovirus Vaccine, Oral)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170826
[St] Status:MEDLINE
[do] DOI:10.1093/infdis/jix059



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