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Initial reports of congenital Zika virus (ZIKV) infection focused on microcephaly at birth with severe brain anomalies; the phenotype has broadened to include microcephaly that develops after birth and neurodevelopmental sequelae. In this narrative review, we summarize medical literature describing motor abnormalities and epilepsy in infants with evidence of congenital ZIKV infection and provide information on the impact of these conditions. Specific scenarios are used to illustrate the complex clinical course in infants with abnormalities that are consistent with congenital Zika syndrome. A search of the English-language medical literature was done to identify motor abnormalities and epilepsy in infants with evidence of congenital ZIKV infection by using Medline and PubMed, Embase, Scientific Electronic Library Online, Scopus, the OpenGrey Repository, and the Grey Literature Report in Public Health. Search terms included "Zika" only and "Zika" in combination with any of the following terms: "epilepsy," "seizure," "motor," and "cerebral palsy." Clinical features of motor abnormalities and epilepsy in these children were reviewed. Thirty-six publications were identified; 8 were selected for further review. Among infants with clinical findings that are consistent with congenital Zika syndrome, 54% had epilepsy and 100% had motor abnormalities. In these infants, impairments that are consistent with diagnoses of cerebral palsy and epilepsy occur frequently. Pyramidal and extrapyramidal motor abnormalities were notable for their early development and co-occurrence. Prompt identification of potential disabilities enables early intervention to improve the quality of life for affected children. Long-term studies of developmental outcomes and interventions in children with congenital ZIKV infection are needed.

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We describe the approach taken by the National Children's Study (NCS) to understanding the role of environmental factors in the development of obesity. We review the literature with regard to the two core hypotheses in the NCS that relate to environmental origins of obesity and describe strategies that will be used to test each hypothesis. Although it is clear that obesity in an individual results from an imbalance between energy intake and expenditure, control of the obesity epidemic will require understanding of factors in the modern built environment and chemical exposures that may have the capacity to disrupt the link between energy intake and expenditure. Through its embrace of the life-course approach to epidemiology, the NCS will be able to study the origins of obesity from preconception through late adolescence, including factors ranging from genetic inheritance to individual behaviors to the social, built, and natural environment and chemical exposures. It will have sufficient statistical power to examine interactions among these multiple influences, including gene-environment and gene-obesity interactions. A major secondary benefit will derive from the banking of specimens for future analysis.

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We describe the approach taken by the National Children's Study (NCS) to understanding the role of environmental factors in the development of obesity. We review the literature with regard to the two core hypotheses in the NCS that relate to environmental origins of obesity and describe strategies that will be used to test each hypothesis. Although it is clear that obesity in an individual results from an imbalance between energy intake and expenditure, control of the obesity epidemic will require understanding of factors in the modern built environment and chemical exposures that may have the capacity to disrupt the link between energy intake and expenditure. Through its embrace of the life-course approach to epidemiology, the NCS will be able to study the origins of obesity from preconception through late adolescence, including factors ranging from genetic inheritance to individual behaviors to the social, built, and natural environment and chemical exposures. It will have sufficient statistical power to examine interactions among these multiple influences, including geneenvironment and geneobesity interactions. A major secondary benefit will derive from the banking of specimens for future analysis.

Descrevemos a abordagem do National Children's Study (NCS) para entender o papel dos fatores ambientais no desenvolvimento da obesidade. Revisamos a literatura a respeito de duas hipóteses principais no NCS que se relacionam a origens ambientais da obesidade e descrevem estratégias que serão utilizadas para testar cada hipótese. Apesar de estar claro que a obesidade em um indivíduo é resultado de um desequilíbrio entre consumo e gasto de energia, o controle da epidemia de obesidade requer o entendimento de fatores no ambiente moderno e exposições químicas que podem ter a capacidade de interromper a ligação entre o consumo e gasto de energia. Através da aceitação da abordagem do curso de vida a epidemiologia, o NCS será capaz de estudar as origens da obesidade da preconcepção ao final da adolescência, incluindo fatores que vão da herança genética a comportamentos individuais, passando pelo ambiente social, construído e natural e exposições químicas. O estudo terá poder estatístico suficiente para examinar as interações entre essas influências múltiplas, incluindo interações entre gene-ambiente e gene-obesidade. Um benefício secundário importante será derivado do banco de espécime para análise futura.

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This paper uses five strategies to evaluate the reliability and other measurement qualities of the Ten Questions screen for childhood disability. The screen was administered for 22,125 children, aged 2-9 years, in Bangladesh, Jamaica and Pakistan. The test-retest approach involving small sub-samples was useful for assessing reliability of overall screening results, but not of individual items with low prevalence. Alternative strategies focus on the internal consistency and structure of the screen as well as item analyses. They provide evidence of similar and comparable qualities of measurement in the three culturally divergent populations, indicating that the screen is likely to produce comparable data across cultures. One of the questions, however, correlates with the other questions differently in Jamaica, where it appears to "over-identify" children as seriously disable. The methods and findings reported here have general applications for the design and evaluation of questionnaires for epidemiologic research, particularly when the goal is to gather comparable data in geographically and culturally diverse settings (AU)

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No screening test for childhood disability in Jamaica has previously been formally evaluated. The present report describes the validity of the Ten Question Screen (TQ) used by community workers in Jamaican component of the International Epidemiology Study of Childhood Disability, done in the parish of Clarendon. It was previously reported by this study that approximately nine per cent of children aged 2-9 years had mild, moderate or severe disabilities (one or more of: motor, visual, hearing speech or cognitive disabilities, or fits). In Clarendon, 5,461 children were screened, using the TQ and a sub-sample of 993 was subsequently assessed by a doctor and a psychologist for the presence of disabilities. The TQ proved to be an acceptable, reliable instrument and was relatively quick and easy to administer. Sensitivity was 41 percent overall, and 64 percent for moderate/severe disability. Specificity was high, at 87 percent and 86 percent, respectively. Due to the low prevalence, the false-positive rates were high, 75 percent and 90 percent, respectively. False-negative rates varied from 2 to 12 percent in the different age/sex groups, with overall rates of 6 percent for all disabilities, combined and 1 percent in serious disabilities. The lack of sensitivity was mainly due to failure to identify disabilities , especially mild cognitive disabilities, in older boys. The unacceptably high rate of false positives on the screening test indicates the need for a second level of screening to decrease the false-positive rates (increase the positive predictive value) of the test. The reasons for the high rate of false-positive results in using the Ten Question Screen and the possibility of reducing thisby using probes and an additional questionnaire were also investigated. In the 522 false-positive cases, analyses were performed of concordance of responses for three different categories of interviewer, of other disabilities not among the ones being detected, impairments, handicaps and the possibility of the parent being excessively worried about the child's health. The use of probes in TQ positive cases and the Activities of Daily Living Questionnaire (ADLQ) were tested to determine whether false positives could be reduced. Forty-four per cent of respondents in false-positive cases changed their response from positive to the community worker to negative to the doctor. Forty-eight per cent of false-positive cases had other disabilities or impairments and 4 percent had developmental handicaps. Worry was slightly more common among mothers of false-positive cases. Use of the probes and ADLQ reduced the false-positive rate (AU)

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Although numerous estimates of the prevalence of seizure disorders in populations in the less developed world have now been published, these estimates are difficult to interpret due to lack of comparability of study methods and criteria for case definition. The results reported in this paper are from a large, collaborative study of disabilities in 2- to 9-year-old children in which standard research procedures and case definitions were used in three diverse populations (located in Bangladesh, Jamaica and Pakistan). A two-phase study design (screening followed by professional evaluations) was used in this study allowing for the professional evaluation to serve as the criterion in the estimation of prevalence, even for rare disorders. As a result, the prevalence estimates reported here have a high degree of comparability across populations and exhibit unusually strong validity for population surveys. Febrile seizures were the most common type of seizure history in all three populations, with point estimates of lifetime prevalence rates of epilepsy (recurrent unprovoked seizures) ranged from 5.8 to 15.5 per 1000. Lifetime prevalence rates of neonatal, all provoked and all unprovoked seizures, as well as estimates of the prevalence of active epilepsy, are also reported.(AU)

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This is the first in a series of papers that report the testing of two instruments for the identification and assessment of childhood disability by community workers (CWs) in Third World countries. It is part of the International Epidemiological Study on Childhood Disability. The Ten Question Screen (TQ) was used as the main instrument to identify disability in a two stage population-based survey of 5478 children aged 2-9 years in Clarendon, Jamaica. In the second stage, TQ positive and 8 percent of the screen negative controls were professionally assessed by a doctor and a psychologist using standard criteria on the main classification system of the ICIDH. Sensitivity of the TQ as a whole varies in different strata of the group and amongst different disabilities, from perfect in girls under 6 years, fits and motor disabilities and for serious disability in all groups except boys over 5 years with a cognitive disability. Specificity was good but the false positive rate was unacceptably high at 74 percent. It was concluded, firstly, that the validation of a simple questionnaire of perceptions of behaviour against objective measurments of impairments was perhaps not fair to the TQ. In spite of this, the TQ would be a very useful instrument in collection disability data for identifying people in need of rehabilitation help, if a way of reducing false positive could be found. (AU)

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A comparison of the efficacy of the key informant and the community survey methods for identifying children with disability was carried out in the Jamaican component of an international epidemiological study of children disability. Approximately 130 key informants were exposed to a two-day workshop giving information on sign of disability, aspects of the project, and available services. Questionnaires were given to enable the informants to refer children and they were reminded six months later. In the survey method, eight community workers completed a house-to-house survey of all families and administered the 10-question screen with probes on 5475 children, 2 to 9 years old. Seventeen referrals were made by the key informants; of these, two were found to have disabilities. Of the 821 children who tested positive on the 10-question screen on the house-to-house survey, 193 had disabilities. We concluded that the key informant method would not be a satisfactory way of identifying cases of childhood disability. (AU)

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An international collaborative study has as its main objective the development of a methodology for the rapid identification of children with disabilities in the age group 2-9 years. It focuses on a simple screening instrument, the ten question screen with probes (TQP), which will provide a tool for the measurement of this health problem. In addition to this objective, the project also compared the effectiveness of two screening approaches for the identification of disability; the use of "key informants" (persons with knowledge about the child population in their area) with the community survey method, in which a house-to-house survey was carried out by primary health care workers. In both cases, children identified as being disabled and a control group were referred to a doctor and psychologist for professional assessment of their disabilities and handicaps. Approximately 120 key informants were exposed to a two-day workshop designed to give them information about the project and distribute questionnaires for the referral of children in their communities. Six months later, they were reminded of the survey and further referrals were solicited. Eight community workers, completed a house-to-house survey of all families in two areas in Clarendon and administered the TQP on 5,400 2-9 year-olds during a one-year period in 1987 and 1988. Seventeen referrals were made by the key informants. Of these, two were seen by the professional team and found to be disabled. The community workers referred over 200 children who were TQP positive (i.e., disabled according to the criteria). It is concluded that, in Jamaica, considerable groundwork and preparation of key informants would have to be done if such persons were to be relied upon for referrals of disabled children (AU)

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