RESUMEN

Introduction: The use of telemedicine in critical care is emerging, however, there is a paucity of information surrounding the costs relative to health gains in the pediatric population. This study aimed to estimate the cost-effectiveness of a pediatric tele-resuscitation (Peds-TECH) intervention compared to the usual care in five community hospital emergency departments (EDs). Using a decision tree analysis approach with secondary retrospective data from a 3-year time period, this cost-effectiveness analysis was completed. Methods: A mixed methods quasi-experimental design was embedded in the economic evaluation of Peds-TECH intervention. Patients aged <18 years triaged as Canadian Triage and Acuity Scale 1 or 2 at EDs were eligible to receive the intervention. Qualitative interviews were conducted with parents/caregivers to explore the out-of-pocket (OOP) expenses. Patient-level health resource utilization was extracted from Niagara Health databases. The Peds-TECH budget calculated one-time technology and operational costs per patient. Base-case analyses determined the incremental cost per year of life lost (YLL) averted, and additional sensitivity analysis confirmed the robustness of the results. Results: Odds ratio for mortality among cases was 0.498 (95% CI: 0.173, 1.43). The average cost of a patient receiving the Peds-TECH intervention was $2,032.73 compared to $317.45 in usual care. In total, 54 patients received the Peds-TECH intervention. Fewer children died in the intervention group resulting in 4.71 YLL. The probabilistic analysis revealed an incremental cost-effectiveness ratio of $64.61 per YLL averted. Conclusion: Peds-TECH appears to be a cost-effective intervention for resuscitating infants/children in hospital emergency departments.

RESUMEN

PURPOSE: Affecting 5-6% of children, Developmental Coordination Disorder (DCD) is a prevalent chronic condition. The nature of the disorder - impaired motor coordination - makes avoidance of physical activity (PA) common. The purpose of this study was to examine the effect of barrier and task self-efficacy on PA behavior in children with DCD and a group of typically developing (TD) children. METHODS: Children were compared on their perceived ability to complete different intensities and duration of PA (task efficacy) and their confidence in completing PA when faced with everyday barriers (barrier efficacy). An accelerometer was used to record their activity over the subsequent week. RESULTS: Children with DCD were found to have significantly lower task efficacy and barrier efficacy. They also spent significantly less time in moderate to vigorous physical activity (MVPA). Multivariate analyses revealed that gender modified the relationship for both groups. Separate multivariate regressions, were therefore conducted by gender. A direct effect of DCD on PA was observed for boys, but not for girls. Further analyses showed that neither task efficacy nor barrier efficacy influenced the relationship between DCD and PA. CONCLUSION: Results from this study confirm that children with DCD have lower task and barrier self-efficacy than TD children and that males have lower PA levels than their TD peers; however neither task or barrier self-efficacy mediated the relationship between DCD and PA.

Asunto(s)

Asunto(s)

RESUMEN

RATIONALE: Among the most widely used instruments to assess developmental co-ordination disorder (DCD) in children are the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) and the Movement Assessment Battery for Children (M-ABC). However, there is little research on agreement between these tests, when administered to children in field-based settings by trained non-clinicians. METHOD: Ten of 75 schools participating in a larger study were randomly selected. All children in grade 4 (n= 340) in each of these schools were assessed at the same time using both the BOTMP-SF and the M-ABC in May of 2005. The order of tests was balanced, with an average gap in time between tests of 10-15 min. All tests were administered by trained research assistants. RESULTS: The correlation between tests was moderate (r= 0.50, P < 0.01). Kappas were low at the fifth (k= 0.19) and 15th (k= 0.29) percentile cut-points, which are generally used to identify cases of DCD. Re-analysis using the relative improvement over chance (RIOC) statistic, however, revealed slightly better agreement at both cut-points (fifth percentile, RIOC = 0.29; 15th percentile, RIOC = 0.47). Children who scored as probable for DCD on both motor tests, as well as on only the BOTMP-SF, had higher body mass index, poorer physical fitness and lower levels of teacher-reported physical ability than those positive for DCD on the M-ABC only or those who scored negatively on both tests. DISCUSSION: In general, the agreement between tests, even after adjustment for RIOC, was poor. Children identified with poor motor competence by both tests or by the BOTMP-SF only are at particular risk for poor physical fitness, overweight/obesity and physical inactivity. It appears that each assessment measures different dimensions of motor ability but that under field-based conditions the M-ABC may be less useful when applied by non-clinicians.

Asunto(s)

RESUMEN

Aim Despite its widespread current use in research and its potential for future application, the validity of the short form of the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP-SF) when administered by trained lay assessors is not known. This paper reports the results of case identification using the Movement Assessment Battery for Children (M-ABC) in a group of children scoring below the sixth percentile on the BOTMP-SF. Methods The BOTMP-SF was administered by trained research assistants to 2058 children. In total, 24 of 128 children aged 10 (n = 10), 11 (n = 10) or 12 (n = 4) scoring below the sixth percentile were randomly selected for further assessment by a paediatric occupational therapist using the M-ABC and the Kaufman Brief Intelligence Test. Results Twenty-one of 24 children positive for motor co-ordination problems on the BOTMP-SF scored below the 15th percentile of the M-ABC, a positive predictive value (PPV) of 0.88 [95% confidence interval (CI) = 0.69 to 0.96]. Fifteen of these children were below the fifth percentile (PPV = 0.63; 95% CI = 0.43 to 0.79). Conclusions The BOTMP-SF seems to be a reasonable alternative to case identification when clinical assessment with the M-ABC is not feasible. Further research is needed to examine the sensitivity and specificity of the short form when used for this purpose.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Developmental coordination disorder (DCD) is a significant problem that affects between 5 and 9% of all children. Since children with DCD are less likely than their non-DCD peers to participate in physical activities, they may be at greater risk for overweight and obesity. In this report, we examine the relationship between DCD and overweight and obesity in a sample of 578 children aged 9-14 y. We also examine whether the relationship between DCD and overweight/obesity is the same for boys and girls, taking into account sex and age-appropriate differences in percentage body fat and body mass index (BMI) criteria. Our results show that for boys, DCD may be a risk factor for overweight/obesity in childhood and early adolescence. For girls, there is no difference in the prevalence of overweight/obesity between children with and without the disorder.

Asunto(s)