RESUMEN
OBJECTIVE: To identify measures of standing balance validated in pediatric populations, and to determine the components of postural control captured in each tool. DATA SOURCES: Electronic searches of MEDLINE, Embase, and CINAHL databases using key word combinations of postural balance/equilibrium, psychometrics/reproducibility of results/predictive value of tests, and child/pediatrics; gray literature; and hand searches. STUDY SELECTION: Inclusion criteria were measures with a stated objective to assess balance, with pediatric (≤18y) populations, with at least 1 psychometric evaluation, with at least 1 standing task, with a standardized protocol and evaluation criteria, and published in English. Two reviewers independently identified studies for inclusion. There were 21 measures included. DATA EXTRACTION: Two reviewers extracted descriptive characteristics, and 2 investigators independently coded components of balance in each measure using a systems perspective for postural control, an established framework for balance in pediatric populations. DATA SYNTHESIS: Components of balance evaluated in measures were underlying motor systems (100% of measures), anticipatory postural control (72%), static stability (62%), sensory integration (52%), dynamic stability (48%), functional stability limits (24%), cognitive influences (24%), verticality (9%), and reactive postural control (0%). CONCLUSIONS: Assessing children's balance with valid and comprehensive measures is important for ensuring development of safe mobility and independence with functional tasks. Balance measures validated in pediatric populations to date do not comprehensively assess standing postural control and omit some key components for safe mobility and independence. Existing balance measures, that have been validated in adult populations and address some of the existing gaps in pediatric measures, warrant consideration for validation in children.
Asunto(s)
Equilibrio Postural/fisiología , Prueba de Esfuerzo , Humanos , Pediatría , Psicometría , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Children with complex needs can face barriers to system access and navigation related to their need for multiple services and healthcare providers. Central intake for pediatric rehabilitation was developed and implemented in 2008 in Winnipeg Manitoba Canada as a means to enhance service coordination and access for children and their families. This study evaluates the process and impact of implementing a central intake system, using pediatric physiotherapy as a case example. METHODS: A mixed methods instrumental case study design was used. Interviews were completed with 9 individuals. Data was transcribed and analyzed for themes. Quantitative data (wait times, referral volume and caregiver satisfaction) was collected for children referred to physiotherapy with complex needs (n = 1399), and a comparison group of children referred for orthopedic concerns (n = 3901). Wait times were analyzed using the Kruskal-Wallis test, caregiver satisfaction was analyzed using Fisher exact test and change point modeling was applied to examine referral volume over the study period. RESULTS: Interview participants described central intake implementation as creating more streamlined processes. Factors that facilitated successful implementation included 1) agreement among stakeholders, 2) hiring of a central intake coordinator, 3) a financial commitment from the government and 4) leadership at the individual and organization level. Mean (sd) wait times improved for children with complex needs (12.3(13.1) to 8.0(6.9) days from referral to contact with family, p < 0.0001; 29.8(17.9) to 24.3(17.0) days from referral to appointment, p < 0.0001) while referral volumes remained consistent. A small but significant increase in wait times was observed for the comparison group (9.6(8.6) to 10.1(6.6) days from referral to contact with family, p < 0.001; 20.4(14.3) to 22.1(13.1) days from referral to appointment, p < 0.0001), accompanied by an increasing referral volume for this group. Caregiver satisfaction remained high throughout the process (p = 0.48). CONCLUSIONS: Central intake implementation achieved the intended outcomes of streamlining processes and improving transparency and access to pediatric physiotherapy (i.e., decreasing wait times) for families of children with complex needs. Future research is needed to build on this single discipline case study approach to examine changes in wait times, therapy coordination and stakeholder satisfaction within the context of continuing improvements for pediatric therapy services within the province.
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Servicios de Salud del Niño/organización & administración , Modalidades de Fisioterapia/organización & administración , Niño , Accesibilidad a los Servicios de Salud , Humanos , Manitoba , Estudios de Casos Organizacionales , Satisfacción del Paciente , Derivación y Consulta , Listas de EsperaRESUMEN
OBJECTIVES: To determine both the prevalence and severity of dehydration of forestry workers harvesting trees in autumn and winter. METHODS: Two cross-sectional observational studies were conducted on convenience samples of 103 and 79 workers in autumn and winter, respectively. The prevalence of dehydration pre- and post-shift was determined using urine specific gravity (U(SG)), and the severity of dehydration by the percent loss of body weight across the shift. RESULTS: Pre-shift, 43% in autumn and 47% in winter were dehydrated (U(SG) > 1.020 g ml(-1)) on arrival at work. There was a significant increase (P ≤ 0.001) in the prevalence of dehydration post-shift as 64% (P ≤ 0.001) in autumn and 63% (P = 0.043) in winter were dehydrated. In each area, ±22% had dehydrated by ≥2% loss of body weight. Pre-shift, 23% in autumn and 13% in winter were overhydrated (U(SG) < 1.013 g ml⻹). Post-shift, 4% in autumn and 2% in winter were overhydrated. An excessive consumption of hypotonic fluid (water) in combination with a reduced salt intake to prevent hypertension exposed an important minority to the risk of potentially fatal dilutional hyponatremia. Neither dehydration nor hyperhydration was related to season, gender, or job category. CONCLUSIONS: During average shifts, the South African forestry workers, regardless of season, gender, or job category, experienced dehydration of a magnitude that compromised both their safety and productivity.
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Deshidratación/epidemiología , Agricultura Forestal , Enfermedades Profesionales/epidemiología , Estaciones del Año , Adulto , Peso Corporal , Estudios Transversales , Deshidratación/fisiopatología , Deshidratación/orina , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/fisiopatología , Enfermedades Profesionales/orina , Prevalencia , Sudáfrica , Gravedad EspecíficaRESUMEN
OBJECTIVE: Compare the nutritional vulnerability, risk of malnutrition, nutritional status and quality of life (QoL) between recipients and non-recipients of nutrition care and support (NCS) of HIV-positive adults. METHODS: In 2009, a household-based cross-sectional study of HIV-positive adults, NCS recipients (n=97) and non-NCS recipients (n=203) from KwaZulu-Natal was conducted. Nutritional vulnerability (socio-economic status; food security; self-reported health status; nutritional knowledge and attitude), risk of malnutrition (nutrition assessment screening tool), anthropometry (body mass index; mid-upper arm circumference; waist-to-hip ratio) and QoL (general health; self-care; physical functioning) were compared between the two groups. RESULT: Although the result suggests a modest impairment of QoL, NCS recipients were twice as likely to have severe impairment of general health; self-care functioning and QoL. Overweight and obesity were common despite indications of high prevalence of food insecurity, possible-risk of malnutrition and diets predominantly of cereals. NCS recipients were more frequently taking anti-retroviral drugs, receiving social grants, reporting good eating plans and owning kitchen gardens. Non-NCS recipients had been generally sick, reported fatigue, nausea, appetite loss and diarrhoea. NCS recipients were twice as likely to experience oral thrush. CONCLUSION: Contextual factors such as low dietary diversity and household food insecurity that exacerbates nutritional vulnerability and malnutrition should be considered when providing NCS to fully achieve nutritional recovery and QoL of HIV-positive adults.
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Infecciones por VIH/dietoterapia , Accesibilidad a los Servicios de Salud , Desnutrición/prevención & control , Estado Nutricional , Calidad de Vida , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Desnutrición/epidemiología , Factores Socioeconómicos , Sudáfrica/epidemiologíaRESUMEN
INTRODUCTION AND AIM: The Department of Health in South Africa, instituted compulsory community service (CS) as one strategy to overcome the chronic shortage of health professionals in underserved and rural areas. A number of articles have listed the reasons for the lack of willingness of health professionals to practice in rural areas. Amongst others they listed the lack of career opportunities, the recruitment of students into health professions from incongruous backgrounds, inappropriate training, bureaucratic problems, poorly equipped hospitals and social isolation. The aim of this study was to examine and explore the factors affecting the professional development of dietitians during CS. METHODS: Thirteen of the 15 community service dietitians (CSDs) currently (2005) undertaking CS in KwaZulu-Natal participated in focus group discussions. Each member of the group was also required to answer a short written questionnaire before the discussions to establish whether there was congruence between the written answers and the verbal discussions. The large group was divided into two sub groups and each session lasted one and a half hours. A list of topics was discussed by each group. The sessions were taped and transcribed and further analysed using the qualitative analysis programme, "QSR NVivo". RESULTS: Analysis of the transcripts revealed a number of thematic areas and included the evaluation of the placement process, obstructions and constraints, the developmental progress of the CSD and means of enhancing professional development. The discussion on the placement process was not contentious, with only three CSDs having reservations about the process. Many obstructions and constraints to service delivery and professional development were revealed and included the lack of supervision and support, the lack of preparedness of the institutions receiving CSDs and the lack of clarity of the CSDs' perception of community service, unhappiness of some CSDs being placed a long way from home, work and role overload, not being part of a team, lack of understanding the CSDs role and the under utilisation of their services. Developmental progress of the CSDs was enhanced by some positive aspects which included the social interactions experienced in the community setting, learning new skills and support that they received from other community service professionals. DISCUSSIONS AND RECOMMENDATIONS: Comparison of the written answers with verbal discussions showed the same results. A number of issues raised in this study have been recorded by other authors. It is recommended that the issue of supervision and support be addressed so that the professional development of CSDs is enhanced. The lack of preparedness of the receiving institutions is a problem that is relatively easy to address and should be made a priority. The training institutions also need to be more proactive in preparing dietetic students for CS. CONCLUSIONS: Compulsory community service as a method of addressing the problems of underserved population has merit. To maximise the benefits the DOH would do well to heed the recommendations by ensuring that there are structures in place to provide adequate resources for and support and supervision of CSDs.
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Técnicos Medios en Salud , Servicios de Salud Comunitaria , Dietética , Grupos Focales , Humanos , Evaluación de Programas y Proyectos de Salud , Salud Rural , SudáfricaRESUMEN
OBJECTIVES: There is little information on the probability of assertive behaviour, interpersonal anxiety and self-efficacy in the literature regarding dietitians. The objective of this study was to establish baseline information of these attributes and the factors affecting them. METHOD: Questionnaires collecting biographical information and self-assessment psychometric scales measuring levels of probability of assertiveness, interpersonal anxiety and self-efficacy were mailed to 350 subjects, who comprised a random sample of dietitians registered with the Health Professions Council of South Africa. RESULTS: Forty-one per cent (n=145) of the sample responded. Self-assessment inventory results were compared to test levels of probability of assertive behaviour, interpersonal anxiety and self-efficacy. The inventory results were compared with the biographical findings to establish statistical relationships between the variables. The hypotheses were formulated before data collection. CONCLUSION: Dietitians had acceptable levels of probability of assertive behaviour and interpersonal anxiety. The probability of assertive behaviour was significantly lower than the level noted in the literature and was negatively related to interpersonal anxiety and positively related to self-efficacy.