RESUMO
The incidence of developmental delay and early intervention (EI) service utilization is not well documented among unauthorized Mexican immigrants, a vulnerable population. Individual interviews were conducted in Spanish with Mexican born women receiving maternal health care. Children 12-60 months of age were screened for developmental delay using the Ages and Stages Questionnaire. 12 % (n = 8) of children assessed (n = 65) were at risk for developmental delay. Of those at risk 38 % (n = 3) participated in EI. An additional 26 % of the children (n = 17) qualified for further monitoring, and of those 59 % (n = 10) received EI. Women with low health literacy had more than four times the odds of having a child with risk of developmental delay (aOR 4.4; 95 % CI 1.3-15.4). Developmental delay was associated with low maternal health literacy in unauthorized Mexican immigrants; however, rates of self-reported EI use in this population are higher than those seen nationally.
Assuntos
Deficiências do Desenvolvimento/etnologia , Letramento em Saúde/estatística & dados numéricos , Americanos Mexicanos/psicologia , Mães/psicologia , Imigrantes Indocumentados/psicologia , Adulto , Pré-Escolar , Deficiências do Desenvolvimento/diagnóstico , Intervenção Educacional Precoce/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Serviços de Saúde MaternaRESUMO
Cultural beliefs may influence parents' willingness to raise concerns on a developmental screener. Our study evaluated the performance of the Parents' Evaluation of Developmental Status (PEDS) in an urban community health center where 75% of families are Spanish speaking. Our primary outcome was the presence of parent-reported concerns either in the medical record or on the PEDS before the PEDS was introduced compared with after it became routine care (post-PEDS). Covariates included family language and child age, gender, and risk status. The adjusted odds of a concern being identified was 1.5 times greater in the post-PEDS period for Developmental concerns and 2.1 times greater for Behavioral concerns. There was no association with family language indicating that the PEDS performs equally well for English- and Spanish-speaking families. The systematic inclusion of developmental screening as part of culturally competent primary care may aid in reducing current disparities in the identification of developmental concerns.
Assuntos
Deficiências do Desenvolvimento/diagnóstico , Emigrantes e Imigrantes , Hispânico ou Latino/etnologia , Idioma , Atenção Primária à Saúde/métodos , Inquéritos e Questionários , Pré-Escolar , Deficiências do Desenvolvimento/etnologia , República Dominicana/etnologia , Feminino , Humanos , Lactente , Masculino , Pais , Fatores Socioeconômicos , População UrbanaRESUMO
OBJECTIVE: To examine how infant overweight and high subcutaneous fat relate to infant motor development. STUDY DESIGN: Participants were from the Infant Care, Feeding, and Risk of Obesity Project, a prospective, longitudinal study of low-income African-American mother-infant dyads assessed from 3 to 18 months of age (836 observations on 217 infants). Exposures were overweight (weight-for-length z-score>or=90th percentile of 2000 Centers for Disease Control/National Center for Health Statistics growth reference) and high subcutaneous fat (sum of 3 skinfold measurements>90th percentile of our sample). Motor development was assessed by using the Bayley Scales of Infant Development-II. Developmental delay was characterized as a standardized Psychomotor Development Index score<85. Longitudinal models estimated developmental outcomes as functions of time-varying overweight and subcutaneous fat, controlling for age and sex. Alternate models tested concurrent and lagged relationships (earlier weight or subcutaneous fat predicting current motor development). RESULTS: Motor delay was 1.80 times as likely in overweight infants compared with non-overweight infants (95% CI,1.09-2.97) and 2.32 times as likely in infants with high subcutaneous fat compared with infants with lower subcutaneous fat (95% CI, 1.26-4.29). High subcutaneous fat was also associated with delay in subsequent motor development (odds ratio, 2.27; 95% CI, 1.08-4.76). CONCLUSIONS: Pediatric overweight and high subcutaneous fat are associated with delayed infant motor development.
Assuntos
Negro ou Afro-Americano , Desenvolvimento Infantil , Deficiências do Desenvolvimento/etiologia , Destreza Motora , Sobrepeso/etiologia , Gordura Subcutânea , Negro ou Afro-Americano/estatística & dados numéricos , Fatores Etários , Índice de Massa Corporal , Peso Corporal , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/etnologia , Deficiências do Desenvolvimento/fisiopatologia , Feminino , Humanos , Renda , Lactente , Masculino , North Carolina/epidemiologia , Sobrepeso/epidemiologia , Sobrepeso/etnologia , Sobrepeso/fisiopatologia , Pobreza , Estudos Prospectivos , Fatores de RiscoRESUMO
International adoption pairs the most vulnerable and high-risk pediatric population with the lowest risk parent group. International adoption also presents unique and rewarding challenges for primary care pediatricians. After receiving information from the medical reviewer, a parent must determine whether or not this child is "their child." The position of the medical reviewer is to provide the family with as much information as possible about the health status of the child by explaining the terminology in the report and assessing the photograph or videotape. It is also the reviewer's job to guide the parent's expectations of the adoption by explaining the inherent differences in the development of children in institutions. In the preadoption phase, we must remember that our ultimate goal is to aid in the permanent placement of a child with a family that has realistic expectations and is well prepared to aid that child to reach his or her fullest potential.
Assuntos
Adoção , Serviços de Saúde da Criança/normas , Proteção da Criança , Competência Clínica/normas , Deficiências do Desenvolvimento , Prontuários Médicos/normas , Atitude do Pessoal de Saúde/etnologia , Criança , Desenvolvimento Infantil , Proteção da Criança/etnologia , Pré-Escolar , China , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/etnologia , Guatemala , Humanos , Lactente , Recém-Nascido , Cooperação Internacional , Coreia (Geográfico) , Pais/psicologia , Pediatria/normas , Relações Profissional-Família , Federação Russa , Estados UnidosRESUMO
OBJECTIVE: Since 1986, American parents have adopted >17300 children from Guatemala. This study assessed the health, growth, and developmental status of 103 Guatemalan adopted children (48 girls; 55 boys) after arrival in the United States. Physical evidence suggestive of prenatal alcohol exposure and adequacy of vaccinations administered were also reviewed. METHODS: Retrospective chart review was conducted of 103 children who were evaluated after arrival in the United States in an international adoption specialty clinic, and a case-matched study was conducted of a subgroup of 50 children who resided in either an orphanage or foster care before adoption. Mean age at arrival was 16 +/- 19 months. Before adoption, 25 children resided in orphanages, 56 resided in foster care, and 22 resided in mixed-care settings. The 25 children who had resided in orphanages before adoption were matched for age at arrival, interval from arrival to clinic visit, and gender with a child adopted from foster care. Health and developmental status of these matched pairs were compared, allowing the first direct comparison of children raised in orphanages or foster care before adoption. RESULTS: Mild growth delays were frequent among the children. Mean z scores for weight, height, and head circumference were, respectively, -1.00, -1.04, and -1.08. Children from foster care had significantly better z scores for height, weight, and head circumference than those from orphanage or mixed care. Among children who were younger than 2 years at arrival, growth measurements correlated inversely with age at arrival. Infectious diseases included intestinal parasites (8%) and latent tuberculosis infection (7%). Other medical conditions included anemia (30%), elevated lead levels (3%), and (using strict criteria) phenotypic facial features suggestive of prenatal alcohol exposure (28%). Adequacy of vaccine records from Guatemala was assessed: 28% met American Academy of Pediatrics standards for vaccine administration. Unsuspected significant medical diagnoses, including congenital anomalies and ocular, neurologic, and orthopedic problems, were found in 14%. Most children were doing well developmentally (80-92% of expected performance), but 14% had global developmental delays. Cognition, expressive and receptive language, and activities of daily living skills correlated inversely with age at arrival for children who were younger than 2 years at adoption. Among the 50 matched children, those who resided in foster care before adoption had better measurements for height, weight, and head circumference at arrival to the United States. Moreover, those who resided in foster care scored significantly better for cognitive skills than those who had previously resided in orphanages (96.3% of age-expected compared with 88.3% of age-expected); other skills did not differ between the 2 groups. No differences were found between the 2 groups of children related to prevalence of medical diagnoses or phenotypic evidence suggesting prenatal alcohol exposure. CONCLUSIONS: Guatemalan adoptees display similar overall patterns of growth and developmental delays as seen in other groups of internationally adopted children, although not as severe. Younger children had better growth and development (cognition, language, and activities of daily living skills) than older children, regardless of location of residence before adoption. Among children who were matched for age, gender, and interval from adoption to evaluation, those who had resided in foster care had better growth and cognitive scores than children who had resided in orphanages before adoption. These findings support the need for timely adoptive placement of young infants and support the placement of children in attentive foster care rather than orphanages when feasible.
Assuntos
Adoção , Anemia Hipocrômica/epidemiologia , Criança Institucionalizada/estatística & dados numéricos , Deficiências do Desenvolvimento/epidemiologia , Cuidados no Lar de Adoção/estatística & dados numéricos , Enteropatias Parasitárias/epidemiologia , Orfanatos/estatística & dados numéricos , Anemia Hipocrômica/etnologia , Estatura , Peso Corporal , Estudos de Casos e Controles , Cefalometria , Cuidado da Criança , Pré-Escolar , Comorbidade , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/etnologia , Deficiências do Desenvolvimento/etnologia , Feminino , Guatemala/etnologia , Humanos , Lactente , Infecções/epidemiologia , Infecções/etnologia , Enteropatias Parasitárias/etnologia , Masculino , Prontuários Médicos , Estudos Retrospectivos , Estados Unidos/epidemiologia , Vacinação/estatística & dados numéricosRESUMO
OBJECTIVES: This study sought to determine whether the short stature of Mapuche children, an indigenous group in Chile, reflects poverty or genetic heritage and whether the international reference population, derived from studies of US children of mostly European origin, is appropriate for assessing growth failure in indigenous peoples of the Americas. METHODS: The study assessed 768 schoolchildren of Mapuche and non-Mapuche ancestry, aged 6 to 9 years, living under conditions of extreme, medium, and low poverty. RESULTS: Growth retardation was strongly related to poverty in both ethnic groups. Within poverty levels, there were no significant differences in stature between ethnic groups, and in low-poverty areas in Santiago, the capital city, mean stature was only slightly less than in the reference population. CONCLUSIONS: Poverty, not ancestry, explains the short stature of Mapuche children, and use of the international reference to assess growth in this population is appropriate.
Assuntos
Estatura/etnologia , Estatura/genética , Crescimento/genética , Indígenas Sul-Americanos , Áreas de Pobreza , Criança , Chile/epidemiologia , Comparação Transcultural , Deficiências do Desenvolvimento/etnologia , Deficiências do Desenvolvimento/etiologia , Feminino , Humanos , Indígenas Sul-Americanos/genética , Masculino , PrevalênciaRESUMO
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 disabled. 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.
Assuntos
Comparação Transcultural , Deficiências do Desenvolvimento/diagnóstico , Avaliação da Deficiência , Bangladesh , Criança , Pré-Escolar , Deficiências do Desenvolvimento/etnologia , Métodos Epidemiológicos , Análise Fatorial , Feminino , Humanos , Jamaica , Masculino , Paquistão , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
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)
Assuntos
Estudo Comparativo , Humanos , Masculino , Feminino , Criança , Comparação Transcultural , Avaliação da Deficiência , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/etnologia , Métodos Epidemiológicos , Jamaica , PaquistãoRESUMO
Failure of nurses and other health care providers to recognize the influence of culture on child development may lead to inappropriate expectations and mislabeling of children as developmentally slow. The effect of cultural influences on parental expectations of children was evident in a study of child-rearing beliefs of 30 Cuban and 30 Haitian immigrant mothers in South Florida. Both Cuban and Haitian children would be considered lagging developmentally when compared with measurements on the personal-social dimension of the Denver II and expectations of American society. Culture-specific implications for transcultural nursing care based on the concept of culture brokerage are discussed.
Assuntos
Desenvolvimento Infantil , Educação Infantil/etnologia , Características Culturais , Deficiências do Desenvolvimento/etnologia , Emigração e Imigração , Conhecimentos, Atitudes e Prática em Saúde , Mães/psicologia , Adulto , Atitude Frente a Saúde/etnologia , Criança , Pré-Escolar , Cuba/etnologia , Deficiências do Desenvolvimento/enfermagem , Florida , Haiti/etnologia , Humanos , Lactente , Mães/educação , Enfermagem TransculturalRESUMO
A sample of 352 children belonging to the East Indian and Black races has been examined and the findings compared with (1) The reported Findings of a survey carried out by Dr. F. G. Rose; (2) Data obtained from Medical Inspection of Queen's College boys in 1938; (3) Weights for English boys and girls at various ages in the general population as found by the Anthropometric Commitee Investigation and quoted from Dr. Rose's report; (4) Average heights for English boys and girls of various ages as recorded by Tuxford and Glegg and quoted from Dr. Rose's report; (5) Results of a survey of school boys in Calcutta and Punjab by Wilson, Ahmad and Mitra in 1936; (6) Results from examination of school children in South India by Aykroyd and Krishman in 1936. ( 5 and 6 from Indian Journal Medical Research 24, 3 ). The survey carried out in Leguan involved a comparatively small sample and the findings must be taken as a general impression (Summary)