scholarly journals Pediatric neurodevelopment by prenatal Zika virus exposure: A cross-sectional study of the Microcephaly Epidemic Research Group Cohort

2020 ◽  
Author(s):  
paula sobral Silva ◽  
Sophie Helena Eickmann ◽  
Ricardo Arraes de Alencar Ximenes ◽  
Ulisses Ramos Montarroyos ◽  
Marília de Carvalho Lima ◽  
...  

Abstract Background: The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in children with different levels of ZIKV-related microcephaly or with prenatal ZIKV exposure in the absence of microcephaly. Methods: We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10-45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVxposure confirmed by maternal RT-PCR testing and no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument, and a SWYC adapted form to compare severe cases. Results: Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were at risk of development delay, and presented similar performance whether evaluated under or over 24 months of age. Among children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were at risk of development delay. For children without microcephaly, the percentages found to be at risk of developmental delays were markedly lower and did not differ by prenatal ZIKV exposure status: Groups 3, 13.8%; Group 4, 21.7%. Conclusions: Among groups of children with prenatal ZIKV exposure, we found a gradient of risk of development delay. Children with severe microcephaly were at highest risk, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.

2020 ◽  
Author(s):  
Paula Fabiana Sobral Silva ◽  
Sophie Helena Eickmann ◽  
Ricardo Arraes de Alencar Ximenes ◽  
Ulisses Ramos Montarroyos ◽  
Marília de Carvalho Lima ◽  
...  

Abstract Background: The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in groups of children with differening severities of ZIKV-related microcephaly and children with prenatal ZIKV exposure in the absence of microcephaly.Methods: We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10-45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Pernambuco, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVexposure confirmed by maternal RT-PCR testing but no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument validated for use in Brazil. Children with severe delays underwent further evaluation with an adapted version of the SWYC.Results: Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among the 114 children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were ‘at risk of development delay’ according to the SWYC instrument. Among the 20 children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were ‘at risk of development delay’. For children without microcephaly, the percentages found to be ‘at risk of developmental delay’ were markedly lower and did not differ by prenatal ZIKV exposure status: Group 3 (N=94), 13.8%; Group 4 (N=46), 21.7%.Conclusions: Among children with prenatal ZIKV exposure, we found a gradient of risk of development delay according to head circumference. Children with severe microcephaly were at highest risk for delays, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC instrument. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.


2020 ◽  
Author(s):  
paula sobral Silva ◽  
Sophie Helena Eickmann ◽  
Ricardo Arraes de Alencar Ximenes ◽  
Ulisses Ramos Montarroyos ◽  
Marília de Carvalho Lima ◽  
...  

Abstract Background: The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in groups of children with differening severities of ZIKV-related microcephaly and children with prenatal ZIKV exposure in the absence of microcephaly.Methods: We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10-45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Pernambuco, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVexposure confirmed by maternal RT-PCR testing but no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument validated for use in Brazil. Children with severe delays underwent further evaluation with an adapted version of the SWYC.Results: Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among the 114 children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were ‘at risk of development delay’ according to the SWYC instrument. Among the 20 children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were ‘at risk of development delay’. For children without microcephaly, the percentages found to be ‘at risk of developmental delay’ were markedly lower and did not differ by prenatal ZIKV exposure status: Group 3 (N=94), 13.8%; Group 4 (N=46), 21.7%.Conclusions: Among children with prenatal ZIKV exposure, we found a gradient of risk of development delay according to head circumference. Children with severe microcephaly were at highest risk for delays, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC instrument. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Paula Fabiana Sobral da Silva ◽  
Sophie Helena Eickmann ◽  
Ricardo Arraes de Alencar Ximenes ◽  
Ulisses Ramos Montarroyos ◽  
Marilia de Carvalho Lima ◽  
...  

Abstract Background The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in groups of children with differening severities of ZIKV-related microcephaly and children with prenatal ZIKV exposure in the absence of microcephaly. Methods We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10–45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Pernambuco, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVexposure confirmed by maternal RT-PCR testing but no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument validated for use in Brazil. Children with severe delays underwent further evaluation with an adapted version of the SWYC. Results Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among the 114 children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were ‘at risk of development delay’ according to the SWYC instrument. Among the 20 children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were ‘at risk of development delay’. For children without microcephaly, the percentages found to be ‘at risk of developmental delay’ were markedly lower and did not differ by prenatal ZIKV exposure status: Group 3 (N = 94), 13.8%; Group 4 (N = 46), 21.7%. Conclusions Among children with prenatal ZIKV exposure, we found a gradient of risk of development delay according to head circumference. Children with severe microcephaly were at highest risk for delays, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC instrument. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.


2020 ◽  
Author(s):  
paula sobral Silva ◽  
Sophie Helena Eickmann ◽  
Ricardo Arraes de Alencar Ximenes ◽  
Ulisses Ramos Montarroyos ◽  
Marília de Carvalho Lima ◽  
...  

Abstract Background The implications for pediatric neurodevelopment and behavior remain sparsely studied in children exposed to congenital infection by Zika Virus (ZIKV). The aim of this study is to compare patterns of neurodevelopment and behavior of children with different levels of Zika-related microcephaly or prenatal exposure without microcephaly. Methods A Cross-sectional study nested in a cohort, including 274 children aged 10–45 months. Participantes were evaluated between Feb/2017 and Aug/2019 in two tertiary care hospitals in Recife/Pernambuco/Brazil. Primary exposure was having ZIKV-related microcephaly or prenatal ZIKV-exposure, confirmed by maternal RT-PCR testing. We included children born during the peak of microcephaly epidemic and post epidemic period, divided in four groups according to clinical and laboratory criteria. Groups 1 and 2 had microcephaly, severe and moderate, respectively. Group 3 was composed of children with laboratory evidence of prenatal ZIKV-exposure and no microcephaly, and Group 4 was a neurotypical control group. We used the Survey of Wellbeing of Young Children (SWYC), a screening instrument validated for Brazil, and an SWYC Adapted Form to compare severe cases. Results Almost all children with severe microcephaly presented neurological abnormalities (98.2%) and risk of development delay (99.1%). The frequency of risk of development delay for the group with moderate microcephaly was 65%. For children without microcephaly, the risk varied from 13.8–21.7%. There was no difference in behavior aspects among groups. According to the Adapted Form, the majority of the children with severe microcephaly scored much lower than expected, and presented similar performance whether evaluated under or over 24 months of age. Conclusions We found a gradient of risk of development delay among groups, being the group with severe microcephaly at the highest risk and the groups of normocephalic exposed children and controls the lowest ones. The Adapted Form was useful to estimate children deficit profile and showed no significant improvement in ability regardless age of assessment. We suggest that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC instrument. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.


Author(s):  
Mohamed N. Al Arifi ◽  
Abdulrahman Alwhaibi

Objective: Fever alone can lead to rare serious complications in children, such as febrile seizures. The aim of this study is to assess the knowledge, beliefs, and behavior of parents toward fever and its management. Methods: A cross-sectional study using an online questionnaire was applied over a period of 3 months, from January to March 2018, to parents who were living in Saudi Arabia. The inclusion criteria were a parent who is a resident of Saudi Arabia, with at least one child aged 6 years or less, while incomplete questionnaires, having a child aged more than 6 years, or parents who were not living in Saudi Arabia were excluded. Results: A total of 656 parents completed the questionnaire. More than two-thirds of the subjects were female, the majority of whom were aged between 25–33 years old. The best-reported place to measure the temperature of children was the armpit (46%), followed by the ear (28%) and the mouth (10.7%). More than half of the parents considered their children feverish at a temperature of 38 °C. The majority of parents (79.7%) reported that the most serious side effects of fever were seizure, brain damage (39.3%), coma (29.9%), dehydration (29.7%), and death (25%). The most common method used to measure a child’s temperature was an electronic thermometer (62.3%). The most common antipyretic was paracetamol (84.5%). Conclusions: Our study demonstrates the good knowledge of parents in identifying a feverish temperature using the recommended route and tools for measuring body temperature.


2021 ◽  
Vol 10 ◽  
Author(s):  
Rachel M. Harris ◽  
Angela M. C. Rose ◽  
Suzanne Soares-Wynter ◽  
Nigel Unwin

Abstract Our objective was to describe, for the first time in an English-speaking Caribbean country, the contribution of ultra-processed foods (UPFs) to nutrients linked to non-communicable disease. Using a cross-sectional study design, dietary data were collected from two non-consecutive 24-h dietary recalls. Recorded food items were then classified according to their degree of processing by the NOVA system. The present study took place in Barbados (2012–13). A representative population-based sample of 364 adult Barbadians (161 males and 203 females) aged 25–64 years participated in the study. UPFs represented 40⋅5 % (838 kcal/d; 95 % CI 791, 885) of mean energy intake. Sugar-sweetened beverages made the largest contribution to energy within the UPF category. Younger persons (25–44 years) consumed a significantly higher proportion of calories from UPF (NOVA group 4) compared with older persons (45–64 years). The mean energy shares of UPF ranged from 22⋅0 to 58⋅9 % for those in the lowest tertile to highest tertile. Within each tertile, the energy contribution was significantly higher in the younger age group (25–44 years) compared with the older (45–64 years). One-quarter of persons consume ≥50 % of their daily calories from UPF, this being significantly higher in younger persons. The ultra-processed diet fraction contained about six times the mean of free sugars and about 0⋅8 times the dietary fibre of the non-ultra-processed fraction (NOVA groups 1–3). Targeted interventions to decrease the consumption of UPF especially in younger persons is thus of high priority to improve the diet quality of Barbadians.


2018 ◽  
Vol 9 (5) ◽  
pp. 64
Author(s):  
M Zakirulla ◽  
AtheerA Al-Hammadi ◽  
NadaA Al-Rabai ◽  
RafiA Togoo ◽  
Ibrahim Alshahrani ◽  
...  

2020 ◽  
Vol 29 (4) ◽  
Author(s):  
Nur Ramadhan ◽  
Yulidar Yulidar ◽  
Abidah Nur ◽  
Zain Hadifah ◽  
Yasir Yasir

Abstract Filariasis is still a global public health problem both in the world and in Indonesia. Aceh is include in one of the provinces with the most clinical cases in Indonesia. The aimed of this study was to determine the description of endemicity status and Related Factors to Instantaneous Transmissions period after Transmission Assessment Survey (TAS) 1 in Pidie district. This research is part of the filariasis elimination evaluation study in Indonesia (Multicenter Filariasis Study) Litbangkes Office Center, Ministry of Health in 2017. The research design was cross sectional study. The study was conducted from February to November 2017. The selected research sites were Buloh and Kambuk Payapi Village in Pidie district. Data was collected by interviewin respondent to obtained information about people's knowledge, attitudes and behavior related to filariasis. In addition, finger blood tests were also conducted on respondents who had been interviewed. The number of respondents by finger blood was 627 and 714 were interviewed. The risk of filariasis transmission still occurred with the finding of 10 positive cases of microfilaria as many as 10 people in Kambuk Payapi village  with B.malayi species. The average filarial density was 86.84 / μl blood.  Respondent’s knowledge about filariasis is still low, community attitudes towads the prevention and treatment of filariasis was positive. Only a portion of respondents were involved in mass treatment. Selective treatment and strengthening synergy across sectors and programs must be increased so that elimination of  filariasis can be achieved. In addition, it is necessary to increase public knowledge through various health promotion media to improve community behaviour to achieve  elimination of filariasis. Abstrak Filariasis masih menjadi masalah kesehatan baik di dunia maupun di Indonesia. Aceh termasuk dalam salah satu provinsi dengan kasus klinis kronis terbanyak di Indonesia. Tujuan penelitian ini adalah mengetahui gambaran status endemisitas filariasis dan faktor yang berpengaruh dengan transmisi setelah Transmission Assessment Survey (TAS) 1 di Kabupaten Pidie. Penelitian ini merupakan bagian dari studi evaluasi eliminasi filariasis di Indonesia (studi Multicenter Filariasis) Badan Litbangkes Kementerian Kesehatan tahun 2017. Desain penelitian adalah cross sectional study. Penelitian dilakukan dari Februari-November 2017. Tempat penelitian adalah di desa Buloh dan desa Kambuk Payapi di Kabupaten Pidie. Pengumpulan data dilakukan wawancara responden untuk mendapatkan informasi tentang pengetahuan, sikap, dan perilaku masyarakat terkait filariasis. Selain itu juga dilakukan pemeriksaan darah jari malam hari pada responden yang sudah diwawancarai.  Jumlah responden yang diperiksa darah jari 627 responden dan yang diwawancarai 714.  Resiko penularan filariasis masih terjadi dengan masih ditemukannya kasus positif mikrofilaria sebanyak 10 orang di desa Kambuk Payapi dengan spesies B.malayi. Rata-rata kepadatan filaria adalah 86,84/µl darah. Pengetahuan responden tentang penyebab filariasis masih rendah, sikap masyarakat terhadap upaya pencegahan dan pengobatan filariasis sudah positif. Namun demikian hanya sebagian responden yang ikut terlibat dalam pengobatan masal. Pengobatan selektif dan memperkuat sinergi lintas sektos dan lintas program harus ditingkatkan agar eliminasi filariasis dapat dicapai. Selain itu diperlukan peningkatan pengetahuan masyarakat melalui berbagai media promosi kesehatan untuk meningkatkan prilaku masyarakat untuk mencapai eliminasi filariasis.  


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