Elizabeth Halley-Castillo

Frecuencia y factores de riesgo asociados a desnutrición de niños con cardiopatía congénita

Objetivo. Determinar la frecuencia y factores asociados a desnutricion en ninos con cardiopatia congenita (CC). Material y metodos. Estudio transversal analitico, hecho entre agosto de 1997 y mayo de 1998, en el servicio de cardiopatias congenitas del hospital de Cardiologia del Centro Medico Nacional Siglo XXI, del Instituto Mexicano del Seguro Social de la Ciudad de Mexico, Mexico, a 244 menores de 17 anos, de ambos sexos, con diagnostico de CC y sin otras malformaciones. El estado de nutricion se evaluo mediante los indices peso/edad (P/E), talla/edad (T/E) y peso/talla (P/T), y se definio desnutricion con puntuaciones Z mayores a -2. Se consideraron factores de riesgo: edad, sexo, antecedentes perinatales, historia de alimentacion, administracion de suplementos nutricios, estado socioeconomico y funcionalidad y composicion de la familia. Se formaron cuatro grupos de CC: acianogenas con flujo pulmonar aumentado (AFPA) o con flujo pulmonar normal (AFPN); cianogenas con flujo pulmonar aumentado (CFPA) o disminuido (CFPD). Analisis estadistico: ji cudrada, U-Mann Whitney, Kruskal-Wallis. Se aplico regresion logistica para el control de las variables de confusion y se calculo razon de momios (RM) e intervalos de confianza al 95% (IC 95%). Resultados. El grupo de AFPA (62.7%) fue el mas frecuente, seguido por CFPD (15.6%), AFPN (11.5%) y CFPA (10.2%); con P/E, 40.9% tuvieron desnutricion; con T/E, 24.6%; y con P/T, 31.1%. Los grupos mas afectados fueron los lactantes y los ninos con CFPA. Los factores asociados a desnutricion fueron: presencia de cardiopatia cianogena (RM 2.54; IC 95% 0.98-6.58) y la falta de administracion de algun complemento nutricio (RM 2.38; IC 95% 1.06-5.34). Entre mayor numero de miembros en una familia (RM 1.42; IC 95% 0.99-2.05) mayor frecuencia de desnutricion; a mayor edad menor riesgo de desnutricion (RM 0.92; IC 95% 0.89-0.96). Conclusiones. La desnutricion en ninos con CC es frecuente; es mas comun en ninos mas pequenos y con cardiopatias cianogenas. Se necesitan programas orientados a las familias para prevenir y disminuir la desnutricion en estos ninos. El texto completo en ingles de este articulo esta disponible en: http://www.insp.mx/salud/index.html

Sistema de Protección Social en Salud para la detección y atención oportuna de problemas del desarrollo infantil en México

a Comision Nacional de Proteccion Social en Salud, Secretaria de Salud, Mexico D.F., Mexico b Unidad de Investigacion en Neurodesarrollo, Hospital Infantil de Mexico Federico Gomez, Mexico, D.F., Mexico c Direccion General del Programa PROSPERA, Comision Nacional de Proteccion Social en Salud, Mexico, D.F., Mexico d Direccion General Adjunta de Seguro Medico Siglo XXI, Comision Nacional de Proteccion Social en Salud, Mexico, D.F., Mexico e Direccion de Investigacion, Hospital Infantil de Mexico Federico Gomez, Mexico, D.F., Mexico f Unidad de Investigacion en Epidemiologia Clinica, Unidad Medica de Alta Especialidad Hospital de Pediatria, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, D.F., Mexico

Escrutinio poblacional del nivel de desarrollo infantil en menores de 5 años beneficiarios de PROSPERA en México

BACKGROUND Evaluación del Desarrollo Infantil or Child Development Evaluation (CDE) test, a screening tool designed and validated in Mexico, classifies child development as normal (green) or abnormal (developmental lag or yellow and risk of delay or red). Population-based results of child development level with this tool are not known. The objective of this work was to evaluate the developmental level of children aged 1-59 months living in poverty (PROSPERA program beneficiaries) through application of the CDE test. METHODS CDE tests were applied by specifically trained and standardized personnel to children <5 years old who attended primary care facilities for a scheduled appointment for nutrition, growth and development evaluation from November 2013 to May 2014. RESULTS There were 5,527 children aged 1-59 months who were evaluated; 83.8% (n=4,632) were classified with normal development (green) and 16.2% (n=895) as abnormal: 11.9% (n=655) as yellow and 4.3% (n=240) as red. The proportion of abnormal results was 9.9% in children <1 year of age compared with 20.8% at 4 years old. The most affected areas according to age were language at 2 years (9.35%) and knowledge at 4 years old (11.1%). Gross motor and social areas were more affected in children from rural areas; fine motor skills, language and knowledge were more affected in males. CONCLUSIONS The proportion of children with abnormal results is similar to other population-based studies. The highest rate in older children reinforces the need for an early-based intervention. The different pattern of areas affected between urban and rural areas suggests the need for a differentiated intervention.

Evaluación diagnóstica del nivel de desarrollo en niños identificados con riesgo de retraso mediante la prueba de Evaluación del Desarrollo Infantil

BACKGROUND The Child Development Evaluation (or CDE Test) was developed in Mexico as a screening tool for child developmental problems. It yields three possible results: normal, slow development or risk of delay. The modified version was elaborated using the information obtained during the validation study but its properties according to the base population are not known. The objective of this work was to establish diagnostic confirmation of developmental delay in children 16- to 59-months of age previously identified as having risk of delay through the CDE Test in primary care facilities. METHODS A population-based cross-sectional study was conducted in one Mexican state. CDE test was administered to 11,455 children 16- to 59-months of age from December/2013 to March/2014. The eligible population represented the 6.2% of the children (n=714) who were identified at risk of delay through the CDE Test. For inclusion in the study, a block randomization stratified by sex and age group was performed. Each participant included in the study had a diagnostic evaluation using the Battelle Development Inventory, 2nd edition. RESULTS From the 355 participants included with risk of delay, 65.9% were male and 80.2% were from rural areas; 6.5% were false positives (Total Development Quotient ˃90) and 6.8% did not have any domain with delay (Domain Developmental Quotient <80). The proportion of delay for each domain was as follows: communication 82.5%; cognitive 80.8%; social-personal 33.8%; motor 55.5%; and adaptive 41.7%. There were significant differences in the percentages of delay both by age and by domain/subdomain evaluated. CONCLUSIONS In 93.2% of the participants, developmental delay was corroborated in at least one domain evaluated.

Impacto de un modelo de capacitación de la prueba Evaluación del Desarrollo Infantil en la atención primaria

BACKGROUND The Child Development Evaluation (CDE) Test is a screening tool designed and validated in Mexico for the early detection of child developmental problems. For professionals who will be administering the test in primary care facilities, previous acquisition of knowledge about the test is required in order to generate reliable results. The aim of this work was to evaluate the impact of a training model for primary care workers from different professions through the comparison of knowledge acquired during the training course. METHODS The study design was a before/after type considering the participation in a training course for the CDE test as the intervention. The course took place in six different Mexican states from October to December 2013. The same questions were used before and after. RESULTS There were 394 participants included. Distribution according to professional profile was as follows: general physicians 73.4%, nursing 7.7%, psychology 7.1%, nutrition 6.1% and other professions 5.6%. The questions with the lowest correct answer rates were associated with the scoring of the CDE test. In the initial evaluation, 64.9% obtained a grade lower than 20 compared with 1.8% in the final evaluation. In the initial evaluation only 1.8% passed compared with 75.15% in the final evaluation. CONCLUSIONS The proposed model allows the participants to acquire general knowledge about the CDE Test. To improve the general results in future training courses, it is required to reinforce during training the scoring and interpretation of the test together with the previous lecture of the material by the participants.