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Evidence-based milestones for surveillance of cognitive, language, and motor development.

ABSTRACT: Fewer than half of the nation's pediatricians conduct systematic surveillance of young children's development. Because time and cost are among the barriers, our objective was to create a brief set of parent-report questions about cognitive, motor, and language milestones that is freely available and can be administered and scored quickly.A team of experts developed candidate items after reviewing existing instruments and prior research. We selected final items based on statistical fit to a graded item response model developed and replicated in separate samples enrolled from primary care settings (n = 469 and 308, respectively). We then developed a 10-item form for each visit on the pediatric periodicity schedule. Combining our initial samples with 395 families enrolled from referral clinics, we tested these forms' concurrent validity with respect to the ASQ-3 and parent reports of developmental diagnoses.A final set of 54 items displayed adequate fit to our statistical model regardless of race/ethnicity, education level, and child gender. Beginning at 4 months, scores on 10-item forms displayed consistent associations with the ASQ-3, and all but the 60-month form detected parents' reports of developmental delay with adequate sensitivity and specificity.The Milestones is one element of the Survey of Well-being of Young Children (SWYC), a brief but comprehensive screening instrument for children under 5 years. The Milestones is a set of evidence-based items with individual normative data that are appropriate for pediatric surveillance. In addition, the scoring of 10-item Milestones forms may provide many advantages of a first level developmental screening instrument.

SUBMITTER: Sheldrick RC

PROVIDER: S-EPMC3993976 | biostudies-literature | 2013 Nov-Dec

REPOSITORIES: biostudies-literature

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Evidence-based milestones for surveillance of cognitive, language, and motor development.

Sheldrick R Christopher RC Perrin Ellen C EC

Academic pediatrics 20131101 6

<h4>Objective</h4>Fewer than half of the nation's pediatricians conduct systematic surveillance of young children's development. Because time and cost are among the barriers, our objective was to create a brief set of parent-report questions about cognitive, motor, and language milestones that is freely available and can be administered and scored quickly.<h4>Methods</h4>A team of experts developed candidate items after reviewing existing instruments and prior research. We selected final items b ...[more]

PMID: 24238685

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Project description:BACKGROUND & AIMS:Barrett's esophagus (BE) recurs in 25% or more of patients treated successfully with radiofrequency ablation (RFA), so surveillance endoscopy is recommended after complete eradication of intestinal metaplasia (CEIM). The frequency of surveillance is informed only by expert opinion. We aimed to model the incidence of neoplastic recurrence, validate the model in an independent cohort, and propose evidence-based surveillance intervals. METHODS:We collected data from the United States Radiofrequency Ablation Registry (US RFA, 2004-2013) and the United Kingdom National Halo Registry (UK NHR, 2007-2015) to build and validate models to predict the incidence of neoplasia recurrence after initially successful RFA. We developed 3 categories of risk and modeled intervals to yield 0.1% risk of recurrence with invasive adenocarcinoma. We fit Cox proportional hazards models assessing discrimination by C statistic and 95% confidence limits. RESULTS:The incidence of neoplastic recurrence was associated with most severe histologic grade before CEIM, age, endoscopic mucosal resection, sex, and baseline BE segment length. In multivariate analysis, a model based solely on most severe pre-CEIM histology predicted neoplastic recurrence with a C statistic of 0.892 (95% confidence limit, 0.863-0.921) in the US RFA registry. This model also performed well when we used data from the UK NHR. Our model divided patients into 3 risk groups based on baseline histologic grade: non-dysplastic BE; indefinite for dysplasia, low-grade dysplasia, and high-grade dysplasia; or intramucosal adenocarcinoma. For patients with low-grade dysplasia, we propose surveillance endoscopy at 1 and 3 years after CEIM; for patients with high-grade dysplasia or intramucosal adenocarcinoma, we propose surveillance endoscopy at 0.25, 0.5, and 1 year after CEIM, then annually. CONCLUSION:In analyses of data from the US RFA and UK NHR for BE, a much-attenuated schedule of surveillance endoscopy would provide protection from invasive adenocarcinoma. Adherence to the recommended surveillance intervals could decrease the number of endoscopies performed yet identify unresectable cancers at rates less than 1/1000 endoscopies.

Project description:ObjectiveTo determine the magnitude of relationships of early life factors with child development in low/middle-income countries (LMICs).DesignMeta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data.Data sourcesWe searched Medline, bibliographies of key articles and reviews, and grey literature to identify studies from LMICs that collected data on early life exposures and child development. The most recent search was done on 4 November 2014. We then invited the first authors of the publications and investigators of unpublished studies to participate in the study.Eligibility criteria for selecting studiesStudies that assessed at least one domain of child development in at least 100 children under 7 years of age and collected at least one early life factor of interest were included in the study.AnalysesLinear regression models were used to assess SMDs in child development by parental and child factors within each study. We then produced pooled estimates across studies using random effects meta-analyses.ResultsWe retrieved data from 21 studies including 20?882 children across 13 LMICs, to assess the associations of exposure to 14 major risk factors with child development. Children of mothers with secondary schooling had 0.14 SD (95% CI 0.05 to 0.25) higher cognitive scores compared with children whose mothers had primary education. Preterm birth was associated with 0.14 SD (-0.24 to -0.05) and 0.23 SD (-0.42 to -0.03) reductions in cognitive and motor scores, respectively. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from -0.18 to -0.10 SDs.ConclusionsDifferential parental, environmental and nutritional factors contribute to disparities in child development across LMICs. Targeting these factors from prepregnancy through childhood may improve health and development of children.

Dataset Information

Evidence-based milestones for surveillance of cognitive, language, and motor development.

Publications

Evidence-based milestones for surveillance of cognitive, language, and motor development.

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