ObjectiveTo evaluate the functional status of pediatric patients after discharge from the pediatric intensive care unit using the Functional Status Scale and to compare the time of invasive mechanical ventilation, length of stay in the pediatric intensive care unit, and Pediatric Index of Mortality 2 results among individuals with different degrees of functional impairment.MethodsA cross-sectional study was conducted on patients who were discharged from a pediatric intensive care unit. The functional evaluation by the Functional Status Scale was performed on the first day after discharge from the unit, and the Pediatric Index of Mortality 2 was used to predict the mortality rate at the time of admission to the pediatric intensive care unit.ResultsThe sample consisted of 50 individuals, 60% of which were male, with a median age of 19 [6 - 61] months. The overall score of the Functional Status Scale was 11.5 [7 - 15], and the highest scores were observed in the "motor function" 3 [1 - 4] and "feeding" 4 [1 - 4] domains. Compared to patients who were not readmitted to the pediatric intensive care unit, patients who were readmitted presented a worse overall score (p = 0.01), worse scores in the "motor function" (p = 0.01), "feeding" (p = 0.02), and "respiratory" (p = 0.036) domains, and a higher mortality rate according to the Pediatric Index of Mortality 2 (p = 0.025).ConclusionEvaluation of the functional status using the Functional Status Scale indicated moderate impairment in patients after discharge from the pediatric intensive care unit, mainly in the "motor function" and "feeding" domains; patients who were readmitted to the pediatric intensive care unit demonstrated worse overall functional, motor function, feeding and respiratory scores. Individuals with greater functional impairment had longer times of invasive mechanical ventilation and hospitalization in the pediatric intensive care unit.

Objective: To systematically review the effectiveness of neuromuscular electrical stimulation (NMES) as an adjuvant therapy to improve gross motor function in children with spastic cerebral palsy. Methods: MEDLINE, EMBASE, Cochrane CENTRAL, PEDro and Scopus were searched. We included randomized controlled trials examining the effects of NMES combined with other therapies on gross motor function as assessed by the Gross Motor Function Measure (GMFM) and its functional dimensions. Two reviewers independently screened, extracted data, assessed the risk of bias (PEDro) and quality of the evidence (GRADE). Results: Six randomized controlled trials (pooled n = 174) were included in the meta-analysis. NMES combined with other therapies presented medium effect size to improve gross motor function in children with cerebral palsy in comparison with conventional physical therapy or neurodevelopmental therapy. Our sensitivity analysis showed that NMES combined with other therapies was effective to improve GMFM-sitting and standing dimensions but not GMFM-walking dimension. Conclusion: Low-quality evidence suggests that NMES may be used as adjuvant therapy to improve sitting and standing dimensions of GMFM in children with spastic cerebral palsy.

Objective: The goal of the present study was to perform a cross-cultural adaptation and clinical validation of the Functional Status Scale for use in the Brazilian population. Design: Cross-cultural adaptation study followed by a cross-sectional validation study. Setting: Single-center PICU at a hospital in Porto Alegre, Brazil. Patients: Children and adolescents of both sexes, 1 month and under 18 years old, who had been treated at the PICU. Interventions: The cross-cultural adaptation consisted of the following stages: translation, synthesis of the translated versions, back translations, synthesis of the back translations, committee review, and pretesting. For the clinical validation stage, the Brazilian Functional Status Scale was applied within 48 hours after discharge from the PICU. The Brazilian Functional Status Scale’s reliability and validity properties were tested. Measurements and Main Results: A total of 314 patients were evaluated. Median age was 24 months (7.0–105.0 mo), 54.1% were males, and their overall functional score was 9 ± 2.8. The Brazilian Functional Status Scale demonstrated excellent interobserver reliability, with an intraclass correlation coefficient of 0.98, and κ coefficients between 0.716 and 1.000 for the functional domains, which indicated good to excellent agreement. Using the Bland-Altman method, we confirmed low variability among the evaluator’s responses (0.93 to –1.06 points). Regarding the Brazilian Functional Status Scale’s content validity, there was a correlation between length of PICU stay (r = 0.378; p < 0.001) and time on invasive mechanical ventilation (r = 0.261; p < 0.05), and the test could discriminate between groups with different comorbidity levels (p < 0.001). Conclusions: The Functional Status Scale has been culturally adapted and validated for use in Brazil and is now available for use in the assessment of functionality in Brazilian children and adolescents.

Objective To evaluate the functional status of pediatric patients undergoing congenital heart surgery after discharge from the intensive care unit, and to evaluate the correlations among clinical variables, functional status and surgical risk. Methods Cross-sectional study including patients aged 1 month to less than 18 years undergoing congenital heart surgery between October 2017 and May 2018. Functional outcome was assessed by the Functional Status Scale, surgical risk classification was determined using the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), and clinical variables were collected from electronic medical records. Results The sample comprised 57 patients with a median age of 7 months (2 - 17); 54.4% were male, and 75.5% showed dysfunction, which was moderate in 45.6% of the cases. RACHS-1 category > 3 was observed in 47% of the sample, indicating higher surgical risk. There was a correlation between functional deficit and younger age, longer duration of invasive mechanical ventilation and longer intensive care unit stay. Moreover, greater functional deficit was observed among patients classified as RACHS-1 category > 3. Conclusion The prevalence of functional deficit was high among children and adolescents with congenital heart disease after cardiac surgery. Higher surgical risk, longer duration of invasive mechanical ventilation, longer intensive care unit stay and younger age were correlated with worse functional status.

Introduction: As medical advances are achieved in the care of chronically ill patients, there is increasing evidence that health-related quality of life (QoL) is associated with poor outcomes, including hospitalization and death. This study aimed to evaluate QoL as a predictor of hospitalization and death in patients with chronic kidney disease (CKD) on hemodialysis. Methods: A retrospective cohort study of 108 patients with CKD on hemodialysis with 24-month follow-up. QoL was assessed by the Kidney Disease Quality of Life Short-Form (KDQOL-SF), including time to first hospitalization and death as outcomes. Results: The highest KDQOL-SF scores at baseline were observed in Sexual function, Dialysis staff encouragement, and Cognitive function, while the lowest scores were observed in Working status, Role physical, and Energy/fatigue. There was an association of Overall health and Role emotional domains with shorter time to first hospitalization. Data analyzed were insufficient to indicate an association of QoL with mortality in this population. Conclusion: QoL was associated with time to first hospitalization in patients with CKD on hemodialysis, but the results were not sufficient to indicate its association with mortality.

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Acreditamos que o conhecimento é a grande estratégia de inclusão e integração, e a escrita é a grande ferramenta do conhecimento, pois ela não apenas permanece, ela floresce e frutifica.

É com muita satisfação que apresentamos o décimo sexto volume da Coleção intitulada “ESTUDOS AVANÇADOS INTERDISCIPLINARES”, que reúne em seus capítulos pesquisadores de diversas instituições com discussões e temáticas que circundam uma gama de possibilidades de pesquisas e de relações dialógicas que certamente podem ser relevantes para o desenvolvimento social brasileiro a partir de uma ótica que contempla as mais vastas questões da sociedade. Tal obra visa dar publicidade a estudos e pesquisas frutos de árduos trabalhos acadêmicos que decerto contribuem, cada um a seu modo, para o aprofundamento de discussões em suas respectivas áreas pois são pesquisas germinadas, frutificadas e colhidas de temas atuais que estão sendo debatidos nas principais universidades nacionais e que refletem o interesse de pesquisadores no desenvolvimento social e científico que possam impactar positivamente a qualidade de vida de homens e de mulheres.