1
|
Powell C, Bamber D, Collins HE, Draper ES, Manktelow B, Kajante E, Cuttini M, Wolke D, Maier RF, Zeitlin J, Johnson S. Recommendations for data collection in cohort studies of preterm born individuals - The RECAP Preterm Core Dataset. Paediatr Perinat Epidemiol 2024. [PMID: 38886295 DOI: 10.1111/ppe.13096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/26/2024] [Accepted: 05/19/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Preterm birth (before 37 completed weeks of gestation) is associated with an increased risk of adverse health and developmental outcomes relative to birth at term. Existing guidelines for data collection in cohort studies of individuals born preterm are either limited in scope, have not been developed using formal consensus methodology, or did not involve a range of stakeholders in their development. Recommendations meeting these criteria would facilitate data pooling and harmonisation across studies. OBJECTIVES To develop a Core Dataset for use in longitudinal cohort studies of individuals born preterm. METHODS This work was carried out as part of the RECAP Preterm project. A systematic review of variables included in existing core outcome sets was combined with a scoping exercise conducted with experts on preterm birth. The results were used to generate a draft core dataset. A modified Delphi process was implemented using two stages with three rounds each. Three stakeholder groups participated: RECAP Preterm project partners; external experts in the field; people with lived experience of preterm birth. The Delphi used a 9-point Likert scale. Higher values indicated greater importance for inclusion. Participants also suggested additional variables they considered important for inclusion which were voted on in later rounds. RESULTS An initial list of 140 data items was generated. Ninety-six participants across 22 countries participated in the Delphi, of which 29% were individuals with lived experience of preterm birth. Consensus was reached on 160 data items covering Antenatal and Birth Information, Neonatal Care, Mortality, Administrative Information, Organisational Level Information, Socio-economic and Demographic information, Physical Health, Education and Learning, Neurodevelopmental Outcomes, Social, Lifestyle and Leisure, Healthcare Utilisation and Quality of Life. CONCLUSIONS This core dataset includes 160 data items covering antenatal care through outcomes in adulthood. Its use will guide data collection in new studies and facilitate pooling and harmonisation of existing data internationally.
Collapse
Affiliation(s)
- Charlotte Powell
- Department of Population Health Sciences, George Davies Centre, University of Leicester, Leicester, UK
| | - Deborah Bamber
- Department of Population Health Sciences, George Davies Centre, University of Leicester, Leicester, UK
| | - Helen E Collins
- Department of Population Health Sciences, George Davies Centre, University of Leicester, Leicester, UK
| | - Elizabeth S Draper
- Department of Population Health Sciences, George Davies Centre, University of Leicester, Leicester, UK
| | - Bradley Manktelow
- Department of Population Health Sciences, George Davies Centre, University of Leicester, Leicester, UK
| | - Eero Kajante
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Clinical Medicine Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway
| | - Marina Cuttini
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS "Eugenio Medea", Lecco, Italy
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
| | - Rolf F Maier
- Children's Hospital, Philipps University of Marburg, Marburg, Germany
| | - Jennifer Zeitlin
- Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, Paris, France
| | - Samantha Johnson
- Department of Population Health Sciences, George Davies Centre, University of Leicester, Leicester, UK
| |
Collapse
|
2
|
Galis R, Mudura D, Trif P, Diggikar S, Prasath A, Ognean ML, Mazela J, Lacatusu A, Ramanathan R, Kramer BW, Singh Y. Milrinone in persistent pulmonary hypertension of newborn: a scoping review. Pediatr Res 2024:10.1038/s41390-024-03234-z. [PMID: 38745027 DOI: 10.1038/s41390-024-03234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
Persistent pulmonary hypertension of the newborn (PPHN) is a common neonatal condition in newborns admitted to the neonatal intensive care units (NICUs). PPHN has still a high mortality and morbidity. Inhaled nitric oxide (iNO) is the first line vasodilator therapy for PPHN in high income countries. In low-to-middle income countries (LMICs), availability of iNO remains scarce and expensive. The purpose of this scoping review was to evaluate the current existing literature for milrinone therapy in PPHN and to identify the knowledge gaps in milrinone use in infants with PPHN. The available evidence for milrinone remains limited both as monotherapy and as an adjuvant to iNO. The studies were heterogeneous, conducted in different settings, with different populations and more importantly the endpoints of these trials were short-term outcomes such as changes in oxygenation and blood pressure. Large prospective studies investigating long-term outcomes, mortality, and the need for Extracorporeal membrane oxygenation (ECMO) are warranted. Randomized controlled trials with milrinone as monotherapy are needed in LMICs where iNO availability remains limited. IMPACT: Milrinone has a potential role in the management of PPHN both as an adjuvant to iNO as well as a monotherapy. This scoping review identified the problems existing in the published literature on milrinone and the barriers to generalization of these results. Multi-centre randomized controlled trials on milrinone, especially involving centers from low- and middle-income countries are needed, where it can be evaluated as first-line pulmonary vasodilator therapy.
Collapse
Affiliation(s)
- Radu Galis
- Department of Neonatology, Emergency County Hospital Bihor, Oradea, Romania.
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.
| | - Diana Mudura
- Department of Neonatology, Emergency County Hospital Bihor, Oradea, Romania
| | - Paula Trif
- Department of Neonatology, Emergency County Hospital Bihor, Oradea, Romania
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea, Romania
| | | | - Arun Prasath
- University of Texas Southwestern, Dallas, TX, USA
| | - Maria Livia Ognean
- Faculty of Medicine, Lucian Blaga University Sibiu, Sibiu, Romania
- Neonatology Department, Clinical County Emergency Hospital Sibiu, Sibiu, Romania
| | - Jan Mazela
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Adrian Lacatusu
- Pediatrics Department, Bega Clinic, Emergency County Hospital Timisoara, Timișoara, Romania
- Victor Babes University, Timisoara, Romania
| | - Rangasamy Ramanathan
- Division of Neonatology, Cedars Sinai Guerin Children's, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Boris W Kramer
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Yogen Singh
- Department of Pediatrics, Division of Neonatology, UC Davis Children's Hospital, UC Davis Health, Sacramento, CA, USA
| |
Collapse
|
3
|
Rausch-Koster TP, van der Aa HPA, Verbraak FD, van Rens GHMB, van Nispen RMA. Perspectives of Patients and Professionals on Implementing a Computer Adaptive Vision-Related Quality of Life Outcome (CAT-EyeQ) in Clinical Practice. Transl Vis Sci Technol 2024; 13:6. [PMID: 38470320 PMCID: PMC10941993 DOI: 10.1167/tvst.13.3.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/29/2024] [Indexed: 03/13/2024] Open
Abstract
Purpose The CAT-EyeQ is a computer adaptive test (CAT) which measures vision-related quality of life in patients having exudative retinal diseases. The aim of this study is to investigate the usability of the CAT-EyeQ in clinical practice and identify potential barriers and facilitators for implementation (problem analysis). Methods Patients and health care professionals participated in the study regarding the usability of the CAT-EyeQ, and clinic managers and health care professionals were included in the problem analysis for implementation. In total, we conducted 18 semi-structured interviews. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview guides and to structure results. Results Six themes were derived from the usability study and problem analysis: (1) quality of the CAT-EyeQ and the applicability to patients' needs and preferences, (2) embedding the CAT-EyeQ in current practice, (3) implementation climate of the eye hospitals, (4) attitude of professionals, (5) engaging and encouraging professionals, and (6) integration of the CAT-EyeQ in health care - needs after piloting. Conclusions Patients and professionals mentioned that the CAT-EyeQ improved insight into the impact of eye diseases on a patient's daily life, it allowed for more attention on the patient perspective and the structured measurement of vision-related quality of life. The main perceived barriers mentioned by professionals for using the CAT-EyeQ were lack of time and the integration of the patient-reported outcome measure (PROM) results within the electronic patient record (EPR). Translational Relevance The CAT-EyeQ, accompanied by an overview of stakeholder perspectives resulting from this implementation study, can now be used in clinical practice.
Collapse
Affiliation(s)
- T. P. Rausch-Koster
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, The Netherlands
- Bergman Clinics, Department of Ophthalmology, Naarden, The Netherlands
| | - H. P. A. van der Aa
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, The Netherlands
- Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| | - F. D. Verbraak
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, The Netherlands
| | - G. H. M. B. van Rens
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, The Netherlands
| | - R. M. A. van Nispen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Geurtzen R, Wilkinson DJC. Incorporating parental values in complex paediatric and perinatal decisions. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:225-235. [PMID: 38219752 DOI: 10.1016/s2352-4642(23)00267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 01/16/2024]
Abstract
Incorporating parental values in complex medical decisions for young children is important but challenging. In this Review, we explore what it means to incorporate parental values in complex paediatric and perinatal decisions. We provide a narrative overview of the paediatric, ethics, and medical decision-making literature, focusing on value-based and ethically complex decisions for children who are too young to express their own preferences. We explain key concepts and definitions, discuss paediatric-specific features, reflect on challenges in learning and expressing values for both parents and health-care providers, and provide recommendations for clinical practice. Decisional values are informed by global and external values and could relate to the child, the parents, and the whole family. These values should inform preferences and assure value-congruent choices. Additionally, parents might hold various meta values on the process of decision making itself. Complex decisions for young children are emotionally taxing, ethically difficult, and often surrounded by uncertainty. These contextual factors make it more likely that values and preferences are initially absent or unstable and need to be constructed or stabilised. Health-care professionals and parents should work together to construct and clarify values and incorporate them into personalised decisions for the child. An open communication style, with unbiased and tailored information in a supportive environment, is helpful. Dedicated training in communication and shared decision making could help to improve the incorporation of parental values in complex decisions for young children.
Collapse
Affiliation(s)
- Rosa Geurtzen
- Amalia Children's Hospital, Radboud Institute of Healthcare Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Dominic J C Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; Oxford Newborn Care Unit, John Radcliffe Hospital, Oxford University, Oxford, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore
| |
Collapse
|
5
|
Mori JD, Kassai MS, Lebrão CW, Affonso-Fonseca FL, Sarni ROS, Suano-Souza FI. Influence of umbilical cord vitamin D serum levels on the growth of preterm infants. Nutrition 2023; 116:112194. [PMID: 37741089 DOI: 10.1016/j.nut.2023.112194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of serum 25-hydroxyvitamin D [25(OH)D] levels at birth in postnatal growth at discharge and 12 mo of corrected age in preterm infants. METHODS This prospective cohort included 63 preterm newborns born before 34 gestational weeks evaluated from birth until 12 mo of corrected age. The serum 25(OH)D levels in umbilical cord blood and from their mothers were evaluated at delivery. RESULTS The mean 25(OH)D levels in preterm newborns were higher than maternal levels (24.8 ± 13.3 ng/mL versus 21 ± 10.2 ng/mL, P < 0.001) and showed a moderate correlation between (r = 0.548; P < 0.001). Considering the body mass index Z-score at 12 mo, 3 (10%), 25 (83%), and 2 (7%) of the preterm infants were thin, had normal body mass index, and were overweight, respectively. The 25(OH)D levels in the umbilical cord did not influence the anthropometric indicators at hospital discharge and 12 mo of corrected age. We observed improvement in all anthropometric indicators assessed over the months, and there was no difference between preterm infants with 25(OH)D levels >20 ng/mL and <20 ng/mL in the umbilical cord. CONCLUSIONS The results of this study suggested that the 25(OH)D serum levels in the umbilical cord did not influence postnatal growth from birth to the first year of life in preterm infants. There was a direct association between maternal and umbilical cord serum 25(OH)D levels.
Collapse
Affiliation(s)
| | | | - Cibele Wolf Lebrão
- Neonatal Unit, Hospital da Mulher - São Bernardo do Campo, São Paulo, Brazil
| | - Fernando Luiz Affonso-Fonseca
- Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Clinical Analysis, Department of Pathology of Centro Universitário Faculdade FMABC, São Paulo, Brazil
| | - Roseli Oselka Saccardo Sarni
- Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Department of Pediatrics, Centro Universitário FMABC, São Paulo, Brazil
| | - Fabíola Isabel Suano-Souza
- Pediatric Department of Centro Universitário FMABC, São Paulo, Brazil; Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
| |
Collapse
|
6
|
Casas-Deza D, Bernal-Monterde V, Betoré-Glaria E, Julián-Gomara AB, Yagüe-Caballero C, Sanz-París A, Fernández-Bonilla EM, Fuentes-Olmo J, Arbones-Mainar JM. Liver Disease Undernutrition Screening Tool Questionnaire Predicts Decompensation and Mortality in Cirrhotic Outpatients with Portal Hypertension. Nutrients 2023; 15:3780. [PMID: 37686812 PMCID: PMC10489934 DOI: 10.3390/nu15173780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Numerous scores are designed to predict outcomes of patients with liver cirrhosis. Our study aimed to evaluate the ability of the Liver Disease Undernutrition Screening Tool (LDUST) in predicting mortality and decompensation in outpatients with clinically significant portal hypertension (CSPH). We hypothesized that LDUST could help identify patients in need of nutritional supplementation and intervention. METHODS A prospective study of 57 CSPH patients (36.8% female, mean age: 63.5 ± 9.9 years) with a median follow-up of 41 months was conducted. Baseline liver function, nutrition, and sarcopenia were assessed, alongside LDUST. During follow-up, the occurrence of liver decompensation, hospital admission, need for emergency care, and mortality were evaluated. RESULTS A total of 56.1% of patients were Child A, and the most frequent etiology was alcohol (50.9%). Malnutrition risk according to LDUST raised mortality (HR: 25.96 (1.47-456.78)), decompensation (HR 9.78 (2.08-45.89)), and admission (HR 4.86 (1.09-21.61)) risks in multivariate Cox analysis. Combining LDUST with Child and MELD scores improved their decompensation prediction (0.936 vs. 0.811 and 0.866 vs. 0.700). CONCLUSIONS The LDUST has a solid ability to predict complications in cirrhosis outpatients with CSPH, and its integration with Child and MELD models enhances their predictive power. LDUST implementation could identify individuals necessitating early nutritional support.
Collapse
Affiliation(s)
- Diego Casas-Deza
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
| | - Vanesa Bernal-Monterde
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
| | - Elena Betoré-Glaria
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
| | - Ana Belén Julián-Gomara
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
| | - Carmen Yagüe-Caballero
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
| | - Alejandro Sanz-París
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
- Endocrinology and Nutrition Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Eva María Fernández-Bonilla
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
| | - Javier Fuentes-Olmo
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (V.B.-M.); (E.B.-G.); (A.B.J.-G.); (C.Y.-C.); (E.M.F.-B.); (J.F.-O.)
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
| | - Jose M. Arbones-Mainar
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain; (A.S.-P.); (J.M.A.-M.)
- Instituto Aragonés de Ciencias de la Salud (IACS), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CiberOBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| |
Collapse
|
7
|
Verstraete J, Amien R. Cross-Cultural Adaptation and Validation of the EuroQoL Toddler and Infant Populations Instrument Into Afrikaans for South Africa. Value Health Reg Issues 2023; 35:78-86. [PMID: 36905789 DOI: 10.1016/j.vhri.2023.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/15/2022] [Accepted: 01/21/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES The EuroQol Group is exploring the development of a health-related quality of life measure for toddlers and infant populations (EuroQoL Toddler and Infant Populations [EQ-TIPS]) aged 0 to 36 months. This study aimed to report on the cross-cultural adaptation and validity of the South African Afrikaans EQ-TIPS. METHODS The development of the Afrikaans EQ-TIPS followed the EuroQol guidelines including forward-backward translation and cognitive interviews with 10 caregivers of children aged 0 to 36 months. Thereafter, 162 caregivers of children 0 to 36 months of age were recruited from a pediatric hospital inpatient and outpatient facility. The EQ-TIPS; Ages and Stages Questionnaire; face, legs, activity, cry, and consolability; and dietary information were completed by all caregivers. The distribution of dimension scores, Spearman's correlation, analysis of variance, and regression analysis were used to explore the validity of the EQ-TIPS. RESULTS The descriptive system of the EQ-TIPS was generally well understood and accepted by caregivers. The correlation coefficients for concurrent validity were significant and moderate for pain and weak and significant for the other dimensions hypothesized to correlate. Known groups were compared and inpatients had a significantly higher report of pain (χ2 = 7.47, P = .024) and more problems reported across all EQ-TIPS dimensions (recorded on the level sum score) (Kruskal Wallis H = 3.809, P = .05) and reported significantly worse health on the visual analog scale (Kruskal Wallis H = 15.387, P < .001). There were no age-related differences except for a lower report of problems with movement in the 0- to 12-month group (χ2 = 10.57, P = .032). CONCLUSION The Afrikaans version of the EQ-TIPS is well understood and accepted by caregivers and valid for use with children aged 0 to 36 months in South Africa.
Collapse
Affiliation(s)
- Janine Verstraete
- Department of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, Rondebosch, Cape Town, South Africa.
| | - Razia Amien
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Rondebosch, Cape Town, South Africa
| |
Collapse
|