Psychometric properties of the Child Health Assessment Questionnaire (CHAQ) applied to children and adolescents with cerebral palsy

<p>Abstract</p> <p>Background</p> <p>Cerebral palsy (CP) patients have motor limitations that can affect functionality and abilities for activities of daily living (ADL). Health related quality of life and health status instruments validated to be applied to these patients do not directly approach the concepts of functionality or ADL. The Child Health Assessment Questionnaire (CHAQ) seems to be a good instrument to approach this dimension, but it was never used for CP patients. The purpose of the study was to verify the psychometric properties of CHAQ applied to children and adolescents with CP.</p> <p>Methods</p> <p>Parents or guardians of children and adolescents with CP, aged 5 to 18 years, answered the CHAQ. A healthy group of 314 children and adolescents was recruited during the validation of the CHAQ Brazilian-version. Data quality, reliability and validity were studied. The motor function was evaluated by the Gross Motor Function Measure (GMFM).</p> <p>Results</p> <p>Ninety-six parents/guardians answered the questionnaire. The age of the patients ranged from 5 to 17.9 years (average: 9.3). The rate of missing data was low (<9.3%). The floor effect was observed in two domains, being higher only in the visual analogue scales (≤ 35.5%). The ceiling effect was significant in all domains and particularly high in patients with quadriplegia (81.8 to 90.9%) and extrapyramidal (45.4 to 91.0%). The Cronbach alpha coefficient ranged from 0.85 to 0.95. The validity was appropriate: for the discriminant validity the correlation of the <it>disability index </it>with the visual analogue scales was not significant; for the convergent validity CHAQ <it>disability index </it>had a strong correlation with the GMFM (0.77); for the divergent validity there was no correlation between GMFM and the pain and overall evaluation scales; for the criterion validity GMFM as well as CHAQ detected differences in the scores among the clinical type of CP (p < 0.01); for the construct validity, the patients' <it>disability index </it>score (mean:2.16; SD:0.72) was higher than the healthy group (mean:0.12; SD:0.23)(p < 0.01).</p> <p>Conclusion</p> <p>CHAQ reliability and validity were adequate to this population. However, further studies are necessary to verify the influence of the ceiling effect on the responsiveness of the instrument.</p

Equilibrium of Global Amphibian Species Distributions with Climate

A common assumption in bioclimatic envelope modeling is that species distributions are in equilibrium with contemporary climate. A number of studies have measured departures from equilibrium in species distributions in particular regions, but such investigations were never carried out for a complete lineage across its entire distribution. We measure departures of equilibrium with contemporary climate for the distributions of the world amphibian species. Specifically, we fitted bioclimatic envelopes for 5544 species using three presence-only models. We then measured the proportion of the modeled envelope that is currently occupied by the species, as a metric of equilibrium of species distributions with climate. The assumption was that the greater the difference between modeled bioclimatic envelope and the occupied distribution, the greater the likelihood that species distribution would not be at equilibrium with contemporary climate. On average, amphibians occupied 30% to 57% of their potential distributions. Although patterns differed across regions, there were no significant differences among lineages. Species in the Neotropic, Afrotropics, Indo-Malay, and Palaearctic occupied a smaller proportion of their potential distributions than species in the Nearctic, Madagascar, and Australasia. We acknowledge that our models underestimate non equilibrium, and discuss potential reasons for the observed patterns. From a modeling perspective our results support the view that at global scale bioclimatic envelope models might perform similarly across lineages but differently across regions

Climate change and outdoor regional living plant collections: an example from mainland Portugal

Original PaperClimate change threatens not only plant species occurring naturally, but also impacts on regional living plant collections, which play an important role in ex situ conservation strategies. In the last few years, several global circulation models have been used to predict different global climate change scenarios. Due to their coarse resolutions, and while more detailed regional approaches are not available, downscaling techniques have been proposed, as a very simple first approach to increase detail. We analysed seven sites on mainland Portugal with potential for species conservation (four botanic gardens and three universities), in the light of downscaled climate change scenarios, using an environmental envelope approach and a predefined bioclimatic neighbourhood for each site. Thresholds for the bioclimatic neighbourhood were based on Rivas-Martı´nez’s Bioclimatic Classification of the Earth. For each site, the expected geographical shift of its original bioclimatic neighbourhood (1950–2000) was mapped for 2020, 2050 and 2080. Analysing those shifts enabled us to delineate knowledge-transfer paths between sites, according to the analysed scenarios. We concluded that, according to the Intergovernmental Panel on Climate Change A2 scenario, all considered sites will be outside the predefined bioclimatic neighbourhood by 2080, while according to the B2 scenario all of them will be inside that neighbourhood, although sometimes marginally so. Therefore, the implementation of global sustainability measures as considered in the B2 scenario family can be of great importance in order to delay significantly the impacts of climate change, giving extra time for the adaptation of the outdoor regional living plant collectionsinfo:eu-repo/semantics/publishedVersio

Fracturing ranked surfaces

Discretized landscapes can be mapped onto ranked surfaces, where every element (site or bond) has a unique rank associated with its corresponding relative height. By sequentially allocating these elements according to their ranks and systematically preventing the occupation of bridges, namely elements that, if occupied, would provide global connectivity, we disclose that bridges hide a new tricritical point at an occupation fraction $p=p_{c}$, where $p_{c}$ is the percolation threshold of random percolation. For any value of $p$ in the interval $p_{c}< p \leq 1$, our results show that the set of bridges has a fractal dimension $d_{BB} \approx 1.22$ in two dimensions. In the limit $p \rightarrow 1$, a self-similar fracture is revealed as a singly connected line that divides the system in two domains. We then unveil how several seemingly unrelated physical models tumble into the same universality class and also present results for higher dimensions

Changing patterns of tobacco consumption in Mozambique: evidence from a migrant study

Background: Maputo, the Mozambique capital, contrasts with the rest of the country with regard to its sociodemographic characteristics and patterns of tobacco exposure. We conducted a migrant study to compare the prevalence of manufactured-cigarette smoking and traditional forms of tobacco use among dwellers in the capital who were also born in Maputo City (MC/MC) with those born in southern (SP/MC) and northern (NP/MC) provinces, and additionally with inhabitants in the latter regions. Methods. In 2003, a representative sample of 12,902 Mozambicans aged 25-64 years was evaluated. We computed age- and education-adjusted prevalence ratios (PR) with 95%-confidence intervals (95%CI) using Poisson regression. Results: The prevalence of any type of tobacco consumption among Maputo City inhabitants born in other provinces contrasted with the pattern observed in locally born inhabitants (SP/MC vs. MC/MC: men, PR, 0.61; 95%CI, 0.44-0.85; women, PR, 0.38, 95%CI, 0.18-0.79; NP/MC vs. MC/MC: men, PR, 0.66; 95%CI, 0.34-1.29; women, PR, 4.56, 95%CI, 1.78-11.69); the prevalence among city inhabitants born in other provinces resembled the pattern seen in inhabitants of their provinces of origin. Traditional forms of tobacco consumption among men were rare in Maputo City, which is in stark contrast to the situation in other provinces. Conclusions: Cultural background, affordability, and availability of different types of tobacco in urban Mozambique need to be considered when developing strategies to control the tobacco epidemic. © 2011 Lunet et al; licensee BioMed Central Ltd.Written informed consent was obtained from all participants. This work was supported by the Mozambique Ministry of Health and by the World Health Organization, with no interference in the design, data collection, data analysis, interpretation, or writing of the manuscript