2002, Number 6
Factores psicosociales asociados al desarrollo de niños con mielomeningocele
Torres GEM, Lara MMC, Camacho GS, González PMA
Full text
Language: Spanish
References: 23
Page: 44-52
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ABSTRACT
Physicians have always been concerned about preserving life, although emphazining its duration rather than quality independent of what the prognosis is. The current situation in medicine needs answers based on good judgement regarding life in the future. Myelomeningocele is a congenital malformation associated with disability. In 1998 the states reporting more cases were Puebla, Veracruz, state of Mexico, Guanajuato and Jalisco. Although the development of these children is impaired, the factors related have not received much attention.The objective of this study was to identify if some clinical and psychosocial factors were related to the development of children with myelomeningocele, at the Hospital para el Niño Poblano. A descriptive, longitudinal study was done in patients with myelomeningocele diagnosed from 1992 to 1999 at the Hospital para el Niño Poblano.
The clinical variables studied were level and size of the myelomeningocele, presence of hydrocephalia and weight at birth. The psychosocial variables were: socioeconomical level, personality of mother and presence of father at home.
Children’s development was evaluated using Alpern’s Profile; retardation was reported in terms of months under cronological age, in five areas of development: physical, self-performance, social and, academic level, and communicational skills.
The statistical analyses were done with nonparametrical tests (U-Mann Whitney and Wilcoxon) and multiple regression. We could interview 72 (80%) of the 90 patients registered at the Hospital; they were 47.4 months old in average (min 4 - max 175); 55.5% of our patients were male, and approximately 60% of them had a good socioeconomical level. Myelomeningocele was most frequently located at the lumbar and lumbosacro level (62.5%), with hydrocephalia in 75% of the cases. Of the 72 evaluated patients, three of them had not been submitted to surgery and 50% were operated in their first week of life.
When the development was evaluated a high level of retardation was found in the physical area (Md= -7.0), whereas the lowest level was reported in the social area (Md=0). Development of girls was better than development of boys in all areas; in the selfperformance area, development was significantly better in girls (Md = 0.5) than in boys (Md = -2.5). The development was a little better in all areas (physics, self-performance, social and academical and in the area of communication) when the injury was located in the sacro level, and was not statistically significant. Children with hydrocephalia presented a significantly greatear disturbance in the physical area (Md = -9.0 vs Md = -3) and self-help (Md = -2.5 vs Md= 1) than children without hydrocephalia.
The development of children whose father lived at home was better in all five developmental areas, this was statistically significant in the social area (Md = -3.0 vs Md = -0). Mother’s personality was not related to the boy’s development; only the neuroticism dimension was related to the development in the physical and social areas (r= -0.23 and r = -0.22).
In our multivariable analysis physical development was predicted by hydrocephalia in a model including this variable, sex, neuroticism and level of the injury. The development in the self-performance area was predicted by sex, hydrocephalia and presence of the father. The academic level was predicted by the level of the injury and thepresence of the father. The communication skills were predicted by the presence of the father at home, in a model that included, besides this variable, level of the injury, hydrocephalia, sex, and age of first surgery.
We found some relevant issues regarding the influence of psychosocial variables in the development of these children besides the myelomeningocele itself. We discuss the roll played by the father in the development of these children. The most relevant methodological features of this investigation were the follow-up of 80% of the original group and the independent assessment of mothers and children.
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