bluuebunny/crossref_metadata_2025 huggingface dataset:
Re-engagement of Low-Income Smokers in Quitline Services: Effects of Incentives and Method of Contact
Authors: Cummins Sharon E , Kirby Carrie A , Wong Shiushing , Anderson Christopher M , Zhu Shu-Hong
Published: October 2022

Introduction

Financial incentives have been shown to improve recruitment of low-income smokers into tobacco quitline services and to improve cessation outcomes. The present study evaluated their use to re-engage low-income smokers who had already used a quitline.

Aims and Methods

Randomly selected Medicaid smokers (N = 5200) who had previously enrolled in a quitline were stratified by time since enrollment (3, 6, 9, or 12 months) and randomly assigned in a 2 × 4 factorial design to receive, by mail or telephone, an invitation to reengage, with an offer of no financial incentive or $10, $20, or $40. The primary outcome measure was re-engagement, defined as use of an additional evidence-based quitline service within 90 days. Data were collected from May 2014 to October 2015 and analyzed in 2022.

Results

Of 5200 participants invited to reengage in quitline services, 9.3% did so within 90 days, compared to 6.3% of a randomly selected comparison group (n = 22 614, p < .0001). Letters resulted in greater re-engagement than calls (10.9% vs. 7.8%, respectively, p = .0001). Among letters, there was a dose–response relationship between incentive level and re-engagement rates (p = .003). Re-engagement decreased as time since enrollment increased, from 13.7% at 3 months to 5.7% at 12 months (all p’s < 0.0001).

Conclusions

Low-income smokers who previously used quitline services can be motivated to reengage in treatment. Mailed letters and automated calls are effective re-engagement strategies. Financial incentives can increase the effectiveness of re-engagement letters. Inviting Medicaid smokers to re-engage with quitline treatment may help to address socioeconomic health disparities and should be standard practice.

Implications

Nicotine addiction is a chronic relapsing disorder, yet most cessation services are designed to help smokers through only one quit attempt. Smoking is increasingly concentrated in populations with physical and psychological co-morbidities, which can make quitting more difficult and impact whether smokers reach out for additional help following relapse. This study examined whether the timing, method, and content of an offer for further assistance influenced re-engagement rates for a vulnerable population of smokers—Medicaid beneficiaries. Relapsing smokers are responsive to re-engagement offers as early as three months, but there is a closing window of opportunity to reach them.
10 The association between underweight and iron status in early childhood: cross-sectional and prospective study
Authors: Borkhoff Sean , Parkin Patricia , Keown-Stoneman Charles , Birken Catherine , Maguire Jonathon , Macarthur Colin , Borkhoff Cory
Published: October 2022

Background

The American Academy of Pediatrics (AAP) identifies poor growth as a risk factor for iron deficiency (ID). There is limited research to provide evidence of this association.

Objectives

To examine the association between underweight and ID in early childhood.

Design/Methods

We enrolled healthy, young children from primary care practices in Toronto, Canada, and used both a cross-sectional and prospective study design. Underweight was defined as a body mass index z-score (zBMI) <-2. In the cross-sectional cohort, children 12-29 months had concurrent measurement of zBMI and serum ferritin. In the prospective cohort, children 6-14 months had measurement of zBMI and at 15-29 months had measurement of serum ferritin. Multivariable regression models examined serum ferritin as a continuous variable (linear models) and categorical variable with ID defined as <12 µg/L (logistic model), adjusted for pre-specified covariates.

Results

For the cross-sectional cohort (n=1953), the mean age was 18.3 (SD 5.0) months, 51 (2.4%) were underweight, and 269 (13.8%) had ID. There was no association between underweight and serum ferritin (change in median serum ferritin 2.01 µg/L, 95% CI -2.22, 7.01, P=0.37) or underweight and ID (OR 0.98, 95% CI 0.43, 2.21, P= 0.95). In contrast, there was a strong negative association between overweight and serum ferritin (change in median serum ferritin -4.19 µg/L, 95% CI -6.93, -1.04, P=0.01), and a positive association between obesity and ID (OR 3.35, 95% CI 1.10, 10.25, P=0.03). For the prospective cohort (n=672), the mean age at outcome was 21.1 (SD 3.5) months, 34 (5.1%) were underweight, and 104 (15.5%) had ID. There was no association between underweight and serum ferritin or underweight and ID.

Conclusion

Using both a cross-sectional and prospective study design, we found no association between underweight and ID in young children 1 to 2 years of age. In contrast, we found a strong association between overweight/obesity and ID. For risk stratification and targeted screening, overweight/obesity may be more important than underweight as a risk factor for ID in young children.
20 Eat Sleep Console: A Quality Improvement Initiative to Improve the Care of Opioid Exposed Newborns at a Community Hospital
Authors: Hagen Ricki , Trottier-Boucher Marie-Noelle , Stockley Katrina
Published: October 2022

Background

As the opioid crisis continues in B.C., more infants are born to mothers using opioids during pregnancy. Many of these newborns experience neonatal opioid withdrawal syndrome (NOWS) and require specialized medical care and prolonged hospital stays.

Objectives

We sought to improve the care of opioid exposed newborns by replacing the Finnegan Neonatal Abstinence Scoring System (FNASS) with the Eat Sleep Console (ESC) protocol. Our aim was to reduce infant NICU length of stay (LOS) and morphine dosing required for withdrawal management.

Design/Methods

A multi-disciplinary team was formed in 2019 and standard quality improvement methodology was implemented using plan-do-study-act cycles. Interventions included NOWS education for maternity and newborn health care providers, pediatric antenatal consults, introduction of as needed morphine, and implementation of the Eat Sleep Console (ESC) assessment tool. Primary outcomes were number of NICU admission days and cumulative morphine dosing required for NOWS treatment. Data from chart reviews was obtained from 2017 to 2021. Qualitative survey data was collected from nursing staff pre and post ESC implementation.

Results

ESC successfully replaced the FNASS, and nursing staff reported overall satisfaction and confidence with the practice change. Forty-four infants were captured in our data analysis, including 21 from the baseline period (FNASS), 12 from intervention group 1 (PRN morphine and FNASS), and 9 from intervention group 2 (PRN morphine and ESC). Cumulative morphine dose decreased by 55% when comparing the two intervention groups (19.45 mg intervention group 1 vs 10.71 mg intervention group 2). Two infants were managed exclusively with ESC non-pharmacological strategies and did not require any morphine. Although NICU LOS increased over time in our project (10.79 days in the baseline group vs 19.64 in the intervention group 2), there were no differences in the LOS between the two intervention groups (18.49 days vs 19.64 days). Unstable maternal opioid use, defined as illicit opioid use two weeks prior to delivery increased as the project progressed and was unbalanced between groups, possibly affecting our overall outcomes (38% unstable mothers in the baseline period vs 78% intervention group 2). Stratified analysis between stable and unstable mothers showed a trend of increased LOS and morphine requirements for infants born to unstable mothers. In our center, the ability to provide 1:1 care by nurse or parent was the most prominent challenge.

Conclusion

ESC successfully replaced the FNASS at our community hospital and has shown a clinically significant decrease in morphine requirements for infants experiencing opioid withdrawal.
21 Spontaneous resolution of post-hemorrhagic ventricular dilatation in preterm newborns and neurodevelopmental outcomes
Authors: Paquette Mariane , Groulx-Boivin Emilie , Khairy May , Beltempo Marc , Dudley Roy W , Ferrand Amaryllis , Bizgu Victoria , Garfinkle Jarred
Published: October 2022

Background

Post-hemorrhagic ventricular dilatation (PHVD) is a serious complication of intraventricular hemorrhage (IVH) in preterm newborns and is associated with significant impairments. The natural evolution of PHVD and developmental implications of spontaneous resolution are not well established.

Objectives

To investigate the natural evolution of PHVD and compare neurodevelopmental impairments in newborns with (1) spontaneous resolution of PHVD; (2) persistent PHVD and (3) PHVD who underwent neurosurgical intervention.

Design/Methods

We conducted a multicenter retrospective cohort study of 5238 newborns born at ≤34 weeks’ gestational age (GA) admitted to two tertiary Neonatal Intensive Care Units (NICU) between 2012 and 2020. Head ultrasounds (HUS) of 476 newborns with IVH grade ≥2 were reviewed to identify PHVD, defined as ventricular index (VI) >97th centile (p97) for GA and anterior horn width (AHW) >6mm on any HUS in the first 6 weeks of life. Newborns with PHVD were divided into three groups, Group 1: newborns with spontaneous resolution of PHVD, defined as the regression of both lateral ventricles below the VI and AHW thresholds, Group 2: newborns with persistent PHVD absent neurosurgical intervention and Group 3: newborns who underwent any neurosurgical intervention. Neurodevelopmental outcomes at 18 months corrected, obtained through chart review, were compared.

Results

Of 108 newborns with PHVD, 88 survived to NICU discharge (mean GA 28.4 weeks, SD 2.8; median age at PHVD diagnosis 8.0 days, IQR 5.0-12.8). Overall, 34/88 (38.6%) newborns had spontaneous resolution of PHVD (Group 1). The median time between PHVD diagnosis and spontaneous resolution was 14.0 days (IQR 6.8-32.3) (Figure). In Group 3, the median time between PHVD diagnosis and the first neurosurgical intervention was 14.0 days (IQR 7.0-23.0). Group 1 had significantly smaller maximal VI (1.8, 3.4, and 11.1mm above p97, p<0.001) and AHW (7.2, 10.8, and 20.3mm, p<0.001) than Groups 2 and 3, respectively, and were less likely to have bilateral PHVD (OR 0.47, 95% CI 0.33-0.67) than Group 3. Neurodevelopmental outcome data at 18 month were available for 53/88 (60.2%) survivors (Table). Group 1 had lower rates of cerebral palsy (17.4% vs 45.8%; p=0.037), global developmental delay (17.4% vs 50.0%; p=0.018), epilepsy (4.3% vs 29.2%; p=0.048) and involvement of ≥3 allied health professionals (34.8% vs 70.8%; p=0.013) compared to Group 3.

Conclusion

Newborns with PHVD without spontaneous resolution are at higher risk for significant neurodevelopmental impairments despite neurosurgical interventions, which may be due to more prominent ventricular dilatation. Strategies aimed at mitigating the burden of impairments in patients without spontaneous resolution are needed.
33 Evaluation of a Secure Messaging System for Children with Medical Complexity
Authors: Parpia Camilla , Moore Clara , Beatty Madison , Miranda Susan , Adams Sherri , Stinson Jennifer , Desai Arti , Bartlett Leah , Culbert Erin , Cohen Eyal , Orkin Julia
Published: October 2022

Background

The Connecting2gether (C2) platform is a secure online information-sharing tool that aims to improve care for children with medical complexity (CMC) and their families. A key feature of C2 is secure messaging which enables parents to communicate with their child’s care team members (CTMs) in a timely manner.

Objectives

(1) Evaluate the use of a secure messaging system, (2) Examine and compare the content of messages to email and phone calls, and (3) Explore parent and CTMs’ perceptions and experience using secure messaging as a method of communication.

Design/Methods

This study is a sub-study of a larger feasibility evaluation of the C2 platform. Parents of CMC were recruited from a tertiary level complex care program to use the C2 platform for 6 months. Parents could invite CTMs involved in their child’s care to register on the platform. Secure messages were extracted from C2 usage reports, and phone and email documentation from the electronic medical record. Quantitative data from C2 usage reports were analyzed using descriptive statistics. Messaging content codes were iteratively developed through review of the C2 messages. Semi-structured interviews were completed with parents and CTMs. Communication and interview data were analyzed using thematic analysis.

Results

36 parents and 43 care team members, including HCPs and family members, registered on the C2 platform. Participants sent a total of 1853 messages on C2 with parents and nurse practitioners sending a mean of 33.1 and 87.4 messages, respectively. 85.5% of all C2 messages were responded to within 24 hours. Email and phone calls focused primarily on clinical concerns and medications, whereas C2 messaging focused more on education, proactive check-ins, and non-medical aspects of the child’s life (Figure 1). Four themes emerged from the participant interviews related to C2 messaging: Connection to Care Team, Efficient Communication, Clinical Uses of Secure Messaging, and Barriers to Use (Figure 2).

Conclusion

Overall, our study provides valuable insight into the benefits of secure messaging in the care of CMC. Secure messaging provided the opportunity for continued patient education, proactive check-ins from HCPs, and casual conversations about family and child life, which contributed to parents feeling an improved sense of connection with their child’s health care team. Secure messaging can be a beneficial additional communication method to improve communication between parents and their care team, reduce the associated burden of care coordination, and ultimately, improve the experience of care delivery.
34 How online care plans promote partnership, trust, and cohesive care for children with medical complexity
Authors: Adams Sherri , Moore Clara , Beatty Madison , Dharmaraj Blossom , Desai Arti , Bartlett Leah , Culbert Erin , Cohen Eyal , Stinson Jennifer , Orkin Julia
Published: October 2022

Background

Children with medical complexity (CMC) require care coordination across hospital, home, and community settings. The use of a medical care plan supports care coordination; however, the content of the care plan is often controlled by the health care team, limiting the ability of parents to edit in real time. It has been suggested that these limitations could be improved by using online care plans shared between parents of CMC and care team members (CTM).

Objectives

The objective of this study was to explore the perspectives of parents and care team members of children with medical complexity following the use of an online care plan.

Design/Methods

This qualitative study utilized grounded theory (GT) to explore parent and CTM experiences using an online editable medical care plan. Parents of CMC were invited to use a novel online patient-facing platform to coordinate their child’s care and edit/share their child’s care plan. They were also able to invite any of their child’s CTM to use the platform. Parents could make changes to the care plan including adding, editing, or deleting information. After 6 months, parents and CTM participated in semi-structured interviews aimed at exploring their experiences using the online care plan. Consistent with GT, constant comparative analysis was used as data analysis occurred concurrently with interviews, which allowed for theoretical sampling and theory generation.

Results

Thirty-five semi-structured interviews with parents (n=15) and CTM (n=20) were conducted. Interviews revealed three major themes (9 sub-themes): 1) navigation of uncharted roles (trust, role sharing, responsibility), 2) requirements for success (collaborative review, electronic medical record integration, online access), and 3) cohesive care (autonomy, accessibility and convenience, same page). These themes informed the creation of a theory outlining how and why a robust online shared care plan can improve care for CMC. Both parents and CTM identified the uniqueness of this care plan located on the online platform as it promoted collaboration and trust whilst allowing for increased autonomy and convenience.

Conclusion

Online shared care plans, implemented in a safe and thoughtful manner, promote cohesive partnering between parents and care team members while allowing easy access to information. This facilitates care coordination and a cohesive partnering between parents and care team members involved in the care of CMC.
37 Accessible and Specialized COVID-19 Testing for Children and Youth with Medical Complexity
Authors: Dharmaraj Blossom , Bruce-Barrett Cindy , Campigotto Aaron , Science Michelle , Orkin Julia
Published: October 2022

Background

COVID-19 testing for symptomatic individuals is a key public health measure for infection prevention and control. However, COVID-19 testing can be uncomfortable without appropriate supports and can lead to testing hesitancy amongst certain populations such as children with medical complexity (CMC) and those with underlying neurological and respiratory conditions. To support COVID-19 testing, a specialized initiative was developed for CMC and their families onsite at The Hospital for Sick Children to enhance testing uptake, reduce barriers to access, and support a safe and accommodated testing environment for families. Multiple modalities of testing were involved and could be completed in their personal vehicle, with specialized support from nurses and child life if needed.

Objectives

The objectives of our study were to investigate the characteristics of CMC and their families who underwent COVID-19 testing through our program, evaluate indications for testing, and collect case positivity rates.

Design/Methods

Prospective data, including testing and population characteristics, were collected from December 2020-August 2021 through a centralized system, and was analyzed using descriptive methods.

Results

335 children (Table 1) with medical complexity came to the COVID-19 Assessment Center for testing. Of those who were tested 88% (294) had neurodevelopmental conditions with highly challenging behaviours (e.g. autism, developmental delay), and 12% (28) were classified as CMC (i.e. those with active use of medical technology e.g. tracheostomy, G-tube etc.).

Of those tested, 6% (21) tested positive for COVID-19. Sixty percent (199) were tested due to having symptoms consistent with COVID-19, 27% (90) had a COVID-19 exposure, 8% (26) were exposed and tested as part of outbreak management and 5% were of an unknown criteria. The majority of completed tests (74%) were nasopharyngeal (NP) swabs, 18% completed saliva tests and 6% completed anterior nares/throat swab tests. Thirteen percent (43) of families requested additional supports such as extra nurses, child life specialists or other accommodations. All patients had a dedicated paediatric nurse and received testing in their personal vehicle.

Conclusion

CMC and their families face unique barriers to COVID-19 testing. A specialized testing centre for CMC was able to support families by providing unique opportunities for testing, revealing a 6% COVID-19 positivity rate. NP swabs that can be painful were supported through in-vehicle testing with dedicated pediatric nurses. Robust health and safety measures, including a coordinated testing approach, are necessary to ensure accessible testing opportunities for CMC and their families. Further research is needed to be able to support this unique population.
54 FACTORS ASSOCIATED WITH TIME TO CLINICAL REMISSION IN PEDIATRIC LUMINAL CROHN'S DISEASE, A RETROSPECTIVE COHORT STUDY
Authors: Sassine Samuel , Zekhnine Souhila Fadela , Qaddouri Marwa , Djani Lisa , Cambron-Asselin Christine , Savoie-Robichaud Mathieu , Lin Yi Fan , Grzywacz Kelly , Groleau Véronique , Dirks Martha , Drouin Éric , Halac Ugur , Marchand Valérie , Girard Chloé , Courbette Olivier , Soglio Dorothée Dal , Patey Natalie , Deslandres Colette , Jantchou Prévost
Published: October 2022

Background

The natural evolution of Crohn’s disease is incompletely understood in the pediatric population. Data on factors influencing time-to-remission are very limited in the literature.

Objectives

The aim of this retrospective cohort study was to describe the time to clinical remission in children with Crohn’s disease as well as changes over the past decade and to identify factors associated with time to clinical remission.

Design/Methods

Patients under 18 years old diagnosed between 2009 and 2019 were included. All data were collected from the patients’ medical records and the CHU Sainte-Justine inflammatory bowel disease registry. Survival analyses and linear regression models were used to assess the impact of clinical, laboratory, endoscopic, histological and therapeutic factors on time to clinical remission.

Results

654 patients were included in the study. There was no change in the time to clinical remission over the past decade. Female sex in adolescents (adjusted beta regression coefficient (aβ)= 31.8 days, p= 0.02), upper digestive tract involvement (aβ= 46.4 days, p= 0.04), perianal disease (aβ= 32.2 days, p= 0.04), presence of active inflammation on biopsies (aβ= 46.7 days, p= 0.01) and oral 5-ASA exposure (aβ=56.6 days, p= 0.002) were all associated with longer time to clinical remission. However, antibiotic exposure (aβ= -29.3 days, p=0.04), increased eosinophils on biopsies (aβ= -29.6 days, p=0.008) and combination of exclusive enteral nutrition and TNF- alpha inhibitors as induction therapy (aβ= -36.8, p=0.04) were associated with shorter time to clinical remission.

Conclusion

In children with newly diagnosed CD, time to clinical remission did not shorten during the decade. It was associated with baseline clinical and histological data and treatment strategies. Combination of enteral nutrition and TNF-alpha inhibitors was associated with faster clinical remission.

Figure 1 : Kaplan-Meier curve representing time to clinical remission in patients 13 years old and older by sex.

Figure 2 : Kaplan-Meier curve representing the time to clinical remission of patients according to the first induction treatment administered.
55 RISK FACTORS ASSOCIATED WITH RELAPSES IN PEDIATRIC LUMINAL CROHN'S DISEASE, A RETROSPECTIVE COHORT STUDY
Authors: Sassine Samuel , Djani Lisa , Cambron-Asselin Christine , Savoie-Robichaud Mathieu , Lin Yi Fan , Qaddouri Marwa , Zekhnine Souhila Fadela , Grzywacz Kelly , Groleau Véronique , Dirks Martha , Drouin Éric , Halac Ugur , Marchand Valérie , Girard Chloé , Courbette Olivier , Patey Natalie , Soglio Dorothée Dal , Deslandres Colette , Jantchou Prévost
Published: October 2022

Background

Crohn's diseaseis an inflammatory bowel disease that has a high incidence in Northern countries. The relapse rate of Crohn's disease one year after diagnosis is around 40 to 50% for all treatment modalities combined. Few risk factors are associated with the risk of relapses of Crohn's disease in children.

Objectives

The aims of this retrospective cohort study were to describe the rate of relapses in children with Crohn's disease, its evolution over the past decade and to determine risk factors associated with relapse.

Design/Methods

Patients under 18 years old and diagnosed between 2009 and 2019 were included. Patients’ clinical, endoscopic, histological, and laboratory characteristics, as well as their treatments, were collected from their medical records and the prospective CHU Sainte-Justine inflammatory bowel disease registry. Survival analyses and Cox regression models were used to assess the impact of those risk factors on relapse.

Results

639 patients were included. There was a decrease in the clinical relapse rate over the past decade: 70.9% of patients diagnosed between 2009 and 2014 experienced a relapse compared to 49.1% of patients diagnosed between 2015 and 2019 (p<0.0001). The following variables were associated with clinical relapse: female sex (adjusted hazard ratio (aHR)= 1.51, p=0.0009), high PCDAI (aHR= 1.02, p=0.04) and SES-CD (aHR= 1.03, p=0.03) scores at diagnosis, upper digestive tract involvement (aHR= 1.59, p=0.0003), exposure to oral 5-ASA (aHR= 1.91, p=0.0003), use of immunomodulatory agents compared to TNF-alpha inhibitors (methotrexate aHR= 1.91, p=0.0006; thiopurines aHR= 2.06, p<0.0001), presence of granulomas (aHR= 1.27, p=0.04) and increased eosinophils on intestinal biopsies (aHR= 1.34, p=0.02), high levels of C-reactive protein (aHR= 1.01, p<0.0001) and fecal calprotectin (aHR=1.09, p<0.0001) during clinical remission and low serum infliximab levels during maintenance (aHR for mean serum infliximab level under 7ug/mL = 2.48, p=0.005).

Conclusion

Relapse risk was significantly associated with baseline clinical, endoscopic, histological and laboratory data and treatment strategies. These results could help better select treatment options for pediatric Crohn's disease at induction and maintenance.

Figure 1: Kaplan-Meier curve representing patients time to relapse according to the first maintenance treatment administered.

Figure 2: Kaplan-Meier curve representing patients time to relapse according to the mean infliximab level in post-induction.
72 Prevalence of Neurodevelopmental Disorder among Indigenous Children: A Systematic Review
Authors: Lau Stuart , Czuczman Natalie , Dennett Liz , Hicks Matthew , Ospina Maria
Published: October 2022

Background

Neurodevelopment involves sensory-motor, cognitive, and social-emotional domains, which can be influenced by biological and psychosocial factors. Poor neurodevelopment can result in missing developmental milestones and neurodevelopmental disorders (NDs) that translate into negative consequences for long-term health and well-being. Indigenous children in countries with similar colonial histories face a disproportionate burden of infant mortality, chronic diseases, injuries, and disability compared to non-Indigenous children. However, there is no consensus on the prevalence of NDs among Indigenous children around the world.

Objectives

This systematic review (PROSPERO 2021 CRD42021238669) synthesized current evidence on the prevalence of NDs among Indigenous children in Australia, Canada, New Zealand, and the USA.

Design/Methods

Comprehensive searches of five databases from 2005 to Feb 15, 2021 were conducted to identify cohort and cross-sectional studies that assessed the objective. Two independent reviewers conducted study selection, data extraction/analysis, and risk of bias assessment. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort and ecological studies (adapted), and the Quality Assessment Tool for Prevalence Studies by Hoy et al. for cross-sectional studies. Prevalence odds ratios (pOR) with 95% confidence intervals (CI) were calculated in random-effects meta-analyses for each ND outcome if there were two or more studies of the same study design.

Results

Of the 864 studies identified, 25 studies met the inclusion criteria. Twelve studies were conducted in Australia, one in Canada, four in New Zealand, and eight in the USA. Four studies evaluated attention-deficit/hyperactivity disorder (ADHD) prevalence, 13 for autism spectrum disorder (ASD), 10 for intellectual disability (ID), and five for motor disorders (MD). Most cohort studies (10/17) had high risk of bias. All cross-sectional studies (n=8) had low risk of bias. The prevalence of ADHD, ASD, ID, and MD for Indigenous children ranged from 2.7-3.9%, 0.07-3.0%, 1.1-3.9%, and 0.18-0.47%, respectively. Prevalence in non-Indigenous children ranged from 1.6-5.6%, 0.31-3.3%, 0.87-2.3%, and 0.22-0.37%. In cross-sectional studies, Indigenous children had decreased odds of ASD (three studies; pOR=0.80; 95% CI: 0.71-0.89) compared to non-Indigenous children. In cohort studies, higher odds of MD (two studies; pOR=1.57; 95%CI: 1.35-1.84) and lower odds of ASD (four studies; pOR=0.46; 95% CI: 0.28-0.76) were found in Indigenous children compared to non-Indigenous children.

Conclusion

Prevalence rates are greater in Indigenous children for MD and lower for ASD compared to their non-Indigenous counterparts. Differences in NDs prevalence between Indigenous and non-Indigenous children may be due to differences in access to health care services/assessment.
75 Identifying High Priority Conditions for Research in Hospitalized Children Using a Data-driven Approach: A Population-based Study
Authors: Gill Peter , Thavam Thaksha , Anwar Mohammed Rashidul , Zhu Jingqin , Parkin Patricia , Cohen Eyal , To Teresa , Mahant Sanjay ,   Canadian Paediatric Inpatient Research Network (PIRN), Paediatric Inpatient Research Network (PIRN)
Published: October 2022

Background

Identifying conditions that should be prioritized for research based on their healthcare system burden is imperative to build a meaningful research agenda for the care of hospitalized children. No previous Canadian prioritization studies have been conducted in this area.

Objectives

To determine the prevalence, cost, and variation in cost of pediatric hospitalizations at all hospital types, to identify conditions that should be prioritized for future research.

Design/Methods

Population-based cross-sectional study of children (< 18 years), with an inpatient hospital encounter between April 1, 2014 and March 31, 2019 in Ontario, Canada. Data were obtained from linked health administrative databases. For each encounter, the most responsible ICD-10-CA discharge diagnosis code was classified into clinical categories using the Pediatric Clinical Classification System. The condition-specific prevalence and cost of pediatric hospitalizations, and condition-specific variation in cost per encounter across hospitals were determined. The variation in cost was evaluated using number of outlier hospitals, and intraclass correlation coefficient (ICC).

Results

There were 627,314 inpatient hospital encounters from 165 hospitals costing $4.3 billion. A total of 408,003 (65.0%) hospitalizations and $1.9 billion (43.8%) in hospital costs occurred at general hospitals. Table 1 presents the 25 most prevalent and 25 most costly conditions (34 in total) ranked by cumulative cost. The top 10 costly conditions accounted for 70.0% of all costs and 59.6% of all encounters. Conditions that were highly prevalent and costly included: low birth weight, preterm newborn, major depressive disorder, pneumonia, other perinatal conditions, bronchiolitis, and neonatal hyperbilirubinemia. Figure 1 illustrates the 25 most costly medical conditions, of which the majority of the most prevalent and costly conditions were newborn conditions. Amongst the most costly conditions, the highest variations in cost across hospitals were observed in two mental health conditions (other mental health disorders [ICC = 0.28]; anxiety disorders [ICC = 0.19]), and three newborn conditions (intrauterine hypoxia and birth asphyxia [ICC = 0.27]; other perinatal conditions [ICC = 0.17]; surfactant deficiency disorder [ICC = 0.17]).

Conclusion

This study identified several newborn and mental health conditions as the most prevalent, costly, and with high variation in cost across hospitals in hospitalized children. These results can be used to generate a research agenda for the care of hospitalized children in general and children’s hospitals to build a stronger evidence-base and improve patient outcomes.
84 It’s all about that trach - Episode II: Acceptability, accessibility, inclusivity and feasibility
Authors: Shah Prachi , Kherani Tamizan , Uwiera Trina , Hicks Anne
Published: October 2022

Background

Pediatric tracheostomy care is a vital but intimidating critical skill required of parents and pediatricians. Consistent caregiver training is vital to promote safety. An Alberta team is developing the “Tracheostomy Journey” to help caregivers navigate and communicate through caring for children with tracheostomy. A needs assessment identified consistent, universal multimodal teaching and communication tools for care providers as a primary need.

Objectives

The objective of this study was to evaluate “train the trainer” pediatric tracheostomy care modules for feasibility, acceptability, accessibility and inclusivity.

Design/Methods

This project evaluated goal-oriented training modules previously developed by the research team to provide simulation-based training to pediatric residents. The modules were adapted to fit the national residency curriculum requirements for CBD (Competency by Design). Pediatric residents participated in simulation with the modules, which were precepted by two simulation experts and a subspecialty fellow. Modules were offered to all trainees regardless of their choice to participate.

Participants completed questionnaires before and after the session, rating their confidence and self-assessed competence, module accessibility, acceptability and inclusiveness and feedback for improvement. Preceptors reported their comfort and self-assessed competence teaching the module content and evaluated content, accessibility, acceptability and inclusiveness.

Results

All 25 General Pediatrics resident participants found the training effective. Pre- and post-workshop surveys showed the training increased confidence in caring for patients, and confidence and competence in various levels of involvement from supporting care to leading and teaching. Qualitative feedback on accessibility, acceptability, and inclusivity was positive. Preceptor evaluation suggested the “train the trainer” aspect was achieved.

Conclusion

Tracheostomy care simulation materials designed to meet CBD goals increased confidence and self-assessed competence for emergency care tasks. A “train the trainer” approach to module design provided subspecialty fellows with confidence using the modules to teach. This trial suggests that “train the trainer” module design is accessible and feasible for resident training programs. Trials with families and allied health caring for children with tracheostomy will be completed next. Universally adoptable “train the trainer” modules are proposed as a means to ensure uniform skill development to effectively deliver care to children with tracheostomy.
93 Mapping Mobile Health Clinics in Canada: Delivering Equitable Primary Care to Children and Vulnerable Populations
Authors: Nguyen Anne Xuan-Lan , Kevorkov Alexander , Li Patricia , Benkelfat Rislaine
Published: October 2022

Background

Low-income and racially diverse populations often have multiple barriers in accessing healthcare and are at increased risk of poor health outcomes. COVID-19 exacerbated these health inequities: decreased in-person appointments, difficult access to virtual care and deprioritization of elective clinical activity led to delays in well-child visits and vaccination. This public health emergency highlighted a need to develop alternative models to enable access to primary care for vulnerable children. While mobile clinics are well-established in the United States, little is known about them in Canada.

Objectives

This study aims to characterize Canadian mobile clinics providing primary care health services to vulnerable populations, including children, and seeks to inform the implementation of a pediatric mobile clinic under development.

Design/Methods

This environmental scan screened scientific databases and the grey literature using a combination of terms designating mobile health clinics and Canadian locations. Relevant Canadian primary care mobile clinic initiatives were subsequently included. We defined primary care mobile clinics as movable health care units providing primary healthcare services delivered by general medical practitioners (pediatricians and family physicians). Examples of excluded initiatives were mobile clinics focused on education/literacy, dental care, vision care, endocrinology, cancer screening, safe injection sites, vaccination, physical rehabilitation and urgent care. Descriptive statistics and qualitative analysis were performed.

Results

29 clinics were identified, of which 26 are still active. Most clinics were located in Ontario (n=11), followed by British Columbia (n=8), Alberta (n=5), Quebec (n=2) and the Maritimes (n=2). The first mobile clinic in Canada was launched in 1996, with an increasing number of new clinics in 2021. While all clinics served vulnerable populations, some targeted specific groups, such as children, people experiencing homelessness, immigrants, LGBTQ+ individuals and Indigenous peoples. We identified three pediatric mobile clinics, two of which targeted teenagers. Onboard the clinics, physicians often worked with nurses, outreach workers and social workers. These professionals provided primary care services, as well as healthcare navigation, sexual education, mental health care, harm reduction supplies, vaccination and emergency care. All mobile clinics partnered with their local government, charities or businesses to fund their initiative.

Conclusion

Mobile health clinics are a growing model of primary care in Canada. They are the result of a multidisciplinary collaboration between healthcare providers, social workers and outreach workers. To this date, Canadian pediatric mobile clinics remain a handful and represent an interesting avenue to address health inequities in children, during the pandemic and beyond.
97 COVID Check-In: Optimizing Cleft & Craniofacial Team Care during COVID-19 using an on-line social paediatrics screening instrument
Authors: Fisher Emily , Szostek Lisa , Ponton Ethan , Lau William , Loock Christine
Published: October 2022

Background

Public health mandates associated with COVID-19 added unprecedented stress on families, providers and the health care systems; including our ambulatory multidisciplinary cleft team care. In order to continue to provide responsive, multidisciplinary team (MDT) cleft and craniofacial care, it was essential to identify direct and indirect impacts of COVID-19 on our patients and families, whilst planning ahead for ongoing coordinated surgical, pediatric, and psychosocial interventions. Our team developed a short on-line psychosocial screening questionnaire that was administered prior to our MDT clinics, using a “What Matters to You” quality improvement (QI) format.

Objectives

1.To establish and test the utility of a “What Matters to You” quality improvement (QI) questionnaire.

2.To use this questionnaire in order to understand the impact of the COVID-19 pandemic on patients and family access to health services.

Design/Methods

Our team developed a 5-question online smartphone-accessible survey and distributed this to families prior to their MDT clinic visit during the COVID-19 pandemic. We analyzed survey results from May 2020-October 2021 in order to understand the impact of COVID-19 on families as well as the utility of our survey system.

Results

Out of 110 sequential MDT visits, families reported that COVID impacted timely access to health services (20%); employment (32%); basic needs like food and shelter (13%); and social capital. Almost half (47%) reported less than 5 people to turn to for extra support. The most common concerns caregivers have about their children were development, learning, and/or school progress (38%); mental health (36%) and social emotional well-being (31%).

Conclusion

Our study shows that 5 key psychosocial screening questions can be utilized to facilitate care coordination, responsiveness, and triage for in-person and virtual care settings, and respond to family centred care priorities in the midst of evolving COVID-19 landscapes.
Architectural and Compositional Diversity of Early Earth Ocean Floor Evidenced by the Paleoarchean Nondweni Greenstone Belt, South Africa
Authors: Wilson Allan , Riganti Angela
Published: October 2022

The nature of the early Archean ocean floor remains a topic of important debate. There are relatively few well-preserved occurrences worldwide where such terrains may be studied in detail because of structural dismemberment, metamorphic overprinting and pervasive early stage hydrothermal alteration to recent weathering. The 3.41-Ga dominantly mafic formations of the Nondweni Greenstone Belt (NGB) covering 270 km2 in the south-eastern Kaapvaal Craton comprise submarine volcanics that exhibit a wide range of textural features, including pillows, chill zones and brecciated flow tops, and various spinifex textures, including the rare platy pyroxene type, cumulate layers, and tuffs. Channelized subaqueous lava lakes that underwent fractionation are capped by thick spinifex-textured units and pillows. Early stage seafloor alteration is regionally variable, ranging from intense to minimal, with preservation of original mineralogy in many areas. Mafic volcanic rocks of the NGB contrast with those of the Barberton Greenstone Belt both in the style of volcanism and in the associated compositional range of komatiitic basalt to basalt with a complete absence of high-Mg komatiites. Olivine-phyric rocks, or derivatives thereof, are largely absent and pyroxene is the main controlling phase with orthopyroxene in the most primitive komatiitic basalts and clinopyroxene in the evolved lava lake sequences. The abundance of orthopyroxene typifies the long-standing silica-enriched character of the Kaapvaal Craton. Three exceptionally well-preserved and well-exposed sequences were studied utilizing hand-drilled samples and deep coring providing unprecedented stratigraphic and textural detail and field controls for more than 400 samples. A unifying feature of the mafic volcanics of the NGB is the range of compositions and ratios of incompatible elements most clearly illustrated by a series of high- and low-Ti compositional lineages reflecting differing sources or degrees of mantle partial melting. Sharp boundaries between high- and low-Ti flow successions indicate sudden changes in the melting regimes or the interaction of flow sequences from different volcanic centres. Th/Nb ranges from 0.1 to 0.2 and reveals crustal contamination of primitive lavas. The primary magma that gave rise to the most primitive komatiitic basalts with 19.5% MgO was derived from partial melting of a mantle plume source in the garnet stability field. Trace element modeling shows that the sequences studied in detail have been modified by fractionation and crustal contamination with the most likely contaminant being the Ancient Gneiss Complex (3.43–3.66 Ga), which is extensively exposed in Eswatini and probably underlies the Paleoarchean terrains in the southern Kaapvaal Craton. The geotectonic setting was likely that of a submerged felsic crustal platform as enclaves within an oceanic plateau.
Examining Physical and Cognitive Function in Chronic Low Back Pain Through the Use of a Multisystem Resilience Framework
Authors: Bartley Emily J , Makhoul Melissa , Palit Shreela , Robinson Michael E , Fillingim Roger B
Published: October 2022

Objectives

Chronic pain results in significant impairment in older adults, yet some individuals maintain adaptive functioning. Limited research has considered the role of positive resources in promoting resilience among older adults. Likewise, these factors have largely been examined independently. We aimed to identify resilience domains based on biopsychosocial factors and explore whether resilience phenotypes vary across sleep disturbance, fatigue, and cognitive function.

Methods

Sixty adults (ages ≥60 years) with chronic low back pain completed measures of psychological, health, and social functioning. On the basis of previously published analyses, principal-components analysis was conducted to create composite domains for these measures, followed by cluster analysis to identify phenotypes.

Results

Four profiles emerged: Cluster 1, with high levels of psychosocial and health-related functioning; Cluster 2, with high health-related functioning and low psychosocial functioning; Cluster 3, with high psychosocial functioning and poorer health; and Cluster 4, with low levels of functioning across all domains. Significant differences across cluster membership emerged for sleep disturbance (ηp2 = 0.29), fatigue (ηp2 = 0.29), and cognitive abilities (ηp2 = 0.47). Individuals with the highest levels of resilience demonstrated more optimal outcomes in sleep and fatigue (P values ≤0.001) than did individuals with a less resilient phenotype. Furthermore, the High-Resilience group (Cluster 1) and the High Psychosocial / Low Health group (Cluster 3) had lower cognitive impairment than did the High Health / Low Psychosocial group (Cluster 2) and the Low-Resilience group (Cluster 4) (P values ≤0.009).

Conclusions

A higher array of protective resources could buffer against the negative sequelae associated with chronic low back pain. These exploratory findings support the multidimensional nature of resilience and suggest that targeting resilience from a multisystem perspective might help to optimize interventions for older adults with chronic pain.
PBDE-47 induces impairment of mitochondrial biogenesis and subsequent neurotoxicity through miR-128-3p/PGC-1α axis
Authors: Tian Zhiyuan , Li Jing , Song Li , Xie Li , Li Dongjie , Xia Tao , Wang Aiguo
Published: October 2022

The potential adverse effects of 2,2′,4,4′-tetrabromodiphenyl ether (PBDE-47) on neurons are extensively studied, and mitochondria are identified as critical targets. This study aimed to investigate whether PBDE-47 impairs mitochondrial biogenesis via the miR-128-3p/PGC-1α axis to trigger mitochondrial dysfunction-related neuronal damage. In vitro neuroendocrine pheochromocytoma (PC12) cells and in vivo Sprague Dawley rat model were adopted. In this study, biochemical methods were used to examine mitochondrial ATP content, cell viability, and expressions of key mitochondrial biogenesis regulators, including peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PGC-1α), nuclear respiratory factor 1 (NRF1), and mitochondrial transcription factor A (TFAM). Mimics and inhibitors of miR-128-3p were employed to explore its role in PBDE-47-induced neurotoxicity. Both in vivo and in vitro evidences suggested that PBDE-47 suppressed PGC-1α/NRF1/TFAM signaling pathways and mitochondrial DNA (mtDNA) encoding proteins synthesis. PBDE-47 also suppressed the relative mtDNA content, mRNA levels of mtDNA-encoded subunits, and mitochondrial ATP levels in vitro. Specifically, 2-(4-tert-butylphenyl) benzimidazole (ZLN005) alleviated PBDE-47-induced neuronal death through the improvement of mitochondrial function by activating PGC-1α/NRF1/TFAM signaling pathways. Mechanistically, PBDE-47 dramatically upregulated miR-128-3p expression. Furthermore, miR-128-3p inhibition enhanced PGC-1α/NRF1/TFAM signaling and abolished PBDE-47-induced impairment of mitochondrial biogenesis. In summary, this study provides in vitro evidence to reveal the role of mitochondrial biogenesis in PBDE-47-induced mitochondrial dysfunction and related neurotoxicity and suggests that miR-128-3p/PGC-1α axis may be a therapeutic target for PBDE-47 neurotoxicity.
Changeable shared bus lane scheme for intersections based on lane signals
Authors: Liu Jiahui , Chen Dawei , Chen Qun
Published: October 2022

To address situations in which the bus lanes at intersections are idle for long periods, this paper proposes a changeable shared bus lane scheme for intersections based on lane signals. This scheme set up two GPS monitoring points for buses in the bus lane of the intersection to monitor the bus approaching the intersection. The lane signals linked to the monitoring points provide car drivers with a signal of whether they can enter the bus lane. This paper establishes an optimization model to maximize the number of vehicles entering the bus lane and uses numerical example simulations to discuss in detail the optimal monitoring point locations in different situations. Without affecting the bus, we obtain the optimal monitoring point setting schemes for several common situations and compare the total delay for ordinary vehicles in the bus lane of the lane-based signal scheme and a baseline case (without the lane-based signal). The results show that this scheme can effectively reduce vehicle delays at intersections. Finally, we discuss the limitations of this scheme and directions for future research.