bluuebunny/crossref_metadata_2025 huggingface dataset:
Seryl-tRNA synthetase promotes translational readthrough by mRNA binding and involvement of the selenocysteine incorporation machinery
Authors: Liu Ze , Wang Justin , Shi Yi , Yee Brian A , Terrey Markus , Zhang Qian , Lee Jenq-Chang , Lin Kuo-I , Wang Andrew H-J , Ackerman Susan L , Yeo Gene W , Cui Haissi , Yang Xiang-Lei
Published: September 2023

Translational readthrough of UGA stop codons by selenocysteine-specific tRNA (tRNASec) enables the synthesis of selenoproteins. Seryl-tRNA synthetase (SerRS) charges tRNASec with serine, which is modified into selenocysteine and delivered to the ribosome by a designated elongation factor (eEFSec in eukaryotes). Here we found that components of the human selenocysteine incorporation machinery (SerRS, tRNASec, and eEFSec) also increased translational readthrough of non-selenocysteine genes, including VEGFA, to create C-terminally extended isoforms. SerRS recognizes target mRNAs through a stem-loop structure that resembles the variable loop of its cognate tRNAs. This function of SerRS depends on both its enzymatic activity and a vertebrate-specific domain. Through eCLIP-seq, we identified additional SerRS-interacting mRNAs as potential readthrough genes. Moreover, SerRS overexpression was sufficient to reverse premature termination caused by a pathogenic nonsense mutation. Our findings expand the repertoire of selenoprotein biosynthesis machinery and suggest an avenue for therapeutic targeting of nonsense mutations using endogenous factors.
Short-range end resection requires ATAD5-mediated PCNA unloading for faithful homologous recombination
Authors: Park Su Hyung , Kim Namwoo , Kang Nalae , Ryu Eunjin , Lee Eun A , Ra Jae Sun , Gartner Anton , Kang Sukhyun , Myung Kyungjae , Lee Kyoo-young
Published: September 2023

Homologous recombination (HR) requires bidirectional end resection initiated by a nick formed close to a DNA double-strand break (DSB), dysregulation favoring error-prone DNA end-joining pathways. Here we investigate the role of the ATAD5, a PCNA unloading protein, in short-range end resection, long-range resection not being affected by ATAD5 deficiency. Rapid PCNA loading onto DNA at DSB sites depends on the RFC PCNA loader complex and MRE11-RAD50-NBS1 nuclease complexes bound to CtIP. Based on our cytological analyses and on an in vitro system for short-range end resection, we propose that PCNA unloading by ATAD5 is required for the completion of short-range resection. Hampering PCNA unloading also leads to failure to remove the KU70/80 complex from the termini of DSBs hindering DNA repair synthesis and the completion of HR. In line with this model, ATAD5-depleted cells are defective for HR, show increased sensitivity to camptothecin, a drug forming protein-DNA adducts, and an augmented dependency on end-joining pathways. Our study highlights the importance of PCNA regulation at DSB for proper end resection and HR.
Evaluation and management of enuresis in the general paediatric setting
Authors: Harris James , Lipson Alisa , Dos Santos Joana
Published: September 2023

Assessing enuresis involves distinguishing monosymptomatic from non-monosymptomatic for this common paediatric problem, and identifying concomitant comorbidities. Addressing co-occurring factors concurrently ensures the best opportunity for a satisfactory outcome. Treatment begins with patient and family education on the natural history of enuresis and practical behavioural guidance. Evidence to support particular interventions is limited, and children and families should be involved when choosing appropriate therapy. Enuresis alarms and desmopressin are treatment options when more active intervention is desired. Clinical refinements and combined treatment modalities are emerging.
1 Youth Experiencing Homelessness Presenting to an Urban Paediatric Emergency Department: A Descriptive Study
Authors: Lachance-Soulard Amelie , Harrison Megan , Reid Sarah
Published: September 2023

Background

Youth experiencing homelessness (YEH) have high rates of both mental and physical health concerns. This population faces multiple barriers in accessing care, resulting in unaddressed needs and reliance on Emergency Departments (ED). In Canada, the use of the paediatric ED by YEH has not been well described, and there is no data exploring the effects of the COVID-19 pandemic lockdown on ED attendance by this population.

Objectives

This study aims: 1) To review the frequency/nature of the presentations to the paediatric ED by YEH; 2) To compare pre- and post-COVID-19 data.

Design/Methods

Medical records were searched for ED encounters where a patient identified a youth shelter as their address and/or had terms documented such as “homeless”, during two time periods: pre-COVID-19 (May 1, 2018–March 15, 2020) and post-COVID-19 lockdown (March 16, 2021–Jan 31, 2022). Pertinent details of the encounters were documented, including chief complaint (CC). Descriptive statistics were used, as well as comparative analysis of the two time periods.

Results

A total of 1103 encounters were included. Over the total 45-month study time period, CCs were split between mental health-related (n=562, 50.9%) and physical health-related presentations (n=541, 49%). Of the mental health CCs, 396 (70.4%) were documented as “depression/overdose/suicidal/self-harm”. The most common CCs related to physical health were injuries (n=127, 23.4%), and pain (n=126, 23.2%).

YEH most commonly attended the paediatric ED between 17:00-00:00 (n=504, 45%), and were triaged as CTAS 3/urgent (n = 676, 61.2%). Of those who completed an Ask Suicide-Screening Questionnaire (ASQ) (n=303), 45.8% (n=139) had an acute positive screen/imminent risk identified.

The most common principal diagnoses documented at disposition were related to injuries/assault/pain (n= 224, 20%), and suicide attempt/self-harm (n=196, 17.7%). Of the 166 outpatient referrals made at discharge from ED, 105 (63%) were to mental health/psychiatry.

While overall there were fewer ED encounters for this population “post COVID-lockdown” (n=465) as compared to “pre-COVID” (n=638) (p-value <0.05), there was a significant reduction in mental health-related CCs (pre-COVID n=365, post-COVID n=197; p-value <0.05), with no significant reduction in physical-related CCs after the pandemic lockdown (pre-COVID, n=273, n=268).

Conclusion

YEH utilize the paediatric ED for both their mental and physical healthcare and frequently report suicide risk. The findings that lower attendance to the paediatric ED for mental health-related concerns followed the pandemic lockdown, while physical health encounters remained steady, may reflect increased barriers to care or novel methods of mental health care delivery post-pandemic.
6 Evaluation of a Standardized Kawasaki Disease Protocol for Management and Follow-Up
Authors: Iseman Rachael , Lai Lillian , Zucker Marc , Roth Johannes , Jackson Elayna
Published: September 2023

Background

In 2017, it was recognized that there was significant variation in the management and follow-up of Kawasaki disease (KD) at our institution, resulting in inefficient use of hospital resources and patient confusion. A multidisciplinary team from cardiology, rheumatology, emergency medicine, infectious diseases (ID), and general paediatrics created a standardized protocol distributed on October 10th, 2019. With the evolution of multisystem inflammatory syndrome in children associated with SARS-COVID 19 (MISC), we expanded our protocol in December 2021 to include a 1-week follow-up echocardiogram (echo).

Objectives

It has been 3 years since the KD standardized protocol was implemented. As a result, we seek to evaluate its effectiveness in improving patient care, specifically in the patients with normal coronary arteries.

Design/Methods

We reviewed the cardiology echo database to define patients who had an echo performed for KD (January 1, 2020-August 17, 2022). These patients were reviewed in the electronic hospital record to define those with a discharge diagnosis of KD.

Results

Of the 138 patients defined, 47 patients were discharged with KD; normal coronary arteries (N=38) were seen in 81% (38/47). Classic KD: 47% (18/38); incomplete KD: 53% (20/38); 13% (5/38) were diagnosed with both MISC and KD. Average age: 3.4 years (3 months to 9.5 years). We observed that rheumatology was consulted in 89% (34/38), cardiology in 100%, and ID in 50% (19/38). All patients were treated with low-dose acetylsalicylic acid (38/38), and the majority were treated with intravenous immunoglobulin, 92% (35/38). Some patients were treated with steroids, 26% (10/38). Average length of stay: 4.8 days (1-18 days).

Twenty-one patients were seen from when we initiated performing a 1-week echo. In addition to the existing protocol, 24% (5/21) of cases missed having a 1-week follow-up echo because the cardiologist was not aware of the practice. Eighty-nine% (34/38) had their 6-week follow-up echo and follow-up in the post-hospitalization clinic (PHC) at the appropriate time. Patients were incorrectly scheduled to see the cardiologist in 13% (5/38) and the PHC in 3% (1/38) cases.

Conclusion

With the implementation of a standardized management and follow-up protocol for KD, our patients are now guaranteed follow-up with access to effective patient-centred care in a streamlined manner that targets appropriate use of resources. A satisfaction survey should be performed to inquire if families are pleased with this process.
7 Ethical Dilemmas Faced by Healthcare Professionals when Considering a Report to Child Protection: Experiences and Perspectives from a Tertiary Paediatric Centre
Authors: Low-Decarie Clara
Published: September 2023

Background

Child maltreatment is an important global problem that is increasingly being recognized as a public health issue as well as a violation of children’s fundamental rights. Mandatory reporting is a legislative attempt to decrease its prevalence and impacts. It is generally thought that these laws improve child maltreatment detection rates. However, the actual effects of such laws, as well as mandated reporters’ perspectives on them, remain unclear. Several studies have explored the many obstacles perceived in the reporting process, including some of which can be considered as moral dilemmas. Very few of these studies have explicitly adopted an ethical lens in the analysis of these situations.

Objectives

Through an exploratory study, our aim was to describe the experiences and perspectives of healthcare professionals from a large paediatric university centre when considering making a report to child protective services. We were interested in the reporting process rather than initial identification. We also explored how profession (nurse, doctor or resident), work environment (general paediatrics team, NICU or ED) and years in practice influenced participants' answers. Additional questions addressed the concept of disclosure of reports to families involved, training on child maltreatment and reporting, and perceived impacts of the COVID-19 pandemic on children’s safety.

Design/Methods

One hundred and thirty-five respondents answered an anonymous online survey constructed by the research team and based on a review of the available literature.

Results

Most participants (96%) had encountered situations of possible child maltreatment through their work and reported being committed to their mandated reporting obligations. However, only 44% of respondents had personally reported a situation to protective services. Teamwork and/or delegation of reporting duties seemed to contribute to the gap between exposure and reporting experiences. Sixty nine percent of participants felt that families should be told about healthcare professionals’ concerns at least as often as possible, but many expressed significant concerns, mostly related to their own safety and well-being. Training was lacking according to 88-89% of respondents. Regarding the COVID-19 pandemic and associated restrictions, participants were concerned for children’s safety in their homes.

Conclusion

Many ethical aspects of the reporting process should be considered when addressing a particular situation but also when teaching and training professionals in the identification and reporting of child maltreatment.
8 Characterizing Opioid Overdose Deaths in Children (COODC Study)
Authors: Assen Katrina , Rieder Michael , Wilson Michael , Urbantke Elizabeth
Published: September 2023

Background

With the opioid epidemic the numbers of fentanyl-related adult deaths are increasing in Canada but there is limited knowledge of fentanyl’s effect on paediatric deaths.

Objectives

Our aim is to describe cases of fatal paediatric opioid toxicity, and their characteristics, to help guide public policy and health care system response.

Design/Methods

Patient information was collected from the opioid investigative aid (OIA) database, which collects all suspected opiate-related deaths in Ontario. A chart review was performed on patients less than 10 years of age between October 1st, 2017, to October 31st, 2021. Patient characteristics were calculated as percentages and a descriptive analysis was conducted.

Results

10 childhood deaths occurred, and the average age was 1.9 (Table 1). The causative opioid was fentanyl alone in 40% of cases, fentanyl in combination in 40%, and hydromorphone and methadone with 10% each. Most cases involved improperly stored medication or illicit substances (Table )2. All had previous child protection service involvement.

Conclusion

In patients less than 10 years of age, there were ten opioid-related deaths over four years, all in children younger than 5 years. Fentanyl was the primary drug involved in 80% of cases. This demonstrates the rise of fentanyl-related opioid deaths in children and elucidates areas for change, including education, proper storage of illicit substances, and implications for the child protection system.
13 “Don’t Want to Be in the Room? Never. Can’t Be in the Room? Yes”: A Mixed Methods Analysis of Barriers and Facilitators to Parental Presence at the Bedside in a Paediatric Intensive Care Unit
Authors: Poole Emily , Ryan Molly , Curran Janet , Foster Jennifer
Published: September 2023

Background

Though a paediatric intensive care unit (PICU) admission is overwhelming for families, bedside parental presence improves child comfort, reduces parental anxiety, and enables family engagement. Previous research has focused on parental presence during events (rounds, resuscitation, and procedures), but little is known about factors influencing parental presence at their child’s bedside for routine PICU care.

Objectives

To identify factors that parents perceive as impacting their capability, opportunity, and motivation to be at the bedside in PICU, and explore parental perceptions about the quality and value of time spent at the bedside.

Design/Methods

This mixed methods study used semi-structured interviews based on the Theoretical Domains Framework (TDF). Participants were parents of children admitted to a Canadian PICU. Participants completed a demographics form and the Medical Term Recognition Test (METER) to assess health literacy. Interviews were coded independently by two researchers using a directed content approach based on the TDF. Once consensus was reached, themes and subthemes were identified inductively within each domain to generate barriers and enablers. Factors were examined for trends based on dichotomized demographics.

Results

Fourteen primary caregivers participated in 11 interviews. Participants were 8 mothers and 6 fathers, of children with both planned (n=4) and unplanned (n=7) admissions. METER scores ranged from 4 to 40, with a mean of 31. Seventy-six barriers and enablers were identified within 13 domains. Factors were most commonly in the ‘environmental context and resources’ domain (n=13) and included “comfortable and functional physical environment”, “medicalization of the child”, and “PICU technology”. Parents emphasized the importance of self-care which, although requiring parents to leave the bedside, allowed them to be fully engaged when they were present. A ubiquitous factor was “maintenance of the parent role”. Parents felt responsible to be present, but recognized alterations in the parental role while in PICU. Parents who were <25 years old, fathers, or those who had first and unplanned PICU admissions identified relatively fewer skills and capabilities supporting their presence. Multiple factors, particularly in the domains of social influence and environmental context, are potentially modifiable to better support parental presence and engagement at the bedside.

Conclusion

Parents perceive multiple factors influencing their capability, opportunity, and drive to be present with their critically ill child in PICU, some of which are amenable to direct intervention by healthcare professionals and hospital policy. Healthcare professionals may maximize parental engagement by attempting to optimize quality, rather than quantity, of time at the bedside.
21 Cross-sectoral Care for Transitional Aged Youth (TAY) with Autism Spectrum Disorders and Intellectual Disabilities (ASD/IDD)
Authors: Young Elizabeth , Henze Megan , Nallathamby Shanthiya , Jegathesan Thivia , Green Laurie , Weyman Karen , Isaacs Barry , Loh Alvin , Milligan Karen
Published: September 2023

Background

The Transition Clinic for Youth and Young Adults (TAY clinic) with ASD/IDD is a unique partnership between the Developmental Sector and Health care sector. Surrey Place Centre, St. Michaels Family Health Teams and Developmental Paediatrics work with families of adolescents and young adults ages 14-22 to help transition from paediatrics-based healthcare and developmental services to adult sectors using a structured approach to transition. This clinic was a pilot project over the past 5 years, and we are using a mix-methods study to evaluate the implementation of the clinic and its impact on the lives of TAY with IDD and their caregivers.

Objectives

To describe patient and caregiver characteristics, usage of clinic, transition goals stated and achieved, and level of support needed.

Design/Methods

Quantitative data was collected using standardized forms including demographics, transition planning goals, and dates of applications to critical services like Developmental Service Ontario and Ontario Disability Support Program. The frequency, intensity and duration of transition planning support provided in the clinic was documented, as well as involvement of crisis services, child protection services, networks of specialized care, and hospital admissions.

Results

To date, 94 families have been supported through this clinic, with notable differences in the intensity and type of services required. Families were evenly distributed across three levels of transitional support need: (1) required consultation only; (2) required short-term intervention and follow up from the team with future crisis planning; and (3) families with extreme complexity, disconnected from the developmental sector and requiring intensive support and, at times, crisis care. In this 3rd group, 30% were regular emergency and crisis service users because of significant risk of harm or death to client or caregiver associated with physical or mental health concerns, and 15% were at risk of homelessness. Barriers to social determinants of health (e.g., housing, food security, social support) and inequities (based on race, immigration status, employment, English language proficiency) were present in all cases. Across all 3 groups, trajectories within the current systems of care were often apparent years before their transition.

Conclusion

Cross-sector models of care are feasible for TAY with IDD. This model of care identified different levels of need for TAY with IDD. Barriers to transition support are rooted in inequities and are often present years prior to transition. Paediatricians can help with earlier identification of families who require and deserve more comprehensive support.
25 Severe and Life-threatening Opioid, Stimulant, and Sedative Use in Canadian Youth: A One-time Survey of Paediatricians and Paediatric Subspecialists
Authors: Carwana Matthew , Chadi Nicholas , Moore Eva , Shariati Helia , Citron Sara
Published: September 2023

Background

Toxic drug supply is a public health emergency in Canada. The syndemic impact of Covid-19 has exacerbated the adverse outcomes of overdose, driving up mortality rates. Despite the fact that opioid use disorder is predominantly viewed as an adult issue, an increasing number of youth in Canada experience severe-life threatening overdose; it is the leading cause of death in youth ages 10-18 in Western Canada. Epidemiologic data related to this population remains limited.

1.Objectives: To determine the minimum incidence of children and adolescents presenting with severe or life-threatening opioid, stimulant, and sedative exposure among youth presenting to Canadian paediatricians and paediatric subspecialists.

2.To describe the treatment and services available for youth presenting with substance use to paediatric care in Canada.

Design/Methods

A one-time cross-sectional survey of Canadian paediatricians and paediatric subspecialists using the Canadian Paediatric Surveillance System (CPSP) was conducted in the Spring of 2022. A population denominator of 2,900,866 was selected based on Statistics Canada census data for children and youth 12-18 in 2021. Data were analyzed using Stata v15.1.

Results

1027 respondents (response rate: 37%) completed the survey, of whom 934 (90.9%) reported providing care to children and youth 12 years and above. 115 (12.3%) respondents indicated managing a youth with severe or life-threatening substance use in the prior 24 months. Most providers operated in urban settings (n=95, 84.8%), but there were cases reported in suburban (n=9, 8.0%) and rural/remote (n=8, 7.1%) environments as well. Calculated minimum cumulative incidence per 100,000/year were: opioid overdose 2.94; opioid use requiring pharmacotherapy 1.69; stimulant toxicity 3.22; and sedative toxicity 3.1 (Table 1). Respondents also reported service availability for youth substance use. Respondent awareness of the availability of overdose-related services was high for outpatient mental health services (85.4% for 12 to15-year-olds, 86.1% for 16 to18-year-olds), but poor to moderate (25.3%-53.1%) for all other surveyed services, including inpatient stabilization and intensive outpatient management.

Conclusion

Paediatricians and paediatric subspecialists interface significantly with youth experiencing severe substance use and overdose. The minimum calculated incidence rates provided are significant and concerning at the population level, despite excluding youth that do not seek physician care after overdose. Paediatric providers have limited awareness of service availability for youth that use substances. Further studies and knowledge translation are required.
26 How Are We Addressing Health Equity in the Paediatric Tertiary Care Setting? An Environmental Scan of Approaches across Canada
Authors: Naguib Mariam , Li Patricia , St-Georges Juliette , Korman Catherine , Chabot Annie , Benkelfat Rislaine
Published: September 2023

Background

Increasingly, paediatricians are asserting the urgent need for effective practices and policies to address child health inequities. Yet there is a paucity of data on the current approaches implemented in Canadian paediatric tertiary care centres. According to the Institute of Health Improvement (IHI), health equity is paramount for a just society that moves toward better well-being for all. The IHI framework lists five priorities to guide health equity initiatives: make health equity a strategic priority; develop structures and processes to support health equity work; deploy specific strategies to address the multiple determinants of health on which health care organizations can have a direct impact; decrease institutional racism within the organization; and develop partnerships with community organizations.

Objectives

The objectives of this study were to: 1) Map out current initiatives addressing health equity, and 2) Explore the facilitators and barriers to achieving health equity, in the tertiary paediatric health care setting in Canada.

Design/Methods

We conducted an environmental scan using in-depth, semi-structured interviews as well as a review of the grey and published literature. We interviewed at least one paediatric resident and one staff (including paediatricians, allied health professionals, and administrators involved in health equity) at all 17 paediatric tertiary care centres in Canada. The interview guide was structured using the IHI framework, to characterize initiatives, as well as facilitators and barriers, to address health equity. We performed a thematic analysis using NVivo. Codes were generated using an inductive and deductive approach, from which themes were identified, refined, and finalized.

Results

We conducted 41 interviews from Fall 2021 to Fall 2022. Recent events, including Black Lives Matter and the COVID pandemic, fuelled health equity initiatives at the hospital- and university-levels. Most institutions were in a reactionary state, with few having formal strategic approaches to address inequities. The initiatives served a variety of priority populations: Indigenous, Black, migrants, rural communities, and children with disabilities, with the focus differing based on geography and the unique challenges faced by each institution. To achieve equity throughout an organization, equity at the staffing level was identified as being a necessity. The barriers to implementing health equity initiatives included lack of accountability, lack of leadership support, limited resources, and lack of institutional awareness. The facilitators included leadership support, health equity champions, and increasing awareness and resources.

Conclusion

A myriad of health equity initiatives are taking place in Canadian paediatric tertiary care centres, which are evolving.
28 Lost in Translation: Canadian Paediatric Resident Education and Practice of Clinical Translation Services
Authors: Peters Sarah , Carwana Matthew , Peebles Erin
Published: September 2023

Background

Canadian paediatric residents provide care to many families with non-English or French language preferences (NEFLP). Lack of communication in a family’s preferred language is inequitable and results in inferior care. Professional medical interpreters offer a route to enhanced understanding and safety. There is no data available about Canadian paediatric residents’ use of interpreters, making it difficult to identify gaps in practice or develop targeted interventions to improve patient experience.

Objectives

An anonymous, 19-item survey (REDCap) was designed to evaluate: (1) interpreter services available in paediatric training centers; (2) resident perception of their ease of access, utility, and value; and (3) barriers and drivers to interpreter use. This survey represents the first collection of data from Canadian paediatric residents about translator services.

Design/Methods

Eligible participants included all paediatric residents enrolled in an accredited Canadian paediatric training program. The survey was distributed by email and available for a three-month period. This project was reviewed and considered within the category of quality improvement and thus exempt from formal review by the hospital ethics committee. Descriptive statistics were performed in STATA v15.1.

Results

122 residents (approximately 19% of eligible participants) responded. Approximately 40% reported no previous training in interpreter use, and 60% desired more training. Interpreter services are widely available but remain underused in a variety of clinical situations: interpreters are most often used during informed consent (98% ‘mostly’ or ‘always’), family meetings (97%), and history-taking (86%), and least often during physical examinations (41%) and bedside rounds (38%). Residents are more likely to use an interpreter if access is easy (97% ‘more likely’ or ‘likely’) or if there is extra time for the encounter (78%). Most residents (85%) felt they provide better care to patients who share their primary language (English or French), compared with families who prefer other languages.

Conclusion

Residents are more confident in their clinical and communication skills when working with families who share their primary language compared with NEFLP families, even when an interpreter is present. Our findings suggest that residents lack the training and confidence to provide equal care to families with varying language preferences. Paediatric training programs should develop curriculum content that not only targets safe and effective interpreter use, but also reviews non-spoken aspects of cultural awareness and safety.
32 Risk Factors for Iron Deficiency in Formula-fed very Preterm Infants: A Population-based Study from Nova Scotia
Authors: Power Grace , Stratas Alexandra , Landry Carmen , Morrison Lisa , Kulkarni Ketan , Campbell-Yeo Marsha , Singh Balpreet , Higgins Michelle , Ghotra Satvinder
Published: September 2023

Background

Iron prophylaxis is routinely recommended for preterm infants, as they are vulnerable to develop iron deficiency (ID). Recent work from our group has demonstrated that despite early iron prophylaxis, ID is common in very preterm infants (VPI), with an incidence of 32% at 4 to 6 months corrected age (CA). Additionally, ID is more prevalent in exclusively formula-fed (FF) VPI compared to infants who are exclusively or partially breast-fed.

Objectives

To explore the risk factors associated with ID in the FF infants.

Design/Methods

A retrospective population-based cohort study was conducted using a provincial database. All VPI born in Nova Scotia from 2005 to 2018 who were exclusively fed with iron-rich formula (>10 mg/L) at 4 to 6 months CA were included. Information about formula type, iron intake from formula, and supplemental iron therapy at 4- to 6-month follow-up was extracted, as were neonatal variables. ID was defined as serum ferritin <20 and <12 mcg/L at 4- and 6-months CA, respectively.

Results

ID was present in 36.8% (105) of 285 FF infants. Table 1 shows key characteristics of ID and non-ID FF infants. Mean gestational age and birth weight were lower in the ID group. More babies in the ID group received blood transfusion (Odds:1.1-3.0). Other maternal and neonatal variables were comparable between the groups. ID children did not have a lower iron intake than non-ID children.

Conclusion

Lower gestational age, lower birth weight, and need for blood transfusions increased the risk of ID in FF infants. Optimal iron supplementation in this population should be guided by a risk-adapted strategy.
33 Gluten-free Diet Knowledge and Adherence in Adolescents with Celiac Disease: A Cross-sectional Study
Authors: Pohoreski Katherine , Horwitz Simonne , Gidrewicz Dominica
Published: September 2023

Background

Adolescents with celiac disease (CD) are at risk for non-adherence to the gluten-free diet (GFD). Knowledge of the GFD may impact adherence.

Objectives

To examine the relationship between knowledge and adherence to the GFD in a local population of adolescents with CD. Secondary objectives were to identify information sources used to learn about the GFD and to compare adolescent and parent knowledge of the GFD.

Design/Methods

Adolescents (12-17 years) with CD and their parents from local paediatric gastroenterology clinics completed an online survey containing a knowledge assessment (Gluten-Free Diet Quiz [GFD-Q]), validated adherence scale, GFD information sources, and demographic/clinical information. GFD-Q scores were categorized as “sufficient knowledge” based on correctly identifying: 3/3 gluten-containing foods, at least 4/7 gluten-free foods, and at least 4/7 foods that may contain gluten. Otherwise, scores were termed as indicating “insufficient knowledge”.

Results

Of 40 adolescents, 15/40 (37%) had sufficient knowledge and 25/40 (63%) had insufficient knowledge. Within the insufficient knowledge group, 14/25 (56%) did not correctly identify enough allowed, gluten-free foods. Parents scored higher on the GFD-Q (67% with sufficient knowledge). Adolescents reported overall adherence to the GFD (88%), with adherence similar between sufficient and insufficient knowledge groups (80% vs. 92%). Most helpful information sources include physicians, another person with CD, parent(s), and Google (online search engine). Apps were infrequently used (20% of adolescents).

Conclusion

Adolescents report good adherence, but struggle with knowledge of the GFD, particularly in identifying gluten-free foods. Further research is required to explore GFD educational tools, including mobile apps and dietician-led teaching sessions.
34 Using Spatial Analysis to Identify Access to IFHP-registered Paediatric Providers in Ontario
Authors: Abeytunge Kawmadi , Alemayheu Gelila , Miller Michael , Suleman Shazeen , Gunz Anna
Published: September 2023

Introduction/Background

Compared to non-refugees, child refugees face a wide array of health disparities, including higher levels of nutritional deficiencies, infectious diseases, and mental illness secondary to experienced poverty, trauma, and migration. After migration, refugee families continue to face health inequities, necessitating access to health care. In Canada, the Interim Federal Health Program (IFHP) provides temporary health care benefits to refugees and refugee claimants who are ineligible for provincial or territorial health insurance. The program requires healthcare providers to register to be reimbursed for care provided. However, physicians are not required to register for IFHP, leading to fewer providers.

Objectives

This study aimed to map where IFHP-registered primary care physicians (PCPs) and paediatricians live and work in Ontario, relative to where IFHP-insured patients live, to identify geographic accessibility of primary healthcare services for paediatric refugee populations.

Design/Methods

We performed spatial analysis using ArcMap (version 10.8.2), a geographic information system (GIS). The practice location of PCPs and paediatricians registered for IFHP as of December 2021 were geocoded and the percent of IHFP provider per population for each Census Tract (CT) was calculated. Refugee populations eligible for IFHP in Ontario by CT, as identified by the 2016 Canadian Census, were calculated as percentages and per 10,000 population, and linked to geospatial data for comparison. Ratios of IFHP providers to refugees were calculated for each CT.

Results

At the time of data collection, there were 481,710 documented refugees living in Ontario, and 11,854 IFHP-registered paediatricians or PCPs. Toronto, Windsor, and Kitchener-Waterloo had the largest percentages of refugees per population (5.4%, 5.1%, and 4.6%, respectively), while Toronto, Hamilton, and London had the highest percentage of IFHP providers per population (0.13%, 0.11%, and 0.09%, respectively). Generally, CTs with the highest proportion of refugees had more IFHP-registered providers, and rural areas had the fewest number of both refugees and IFHP-registered providers. However, there were 941 CTs recognized across Ontario with identified refugee populations but no registered IFHP providers. The CTs with the highest ratio of IFHP providers to refugees were in Toronto and Ottawa (3.9, 2.0 in Toronto, and 2.1 in Ottawa, respectively).

Conclusion

While some regions with large refugee populations have registered IFHP PCP providers, there are regions that are relative IFHP provider-deserts for resident refugees. Identifying areas where geographic barriers are likely to exist in Ontario is necessary to improve accessibility of existing services and could help reduce healthcare inequities faced by the refugee population.
35 Estimating the Impact of Pregnancy and Childbirth Interventions Coverage on Neonatal Survival during the COVID-19 Pandemic in Nepal
Authors: Dharel Dinesh , Paudel Deepak , Muhajarine Nazzem
Published: September 2023

Background

The indirect impact of the COVID-19 pandemic on neonatal survival, especially in a resource-constrained and yet previously well-performing nation and in terms of reductions in maternal and neonatal mortality rates, is of global health interest.

Objectives

We estimated additional newborn lives saved by pregnancy and childbirth interventions during the COVID-19 pandemic in Nepal.

Design/Methods

We used an open-access linear deterministic model, Lives Saved Tool (LiST), to estimate additional newborn lives saved in a year, based on the change in coverage of specified pregnancy and childbirth interventions from the previous year. We kept the rest of the interventions and the effectiveness values unchanged from the ‘default’ in the LiST model. We ran LiST projections based on coverage changes of three or more antenatal care visits and institutional delivery using: (i) ‘actual’ coverage rates reported by health facilities and published in the government’s annual reports; and (ii) ‘target’ coverage rates from the Nepal Every Newborn Action Plan. In those two scenarios, we compared the estimates of additional lives saved in the last three years.

Results

The number of additional newborn lives saved (with a 95% confidence interval) in a year based on ‘actual’ versus ‘target’ intervention coverage rates varied considerably during the three years of the COVID-19 pandemic: 124 (95% CI: 85,177) vs 115 (78,163) in the year 2020; 83 (57, 118) vs 226 (155,323) in 2021, and 228 (156,323) vs 333 (228,471) in 2022. The top four interventions during childbirth would contribute to 70% (304 of 435) of additional lives saved, based on ‘actual’ coverage rates, compared to 87% (588 of 674) based on the ‘target’ coverages. Neonatal resuscitation saved the most newborn lives (91 vs 178), followed by thermal protection (77 vs 148), clean cord care (72 vs 138), and assisted vaginal delivery (64 vs 124). Prematurity, birth asphyxia, and sepsis are the top three causes of lives lost, contributing to around 72% of neonatal mortality, with estimated neonatal mortality rates of 19.46, 19.53, and 19.28 per 1000 live births in the years 2020, 2021, and 2022 respectively.

Conclusion

A one-third reduction in estimated additional newborn lives saved in the year 2021 compared to 2020, and a significant difference noted that same year on estimates based on ‘actual’ versus ‘target’ coverage rates of antenatal care and institutional delivery in Nepal, may reflect an indirect impact of reduced coverage of pregnancy and childbirth interventions on neonatal mortality during the peak of the COVID-19 pandemic.
36 Quality Improvement Integrated Kangaroo Mother Care (QIiKMC)-Development with Evidence-based Practice for Improving Quality (EPIQ) to Improve Learning and Implementation
Authors: McMillan Doug , Singhal Nalini , Kyoyagala Stella , Niermeyer Susan , Kabirigi Julieth , Keenan William , KC Ashish , Kamaluddeen Majeeda , Aziz Khalid
Published: September 2023

Introduction/Background

Kangaroo Mother Care (KMC) improves outcome for small newborns, but implementation has been slow. This lag may be associated with lack of short, effective learning programs for healthcare workers, and limited ability to overcome barriers to KMC program development.

Objectives

To develop a practical learning program for KMC with focus on facilitating healthcare workers assisting the learning of mothers and other family members in KMC care of small babies. To integrate KMC with quality improvement to assist healthcare workers overcome barriers to implementation and improve practice.

Design/Methods

Six neonatologists, with other global experts, developed as simulation-based, interactive, 12-contact-hour learning program with virtual pilot testing in Uganda, Tanzania, and Nepal, prior to implementation in Mbarara Regional Referral Hospital in Uganda. Revisions in QIiKMC course content and integration with quality improvement were accompanied by development of A KMC Readiness, Survey, Knowledge and Confidence Check, Parent Information, and Course Evaluation, with all components available at www.cnf-fnc.ca.

Results

Thirty-three nurses and physicians increased knowledge scores from 79% to 88% post-learning. 77% indicated the course was useful or very useful, appreciating “The link between EPIQ and KMC in identification and solving problems” and the “Usefulness of family involvement in caring for the newborn in the hospital and home”. Participants indicated preferences for face-to-face learning and more time for hands-on practice. KMC for small babies increased from 0% to 65% (by August-October 2022). Length of hospital stay decreased by 5 days. Government increased KMC beds from 4 to 8. Staff reported increased job satisfaction along with increased quality improvement activities. Family members in addition to mothers were involved (especially with multiple births or if the mother was ill). Families helped other families with learning. One father reported that “When my baby grows up, I will let him know that it was my warmth which kept him alive”.

Conclusion

Development of a short, practical KMC learning program was feasible. Integration with quality improvement was empowering and impactful.

Acknowledgements

Funding from the Royal College of Physicians and Surgeons of Canada and a Rotary Global Grant is appreciated.

Potential competing interests

Funding for learning program development was received from the Royal College of Physicians and Surgeons of Canada. Funding for KMC implementation in Uganda was supported by a Rotary Global Grant.
Poster ID: 39 How is Paediatric Inpatient Care in Canadian Hospitals Structured to Respond to the Needs of Children with Medical Complexity?
Authors: Miandoab Sadaf Ghanbari , Dewan Tammie , Buchanan Francine , Gaucher Nathalie , Gill Peter , Lim Audrey , McKinnon Alexandra
Published: September 2023

Background

Children with medical complexity (CMC) have diverse medical diagnoses and the following characteristics: multisystem disease, functional limitations, high care needs, and high healthcare utilization. CMC have intensive inpatient resource use with associated high healthcare costs. Best practices and service delivery models to guide inpatient care of CMC are not yet established and likely vary considerably among institutions.

Objectives

The objective of this study is to describe the availability and organization of resources for CMC during inpatient care across Canadian paediatric hospitals and assess how these services are adapted to the specific needs of CMC.

Design/Methods

This environmental scan was conducted as a cross-sectional, researcher-administered virtual survey. The instrument was developed based on a literature review of inpatient complex care and consensus among a panel of content experts. The survey was pilot tested with two complex care physicians and one with expertise in questionnaire development. The survey was available in both English and French.

Survey participants were identified through snowball sampling within the Canadian Paediatric Inpatient Research Network (PIRN) with the aim of identifying a key informant from each paediatric hospital. Consistent members of the research team administered survey questions to participants via Zoom, and responses were entered into the Qualtrics platform. Quantitative survey responses were analyzed using univariate descriptive analysis. Qualitative responses were categorized and described for comparative purposes.

Results

Ten interviews were conducted representing ten different paediatric hospitals. Although nine had established complex care programs, only one of these had a specific inpatient care team for CMC. The physician-to-patient and nurse-to-patient ratios were the same for CMC and non-CMC patients. All sites had some form of standardized documentation to support inpatient care of CMC, but each had different elements and purposes. Only two sites had conducted formal evaluation of their inpatient program for CMC. Key informants rated their hospital’s ability to meet the specific inpatient needs of CMC as a 6.5 out of 10 (on average), with a range of 4-8.

Conclusion

These results suggest a relative lack of inpatient resources directed to CMC, with a high proportion of sites having a complex care program but with few that include a dedicated inpatient team. Further, there is a lack of standardization across the country in terms of documentation and best practices. Key informants perceive room for improvement in inpatient care at their sites. Future studies will identify evidence-based best practices that can be further evaluated and spread.
40 Analgesia in Sickle Cell Disease: Do We Give the Right Dose? A Systematic Review of Pharmacokinetic Studies
Authors: Kleiber Niina , Czech Ann-Sophie , Bernier Gabrielle , Pastore Yves , Doré-Bergeron Marie-Joëlle , Trottier Evelyne D , Théorêt Yves , Autmizguine Julie , Pincivy Alix
Published: September 2023

Background

Children with sickle cell disease (SCD) suffer from lifelong episodes of unpredictable acute pain that alter their quality of life. Despite prompt pain treatment, hospitalization is often required for pain management. SCD is a multisystemic disease affecting organ function (e.g., renal hyperfiltration, change in liver blood flow). Altogether, these changes could alter pharmacokinetics (PK).

Objectives

We hypothesize that SCD leads to changes in PK of analgesics potentially contributing to treatment failure using regular medication doses.

Design/Methods

A systematic literature review to describe the current evidence on the effect of SCD on analgesic disposition in children was performed by a librarian on 5 databases from inception until February 2021 and independently assessed by two reviewers. All full text articles, including PK data in children with SCD, were included. The reported differences in PK parameters between children with and without SCD were examined.

Results

Among 5170 retrieved abstracts, 84 full text articles were reviewed, and 7 studies were included on 128 patients. Studied drugs were morphine (IV and PO), lidocaine (IV), methadone (IV) and rofecoxib (PO). In children with SCD, clearance of IV morphine was 42-61% higher compared with non-SCD controls. Hepatic metabolism of lidocaine was decreased in children with SCD compared to healthy controls. No significant PK changes were noted for methadone and rofecoxib compared with non-SCD controls.

Conclusion

SCD leads to significant changes in PK of analgesics, but data are scarce. Increased clearance of morphine suggests that higher doses may be needed in children with SCD. Data on commonly used analgesics like acetaminophen, ibuprofen and ketamine are critically missing. Dosing of analgesics adapted to SCD are needed and may potentially improve pain control in this population.