bluuebunny/crossref_metadata_2025_split huggingface dataset:
54 Consistency in a Pediatric Developmental Disability Elective for Preclinical Medical Students: Five Years of Student Experience
Authors: Simin Irina , Thornton Siobhan , Fong-Leboeuf Alexis , Andrews Debra 
Published: August 2020

Abstract

Background
There is an increasing recognition for medical students to receive more training in caring for patients with developmental disabilities (PWDD). Studies have found that providing training and encounter opportunities with PWDD for medical students improves their attitudes, comfort level, and knowledge. PWDD can have more sensitivity to changes in health than others, highlighting the importance of providing educational opportunities for medical professionals. To mitigate these outcomes, this preclinical 12-hour elective: “Developing Skills for Developmental Disabilities” (DSDD) was developed with the primary learning objective of improving students’ knowledge of and attitudes toward developmental disabilities in pediatrics.

Objectives
The current study’s objective was to evaluate the consistency of students’ perceived confidence ratings in assessing and managing children presenting with developmental delay or disability, despite changes in workplace educational setting across 5 years.

Design/Methods
Students received 6 hours of content-specific didactic teachings in addition to the standard second year developmental pediatrics curriculum. Content was provided by a team of developmental pediatricians and physiatrists. Didactic session topics included child development, estimating developmental age, assistive technologies, and breaking bad news, to supplement the 6 hours of clinical experience at a rehabilitation hospital. Students attended medical assessments with the opportunity to conduct a brief interview with the child’s family, observe pediatric PWDD in treatment programs, and interact with interdisciplinary teams. Students were given pre- and post-elective self-assessment surveys administered on a 5-point Likert scale. Questions pertained to students’ self-perceived comfort and knowledge regarding pediatric PWDD. Scores pre- and post-elective were used to calculate relative improvement of participants.

Results
120 students enrolled in DSDD, with 94 students meeting elective requirements. On average, 77.2% (SD = 6.2%) of students were female and 81.4% (SD = 12.9%) reported having prior experience with PWDD. Statistically significant (p&lt;0.05) relative improvements were present in 9 of 10 scores for 2 of 5 years and all 10 in the other 3 years. Improved scores involved increases in confidence in interacting with PWDD, taking histories, recommending appropriate resources to families, and estimating developmental age.

Conclusion
DSDD may support acquisition of clinically relevant skills beyond those learned in the standard curriculum, as students consistently reported improvements in confidence across the same domains over 5 cohort years of this elective. The demonstration of maintained improvement is important because it may be translatable to future clinical practice and have implications towards optimizing outcomes for pediatric PWDD.
55 Profiles of Sleep Problems among Young Children with Autism Spectrum Disorders
Authors: Zwaigenbaum Lonnie , Zaidman-Zait Anat , Duku Eric , Bennett Teresa , Mirenda Pat , Smith Isabel , Szatmari Peter , Vaillancourt Tracy , Waddell Charlotte , Elsabbagh Mayada , Georgiades Stelios , Kerns Connor , Ungar Wendy 
Published: August 2020

Abstract

Background
Sleep problems are more common and severe among children with autism spectrum disorder (ASD) compared to their typically developing peers. The goal of this study was to characterize sleep problems profiles and their clinical correlates, based on a five-factor model of the Children’s Sleep Habits Questionnaire (CSHQ) among preschool children with ASD.

Objectives
(1) To describe empirically-derived patterns (i.e., latent profiles) of sleep problems among young children with ASD; and (2) To examine relations between family cumulative risk and emotional-behavioral dysregulation symptoms and sleep profile membership.

Design/Methods
The study included 318 three-to-five year old children (M= 49.45 months; SD = 5.77). Latent profile analysis was used to identify and describe profiles of sleep problems. Sleep problems were assessed using a previously established CSHQ five-factor model: (1) Bedtime Routine; (2) Sleep Onset & Duration; (3) Night Waking; (4) Morning Waking; and (5) Sleep Disordered Breathing, with higher scores indicating greater problems. We assess whether profile membership was associated with dysregulation difficulties (CBCL 1.5-5) and family cumulative risk index (CRI; constructed based on socioeconomic status, maternal distress, family functioning, and other related factors) using a three-step method (Vermunt & Magidson, 2013).

Results
A five-profile model of children’s sleep problems showed the best fit (Figure 1). Profile 1, Nighttime Sleep Problems (28%), consisted of children with scores around the sample mean, except relatively lower scores on Morning Waking. Profile 2, Severe Sleep Problems (25%), consisted of children with relatively high scores across all sleep problems. Profile 3, Low Sleep Problems (18%), included children with the lowest levels of all sleep problems. Profile 4, Moderate Sleep Problems (17%), included children with all sleep problem levels near the sample mean. Profile 5, Morning Waking Problems (12%), consisted of children with low scores on Bedtime Routine problems but pronounced Morning Waking problems. Dysregulation difficulties (Wald = 13.90; p = .001) and family CRI (Wald = 13.27; p =.001) emerged as significant predictors of profile membership. Higher CRI was associated with higher odds of membership in Profile 2 (Severe Sleep Problems), and lower scores for dysregulation difficulties were associated with higher odds of membership in Profile 3 (Low Sleep Problems).

Conclusion
Children with ASD present distinct profiles of sleep problems that differ, not only by overall severity, but also by relative severity across types of sleep problems. Children’s dysregulation and family risk should be considered in examining children’s sleep.
56 Asking about psychosocial risk factors as part of developmental surveillance: what do parents think about it?
Authors: Plaisance Madeleine , Bourque Claude-Julie , Cousineau Dominique , Chabot Marie-Kim , Valderrama Alena , Lemieux Danièle , Simard Marie-Noelle , Luu Thuy Mai , Gosselin Julie 
Published: August 2020

Abstract

Background
Child development is influenced by the psychosocial environment. As part of developmental surveillance, identifying psychosocial risk factors that could hinder optimal development is therefore important. However, whether parents consider this type of question pertinent and acceptable remains unknown.

Objectives
To examine parental perception regarding the acceptability of asking questions about psychosocial background as part of a standardized developmental surveillance questionnaire.

Design/Methods
Using an online questionnaire and a snowball sampling approach, we surveyed parents living with at least one child &lt;12 years of age over a 6 week-period. They were asked to rank acceptability on a 5-point Likert scale of four psychosocial and two medical indicators related to child development and to justify their answer. Descriptive statistics were computed and qualitative thematic content analysis was done on textual comments.

Results
Of 1651 participants, 97% were mothers and 93% declared having a post-secondary degree. Median age was 34 years old (interquartile range 31-38). An overwhelming majority found acceptable the questions about concerns regarding their child development (99%) and family history of developmental problems (95%). Psychosocial indicators were considered acceptable in the following proportions: substance abuse (84%), food insecurity (77%), past maternal history of depression (74%), and education level (65%). Higher rates of acceptability correlated with higher educational levels. Main themes that emerged regarding unacceptability were as follows: questions being offensive or intrusive, questions not relevant to child development, improper physical environment to ask such questions and lack of relationship with the health care professional in charge.

Conclusion
As part of developmental surveillance, questions on psychosocial risk factors can be disturbing to parents and must be addressed in a trusting environment and with a sensitive manner.
61 Cow’s milk fat and child adiposity: a prospective cohort study
Authors: Vanderhout Shelley , Keown-Stoneman Charles , Birken Catherine , Thorpe Kevin , O’Connor Deborah , Maguire Jonathon 
Published: August 2020

Abstract

Background
International guidelines recommend that children older than 2 years of age consume reduced fat (0.1-2%) instead of whole cow’s milk (3.25% fat) to prevent childhood obesity, but these guidelines are consensus-based and have a low GRADE level of evidence.

Objectives
The primary objective of this study was to evaluate the longitudinal relationship between cow’s milk fat (0.1-3.25%) intake and Body Mass Index z-score (zBMI) in children aged 9 months to 8 years. The secondary objective was to determine the relationship between cow’s milk fat intake and odds of overweight (zBMI &gt;1) and obesity (zBMI &gt; 2).

Design/Methods
A prospective cohort study of children 9 months to 8 years of age was conducted through the TARGet Kids! primary care research network. The primary exposure was cow’s milk fat consumption (skim (0.1%), 1%, 2%, or whole [3.25%]), measured by parental report. The primary outcome was zBMI, an age and sex adjusted measure of child adiposity. Height and weight were measured by trained research assistants and zBMI was determined according to the WHO growth standards. A linear mixed effects model and logistic generalized estimating equations were used to determine the longitudinal association between cow’s milk fat intake and child zBMI.

Results
Among children aged 9 months to 8 years of age (N= 7467), each 1% increase in cow’s milk fat consumed was associated with a 0.05 lower zBMI score (95% CI -0.07 to -0.03, p&lt; 0.0001). Compared to children who consumed reduced fat (0.1-2%) cow’s milk, there was evidence that children who consumed whole cow’s milk had 16% lower odds of overweight (OR=0.84, 95% CI 0.77 to 0.91), p&lt; 0.0001) and 18% lower odds of obesity (OR= 0.82, 95% CI 0.68 to 1.00, p= 0.047).

Conclusion
Guidelines for reduced fat instead of whole cow’s milk during childhood may not be effective in preventing overweight or obesity. Randomized controlled trial data is needed to understand which cow’s milk fat optimizes child growth, development and nutrition.
63 A Needs Assessment of Syrian Refugee Families Regarding a Children & Youth Health Promotion Program in Arabic
Authors: Jaafar Ahmad , Al-Hashemi Eiman , Bahabri Aban , Alrowayshed Mohammed , Hunter Andrea , Canisius Elisabeth 
Published: August 2020

Abstract

Background
Refugee families, particularly children and youth, are considered a vulnerable population. They face many health concerns, including barriers to accessing the healthcare system, which may stem from lack of familiarity with the health care system. Despite the great efforts Canada is putting forward to address newcomer needs, there are limited health promotion efforts directed at Arabic-speaking refugee families, particularly in the wake of the influx of Syrian families since 2015. In fact, there is a lack of well-structured, evidence-based, health promotion program, specifically focusing on Arabic-speaking refugee children and youth.

Objectives

Design/Methods
We took a qualitative approach, in which semi-structured interviews were audio-recorded, transcribed, translated, coded and analyzed using a qualitative framework technique. Six focus groups were conducted, in which a total of 25 Arabic-speaking refugee parents were interviewed by Arabic-speaking interviewers.

Results
Among the 25 participants, 18 reported that they were not aware of existing health promotion presentations in our local area. Moreover, none of the 7 participants who were aware of such presentations have ever attended any. The major reason reported is not being invited to attend. Additionally, of the 25 participants, 24 have expressed their desire of having a child and youth health promotion program in Arabic. Among the most requested topics to be presented include medication coverage and pharmacy access in Canada, first-aid management, dental care, interpretation services, healthy lifestyle, fever measurement and management, prevention of unintentional injuries, navigating the Canadian healthcare system and mental health. Moreover, several factors were described to facilitate the families’ attendance to the health promotion presentations. These include presenting about topics of relevance to the refugee families, having the presentations in Arabic, providing parking spaces, having someone to accompany the families’ children during the presentations, arranging the presentations over the weekend or after 5 pm during the weekdays and holding the presentations in a place close to where the families live.

Conclusion
Arabic-speaking refugee families describe strong interest in attending in-person health promotion sessions in Arabic, focusing on child and youth health, and outline diverse topics of interest.
66 Piloting a respectful challenges workshop in pediatric residency training
Authors: Martin Ashley , Manos Sarah 
Published: August 2020

Abstract

Background
Unaddressed conflict has been shown to negatively impact resident wellness and patient safety, and development of communication and conflict resolution skills are key competencies in medical education. While there are a number of existing communication training programs directed at healthcare providers, these can be costly and difficult to accommodate in an already packed curriculum. We developed a conflict resolution workshop to address local conflict scenarios facing our residents that could be integrated into our program curriculum at no cost.

Objectives
Evaluate resident satisfaction with the addition of a “respectful challenges” workshop to our training program’s academic curriculum.

Design/Methods
We designed a two- hour workshop for pediatric residents at our institution focusing on addressing conflict during residency training. A didactic lecture outlining different approaches was followed by three role-playing scenarios with coaching (conflict with another resident, allied health and faculty). The workshop was facilitated by a senior resident and faculty identified by residents as “approachable”. Residents (PGY1-4) were asked to evaluate the workshop’s content and effectiveness as well as their own comfort addressing conflict using pre and post-surveys with Likert scales. Results of the survey were analyzed using descriptive statistics.

Results
A total of 15 residents were involved in the workshop and completed the pre and post surveys. Eleven were female. Six indicated that they had some form of previous training in conflict management. All residents reported having experienced workplace conflict at least a few times per year, but most said they didn’t always address it (73%). Twelve (80%) thought it was either “quite” or “extremely important” that conflict resolution skills be taught in residency.
All 15 residents felt that the scenarios represented real life and that the format was an appropriate way to discuss conflict in the workplace. The majority of residents felt the workshop helped them better understand their approach to conflict and allowed them to feel better prepared to face challenges in the future (14/15 and 11/15 rated as “quite” or “extremely”). Eighty percent of residents reported that they would feel more comfortable addressing workplace conflict after the workshop.

Conclusion
This concise workshop provided a foundation on conflict resolution for our residents. The use of role play and coaching during simulated scenarios was well received, and residents reported increased comfort approaching workplace conflict in the future. Further evaluation will be important to determine if residents translate these skills into practice.
67 Airway Skills in Paediatrics: Infants are Not Just Little Children
Authors: White Jessica , Rowan-Legg Anne , Chanchlani Rahul , Writer Hilary , Gupta Ronish 
Published: August 2020

Abstract

Background
Airway skills such as intubation and bag-valve-mask ventilation (BVM) have historically been considered necessary skills for all general paediatricians. Recently, evidence has driven practice toward goals of reduced invasive respiratory intervention and support. While patient outcomes have improved, implications include reduced airway skill training opportunities for paediatric residents, and possibly challenges in maintaining proficiency for practicing paediatricians. From postgraduate and continuing professional educational perspectives, the specific airway skill needs for Canadian paediatricians in contemporary practice are unclear.

Objectives
Identify those airway skills that are critical to general paediatric practice in Canada, and whether the skill needs differ by patient age.

Design/Methods
Data on general paediatric procedural practice was collected in 2018 via a one-time survey through the Canadian Paediatric Surveillance Program. A database was created from the 938 collected responses. The survey asked paediatricians to indicate the frequency of performance, opinion of importance, and challenges in maintaining proficiency of various airway procedures. Data was analyzed descriptively, and questions discriminating infant (age &lt; 2y) vs. child (age ≥ 2y) were compared by chi-square or Fisher’s exact test, as appropriate.

Results
In total, 481 (51.3%) respondents worked ≥ 50% in general paediatrics and formed the main analysis group. Responses represented broad ranges of career duration, national geography, and practice settings. BVM of infants was the most commonly performed procedure, with 196 (40.8%) performing this monthly. Infant intubation was performed monthly by 58 (12.1%). A total of 355 (73.8%) and 402 (83.6%) reported never performing laryngeal-mask airway insertion and tracheostomy tube exchange respectively. Both BVM and intubation were performed significantly more frequently in infants than in children (p &lt; 0.001). While many respondents considered BVM and intubation of children as essential skills, significantly more rated performing these skills on infants as essential to their practice (p &lt; 0.001). Of those paediatricians that performed procedures as part of their practice, 68/309 (22.0%) and 192/304 (63.2%) reported difficulty in maintaining proficiency in the skills of infant BVM and intubation respectively.

Conclusion
Although variably utilized, airway skills in infants and children remain a core aspect of practice for many general paediatricians. Specifically, skills related to infants were performed more frequently and were more often rated as essential. Most respondents felt it was challenging to maintain proficiency in several airway skills. Accordingly, airway skills, especially those involving infants, should be emphasized in paediatric residency programs and continuing professional development activities.
76 The predictive validity of MyHEARTSMAP for psychosocial screening in the emergency department
Authors: Atwal Amanbir , Doan Quynh , Wright Bruce , Hankinson Elizabeth , Virk Punit , Azizi Hawmid , Stenstrom Rob , Black Tyler , Gokiert Rebecca , Newton Amanda 
Published: August 2020

Abstract

Background
Mental health concerns in childhood and adolescence are prevalent, affecting nearly one million Canadian youth. In the absence of screening, up to 98% of these concerns can go undiagnosed, leading to significant health, educational, and social consequences. Consequently, the American Academy of Pediatrics recommends the development of screening tools to facilitate early identification and access to treatment.
The Emergency Department (ED) represents a unique environment to implement such universal screening, as it is immediately accessible and may be the only point of contact for some vulnerable youth with undiagnosed illness. However, there are few existing instruments which take into account commonly cited barriers such as time constraints, disruption of ED flow, limited resources, and patient privacy.

Objectives
To facilitate efficient screening with minimal impact on ED flow, our team developed MyHEARTSMAP, an electronic self-administered screening tool. The tool is adapted from HEARTSMAP, a previously validated computerized assessment and management tool used by ED clinicians. MyHEARTSMAP has previously been evaluated for face validity and inter-rater reliability. Here, we measured the sensitivity and specificity of MyHEARTSMAP in identifying mental health concerns in youth.

Design/Methods
A prospective cohort study was conducted at two tertiary care pediatric EDs. Eligible youth aged 10-17 years presenting for a non-mental health complaint were invited to self-screen using MyHEARTSMAP. An accompanying parent/guardian could also complete an assessment of their child. The sensitivity and specificity was measured as the proportion of screened youth with mental health concerns identified through self-assessment by MyHEARTSMAP compared to assessment performed by a clinician (criteron standard).

Results
760 youth and/or parents completed the study intervention. The sensitivity at identifying any psychiatric concerns was comparable between youth and guardian assessments: 92.7% (95%CI: 89.1, 95.4%) and 93.1% (95%CI: 89.5, 95.8%) respectively. The specificity at identifying youth without any psychiatric issues was also comparable between youth and their guardians: 42.2% (95%CI: 37.3, 47.3) and 37.0% (95%CI: 32.2,42.1), respectively.

Conclusion
MyHEARTSMAP is sensitive for identifying youth with mental health concerns. While it showed only modest specificity, false positives were almost entirely (98%) mild issues identified by youth and deemed to be normal by clinicians. This would not place a burdensome demand on mental health services and could be effectively assessed without specialized psychiatric training. Thus, MyHEARTSMAP may be an effective tool for early identification and management of mental health concerns.