bluuebunny/crossref_metadata_2025_split huggingface dataset:
49 Rooming-In to Treat Neonatal Abstinence Syndrome
Authors: Piteau Shalea , Vyas Meera , Papadakos Peter 
Published: August 2020

Abstract

Background
Ontario has been facing a steady rise in the number of individuals abusing narcotics. Newly implemented rooming-in programs in Ontario have allowed infants of opioid-dependent mothers to stay in the same room as their mother while the infant continues to be monitored for signs of neonatal abstinence syndrome (NAS).

Objectives
To retroactively review the impact of a rooming-in program for babies at risk of NAS on the need for pharmacologic treatment and length of stay in one community hospital site in Belleville, Ontario.

Design/Methods
Belleville General Hospital developed a rooming-in program for newborns at risk of NAS in July 2015. Prior to its inception, the standard of care was to admit these infants to the special care nursery for monitoring and treatment. Charts were reviewed to collect data on infants born to mothers using opioids in the 24 months prior to (July 2013 – June 2015) and after (July 2015 – June 2017) the implementation of our program. The two groups were compared for the primary outcomes studied, including the number of babies started on morphine and length of stay in hospital. Secondary outcomes were also examined, including breast feeding rates, resource intensity weight, and total hospital cost.

Results
Rooming-in is associated with a reduction in the need for treatment with morphine, shorter length of stay in hospital, improved breast feeding rates, and lower total hospital cost.

Conclusion
Our study demonstrates that rooming-in programs for babies born to mothers using opioids have benefits in terms of quality of care and health care resource utilization. These findings add to the existing literature on NAS that rooming-in can be successfully implemented in a community hospital.
73 Sleep Duration and Internalizing Symptoms in Children
Authors: Wu Liliana , Charach Alice , Keown-Stoneman Charles , Birken Catherine , Constantin Evelyn , Maguire Jonathon , Stremler Robyn 
Published: August 2020

Abstract

Background
Emotional problems such as anxiety and low mood have been associated with sleep problems in children.

Objectives
This study’s objective was to assess the association between sleep duration and internalizing symptoms in children age 5-12 years (y). Next, we evaluated whether meeting the National Sleep Foundation’s guidelines for sufficient sleep (≥10 hours, age 3-5; ≥9, age 6-12) is associated with internalizing symptoms.

Design/Methods
A cross-sectional study in N = 800 healthy children ages 5-12y, recruited from primary care physicians’ offices in Toronto, Canada was conducted through TARGet Kids! research network. Using linear regression, we investigated the association between parent reported sleep duration (hours) and parent reported internalizing symptoms using the Strengths and Difficulties Questionnaire (SDQ), controlling for child age, sex, zBMI, family composition, and maternal education.

Results
The adjusted model showed an inverse association between sleep duration and internalizing symptoms (β estimate = -0.33 (95%CI -0.57, -0.07), p=0.011). Of children aged 6-12y, 36 (6%), and of those aged 5y, 28 (14%) did not meet guidelines for sufficient sleep. Insufficient sleep was inversely associated with internalizing symptoms (β estimate = -0.70 (-1.38, -0,02), p=0.044). However, the association attenuated slightly once adjusted for child age, sex, zBMI, family composition, and maternal education (β estimate = -0.64 (-1.38, 0.10), p=0.088).

Conclusion
There is evidence that a parent reported decrease in sleep of 3 hours is associated with a small (1 point) increase on the internalizing scale in children between 5 and 12 years. The primary limitation is that sleep duration and internalizing symptoms were reported by parents.
79 Acceptability and impact of psychosocial screening in the emergency department
Authors: Hankinson Elizabeth , Doan Quynh , Wright Bruce , Atwal Amanbir , Virk Punit , Azizi Hawmid , Stenstrom Rob , Black Tyler , Gokiert Rebecca , Newton Amanda 
Published: August 2020

Abstract

Background
Psychosocial concerns in youth are prevalent and undertreated. Early identification through screening may promote appropriate management before youth present in crisis.

Objectives
Our primary objective was to assess the acceptability of psychosocial screening in the pediatric emergency department (ED) setting. Secondarily, we report the prevalence of psychosocial issues among youth with non-psychiatric ED presentations, and the impact of screening on mental health resource-seeking behaviour.

Design/Methods
We conducted a prospective cohort study of youth aged 10-17 years at two pediatric EDs. Youth with a mental health-related reason for visiting the ED were excluded. Eligible and consenting youth (and their families) completed a comprehensive psychosocial self-assessment delivered on an electronic tablet, followed by standardized clinician assessment. Consent to participate in the study was used as a proxy measure for acceptability of screening. Participants with identified psychosocial resource needs were followed up at 30 days with a semi-structured telephone/email interview to assess whether they had sought recommended resources and to explore barriers to accessing care.

Results
Of the 1432 eligible youth given the opportunity to enrol, 795 consented. Among the 637 youth who declined enrolment, 467 specified that they declined for reasons other than not wanting to conduct a psychosocial self-assessment. This suggests that at least 55.5% (95% CI = 52.9%, 58.1%) and up to 88.1% (95% CI = 86.4%, 89.8%) find screening acceptable.
Among the 760 participants who completed clinician assessment, 276 (36.3%) were identified as having a psychosocial resource need. Resources were already in place for 105 youth, leaving 171 (22.5%) with newly identified or unmet psychosocial needs. Only 41 (33.1%) of the 124 participants and/or their families who completed a 30-day follow up interview reported attempting to access the recommended resources, despite 92 (74.2%) stating they agreed with the original recommendations. The most common reason for not accessing care was the belief that the recommendations were not yet necessary or were not a priority. Of those who had attempted to access resources, 18 (43.9%) were unsuccessful at the time of interview, with the most common barrier being access delay (e.g. on a waitlist).

Conclusion
We found that previously unidentified/unmet psychosocial needs are prevalent among youth in the ED, and that screening is generally acceptable. However, a limited number of those who screened positive attempted to access resources, and when they did, access was often unsuccessful or delayed. More work is needed to address barriers to timely psychosocial care.
91 Mental Health Burden of Adolescents with Dysautonomia
Authors: Galvin Claire , De Souza Astrid , Potts Jim , Sneddon Penny , Sanatani Shubhayan , Armstrong Kathryn 
Published: August 2020

Abstract

Background
Dysautonomia of Adolescence (DAOA) results from a dysregulation of the autonomic nervous system during puberty and affects multiple organ systems in the body. Symptoms have a significant impact on quality of life (QoL) with many adolescents reporting a poorer QoL compared to other pediatric chronic illness populations. Furthermore, there is a paucity of research looking at underlying mental health conditions in patients with DAOA that might be contributing to poor QoL.

Objectives
The aim of this review was to characterize the underlying mental health status of patients with DAOA followed in a tertiary care DAOA Clinic.

Design/Methods
Single-centre retrospective chart review (January 2017-November 2019) of all current patients followed in a tertiary care DAOA Clinic. Mental health challenges were classified as significant symptoms reported and/or formal diagnosis of anxiety, depression, attention deficit hyperactivity disorder, obsessive compulsive disorder, eating disorders, somatization, mood disorders, suicidal ideation, and self-harm. Frequency tables were generated for all categorical variables.

Results
Seventy-three patients are currently being followed in the DAOA clinic. Fifty-five of 73 (75%) had some form of mental health challenge including 11 (15%) which had a history of suicidal ideation and/or self-harm, 12 (17%) had no mental health concerns, and 6 (8%) are unknown.
Of the 55 patients with a mental health challenge, 27 (49%) were diagnosed with a mental health condition prior to formal DAOA diagnosis and 10 (18%) were diagnosed after DAOA diagnosis. Eighteen (14%) reported symptoms of a mental health challenge but no confirmed mental health diagnosis. A breakdown of mental health symptoms and diagnoses are shown in Table 1.

Of the 73 current patients, 41 (56%) accessed psychology services either through the DAOA Clinic or in the community, 9 (12%) have been referred to other health care services, and 8 (11%) did not access services. Psychiatric services were required by 15 patients (21%).

Conclusion
Three-quarters of DAOA patients report some mental health challenges. This emphasizes the need for psychology to support patients with DAOA. It is unclear as to whether a mental health challenge exacerbates symptoms of DAOA or DAOA symptoms negatively impact their mental health.
93 “I don’t want them to think that what they said matters”: How Adolescents with Severe Obesity Cope with Bullying
Authors: Ye Linlei , Walsh Orla , Dettmer Elizabeth , Regina Andrea , Christian Jennifer , Hamilton Jill , Toulany Alene 
Published: August 2020

Abstract

Background
Adolescents with severe obesity are subject to a high prevalence of weight-based victimization that may contribute to mental health symptoms. The ability to better cope with this victimization could potentially modulate the psychological sequelae. This is the first qualitative study to address the paucity of literature focusing on how adolescents with severe obesity cope with victimization.

Objectives
To explore how adolescents with severe obesity cope with weight-related victimization and how it subsequently affects their psychological well-being.

Design/Methods
This was a qualitative research study using an interpretive phenomenological analytic approach. One-on-one semi structured interviews were completed with 19 adolescents (73% female) aged 16 – 19 years, enrolled in a tertiary hospital weight management program. A diverse array of patient experiences of weight-based victimization were sought to explore their coping mechanisms and how the experiences affected them. The interviews were transcribed and sequentially independently analyzed by the research team until thematic saturation was achieved.

Results
The majority of participants (89.5%) described being a victim of weight-based victimization and highlighted its significant emotional impact. Two key themes were identified that captured the various coping strategies used by participants. The minority (52.9%) described approach coping strategies where they acted on the source to invoke change by standing up for themselves, helping others in similar situations or becoming a bully themselves. Whilst the majority (94.1%) used avoidant coping strategies such as feigning a strong exterior façade, denial, isolation and self-harm. Nearly half (47.1%) used both strategies. It is possible that the study participants did not feel they had control over the weight related bullying, and therefore, were more likely to choose avoidant coping styles.

Conclusion
Adolescents with severe obesity commonly use avoidant coping strategies to passively regulate emotions, including problem avoidance, wishful thinking, self-criticism and social withdrawal to cope with weight-based victimization. As part of a comprehensive approach to the management of adolescents with severe obesity, counseling should be offered on how to use alternative coping mechanisms in the face of weight-based victimization.
103 Pediatric resident knowledge and comfort in providing care to transgender youth: A single centre needs assessment
Authors: Paciocco Helen , Johnson Natasha , Hunter Andrea 
Published: August 2020

Abstract

Background
Transgender youth experience high rates of health disparities and inequities. There is currently no formal curriculum for transgender health within our centre’s pediatric residency program. This gap in training is similar to other programs across the country. With the drastic rise in trans youth patients seeking care, general pediatricians will be the first point of contact for many. Pediatricians therefore need to be equipped with the proper knowledge and skill to provide care to these patients.

Objectives
We conducted a needs assessment to assess pediatric residents’ comfort with the health care needs of transgender patients, and to assess knowledge about the medical management of transgender youth. The goal was to identify learning gaps within our centre’s residency program to guide future curriculum.

Design/Methods
A survey with Likert scale and case-based questions, based on literature review, identified key components of trans care. The study was granted an exemption from ethics review.

Results
We achieved a 50% response rate (24/58) from pediatric residents, and 50% of these residents were in their senior years (PGY3 and PGY4). All residents felt it was important to have trans specific training during residency. While the majority of senior residents received training during their residency, the total duration was estimated to be ≤ 5 hours. Despite the training received, only 50% [95% CI: 30, 70] of residents felt comfortable asking patients about their gender identity, and only 8% [0, 19] and 33% [14, 52] of residents were comfortable diagnosing gender dysphoria in children and teens, respectively. Most residents felt uncomfortable addressing trans specific health care needs, and 83% [62, 100] of senior residents were uncomfortable counselling patients on available gender affirming pharmacologic agents. Similarly, 92% [77, 100] of senior residents felt uncomfortable prescribing either GnRH analogs or hormonal therapy for trans youth. Lastly, only 58% [30, 86] of senior residents felt comfortable performing Tanner staging in trans patients.

Conclusion
In order to help narrow the gap in care for trans patients, we need to better educate pediatric residents on trans specific health care. Future curriculum should focus on discussing gender identity, identifying gender dysphoria, performing Tanner staging, and counselling patients on gender affirming pharmacologic therapies. These skills are critical for general pediatricians to adequately provide care to trans youth.
104 House Rules and Clean Kids: The down-low on Tobacco
Authors: Zhang Caseng , Hicks Alex , Osornio-Vargas Alvaro , Brennan Lesley , Hicks Matt , Hicks Anne 
Published: August 2020

Abstract

Background
Despite multiple published guidelines outlining the potential health risks caused by tobacco smoke, young children continue to be exposed to the detrimental effects of household smoking. Environmental factors also have the potential to influence levels of tobacco exposure in children. Many factors such as comfort can influence the decisions of smoking parents to smoke indoors, increasing potential harm for children. Understanding the correlation between various locations within the household and tobacco exposure is helpful in informing a harm reduction strategy for smokers. This project compared the location of reported tobacco use to detection of the nicotine byproduct cotinine in children’s urine samples.

Objectives
To determine the impact of smoking location on unintentional tobacco exposure in children.

Design/Methods
This prospective cross-sectional study focused on children under age ten, since 13% of Canadian children in grades 6 and up have tried a cigarette at least once. Of 286 parents approached during a pediatrician visit, 231 agreed to complete an exposure questionnaire and 132 children were able to provide a urine sample during the visit. A standard ELISA assay was used to measure urine cotinine.

Results
About half of the 31% of households that reported smoking had an indoor smoking ban. Some indoor smokers isolated their activity to the garage (56%). Of the 84 children with detectable urine cotinine, 62 lived in homes that reported smoking. This suggests that some children were exposed to tobacco smoke through other sources or the underestimation of potential tobacco exposure. Fifteen percent of children from smoking homes had cotinine levels similar to nonsmoking homes. Children of indoor smokers were more likely to have detectable cotinine than those of outdoor smokers.

Conclusion
Roughly 50% of smokers with children have an indoor smoking ban as a harm reduction strategy. In our study, children of smokers with an indoor smoking ban were less likely to have detectable urine cotinine. Although not smoking is the best strategy, limiting smoking to outside is an optimal harm mitigation strategy. For families with indoor smokers, encouraging them to isolate smoking to a single space like the garage may decrease unintentional pediatric exposure.
107 A Novel Transition Clinic For Adolescents and Young Adults With Non-Malignant Blood Disorders
Authors: Jegathesan Thivia , Roth Megan , Florence Melissa , Mistry Niraj , Bonifacio Herbert J , Sgro Michael , Baker Jillian 
Published: August 2020

Abstract

Background
Transition clinics have been introduced as a way to address the unique needs of adolescent and young adult populations (AYA). AYA transition clinics for non-malignant blood disorders that require continuous care and management such as chronic immune thrombocytopenia (ITP) and Hereditary Spherocytosis (HS), have not been evaluated to date. In addition, the concerns and barriers to accessing care among this population have not been previously described.

Objectives
To explore the needs of AYA patients with a non-malignant hematological condition in order to improve their transition to the adult healthcare system through a transition clinic.

Design/Methods
A prospective cross-sectional survey study was conducted with AYA patients with a new or existing non-malignant hematological condition attending an AYA clinic in Toronto. Patients were prospectively provided a survey prior to their clinic appointment via text message.

Results
Twenty eight patients completed the survey. Most of the patients were female (84.6%) and between 16-25 years of age. Patients were in school (57%) or working (25%). Over half of the patients (53%) reported to seeing a doctor at least once a year. In order to attend clinic appointments, 61% reported taking public transportation, 10% of patients receive a ride from their family and 29% of patients either drove themselves or walked/biked to clinic. Twenty-seven percent of patients were unsure of their condition, 50% did not know the cause of their condition, and over 70% of patients were concerned about their health at least once a day. Almost all patients had concerns about transitioning to adult care with concerns including 1) Adult care not understanding their needs, 2) Increased responsibility of their care and 3) Working with a new clinical care team. Despite their concerns of transition to an adult healthcare system, 67% of patients reported taking on most of the responsibility of their health including booking appointments, and taking their medication. However, the proportion of patients who wanted their parents at their appointments equaled those that did not. Finally, patients reported the following areas of their life their health has negatively impacted; 1) School, 2) Social interactions with family and friends, and 3) Work.

Conclusion
As seen in other diseases, AYA patients with non-malignant hematological conditions have concerns about transitioning to adult care. Young adults have varying degrees of interest and abilities regarding self-care, and are particularly vulnerable to the impact of health issues. Several factors need to be considered when caring for this unique population, that if addressed can improve the transition experience.
108 Palliative care for neonates: Retrospective mixed methods review of infant death in the Neonatal Intensive Care Unit
Authors: Journault Marina , Stenekes Simone , McClure Robin , Ruth Chelsea 
Published: August 2020

Abstract

Background
Neonatal palliative care is an under researched yet growing field in the provision of intensive care to neonates. There are currently no studies which explore infant death in the Neonatal Intensive Care Unit (NICU) itself where a shift from intensive to palliative care may occur.

Objectives
The purpose of this study was to explore the circumstances of infant death in the NICU and understand current utilization of specialist palliative care in this area. It aimed to characterize the infants’ clinical course and add unique understanding by analyzing documentation related to end of life care.

Design/Methods
A retrospective chart review of infants who died in a single centre NICU between January 2017 and March 2018 was undertaken. Infants of any gestational and post-natal age were included, excluding infants who died prior to arrival to the NICU or were discharged or transferred prior to death. Chart notes relating to prognosis, advanced care planning, and palliative interventions were sampled, coded, and collated for thematic analysis.

Results
Twenty-five infants met study criteria. Of these, 92% were preterm with more than half below 28 weeks gestation. Median age at death was 5.2 days (IQR 1, 26.2). All infants required ventilator support with planned withdrawal occurring in 60%. Specialist palliative care was involved in 28%; these infants tended to be older (mean age at death = 78 days). Most infants were labelled as “critical” 2-5 days prior to death. Seventy-six percent of infants were held on their last day of life with 72% of families having memory making documented as part of their care. Qualitative excerpts revealed themes of hope and acceptance, parental presence, and framed discussion. Within these emerged concepts of “parental agreement” and “palliative language/approach”.

Conclusion
There is a growing need for both primary and specialist palliative care in the NICU. This study highlights an under researched area and generates many more important questions. By exploring documented language, we aim to understand and improve the ability to frame the discussion while ensuring quality end of life care for dying infants and their families in the NICU.