bluuebunny/crossref_metadata_2025_split huggingface dataset:
112 Becoming parents again: the challenges of raising grandchildren as main caregiver
Authors: Martin Ashley , Albrechtsons Daniel , Aumeerally Nadia , Wong Tania 
Published: August 2020

Abstract

Background
‘Skipped generation households’ in which grandparents are the main caregiver to children under 18 years of age, are becoming common in Canada. Reasons for this include teen pregnancy, the death of a parent, mental illness and addictions. These grandparents and the grandchildren they care for are at significantly increased risk of physical and mental illness, yet receive less psychosocial and financial assistance compared to children that enter the foster system. Research on this population in Canada is limited.

Objectives
Our study aimed to use the lived experiences of skipped generation families to better identify their needs in the healthcare system.

Design/Methods
We conducted semi-structured interviews of grandparent primary caregivers from ten households in our community to chronicle their lived experiences raising their grandchildren. Participants were identified and recruited by general pediatricians using convenience sampling. Interviews were recorded, transcribed verbatim, coded using Atlas.ti software and classified into themes by consensus.

Results
A total of 11 primary caregiver grandparents from 10 households participated in interviews. Nine participants were female. The average age of grandparents was 56 years (range 45 to 64 years) and on average they had been caring for their grandchild for 4 years (range 0.9 to 9 years). Eight households began caring for their grandchild following involvement of the Department of Community Services.
Five primary themes emerged from the interviews: Changes in family dynamics, psychosocial impact on grandchild and grandparent, lack of resources for grandparent caregivers, challenges parenting later in life, and resilience inspired by the love of family. Many participants described feeling unsupported, both financially and emotionally, after assuming care of their grandchildren and identified a need for additional counselling services, childcare subsidies and assistance through respite care. All participants involved highlighted that caring for their grandchildren changed their lives in many positive ways.

Conclusion
While grandparents are frequently prioritized as caregivers of apprehended children, our study suggests that they are also disproportionately under-resourced and poorly supported relative to children that instead enter the foster care system. Based on these findings, we urge for the provision of critical resources to address the emotional, respite and financial needs of these vulnerable children and their grandparents.
114 Distributional Decomposition: A Novel Method for Understanding Inequities in Child Growth, Behavior and Development
Authors: Fuller Anne , Siddiqi Arjumand , Shahidi Faraz , Anderson Laura , Keown-Stoneman Charles , Maguire Jonathon , Birken Catherine 
Published: August 2020

Abstract

Background
Income related inequities in child health are well-established, with children from lower income households showing increased risk of obesity, behavior problems, and delayed development. To facilitate clinical diagnosis, outcomes are conventionally measured in dichotomous terms. However, inequities may exist along the entire range of distribution, with implications for population health.

Objectives
Our primary objective was to examine differences in the distribution of three measures of child health by income: body mass index (BMI), behavior difficulties and development.

Design/Methods
This was a cross sectional study of children enrolled in a primary care practice-based research cohort. Our study included generally healthy children recruited from age 0-5 years. Dependent variables were 1) BMI z-score (zBMI) at 5 years; 2) behavior: total score on the Strengths and Difficulties Questionnaire (SDQ), measured at 3-5 years; 3) development: total score on the Infant Toddler Checklist (ITC), measured at 18-24 months. Independent variable was parent-reported annual household income (&lt; $100,000 vs ≥ $100000). We then used distributional decomposition, which uses mathematical re-weighting to construct a counterfactual distribution that describes the distribution of the lower income group based on the predictor profile (child age, sex, birthweight, prematurity, breastfeeding duration; maternal age, education, immigration status, ethnicity) of the higher income group.

Results
Our study samples consisted of 1649 (zBMI), 764 (SDQ) and 761 (ITC) children. Mean BMI z-score was 0.16, median total difficulties score was 7, median ITC score was 48. Comparing distributions graphically (Figure 1), children with low income have a higher risk distribution for all outcomes; for example, children with low income were more likely to have BMI z-scores in the underweight and obese ranges. For each outcome, the counterfactual curve lower income children with the predictor profile of their higher income counterparts reduced inequities somewhat, particularly in the normal or low risk range, but not in the high-risk range. However, there were notable unexplained portions of inequity remaining.

Conclusion
In a cohort of generally healthy children, we found evidence of meaningful income-related inequities in the distribution of child zBMI, behavior difficulties, and development. Population health interventions aiming to mitigate these inequities by addressing common predictors may improve outcomes in the normal range; however targeted clinical interventions are likely required for those in the high-risk range.
116 Association between family income, risk for food insecurity and iron deficiency in healthy young Canadian children
Authors: Bayoumi Imaan , Parkin Patricia C , Birken Catherine S , Maguire Jonathon L , Borkhoff Cornelia M 
Published: August 2020

Abstract

Background
Iron deficiency peaks in prevalence (12% or higher) in early childhood and has been associated with poor developmental outcomes. Previous research examining associations between income and food insecurity (FI) with iron deficiency has been inconsistent and most did not measure iron status directly using serum ferritin or control for potential confounding variables.

Objectives
To examine the independent effects of family income and family risk for FI on iron status in healthy young children attending primary care.

Design/Methods
Healthy children ages 12–29 months were included in a cross-sectional analysis. Family income and risk for FI were collected from parents through self-reported questionnaires. Children with an affirmative response to the 1-item FI screen on the NutriSTEP (a validated screening tool of nutritional risk) or to at least one of the 2 items on the 2-item FI screen based on the 18-item Household Food Security Survey were categorized as a family at risk for FI. Iron status was assessed by serum ferritin. Children with C-reactive protein (CRP) &gt;5 mg/L were excluded. Multivariable logistic regression analyses were used to examine the associations between both family income and family risk for FI with iron deficiency (serum ferritin &lt;12µg/L) and IDA (serum ferritin &lt;12 µg/L and hemoglobin &lt;110 g/L), adjusting for age, sex, birthweight, zBMI, CRP, breastfeeding duration, bottle use, cow’s milk intake, formula feeding in the first year.

Results
Of 1245 children included, 131 (10.5%) of children were from households with a family income of &lt;$40,000, 77 (6.2%) children were from families at risk for FI, 15% had iron deficiency, and 5% had IDA. The odds of children with a family income of &lt;$40,000 having iron deficiency was 3 times (95% CI: 1.75, 5.26; P&lt;0.0001) and having IDA was 4 times (95% CI: 1.71, 9.25; P=0.001) that for children in the highest family income group. Fully adjusted logistic regression showed weak evidence of a decreased odds of iron deficiency among children in families at risk for FI (OR 0.44, 95% CI: 0.19, 1.04; P=0.06) than all other children, and no association with IDA (OR 0.18, 95% CI: 0.02, 1.38; P=0.10).

Conclusion
A low family income of &lt;$40,000 was associated with an increased risk for iron deficiency and IDA in young children. Risk for FI was not a risk factor for iron deficiency or IDA. Targeting income security may be more effective than targeting access to food to reduce health inequities in iron deficiency.
COVID-19 and chronic renal disease: clinical characteristics and prognosis
Authors: Yang D , Xiao Y , Chen J , Chen Y , Luo P , Liu Q , Yang C , Xiong M , Zhang Y , Liu X , Chen H , Deng A , Huang K , Cheng B , Peng A 
Published: August 2020

Summary

Background
Patients on dialysis were susceptible to coronavirus disease 2019 (COVID-19) and were prone to severe clinical characteristics after infection; acute kidney injury was related to mortality in COVID-19 cases. Limited is known about the characteristics of COVID-19 patients with end-stage renal disease not requiring renal replacement therapy (RRT).

Aim
Evaluate clinical characteristics, course and outcomes of COVID-19 patients with chronic kidney disease (CKD) who did not require RRT and those on dialysis.

Design
A two-center retrospective study.

Methods
A total of 836 adult patients with COVID-19 (24 CKD not on dialysis; 15 dialysis-dependent CKD) were included. The study includes no patients with renal transplantation. Risk factors were explored.

Results
CKD not requiring RRT is an independent risk factor for in-hospital death [adjusted odds ratio (aOR) 7.35 (95% CI 2.41–22.44)] and poor prognosis [aOR 3.01 (95% CI 1.23–7.33)]. Compared with COVID-19 cases without CKD, those with CKD not requiring RRT showed similar percentage of initial moderate cases (75.00% vs. 73.65%) but higher incidence of in-hospital neutrophilia (50.00% vs. 27.30%) or death (50.00% vs. 9.03%). The odds ratio of dialysis associated to mortality in CKD patients was 2.00 (95% CI 0.52–7.63), suggesting COVID-19 patients with dialysis-dependent CKD were at greater risk of in-hospital death. For COVID-19 patients with CKD not requiring RRT, statins reduced the risk of neutrophilia [OR 0.10 (95% CI 0.01–0.69)] while diuretics increased the risk of neutrophilia [OR 15.4 (95% CI 1.47–160.97)], although both showed no association to mortality.

Conclusion
COVID-19 patients with CKD presented high incidence of neutrophilia, poor prognosis and in-hospital death, with dialysis patients being more vulnerable.
Proprotein convertase subtilisin/kexin type 9 in the dyslipidaemia of patients with axial spondyloarthritis is related to disease activity
Authors: de Armas-Rillo Laura , Quevedo-Abeledo Juan C , de Vera-González Antonia , González-Delgado Alejandra , García-Dopico José A , Jimenez-Sosa Alejandro , Rodríguez-Lozano Carlos , González-Gay Miguel A , Ferraz-Amaro Iván 
Published: August 2020

Abstract

Objective
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a serine protease that regulates cholesterol metabolism and has been linked to cardiovascular (CV) risk. The purpose of the present study was to examine whether PCSK9 levels are related to abnormalities in the lipid profile and the development of atherosclerosis that occurs in patients with axial SpA (axSpA).

Methods
We performed a cross-sectional study that encompassed 545 individuals; 299 patients with axSpA and 246 statin use–matched controls. PCSK9 and standard lipid profiles were analysed in patients and controls. Carotid intima-media thickness (cIMT) and carotid plaques were assessed in patients. A multivariable analysis, adjusted for standard CV risk factors, was performed to evaluate the influence of PCSK9 on axSpA-related dyslipidaemia and subclinical carotid atherosclerosis.

Results
Total cholesterol, high-density lipoprotein and low density lipoprotein cholesterol, lipoprotein (a) and apolipoprotein A1 were significantly lower in axSpA patients than controls. PCSK9 serum levels [β coefficient −44 ng/dl (95% CI −60, −27), P = 0.000] were also downregulated in axSpA patients after fully multivariable adjustment. ASDAS-CRP was found to be independently and significantly related to PCSK9 [β coefficient 10 ng/dl (95% CI 1, 18), P = 0.023] after analysing fully adjusted models that took age, sex and the rest of the lipid profile molecules into account. Whereas patients taking prednisone showed higher serum levels of PCSK9 [55 ng/ml (95% CI 24, 8), P = 0.001], those under anti-TNF-α therapies exhibited lower levels [β coefficient −26 ng/ml (95% CI −43, −9], P = 0.003].

Conclusion
PCSK9 is downregulated in patients with axSpA. Disease activity is positive and significantly related to PSCK9. Anti-TNF-therapy yields a reduction in PCSK9 serum levels.
Largest scale dissociation of brain activity at propofol-induced loss of consciousness
Authors: Pujol Jesus , Blanco-Hinojo Laura , Gallart Lluís , Moltó Luís , Martínez-Vilavella Gerard , Vilà Esther , Pacreu Susana , Adalid Irina , Deus Joan , Pérez-Sola Víctor , Fernández-Candil Juan 
Published: August 2020

Abstract
The brain is a functional unit made up of multilevel connected elements showing a pattern of synchronized activity that varies in different states. The wake–sleep cycle is a major variation of brain functional condition that is ultimately regulated by subcortical arousal- and sleep-promoting cell groups. We analyzed the evolution of functional MRI (fMRI) signal in the whole cortex and in a deep region including most sleep- and wake-regulating subcortical nuclei at loss of consciousness induced by the hypnotic agent propofol. Optimal data were obtained in 21 of the 30 healthy participants examined. A dynamic analysis of fMRI time courses on a time-scale of seconds was conducted to characterize consciousness transition, and functional connectivity maps were generated to detail the anatomy of structures showing different dynamics. Inside the magnet, loss of consciousness was marked by the participants ceasing to move their hands. We observed activity synchronization after loss of consciousness within both the cerebral cortex and subcortical structures. However, the evolution of fMRI signal was dissociated, showing a transient reduction of global cortico-subcortical coupling that was restored during the unconscious state. An exception to cortico-subcortical decoupling was a brain network related to self-awareness (i.e. the default mode network) that remained connected to subcortical brain structures. Propofol-induced unconsciousness is thus characterized by an initial, transitory dissociated synchronization at the largest scale of brain activity. Such cortico-subcortical decoupling and subsequent recoupling may allow the brain to detach from waking activity and reorganize into a functionally distinct state.
Infectious disease considerations in immunocompromised patients
Authors: McGrath Bridget , Broadhurst Mary , Roman Christopher 
Published: August 2020

ABSTRACT
Immunocompromised patients account for about 3% of the US population. Complications arising from infection are common in these patients and can present diagnostic and therapeutic challenges. This article describes the pathophysiology of immunosuppression in five common immunocompromised states—asplenia, HIV infection, solid organ transplant, biologic use, and cancer—as well as specific infectious risks and considerations for affected patients and how to manage them.
Emerging practices in onboarding programs for PAs
Authors: Sanchez Mara , Anglin Lorraine , Rana Rachel , Butterfield Rita , Everett Christine M. , Morgan Perri 
Published: August 2020

ABSTRACT

Objective:
Healthcare organizations are interested in creating onboarding programs to assist new PA and NP employees as they transition to practice settings. There is a need for information on what the ideal content and topic areas are for clinics to include in their onboarding programs.

Methods:
In 2018, we interviewed 13 administrators of onboarding programs. Interviews were transcribed and analyzed for themes by a team of researchers, with feedback from interviewees.

Results:
Eight content areas were identified and described in this paper: culture and values; goals and strategies; task proficiency; rules and policies; structure; working relationships; wellness; and navigation and politics.

Conclusions:
These common content areas may provide a starting point for organizations designing onboarding programs for their unique organizations.
The vaping epidemic
Authors: Huey Sally , Tierney Catherine , Granitto Margaret , Brien Lori 
Published: August 2020

Abstract:
Youth e-cigarette use was declared a national epidemic in 2018. This article discusses e-cigarette- or vaping-associated lung injury (EVALI) and highlights the unique role nurses can have as advocates, patient educators, and champions of health promotion and disease prevention for their patients and families.
Competitive Interactions between Halothane and Isoflurane at the Carotid Body and TASK Channels
Authors: Pandit Jaideep J. , Huskens Nicky , O’Donohoe Peadar B. , Turner Philip J. , Buckler Keith J. 
Published: August 2020

Background
The degree to which different volatile anesthetics depress carotid body hypoxic response relates to their ability to activate TASK potassium channels. Most commonly, volatile anesthetic pairs act additively at their molecular targets. We examined whether this applied to carotid body TASK channels.

Methods
We studied halothane and isoflurane effects on hypoxia-evoked rise in intracellular calcium (Ca2
+
i, using the indicator Indo-1) in isolated neonatal rat glomus cells, and TASK single-channel activity (patch clamping) in native glomus cells and HEK293 cell line cells transiently expressing TASK-1.

Results
Halothane (5%) depressed glomus cell Ca2+
i hypoxic response (mean ± SD, 94 ± 4% depression; P < 0.001 vs. control). Isoflurane (5%) had a less pronounced effect (53 ± 10% depression; P < 0.001 vs. halothane). A mix of 3% isoflurane/1.5% halothane depressed cell Ca2+
i response (51 ± 17% depression) to a lesser degree than 1.5% halothane alone (79 ± 15%; P = 0.001), but similar to 3% isoflurane alone (44 ± 22%; P = 0.224), indicating subadditivity. Halothane and isoflurane increased glomus cell TASK-1/TASK-3 activity, but mixes had a lesser effect than that seen with halothane alone: 4% halothane/4% isoflurane yielded channel open probabilities 127 ± 55% above control, versus 226 ± 12% for 4% halothane alone (P = 0.009). Finally, in HEK293 cell line cells, progressively adding isoflurane (1.5 to 5%) to halothane (2.5%) reduced TASK-1 channel activity from 120 ± 38% above control, to 88 ± 48% (P = 0.034).

Conclusions
In all three experimental models, the effects of isoflurane and halothane combinations were quantitatively consistent with the modeling of weak and strong agonists competing at a common receptor on the TASK channel.

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The Pathophysiology, Diagnosis, and Management of Wolff–Parkinson–White Syndrome in the Neonate
Authors: Chambers Stephanie , Jnah Amy , Newberry Desi 
Published: August 2020

Background:
Wolff–Parkinson–White (WPW) is a congenital defect of the cardiac conduction system (CCS), with proliferation of extra embryologic conduction pathways and rapid conduction of electrical impulses. The estimated neonatal incidence of 0.1% to 0.2% may be misrepresented secondary to missed or misdiagnosis. Undiagnosed WPW can result in sudden cardiac death.

Purpose:
To discuss the pathogenesis, manifestations, diagnosis, management, and lifespan implications of WPW in the prenatal and postnatal periods.

Methods/Search Strategy:
A literature review was conducted using PubMed, CINAHL, and Google Scholar (2013-2019). Search terms included (newborn OR infant), wolff parkinson white, pathogenesis, management, and ventricular preexcitation. After removal of duplicates, 267 references were identified, abstracts reviewed, and 30 publications fully evaluated.

Findings/Results:
Separation of the heart chambers begins around 7 weeks' gestation with formation of the annulus fibrosis complete after term. The unknown external environmental influence on the development of the preterm infant's CCS places neonates at risk for persistent atrioventricular reentrant tachycardia with WPW development. Ensuring an appropriate diagnosis is crucial, as an incorrect diagnosis could mean death.

Implications for Practice:
Due to the rarity of WPW, any fetal or neonatal supraventricular tachycardia requires further evaluation with an electrocardiogram and involvement of an experienced cardiologist for diagnosis. One episode of supraventricular tachycardia warrants evaluation for WPW, as recurring episodes may result in irreversible damage.

Implications for Research:
The recommendations for treatment of WPW in the prenatal and immediate postnatal periods are based heavily on standards of care for the adult population. A paucity of evidenced-based literature exists and future research is crucial to understand the true incidence, physiologic effects, and lifespan implications of WPW on neonates.
Randomized Controlled Study to Compare Uncovered Stent Versus Covered Stent as Percutaneous Endoprosthesis for Malignant Biliary Obstruction (JIVROSG-0207)
Authors: Onishi Yasuyuki , Yoshioka Tetsuya , Arai Yasuaki , Inaba Yoshitaka , Saito Hiroya , Aramaki Takeshi , Anai Hiroshi , Sone Miyuki 
Published: August 2020

Objectives:
The objective of this study was to compare the clinical effectiveness of uncovered stent and covered stent as percutaneous endoprosthesis for malignant biliary obstruction of the extrahepatic bile duct.

Materials and Methods:
After completion of percutaneous internal and external tube placement for unresectable malignant biliary obstruction, 60 patients were registered and randomly assigned in a 1:1 ratio to an uncovered or covered stent group. Metallic stent placement was performed within 1 week after registration, and an external biliary drainage tube was removed >3 days after stent placement. The primary endpoint was the obstructive jaundice-free survival rate at 24 weeks after registration, and the secondary endpoints were the success rate of percutaneous tube removal and adverse events.

Results:
The obstructive jaundice-free survival rate at 24 weeks after registration was 13/29 (44.8%, 95% confidence interval [CI]: 28.4%-62.5%) and 15/30 (50.0%, 95% CI: 33.2%-66.8%) in the uncovered and covered stent groups, respectively. The success rate of percutaneous tube removal was 28/29 (96.6%, 95% CI: 82.8%-99.4%) and 30/30 (100%, 95% CI: 90.5%-100%) in the uncovered and covered stent groups, respectively. There were no procedure-related deaths. Twenty-eight adverse events were observed in 21 patients (7 in the uncovered stent group and 14 in the covered stent group).

Conclusions:
There was no significant difference in the obstructive jaundice-free survival rate at 24 weeks between the 2 groups. Considering the technical difficulty and invasiveness of covered stent placement, the placement of covered stents may not be needed in patients with a short prognosis of <24 weeks.