bluuebunny/crossref_metadata_2025_split huggingface dataset:
NEURODEVELOPMENTAL OUTCOMES AT 4–10 YEARS OF AGE IN CHILDREN BORN AT 22–25 WEEKS GESTATIONAL AGE: AN UPDATED META-ANALYSIS
Authors: Ding Sharon , Daboval Thierry , Lemyre Brigitte , Barrowman Nick , Moore Gregory 
Published: May 2018

Abstract

BACKGROUND
Published data on long-term outcomes are an important resource for clinicians to support expectant parents making perinatal care decisions.

OBJECTIVES
To update our 2013 meta-analysis with data from recently published, high quality cohorts of 22–25 wk GA infants using relevant definitions of neurodevelopmental disability (NDD).

DESIGN/METHODS
We used a peer-reviewed electronic search and grey search. Two authors independently reviewed cohorts published after May 2012 with the following inclusion criteria: born ≥1995 in a developed nation, assessed for NDD at 4–10 yrs; prospective data collection, <30% loss to follow-up, consistent definitions for moderate-to-severe (M-S) NDD as per those from EPICure; and results reported by GA. We contacted authors for clarification. Random-effects meta-analysis was used to provide pooled proportions at each GA. Weighted regression was used to examine the relationship between GA and NDD within each study. I2 was used to assess heterogeneity.

RESULTS
From 2481 titles, 20 full-text articles were reviewed and six (added to the nine from 2013) met inclusion criteria. High heterogeneity at higher GA and wide CIs at lower GA persisted. Results showed rates of M-S NDD in school-age survivors were: 42% (95%CI 23,64%; I2 0%) at 22 wks; 41% (95%CI 31,52%; I2 30%) at 23 wks; 32% (95%CI 25,39%; I2 44%) at 24 wks; and 23% (95%CI 18,29%; I2 60%) at 25 wks GA. The new analysis continued to show a significant decrease in likelihood of M-S NDI between each GA wk (8.1% decrease per wk (95%CI -11.8, -4.5%, p<0.001) but not for likelihood of severe NDD (2.7% decrease per wk (95%CI -6.6, 1.3%), I2 45%, p=0.18).

CONCLUSION
This high quality data can be used by physicians to support parents during the decision-making process for their infant. Heterogeneity and a small sample size at 22 wk GA remains a concern in the interpretation of the data.
INVESTIGATING THE PHOTOTHERAPY THRESHOLDS IN PRETERM INFANTS
Authors: Jegathesan Thivia , Sgro Michael , Shah Vibhuti , Campbell Aidan , Campbell Douglas 
Published: May 2018

Abstract

BACKGROUND
Currently there are limited guidelines for the management of hyperbilirubinemia in preterm infants. Current guidelines are limited to individual sites and are consensus-based opinions. The current decrease in chronic bilirubin encephalopathy in preterm infants is a result of liberal use of phototherapy that are not based on evidence from a large dataset of preterm infants. The pattern of bilirubin levels in preterm is unclear and currently based on clinical judgement. Nomograms in term infants has been proven to be beneficial and effective in reducing unnecessary treatment of hyperbilirubinemia. A nomogram designed for preterm infants would allow health professionals to quantify risk based on evidence based methods and reduce the number of test done on preterm infants.

OBJECTIVES
The objectives of this study are 1) To determine photherapy thresholds in preterm infants and 2) To determine the normative pattern of bilirubin values in preterm infants.

DESIGN/METHODS
A multi-site retrospective chart review of preterm infants ≤ 35 weeks gestation born between January 2012- November 2017 was conducted. The following data was collected; all TSB, postnatal hours of age, duration of phototherapy, infant characteristics (gestational age, birth weight, outcomes) and maternal history (inter and anter partum medication). TSB samples prior to the initiation of phototherapy were analyzed per hour and stratified by gestational age groups.

RESULTS
A total of 330 preterm infants were included in the retrospective review (50 24-28 weeks gestation, 100 29-32 weeks gestation, and 180 33–35 weeks gestation). The mean peak bilirubin in infants 33-35 week gestation was 198 umol/L at 4 days. These infants were started on phototherapy at a mean age of 89 hours. At 24 hours of age these infants’ bilirubin was 104 umol/L (72-189umol/L). The mean peak bilirubin in infants 29–32 weeks gestation was 181umol/L at 5 days. At 24 hours of age the mean bilirubin was 109 umol/L. Finally in infants 24–28 weeks gestation the mean peak bilirubin was 127 umol/L at 4 days. These infants were started on phototherapy at 44 hours of age.

CONCLUSION
Bilirubin values in preterm infants is hetergenous across gestional ages. Phototherapy treatment thresholds are lower in preterm infants between 24–28 weeks gestation. A nomogram for preterm infants maybe possible in infants between 29–35 weeks. Further research is required to determine hour specific bilirubin levels in preterm infants.
COMPARING WAIT TIMES OF SINGLE-MOTHER AND TWO-PARENT HOUSEHOLDS ACCESSING DEVELOPMENTAL SERVICES THROUGH SCHOOL-BASED HEALTH CLINICS
Authors: Gunaseelan Vinusha , Aiyadurai Ramanan , Freeman Sloane 
Published: May 2018

Abstract

BACKGROUND
Families in inner-city neighborhoods experience socioeconomic challenges that inhibit access to healthcare providers who could detect development concerns in children. Additionally, studies show low-income, single motherhood to be a significant risk factor for childhood developmental issues.
With wait times for developmental assessments and publicly funded services ranging from 9 to 18 months, children may not receive diagnosis and support in a timely manner. School-based health clinics (SBHCs) are easy access points for children to receive necessary services, such as diagnoses and management of health and developmental concerns especially for inner city children facing barriers to health care access.

OBJECTIVES
To measure the efficacy of SBHCs in alleviating barriers to developmental services for children from inner-city, single-mother households, by comparing wait times to children from two-parent households.

DESIGN/METHODS
A retrospective chart review of 700 children from two inner-city SBHCs was conducted over 7 years. Family demographic data were collected through the registration process and analyzed. Wait times for developmental assessments were determined from the first developmental concern to assessment by a developmental paediatrician. Independent t-tests were used to compare wait times for children from single-mother households to children from two-parent households.

RESULTS
The mean age of children seen was 6.9 years (two-parent households) and 7.6 years (single-mother households). 35% of children from single-mother households (n=169), and 36% of children from two-parent households (n=369) received referrals to the SBHC developmental paediatrician. The mean wait times were 129.08 days for single-mother households, and 105.81 days for two-parent households. No significant difference was found in wait time from first developmental concern to seeing a developmental paediatrician (p>0.05).

CONCLUSION
The SBHC program is a novel healthcare delivery model alleviating barriers to developmental healthcare access for both single-mother and two-parent families. Wait times experienced by SBHC users to see developmental specialists were shorter than the times reported in the literature. The lack of significant difference in wait times between children from single-mother and two-parent households demonstrates how SBHCs alleviate barriers to single-mother households as effectively as two-parent households.
EVALUATING THE PREDICTIVE VALIDITY OF THE NIPISSING DISTRICT DEVELOPMENTAL SCREEN IN PRIMARY CARE SETTINGS AT THE 18-MONTH HEALTH SUPERVISION VISIT
Authors: Gunaseelan Vinusha , Parkin Patricia , Bayoumi Imaan , Jiang Patricia , Medline Alexandra , Osmond Michael , Birken Catherine , Maguire Jonathon , Borkhoff Cory 
Published: May 2018

Abstract

BACKGROUND
The Canadian Paediatric Society (CPS) recommends that every Canadian physician caring for young children provide an enhanced 18-month well-baby visit including the use of a developmental screening tool, such as the Nipissing District Developmental Screen (NDDS). The Province of Ontario implemented an enhanced 18-month well-baby visit specifically emphasizing the NDDS, which is now widely used in Ontario primary care. However, the diagnostic accuracy of the NDDS in identifying early developmental delays in real-world clinical settings is unknown.

OBJECTIVES
To assess the predictive validity of the NDDS in primary care for identifying developmental delay and prompting a specialist referral at the 18-month health supervision visit.

DESIGN/METHODS
This was a prospective longitudinal cohort study enrolling healthy children from primary care practices. Parents completed the 18-month NDDS during their child’s scheduled health supervision visit between January 2012 and February 2015. Using a standardized data collection form, research personnel abstracted data from the child’s health records regarding the child’s developmental outcomes following the 18-month assessment. Data collected included confirmed diagnoses of a development delay, specialist referrals, family history, and interventions. Research personnel were blind to the results of the NDDS. We assessed the diagnostic test properties of the NDDS with a confirmed diagnosis of developmental delay as the criterion measure. The specificity, sensitivity, positive predictive value, and negative predictive value were calculated, with 95% confidence intervals.

RESULTS
We included 255 children with a mean age of 18.5 months (range, 17.5–20.6) and 139 (55%) were male. 102 (40%) screened positive (1+ flag result on their NDDS). A total of 48 (19%) children were referred, and 23 (9%) had a confirmed diagnosis of a developmental delay (speech and language: 14; gross motor: 4; autism spectrum disorder: 3; global developmental delay: 1; developmental delay: 1). The sensitivity was 74% (95% CI: 52–90%), specificity was 63% (95% CI: 57–70%), positive predictive value was 17% (95% CI:10–25%), and the negative predictive value was 96% (95% CI: 92–99%).

CONCLUSION
For developmental screening tools, sensitivity between 70%-80% and specificity of 80% have been suggested. The NDDS has moderate sensitivity and specificity in identifying developmental delay at the 18-month health supervision visit. The 1+NDDS flag cut-point may lead to overdiagnosis with more children with typical development being referred, leading to longer wait times for specialist referrals among children in need. Future work includes investigating the diagnostic accuracy of combining the NDDS with other screening tools.
THE ROLE OF DEVELOPMENTAL TOXICANTS AND SOCIO-ECONOMIC STATUS ON CONGENITAL HEART DISEASE IN URBAN AND RURAL ALBERTA
Authors: Ngwezi Deliwe , Hornberger Lisa , Serrano-Lomelin Jesus , Nielsen Charlene , Fruitman Deborah , Vargas Alvaro Osornio 
Published: May 2018

Abstract

BACKGROUND
Evidence is emerging suggesting associations between environmental pollutants, socio-economic status (SES) and congenital heart disease (CHD); however, it is still inconclusive. Furthermore, it has been documented in environmental injustice studies that people with low socio-economic status are disproportionately vulnerable to environmental hazards and therefore are victims of a double jeopardy.

OBJECTIVES
We sought to explore the effect of exposure to groups of developmental toxicants (DTs) and SES on CHD development in urban and rural Alberta.

DESIGN/METHODS
We identified 2,413 CHD cases and postal codes (PC) from echocardiographic databases (2003–2010). We used previously defined groups of DTs comprised of: 1- organics and gases, 2-organics and 3-heavy metals. Exposure was assigned to each PC as the sum of the product of multiplying amounts of DTs (tonnes) emitted from any industrial facility within 10 km radius during the whole study period, by the inverse distance from the facility to the centroid of the PC. Exposures were categorized into deciles from 1(lowest) to 10 (highest) for group 1 DTs and tertiles (1=lowest to 3 =highest), for groups 2 and 3 DTs and the SES index. Poisson regression models were used to calculate risk ratios and 95% CI, adjusted for SES index or DTs and traffic-related surrogates (NO2, PM2.5).

RESULTS
Adjusted Effect of DT Exposure: Group 1 DT showed increased risk in urban and rural regions in the 10th decile of exposure, aRR=1.85(1.5, 2.3) and 2.67(1.04, 6.8, respectively). Group 2 DT risk was increased only in urban 3rd tertile, RR=1.45(1.3, 1.6). Group 3 DTs were associated with an increased risk in urban and rural regions in the 3rd tertile of exposure [aRR=1.16(1.04, 1.3), and 2.8(1.14, 7.1, respectively)].
Adjusted Effect of SES: SES was independently associated with an increased risk of CHD in urban lowest tertile, [aRR=1.13(1.0, 1.3)] and rural lowest and middle SES tertile, [aRR=2.9(1.9, 4.8) and 1.6(1.1, 2.6), respectively].

CONCLUSION
High exposures to groups of DTs and SES were independently associated with an increased risk of CHD in urban and rural Alberta. This suggests that neighborhood SES in Alberta does not impose a disproportional exposure to DTs. Furthermore, SES had a greater impact in rural compared to urban regions. We would like to explore for interactions between the SES and DT exposures and to determine if there is environmental injustice in Alberta.
USE OF UNSAFE TEETHING REMEDIES IN A MID-SIZE CITY: A SURVEY
Authors: Abdulsatar Farah , Taheri Sepideh , Miller Michael 
Published: May 2018

Abstract

BACKGROUND
Various remedies are available to parents for relieving teething symptoms in their infants and toddlers. Some remedies, such as amber necklaces, have no evidence of their efficacy, yet are being widely marketed and increasingly used across North America. On the contrary, teething necklaces are unsafe, corroborated by recent reports of suffocation accidents and death attributed to their use. There is no published literature on the prevalence of teething remedies and what may determine parents’ choices.

OBJECTIVES
The primary objective was to assess the prevalence of unsafe teething remedies, especially teething necklaces. The secondary objective was to determine any association between the use of unsafe teething remedies and (a) socioeconomic status (SES), and (b) maternal education.

DESIGN/METHODS
Children aged 12–18 months in a mid-sized Canadian city visiting their primary care providers for routine well-baby checks were included. Children aged <12 or >18 months and those with chronic medical conditions were excluded. Parents completed a survey about their child’s teething symptoms and the remedies used to relieve them. Unsafe remedies were based on recommendations published by the Canadian Paediatric Society and American Academy of Pediatrics. They included oral-numbing gels, necklaces (Amber and Hazelwood), and liquid-containing teething rings.

RESULTS
Out of 130 surveys, 123 were included for statistical analysis due to missing data. Mean (SD) infant age was 14.47 (2.56) months, and mean (SD) age at first tooth was 6.92 (2.00) months. Overall, 98% of families used teething remedies with 67% of them using unsafe remedies. Of these families, 27% used Amber and 5% used Hazelwood necklaces. 28% of families used more than one unsafe remedy. No significant correlations were found between unsafe remedy use and SES or maternal education. However, a significant negative correlation was noted between SES and use of oral-numbing gels (Spearman’s rho = -0.23, p=0.01).

CONCLUSION
This study showed that a majority of parents are using unsafe teething remedies for their infants including Amber teething necklaces, despite lack of evidence to support their efficacy and recommendations against their use. Use of unsafe teething remedies transcends SES and education level. With recent reports of child injury and death associated with their use, the findings of this survey support the need for a new approach to parental education about the safety of teething remedies.
Examining access to Psychoeducational Assessments by Socioeconomic factors for children with behavioral referrals
Authors: Gander Sarah , Campbell Sarah 
Published: May 2018

Abstract

BACKGROUND
The psycho-educational assessment (PEA) is often recommended in behavioural presentations in children. The PEA assesses cognitive ability and detects any learning disabilities which may be the direct cause, or comorbidity, of a behavioral problem. This essential tool directs the child and family to appropriate treatment or intervention, and is critical for the school to design effective programming for the child. However, access to this assessment is quite variable. Some students may receive the PEA from a school psychologist if it has been established that other interventions have proven ineffective, but may experience long wait times. This study looked at a group of behavioural referrals at a local paediatric clinic to determine how many children had received a PEA, and if access seemed to be affected by their socioeconomic status (SES).

OBJECTIVES
• To identify how many of these behavioural referrals have also received PEAs.
• To understand the SES distribution among the children receiving behavioural referrals.
• To determine if children with higher SES status are more likely to have received PEAs.

DESIGN/METHODS
All behavioural referrals at this clinic are subject to an intake interview with a clinic nurse, who gathers a detailed medical, social and family history. This includes a list of previously accessed services and resources, including the PEA. Socioeconomic status was defined by the Quintile-Annual-Income-Per-Person-Equivalent (QAIPPE) associated with the dissemination area (DA) of the family residence. Patients were divided into these quintiles to determine the number of referrals from each quintile, and the percentage of children from each quintile that had received a PEA.

RESULTS
More than half of the referrals (51.2%; n=342) come from families living in DAs of the two lowest income quintiles. Of those children living in neighbourhoods in the two highest income quintiles, 27% had received the PEA prior to referral, as compared to 12.6% of those children living in the three lower income quintile neighbourhoods.

CONCLUSION
This demonstrates that children from low income neighbourhoods are receiving more behavioural referrals but are less likely to have received a PEA. This is a barrier to delivering timely and effective service as many children will wait over a year for their paediatric appointment only to find that they may have been better serviced elsewhere. Improving access to the PEA would improve the treatment of this population and help eliminate duplication and unnecessary service provision.
(MED) RESIDENT SATISFACTION IN CANADIAN PEDIATRIC RESIDENT CONTINUITY CLINICS
Authors: El-Korazati Adila , Peebles Erin , Miller Michael , Babic Bojana 
Published: May 2018

Abstract

BACKGROUND
Resident continuity clinics (RCCs) provide an opportunity for residents to gain experience with longitudinal care in an outpatient setting. RCCs have become a part of almost all recognized residency training programs across specialties in North America. However, the structure, function, and effectiveness of RCCs vary widely.

OBJECTIVES
To determine resident perspective on the structure and function of paediatric RCCs and investigate which factors were associated with resident satisfaction with paediatric RCCs.

DESIGN/METHODS
A qualitative survey of Canadian paediatric resident trainees was conducted to assess their RCC experience. The survey was administered through the REDCap© database and distributed through the Canadian Pediatric Program Directors Consortium in June-July 2016.

RESULTS
There were 127 respondents. Approximately 40% participated in RCCs. The majority of respondents were likely to recommend RCCs to other programs. The most common structure reported was a monthly half-day clinic overseen by an academic paediatrician. Referrals were mainly from inpatient wards, emergency department or family physicians. The majority of residents were satisfied with their experience (n=33, 71.7%). Participants in resident-run RCCs had more positive views compared to participants in staff-run RCCs (all U≥25.0, p≤0.009). Contributing factors to a positive RCC experience included patient-resident continuity, being viewed as the main care provider, and learning to make independent management decisions.

CONCLUSION
Almost all respondents felt that RCCs should be part of paediatric residency training. Further research is needed to determine the optimal structure for paediatric RCCs. Understanding our current training environment is an important precursor for informing program leadership and national policymakers who wish to improve ambulatory care training
RESEARCH COLLABORATION WITHIN A DEPARTMENT OF PEDIATRICS: A SOCIAL NETWORK ANALYSIS OF COAUTHORSHIP PATTERNS
Authors: Howden Kaitlyn , Duffet Mark , Xu Grace , Chan Anthony 
Published: May 2018

Abstract

BACKGROUND
Research is a collaborative undertaking. Through collaborators, researchers have access to expertise, experience, and resources which may result in increased research productivity. Social network analysis is a set of techniques that focuses primarily on the patterns and characteristics of relationships among individuals.

OBJECTIVES
To describe the social network structure —the extent and patterns of collaboration among members — of a department of paediatrics and identify prominent individuals and divisions.

DESIGN/METHODS
We conducted a social network analysis of coauthorship. We included faculty members in a single department of paediatrics with at least 1 publication. We excluded those with a clinical appointment. We used PubMed to identify publications and Web of Science to obtain the total citations for each publication.

RESULTS
We included 99 faculty who authored 3 939 publications. The median (Q1, Q3) number of publications per faculty member was 12 (5, 39), ranging from 1 to 478. 83 (80%) of the faculty have coauthored a publication with another faculty member; the median (Q1, Q3) number of collaborators per faculty member was 3 (2, 8) and ranged from 0 to 21. 450 (11%) of publications included more than one faculty member as a coauthor. In the network diagram, 80 (81%) of faculty members were connected by coauthorship to a single large cluster. Neither the number of publications (increase in odds 1.0, 95% CI 1.0–1.1; p = 0.16) or h-index (increase in odds 1.0, 95% CI 1.0-1.0; p = 0.74) was associated with increased odds of a faculty member collaborating with another faculty member. Factors associated with increased odds of any two faculty members collaborating were: being from the same division (increase in odds 5.0, 95% CI 3.9–6.3; p<0.001) and both coauthoring a publication with a common faculty member (increase in odds 4.8, 95% CI 3.8–6.2; p<0.001). Being of different genders or differences in number of publications or h-index was not associated with changes in the odds of collaboration.

CONCLUSION
Social network analysis of coauthorship can provide insight into the social structure and research collaboration of an academic department. This structure should be considered in efforts to improve collaboration and research productivity.