bluuebunny/crossref_metadata_2025_split huggingface dataset:
MODE OF DELIVERY AND ITS IMPACT ON NEONATAL OUTCOMES IN PRETERM INFANTS
Authors: McKnight Sarah , Gautam Bishal , Miller Michael , Richardson Bryan S , da Silva Orlando 
Published: May 2018

Abstract

BACKGROUND
The optimal mode of delivery for preterm infants remains controversial, and routine Caesarean sections (C/S) are not recommended, except for maternal indications. Nonetheless, many preterm infants are delivered by C/S, particularly those in breech presentation, and recent retrospective data have suggested that these infants may have improved outcomes.

OBJECTIVES
To examine whether C/S as the mode of preterm delivery is associated with decreased mortality and improved short term outcomes.

DESIGN/METHODS
This retrospective, population-based cohort study examined infants with a gestational age between 23 0/7 weeks and 32 6/7 weeks, born between January 1, 2007 and December 31, 2016, and admitted to the Neonatal Intensive Care Unit at a single Canadian Tertiary Care hospital. Infants with major congenital anomalies were excluded. Data were abstracted from the local Neonatal-Perinatal database for all infants. Two groups, those delivered vaginally and those delivered by C/S, were compared for major neonatal outcomes including the primary outcomes of death and severe intraventricular hemorrhage (IVH), defined as grade 3 or higher.

RESULTS
A total of 1442 infants met inclusion criteria (784 born by C/S and 658 vaginally). There was no significant difference in neonatal mortality (7.0% vs 7.1%, p=0.925) or severe IVH (6.1% vs 7.4%, p=0.317). There was, however, a significant difference in the incidence of IVH, any grade (19.9% vs 27.5%, p=0.001), which remained after controlling for other significant predictors. There were no other significant differences in the secondary outcomes examined including need for extensive resuscitation, respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia, or retinopathy of prematurity.

CONCLUSION
Caesarean section was not associated with decreased mortality in preterm infants, relative to vaginal births. Caesarean section was associated with a reduced rate of IVH (any grade) and there was a trend towards decreased severe IVH which may warrant further study.
ASSESSMENT OF HEART RATE USING AUSCULTATION AND ELECTROCARDIOGRAPHY DURING NEONATAL RESUSCITATION IN A PORCINE MODEL OF ASPHYXIA
Authors: Patel Sparsh , Cheung Po-Yin , Lee Tze-Fun , Mustofa Jannatul , Pasquin Matteo , O’Reilly Megan , Schmolzer Georg 
Published: May 2018

Abstract

BACKGROUND
Recent neonatal resuscitation guidelines have suggested the potential benefit of introducing Electrocardiography (ECG) to monitor neonatal heart rate (HR) as standard of care for newborns receiving respiratory support in the delivery room due to advantages over auscultation.

OBJECTIVES
To assess effectiveness of HR detection using either ECG or auscultation.

DESIGN/METHODS
We reviewed recordings from our piglet neonatal resuscitations to compare an ECG with auscultation for assessing the detection of HR at cardiac arrest. Term newborn piglets (n=41) were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia, which was achieved by clamping the endotracheal tube until asystole. Asystole was confirmed by using Electrocardiography and auscultation.

RESULTS
The median (±IQR) duration of asphyxia was 318 (200–560)sec. In 41 piglets both auscultation and ECG HR were assessed. In 11 (27%) cases both auscultation and ECG correctly identified a bradycardic HR (mean (SD) 32(14)/min) at the beginning of chest compression. In 11 (27%) cases both auscultation and ECG correctly identified absent of any HR. However, in 19 (46%) cases auscultation did not detect a HR while ECG did detect a HR. Overall, the Positive Predictive Value was 37%, Negative Predictive Value was 100%, Sensitivity was 100%, and Specificity was 37% for the ECG to display accurate HR during asphyxia in newborn piglets.

CONCLUSION
Our data illustrates the need for caution in the routine use of ECG monitoring for all neonatal who might need advanced resuscitation in the deliver room.
IS IT A SURPRISE? SHOCKING SUB-OPTIMAL MEDICATION SAFETY IN CHILDREN WITH MEDICAL COMPLEXITY
Authors: Patel Hema , Bourassa Marie-Helene , Huth Kathleen , Vandecruys Patricia 
Published: May 2018

Abstract

BACKGROUND
There are increasing numbers of children with medical complexity (CMC) worldwide. CMC make multiple transitions between healthcare settings and providers; frequently receiving multiple medications. While the risk of medication error in children is recognized, data on CMC, perhaps one of the most vulnerable groups, is lacking.

OBJECTIVES
To explore parental knowledge, perceptions and behaviours around medication safety and to identify and describe recalled medication errors in order to guide future efforts in quality and safety.

DESIGN/METHODS
Study participants: Parents of CMC followed in a university hospital based specialized clinic. Study design: Cross-sectional prospective survey, administered by face-to-face interview.
Study methods: Because no pre-existing suitable validated survey tool was identified, a 35-item bilingual survey was developed using quantitative and qualitative methods. Testing for face and construct validity was conducted. Consecutive parents of CMC presenting to a designated clinic were approached for study participation. Following informed consent, parents were interviewed for 12–15 minutes with responses entered into a web-based secure database with integrated statistical analysis for data interpretation. Additional diagnostic, verification and healthcare utilization data were collected from the medical chart.

RESULTS
Complete data was collected for 51 CMC; 77% of respondents were mothers; 3 parents declined to participate. Children, 35% female, ranged in age between 6 months and 17 years. Polypharmacy was common; 77% of CMC had 3 or more medications, 53% had five or more daily medications. Only 37% of parents reported having a complete list of their child’s medications; less than quarter of those administering liquid medications were able to report the actual dose/concentration. Almost two-thirds of parents were worried that their child might have a medication error in the future with 45% recalling at least one medication error in the past. Of these parents, 76% reported that the error occurred during inpatient hospital stay, most commonly due to a dosage error. The reported impact on the child due to the error included life-threatening situations.

CONCLUSION
Medication error in CMC is perceived and reported as a significant risk by parents. Nonetheless, only a minority were able to show a list of their child’s medications. The rate of reported errors suggests that existing prevention practices remain suboptimal. Further study in other care settings is warranted to confirm these findings and to determine which strategies may be most effective in reducing the risk of medication error in CMC.
DEVELOPMENT OF A SCORING SYSTEM FOR THE NURSING WORKLOAD IN A PEDIATRIC INTENSIVE CARE UNIT
Authors: Eberle Alexa , Jouvet Philippe , Charette Sylvie , Provost Bryan 
Published: May 2018

Abstract

BACKGROUND
Nursing workload evaluation tools are designed to determine adequate staffing for a given shift. Only retrospective tools that do not predict the number of nurses needed to start a shift exist. A prospective nursing workload evaluation tool (SJ score), developed by a group of nurses with items based on previously published retrospective scores and clinical experience, includes 16 weighted sections (scored from 0 to >100 with 1 point ≈ 5 min nurse workload).

OBJECTIVES
This study’s aim is to assess the reliability and validity of the SJ score in the Paediatric Intensive Care Unit (PICU).

DESIGN/METHODS
Inclusion criteria: children admitted in a PICU, age < 18 yo. Exclusion criteria: already included 3 times in this study (phase 1 only) or children discharged 2 hr after the beginning of the nurse shift studied. Children were scored for 8 hr nursing shifts. Phase 1 (pilot validation) required simultaneous prospective SJ scoring by the nurse in charge (NIC) and chief nurse (SC), then a retrospective SJ score by an independent trained investigator (AE). Phase 2 (validation in the real context of the PICU), which used an improved SJ score, required that each child had an SJ score prospectively by the NIC of the previous shift, then retrospectively by the NIC of the dedicated shift. Statistical analysis included the intraclass correlation (ICC) and a Bland Altman plot. Bland Altman was considered acceptable if mean difference was closed to 0. For ICC: 0.40<ICC<0.59_Fair, 0.60<ICC<0.74_Good, 0.75<ICC<1_Excellent.

RESULTS
165 patients’ shifts observations were performed in phase 1. In the comparison between the prospective score performed by the NIC and SC, the Bland Altman mean difference was -0.03 with limits of agreement between -3.63 and 3.58, and the ICC was good: 0.63 with 95%confidence interval (95ICC) from 0.40 to 0.93. In the comparison between the prospective score of the NIC and AE retrospective score, the ICC was fair: 0.52 with 95ICC from 0.32 to 0.78. In phase 2, 2599 patients’ shifts were studied. The Bland Altman mean difference was 0.21 with limits of agreement between -10.5 and 10.9, and the ICC was excellent: 0.86 with 95ICC from 0.85 to 0.87.

CONCLUSION
The SJ score prospectively predicted well nursing workload in a single PICU. Additional studies are needed to determine the validity in other PICUs.
EVALUATION OF EXECUTIVE FUNCTIONING AND BEHAVIOUR IN YOUNG ADOLESCENTS WITH ADHD: A FOLLOW-UP STUDY
Authors: Lemay Jean-Francois , Hai Tasmia , Kubas Hanna , MacMaster Frank 
Published: May 2018

Abstract

BACKGROUND
Executive functioning (EF) impairment is frequent in the ADHD population. Psychostimulant medications (e.g. Methylphenidate [MPH]) are considered effective in reducing EF symptomatology. Limited studies have investigated the long-term effects of MPH on EF in young adolescents with ADHD (A-ADHD).

OBJECTIVES
To evaluate EF and behaviour challenges across three time points in A-ADHD who were involved in a MPH treatment trial. EF and behavioural functioning were evaluated using two separate parent questionnaires.

DESIGN/METHODS
A total of 21 A-ADHD (males=62%; n=13), ages 9–14 (M=12.33 years, SD=1.55 years) were evaluated at three separate time points: 1) Baseline (BL: no medication); 2) Best Dose (BD: following a 4-week trial of MPH treatment); and 3) long term Follow-Up (FU: defined as up to 2 years following best dose). Parents completed two behaviour rating scales: Behaviour Rating Inventory of Executive Functioning (BRIEF) and Behaviour Assessment System for Children (BASC-2). Repeated measures analyses of variance (RmANOVA) were conducted measuring changes in EF and behavioural challenges over the three time points (BL, BD, and FU).

RESULTS
Significant differences were obtained in EF ratings over time on the BRIEF Behavioural Regulation Index (BRIEF-BRI; F (2,36) = 20.71, p < 0.001) and Metacognition Index (BRIEF-MI; F (2,36) = 26.83, p < 0.001). Pairwise comparison indicated a) significant decrease in symptom ratings for both indexes between time points BL and BD, and b) significant increase in symptom ratings for indexes between time points BD and FU. Similarly, behavioural ratings obtained on all BASC-2 indexes (Externalizing Problems, Internalizing Problems, Behavioral Symptoms, and Adaptive Skills) revealed a significant effect of time (F (2,36) range = 4.55 to 26.28, p range = <.001 to <.05). Pairwise comparison indicated a) significant decrease in symptom ratings across all BASC-2 indexes between BL and BD, and b) increase in symptom ratings across all BASC-2 indexes between BD and FU time points. Therefore, parent ratings indicated clinically significant difficulties with EF and behaviour during BL and FU and average EF and behaviour scores during BD.

CONCLUSION
During follow-up, parents of A-ADHD continue to report challenges in EF and in all aspects of behaviours and adaptive skills. Although parents reported positive changes during the MPH trial (BD), these behavioural improvements were not seen at follow-up. The combined use of screening tools for EF (BRIEF) and behaviour (BASC-2) might be of interest to paediatricians when monitoring medication responses in young adolescents with ADHD.
PERSPECTIVES OF NON-URBAN GENERAL PEDIATRICIANS ON DIAGNOSING AUTISM SPECTRUM DISORDER
Authors: Das Jennifer , Hartman Laura , King Gillian , Jones-Stokreef Nicola , Hepburn Charlotte Moore , Penner Melanie 
Published: May 2018

Abstract

BACKGROUND
Wait times for autism spectrum disorder (ASD) diagnosis contribute to delayed access to ASD interventions, which are most effective at young ages. General paediatricians (GPs) represent a potential resource for increasing diagnostic capacity and decreasing wait times for ASD diagnostic assessments. No current research has yet to solicit perspectives of non-urban GPs on ASD diagnosis.

OBJECTIVES
The objective of this project was to explore the perspectives of GPs practicing in smaller Ontario communities regarding their diagnostic processes and their role in ASD diagnostic assessment.

DESIGN/METHODS
We performed a qualitative study using thematic analysis of GPs’ experiences with cases of suspected ASD. GPs from three small/medium-sized Ontario communities (population range: 14,000–64,000) were recruited to provide variation in perspectives. Semi-structured interviews were conducted, transcribed, and coded. A preliminary theoretical framework was developed and sent to participants with a request for feedback (member checking). Feedback did not necessitate any significant changes to the framework.

RESULTS
14 GPs participated in interviews (7 from Community A, 4 from Community B, 3 from Community C). All participants considered ASD diagnosis to be in the GP’s scope of practice and part of their service to their community. Many sought out and self-funded additional ASD training as necessitated by their practices. Our framework identified three stages in the diagnosis of ASD: pre-assessment (gathering information prior to the first clinic visit), diagnosis, and service access. All of these stages are influenced by ecological factors including the individual patient/family, individual physician factors, factors reflecting the GP’s community group practice (i.e., how the group has decided its members will approach developmental referrals), and factors concerning the broader system of ASD care.

CONCLUSION
GPs practicing in non-urban Ontario communities routinely diagnose ASD and see this as part of their scope of practice. Compared to their urban counterparts, they emphasized a stronger sense of responsibility to provide this service to their communities. Strategies aimed at increasing diagnostic capacity should target group practices, increase availability of ASD specific training programs, and improve efficiency of clinic visits through pre-clinic information gathering. Further research regarding accuracy of GP assessments is required.
SUBNORMAL BIRTHWEIGHT AND INDUSTRIAL AIR POLLUTANTS – A COMPARISON OF SPATIAL-TEMPORAL HOT SPOT PATTERNS
Authors: Nielsen Charlene , Amrhein Carl , Serrano Lomelin Jesus , Zaiane Osmar , Vargas Alvaro Osornio 
Published: May 2018

Abstract

BACKGROUND
Disorders related to short gestation and low birth weight are the 2nd cause of infant death in Canada and have been increasing, especially in Alberta. Individual maternal risks are important but environmental exposures during pregnancy may restrict fetal growth. This contributes to small for gestational age (SGA: < tenth percentile weight for pregnancy duration) and low birth weight at term (LBWT: <2500 grams at ≥37 weeks-gestation).

OBJECTIVES
We examined the spatial-temporal patterns of SGA and LBWT with patterns of pollutants around conception, middle trimester, and birth.

DESIGN/METHODS
We aggregated postal code locations of mothers’ residences from the 2006–2012 birth registry in to space-time bins to analyze emerging hot spots. We applied the space-time pattern analysis on 70 industrial chemical emissions from the National Pollutant Release Inventory (NPRI) in estimated three month intervals. Then we statistically associated the classified patterns of SGA/LBWT with the pollutant patterns using the kappa statistic to determine how much the hot spot categories agree. The difference between kappa values indicated which trimester would be more important for which chemical.

RESULTS
​There was an increasing trend for SGA (consecutive hot spots) and for LBWT (sporadic hot spots) in major urban centers. There was an increasing trend for 15 chemicals (varying hot spots). 28 chemical patterns had a kappa index greater than 0.2 with SGA or LBWT patterns. Although there is poor agreement between the space-time patterns, the maximum kappa values occurred mostly with LBWT and around birth.

CONCLUSION
Spatial-temporal patterns of chemicals identified in published literature (e.g. particulate matter and gases) agreed more with timing around conception; however, there were additional pollutants identified during the birth trimester. Our research is moving us toward a better understanding of the spatial-temporal link between environment and early health.
EXERCISE AS AN EDUCATIONAL TOOL: A PILOT PROJECT
Authors: Bhardwaj Sumeet , McDougall Alexandre , Dhillon Navpreet , Grewal Jasleen , Burey Sharon 
Published: May 2018

Abstract

BACKGROUND
Exercise has been shown to have long term effects in improving social skills, scholastic performance and quality of life in all children. Unfortunately, physical education courses continue to have their dedicated curricular times reduced. Students may have as little as one period of curricular physical activity per week. Conversely, there is middle school in Windsor, Ontario that has implemented a daily curricular period dedicated to physical activity. This study aimed to assess the effects of this schools’ exercise programme on their students’ social skills, scholastic performance and quality of life.

OBJECTIVES
Our objective is to study the effects of a daily physical activity period as part of an educational curriculum on student physical fitness, academic performance and self reported quality of life.

DESIGN/METHODS
We undertook a naturalistic observational study that examined the results of a daily exercise program for Grade 7 students attending École Secondaire E.J. Lajeunesse in Windsor. At this school, all students in Grade 7 and Grade 8 participate in a daily one-and-a-half-hour exercise programme consisting of two different streams: hockey or dance. All Grade 7 students and their families attending the school were asked to participate in our research trial. To study the effects of the exercise programme, student physical fitness, academic performance, and self-rated quality of life were assessed. Specific outcome measures used include: 20 metre sprint test, beep test, squat strength, bench press strength, the Pediatric Quality of Life Inventory, academic grades in mathematics, English and French, and academic learning skills.

RESULTS
Due to difficulties in participant recruitment and retention, only the following results could be analyzed. After one year of the structured hockey exercise program, the participants demonstrated significant increases in sprint speed (p < 0.0001), beep test (p < 0.005), squat strength (p < 0.0001) and bench press strength (p < 0.0001). There was also an increase in scores assessing organization, independence, collaboration, initiative and self regulation. An increase was noted in the participant’s grades in English and French. Little change was seen in mathematics and science grades.

CONCLUSION
After one year of consistent exercise, study participants demonstrated significant improvements in physical fitness, learning skills and language studies performance. Our results outline multiple benefits of implementing an organized daily physical period as part of the educational curriculum. A follow up to this preliminary study is currently underway to evaluate the effectiveness of school exercise programs on ADHD symptoms.
CHARACTERISTICS OF ANEMIA AND IRON STATUS AND THEIR ASSOCIATIONS WITH BLOOD MANGANESE AND LEAD AMONG CHILDREN AGED FROM 3 TO 19 YEARS OLD FROM FOUR NORTHERN FIRST NATION COMMUNITIES IN QUEBEC
Authors: Tahir Emad 
Published: May 2018

Abstract

BACKGROUND
Prevalence of anemia and iron deficiency (ID) are higher among indigenous children in Canada, although few data are available in Quebec. Iron is metal that interact with the absorption of manganese (Mn) and Lead (Pb) cobalt (Co). ID is known to upregulate these metals, thereby increasing their absorption, concentration inside the body and their toxicity.

OBJECTIVES
The objectives of the present study are to: (i) Characterize ID and anemia prevalence and their protective/risk factors; and (ii) Study associations between blood Mn, Pb and iron status biomarkers.

DESIGN/METHODS
Data from The 2015 First Nation Youth Health and Environment Pilot Study was conducted among children (3 to 19 y, n = 198) from four First Nations communities in Quebec will be used in these study where, blood samples and anthropometric measures were collected, hemoglobin was measured on site using an Hemocue analyser. Protective/risk factors including education, food security, housing conditions and lifestyle and dietary habits were documented using interview-administered questionnaire to children’ parents. Serum ferritin and blood Pb, Mn, Co, Zn and Ca were measured by Modular P analyser and ICPMS. Descriptive and multiple regression statistical analyses adjusting for relevant co-variables were used.

RESULTS
Results showed ID and anemia prevalence of 20.7% and 17.6% respectively, among which 8.8% presented iron deficiency anemia. Moreover, up to 11.9% had elevated blood Mn (median = 15.9 µg/L, range 7.1 to 31.9 µg/L) of which 27.5% presented ID. However, blood Pb was low (median = 5.4 µg/L, range 1.8 to 50.8 µg/L). Multiple logistic regression analysis showed that crystal juice intake was associated with lower ID and anemia (OR (95%): 0.50 (0.30 - 0.82) and 0.47 (0.26 - 0.87) respectively) in girls. Likewise, the presence of hunter in the household was associated with lower anemia in girls (0.09 (0.02 - 0.53)). No factors were associated with ID in boys, and for anemia, lower serum ferritin and older age was associated with higher prevalence of anemia (1.08 (1.01 - 1.14) and 1.23 (1.02 - 1.48) respectively). In adjusted models, blood Mn was negatively associated with serum ferritin concentrations (ß = -0.05; p < 0.02) in girls and positively associated with blood Co (ß = 8.50; p < 0.01) in boys.

CONCLUSION
Findings on high prevalence of ID, anemia and elevated blood Mn among children form these First Nation communities support that, community and family activities increasing traditional foods consumption improve nutritional status and suggest that foods and beverages naturally rich in vitamin C - but lower in added sugar than crystal juice - would improve iron intake in girls, which would contribute to improve their iron status, decrease anemia and restore normal Mn blood levels.