bluuebunny/crossref_metadata_2025_split huggingface dataset:
15 Predictive validity of two developmental screening tools at the 18-month visit and neurodevelopmental consultation at an average age of 8 years
Authors: Borkhoff Cornelia M , Imsirovic Haris , Bayoumi Imaan , Macarthur Colin , Nurse Kimberly M , Feldman Mark , Lau Eddy , Knight Braden , Birken Catherine S , Maguire Jonathon L , Parkin Patricia C 
Published: October 2024

Abstract

Background
The Canadian Paediatric Society (CPS) recommends an enhanced 18-month well-baby visit incorporating a developmental screening tool to stimulate discussion with parents, and notes that a widely used tool is the Nipissing District Developmental Screen (NDDS). For early detection of autism spectrum disorder, the CPS notes that a commonly used screening tool is the Infant Toddler Checklist (ITC).

Objectives
To examine the predictive validity of the ITC and NDDS at the 18-month visit using later neurodevelopmental consultation as the criterion measure; and examine whether positive developmental screening was associated with health care utilization (HCU).

Design/Methods
Using a prospective design, parents completed the ITC and the NDDS at the 18-month visit in primary care practices. Seven types of HCU were collected from health administrative databases, via linkage using the child’s health insurance number, including: neurodevelopmental consultation, special paediatric consultation, scheduled primary care visit billings, unscheduled primary care or minor visit billings, other non-primary care visit billings, hospitalizations, and emergency department visits. Covariates included child and family characteristics. We calculated screening test properties (using neurodevelopmental consultation as the criterion) and used multivariable negative binomial regression to estimate rate ratios (RR) for each of the 7 types of HCU.

Results
For both the ITC (n=1460) and NDDS (n=802) cohorts, mean age at screening was 18 months and mean age at follow up was 8 years. Of the ITC cohort, 11% were screen positive, 2.6% had a neurodevelopmental consultation. A positive ITC had 40% sensitivity (95% CI 24%-57%), 90% specificity (95% CI 88%-91%), 10% false positive rate (95% CI 9%-12%). A positive ITC was associated with 6 of 7 types of HCU, including neurodevelopmental consultation (RR=2.78, 95% CI 1.37-5.67). Of the NDDS cohort, 36% were screen positive, 2.5% had a neurodevelopmental consultation. A positive NDDS had a sensitivity of 50% (95% CI 27%-73%), specificity of 65% (95% CI 61%-68%), false positive rate of 35% (95% CI 31%-40%). A positive NDDS was associated with only 1 of 7 types of HCU: unscheduled primary care or minor visit billings 1.24 (95% CI 1.01, 1.53, p=0.04).

Conclusion
The predictive validity of the ITC was stronger than the NDDS due to high specificity and low false positive rates. The low sensitivity of the ITC is similar to other screening tools used at 18 months, highlighting the importance of ongoing developmental surveillance. The false positive rate of the NDDS is unacceptably high for a screening tool.
30 Access to Autism Spectrum Disorder services for marginalized families in Canada: A scoping review
Authors: Chow Selina , Chang Oswin , Rajeswaran Thenugaa , Gojsevic Milena , Lewis Iveta , Smile Sharon , Kawamura Anne , D'Costa Rhea 
Published: October 2024

Abstract

Background
In Canada, despite universal healthcare, immigrant and racially marginalized families face unique barriers when accessing Autism Spectrum Disorder (ASD) services for their children. Exploring these experiences is critical to inform the federal government’s efforts to create a national autism strategy that serves children and families with ASD in Canada.

Objectives
We conducted a scoping review of immigrant, refugee, and racially marginalized families’ access to, utilization, and experiences with ASD services in Canada.

Design/Methods
The Joanna Briggs Institute scoping review methodology was used. A literature search in MEDLINE, EMBASE, CINAHL, APA PsycINFO, Scopus, and Web of Science was conducted in August 2023. English and French-language qualitative studies describing the experiences of marginalized families in Canada with accessing and/or using ASD services for their child &lt;18 years were included. To assess eligibility of search results, title, abstract, and full-text screening were conducted independently by two reviewers. For included studies, two reviewers extracted data and appraised articles using the Critical Appraisal Skills Programme qualitative checklist.

Results
There were 4,489 search results. After de-duplication, 3,804 studies remained. Of these studies, 12 met inclusion criteria – representing 320 immigrant caregivers living in Ontario (n=167), Quebec (n=151), and British Columbia (n=2). Caregivers immigrated from Africa (n=55), Latin America (n=43), Europe (n=25), Asia (n=13), North America (n=11), the Middle East (n=4), and unreported (n=169). Of note, no studies focused on refugees. Common barriers when accessing ASD services were related to: difficulties navigating the health system (wait times, limited resources in the public system, high costs for private services, lack of collaboration between school and healthcare providers), challenges interacting with service providers (feeling unheard, discrimination, lack of continuity of care), and cultural differences (regarding ASD, language barriers, social isolation). In contrast, families identified supportive healthcare and school personnel, provision of culturally-specific multilingual resources, and parent-led peer support networks as key facilitators to ASD service access and use.

Conclusion
These results highlight gaps in existing research, especially around the experiences of refugee families. Our findings reiterate the importance of greater caregiver involvement in informing evidence-based recommendations to improve Canadian service provision, policy, and research. This national focus is especially relevant, given that 23% of Canadians in the most recent 2021 census are landed immigrants – representing the highest proportion of immigrants in Canada to date and emphasizing the growing need for culturally competent care.
38 Disparities in health outcomes by the age of five among preterm children in rural versus urban communities in British Columbia
Authors: Richter Lindsay , Shen Ye , Lisonkova Sarka , Ting Joseph 
Published: October 2024

Abstract

Background
Health disparities exist between than urban and rural communities, as rates of preterm birth, severe maternal morbidity and severe neonatal morbidity are higher in rural areas. There are limited population-based studies on early childhood health outcomes among those born preterm by geographical area.

Objectives
To compare health service use, morbidity, and medication use for up to five years of age between preterm children in rural versus urban residences.

Design/Methods
The study included liveborn infants at 22-44 weeks’ gestational age (GA) in British Columbia (BC), Canada, 2004-2014. Follow-up data to December 2019 included linked health information from four provincial databases (perinatal database, outpatient visits, hospitalizations, and outpatient prescriptions). Urban-rural status was based on maternal residence at birth. Rate ratios (RR) of health service use, childhood morbidity and medication use were compared within GA categories (22-27, 28-33, 34-36, 37-44) by rural vs. urban region using Poisson regression.

Results
There were 49,555 (10.9%) rural and 406,149 (89.1%) urban children included in this study. 42,789 children were born at &lt;37 weeks GA, and the preterm birth rate was 9.4%. Compared to urban areas, children in rural regions had more hospitalizations (28-33 weeks: RR 1.35, 95% CI: 1.19-1.51; 34-36 weeks: RR 1.35, 95% CI 1.27-1.44; 37-44 weeks: RR 1.32, 95% CI 1.29-1.34) by five years of age; and significantly fewer outpatient visits (22-27 weeks: RR 0.90, 95% CI: 0.87-0.93; 28-33 weeks: RR 0.81, 95% CI: 0.80-0.82; 34-36 weeks: RR 0.75, 95% CI 0.74-0.75; 37-44 weeks: RR 0.71, 95% CI 0.71-0.71). Rural children born at 34-36 weeks had significantly higher rates of bronchiolitis (RR: 1.35, 95% CI: 1.16-1.56) compared to urban children. They were prescribed more antibiotics and bronchodilators (RR: 1.15, 95% CI: 1.13-1.17, and RR: 1.12, 95% CI: 1.05-1.19, respectively).

Conclusion
Compared with urban areas, preterm children living in rural regions of BC had higher rates of hospitalization, higher rates of bronchiolitis and more frequent prescriptions of antibiotics and bronchodilators by five years of age. These disparities in health status and service use warrant further research and public health interventions.
41 Neonatal outcomes with exclusive breast milk in infants with gastroschisis: A systematic review and meta-analysis
Authors: Suntharalingam Hareshan , Armstrong Jennifer , Briatico Daniel , Huisman Esther , Shah Prakesh S , Livingston Michael H 
Published: October 2024

Abstract

Background
Infants with gastroschisis may experience prolonged stays in hospital as they transition from parenteral nutrition to enteral feeds. Some studies suggest that patients who receive exclusive breast milk experience better outcomes than those who receive supplemental or exclusive formula. These findings are inconsistent and the evidence for exclusive breast milk remains uncertain.

Objectives
To systematically review and meta-analyze the effectiveness of exclusive breast milk in infants with gastroschisis.

Design/Methods
We searched Medline, Embase, and Cochrane without language restriction from inception until June 2023. Manual searches of trial registries and reference lists of relevant articles were also performed. We included studies that assessed the effectiveness of exclusive breast milk compared to formula among infants with gastroschisis. Title, abstract, full-text screening, and data extraction were completed by two independent reviewers. The Newcastle-Ottawa Scale was used to assess the risk of bias. Our outcomes of interest were time to full enteral feeds, days of parenteral nutrition, length of stay, necrotizing enterocolitis (NEC), cholestasis, and mortality. RevMan was used to meta-analyze treatment effects using a random effects model whenever possible. Summary statistics were reported as relative risk (RR) with 95% confidence intervals (95% CI).

Results
We identified 130 studies of which six were selected for review. All included studies were observational and retrospective. Only 3 studies (n=3211 participants) reported outcome data that were amenable to meta-analysis. All participants received exclusive breast milk (n=1009) or supplemental or exclusive formula (n=2202). Exposure to exclusive breast milk was associated with a lower risk of mortality compared to those who received formula (unadjusted RR=0.36; 95% CI: 0.13-0.96, 2 studies, n=3157, I2=0%). Exposure to exclusive breast milk was not associated with a decrease in NEC (unadjusted RR=0.20; 95% CI: 0.03-1.14; 3 studies, n=3211, I2=0%). The primary source of bias among included studies was lack of adjustment for confounders. We identified one randomized controlled trial comparing exclusive breast milk to formula. This study was stopped due to low recruitment.

Conclusion
The use of exclusive breast milk among infants with gastroschisis may be associated with a reduction in mortality; however, this estimate is based on small numbers from observational studies. Estimates may change as more data become available. Further research is needed to establish best feeding practices, including the role of human donor milk.
50 Co-designing an intervention with asylum seeking youth to improve access to healthcare in Canada using human-centered design
Authors: Nwebube Chioma , Parmar Puneet , McIntyre Jenn , Johnson Shay , Begun Stephanie , Vandermorris Ashley , Giroux Ryan , Ye Amber , Suleman Shazeen 
Published: October 2024

Abstract

Background
Asylum seeking youth in Canada and the United States face multiple barriers to accessing healthcare, leaving them at greater risk of worse health outcomes. In a previous study, we found that limited knowledge of the Canadian health care system and few navigation supports were a key barrier to care for asylum seeking youth, yet no youth-developed intervention existed to support this population. Human-centered design (HCD) develops meaningful interventions with communities who have been historically marginalized.

Objectives
This study sought to co-design an intervention to increase youth empowerment and access to health care for asylum seeking youth in Canada.

Design/Methods
This was a community-based participatory-action research (CBPAR) study, and combined human-centered design (HCD) methodologies. We obtained research ethics board approval for this study (#SMH REB 22-117). In partnership with two community organizations that supported asylum seeking youth in a large Canadian city, a youth advisory board was created. In multiple co-creation sessions over a calendar year, an intervention was developed in rapid prototyping sessions and refined with feedback, to develop a final pilot intervention.

Results
A total of 7 asylum-seeking youth participated in the youth advisory board, ranging in age from 12-19, representing 3 different languages and included youth who self-identified with chronic medical conditions. Over a 15-month period, they participated in 6 co-creation sessions to develop a multi-lingual, web-based tool; youth specifically stated they did not believe an app would be helpful, but rather a resource that could be easily accessed. The youth advisory board shared they had limited understanding of the Canadian healthcare system, as well as interim and provincial health insurance. Youth felt the tool should answer questions about how health insurance worked, be brightly colored, use dyslexia-friendly font and be easily saved on a smartphone as an image. A multi-lingual wallet card was developed for youth to easily present at healthcare encounters, particularly if they did not have provincial health insurance, to help youth communicate their coverage, language and needs.

Conclusion
To our knowledge, we developed the first co-designed tool in Canada for youth asylum seekers, by youth, to improve and empower youth to receive health care services they are entitled to through navigation support. Given the high degree of marginalization faced by asylum seeking youth, this intervention has the promise to improve health outcomes. Feasibility and acceptability of this study will be evaluated in subsequent studies.
64 Respiratory outcomes by five years of age among children born preterm: A population-based study using health services data
Authors: van Warmerdam Jacqui , Shen Ye , Richter Lindsay , Yang Connie , Lisonkova Sarska , Wong Jonathan , Roberts Ashley , Chan Edmond , Bone Jeffrey , Kieran Emily , Ting Joseph 
Published: October 2024

Abstract

Background
While neonatal care advancements have led to increased survival of preterm infants, many experience ongoing respiratory complications.

Objectives
Healthcare administrative data offers a comprehensive measure of neonatal outcomes. Our study used population-based data to describe rates of healthcare contacts for respiratory disease among children born preterm.

Design/Methods
A retrospective cohort of infants born in British Columbia between 2004-2014 was identified using a provincial birth registry. By linking to population-based healthcare data, we captured population demographics, birth data, and healthcare visits for respiratory causes [outpatient visits, hospitalizations, and intensive care (ICU) admissions] up to 5 years of age. The rate of healthcare visits due to asthma, bronchiolitis, and pneumonia were compared between preterm (22-36 weeks) and term/post-date infants (37-44 weeks GA) using Poisson regression.

Results
Children born at term (n=413,140) were compared to children born at 34-36 week GA (n=33,227), 28-33 week GA (n=8362), and 22-27 week GA (n=1231). Compared to term infants, rates of hospitalizations and ICU admission for all respiratory causes were higher among children born preterm. Children born 22-27 weeks GA had the highest rates of hospitalization for asthma [rate ratio (RR) 9.4, 95% CI 7.9-11.1], bronchiolitis (RR 10.5, 95% CI 9.3-11.8) and pneumonia (RR 15.9, 95% CI 14.3-17.7). Rates of ICU admission for asthma (RR 27.1, 95% CI 17.2-40.4) and pneumonia (RR 58.1, 95% CI 46.6-71.7) were highest among 22-27 week GA infants. Increased rates persist among children born 34-36 weeks GA, with higher rates of hospitalization for asthma (RR 1.8, 95% CI 1.6-1.9), bronchiolitis (RR 2.1, 95% CI 2.0-2.2), and pneumonia (RR 1.8, 95% CI 1.7-2.0) compared to term infants.

Conclusion
Preterm infants experience significantly higher rates of outpatient visits, hospitalizations, and ICU admissions for respiratory disease compared to term infants. Healthcare utilization, including ICU admissions, increased with decreasing gestational age. Of note, increased rates of respiratory disease were also found among infants born 34-36 weeks GA. Our study is the first to use population based data to describe rates of healthcare contacts for respiratory disease among preterm infants, providing insight to long-term respiratory disease burden.
68 Feasibility of applying synchronized and proportional negative pressure ventilation in preterm infants with respiratory distress (NeoVest)
Authors: Beck Jennifer , Sinderby Christer , Campbell Douglas 
Published: October 2024

Abstract

Background
In preterm infants, application of negative pressure ventilation (NPV) may offer advantages to traditional methods of nasal continuous positive airway pressure (nCPAP). In a pre-clinical model, we recently described the “NeoVest”, a system consisting of a sealed abdominal interface and a ventilator that applies NPV in synchrony and in proportion to the diaphragm electrical activity (Edi) (Beck 2022). In animals with loaded breathing, the Neovest allowed a 50% reduction in Edi, and demonstrated specific diaphragm unloading, without hemodynamic effects. The NeoVest system, and its interface, have yet to be evaluated in human infants.

Objectives
The aim of the study was to evaluate the feasibility of applying synchronized and proportional NPV with an abdominal interface in infants with respiratory distress.

Design/Methods
This is a prospective feasibility trial. The inclusion criteria were admission to the Neonatal Intensive Care Unit with respiratory distress, birthweight&gt;1.5kg, &lt;6 weeks of age, FiO2 &lt;0.35, clinically stable with no recent apneas and bradycardias, nCPAP &lt;8 cm H2O and at least 48 hrs old, or post-extubation. After parental consent, the feeding tube was exchanged for a 6F “Edi catheter” (for feeding and measuring Edi), and sensors were placed (heart rate, oxygen saturation, transcutaneous CO2, and non-invasive blood pressure (BP)). Figure 1 shows the Neovest interface on a manikin. The five protocol steps were: nCPAP ON/NeoVest OFF (10 min), nCPAP ON/NeoVest ON (10 min), NO ASSIST (1 min), NeoVest only medium (10 min), NeoVest high (5 min), NeoVest low (5 min).

Results
Eight babies have been included to this point. The principal diagnoses were Respiratory Distress Syndrome and/or Transient Tachypnea of the Newborn. Mean weight was 2186±480g and age 10±8 days old. All babies tolerated the physical application of the vest. As shown in Figure 2, there was no significant difference in Edipk when the vest was placed (12.4±5.5 vs. 11.1±3.5 uV). During the period of no assist, Edipk was higher (18.8 ±7.3 uV) than nCPAP or NeoVest periods (p= 0.012), which were not significantly different from each other. Neural respiratory rate was the same for all periods tested. As per its design, the Neovest system delivered negative pressure in synchrony and in proportion to the Edi. Negative pressures applied (□PVEST) were -9±4, -11±4, and -7±5 cmH2O (Figure 2) for the three NeoVest periods. All infants were clinically stable with no disruptions to vital signs.

Conclusion
Applying synchronized and proportional negative pressure with the NeoVest system was feasible and showed promise with regards to diaphragm unloading. Future studies are required to evaluate the NeoVest utility for longer periods and compared to other methods of respiratory support.
70 Implementation of nurse facilitated, structured, post-event clinical debriefs in four neonatal intensive care units using the INFO model
Authors: Ediger Krystyna , Law Brenda , Godbout Vanessa , Trinh Faith , Rose Stuart 
Published: October 2024

Abstract

Background
Neonatal intensive care units (NICUs) often experience acute clinical events. Post-event team debriefs can reinforce success, identify areas for improvement, and improve healthcare providers’ (HCP) psychological coping. However, barriers exist to successful debriefs, and poor debriefs can increase HCP stress.

Objectives
To implement and evaluate structured post-event clinical debriefs for NICUs within a regional neonatal program.

Design/Methods
We assembled a multi-disciplinary implementation team, adapted an existing tool (INFO Clinical Debriefing Tool), and identified champions for each site (2 level 2 NICUs, 1 level 3 perinatal NICU, and 1 level 4 surgical NICU). A REDCap database, debrief triggers, feedback process for recommendations to quality improvement leads and frontline HCPs were developed. We chose charge nurses as facilitators as they were consistently present but were not team leads. Facilitators were trained in 2-hour Zoom sessions with a didactic presentation followed by simulated debriefing practice. Debriefs were then started and tracked. A post-implementation survey was conducted at 6 months.

Results
Eighty-one HCPs responded to the pre survey, identifying time stress and skill / availability of facilitators as main barriers. Most nurses (75%) were comfortable participating in debriefs; this approached 100% in other disciplines. However, there were negative experiences reported. (Table 1) Ninety-five debriefs were conducted in 6 months; 50% were delivery room resuscitations, 14% were in-unit events. Median 7 (IQR 5-8) HCPs attended; 85% had 3 or more disciplines attending. Most (81%) were led by trained facilitators, with 80% led by nurses or respiratory therapists. Debriefs took a median 12 minutes (IQR 8-17), and generated recommendations for improvements to equipment, team communication, and processes. Two sites had more success with uptake, facilitated by consistent presence of champions. Barriers to implementation included: availability of trained facilitators, time constraints, competing unit priorities. The post survey (85 responses) showed a positive view of INFO debriefs. Most respondents (88%) had participated in at least 1 debrief; of these 76% report positive / very positive experience, 76% thought team members always had the chance to speak up, and 78% felt the INFO process provided an effective mechanism for communicating concerns. Participants still listed time pressure as the main barrier.(Table 2)

Conclusion
Nurse-led, structured post-event clinical debriefs can be implemented in NICUs and are positively viewed by participants. NICUs experience implementation barriers that need to be considered.