bluuebunny/crossref_metadata_2025_split huggingface dataset:
55 Post-pandemic paediatric asthma admissions: Clinical characteristics and outcomes of children hospitalized with asthma in 2022: The READAPT-Kids study cohort
Authors: Kim Min Jung , Gill Peter J , Mtaweh Haifa , Freire Gabrielle , Yang Connie L , Rayment Jonathan H , Mahant Sanjay , Morris Shaun K , Seaton Claire 
Published: October 2024

Abstract

Background
Asthma exacerbations triggered by acute respiratory infections (ARIs) are a major cause of hospitalizations in children. There were large reductions in asthma admission during the SARS-CoV2 pandemic. Following the relaxation of public health interventions, there was a resurgence in admissions for ARIs. The effect of this rebound in ARIs on asthma management practices and outcomes is not well understood.

Objectives
To describe sociodemographic characteristics, etiology, management, and clinical outcomes of children and youth under the age of 18 years admitted to a tertiary care paediatric hospital with an acute asthma exacerbation from July 1, 2022 to Dec 31, 2022.

Design/Methods
An observational cohort study of children and youth less than 18 years, hospitalized with an acute asthma exacerbation from July 1, 2022 to Dec 31, 2022 at a single large Canadian children’s hospital. This was a subgroup analysis of the READAPT-Kids study cohort (Clinical chaRacteristics and outcomEs of hospitAlized children with Acute resPiratory infecTions.) Cases were identified using ICD-10-CA codes, then manually screened for inclusion. Detailed clinical and demographic information was extracted.

Results
Among 551 patients hospitalized with an ARI, 29.2% (n=161) were diagnosed with an asthma exacerbation. 99 were male (61.5%) with a median age of 3.8 years (IQR 2.2-6.3). 41.3% (n=64) had a previously documented asthma history, and of those, only 16.9% were taking any form of asthma therapy at admission. In hospital, 91.4% were given systemic corticosteroids, 86.5% had at least 1 viral pathogen identified, 72.2% had a chest x ray, 42.1% received antibiotics, and 23.7% had high flow nasal cannula oxygen outside of the paediatric intensive care (PICU). 22.4% (n=36), were admitted to the PICU, and 3.7% required invasive mechanical ventilation, there were no patient deaths. Median length of stay was 2.6 days (IQR 1.7–4.6 days). At discharge, 79.5% were prescribed regular inhaled corticosteroid therapy.

Conclusion
Asthma admissions accounted for a significant proportion of children hospitalized with ARIs in the post-pandemic era, with one fifth requiring transfer to PICU. CXR and antibiotic usage were high. Over 80% of those with a previous diagnosis of asthma were not taking inhaled corticosteroids at the time of admission.
56 Iron deficiency is common in extreme preterm infants despite prophylactic iron supplementation
Authors: Barr Hudson , Morrison Lisa , Ketan Kulkarni , Ghotra Satvinder 
Published: October 2024

Abstract

Background
Iron deficiency (ID) in childhood is linked to adverse neurodevelopmental outcomes in the long-term. Extremely premature infants (EPI; born &lt; 28 weeks gestation) are more susceptible to ID due to a multitude of factors including lower iron reserves at birth, rapid growth, immature erythropoiesis, and multiple phlebotomy tests during hospital stay. Therefore, professional societies advise prophylactic iron therapy for these infants from 2-6 weeks age until 6-12 months. However, there is paucity of data on the iron status in EPI receiving this prophylactic iron supplementation.

Objectives
To investigate the prevalence and risk factors associated with ID in EPI.

Design/Methods
A retrospective cohort study analyzed a Provincial database of EPIs born between 2005-2018. Infants with congenital malformations, chromosomal anomalies and blood disorders were excluded. All included infants received prophylactic iron supplementation from 2-4 weeks of chronological age that was recommended to continue at discharge until 9-12 months corrected age (CA). At 4-6 months CA, these infants underwent blood testing. ID was defined as serum ferritin &lt; 20mcg/L at 4 months CA or SF &lt; 12mcg/L at 6 months CA. Through a univariate analysis using single-variable logistic regression, factors linked to ID were identified. Those with a p-value &lt; 0.20 progressed to a multivariable model, retaining variables with a p-value &lt; 0.05.

Results
Of 146 infants, 45.9% had ID. ID group had lower mean ferritin (16.4 µg/L vs 50.0 µg/L, p &lt; .001) and reticulocyte hemoglobin equivalent (28.4pg vs 31.6pg, p &lt; .001) compared to the non-ID group. ID prevalence reduced from 59.7% in 2005-2011 to 40.3% in 2012-2018 cohort. Exclusive or partial breastfeeding at 4-6 months CA was protective against ID (Odds: 0.2, p = 0.003). Iron therapy at 4-6 months CA was not protective in the final model. Notably, 27.4% stopped iron therapy before 4-6 months CA, and exclusive formula-fed infants had notably lower iron intake than breastfed infants (66.1% vs 99.1%, p = 0.006).

Conclusion
Nearly half of the EPI exhibited ID at 4-6 months CA despite prophylactic iron supplementation. About a quarter discontinued therapy before reaching this age. Breastfeeding at this age was protective against ID. This high prevalence of ID in EPI underscores the need of future studies to discern strategies to mitigate ID in this vulnerable population.
67 A population-based cohort study of endocrine outcomes within the first 5 years of life in children born preterm
Authors: Lam Carol , Shen Ye , Richter Lindsay , Ting Joseph 
Published: October 2024

Abstract

Background
Preterm birth (&lt;37 weeks’ gestational age [GA]) occurs in 8% of live births in Canada. While advancements in neonatal medicine have led to increased survival in preterm births, infants born preterm continue to sustain short- and long-term health sequelae. There is paucity of large population studies evaluating childhood health care outcomes, including endocrine-related outcomes, in recent birth cohorts.

Objectives
To evaluate the rates of endocrine conditions during the first 5 years of life in children born preterm and term.

Design/Methods
The study cohort included liveborn infants at 22-44 weeks’ GA in British Columbia, Canada between 2004-2014. Follow-up data to December 2019 included linked health services use information from four BC provincial databases (perinatal database, hospitalizations, outpatient services, and outpatient prescriptions). Rates of outcomes were compared by GA at birth (37-44 weeks reference category) using robust Poisson regression.

Results
There were 455,960 children included in this study with 42,820 (9.4%) born at &lt;37 weeks GA. Results are summarized in Table 1 and Table 2. Compared to children born at 37-44 weeks’ gestations, infants born at 36 weeks’ gestation or younger have an increased rate of thyroid disorders between 0 months and 5 years (rate ratio [RR]: 1.45, 95% confidence interval [CI]: 0.78-2.43; RR: 1.83, 95% CI 1.51-2.20; RR: 1.41 95% CI 1.26-1.57 for 22-27 weeks, 28-33 weeks and 34-36 weeks GA, respectively). Similarly, infants born at 36 weeks’ gestation or younger have a higher rate of conditions in growth and development (RR: 3.05, 95% CI: 0.76-7.96; RR: 3.20, 95% CI 2.04-4.76; RR: 1.42 95% CI 1.02-1.94 for 22-27 weeks, 28-33 weeks and 34-36 weeks gestations, respectively) and bone health conditions (RR: 1.38, 95% CI: 1.27-1.49; RR: 1.04, 95% CI 1.00-1.08; RR: 1.05 95% CI 1.03-1.07 for 22-27 weeks, 28-33 weeks and 34-36 weeks gestations, respectively). There was no difference in rates of conditions related to glucose metabolism such as diabetes mellitus or hypoglycemia.

Conclusion
Children born preterm have increased rates of endocrine conditions by age 5. Disorders of thyroid, growth and development are increased in infants born preterm. Children born preterm have an increase rate of bone-related disorders, including those born late-preterm. These results provide useful prognostic information for follow-up care for preterm children and for healthcare resource planning. Furthermore, these results highlight areas of future research in endocrine health among preterm infants.
71 Development and validation of the COCINL scale assessing family resilience in the NICU among parents of preterm infants
Authors: Laporte Geneviève , Gélinas Céline , Genest Christine , Aita Marilyn 
Published: October 2024

Abstract

Background
Given the negative impact of parental distress on preterm infants and their families, examining the role of family resilience in the neonatal intensive care unit (NICU) is a promising avenue for promoting parental mental health while remaining consistent with family-centered care. A tool to assess NICU family resilience is essential to guide care and research, yet none specifically adapted for the neonatal context exists to date according to a recent systematic review.

Objectives
Therefore, the aim of this study was to develop and validate a new scale, the COCINL scale, designed to measure family resilience in the context of neonatal care among French-speaking parents of preterm infants.

Design/Methods
This methodological design study was carried out in four successive phases: (I) compilation of an item pool (II) mixed-method evaluation of content validity (clarity, relevance, representativeness) involving 12 experts, (III) pre-testing and electronic administration of the COCINL scale, along with a measure of psychological distress (Kessler-6) and an open-ended self-report question on family resilience to parents of preterm infants (n=88) and (IV) psychometric testing of the COCINL scale (internal consistency, construct validity, exploratory sensitivity and specificity). Parents of preterm infants and experts were recruited by convenience sampling from two urban, level III NICUs.

Results
From a pool of 112 items, 55 items were favorably evaluated after content validation (S-CVI&gt;0.95). Based on preliminary interitem correlations and internal consistency results, the COCINL scale was shortened to 42 items and divided in four subscales. High internal consistency is also shown in subscales (0.796 to 0.908) and total scale (0.937) Cronbach’s alphas. The COCINL scale displays adequate construct validity, as determined by the Pearson correlation obtained between scores of family resilience and psychological distress (r=-0.236, p=0.027). Strong in between correlations of the four subscales and with the COCINL total score (0.732 to 0.851), further indicated good construct validity. Exploratory sensitivity and specificity analysis revealed the COCINL scale compares to participants' self-reported perception of family resilience (AUC 0.754).

Conclusion
The COCINL scale has shown strong evidence of validity and internal consistency. Thus, the scale can be recommended for research use as a measure of family resilience in the neonatal context. Still, additional evidence of its validity and reliability should be compiled before clinical use is considered. The COCINL scale could potentially support the development, evaluation and implementation of nursing interventions consistent with the family-centered care approach being promoted in NICUs across Canada and worldwide.
72 Hospital level of service, rural-urban hospital location, and neonatal resuscitation interventions at birth: A population-based study in Alberta, Canada from 2000-2020
Authors: Pickett Breanna , Crawford Susan , McNeil Deborah , Schmolzer Georg , Soraisham Amuchou , Pan Bo , Shonoski Heather , Aziz Khalid , Law Brenda 
Published: October 2024

Abstract

Background
Advanced neonatal resuscitation interventions (ANRIs: endotracheal intubation, chest compressions, and epinephrine) are rarely needed for infants born at ≥34 weeks gestational age (GA). However, healthcare providers (HCPs) in community hospitals can encounter the need for ANRIs, while having less experience and resources than HCPs in centers with neonatal intensive care units (NICUs). Understanding practice differences between hospitals of different levels of service (LofS) and rural/urban location can inform quality improvement to reduce health disparities.

Objectives
To examine how hospital level of service and rural/urban location relate to ANRI rates in Alberta, Canada, a universal public health system with standardized Neonatal Resuscitation Program (NRP) training.

Design/Methods
All live births ≥34 weeks GA in Alberta from 2000-2020 inclusive were examined using retrospective, population-level administrative data from the Alberta Perinatal Health Program (APHP). Hospitals (n=97) were contacted to determine annual LofS during the study period, with levels (0,1A/B/C,2,3) based on provincial obstetrical triage for availability of delivery support, cesarean-sections, obstetricians, paediatricians/neonatologists, and NICUs. Hospitals were further subcategorized by population and proximity to metropolitan centers.(Table 1) Rates of individual interventions or any ANRI were compared.

Results
There were 971,403 live births during the study period with a mean GA of 38.9 weeks; 1.6% were missing ANRI data, 955,835 births were included. Most occurred in hospitals with level 2 (57.4%) or level 3 (21.8%) NICUs; few occurred at sites with no delivery support (Level 0, 0.1%). ANRI rates were intubation (0.8%), chest compression (0.2%), and epinephrine (0.02%), any ANRI (0.96%, ~1/1000 live births). However, chest compression rates progressively decrease, and intubation rates progressively increase as LofS increases.(Table 1, Figure 1) When considering rural/urban location, there were outliers in chest compression rates in remote 0 (25.4/1000 live births) and metro-influenced 1A (30.2/1000 live births), intubation in remote 1C (33.3/1000 live births) and metro 0 (193.5/1000 live births) and epinephrine in metro 0 (64.5/1000 live births).

Conclusion
In this population-based cohort study of ≥34 weeks births, there were higher chest compressions rates and lower intubations rates at hospitals without NICUs despite standardized training. Reasons for this difference require further investigation; potential solutions such as targeted outreach education and introduction of laryngeal mask airways could be explored.
79 Using artificial intelligence and machine learning to automate injury prevention surveillance data
Authors: Singh Devin , Celik Alper , Zhang Evangeline , Rosenfield Daniel 
Published: October 2024

Abstract

Background
The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) is a pan-Canadian injury and poisoning surveillance system that tracks patients presenting to Canadian Emergency Departments (EDs). Like many surveillance systems, data is input in a manual fashion with humans screening all charts. Natural language processing algorithms using transformer models can analyze text from triage notes of previous CHIRPP-positive patients to train models to predict future CHIRPP patients. We sought to automate these functions using machine learning and artificial intelligence.

Objectives
The objective of this initiative is to automate detection of injured patients using artificial intelligence. Once charts are identified, a further summarization model will automatically generate a narrative of the events surrounding the injury, as required for the surveillance system.

Design/Methods
ED notes were obtained from an electronic health record for all patients visiting the ED from October 2018 to December 2021 (n =203626). All charts were manually reviewed to determine if patients met the criteria for CHIRPP. CHIRPP-positive patients made up 24.8% (n = 50499) of the total presentations. Patient charts were randomly split into train (70%) and validation (30%) datasets. Pre-trained distilbert-base-uncased model from Huggingface was utilized. The best model according to AUROC was selected for further development. For note summarization, we fine-tuned a multi-task model (t5-small) from the Huggingface repository. We used human summaries from the same dataset (October 2018-December 2021) as training data (49,078 note, summary pairs). A 70/30 train/validation split was performed.

Results
Our model captured 90% of all positive cases while reducing the total number of charts for review by 77%, 75% and 63% for train, validation and test sets respectively. See AUC curve (figure 1). Based on 2022 volumes this is a reduction to 24,027 from 64,938 charts. For note summarization, when we compared the cosine similarities of human summaries to actual note text vs t5-small summaries to note text we saw remarkable similarity implying high model performance.

Conclusion
Our model has shown that high volumes of charts that were previously screened manually can utilize natural language processing to automate the task with minimal sacrifices in terms of data capture and accuracy, dramatically reducing cost while improving speed to reporting. Our summarization model also showed potential for further automating this process. This application to an injury prevention program has wide scale applicability and scalability.
83 What is social paediatrics and how do we teach it? A scoping review of social medicine curricula in the child and youth health context across health disciplines
Authors: Rosenkrantz Maya , Schrewe Brett , Jassemi Sara 
Published: October 2024

Abstract

Background
Social paediatrics is a field that focuses on addressing social and environmental factors that affect children’s health and wellbeing1. Over recent years in medical education, social paediatrics has become increasingly recognized as foundational to undergraduate and postgraduate paediatrics curricula. Paediatric residency programs worldwide have been developing and offering social paediatrics curricula, yet we lack understanding of effective strategies for teaching it to medical trainees.
1. Spencer N, Colomer C, Alperstein G, et al. Social paediatrics. J Epidemiol Community Health. 2005;59(2):106-108. doi:10.1136/jech.2003.017681

Objectives
We conducted a scoping review to describe the various educational interventions used to teach content and practice related to social paediatrics.

Design/Methods
We conducted a scoping review to describe the various educational interventions used to teach content and practice related to social paediatrics. Our literature search first drew upon Ovid MEDLINE and MedEd PORTAL, with subsequent studies identified through reference searching in relevant articles. We included studies that described and/or evaluated educational interventions aimed to teach elements of social paediatrics. We excluded studies published before 2000. We extracted data from the selected articles and conducted thematic analysis.

Results
Our search yielded 443 articles. Initial screen by title and/or abstract and subsequent screen by abstract and/or full text yielded 28 papers. Where it was unclear if studies met inclusion criteria, two additional researchers reviewed the full text. With the addition of articles found in references of the provisional articles, a total of 36 papers were included in the review. Of those, 17 (47%) described curricular interventions at the level of paediatric residency, 7 (19%) described medical school curricula, and 8 (22%) included non-medicine fields such as dentistry, nursing, research, and others. Fifty percent of curricula required self-directed learning, while a different 50% subset had a formal reflection process as part of learning consolidation. We organized the literature thematically into the following themes: interdisciplinary collaboration, community partnership, advocacy training, and experiential learning.

Conclusion
Our scoping review describes a variety of curricular interventions aimed to teach elements of social paediatrics, with a large focus on social determinants of health, primarily poverty, and a relative lack of focus on the underlying structural, systemic, and social justice issues underpinning these health determinants. We need to consider how the pedagogical strategies on offer can be purposed towards the development of more robust social paediatrics curricula at the postgraduate level.
Labor-inclusive corporatism after democratic transitions: Institutionalization in South Africa and Brazil
Authors: Castro Henrique A 
Published: October 2024

Abstract
Under what conditions has corporatist policymaking become institutionalized in newly transitioned democracies? I argue that transitions have provided temporary opportunities for unions to push for laws they can later use to protect their place in economic councils. The relevant sets of legal rules, which I call compulsory deliberation, enable non-‘State official’ members to resist governmental disruption of such councils despite them composing the Executive’s structure. I compare South Africa and Brazil, two ‘most similar’ cases that featured sequences of chronically unstable labor-excluding councils under authoritarian regimes. I argue that the former broke out of this trajectory while the latter did not because South African unions developed aspirations for durable policy influence before the transition, whereas Brazilian ones only did so afterward and thus mobilized too late. Although Brazilian governments have enacted dozens of regulations covering as many councils, these have only served as short-term instruments for marketing policies.
Pharmacological inhibition of histamine N-methyltransferase extends wakefulness and suppresses cataplexy in a mouse model of narcolepsy
Authors: Naganuma Fumito , Girgin Birkan , Agu Anne Bernadette S , Hirano Kyosuke , Nakamura Tadaho , Yanai Kazuhiko , Vetrivelan Ramalingam , Mochizuki Takatoshi , Yanagisawa Masashi , Yoshikawa Takeo 
Published: October 2024

Abstract
Histamine, a neurotransmitter, plays a predominant role in maintaining wakefulness. Furthermore, our previous studies showed that histamine N-methyltransferase (HNMT), a histamine-metabolizing enzyme, is important for regulating brain histamine concentration. However, the effects of pharmacological HNMT inhibition on mouse behavior, including the sleep–wake cycle and cataplexy, in a mouse model of narcolepsy have not yet been investigated. In the present study, we investigated the effects of metoprine, an HNMT inhibitor with high blood-brain barrier permeability, in wild-type (WT) and orexin-deficient (OxKO) narcoleptic mice. Metoprine increased brain histamine concentration in a time- and dose-dependent manner without affecting peripheral histamine concentrations. Behavioral tests showed that metoprine increased locomotor activity in both novel and familiar environments, but did not alter anxiety-like behavior. Sleep analysis showed that metoprine increased wakefulness and decreased non-rapid eye movement (NREM) sleep through the activation of the histamine H1 receptor (H1R) in WT mice. In contrast, the reduction of rapid eye movement (REM) sleep by metoprine occurred independent of H1R. In OxKO mice, metoprine was found to prolong wakefulness and robustly suppress cataplexy. In addition, metoprine has a greater therapeutic effect on cataplexy than pitolisant, which induces histamine release in the brain and has been approved for patients with narcolepsy. These data demonstrate that HNMT inhibition has a strong effect on wakefulness, demonstrating therapeutic potential against cataplexy in narcolepsy.