bluuebunny/crossref_metadata_2025_split huggingface dataset:
47 Prevalence of and Factors Associated with Language Impairment in Canadian Children with ASD
Authors: Lee Nolan , Weikum Whitney , Ip Angie 
Published: October 2022

Abstract

Background
Autism Spectrum Disorder (ASD) is a life-long neurodevelopmental disorder affecting 1 in 66 Canadians aged 5-17, and language impairment is a common comorbidity in this population. We aimed to determine the relative prevalence of diagnosed language impairment in children with ASD. We also examined factors associated with language impairment in children with ASD.

Objectives
1 – To determine the relative prevalence of language impairment in children diagnosed with ASD.
2 – To identify factors associated with language impairment in children with ASD.

Design/Methods
Our study sample included 6,862 children aged 0-19 years, assessed for ASD (61% diagnosed with ASD) between 2010-2017 in British Columbia, Canada. ASD was diagnosed by a provincially qualified specialist and the assessment included the use of the Autism Diagnostic Observation Schedule (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R). We also looked for associations between language impairment and gender, age, intellectual disability (ID), family history of language disorders, and attention deficit hyperactivity disorder (ADHD), using chi-square analyses.

Results
The overall prevalence of language impairment in children diagnosed with ASD (n = 1820, 44%) was similar to those not diagnosed (n = 1199, 44%). There was more mixed receptive/expressive (80% vs 65%) and less expressive only (22% vs 29%) language impairment in children diagnosed with ASD than without. Looking only at the children diagnosed with ASD, there was no significant difference when evaluating gender (boys 44%, girls 41%; p = 0.094), but younger age was positively associated with language impairment (age &lt;6y 53%, ≥6y 24%; p &lt; 0.01). Increasing severity of ID was negatively associated with language impairment (mild: 44%, p = 0.911; moderate: 33%, p = 0.001; severe: 21%, p &lt; 0.001). Family history of speech language disorder was positively associated with language impairment (no family history 12%, family history 20%; p &lt; 0.01). Presence of comorbid ADHD was negatively associated with language impairment (no ADHD 47%, ADHD 28%; p &lt; 0.01).

Conclusion
In children who have been referred for an ASD assessment, the prevalence of language impairment is similar in those with and without ASD. Children with ASD are more likely to be diagnosed with mixed language impairment than expressive only language impairment, although this difference may in part be due to challenges in fully assessing a child with ASD’s receptive language.
48 Transforming Transitions: Developing Cultural Competence in Supporting Caregivers of Children and Youth Growing Up with Autism Spectrum Disorder
Authors: Rajendram Rageen , Kaur Pardeep , John Tomisin , Babra Isha , Zubairi Mohammad Samad , Young Elizabeth , Minhas Ripudaman 
Published: October 2022

Abstract

Background
Transition to adulthood is a stressful time for caregivers of children and youth with Autism Spectrum Disorder (ASD). Anecdotally, we know that cultural perspectives can directly influence decisions made around ASD diagnosis, treatment, and transition to adulthood. However, there is a paucity of research into these cultural perspectives and how they may affect illness trajectories.

Objectives
1.Through open-ended responses, identify cultural values that play a role in decision making around health care and life course planning during transition to adulthood in ASD.
2.Identify criteria for success in adulthood from parents of children and youth with ASD in a culturally diverse population.
3.Identify systemic barriers that prevent families from accessing culturally sensitive care
4.Educate health care workers on any unique cultural perspective that may impact transition planning.

Design/Methods
In-depth interviews (IDIs) were conducted with caregivers (i.e., parents/guardians) of children and youth with autism. Interviews were recorded, transcribed, and coded using deductive and inductive coding methods by two independent coders, with inter-rater reliability confirmed by Cohen’s kappa coefficient.

Results
A total of 12 IDIs were conducted. The main themes that were discussed included caregivers’ understanding of adulthood for their child with ASD, barriers to accessing services, the importance of culture and religion/spirituality to their child’s future, recommendations to improve current services and programming and the impact of the COVID-19 pandemic on decision-making. Caregivers expressed their desire for their child to be independent as they transition to adulthood. They also described how cultural or religious/spiritual practices are integrated into their child’s life and the importance of maintaining their cultural identity. Caregivers emphasized the lack of culturally tailored resources as their child transitions to adulthood to maintain that sense of community.

Conclusion
Caregivers’ cultural perspectives are an integral part of their identity and an important aspect of their environment that should be taken into consideration as children and youth with ASD transition to adulthood.
52 Underweight in the first 2 years of life and growth in later childhood
Authors: South Courtney , Keown-Stoneman Charles , Birken Catherine , Zlotkin Stanley , Malik Vasanti , Maguire Jonathon 
Published: October 2022

Abstract

Background
Underweight occurs when caloric intake is insufficient to maintain growth. While it has long been assumed that underweight in the first 2 years of life is associated with lower growth potential in later childhood, longer term growth outcomes in high income countries are unclear.

Objectives
The primary objective was to evaluate the relationship between underweight in the first 2 years of life and body mass index z-score (zBMI) in later childhood. Secondly, we examined the relationship between underweight in the first 2 years of life and weight-for-age z-score (WAZ) and height-for-age z-score (HAZ) in later childhood, and how sex and the zBMI growth trajectory in the first 2 years of life modify these associations.

Design/Methods
This was a prospective cohort study conducted through The Applied Research Group for Kids (TARGetKids!) practice-based research network. Healthy children 0-10 years of age were included. The primary exposure was underweight in the first 2 years of life using zBMI &lt;-2 as per the World Health Organization (WHO). The primary outcome was zBMI, and secondary outcomes were WAZ and HAZ between 2 and 10 years of age. Linear mixed effects models were used for the primary and secondary analysis to take into account multiple growth measures over time. Interaction terms for sex, and the zBMI growth trajectory in the first 2 years of life were used to explore effect modification.

Results
Among the 5,803 children included in the primary analysis, the mean age was 4.07 months, and 52.2% were male at baseline. In adjusted models, underweight in the first 2 years of life was associated with lower zBMI, lower WAZ, and higher odds of underweight at 2, 5, and 10 years of age (p &lt;0.0001). Underweight in the first 2 years was associated with a lower HAZ at 2 years of age (p&lt;0.0001), but not 5 (p=0.08), or 10 years of age (p=0.8). Females with underweight had lower zBMI and WAZ at 5 and 10 years of age, and lower HAZ at 10 years of age compared to males with underweight (p&lt;0.05). Children with underweight and lower growth trajectory in the first 2 years had lower zBMI, WAZ, HAZ, and higher odds of underweight at 2, 5, and 10 years of age compared to children who did not have underweight (p&lt;0.05). Children with underweight and high growth trajectory in the first 2 years had similar zBMI, WAZ, higher HAZ and lower odds of overweight at 10 years of age (p&lt;0.05), compared to children who did not have underweight.

Conclusion
Underweight in the first 2 years of life was associated with lower growth in later childhood. These relationships were amplified for females and children with underweight who had low growth trajectory in the first 2 years of life and were attenuated among children with underweight who had high growth trajectory in the first 2 years of life.
53 The association between maternal preconception BMI and child zBMI growth rates
Authors: Deveci Arin , Keown-Stoneman Charles , Maguire Jonathon , O'Connor Deborah , Birken Catherine 
Published: October 2022

Abstract

Background
Elevated body mass index (BMI) and rapid growth in early childhood are important predictors of obesity risk. While studies have identified an association between maternal preconception BMI and child BMI z-scores (zBMI), the association with zBMI growth rates during distinct growth periods is unclear.

Objectives
To assess the association between maternal preconception BMI and child zBMI growth rates and BMI z-scores, in children aged 0 to 10 years old. Additionally, to examine whether child sex and gestational weight gain (GWG) modify these associations.

Design/Methods
This longitudinal study consisted of healthy children (0 to 10 years) enrolled in a primary care practice-based research cohort. The exposure was maternal BMI measured during the preconception period, defined as the 2 years prior to pregnancy. The primary outcome was child zBMI growth, modeled with piecewise linear splines for age. The secondary outcome was repeated measures of child BMI z-scores. Piecewise linear mixed models were used to determine the association with growth, while linear mixed models were used for zBMI. Effect modification by child sex and GWG was explored.

Results
499 children were included. Maternal preconception BMI had a small, but statistically significant association with child zBMI growth rates during some growth periods, with the strongest association from 0 to 4 months (0.007; p=0.004). Maternal preconception BMI was also associated with child zBMI; 1kg/m2 increase was associated with 0.03 zBMI increase (p=0.001). Child sex and maternal GWG did not modify these associations.

Conclusion
There is evidence to suggest an association between maternal preconception BMI and child zBMI growth and scores. In addition to maternal and pregnancy benefits, preconception interventions may have longer-term benefits for child growth.
57 Update of IMPACT Invasive Meningococcal Surveillance, 2016-2020
Authors: Bettinger Julie , Sadarangani Manish , Le Saux Nicole , Morris Shaun , Top Karina , Halperin Scott , Tsang Raymond 
Published: October 2022

Abstract

Background
Meningococcal conjugate vaccine (MCV) programs in Canada began in 2002.

Objectives
This study examines the most recent surveillance data to describe the current Canadian epidemiology of invasive meningococcal disease (IMD) and the effect of MCV programs, especially on age and serogroup distribution.

Design/Methods
Active metropolitan area surveillance for hospitalization of adults and children due to IMD, which was defined as a clinical infection with Neisseria meningitidis isolated or detected by molecular methods or culture from a sterile body site. The study was conducted via the 12 centres of the Canadian Immunization Monitoring Program, Active (IMPACT) network from January 1, 2016 – December 31, 2020.

Results
During 2016-2020, a total of 105 pediatric (&lt;20 years of age) and 145 adult IMD cases occurred. Serogroup B accounted for the greatest proportion of pediatric cases (N=58, 55.2%), followed by W (n=19, 18.1%) and Y (n=9, 8.6%) and C (n=2, 1.9%). Among adults, serogroup W accounted for the majority of cases (n=55, 38.0%), followed by Y (n=41, 28.3%), B (n=33, 22.8%) and C (n=7, 4.8%). The age distribution for serogroups covered by MCV programs has shifted to adults. The median age was 24.2 years (33.4 mean). Whereas the median age of serogroup B cases was 7.7 years (19.4 years mean) with 63.7% of cases occurring in children &lt; 19 years of age and 46.2% in children 0-4 years of age.
A total of 20 people died from meningococcal infections in 2016–2020. Five deaths were in children, four from serogroup B and one from serogroup W. Fifteen deaths were in adults, one from serogroup B, eight from serogroup W, three from serogroup Y, and three from Non-typeable/Other/Unknown serogroups.

Conclusion
Serogroup B, which is not covered by MCV programs, still accounts for the majority of pediatric IMD. Serogroup C has been controlled and rarely causes pediatric infection. With the implementation of MCV programs in children and adolescents, the median and mean age at infection has increased across all serogroups, except serogroup B. Serogroup W is still causing IMD among pediatric age groups.
58 Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada
Authors: Piché-Renaud Pierre-Philippe , Panetta Luc , Farrar Daniel , Hepburn Charlotte Moore , Drouin Olivier , Papenburg Jesse , Salvadori Marina , Laffin-Thibodeau Melanie , Kakkar Fatima , Morris Shaun 
Published: October 2022

Abstract

Background
There are limited data on outcomes of SARS-CoV-2 infection among infants (&lt;1 year of age). In the absence of approved vaccines for infants, understanding characteristics associated with hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and public health interventions.

Objectives
The objective of this study was to describe the clinical manifestations, disease severity, and characteristics associated with hospitalization among infants infected with the initial strains of SARS-CoV-2.

Design/Methods
This is a nationwide prospective observational study using the infrastructure of the Canadian Paediatric Surveillance Program. All cases of infants aged &lt;1 year of age with microbiologically confirmed SARS-CoV-2 infection were reported from April 8th 2020 to May 31st 2021, and were classified by disease severity and primary cause of hospitalization. Multivariable logistic regression was performed to identify infants' characteristics associated with hospitalization.

Results
A total of 531 cases were reported, including 332 (62.5%) non-hospitalized and 199 (37.5%) hospitalized infants. Among hospitalized infants, 141 of 199 infants (70.9%) were admitted because of COVID-19-related illness, and 58 (29.1%) were admitted for reasons other than acute COVID-19. Amongst all cases with SARS-CoV-2 infection, the most common presenting symptoms included fever (66.5%), coryza (47.1%), cough (37.3%) and decreased oral intake (25.0%). In our main analysis, infants with a comorbid condition had higher odds of hospitalization compared to infants with no comorbid conditions, and infants &lt;1 month had higher odds of hospitalization than infants aged 1-3 months (Table). In total, 20 infants (3.8%) met criteria for severe disease.

Conclusion
We describe one of the largest cohorts of infants with SARS-CoV-2 infection. Overall, severe COVID-19 in this age group is uncommon with most infants having mild disease. Comorbid conditions and younger age were associated with COVID-19-related hospitalization amongst infants.
59 Understanding asymptomatic testing uptake amongst school aged children and staff for SARS-CoV-2 testing in elementary and secondary schools
Authors: Cardenas Analyssa , Bruce-Barrett Cindy , Campigotto Aaron , Dharmaraj Blossom , McGovern Christine , Science Michelle , Orkin Julia 
Published: October 2022

Abstract

Background
Enhanced health and safety measures, such as symptom screening, physical distancing, cohorting, masking, and asymptomatic testing for children have been introduced into schools to prevent SARS-CoV-2 transmission. Although asymptomatic testing has been considered a measure to reduce in-school transmission, it has not been broadly implemented or evaluated. To address this, a pilot project with public health, school boards, and hospital-based testing partners was established to assess the feasibility of offering on-site and low barrier SARS-CoV-2 polymerase chain reaction (PCR) testing across schools in the Toronto region.

Objectives
The primary objective of this study was to assess the feasibility of offering on-site and low barrier PCR asymptomatic testing across schools in the Toronto region.

Design/Methods
A six-week testing pilot across the Greater Toronto Area took place. Schools were selected to participate in expanded testing to determine case prevalence in high-risk settings of school-based SARS-CoV-2. Students and staff were excluded if they had tested positive for COVID-19 in the last 3 months. Different testing opportunities were offered based on the testing partner and school preference including location and modality. Descriptive methods were used to assess the uptake of testing and case positivity by individuals recommended to be tested.

Results
Eighteen schools participated in the pilot testing. All students and staff were invited to participate in asymptomatic testing. Testing was offered to 9282 students and 1000 staff, and testing uptake was 29% (2729 students) and 54% (544 staff), respectively. Forty-eight percent of tests (1645) were oral nasal tests, 18% (622) were NP swab tests and 33% (1120) were saliva tests. Of the saliva tests, 52% (590) were on-site saliva tests and 48% (530) were take-home saliva kits. The staff and student positivity rate for on-site testing was 1.9% and 4.9% for tests completed at the COVID-19 Assessment Center at SickKids.

Conclusion
Results from this pilot project demonstrate that on-site PCR testing uptake remained low despite offering in-school testing, specialized support, and reduced barriers by using non-invasive testing with the use of saliva/oral nasal/PCR testing kits. Results highlight the challenges of asymptomatic testing and the balance of resource utilization for low case counts. Future studies should examine alternate means of symptomatic testing.
83 Pediatric Resident Perspectives on a Procedure Day Pilot Program
Authors: Harry Bishal , Bhatt Mihir 
Published: October 2022

Abstract

Background
Royal College objectives emphasize the importance of competencies in lumbar punctures (LPs) amongst pediatric trainees. While a relatively common procedure in pediatrics, studies show that skills decay over time and that trainees may experience uncertainty and variable success rates in performing LPs. Unsuccessful LPs can lead to increased treatment costs, inappropriate antibiotic use, and patient morbidity. Further, the Hematology/Oncology department at our centre has diagnostic and therapeutic LPs that are performed under procedural sedation weekly and do not always have a learner in attendance.

Objectives
To implement an initiative in a pediatric residency program allowing residents to sign up for these procedure days. The goals of this initiative were to provide additional opportunities in a safe, controlled, and well-supervised setting to improve LP competence and confidence amongst residents. In addition, we can use this to develop a formal procedural curriculum in our program.

Design/Methods
A pilot proposal was presented to all stakeholders (program leadership and hematology/oncology departments) for approval. Residents were then able to sign up for twice-weekly procedure days to enhance LP skills. Following the pilot, residents were sent a questionnaire to assess their perceptions of the initiative and skill enhancement using a 5-point Likert scale. With the second iteration of this initiative due to start in 2022, we will be using pre- and post-procedure day surveys to further assess self-reported improvement in various domains.

Results
A total of 14 residents signed up for 42% of eligible days (range of 1-4 days per resident). Total number of LPs ranged from 2-20 per resident over the pilot. All respondents agreed that the initiative was useful in improving their technical skills and confidence. 91% of respondents strongly agreed this pilot should continue to be implemented in the program.

Conclusion
This educational initiative successfully improved resident perceptions of LP skills. Residents felt they were more confident and skillful after this enhanced educational opportunity.
90 An analysis of COVID-19 public health measure adherence among parents and children and the corresponding effects of lockdowns and school closures
Authors: Aglipay Mary , Semalhago Justin , Keown-Stoneman Charles , Tuite Ashleigh , Birken Catherine , Maguire Jonathon 
Published: October 2022

Abstract

Background
Public health preventive measures have been a necessary intervention in preventing COVID-19 transmission.

Objectives
The objectives of this study were 1) To investigate how the adherence to COVID-19 public health measures among parents and children in Ontario changed over time; 2) To determine if provincial lockdowns were associated with higher adherence to public health measures among parents; 3) To determine if school closures were associated with higher adherence to public health measures among children.

Design/Methods
A longitudinal study was conducted in children aged 0-10 years and their parents through the TARGet Kids! COVID-19 Study of Children and Families in the Greater Toronto Area, Canada (April 2020 -May 2021). Parents completed weekly questionnaires on sociodemographics and public health practices. The primary exposure was calendar date. Secondary exposures were provincial lockdowns and school closures. The primary outcome was adherence to public health preventive measures (staying home, limiting visitors in the home, avoiding contact with others, socially distancing, and handwashing, measured as number of days practicing per week) measured separately for parents and children. Linear mixed effects regression and piecewise linear splines mixed effects models were conducted.

Results
819 children and their parents contributed 13,220 observations to the study over 13 months. Mean age was 5.6 years (SD=2.7) and 373 were female (45.5%). 273 children (35.1%) had a parent who worked as an essential worker and 254 (35.4%) of families lived in a COVID-19 ‘hotspot’. The number of days per week that parents adhered to all 5 public health measures decreased by 0.029 days (p&lt;0.001), and by 0.146 days for children (p&lt;0.001) over the study duration. For parents, adherence to the five public health measures decreased over time during the first lockdown (β=-0.06, p&lt;0.001) and first reopening (β=-0.01, p&lt;0.001), but increased again during the second lockdown (β=0.01, p&lt;0.001). For children, adherence to the five public health measures decreased over time during the first school closure, increased during the second closure, and decreased during second reopening (β=-0.04, p&lt;0.01). See Figure 1.

Conclusion
Parents and children both decreased in their adherence to social distancing, staying at home, and avoiding contact with others over time. Lockdown after a period of reopening increased parent adherence to public health measures and school closures increased adherence in children. Supports may be necessary to help children and parents maintain adherence to public measures over prolonged periods of lockdown and school closure.