bluuebunny/crossref_metadata_2025_split huggingface dataset:
54 FACTORS ASSOCIATED WITH TIME TO CLINICAL REMISSION IN PEDIATRIC LUMINAL CROHN'S DISEASE, A RETROSPECTIVE COHORT STUDY
Authors: Sassine Samuel , Zekhnine Souhila Fadela , Qaddouri Marwa , Djani Lisa , Cambron-Asselin Christine , Savoie-Robichaud Mathieu , Lin Yi Fan , Grzywacz Kelly , Groleau Véronique , Dirks Martha , Drouin Éric , Halac Ugur , Marchand Valérie , Girard Chloé , Courbette Olivier , Soglio Dorothée Dal , Patey Natalie , Deslandres Colette , Jantchou Prévost 
Published: October 2022

Abstract

Background
The natural evolution of Crohn’s disease is incompletely understood in the pediatric population. Data on factors influencing time-to-remission are very limited in the literature.

Objectives
The aim of this retrospective cohort study was to describe the time to clinical remission in children with Crohn’s disease as well as changes over the past decade and to identify factors associated with time to clinical remission.

Design/Methods
Patients under 18 years old diagnosed between 2009 and 2019 were included. All data were collected from the patients’ medical records and the CHU Sainte-Justine inflammatory bowel disease registry. Survival analyses and linear regression models were used to assess the impact of clinical, laboratory, endoscopic, histological and therapeutic factors on time to clinical remission.

Results
654 patients were included in the study. There was no change in the time to clinical remission over the past decade. Female sex in adolescents (adjusted beta regression coefficient (aβ)= 31.8 days, p= 0.02), upper digestive tract involvement (aβ= 46.4 days, p= 0.04), perianal disease (aβ= 32.2 days, p= 0.04), presence of active inflammation on biopsies (aβ= 46.7 days, p= 0.01) and oral 5-ASA exposure (aβ=56.6 days, p= 0.002) were all associated with longer time to clinical remission. However, antibiotic exposure (aβ= -29.3 days, p=0.04), increased eosinophils on biopsies (aβ= -29.6 days, p=0.008) and combination of exclusive enteral nutrition and TNF- alpha inhibitors as induction therapy (aβ= -36.8, p=0.04) were associated with shorter time to clinical remission.

Conclusion
In children with newly diagnosed CD, time to clinical remission did not shorten during the decade. It was associated with baseline clinical and histological data and treatment strategies. Combination of enteral nutrition and TNF-alpha inhibitors was associated with faster clinical remission.
Figure 1 : Kaplan-Meier curve representing time to clinical remission in patients 13 years old and older by sex.

Figure 2 : Kaplan-Meier curve representing the time to clinical remission of patients according to the first induction treatment administered.
55 RISK FACTORS ASSOCIATED WITH RELAPSES IN PEDIATRIC LUMINAL CROHN'S DISEASE, A RETROSPECTIVE COHORT STUDY
Authors: Sassine Samuel , Djani Lisa , Cambron-Asselin Christine , Savoie-Robichaud Mathieu , Lin Yi Fan , Qaddouri Marwa , Zekhnine Souhila Fadela , Grzywacz Kelly , Groleau Véronique , Dirks Martha , Drouin Éric , Halac Ugur , Marchand Valérie , Girard Chloé , Courbette Olivier , Patey Natalie , Soglio Dorothée Dal , Deslandres Colette , Jantchou Prévost 
Published: October 2022

Abstract

Background
Crohn's diseaseis an inflammatory bowel disease that has a high incidence in Northern countries. The relapse rate of Crohn's disease one year after diagnosis is around 40 to 50% for all treatment modalities combined. Few risk factors are associated with the risk of relapses of Crohn's disease in children.

Objectives
The aims of this retrospective cohort study were to describe the rate of relapses in children with Crohn's disease, its evolution over the past decade and to determine risk factors associated with relapse.

Design/Methods
Patients under 18 years old and diagnosed between 2009 and 2019 were included. Patients’ clinical, endoscopic, histological, and laboratory characteristics, as well as their treatments, were collected from their medical records and the prospective CHU Sainte-Justine inflammatory bowel disease registry. Survival analyses and Cox regression models were used to assess the impact of those risk factors on relapse.

Results
639 patients were included. There was a decrease in the clinical relapse rate over the past decade: 70.9% of patients diagnosed between 2009 and 2014 experienced a relapse compared to 49.1% of patients diagnosed between 2015 and 2019 (p&lt;0.0001). The following variables were associated with clinical relapse: female sex (adjusted hazard ratio (aHR)= 1.51, p=0.0009), high PCDAI (aHR= 1.02, p=0.04) and SES-CD (aHR= 1.03, p=0.03) scores at diagnosis, upper digestive tract involvement (aHR= 1.59, p=0.0003), exposure to oral 5-ASA (aHR= 1.91, p=0.0003), use of immunomodulatory agents compared to TNF-alpha inhibitors (methotrexate aHR= 1.91, p=0.0006; thiopurines aHR= 2.06, p&lt;0.0001), presence of granulomas (aHR= 1.27, p=0.04) and increased eosinophils on intestinal biopsies (aHR= 1.34, p=0.02), high levels of C-reactive protein (aHR= 1.01, p&lt;0.0001) and fecal calprotectin (aHR=1.09, p&lt;0.0001) during clinical remission and low serum infliximab levels during maintenance (aHR for mean serum infliximab level under 7ug/mL = 2.48, p=0.005).

Conclusion
Relapse risk was significantly associated with baseline clinical, endoscopic, histological and laboratory data and treatment strategies. These results could help better select treatment options for pediatric Crohn's disease at induction and maintenance.
Figure 1: Kaplan-Meier curve representing patients time to relapse according to the first maintenance treatment administered.

Figure 2: Kaplan-Meier curve representing patients time to relapse according to the mean infliximab level in post-induction.
72 Prevalence of Neurodevelopmental Disorder among Indigenous Children: A Systematic Review
Authors: Lau Stuart , Czuczman Natalie , Dennett Liz , Hicks Matthew , Ospina Maria 
Published: October 2022

Abstract

Background
Neurodevelopment involves sensory-motor, cognitive, and social-emotional domains, which can be influenced by biological and psychosocial factors. Poor neurodevelopment can result in missing developmental milestones and neurodevelopmental disorders (NDs) that translate into negative consequences for long-term health and well-being. Indigenous children in countries with similar colonial histories face a disproportionate burden of infant mortality, chronic diseases, injuries, and disability compared to non-Indigenous children. However, there is no consensus on the prevalence of NDs among Indigenous children around the world.

Objectives
This systematic review (PROSPERO 2021 CRD42021238669) synthesized current evidence on the prevalence of NDs among Indigenous children in Australia, Canada, New Zealand, and the USA.

Design/Methods
Comprehensive searches of five databases from 2005 to Feb 15, 2021 were conducted to identify cohort and cross-sectional studies that assessed the objective. Two independent reviewers conducted study selection, data extraction/analysis, and risk of bias assessment. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort and ecological studies (adapted), and the Quality Assessment Tool for Prevalence Studies by Hoy et al. for cross-sectional studies. Prevalence odds ratios (pOR) with 95% confidence intervals (CI) were calculated in random-effects meta-analyses for each ND outcome if there were two or more studies of the same study design.

Results
Of the 864 studies identified, 25 studies met the inclusion criteria. Twelve studies were conducted in Australia, one in Canada, four in New Zealand, and eight in the USA. Four studies evaluated attention-deficit/hyperactivity disorder (ADHD) prevalence, 13 for autism spectrum disorder (ASD), 10 for intellectual disability (ID), and five for motor disorders (MD). Most cohort studies (10/17) had high risk of bias. All cross-sectional studies (n=8) had low risk of bias. The prevalence of ADHD, ASD, ID, and MD for Indigenous children ranged from 2.7-3.9%, 0.07-3.0%, 1.1-3.9%, and 0.18-0.47%, respectively. Prevalence in non-Indigenous children ranged from 1.6-5.6%, 0.31-3.3%, 0.87-2.3%, and 0.22-0.37%. In cross-sectional studies, Indigenous children had decreased odds of ASD (three studies; pOR=0.80; 95% CI: 0.71-0.89) compared to non-Indigenous children. In cohort studies, higher odds of MD (two studies; pOR=1.57; 95%CI: 1.35-1.84) and lower odds of ASD (four studies; pOR=0.46; 95% CI: 0.28-0.76) were found in Indigenous children compared to non-Indigenous children.

Conclusion
Prevalence rates are greater in Indigenous children for MD and lower for ASD compared to their non-Indigenous counterparts. Differences in NDs prevalence between Indigenous and non-Indigenous children may be due to differences in access to health care services/assessment.
75 Identifying High Priority Conditions for Research in Hospitalized Children Using a Data-driven Approach: A Population-based Study
Authors: Gill Peter , Thavam Thaksha , Anwar Mohammed Rashidul , Zhu Jingqin , Parkin Patricia , Cohen Eyal , To Teresa , Mahant Sanjay ,   Canadian Paediatric Inpatient Research Network (PIRN), Paediatric Inpatient Research Network (PIRN)
Published: October 2022

Abstract

Background
Identifying conditions that should be prioritized for research based on their healthcare system burden is imperative to build a meaningful research agenda for the care of hospitalized children. No previous Canadian prioritization studies have been conducted in this area.

Objectives
To determine the prevalence, cost, and variation in cost of pediatric hospitalizations at all hospital types, to identify conditions that should be prioritized for future research.

Design/Methods
Population-based cross-sectional study of children (&lt; 18 years), with an inpatient hospital encounter between April 1, 2014 and March 31, 2019 in Ontario, Canada. Data were obtained from linked health administrative databases. For each encounter, the most responsible ICD-10-CA discharge diagnosis code was classified into clinical categories using the Pediatric Clinical Classification System. The condition-specific prevalence and cost of pediatric hospitalizations, and condition-specific variation in cost per encounter across hospitals were determined. The variation in cost was evaluated using number of outlier hospitals, and intraclass correlation coefficient (ICC).

Results
There were 627,314 inpatient hospital encounters from 165 hospitals costing $4.3 billion. A total of 408,003 (65.0%) hospitalizations and $1.9 billion (43.8%) in hospital costs occurred at general hospitals. Table 1 presents the 25 most prevalent and 25 most costly conditions (34 in total) ranked by cumulative cost. The top 10 costly conditions accounted for 70.0% of all costs and 59.6% of all encounters. Conditions that were highly prevalent and costly included: low birth weight, preterm newborn, major depressive disorder, pneumonia, other perinatal conditions, bronchiolitis, and neonatal hyperbilirubinemia. Figure 1 illustrates the 25 most costly medical conditions, of which the majority of the most prevalent and costly conditions were newborn conditions. Amongst the most costly conditions, the highest variations in cost across hospitals were observed in two mental health conditions (other mental health disorders [ICC = 0.28]; anxiety disorders [ICC = 0.19]), and three newborn conditions (intrauterine hypoxia and birth asphyxia [ICC = 0.27]; other perinatal conditions [ICC = 0.17]; surfactant deficiency disorder [ICC = 0.17]).

Conclusion
This study identified several newborn and mental health conditions as the most prevalent, costly, and with high variation in cost across hospitals in hospitalized children. These results can be used to generate a research agenda for the care of hospitalized children in general and children’s hospitals to build a stronger evidence-base and improve patient outcomes.
84 It’s all about that trach - Episode II: Acceptability, accessibility, inclusivity and feasibility
Authors: Shah Prachi , Kherani Tamizan , Uwiera Trina , Hicks Anne 
Published: October 2022

Abstract

Background
Pediatric tracheostomy care is a vital but intimidating critical skill required of parents and pediatricians. Consistent caregiver training is vital to promote safety. An Alberta team is developing the “Tracheostomy Journey” to help caregivers navigate and communicate through caring for children with tracheostomy. A needs assessment identified consistent, universal multimodal teaching and communication tools for care providers as a primary need.

Objectives
The objective of this study was to evaluate “train the trainer” pediatric tracheostomy care modules for feasibility, acceptability, accessibility and inclusivity.

Design/Methods
This project evaluated goal-oriented training modules previously developed by the research team to provide simulation-based training to pediatric residents. The modules were adapted to fit the national residency curriculum requirements for CBD (Competency by Design). Pediatric residents participated in simulation with the modules, which were precepted by two simulation experts and a subspecialty fellow. Modules were offered to all trainees regardless of their choice to participate.
Participants completed questionnaires before and after the session, rating their confidence and self-assessed competence, module accessibility, acceptability and inclusiveness and feedback for improvement. Preceptors reported their comfort and self-assessed competence teaching the module content and evaluated content, accessibility, acceptability and inclusiveness.

Results
All 25 General Pediatrics resident participants found the training effective. Pre- and post-workshop surveys showed the training increased confidence in caring for patients, and confidence and competence in various levels of involvement from supporting care to leading and teaching. Qualitative feedback on accessibility, acceptability, and inclusivity was positive. Preceptor evaluation suggested the “train the trainer” aspect was achieved.

Conclusion
Tracheostomy care simulation materials designed to meet CBD goals increased confidence and self-assessed competence for emergency care tasks. A “train the trainer” approach to module design provided subspecialty fellows with confidence using the modules to teach. This trial suggests that “train the trainer” module design is accessible and feasible for resident training programs. Trials with families and allied health caring for children with tracheostomy will be completed next. Universally adoptable “train the trainer” modules are proposed as a means to ensure uniform skill development to effectively deliver care to children with tracheostomy.
93 Mapping Mobile Health Clinics in Canada: Delivering Equitable Primary Care to Children and Vulnerable Populations
Authors: Nguyen Anne Xuan-Lan , Kevorkov Alexander , Li Patricia , Benkelfat Rislaine 
Published: October 2022

Abstract

Background
Low-income and racially diverse populations often have multiple barriers in accessing healthcare and are at increased risk of poor health outcomes. COVID-19 exacerbated these health inequities: decreased in-person appointments, difficult access to virtual care and deprioritization of elective clinical activity led to delays in well-child visits and vaccination. This public health emergency highlighted a need to develop alternative models to enable access to primary care for vulnerable children. While mobile clinics are well-established in the United States, little is known about them in Canada.

Objectives
This study aims to characterize Canadian mobile clinics providing primary care health services to vulnerable populations, including children, and seeks to inform the implementation of a pediatric mobile clinic under development.

Design/Methods
This environmental scan screened scientific databases and the grey literature using a combination of terms designating mobile health clinics and Canadian locations. Relevant Canadian primary care mobile clinic initiatives were subsequently included. We defined primary care mobile clinics as movable health care units providing primary healthcare services delivered by general medical practitioners (pediatricians and family physicians). Examples of excluded initiatives were mobile clinics focused on education/literacy, dental care, vision care, endocrinology, cancer screening, safe injection sites, vaccination, physical rehabilitation and urgent care. Descriptive statistics and qualitative analysis were performed.

Results
29 clinics were identified, of which 26 are still active. Most clinics were located in Ontario (n=11), followed by British Columbia (n=8), Alberta (n=5), Quebec (n=2) and the Maritimes (n=2). The first mobile clinic in Canada was launched in 1996, with an increasing number of new clinics in 2021. While all clinics served vulnerable populations, some targeted specific groups, such as children, people experiencing homelessness, immigrants, LGBTQ+ individuals and Indigenous peoples. We identified three pediatric mobile clinics, two of which targeted teenagers. Onboard the clinics, physicians often worked with nurses, outreach workers and social workers. These professionals provided primary care services, as well as healthcare navigation, sexual education, mental health care, harm reduction supplies, vaccination and emergency care. All mobile clinics partnered with their local government, charities or businesses to fund their initiative.

Conclusion
Mobile health clinics are a growing model of primary care in Canada. They are the result of a multidisciplinary collaboration between healthcare providers, social workers and outreach workers. To this date, Canadian pediatric mobile clinics remain a handful and represent an interesting avenue to address health inequities in children, during the pandemic and beyond.
97 COVID Check-In: Optimizing Cleft & Craniofacial Team Care during COVID-19 using an on-line social paediatrics screening instrument
Authors: Fisher Emily , Szostek Lisa , Ponton Ethan , Lau William , Loock Christine 
Published: October 2022

Abstract

Background
Public health mandates associated with COVID-19 added unprecedented stress on families, providers and the health care systems; including our ambulatory multidisciplinary cleft team care. In order to continue to provide responsive, multidisciplinary team (MDT) cleft and craniofacial care, it was essential to identify direct and indirect impacts of COVID-19 on our patients and families, whilst planning ahead for ongoing coordinated surgical, pediatric, and psychosocial interventions. Our team developed a short on-line psychosocial screening questionnaire that was administered prior to our MDT clinics, using a “What Matters to You” quality improvement (QI) format.

Objectives
1.To establish and test the utility of a “What Matters to You” quality improvement (QI) questionnaire.
2.To use this questionnaire in order to understand the impact of the COVID-19 pandemic on patients and family access to health services.

Design/Methods
Our team developed a 5-question online smartphone-accessible survey and distributed this to families prior to their MDT clinic visit during the COVID-19 pandemic. We analyzed survey results from May 2020-October 2021 in order to understand the impact of COVID-19 on families as well as the utility of our survey system.

Results
Out of 110 sequential MDT visits, families reported that COVID impacted timely access to health services (20%); employment (32%); basic needs like food and shelter (13%); and social capital. Almost half (47%) reported less than 5 people to turn to for extra support. The most common concerns caregivers have about their children were development, learning, and/or school progress (38%); mental health (36%) and social emotional well-being (31%).

Conclusion
Our study shows that 5 key psychosocial screening questions can be utilized to facilitate care coordination, responsiveness, and triage for in-person and virtual care settings, and respond to family centred care priorities in the midst of evolving COVID-19 landscapes.
Architectural and Compositional Diversity of Early Earth Ocean Floor Evidenced by the Paleoarchean Nondweni Greenstone Belt, South Africa
Authors: Wilson Allan , Riganti Angela 
Published: October 2022

Abstract
The nature of the early Archean ocean floor remains a topic of important debate. There are relatively few well-preserved occurrences worldwide where such terrains may be studied in detail because of structural dismemberment, metamorphic overprinting and pervasive early stage hydrothermal alteration to recent weathering. The 3.41-Ga dominantly mafic formations of the Nondweni Greenstone Belt (NGB) covering 270 km2 in the south-eastern Kaapvaal Craton comprise submarine volcanics that exhibit a wide range of textural features, including pillows, chill zones and brecciated flow tops, and various spinifex textures, including the rare platy pyroxene type, cumulate layers, and tuffs. Channelized subaqueous lava lakes that underwent fractionation are capped by thick spinifex-textured units and pillows. Early stage seafloor alteration is regionally variable, ranging from intense to minimal, with preservation of original mineralogy in many areas. Mafic volcanic rocks of the NGB contrast with those of the Barberton Greenstone Belt both in the style of volcanism and in the associated compositional range of komatiitic basalt to basalt with a complete absence of high-Mg komatiites. Olivine-phyric rocks, or derivatives thereof, are largely absent and pyroxene is the main controlling phase with orthopyroxene in the most primitive komatiitic basalts and clinopyroxene in the evolved lava lake sequences. The abundance of orthopyroxene typifies the long-standing silica-enriched character of the Kaapvaal Craton. Three exceptionally well-preserved and well-exposed sequences were studied utilizing hand-drilled samples and deep coring providing unprecedented stratigraphic and textural detail and field controls for more than 400 samples. A unifying feature of the mafic volcanics of the NGB is the range of compositions and ratios of incompatible elements most clearly illustrated by a series of high- and low-Ti compositional lineages reflecting differing sources or degrees of mantle partial melting. Sharp boundaries between high- and low-Ti flow successions indicate sudden changes in the melting regimes or the interaction of flow sequences from different volcanic centres. Th/Nb ranges from 0.1 to 0.2 and reveals crustal contamination of primitive lavas. The primary magma that gave rise to the most primitive komatiitic basalts with 19.5% MgO was derived from partial melting of a mantle plume source in the garnet stability field. Trace element modeling shows that the sequences studied in detail have been modified by fractionation and crustal contamination with the most likely contaminant being the Ancient Gneiss Complex (3.43–3.66 Ga), which is extensively exposed in Eswatini and probably underlies the Paleoarchean terrains in the southern Kaapvaal Craton. The geotectonic setting was likely that of a submerged felsic crustal platform as enclaves within an oceanic plateau.