bluuebunny/crossref_metadata_2025_split huggingface dataset:
8 The Effect of Decreased Physical Activity on Physical and Mental Health of School-Aged Children During the COVID-19 Pandemic
Authors: McCann Maggie , Kumar Kriti , Lepore Natasha , Metivier Emma , Lahey Kelcie , Barootes Hailey , Holyer Karissa , Miller Michael , Lim Rod 
Published: October 2022

Abstract

Background
School-aged children are recommended to complete at least one hour of moderate to vigorous intensity physical activity per day. North American data has shown that due to COVID-19 restrictions placed on in person schooling and extracurricular activities, children were not meeting recommended levels of physical activity. Additional barriers to activity during the first wave of the COVID-19 pandemic included lack of access to public facilities including community centers, parks, and outdoor recreation. Decreased physical activity in children has been shown to have a negative impact on both physical and mental health, and childhood development. However, there is a paucity of literature on parents’ perceptions of the association between physical activity and physical and mental health.

Objectives
The objective of this study was to gain a better understanding of the implications of the COVID-19 pandemic on levels of physical activity and parents’ perceptions surrounding physical activity and physical and mental health.

Design/Methods
An online survey was distributed to parents of school-aged children aged 4-13 in Ontario. The survey included questions regarding demographics, children’s physical activity prior to and during the first wave of the COVID-19 pandemic, and parental perceptions regarding the pandemic’s impact on mental and physical health. This study received ethics approval, was hosted on the REDCapTM platform, and distributed from February-June 2021 through a local school board, the Pediatrics section of the Ontario Medical Association, and through social media.

Results
Of 361 participants, 90.4% strongly agreed that physical activity was important for mental health, and 92.2% strongly agreed that physical activity was important for physical health. There was a statistically significant decrease in the overall mean number of hours of physical activity per week between pre-COVID and the first wave of COVID (mean difference = 9.34 hours, SD = 10.06, p&lt;0.001). Additionally, parents of children with decreased physical activity reported a statistically significant negative impact on physical and mental health as compared to parents whose children had no change in amount of physical activity. Decreased energy, poor sleep, increased anxiety, mood disturbances, and disruptive behaviour were noted by over 50% of respondents.

Conclusion
This survey highlights that parents themselves perceived a significant negative impact on children’s mental and physical well-being with decreased physical activity during the COVID-19 pandemic. This emphasizes the importance of retaining access to recreational facilities and extracurricular activities. Future research includes identifying ways to re-engage parents and children with physical activity during times of decreased access.
9 Congenital Heart Disease and Autism Spectrum Disorders: Is There a Link?
Authors: Gu Sophia , Zhang Qian , Katyal Abhay , Chung Winnie , Franciosi Sonia , Sanatani Shubhayan 
Published: October 2022

Abstract

Background
Congenital heart disease (CHD) has been linked to an increased incidence of intellectual disability and neurodevelopmental impairments in young patients. The relationship between CHD and autism spectrum disorders (ASD) is not well investigated.

Objectives
We performed a systematic review and meta-analysis of the medical literature to assess the evidence linking CHD to incidence of ASD.

Design/Methods
A systematic review of studies on CHD and ASD in PubMed, Cochrane and ISI from 1965 to May 2021 was conducted. Only retrospective or prospective cohort, case-control and cross-sectional human studies in the English language were included. Quantitative estimates of association between CHD and ASD were extracted from eligible studies for the meta-analysis. Pooled estimates were obtained using a random effect models fit by a generalised linear mixed model. Quantitative results not included in the meta-analysis were summarized using descriptive statistics.

Results
We screened 2,709 articles and 24 articles were included in this review. Among the 24 studies, there was a total of 348,771 subjects (12,114 CHD, 9,829 ASD and 326,828 controls). Patient age (range of 0 to 26 years) was reported in all studies. The proportion of males in CHD, ASD and controls were 50%, 80%, and 55%. CHD diagnosis ranged from non-specific (9/16), single ventricle lesion (2/16), dextro-transposition of the great arteries (2/16), and tetralogy of Fallot (1/16). Overall, seven articles reported a 4.66 times increase in the percentage of ASD cases in patients with CHD compared to the percentage of ASD cases in the general population: (5.87% vs 1.14% of ASD cases in CHD vs the general population). Seven of 24 studies were eligible for the meta-analysis, which included information on a total of 250,611 subjects (3,984 CHD, 9,829 ASD, and 236,798 controls). The summary estimate indicated that CHD patients are associated with almost double the odds of being diagnosed with autism compared with non-CHD patients: (OR 1.99, 95% CI 1.77-2.24, p&lt;0.01). Early developmental delay, perinatal factors, genetics and neurological development were potential risk factors and etiologies for the onset of ASD in CHD patients. Suggestions for improvement of future clinical care include early identification and treatment of ASD among the CHD population. Limitations of this study include few articles explicitly exploring the link between CHD and ASD and lack of standardized ASD endpoints.

Conclusion
This review outlines that CHD patients are at an increased risk of presenting with a diagnosis or symptoms suggestive of ASD.
11 Clinician Management of Childhood Dyslipidemia in the Community Setting
Authors: Tom Katherine , De Silva Natasha , Polack Alicia , Singh Karishma , Keown-Stoneman Charles , Maguire Jonathon , Birken Catherine , Wong Peter 
Published: October 2022

Abstract

Background
Childhood dyslipidemia is a known risk factor for the development of cardiovascular disease (CVD) in adulthood. Although adverse health outcomes of dyslipidemias are rare in childhood, the atherosclerotic process begins in early life. An overlooked lifelong progression of disease may result in myocardial infarction and stroke in later life. There are currently no Canadian paediatric guidelines for lipid screening. Despite dyslipidemia identification, early treatment or management may not be initiated. Primary care providers (PCP) are well positioned to advise and reinforce cardiovascular health behaviours to minimize the risk of CVD and promote lifelong cardiovascular health.

Objectives
To describe clinician practice patterns associated with childhood dyslipidemia management in the community setting.

Design/Methods
A retrospective chart review was conducted for children 2 to 10 years of age with abnormal lipid profiles. Participants were recruited from a practice-based research network. Non-fasting blood samples were obtained. The primary study outcome was the proportion of physicians engaging in each step of management practice. R version 3.6.2 (R Foundation for Statistical Computing, Vienna, Austria) was used for statistical analysis.

Results
Among 462 children identified with dyslipidemia, all were seen by PCP at their next follow-up visit. PCP rarely informed families about abnormal lipid profiles. PCP frequently counselled on diet and eating habits (n=424, 95.1%), but less often on physical activity (n=154, 34.5%), screen time (n=24, 5.4%), and sleep (n=1, 0.2%). Family history of CVD, diabetes, high cholesterol, or hypertension was infrequently discussed (n=5, 1.1%). PCP repeated fasting lipid profiles uncommonly (n=20, 4.5%). Management plans for abnormal lipid profiles were not documented. Only one participant had a follow-up visit (n=1, 0.2%). Referrals were rarely made to dieticians (n=2, 0.4%) and were not in response to abnormal lipid levels.

Conclusion
Dyslipidemia in childhood is a risk factor for the development of adult cardiovascular disease. Among children with abnormal lipid profiles, our study showed PCP rarely identified and initiated early management for abnormal lipid levels. Our results may inform the need for paediatric lipid screening and management guidelines to develop best clinical practice.
15 Ranking and rating severity: stakeholder perspectives of neurodevelopmental impairment after preterm birth
Authors: Richter Lindsay , Chera Amarpreet , Luu Thuy-Mai , Bone Jeffrey N , Bourque Claude-Julie , Janvier Annie , Zhang-Jiang Sofía , Synnes Anne 
Published: October 2022

Abstract

Background
Children born very preterm are at increased risk of neurodevelopmental impairment (NDI). NDI rates are used to make critical healthcare decisions. The Canadian Neonatal Follow-Up Network (CNFUN) defines severe NDI at age 18–24 months as Bayley-III Cognitive, Motor or Language composite scores &lt;70, need for hearing aids or cochlear implants, bilateral visual impairment or non-ambulatory cerebral palsy (Gross Motor Classification System level 3 or higher). This definition was developed using the perspectives of clinicians and scientists. Stakeholders including parents/caregivers, persons born preterm and community partners have never been asked how they categorize disabilities and rank different impairments.

Objectives
To evaluate stakeholder perspective of severity of disability and ranking of different health conditions all defined as severe by CNFUN using clinical vignettes.

Design/Methods
Ten clinical vignettes describing 18 month old children with combinations of single and multiple impairments based on the CNFUN definition of severe NDI and one clinical vignette describing a child without NDI (control) were co-developed by clinicians and parents. The survey of 11 vignettes was distributed to: (1) British Columbian parents of very preterm children during follow-up clinic visits; and (2) Canadian and international parents, families, individuals with lived experience with prematurity and/or NDI and their social networks using a snowball sampling technique. Participants rated the severity of each vignette on a scale from 0 (worst possible health) to 10 (best possible health) and answered if they perceived the vignette to represent a severe disability. Results were analyzed descriptively and mean differences from the control were compared using a linear mixed effects model.

Results
827 participants and 4553 vignettes were completed with no significant difference by population sampled. Participants classified the clinical vignettes as describing a severe condition ranging from 5% for the cognitive delay vignette to 55% for the cerebral palsy and language delay vignette. Mean difference in rank compared to control is shown in Figure 1. Only the ranking of the latter vignette was significantly different from the control.

Conclusion
Most key stakeholders do not perceive clinical vignettes describing CNFUN definitions of severe NDI as truly severe. Components of severe NDI rank differently but only the cerebral palsy and language delay vignette varies significantly. Current CNFUN definitions of severe NDI need to be revised.
17 Early nasal intermittent positive pressure ventilation versus early nasal continuous positive airway pressure for preterm infants
Authors: Lemyre Brigitte , Deguise Marc-Olivier , Benson Paige , Haresh Kirpalani , Ekhaguere Osayame A , Davis Peter G 
Published: October 2022

Abstract

Background
Respiratory distress syndrome (RDS) is very common in preterm infants and multiple options are available to support their breathing in the early neonatal course. Non-invasive ventilation has become widely used given the opportunity to avoid intubation, mechanical ventilation and reduce the risk of ventilator-associated lung injury. Non-invasive ventilation includes nasal continuous positive airway pressure (NCPAP) and non-invasive positive pressure ventilation (NIPPV). NCPAP provides one constant pressure throughout the respiratory cycle. NIPPV additionally provides higher-pressure breaths (peak inspiratory pressure – PIP) over the constant baseline pressure. The use of these two modalities has previously been compared in a Cochrane systematic review to better comprehend the favoured option in preterm with RDS.

Objectives
We re-examine the risks and benefits of NIPPV versus NCPAP when implemented within the first 6 hours after birth, for preterm infants with respiratory distress in this updated Cochrane review.

Design/Methods
We used the criteria and standard methods of Cochrane and Cochrane Neonatal to conduct a comprehensive literature search for inclusion of all randomized, quasi-randomized trials and cross-over trials fitting our inclusion criteria. Primary endpoints are respiratory failure and the need for intubated ventilatory support during the first week of life. Secondary endpoints included chronic lung disease, length of stay (LOS), pneumothorax, and mortality. We analyzed the included trials using risk ratio (RR), risk difference and the number needed to treat for an additional beneficial outcome or an additional harmful outcome for dichotomous outcomes, and mean difference (MD) for continuous outcomes. We used the GRADE approach to assess the quality of evidence.

Results
In this updated systematic review, we screened 1143 studies for the title and abstract screening. 36 studies were retained for full-text review and 8 new trials were added to this update. We re-affirmed the superiority of NIPPV VS CPAP to prevent respiratory failure (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.52 to 0.75), in reducing the need for intubation (risk ratio RR 0.70, CI 0.60 to 0.82), chronic lung disease (risk ratio RR 0.68, CI 0.50 to 0.92) and LOS (Mean difference -3.05 days, CI -4.92, -1.17). We did not find any difference in the mortality rate or rate of pneumothorax. For most outcomes, the certainty of evidence was graded as moderate or low.

Conclusion
NIPPV is superior to NCPAP as a primary respiratory support modality for preterm infants with RDS, in preventing respiratory failure and the need for intubation in the first week of life.
26 Investigating Noise Exposure to Newborn Infants with Respiratory Support: Methodological Considerations
Authors: Singh Devika , Fusch Gerhard 
Published: October 2022

Abstract

Background
Excessive noise in the NICU may lead to serious long-term effects on hearing impairment and sensory development in newborns. As such, the maximum recommended noise level is 45 dBA. Reported studies regarding noise exposure of ventilated preterm infants show inconsistent results; however, these studies also vary considerably in their methodology in terms of noise ascertainment (Table 1). We hypothesize that the study methodology significantly influenced data quality.

Objectives
Our aim is to investigate if measured ventilator noise levels from previous literature could potentially be the result of methodological shortfalls of the study design rather than perceivable noise levels.

Design/Methods
A ventilator circuit was set up using nCPAP and high frequency mode with nasal prongs. Noise levels were measured using a commercially calibrated noise meter. Three different scenarios were tested. (1) Measurements were taken at different angles of (0°to 180°), with 180° facing the end of the nasal prongs, without a mannequin, with the membrane/orifice of the noise meter placed 2 mm laterally from the prongs. (2) Noise levels were measured at 180° at distances of 0 to 20 mm from the nasal prongs. (3) Measurements were taken in the oral cavity of a life-size intubation mannequin of a newborn baby.

Results
Overall, the noise levels produced at different settings varied significantly, ranging from 45.7 dB to 82.2 dB. The average environmental background noise was 44.4 dB. Noise levels typically increased as the angle increased, with the highest noise level at 180° for both high frequency and nCPAP mode, at 58.4 dB and 58.2 dB, respectively (Figure 1). Noise levels recorded at high frequency were slightly higher than nCPAP values. Furthermore, in regards to distance, the highest mean value, 82.2 dB was recorded with the noise meter approximately 3 mm from the nasal prongs, with the lowest mean value, 47.6 dB, being recorded at ~20 mm. During trials with the mannequin, the lowest value, 50.1 dB, was recorded at the entrance of the mouth with slightly higher values being recorded within the oral cavity.

Conclusion
The results indicate that small changes in experimental settings, such as positioning and distance from the nasal prongs, can greatly influence noise levels, particularly above the recommended levels for neonates. In summary, some study results are potentially influenced more by the study design than the device type or ventilator setting. Further research and detailed reporting in the NICU is recommended.
27 Neurodevelopmental Outcomes of Preterm Infants Born &lt;29 weeks with Bronchopulmonary Dysplasia Associated Pulmonary Hypertension: A Multicenter Study
Authors: Thomas Soumya , Jain Sunil , Murthy Prashanth , Joseph Chacko , Soraisham Amuchou , Tang Selphee , Dosani Aliyah , Lodha Abhay 
Published: October 2022

Abstract

Background
More than 1 in 4 preterm infants with bronchopulmonary dysplasia (BPD) develop BPD-associated pulmonary hypertension (BPD-PH) that is associated with significant morbidity. Data regarding neurodevelopmental outcomes with BPD-PH in preterm infants are lacking.

Objectives
To determine neurodevelopmental outcomes of preterm infants born &lt; 29 weeks gestational age (GA) with BPD associated pulmonary hypertension at 18 to 24 months corrected gestational age (CGA).

Design/Methods
In this retrospective cohort study, preterm infants born &lt; 29 weeks GA between January 2016 and December 2019 at level 3 Neonatal Intensive Care Units at Foothills Hospital in Calgary and the University of Texas Medical Branch (UTMB) in Galveston, who were evaluated at 18-24 months CGA in the neonatal follow-up clinics were included. We compared demographic factors, neurodevelopmental status including Bayley-III scores and sensory impairments between the two groups based on the presence of PH at 36 weeks CGA: Group I: BPD with PH and Group II: BPD without PH, using univariate and multivariable regression models. The primary outcome was a composite of death or neurodevelopmental impairments (NDI). NDI was defined as any cerebral palsy (GMFCS≥1), Bayley-III score &lt; 85 on one or more of the cognitive, motor, or language composite scores, sensorineural or mixed hearing impairment or unilateral or bilateral visual impairment.

Results
Of 372 eligible infants, 118 (Group I [BPD-PH] =7, Group II [BPD with no PH] =111) were lost to follow up. Of the remaining 254 infants, 52 in Group I and 202 in Group II were followed at 18-24 months CGA. Group I and Group II had median (IQR) birth weight of 710g (323) and 815g (314) [p=0.004] and median gestational ages (IQR) were 25 weeks (2) and 26 weeks (2) [p=0.020], respectively . Rates of associated impairments are shown in Figure 1. Infants in BPD-PH group (Group I) were more likely to have mortality or NDI (adjusted Odds Ratio [aOR] 3.82; 95% CI: 1.17-12.41) (Table 1).

Conclusion
BPD-PH in preterm infants born &lt; 29 weeks GA is associated with increased odds of the composite outcome of death or neurodevelopmental impairment and language delay at 18-24 months CGA.
35 Co-Creation, Development and Evaluation of Online Care Maps for Children with Medical Complexity
Authors: Adams Sherri , Dharmaraj Blossom , Beatty Madison , Moore Clara , Desai Arti , Bartlett Leah , Culbert Erin , Cohen Eyal , Stinson Jennifer , Orkin Julia 
Published: October 2022

Abstract

Background
Given the nature of their child’s underlying condition, parents of children with medical complexity (CMC) are relied upon to act as the primary care coordinator for their child. Tools like a care map have been shown to be effective in supporting patients and families, however, the use of an online care map that can be edited in real time has not been used and evaluated.

Objectives
The aims of this study were to: 1) determine the requirements and design features of a co-created online platform supporting care map creation, 2) use the platform for the development of a shareable standardized parent created care map, and 3) explore the utility and feasibility of an online care map from multiple perspectives including (i) parents, (ii) health care providers (HCPs), and (iii) non-HCPs.

Design/Methods
This qualitative study utilized interpretive description. Purposive sampling guided participant selection. In phase 1, the requirements and design features for a care map creation tool situated in an online patient and family facing platform were identified through semi-structured interviews with parents and HCPs/non-HCPs of CMC. This data was used to co-create the care map feature. In phase 2, parents used this online platform to create, update, and share care maps. Semi-structured interviews with parents and HCPs/non-HCPs of CMC were conducted to explore care map creation and utility.

Results
In phase 1, thirty-two interviews with parents (n=16) and HCPs/non-HCPs (n=16) were conducted. Four primary themes related to the requirements and design features for an online care map were identified and included: 1) useful features, 2) suggestions, 3) sharing, and 4) future use, which informed development of the online tool. In phase 2, thirty-six parents were on boarded to the online platform with n=25 (69%) choosing to create a care map. Semi-structured interview data with parents (n=15) and HCPs/non-HCPs (n=13) demonstrated four primary themes to inform the future use of online care maps: 1) clinical usage of care maps, 2) benefits of use, 3) challenges for usage, and 4) suggestions to improve usability.

Conclusion
Parents have valuable feedback informing the co-creation of an online platform to create and share care maps. Parents reported uncertainty in the clinical usage of care maps, however, HCPs found them very informative. Further research is needed to understand the importance of education and clarity of roles in the use of a care map for clinical care of CMC.