bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self-Blame and Avoidance Coping as Predictors of Post-Traumatic Stress Symptoms Among Sexually Abused Children
Authors: Bernard-Bonnin AC , Gauthier-Duchesne A , Allard-Dansereau C , Hébert M 
Published: September 2022

Abstract
BACKGROUND: Child sexual abuse is clearly associated with posttrau-matic stress symptoms (PTSS). Prior studies have identified self-blame and coping as important predictors of PTSS among adult survivors of sexual assault. However, few studies have explored the potential impact of self-blame and avoidance coping in influencing PTSS in children who have disclosed sexual abuse.
OBJECTIVES: This study attempted to test the contribution of self-blame and avoidance coping to the prediction of PTSS among sexually abused children. The severity of the abuse and child’s gender were also examined.
DESIGN/METHODS: The sample consisted of 477 sexually abused children (319 girls and 128 boys), aged 6 to 12. Self-blame and PTSS were evaluated by the Children’s Impact of Traumatic Events Scale II. A brief version of the Self-Report Coping Scale was used to assess children’s coping avoidance. These questionnaires were child self-report measures. The severity of the abuse was categorized as (1) less severe (physical contact over clothing), (2) severe (physical contact under clothing without penetration or force) and (3) more severe (physical contact with penetration or attempted penetration). Linear regression analysis was used to test the contribution of self-blame and avoidance coping to the prediction of PTSS. First, the child’s gender and the severity of the abuse were entered, and secondly, self-blame and avoidance coping.
RESULTS: A total of 10.7% of the sample reported less severe sexual abuse, 27.7% reported severe sexual abuse and 61.6% reported more severe abuse. The model which only included child’s gender and severity of the abuse explained 3.8% of the variance (F=9.04, p&lt;0.001) in PTSS. Adding self-blame and avoidance coping, the proportion of explained variance increased to 35.1% (F=56.62%, p&lt;0.001). Being a girl (beta=0.15, p&lt;0.001), reporting high levels of self-blame (beta=0.26, p&lt;0.001) and using avoidance coping (beta=0.43, p&lt;0.001) were predictors of PTSS. The severity of the abuse was significant into the first model (beta=0.14, p=0.004), but not into the final one (beta=0.08, p=0.057).
CONCLUSION: Results suggest that sense of self-blame and using avoidance coping are important targets for clinical intervention with sexually abused children, because these factors contribute to the prediction of PTSS among this vulnerable population.
Two Decades of Measuring Ins and Outs: 20 Years of Paediatric Intensive Care Unit Admissions and DISCHARGES At A Small, Tertiary Care Paediatric Hospital with A Large Geographic Catchment Area
Authors: Krmpotic K , Young M 
Published: September 2022

Abstract
BACKGROUND: Over the past three decades, pediatric critical care has become recognized as its own subspecialty, with well documented benefits for critically ill children cared for by a pediatric intensivist, in the Pediatric Intensive Care Unit (PICU) of a tertiary care hospital. Previous studies describing the demographic of critically ill children have been conducted in large hospitals that provide tertiary and quaternary care, or nation-wide studies including several PICUs.
OBJECTIVES: The primary objective of this study was to describe the volume and type of patients admitted to the PICU of a small, tertiary care pediatric hospital with a large geographic catchment area over a period of 20 years.
DESIGN/METHODS: We audited a prospectively maintained, administrative database to determine the age, primary diagnosis, length of stay, and outcome for all children, newborn to 18 years of age, who were admitted to the PICU at the Janeway Children’s Health and Rehabilitation Centre in St. John’s, Newfoundland between January 1, 1995 and December 31, 2015.
RESULTS: Data were available for 3800 admissions. Children requiring admission to PICU were a median age of 7.1 years (IQR 1.5 - 13.6 years). Medical patients accounted for 60% of admissions with most common diagnoses being respiratory insufficiency (32%), metabolic conditions (15%), neurological conditions (15%), trauma (14%), and cardiac insufficiency (6%). The remainder of admissions were for surgical patients from general surgery (50%), orthopedics (29%), and neurosurgery (21%). Median length of stay for admitted children was 2 days (IQR 1 – 5 days). Overall mortality rates were 2.8%.
CONCLUSION: Despite the benefits associated with regionalization of pediatric critical care for acutely ill children, positive outcomes and low mortality rates are observed in a small, tertiary care hospital with a large catchment area that is geographically isolated from other parts of the country. We were able to identify common admission diagnoses for our patient population, comparable to those reported at larger institutions.
A Retrospective Review of Service Documentation by Physicians Following Families of Children Diagnosed with Autism Spectrum Disorder: Identifying Gaps in Communication
Authors: Dunlap H , Ler S , Jegathesan T , Minhas R , Huber J , Young E 
Published: September 2022

Abstract
BACKGROUND: Currently very little is reported on the best way for family physicians and pediatricians to manage children diagnosed with autism spectrum disorder (ASD). There is no standard way to monitor whether families manage to access services, how long they wait for services, and what they do if services are deferred/denied. Consequently, families are often left with limited guidance and support when accessing developmental services.
OBJECTIVES: To evaluate the documentation patterns in medical charts of children diagnosed with ASD between 0-6-years old, whose care is shared between general and developmental pediatricians working in an inner-city setting. In particular, to study how physicians document the timeline and access to medical investigations and community services recommended by physicians.
DESIGN/METHODS: A retrospective chart review of a random sample of approximately 40 patients diagnosed between 0-6-years old with ASD followed by general and developmental pediatricians is currently being conducted at St. Michael’s Hospital. A systematic review of referral pathway to diagnosis, medical investigations, procurement of financial support and access to community services will be performed. Details obtained for review include date of recommendation, parent contact date, date on wait list, start date, and end date.
RESULTS: Preliminary data from 30 patient medical records revealed inconsistencies in how services were documented by physicians. 80% of charts noted that Intensive Behavior Intervention (IBI), Applied Behaviour Analysis (ABA) and speech and language therapy (SLP) were recommended and/or accessed by families. However, the recorded timeline of access varied extensively, with start and end dates recorded in ≤ 20% of charts for ABA, ≤ 50% of charts for SLP and ≤ 70-80% of charts for IBI. ABA therapy appeared to be the most difficult to access, with uptake occurring in only 50% of recommendations. Medical investigation results were often present, however the dates for hearing and vision tests were inconsistently recorded by the pediatrician in the medical charts. Parent education and attendance to drop-in centres were not recommended or accessed in 50% and 25% of patient charts respectively.
CONCLUSION: Preliminary results demonstrate inconsistent patterns of documentation by pediatricians following children with ASD when monitoring medical and community services, especially when recording timelines. Advocating for timely involvement in appropriate services requires an awareness of patients’ past and current involvement in services. Thus, further research may be warranted to determine why certain services are less frequently documented, and how these gaps in communication can be improved to ensure optimal management.
Prevalence of Autism in Children Prenatally Exposed to Alcohol: A Pilot Study
Authors: Young E , Stade B , Falsetti A , Fulford E , Jegathesan T 
Published: September 2022

Abstract
BACKGROUND: The prevalence of autism among Canadian children is 1.1 in 100.1 The possibilty of an association between prenatal alcohol exposure and autism was based on early case reports describing autistic behaviour in children with Fetal Alcohol Syndrome.2
OBJECTIVES: The objective of this study was to identify the prevalence of autism in children prenatally exposed to alcohol.
DESIGN/METHODS: A chart review was conducted of 220 children, aged 4 to 16 years, admitted to a Fetal Alcohol Spectrum Disorder(FASD) Clinic, and prenatally exposed to alcohol. Descriptive statistics were used to determine prevalence of the autism diagnosis,number of children diagnosed with FASD, and relevant demographic data.
RESULTS: Nine (9) of the total 220 children, or 4.1 %,had been diagnosed with autism using standarized tests. Mean age was 7.6 years with a range of 4.3 to 14.2 years. Five (5) of the children were boys, and 4 were girls. Six (6) additional children had autistic behaviours: autism was ruled out in 2 of the 6 children, and 4 had not been assessed. Eight (8) of the 9 children diagnosed with autism were also diagnosed with FASD, and in 1 child the diagnosis was deferred.
CONCLUSION: The prevalence of autism among children prenatally exposed to alcohol was significantly higher than the overall Canadian population (4.1 % vs. 1.1 %). Implications for practice and research are described.
Prevalence of overweight And Obesity in Canadian Children: A Decade of Progress in the Canadian Community Health and Health Measure Surveys
Authors: Rodd C , Sharma A 
Published: September 2022

Abstract
BACKGROUND: Previous studies using the Canadian Community Health Survey (CCHS) demonstrated an increase in the prevalence of overweight or obesity in Canadian children from 23.3% to 34.7% (1978– 2004) using the new 2010 WHO for Canada Growth Charts.
OBJECTIVES: To better define temporal trends in overweight and obesity status, this study examines additional data from the Canadian Health Measures Survey (CHMS, 2009-2013) by applying current Canadian definitions based on WHO body mass index (BMI) thresholds and recently validated waist-circumference norms from NHANES III (1988-1994). Associations with variables such as family income, parent education and number of parents were also explored over this time frame.
DESIGN/METHODS: Directly measured heights and weights were available for 14,014 children aged 3-19y from the decade 2004 to2013 in CCHS (n=8976)CHMS cycle 2 (n=2578) and CHMS cycle 3 (n= 2460). Z-scores for BMI, height, and weight were based on the 2014 WHO Growth Charts for Canada, including their new extension of weight-for-age beyond 10y. For waist circumference and waist-height ratios, we used new charts from the NHANES III reference population. Inverse probability survey weights were used to account for non-response and under-coverage.
RESULTS: The sex distribution was similar in each survey cycle and ~ 80% were of white race/ethnicity. Using current WHO definitions based on BMI, we observed a decline in the proportion ‘overweight or obese’ from 30.7% (95%CI=29.4–32.0) to 27.0% (25.7–28.3, p&lt;0.001) and a stabilizations in obesity rates at ~13%. Rates of overweight and obesity were higher in boys, non-whites, and older children. These trends persisted after regression adjustment for age, gender, and race-ethnicity. Although declining, median Z-scores for BMI, weight, and height were positive compared to the WHO reference population. Waist-circumference and waist-height ratio Z-scores were negative, with less central adiposity than American children in historic or contemporary NHANES cohorts. Temporal trends in overweight/obesity appear to vary with family income, educational achievement, and immigrant status.
CONCLUSION: After a period of dramatic growth, both BMI-Z-scores and the prevalence of overweight or obesity appear to be declining in in Canadian children, attesting to progress against this important public health challenge.
How Well Does the Nipissing District Developmental Screen (NDDS) Identify Communication Problems in Infants?
Authors: Heuvel M Van den , Borkhoff C , Koroshegyi C , Zabih W , Maguire J , Birken C , Parkin P 
Published: September 2022

Abstract
BACKGROUND: Communication problems are often the first presenting problem in infants with developmental disabilities. With early detection, intervention can start. The 18-month Nipissing District Developmental Screen (NDDS) was created as a developmental checklist for use in primary care. The Infant Toddler Checklist (ITC) is a validated questionnaire for detecting communication problems. Our objective was to examine how well the 18-month NDDS identifies communication problems. We therefore assessed the convergent validity of the 18-month NDDS with the ITC as a gold standard.
OBJECTIVES: To examine how well the 18-month NDDS identifies communication problems. To compare parents’ answers to a similar question, “How many different words does your child use?”, on both checklists.
DESIGN/METHODS: Healthy children (n = 348, 55% male, mean age 18.6 months, SD 0.7) were recruited during scheduled health supervision visits. Parents completed both the 18-months NDDS and ITC. We assessed the convergent validity of the 18-month NDDS with the ITC as a gold standard. Correlation (Spearman) and the level of agreement (Cohen’s kappa, sensitivity, specificity) were calculated. For our secondary outcome, we compared the percentage of agreement between the answers to the same question on both instruments.
RESULTS: On the NDDS, 138 (39.7%) children had “one or more flags” (+1 NDDS) and 54 (15.8%) children had “two or more flags” (+2 NDDS). 13 (3.7%) infants had a concern on the total ITC score, 31 (8.9%) a speech-, 9 (2.6%) a social -, and 14 (4.0%) a symbolic concern.The +2 NDDS had a medium correlation (Spearman’s rho 0.42) and a fair agreement (Cohen’s kappa 0.32) with the ITC. Sensitivity and specificity of the NDDS using the +1 and + 2 flag cut-offs in detecting concerns compared with the ITC are shown in the table.The similar question about number of words spoken by 18-month old infants revealed agreement between the NDDS and ITC; 24.4% versus 30.8% of the 18-month old infants did not speak 20 words or more respectively.
CONCLUSION: Infants with a severe overall communication delay were identified with the 18-months NDDS. The low sensitivity of the 2+ NDDS flag in detecting speech and social concerns suggests that infants who could benefit from early interventions may not be identified.The low specificity of the 1+ NDDS flag may cause unnecessary concerns for parents.For the early identification of all levels of communicationdelays, we recommend using a standardized questionnaire like the ITC.
Reduction of the 28-Day Readmission Rate for Children with Sickle Cell Disease
Authors: Beck C , Kirby-Allen M , Cheong M , Langrish K , Clarke A , Nishimura C , Palmer M , Gervais A , Moloney J , Mack L 
Published: September 2022

Abstract
BACKGROUND: Failure to provide coordinated care may lead to inefficiencies and negatively impact the quality of patient care provided. For children with sickle cell disease (SCD) at our tertiary care children’s hospital, traditionally hematology has provided ambulatory and consultative care, and general paediatrics has provided inpatient management. We fostered collaboration and used quality improvement (QI) methods to improve patient care, using hospital readmission rates as our primary QI measure.
OBJECTIVES: To reduce the 28-day readmission rate for pediatric patients with SCD from current levels (18.5%) to 14% over a 12-month period.
DESIGN/METHODS: An interdisciplinary team diagnosed and developed strategies to address gaps in care coordination. A chart audit was conducted and a process map of the hospital journey was created to identify opportunities for improvement. Based on impact and effort, the following strategies were prioritized and implemented: standardization of pain management, support for patients at highest risk of readmission, streamlining the discharge process, and increased use of hydroxyurea. Quarterly data were abstracted via Health Records from the Discharge Abstract Database (DAD). The measure of interest was the percentage of patients (0-18 years of age) with SCD and crisis readmitted with the same or related diagnosis within 28 days. Patients were identified using the ICD10 code D57.0; “crisis” includes vaso-occlusive crisis, acute chest syndrome, and splenic sequestration. Individual process measures reflecting our multiple improvement strategies were also collected.
RESULTS: From fiscal year 2013-14 to 2014-15, the total number of patient admissions for SCD decreased from 173 to 166. The readmission rate, as defined above, decreased from 18.5% to 10.8%. Other measures specifically reflecting our improvement strategies continue to be followed with ongoing process improvement.
CONCLUSION: A multi-modal strategy approach aimed at coordinating care has led to a decrease in rate of readmission for children with SCD below the established target. Ongoing monitoring will be required to ensure sustainability of this result. Further opportunities for standardization of care for this patient population include updating relevant clinical practice guidelines and order sets; implementing “pain plans” for transition home; and optimizing outpatient follow-up.
Evaluation of a Child Safety Program Based on the Safe Community Model in Canada
Authors: Beaulieu E , Cyr C , Santschi M 
Published: September 2022

Abstract
BACKGROUND: Despite national safety programs, unintentional injuries remain an important health problem in children and adolescents. Cycling, pedestrian and young drivers injuries are particularly influenced by specific community and city aspects. The World Health Organization (WHO) developed community based programs that have been effectively implemented as complements to national safety programs to prevent injuries.
OBJECTIVES: The aim of this study was to evaluate the effectiveness of a local program based on a WHO Safe Community model to reduce cycling, pedestrian and young drivers injuries.
DESIGN/METHODS: A population based quasi-experimental design was used. Pre-implementation and post-implementation data of cycling and pedestrian injury rates (0-15 years) and young drivers injury rates (16-24 years) were collected in the intervention area (Sherbrooke) and in two control communities (Trois-Rivières and Gatineau) in Québec, Canada. RESULTS: Sherbrooke, Gatineau and Trois-Rivières had respectively 69, 82 and 119 cycling and pedestrian injury rate per 100000 children-year in the pre implementation period. Despite its already lower pre-implementation rate, Sherbrooke showed a statistically significant reduction in the post-implementation injury rate compared to Trois-Rivières (Sherbrooke: 49:100000 children-year (OR comparing pre-post rates 0.70 ; 95%CI : 0.45-1.08) and Trois-Rivières 80:100000 children-year (OR comparing pre-post rates 0.68; 95%CI: 0.46-1.0). Gatineau showed a cycling and pedestrian post-implementation injury rate of 63:100000 (OR 0.77; 95%CI: 0.58-1.02). Sherbrooke had the largest young drivers injury reduction with rates of 2912:100000 young driver-year (pre) to 2121: 100000 young driver-year (post) (OR 0.73; 95%CI: 0.66-0.8). Gatineau and Trois-Rivieres showed respectively young drivers injury rate lowering from 2383: 100000 to 2099: 100000 young driver-year (OR 0.88; 95%CI: 0.81-0.95) and from 3447: 100000 to 3295: 100000 young driver-year (OR 0.96; 95%CI 0.87-1.05).
CONCLUSION: Safe Community program established in Sherbrooke was associated with favorable results in injury prevention. Despite its lower pedestrian and cycling injury rate before the intervention, post-implementation injury rate in Sherbrooke was significantly lower compared to Trois-Rivieres. Concerning young drivers injury rates, Sherbrooke showed the biggest reduction, compared to Trois-Riviere and Gatineau. In addition to national injury prevention programs, communities should be encouraged to adopt WHO safe community programs to reduce to a minimum unintentional injury rates in children and adolescents.
The Emotional Intelligence of Paediatric Residents – A Descriptive Cross-Sectional Study
Authors: McLeod S , Sonnenberg L 
Published: September 2022

Abstract
BACKGROUND: Emotional Intelligence (EI) is a type of social intelligence with high scores achieved through factors including being empa-thetic in interpersonal relationships, displaying flexibility in adapting to change, and managing stressful situations. There has been an explosion of research into EI in medicine since many of the social competencies described may have a direct impact on patient care.
OBJECTIVES: The objective of this study was to describe EI of pediatric residents and to identify if there are EI skills that should be selected for targeted intervention in this population.
DESIGN/METHODS: This was a cross-sectional study administering the EQi-2.0© psychometric instrument to all pediatric residents at a Canadian residency program. Scores were analyzed by year of training, gender, and age.
RESULTS: Thirty-five residents completed the EQi-2.0© (100% response rate). Their overall EI score was not significantly different than a normative group of college educated professionals. There was no correlation between overall EI and year of training, gender, or age. Residents had relative strengths in the subcategories Emotional expression, Interpersonal Relationships, Empathy, and Impulse Control (all p&lt;0.05). Areas of relative weakness were in the subcategories Stress Tolerance, Assertiveness, Independence and Problem Solving (all p&lt;0.05). There were significantly higher scores in the subcategories Independence, and Problem Solving for residents over thirty years old when compared to younger residents (both p&lt;0.05).
CONCLUSION: The EI of pediatric residents is consistent with that of other professionals. Educational interventions may be useful in the areas of weakness, however, individual score reports vary so emphasizing the individual learning needs of each resident based on their weaknesses may be the best educational intervention to enhance the physician-patient relationship.