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Long D, Minogue J, Charles K, Morgan S, Schults J, Le Marsney R, Stocker C, Gibbons KS, Dow B. Neurodevelopmental outcome and quality of life in children admitted to the paediatric intensive care unit: A single-centre Australian cohort study. Aust Crit Care 2024; 37:903-911. [PMID: 38866692 DOI: 10.1016/j.aucc.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/15/2024] [Accepted: 05/02/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The development of new morbidities has become increasingly identified in paediatric critical care medicine. To date, there has been limited research of long-term outcomes following paediatric critical illness in Australia. OBJECTIVES The objective of this study was to quantify neurodevelopmental impairments in children following paediatric intensive care unit (PICU) discharge and their association with health-related quality of life (HRQoL). METHODS A single-centre ambidirectional cohort study at an Australian hospital. Parents of children admitted to the PICU between 2015 and 2017 were invited to participate. Neurodevelopmental outcome and HRQoL was prospectively evaluated, using the Ages and Stages Questionnaire (<5 years), Strengths and Difficulties Questionnaire (≥5 years), and Pediatric Quality of Life Inventory™, respectively. RESULTS A total of 230 parents of critically ill children participated. Children were 1.9 years old (median, interquartile range [IQR]: 0.2, 7.5), male (59.6%), and ventilated (49.1%) at PICU admission. The median time to follow-up was 24.4 months (IQR: 16.3, 36.7). Parent respondents were more likely to be female (85.5%), White (88.3%), and partnered (81.1%). The incidence of overall neurodevelopmental impairment was 30% (33% in children aged <5 years; 24% in children aged ≥5 years). The incidence of poor HRQoL was 37.9%. History of developmental delay was independently associated with overall neurodevelopmental impairment (adjusted odds ratio [aOR]: 4.21, 95% confidence interval: 2.05, 8.63) and poor HRQoL (aOR: 7.29, 95% confidence interval: 3.26, 16.27). Two or more PICU admissions (aOR: 4.10, IQR: 1.82, 9.26) was also associated with poor HRQoL. CONCLUSIONS This is the first contemporary view of PICU long-term outcomes conducted in Australia and significantly informs ongoing research in this area. Approximately one-third of PICU survivors demonstrate neurodevelopmental impairment and reduced quality of life. Multiple domains of post-intensive care syndrome-paediatrics must be considered to have a comprehensive understanding of child outcomes. Assessment of baseline/premorbid functioning is also essential in order to understand the true impact of illness and PICU admission.
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Affiliation(s)
- Debbie Long
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Australia; Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia.
| | - Jessicah Minogue
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Neonatal Intensive Care Unit, Mater Mother's Hospital, Brisbane, Australia
| | - Karina Charles
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Australia; Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia; Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Australia
| | - Suzanne Morgan
- Child Health Research Centre, The University of Queensland, Brisbane, Australia; Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia
| | - Jessica Schults
- Child Health Research Centre, The University of Queensland, Brisbane, Australia; Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia; Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Australia
| | - Renate Le Marsney
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Christian Stocker
- Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia
| | - Kristen S Gibbons
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Belinda Dow
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Australia
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Holley AL, Battison EA, Heierle J, Clohessy D, Wesemann D, Hall T, Orwoll B, Wilson AC, Williams C. Long-term Pain Symptomatology in PICU Survivors Aged 8-18 Years. Hosp Pediatr 2023; 13:641-655. [PMID: 37357737 PMCID: PMC10312233 DOI: 10.1542/hpeds.2022-007027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Children discharged from the PICU often experience long-term physical, psychological, social and cognitive challenges, described as postintensive care syndrome. This study fills a critical gap by describing the long-term pain symptoms many children experience using child self-report. METHODS Participants in this cross-sectional study were children aged 8 to 18 years (and 1 parent, n = 64 dyads) who were 8 to 24 months post-PICU discharge. Participants completed measures assessing pain, psychosocial function, and treatment utilization. Health information relevant to the PICU admission was obtained from the electronic medical record. RESULTS Children were an average age of 14.3 years and 50% female. Average pain intensity in the past month was 3.65 (0-10 numeric rating scale), with 36% of children reporting pain ≥2 to 3 days a week. Youth with higher intensity (≥4) and more frequent pain (≥2-3 days a week) had greater pain catastrophizing, pain-related fear, anxiety, and sleep disturbance than those with less frequent and intense pain. Higher pain frequency was also associated with greater pain-related disability and depressive symptoms. Pain was not associated with any PICU-related variables abstracted from the electronic medical record. Parents reported children frequently accessed pain treatment services postdischarge; however, 37.5% reported the coronavirus disease 2019 pandemic impacted access to recommended services. CONCLUSIONS A significant portion of children experience pain post-PICU discharge. For many of these children, pain is frequent and is associated with impairments in psychosocial function. Future prospective research studies can be used to identify risk factors of poor pain outcomes so children can receive targeted interventions.
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Affiliation(s)
- Amy L. Holley
- Division of Pediatric Psychology, Department of Pediatrics
| | | | | | - Denae Clohessy
- Division of Pediatric Psychology, Department of Pediatrics
| | | | - Trevor Hall
- Division of Pediatric Psychology, Department of Pediatrics
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
| | - Ben Orwoll
- Division of Pediatric Critical Care, Departments of Pediatrics
- Medical Informatics and Clinical Epidemiology
| | - Anna C. Wilson
- Division of Pediatric Psychology, Department of Pediatrics
| | - Cydni Williams
- Division of Pediatric Critical Care, Departments of Pediatrics
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
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Yuliarto S, Ramadhanti A, Khalasha T, Kadafi KT, Ariani A. Predictors of neurocognitive and psychological disorders in children after intensive care admission: A prospective cohort study. Health Sci Rep 2023; 6:e1340. [PMID: 37334038 PMCID: PMC10268591 DOI: 10.1002/hsr2.1340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023] Open
Abstract
Background and Aims Children admitted in the pediatric intensive care unit (PICU) often deal with long-term morbidities affecting physical, cognitive, emotional, social, and psychiatric symptoms. We aimed to identify the internal and external factors which predict the occurrence of neurocognitive and psychological disorders in survivors at 3 months after PICU discharge. Methods We identified 53 critically ill children, ages 4-18 years old, admitted in PICU for more than 24 h, and survived. We evaluated neurocognitive disorder with Pediatric Cerebral Perfomance Category (PCPC) and psychological disorders with Strengths and Difficulties Questionnaire (SDQ) at the time of PICU discharge and repeated in 3 months afterward. We evaluated the internal and external risk factors related to neurocognitive and psychological disorders in PICU survivors. The internal risk factors were age, gender, family composition, and socioeconomic status. The external risk factors were: surgical intervention, neurological disease, predicted death rate by pediatric index mortality (PIM)-2 score, PICU length of stay (LOS), days of mechanical ventilation, and the number of therapeutic interventions. Results There were significant improvement in neurocognitive disorders (p < 0.001), peer problems, (p = 0.01), and prosocial behaviors (p = 0.00) in children at 3 months after the PICU discharge. Age of 4-5 years has a significant effect on neurocognitive disorders (p = 0.04), while male gender (p = 0.02), low-social economy, non-intact family composition (p = 0.01), neurological disease (p = 0.04), surgical intervention (p = 0.01), and TISS score (p = 0.00) have a significant effect on psychological disorders in children at 3 months after the PICU discharge. Conclusion Neurocognitive disorders, peer problems, and prosocial behaviors improved in a few patients 3 months after PICU discharge. Age of 4-5 years was a risk factor of the persisted neurocognitive disorder, whereas male gender, low-social economy, non-intact family composition, neurological disease, surgical intervention, and TISS score were risk factors of persisted psychological disorder at 3 months after PICU.
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Affiliation(s)
- Saptadi Yuliarto
- Department of Pediatrics, Medical FacultyUniversitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
| | - Ardhanis Ramadhanti
- Department of Pediatrics, Medical FacultyUniversitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
| | - Takhta Khalasha
- Department of Pharmacology, Medical FacultyUniversitas BrawijayaMalangIndonesia
| | - Kurniawan Taufiq Kadafi
- Department of Pediatrics, Medical FacultyUniversitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
| | - Ariani Ariani
- Department of Pediatrics, Medical FacultyUniversitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
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Daughtrey H, Slain KN, Derrington S, Evans IVR, Goodman DM, Christie LM, Li S, Lin JC, Long DA, Madden MA, VandenBranden S, Smith M, Pinto NP, Maddux AB, Fink EL, Watson RS, Dervan LA. Measuring Social Health Following Pediatric Critical Illness: A Scoping Review and Conceptual Framework. J Intensive Care Med 2023; 38:32-41. [PMID: 35603750 DOI: 10.1177/08850666221102815] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Social health is an important component of recovery following critical illness as modeled in the pediatric Post-Intensive Care Syndrome framework. We conducted a scoping review of studies measuring social outcomes (measurable components of social health) following pediatric critical illness and propose a conceptual framework of the social outcomes measured in these studies. DATA SOURCES PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Registry. STUDY SELECTION We identified studies evaluating social outcomes in pediatric intensive care unit (PICU) survivors or their families from 1970-2017 as part of a broader scoping review of outcomes after pediatric critical illness. DATA EXTRACTION We identified articles by dual review and dual-extracted study characteristics, instruments, and instrument validation and administration information. For instruments used in studies evaluating a social outcome, we collected instrument content and described it using qualitative methods adapted to a scoping review. DATA SYNTHESIS Of 407 articles identified in the scoping review, 223 (55%) evaluated a social outcome. The majority were conducted in North America and the United Kingdom, with wide variation in methodology and population. Among these studies, 38 unique instruments were used to evaluate a social outcome. Specific social outcomes measured included individual (independence, attachment, empathy, social behaviors, social cognition, and social interest), environmental (community perceptions and environment), and network (activities and relationships) characteristics, together with school and family outcomes. While many instruments assessed more than one social outcome, no instrument evaluated all areas of social outcome. CONCLUSIONS The full range of social outcomes reported following pediatric critical illness were not captured by any single instrument. The lack of a comprehensive instrument focused on social outcomes may contribute to under-appreciation of the importance of social outcomes and their under-representation in PICU outcomes research. A more comprehensive evaluation of social outcomes will improve understanding of overall recovery following pediatric critical illness.
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Affiliation(s)
- Hannah Daughtrey
- 8404Children's National Hospital Heart Institute, Division of Pediatric Cardiology, Children's National Hospital, Washington, DC, USA
| | - Katherine N Slain
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, 159284Case Western Reserve University School of Medicine & UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Sabrina Derrington
- Division of Anesthesiology & Critical Care and the Center for Pediatric Bioethics, 5150Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Idris V R Evans
- Department of Critical Care Medicine, 12317University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, Pennsylvania, USA
| | - Denise M Goodman
- Pediatric Critical Care Medicine, Department of Pediatrics, 12244Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - LeeAnn M Christie
- 72462Dell Children's Medical Center of Central Texas, Austin, Texas, USA
| | - Simon Li
- Pediatric Critical Care Medicine, Department of Pediatrics, 12287Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - John C Lin
- Pediatric Critical Care Medicine, Department of Pediatrics, 12275Washington University School of Medicine, St. Louis, MO, USA
| | - Debbie A Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology; Paediatric Intensive Care Unit, 94273Queensland Children's Hospital, Brisbane, Australia
| | - Maureen A Madden
- Rutgers Robert Wood Johnson Medical School, New Brunswick, 551419New Jersey & Bristol Myers Squibb Children's Hospital, New Brunswick, New Jersey
| | - Sara VandenBranden
- Pediatric Critical Care Medicine, 24319Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - McKenna Smith
- Department of Pediatrics, Critical Care Medicine, 12348University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Neethi P Pinto
- Department of Anesthesiology and Critical Care Medicine, 6567Children's Hospital of Philadelphia, Philadelphia, PA
| | - Aline B Maddux
- Pediatric Critical Care Medicine, Department of Pediatrics, 12225University of Colorado and Children's Hospital Colorado, Aurora, CO, USA
| | - Ericka L Fink
- Department of Critical Care Medicine, 6619UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - R Scott Watson
- Pediatric Critical Care Medicine, Department of Pediatrics, 12353University of Washington School of Medicine, Seattle, WA, USA
- 502985Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Leslie A Dervan
- Pediatric Critical Care Medicine, Department of Pediatrics, 12353University of Washington School of Medicine, Seattle, WA, USA
- Center for Clinical and Translational Research, 547305Seattle Children's Research Institute, Seattle, WA, USA
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Abstract
OBJECTIVES Children with severe chronic illness are a prevalent, impactful, vulnerable group in PICUs, whose needs are insufficiently met by transitory care models and a narrow focus on acute care needs. Thus, we sought to provide a concise synthetic review of published literature relevant to them and a compilation of strategies to address their distinctive needs. DATA SOURCES English language articles were identified in MEDLINE using a variety of phrases related to children with chronic conditions, prolonged admissions, resource utilization, mortality, morbidity, continuity of care, palliative care, and other critical care topics. Bibliographies were also reviewed. STUDY SELECTION Original articles, review articles, and commentaries were considered. DATA EXTRACTION Data from relevant articles were reviewed, summarized, and integrated into a narrative synthetic review. DATA SYNTHESIS Children with serious chronic conditions are a heterogeneous group who are growing in numbers and complexity, partly due to successes of critical care. Because of their prevalence, prolonged stays, readmissions, and other resource use, they disproportionately impact PICUs. Often more than other patients, critical illness can substantially negatively affect these children and their families, physically and psychosocially. Critical care approaches narrowly focused on acute care and transitory/rotating care models exacerbate these problems and contribute to ineffective communication and information sharing, impaired relationships, subpar and untimely decision-making, patient/family dissatisfaction, and moral distress in providers. Strategies to mitigate these effects and address these patients' distinctive needs include improving continuity and communication, primary and secondary palliative care, and involvement of families. However, there are limited outcome data for most of these strategies and little consensus on which outcomes should be measured. CONCLUSIONS The future of pediatric critical care medicine is intertwined with that of children with serious chronic illness. More concerted efforts are needed to address their distinctive needs and study the effectiveness of strategies to do so.
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Ko MSM, Poh PF, Heng KYC, Sultana R, Murphy B, Ng RWL, Lee JH. Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:e215767. [PMID: 35040918 PMCID: PMC8767488 DOI: 10.1001/jamapediatrics.2021.5767] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE The pediatric intensive care unit (PICU) exposes children to stressful experiences with potential long-term psychological repercussions. However, current understanding of post-PICU psychological outcomes is incomplete. OBJECTIVE To systematically review and evaluate reported long-term psychological outcomes among children previously admitted to the PICU. DATA SOURCES A systematic search of the Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE (PubMed), and PsycINFO was conducted from database inception to June 2021. Search terms included phrases related to intensive care (eg, intensive care units and critical care) and terms for psychological disorders (eg, posttraumatic stress disorder, depressive disorder, conduct disorder, and neurodevelopmental disorder) limited to the pediatric population. STUDY SELECTION This systematic review and meta-analysis included randomized clinical trials and observational studies reporting psychological disorders among children younger than 18 years who were admitted to the PICU with follow-up for at least 3 months. Psychological disorders were defined using the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Children were excluded if they were admitted to the PICU for primary brain conditions (eg, traumatic brain injury, meningoencephalitis, and brain tumors) or discharged to the home for palliative care. DATA EXTRACTION AND SYNTHESIS Titles and abstracts were independently screened by 2 reviewers, with data extraction conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were pooled using a random-effects model during meta-analysis. MAIN OUTCOMES AND MEASURES Age-corrected IQ scores and long-term psychological outcomes measured by scales such as the Child Behavior Checklist (higher scores indicate more behavioral problems) among children admitted to the PICU. RESULTS Of 9193 records identified, 31 independent studies (5 randomized clinical trials and 26 observational studies) involving 7786 children (mean age, 7.3 years [95% CI, 6.2-8.4 years]; 4267 boys [54.8%]; race and ethnicity were not reported by all studies) admitted to the PICU were included. Overall, 1 of 19 children (5.3%) to 14 of 16 children (88.0%) previously admitted to the PICU were reported to have at least 1 psychological disorder. Studies that examined posttraumatic stress disorder reported that 6 of 60 children (10.0%) to 31 of 102 children (30.4%) met the diagnostic criteria for the disorder at 3 to 6 months of follow-up. Compared with healthy children, those admitted to the PICU had lower IQ scores at 1 to 2 years of follow-up (mean, 89.40 points [95% CI, 88.33-90.47 points] vs 100.70 points [95% CI, 99.43-101.97 points]; P < .001) and 3 to 5 years of follow-up (mean, 88.54 points [95% CI, 83.92-93.16 points] vs 103.18 [95% CI, 100.36-105.99 points]; P < .001) and greater total emotional and behavioral problems at 4 years of follow-up (mean, 51.69 points [95% CI, 50.37-53.01 points] vs 46.66 points [95% CI, 45.20-48.13 points]; P < .001). CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found a high burden of psychological sequelae among children previously admitted to the PICU, suggesting that risk stratification and early interventions are needed for high-risk groups.
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Affiliation(s)
| | - Pei-Fen Poh
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore
| | | | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Beverly Murphy
- Medical Center Library and Archives, Duke University, Durham, North Carolina
| | - Regina Wan Leng Ng
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore
| | - Jan Hau Lee
- MD Programme, Duke-NUS Medical School, Singapore,Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore
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Murray AL, Speyer LG, Hall HA, Valdebenito S, Hughes C. Teacher Versus Parent Informant Measurement Invariance of the Strengths and Difficulties Questionnaire. J Pediatr Psychol 2021; 46:1249-1257. [PMID: 34333621 PMCID: PMC8561254 DOI: 10.1093/jpepsy/jsab062] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives Obtaining a multi-informant perspective is important when assessing mental health issues in childhood and adolescence. Obtaining ratings from both parents and teachers also facilitates the evaluation of similarities and contrasts in the nature and severity of symptoms across home and school contexts. However, these informants may differ in their interpretations of observed behaviors, raising questions about the validity of comparing parents’ and teachers’ ratings. Methods We evaluated the cross-informant measurement invariance of one of the most widely used measures of child and adolescent mental health: The Strengths and Difficulties Questionnaire (SDQ). Using data from the UK-population representative Millennium Cohort Study, we evaluated configural, metric, and scalar measurement invariance across parents and teachers when children were aged 7 (N = 10,221) and 11 (N = 10,543). Results Scalar measurement invariance held at both ages. Parents reported higher levels of symptoms in all domains measured at both ages as well as higher prosociality. Conclusions For a UK sample, valid comparisons of parent and teacher SDQ ratings at ages 7 and 11 appear to be possible, facilitating the evaluation of contextual differences in child mental health problems. Further, parents report more problem and prosocial behavior in their children than teachers attribute to them.
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Affiliation(s)
| | | | | | | | - Claire Hughes
- Department of Psychology, Centre for Family Research, University of Cambridge
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Royer ASM, Busari JO. A systematic review of the impact of intensive care admissions on post discharge cognition in children. Eur J Pediatr 2021; 180:3443-3454. [PMID: 34114079 PMCID: PMC8192269 DOI: 10.1007/s00431-021-04145-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Abstract
Understanding how hospitalization affects cognitive development is crucial to safeguard children's cognition; however, there is little research evaluating the associations between NICU or PICU hospitalization and survivors' cognition. The objective of this study is to identify and characterize the associations between a neonatal or pediatric ICU hospitalization and the short- and long-term cognition of survivors. The databases Cochrane Library, Medline, EBSCO, Embase, and Google Scholar and the journals JAMA Pediatrics, Journal of Pediatrics, Pediatrics, Archives of Disease in Childhood, Academic Pediatrics, Pediatric Critical Care Medicine and Child Development were searched until April 2021. Retrieved article references were analyzed. Included articles investigated cognition as an outcome of ICU hospitalization in non-preterm neonatal or pediatric patients. Case studies and studies analyzing diagnosis or treatment interventions were excluded. Four prospective cohort or case-control studies and two retrospective cohort studies were included, totaling 2172 neonatal and 42368 pediatric patients. Quality assessment using the BMJ Criteria and Cochrane Collaboration's Risk-of-Bias tool displayed good results. Significant negative associations were found between neonatal cognition and length-of-ICU-stay at 9- (p<0.001) and 24 months (p<0.01), and between pediatric cognition and length-of-ICU-stay at discharge (p<0.001). Additional weeks on the neonatal ICU increased odds of impairment at 9- (OR 1.08, 95%CI 1.034-1.112) and 24 months (OR 1.11, 95%CI 1.065-1.165).Conclusion: There is a significant negative correlation between NICU and PICU hospitalization and the short- and long-term cognitive status. Future research must identify patient- and hospital-related risk factors and develop management strategies. What is Known: • Cognitive development relies on the presence of stimulating factors and absence of risk factors, and is hypothesized to be directly and indirectly affected by hospitalization in the short and long term. • No research examines the relation between survivor cognition post-discharge of a general pediatric hospitalization, and scarcely more of a neonatal or pediatric intensive care hospitalization. What is New: • NICU and PICU hospitalization is independent risk factors for survivor impaired cognition in the short and in the long term with a dose-response effect. High risk patients for cognitive impairment should be identified and appropriately followed-up. • Patients with an ICU hospitalization of over 2.5 days and two or more of the following factors should be considered high risk: increased mortality risk, invasive interventions, neurological or oncological diagnosis, postnatal complications or decreased maternal mental health status.
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Affiliation(s)
- Ana Sánchez-Moreno Royer
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229ER Maastricht, Netherlands
| | - Jamiu O. Busari
- Faculty of Health, Medicine and Life Sciences, Educational Development Research Department, Maastricht University, Universiteitssingel 40, 6229ER Maastricht, Netherlands ,Department of Pediatrics and HOH Academy, Horacio Oduber Hospital, Dr. HE Oduber Boulevard #1, Oranjestad, Aruba
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School Performance After Pediatric Intensive Care-Association of Mental Well-Being, Chronic Illnesses, and Family Socioeconomic Status. Pediatr Crit Care Med 2020; 21:e1099-e1105. [PMID: 32769702 DOI: 10.1097/pcc.0000000000002564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe school performance in pediatric intensive care survivors, as well as the influence of chronic diseases, psychological well-being, and family socioeconomic status on poor school performance. DESIGN Register-based observational descriptive follow-up study. SETTING A multicenter national study. PATIENTS All pediatric patients who were admitted to an ICU in Finland in 2009-2010. Children and adolescents of or beyond school age. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Questionnaires regarding the child's coping in school classes, chronic illnesses, as well as family socioeconomic factors were sent to every child alive 6 years after discharge from intensive care in Finland. Mental well-being was measured with the Strengths and Difficulties Questionnaire. There were 1,109 responders in an ICU group of 3,674 children. Seven-hundred fifty-three of the respondents were of school age or older. Of these, 13% (101/753) demonstrated poor school performance. Children with difficulties in school more often had a need for regular medication (71.3% vs 32.4%; p < 0.001), healthcare visits (91.1% vs 80.6%; p = 0.01), some regular therapy (60.4% vs 13.7%; p < 0.001), chronic illnesses (86.3% vs 48.4%; p < 0.001), or additional ICU admissions (36.5% vs 14.9%; p = 0.003). Schooling difficulties were reported more often in children with abnormal Strengths and Difficulties Questionnaire scores compared to those with normal or borderline scores (24.8% vs 5.4%; p < 0.001). In an adjusted logistic regression model, which included age, number of chronic diseases, and need for therapy, poor school performance was predicted by abnormal Strengths and Difficulties Questionnaire scores, nonacademic parental education, and paternal manual labor status. CONCLUSIONS Difficulties in school were more frequent when the child had chronic comorbid illnesses, especially neurologic or chromosomal abnormalities, had poor mental health, father was employed in manual labor, or parents were uneducated.
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Xu W, Zhao S. The Influence of Entrepreneurs' Psychological Capital on Their Deviant Innovation Behavior. Front Psychol 2020; 11:1606. [PMID: 32982813 PMCID: PMC7485554 DOI: 10.3389/fpsyg.2020.01606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/15/2020] [Indexed: 12/25/2022] Open
Abstract
This study explores the influence of psychological capital on the deviant innovation behavior, with the purpose of realizing the application and development of positive psychology in the field of innovation and creation. First, the data was obtained based on the questionnaire, and the Likert scale was adopted to measure the variables effectively, in which 1 point means “never,” 2 points mean “rarely,” and 5 points mean “always.” Second, the SPSS 26.0 statistical analysis software was adopted, and a statistical analysis was made on the correlation among deviant innovation, psychological capital, work values, and work remodeling. Third, the relationship between psychological capital and deviant innovation behavior was explored using the analytic hierarchy process (AHP). The results showed that the reliability of each scale is good, Cronbach’s α coefficients are all higher than 0.8, and the fitting effect of the four-factor model is the best, proving that the highest differentiation validity can be achieved using the proposed method. Furthermore, there are significant correlations among entrepreneur’s psychological capital, entrepreneur’s work values, and entrepreneurship work remodeling and deviant innovation behavior, among which the psychological capital and work values are the most correlated with deviant innovation. With the psychological capital of entrepreneurs as the adjustment variable and the interaction added, the explanation rate of the level equation is increased from 17 to 24.2%. Therefore, the psychological capital of entrepreneurs plays a very big role in regulating work values and deviant innovation behavior. In the current environment of innovation and entrepreneurship development, it is necessary for entrepreneurs to give full reign to the regulatory role of their own psychological capital, so as to promote the development of self-active deviant innovation activities and encourage employees to actively innovate and create.
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Affiliation(s)
- Wenhai Xu
- School of Law, Tongji University, Shanghai, China
| | - Shouzheng Zhao
- School of Law, Shanghai International Studies University, Shanghai, China
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