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Boswell EK, Crouch E. Brief Report: Rural-Urban Differences in Disability Prevalence, Healthcare Services Utilization, and Participation in Special Education. J Autism Dev Disord 2024:10.1007/s10803-024-06434-y. [PMID: 38941047 DOI: 10.1007/s10803-024-06434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/29/2024]
Abstract
Previous research has found that rural children are more likely to be disabled but are less likely to receive care. Both rural and disabled children were significantly impacted by the pandemic, particularly in terms of service utilization. Therefore, this study seeks to identify rural-urban differences in the prevalence of various disability indicators and in the receipt of educational and healthcare services. Data from 12,828 children aged 2-17 who participated in the 2021-2022 National Health Interview Survey (NHIS) was used to examine rural-urban differences in three different disability indicators and in education and health services utilization. Disability indicators included the Washington Group Short Set Composite Disability Indicator, a developmental disability indicator, and a neurodivergence indicator. Bivariate analysis, via Rao-Scott chi-square tests, was used to examine rural-urban disparities. Compared to their urban counterparts, rural children were more likely to have a positive Washington Group Short Set Composite Disability Indicator (14.3% vs. 10.6%) and neurodivergence indicator (17Ð.3% vs. 14.1%). Rural children with disabilities were more likely to have received prescription medication for behavioral, mental, or emotional health or concentration in the past year than urban children (34.2% vs. 25.9%). There was no rural-urban difference in the prevalence of developmental disabilities or other forms of health care use and special education participation. This report highlights the need for further investigation into underlying causes of rural-urban disparities in the prevalence of disabilities, as well as the need for continued support for programs and policies designed to support rural children with disabilities.
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Affiliation(s)
- Emma K Boswell
- Rural and Minority Health Research Center, University of South Carolina, 220 Stoneridge Dr, Columbia, SC, 29210, USA.
| | - Elizabeth Crouch
- Rural and Minority Health Research Center, University of South Carolina, 220 Stoneridge Dr, Columbia, SC, 29210, USA
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Hu Y, Callander E. Long-Term Effect of Having a Child at Risk of Developmental Delays on Parental Labor Force Participation. Matern Child Health J 2024; 28:1052-1060. [PMID: 38334864 PMCID: PMC11058796 DOI: 10.1007/s10995-024-03897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This study aimed to examine the long-term influence of having a child at risk of different developmental delays (communication, mobility, self-care, relating, learning, coping, or behaving) on parental labor force participation as the child grows. METHOD A retrospective cohort was conducted using data from the Longitudinal Study of Australian Children survey, Waves 1-8 covering birth to 15 years of age of children. Multivariable logistic regressions were used to explore the odds ratio of mothers being out of the labor force at different children's ages. Cox proportional hazards models were utilized to identify the 'risk' of mothers returning to the workforce after leaving. All models were adjusted for the mother's age, education attainment, and employment status at time of birth, as well as marital status at the current wave. RESULTS There were 5,107 records of children, and 266 of them were at risk of any developmental delays at age 4-5 years. This sample represents 243, 026 children born in Australia in 2003/04. After adjusting for potential confounders, mothers of children at risk of each type of developmental delay (except mobility and self-care) had greater odds of being out of, and not returning to the labor force from children aged 2-3 to 14-15 years, when compared to mothers of children who are not at risk of developmental delays. Similar differences were found for fathers but were distinctly small and with narrower fluctuations, compared to mothers. CONCLUSION Policies and programs funded by the government are greatly needed to support the mothers of children at risk of developmental delays.
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Affiliation(s)
- Yanan Hu
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- University of Technology Sydney, Building 10, Level 8, Room 109 235-253 Jones Street, Ultimo, NSW, 2007, Australia.
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Yu C, Wong E, Gignac J, Walker M, Ross T. A Scoping Review of Pediatric Healthcare Built Environment Experiences and Preferences Among Children With Disabilities and Their Families. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:309-325. [PMID: 38130020 PMCID: PMC11080387 DOI: 10.1177/19375867231218035] [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] [Indexed: 12/23/2023]
Abstract
BACKGROUND Some children with disabilities (CWD) frequently visit pediatric healthcare settings for appointments. Their age, disability, and regular visits mean that they have unique experiences in healthcare settings. While previous research has explored the clinical experiences of CWD, little is known about their experiences of pediatric healthcare built environments, even though these environments may play an important role in shaping their perceptions of care. Given the significant time that some CWD and chronic illnesses (e.g., cancer) spend in healthcare environments and the impact that these settings can have on their experiences, the knowledge gap concerning how they view, and experience healthcare built environments demands attention. OBJECTIVE To explore how CWD and their families experience pediatric healthcare built environments. METHODS A scoping review was conducted by searching five health science and interdisciplinary literature databases using terms related to children, disability, healthcare, and built environment. The search identified 5,397 records that were screened independently by three reviewers. RESULTS Nineteen studies met inclusion criteria and were considered in the final review. Findings indicate that CWD and their families value healthcare built environment features that support social engagement, patient privacy, and parental presence. Further, the age of a child was highlighted as an important factor that influences the built environment preferences of CWD. CONCLUSIONS CWD and their families prefer certain healthcare built environment features to optimize their experiences in these settings. Healthcare designers can leverage these findings to advance more inclusive pediatric healthcare spaces to improve care and the quality of life for CWD and their families.
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Affiliation(s)
- Clarissa Yu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Emi Wong
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Juliana Gignac
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Meaghan Walker
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Timothy Ross
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Geography and Planning, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
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Tschida JE, Lee JD, Pomales-Ramos A, Koo V. Reported quality indicators and implementation outcomes of community partnership in autism intervention research: A systematic review. Autism Res 2024; 17:215-233. [PMID: 38356206 DOI: 10.1002/aur.3103] [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: 07/24/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024]
Abstract
There is minimal research on the quality of community partnerships in studies of interventions for autistic children. However, building high quality community engagement in autism intervention research may improve implementation outcomes. This systematic review examined studies that report community partnership in autism intervention research. A total of 135 articles were identified and 11 of these articles were included in the final review. Community partnership data were extracted using indicators from the conceptual framework for assessing research-practice partnerships (RPP; Henrick et al., Henrick et al., Assessing research-practice partnerships: Five dimensions of effectiveness, William T. Grant Foundation, 2017) and implementation outcomes data were extracted using the taxonomy of distinct implementation outcomes (Proctor et al., Administration and Policy in Mental Health and Mental Health Services Research, 38:65-76, 2011). Quality of studies were appraised using JBIs critical appraisal tools (Munn et al., JBI Evidence Synthesis, 18:2127-2133, 2020). RPP indicators and implementation outcomes were variably reported across studies. RPP indicators and implementation outcomes more likely to be reported were related to building trust, cultivating partnership relationships, conducting rigorous research to inform action, acceptability, and feasibility. RPP indicators and implementation outcomes less likely to be reported were related to building capacity to engage in partnership work, sustainability, cost, and penetration. Together, these results may suggest the need for increased sustainability and capacity building efforts in partnerships and increased guidelines for reporting outcomes.
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Affiliation(s)
- Jessica E Tschida
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - James D Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children's Autism Center, Seattle, Washington, USA
| | | | - Vivien Koo
- Open Doors for Multicultural Families, Kent, Washington, USA
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Lambiase CV, Mansi G, Salomè S, Conelli ML, Vendemmia M, Zurlo MC, Raimondi F, Capasso L. The financial burden experienced by families during NICU hospitalization and after discharge: A single center, survey-based study. Eur J Pediatr 2024; 183:903-913. [PMID: 38038769 PMCID: PMC10912114 DOI: 10.1007/s00431-023-05352-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
To investigate a broad array of costs and perceived financial burden (FB) faced by families of NICU graduates both during hospitalization and after discharge. Cross-sectional survey-based study design. A survey measuring socio-demographics, direct non-medical costs, indirect costs, social support and perceived FB was developed. One-hundred-twenty-two pairs of parents of NICU graduates participated in the study. Most of the families (87.7%) experienced FB due to NICU hospitalization. The median cost of visiting infant during NICU admission was 615 euros (range: 42,7320). FB correlated with cost for drugs (ρ = .271, p < .05, 95%CI:[.020, .490]), dietary supplement (ρ = .385, p < .05, CI:[.010, .665]), behavioral disorders (ρ = -.186, p < .05, 95%CI:[-.356, -.003]), language delay (ρ = .243, p < .01, CI:[-.408, -.063]) and comorbidities (ρ = -.206, p < .05, 95% CI:[-.374, -.024]). Transportation costs due to medical visits (ρ = .415, p < .01, 95% CI:[.239, .564]) and therapy sessions (ρ = .517, p < .05, CI:[.121, .771]) correlated with higher FB. Grandparents of the infant were the most frequent source of help (86.1%). Families having infants with adverse outcome experienced more hospitalizations after NICU discharge (p < .05) and higher FB (p < .01) than families with typically developing infant. Lack of government financial help was associated with higher perceived FB (CI:[1.117,29.127], p < .05). Conclusions: Our findings demonstrated that parents of NICU graduates experience high rates of FB, highlighting their sources (e.g., grandparents support) and difficulties (e.g., private therapy costs) through the lens of patient perspective. Our study promotes reflection on policies which should be adopted from the European health services that are similar to the Italian one to support NICU graduate families and reduce inequalities. What is Known: • Families of NICU graduates face several kinds of costs during hospitalization and after discharge. What is New: • NICU hospitalization is a multifaceted event that impact financial burden experienced by families. • NICU graduate families whose infant had adverse outcome and felt lack of financial help from local policy makers experience higher rates of financial burden.
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Affiliation(s)
- Carmine Vincenzo Lambiase
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Department of Humanities, University of Naples Federico II, Via Porta di Massa 1, 80133, Naples, Italy.
| | - Giuseppina Mansi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Serena Salomè
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Laura Conelli
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Vendemmia
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Clelia Zurlo
- Department of Humanities, University of Naples Federico II, Via Porta di Massa 1, 80133, Naples, Italy
- Dynamic Psychology Laboratory, Department of Political Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
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Gordon K, Gordon L, Basu AP. Social prescribing for children and young people with neurodisability and their families initiated in a hospital setting: a systematic review. BMJ Open 2023; 13:e078097. [PMID: 38135327 PMCID: PMC11148699 DOI: 10.1136/bmjopen-2023-078097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Social prescribing (SP) is a non-medical intervention in which professionals refer patients to a link worker (LW), who connects them with appropriate support. Children and young people (CYP) with neurodisability often have unmet needs and may bypass community initiatives. We undertook a review of hospital-initiated SP for CYP with neurodisability. DESIGN Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and using Mixed Methods Appraisal Tool. DATA SOURCES Medline, PsycINFO, PsycARTICLES, Embase, CINAHL, Scopus, Web of Science and FutureNHS, searched from 1 January 2000 to 19 October 2023, with no language restrictions. ELIGIBILITY CRITERIA Studies describing SP interventions for CYP (ages 0-25 years) with neurodisability/neurodivergence. EXCLUSIONS interventions outside of secondary care; with no description; or no LW. DATA EXTRACTION AND SYNTHESIS Two researchers independently screened references. Data were charted, summarised, quality assessments performed and narratively reviewed. RESULTS After removal of duplicates, 518 references were identified. Following screening, eight articles (covering five SP schemes) were included. Rahi et al connected 68 families of CYP newly diagnosed with visual impairment to a community LW. Families needed information about social and educational services, and emotional support. Healthcare professionals had more time for clinical issues. Six papers described three different digital interventions supporting in total 86 CYP with traumatic brain injury and their families. Wade et al (2004, 2005a, 2005b) provided a website with core and individualised sessions, and weekly therapist support. Wade et al (2018) provided a smartphone application, website and weekly meetings with an online coach. These interventions boosted social behaviours. Wade et al (2014, 2015) found that online family problem-solving therapy improved overall child functioning compared with self-guided resources. Toutain et al (2009) provided non-medical support to 11 children with fetal alcohol syndrome and their mothers. No outcome data were provided. Studies reported benefits to health, well-being, healthcare usage, knowledge, skills, satisfaction and service delivery. CONCLUSION Literature describing hospital-initiated SP schemes for CYP with neurodisability, while sparse, suggests potential benefit. PROSPERO REGISTRATION NUMBER CRD42022384188.
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Affiliation(s)
- Katie Gordon
- School of Psychology, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Laura Gordon
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Anna Purna Basu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Paediatric Neurology, Great North Childrens Hospital, Newcastle upon Tyne, Tyne and Wear, UK
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Yilmaz A, Cebi MN, Yilmaz G, Karacaoglu G, Aydin SN, Perk Y, Vural M. Long-term neurodevelopmental effects of exclusively high cord lactate levels in term newborn. J Matern Fetal Neonatal Med 2023; 36:2284115. [PMID: 37989542 DOI: 10.1080/14767058.2023.2284115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Cord arterial blood gas analysis (ABGA) results are used as diagnostic criteria for hypoxic-ischemic encephalopathy in newborns with suspected perinatal asphyxia. This study evaluated the effect of cord ABGA lactate level on the long-term neurodevelopment of newborns without any clinical signs of perinatal asphyxia. METHODS This clinical observation study was designed among term babies born between 2018 and 2019 in our unit. Cases with a 5-min Apgar score <7 and signs of fetal distress in their antenatal follow-up were excluded. The cases (n = 1438) were divided into two groups those with high cord lactate levels (above 5 mmol/L, n = 92) and those with low lactate levels (below 2 mmol/L, n = 255). An Ages and Stages Questionnaire, Third Edition (ASQ-3) developmental screening questionnaire was sent to all parents. Patients with a chronological age between 24 and 42 months and for whom the parents fulfilled the questionnaire (low lactate group, n = 29, and high lactate group, n = 45) were evaluated. RESULTS No difference was observed between the two groups in terms of demographic characteristics such as age (p = .1669), male gender (p = .906), mother's working situation (p = .948), mother's education level (p = .828), father's education level (p = .507), and family's total income (p = .642). Mean ACQ-3 developmental screening test scores were significantly lower in the high lactate group compared to the low lactate group concerning; fine motor (40 vs. 60, p = .001), problem-solving (50 vs. 60, p = .002), and personal social development (45 vs. 60, p = .003). No difference was observed in terms of communication and gross motor total scores. DISCUSSION In general practice, routine cord ABGA is not generally recommended for patients with normal Apgar scores and no suspected hypoxia. However, in this study, we observed that cases with a normal 5-min Apgar score, no suspected perinatal asphyxia, and a cord lactate value of ≥5 fell behind their peers when evaluated with the ACQ-3 developmental screening questionnaire.
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Affiliation(s)
- Aslan Yilmaz
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Memnune Nur Cebi
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Gizem Yilmaz
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Gursel Karacaoglu
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Sümeyye Nur Aydin
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Yildiz Perk
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Mehmet Vural
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
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Jia XY, Andreou P, Brown C, Constantin E, Godbout R, Hanlon-Dearman A, Ipsiroglu O, Reid G, Shea S, Smith IM, Zwicker JD, Weiss SK, Corkum P. An eHealth Program for Insomnia in Children With Neurodevelopmental Disorders (Better Nights, Better Days): Protocol for an Economic Evaluation of a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46735. [PMID: 37698915 PMCID: PMC10523210 DOI: 10.2196/46735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Children with neurodevelopmental disorders have a high risk of sleep disturbances, with insomnia being the most common sleep disorder (ie, chronic and frequent difficulties with going and staying asleep). Insomnia adversely affects the well-being of these children and their caregivers. Pediatric sleep experts recommend behavioral interventions as the first-line treatment option for children. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a 5-session eHealth behavioral intervention delivered to parents to improve outcomes (eg, Pediatric Quality of Life Inventory [PedsQL]) for their children (ages 4-12 years) with insomnia and who have a diagnosis of mild to moderate attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, or fetal alcohol spectrum disorder. If cost-effective, BNBD-NDD can be a scalable intervention that provides value to an underserved population. OBJECTIVE This protocol outlines an economic evaluation conducted alongside the BNBD-NDD randomized controlled trial (RCT) that aims to assess its costs, efficacy, and cost-effectiveness compared to usual care. METHODS The BNBD-NDD RCT evaluates the impacts of the intervention on children's sleep and quality of life, as well as parents' daytime functioning and psychosocial health. Parent participants were randomized to the BNBD-NDD treatment or to usual care. The economic evaluation assesses outcomes at baseline and 8 months later, which include the PedsQL as the primary measure. Quality of life outcomes facilitate the comparison of competing interventions across different populations and medical conditions. Cost items include the BNBD-NDD intervention and parent-reported usage of private and publicly funded resources for their children's insomnia. The economic evaluation involves a reference case cost-effectiveness analysis to examine the incremental cost of BNBD-NDD per units gained in the PedsQL from the family payer perspective and a cost-consequence analysis from a societal perspective. These analyses will be conducted over an 8-month time horizon. RESULTS Research funding was obtained from the Kids Brain Health Network in 2015. Ethics were approved by the IWK Health Research Ethics Board and the University of Calgary Conjoint Health Research Ethics Board in January 2019 and June 2022, respectively. The BNBD-NDD RCT data collection commenced in June 2019 and ended in April 2022. The RCT data are currently being analyzed, and data relevant to the economic analysis will be analyzed concurrently. CONCLUSIONS To our knowledge, this will be the first economic evaluation of an eHealth intervention for insomnia in children with neurodevelopmental disorders. This evaluation's findings can inform users and stakeholders regarding the costs and benefits of BNBD-NDD. TRIAL REGISTRATION ClinicalTrial.gov NCT02694003; https://clinicaltrials.gov/study/NCT02694003. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46735.
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Affiliation(s)
- Xiao Yang Jia
- The School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Pantelis Andreou
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Cary Brown
- Faculty of Rehabilitation Medicine - Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | | | - Roger Godbout
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
| | - Ana Hanlon-Dearman
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Osman Ipsiroglu
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Graham Reid
- Departments of Psychology, The University of Western Ontario, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Department of Paediatrics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
| | - Sarah Shea
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Isabel M Smith
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | | | - Shelly K Weiss
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Pomales-Ramos A, Tokish H, Howard M, Straiton D, Ingersoll B. A mixed-methods examination of clinicians' perceived barriers to telehealth delivered applied behavior analysis. Front Psychol 2023; 14:1173644. [PMID: 37546433 PMCID: PMC10399227 DOI: 10.3389/fpsyg.2023.1173644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/14/2023] [Indexed: 08/08/2023] Open
Abstract
Following the COVID-19 pandemic, clinicians relied on telehealth to ensure continuity of essential healthcare services, such as Applied Behavior Analysis (ABA). Identifying barriers and examining them in the context of other implementation outcomes is important to support appropriate adaptations and sustainability of telehealth-delivered ABA services. Convergent mixed methods design was utilized to identify barriers experienced by ABA clinicians (N = 388) when delivering ABA services over telehealth to autistic children and their families following the first six months of the COVID-19 pandemic. Additionally, barriers were examined in relation to telehealth implementation outcomes and intentions for continued adoption. Findings reveal that clinicians rated providing direct services (M = 3.52, SD = 1.14) as more difficult than conducting assessments (M = 3.29, SD = 1.06), and both as more difficult than providing parent-mediated interventions [(M = 2.47, SD = 1.11), F(2, 381) = 162.26, p < 0.001]. A principal components analysis indicated a 3-factor solution of barriers related to: (1) technology (α = 0.82), (2) administrative tasks (α = 0.88), and (3) client characteristics (α = 0.88). The most frequently endorsed barriers were related to client characteristics, including increased difficulty providing telehealth services to children who elope (M = 4.37, SD = 0.81), children who exhibit challenging behaviors (M = 4.31; SD = 0.83), and children who are in the preverbal stage or use nonverbal language to communicate (M = 4.07; SD = 1.00). Fewer barriers related to client characteristics uniquely predicted implementation variables including acceptability, appropriateness, and feasibility. Thematic analysis revealed challenges related to technology, caregiver involvement, child engagement, implementation of intervention strategies over telehealth, and administrative or logistical barriers. These findings highlight the need for targeted strategies that facilitate telehealth use to address specific client needs and support the implementation of telehealth services in usual care settings.
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10
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Currie G, Materula D, Gall N, Lachuk G, Richard C, Yohemas M, Dewan T, Gibbard WB, Zwicker J. Care coordination of children with neurodevelopmental disabilities and medical complexity during the COVID-19 pandemic: Caregiver experiences. Child Care Health Dev 2023. [PMID: 37407028 DOI: 10.1111/cch.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/19/2023] [Accepted: 03/04/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic and subsequent public health restrictions created significant challenges for children with neurodevelopmental disabilities with medical complexity and their caregivers including restrictions in care coordination for children and their families. Care coordination enhances families' skills in accessing and coordinating medical, education and disability care across sectors and systems. OBJECTIVE This study examined the implications of pandemic restrictions on care coordination from caregiver perspectives. These experiences can inform emergency preparedness planning and recovery strategies. METHOD A qualitative descriptive design was utilized to explore and describe the experience of caregivers of children with neurodevelopmental disabilities and medical complexity. Nineteen caregivers were interviewed about their experience with care coordination during the pandemic. FINDINGS Caregiver experiences of care coordination during the pandemic highlighted the importance of care coordination during a public health emergency. Two themes emerged: (1) disruptions to care coordination from initial COVID-19 restrictions leading to lack of access to supports and services, increasing level of need, and impacts of disruption for caregivers and children; and (2) adaptation and responsiveness to COVID-19 restrictions by advocating for families and managing uncertainties. RECOMMENDATIONS Recommendations include recognition of care coordination as a protective factor, designation as an essential service and sustained or increased funding for care coordination during emergencies. Families should be engaged in identifying care needs during care coordination, including during public health emergencies.
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Affiliation(s)
- Genevieve Currie
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- School of Nursing and Midwifery, Mount Royal University, Calgary, Alberta, Canada
| | - Dercia Materula
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - Nadine Gall
- Alberta Health Services, Calgary, Alberta, Canada
| | - Gina Lachuk
- Alberta Health Services, Calgary, Alberta, Canada
| | | | | | - Tammie Dewan
- Alberta Health Services, Calgary, Alberta, Canada
| | | | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Alberta, Canada
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Parental Perceptions of the Impact of the COVID-19 Pandemic on the Sleep of Children With Neurodevelopmental Disorders. J Pediatr Health Care 2023; 37:179-184. [PMID: 36283892 PMCID: PMC9510090 DOI: 10.1016/j.pedhc.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Little is known about the impact of the COVID-19 pandemic on sleep in schoolaged children with neurodevelopmental disorders. This study aimed to (1) determine and describe the impact of the COVID-19 pandemic, and (2) identify and describe contributing factors. METHOD Parents of children with neurodevelopmental disorders and insomnia symptoms (n = 100) were surveyed to determine if their child's sleep had changed because of the COVID-19 pandemic. Parents who reported changes were asked to describe how the pandemic influenced their child's sleep. RESULTS Most parents (66%) reported the pandemic did not worsen their child's sleep, 30% stated their child's sleep had worsened, and 4% reported an improvement. Stress and anxiety about the pandemic, disrupted routines, and increased screen time were common parent-identified contributing factors. DISCUSSION Health care providers should explore strategies to mitigate contributing factors, such as anxiety about the pandemic, disrupted routines, and increased screen time.
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Berrigan P, Scott CWM, Zwicker JD. Employment, Education, and Income for Canadians with Developmental Disability: Analysis from the 2017 Canadian Survey on Disability. J Autism Dev Disord 2023; 53:580-592. [PMID: 32662052 PMCID: PMC9944698 DOI: 10.1007/s10803-020-04603-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study assessed needs and outcomes for people with developmental disability (DD) to understand the socioeconomic status of this group prior to implementation of the Accessible Canada Act in June 2019. The 2017 Canadian Survey on Disability (CSD) was used to analyze data for a sample of individuals with self-reported disability. Data related to employment, education, income, housing, caregivers, and use of government benefits is reported. Compared to the general Canadian public, persons with DD are less likely to: finish high-school or post-secondary education; participate in the labor force or be employed; and earn on average less/year in total income. To align with recent accessibility legislation, significant progress is needed to address disparities for people with DD.
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Affiliation(s)
- Patrick Berrigan
- The School of Public Policy, University of Calgary, 906 - 8 Ave SW 5th floor, Calgary, AB, T2P 1H9, Canada.
| | - Craig W M Scott
- The School of Public Policy, University of Calgary, 906 - 8 Ave SW 5th floor, Calgary, AB, T2P 1H9, Canada
| | - Jennifer D Zwicker
- The School of Public Policy, University of Calgary, 906 - 8 Ave SW 5th floor, Calgary, AB, T2P 1H9, Canada
- Faculty of Kinesiology, University of Calgary, 376 Collegiate Blvd NW, Calgary, AB, T2N 4V8, Canada
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Russell MJ, Scott CWM, Berrigan P, Murias K, Gibbard WB, Cui X, Tough S, Zwicker JD. The transition to adult income supports for youth that received special education in British Columbia, Canada: A cohort study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4363-e4374. [PMID: 35574712 DOI: 10.1111/hsc.13829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 03/28/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Youth in special education have complex needs that are supported across multiple systems. Our research investigates the use of adult income assistance, as one structure that supports youth as they transition to adulthood. We created a cohort of youth (5-22 years old) using linked administrative data from British Columbia government ministries from 1996 to 2018. Youth were grouped by their special education funding (most to least; Level 1, Level 2, Level 3, Unfunded, and no special education). We investigated (1) youth characteristics and service use patterns, (2) which youth used income supports after the child-to-adult transition (19-22 years old), and what youth characteristics and service use patterns were associated with use, and (3) how much income support they used (CAD$). Of 174,527 youth, 254 (0.1%) were Level 1, 6020 (3.4%) were Level 2, 4409 (2.5%) were Level 3, 21,232 (12.2%) were Unfunded, and 142,612 (81.7%) were not in special education. Youth assigned higher funding levels, compared to lower levels, generally had increased service use, and in the transition to adult services were more likely to use income supports, and received more income support. An important exception was youth with serious behavioural/mental health special education funding (Level 3), who had increased service use for their level of funding, but received less income support due to a reliance on Temporary versus Disability Assistance. Youth that received an accredited diploma were less likely to use income supports. Factors related to the use of income supports are further described. This study highlights differences in access to income support when youth transition to adult services and considerations around equitable access to support.
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Affiliation(s)
- Matthew Joseph Russell
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- PolicyWise for Children & Families, Edmonton, Alberta, Canada
| | | | - Patrick Berrigan
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - Kara Murias
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - W Ben Gibbard
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Xinjie Cui
- PolicyWise for Children & Families, Edmonton, Alberta, Canada
| | - Suzanne Tough
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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14
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Scott CWM, Russell MJ, Tough S, Zwicker JD. Income assistance use among young adults who were in British Columbia special education: A longitudinal cohort study. PLoS One 2022; 17:e0274672. [PMID: 36206290 PMCID: PMC9543764 DOI: 10.1371/journal.pone.0274672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Persons with disability (PWD) experience disproportionately high poverty rates in Canada. This trend is apparent especially among youth compared to those who develop disabilities later in life. PWD in poverty have additional needs that increase barriers to full participation in society and translate to higher basic costs for daily living. Despite the existence of income assistance programs in Canada to mitigate income inequalities faced by PWDs, access to these programs can be limited. OBJECTIVE To describe use of income assistance for young adults with disability in British Columbia for the development of potential approaches to improve realized access to these programs. METHODS We conducted a population-based retrospective cohort study using British Columbia linked administrative data. We described differences in income assistance use among PWD by the level of special education funding received during primary school education (from most to least; Level 1, Level 2, Level 3, Unfunded, and no special education) and family composition. We also provided longitudinal patterns of income assistance use. RESULTS Of 218,324 young adults, 88% received no special education, 0.1% used Level One, 1.6% used Level Two, 2.9% used Level Three, and 7.1% used Unfunded special education coding. Young adults with Level One special education funding had the highest rates of hospitalizations and continuing care, with no hospitalization due to homelessness. Those with Level Three special education coding had higher rates of hospitalization and hospitalization due to homelessness than Level Two young adults. When transitioning to adulthood initially, Level One and Two funded individuals used relatively more disability income assistance than individuals from the other funding levels. Nearly all BCEA users with higher funded special education codes used this disability-specific program, while lesser funded special education codes used the Temporary Assistance more frequently, for a longer duration and were more likely to be persistent Temporary Assistance users. CONCLUSIONS Sustainable and reliable access to income assistance programs remains an issue across the heterogeneity of needs faced by young adults with disability.
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Affiliation(s)
- Craig William Michael Scott
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Joseph Russell
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- PolicyWise for Children & Families, Edmonton, Alberta, Canada
| | - Suzanne Tough
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer D. Zwicker
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
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15
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Improving Care for Families and Children with Neurodevelopmental Disorders and Co-occurring Chronic Health Conditions Using a Care Coordination Intervention. J Dev Behav Pediatr 2022; 43:444-453. [PMID: 35849484 DOI: 10.1097/dbp.0000000000001102] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This clinical intervention study aimed to improve care integration and health service delivery for children with concurrent neurodevelopmental disorders and chronic health conditions. This population has significant unmet needs and disproportionate deficits in service delivery. A lack of coordination across child service sectors is a common barrier to successful treatment and support of children with neurodevelopmental disorders with complex medical needs. METHODS This project implemented an innovative care coordination model, involving one-on-one supports from a trained care coordinator who liaised with the broader intersectoral care team to improve joint care planning, integration of services, and the experience of both families and care providers. To evaluate the impact of care coordination activities, a single-group interventional study was conducted using a repeated-measures framework (at 0, 6, and 12 months) using previously established outcome measures. RESULTS Over 2 years, this project provided care coordination to 84 children and their families, with an age range from 2 to 17 years. The care coordination intervention demonstrated positive impacts for children, families, and care teams and contributed to clinical efficiencies. Children had fewer visits to the emergency department and less frequent acute care use. Improvement in access to services, joint care planning and communication across providers, and better linkage with school supports were demonstrated. Families reported that the program decreased their stress around coordinating care for their child. CONCLUSION This work demonstrated that intersectoral care coordination is attainable through innovative and collaborative practice for children with complex neurodevelopmental and medical needs.
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16
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Okwara FNO, le Roux SM, Donald KA. Health Service Utilization by Young Children with Autism Spectrum Disorder Versus Global Developmental Delay at a Tertiary Center in a Resource-Limited Setting. J Dev Behav Pediatr 2022; 43:e320-e329. [PMID: 35125466 DOI: 10.1097/dbp.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We investigated patterns and predictors of health service utilization (HSU) among children with autism spectrum disorder (ASD) and global developmental delays (GDD, non-ASD) attending tertiary services in a resource-constrained setting. METHOD Caregivers and children (diagnosed with either ASD or GDD) attending the developmental service were enrolled into a retrospective cohort study. Sociodemographic factors, clinical factors, and service use over the preceding year were collected using structured questionnaires and medical record reviews. RESULTS We enrolled 240 households (116 ASD, 124 GDD; ages 3-8 years; male:female ratio 2:1). The majority (84%) had moderate-to-severe symptoms, and 42% were nonverbal. Children with GDD had higher levels of underlying syndromic diagnoses than those with ASD (46, 37.1%; 14, 9.5%); (p < 0.01) and more co-occurring comorbidities (51, 41.0%; 14, 12.1%; p = 0.0001). Those with GDD had higher mean total HSU visits (13.3; 11.5; p = 0.02), higher mean specialist visits (4.0:2.0; p = 0.001), and more hospitalizations than those with ASD (38, 31%; 16, 14%; p = 0.02). Other services were similarly attended by both groups: therapy 6.0 (2.0-10.0), emergency visits 1.0 (1.0-2.0), auxiliary services 0 (0-1.0), and primary care visits 0 (0-1.0). Having an employed parent was the strongest predictor of increased HSU (p = 0.05). CONCLUSION Despite high functional impairment in this cohort, many households underutilized therapy services. There was skewed attendance of emergency and specialist services over primary care services. Children with GDD had greater HSU compared with those with ASD, primarily because of more specialist visits. HSU could be improved by caregiver education, household economic empowerment, and strengthening of primary care services.
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Affiliation(s)
- Florence N O Okwara
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
- Department of Paediatrics and Child Health, Kenyatta University, Kenya
| | - Stanzi M le Roux
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Kirsten A Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, South Africa
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17
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Gitimoghaddam M, Chichkine N, McArthur L, Sangha SS, Symington V. Applied Behavior Analysis in Children and Youth with Autism Spectrum Disorders: A Scoping Review. Perspect Behav Sci 2022; 45:521-557. [PMID: 36249174 PMCID: PMC9458805 DOI: 10.1007/s40614-022-00338-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 12/18/2022] Open
Abstract
AbstractThis manuscript provides a comprehensive overview of the impact of applied behavior analysis (ABA) on children and youth with autism spectrum disorders (ASD). Seven online databases and identified systematic reviews were searched for published, peer-reviewed, English-language studies examining the impact of ABA on health outcomes. Measured outcomes were classified into eight categories: cognitive, language, social/communication, problem behavior, adaptive behavior, emotional, autism symptoms, and quality of life (QoL) outcomes. Improvements were observed across seven of the eight outcome measures. There were no included studies that measured subject QoL. Moreover, of 770 included study records, only 32 (4%) assessed ABA impact, had a comparison to a control or other intervention, and did not rely on mastery of specific skills to mark improvement. Results reinforce the need for large-scale prospective studies that compare ABA with other non-ABA interventions and include measurements of subject QoL to provide policy makers with valuable information on the impacts of ABA and other existing and emerging interventions.
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Affiliation(s)
- Mojgan Gitimoghaddam
- University of British Columbia Faculty of Medicine, Vancouver, British Columbia Canada
| | | | - Laura McArthur
- Club Aviva Recreation Ltd., Coquitlam, British Columbia Canada
| | - Sarabjit S Sangha
- Club Aviva Recreation Ltd., Coquitlam, British Columbia Canada
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia
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18
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Bartel NJ, Boyle DW, Hines AC, Tomlin AM, Nitu ME, Szczepaniak D, Abu-Sultaneh SMA. Virtual Developmental Screening After Invasive Mechanical Ventilation in Children: A Prospective Cohort Pilot Study. Pediatr Crit Care Med 2022; 23:e219-e223. [PMID: 34991139 DOI: 10.1097/pcc.0000000000002888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES With decreasing PICU mortality, survivor morbidity has increased. This study aims to evaluate feasibility of virtual PICU-led follow-up of patients at risk for pediatric postintensive care syndrome. DESIGN Prospective cohort study. SETTING Single-center, quaternary children's hospital. PATIENTS Children less than or equal to 4 years without known preexisting neurodevelopmental deficits requiring greater than or equal to 12 hours mechanical ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Age-appropriate Ages and Stages Questionnaires, Third Edition (ASQ-3) were administered via a web-based system at 3, 6, and 12 months following PICU discharge. Primary-care physicians were notified of results; at-risk patients were referred to early developmental intervention. Forty-eight patients enrolled with median age 11.5 months (interquartile range [IQR], 2-19.5 mo) and median mechanical ventilation duration 92.5 hours (IQR, 40.5-147 hr). Fifty-eight percent completed greater than or equal to 1 ASQ-3. Lower caregiver educational achievement, lower income, and single-caregiver status were associated with lower ASQ-3 completion rates. Of those completing any ASQ-3, 50% flagged as at-risk for developmental delay and referred to early developmental intervention. There was no association between patient characteristics and abnormal ASQ-3. CONCLUSIONS Virtual caregiver-completed surveillance is a promising method to screen children for neurodevelopmental abnormalities following PICU hospitalization and facilitate early referral for developmental intervention, but special attention must be dedicated to families with limited resources for follow-up.
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Affiliation(s)
- Nicholas J Bartel
- Department of Pediatrics, Indiana University Schoolof Medicine, Indianapolis, IN
| | - David W Boyle
- Department of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Abbey C Hines
- Department of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Angela M Tomlin
- Department of Child Development, Indiana University School of Medicine, Indianapolis, IN
| | - Mara E Nitu
- Department of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Dorota Szczepaniak
- Department of Pediatrics, Indiana University Schoolof Medicine, Indianapolis, IN
| | - Samer M A Abu-Sultaneh
- Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
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19
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Xiong T, McGrath PJ, Yakovenko I, Thomson D, Kaltenbach E. Parenting-related trauma exposure among parents of children with intellectual and developmental disorders: Development and validation of the Parenting Trauma Checklist. J Trauma Stress 2022; 35:759-770. [PMID: 34989449 DOI: 10.1002/jts.22779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/16/2021] [Accepted: 09/30/2021] [Indexed: 01/14/2023]
Abstract
Parents of children with intellectual and developmental disorders (IDDs) often encounter parenting-related traumatic events. Trauma exposure is a risk factor for mental health problems, including posttraumatic stress disorder (PTSD). Little is known regarding the types of traumatic events that parents commonly experience and how to best assess parenting-related trauma exposure. To address this gap, we developed the Parenting Trauma Checklist (PTC) and tested its psychometric properties. The PTC was created based on an extensive literature review and consultation with stakeholders, which led to the creation of a 17-item instrument. Participants (N = 424) were Canadian parents of children with IDDs who completed an online test battery that included the PTC and several questionnaires to assess PTSD symptoms, global mental and physical health, lifetime trauma exposure, and functional impairment, which were included to test the validity of the new instrument. The PTC demonstrated good construct validity. Ninety four percent of the sample reported parenting-related trauma exposure. Parents reported having experienced an average of 5.79 parenting-related traumatic events, with seeing their child undergo a medical procedure the most frequently endorsed event (68.6%). Experiencing more parenting-related traumatic events was positively associated with higher PTSD symptom levels, r = .35, p < .001. The PTC is a promising instrument that can be used to examine parenting-related trauma exposure. The measure can be used as a screening tool to detect parents' risk of traumatic stress disorders, evaluate traumatic experiences, and assess whether trauma-focused treatment is warranted.
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Affiliation(s)
- Ting Xiong
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Patrick J McGrath
- Department of Psychiatry, Dalhousie University, Halifax, Canada.,IWK Health Centre, Halifax, Canada
| | - Igor Yakovenko
- Department of Psychiatry, Dalhousie University, Halifax, Canada
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20
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Salvino C, Spencer C, Filipe AM, Lach LM. Mapping of Financial Support Programs for Children With Neurodisabilities Across Canada: Barriers and Discrepancies Within a Patchwork System. JOURNAL OF DISABILITY POLICY STUDIES 2022. [DOI: 10.1177/10442073211066776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A cross-jurisdictional pan-Canadian environmental scan was conducted to identify provincial, territorial, and federal financial supports available to families with children living with neurodisabilities. In partnership with the organization Childhood Disability LINK, flowchart-styled pathway documents were developed for each financial support identified, mapping out the processes required to access each support. A critical analysis was completed as it relates to structural barriers, accessibility of program information and geographic discrepancies. The results revealed that, despite almost universal availability of programs to support families of children living with neurodisabilities, significant barriers and inequity remain. This included considerable variation in access to financial support based on geographic and jurisdictional discrepancies, absence of adequate and accurate information about programs, and minimal support provided to families in the application process. We argue that the barriers and discrepancies identified were an inherent result of the Canadian federalist fragmentation of the delivery of social care and financial support programs for children living with neurodisabilities. A more unified response by Canadian provincial, territorial, and federal governments is clearly needed to take positive steps to address the consequences of federalist fragmentation and respond to the structural barriers and geographic discrepancies identified by this study.
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Krasovsky T, Barak S, Dishon-Berkovits M, Sadeh Y, Landa J, Brezner A, Silberg T. Factors associated with Multidisciplinary Healthcare Resource Utilization Following Discharge from Pediatric Rehabilitation: A One-year Follow-up Study. Phys Occup Ther Pediatr 2022; 42:579-594. [PMID: 35440261 DOI: 10.1080/01942638.2022.2061887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS To characterize multidisciplinary healthcare resource utilization (mHRU), including physical, occupational, speech and psychosocial therapy one-year following discharge from prolonged inpatient and outpatient pediatric rehabilitation in Israel and to identify factors associated with long-term mHRU. METHODS According to Andersen's model of health service use, predisposing (child's age and sex), enabling (district of origin, income level, parental education, insurance) and need factors (injury type, functional status, family psychosocial risk) were collected from parents of children hospitalized for >1 month in a large rehabilitation hospital in Israel, and phone interviews were held 3-months (T1), 6-months (T2) and 12-months (T3) post-discharge. The effect of time and the role of various factors on mHRU, operationalized as number of therapy sessions in the previous 2 weeks, were evaluated. RESULTS Sixty-one families participated at T1 and T2, and 46 participated at T3. HRU was similar over time. Predisposing factors (age) and need factors (functional status and psychosocial risk) were associated with specific disciplines of mHRU, but enabling factors were not. CONCLUSIONS mHRU is high and stable 12-months post-discharge. The lack of impact of enabling factors on mHRU, and the discipline-specific impact of predisposing and need factors, support equity of care provision for children following prolonged rehabilitation.
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Affiliation(s)
- Tal Krasovsky
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Sharon Barak
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Kaye Academic College of Education, Physical Education, Beer-Sheva, Israel.,College of Public Health, Ben Gurion University, Beer-Sheva, Israel
| | | | - Yaara Sadeh
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Jana Landa
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
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22
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Levin-Decanini T, Henderson C, Mistry S, Dwarakanath N, Ray K, Miller E, Houtrow A. Decreased access to therapeutic services for children with disabilities during COVID-19 stay-at-home orders in Western Pennsylvania. J Pediatr Rehabil Med 2022; 15:517-521. [PMID: 35848043 DOI: 10.3233/prm-200799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Assess the effects of stay-at-home orders on access to services utilized by families of children with disabilities (CWD). METHODS Cross-sectional weekly surveys were fielded over four weeks, during which western Pennsylvania was under stay-at-home orders. Respondents were divided into families of CWD (N = 233) or without CWD (N = 1582). Survey questions included measures of socio-economic status, and families of CWD answered questions regarding access to services pre and post-initiation of stay-at-home orders. Differences between families with and without CWD were analyzed using chi-square tests. RESULTS Among families of CWD that had used services previously, 76.6% of survey respondents stated that they had decreased access, with the greatest percentage experiencing loss among those previously utilizing early intervention (75.5%), outpatient therapies (69.1%), or school-based therapies (80.7%). Compared to families without CWD, families of CWD were more likely to report lower pre-COVID-19 annual incomes (p < 0.001), job or income loss related to COVID-19 (p < 0.001), and higher levels of perceived stress (p < 0.001). CONCLUSION CWD experienced loss of services during stay-at-home orders implemented as COVID-19 mitigation measures. Due to decreased access to needed services, CWD may be at risk of medical complications and loss of developmental progress.
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Affiliation(s)
- Tal Levin-Decanini
- Complex Care Center, General Academic Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Cynterria Henderson
- Department of Pediatrics, School of Medicine, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Sejal Mistry
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Namita Dwarakanath
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Kristin Ray
- Department of Pediatrics, School of Medicine, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Amy Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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23
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Benevent J, Hurault-Delarue C, Araujo M, Revet A, Sommet A, Lacroix I, Damase-Michel C. Prenatal Drug Exposure in Children With a History of Neuropsychiatric Care: A Nested Case-Control Study. Front Psychiatry 2022; 13:795890. [PMID: 35392389 PMCID: PMC8980541 DOI: 10.3389/fpsyt.2022.795890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/15/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Neuropsychiatric disorders in childhood after prenatal drug exposure raises concerns. Most of the published studies focused on psychotropic medications. This study investigated which prenatal medication exposure was associated with neuropsychiatric disorders in childhood. METHODS A case-control study, nested in the French POMME cohort, was conducted to compare prenatal medication exposure between children with a history of neuropsychiatric care (ages 0-8 years) and children in a control group. POMME included children born in Haute-Garonne to women covered by the general Health Insurance System, between 2010 and 2011 (N = 8,372). Cases were identified through: (1) reimbursement for neuropsychiatric care; (2) psychomotor development abnormalities specified on health certificates; and (3) reimbursement for methylphenidate or neuroleptics. Controls had none of these criteria. Prenatal exposure to each of the major "Anatomical Therapeutic Chemical" classes was compared between the groups. Class(es) for which there was a statistically significant difference (after Bonferroni adjustment, i.e., p < 0.0033) was(were) compared using logistic regression. RESULTS A total of 723 (8.6%) cases and 4,924 (58.8%) controls were identified. This study showed a statistically significant difference in prenatal exposure to nervous system drugs (excluding analgesics) between the groups [ORa: 2.12 (1.55; 2.90)]. Differences (not statistically significant at the 0.0033 threshold) were also observed for the ATC classes: Musculoskeletal, Genito-urinary System and Sex Hormones, Alimentary Tract and Anti-infectives. CONCLUSION Through identification of children with neuropsychiatric disorders and of their prenatal medication exposure, this study provides guidance for the assessment of long-term neuropsychiatric effects after prenatal medication exposure, without focusing on psychotropic medications.
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Affiliation(s)
- Justine Benevent
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital (CHU de Toulouse), CERPOP - SPHERE Team, Inserm, Toulouse, France
| | - Caroline Hurault-Delarue
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital (CHU de Toulouse), CERPOP - SPHERE Team, Inserm, Toulouse, France
| | - Mélanie Araujo
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital (CHU de Toulouse), CERPOP - SPHERE Team, Inserm, Toulouse, France
| | - Alexis Revet
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital (CHU de Toulouse), CERPOP - SPHERE Team, Inserm, Toulouse, France.,Department of Child and Adolescent Psychiatry, Toulouse University Hospital (CHU de Toulouse), Toulouse, France
| | - Agnès Sommet
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital (CHU de Toulouse), CERPOP - SPHERE Team, Inserm, Toulouse, France
| | - Isabelle Lacroix
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital (CHU de Toulouse), CERPOP - SPHERE Team, Inserm, Toulouse, France
| | - Christine Damase-Michel
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital (CHU de Toulouse), CERPOP - SPHERE Team, Inserm, Toulouse, France
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Kelm K, Bolduc FV. How Knowledge Mapping Can Bridge the Communication Gap Between Caregivers and Health Professionals Supporting Individuals With Complex Medical Needs: A Study in Fragile X Syndrome. Front Psychiatry 2021; 12:731011. [PMID: 34899415 PMCID: PMC8651701 DOI: 10.3389/fpsyt.2021.731011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
The challenges of caring for children with complex health needs, such as intellectual disability (ID) and autism spectrum disorder (ASD), are multiple and experienced by both caregivers and health professionals. Fragile X syndrome (FXS) is the most common single gene cause of ID and ASD, and provides a pertinent model to understand these complexities of care, as well as the communication challenges experienced between caregivers and healthcare professionals. In recent years both caregivers and healthcare professionals have recognized the need for enhancing communication both in clinical and research settings. Knowledge mapping has emerged as a tool to support quality communication between team participants. Here we review how differences in mental models, as well as challenges related to health literacy and knowledge transfer can have an impact on communication. Next, we present different knowledge mapping approaches used in complex situations, with a focus on concept maps and care maps. Finally, we highlight the potential benefits and limitations of mapping to improve communication issues related to caring for individuals with FXS and potentially other neurodevelopmental disorders (NDDs).
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Affiliation(s)
- Karen Kelm
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Francois V. Bolduc
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Women and Children Health Research Institute, University of Alberta, Edmonton, AB, Canada
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25
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Klau J, Abou Jamra R, Radtke M, Oppermann H, Lemke JR, Beblo S, Popp B. Exome first approach to reduce diagnostic costs and time - retrospective analysis of 111 individuals with rare neurodevelopmental disorders. Eur J Hum Genet 2021; 30:117-125. [PMID: 34690354 PMCID: PMC8738730 DOI: 10.1038/s41431-021-00981-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 11/09/2022] Open
Abstract
This single-center study aims to determine the time, diagnostic procedure, and cost saving potential of early exome sequencing in a cohort of 111 individuals with genetically confirmed neurodevelopmental disorders. We retrospectively collected data regarding diagnostic time points and procedures from the individuals' medical histories and developed criteria for classifying diagnostic procedures in terms of requirement, followed by a cost allocation. All genetic variants were re-evaluated according to ACMG recommendations and considering the individuals' phenotype. Individuals who developed first symptoms of their underlying genetic disorder when Next Generation Sequencing (NGS) diagnostics were already available received a diagnosis significantly faster than individuals with first symptoms before this cutoff. The largest amount of potentially dispensable diagnostics was found in genetic, metabolic, and cranial magnetic resonance imaging examinations. Out of 407 performed genetic examinations, 296 (72.7%) were classified as potentially dispensable. The same applied to 36 (27.9%) of 129 cranial magnetic resonance imaging and 111 (31.8%) of 349 metabolic examinations. Dispensable genetic examinations accounted 302,947.07€ (90.2%) of the total 335,837.49€ in potentially savable costs in this cohort. The remaining 32,890.42€ (9.8%) are related to non-required metabolic and cranial magnetic resonance imaging diagnostics. On average, the total potentially savable costs in our study amount to €3,025.56 per individual. Cost savings by first tier exome sequencing lie primarily in genetic, metabolic, and cMRI testing in this German cohort, underscoring the utility of performing exome sequencing at the beginning of the diagnostic pathway and the potential for saving diagnostic costs and time.
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Affiliation(s)
- Julia Klau
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Maximilian Radtke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Henry Oppermann
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany.,Center for Rare Diseases, University of Leipzig Medical Center, Leipzig, Germany
| | - Skadi Beblo
- Center for Rare Diseases, University of Leipzig Medical Center, Leipzig, Germany
| | - Bernt Popp
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany.
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Implications of Disability Severity on 24-Hour Movement Guideline Adherence Among Children With Neurodevelopmental Disorders in the United States. J Phys Act Health 2021; 18:1325-1331. [PMID: 34548417 DOI: 10.1123/jpah.2021-0282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/04/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Research has established beneficial associations between 24-hour movement guideline adherence and several health outcomes in typically developing (TD) children, but these relationships are poorly understood in children with neurodevelopmental disorders (NDD). This study examined (1) 24-hour movement guideline adherence, (2) the influence of disability severity, and (3) associations between guideline adherence and health outcomes of TD children and children with NDD. METHODS This cross-sectional study used data from the 2018 and 2019 cycles of the US National Survey of Children's Health. Parental/caregiver reports of movement behaviors (physical activity, screen time, and sleep), disability severity (limitations to daily activities), and health outcomes (general health status, anxiety, and depression) were provided for 8554 children with NDD and 19,669 TD children aged 6-17 years. RESULTS Children with NDD had significantly lower odds of meeting each movement behavior guideline compared to TD children; these effects were most pronounced for those who experienced consistent limitations to daily activities. Meeting at least 2 guidelines significantly lowered the odds for anxiety and depression, and increased the odds for better general health for children with NDD. DISCUSSION These findings suggest that degree of disability severity has a strong influence on adherence to 24-hour movement guidelines among children with NDD.
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Kowanda M, Cartner L, Kentros C, Geltzeiler AR, Singer KE, Weaver WC, Lehman CD, Smith S, Smith RS, Walsh LK, Diehl K, Nagpal N, Brooks E, Mebane CM, Wilson AL, Marvin AR, White LC, Law JK, Jensen W, Daniels AM, Tjernagel J, Snyder LG, Taylor CM, Chung WK. Availability of Services and Caregiver Burden: Supporting Individuals With Neurogenetic Conditions During the COVID-19 Pandemic. J Child Neurol 2021; 36:760-767. [PMID: 33829918 PMCID: PMC8033176 DOI: 10.1177/08830738211001209] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Because of the COVID-19 pandemic, in-person services for individuals with neurodevelopmental disabilities were disrupted globally, resulting in a transition to remote delivery of services and therapies. For individuals with neurogenetic conditions, reliance on nonclinical caregivers to facilitate all therapies and care was unprecedented. The study aimed to (1) describe caregivers' reported impact on their dependent's services, therapies, medical needs, and impact on themselves as a result of the COVID-19 pandemic and (2) assess the relationship between the extent of disruption of services and the degree of self-reported caregiver burden. Two online questionnaires were completed by caregivers participating in Simons Searchlight in April and May 2020. Surveys were completed by caregivers of children or dependent adults with neurodevelopmental genetic conditions in Simons Searchlight. Caregivers reported that the impact of the COVID-19 pandemic moderately or severely disrupted services, therapies, or medical supports. The majority of caregivers were responsible for providing some aspect of therapy. Caregivers reported "feeling stressed but able to deal with problems as they arise," and reported lower anxiety at follow-up. Caregivers reported that telehealth services were not meeting the needs of those with complex medical needs. Future surveys will assess if and how medical systems, educational programs, therapists, and caregivers adapt to the challenges arising during the COVID-19 pandemic.
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Affiliation(s)
| | | | - Catherine Kentros
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexa R. Geltzeiler
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Kaitlyn E. Singer
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA, USA
| | - W. Curtis Weaver
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA, USA
| | | | - Simone Smith
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA, USA
| | | | | | | | | | | | - Caroline M. Mebane
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Ashley L. Wilson
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Alison R. Marvin
- Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, Baltimore, MD, USA
| | | | - J. Kiely Law
- Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, Baltimore, MD, USA
| | | | | | | | | | - Cora M. Taylor
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA, USA
| | - Wendy K. Chung
- Simons Foundation, New York, NY, USA,Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA,Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA,Wendy K. Chung, MD, PhD, Simons Foundation, New York, NY 10010, USA.
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28
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Prasad AN, Corbett B. Neurodevelopmental Disabilities in Canadian Children: Prevalence Data from the National Longitudinal Study of Children and Youth. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0039-3400974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Aim Using population surveys of chronic health conditions, the present study aimed to examine changing trends in the prevalence of neurodevelopmental disabilities (NDD) with age and determine population-based estimates of prevalence and census-based estimates of absolute numbers of affected children.
Methods We analyzed data from three cycles (1994–1999) of Canada's National Longitudinal Survey of Children and Youth (NLSCY) (Statistics Canada Survey).
Results Cross-sectional prevalence rates for chronic NDD in children from birth to 15 years across cycle 1 to 3 of the NLSCY show an increasing trend over the years from 1994 to 1999. Population-based estimates were also calculated from census data. Weighted prevalence rates for four conditions in children aged birth to 15 years increased across the three cycles, except for cerebral palsy. Prevalence estimates in cycle 3 were: epilepsy 5.26/1,000 (95% confidence interval [CI]: 5.01, 5.52), cerebral palsy 2.81/1,000 (95% CI: 2.62, 2.99), intellectual disability 4.77/1,000 (95% CI: 4.53, 5.02), and learning disability 57.06/1,000 (95% CI, 56.36, 57.76). A male gender preponderance was noted for each NDD using logistic regression.
Interpretation Prevalence rates of NDD in Canadian children show an incremental trend across three cycles in four conditions covered in the survey. The changing trends over the three cycles are discussed.
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Affiliation(s)
- Asuri Narayan Prasad
- Epilepsy Program, Division of Pediatric Neurology, Department of Pediatrics, London Health Sciences Centre and Children’s Hospital of Western Ontario, London, Ontario, Canada
| | - Bradley Corbett
- Richard Ivey School of Business, Western University, London, Ontario, Canada
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29
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Russell MJ, Michael Scott CW, Murias K, Ben Gibbard W, Cui X, Tough S, Zwicker JD. Cross-ministry data on service use and limitations faced by children in special education. Disabil Health J 2021; 14:101118. [PMID: 34074619 DOI: 10.1016/j.dhjo.2021.101118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Children with disabilities often face limitations that cross support sectors. OBJECTIVE Our aim was to measure cross-ministry service use, outcomes, and functional limitations faced by children who qualified for special education. METHODS We used longitudinal British Columbia ministry data linked to children (0-18y) registered in K-12 education. Children were grouped by special education funding (most to least; Level 1, Level 2, Level 3, Unfunded, and no special education), and related to 1) service use patterns, 2) the age they first used disability services, and 3) functional limitations reported in health visits. We also reported how length of special education use related to disability service use. RESULTS Of 111,274 children, 154(0.1%) were Level 1, 4427(4.0%) Level 2, 2897(2.6%) Level 3, 13472(12.1%) Unfunded, and 90324(81.2%) not in special education. Children with higher funding levels, compared to lower levels of funding, generally were more likely to experience poorer outcomes, have functional limitations, have service needs, and receive early support. One exception was children with serious behavioural/mental health special education coding, which had poorer outcomes for their level of funding. Children received child disability supports early (about half of users started by 4y), but use was mostly limited to those with many years (9+years) of funded special education (70.7% of the all users) and biased to certain special education codes (i.e., Level 1, severe intellectual disability, and autism). CONCLUSIONS This study provides evidence of the long-term, diverse needs of children in special education and may be used to inform decisions surrounding their support.
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Affiliation(s)
- Matthew Joseph Russell
- School of Public Policy, University of Calgary, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta, T2P 1H9, Canada; Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada; PolicyWise for Children & Families, 1000-9925 109 St NW, Edmonton, AB T5K 2J8, Canada.
| | - Craig William Michael Scott
- School of Public Policy, University of Calgary, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta, T2P 1H9, Canada
| | - Kara Murias
- Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada
| | - W Ben Gibbard
- Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada
| | - Xinjie Cui
- PolicyWise for Children & Families, 1000-9925 109 St NW, Edmonton, AB T5K 2J8, Canada
| | - Suzanne Tough
- Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada; Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, 906 8th Avenue S.W., 5th Floor, Calgary, Alberta, T2P 1H9, Canada; Faculty of Kinesiology, University of Calgary, 376 Collegiate Blvd NW, Calgary, Alberta, T2N 1N4, Canada
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Lassandro G, Ciaccia L, Amoruso A, Palladino V, Palmieri VV, Giordano P. Focus on MicroRNAs as Biomarker in Pediatric Diseases. Curr Pharm Des 2021; 27:826-832. [PMID: 33087027 DOI: 10.2174/1381612826666201021125512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND MiRNAs are a class of small non-coding RNAs that are involved in the post-transcriptional regulation of gene expression. MiRNAs are considered a class of epigenetic biomarkers. These biomarkers can investigate disease at different stages: diagnosis, therapy or clinical follow-up. OBJECTIVE The aim of this paper is to highlight the innovative use of miRNAs in several childhood diseases. METHODS We conducted a literature review to search the usage of miRNAs in pediatric clinical routine or experimental trials. RESULTS We found a possible key role of miRNAs in different pediatric illnesses (metabolic alterations, coagulation defects, cancer). CONCLUSION The modest literature production denotes that further investigation is needed to assess and validate the promising role of miRNAs as non-invasive biomarkers in pediatric disorders.
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Affiliation(s)
- Giuseppe Lassandro
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Loredana Ciaccia
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Anna Amoruso
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Valentina Palladino
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Viviana V Palmieri
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Paola Giordano
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
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An Integrated Care Strategy for Pre-schoolers with Suspected Developmental Disorders: The Optimus Co-design Project that has Made it to Regular Care. Int J Integr Care 2021; 21:3. [PMID: 33953649 PMCID: PMC8051154 DOI: 10.5334/ijic.5494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Multiple neurodevelopmental problems affect 7–8% of children and require evaluation by more than one profession, posing a challenge to care systems. Description: The local problem comprised distressed parents, diagnostic processes averaging 36 months and 28 visits with 42% of children >4 years at referral to adequate services, and no routines for patient involvement. The co-design project was developed through a series of workshops using standard quality improvement methodology, where representatives of all services, as well as parents participated. The resulting integrated care model comprises a team of professionals who evaluate the child during an average of 5.4 appointments (N = 95), taking 4.8 weeks. Parents were satisfied with the holistic service model and 70% of children were under 4 at referral (p < 0.05). While 75% of children were referred, 25% required further follow-up by the team. Discussion: The Optimus model has elements of vertical, clinical and service integration. Reasons for success included leadership support, buy-in from the different organisations, careful process management, a team co-ordinator, and insistent user involvement. Conclusion: Evaluating multiple neurodevelopmental problems in children requires an integrated care approach. The Optimus care model is a relevant showcase for how people-initiated integrated care reforms can make it into usual care.
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Gajwani R, Dinkler L, Lundström S, Lichtenstein P, Gillberg C, Minnis H. Mania symptoms in a Swedish longitudinal population study: The roles of childhood trauma and neurodevelopmental disorders. J Affect Disord 2021; 280:450-456. [PMID: 33242716 DOI: 10.1016/j.jad.2020.10.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/13/2020] [Accepted: 10/31/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adult psychiatric disorders are associated with both childhood traumatic experiences (CTEs) and neurodevelopmental disorders (NDDs). CTEs and NDDs frequently co-occur in childhood, but their combined risk effect on the emergence of juvenile mania symptoms has not yet been examined. METHODS In a population-representative Swedish twin study, CTEs and NDDs were assessed in 3,348 nine-year old twins born between 1998 and 2001, and treated as dichotomous predictors (any CTEs, any NDDs). Follow-up data were gathered at age 15 through parental reports of mania symptoms, yielding a symptom count score. RESULTS Both CTEs and NDDs at age 9 contributed uniquely to an increase in mania symptoms at age 15. Children with both risk factors had 1.6 times the rate of mania symptoms as children with CTEs-only (Incidence rate ratio [IRR] 1.63, 95% CI 1.37-1.93), and 1.3 times the rate of mania symptoms as children with NDDs-only (IRR 1.26, 95% CI 1.06-1.50). There was no evidence for an interactive effect of CTEs and NDDs. NDDs showed a trend towards having a larger effect on mania symptoms than CTEs (NDDs-only vs. CTEs-only: IRR 1.29, 95% CI 0.99-1.68). LIMITATIONS Although it is a strength of the study that the data on exposures and outcome were collected prospectively, parental recall of CTEs was required and CTEs may be under-reported. CONCLUSIONS NDDs are at least as important as CTEs in the development of mania symptoms, and their risk is additive. Those with a history of both CTEs and NDDs should be monitored closely for the development of more severe psychiatric presentations.
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Affiliation(s)
- Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Lisa Dinkler
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Christopher Gillberg
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
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Russell MJ, Zhang Y, Cui X, Tough S, Zwicker JD. Use of family disability service by families with young children with disabilities. Dev Med Child Neurol 2021; 63:81-88. [PMID: 32003474 PMCID: PMC7754115 DOI: 10.1111/dmcn.14478] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2019] [Indexed: 01/03/2023]
Abstract
AIM To investigate which families with young children with disabilities used disability services and when they used services to inform policy on service delivery. METHOD We used linked administrative data from different ministries in Alberta to describe families' use of disability services when their children were between the ages of 3 and 8 years old. Disability was investigated on the basis of the presence of a severe special education code for children, and level of special education code. The outcome was the use of family disability services. RESULTS Of 31 346 children, 24 761 (79.0%) had no special education code, 3982 (12.7%) had a mild special education code, and 2603 (8.3%) had a severe special education code. Level of special education code was associated with child characteristics and service use. Children with severe special education codes generally were more likely to report service use and have poor outcomes than those with less severe codes. Of note, 26% of children with severe special education codes used family disability services. In addition, among children with severe special education codes, many years of severe coding (compared with fewer years) had the strongest association with family disability service use (prevalence ratio 5.50; 95% confidence interval 4.10-7.37). Associations with family disability service use were seen with mental health, health care, and educational achievement. Interactions between child characteristics and service use were observed. INTERPRETATION This study provides evidence that families were more likely to use disability services when they were involved with other services, and that use interacts with various factors. The findings highlight the importance of considering service eligibility, referral, and integration.
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Affiliation(s)
- Matthew J Russell
- PolicyWise for Children & FamiliesEdmontonCanada
- Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryCanada
- School of Public PolicyUniversity of CalgaryCalgaryCanada
| | - Yunqi Zhang
- PolicyWise for Children & FamiliesEdmontonCanada
| | - Xinjie Cui
- PolicyWise for Children & FamiliesEdmontonCanada
| | - Suzanne Tough
- Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryCanada
- PaediatricsCumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Jennifer D Zwicker
- School of Public PolicyUniversity of CalgaryCalgaryCanada
- Department of KinesiologyUniversity of CalgaryCalgaryCanada
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Majnemer A, McGrath PJ, Baumbusch J, Camden C, Fallon B, Lunsky Y, Miller SP, Sansone G, Stainton T, Sumarah J, Thomson D, Zwicker J. Time to be counted: COVID-19 and intellectual and developmental disabilities—an RSC Policy Briefing. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has impacted the lives and well-being of all people globally, with consequences being observed across all domains from physical and mental health, to education and employment outcomes, to access to community supports and services. However, the disproportionate impact of the COVID-19 pandemic and its associated public health restrictions on individuals with intellectual and developmental disabilities (IDD) has largely been overlooked. Not only do people with IDD have a greater risk of severe complications and death from the virus as shown in large-scale studies, but they also face significant short- and long-term consequences of COVID-related public health measures on their mental health and well-being. At a time when this vulnerable population is already feeling undervalued, ignored, and forgotten, it is imperative that the risks facing adults and children with IDD—as well as their families and caregivers—are recognized, valued, and addressed through a disability-inclusive approach to Canada’s pandemic policy response planning. This requires both a mainstreaming of disability inclusion into all COVID-19 response and recovery policies as well as disability-specific policies to address the unique barriers and challenges encountered by people with IDD during the pandemic. The recommendations in this policy briefing aim to achieve a more inclusive, accessible, and sustainable Canada for people with IDD both during and after the pandemic—an approach that will result in benefits for all of society.
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Affiliation(s)
- Annette Majnemer
- School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H3G 1Y5, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
| | - Patrick J. McGrath
- Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
- IWK Health Centre, Halifax, NS B3K 6R8, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada
- Canadian Institute of Health Research Chair in Sex & Gender Science, Ottawa, ON K1A 0W9, Canada
| | - Chantal Camden
- École de Réadaptation, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
- CRCHUS et à l’IUPLSSS, Sherbrooke, QC J1H 5N4, Canada
| | - Barbara Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Steven P. Miller
- Neurology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Genevieve Sansone
- Fraser Mustard Policy Bench, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Tim Stainton
- School of Social Work, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
- Canadian Institute for Inclusion and Citizenship, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
| | - John Sumarah
- Counselling Psychology, Acadia University, Wolfville, NS B4P 2R6, Canada
| | | | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, AB T2P 1H9, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
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35
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Fortune J, Murphy P, Merchant N, Kerr C, Kroll T, Walsh A, Norris M, Lavelle G, Ryan J. Transition from child-centred to adult-oriented healthcare systems for young people with neurodisability: a scoping review protocol. HRB Open Res 2020; 3:61. [PMID: 33215059 PMCID: PMC7656277 DOI: 10.12688/hrbopenres.13095.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background: The transition from child-centred to adult-oriented healthcare is a challenging time for young people with neurodisability. As the prevalence of neurodisability increases, greater numbers of young people will eventually transfer to the adult healthcare system. While there is a growing recognition of the importance of providing quality, transitional care, little is known about how to manage and optimise this process for young people with neurodisability. The objective of this scoping review is to examine and map existing literature related to the transition from child-centred to adult-oriented healthcare systems for young people with neurodisability. Methods: Systematic literature searches of OVID MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library and Web of Science will be conducted from inception to present. A structured iterative search of grey literature will be conducted. This review will consider all study designs examining the transition from child to adult health services in neurodisability. Two reviewers will independently screen each retrieved title and abstract and assess full-text articles against the inclusion criteria to determine eligibility. Data will be extracted and synthesised quantitatively and qualitatively. The process and reporting will follow PRISMA-ScR guidelines. Conclusion: This review will provide a broad and systematically mapped synthesis of the extent and nature of the available published and unpublished literature on transition from child-centred to adult-oriented healthcare systems in neurodisability. The results will be used to determine gaps in the current evidence base in order to prioritise areas for future research.
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Affiliation(s)
- Jennifer Fortune
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Murphy
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Nabil Merchant
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Kerr
- Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Aisling Walsh
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Jennifer Ryan
- RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Brunel University London, London, England, UK
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36
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Currie G, Szabo J. Social isolation and exclusion: the parents' experience of caring for children with rare neurodevelopmental disorders. Int J Qual Stud Health Well-being 2020; 15:1725362. [PMID: 32048917 PMCID: PMC7034477 DOI: 10.1080/17482631.2020.1725362] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Purpose: The experiences of parents caring for the complex care needs of children with rare neurodevelopmental disorders are not well understood. Parents struggle to meet their children's medical, behavioural, and social needs within and across health, social, and family systems. The purpose of this study was to explore the parents' experience of caring for medical and social care needs for children with rare neurodevelopmental disorders.Methods: Hermeneutic phenomenology was used for the data analysis. Fifteen parents participated in semi-structured interviews.Results: Interpretive analysis revealed four insights: (a) difference in children's behaviours and disease manifestations led to misunderstanding and vulnerability within social domains, (b) social taboo and stigma were experienced with rarity, (c) fragmented disconnected care from health and social systems impacted families, and (d) incomprehension from friends and family occurs when managing daily care.Conclusion: New interpretations and increased understanding of parents' experiences are required in supporting parents caring for children with complex needs. Understanding parents' experiences could reduce social isolation and exclusion, and mitigate appropriate and supportive practices and services within and across medical, social, and family systems.
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Affiliation(s)
- Genevieve Currie
- School of Nursing and Midwifery, Faculty of Health, Community and Education, Mount Royal University, Calgary, Alberta, Canada
| | - Joanna Szabo
- School of Nursing and Midwifery, Faculty of Health, Community and Education, Mount Royal University, Calgary, Alberta, Canada
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Solmi M, Dragioti E, Arango C, Radua J, Ostinelli E, Kilic O, Yilmaz UE, Yalcinay-İnan M, Soares FC, Mariano L, Mosillo P, Cortese S, Correll CU, Carvalho AF, Shin JI, Fusar-Poli P. Risk and protective factors for mental disorders with onset in childhood/adolescence: An umbrella review of published meta-analyses of observational longitudinal studies. Neurosci Biobehav Rev 2020; 120:565-573. [PMID: 32931804 DOI: 10.1016/j.neubiorev.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 01/21/2023]
Abstract
The patho-etiology of mental disorders with onset in childhood or adolescence remains largely unknown. We conducted an umbrella review of meta-analyses (MAs) on environmental factors associated with mental disorders with onset in childhood/adolescence. We searched Pubmed-MEDLINE/EMBASE/PsycInfo databases, last search April 29th, 2020. Quality of MAs was measured with AMSTAR-2. Out of 6851 initial references, ten articles met inclusion criteria, providing 23 associations between 12 potential environmental factors and nine disorders (cases: 8884; N = 3,660,670). While almost half of the associations were nominally significant, none of them met criteria from either convincing or highly suggestive evidence. A single association was supported by suggestive evidence (maternal exposure to lithium or antipsychotics with neuromotor deficits), but it was affected by confounding by indication. Ten more associations had weak evidence, and 12 associations were not statistically significant. Quality of meta-analyses was rated as high in two, moderate in one, low in four, critically low in two, and not pertinent in one (individual participant data). Methodologically-sound research is needed in this field.
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Affiliation(s)
- Marco Solmi
- Neurosciences Department, University of Padua, Padua, Italy; Neuroscience Center, University of Padua, Padua, Italy; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, United Kingdom
| | - Elena Dragioti
- Pain and Rehabilitation Center and Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, University of Linköping, SE- 581 85, Linköping, Sweden
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, Universidad Complutense, School of Medicine, Madrid, Spain
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, United Kingdom; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Catalonia, Spain; Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | | | - Ozge Kilic
- Department of Psychiatry, Koç University Hospital, Istanbul, Turkey
| | | | | | - Fernanda Cunha Soares
- Research Group on Lifestyles and Health, University of Pernambuco, Arnóbio Marquês Street, 310, Recife, 50100-130, PE, Brazil; Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Luca Mariano
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Pierluca Mosillo
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Samuele Cortese
- Centre for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK; Solent NHS Trust, Southampton, UK; New York University Child Study Center, New York, NY, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA; Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto, Canada; IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, United Kingdom; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK.
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38
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Bogossian A, Majnemer A, Racine E. Contextualized Autonomy in Transitional Care for Youth With Neurologic Conditions: The Role of the Pediatric Neurologist. J Child Neurol 2020; 35:536-542. [PMID: 32338583 DOI: 10.1177/0883073820918454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Youth with neurologic conditions experience multiple life transitions. The transfer from pediatric to adult health care systems exemplifies one such complex and multifaceted transition that occurs in parallel with developmental, legal, and social changes that may influence the roles and responsibilities of youth and their caregivers. As a result, ethical situations, questions, and challenges may surface in transition care to which pediatric neurologists may be confronted. In this article, we focus on the topic of autonomy and situations that may arise in transition care in the context of pediatric neurology. Building from a clinical case, we present the concept of contextualized autonomy to work through the questions that arise in the case and propose ways of thinking through those challenging situations in transition care.
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Affiliation(s)
- Aline Bogossian
- School of Social Work, Faculty of Arts and Science, Université de Montréal, Pavillon Lionel-Groulx, Montréal, Quebec, Canada
| | - Annette Majnemer
- School of Physical & Occupational Therapy, McGill University, Montréal, Quebec, Canada.,Montreal Children's Hospital and RI-McGill University Health Centre & Centre for Interdisciplinary Research in Rehabilitation, Montréal, Quebec, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Quebec, Canada.,Department of Neurology and Neurosurgery, Biomedical Ethics Unit and Division of Experimental Medicine, McGill University, Montréal, Quebec, Canada
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Assenza C, Cacciatore D, Manica M, Iosa M, Foti C, Gobbetti T, Paolucci S, Morelli D. Assistive products and childhood neurodisability: a retrospective study on factors associated with aids/orthoses prescription. Eur J Phys Rehabil Med 2020; 56:412-420. [PMID: 32406225 DOI: 10.23736/s1973-9087.20.06224-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children affected by pathologies causing neurodisability go through motor, cognitive, sensory and other limitations. The selection of assistive products can influence their level of independence and quality of life. AIM The present study investigated the possibility to assess the equipment needs of children with neurodisabilities, based on their clinical characteristics. DESIGN A retrospective observational study. SETTING Outpatients. POPULATION Inclusion criteria: diagnosis of cerebral palsy or genetic/chromosomal/syndromic disorders, age range 0-18 years, intelligence quotient evaluation, medical history of positive or negative presence of epilepsy and of communication disorders, admission at our neurorehabilitation service between 2007 and 2017, and registration of all equipment prescribed to each child. METHODS In 192 children (111 males, 57.81%) we evaluated the relationship between several independent variables (diagnosis, sex, Gross Motor Function Classification System level, intelligence quotient, history of epilepsy and communication disorders) and equipment prescription by means of logistic regression models. RESULTS Our data showed significant correlation between the Gross Motor Function Classification System level and the equipment prescribed. A history of seizures was negatively correlated with walker prescriptions (the log odds of prescription decreases by -2.156; CI: -4.16 to -0.65) and positively with those of stroller (the log odds increases by 1.427; CI: 0.22 to 2.69). Stroller and knee-ankle-foot orthoses and hip-knee-ankle-foot orthoses prescriptions were negatively correlated with the cerebral palsy diagnosis. The prescription of foot orthoses was positively correlated with mental retardation (the log odds increases by 0.358; CI: 0.12 to 0.61). A negative correlation between communication disorders and the prescription of ankle-foot orthoses and communication/learning devices was also found (the log odds decreases by -0.833; CI -1.66 to -0.01). CONCLUSIONS Several clinical characteristics correlate with specific equipment needs. CLINICAL REHABILITATION IMPACT The definition of the clinical characteristics with a potential predicting value, may facilitate the task of physician on choosing what is more appropriate to prescribe, as well as the authorizing office responsible for evaluating the appropriateness of prescriptions. Furthermore, it could be possible to foresee the care needs in terms of type and number of aids/orthoses and to guarantee every disabled child the possibility to take advantage of the same opportunities.
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Affiliation(s)
- Carla Assenza
- Department of Pediatric Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy - .,Physical and Rehabilitation Medicine, Tor Vergata University, Rome, Italy -
| | - Denise Cacciatore
- Department of Pediatric Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy
| | | | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy
| | - Calogero Foti
- Physical and Rehabilitation Medicine, Tor Vergata University, Rome, Italy
| | - Tiziana Gobbetti
- Department of Pediatric Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy
| | - Daniela Morelli
- Department of Pediatric Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy
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40
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Filipe AM, Bogossian A, Zulla R, Nicholas D, Lach LM. Developing a Canadian framework for social determinants of health and well-being among children with neurodisabilities and their families: an ecosocial perspective. Disabil Rehabil 2020; 43:3856-3867. [DOI: 10.1080/09638288.2020.1754926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Angela M. Filipe
- Department of Sociology, McGill University, Montréal, Canada
- Centre for Research on Children and Families, McGill University, Montréal, Canada
| | - Aline Bogossian
- École de Travail Social, Université de Montréal, Montréal, Canada
| | - Rosslynn Zulla
- Faculty of Social Work, University of Calgary, Calgary, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Canada
| | - Lucyna M. Lach
- Centre for Research on Children and Families, McGill University, Montréal, Canada
- School of Social Work, Faculty of Arts, McGill University, Montréal, Canada
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41
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Cairncross ZF, Chaput KH, McMorris C, Ospina M, Brown HK, Metcalfe A. Roles of the underlying cause of delivery and gestational age on long-term child health. Paediatr Perinat Epidemiol 2020; 34:331-340. [PMID: 32043606 DOI: 10.1111/ppe.12648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/11/2019] [Accepted: 12/25/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical conditions leading to delivery are heterogeneous. However, most studies examining the short- and long-term consequences of birth on child health only consider gestational age at delivery, not the underlying cause. OBJECTIVE To examine the effect of both gestational age at delivery and underlying cause of delivery on child health outcomes. METHODS This population-based retrospective cohort study of singleton infants born in Alberta (April 2004-March 2005) used linked administrative and perinatal data to identify birth subtypes by underlying cause (infection/inflammation (I/I), placental dysfunction (PD), both, or neither), gestational age at delivery, and child health outcomes (neonatal morbidity and mortality, paediatric complex chronic conditions, and neurodevelopmental disorders and disabilities). Poisson regression with robust variance was used to assess differences in the (adjusted) risk ratio (RR) of each outcome by gestational age, and by cause of delivery. The roles of gestational age and cause of delivery were examined using mediation analysis methods. RESULTS A total of 38,192 children were included, with 66.7% experiencing neither I/I nor PD (I/I: 4.0%, PD: 27.5%, both: 1.8%). Infants born preterm had higher risk of all outcomes compared to those born at term and late-term. Infants with exposure to both causes had higher risk of all outcomes (neonatal morbidity, RR 8.96, 95% confidence interval [CI] 7.55, 10.63; paediatric complex chronic conditions, RR 3.94, 95% CI 3.08, 5.05; and neurodevelopmental disorders, RR 1.58, 95% CI 1.37, 1.84). The effect of underlying cause of delivery on child health outcomes was partially explained by gestational age, more in cases involving I/I than in those involving PD alone. CONCLUSIONS Short- and long-term child health outcomes differ by the underlying cause leading to delivery, as well as the gestational age at delivery. Having a clearer prognosis for infants may promote the use of clinical interventions earlier for children at increased risk.
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Affiliation(s)
- Zoe F Cairncross
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Kathleen H Chaput
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Carly McMorris
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Maria Ospina
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
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42
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Russell MJ, Premji S, Mcdonald S, Zwicker JD, Tough S. Health care service for families with children at early risk of developmental delay: an All Our Families cohort study. Dev Med Child Neurol 2020; 62:338-345. [PMID: 31469170 PMCID: PMC7028137 DOI: 10.1111/dmcn.14343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 12/15/2022]
Abstract
AIM This study examined children's health care service use, mothers' workforce participation, and mothers' community engagement based on children's risk of developmental delay. METHOD We used data from the All Our Families study, a prospective pregnancy cohort. Ages and Stages Questionnaire (ASQ) scores at year 2 indicated risk of developmental delay. To investigate the impact of risk of developmental delay when children were not diagnosed, a sensitivity analysis excluded reports of neurodevelopmental disorder (NDD) diagnosis at year 3. Outcomes were maternal reports of children's health and allied health visits (and estimated costs), and maternal workforce participation and community engagement from year 2 to 3. RESULTS Among 1314 mother-child dyads, 209 (16%) children were classified as being at risk of developmental delay by the ASQ, and 42 (3%) had a reported diagnosis of NDD. Risk of developmental delay was related to increased use of allied health care services (incidence risk ratio 5.04 [year 3]; 95% confidence interval 2.49-10.2) and health visits (incidence risk ratio 1.33 [year 3]; 95% confidence interval 1.14-1.54). The average expected allied health costs were greater for children at risk versus not at risk of developmental delay. However, when excluding children with reported diagnoses of an NDD from this analysis, increased service use and costs in the remaining at-risk population were not observed. Community engagement and workplace participation among families did not differ on the basis of risk of developmental delay. INTERPRETATION These results suggest increased health care service use by families of children at risk of developmental delay is driven by those receiving a diagnosis of an NDD in the subsequent year. WHAT THIS PAPER ADDS Early developmental delay risk was related to health care service use and costs. Diagnosis of neurodevelopmental disorder drove increased health care service use and costs. Early developmental delay risk did not relate to parental workforce participation. Early developmental delay risk did not relate to community engagement participation.
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Affiliation(s)
- Matthew J Russell
- Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
- School of Public PolicyUniversity of CalgaryCalgaryABCanada
- PolicyWise for Children & FamiliesUniversity of CalgaryCalgaryABCanada
| | - Shainur Premji
- Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
- School of Public PolicyUniversity of CalgaryCalgaryABCanada
| | - Sheila Mcdonald
- Paediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Jennifer D Zwicker
- School of Public PolicyUniversity of CalgaryCalgaryABCanada
- Department of KinesiologyUniversity of CalgaryCalgaryABCanada
| | - Suzanne Tough
- Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Paediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
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43
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Lamsal R, Finlay B, Whitehurst DGT, Zwicker JD. Generic preference-based health-related quality of life in children with neurodevelopmental disorders: a scoping review. Dev Med Child Neurol 2020; 62:169-177. [PMID: 31225644 PMCID: PMC7065222 DOI: 10.1111/dmcn.14301] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2019] [Indexed: 12/11/2022]
Abstract
AIM To describe how generic preference-based health-related quality of life (HRQoL) instruments have been used in research involving children with neurodevelopmental disorders (NDD). METHOD A systematic search of nine databases identified studies that used generic preference-based HRQoL instruments in children with NDD. Data extracted following the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Review guidelines included type of NDD, instrument used, respondent type, justification, and critical appraisal for these selections. RESULTS Thirty-six studies were identified: four cost-utility analyses; 15 HRQoL assessments; five economic burden studies; three intervention studies; and nine 'other'. The Health Utilities Index (Mark 2 and Mark 3) and EuroQoL 5D (EQ-5D; three-level EQ-5D, five-level EQ-5D, and the youth version of the EQ-5D) instruments were most frequently used (44% and 31% respectively). The relatively low use of these instruments overall may be due to a lack of psychometric evidence, inconsistency in justification for and lack of clarity on appropriate respondent type and age, and geographical challenges in applying preference weights. INTERPRETATION This study highlights the dearth of studies using generic preference-based HRQoL instruments in children with NDD. The use of cost-utility analysis in this field is limited and validation of these instruments for children with NDD is needed. The quality of data should be considered before guiding policy and care decisions. WHAT THIS PAPER ADDS Limited use of generic preference-based health-related quality of life (HRQoL) instruments in studies on children with neurodevelopmental disorders. Only 11% of studies were cost-utility analyses. Inconsistencies in justification for choosing generic preference-based HRQoL instruments and respondent types.
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Affiliation(s)
- Ramesh Lamsal
- School of Public PolicyUniversity of CalgaryCalgaryAlbertaCanada
| | - Brittany Finlay
- School of Public PolicyUniversity of CalgaryCalgaryAlbertaCanada
| | - David G T Whitehurst
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada,Centre for Clinical Epidemiology and EvaluationVancouver Coastal Health Research InstituteVancouverBritish ColumbiaCanada
| | - Jennifer D Zwicker
- School of Public PolicyUniversity of CalgaryCalgaryAlbertaCanada,Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
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44
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Rothwell DW, Gariépy G, Elgar FJ, Lach LM. Trajectories of poverty and economic hardship among American families supporting a child with a neurodisability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:1273-1284. [PMID: 31297920 PMCID: PMC6771969 DOI: 10.1111/jir.12666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/30/2019] [Accepted: 05/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Caring for a child with a neurodisability (ND) impacts the financial decisions, relationships and well-being of family members, but evidence on the economic trajectories of families throughout the life course is missing. METHODS Using data from the Panel Study of Income Dynamics, we tracked the families of 3317 children starting 5 years before childbirth until the child reached 20 years of age. We used regression and latent growth curve modelling to estimate trajectories of poverty and economic hardship over time. RESULTS Families with a child with an ND had higher rates of poverty and economic hardship prior to childbirth and persistently over time. Analysis uncovered five latent trajectories for each indicator. After controlling for family and caregiver characteristics that preceded the birth of the child, raising a child with an ND was not associated with a unique trajectory of poverty. Families raising a child with an ND were however more likely to experience persistent economic hardship. CONCLUSIONS The study establishes descriptive evidence for how having a child with an ND relates to changes in family economic conditions. The social and economic conditions that precede the child's birth seem to be driving the economic inequalities observed later throughout the life course.
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Affiliation(s)
- D. W. Rothwell
- Human Development &Family Sciences, College of Public Health and Human SciencesOregon State UniversityCorvallisORUSA
| | - G. Gariépy
- Department of Social and Preventive MedicineUniversity of MontrealMontrealQCCanada
| | - F. J. Elgar
- Institute for Health and Social PolicyMcGill UniversityMontrealQCCanada
| | - L. M. Lach
- School of Social WorkMcGill UniversityMontrealQCCanada
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Seppänen AV, Bodeau-Livinec F, Boyle EM, Edstedt-Bonamy AK, Cuttini M, Toome L, Maier RF, Cloet E, Koopman-Esseboom C, Pedersen P, Gadzinowski J, Barros H, Zeitlin J. Specialist health care services use in a European cohort of infants born very preterm. Dev Med Child Neurol 2019; 61:832-839. [PMID: 30508225 DOI: 10.1111/dmcn.14112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2018] [Indexed: 12/27/2022]
Abstract
AIM Children born very preterm require additional specialist care because of the health and developmental risks associated with preterm birth, but information on their health service use is sparse. We sought to describe the use of specialist services by children born very preterm in Europe. METHOD We analysed data from the multi-regional, population-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of births before 32 weeks' gestation in 11 European countries. Perinatal data were abstracted from medical records and parents completed a questionnaire at 2 years corrected age (4322 children; 2026 females, 2296 males; median gestational age 29wks, interquartile range [IQR] 27-31wks; median birthweight 1230g, IQR 970-1511g). We compared parent-reported use of specialist services by country, perinatal risk (based on gestational age, small for gestational age, and neonatal morbidities), maternal education, and birthplace. RESULTS Seventy-six per cent of the children had consulted at least one specialist, ranging across countries from 53.7% to 100%. Ophthalmologists (53.4%) and physiotherapists (48.0%) were most frequently consulted, but individual specialists varied greatly by country. Perinatal risk was associated with specialist use, but the gradient differed across countries. Children with more educated mothers had higher proportions of specialist use in three countries. INTERPRETATION Large variations in the use of specialist services across Europe were not explained by perinatal risk and raise questions about the strengths and limits of existing models of care. WHAT THIS PAPER ADDS Use of specialist services by children born very preterm varied across Europe. This variation was observed for types and number of specialists consulted. Perinatal risk was associated with specialist care, but did not explain country-level differences. In some countries, mothers' educational level affected use of specialist services.
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Affiliation(s)
- Anna-Veera Seppänen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris, France.,Collège Doctoral, Sorbonne Université, Paris, France
| | - Florence Bodeau-Livinec
- Ecole des Hautes Etudes en Santé Publique, Rennes, France.,DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Elaine M Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Anna-Karin Edstedt-Bonamy
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Liis Toome
- Tallinn Children's Hospital, Tallinn, Estonia.,University of Tartu, Tartu, Estonia
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Eva Cloet
- Public Health, Vrije Universiteit Brussel Faculteit Geneeskunde en Farmacie, Brussels, Belgium.,Paediatric Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Corine Koopman-Esseboom
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Jennifer Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris, France
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46
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Lamsal R, Ungar WJ. Impact of growing up with a sibling with a neurodevelopmental disorder on the quality of life of an unaffected sibling: a scoping review. Disabil Rehabil 2019; 43:586-594. [PMID: 31106599 DOI: 10.1080/09638288.2019.1615563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Growing up with a sibling with a neurodevelopmental disorder can have positive and negative effects on personal, social and emotional well-being; however, little is known about the impacts on unaffected siblings' quality of life. The purpose of this review was to synthesize evidence from studies evaluating the quality of life of unaffected siblings of children with neurodevelopmental disorders. METHOD A systematic search was conducted on four databases to identify studies reporting the quality of life of unaffected siblings of children with neurodevelopmental disorders. RESULTS Seven studies met the inclusion criteria. Four studies reported impaired quality of life in unaffected siblings of children with neurodevelopmental disorder while three studies reported not the impaired quality of life. Parents reported the lower quality of life for children with or without neurodevelopmental disorders compared to children's self-reports. CONCLUSIONS This review provides the mixed evidence on the quality of life in unaffected siblings of children with neurodevelopmental disorders, and identifies the substantial gap in the research regarding the impacts of children's neurodevelopmental disorders on the quality of life of their unaffected siblings. Assessment of unaffected siblings' quality of life is necessary to identify those who may be at risk and to provide support programs for physical and emotional well-being. Future research examining the quality of life of unaffected siblings across a variety of NDD is needed.Implications for rehabilitationGrowing up with a sibling with a neurodevelopmental disorder influences the personal and social development of the unaffected child.Measuring quality of life can have a meaningful impact on the lives of unaffected siblings of children with neurodevelopmental disorders and their families. Evidence generated from such studies can be used by healthcare providers such as physicians, nurses, psychologists, and social workers to recommend appropriate supports to the family and siblings.
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Affiliation(s)
- Ramesh Lamsal
- Program of Child Health Evaluation Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Wendy J Ungar
- Program of Child Health Evaluation Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Arim RG, Miller AR, Kohen DE, Guèvremont A, Lach LM, Brehaut JC. Changes in the health of mothers of children with neurodevelopmental disabilities: An administrative data study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 86:76-86. [PMID: 30684833 DOI: 10.1016/j.ridd.2018.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/14/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Using linked administrative health data, this study compared the health and healthcare service utilization between mothers of children with and without neurodevelopmental disabilities (NDD), before, during, and after the birth of a child. METHODS The population (N = 25,388) was based on a cohort of children born in 2000 and who were, along with their mothers, continuously registered with the British Columbia's universal health insurance program between 2000 and 2007. RESULTS Compared to mothers of children without NDD, mothers of children with NDD were more likely to have chronic conditions and higher service utilization before child birth. Mothers of children with NDD showed a smaller increase in physician visits in the year before birth but a greater increase in different prescription drugs in the year after birth. There was no further divergence (or convergence) in health and service utilization between the groups in the 7-year period post-birth. CONCLUSIONS Differences in health and healthcare service utilization between mothers of children with and without NDD existed before the birth of the child and did not diverge in the 7 years post-birth. Replication of these findings is warranted as well as follow-up analyses examining longer term outcomes for mothers beyond 7 years post-birth.
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Affiliation(s)
- Rubab G Arim
- Health Analysis Division, Statistics Canada, 100 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada.
| | - Anton R Miller
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2D19, BC Children's Hospital, Vancouver, British Columbia, V6H 3V4, Canada
| | - Dafna E Kohen
- Health Analysis Division, Statistics Canada, 100 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada
| | - Anne Guèvremont
- Health Analysis Division, Statistics Canada, 100 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada
| | - Lucy M Lach
- School of Social Work, McGill University, 3506 University Street, #300, Montreal, Québec, H3A 2A7, Canada
| | - Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 511, Ottawa, Ontario, K1H 8L6, Canada
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48
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Ryan JM, Allen E, Gormley J, Hurvitz EA, Peterson MD. The risk, burden, and management of non-communicable diseases in cerebral palsy: a scoping review. Dev Med Child Neurol 2018; 60:753-764. [PMID: 29572812 DOI: 10.1111/dmcn.13737] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 12/26/2022]
Abstract
AIM To examine the risk, burden, and management of non-communicable diseases (NCDs) among people with cerebral palsy (CP). METHOD Databases (Ovid MEDLINE, Embase Ovid, CINAHL Plus) were systematically searched up to August 2017. Data on the prevalence of risk factors for, and the burden and management of, cardiovascular diseases, diabetes, cancers, and respiratory diseases were extracted. RESULTS Thirty-six studies that examined the prevalence of risk factors among people with CP were identified. There was inconsistent evidence that people with CP had higher prevalence of metabolic risk factors such as hypertension, hyperlipidaemia, and obesity, but strong evidence that they participated in low levels of physical activity, compared with people without CP. Seven studies reported on the burden of NCDs. Adults with CP had a higher risk of NCDs, including stroke, chronic obstructive pulmonary disease, and other heart conditions, and death due to NCDs, including cancers, chronic obstructive pulmonary disease, stroke, and ischaemic heart disease, compared with the general population. Only one study reported on the management of NCD, specifically the uptake of breast cancer screening among females. INTERPRETATION The burden of NCDs is higher among adults with CP compared with the general population. Further research is required to determine the prevalence of metabolic risk factors and management of NCDs among people with CP. WHAT THIS PAPER ADDS Adults with cerebral palsy (CP) have an increased risk of non-communicable diseases (NCDs) and increased risk of death because of NCDs. Evidence is inconsistent about the elevated prevalence of metabolic risk factors for NCDs. Evidence is consistent that people with CP participate in reduced physical activity. Only one study reported on management of NCD among people with CP. Available evidence suggests people with CP are less likely to receive preventive medicine.
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Affiliation(s)
- Jennifer M Ryan
- College of Health and Life Sciences, Brunel University, London, UK.,Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - John Gormley
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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49
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Lamsal R, Dutton DJ, Zwicker JD. Using the ages and stages questionnaire in the general population as a measure for identifying children not at risk of a neurodevelopmental disorder. BMC Pediatr 2018; 18:122. [PMID: 29614989 PMCID: PMC5883588 DOI: 10.1186/s12887-018-1105-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/27/2018] [Indexed: 01/01/2023] Open
Abstract
Background Early detection of neurodevelopmental disorders (NDDs) enables access to early interventions for children. We assess the Ages and Stages Questionnaire (ASQ)’s ability to identify children with a NDD in population data. Method Children 4 to 5 years old in the National Longitudinal Survey of Children and Youth (NLSCY) from cycles 5 to 8 were included. The sensitivity, specificity, positive and negative predictive values were calculated for the ASQ at 24, 27, 30, 33, 36 and 42 months. Fixed effects regression analyses assessed longitudinal associations between domain scores and child age. Results Specificity for the ASQ was high with 1SD or 2SD cutoffs, indicating good accuracy in detecting children who will not develop a NDD, however the sensitivity varied over time points and cut-offs. Sensitivity for the 1 SD cutoff at 24 months was above the recommended value of 70% for screening. Differences in ASQ domains scores between children with and without NDD increases with age. Conclusions The high specificity and negative predictive values of the ASQ support its use in identifying children who are not at the risk of developing a NDD. The capacity of the ASQ to identify children with a NDD in the general population is limited except for the ASQ-24 months with 1SD and can be used to identify children at risk of NDD. Electronic supplementary material The online version of this article (10.1186/s12887-018-1105-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ramesh Lamsal
- School of Public Policy, University of Calgary, 906 8th Ave SW, Calgary, Canada
| | - Daniel J Dutton
- School of Public Policy, University of Calgary, 906 8th Ave SW, Calgary, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, 906 8th Ave SW, Calgary, Canada. .,Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
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50
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Cloet E, Leys M, De Meirleir L. Access to early diagnostics, intervention, and support for children with a neurobiological developmental delay or disorder. Dev Med Child Neurol 2017; 59:1215-1216. [PMID: 28944462 DOI: 10.1111/dmcn.13583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Eva Cloet
- Department of Public Health, Research Group OPIH, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Mark Leys
- Department of Public Health, Research Group OPIH, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Linda De Meirleir
- Department of Paediatric Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium
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