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Abbott J, Fraser LK, Jarvis S. Inequalities in emergency care use across transition from paediatric to adult care: a retrospective cohort study of young people with chronic kidney disease in England. Eur J Pediatr 2024; 183:3105-3115. [PMID: 38668794 DOI: 10.1007/s00431-024-05561-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 06/22/2024]
Abstract
Transition of young people with chronic kidney disease (CKD) from paediatric to adult healthcare has been associated with poor outcomes, but few population-level studies examine trends in subgroups. We aimed to assess sociodemographic inequalities in changes in unplanned secondary care utilisation occurring across transfer to adult care for people with CKD in England. A cohort was constructed from routine healthcare administrative data in England of young people with childhood-diagnosed CKD who transitioned to adult care. The primary outcome was the number of emergency inpatient admissions and accident and emergency department (A&E) attendances per person year, compared before and after transfer. Injury-related and maternity admissions were excluded. Outcomes were compared via sociodemographic data using negative binomial regression with random effects. The cohort included 4505 individuals. Controlling for age, birth year, age at transfer, region and sociodemographic factors, transfer was associated with a significant decrease in emergency admissions (IRR 0.75, 95% CI 0.64-0.88) and no significant change in A&E attendances (IRR 1.10, 95% CI 0.95-1.27). Female sex was associated with static admissions and increased A&E attendances with transfer, with higher admissions and A&E attendances compared to males pre-transfer. Non-white ethnicities and higher deprivation were associated with higher unplanned secondary care use. CONCLUSION Sociodemographic inequalities in emergency secondary care usage were evident in this cohort across the transition period, independent of age, with some variation between admissions and A&E use, and evidence of effect modification by transfer. Such inequalities likely have multifactorial origin, but importantly, could represent differential meetings of care needs. WHAT IS KNOWN • In chronic kidney disease (CKD), transfer from paediatric to adult healthcare is associated with declining health outcomes. • Known differences in CKD outcomes by sociodemographic factors have limited prior exploration in the context of transfer. WHAT IS NEW • Population-level data was used to examine the impacts of transfer and sociodemographic factors on unplanned secondary care utilisation in CKD. • Healthcare utilisation trends may not reflect known CKD pathophysiology and there may be unexplored sociodemographic inequalities in the experiences of young people across transfer.
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Affiliation(s)
- Jasmin Abbott
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
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2
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Bhatnagar S, Mitelpunkt A, Rizzo JJ, Zhang N, Guzman T, Schuetter R, Vargus-Adams J, Bailes AF, Greve K, Gerstle M, Pedapati E, Aronow B, Kurowski BG. Mental Health Diagnoses Risk Among Children and Young Adults With Cerebral Palsy, Chronic Conditions, or Typical Development. JAMA Netw Open 2024; 7:e2422202. [PMID: 39028671 PMCID: PMC11259902 DOI: 10.1001/jamanetworkopen.2024.22202] [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: 02/26/2024] [Accepted: 05/15/2024] [Indexed: 07/21/2024] Open
Abstract
Importance Mental health (MH) issues in children with cerebral palsy (CP) are poorly understood compared with other pediatric populations. Objective To examine MH diagnosis code assignment among children and young adults with CP and compare with typically developing (TD) and chronic condition (CC) pediatric populations. Design, Setting, and Participants This case-control study used International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes to create a CP case set and CC and TD control sets using electronic health record data of children and young adults from a large tertiary care children's hospital in the midwestern United States between 2010 and 2022. Case-control matching was performed to control for demographic factors. Data were analyzed from June to December 2023. Exposures All MH diagnosis codes were mapped to ICD-10-CM and categorized using Clinical Classifications Software Refined (CCSR). Main Outcomes and Measures The incidence rates of MH CCSR categories were calculated. Descriptive and comparative statistics were used to evaluate the significance and odds associated with factors. Results Data from 216 794 individuals (mean [SD] baseline age, 4.3 [5.1] years; 118 562 [55%] male) were analyzed, including 3544 individuals with CP, 142 160 individuals with CC, and 71 080 TD individuals. The CP cohort spread across Gross Motor Function Classification System (GMFCS) levels I (981 individuals [28%]), II (645 individuals [18%]), III (346 individuals [10%]), IV (502 individuals [14%]), and V (618 individuals [17%]). Rates varied significantly for anxiety (824 individuals with CP [23%]; 25 877 individuals with CC [9%]; 6274 individuals with TD [18%]), attention-deficit/hyperactivity disorder (534 individuals with CP [15%]; 22 426 individuals with CC [9%]; 6311 individuals with TD [16%]); conduct or impulse disorder (504 individuals with CP [14%]; 13 209 individuals with CC [5%]; 3715 individuals with TD [9%]), trauma or stress disorders (343 individuals with CP [10%]; 18 229 individuals with CC [8%]; 5329 individuals with TD [13%]), obsessive-compulsive disorder (251 individuals with CP [7%]; 3795 individuals with CC [1%]; 659 individuals with TD [3%]), depression (108 individuals with CP [3%]; 12 224 individuals with CC [5%]; 4007 individuals with TD [9%]), mood disorders (74 individuals with CP [2%]; 4355 individuals with CC [2%]; 1181 individuals with TD [3%]), and suicidal ideation (72 individuals with CP [2%]; 7422 individuals with CC [5%]; 3513 individuals with TD [5%]). There was significant variation in odds of MH diagnoses by GMFCS level (I-II vs III-V: odds ratio [OR], 1.23; 95% CI, 1.09-1.40; P = .001). Among individuals with CP, males were more likely than females to have diagnosis codes for conduct or impulse disorders (OR, 1.41; 95% CI, 1.16-1.73) and attention-deficit/hyperactivity disorder (OR, 1.41 [95% CI, 1.15-1.73]). Black individuals, compared with White individuals, were more likely to have diagnoses for obsessive-compulsive disorder (OR, 1.57 [95% CI, 1.14-2.16]), other mood disorders (OR, 1.85 [95% CI, 1.01-3.38]), and trauma or stress disorders (OR, 1.94 [95% CI, 1.44-2.63]). Odds for trauma or stress disorders were elevated for individuals who identified as other races compared with White individuals (OR, 2.80 [95% CI, 2.03-3.87]). Conclusions and Relevance In this case-control study of children and young adults with CP and matched comparisons, anxiety and conduct or impulse diagnoses were higher in individuals with CP. The lower diagnosis rates of depression and suicidal ideation may indicate underdiagnosis among individuals with CP. There is likely a need for assessment tools that are more suitable for children with CP.
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Affiliation(s)
- Surbhi Bhatnagar
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Alexis Mitelpunkt
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Pediatric Rehabilitation, Dana-Dwek Children’s Hospital, Tel Aviv Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Juliana J. Rizzo
- College of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Nanhua Zhang
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tess Guzman
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ryan Schuetter
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jilda Vargus-Adams
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy F. Bailes
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Kelly Greve
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Melissa Gerstle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ernest Pedapati
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Child Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Bruce Aronow
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brad G. Kurowski
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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3
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Im Y, Jung S, Park Y, Eom JH. Research Trends in Family-Centered Care for Children With Chronic Disease: Keyword Network Analysis. Comput Inform Nurs 2024; 42:504-514. [PMID: 38917036 DOI: 10.1097/cin.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Family-centered care is an approach to promote the health and well-being of children with chronic diseases and their families. This study aims to explore the knowledge components, structures, and research trends related to family-centered care for children with chronic conditions. We conducted the keyword network analysis in three stages using the keywords provided by the authors of each study: (1) search and screening of relevant studies, (2) keyword extraction and refinement, and (3) data analysis and visualization. The core keywords were child, adolescence, parent, and disabled. Four cohesive subgroups were identified through degree centrality. Research trends in the three phases of a recent decade have been changed. With the systematic understanding of the context of the knowledge structure, the future research and effective strategy establishment are suggested based on family-centered care for children with chronic disease.
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Affiliation(s)
- YeoJin Im
- Author Affiliations: College of Nursing Science, East-West Nursing Research Institute, Kyung Hee University, Seoul (Drs Im and Park, and Ms Eom); and College of Nursing, Research Institute of Nursing Science, Pusan National University (Dr Jung), Busan, Republic of Korea
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Herbert K, Herlitz L, Woodman J, Powell C, Morris S. Patient and caregiver characteristics associated with differential use of primary care for children and young people in the UK: a scoping review. BMJ Open 2024; 14:e078505. [PMID: 38760051 PMCID: PMC11103219 DOI: 10.1136/bmjopen-2023-078505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/24/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE To systematically map evidence to answer the research question: What is the relationship between the characteristics of children and young people (CYP) or their caregivers and primary care service use in the UK, taking into account underlying healthcare needs? DESIGN: Scoping review. SETTING Primary care. ELIGIBILITY CRITERIA English-language quantitative or mixed-methods studies published between 2012 and 2022. DATA SOURCES Medline, Embase, Scopus and Web of Science Social Sciences Citation Index, and grey literature. RESULTS 22 eligible studies were identified, covering general practice (n=14), dental health (n=4), child mental health (MN) services (n=3) and immunisation (n=1). Only eight studies (36%) controlled for variables associated with healthcare need (eg, age, birth weight and long-term conditions). In these, evidence of horizontal inequity in primary care use was reported for CYP living in deprived areas in England, with and without complex needs. Horizontal inequity was also identified in primary care MN referrals for CYP in England identifying as mixed-race, Asian or black ethnicity, compared with their white British peers. No evidence of horizontal inequity was observed, however, in primary care use for CYP in England exposed to parental depression, or for CYP children from low-income households in Scotland. Increasing CYP's age was associated with decreasing primary care use across included studies. No studies were found regarding CYP from Gypsy or Traveller communities, children in care, or those with disabilities or special educational needs. CONCLUSIONS There is evidence that socioeconomic factors impact on CYP's primary care use, in particular age, ethnicity and deprivation. However, better quality evidence is required to evaluate horizontal inequity in use and address knowledge gaps regarding primary care use for vulnerable CYP populations and the impact of policy and practice related 'supply side' of primary care.
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Affiliation(s)
- Kevin Herbert
- Cambridge Research Methods Hub, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Lauren Herlitz
- Population, Policy and Practice Department, UCL GOS Institute of Child Health, London, UK
| | - Jenny Woodman
- Institute of Education, UCL Social Research Institute, London, UK
| | - Claire Powell
- Population, Policy and Practice Department, UCL GOS Institute of Child Health, London, UK
| | - Stephen Morris
- Cambridge Research Methods Hub, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
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5
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Svavarsdottir EK, Lemos S, Andrade L, Barbieri-Figueiredo MDC, Tryggvadottir GB, Lima L. Psychometric Testing of the Experience of Integrating Chronic Illness into Family Life Questionnaire. JOURNAL OF FAMILY NURSING 2024; 30:174-184. [PMID: 38528681 DOI: 10.1177/10748407241236010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Family members' experience of integrating chronic illnesses or chronic conditions into family life is valuable information for health care professionals, such as nurses, to understand, improve, and adjust the care provided to families of chronically ill patients. Furthermore, the assessment of the experience of integrating chronic illness into family life can support family nursing interventions and reduce suffering. This study aimed to adapt and psychometrically test a new Likert-type questionnaire on the experience of integrating pediatric chronic illness into family life (EICI-FLQ) in two European samples. A sample of 164 primary caregivers of children/adolescents with chronic illnesses/conditions in Iceland and another sample of 237 primary caregivers with children/adolescents with chronic illnesses/conditions in Portugal completed the online questionnaire. Exploratory factor analysis of the Icelandic sample yielded support for a one-factor solution with acceptable internal reliability (Cronbach's α = .866). Confirmatory factor analysis of the one-factor structure in the Portuguese sample indicated good model fit and similar internal reliability (Cronbach's α = .838). This instrument has good psychometric characteristics and is a promising tool for measuring the experience of integrating pediatric chronic illness into family life in clinical and research settings.
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Affiliation(s)
| | - Sara Lemos
- University of Porto Institute of Biomedical Sciences Abel Salazar, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Luísa Andrade
- Nursing School of Porto, Portugal
- Center for Health Technology and Services Research at the Health, Research Network (CINTESIS@RISE), Porto, Portugal
| | - Maria Do Céu Barbieri-Figueiredo
- University of Porto Institute of Biomedical Sciences Abel Salazar, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Nursing School of Porto, Portugal
- University of Huelva, Spain
| | | | - Lígia Lima
- Center for Health Technology and Services Research at the Health, Research Network (CINTESIS@RISE), Porto, Portugal
- Nursing School of Porto, Portugal
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6
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Thomas S, Ryan NP, Byrne LK, Hendrieckx C, White V. Psychological Distress Among Parents of Children With Chronic Health Conditions and Its Association With Unmet Supportive Care Needs and Children's Quality of Life. J Pediatr Psychol 2024; 49:45-55. [PMID: 37840456 PMCID: PMC10799716 DOI: 10.1093/jpepsy/jsad074] [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] [Received: 04/19/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE To assess parent psychological distress in families of children with common chronic health conditions (CHC) and to explore relationships between parent psychological distress, unmet supportive care needs and children's quality of life (QoL). METHOD Cross-sectional study involving parents of children diagnosed with a common CHC between 0 and 12 years of age and who had received treatment within the last 5 years. Eligible parents completed an online survey, that included the Depression Anxiety Stress Scale (DASS-21) assessing distress in parents and a 34-item assessment of unmet supportive care needs across 6 domains. Parents completed ratings of their child's current functioning (QoL) using the 23-item PedsQL. Multivariable regression models examined the relative association between unmet needs, children's QoL and parents' depression, anxiety, and stress. RESULTS The sample consisted of 194 parents of children with congenital heart disease (n=97; 50%), diabetes (n=50; 26%), cancer (n=39; 20%), and asthma (n=8; 4%). A significant proportion of parents had moderate-severe symptoms of depression (26%), anxiety (38%), and stress (40%). Of the PedsQL scales, the poorest outcomes were found for emotional and school functioning. Multivariable analyses showed that both higher unmet needs and poorer child emotional functioning were associated with parent depression, anxiety, and stress symptoms. CONCLUSION Evidence linking parent distress symptoms to higher unmet needs and poorer child emotional functioning suggests these factors may be targets for interventions to alleviate parent distress. Longitudinal research using larger samples is required to replicate findings, and clarify the magnitude and direction of associations.
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Affiliation(s)
- Sangeetha Thomas
- Faculty of Health, School of Psychology, Deakin University, Australia
| | - Nicholas P Ryan
- Faculty of Health, School of Psychology, Deakin University, Australia
- Department of Paediatrics, University of Melbourne, Australia
| | - Linda K Byrne
- Faculty of Health, School of Psychology, Deakin University, Australia
- Faculty of Psychology, Counselling and Psychotherapy, The Cairnmillar Institute, Australia
| | - Christel Hendrieckx
- Faculty of Health, School of Psychology, Deakin University, Australia
- The Australian Centre for Behavioural Research in Diabetes, Australia
- Faculty of Health, Institute of Health Transformation, Deakin University, Australia
| | - Victoria White
- Faculty of Health, School of Psychology, Deakin University, Australia
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
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7
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Wilde H, Tomlinson C, Mateen BA, Selby D, Kanthimathinathan HK, Ramnarayan P, Du Pre P, Johnson M, Pathan N, Gonzalez-Izquierdo A, Lai AG, Gurdasani D, Pagel C, Denaxas S, Vollmer S, Brown K. Hospital admissions linked to SARS-CoV-2 infection in children and adolescents: cohort study of 3.2 million first ascertained infections in England. BMJ 2023; 382:e073639. [PMID: 37407076 PMCID: PMC10318942 DOI: 10.1136/bmj-2022-073639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To describe hospital admissions associated with SARS-CoV-2 infection in children and adolescents. DESIGN Cohort study of 3.2 million first ascertained SARS-CoV-2 infections using electronic health care record data. SETTING England, July 2020 to February 2022. PARTICIPANTS About 12 million children and adolescents (age <18 years) who were resident in England. MAIN OUTCOME MEASURES Ascertainment of a first SARS-CoV-2 associated hospital admissions: due to SARS-CoV-2, with SARS-CoV-2 as a contributory factor, incidental to SARS-CoV-2 infection, and hospital acquired SARS-CoV-2. RESULTS 3 226 535 children and adolescents had a recorded first SARS-CoV-2 infection during the observation period, and 29 230 (0.9%) infections involved a SARS-CoV-2 associated hospital admission. The median length of stay was 2 (interquartile range 1-4) days) and 1710 of 29 230 (5.9%) SARS-CoV-2 associated admissions involved paediatric critical care. 70 deaths occurred in which covid-19 or paediatric inflammatory multisystem syndrome was listed as a cause, of which 55 (78.6%) were in participants with a SARS-CoV-2 associated hospital admission. SARS-CoV-2 was the cause or a contributory factor in 21 000 of 29 230 (71.8%) participants who were admitted to hospital and only 380 (1.3%) participants acquired infection as an inpatient and 7855 (26.9%) participants were admitted with incidental SARS-CoV-2 infection. Boys, younger children (<5 years), and those from ethnic minority groups or areas of high deprivation were more likely to be admitted to hospital (all P<0.001). The covid-19 vaccination programme in England has identified certain conditions as representing a higher risk of admission to hospital with SARS-CoV-2: 11 085 (37.9%) of participants admitted to hospital had evidence of such a condition, and a further 4765 (16.3%) of participants admitted to hospital had a medical or developmental health condition not included in the vaccination programme's list. CONCLUSIONS Most SARS-CoV-2 associated hospital admissions in children and adolescents in England were due to SARS-CoV-2 or SARS-CoV-2 was a contributory factor. These results should inform future public health initiatives and research.
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Affiliation(s)
- Harrison Wilde
- Department of Statistics, University of Warwick, Warwick, UK
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
| | - Christopher Tomlinson
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
- UCL UK Research and Innovation Centre for Doctoral Training in AI-enabled Healthcare Systems, UCL, London, UK
- University College London Hospitals Biomedical Research Centre, UCL, London, UK
| | - Bilal A Mateen
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
- University College London Hospitals Biomedical Research Centre, UCL, London, UK
- Wellcome Trust, London, UK
| | - David Selby
- Department for Data Science and its Applications, German Research Centre for Artificial Intelligence (DFKI), Kaiserslautern, Germany
- Department of Computer Science, TU Kaiserslautern, Kaiserslautern, Germany
| | | | - Padmanabhan Ramnarayan
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London UK Imperial College London, London, UK
| | - Pascale Du Pre
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK
| | - Mae Johnson
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK
| | - Nazima Pathan
- University Department of Paediatrics, Cambridge University, Cambridge, UK
| | | | - Alvina G Lai
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
| | - Deepti Gurdasani
- William Harvey Institute, Queen Mary University of London, London, UK
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Spiros Denaxas
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
- University College London Hospitals Biomedical Research Centre, UCL, London, UK
| | - Sebastian Vollmer
- Department for Data Science and its Applications, German Research Centre for Artificial Intelligence (DFKI), Kaiserslautern, Germany
- Department of Computer Science, TU Kaiserslautern, Kaiserslautern, Germany
| | - Katherine Brown
- Institute of Cardiovascular Science, UCL, London, UK
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK
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8
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Coveney K, O'Donnell D, Stokes D, Kroll T. The experiences of siblings of children with chronic illness of health-related communication directed at them: a systematic review protocol and thematic synthesis of qualitative studies. HRB Open Res 2023. [DOI: 10.12688/hrbopenres.13676.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
The psychological, social and financial impact that chronic illness can have on a family and in particular the siblings of children with chronic illness (SCWCI) is well documented. Siblings are at risk of a variety of psychosocial and physical problems such as suffering from anxiety, experiencing headaches, appetite loss. However, the experiences with health-related communication of SCWCI is not well known. This may leave them with suboptimal information. The aim of this systematic review described in this protocol is to understand SCWCI experience of targeted health-related communication; detailing the communication strategies utilised, how helpful the information was and what they wish would be different. The Preferred Reporting Items for Systematic reviews and Meta-analysis for Protocols (PRISMA-P) checklist will be used to frame this protocol. Registration: PROSPERO (393998, 03 February 2023).
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9
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Mohammadi F, Zahra Masoumi S, Oshvandi K, Bijani M, Nikrouz L. Death anxiety, resilience, and family cohesion in parents of children and adolescents in the end stages of life. Front Psychol 2023; 14:1057003. [PMID: 36844349 PMCID: PMC9950632 DOI: 10.3389/fpsyg.2023.1057003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023] Open
Abstract
Purpose Adolescents in the end stages of life impose a lot of psychological stress on other family members, which may affect their resilience and quality of life. So, the aim of the present study was to investigate death anxiety, family adaptability and cohesion, and resilience in the parents of children and adolescents who were at the end stages of life. Methods This is a cross-sectional study. Two hundred and ten parents were selected by convenience sampling and completed the questionnaires such as demographics survey, the death anxiety scale, Connor-Davidson resilience scale, family adaptability, and cohesion scale. Data were analyzed by descriptive statistics (frequency, percentage, mean, and standard deviation), independent t-test, ANOVA, and multiple linear regressions. The significance level was set at p < 0.05. Result The findings showed that death anxiety in parents of children and adolescents in the end stages of life has a significant inverse correlation with family adaptability and cohesion (p < 0.001, r = -0.92) and resilience (p < 0.001, r = -0.90). The variables of family adaptability and cohesion, resilience, number of children, the children's illness duration, and marital status can predict 61.34% of the death anxiety variance in these parents. Conclusion The parents of children and adolescents in end stages of life reported high death anxiety and moderate family adaptability and cohesion, but low resilience. Accordingly, pediatric nurses and healthcare policymakers should develop comprehensive support plans for these parents to facilitate their adaptation and increase their family adaptability and cohesion.
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Affiliation(s)
- Fateme Mohammadi
- Chronic Diseases (Home Care) Research Center and Autism Spectrum Disorders Research Center, Department of Nursing, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Seyedeh Zahra Masoumi
- Department of Midwifery, School of Nursing and Midwifery, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Khodayar Oshvandi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mother and Child Care Research Center, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Mostafa Bijani
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran,*Correspondence: Mostafa Bijani,
| | - Leila Nikrouz
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
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10
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Schneck E, Wolff J, Graesner JT, Hauch H. Editorial: Emergency medicine in pediatric patients with chronic diseases. Front Pediatr 2023; 11:1185636. [PMID: 37063684 PMCID: PMC10098360 DOI: 10.3389/fped.2023.1185636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 04/18/2023] Open
Affiliation(s)
- Emmanuel Schneck
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University Giessen, Giessen, Germany
- Correspondence: Emmanuel Schneck
| | - Johannes Wolff
- Department of Oncology, Cleveland Clinic, Pediatric Oncology, Cleveland, OH, United States
| | - Jan-Thorsten Graesner
- Department of Anesthesiology and Intensive Care Medicine, Institute of Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Holger Hauch
- Department of Pediatric Oncology and Hematology, Justus Liebig University Giessen, Giessen, Germany
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11
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Jaberi E, Kassai B, Berard A, Grenet G, Nguyen KA. Drug-related risk of hospital readmission in children with chronic diseases, a systematic review. Therapie 2022:S0040-5957(22)00164-0. [PMID: 36192191 DOI: 10.1016/j.therap.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/01/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Drug-related problems (DRPs) are one of the leading causes of hospital readmissions. Children with chronic diseases are more likely to experience DRPs than adults. The burden and characteristics of drug-related readmissions at and after hospital discharge in children remain unclear. OBJECTIVE We aimed to summarize the impact of DRPs at and after hospital discharge on the risk of readmissions in children with chronic diseases. METHODS We conducted a systematic review searching PubMed from inception until January 2022. Study selection criteria were studies assessing the impact of different factors at discharge and after discharge on the risk of hospital readmissions in children with chronic diseases, reporting an assessment of DRPs. DRP could be the only risk factor assessed or one among others. Included studies were assessed with the Risk of Bias in Non-Randomized Studies - of Exposure (ROBINS-E) tool. We summarized the qualitative impact of the reported DRPs on hospital readmission as conclusive (significant association) or inconclusive. RESULTS Of the 4734 studies initially identified, 13 met inclusion criteria. Eleven studies were retrospective, using electronic health records. The studies assessed the impact of DRPs at or after discharge according to the type of medication (in 6 studies), number of medication (in 5 studies) and medication nonadherence (in 2 studies). From the 44 reported associations between DRPs and the risk of readmission 26 (59% [95% CI, 43%-73%]) were conclusive, of which 81% increased the risk and 19% decreased the risk, and 17 (39% [95% CI, 24%-55%]) were inconclusive. CONCLUSION The impact of DRPs on hospital readmissions in children with chronic diseases displayed conflicting results, estimated associations having potentially a serious risk of bias. We need more evidence with a lower risk of bias.
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Chua C, Bull C, Callander EJ. Income support for parents of children with chronic conditions and disability: where do we draw the line? A policy review. Arch Dis Child 2022; 107:591-595. [PMID: 34810172 DOI: 10.1136/archdischild-2021-322663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/07/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this review was to identify and describe whether parents who have had to stop paid employment to care for a child with a chronic condition or disability are eligible for unemployment, family and children, and disability and carer government-provided financial benefits. DESIGN Policy review. SETTING Group of seven high-income countries. MAIN OUTCOME MEASURES All policies related to unemployment, family and children, and disability and carer benefits were included. Information regarding the policy type and description, parent/carer qualification, amount of financial support payable, eligibility criteria and information source were extracted. Payment schedules were converted into 2020 US dollars, using Purchasing Power Parities. Maximum monthly benefit payments were compared with standardised per capita monthly costs of living to determine payment support suitability. RESULTS Fifty-eight policies relevant to unemployment, family and children, and disability and carer benefit supports were identified. Germany had the highest number of welfare policies for individuals not in employment (n=11), followed by the USA (n=6). Parents or carers of children with chronic conditions or disability who were not in employment qualified for 31 of the 58 policies (53.4%). Most policies required a child to have an impaired ability to function, not just a chronic condition or disability. CONCLUSIONS Greater support for parents and carers to continue their paid employment alongside caring responsibilities is necessary. Graded benefit schedules will also be critical to supporting the spectrum of childhood chronic conditions and disability, and the subsequent spectrum of caring responsibility.
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Affiliation(s)
- Clara Chua
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Claudia Bull
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emily Joy Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Libuy N, Gilbert R, Mc Grath-Lone L, Blackburn R, Etoori D, Harron K. Gestational age at birth, chronic conditions and school outcomes: a population-based data linkage study of children born in England. Int J Epidemiol 2022; 52:132-143. [PMID: 35587337 PMCID: PMC9908051 DOI: 10.1093/ije/dyac105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/28/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION We aimed to generate evidence about child development measured through school attainment and provision of special educational needs (SEN) across the spectrum of gestational age, including for children born early term and >41 weeks of gestation, with and without chronic health conditions. METHODS We used a national linked dataset of hospital and education records of children born in England between 1 September 2004 and 31 August 2005. We evaluated school attainment at Key Stage 1 (KS1; age 7) and Key Stage 2 (KS2; age 11) and any SEN by age 11. We stratified analyses by chronic health conditions up to age 2, and size-for-gestation, and calculated population attributable fractions (PAF). RESULTS Of 306 717 children, 5.8% were born <37 weeks gestation and 7.0% had a chronic condition. The percentage of children not achieving the expected level at KS1 increased from 7.6% at 41 weeks, to 50.0% at 24 weeks of gestation. A similar pattern was seen at KS2. SEN ranged from 29.0% at 41 weeks to 82.6% at 24 weeks. Children born early term (37-38 weeks of gestation) had poorer outcomes than those born at 40 weeks; 3.2% of children with SEN were attributable to having a chronic condition compared with 2.0% attributable to preterm birth. CONCLUSIONS Children born with early identified chronic conditions contribute more to the burden of poor school outcomes than preterm birth. Evaluation is needed of how early health characteristics can be used to improve preparation for education, before and at entry to school.
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Affiliation(s)
- Nicolás Libuy
- Corresponding author. Centre for Longitudinal Studies, UCL Social Research Intitute, 55-59 Gordon Square, WCH1 0NU, London, UK. E-mail:
| | - Ruth Gilbert
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Ruth Blackburn
- Institute of Health Informatics, University College London, London, UK
| | - David Etoori
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Katie Harron
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Grath-Lone LM, Jay MA, Blackburn R, Gordon E, Zylbersztejn A, Wijlaars L, Gilbert R. What makes administrative data "research-ready"? A systematic review and thematic analysis of published literature. Int J Popul Data Sci 2022; 7:1718. [PMID: 35520099 PMCID: PMC9052961 DOI: 10.23889/ijpds.v6i1.1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Administrative data are a valuable research resource, but are under-utilised in the UK due to governance, technical and other barriers (e.g., the time and effort taken to gain secure data access). In recent years, there has been considerable government investment in making administrative data "research-ready", but there is no definition of what this term means. A common understanding of what constitutes research-ready administrative data is needed to establish clear principles and frameworks for their development and the realisation of their full research potential. Objective To define the characteristics of research-ready administrative data based on a systematic review and synthesis of existing literature. Methods On 29th June 2021, we systematically searched seven electronic databases for (1) peer-reviewed literature (2) related to research-ready administrative data (3) written in the English language. Following supplementary searches and snowball screening, we conducted a thematic analysis of the identified relevant literature. Results Overall, we screened 2,375 records and identified 38 relevant studies published between 2012 and 2021. Most related to administrative data from the UK and US and particularly to health data. The term research-ready was used inconsistently in the literature and there was some conflation with the concept of data being ready for statistical analysis. From the thematic analysis, we identified five defining characteristics of research-ready administrative data: (a) accessible, (b) broad, (c) curated, (d) documented and (e) enhanced for research purposes. Conclusions Our proposed characteristics of research-ready administrative data could act as a starting point to help data owners and researchers develop common principles and standards. In the more immediate term, the proposed characteristics are a useful framework for cataloguing existing research-ready administrative databases and relevant resources that can support their development.
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Affiliation(s)
| | - Matthew A. Jay
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, UK
| | - Ruth Blackburn
- Institute of Health Informatics, University College London, UK
| | - Emma Gordon
- Administrative Data Research UK, Economic & Social Research Council, UK
| | - Ania Zylbersztejn
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, UK
| | - Linda Wijlaars
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, UK
| | - Ruth Gilbert
- Institute of Health Informatics, University College London, UK
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, UK
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Punjabi N, Marszalek K, Beaney T, Shah R, Nicholls D, Deeny S, Hargreaves D. Categorising high-cost high-need children and young people. Arch Dis Child 2022; 107:346-350. [PMID: 34535444 PMCID: PMC8938672 DOI: 10.1136/archdischild-2021-321654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 08/22/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To describe the characteristics of high-cost high-need children and young people (CYP) (0-24 years) in England. METHODS Retrospective observational study using data from the Clinical Practice Research Database linked to Hospital Episode Statistics in 2014/2015 and 2015/2016. Healthcare utilisation of primary and secondary care services were calculated, and costs were estimated using Healthcare Resource Group for secondary care and Personal Social Services Research Unit for primary care. High-cost high-need CYP were defined as the top 5% of users by cost. RESULTS 3891 of 73 392 CYP made up the top 5% that were classified as high-cost high-need, and this group accounted for 54% of total annual costs. In this population, 7.3% were males <5 years and 11.0% were females 20-24 years. Inpatient care (acute) accounted for 63% of known spending in high-cost high-need patients. Total mean monthly cost per patient was 22.7 times greater in the high-cost high-need group compared with all other patients (£4417 vs £195). 29% of CYP in the high-cost high-need group in 2014/2015 were also classified as high-cost high-need in the following year. CONCLUSIONS These findings indicate the importance of further understanding and anticipating trends in CYP health spending to optimise care, reduce costs and inform new models of care. This includes integrated services, a further look into societal factors in reducing health inequalities and a particular focus of mental health services, the demand of which increases with age.
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Affiliation(s)
- Nikita Punjabi
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | | | - Thomas Beaney
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Rakhee Shah
- Community Paediatrics, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Dasha Nicholls
- Department of Brain Sciences, Imperial College London, London, UK
| | - Sarah Deeny
- Data Analytics, The Health Foundation, London, UK
| | - Dougal Hargreaves
- Department of Primary Care & Public Health, Imperial College London, London, UK
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Bond DM, Ampt A, Festa M, Teo A, Nassar N, Schell D. Factors associated with admission of children to an intensive care unit and readmission to hospital within 28 days of discharge: A population-based study. J Paediatr Child Health 2022; 58:579-587. [PMID: 34704639 DOI: 10.1111/jpc.15766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 09/12/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
AIM Hospital readmissions within 28 days are an important performance measurement of quality and safety of health care. The aims of this study were to examine the rates, trends and characteristics of paediatric intensive care unit admissions, and factors associated with readmissions to hospital within 28 days of discharge. METHODS This retrospective, population-based record linkage study included all children ≥28 days and <16 years old admitted to an intensive care unit (ICU) in a New South Wales (NSW) public hospital from 2004 to 2013. Data were sourced from the NSW Admitted Patients Data Collection and the NSW Registry of Births, Deaths and Marriages, Death Registration. RESULTS We identified 21 200 ICU admissions involving 17 130 children. Admissions increased by 24% over the study period with the greatest increase attributed to respiratory and musculoskeletal conditions. A higher proportion of children were <5 years, male, lived in major cities, were publicly insured and had chronic conditions. The median length of ICU stay was 42 h and overall hospital stay was 7 days. There were 905 deaths, two-thirds during the index admission with the leading causes being injuries, cancer and infections. Twenty-three per cent of ICU admissions were readmitted to hospital within 28 days of discharge. Associated independent factors were younger age, longer index hospital stay and emergency index admission. Children with chronic conditions of cancer and genitourinary disorders were more likely to be readmitted. CONCLUSIONS Identification of complex chronic conditions, consideration of long-term health planning and interventions intended to reduce readmission is warranted in order to reduce the burden to families and the health-care system.
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Affiliation(s)
- Diana M Bond
- Child Population Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Ampt
- Child Population Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marino Festa
- Kids Critical Care Research, Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Arthur Teo
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - David Schell
- Kids Critical Care Research, Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Borensztajn DM, Hagedoorn NN, Carrol ED, von Both U, Emonts M, van der Flier M, de Groot R, Herberg J, Kohlmaier B, Levin M, Lim E, Maconochie IK, Martinon-Torres F, Nijman RG, Pokorn M, Rivero-Calle I, Tsolia M, van der Velden FJS, Vermont C, Zavadska D, Zenz W, Zachariasse JM, Moll HA. Febrile children with comorbidities at the emergency department - a multicentre observational study. Eur J Pediatr 2022; 181:3491-3500. [PMID: 35796793 PMCID: PMC9395458 DOI: 10.1007/s00431-022-04552-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
Abstract
UNLABELLED We aimed to describe characteristics and management of children with comorbidities attending European emergency departments (EDs) with fever. MOFICHE (Management and Outcome of Fever in children in Europe) is a prospective multicentre study (12 European EDs, 8 countries). Febrile children with comorbidities were compared to those without in terms of patient characteristics, markers of disease severity, management, and diagnosis. Comorbidity was defined as a chronic underlying condition that is expected to last > 1 year. We performed multivariable logistic regression analysis, displaying adjusted odds ratios (aOR), adjusting for patient characteristics. We included 38,110 patients, of whom 5906 (16%) had comorbidities. Most common comorbidities were pulmonary, neurologic, or prematurity. Patients with comorbidities more often were ill appearing (20 versus 16%, p < 0.001), had an ED-Paediatric Early Warning Score of > 15 (22 versus 12%, p < 0.001), or a C-reactive protein > 60 mg/l (aOR 1.4 (95%CI 1.3-1.6)). They more often required life-saving interventions (aOR 2.7, 95% CI 2.2-3.3), were treated with intravenous antibiotics (aOR 2.3, 95%CI 2.1-2.5), and were admitted to the ward (aOR 2.2, 95%CI 2.1-2.4) or paediatric intensive care unit (PICU) (aOR 5.5, 95% CI 3.8-7.9). They were more often diagnosed with serious bacterial infections (aOR 1.8, 95%CI 1.7-2.0), including sepsis/meningitis (aOR 4.6, 95%CI 3.2-6.7). Children most at risk for sepsis/meningitis were children with malignancy/immunodeficiency (aOR 14.5, 8.5-24.8), while children with psychomotor delay/neurological disease were most at risk for life-saving interventions (aOR 5.3, 4.1-6.9) or PICU admission (aOR 9.7, 6.1-15.5). CONCLUSIONS Our data show how children with comorbidities are a population at risk, as they more often are diagnosed with bacterial infections and more often require PICU admission and life-saving interventions. WHAT IS KNOWN • While children with comorbidity constitute a large part of ED frequent flyers, they are often excluded from studies. WHAT IS NEW • Children with comorbidities in general are more ill upon presentation than children without comorbidities. • Children with comorbidities form a heterogeneous group; specific subgroups have an increased risk for invasive bacterial infections, while others have an increased risk of invasive interventions such as PICU admission, regardless of the cause of the fever.
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Affiliation(s)
- Dorine M. Borensztajn
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Nienke N. Hagedoorn
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Enitan D. Carrol
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK ,Department of Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK ,Liverpool Health Partners, Liverpool, UK
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany ,DZIF, German Centre for Infection Research, Partner Site Munich, Munich, Germany
| | - Marieke Emonts
- Great North Children’s Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK ,NIHR Newcastle Biomedical Research Centre Based at Newcastle Upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Michiel van der Flier
- Department of Paediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboudumc, Nijmegen, The Netherlands ,Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ronald de Groot
- Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands ,Radboud Center for Infectious Diseases, Radboudumc, 6525 GA Nijmegen The Netherlands
| | - Jethro Herberg
- Section of Paediatric Infectious Diseases, Imperial College of Science, Technology and Medicine, London, UK
| | - Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Imperial College of Science, Technology and Medicine, London, UK
| | - Emma Lim
- Great North Children’s Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ian K. Maconochie
- Section of Paediatric Infectious Diseases, Imperial College of Science, Technology and Medicine, London, UK
| | - Federico Martinon-Torres
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ruud G. Nijman
- Section of Paediatric Infectious Diseases, Imperial College of Science, Technology and Medicine, London, UK
| | - Marko Pokorn
- Department of Infectious Diseases, University Medical Centre Ljubljana, Univerzitetni Klinični Center, Ljubljana, Slovenia
| | - Irene Rivero-Calle
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Tsolia
- Second Department of Paediatrics, National and Kapodistrian University of Athens, P. and A. Kyriakou Children’s Hospital, Athens, Greece
| | - Fabian J. S. van der Velden
- Great North Children’s Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Clementien Vermont
- Department of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Dace Zavadska
- Department of Pediatrics, Children Clinical University Hospital, Rīgas Stradiņa universitāte, Riga, Latvia
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Joany M. Zachariasse
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Henriette A. Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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Digital Technologies for Children and Parents Sharing Self-Management in Childhood Chronic or Long-Term Conditions: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121203. [PMID: 34943399 PMCID: PMC8700031 DOI: 10.3390/children8121203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/24/2021] [Accepted: 12/09/2021] [Indexed: 01/20/2023]
Abstract
Worldwide, the prevalence of chronic (or long-term) conditions in children and young people from birth to 18 years (children) is increasing. Promoting competent and effective self-management skills early in the trajectory is important to improve adherence to treatment and optimise quality of life. Successful self-management, therefore, requires parents and children who are developmentally able to develop a range of complex skills, including the use of digital technologies. This scoping review aimed to identify primary research investigating digital technologies for children and parents sharing self-management in childhood chronic illnesses. A comprehensive search of electronic databases was conducted. Nineteen papers were included, assessed for quality and methodological rigour using the Hawker tool and thematically analysed. Three themes were identified: (i) the feasibility and acceptability of using technology, (ii) the usability of technologies and (iii) the effect of technologies on adherence and self-management skills. The results indicate that technologies such as mobile apps and websites can assist the management of long-term conditions, are an acceptable method of delivering information and can promote the development of effective self-management skills by parents and children. However, future technology design must include children and parents in all stages of development.
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Jarvis S, Richardson G, Flemming K, Fraser L. Estimation of age of transition from paediatric to adult healthcare for young people with long term conditions using linked routinely collected healthcare data. Int J Popul Data Sci 2021; 6:1685. [PMID: 34805553 PMCID: PMC8576739 DOI: 10.23889/ijpds.v6i1.1685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Healthcare transitions, including from paediatric to adult services, can be disruptive and cause a lack of continuity in care. Existing research on the paediatric-adult healthcare transition often uses a simple age cut-off to assign transition status. This risks misclassification bias, reducing observed changes at transition (adults are included in the paediatric group and vice versa) possibly to differing extents between groups that transition at different ages. Objective To develop and assess methods for estimating the transition point from paediatric to adult healthcare from routine healthcare records. Methods A retrospective cohort of young people (12 to 23 years) with long term conditions was constructed from linked primary and secondary care data in England. Inpatient and outpatient records were classified as paediatric or adult based on treatment and clinician specialities. Transition point was estimated using three methods based on record classification (First Adult: the date of first adult record; Last Paediatric: date of last paediatric record; Fitted: a date determined by statistical fitting). Estimated transition age was compared between methods. A simulation explored impacts of estimation approaches compared to a simple age cut-off when assessing associations between transition status and healthcare events. Results Simulations showed using an age-based cut-off at 16 or 18 years as transition point, common in research on transition, may underestimate transition-associated changes. Many health records for those aged <14 years were classified as adult, limiting utility of the First Adult approach. The Last Paediatric approach is least sensitive to this possible misclassification and may best reflect experience of the transition. Conclusions Estimating transition point from routine healthcare data is possible and offers advantages over a simple age cut-off. These methods, adapted as necessary for data from other countries, should be used to reduce risk of misclassification bias in studies of transition in nationally representative data.
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Affiliation(s)
- Stuart Jarvis
- Martin House Research Centre, Department of Health Sciences University of York, United Kingdom
| | | | - Kate Flemming
- Department of Health Sciences, University of York, United Kingdom
| | - Lorna Fraser
- Martin House Research Centre, Department of Health Sciences University of York, United Kingdom
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Wright S, Conn BM, Shahinian M, Keyllian C, Tanaka D, Iverson E. Finding MyVOICE: A Mixed-Methods Examination of Health Outcomes of Young Adults with Chronic Illness Transitioning from Pediatric to Adult Health Care. J Pediatr Health Care 2021; 35:610-620. [PMID: 34325977 DOI: 10.1016/j.pedhc.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study examines health use outcomes of young adults with chronic illness following participation in a transition program and identifies variables that impact outcomes. METHOD A sample of 119 ethnically diverse, low-income young adults (mean age = 21.8 years) was interviewed 6 months post-transition. Chi-square tests and logistic regression analyses examined the relationship between variables and outcomes. Responses to open-ended questions provided context to findings. RESULTS Primary care and insurance linkage were significantly higher for patients enrolled in a fully-formed clinic than patients enrolled early in the clinic's development. Patients with multiple diagnoses reported significantly more hospitalizations and specialty care engagement. Hospitalizations and possession of medical records differed significantly by subspecialty. Visit number predicted hospitalizations after accounting for subspecialty, but not after accounting for the number of conditions. DISCUSSION This study highlights the impact of disease type and severity on post-transition outcomes following participation in a transition program serving socially and medically complex patients.
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Masarwa R, Lefebvre C, Platt RW, Filion KB. General practitioner prescribing trends among pediatric patients in the United Kingdom: 1998-2018. Pharmacoepidemiol Drug Saf 2021; 31:302-313. [PMID: 34708900 DOI: 10.1002/pds.5377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To describe the prescribing trends of 17 therapeutic drug categories and the specific drug classes of systemic antibiotics, analgesics, and antidepressants in children and adolescents in the United Kingdom between 1998 and 2018. METHODS A population-based retrospective cohort study including children and adolescents aged 018 years. Overall and annual prescription rates per 10 000 person-years and corresponding 95% confidence intervals (CIs) were calculated. Rate ratios and 95% CIs were calculated to assess changes in prescription rates during the study period using Poisson regression. RESULTS Among 4 075 527 children and adolescents during the study period from 1998 to 2018, the prescribing rates increased by 15% for attention deficit hyperactivity disorder drugs (rate ratio: 1.15, 95% CI: 1.12-1.18), 14% for anxiolytics and hypnotics (rate ratio: 1.14, 95% CI: 1.13-1.16), and 8% for drugs for gastroesophageal reflux disease (GERD) (rate ratio: 1.08, 95% CI: 1.07-1.09). Prescribing rates decreased by 6% for cough preparations (rate ratio: 0.94, 95% CI: 0.92-0.95) and by 3% for analgesics (rate ratio: 0.97, 95% CI: 0.96-0.99). No meaningful changes were observed for systemic antibiotics (rate ratio: 1.02, 95% CI: 0.99-1.04). Among specific drug classes, prescribing rates decreased for broad-spectrum penicillins and cephalosporins, and they increased for selective serotonin reuptake inhibitors, opioids, and drugs for migraine. CONCLUSIONS Between 1998 and 2018, the prescribing of centrally acting drugs and drugs for GERD increased among pediatric patients, whereas prescribing of cough preparations and analgesics declined in this population.
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Affiliation(s)
- Reem Masarwa
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Claire Lefebvre
- Department of Pediatrics, Centre Hospitalier Universitaire Ste-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Robert W Platt
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Kristian B Filion
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Moonpanane K, Kodyee S, Potjanamart C, Purkey E. Adjusting the family's life: A grounded theory of caring for children with special healthcare needs in rural areas, Thailand. PLoS One 2021; 16:e0258664. [PMID: 34695121 PMCID: PMC8544842 DOI: 10.1371/journal.pone.0258664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/03/2021] [Indexed: 11/19/2022] Open
Abstract
This study aims to understand the experiences of families of children with special healthcare needs in rural areas in Thailand. Grounded theory (GT) was employed to understand families' experiences when caring for children with special healthcare needs (CSHCN) in rural areas. Forty-three family members from thirty-four families with CSHCN participated in in-depth interviews. Interviews were recorded and transcribed. The constant comparative method was used for data analysis and coding analysis. Adjusting family's life was the emergent theory which included experiencing negative effects, managing in home environment, integrating care into a community health system, and maintaining family normalization. This study describes the process that families undergo in trying to care for CSHCN while managing their lives to maintain a sense of normalcy. This theory provides some intervention opportunities for health care professionals when dealing with the complexities in their homes, communities and other ambulatory settings throughout the disease trajectory, and also indicates the importance of taking into consideration the family's cultural background.
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Affiliation(s)
| | - Salisa Kodyee
- School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand
| | | | - Eva Purkey
- Department of Family Medicine, Faculty of Health Science, Queen’s University, Kingston, Canada
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Burns S, Doering K, Koller D, Stratton C. School reintegration following hospitalisation for children with medical complexity and chronic disease diagnoses: a scoping review protocol. BMJ Open 2021; 11:e052493. [PMID: 34697117 PMCID: PMC8547354 DOI: 10.1136/bmjopen-2021-052493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Schools play a significant role in children's social, emotional and intellectual well-being. For children with medical complexity (CMC) and chronic disease diagnoses (CDD), an absence from school due to prolonged hospitalisation places them at risk for greater social exclusion and poorer academic outcomes than their healthy counterparts. Processes that support the school reintegration of children with complex and chronic medical conditions currently lack consistency and identified evidence-based practices. This scoping review aims to integrate the relevant literature on current reintegration procedures as well as assess stakeholders' perceived challenges related to children with CMC and CDD's return to school following hospitalisation. Finally, information will be synthesised regarding parental and child involvement in reintegration strategies. METHODS AND ANALYSIS The current scoping review follows the five-stage framework proposed by Arksey and O'Malley (2005). The search syntax will be applied in Medline, Web of Science, PsycInfo, Education Resource, ERIC, CINAHL and SocIndex. Peer-reviewed journal articles will be included without the restriction of publication year or language. However, only children and adolescents aged 4-18 with CMC and CDD, who have been out of school for 2 weeks or more and reintegrated into a non-hospital school setting will be included. Articles will be screened by two authors based on the outlined eligibility criteria. Data will be summarised qualitatively and where applicable, visualisation techniques such as tables, graphs and figures will be implemented to address approaches, strategies and outcomes related to reintegration to school following hospitalisation. ETHICS AND DISSEMINATION The current study comprises available publications and does not collect primary data. For this reason, ethics approval is not necessary. The results of this scoping review will be prepared and submitted for publication in a peer-reviewed journal and presented at future conferences to key stakeholders focusing on educational accessibility and inclusion.
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Affiliation(s)
- Samantha Burns
- Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Katie Doering
- Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Donna Koller
- Early Childhood Studies, Ryerson University, Toronto, Ontario, Canada
| | - Catherine Stratton
- Chronic Disease Epidemiology, Yale University, New Haven, Connecticut, USA
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Samal L, Fu HN, Camara DS, Wang J, Bierman AS, Dorr DA. Health information technology to improve care for people with multiple chronic conditions. Health Serv Res 2021; 56 Suppl 1:1006-1036. [PMID: 34363220 PMCID: PMC8515226 DOI: 10.1111/1475-6773.13860] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To review evidence regarding the use of Health Information Technology (health IT) interventions aimed at improving care for people living with multiple chronic conditions (PLWMCC) in order to identify critical knowledge gaps. DATA SOURCES We searched MEDLINE, CINAHL, PsycINFO, EMBASE, Compendex, and IEEE Xplore databases for studies published in English between 2010 and 2020. STUDY DESIGN We identified studies of health IT interventions for PLWMCC across three domains as follows: self-management support, care coordination, and algorithms to support clinical decision making. DATA COLLECTION/EXTRACTION METHODS Structured search queries were created and validated. Abstracts were reviewed iteratively to refine inclusion and exclusion criteria. The search was supplemented by manually searching the bibliographic sections of the included studies. The search included a forward citation search of studies nested within a clinical trial to identify the clinical trial protocol and published clinical trial results. Data were extracted independently by two reviewers. PRINCIPAL FINDINGS The search yielded 1907 articles; 44 were included. Nine randomized controlled trials (RCTs) and 35 other studies including quasi-experimental, usability, feasibility, qualitative studies, or development/validation studies of analytic models were included. Five RCTs had positive results, and the remaining four RCTs showed that the interventions had no effect. The studies address individual patient engagement and assess patient-centered outcomes such as quality of life. Few RCTs assess outcomes such as disability and none assess mortality. CONCLUSIONS Despite a growing body of literature on health IT interventions or multicomponent interventions including a health IT component for chronic disease management, current evidence for applying health IT solutions to improve care for PLWMCC is limited. The body of literature included in this review provides critical information on the state of the science as well as the many gaps that need to be filled for digital health to fulfill its promise in supporting care delivery that meets the needs of PLWMCC.
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Affiliation(s)
- Lipika Samal
- Brigham and Women's HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Helen N. Fu
- Indiana University Richard M. Fairbanks School of Public HealthIndianapolisINUSA
- Regenstrief InstituteCenter for Biomedical InformaticsIndianapolisINUSA
| | - Djibril S. Camara
- Center for Disease Control and Prevention, Center for Surveillance, Epidemiology, and Laboratory Services (CSELS) Division of Scientific Education and Professional Development, Public Health Informatics Fellowship ProgramAtlantaGeorgiaUSA
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and QualityRockvilleMDUSA
| | - Jing Wang
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and QualityRockvilleMDUSA
- Florida State University College of NursingTallahasseeFloridaUSA
- Health and Aging Policy Fellows Program at Columbia UniversityNew YorkNYUSA
| | - Arlene S. Bierman
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and QualityRockvilleMDUSA
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Sreeram II, ten Kate CA, van Rosmalen J, Schnater JM, Gischler SJ, Wijnen RMH, IJsselstijn H, Rietman AB. Patient-Reported Outcome Measures and Clinical Outcomes in Children with Foregut Anomalies. CHILDREN-BASEL 2021; 8:children8070587. [PMID: 34356566 PMCID: PMC8307606 DOI: 10.3390/children8070587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/02/2022]
Abstract
Increasing numbers of children and adults with chronic disease status highlight the need for a value-based healthcare system. Patient-reported outcome measures (PROMs) are essential to value-based healthcare, yet it remains unclear how they relate to clinical outcomes such as health and daily functioning. We aimed to assess the added value of self-reported PROMs for health status (HS) and quality of life (QoL) in the long-term follow-up of children with foregut anomalies. We evaluated data of PROMs for HS and/or QoL among eight-year-olds born with congenital diaphragmatic hernia (CDH), esophageal atresia (EA), or congenital lung malformations (CLM), collected within the infrastructure of a multidisciplinary, longitudinal follow-up program. Clinical outcomes were categorized into different outcome domains, and their relationships with self-reported HS and QoL were assessed through multivariable linear regression analyses. A total of 220 children completed HS and/or QoL self-reports. In children with CDH and EA, lower cognition was significantly associated with lower self-reported HS. Due to the low number of cases, multivariable linear regression analysis was not possible in children with CLM. HS, QoL, and clinical outcomes represent different aspects of a child’s wellbeing and should be measured simultaneously to facilitate a more holistic approach to clinical decision making.
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Affiliation(s)
- Isabel I. Sreeram
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Chantal A. ten Kate
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Centre, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands;
- Department of Epidemiology, Erasmus University Medical Centre, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Johannes M. Schnater
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Saskia J. Gischler
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - René M. H. Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - André B. Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-(0)-10-7040209
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Zambrana RE, Torres-Burgos D, Carvajal DN. Expert Perspectives on Effective Community-Based Pediatric Healthcare for Low-Income Latino Families: Persistent Issues over Time. J Racial Ethn Health Disparities 2021; 9:1051-1061. [PMID: 33942249 DOI: 10.1007/s40615-021-01044-1] [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: 02/09/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/24/2022]
Abstract
US Latinos continue to experience significant health inequity, despite fluctuating healthcare policies over the past 20 years. Recent studies highlight the importance of comprehensive care and collaboration of stakeholders in reducing inequity. Few studies examine the perspectives of community-based organization leaders, health researchers, and policy experts regarding the most effective practices in the delivery of healthcare to Latino children and families. This unique study employed a mixed-methods cross-sectional design to compare perceptions of effective practices and action strategies among two groups. Analysis of qualitative data gathered from 17 organizational leaders and 28 research/policy experts resulted in four broad themes: (1) engagement of families as participants in their healthcare; (2) provision of comprehensive, family-focused healthcare services across the lifespan; (3) engagement of ethnically competent staff to provide outreach; and (4) development of community collaborations for resource building. Respondents identified three major barriers to the provision of high-quality care: (1) inequities in social determinants; (2) ongoing changes in insurance coverage; and (3) funding challenges for the support of community-based health centers (CHCs). Although the data were collected in 2001, these thematic findings remain relevant given the persistence of inequities and the lack of progress in mitigating inequity among Latino children and families, despite evolving healthcare system changes. The study conclusions reaffirm the importance of community-driven preventive healthcare services across the life course. These community services are the frontline of healthcare for many Latino children and their families; therefore, their sustainability is crucial. The voices of organizational leaders, health research, and policy experts are important and relevant.
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Affiliation(s)
- Ruth Enid Zambrana
- Harriet Tubman Department of Women, Gender and Sexuality Studies, University of Maryland, College Park, MD, 20742, USA.
| | | | - Diana N Carvajal
- Department of Family & Community Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Barbieri-Figueiredo MDC. El cuidado de la familia del niño o joven con enfermedad crónica: un imperativo para las enfermeras. ENFERMERIA CLINICA 2021; 31:133-134. [DOI: 10.1016/j.enfcli.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
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Barratt M, Bail K, Paterson C. Children living with long-term conditions: A meta-aggregation of parental experiences of partnership nursing. J Clin Nurs 2021; 30:2611-2633. [PMID: 33829591 DOI: 10.1111/jocn.15770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 01/30/2023]
Abstract
AIM To explore how parents of children with long-term conditions experience partnership in paediatric and neonatal nursing care and to identify existing partnership barriers and facilitators. BACKGROUND Parent-nurse partnership is fundamental to paediatric and neonatal nursing. Partnership is characterised by five attributes: parental participation, negotiation, mutual trust and respect, shared roles and decision-making, and communication. Little is known about the parental experiences of partnership nursing specific to children living with a long-term condition. DESIGN A qualitative meta-aggregation review following Joanna Briggs Institute meta-aggregation approach. METHODS A comprehensive search was conducted in six electronic databases. Studies were assessed according to the inclusion and exclusion criteria. Qualitative findings with illustrative quotes from included studies were extracted and grouped into categories which informed the synthesised findings. This review has been reported according to the PRISMA guidelines. FINDINGS A total of 4,404 studies were screened, 162 full-text studies were assessed against the inclusion and exclusion criteria, and a total of six studies were included. The meta-aggregation developed three overarching synthesised findings which were as follows: (a) empowering parents to become involved, (b) effective communication to recognise mutual expertise and (c) collaborative nurse-family relationships. CONCLUSION Parents valued collaboration where both parents and nurses are recognised equally for their skills and expertise. A power struggle existed between parents and nurses when expertise was not recognised. Parents appreciated nurses who empowered them to develop new skills and knowledge in the care of their own child. RELEVANCE TO CLINICAL PRACTICE Nurses need to recognise the skills and knowledge that parents have surrounding the care requirements of their own children. Collaboration and negotiation are key to successful partnership between nurses and parents. Nurses need to frequently reflect on how they are successfully partnering with both parents and children and ensure all parties in the nurse/parent/child triad feel supported and empowered.
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Affiliation(s)
- Macey Barratt
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT, Australia
| | - Kasia Bail
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT, Australia.,Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Canberra, ACT, Australia
| | - Catherine Paterson
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT, Australia.,Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Canberra, ACT, Australia.,Prehabilitation, Activity, Cancer, Exercises and Survivorship (PACES) Research Group, University of Canberra, Bruce, ACT, Australia.,Robert Gordon University, Aberdeen, UK
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Knibb RC, Gore C. Challenges for transition from paediatric to adult services for young people with allergic conditions in the United Kingdom. Clin Exp Allergy 2021; 50:1120-1121. [PMID: 33463809 DOI: 10.1111/cea.13737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Rebecca C Knibb
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Claudia Gore
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK.,Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK
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Munambah N, Cordier R, Speyer R, Toto S, Ramugondo EL. A Systematic Review Comparing the Play Profiles of Children with Special Health Care Needs with Typically Developing Children. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9582795. [PMID: 33274233 PMCID: PMC7695500 DOI: 10.1155/2020/9582795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Although play has been used as a means to meet therapeutic goals by health care practitioners for a long time, there is a need to continuously review its conceptualisation and use in everyday practice to promote evidence-based practice. This systematic review aimed to evaluate the evidence on how the play of children with Special Health Care Needs (SHCN) is similar or different to that of typically developing children. METHODS Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, we conducted a comprehensive review across five electronic databases for all studies that compared how the play of children with SHCN was similar or different to that of typically developing children. Data were extracted from the included studies, and methodological quality was assessed. RESULTS Eighteen studies met eligibility criteria. All the studies in this review were at risk of bias due to the study design. There was great variation in sample sizes, ranging between five and 112 participants in the diagnostic groups and five and 546 participants in control groups (typically developing children). The included studies investigated different aspects of play, which made it difficult to synthesise. However, of the 18 studies reviewed, thirteen reported that children with SHCN engage in less play, compared with typically developing children. CONCLUSIONS Evidence supports the assumption that children with SHCN are less playful and spend less time engaging in play compared with typically developing children. This systematic review reveals paucity of research on play for children with several common chronic conditions such as HIV/AIDS, cancer, and cardiovascular diseases. Future studies need to reduce risks of bias, including the use of appropriate sample sizes, and must provide detailed results after investigating play in children with SHCN.
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Affiliation(s)
| | - Reinie Cordier
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Renée Speyer
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, Netherlands
- Department Special Needs Education, University of Oslo, Oslo, Norway
| | - Sivuyisiwe Toto
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Elelwani L. Ramugondo
- Department of Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, South Africa
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Uhm JY, Choi MY, Lee H. School nurses' perceptions regarding barriers and facilitators in caring for children with chronic diseases in school settings: A mixed studies review. Nurs Health Sci 2020; 22:868-880. [PMID: 33084226 DOI: 10.1111/nhs.12786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/06/2020] [Accepted: 10/18/2020] [Indexed: 12/27/2022]
Abstract
This study aimed to understand school nurses' perceptions regarding barriers to and facilitators for health care services for children with chronic diseases in school settings. Using the PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and Web of Science databases, a mixed studies review was conducted for literature published between January 2011 and June 2020. We performed a mixed-methods systematic review using a convergent integrated approach. A quality appraisal of the included studies was conducted using a mixed-methods appraisal tool. Twenty-seven articles (10 qualitative, 10 quantitative, and seven mixed-methods) that met the inclusion criteria were analyzed. Integrated findings that emerged from data synthesis were categorized into four levels (intrapersonal level, interpersonal level, institutional level, and community and public policy level) based on a socio-ecological model framework. This mixed systematic review provides a comprehensive understanding of school nurses' perceived barriers and facilitators when providing school health care for students with chronic diseases and how these barriers and facilitators interact across multiple systems. Further policies and strategies should be developed to provide effective school health services considering this study's findings.
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Affiliation(s)
- Ju-Yeon Uhm
- Department of Nursing, Pukyong National University, Busan, Republic of Korea
| | - Mi-Young Choi
- Department of Nursing Science, Chungbuk National University, Cheongju, Republic of Korea
| | - Hyojung Lee
- Department of Nursing, Gangdong University, Eumseong-gun, Republic of Korea
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Unplanned PICU Readmission in a Middle-Income Country: Who Is at Risk and What Is the Outcome? Pediatr Crit Care Med 2020; 21:e959-e966. [PMID: 32590834 DOI: 10.1097/pcc.0000000000002406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To study the rate of unplanned PICU readmission, determine the risk factors and its impact on mortality. DESIGN A single-center retrospective cross-sectional study. SETTING Tertiary referral PICU in Johor, Malaysia. PATIENTS All children admitted to the PICU over 8 years were included. Patients readmitted into PICU after the first PICU discharge during the hospitalization period were categorized into "early" (within 48 hr) and "late" (after 48 hr), and factors linked to the readmissions were identified. The mortality rate was determined and compared between no, early, and late readmission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 2,834 patients in the study with 70 early and 113 late readmissions. Therefore, the rate of early and late PICU readmission was 2.5% (95% CI, 1.9-3.0%) and 3.9% (95% CI, 3.2-4.7%), respectively. The median length of stay of the second PICU admission for early and late readmissions was 2.7 days (interquartile range, 1.1-7.0 d) and 3.2 days (interquartile range, 1.2-7.5 d), respectively. The majority of early and late readmissions had a similar diagnosis with their first PICU admission. Multivariable multinomial logistic regression revealed a Pediatric Index Mortality 2 score of greater than or equal to 15, chronic cardiovascular condition, and oxygen supplement upon discharge as independent risk factors for early PICU readmission. Meanwhile, an infant of less than 1 year old, having cardiovascular, other congenital and genetic chronic conditions and being discharged between 8 AM and 5 PM was an independent risk factor for late readmission. There was no significant difference in the mortality rate of early (12.9%), late (13.3%), and no readmission (10.7%). CONCLUSIONS Despite the lack of resources and expertise in lower- and middle-income countries, the rate and factors for PICU readmission are similar to those in high-income countries. However, PICU readmission has no statistically significant association with mortality.
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Bell J, Lingam R, Wakefield CE, Fardell JE, Zeltzer J, Hu N, Woolfenden S, Callander E, Marshall GM, Nassar N. Prevalence, hospital admissions and costs of child chronic conditions: A population-based study. J Paediatr Child Health 2020; 56:1365-1370. [PMID: 32502332 DOI: 10.1111/jpc.14932] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/23/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022]
Abstract
AIM To determine population-based prevalence, hospital use and costs for children admitted to hospital with chronic conditions. METHODS We used hospital admissions data for children aged <16 years, 2002-2013 in New South Wales, Australia. RESULTS Of all admissions, 35% (n = 692 514) included a diagnosis of a chronic condition. In 2013, prevalence was 25.1 per 1000 children. Children with greater socio-economic disadvantage or living in regional and remote areas had lower prevalence, but a higher proportion of emergency admissions. Prevalence rates were highest for respiratory and neurological conditions (9.4, 7.4 per 1000, respectively). Mental health conditions were most common in older children. Admissions involving chronic conditions had longer length of stay (3.0 vs. 1.6 days), consumed more bed-days (50% of total) and involved 43% of total hospital costs. CONCLUSION Differences in prevalence and use of hospital services suggest inequities in access and need for more appropriate and equitable models of care.
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Affiliation(s)
- Jane Bell
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Behavioural Sciences Unit, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Joanna E Fardell
- Behavioural Sciences Unit, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Justin Zeltzer
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nan Hu
- Population Child Health Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sue Woolfenden
- Population Child Health Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Community Child Health, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Emily Callander
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Glenn M Marshall
- Behavioural Sciences Unit, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Nukpezah RN, Cheraghi MA, Pashaeypoor S, Sadat Hoseini AS. Perspectives of parents on the meaning of happiness in children with long-term illness: A hybrid concept analysis. Nurs Open 2020; 7:1506-1516. [PMID: 32802371 PMCID: PMC7424432 DOI: 10.1002/nop2.532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/07/2020] [Accepted: 05/01/2020] [Indexed: 12/01/2022] Open
Abstract
Aim To define the concept of happiness among children with chronic disease. Background Happiness is an old human quest, the existing literature on the definition of happiness among children with chronic diseases is sparse. Methods The three-phase hybrid model was used. In the first (theoretical) phase, a literature review was conducted. In the second (fieldwork) phase, the semi-structured interview data were analysed through content analysis. Ten participants were purposively sampled. In the third (final analytic) phase, the practical definition of the concept was identified. Results The practical definition of happiness in a Ghanaian chronically ill child is the "subjective and positive lifelong process of adapting to biological, physiological, psychosocial, economic and environmental changes caused by the disease trajectory, which affects the well-being of the child and the family." Conclusions This study offers a background for selecting appropriate health indicators and outcome measures in promoting happiness in children with chronic diseases.
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Affiliation(s)
- Ruth Nimota Nukpezah
- Department of Pediatric Nursing, School of Nursing & MidwiferyInternational Campus ‐ Tehran University of Medical Sciences, IranTehranIran
| | - Mohammad Ali Cheraghi
- Research Center for Quran, Hadith, and Medicine, Spiritual Health GroupTehran University of Medical SciencesTehranIran
| | - Shahzad Pashaeypoor
- Department of Community Health and Geriatric NursingSchool of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Akram Sadat Sadat Hoseini
- Department of Pediatric NursingSchool of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
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Larson MR, Latendresse SJ, Teasdale A, Limbers CA. The Pediatric Inventory for Parents: Development of a short-form in fathers of children with type 1 diabetes (T1D). Child Care Health Dev 2020; 46:468-484. [PMID: 32297367 DOI: 10.1111/cch.12769] [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] [Received: 10/11/2019] [Revised: 02/17/2020] [Accepted: 03/05/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Pediatric Inventory for Parents (PIP) is a 42-item measure of paediatric parenting stress that results in 84 responses. Although this measure has been extensively validated, the number of items in the instrument may hinder clinical applicability. METHODS The current study reports on the development of a short-form of the PIP using data from 344 fathers of children with type 1 diabetes. Recommendations for short-form development as well as item response theory (IRT) were used to construct a 13-item PIP Short-Form that results in 26 responses. RESULTS The retained items were chosen to reflect the content domains of the original form of the PIP and demonstrated acceptable item fit under the partial credit model (PCM; Infit and Outfit indices closest to one and items with thresholds across the span of the latent trait). CONCLUSIONS The PIP Short-Form may allow health care professionals to more feasibly assess paediatric parenting stress among parents of children with chronic health conditions. Future studies are needed to validate this new short-form.
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Affiliation(s)
- Madeline R Larson
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | | | - Ashley Teasdale
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.,Texas Children's Hospital, Houston, TX, USA
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Azar R, Doucet S, Horsman AR, Charlton P, Luke A, Nagel DA, Hyndman N, Montelpare WJ. A concept analysis of children with complex health conditions: implications for research and practice. BMC Pediatr 2020; 20:251. [PMID: 32456672 PMCID: PMC7248453 DOI: 10.1186/s12887-020-02161-2] [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: 08/01/2019] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background This concept analysis aimed to clarify the meaning of “children with complex health conditions” and endorse a definition to inform future research, policy, and practice. Methods Using Walker and Avant’s (2011)‘s approach, we refined the search strategy with input from our team, including family representatives. We reviewed the published and grey literature. We also interviewed 84 health, social, and educational stakeholders involved in the care of children with complex health conditions about their use/understanding of the concept. Results We provided model, borderline, related, and contrary cases for clarification purposes. We identified defining attributes that nuance the concept: (1) conditions and needs’ breadth; (2) uniqueness of each child/condition; (3) varying extent of severity over time; 4) developmental age; and (5) uniqueness of each family/context. Antecedents were chronic physical, mental, developmental, and/or behavioural condition(s). There were individual, family, and system consequences, including fragmented services. Conclusions Building on previous definitions, we proposed an iteration that acknowledges the conditions’ changing trajectories as involving one or more chronic condition(s), regardless of type(s), whose trajectories can change over time, requiring services across sectors/settings, oftentimes resulting in a lower quality of life. A strength of this paper is the integration of the stakeholders’/family’s voices into the development of the definition.
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Affiliation(s)
- Rima Azar
- Psychobiology of Stress and Health Lab, Psychology Department, Mount Allison University, 49A York Street, Sackville, NB, E4L 1C7, Canada. .,NaviCare/SoinsNavi, Sackville, Canada.
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, PO Box 5050, Saint John, NB, E2L 4L5, Canada
| | - Amanda Rose Horsman
- Interdisciplinary Studies, School of Graduate Studies, University of New Brunswick, 100 Tucker Park Rd, Box 5050, Saint John, NB, E2L 4L5, Canada
| | - Patricia Charlton
- Faculty of Nursing, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, PO Box 5050, Saint John, NB, E2L 4L5, Canada
| | - Daniel A Nagel
- Department of Nursing and Health Sciences, University of New Brunswick, PO Box 5050, Saint John, NB, E2L 4L5, Canada
| | - Nicky Hyndman
- Veterans Affairs Canada, PO Box 7700, Charlottetown, PE, C1A 8M9, Canada
| | - William J Montelpare
- Faculty of Science, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
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Coffey MJ, McKay IR, Doumit M, Chuang S, Adams S, Stelzer-Braid S, Waters SA, Kasparian NA, Thomas T, Jaffe A, Katz T, Ooi CY. Evaluating the Alimentary and Respiratory Tracts in Health and disease (EARTH) research programme: a protocol for prospective, longitudinal, controlled, observational studies in children with chronic disease at an Australian tertiary paediatric hospital. BMJ Open 2020; 10:e033916. [PMID: 32295774 PMCID: PMC7200033 DOI: 10.1136/bmjopen-2019-033916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/08/2020] [Accepted: 03/24/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Chronic gastrointestinal and respiratory conditions of childhood can have long-lasting physical, psychosocial and economic effects on children and their families. Alterations in diet and intestinal and respiratory microbiomes may have important implications for physical and psychosocial health. Diet influences the intestinal microbiome and should be considered when exploring disease-specific alterations. The concepts of gut-brain and gut-lung axes provide novel perspectives for examining chronic childhood disease(s). We established the 'Evaluating the Alimentary and Respiratory Tracts in Health and disease' (EARTH) research programme to provide a structured, holistic evaluation of children with chronic gastrointestinal and/or respiratory conditions. METHODS AND ANALYSIS The EARTH programme provides a framework for a series of prospective, longitudinal, controlled, observational studies (comprised of individual substudies), conducted at an Australian tertiary paediatric hospital (the methodology is applicable to other settings). Children with a chronic gastrointestinal and/or respiratory condition will be compared with age and gender matched healthy controls (HC) across a 12-month period. The following will be collected at baseline, 6 and 12 months: (i) stool, (ii) oropharyngeal swab/sputum, (iii) semi-quantitative food frequency questionnaire, (iv) details of disease symptomatology, (v) health-related quality of life and (vi) psychosocial factors. Data on the intestinal and respiratory microbiomes and diet will be compared between children with a condition and HC. Correlations between dietary intake (energy, macro-nutrients and micro-nutrients), intestinal and respiratory microbiomes within each group will be explored. Data on disease symptomatology, quality of life and psychosocial factors will be compared between condition and HC cohorts.Results will be hypothesis-generating and direct future focussed studies. There is future potential for direct translation into clinical care, as diet is a highly modifiable factor. ETHICS AND DISSEMINATION Ethics approval: Sydney Children's Hospitals Network Human Research Ethics Committee (HREC/18/SCHN/26). Results will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04071314.
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Affiliation(s)
- Michael J Coffey
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Isabelle R McKay
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Doumit
- Department of Physiotherapy, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
| | - Sandra Chuang
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
| | - Susan Adams
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Surgery, Sydney Children's Hospital Randwick & Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Sacha Stelzer-Braid
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Shafagh A Waters
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Molecular and Integrative Cystic Fibrosis (miCF) Research Centre®, Sydney, New South Wales, Australia
| | - Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Cincinnati Children's Center for Heart Disease and the Developing Mind, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center & Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Torsten Thomas
- Centre for Marine Science and Innovation, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Molecular and Integrative Cystic Fibrosis (miCF) Research Centre & Department of Respiratory, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Tamarah Katz
- Department of Nutrition and Dietetics, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
| | - Chee Y Ooi
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Molecular and Integrative Cystic Fibrosis (miCF) Research Centre & Department of Respiratory, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
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Bossen D, Broekema A, Visser B, Brons A, Timmerman A, van Etten-Jamaludin F, Braam K, Engelbert R. Effectiveness of Serious Games to Increase Physical Activity in Children With a Chronic Disease: Systematic Review With Meta-Analysis. J Med Internet Res 2020; 22:e14549. [PMID: 32234697 PMCID: PMC7160705 DOI: 10.2196/14549] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 11/21/2019] [Accepted: 01/27/2020] [Indexed: 12/18/2022] Open
Abstract
Background Physical activity (PA) is important for children with a chronic disease. Serious games may be useful to promote PA levels among these children. Objective The primary purpose of this systematic review was to evaluate the effectiveness of serious games on PA levels in children with a chronic disease. Methods PubMed, EMBASE, PsycINFO, ERIC, Cochrane Library, and CINAHL were systematically searched for articles published from January 1990 to May 2018. Both randomized controlled trials and controlled clinical trials were included to examine the effects of serious games on PA levels in children with a chronic disease. Two investigators independently assessed the intervention, methods, and methodological quality in all articles using the Cochrane risk of bias tool. Both qualitative and quantitative analyses were performed. Results This systematic review included 9 randomized controlled trials (886 participants). In 2 of the studies, significant between-group differences in PA levels in favor of the intervention group were reported. The meta-analysis on PA levels showed a nonsignificant effect on moderate to vigorous PA (measured in minutes per day) between the intervention and control groups (standardized mean difference 0.30, 95% CI –0.15 to 0.75, P=.19). The analysis of body composition resulted in significantly greater reductions in BMI in the intervention group (standardized mean difference –0.24, 95% CI –0.45 to 0.04, P=.02). Conclusions This review does not support the hypothesis that serious games improve PA levels in children with a chronic disease. The meta-analysis on body composition showed positive intervention effects with significantly greater reductions in BMI in favor of the intervention group. A high percentage of nonuse was identified in the study of serious games, and little attention was paid to behavior change theories and specific theoretical approaches to enhance PA in serious games. Small sample sizes, large variability between intervention designs, and limited details about the interventions were the main limitations. Future research should determine which strategies enhance the effectiveness of serious games, possibly by incorporating behavior change techniques.
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Affiliation(s)
- Daniël Bossen
- ACHIEVE Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Aline Broekema
- ACHIEVE Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Bart Visser
- ACHIEVE Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Annette Brons
- Digital Life Centre, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | | | | | - Katja Braam
- ACHIEVE Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Raoul Engelbert
- ACHIEVE Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam University Medical Center, Rehabilitation, University of Amsterdam, Amsterdam, Netherlands.,Amsterdam University Medical Center, Pediatrics, University of Amsterdam, Amsterdam, Netherlands
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40
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Children With Complex Chronic Conditions: A Multifaceted Contemporary Medical Challenge Not Restricted to PICUs. Pediatr Crit Care Med 2020; 21:298-299. [PMID: 32142032 DOI: 10.1097/pcc.0000000000002228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mansfield KL, Gallacher JE, Mourby M, Fazel M. Five models for child and adolescent data linkage in the UK: a review of existing and proposed methods. EVIDENCE-BASED MENTAL HEALTH 2020; 23:39-44. [PMID: 32046992 PMCID: PMC7034351 DOI: 10.1136/ebmental-2019-300140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 01/10/2023]
Abstract
Over the last decade dramatic advances have been made in both the technology and data available to better understand the multifactorial influences on child and adolescent health and development. This paper seeks to clarify methods that can be used to link information from health, education, social care and research datasets. Linking these different types of data can facilitate epidemiological research that investigates mental health from the population to the patient; enabling advanced analytics to better identify, conceptualise and address child and adolescent needs. The majority of adolescent mental health research is not able to maximise the full potential of data linkage, primarily due to four key challenges: confidentiality, sampling, matching and scalability. By presenting five existing and proposed models for linking adolescent data in relation to these challenges, this paper aims to facilitate the clinical benefits that will be derived from effective integration of available data in understanding, preventing and treating mental disorders.
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Affiliation(s)
- Karen Laura Mansfield
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Miranda Mourby
- Centre for Health, Law and Emerging Technologies (HeLEX), Faculty of Law, University of Oxford, Oxford, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
- Children's Psychological Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Zylbersztejn A, Verfürden M, Hardelid P, Gilbert R, Wijlaars L. Phenotyping congenital anomalies in administrative hospital records. Paediatr Perinat Epidemiol 2020; 34:21-28. [PMID: 31960476 PMCID: PMC7003968 DOI: 10.1111/ppe.12627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/27/2019] [Accepted: 11/07/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Congenital anomalies are a major cause of co-morbidity in children. Diagnostic code lists are increasingly used to identify congenital anomalies in administrative health records. Evidence is lacking on comparability of these code lists. OBJECTIVES To compare prevalence of congenital anomalies and prognostic outcomes for children with congenital anomalies identified in administrative health records using three different code lists. METHODS We developed national cohorts of singleton livebirths in England (n = 7 354 363, 2003-2014) and Scotland (n = 493 556, 2003-2011). Children with congenital anomalies were identified if congenital anomaly diagnosis was recorded at birth, during subsequent hospital admission or as cause of death before 2 years old. We used three code lists: the EUROCAT list for congenital anomaly surveillance in Europe; the Hardelid list developed to identify children with chronic conditions (including congenital anomalies) admitted to hospital in England; and the Feudtner list developed to indicate children with complex chronic conditions (including congenital anomalies) admitted to hospitals in the United States. We compared prevalence, and risks of postnatal hospital readmission and death according to each code list in England and Scotland. RESULTS Prevalence of congenital anomalies was highest using the EUROCAT list (4.1% of livebirths in England, 3.7% in Scotland), followed by Hardelid (3.1% and 3.0% of livebirths, respectively) and Feudtner (1.8% and 1.5% of livebirths, respectively). 67.2%-73.3% of children with congenital anomalies in England and 65.2%-77.0% in Scotland had at least one postnatal hospital admission across the three code lists; mortality ranged between 42.6-75.4 and 41.5-88.7 deaths per 1000 births in England Scotland, respectively. The risk of these adverse outcomes was highest using Feudtner and lowest using EUROCAT code lists. CONCLUSIONS The prevalence of congenital anomalies varied by congenital anomaly code list, over time and between countries, reflecting in part differences in hospital coding practices and admission thresholds. As a minimum, researchers using administrative health data to study congenital anomalies should report sensitivity analyses using different code lists.
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Affiliation(s)
- Ania Zylbersztejn
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
- Children and Families Policy Research UnitUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Maximiliane Verfürden
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
- Children and Families Policy Research UnitUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Pia Hardelid
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
- Children and Families Policy Research UnitUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Ruth Gilbert
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
- Children and Families Policy Research UnitUCL Great Ormond Street Institute of Child HealthLondonUK
- Health Data Research UK LondonUCLLondonUK
| | - Linda Wijlaars
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
- Children and Families Policy Research UnitUCL Great Ormond Street Institute of Child HealthLondonUK
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Tseng JJ, Lin CH, Lin MC. Long-Term Outcomes of Pediatric Enterovirus Infection in Taiwan: A Population-Based Cohort Study. Front Pediatr 2020; 8:285. [PMID: 32596191 PMCID: PMC7303813 DOI: 10.3389/fped.2020.00285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/06/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction: The major burden of diseases in childhood has shifted from infectious diseases to chronic health conditions in recent decades. Although the rates of infectious diseases have decreased, the incidence of chronic diseases stemming from infectious agents continues to grow. Enterovirus is a major infectious disease of childhood and has been linked to numerous chronic diseases. We analyzed population-based data from Taiwan's National Health Insurance Research Database (NHIRD) to investigate the correlations between enterovirus infection and major chronic health conditions in children. Method: Children diagnosed with enterovirus (EV) infection during 1999-2003 were identified from the Longitudinal Health Insurance Database 2000 (LHID 2000), a subdataset of Taiwan's National Health Insurance Research Database (NHIRD). A total of 14,168 patients were selected after excluding patients with existing chronic diseases and missing data. Another 14,168 children matched by age and sex were selected as the control group. Five primary outcomes, including attention deficit and hyperactivity disorder (ADHD), epilepsy, asthma, allergic rhinitis, and atopic dermatitis, were recorded. Results: The risks of ADHD, asthma, allergic rhinitis, and epilepsy were significantly increased in the EV group compared with the control group. The risk of atopic dermatitis was significantly increased in the crude model. However, there were no significant differences in the adjusted model. The risks of ADHD, asthma, allergic rhinitis, and epilepsy were also significantly increased in patients with severe EV infection compared with patients with non-severe EV infection. Conclusion: Chronic diseases, such as ADHD, epilepsy, asthma, allergic rhinitis, and atopic dermatitis were shown to be associated with enterovirus infection during childhood. EV infection during early childhood might have long-term public health implications and thus prevention strategies should be implemented.
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Affiliation(s)
- Jui-Ju Tseng
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Chih Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Food and Nutrition, Providence University, Taichung, Taiwan
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44
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Bele S, Chugh A, Mohamed B, Teela L, Haverman L, Santana MJ. Patient-Reported Outcome Measures in Routine Pediatric Clinical Care: A Systematic Review. Front Pediatr 2020; 8:364. [PMID: 32850521 PMCID: PMC7399166 DOI: 10.3389/fped.2020.00364] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/01/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction: Integration of patient-reported outcome measures (PROMs) in routine clinical care is growing but lacks consolidated evidence around its impact on pediatric care. This systematic review aims to evaluate the impact of integrating PROMs in routine pediatric clinical care on various outcomes in pediatric clinical care. Data Sources: MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane Library. Web of Science database was searched selectively to ensure extended coverage. Study Selection: We included longitudinal studies reporting on the integration of PROMs in routine pediatric clinical care of chronic diseases. Studies in languages other than English, published prior to the year 2000, and reporting on secondary data were excluded. Data Extraction: Two reviewers independently extracted data from included studies. Extracted data included citation of each study, type of healthcare setting, location of the study, characteristics of patient population, type of chronic disease, name and type of PROM, mode of administration, and reported outcomes. Results: Out of 6,869 articles, titles and abstracts of 5,416 articles and full text of 23 articles were screened in duplicate. Seven articles reporting results from six studies met eligibility criteria. Integration of PROMs increased the identification and discussion around health-related quality of life (HRQOL), especially in psychosocial and emotional domains, but showed mixed results with the impact on quality of care. No studies assessed the impact of integrating PROMs on healthcare utilization. Limitations: Due to significant heterogeneity in the studies, a meta-analysis was not conducted. Conclusions: Integrating PROMs could have a positive impact on HRQOL; however, further studies are required to determine the impact of PROMs in routine pediatric clinical care.
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Affiliation(s)
- Sumedh Bele
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Postgraduate Medical Education, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Ashton Chugh
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bijan Mohamed
- School of Physical Therapy, Western University, London, ON, Canada
| | - Lorynn Teela
- Psychosocial Department, Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Lotte Haverman
- Psychosocial Department, Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Maria J Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Ma V, Palasanthiran P, Seale H. Exploring strategies to promote influenza vaccination of children with medical comorbidities: the perceptions and practices of hospital healthcare workers. BMC Health Serv Res 2019; 19:911. [PMID: 31783856 PMCID: PMC6883556 DOI: 10.1186/s12913-019-4742-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore how the influenza vaccine is promoted and delivered to children with medical comorbidities in the hospital setting, as well as the facilitators of and barriers to vaccination from the healthcare worker perspective. METHODS Semi-structured interviews were conducted with staff members (n = 17) at a paediatric hospital in Sydney, Australia between April and July 2018. This included nurses, clinical nurse consultants, pediatricians and department heads. The interviews were transcribed and analysed iteratively to generate the major themes. RESULTS Approaches used to promote and/or deliver the influenza vaccine varied among the participants. Some described the vaccine as an ingrained component of their clinical consultation. Others acknowledged that there was missed opportunities to discuss or provide the vaccine, citing competing priorities as well as a lack of awareness, time and resources. Participants perceived that some parents had concerns about safety and appropriateness of the vaccine for their child. While there was some support for sending reminders and/or educating patients through the hospital, there were differing perspectives on whether tertiary centres should be delivering the vaccine. CONCLUSION Hospital-based interventions to increase vaccine uptake must consider the needs of staff. Easily accessible information and increased awareness of the recommendations among staff may lead to improved uptake in this hospital. Additional resources would be required to increase on-site delivery of the vaccine.
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Affiliation(s)
- Vanessa Ma
- Undergraduate Medicine Program, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Pamela Palasanthiran
- Sydney Children's Hospitals Network, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
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Brenner M, O'Shea MP, Larkin P, Luzi D, Pecoraro F, Tamburis O, Berry J, Alexander D, Rigby M, Blair M. Management and integration of care for children living with complex care needs at the acute-community interface in Europe. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 2:822-831. [PMID: 30336896 DOI: 10.1016/s2352-4642(18)30272-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 01/10/2023]
Abstract
With improvements in neonatal and paediatric care, more children living with complex care needs are surviving beyond infancy into late childhood and adulthood than in the past. We examined the current approach to the management and integration of care of children living with complex care needs in 30 European countries, as well as the implications for primary care service delivery. This descriptive study, with an embedded qualitative aspect, consisted of questions adapted from the Standards for Systems of Care for Children and Youth with Special Health Care Needs, and included questions on a complex care European survey of change, adapted from the Eurobarometer survey. The analysis indicates that few systems are in place in countries across Europe to identify all the health-care providers who deliver care to a child living with complex care needs, and that less than half of all countries surveyed have policies in place to support care coordination for these children. Primary care physicians have little involvement in care planning for children before their discharge to the community setting, and there is little parental participation in policy development. Access to, and governance of, care for these children varies widely. Particular issues identified pertain to parents as catalysts of optimum integration of care, pathways to specialist care, and the need for comprehensive national integrated care programmes.
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Affiliation(s)
- Maria Brenner
- School of Nursing & Midwifery, Trinity College Dublin, University of Dublin, Dublin, Ireland.
| | - Miriam P O'Shea
- School of Nursing & Midwifery, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Philip Larkin
- Lausanne University Medical Centre, Lausanne, Switzerland
| | - Daniela Luzi
- Institute for Research on Population and Social Policies, Italian National Research Council, Rome, Italy
| | - Fabrizio Pecoraro
- Institute for Research on Population and Social Policies, Italian National Research Council, Rome, Italy
| | - Oscar Tamburis
- Institute for Research on Population and Social Policies, Italian National Research Council, Rome, Italy
| | - Jay Berry
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Denise Alexander
- Imperial College of Science, Technology, and Medicine, London, UK
| | - Michael Rigby
- Section of Paediatrics, Faculty of Medicine, Imperial College of Science, Technology, and Medicine, London, UK
| | - Mitch Blair
- Section of Paediatrics, Faculty of Medicine, Imperial College of Science, Technology, and Medicine, London, UK
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47
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Fuengfoo A, Leelathanaporn S, Mekrungcharas T, Sakulnoom K, Owjinda S, Noipong P, Srinuan S, Kumjaroen S, Phonok N. Effectiveness of the Hospital Learning Center (Queen Sirikit National Institute of Child Health): Satisfaction with service and parents' attitudes towards children's illness. F1000Res 2019; 8:1616. [PMID: 32477495 PMCID: PMC7218477 DOI: 10.12688/f1000research.18846.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2019] [Indexed: 12/01/2022] Open
Abstract
Background: All children, whether healthy or ill, should have access to equal educational opportunities. Healthcare institutions and hospitals have been approved to work with schools to establish learning centers to provide education to sick children. This study has been conducted to develop a practical model for learning centers in hospitals across Thailand to create equality and ensure valuable human resources for the future. The main goal of this study was to evaluate the effectiveness of a hospital learning center for continuing education of child patients and to determine the factors that are most appropriate study plans, the parents' attitude about their child's illness, and the children's satisfaction with the learning center. Methods: The total sample population was 400, consisting of 200 parents and 200 child patients aged 4 to 18 years. The respondents were given a questionnaire to obtain their feedback using a Likert scale. Results: The most common child patients were those with chronic illness followed by those with common illnesses, and lastly children with developmental problems. All 200 children received continuing education; 20 child patients (10%) who had been evaluated received a modified education plan. After analyzing the results of satisfaction with the learning center, the scores ranged from 4.21 to 5.00 (mean = 4.28, SD = 0.62). Conclusions: Sick children can continue their education at the hospital learning center in Queen Sirikit National Institute of Child Health. Study plans can be modified to suit children with chronic illnesses and developmental problems, children in primary and secondary school, and those requiring prolonged hospitalization. Parents in the study had appropriate attitudes about the disease and education of their children. Sick children gave the highest ratings showing extremely high satisfaction with the hospital learning center.
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Affiliation(s)
- Adidsuda Fuengfoo
- Pediatric Department, Queen Sirikit National Institute of Child Health, Bangkok, 10400, Thailand
| | - Sija Leelathanaporn
- Pediatric Department, Queen Sirikit National Institute of Child Health, Bangkok, 10400, Thailand
| | - Thanyaporn Mekrungcharas
- Pediatric Department, Queen Sirikit National Institute of Child Health, Bangkok, 10400, Thailand
| | - Kim Sakulnoom
- Pediatric Department, Queen Sirikit National Institute of Child Health, Bangkok, 10400, Thailand
| | - Sumitra Owjinda
- Pediatric Department, Queen Sirikit National Institute of Child Health, Bangkok, 10400, Thailand
| | - Piyanat Noipong
- Pediatric Department, Queen Sirikit National Institute of Child Health, Bangkok, 10400, Thailand
| | - Suphawan Srinuan
- Pediatric Department, Queen Sirikit National Institute of Child Health, Bangkok, 10400, Thailand
| | - Sarunya Kumjaroen
- Pediatric Department, Queen Sirikit National Institute of Child Health, Bangkok, 10400, Thailand
| | - Natchanan Phonok
- Pediatric Department, Queen Sirikit National Institute of Child Health, Bangkok, 10400, Thailand
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48
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McKeown A, Cliffe C, Arora A, Griffin A. Ethical challenges of integration across primary and secondary care: a qualitative and normative analysis. BMC Med Ethics 2019; 20:42. [PMID: 31269930 PMCID: PMC6610833 DOI: 10.1186/s12910-019-0386-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/26/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This paper explores ethical concerns arising in healthcare integration. We argue that integration is necessary imperative for meeting contemporary and future healthcare challenges, a far stronger evidence base for the conditions of its effectiveness is required. In particular, given the increasing emphasis at the policy level for the entire healthcare infrastructure to become better integrated, our analysis of the ethical challenges that follow from the logic of integration itself is timely and important and has hitherto received insufficient attention. METHODS We evaluated an educational intervention which aims to improve child health outcomes by making transitions between primary to secondary care more efficient, ensuring children and parents are better supported throughout. The programme provided skills for trainee paediatricians and general practitioners (GPs) in co-designing integrated clinical services. RESULTS The key ethical challenges of integrated care that arose from a clinical perspective are: professional identity and autonomy in an integrated working environment; the concomitant extent of professional responsibility in such an environment; and the urgent need for more evidence to be produced on which strategies for integrating at scale can be based. CONCLUSIONS From our analysis we suggest a tentative way forward, viewed from a normative position broadly situated at the intersection of deontology and care ethics. We adopt this position because the primary clinical ethical issues in the context of integrated care concern: how to ensure that all duties of care to individual patients are met in a newly orientated working environment where clinical responsibility may be ambiguous; and the need to orientate care around the patient by foregrounding their autonomous preferences and ensuring good patient clinician relationships in clinical decision-making.
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Affiliation(s)
- Alex McKeown
- Department of Psychiatry, University of Oxford, Warneford Lane, Oxford, OX3 7JX, England
| | - Charlotte Cliffe
- University College London Medical School, 74 Huntley Street, London, WC1E 6AU, England
| | - Arun Arora
- University of Manchester Medical School, Oxford Road, Manchester, M13 9PL, UK
| | - Ann Griffin
- Research Department for Medical Education, University College London Medical School, 74 Huntley Street, London, WC1E 6AU, England.
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Schraeder K, Nettel-Aguirre A, Mackie A, Barrett O, Johnson DW, Ryan AR, Dimitropoulos G, Samuel S. Identifying a retrospective cohort of adolescents with chronic health conditions from a paediatric hospital prior to transfer to adult care: the Calgary Transition Cohort. BMJ Open 2019; 9:e027045. [PMID: 31061046 PMCID: PMC6501955 DOI: 10.1136/bmjopen-2018-027045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The Calgary Transition Cohort was created to examine health service utilisation by adolescents affected by chronic health conditions seen in a tertiary paediatric hospital in the province of Alberta, Canada. The cohort includes adolescents who received care before the implementation of a hospital-wide intervention to improve transitions to adult care. PARTICIPANTS Using hospital records, a stepwise methodology involving a series of algorithms based on adolescents' visit frequency to a hospital ambulatory chronic care clinic (CCC) was used to identify the cohort. A visit frequency of ≥4 visits in any 24-month window, during the ages of 12-17 years old, was used to identify eligible adolescents, as agreed on by key stakeholders and chronic disease clinical providers, and reflects the usual practice at the hospital for routine care of children with chronic disease. FINDINGS TO DATE Adolescents with ≥4 visits to the same CCC in any 2-year period (n=1344) with a median of 8.7 years of follow-up data collected (range 1.4-9.1). The median age at study entry was 14 years (range 12-17) and 22 years (range 14-24) at study exit. The cohort was linked (97% successful match proportion) to their population-level health records that allowed for examination of occurrence of chronic disease codes in health utilisation encounters (ie, physician claims, hospital admissions and emergency room visits). At least one encounter with a chronic disease code (International Classification of Diseases, 9th/10th Revisions) was observed during the entire study window in 87.9% of the cohort. FUTURE PLANS The Calgary Transition Cohort will be used to address existing knowledge gaps about health service utilisation by adolescents, seen at a tertiary care hospital, affected by a broad group of chronic health conditions. These adolescents will require transition to adult-oriented care. Longitudinal analysis of health service use patterns over a 9-year window (2008-2016) will be conducted.
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Affiliation(s)
- Kyleigh Schraeder
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Andrew Mackie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - David W Johnson
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | | | | | - Susan Samuel
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Al-Yateem N, Brenner M, Alrimawi I, Al-Shujairi A, Al-Yateem S. Predictors of uncertainty in parents of children living with chronic conditions. Nurs Child Young People 2019:e1102. [PMID: 31468904 DOI: 10.7748/ncyp.2019.e1102] [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: 08/08/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Uncertainty in illness implies no meaning has been attributed to an illness event. Although many studies focus on this issue in adults, there is limited research into children with chronic illnesses. Parental uncertainty has been associated with increased risk of post-traumatic stress, which can in turn adversely affect child and parent coping strategies. AIM To identify the characteristics of parents who are at greater risk of uncertainty and the associated characteristics of their children's chronic illnesses. METHOD An exploratory, cross-sectional study design was adopted across three different sites in the United Arab Emirates. Data were collected from parents who accompanied their children, who were receiving treatment, using a validated, culturally adapted Parent Perception of Uncertainty Scale. RESULTS Scores for illness uncertainty ranged from 86.5 to 92.6, on a scale of 31-155, with higher scores indicating greater uncertainty. The highest scores were found in parents of children being cared for in ward settings who had previously been hospitalised, parents of children up to two years of age or those approaching adolescence, fathers, and parents whose first language was Arabic. CONCLUSION The groups of parents with the highest illness uncertainty may benefit most from interventions to improve communication and psychological support.
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Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates, adjunct lecturer and researcher, School of Nursing, Midwifery and Indigenous Health, Faculty of Science, Charles Sturt University and Research Institute for Medical and Health Science, University of Sharjah, United Arab Emirates
| | - Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | | | - Arwa Al-Shujairi
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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