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Puntoni M, Maglietta G, Caminiti C, Miniaci A, Lanari M, Caramelli F, Marchetti F, De Fanti A, Iughetti L, Biasucci G, Suppiej A, Miceli A, Ghizzi C, Vergine G, Aricò M, Stella M, Esposito S. Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric emergency department use: a quasi-experimental study interrupted time-series analysis in North Italian hospitals, 2017 to 2022. Front Public Health 2024; 12:1439078. [PMID: 39145166 PMCID: PMC11322479 DOI: 10.3389/fpubh.2024.1439078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
Background The use of Non-Pharmaceutical Interventions (NPIs) during the COVID-19 pandemic is debated. Understanding the consequences these measures may have on vulnerable populations including children and adolescents is important. Methods This is a multicenter, quasi-experimental before-after study involving 12 hospitals of the North Italian Emilia-Romagna Region, with NPI implementation as the intervention event. The 3 years preceding NPI implementation (in March 2020) constituted the pre-pandemic phase. The subsequent 2 years were further subdivided into a school closure phase (SC) and a subsequent mitigation measures phase (MM) with milder restrictions. Interrupted Time Series (ITS) regression analysis was used to calculate PED Standardized Incidence Rate Ratios (SIRR) on the diagnostic categories exhibiting the greatest frequency and/or variation. Results In the 60 months of the study there were 765,215 PED visits. Compared to the pre-pandemic rate, overall PED presentations dropped by 58 and 39% during SC and MM, respectively. "Symptoms, signs and Ill-defined conditions," "Injury and poisoning" and "Diseases of the Respiratory System" accounted for 74% of the reduction. A different pattern was instead seen for "Mental Disorders," which exhibited the smallest decrease during SC, and is the only category which rose already at the end of SC. ITS analysis confirmed the strong decrease during SC (level change, IRR 0.17, 95%CI 0.12-0.27) and a significant increase in MM (slope change, IRR 1.23, 95%CI 1.13-1.33), with the sharpest decline (-94%) and rise (+36%) observed in the "Diseases of the Respiratory System" category. Mental Disorders showed a significant increasing trend of 1% monthly over the whole study period exceeding pre-pandemic levels at the end of MM. Females and adolescents showed higher increasing rates both in SC and MM. Conclusion NPIs appear to have influenced PED attendance in different ways according to diagnostic categories, mirroring different mechanisms of action. These effects are beneficial in some cases and harmful in others, and establishing a clear balance between pros and cons is a difficult task for public health decision makers. The role of NPIs on PED use appropriateness deserves investigation. The rise in pediatric mental disorders independent of the pandemic makes interventions addressing these issues urgent.
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Affiliation(s)
- Matteo Puntoni
- Clinical and Epidemiological Research Unit, University-Hospital of Parma, Parma, Italy
| | - Giuseppe Maglietta
- Clinical and Epidemiological Research Unit, University-Hospital of Parma, Parma, Italy
| | - Caterina Caminiti
- Clinical and Epidemiological Research Unit, University-Hospital of Parma, Parma, Italy
| | - Angela Miniaci
- Pediatric Clinic, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Federico Marchetti
- Pediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Alessandro De Fanti
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Iughetti
- Pediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Andrea Miceli
- Pediatric Unit, Pavullo Hospital, AUSL Modena, Modena, Italy
| | | | | | - Melodie Aricò
- Pediatric Unit, G.B. Morgagni – L. Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | | | - Susanna Esposito
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Pediatric Clinic, University-Hospital of Parma, Parma, Italy
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Dowling-Cullen C, Sakellariou D. Decision-making regarding accessing paediatric unscheduled healthcare during the COVID-19 pandemic: a mixed methods rapid review and thematic synthesis. BMJ Open 2024; 14:e085796. [PMID: 39053956 DOI: 10.1136/bmjopen-2024-085796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE Reductions in paediatric unscheduled healthcare utilisation were seen during the COVID-19 pandemic, with concerns around their impact on children's health. The reasons for these changes are not well described. This review aims to explore the factors reported by parents that influenced their decision-making around accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DESIGN Mixed methods rapid review and thematic synthesis based on the Enhancing Transparency of Reporting the Synthesis of Qualitative research framework. DATA SOURCES MEDLINE, Embase, Web of Science, PsycEXTRA, PsycINFO, Global Health, Global Index Medicus, Dissertations and Theses Global, Google Scholar and OAISter. Studies published from January 2020 to July 2023 were included. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative, quantitative and mixed methods studies that assessed the perspectives of parents on decisions to access or delay or avoid accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DATA EXTRACTION AND SYNTHESIS Nvivo 14.23.0 was used to code results the of the primary studies and develop themes, following a thematic synthesis approach. RESULTS Twelve studies were included, all from high-income settings, mainly in Europe. The studies were conducted across varying times and levels of COVID-19-related restrictions. The principal descriptive themes identified were (i) concerns about COVID-19 infection, (ii) balancing and navigating risks, (iii) perception of healthcare service status and conditions and (iv) perception of information and advice. These were developed into analytic themes to further describe the decision-making process. CONCLUSIONS Parents balanced a range of risks, concerns, advice and responsibilities when considering accessing paediatric unscheduled healthcare during the COVID-19 pandemic. External sources of advice and information were important; misconceptions around public health advice may reflect the multitude of information sources and the rapidly changing circumstances of the pandemic. Public health policy and planning should consider parent perspectives when developing measures to ensure equitable access to appropriate paediatric healthcare services.
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Neill S, Bayes N, Thompson M, Croxson C, Roland D, Lakhanpaul M. Helping parents know when to seek help for an acutely ill child: Evidence based co-development of a mobile phone app using complex intervention methodology. Int J Med Inform 2024; 187:105459. [PMID: 38640593 DOI: 10.1016/j.ijmedinf.2024.105459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Acute illness accounts for the majority of episodes of illness in children under five years of age and is the age group with the highest consultation rate in general practice in the UK. The number of children presenting to emergency care is also steadily increasing, having risen beyond pre-pandemic numbers. Such high, and increasing, rates of consultation have prompted concerns about parents' level of knowledge and confidence in caring for their children when they are ill, and particularly when and how to seek help appropriately. AIM The ASK SNIFF collaboration research programme identified parents' need for accurate and accessible information to help them know when to seek help for a sick child in 2010. This paper presents the resulting programme of research which aimed to co-develop an evidence-based safety netting intervention (mobile app) to help parents know when to seek help for an acutely ill child under the age of five years in the UK. METHODS Our programme used a collaborative six step process with 147 parent and 324 health professional participants over a period of six years including: scoping existing interventions, systematic review, qualitative research, video capture, content identification and development, consensus methodology, parent and expert clinical review. RESULTS Our programme has produced evidence-based content for an app supported by video clips. Our collaborative approach has supported every stage of our work, ensuring that the end result reflects the experiences, perspectives and expressed needs of parents and the clinicians they consult. CONCLUSION We have not found any other resource which has used this type of approach, which may explain why there is no published evaluation data demonstrating the impact of existing UK resources. Future mobile apps should be designed and developed with the service users for whom they are intended.
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Affiliation(s)
- Sarah Neill
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK.
| | - Natasha Bayes
- Faculty of Health, University of Northampton, Northampton, UK.
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, USA.
| | - Caroline Croxson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK; SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK.
| | - Monica Lakhanpaul
- UCL Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; Community Paediatrics, Whittington Health NHS, London N19 5NF, UK.
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Sweeny AL, Keijzers GB, Palipana D, Gerrard J, Crilly JL. Emergency department presentations in Queensland by First Nations people, remote residents, and young children during the COVID-19 pandemic, 2020: interrupted time series analysis. Med J Aust 2024; 220:579-581. [PMID: 38802120 DOI: 10.5694/mja2.52321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/16/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Amy L Sweeny
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
- Gold Coast Hospital and Health Service, Gold Coast, QLD
| | | | - Dinesh Palipana
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
- Gold Coast Hospital and Health Service, Gold Coast, QLD
| | - John Gerrard
- Gold Coast Hospital and Health Service, Gold Coast, QLD
- Office of the Chief Health Officer, Queensland Health, Brisbane, QLD
| | - Julia L Crilly
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
- Gold Coast Hospital and Health Service, Gold Coast, QLD
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Roland D. When is a 'decision' an important decision in a decision tool. Arch Dis Child 2024; 109:454-455. [PMID: 38272646 DOI: 10.1136/archdischild-2023-326575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Damian Roland
- SAPPHIRE Group, Population Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
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Bellini T, Brisca G, Mariani M, Caorsi R, Bustaffa M, Drago E, Strati MF, Piccotti E, Moscatelli A, Gattorno M, Castagnola E. Epidemiological and clinical evolution of multisystem inflammatory syndrome in children throughout the SARS-CoV-2 pandemic in a tertiary Italian children's hospital. Acta Paediatr 2024; 113:523-530. [PMID: 38066729 DOI: 10.1111/apa.17054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/19/2023] [Accepted: 11/28/2023] [Indexed: 02/13/2024]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening disease temporally linked to SARS-CoV-2 whose incidence and clinical presentation may have been altered by the different SARS-CoV-2 variants and by vaccination. METHODS We retrospectively collected the data of all MIS-C cases admitted to the Gaslini Children's Hospital, the hub for SARS-CoV-2 related diseases in Liguria region, Italy, from 01 October 2020, to 30 November 2022, evaluating the ratio between MIS-C cases and (1) COVID-19 paediatric cases in our region, (2) emergency department admissions and (3) emergency department febrile patients. We also compared MIS-C incidence in pre- post-vaccination periods. RESULTS We observed a significant global decline in the incidence of MIS-Cover the four variant periods and after the starting of vaccination whereas clinical features, therapeutic management and severity did not significantly vary. CONCLUSIONS In our setting, we demonstrated a significant decrease of MIS-C incidence according to the predominant variant and including not vaccinated children. Regardless of variant type, the patients showed similar phenotypes and severity throughout the pandemic. SARS-CoV-2 variants as well as immune protection after previous infections and/or vaccination may have interacted by playing different roles and reducing the incidence of MIS-C.
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Affiliation(s)
- Tommaso Bellini
- Pronto Soccorso e Medicina d'Urgenza, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giacomo Brisca
- Terapia Semintensiva, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marcello Mariani
- Pediatria e Malattie Infettive, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Roberta Caorsi
- Centro Malattie Autoinfiammatorie e Immunodeficienze, Istituto Giannina Gaslini, IRCCS, Genoa, Italy
| | - Marta Bustaffa
- Pronto Soccorso e Medicina d'Urgenza, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Enrico Drago
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantile (DINOGMI), University of genoa, Genoa, Italy
| | - Marina Francesca Strati
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantile (DINOGMI), University of genoa, Genoa, Italy
| | - Emanuela Piccotti
- Pronto Soccorso e Medicina d'Urgenza, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Marco Gattorno
- Centro Malattie Autoinfiammatorie e Immunodeficienze, Istituto Giannina Gaslini, IRCCS, Genoa, Italy
| | - Elio Castagnola
- Pediatria e Malattie Infettive, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Jaboyedoff M, Starvaggi C, Suris JC, Kuehni CE, Gehri M, Keitel K. Drivers for low-acuity pediatric emergency department visits in two tertiary hospitals in Switzerland: a cross-sectional, questionnaire-based study. BMC Health Serv Res 2024; 24:103. [PMID: 38238764 PMCID: PMC10797974 DOI: 10.1186/s12913-023-10348-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 11/18/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE Low-acuity pediatric emergency department (PED) visits are frequent in high-income countries and have a negative impact on patient care at the individual and health system levels. Knowing what drives low-acuity PED visits is crucial to inform adaptations in health care delivery. We aimed to identify factors associated with low-acuity PED visits in Switzerland, including socioeconomic status, demographic features, and medical resources of families. METHODS We conducted a prospective, questionnaire-based study in the PEDs of two Swiss tertiary care hospitals, Bern and Lausanne. We invited all consecutive children and their caregiver attending the PED during data collection times representative of the overall PED consultation structure (e.g. day/night, weekdays/weekends) to complete a questionnaire on demographic features, socioeconomic status, and medical resources. We collected medical and administrative data about the visit and defined low-acuity visits as those meeting all of the following criteria: (1) triage category 4 or 5 on the Australasian Triage Scale, (2) no imaging or laboratory test performed, and (3) discharge home. We used a binary multiple logistic regression model to identify factors associated with low-acuity visits. RESULTS We analysed 778 PED visits (September 2019 to July 2020). Most children visiting our PEDs had a designated primary care provider (92%), with only 6% not having seen them during the last year. Fifty-five per cent of caregivers had asked for medical advice before coming to the PED. The proportion of low-acuity visits was 58%. Low-acuity visits were associated with caregiver's difficulties paying bills (aOR 2.6, 95% CI 1.6 - 4.4), having already visited a PED in the last 6 months (aOR 1.7, 95% CI 1.1 - 2.5) but not with parental education status, nor parental country of birth, parental employment status or absence of family network. CONCLUSION Economic precariousness is an important driver for low-acuity PED visits in Switzerland, a high-income country with compulsory health coverage where most children have a designated primary care provider and a regular pediatric follow-up. Primary care providers and PEDs should screen families for economic precariousness and offer anticipatory guidance and connect those in financial need to social support.
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Affiliation(s)
- Manon Jaboyedoff
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Carl Starvaggi
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joan-Carles Suris
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Mario Gehri
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kristina Keitel
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Kyne S, Ní Shíocháin D, McDonnell C, Byrne A, Sutton-Fitzpatrick U, Crowley N, Nertney L, Myers C, Waldron J, Ahmed A, Wrynne C, Fennell J, Fitzpatrick P, Fitzsimons JJ, Scanlan B, Vaughan D, Gorman KM, Cunney R, Smyth AE, Hourihane JO. Increased rates of invasive bacterial disease in late 2022. Eur J Pediatr 2024; 183:323-334. [PMID: 37882822 DOI: 10.1007/s00431-023-05282-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
Invasive bacterial disease is associated with significant morbidity and mortality. In winter 2022, there was an apparent increased rate of invasive bacterial disease compared to preceding years. Cross-site retrospective analysis of the three Children's Health Ireland (CHI) hospitals looking at children admitted between 1st October 2022-31st December 2022 (Q4) with community-acquired invasive bacterial disease, defined as an abscess in a normally sterile site in the head, neck and chest or isolation or PCR detection of Streptococcus pneumoniae, Neisseria meningitidis, Streptococcus pyogenes (Group A streptococcus) or Haemophilus influenzae from a normally sterile site. Case numbers were compared to Q4 in each of 2018-2021. Eighty-two children met the case definition in Q4 2022 vs 97 (Q4 2018-2021). In 2022, 42/82 (51%) were female, median age 3.75 years (1.5-8.25 years). Only 2 (2%) were immunosuppressed and 2 others (2%) had underlying neurodisability. Fifty (61%) were admitted on second or subsequent presentation to a healthcare setting. Fifty-six (68%) had an abscess in a sterile site. Bloodstream infection (positive blood culture or PCR: 24 (29%)) was the most common site of infection, followed by neck 22 (27%) and intracranial 12 (15%). Group A streptococcus (GAS) 27 (33%) was the most common organism isolated. Seven cases (9%) died in 2022 compared to 2 patients (2%) from 2018 to 2021 (p < 0.05). More children had Paediatric Overall Performance Category (POPC) scores > 1 in 2022 than 2018-2021 (p = 0.003). Conclusion: Invasive bacterial diseases increased in Q4 2022 with higher morbidity and mortality than in the preceding 4 years. Group A streptococcal infection was the most significant organism in 2022. What is known: • Invasive bacterial disease is the leading cause of childhood mortality globally. • There was an increase in cases of invasive Group A streptococcus infections reported in many countries (including Ireland) during the winter of 2022/23. What is new: • Head, neck and chest abscesses increased in Q4 of 2022 compared to the previous 4 years combined. • Invasive bacterial infections in Q4 of 2022 were associated with higher rates of mortality (9%), paediatric intensive care unit (PICU) admission (24%) and requirement for surgical drainage or intervention (67%) than in the preceding years.
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Affiliation(s)
- Sarah Kyne
- General Paediatrics, Children's Health Ireland, Dublin, Ireland.
| | | | | | - Aisling Byrne
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | | | - Niamh Crowley
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Leona Nertney
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Conor Myers
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - John Waldron
- Radiology, Children's Health Ireland, Dublin, Ireland
| | - Aneeq Ahmed
- Radiology, Children's Health Ireland, Dublin, Ireland
| | - Caragh Wrynne
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Jerome Fennell
- Clinical Microbiology, Children's Health Ireland, Dublin, Ireland
| | - Patrick Fitzpatrick
- Emergency Medicine, Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| | - John J Fitzsimons
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| | - Barry Scanlan
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - David Vaughan
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Kathleen M Gorman
- Neurology, Children's Health Ireland, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Robert Cunney
- Clinical Microbiology, Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| | - Anna E Smyth
- Radiology, Children's Health Ireland, Dublin, Ireland
| | - Jonathan O'B Hourihane
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
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Ponmani C, Nijman RG, Roland D, Barrett M, Hulse T, Whittle V, Lyttle MD. Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. Arch Dis Child 2023; 108:799-807. [PMID: 37197894 DOI: 10.1136/archdischild-2022-325280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVES To describe the incidence of new onset paediatric diabetes mellitus, clinical characteristics and patterns of presentation to emergency departments (ED) during the COVID-19 pandemic, and to assess whether this increase was associated with SARS-CoV-2 infection. DESIGN Retrospective medical record review. SETTING Forty nine paediatric EDs across the UK and Ireland. PATIENTS All children aged 6 months to 16 years presenting to EDs with (1) new onset diabetes or (2) pre-existing diabetes with diabetic ketoacidosis (DKA), during the COVID-19 pandemic (1 March 2020-28 February 2021) and the preceding year (1 March 2019-28 February 2020). RESULTS There were increases in new onset diabetes (1015 to 1183, 17%), compared with background incidence of 3%-5% in the UK over the past 5 years. There were increases in children presenting with new onset diabetes in DKA (395 to 566, 43%), severe DKA (141 to 252, 79%) and admissions to intensive care (38 to 72, 89%). Increased severity was reflected in biochemical and physiological parameters and administration of fluid boluses. Time to presentation from symptom onset for children presenting with new onset diabetes and DKA were similar across both years; healthcare seeking delay did not appear to be the sole contributing factor to DKA during the pandemic. Patterns of presentation changed in the pandemic year and seasonal variation was lost. Children with pre-existing diabetes presented with fewer episodes of decompensation. CONCLUSIONS There were increases in new onset diabetes in children and a higher risk of DKA in the first COVID pandemic year.
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Affiliation(s)
- Caroline Ponmani
- Department of Paediatric Emergency Medicine, Barking Havering and Redbridge University Trust, London, UK
| | - Ruud G Nijman
- Department of Paediatric Emergency Medicine, Division of Medicine, St. Mary's hospital - Imperial College NHS Healthcare Trust, London, UK
- Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, UK
- SAPPHIRE Group, Health Sciences, University of Leicester, UK
| | - Michael Barrett
- Department of Paediatric Emergency Medicine, Children's Health Ireland, Dublin, Ireland
- Women's and Children's Health, University College, Dublin, Ireland
| | - Tony Hulse
- Department of Paediatric Endocrinology, Evelina London Children's Hospital, Guys and St. Thomas' NHS Foundation Trust, London, UK
| | - Victoria Whittle
- Department of Paediatric and Child Health, South Tyneside and Sunderland NHS foundation trust, Sunderland Royal Hospital, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), Bristol, UK
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Rahman N, Pines JM. What we can learn from paediatric ED visit changes during pandemics and epidemics. Evid Based Nurs 2023; 26:146. [PMID: 36914230 DOI: 10.1136/ebnurs-2022-103656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Nishad Rahman
- Department of Emergency Medicine, LifeBridge Health, Baltimore, Maryland, USA
| | - Jesse M Pines
- Department of Emergency Medicine, US Acute Care Solutions; Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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11
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Ailioaie LM, Ailioaie C, Litscher G. Infection, Dysbiosis and Inflammation Interplay in the COVID Era in Children. Int J Mol Sci 2023; 24:10874. [PMID: 37446047 DOI: 10.3390/ijms241310874] [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: 05/28/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
For over three years, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents has generated repercussions, especially a few weeks after infection, for symptomatic patients who tested positive, for asymptomatic ones, or even just the contacts of an infected person, and evolved from severe forms such as multisystem inflammatory syndrome in children (MIS-C) to multifarious clinical manifestations in long COVID (LC). Referred to under the umbrella term LC, the onset of persistent and highly heterogeneous symptoms such as fatigue, post-exertion malaise, cognitive dysfunction, and others have a major impact on the child's daily quality of life for months. The first aim of this review was to highlight the circumstances of the pathophysiological changes produced by COVID-19 in children and to better understand the hyperinflammation in COVID-19 and how MIS-C, as a life-threatening condition, could have been avoided in some patients. Another goal was to better identify the interplay between infection, dysbiosis, and inflammation at a molecular and cellular level, to better guide scientists, physicians, and pediatricians to advance new lines of medical action to avoid the post-acute sequelae of SARS-CoV-2 infection. The third objective was to identify symptoms and their connection to molecular pathways to recognize LC more easily. The fourth purpose was to connect the triggering factors of LC with related sequelae following acute SARS-CoV-2 injuries to systems and organs, the persistence of the virus, and some of its components in hidden reservoirs, including the gut and the central nervous system. The reactivation of other latent infectious agents in the host's immune environments, the interaction of this virus with the microbiome, immune hyperactivation, and autoimmunity generated by molecular mimicry between viral agents and host proteins, could initiate a targeted and individualized management. New high-tech solutions, molecules, probiotics, and others should be discovered to innovatively solve the interplay between RNA persistent viruses, microbiota, and our immune system.
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Affiliation(s)
- Laura Marinela Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania
| | - Constantin Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania
| | - Gerhard Litscher
- President of the International Society for Medical Laser Applications (ISLA Transcontinental), German Vice President of the German-Chinese Research Foundation (DCFG) for TCM, Honorary President of the European Federation of Acupuncture and Moxibustion Societies, 8053 Graz, Austria
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