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Prochnow T, Patterson MS, Umstattd Meyer MR. A social network analysis approach to group and individual perceptions of child physical activity. HEALTH EDUCATION RESEARCH 2020; 35:564-573. [PMID: 32918452 DOI: 10.1093/her/cyaa035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Abstract
Child physical activity (PA) is influenced by social environment. Self-perception and perception of others' behaviors may impact health behaviors such as PA. This study examines associations between child networks, perception of their own PA and the network's perception of their PA. Children (n = 89, M age = 10.00, SD = 1.34) at a summer care program reported demographics (54% female; 46% Black), PA, and physical skill competency. Children indicated up to five people they interacted with the most while at the program and how active they perceived each person to be. Multilevel modeling was used to determine significant associations between skill competency, network measures, and child's perception of their own PA, the network's perception of their PA, and the absolute difference between the two. Children perceived themselves to be more physically active if they perceived their friends were more physically active. Children who were central in the network and more physically competent were perceived as more active by their peers. Absolute differences between self-reported and network perceived PA were significantly larger for females. This work builds on understanding of how network position may impact child PA perceptions at summer care programs. Implications of these perceptions for PA promotion programs are discussed.
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Affiliation(s)
- Tyler Prochnow
- Baylor University, Robbins College of Health and Human Sciences, One Bear Place No. 97313, Waco, TX 76798, USA
| | - Megan S Patterson
- Texas A&M University, Department of Health and Kinesiology, MS 4243 TAMU, College Station, TX 77843, USA
| | - M Renee Umstattd Meyer
- Baylor University, Robbins College of Health and Human Sciences, One Bear Place No. 97313, Waco, TX 76798, USA
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Long T, Rowland A, Cotterill S, Woby S, Heal C, Garratt N, Brown S, Roland D. Opt-out Consent in Children's Emergency Medicine Research. Compr Child Adolesc Nurs 2020; 45:1-12. [PMID: 32936676 DOI: 10.1080/24694193.2020.1812766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
There is global acceptance that individuals should be allowed to decide whether or not to take part in research studies, and to do so after being informed about the nature of the research and the risk that might attach to participation. The process of providing detailed information before seeking consent (formalized by signatures) in advance of undertaking research procedures may not be possible in some circumstances, and sometimes an amended approach may be adopted. The use of opt-out consent has been recognized as a valid and ethical means of recruiting participants to studies particularly with large samples and where the risk to participants is small. However, it is sometimes misunderstood and can be a problematic factor in being accepted by research ethics committees and governing authorities. This may be due partly to differing expectations of the amount of information and support offered, together with the nature of the process that is adopted to ensure that a decision has been made rather than consent simply being assumed. In accordance with ongoing discussions with young people, and following consultation with parents, an opt-out consent strategy including varied means of providing information was employed in a large study of 44,501 cases of children attending emergency or urgent care departments. The study was conducted over more than 12 months in dissimilar emergency departments and an urgent care unit, and was designed to support better decision-making in pediatric emergency departments about whether children need to be admitted to hospital or can be discharged home safely. Robust analysis of the factors that exerted the greatest impact on predicting the need to admit or the safety of discharging children led to a revised version of an existing tool. In this article, we review approaches to consent in research, the nature and impact of opt-out consent, the factors that made this an effective strategy for this study, but also more recent concerns which may make opt-out consent no longer acceptable.
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Affiliation(s)
- Tony Long
- School of Health & Society, University of Salford, Salford, UK
| | - Andrew Rowland
- School of Health & Society, University of Salford, Salford, UK
- Emergency Department, North Manchester General Hospital, The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Steve Woby
- School of Health & Society, University of Salford, Salford, UK
- Northern Care Alliance NHS Group, Salford, UK
| | - Calvin Heal
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Steve Brown
- Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Damian Roland
- Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
- Paediatric Emergency Medicine, SAPPHIRE Group, University of Leicester, Leicester, UK
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3
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Huang SS, Niederman R. Economic Evaluations of School Sealant Programs and the Consent Conundrum. J Dent Res 2018; 98:145-147. [PMID: 30354919 DOI: 10.1177/0022034518806838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- S S Huang
- 1 Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY, USA
| | - R Niederman
- 1 Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY, USA
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4
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McCullough MB, Janicke D, Odar Stough C, Robson S, Bolling C, Zion C, Stark L. Barriers to Recruitment in Pediatric Obesity Trials: Comparing Opt-in and Opt-out Recruitment Approaches. J Pediatr Psychol 2017; 42:174-185. [PMID: 27328916 DOI: 10.1093/jpepsy/jsw054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/23/2016] [Indexed: 11/14/2022] Open
Abstract
Objective To compare the efficacy of opt-in versus opt-out recruitment methods in pediatric weight management clinical trials. Methods Recruitment of preschoolers and school-age children across two obesity randomized controlled trials (RCTs) were compared using the same opt-in recruitment approach (parents contact researchers in response to mailings). Opt-in and opt-out strategies (parents send decline postcard in response to mailings if they do not want to participate) were then compared across two preschool obesity RCTs. Results Opt-in strategies yielded a significantly lower overall recruitment rate among preschoolers compared with school-age children. Among preschoolers, an opt-out strategy demonstrated a significantly higher overall recruitment rate compared with an opt-in strategy with the main advantage in the number of families initially contacted. Conclusions Opt-out recruitment strategies may be more effective in overcoming the barriers of recruitment in the preschool age-group because it does not rely on parent recognition of obesity.
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Affiliation(s)
- Mary Beth McCullough
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Cathleen Odar Stough
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shannon Robson
- Department of Behavioral Health and Nutrition, University of Delaware, 26 N College Avenue, Newark, DE, USA
| | | | - Cindy Zion
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lori Stark
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Fernandes DM, Roland AP, Morris MC. Parental opinions regarding an opt-out consent process for inpatient pediatric prospective observational research in the US. Pragmat Obs Res 2017; 8:1-8. [PMID: 28176926 PMCID: PMC5266095 DOI: 10.2147/por.s126509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore parental opinions regarding opt-out consent for inpatient pediatric prospective observational research in the US. STUDY DESIGN A series of handouts describing hypothetical observational research studies with opt-out consent were reviewed by parents of hospitalized children. A verbal survey explored parental opinions about the proposed consent process. RESULTS A total of 166 parents reviewed the handout and completed the survey. Only 2/166 parents (1.2%) objected to the study described and another 10 (6.0%) cited concern about the privacy of their child's medical information. A total of 157 parents were asked "Is it okay to tell you about this kind of research using this handout?" - 116 (74%) responded positively, 19 (12%) responded negatively, and 21 (13%) made an indeterminate or neutral response. When parents were asked to recommend a specific consent approach for observational research, 86 (52%) chose an opt-in approach, 54 (33%) chose opt-out, and 25 (15%) chose "no consent needed". There were no significant associations between parental preferences and whether the child was admitted to the intensive care unit vs. pediatric ward, and no significant difference found based on type of handout reviewed (generic vs. study-specific). CONCLUSION Few parents voiced objection to a hypothetical opt-out consent process for inpatient pediatric prospective observational research. When asked to recommend a specific consent approach, though, approximately half chose an opt-in approach. These data suggest that an opt-out consent process for observational inpatient research is likely to be acceptable to parents, but assessment of an opt-out consent process in a real-world setting is needed.
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Affiliation(s)
| | - Allison P Roland
- Postbaccalaureate Prehealth Studies Program, NYU College of Arts and Science
| | - Marilyn C Morris
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
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Dember LM, Archdeacon P, Krishnan M, Lacson E, Ling SM, Roy-Chaudhury P, Smith KA, Flessner MF. Pragmatic Trials in Maintenance Dialysis: Perspectives from the Kidney Health Initiative. J Am Soc Nephrol 2016; 27:2955-2963. [PMID: 27401689 PMCID: PMC5042681 DOI: 10.1681/asn.2016030340] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Pragmatic clinical trials are conducted under the real-world conditions of clinical care delivery. As a result, these trials yield findings that are highly generalizable to the nonresearch setting, identify interventions that are readily translatable into clinical practice, and cost less than trials that require extensive research infrastructures. Maintenance dialysis is a setting especially well suited for pragmatic trials because of inherently frequent and predictable patient encounters, highly granular and uniform data collection, use of electronic data systems, and delivery of care by a small number of provider organizations to approximately 90% of patients nationally. Recognizing the potential for pragmatic trials to generate much needed evidence to guide the care of patients receiving maintenance dialysis, the Kidney Health Initiative assembled a group of individuals with relevant expertise from academia, industry, and government to provide the nephrology community with information about the design and conduct of such trials, with a specific focus on the dialysis setting. Here, we review this information, and where applicable, use experience from the ongoing Time to Reduce Mortality in End Stage Renal Disease Trial, a large cluster-randomized, pragmatic trial evaluating hemodialysis session duration, to illustrate challenges and solutions to operational, ethical, and regulatory issues.
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Affiliation(s)
- Laura M Dember
- Renal, Electrolyte and Hypertension Division and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Patrick Archdeacon
- Office of Medical Policy and Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | - Eduardo Lacson
- Nephrology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Shari M Ling
- Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Prabir Roy-Chaudhury
- Division of Nephrology, The University of Arizona College of Medicine and Southern Arizona Veterans Administration Health Care System, Tucson, Arizona
| | - Kimberly A Smith
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Michael F Flessner
- Division of Kidney, Urology, and Hematology, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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McKinney RE, Beskow LM, Ford DE, Lantos JD, McCall J, Patrick-Lake B, Pletcher MJ, Rath B, Schmidt H, Weinfurt K. Use of altered informed consent in pragmatic clinical research. Clin Trials 2015; 12:494-502. [PMID: 26374677 PMCID: PMC4688909 DOI: 10.1177/1740774515597688] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are situations in which the requirement to obtain conventional written informed consent can impose significant or even insurmountable barriers to conducting pragmatic clinical research, including some comparative effectiveness studies and cluster-randomized trials. Although certain federal regulations governing research in the United States (45 CFR 46) define circumstances in which any of the required elements may be waived, the same standards apply regardless of whether any single element is to be waived or whether consent is to be waived in its entirety. Using the same threshold for a partial or complete waiver limits the options available to institutional review boards as they seek to optimize a consent process. In this article, we argue that new standards are necessary in order to enable important pragmatic clinical research while at the same time protecting patients' rights and interests.
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Affiliation(s)
- Ross E McKinney
- Trent Center for Bioethics, Humanities, & History of Medicine and Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Daniel E Ford
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - John D Lantos
- Children's Mercy Bioethics Center, Children's Mercy Hospital, Kansas City, MO, US
| | | | - Bray Patrick-Lake
- Clinical Trials Transformation Initiative, Duke Translational Medicine Institute, Durham, NC, USA
| | - Mark J Pletcher
- Departments of Epidemiology and Biostatistics and Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Brian Rath
- Buchanan Ingersoll & Rooney PC, Princeton, NJ, USA
| | - Hollie Schmidt
- Accelerated Cure Project for Multiple Sclerosis, Waltham, MA, USA
| | - Kevin Weinfurt
- Duke Clinical Research Institute, Durham, NC, USA Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
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Lantos JD, Wendler D, Septimus E, Wahba S, Madigan R, Bliss G. Considerations in the evaluation and determination of minimal risk in pragmatic clinical trials. Clin Trials 2015; 12:485-93. [PMID: 26374686 DOI: 10.1177/1740774515597687] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Institutional review boards, which are charged with overseeing research, must classify the riskiness of proposed research according to a federal regulation known as the Common Rule (45 CFR 46, Subpart A) and by regulations governing the US Food and Drug Administration codified in 21 CFR 50. If an institutional review board determines that a clinical trial constitutes "minimal risk," there are important practical implications: the institutional review board may then allow a waiver or alteration of the informed consent process; the study may be carried out in certain vulnerable populations; or the study may be reviewed by institutional review boards using an expedited process. However, it is unclear how institutional review boards should assess the risk levels of pragmatic clinical trials. Such trials typically compare existing, widely used medical therapies or interventions in the setting of routine clinical practice. Some of the therapies may be considered risky of themselves but the study comparing them may or may not add to that pre-existing level of risk. In this article, we examine the common interpretations of research regulations regarding minimal-risk classifications and suggest that they are marked by a high degree of variability and confusion, which in turn may ultimately harm patients by delaying or hindering potentially beneficial research. We advocate for a clear differentiation between the risks associated with a given therapy and the incremental risk incurred during research evaluating those therapies as a basic principle for evaluating the risk of a pragmatic clinical trial. We then examine two pragmatic clinical trials and consider how various factors including clinical equipoise, practice variation, research methods such as cluster randomization, and patients' perspectives may contribute to current and evolving concepts of minimal-risk determinations, and how this understanding in turn affects the design and conduct of pragmatic clinical trials.
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Affiliation(s)
- John D Lantos
- Children's Mercy Bioethics Center, Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - David Wendler
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Edward Septimus
- Department of Internal Medicine, Texas A&M Health Science Center, Houston, TX, USA Clinical Services Group, Hospital Corporation of America, Nashville, TN, USA
| | - Sarita Wahba
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Rosemary Madigan
- Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Geraldine Bliss
- Research Support Committee, Phelan-McDermid Syndrome Foundation, Venice, FL, USA
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Vain NE, Musante GA, Mariani GL. Meconium Stained Newborns: Ethics for Evidence in Resuscitation. J Pediatr 2015; 166:1109-12. [PMID: 25720365 DOI: 10.1016/j.jpeds.2015.01.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 01/28/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Nestor E Vain
- Department of Pediatrics, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina; FUNDASAMIN (Fundación para la Salud Materno Infantil), Buenos Aires, Argentina; Department of Neonatology, Hospitals Sanatorio de la Trinidad Palermo and San Isidro, Buenos Aires, Argentina.
| | - Gabriel A Musante
- Department of Pediatrics, Facultad de Ciencias Biomédicas, Universidad Austral, Argentina; Department of Maternal and Child Health, Hospital Universitario Austral, Pilar, Argentina
| | - Gonzalo L Mariani
- Department of Pediatrics, School of Medicine, University Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Neonatology Division, Hospital Italiano, Buenos Aires, Argentina
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10
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Abstract
The assessment of safety and efficacy of therapeutics for children and adolescents requires the use of multi-centered designs. However, the need to obtain ethical approval from multiple independent research ethics boards (REBs) presents as a challenge to investigators and sponsors who must consider local requirements while ensuring that the protection of human subjects is consistent across sites. In pediatrics, this requirement is complicated by pediatric-specific ethical concerns such as the acquisition of assent and consent and the need for pediatric expertise to assess the scholarly merit of the proposed research. Efforts to tackle these challenges have focused on the process of ethics review, which will improve efficiency. In addition to improving process, we suggest further research to fill gaps in the evidence base for recommendations and decisions made by REBs, specifically their effectiveness to protect human subjects. Evidence gathered will contribute to the successful development, adoption and implementation of harmonized guidance to apply ethics principles in order to protect children through research rather than from research.
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Affiliation(s)
- Allison C Needham
- Child Health Evaluative Sciences CHES, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada,
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