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Kemps N, Holband N, Boeddha NP, Faal A, Juliana AE, Kavishe GA, Keitel K, van ‘t Kruys KH, Ledger EV, Moll HA, Prentice AM, Secka F, Tan R, Usuf E, Unger SA, Zachariasse JM. Validation of the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in low- and middle-income countries: A multicentre observational study. PLOS Glob Public Health 2024; 4:e0002716. [PMID: 38512949 PMCID: PMC10956749 DOI: 10.1371/journal.pgph.0002716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024]
Abstract
Early recognition of children at risk of serious illness is essential in preventing morbidity and mortality, particularly in low- and middle-income countries (LMICs). This study aimed to validate the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in acute care settings in LMICs. This observational study is based on previously collected clinical data from consecutive children attending four diverse settings in LMICs. Inclusion criteria and study periods (2010-2021) varied. We simulated the ED-PEWS, consisting of patient age, consciousness, work of breathing, respiratory rate, oxygen saturation, heart rate, and capillary refill time, based on the first available parameters. Discrimination was assessed by the area under the curve (AUC), sensitivity and specificity (previously defined cut-offs < 6 and ≥ 15). The outcome measure was for each setting a composite marker of high urgency. 41,917 visits from Gambia rural, 501 visits from Gambia urban, 2,608 visits from Suriname, and 1,682 visits from Tanzania were included. The proportion of high urgency was variable (range 4.6% to 24.9%). Performance ranged from AUC 0.80 (95%CI 0.70-0.89) in Gambia urban to 0.62 (95%CI 0.55-0.67) in Tanzania. The low-urgency cut-off showed a high sensitivity in all settings ranging from 0.83 (95%CI 0.81-0.84) to 1.00 (95%CI 0.97-1.00). The high-urgency cut-off showed a specificity ranging from 0.71 (95%CI 0.66-0.75) to 0.97 (95%CI 0.97-0.97). The ED-PEWS has a moderate to good performance for the recognition of high urgency children in these LMIC settings. The performance appears to have potential in improving the identification of high urgency children in LMICs.
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Affiliation(s)
- Naomi Kemps
- Department of General Paediatrics, Erasmus MC- Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Natanael Holband
- Department of Paediatrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Navin P. Boeddha
- Department of General Paediatrics, Erasmus MC- Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Paediatrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Abdoulie Faal
- Applications Development & e-Health Department, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Amadu E. Juliana
- Department of Paediatrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Godfrey A. Kavishe
- National Institute of Medical Research–Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Kristina Keitel
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
- Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Basel, Switzerland
| | | | - Elizabeth V. Ledger
- Department of Paediatrics, Bristol Royal Hospital for Children, Bristol, The United Kingdom
| | - Henriëtte A. Moll
- Department of General Paediatrics, Erasmus MC- Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Andrew M. Prentice
- Nutrition and Planetary Health Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Fatou Secka
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Rainer Tan
- Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Basel, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Effua Usuf
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Stefan A. Unger
- Department of Child Life and Health, University of Edinburgh, Edinburgh, The United Kingdom
| | - Joany M. Zachariasse
- Department of General Paediatrics, Erasmus MC- Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Hagenaar DA, Bindels-de Heus KGCB, van Gils MM, van den Berg L, Ten Hoopen LW, Affourtit P, Pel JJM, Joosten KFM, Hillegers MHJ, Moll HA, de Wit MCY, Dieleman GC, Mous SE. Outcome measures in Angelman syndrome. J Neurodev Disord 2024; 16:6. [PMID: 38429713 PMCID: PMC10905876 DOI: 10.1186/s11689-024-09516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/29/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Angelman syndrome (AS) is a rare neurodevelopmental disorder characterized by severe intellectual disability, little to no expressive speech, visual and motor problems, emotional/behavioral challenges, and a tendency towards hyperphagia and weight gain. The characteristics of AS make it difficult to measure these children's functioning with standard clinical tests. Feasible outcome measures are needed to measure current functioning and change over time, in clinical practice and clinical trials. AIM Our first aim is to assess the feasibility of several functional tests. We target domains of neurocognitive functioning and physical growth using the following measurement methods: eye-tracking, functional Near-Infrared Spectroscopy (fNIRS), indirect calorimetry, bio-impedance analysis (BIA), and BOD POD (air-displacement plethysmography). Our second aim is to explore the results of the above measures, in order to better understand the AS phenotype. METHODS The study sample consisted of 28 children with AS aged 2-18 years. We defined an outcome measure as feasible when (1) at least 70% of participants successfully finished the measurement and (2) at least 60% of those participants had acceptable data quality. Adaptations to the test procedure and reasons for early termination were noted. Parents rated acceptability and importance and were invited to make recommendations to increase feasibility. The results of the measures were explored. RESULTS Outcome measures obtained with eye-tracking and BOD POD met the definition of feasibility, while fNIRS, indirect calorimetry, and BIA did not. The most important reasons for early termination of measurements were showing signs of protest, inability to sit still and poor/no calibration (eye-tracking specific). Post-calibration was often applied to obtain valid eye-tracking results. Parents rated the BOD POD als most acceptable and fNIRS as least acceptable for their child. All outcome measures were rated to be important. Exploratory results indicated longer reaction times to high salient visual stimuli (eye-tracking) as well as high body fat percentage (BOD POD). CONCLUSIONS Eye-tracking and BOD POD are feasible measurement methods for children with AS. Eye-tracking was successfully used to assess visual orienting functions in the current study and (with some practical adaptations) can potentially be used to assess other outcomes as well. BOD POD was successfully used to examine body composition. TRIAL REGISTRATION Registered d.d. 23-04-2020 under number 'NL8550' in the Dutch Trial Register: https://onderzoekmetmensen.nl/en/trial/23075.
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Affiliation(s)
- Doesjka A Hagenaar
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands.
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands.
| | - Karen G C B Bindels-de Heus
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Maud M van Gils
- Vestibular and Oculomotor Research Group, Department of Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Louise van den Berg
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Leontine W Ten Hoopen
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Philine Affourtit
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Dietetics, Erasmus MC, Rotterdam, The Netherlands
| | - Johan J M Pel
- Vestibular and Oculomotor Research Group, Department of Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Koen F M Joosten
- Division of Pediatric ICU, Department of Neonatal and Pediatric ICU, Erasmus MC, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Marie-Claire Y de Wit
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Neurology and Paediatric Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Gwen C Dieleman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Sabine E Mous
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
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Hagenaar DA, Bindels-de Heus KGCB, Lubbers K, Ten Hoopen LW, Rietman AB, de Nijs PFA, Hillegers MHJ, Moll HA, de Wit MCY, Dieleman GC, Mous SE. Child characteristics associated with child quality of life and parenting stress in Angelman syndrome. J Intellect Disabil Res 2024; 68:248-263. [PMID: 38009976 DOI: 10.1111/jir.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Angelman syndrome (AS) is a rare neurodevelopmental disorder characterised by severe intellectual disability, movement disorder, epilepsy, sleeping problems, and behavioural issues. Little is known on child health-related quality of life (HRQoL) in AS. AS family studies have reported elevated parenting stress and a high impact of the child's syndrome on the parent. It is unclear which factors influence child HRQoL and parenting stress/impact in AS. METHODS We collected data prospectively through standardised clinical assessments of children with AS at the ENCORE Expertise centre for Angelman Syndrome at the Erasmus MC Sophia Children's Hospital. A linear regression analysis was conducted for the following outcome variables: (1) child HRQoL (Infant and Toddler Quality of Life Questionnaire); (2) the impact of the child's syndrome on the parent (Infant and Toddler Quality of Life Questionnaire); and (3) parenting stress (Parenting Stress Index). Predictor variables were child genotype, epilepsy, sleeping problems (Sleep Disturbance Scale for Children), cognitive developmental level (Bayley Cognition Scale), autistic features (Autism Diagnostic Observation Schedule) and emotional/behavioural problems (Child Behaviour Checklist). Covariates were sex, age and socio-economic status. RESULTS The study sample consisted of 73 children with AS, mean age = 9.1 years, range = 2-18 years. Emotional/behavioural problems were the strongest significant predictor of lowered child HRQoL. Internalising problems were driving this effect. In addition, having the deletion genotype and higher age was related to lower child HRQoL. Sleeping problems were related to a higher impact of the child's syndrome on the parent. Finally, emotional/behavioural problems were associated with higher parenting stress. Cognitive developmental level, autistic features and epilepsy were not a significant predictor of child HRQoL and parenting stress/impact. CONCLUSIONS These results suggest that interventions aimed at increasing child HRQoL and decreasing parenting stress/impact in AS should focus on child emotional/behavioural problems and sleeping problems, using a family-centred approach.
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Affiliation(s)
- D A Hagenaar
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - K G C B Bindels-de Heus
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - K Lubbers
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - L W Ten Hoopen
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - A B Rietman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - P F A de Nijs
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - M H J Hillegers
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - H A Moll
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - M C Y de Wit
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Neurology and Paediatric Neurology, Erasmus MC, Rotterdam, the Netherlands
| | - G C Dieleman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - S E Mous
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
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Tan CD, Vermont CL, Zachariasse JM, von Both U, Eleftheriou I, Emonts M, van der Flier M, Herberg J, Kohlmaier B, Levin M, Lim E, Maconochie IK, Martinon-Torres F, Nijman RG, Pokorn M, Rivero-Calle I, Tsolia M, Zenz W, Zavadska D, Moll HA, Carrol ED. Emergency medical services utilisation among febrile children attending emergency departments across Europe: an observational multicentre study. Eur J Pediatr 2023; 182:3939-3947. [PMID: 37354239 PMCID: PMC10570223 DOI: 10.1007/s00431-023-05056-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/24/2023] [Accepted: 06/04/2023] [Indexed: 06/26/2023]
Abstract
Children constitute 6-10% of all patients attending the emergency department (ED) by emergency medical services (EMS). However, discordant EMS use in children occurs in 37-61% with fever as an important risk factor. We aimed to describe EMS utilisation among febrile children attending European EDs. This study is part of an observational multicentre study assessing management and outcome in febrile children up to 18 years (MOFICHE) attending twelve EDs in eight European countries. Discordant EMS use was defined as the absence of markers of urgency including intermediate/high triage urgency, advanced diagnostics, treatment, and admission in children transferred by EMS. Multivariable logistic regression analyses were performed for the association between (1) EMS use and markers of urgency, and (2) patient characteristics and discordant EMS use after adjusting all analyses for the covariates age, gender, visiting hours, presenting symptoms, and ED setting. A total of 5464 (15%, range 0.1-42%) children attended the ED by EMS. Markers of urgency were more frequently present in the EMS group compared with the non-EMS group. Discordant EMS use occurred in 1601 children (29%, range 1-59%). Age and gender were not associated with discordant EMS use, whereas neurological symptoms were associated with less discordant EMS use (aOR 0.2, 95%CI 0.1-0.2), and attendance out of office hours was associated with more discordant EMS use (aOR 1.6, 95%CI 1.4-1.9). Settings with higher percentage of self-referrals to the ED had more discordant EMS use (p < 0.05). Conclusion: There is large practice variation in EMS use in febrile children attending European EDs. Markers of urgency were more frequently present in children in the EMS group. However, discordant EMS use occurred in 29%. Further research is needed on non-medical factors influencing discordant EMS use in febrile children across Europe, so that pre-emptive strategies can be implemented. What is Known: •Children constitute around 6-10% of all patients attending the emergency department by emergency medical services. •Discordant EMS use occurs in 37-61% of all children, with fever as most common presenting symptom for discordant EMS use in children. What is New: •There is large practice variation in EMS use among febrile children across Europe with discordance EMS use occurring in 29% (range 1-59%), which was associated with attendance during out of office hours and with settings with higher percentage of self-referrals to the ED. •Future research is needed focusing on non-medical factors (socioeconomic status, parental preferences and past experience, healthcare systems, referral pathways, out of hours services provision) that influence discordant EMS use in febrile children across Europe.
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Affiliation(s)
- Chantal D. Tan
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Clementien L. Vermont
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Joany M. Zachariasse
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians University, Munich, Germany
- German Centre for Infection Research, DZIF, Partner Site, Munich, Germany
| | - Irini Eleftheriou
- Second Department of Paediatrics, P. and A. Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, 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, Newcastle Upon Tyne Hospitals NHS Trust, Westgate Rd, Newcastle Upon Tyne, NE4 5PL UK
| | - Michiel van der Flier
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, RadboudUMC, Nijmegen, the Netherlands
- Paediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, RadboudUMC, Nijmegen, the Netherlands
- Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jethro Herberg
- Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Emma Lim
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Department of Medicine, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Ian K. Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, London, UK
| | - Federico Martinon-Torres
- Genetics, Vaccines, Infections and Paediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ruud G. Nijman
- Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Marko Pokorn
- Department of Infectious Diseases and Faculty of Medicine, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Irene Rivero-Calle
- Genetics, Vaccines, Infections and Paediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Tsolia
- Second Department of Paediatrics, P. and A. Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Dace Zavadska
- Department of Paediatrics, Children Clinical University Hospital, Rīgas Stradiņa Universitāte, Riga, Latvia
| | - Henriëtte A. Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Enitan D. Carrol
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
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5
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van der Velden FJS, de Vries G, Martin A, Lim E, von Both U, Kolberg L, Carrol ED, Khanijau A, Herberg JA, De T, Galassini R, Kuijpers TW, Martinón-Torres F, Rivero-Calle I, Vermont CL, Hagedoorn NN, Pokorn M, Pollard AJ, Schlapbach LJ, Tsolia M, Elefhteriou I, Yeung S, Zavadska D, Fink C, Voice M, Zenz W, Kohlmaier B, Agyeman PKA, Usuf E, Secka F, de Groot R, Levin M, van der Flier M, Emonts M, Cunnington A, De T, Herberg J, Kaforou M, Wright V, Baumard L, Bellos E, D’Souza G, Galassini R, Habgood-Coote D, Hamilton S, Hoggart C, Hourmat S, Jackson H, Maconochie I, Menikou S, Lin N, Nichols S, Nijman R, Powell O, Pena Paz I, Shah P, Shen CF, Vito O, Wilson C, Abdulla A, Ali L, Darnell S, Jorgensen R, Mustafa S, Persand S, Stevens MM, Kim N, Kim E, Fidler K, Dudley J, Richmond V, Tavliavini E, Shen CF, Liu CC, Wang SM, Martinón-Torres F, Salas A, González FÁ, Farto CB, Barral-Arca R, Castro MB, Bello X, García MB, Carnota S, Cebey-López M, Curras-Tuala MJ, Suárez CD, Vicente LG, Gómez-Carballa A, Rial JG, Iglesias PL, Martinón-Torres F, Martinón-Torres N, Sánchez JMM, Pérez BM, Pardo-Seco J, Rodríguez LP, Pischedda S, Vázquez SR, Calle IR, Rodríguez-Tenreiro C, Redondo-Collazo L, Ora MS, Salas A, Fernández SS, Trasorras CS, Iglesias MV, Zavadska D, Balode A, Bārzdiņa A, Deksne D, Gardovska D, Grāvele D, Grope I, Meiere A, Nokalna I, Pavāre J, Pučuka Z, Selecka K, Rudzāte A, Svile D, Urbāne UN, Usuf E, Bojang K, Zaman SMA, Secka F, Anderson S, Sarr AR, Saidykhan M, Darboe S, Ceesay S, D’alessandro U, Moll HA, Vermont CL, Borensztajn DM, Hagedoorn NN, Tan C, Zachariasse J, Dik W, Agyeman PKA, Berger C, Giannoni E, Stocker M, Posfay-Barbe KM, Heininger U, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Natalucci G, Relly C, Riedel T, Aebi C, Schlapbach LJ, Carrol ED, Cocklin E, Jennings R, Johnston J, Khanijau A, Leigh S, Lewis-Burke N, Newall K, Romaine S, Tsolia M, Eleftheriou I, Tambouratzi M, Marmarinos A, Xagorari M, Syggelou K, Fink C, Voice M, Calvo-Bado L, Zenz W, Kohlmaier B, Schweintzger NA, Sagmeister MG, Kohlfürst DS, Zurl C, Binder A, Hösele S, Leitner M, Pölz L, Rajic G, Bauchinger S, Baumgart H, Benesch M, Ceolotto A, Eber E, Gallistl S, Gores G, Haidl H, Hauer A, Hude C, Keldorfer M, Krenn L, Pilch H, Pfleger A, Pfurtscheller K, Nordberg G, Niedrist T, Rödl S, Skrabl-Baumgartner A, Sperl M, Stampfer L, Strenger V, Till H, Trobisch A, Löffler S, Yeung S, Dewez JE, Hibberd M, Bath D, Miners A, Nijman R, Fitchett E, de Groot R, van der Flier M, de Jonge MI, van Aerde K, Alkema W, van den Broek B, Gloerich J, van Gool AJ, Henriet S, Huijnen M, Philipsen R, Willems E, Gerrits G, van Leur M, Heidema J, de Haan L, Miedema C, Neeleman C, Obihara C, Tramper-Stranders G, Pollard AJ, Kandasamy R, Paulus S, Carter MJ, O’Connor D, Bibi S, Kelly DF, Gurung M, Thorson S, Ansari I, Murdoch DR, Shrestha S, Oliver Z, Emonts M, Lim E, Valentine L, Allen K, Bell K, Chan A, Crulley S, Devine K, Fabian D, King S, McAlinden P, McDonald S, McDonnell A, Pickering A, Thomson E, Wood A, Wallia D, Woodsford P, Baxter F, Bell A, Rhodes M, Agbeko R, Mackerness C, Baas B, Kloosterhuis L, Oosthoek W, Arif T, Bennet J, Collings K, van der Giessen I, Martin A, Rashid A, Rowlands E, de Vries G, van der Velden F, Soon J, Valentine L, Martin M, Mistry R, von Both U, Kolberg L, Zwerenz M, Buschbeck J, Bidlingmaier C, Binder V, Danhauser K, Haas N, Griese M, Feuchtinger T, Keil J, Kappler M, Lurz E, Muench G, Reiter K, Schoen C, Mallet F, Brengel-Pesce K, Pachot A, Mommert M, Pokorn M, Kolnik M, Vincek K, Srovin TP, Bahovec N, Prunk P, Osterman V, Avramoska T, Kuijpers T, Jongerius I, van den Berg JM, Schonenberg D, Barendregt AM, Pajkrt D, van der Kuip M, van Furth AM, Sprenkeler E, Zandstra J, van Mierlo G, Geissler J. Correction to: Febrile illness in high-risk children: a prospective, international observational study. Eur J Pediatr 2023; 182:555-556. [PMID: 36689005 PMCID: PMC9899168 DOI: 10.1007/s00431-022-04788-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Fabian J. S. van der Velden
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gabriella de Vries
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.416135.40000 0004 0649 0805Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Alexander Martin
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Lim
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ulrich von Both
- grid.5252.00000 0004 1936 973XDivision Paediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Laura Kolberg
- grid.5252.00000 0004 1936 973XDivision Paediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Enitan D. Carrol
- grid.10025.360000 0004 1936 8470Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK ,grid.417858.70000 0004 0421 1374Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Aakash Khanijau
- grid.10025.360000 0004 1936 8470Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK ,grid.417858.70000 0004 0421 1374Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Jethro A. Herberg
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Tisham De
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Rachel Galassini
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Taco W. Kuijpers
- grid.7177.60000000084992262Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Federico Martinón-Torres
- grid.411048.80000 0000 8816 6945Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain ,grid.11794.3a0000000109410645Grupo de Genetica, Vacunas, Infecciones y Pediatria, Instituto de Investigacion Sanitaria de Santiago, Universidad de Santiago, Santiago de Compostela, Spain ,grid.512891.6Consorcio Centro de Investigacion Biomedicaen Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Irene Rivero-Calle
- grid.411048.80000 0000 8816 6945Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Clementien L. Vermont
- grid.416135.40000 0004 0649 0805Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Nienke N. Hagedoorn
- grid.416135.40000 0004 0649 0805Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Marko Pokorn
- grid.29524.380000 0004 0571 7705University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrew J. Pollard
- grid.4991.50000 0004 1936 8948Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Luregn J. Schlapbach
- grid.412341.10000 0001 0726 4330Neonatal and Pediatric Intensive Care Unit, Children’s Research Center, University Children’s Hospital Zürich, University of Zürich, Zurich, Switzerland
| | - Maria Tsolia
- grid.5216.00000 0001 2155 08002nd Department of Pediatrics, National and Kapodistrian University of Athens, Children’s Hospital ‘P, and A. Kyriakou’, Athens, Greece
| | - Irini Elefhteriou
- grid.5216.00000 0001 2155 08002nd Department of Pediatrics, National and Kapodistrian University of Athens, Children’s Hospital ‘P, and A. Kyriakou’, Athens, Greece
| | - Shunmay Yeung
- grid.8991.90000 0004 0425 469XClinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Dace Zavadska
- grid.17330.360000 0001 2173 9398Department of Pediatrics, Rīgas Stradina Universitāte, Children’s Clinical University Hospital, Riga, Latvia
| | - Colin Fink
- grid.7372.10000 0000 8809 1613Micropathology Ltd, University of Warwick, Warwick, UK
| | - Marie Voice
- grid.7372.10000 0000 8809 1613Micropathology Ltd, University of Warwick, Warwick, UK
| | - Werner Zenz
- grid.11598.340000 0000 8988 2476Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Benno Kohlmaier
- grid.11598.340000 0000 8988 2476Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Philipp K. A. Agyeman
- grid.5734.50000 0001 0726 5157Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Effua Usuf
- grid.415063.50000 0004 0606 294XMedical Research Council Unit, Serrekunda, The Gambia
| | - Fatou Secka
- grid.415063.50000 0004 0606 294XMedical Research Council Unit, Serrekunda, The Gambia
| | - Ronald de Groot
- grid.461578.9Pediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael Levin
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Michiel van der Flier
- grid.461578.9Pediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.7692.a0000000090126352Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, 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, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK.
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6
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Leeb F, Sharma U, Yeghiazaryan L, Moll HA, Greber-Platzer S. Improving the safety of the Manchester triage system for children with congenital heart disease. Eur J Pediatr 2022; 181:3831-3838. [PMID: 36029332 PMCID: PMC9546792 DOI: 10.1007/s00431-022-04594-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/16/2022] [Accepted: 08/15/2022] [Indexed: 11/07/2022]
Abstract
UNLABELLED This study is a prospective evaluation of the validity of a Manchester triage system (MTS) modification for detecting under-triaged pediatric patients with congenital heart disease (CHD). Children with CHD visiting the emergency unit of the Department of Pediatrics and Adolescent Medicine, University Hospital Vienna in 2014 were included. The MTS modification updated the prioritization of patients with complex syndromic diseases, specific symptoms related to chronic diseases, decreased general condition (DGC), profound language impairment, unknown medical history, or special needs. A four-level outcome severity index based on diagnostic and therapeutic interventions, admission to hospital, and follow-up strategies was defined as a reference standard for the correct clinical classification of the MTS urgency level. Of the 19,264 included children, 940 had CHD. Of this group, 266 fulfilled the inclusion criteria for the modified triage method. The MTS modification was significantly more often applied in under-triaged (65.9%) than correctly or over-triaged (25%) children with CHD (p-value χ2 test < 0.0001, OR 5.848, 95% CI: 3.636-9.6). CONCLUSION The MTS urgency level upgrade modification could reduce under-triage in children with CHD. Applying a safety strategy concept to the MTS could mitigate under-triage in such a high-risk patient group. WHAT IS KNOWN • The Manchester triage system is considered to be valid and reliable but tends to over-triage. • A study by Seiger et al. showed poor performance in children with chronic illnesses, especially in children with cardiovascular diseases. WHAT IS NEW • The MTS modification with one urgency level upgrade could decrease under-triage in children with congenital heart disease. • As reference standard a four level outcome severity index (OSI) was established to include diagnostic investigations, medical interventions, hospital admission or follow up visits in the assessment.
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Affiliation(s)
- Franziska Leeb
- grid.22937.3d0000 0000 9259 8492Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Ursula Sharma
- grid.22937.3d0000 0000 9259 8492Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Lusine Yeghiazaryan
- grid.22937.3d0000 0000 9259 8492Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Medical Statistics, Medical University Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Henriëtte A. Moll
- grid.416135.40000 0004 0649 0805Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Wytemaweg 80, 3015 Rotterdam, CN Netherlands
| | - Susanne Greber-Platzer
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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7
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Tan CD, van der Walle EEPL, Vermont CL, von Both U, Carrol ED, Eleftheriou I, 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, Yeung S, Zenz W, Zavadska D, Moll HA. Correction to: Guideline adherence in febrile children below 3 months visiting European Emergency Departments: an observational multicenter study. Eur J Pediatr 2022; 181:4211-4214. [PMID: 36269427 PMCID: PMC9649469 DOI: 10.1007/s00431-022-04664-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chantal D. Tan
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, the Netherlands
| | - Eline E. P. L. van der Walle
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, the Netherlands
| | - Clementien L. Vermont
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- German Centre for Infection Research, PDZIF Partner Site Munich, Munich, Germany
| | - Enitan D. Carrol
- Institute of Infection, Veterinary and Ecological Sciences Liverpool, University of Liverpool, Liverpool, UK
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Irini Eleftheriou
- Second Department of Paediatrics, National and Kapodistrian University of Athens, P. and A. Kyriakou Children’s Hospital, Athens, Greece
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, 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, Westgate Rd, Newcastle upon Tyne, NE4 5PL UK
| | - Michiel van der Flier
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, RadboudUMC, Nijmegen, the Netherlands
- Paediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, RadboudUMC, Nijmegen, the Netherlands
- Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ronald de Groot
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, RadboudUMC, Nijmegen, the Netherlands
| | - Jethro Herberg
- Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Emma Lim
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Medicine, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian K. Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, London, UK
| | - Federico Martinon-Torres
- Vaccines, Infections and Paediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela. Genetics, Santiago de Compostela, Spain
| | - Ruud G. Nijman
- Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Marko Pokorn
- Department of Infectious Diseases and Faculty of Medicine, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Irene Rivero-Calle
- Vaccines, Infections and Paediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela. Genetics, 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
| | - Shunmay Yeung
- London School of Hygiene and Tropical Medicine, Faculty of Tropical and Infectious Disease, London, UK
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Dace Zavadska
- Rīgas Stradiņa universitāte, Department of Paediatrics, Children Clinical University Hospital, Riga, Latvia
| | - Henriëtte 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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8
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Looman KIM, Cecil CAM, Grosserichter‐Wagener C, Kiefte‐de Jong JC, Zelm MC, Moll HA. Associations between T cells and attention problems in the general pediatric population: The Generation R study. JCPP Advances 2021. [DOI: 10.1002/jcv2.12038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kirsten I. M. Looman
- Generation R Study Group Erasmus MC University Medical Center Rotterdam The Netherlands
- Department of Pediatrics Sophia Children's Hospital Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Charlotte A. M. Cecil
- Department of Child and Adolescent Psychiatry/Psychology Erasmus MC University Medical Center Rotterdam The Netherlands
- Department of Epidemiology Erasmus MC University Medical Center Rotterdam The Netherlands
- Molecular Epidemiology Department of Biomedical Data Sciences Leiden University Medical Center Leiden The Netherlands
| | | | - Jessica C. Kiefte‐de Jong
- Department of Epidemiology Erasmus MC University Medical Center Rotterdam The Netherlands
- Department of Public Health and Primary Care/LUMC Campus The Hague Leiden University Medical Center Leiden The Netherlands
| | - Menno C. Zelm
- Department of Immunology and Pathology Central Clinical School Monash University and Alfred Hospital Melbourne Victoria Australia
| | - Henriëtte A. Moll
- Department of Pediatrics Sophia Children's Hospital Erasmus MC University Medical Center Rotterdam The Netherlands
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9
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Looman KIM, van Mierlo MMF, van Zelm MC, Hu C, Duijts L, de Jongste JC, Nijsten T, Pardo LM, Kiefte-de Jong JC, Moll HA, Pasmans SGMA. Increased Th22 cell numbers in a general pediatric population with filaggrin haploinsufficiency: The Generation R Study. Pediatr Allergy Immunol 2021; 32:1360-1368. [PMID: 33715246 PMCID: PMC8451856 DOI: 10.1111/pai.13502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/09/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mutations in the filaggrin gene (FLG) affect epidermal barrier function and increase the risk of atopic dermatitis (AD). We hypothesized that FLG mutations affect immune cell composition in a general pediatric population. Therefore, we investigated whether school-aged children with and without FLG mutations have differences in T- and B-cell subsets. METHODS This study was embedded in a population-based prospective cohort study, the Generation R Study, and included 523 children of European genetic ancestry aged 10 years. The most common FLG mutations in the European population (R501X, S1085CfsX36, R2447X, and S3247X) were genotyped. Additionally, 11-color flow cytometry was performed on peripheral blood samples to determine helper T (Th), regulatory T (Treg), and CD27+ and CD27- memory B cells. Subset analysis was performed in 358 non-AD and 102 AD cases, assessed by parental questionnaires. RESULTS FLG mutations were observed in 8.4% of the total population and in 15.7% of the AD cases. Children with any FLG mutation had higher Th22 cell numbers compared to FLG wild-type children in the general and non-AD population. Children with and without FLG mutations had no difference in Th1, Th2, Th17, Treg, or memory B-cell numbers. Furthermore, in children with AD, FLG mutation carriership was not associated with differences in T- and B-cell subsets. CONCLUSIONS School-aged children of a general population with FLG mutations have higher Th22 cell numbers, which reflects the immunological response to the skin barrier dysfunction. FLG mutations did not otherwise affect the composition of the adaptive immunity in this general pediatric population.
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Affiliation(s)
- Kirsten I M Looman
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of General Pediatrics, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Minke M F van Mierlo
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital-Center of Pediatric Dermatology, Rotterdam, The Netherlands
| | - Menno C van Zelm
- Department Immunology and Pathology, Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Chen Hu
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital-Center of Pediatric Dermatology, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johan C de Jongste
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital-Center of Pediatric Dermatology, Rotterdam, The Netherlands
| | - Luba M Pardo
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital-Center of Pediatric Dermatology, Rotterdam, The Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Public Health and Primary Care, Leiden University Medical Center/LUMC Campus, Leiden, The Netherlands
| | - Henriëtte A Moll
- Department of General Pediatrics, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital-Center of Pediatric Dermatology, Rotterdam, The Netherlands
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10
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Hagedoorn NN, Wagenaar JHL, Nieboer D, Bath D, Von Both U, Carrol ED, Eleftheriou I, Emonts M, Van Der Flier M, De Groot R, Herberg J, Kohlmaier B, Levin M, Lim E, Maconochie I, Martinon-Torres F, Nijman R, Pokorn M, Rivero Calle I, Tsolia M, Yeung S, Zavadska D, Zenz W, Vermont CL, Oostenbrink R, Moll HA. Impact of a clinical decision rule on antibiotic prescription for children with suspected lower respiratory tract infections presenting to European emergency departments: a simulation study based on routine data. J Antimicrob Chemother 2021; 76:1349-1357. [PMID: 33564871 DOI: 10.1093/jac/dkab023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/11/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Discriminating viral from bacterial lower respiratory tract infections (LRTIs) in children is challenging thus commonly resulting in antibiotic overuse. The Feverkidstool, a validated clinical decision rule including clinical symptoms and C-reactive protein, safely reduced antibiotic use in children at low/intermediate risk for bacterial LRTIs in a multicentre trial at emergency departments (EDs) in the Netherlands. OBJECTIVES Using routine data from an observational study, we simulated the impact of the Feverkidstool on antibiotic prescriptions compared with observed antibiotic prescriptions in children with suspected LRTIs at 12 EDs in eight European countries. METHODS We selected febrile children aged 1 month to 5 years with respiratory symptoms and excluded upper respiratory tract infections. Using the Feverkidstool, we calculated individual risks for bacterial LRTI retrospectively. We simulated antibiotic prescription rates under different scenarios: (1) applying effect estimates on antibiotic prescription from the trial; and (2) varying both usage (50%-100%) and compliance (70%-100%) with the Feverkidstool's advice to withhold antibiotics in children at low/intermediate risk for bacterial LRTI (≤10%). RESULTS Of 4938 children, 4209 (85.2%) were at low/intermediate risk for bacterial LRTI. Applying effect estimates from the trial, the Feverkidstool reduced antibiotic prescription from 33.5% to 24.1% [pooled risk difference: 9.4% (95% CI: 5.7%-13.1%)]. Simulating 50%-100% usage with 90% compliance resulted in risk differences ranging from 8.3% to 15.8%. Our simulations suggest that antibiotic prescriptions would be reduced in EDs with high baseline antibiotic prescription rates or predominantly (>85%) low/intermediate-risk children. CONCLUSIONS Implementation of the Feverkidstool could reduce antibiotic prescriptions in children with suspected LRTIs in European EDs.
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Affiliation(s)
- Nienke N Hagedoorn
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Josephine H L Wagenaar
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - David Bath
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Ulrich Von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Partner site Munich, German Center for Infection Research (DZIF), Germany
| | - Enitan D Carrol
- Institute of Infection, Veterinary and Ecological Sciences Global Health Liverpool, University of Liverpool, UK.,Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Liverpool Health Partners, Liverpool, UK
| | - Irini Eleftheriou
- Second Department of Paediatrics, National and Kapodistrian University of Athens, P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, 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, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Michiel Van Der Flier
- Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald De Groot
- Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Jethro Herberg
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Emma Lim
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, 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, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Federico Martinon-Torres
- Genetics, Vaccines, Infections and Paediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ruud Nijman
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Marko Pokorn
- Department of Infectious Diseases, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Irene Rivero Calle
- Genetics, Vaccines, Infections and Paediatrics 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. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Shunmay Yeung
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Dace Zavadska
- Department of Paediatrics, Children's Clinical University Hospital, Rīgas Stradiņa universitāte, Riga, Latvia
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Clementien L Vermont
- Department of Paediatric Infectious diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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11
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Hill DL, Carr EJ, Rutishauser T, Moncunill G, Campo JJ, Innocentin S, Mpina M, Nhabomba A, Tumbo A, Jairoce C, Moll HA, van Zelm MC, Dobaño C, Daubenberger C, Linterman MA. Immune system development varies according to age, location, and anemia in African children. Sci Transl Med 2021; 12:12/529/eaaw9522. [PMID: 32024802 DOI: 10.1126/scitranslmed.aaw9522] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/19/2019] [Accepted: 01/13/2020] [Indexed: 12/14/2022]
Abstract
Children from low- and middle-income countries, where there is a high incidence of infectious disease, have the greatest need for the protection afforded by vaccination, but vaccines often show reduced efficacy in these populations. An improved understanding of how age, infection, nutrition, and genetics influence immune ontogeny and function is key to informing vaccine design for this at-risk population. We sought to identify factors that shape immune development in children under 5 years of age from Tanzania and Mozambique by detailed immunophenotyping of longitudinal blood samples collected during the RTS,S malaria vaccine phase 3 trial. In these cohorts, the composition of the immune system is dynamically transformed during the first years of life, and this was further influenced by geographical location, with some immune cell types showing an altered rate of development in Tanzanian children compared to Dutch children enrolled in the Generation R population-based cohort study. High-titer antibody responses to the RTS,S/AS01E vaccine were associated with an activated immune profile at the time of vaccination, including an increased frequency of antibody-secreting plasmablasts and follicular helper T cells. Anemic children had lower frequencies of recent thymic emigrant T cells, isotype-switched memory B cells, and plasmablasts; modulating iron bioavailability in vitro could recapitulate the B cell defects observed in anemic children. Our findings demonstrate that the composition of the immune system in children varies according to age, geographical location, and anemia status.
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Affiliation(s)
- Danika L Hill
- Lymphocyte Signalling and Development, Babraham Institute, Cambridge CB22 3AT, UK. .,Department of Immunology and Pathology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Edward J Carr
- Lymphocyte Signalling and Development, Babraham Institute, Cambridge CB22 3AT, UK.,Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Tobias Rutishauser
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland.,University of Basel, Basel 4001, Switzerland
| | - Gemma Moncunill
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Catalonia 08036, Spain
| | - Joseph J Campo
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Catalonia 08036, Spain
| | - Silvia Innocentin
- Lymphocyte Signalling and Development, Babraham Institute, Cambridge CB22 3AT, UK
| | - Maxmillian Mpina
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland.,University of Basel, Basel 4001, Switzerland.,Ifakara Health Institute, Bagamoyo, Tanzania
| | - Augusto Nhabomba
- Centro de Investigação em Saúde de Manhiça, Maputo, CP 1929, Mozambique
| | - Anneth Tumbo
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland.,University of Basel, Basel 4001, Switzerland.,Ifakara Health Institute, Bagamoyo, Tanzania
| | - Chenjerai Jairoce
- Centro de Investigação em Saúde de Manhiça, Maputo, CP 1929, Mozambique
| | - Henriëtte A Moll
- Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam 3015 GD, Netherlands
| | - Menno C van Zelm
- Department of Immunology and Pathology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Carlota Dobaño
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Catalonia 08036, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, CP 1929, Mozambique
| | - Claudia Daubenberger
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland. .,University of Basel, Basel 4001, Switzerland
| | - Michelle A Linterman
- Lymphocyte Signalling and Development, Babraham Institute, Cambridge CB22 3AT, UK.
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12
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Hartman SJF, Upadhyay PJ, Hagedoorn NN, Mathôt RAA, Moll HA, van der Flier M, Schreuder MF, Brüggemann RJ, Knibbe CA, de Wildt SN. Current Ceftriaxone Dose Recommendations are Adequate for Most Critically Ill Children: Results of a Population Pharmacokinetic Modeling and Simulation Study. Clin Pharmacokinet 2021; 60:1361-1372. [PMID: 34036552 PMCID: PMC8505376 DOI: 10.1007/s40262-021-01035-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 12/01/2022]
Abstract
Background and Objective Ceftriaxone is a cornerstone antibiotic for critically ill children with severe infections. Despite its widespread use, information on the pharmacokinetics of ceftriaxone is lacking in this population. We aimed to determine ceftriaxone pharmacokinetics in critically ill children and to propose ceftriaxone dosing guidelines resulting in adequate target attainment using population pharmacokinetic modeling and simulation. Methods Critically ill children (aged 0–18 years) treated with intravenous ceftriaxone (100 mg/kg once daily, infused in 30 minutes) and a central or arterial line in place were eligible. Opportunistic blood sampling for total and unbound ceftriaxone concentrations was used. Population pharmacokinetic analysis was performed using non-linear mixed-effects modeling on NONMEM™ Version 7.4.3. Simulations were performed to select optimal doses using probability of target attainment for two pharmacokinetic targets of the minimum inhibitory concentration (MIC) reflecting the susceptibility of pathogens (f T > MIC 100% and fT > 4 × MIC 100%). Results Two hundred and five samples for total and 43 time-matched samples for unbound plasma ceftriaxone concentrations were collected from 45 patients, median age 2.5 (range 0.1–16.7) years. A two-compartment model with bodyweight as the co-variate for volume of distribution and clearance, and creatinine-based estimated glomerular filtration rate as an additional covariate for clearance, best described ceftriaxone pharmacokinetics. For a typical patient (2.5 years, 14 kg) with an estimated glomerular filtration rate of 80 mL/min/1.73 m2, the current 100-mg/kg once-daily dose results in a probability of target attainment of 96.8% and 60.8% for a MIC of 0.5 mg/L and 4 × MIC (2 mg/L), respectively, when using fT > MIC 100% as a target. For a 50-mg/kg twice-daily regimen, the probability of target attainment was 99.9% and 93.4%, respectively. Conclusions The current dosing regimen of ceftriaxone provides adequate exposure for susceptible pathogens in most critically ill children. In patients with an estimated glomerular filtration rate of > 80 mL/min/1.73 m2 or in areas with a high prevalence of less-susceptible pathogens (MIC ≥ 0.5 mg/L), a twice-daily dosing regimen of 50 mg/kg can be considered to improve target attainment. Clinical Trial Registration POPSICLE study (ClinicalTrials.gov, NCT03248349, registered 14 August, 2017), PERFORM study (ClinicalTrials.gov, NCT03502993, registered 19 April, 2018). Supplementary Information The online version contains supplementary material available at 10.1007/s40262-021-01035-9.
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Affiliation(s)
- Stan J F Hartman
- Department of Pharmacology and Toxicology, Radboud Institute of Health Sciences, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Parth J Upadhyay
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - Nienke N Hagedoorn
- Division of General Pediatrics, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ron A A Mathôt
- Department of Hospital Pharmacy-Clinical Pharmacology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henriëtte A Moll
- Division of General Pediatrics, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel van der Flier
- Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Section Pediatric Infectious Diseases, Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Radboud Institute of Molecular Life Sciences, Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands
| | - Roger J Brüggemann
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Catherijne A Knibbe
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands.,Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Saskia N de Wildt
- Department of Pharmacology and Toxicology, Radboud Institute of Health Sciences, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. .,Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Intensive Care Medicine, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, The Netherlands.
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13
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Borensztajn D, Zachariasse JM, Greber-Platzer S, Alves CF, Freitas P, Smit FJ, van der Lei J, Steyerberg EW, Maconochie I, Moll HA. Shortness of breath in children at the emergency department: Variability in management in Europe. PLoS One 2021; 16:e0251046. [PMID: 33951099 PMCID: PMC8099081 DOI: 10.1371/journal.pone.0251046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 04/20/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Our aim was to describe variability in resource use and hospitalization in children presenting with shortness of breath to different European Emergency Departments (EDs) and to explore possible explanations for variability. DESIGN The TrIAGE project, a prospective observational study based on electronic health record data. PATIENTS AND SETTING Consecutive paediatric emergency department visits for shortness of breath in five European hospitals in four countries (Austria, Netherlands, Portugal, United Kingdom) during a study period of 9-36 months (2012-2014). MAIN OUTCOME MEASURES We assessed diversity between EDs regarding resource use (diagnostic tests, therapy) and hospital admission using multivariable logistic regression analyses adjusting for potential confounding variables. RESULTS In total, 13,552 children were included. Of those, 7,379 were categorized as immediate/very urgent, ranging from 13-80% in the participating hospitals. Laboratory tests and X-rays were performed in 8-33% of the cases and 21-61% was treated with inhalation medication. Admission rates varied between 8-47% and PICU admission rates varied between 0.1-9%. Patient characteristics and markers of disease severity (age, sex, comorbidity, urgency, vital signs) could explain part of the observed variability in resource use and hospitalization. However, after adjusting for these characteristics, we still observed substantial variability between settings. CONCLUSION European EDs differ substantially regarding the resource use and hospitalization in children with shortness of breath, even when adjusting for patient characteristics. Possible explanations for this variability might be unmeasured patient characteristics such as underlying disease, differences in guideline use and adherence or different local practice patterns.
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Affiliation(s)
- Dorine Borensztajn
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Joany M. Zachariasse
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Susanne Greber-Platzer
- Department of Paediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Claudio F. Alves
- Department of Paediatrics, Hospital Prof. Dr. Fernando da Fonseca, Lisbon, Portugal
| | - Paulo Freitas
- Intensive Care Unit, Hospital Prof. Dr. Fernando da Fonseca, Lisbon, Portugal
| | - Frank J. Smit
- Department of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ewout W. Steyerberg
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ian Maconochie
- Department of Paediatric Accident and Emergency, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Henriëtte A. Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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14
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van der Tas JT, Wolvius EB, Kragt L, Rivadeneira F, Moll HA, Steegers EAP, Schalekamp-Timmermans S. Caries experience among children born after a complicated pregnancy. Community Dent Oral Epidemiol 2020; 49:225-231. [PMID: 33219527 PMCID: PMC8246927 DOI: 10.1111/cdoe.12593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 01/27/2023]
Abstract
Objectives Behavioural and lifestyle factors, as oral hygiene and diet, are well‐established risk factors in the pathogenesis of dental caries, though displaying large differences in susceptibility across individuals. Since enamel formation already starts in utero, pregnancy course and outcome may eventually play a role in enamel strength and caries susceptibility. Therefore, we studied the association between history of pregnancy complications and the caries experience in their six‐year‐old children. The pregnancy complications included small for gestational age (SGA), spontaneous preterm birth (sPTB), gestational hypertension (GH), pre‐eclampsia (PE), individually, and a combination of those, designated as placental syndrome. Methods This study was embedded in Generation R, a prospective longitudinal Dutch multiethnic pregnancy cohort study. Information about pregnancy complications was obtained from questionnaires completed by midwives and obstetricians with cross‐validation in medical records. These included SGA, sPTB, GH and PE. Caries experience was assessed with the decayed, missing and filled teeth (dmft) index at a mean age of six years. The association between dental caries experience and a history of pregnancy complications was studied by using hurdle negative binomial (HNB) models. Results We were able to assess the dmft index in 5323 six‐year‐old children (mean age 6.2 years, SD 0.5). We did not find an association between the different pregnancy complications and dental caries experience in childhood, whether for SGA, sPTB, GH, PE, or for the combined outcome placental syndrome (HNB estimates: OR 1.02, 95%CI 0.87 ‐ 1.19; RR 0.90, 95%CI 0.78 ‐ 1.04). Further adjustment of the models with different confounders did not alter the outcome. Conclusions Although it is expected that prenatal stress can be a risk factor for caries development later in life, our findings do not support this hypothesis. Therefore, we believe disparities in caries experience between children are probably not explained by early life events during a critical intrauterine period of development.
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Affiliation(s)
- Justin T van der Tas
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eppo B Wolvius
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lea Kragt
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric A P Steegers
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sarah Schalekamp-Timmermans
- The Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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15
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van Meel ER, Jaddoe VWV, Looman KIM, de Jongste JC, Moll HA, Duijts L. Airway bacterial carriage and childhood respiratory health: A population-based prospective cohort study. Pediatr Allergy Immunol 2020; 31:774-782. [PMID: 32524657 PMCID: PMC7587008 DOI: 10.1111/pai.13310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Airway bacterial carriage might play a role in respiratory disease. We hypothesize that nasal carriage with Staphylococcus aureus or nasopharyngeal carriage with Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae predisposes individuals to adverse respiratory health. OBJECTIVE To examine the association of early-life airway bacterial carriage with respiratory tract infections and vice versa, and of early-life airway bacterial carriage with wheezing, lung function, and asthma in later childhood. METHODS We collected upper airway swabs for bacterial culturing for S aureus, H influenzae, M catarrhalis, and H influenzae at six timepoints between the ages of 6 weeks and 6 years among 945 children participating in a population-based prospective cohort study. Information on respiratory tract infections and wheezing until age 6 years, and asthma at age 10 years was obtained by questionnaires. Lung function at age 10 years was measured by spirometry. We tested possible bidirectional associations between airway bacterial carriage and respiratory tract infections by cross-lagged models, and associations of repeatedly measured airway bacterial carriage with wheezing, lung function, and asthma by generalized estimating equations models and regression models. RESULTS Cross-lagged modeling showed that early-life airway bacterial carriage was not consistently associated with upper and lower respiratory tract infections or vice versa. Nasopharyngeal carriage with any bacteria in infancy was associated with an increased risk of wheezing (OR [95% CI]: 1.66 [1.31, 2.10]). Airway bacterial carriage was not consistently associated with school-age lung function or asthma. CONCLUSION Nasopharyngeal carriage with any bacteria is associated with wheezing, but not respiratory tract infections, asthma, or lung function.
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Affiliation(s)
- Evelien R van Meel
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kirsten I M Looman
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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16
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Van Remmerden MC, Hoogland L, Mous SE, Dierckx B, Coesmans M, Moll HA, Lubbers K, Lincken CR, Van Eeghen AM. Growing up with Fragile X Syndrome: Concerns and Care Needs of Young Adult Patients and Their Parents. J Autism Dev Disord 2020; 50:2174-2187. [PMID: 30879259 PMCID: PMC7261272 DOI: 10.1007/s10803-019-03973-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Little is known about care needs of young adults with Fragile X Syndrome (FXS). Patient-driven information is needed to improve understanding and support of young adults with FXS. A qualitative study was performed in 5 young adult patients (aged 18–30), and 33 parents of young adults. Concerns and care needs were categorized using the International Classification of Functioning, Disability, and Health. Results indicated concerns on 14 domains for males, and 13 domains for females, including physical, psychological and socio-economical issues. In both groups parents reported high stress levels and a lack of knowledge of FXS in adult care providers. This study revealed concerns on various domains, requiring gender-specific, multidisciplinary transitional care and adult follow-up for patients with FXS.
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Affiliation(s)
- M C Van Remmerden
- The Hartekamp Groupe, Care and Service Center for People with Intellectual Disabilities, Haarlem, The Netherlands
| | - L Hoogland
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands.,ASVZ, Care and Service Center for People with Intellectual Disabilities, Sliedrecht, The Netherlands
| | - S E Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - B Dierckx
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Coesmans
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H A Moll
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of General Pediatrics, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K Lubbers
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C R Lincken
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of General Pediatrics, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A M Van Eeghen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Room SP-1536, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands. .,Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands. .,'s Heeren Loo Zorggroep, Care and Service Center for People with Intellectual Disabilities, Amersfoort, The Netherlands.
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17
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Zachariasse JM, Borensztajn DM, Nieboer D, Alves CF, Greber-Platzer S, Keyzer-Dekker CMG, Maconochie IK, Steyerberg EW, Smit FJ, Moll HA. Sex-specific differences in children attending the emergency department: prospective observational study. BMJ Open 2020; 10:e035918. [PMID: 32948551 PMCID: PMC7500294 DOI: 10.1136/bmjopen-2019-035918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the role of sex in the presentation and management of children attending the emergency department (ED). DESIGN The TrIAGE project (TRiage Improvements Across General Emergency departments), a prospective observational study based on curated electronic health record data. SETTING Five diverse European hospitals in four countries (Austria, The Netherlands, Portugal, UK). PARTICIPANTS All consecutive paediatric ED visits of children under the age of 16 during the study period (8-36 months between 2012 and 2015). MAIN OUTCOME MEASURES The association between sex (male of female) and diagnostic tests and disease management in general paediatric ED visits and in subgroups presenting with trauma or musculoskeletal, gastrointestinal and respiratory problems and fever. Results from the different hospitals were pooled in a random effects meta-analysis. RESULTS 116 172 ED visits were included of which 63 042 (54%) by boys and 53 715 (46%) by girls. Boys accounted for the majority of ED visits in childhood, and girls in adolescence. After adjusting for age, triage urgency and clinical presentation, girls had more laboratory tests compared with boys (pooled OR 1.10, 95% CI 1.05 to 1.15). Additionally, girls had more laboratory tests in ED visits for respiratory problems (pooled OR 1.15, 95% CI 1.04 to 1.26) and more imaging in visits for trauma or musculoskeletal problems (pooled OR 1.10, 95% CI 1.01 to 1.20) and respiratory conditions (pooled OR 1.14, 95% CI 1.05 to 1.24). Girls with respiratory problems were less often treated with inhalation medication (pooled OR 0.76, 95% CI 0.70 to 0.83). There was no difference in hospital admission between the sexes (pooled OR 0.99, 95% CI 0.95 to 1.04). CONCLUSION In childhood, boys represent the majority of ED visits and they receive more inhalation medication. Unexpectedly, girls receive more diagnostic tests compared with boys. Further research is needed to investigate whether this is due to pathophysiological differences and differences in disease course, whether girls present signs and symptoms differently, or whether sociocultural factors are responsible.
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Affiliation(s)
- Joany M Zachariasse
- Department of General Paediatrics, Erasmus MC- Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dorine M Borensztajn
- Department of General Paediatrics, Erasmus MC- Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - Claudio F Alves
- Department of Paediatrics, Emergency Unit, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | | | | | - Ian K Maconochie
- Department of Pediatric Emergency Medicine, Imperial College NHS Healthcare Trust, London, UK
| | - Ewout W Steyerberg
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank J Smit
- Department of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of General Paediatrics, Erasmus MC- Sophia Children's Hospital, Rotterdam, The Netherlands
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18
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Hagedoorn NN, Borensztajn DM, Nijman R, Balode A, von Both U, Carrol ED, Eleftheriou I, Emonts M, van der Flier M, de Groot R, Herberg J, Kohlmaier B, Lim E, Maconochie I, Martinon-Torres F, Nieboer D, Pokorn M, Strle F, Tsolia M, Yeung S, Zavadska D, Zenz W, Vermont C, Levin M, Moll HA. Variation in antibiotic prescription rates in febrile children presenting to emergency departments across Europe (MOFICHE): A multicentre observational study. PLoS Med 2020; 17:e1003208. [PMID: 32813708 PMCID: PMC7444592 DOI: 10.1371/journal.pmed.1003208] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 07/28/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The prescription rate of antibiotics is high for febrile children visiting the emergency department (ED), contributing to antimicrobial resistance. Large studies at European EDs covering diversity in antibiotic and broad-spectrum prescriptions in all febrile children are lacking. A better understanding of variability in antibiotic prescriptions in EDs and its relation with viral or bacterial disease is essential for the development and implementation of interventions to optimise antibiotic use. As part of the PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union) project, the MOFICHE (Management and Outcome of Fever in Children in Europe) study aims to investigate variation and appropriateness of antibiotic prescription in febrile children visiting EDs in Europe. METHODS AND FINDINGS Between January 2017 and April 2018, data were prospectively collected on febrile children aged 0-18 years presenting to 12 EDs in 8 European countries (Austria, Germany, Greece, Latvia, the Netherlands [n = 3], Spain, Slovenia, United Kingdom [n = 3]). These EDs were based in university hospitals (n = 9) or large teaching hospitals (n = 3). Main outcomes were (1) antibiotic prescription rate; (2) the proportion of antibiotics that were broad-spectrum antibiotics; (3) the proportion of antibiotics of appropriate indication (presumed bacterial), inappropriate indication (presumed viral), or inconclusive indication (unknown bacterial/viral or other); (4) the proportion of oral antibiotics of inappropriate duration; and (5) the proportion of antibiotics that were guideline-concordant in uncomplicated urinary and upper and lower respiratory tract infections (RTIs). We determined variation of antibiotic prescription and broad-spectrum prescription by calculating standardised prescription rates using multilevel logistic regression and adjusted for general characteristics (e.g., age, sex, comorbidity, referral), disease severity (e.g., triage level, fever duration, presence of alarming signs), use and result of diagnostics, and focus and cause of infection. In this analysis of 35,650 children (median age 2.8 years, 55% male), overall antibiotic prescription rate was 31.9% (range across EDs: 22.4%-41.6%), and among those prescriptions, the broad-spectrum antibiotic prescription rate was 52.1% (range across EDs: 33.0%-90.3%). After standardisation, differences in antibiotic prescriptions ranged from 0.8 to 1.4, and the ratio between broad-spectrum and narrow-spectrum prescriptions ranged from 0.7 to 1.8 across EDs. Standardised antibiotic prescription rates varied for presumed bacterial infections (0.9 to 1.1), presumed viral infections (0.1 to 3.3), and infections of unknown cause (0.1 to 1.8). In all febrile children, antibiotic prescriptions were appropriate in 65.0% of prescriptions, inappropriate in 12.5% (range across EDs: 0.6%-29.3%), and inconclusive in 22.5% (range across EDs: 0.4%-60.8%). Prescriptions were of inappropriate duration in 20% of oral prescriptions (range across EDs: 4.4%-59.0%). Oral prescriptions were not concordant with the local guideline in 22.3% (range across EDs: 11.8%-47.3%) of prescriptions in uncomplicated RTIs and in 45.1% (range across EDs: 11.1%-100%) of prescriptions in uncomplicated urinary tract infections. A limitation of our study is that the included EDs are not representative of all febrile children attending EDs in that country. CONCLUSIONS In this study, we observed wide variation between European EDs in prescriptions of antibiotics and broad-spectrum antibiotics in febrile children. Overall, one-third of prescriptions were inappropriate or inconclusive, with marked variation between EDs. Until better diagnostics are available to accurately differentiate between bacterial and viral aetiologies, implementation of antimicrobial stewardship guidelines across Europe is necessary to limit antimicrobial resistance.
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Affiliation(s)
- Nienke N. Hagedoorn
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Dorine M. Borensztajn
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Ruud Nijman
- Section of Paediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Anda Balode
- Department of Paediatrics, Children’s Clinical University Hospital, Rīgas Stradiņa Universitāte, Riga, Latvia
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, University Hospital, Ludwig Maximilian University, Munich, Germany
- Partner Site Munich, German Center for Infection Research (DZIF), Munich, Germany
| | - Enitan D. Carrol
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Irini Eleftheriou
- Second Department of Paediatrics, P. & A. Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michiel van der Flier
- Paediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
- Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ronald de Groot
- Paediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Jethro Herberg
- Section of Paediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Emma Lim
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Federico Martinon-Torres
- Genetics, Vaccines, Infections and Paediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marko Pokorn
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maria Tsolia
- Second Department of Paediatrics, P. & A. Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Shunmay Yeung
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Dace Zavadska
- Department of Paediatrics, Children’s Clinical University Hospital, Rīgas Stradiņa Universitāte, Riga, Latvia
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Clementien Vermont
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Michael Levin
- Section of Paediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Henriëtte A. Moll
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, the Netherlands
- * E-mail:
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19
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van Meel ER, Attanasi M, Jaddoe VWV, Reiss IKM, Moll HA, de Jongste JC, Duijts L. C hlamydia trachomatis during pregnancy and childhood asthma-related morbidity: a population-based prospective cohort. Eur Respir J 2020; 56:56/1/1901829. [PMID: 32703819 DOI: 10.1183/13993003.01829-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 04/01/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Chlamydia trachomatis is the most commonly reported sexually transmitted disease and although infection during pregnancy is associated with neonatal complications, long-term respiratory consequences are unknown. We aimed to determine whether C. trachomatis infection during pregnancy is associated with asthma-related symptoms across childhood METHODS: This study among 2475 children and their mothers was embedded in a population-based prospective cohort study. Maternal urine samples were tested for C. trachomatis infection during pregnancy. Questionnaires provided information on childhood physician-attended lower respiratory tract infections and wheezing, and current asthma at age 10 years. Lung function was measured by spirometry at age 10 years. RESULTS The prevalence of C. trachomatis infection during pregnancy was 3.2% (78 out of 2475). C. trachomatis infection during pregnancy was not associated with lower respiratory tract infections until age 6 years, but was associated with a higher odds of wheezing in children until age 10 years (OR 1.50 (95% CI 1.10-2.03)). C. trachomatis infection during pregnancy was associated with an increased odds of asthma (OR 2.29 (95% CI 1.02-5.13)), and with a lower forced expiratory volume in 1 s/forced vital capacity and forced expiratory flow at 75% of forced vital capacity (z-score difference -0.28 (95% CI -0.52- -0.04) and -0.24 (95% CI -0.46- -0.01), respectively) in children at age 10 years. The observed associations were only partly explained by mode of delivery, gestational age at birth or birthweight. CONCLUSIONS C. trachomatis infection during pregnancy is associated with increased odds of wheezing, asthma and impaired lung function. The causality of the observed associations and potential underlying mechanisms need to be explored.
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Affiliation(s)
- Evelien R van Meel
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marina Attanasi
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Dept of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Dept of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Dept of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands .,Dept of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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20
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Zachariasse JM, Nieboer D, Maconochie IK, Smit FJ, Alves CF, Greber-Platzer S, Tsolia MN, Steyerberg EW, Avillach P, van der Lei J, Moll HA. Development and validation of a Paediatric Early Warning Score for use in the emergency department: a multicentre study. Lancet Child Adolesc Health 2020; 4:583-591. [PMID: 32710839 DOI: 10.1016/s2352-4642(20)30139-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Paediatric Early Warning Scores (PEWSs) are being used increasingly in hospital wards to identify children at risk of clinical deterioration, but few scores exist that were designed for use in emergency care settings. To improve the prioritisation of children in the emergency department (ED), we developed and validated an ED-PEWS. METHODS The TrIAGE project is a prospective European observational study based on electronic health record data collected between Jan 1, 2012, and Nov 1, 2015, from five diverse EDs in four European countries (Netherlands, the UK, Austria, and Portugal). This study included data from all consecutive ED visits of children under age 16 years. The main outcome measure was a three-category reference standard (high, intermediate, low urgency) that was developed as part of the TrIAGE project as a proxy for true patient urgency. The ED-PEWS was developed based on an ordinal logistic regression model, with cross-validation by setting. After completing the study, we fully externally validated the ED-PEWS in an independent cohort of febrile children from a different ED (Greece). FINDINGS Of 119 209 children, 2007 (1·7%) were of high urgency and 29 127 (24·4%) of intermediate urgency, according to our reference standard. We developed an ED-PEWS consisting of age and the predictors heart rate, respiratory rate, oxygen saturation, consciousness, capillary refill time, and work of breathing. The ED-PEWS showed a cross-validated c-statistic of 0·86 (95% prediction interval 0·82-0·90) for high-urgency patients and 0·67 (0·61-0·73) for high-urgency or intermediate-urgency patients. A cutoff of score of at least 15 was useful for identifying high-urgency patients with a specificity of 0·90 (95% CI 0·87-0·92) while a cutoff score of less than 6 was useful for identifying low-urgency patients with a sensitivity of 0·83 (0·81-0·85). INTERPRETATION The proposed ED-PEWS can assist in identifying high-urgency and low-urgency patients in the ED, and improves prioritisation compared with existing PEWSs. FUNDING Stichting de Drie Lichten, Stichting Sophia Kinderziekenhuis Fonds, and the European Union's Horizon 2020 research and innovation programme.
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Affiliation(s)
- Joany M Zachariasse
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ian K Maconochie
- Department of Paediatric Emergency Medicine, Imperial College NHS Healthcare Trust, London, UK
| | - Frank J Smit
- Department of Paediatrics, Maasstad Hospital, Rotterdam, Netherlands
| | - Claudio F Alves
- Department of Paediatrics, Emergency Unit, Hospital Professor Doutor Fernando da Fonseca, Lisbon, Portugal
| | - Susanne Greber-Platzer
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Maria N Tsolia
- National and Kapodistrian University of Athens, Second Department of Paediatrics, P and A Kyriakou Children's Hospital, Athens, Greece
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Paul Avillach
- Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands; Harvard Medical School, Department of Biomedical Informatics, Boston, MA, USA
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Henriëtte A Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands.
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21
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van Meel ER, Jaddoe VWV, Reiss IKM, van Zelm MC, de Jongste JC, Moll HA, Duijts L. The influence of Epstein-Barr virus and cytomegalovirus on childhood respiratory health: A population-based prospective cohort study. Clin Exp Allergy 2020; 50:499-507. [PMID: 32037652 PMCID: PMC7187347 DOI: 10.1111/cea.13579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 01/03/2023]
Abstract
Background Epstein‐Barr virus (EBV) and cytomegalovirus (CMV) infection are common in early childhood. CMV infection favours a T‐helper‐1 and EBV infection a T‐helper‐2 cell response, possibly leading to disbalanced T‐helper cell response, and subsequent risk of asthma or atopy. Objective To study the associations of EBV and CMV with lung function, asthma and inhalant allergic sensitization at school age. Methods This study among 3546 children was embedded in a population‐based prospective cohort. At age 6 years, serum IgG levels against EBV and CMV were measured by ELISA. At age 10 years, lung function was measured by spirometry, asthma by questionnaire and inhalant allergic sensitization by skin prick test. Results Unadjusted models showed that seropositivity for EBV was associated with a higher FEV1 and FEF75 (Z‐score difference (95% CI): 0.09 (0.02, 0.16) and 0.09 (0.02, 0.15)), while seropositivity for CMV was not. Specific combinations of viruses showed that seropositivity for EBV was only associated with FEV1 and FEF75 in the presence of seropositivity for CMV (0.12 (0.04, 0.20)) and 0.08 (0.01, 0.15)). Seropositivity for CMV in the absence of seropositivity for EBV was associated with an increased risk of inhalant allergic sensitization (OR (95% CI): 1.31 (1.02, 1.68)). All effect estimates attenuated into non‐significant mainly after adjustment for child's ethnicity. Seropositivity for EBV or CMV was not associated with asthma. Conclusions and Clinical Relevance Associations of EBV and CMV infections in early childhood with school‐age lung function and inhalant allergic sensitization are explained by ethnicity, or sociodemographic and lifestyle‐related factors.
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Affiliation(s)
- Evelien R van Meel
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Menno C van Zelm
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Immunology and Pathology, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Vic., Australia
| | - Johan C de Jongste
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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22
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Schinkelshoek G, Borensztajn DM, Zachariasse JM, Maconochie IK, Alves CF, Freitas P, Smit FJ, van der Lei J, Steyerberg EW, Greber-Platzer S, Moll HA. Management of children visiting the emergency department during out-of-office hours: an observational study. BMJ Paediatr Open 2020; 4:e000687. [PMID: 32984551 PMCID: PMC7493126 DOI: 10.1136/bmjpo-2020-000687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim was to study the characteristics and management of children visiting the emergency department (ED) during out-of-office hours. METHODS We analysed electronic health record data from 119 204 children visiting one of five EDs in four European countries. Patient characteristics and management (diagnostic tests, treatment, hospital admission and paediatric intensive care unit admission) were compared between children visiting during office hours and evening shifts, night shifts and weekend day shifts. Analyses were corrected for age, gender, Manchester Triage System urgency, abnormal vital signs, presenting problems and hospital. RESULTS Patients presenting at night were younger (median (IQR) age: 3.7 (1.4-8.2) years vs 4.8 (1.8-9.9)), more often classified as high urgent (16.3% vs 9.9%) and more often had ≥2 abnormal vital signs (22.8% vs 18.1%) compared with office hours. After correcting for disease severity, laboratory and radiological tests were less likely to be requested (adjusted OR (aOR): 0.82, 95% CI 0.78-0.86 and aOR: 0.64, 95% CI 0.60-0.67, respectively); treatment was more likely to be undertaken (aOR: 1.56, 95% CI 1.49-1.63) and patients were more likely to be admitted to the hospital (aOR: 1.32, 95% CI 1.24-1.41) at night. Patterns in management during out-of-office hours were comparable between the different hospitals, with variability remaining. CONCLUSIONS Children visiting during the night are relatively more seriously ill, highlighting the need to keep improving emergency care on a 24-hour-a-day basis. Further research is needed to explain the differences in management during the night and how these differences affect patient outcomes.
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Affiliation(s)
- Gina Schinkelshoek
- Department of General Paediatrics, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Dorine M Borensztajn
- Department of General Paediatrics, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Joany M Zachariasse
- Department of General Paediatrics, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Ian K Maconochie
- Department of Paediatric Accident and Emergency, Imperial College Healthcare NHS Trust, London, UK
| | - Claudio F Alves
- Department of Paediatrics, Professor Doutor Fernando Fonseca Hospital, Amadora, Lisboa, Portugal
| | - Paulo Freitas
- Intensive Care Unit, Professor Doutor Fernando Fonseca Hospital, Amadora, Lisboa, Portugal
| | - Frank J Smit
- Department of Paediatrics, Maasstad Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Susanne Greber-Platzer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Henriëtte A Moll
- Department of General Paediatrics, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands
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23
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Looman KIM, Meel ER, Grosserichter‐Wagener C, Vissers FJM, Klingenberg JH, Jong NW, Jongste JC, Pasmans SGMA, Duijts L, Zelm MC, Moll HA. Associations of Th2, Th17, Treg cells, and IgA + memory B cells with atopic disease in children: The Generation R Study. Allergy 2020; 75:178-187. [PMID: 31385614 DOI: 10.1111/all.14010] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/10/2019] [Accepted: 06/18/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND New insights into immune cells could contribute to treatment and monitoring of atopic disease. Because nongenetic factors shape the human immune system, we here studied these immune cells in a large cohort with atopic children with adjustment for prenatal and postnatal confounders. METHODS Information on atopic dermatitis, inhalant- and food-allergic sensitization, asthma lung function scores was obtained from 855 10-year-old children within the Generation R cohort. 11-color flow cytometry was performed to determine CD27+ and CD27- IgG+ , IgE+ and IgA+ memory B cells, Th1, Th2, Th17, and Treg-memory cells from venous blood. Associations between any atopic disease, the individual atopic diseases, and immune cell numbers were determined. RESULTS Children with any atopic disease had higher Th2, Treg, Treg-memory, and CD27+ IgA+ memory B-cell numbers compared to children without atopic disease. When studying the individual diseases compared to children without the individual diseases, children with atopic dermatitis, inhalant-, and food-allergic sensitization had higher memory Treg cell numbers 12.3% (95% CI 4.2; 21.0), (11.1% (95% CI 3.0; 19.8), (23.7% (95% CI 7.9; 41.8), respectively. Children with food-allergic sensitization had higher total B and CD27+ IgA+ memory B-cell numbers (15.2% [95% CI 3.2; 28.7], 22.5% [95% CI 3.9; 44.3], respectively). No associations were observed between asthma and B- or T-cell numbers. CONCLUSION Children with any atopic disease and children with inhalant- and food-allergic sensitization or atopic dermatitis had higher circulating memory Treg cells, but not higher IgE+ B-cell numbers. The associations of higher Treg and CD27+ IgA+ B-cell numbers in children with food-allergic sensitization are suggestive of TGF-β-mediated compensation for chronic inflammation.
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Affiliation(s)
- Kirsten I. M. Looman
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam the Netherlands
- Department of Pediatrics Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Evelien R. Meel
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam the Netherlands
- Department of Pediatrics, Division of Respiratory Medicine and Allergology Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
- Department of Epidemiology Erasmus MC, University Medical Center Rotterdam the Netherlands
| | | | - Floor J. M. Vissers
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam the Netherlands
- Department of Pediatrics Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Janice H. Klingenberg
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam the Netherlands
- Department of Pediatrics Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Nicolette W. Jong
- Department of Internal Medicine, Division of Allergology Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Johan C. Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
| | | | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
- Department of Pediatrics, Division of Neonatology Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
| | - Menno C. Zelm
- Department of Immunology and Pathology, Central Clinical School Monash University and Alfred Hospital Melbourne Victoria Australia
| | - Henriëtte A. Moll
- Department of Pediatrics Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam the Netherlands
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Bindels-de Heus KGCB, Mous SE, Ten Hooven-Radstaake M, van Iperen-Kolk BM, Navis C, Rietman AB, Ten Hoopen LW, Brooks AS, Elgersma Y, Moll HA, de Wit MCY. An overview of health issues and development in a large clinical cohort of children with Angelman syndrome. Am J Med Genet A 2019; 182:53-63. [PMID: 31729827 PMCID: PMC6916553 DOI: 10.1002/ajmg.a.61382] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 01/22/2023]
Abstract
This study presents a broad overview of health issues and psychomotor development of 100 children with Angelman syndrome (AS), seen at the ENCORE Expertise Center for AS in Rotterdam, the Netherlands. We aimed to further delineate the phenotype of AS, to evaluate the association of the phenotype with genotype and other determinants such as epilepsy and to get insight in possible targets for intervention. We confirmed the presence of a more severe phenotype in the 15q11.2‐q13 deletion subtype. Novel findings were an association of (early onset of) epilepsy with a negative effect on development, a high occurrence of nonconvulsive status epilepticus, a high rate of crouch gait in the older children with risk of deterioration of mobility, a relatively low occurrence of microcephaly, a higher mean weight for height in all genetic subtypes with a significant higher mean in the nondeletion children, and a high occurrence of hyperphagia across all genetic subtypes. Natural history data are needed to design future trials. With this large clinical cohort with structured prospective and multidisciplinary follow‐up, we provide unbiased data on AS to support further intervention studies to optimize outcome and quality of life of children with AS and their family.
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Affiliation(s)
- Karen G C B Bindels-de Heus
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
| | - Sabine E Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Maartje Ten Hooven-Radstaake
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
| | - Bianca M van Iperen-Kolk
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Physical Therapy, Erasmus MC, Rotterdam, The Netherlands
| | - Cindy Navis
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of ENT (Speech & Language Pathology), Erasmus MC, Rotterdam, The Netherlands
| | - André B Rietman
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Leontine W Ten Hoopen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Alice S Brooks
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | | | - Ype Elgersma
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
| | - Marie-Claire Y de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Neurology and Pediatric Neurology, Erasmus MC, Rotterdam, The Netherlands
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25
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Wahab RJ, Beth SA, Derks IPM, Jansen PW, Moll HA, Kiefte-de Jong JC. Celiac Disease Autoimmunity and Emotional and Behavioral Problems in Childhood. Pediatrics 2019; 144:peds.2018-3933. [PMID: 31492765 DOI: 10.1542/peds.2018-3933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Celiac disease (CeD) is associated with psychopathology in children. It is unknown whether this association is present in children with celiac disease autoimmunity (CDA) identified by screening. We examined the associations between subclinical CDA and emotional and behavioral problems in children without previous CeD diagnosis. METHODS In a population-based cohort study of 3715 children (median age: 6 years), blood titers of tissue transglutaminase autoantibodies were analyzed. CDA was defined as a measurement of tissue transglutaminase autoantibodies ≥7 U/mL (n = 51). Children with previous CeD diagnosis or children on a gluten-free diet, were excluded. The Child Behavior Checklist (CBCL) was filled in by parents and was used to assess behavioral and emotional problems of children at a median age of 5.9 years. Multiple linear regression models were applied to evaluate the cross-sectional associations between CDA and CBCL scores. Sensitivity analyses were done in a subgroup of children who were seropositive carrying the HLA antigen risk alleles for CeD. RESULTS In basic models, CDA was not associated with emotional and behavioral problems on the CBCL scales. After adjustment for confounders, CDA was significantly associated with anxiety problems (β = .29; 95% confidence interval 0.02 to 0.55; P = .02). After exclusion of children who did not carry the HLA-DQ2 and/or HLA-DQ8 risk alleles (n = 4), CDA was additionally associated with oppositional defiant problems (β = .35; 95% confidence interval 0.02 to 0.69). Associations were not explained by gastrointestinal complaints. CONCLUSIONS Our results reveal that CDA, especially combined with the HLA-DQ2 and HLA-DQ8 risk alleles, is associated with anxiety problems and oppositional defiant problems. Further research should be used to establish whether behavioral problems are a reflection of subclinical CeD.
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Affiliation(s)
- Rama J Wahab
- Generation R Study Group and.,Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sytske A Beth
- Generation R Study Group and.,Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ivonne P M Derks
- Generation R Study Group and.,Departments of Child and Adolescent Psychiatry and Psychology and
| | - Pauline W Jansen
- Departments of Child and Adolescent Psychiatry and Psychology and.,Psychology, Education, and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands; and
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands; .,Department of Public Health and Primary Care, Campus The Hague, Leiden University Medical Center, The Hague, Netherlands
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26
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Gervin K, Salas LA, Bakulski KM, van Zelm MC, Koestler DC, Wiencke JK, Duijts L, Moll HA, Kelsey KT, Kobor MS, Lyle R, Christensen BC, Felix JF, Jones MJ. Systematic evaluation and validation of reference and library selection methods for deconvolution of cord blood DNA methylation data. Clin Epigenetics 2019; 11:125. [PMID: 31455416 PMCID: PMC6712867 DOI: 10.1186/s13148-019-0717-y] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/29/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Umbilical cord blood (UCB) is commonly used in epigenome-wide association studies of prenatal exposures. Accounting for cell type composition is critical in such studies as it reduces confounding due to the cell specificity of DNA methylation (DNAm). In the absence of cell sorting information, statistical methods can be applied to deconvolve heterogeneous cell mixtures. Among these methods, reference-based approaches leverage age-appropriate cell-specific DNAm profiles to estimate cellular composition. In UCB, four reference datasets comprising DNAm signatures profiled in purified cell populations have been published using the Illumina 450 K and EPIC arrays. These datasets are biologically and technically different, and currently, there is no consensus on how to best apply them. Here, we systematically evaluate and compare these datasets and provide recommendations for reference-based UCB deconvolution. RESULTS We first evaluated the four reference datasets to ascertain both the purity of the samples and the potential cell cross-contamination. We filtered samples and combined datasets to obtain a joint UCB reference. We selected deconvolution libraries using two different approaches: automatic selection using the top differentially methylated probes from the function pickCompProbes in minfi and a standardized library selected using the IDOL (Identifying Optimal Libraries) iterative algorithm. We compared the performance of each reference separately and in combination, using the two approaches for reference library selection, and validated the results in an independent cohort (Generation R Study, n = 191) with matched Fluorescence-Activated Cell Sorting measured cell counts. Strict filtering and combination of the references significantly improved the accuracy and efficiency of cell type estimates. Ultimately, the IDOL library outperformed the library from the automatic selection method implemented in pickCompProbes. CONCLUSION These results have important implications for epigenetic studies in UCB as implementing this method will optimally reduce confounding due to cellular heterogeneity. This work provides guidelines for future reference-based UCB deconvolution and establishes a framework for combining reference datasets in other tissues.
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Affiliation(s)
- Kristina Gervin
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
- PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Lucas A Salas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, USA
| | - Kelly M Bakulski
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Menno C van Zelm
- Department of Immunology and Pathology, Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Australia
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Devin C Koestler
- Department of Biostatistics, University of Kansas Medical Center, Kansas, KS, USA
| | - John K Wiencke
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Liesbeth Duijts
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Karl T Kelsey
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Michael S Kobor
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Robert Lyle
- PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Brock C Christensen
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, USA
- Department of Molecular and Systems Biology, and Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Lebanon, USA
- Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Lebanon, USA
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Meaghan J Jones
- Department of Biochemistry and Medical Genetics, University of Manitoba, and Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
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27
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Vredebregt SJ, Moll HA, Smit FJ, Verhoeven JJ. Recognizing critically ill children with a modified pediatric early warning score at the emergency department, a feasibility study. Eur J Pediatr 2019; 178:229-234. [PMID: 30413883 DOI: 10.1007/s00431-018-3285-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/28/2018] [Accepted: 10/30/2018] [Indexed: 11/27/2022]
Abstract
Pediatric Early Warning Scores were developed to monitor clinical deterioration of children admitted to the hospital. Pediatric Early Warning Scores could also be useful in the Emergency Department to quickly identify critically ill patients so treatment can be started without delay. To determine if a newly designed, fast, and easy to use Modified Pediatric Early Warning Score can identify critically ill children in the Emergency Department. We conducted a retrospective observational study in the Emergency Department of an urban district hospital in Rotterdam, the Netherlands. Patients < 16 years attending the Emergency Department with an internal medical problem were included. Immediate intensive care unit admission was used as a measure for critically ill children. During the study period 2980 children attended the Emergency Department, ten (0.4%) of them required immediate intensive care unit admission. The Modified Pediatric Early Warning Score can identify critically ill children in the general pediatric Emergency Department population (area under the ROC curve 0.82). A sensitivity of 80% and specificity of 85% show potential to rule out critical illness in children visiting the Emergency Department when these results are validated in a larger population. A model containing both the Modified Pediatric Early Warning Score and the Manchester Triage System did not perform significantly better than the Manchester Triage System alone but did show a positive tendency in favor of the model containing the Modified Pediatric Early Warning Score and Manchester Triage System, area under the ROC curve 0.89 [95% CI 0.77-1.00] versus area under the ROC curve 0.82 [95% CI 0.68-0.95].Conclusions: In this feasibility study, the Modified Pediatric Early Warning Score could be a fast and easy to use tool to identify critically ill children in the general pediatric Emergency Department population. The effectiveness of the Modified Pediatric Early Warning Score may be optimized if combined with triage systems such as the Manchester Triage System. A larger prospective study is needed to confirm our results. What is known: • Pediatric Early Warning Scores can identify children who are in need for immediate intensive care unit admission at the Emergency Department. • Pediatric Early Warning Scores can be time-consuming, contain subjective parameters or parameters which are difficult to obtain in a reliable and standardized method. What is new: • We introduce a simplified, manageable and smartly designed Pediatric Early Warning Score on a pocket card based on an existing and previously investigated Pediatric Early Warning Score. • In this feasibility study the diagnostic performance of the Modified Pediatric Early Warning Score to predict immediate intensive care unit admission in the Emergency Department is in line with the original Pediatric Early Warning Scores but has to be validated on a larger scale.
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Affiliation(s)
- S J Vredebregt
- Department of Pediatrics, Maasstad Hospital, Room 1F2042, PO box 9100, 3007 AC, Rotterdam, The Netherlands
| | - H A Moll
- Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, dr. Molenwaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - F J Smit
- Department of Pediatrics, Maasstad Hospital, Room 1F2042, PO box 9100, 3007 AC, Rotterdam, The Netherlands
| | - J J Verhoeven
- Department of Pediatrics, Maasstad Hospital, Room 1F2042, PO box 9100, 3007 AC, Rotterdam, The Netherlands.
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Rietman AB, van der Vaart T, Plasschaert E, Nicholson BA, Oostenbrink R, Krab LC, Descheemaeker MJ, Wit MCYD, Moll HA, Legius E, Nijs PFAD. Emotional and behavioral problems in children and adolescents with neurofibromatosis type 1. Am J Med Genet B Neuropsychiatr Genet 2018; 177:319-328. [PMID: 29243874 DOI: 10.1002/ajmg.b.32612] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022]
Abstract
To assess emotional and behavioral problems in children and adolescents with neurofibromatosis type 1,parents of 183 individuals aged 10.8 ± 3.1 years (range 6-17) completed the Child Behavior Checklist (CBCL). Also, 173 teachers completed the Teacher's Report Form (TRF), and 88 adolescents (children from 11 to 17 years) completed the Youth Self-Report (YSR). According to parental ratings, 32% scored in the clinical range (above the 90th percentile). This percentage was much lower when rated by teachers or adolescents themselves. Scores from all informants on scales for Somatic complaints, Social problems, and Attention problems were significantly different from normative scores. Attentional problems were associated with lower verbal IQ, male gender, younger age, and ADHD-symptoms. Disease-related factors did not predict behavioral problems scores. Substantial emotional and behavioral problems were reported by parents, teachers, and to a lesser extent by adolescents with NF1 themselves. Possibly, a positive illusory bias affects the observation of behavioral problems by adolescents with NF1.
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Affiliation(s)
- André B Rietman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Thijs van der Vaart
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Neuroscience, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Ellen Plasschaert
- Centre for Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Bethany A Nicholson
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Rianne Oostenbrink
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Lianne C Krab
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Marie-Claire Y de Wit
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pediatric Neurology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Henriëtte A Moll
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Eric Legius
- Centre for Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Pieter F A de Nijs
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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van der Tas JT, Elfrink MEC, Heijboer AC, Rivadeneira F, Jaddoe VWV, Tiemeier H, Schoufour JD, Moll HA, Ongkosuwito EM, Wolvius EB, Voortman T. Foetal, neonatal and child vitamin D status and enamel hypomineralization. Community Dent Oral Epidemiol 2018; 46:343-351. [PMID: 29493792 PMCID: PMC6446811 DOI: 10.1111/cdoe.12372] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 01/21/2018] [Indexed: 02/05/2023]
Abstract
Objectives Recent literature suggested that higher vitamin D concentrations in childhood are associated with a lower prevalence of molar incisor hypomineralization (MIH). As tooth development already starts in utero, we aimed to study whether vitamin D status during foetal, postnatal and childhood periods is associated with the presence of hypomineralized second primary molars (HSPMs) and/or MIH at the age of six. Methods Our study was embedded in the Generation R Study, a population‐based, prospective cohort from foetal life onwards in Rotterdam, the Netherlands. HSPMs and MIH were scored from intraoral photographs of the children at their age of six. Serum 25(OH)D concentrations were measured at three points in time, which resulted in three different samples; mid‐gestational in mothers’ blood (n = 4750), in umbilical cord blood (n = 3406) and in children's blood at the age of 6 years (n = 3983). Results The children had a mean (±SD) age of 6.2 (±0.5) years at the moment of taking the intraoral photographs. After adjustment for confounders, no association was found between foetal 25(OH)D concentrations and the presence of HSPMs (OR 1.02 per 10 nmol/L higher 25(OH)D, 95% CI: 0.98‐1.07) or MIH (OR 1.05 per 10 nmol/L increase, 95% CI: 0.98‐1.12) in 6‐year‐olds. A higher 25(OH)D concentration in umbilical cord blood resulted in neither lower odds of having HSPM (OR 1.05, 95% CI: 0.98‐1.13) nor lower odds of having MIH (OR 0.95, 95% CI: 0.84‐1.07) by the age of six. Finally, we did not find higher 25(OH)D concentrations at the age of six to be associated with a significant change in the odds of having HSPM (OR 0.97, 95% CI: 0.92‐1.02) or MIH (OR 1.07, 95% CI: 0.98‐1.16). Conclusions 25(OH)D concentrations in prenatal, early postnatal and later postnatal life are not associated with the presence of HPSMs or with MIH at the age of six. Future observational research is required to replicate our findings. Furthermore, it is encouraged to focus on identifying other modifiable risk factors, because prevention of hypomineralization is possible only if the causes are known.
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Affiliation(s)
- Justin T van der Tas
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marlies E C Elfrink
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, Amsterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/psychology, Erasmus University Medical Center/Sophia, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Josje D Schoufour
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Edwin M Ongkosuwito
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eppo B Wolvius
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Trudy Voortman
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Zachariasse JM, Nieboer D, Oostenbrink R, Moll HA, Steyerberg EW. Multiple performance measures are needed to evaluate triage systems in the emergency department. J Clin Epidemiol 2017; 94:27-34. [PMID: 29154810 DOI: 10.1016/j.jclinepi.2017.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/15/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Emergency department triage systems can be considered prediction rules with an ordinal outcome, where different directions of misclassification have different clinical consequences. We evaluated strategies to compare the performance of triage systems and aimed to propose a set of performance measures that should be used in future studies. STUDY DESIGN AND SETTING We identified performance measures based on literature review and expert knowledge. Their properties are illustrated in a case study evaluating two triage modifications in a cohort of 14,485 pediatric emergency department visits. Strengths and weaknesses of the performance measures were systematically appraised. RESULTS Commonly reported performance measures are measures of statistical association (34/60 studies) and diagnostic accuracy (17/60 studies). The case study illustrates that none of the performance measures fulfills all criteria for triage evaluation. Decision curves are the performance measures with the most attractive features but require dichotomization. In addition, paired diagnostic accuracy measures can be recommended for dichotomized analysis, and the triage-weighted kappa and Nagelkerke's R2 for ordinal analyses. Other performance measures provide limited additional information. CONCLUSION When comparing modifications of triage systems, decision curves and diagnostic accuracy measures should be used in a dichotomized analysis, and the triage-weighted kappa and Nagelkerke's R2 in an ordinal approach.
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Affiliation(s)
- Joany M Zachariasse
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, P.O. Box 2040, 3000 CB, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, P.O. Box 2040, 3000 CB, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, P.O. Box 2040, 3000 CB, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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van Meel ER, den Dekker HT, Elbert NJ, Jansen PW, Moll HA, Reiss IK, de Jongste JC, Jaddoe VWV, Duijts L. A population-based prospective cohort study examining the influence of early-life respiratory tract infections on school-age lung function and asthma. Thorax 2017. [PMID: 29101282 DOI: 10.1136/thoraxjnl‐2017‐210149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Early-life respiratory tract infections could affect airway obstruction and increase asthma risk in later life. However, results from previous studies are inconsistent. OBJECTIVE We examined the associations of early-life respiratory tract infections with lung function and asthma in school-aged children. METHODS This study among 5197 children born between April 2002 and January 2006 was embedded in a population-based prospective cohort study. Information on physician-attended upper and lower respiratory tract infections until age 6 years (categorised into ≤ 3 and >3-6 years) was obtained by annual questionnaires. Spirometry measures and physician-diagnosed asthma were assessed at age 10 years. RESULTS Upper respiratory tract infections were not associated with adverse respiratory outcomes. Compared with children without lower respiratory tract infections ≤3 years, children with lower respiratory tract infections ≤3 years had a lower FEV1, FVC, FEV1:FVC and forced expiratory flow at 75% of FVC (FEF75) (Z-score (95% CI): ranging from -0.22 (-0.31 to -0.12) to -0.12 (-0.21 to -0.03)) and an increased risk of asthma (OR (95% CI): 1.79 (1.19 to 2.59)). Children with lower respiratory tract infections >3-6 years had an increased risk of asthma (3.53 (2.37 to 5.17)) only. Results were not mediated by antibiotic or paracetamol use and not modified by inhalant allergic sensitisation. Cross-lagged modelling showed that results were not bidirectional and independent of preschool wheezing patterns. CONCLUSION Early-life lower respiratory tract infections ≤3 years are most consistently associated with lower lung function and increased risk of asthma in school-aged children.
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Affiliation(s)
- Evelien R van Meel
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Herman T den Dekker
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Niels J Elbert
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Pauline W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Irwin K Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Johan C de Jongste
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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32
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van Meel ER, den Dekker HT, Elbert NJ, Jansen PW, Moll HA, Reiss IK, de Jongste JC, Jaddoe VWV, Duijts L. A population-based prospective cohort study examining the influence of early-life respiratory tract infections on school-age lung function and asthma. Thorax 2017; 73:167-173. [PMID: 29101282 DOI: 10.1136/thoraxjnl-2017-210149] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 09/27/2017] [Accepted: 10/09/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Early-life respiratory tract infections could affect airway obstruction and increase asthma risk in later life. However, results from previous studies are inconsistent. OBJECTIVE We examined the associations of early-life respiratory tract infections with lung function and asthma in school-aged children. METHODS This study among 5197 children born between April 2002 and January 2006 was embedded in a population-based prospective cohort study. Information on physician-attended upper and lower respiratory tract infections until age 6 years (categorised into ≤ 3 and >3-6 years) was obtained by annual questionnaires. Spirometry measures and physician-diagnosed asthma were assessed at age 10 years. RESULTS Upper respiratory tract infections were not associated with adverse respiratory outcomes. Compared with children without lower respiratory tract infections ≤3 years, children with lower respiratory tract infections ≤3 years had a lower FEV1, FVC, FEV1:FVC and forced expiratory flow at 75% of FVC (FEF75) (Z-score (95% CI): ranging from -0.22 (-0.31 to -0.12) to -0.12 (-0.21 to -0.03)) and an increased risk of asthma (OR (95% CI): 1.79 (1.19 to 2.59)). Children with lower respiratory tract infections >3-6 years had an increased risk of asthma (3.53 (2.37 to 5.17)) only. Results were not mediated by antibiotic or paracetamol use and not modified by inhalant allergic sensitisation. Cross-lagged modelling showed that results were not bidirectional and independent of preschool wheezing patterns. CONCLUSION Early-life lower respiratory tract infections ≤3 years are most consistently associated with lower lung function and increased risk of asthma in school-aged children.
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Affiliation(s)
- Evelien R van Meel
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Herman T den Dekker
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Niels J Elbert
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Pauline W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Irwin K Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Johan C de Jongste
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Zachariasse JM, van der Lee D, Seiger N, de Vos-Kerkhof E, Oostenbrink R, Moll HA. The role of nurses' clinical impression in the first assessment of children at the emergency department. Arch Dis Child 2017; 102:1052-1056. [PMID: 28601795 DOI: 10.1136/archdischild-2017-312860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/06/2017] [Accepted: 04/30/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the diagnostic value and determinants of nurses' clinical impression for the recognition of children with a serious illness on presentation to the emergency department (ED). DESIGN Secondary analysis of a prospective cohort. SETTING AND PATIENTS 6390 consecutive children <16 years of age presenting to a paediatric ED with a non-surgical chief complaint and complete data available. MAIN OUTCOME MEASURES Diagnostic accuracy of nurses' clinical impression for the prediction of serious illness, defined by intensive care unit (ICU) and hospital admission. Determinants of nurses' impression that a child appeared ill. RESULTS Nurses considered a total of 1279 (20.0%) children appearing ill. Sensitivity of nurses' clinical impression for the recognition of patients requiring ICU admission was 0.70 (95% CI 0.62 to 0.76) and specificity was 0.81 (95% CI 0.80 to 0.82). Sensitivity for hospital admission was 0.48 (95% CI 0.45 to 0.51) and specificity was 0.88 (95% CI 0.87 to 0.88). When adjusted for age, gender, triage urgency and abnormal vital signs, nurses' impression remained significantly associated with ICU (OR 4.54; 95% CI 3.09 to 6.66) and hospital admission (OR 4.00; 95% CI 3.40 to 4.69). Ill appearance was positively associated with triage urgency, fever and abnormal vital signs and negatively with self-referral and presentation outside of office hours. CONCLUSION The overall clinical impression of experienced nurses at the ED is on its own, not an accurate predictor of serious illness in children, but provides additional information above some well-established and objective predictors of illness severity.
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Affiliation(s)
- Joany M Zachariasse
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dominique van der Lee
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nienke Seiger
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Evelien de Vos-Kerkhof
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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34
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Looman KIM, Jansen MAE, Voortman T, van den Heuvel D, Jaddoe VWV, Franco OH, van Zelm MC, Moll HA. The role of vitamin D on circulating memory T cells in children: The Generation R study. Pediatr Allergy Immunol 2017; 28:579-587. [PMID: 28686349 DOI: 10.1111/pai.12754] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Previous studies have demonstrated that vitamin D affects T-cell function and maturation via the vitamin D receptor. However, no studies in children have been performed on this topic. Because most of the T-cell memory is formed in the first 5 years of life, we aimed to determine the association between serum 25-hydroxyvitamin D (25(OH)D) levels and numbers of circulatory naive, central memory (Tcm), and effector memory (Tem) T lymphocytes in a large population of healthy children. METHODS Among 3189 children participating in a population-based prospective cohort, we measured 25(OH)D levels and performed detailed immunophenotyping of naive and memory T lymphocytes at a median age of 6.0 years (95% range 5.7-7.9). Detailed lymphocyte subsets were available in 986 children. Multivariable linear regression analyses were performed to determine the association between 25(OH)D and the maturation of T lymphocytes in children adjusted for cord blood 25(OH)D levels, herpes seropositivity, sociodemographic and lifestyle confounders. Furthermore, multivariable logistic regression analyses were performed to determine associations between 25(OH)D and childhood infections. RESULTS Higher 25(OH)D levels were associated with higher numbers of Tem lymphocytes. Every 10 nmol/L higher 25(OH)D was associated with 2.20% (95% CI 0.54-3.89; P=.009) higher CD4TemRA, 1.50% (95% CI 0.38-2.62; P=.008) higher CD4TemRO, and 1.82% (95% CI 0.11-3.56; P=.037) higher CD8TemRA cell numbers. Generally, stronger associations were observed among boys. 25(OH)D levels were not significantly associated with naive, Tcm cell numbers, herpes seropositivity, or URTIs. CONCLUSIONS Our results suggest that vitamin D enhances cellular immunity in young children.
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Affiliation(s)
- Kirsten I M Looman
- Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Michelle A E Jansen
- Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Trudy Voortman
- Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Diana van den Heuvel
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Vincent W V Jaddoe
- Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Menno C van Zelm
- Department of Immunology and Pathology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, VIC, Australia
| | - Henriëtte A Moll
- Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Leermakers ETM, van den Hooven EH, Franco OH, Jaddoe VWV, Moll HA, Kiefte-de Jong JC, Voortman T. A priori and a posteriori derived dietary patterns in infancy and cardiometabolic health in childhood: The role of body composition. Clin Nutr 2017; 37:1589-1595. [PMID: 28830701 DOI: 10.1016/j.clnu.2017.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/01/2017] [Accepted: 08/08/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Cardiometabolic risk has its origins in early life. However, it is unclear whether diet during early childhood is associated with cardiometabolic health, and what the role is of obesity. We aimed to study whether overall diet during early childhood is associated with cardiometabolic health and to examine if difference in body composition explain this association. METHODS We examined associations of different types of dietary patterns in infancy with cardiometabolic health at school age among 2026 Dutch children participating in a population-based cohort in the Netherlands. Food intake at the age of 1 year was assessed with a food-frequency questionnaire. Three dietary pattern approaches were used: 1) An a priori-defined diet quality score; 2) dietary patterns based on variation in food intake, derived from principal component analysis (PCA); and 3) dietary patterns based on variations in fat and fat-free mass index, derived with reduced-rank regression (RRR). At the children's age of 6 years, we measured their body composition, systolic and diastolic blood pressure, and serum concentrations of insulin, triglycerides, and HDL-cholesterol, which we combined in a cardiometabolic risk-factor score. RESULTS We observed that, after adjustment for confounders, children with higher adherence to a 'Health-conscious' PCA-derived pattern had a lower cardiometabolic risk-factor score (-0.07 SD (95%CI -0.12; -0.02) per SD). This association did not change after adjustment for fat and fat-free mass index. The RRR-derived dietary patterns based on variations in body composition were not associated with the cardiometabolic risk-factor score. CONCLUSIONS Our results suggest that diet in early childhood may affect cardiometabolic health independent of differences in body composition.
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Affiliation(s)
- Elisabeth T M Leermakers
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Edith H van den Hooven
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Leiden University College, The Hague, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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36
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Nguyen AN, Elbert NJ, Pasmans SGMA, Kiefte-de Jong JC, de Jong NW, Moll HA, Jaddoe VWV, de Jongste JC, Franco OH, Duijts L, Voortman T. Diet Quality throughout Early Life in Relation to Allergic Sensitization and Atopic Diseases in Childhood. Nutrients 2017; 9:nu9080841. [PMID: 28783056 PMCID: PMC5579634 DOI: 10.3390/nu9080841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/28/2017] [Accepted: 08/02/2017] [Indexed: 01/16/2023] Open
Abstract
Early-life nutrition is an important modifiable determinant in the development of a child’s immune system, and may thereby influence the risk of allergic sensitization and atopic diseases. However, associations between overall dietary patterns and atopic diseases in childhood remain unclear. We examined associations of diet quality in early life with allergic sensitization, self-reported physician-diagnosed inhalant and food allergies, eczema, and asthma among 5225 children participating in a population-based cohort in the Netherlands. Diet was assessed during pregnancy, infancy, and childhood using validated food-frequency questionnaires. We calculated food-based diet quality scores (0–10 or 0–15), reflecting adherence to dietary guidelines. At age 10 years, allergic sensitization was assessed with skin prick tests. Information on physician-diagnosed inhalant and food allergies, eczema, and asthma was obtained with questionnaires. We observed no associations between diet quality during pregnancy and allergic sensitization (odds ratio (OR) = 1.05 per point in the diet score, 95% confidence interval (CI): 0.99, 1.13), allergies (0.96, 95% CI: 0.88, 1.04), eczema (0.99, 95% CI: 0.93, 1.06), or asthma (0.93, 95% CI: 0.85, 1.03) in childhood. Also, diet quality in infancy or childhood were not associated with atopic outcomes in childhood. Our findings do not support our hypothesis that a healthy dietary pattern in early life is associated with a lower risk of allergic sensitization or atopic diseases in childhood.
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Affiliation(s)
- Anh N Nguyen
- Department of Epidemiology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
- The Generation R Study Group, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Niels J Elbert
- The Generation R Study Group, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
- Department of Dermatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Suzanne G M A Pasmans
- Department of Dermatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
- Department of Pediatrics, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
- Department of Global Public Health, Leiden University College, 3595 DG The Hague, The Netherlands.
| | - Nicolette W de Jong
- Department of Internal Medicine, Division of Allergology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Vincent W V Jaddoe
- Department of Epidemiology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
- The Generation R Study Group, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
- Department of Pediatrics, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Johan C de Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
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Jansen MAE, van den Heuvel D, Jaddoe VWV, van Zelm MC, Moll HA. Abnormalities in CD57+ cytotoxic T cells and Vδ1+ γδT cells in subclinical celiac disease in childhood are affected by cytomegalovirus. The Generation R Study. Clin Immunol 2017; 183:233-239. [PMID: 28456719 DOI: 10.1016/j.clim.2017.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/26/2016] [Accepted: 04/26/2017] [Indexed: 02/06/2023]
Abstract
Celiac disease (CD) is a digestive and autoimmune disorder driven by an immune response to modified gluten peptides. Affected intestines show infiltrates of various T-cell and NK-cell subsets. It is currently unclear if individuals with subclinical CD have systemic abnormalities in immune cells. We here studied whether subclinical CD is associated with changes in blood CD57-expressing and Vδ1-expressing lymphocytes in children, and whether cytomegalovirus (CMV) infection modifies this association. Included were 1068 children from the Generation R Study. Serum Immunoglobulin G (IgG) levels against CMV were measured by ELISA; Tissue transglutaminase type 2 antibody (TG2A) levels with fluorescence enzyme immunoassay (FEIA). Duodenal biopsies, additional Human Leukocyte Antigen (HLA) DQ 2.2, 2.5 and 8 and endomysial antibody (EMA) typing were performed in TG2A positive children. Subclinical CD cases (n=12) had 1.8 fold (95% CI 1.06; 3.1) fewer Vδ1+ T cells which was predominantly observed in CMV seronegative children (p-interaction 0.02), and 2.7 fold (95% CI 1.25; 5.99) more CD57+ T cells than HLA DQ2/-DQ8 positive controls (n=339). Hence, children with subclinical CD have alterations in specific blood T cell subsets that are linked to viral pathology. The observed interaction effect between subclinical CD and CMV may contribute to the understanding of disease pathogenesis.
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Affiliation(s)
- M A E Jansen
- The Generation R Study Group, Erasmus MC-Sophia, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands; Department of Immunology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - D van den Heuvel
- Department of Immunology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - V W V Jaddoe
- The Generation R Study Group, Erasmus MC-Sophia, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - M C van Zelm
- Department of Immunology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands; Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - H A Moll
- Department of Pediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands.
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van der Tas JT, Kragt L, Elfrink MEC, Bertens LCM, Jaddoe VWV, Moll HA, Ongkosuwito EM, Wolvius EB. Social inequalities and dental caries in six-year-old children from the Netherlands. J Dent 2017; 62:18-24. [PMID: 28450065 DOI: 10.1016/j.jdent.2017.04.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The purpose of our study was to investigate the association of different socioeconomic and sociodemographic factors with dental caries in six-year-old children. Furthermore, we applied a district based approach to explore the distribution of dental caries among districts of low and high socioeconomic position (SEP). METHODS In our cross-sectional study 5189 six-year-olds were included. This study was embedded in a prospective population-based birth cohort study in Rotterdam, the Netherlands, the Generation R Study. Parental education level, parental employment status, net household income, single parenting, and teenage pregnancy were considered as indicators for SEP. Dental caries was scored on intraoral photographs by using the decayed, missing, and filled teeth (dmft) index. We compared children without caries (dmft=0) to children with mild caries (dmft=1-3) or severe caries (dmft >3). Multinomial logistic regression analyses and binary logistic regression analyses were performed to study the association between SEP and caries, and between district and caries, respectively. RESULTS Only maternal education level remained significantly associated with mild caries after adjusting for all other SEP-indicators. Paternal educational level, parental employment status, and household income additionally served as independent indicators of SEP in children with severe caries. Furthermore, living in more disadvantaged districts was significantly associated with higher odds of dental caries. CONCLUSION Dental caries is more prevalent among six-year-old children with a low SEP, which is also visible at the district level. Maternal educational level is the most important indicator of SEP in the association with caries. CLINICAL SIGNIFICANCE Our results should raise concerns about the existing social inequalities in dental caries and should encourage development of dental caries prevention strategies. New knowledge about the distribution of oral health inequalities between districts should be used to target the right audience for these strategies.
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Affiliation(s)
- Justin T van der Tas
- The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Lea Kragt
- The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Marlies E C Elfrink
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Vincent W V Jaddoe
- The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Epidemiology, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Paediatrics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Henriëtte A Moll
- The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Paediatrics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Edwin M Ongkosuwito
- The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
| | - Eppo B Wolvius
- The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
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den Hollander WJ, Schalekamp - Timmermans S, Holster IL, Jaddoe VW, Hofman A, Moll HA, Perez-Perez GI, Blaser MJ, Steegers EA, Kuipers EJ. Helicobacter pylori colonization and pregnancies complicated by preeclampsia, spontaneous prematurity, and small for gestational age birth. Helicobacter 2017; 22:10.1111/hel.12364. [PMID: 27786400 PMCID: PMC5352538 DOI: 10.1111/hel.12364] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Preeclampsia (PE), small for gestational age (SGA), and spontaneous preterm birth (PTB) each may be complications of impaired placental function in pregnancy. Although their exact pathogenesis is still unknown, certain infectious agents seem to play a role. Helicobacter pylori (H. pylori) colonization has been associated with increased risk for PE. Our aim was to assess the association between H. pylori colonization and PE, SGA, and PTB. MATERIAL AND METHODS We measured IgG anti-H. pylori and CagA antibodies in serum of pregnant women (median 20.5 weeks, range 16.5-29.4) who participated in a population-based prospective cohort study. Delivery and medical records were assessed. Information on demographics, education, and maternal risk factors was collected by questionnaire. We used multivariate logistic regression analyses to assess associations between H. pylori colonization and PE, SGA, and PTB. RESULTS In total, 6348 pregnant women were assessed. H. pylori positivity was found in 2915 (46%) women, of whom 1023 (35%) also were CagA-positive. Pregnancy was complicated by PE, SGA, or PTB in 927 (15%) women. H. pylori colonization was associated with PE (aOR 1.51; 95%CI 1.03-2.25). Differentiation according to CagA status revealed the same risk. H. pylori was positively related with SGA, mainly explained by CagA-positive strains (aOR 1.34; 1.04-1.71). No association was observed between H. pylori and PTB. CONCLUSIONS Our data suggest that H. pylori colonization may be a risk factor for PE and SGA. If these associations are confirmed by future studies and shown to be causal, H. pylori eradication may reduce related perinatal morbidity and mortality.
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Affiliation(s)
- Wouter J. den Hollander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | | | - I. Lisanne Holster
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Vincent W. Jaddoe
- Department of Pediatrics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands,Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Henriëtte A. Moll
- Department of Pediatrics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | | | - Martin J. Blaser
- Departments of Medicine and Microbiology, New York Langone Medicine Center, New York, USA
| | - Eric A.P. Steegers
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Ernst J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands,Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Zachariasse JM, Seiger N, Rood PPM, Alves CF, Freitas P, Smit FJ, Roukema GR, Moll HA. Validity of the Manchester Triage System in emergency care: A prospective observational study. PLoS One 2017; 12:e0170811. [PMID: 28151987 PMCID: PMC5289484 DOI: 10.1371/journal.pone.0170811] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 01/11/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine the validity of the Manchester Triage System (MTS) in emergency care for the general population of patients attending the emergency department, for children and elderly, and for commonly used MTS flowcharts and discriminators across three different emergency care settings. METHODS This was a prospective observational study in three European emergency departments. All consecutive patients attending the emergency department during a 1-year study period (2010-2012) were included. Validity of the MTS was assessed by comparing MTS urgency as determined by triage nurses with patient urgency according to a predefined 3-category reference standard as proxy for true patient urgency. RESULTS 288,663 patients were included in the analysis. Sensitivity of the MTS in the three hospitals ranged from 0.47 (95%CI 0.44-0.49) to 0.87 (95%CI 0.85-0.90), and specificity from 0.84 (95%CI 0.84-0.84) to 0.94 (95%CI 0.94-0.94) for the triage of adult patients. In children, sensitivity ranged from 0.65 (95%CI 0.61-0.70) to 0.83 (95%CI 0.79-0.87), and specificity from 0.83 (95%CI 0.82-0.83) to 0.89 (95%CI 0.88-0.90). The diagnostic odds ratio ranged from 13.5 (95%CI 12.1-15.0) to 35.3 (95%CI 28.4-43.9) in adults and from 9.8 (95%CI 6.7-14.5) to 23.8 (95%CI 17.7-32.0) in children, and was lowest in the youngest patients in 2 out of 3 settings and in the oldest patients in all settings. Performance varied considerably between the different emergency departments. CONCLUSIONS Validity of the MTS in emergency care is moderate to good, with lowest performance in the young and elderly patients. Future studies on the validity of triage systems should be restricted to large, multicenter studies to define modifications and improve generalizability of the findings.
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Affiliation(s)
- Joany M. Zachariasse
- Department of General Paediatrics, Erasmus MC- Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Nienke Seiger
- Department of General Paediatrics, Erasmus MC- Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Pleunie P. M. Rood
- Department of Emergency Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Claudio F. Alves
- Department of Paediatrics, Emergency Unit, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Paulo Freitas
- Intensive Care Unit, Hospital Professor Doutor Fernando da Fonseca, Amadora, Lisbon, Portugal
| | - Frank J. Smit
- Department of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | - Gert R. Roukema
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Henriëtte A. Moll
- Department of General Paediatrics, Erasmus MC- Sophia Children’s Hospital, Rotterdam, The Netherlands
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Stroobant W, Braun KV, Kiefte-de Jong JC, Moll HA, Jaddoe VW, Brouwer IA, Franco OH, Voortman T. Intake of Different Types of Fatty Acids in Infancy Is Not Associated with Growth, Adiposity, or Cardiometabolic Health up to 6 Years of Age. J Nutr 2017; 147:413-420. [PMID: 28122928 DOI: 10.3945/jn.116.241018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/02/2016] [Accepted: 01/04/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Studies in adults indicate that a lower saturated and higher unsaturated fat intake is associated with a lower risk of metabolic syndrome and cardiovascular diseases. However, studies on fat intake in relation to cardiometabolic health during childhood are scarce.Objective: We examined associations between dietary intake of fatty acids (FAs) at age 1 y and measures of growth, adiposity, and cardiometabolic health up to age 6 y.Methods: This study was conducted in 2927 children participating in the Generation R Study, a multiethnic, prospective, population-based cohort in the Netherlands. We measured children's total fat intake and intakes of saturated FAs (SFAs), monounsaturated FAs (MUFAs), and polyunsaturated FAs (PUFAs) at a median age of 12.9 mo (95% range: 12.2, 18.9 mo) with a food-frequency questionnaire. We repeatedly measured their height and weight up to age 6 y. At 6 y of age, we measured body fat percentage, diastolic and systolic blood pressure, and serum insulin, triacylglycerol, and HDL cholesterol. These outcomes were combined into a cardiometabolic risk factor score. We examined associations of FA intake with repeated measures of height, weight, and body mass index by using linear mixed models and with cardiometabolic outcomes by using linear regression models, adjusting for sociodemographic and lifestyle factors and taking into account macronutrient substitution effects.Results: In multivariable models, we observed no associations of a higher intake of total fat or SFAs, MUFAs, or PUFAs with growth, adiposity, or cardiometabolic health when fat was consumed at the expense of carbohydrates. In subsequent models, there were also no associations observed for higher MUFA or PUFA intakes at the expense of SFAs with any of the outcomes. Results did not differ by sex, ethnicity, age, or birth weight.Conclusion: The results of this study did not support our hypothesis that intake of different types of FAs was associated with adiposity or cardiometabolic health among children.
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Affiliation(s)
| | | | | | - Henriëtte A Moll
- Pediatrics, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Vincent Wv Jaddoe
- Departments of Epidemiology and.,Pediatrics, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Ingeborg A Brouwer
- Department of Health Sciences, Vrije Universiteit, Amsterdam, Netherlands
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Kooijman MN, Kruithof CJ, van Duijn CM, Duijts L, Franco OH, van IJzendoorn MH, de Jongste JC, Klaver CCW, van der Lugt A, Mackenbach JP, Moll HA, Peeters RP, Raat H, Rings EHHM, Rivadeneira F, van der Schroeff MP, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Wolvius E, Felix JF, Jaddoe VWV. The Generation R Study: design and cohort update 2017. Eur J Epidemiol 2017. [PMID: 28070760 DOI: 10.1007/s10654‐016‐0224‐9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health from fetal life, childhood and young adulthood. This multidisciplinary study focuses on several health outcomes including behaviour and cognition, body composition, eye development, growth, hearing, heart and vascular development, infectious disease and immunity, oral health and facial growth, respiratory health, allergy and skin disorders of children and their parents. Main exposures of interest include environmental, endocrine, genomic (genetic, epigenetic, microbiome), lifestyle related, nutritional and socio-demographic determinants. In total, 9778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. Response at baseline was 61%, and general follow-up rates until the age of 10 years were around 80%. Data collection in children and their parents includes questionnaires, interviews, detailed physical and ultrasound examinations, behavioural observations, lung function, Magnetic Resonance Imaging and biological sampling. Genome and epigenome wide association screens are available. Eventually, results from the Generation R Study contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.
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Affiliation(s)
- Marjolein N Kooijman
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Claudia J Kruithof
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marinus H van IJzendoorn
- Center for Child and Family Studies, Leiden University, Leiden, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Edmond H H M Rings
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marc P van der Schroeff
- Department of Otolaryngology, Head and Neck Surgery, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eppo Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Janine F Felix
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Kooijman MN, Kruithof CJ, van Duijn CM, Duijts L, Franco OH, van IJzendoorn MH, de Jongste JC, Klaver CCW, van der Lugt A, Mackenbach JP, Moll HA, Peeters RP, Raat H, Rings EHHM, Rivadeneira F, van der Schroeff MP, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Wolvius E, Felix JF, Jaddoe VWV. The Generation R Study: design and cohort update 2017. Eur J Epidemiol 2017; 31:1243-1264. [PMID: 28070760 PMCID: PMC5233749 DOI: 10.1007/s10654-016-0224-9] [Citation(s) in RCA: 530] [Impact Index Per Article: 75.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/30/2016] [Indexed: 12/31/2022]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health from fetal life, childhood and young adulthood. This multidisciplinary study focuses on several health outcomes including behaviour and cognition, body composition, eye development, growth, hearing, heart and vascular development, infectious disease and immunity, oral health and facial growth, respiratory health, allergy and skin disorders of children and their parents. Main exposures of interest include environmental, endocrine, genomic (genetic, epigenetic, microbiome), lifestyle related, nutritional and socio-demographic determinants. In total, 9778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. Response at baseline was 61%, and general follow-up rates until the age of 10 years were around 80%. Data collection in children and their parents includes questionnaires, interviews, detailed physical and ultrasound examinations, behavioural observations, lung function, Magnetic Resonance Imaging and biological sampling. Genome and epigenome wide association screens are available. Eventually, results from the Generation R Study contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.
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Affiliation(s)
- Marjolein N Kooijman
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Claudia J Kruithof
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marinus H van IJzendoorn
- Center for Child and Family Studies, Leiden University, Leiden, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Edmond H H M Rings
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marc P van der Schroeff
- Department of Otolaryngology, Head and Neck Surgery, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eppo Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Janine F Felix
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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de Vos-Kerkhof E, Krecinic T, Vergouwe Y, Moll HA, Nijman RG, Oostenbrink R. Comparison of peripheral and central capillary refill time in febrile children presenting to a paediatric emergency department and its utility in identifying children with serious bacterial infection. Arch Dis Child 2017; 102:17-21. [PMID: 27339165 DOI: 10.1136/archdischild-2015-308519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/05/2016] [Accepted: 06/03/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the agreement between peripheral and central capillary refill time (pCRT/cCRT) and their diagnostic values for detecting serious bacterial infection (SBI) in febrile children attending the paediatric emergency department (ED). DESIGN Prospective observational study. SETTING Paediatric ED, Erasmus Medium Care-Sophia Children's hospital, the Netherlands. PATIENTS 1193 consecutively included, previously healthy, febrile children (1 month-16 years) with both pCRT measurements and cCRT measurements available. SBI diagnosis was based on abnormal radiographic findings and/or positive cultures from normally sterile locations in addition to clinical criteria. MAIN OUTCOME MEASURES Agreement between pCRT and cCRT (Cohen's κ), overall and stratified for age and body temperature. The diagnostic value of pCRT and cCRT for SBI was assessed with logistic regression. RESULTS Overall agreement was 0.35 (95% CI 0.27 to 0.43; considered 'fair'). Although not significant, agreement was lower in children aged 1-<5 years (κ: 0.15 (95% CI 0.04 to 0.27)) and decreased with higher body temperatures with κ ranging from 0.55 (95% CI 0.32 to 0.79) for temperature <37.5°C to 0.21 (95% CI 0.07 to 0.34) for temperature >39.5°C. Abnormal pCRT (>2 s) was observed in 153 (12.8%; 95% CI 10.9% to 14.7%) and abnormal cCRT in 55 (4.6%; 95% CI 3.4% to 5.8%) children. The OR of abnormal pCRT (>2 s) for predicting SBI was 1.10 (95% CI 0.65 to 1.84). For abnormal cCRT (>2 s), the OR was 0.43 (95% CI 0.13 to 1.39). CONCLUSIONS The pCRT and cCRT values showed only fair agreement in a general population of febrile children at the ED, and no significant association with age or body temperature was found. Only a small part of febrile children at risk for serious infections at the ED show abnormal CRT values. Both abnormal pCRT and cCRT (defined as >2 s) performed poorly and were non-significant in this study detecting SBI in a general population of febrile children.
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Affiliation(s)
- Evelien de Vos-Kerkhof
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Tarik Krecinic
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Yvonne Vergouwe
- Department of Public Health, Centre for Medical Decision Making, Erasmus MC, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ruud G Nijman
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Bindels de Heus GCB, Ball LM, Michiels EMC, Moll HA, Niks EH, van Walraven SM. [Paediatric palliative care: multidisciplinary and pro-active]. Ned Tijdschr Geneeskd 2017; 161:D857. [PMID: 28294926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Every child with a life-limiting or threatening illness, and his or her family, has a right to palliative care. Palliative care is not limited to end-of-life care, but starts from the moment of diagnosis and is independent of whether there are curative options. To optimise quality of life of both the child and the family, the emphasis of care should be on both somatic and psychosocial and spiritual aspects from the very start, and goals should be set together with the child and the family. A multidisciplinary and pro-active approach is essential if this is to be achieved. It is, therefore, strongly recommended that at least every academic hospital should have a multidisciplinary paediatric palliative care team.
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Tromp IIM, Franco OH, van den Hooven EH, Heijboer AC, Jaddoe VWV, Duijts L, de Jongste JC, Moll HA, Kiefte-de Jong JC. 25-Hydroxyvitamin D concentrations, asthma and eczema in childhood: The generation R study. Clin Nutr 2016; 37:169-176. [PMID: 28017448 DOI: 10.1016/j.clnu.2016.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 11/09/2016] [Accepted: 11/19/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND & AIMS A role of vitamin D in the development of respiratory and allergic disease in children remains unclear. It may be likely that vitamin D has an effect on airway inflammation, but only few studies examined the effect in children. We aimed to examine whether serum 25-hydroxyvitamin D (25(OH) vitamin D) concentrations are associated with the fraction of exhaled nitric oxide (FeNO), airway interrupter resistance (Rint), physician diagnosed asthma ever, wheezing and eczema in a population-based cohort study in 6 year old children. METHODS Serum 25(OH) vitamin D concentration was assessed in 3815 children. 25(OH) vitamin D concentrations ≥75 nmol/L were considered as sufficient, between 50 and 75 nmol/L as insufficient, and <50 nmol/L as deficient. FeNO and Rint were measured at the research center. Data on physician diagnosed asthma, wheezing, and eczema were obtained by parent-reported questionnaires. RESULTS In comparison with sufficient 25(OH) vitamin D concentration, deficient concentrations were associated with elevated FeNO of ≥25 ppb (OR: 2.54; 95% CI: 1.34-4.80). In addition, deficient and insufficient 25(OH) vitamin D concentrations were associated with a lower Rint (Z-score: -1.26; 95% CI: -1.66 to -0.85) (ß: -0.75; 95% CI: -1.08 to -0.42), and increased risks of eczema (OR: 1.65; 95% CI: 1.13-2.41) (OR: 1.44; 95% CI: 1.06-1.95). Insufficient 25(OH) vitamin D concentration were associated with a decreased risk of physician diagnosed asthma ever (OR: 0.59; 95% CI: 0.38-0.94). CONCLUSIONS Our results indicate that lower 25(OH) vitamin D levels are associated with elevated FeNO levels, but lower Rint values. Lower 25(OH) vitamin D levels are also associated with a decreased risk for asthma diagnoses but an increased risk for eczema.
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Affiliation(s)
- Ilse I M Tromp
- From the Generation R Study Group, The Netherlands; Departments of Pediatrics, Erasmus University, Rotterdam, The Netherlands
| | - Oscar H Franco
- Departments of Epidemiology, Erasmus University, Rotterdam, The Netherlands
| | | | - Annemieke C Heijboer
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Vincent W V Jaddoe
- From the Generation R Study Group, The Netherlands; Departments of Epidemiology, Erasmus University, Rotterdam, The Netherlands; Departments of Pediatrics, Erasmus University, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Departments of Epidemiology, Erasmus University, Rotterdam, The Netherlands; Division of Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands; Division of Neonatology, Erasmus University, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Division of Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Departments of Pediatrics, Erasmus University, Rotterdam, The Netherlands
| | - Jessica C Kiefte-de Jong
- Departments of Epidemiology, Erasmus University, Rotterdam, The Netherlands; Global Public Health, Leiden University College, The Hague, The Netherlands; Departments of Pediatrics, Erasmus University, Rotterdam, The Netherlands.
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van den Heuvel D, Jansen MAE, Nasserinejad K, Dik WA, van Lochem EG, Bakker-Jonges LE, Bouallouch-Charif H, Jaddoe VWV, Hooijkaas H, van Dongen JJM, Moll HA, van Zelm MC. Effects of nongenetic factors on immune cell dynamics in early childhood: The Generation R Study. J Allergy Clin Immunol 2016; 139:1923-1934.e17. [PMID: 27913304 DOI: 10.1016/j.jaci.2016.10.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/29/2016] [Accepted: 10/05/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Numbers of blood leukocyte subsets are highly dynamic in childhood and differ greatly between subjects. Interindividual variation is only partly accounted for by genetic factors. OBJECTIVE We sought to determine which nongenetic factors affect the dynamics of innate leukocytes and naive and memory lymphocyte subsets. METHODS We performed 6-color flow cytometry and linear mixed-effects modeling to define the dynamics of 62 leukocyte subsets from birth to 6 years of age in 1182 children, with 1 to 5 measurements per subject. Subsequently, we defined the effect of prenatal maternal lifestyle-related or immune-mediated determinants, birth characteristics, and bacterial/viral exposure-related determinants on leukocyte subset dynamics. RESULTS Functionally similar leukocyte populations were grouped by using unbiased hierarchical clustering of patterns of age-related leukocyte dynamics. Innate leukocyte numbers were high at birth and predominantly affected by maternal low education level. Naive lymphocyte counts peaked around 1 year, whereas most memory lymphocyte subsets more gradually increased during the first 4 years of life. Dynamics of CD4+ T cells were predominantly associated with sex, birth characteristics, and persistent infections with cytomegalovirus (CMV) or EBV. CD8+ T cells were predominantly associated with CMV and EBV infections, and T-cell receptor γδ+ T cells were predominantly associated with premature rupture of membranes and CMV infection. B-cell subsets were predominantly associated with sex, breast-feeding, and Helicobacter pylori carriership. CONCLUSIONS Our study identifies specific dynamic patterns of leukocyte subset numbers, as well as nongenetic determinants that affect these patterns, thereby providing new insights into the shaping of the childhood immune system.
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Affiliation(s)
- Diana van den Heuvel
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Michelle A E Jansen
- Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Kazem Nasserinejad
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Willem A Dik
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ellen G van Lochem
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | | | - Vincent W V Jaddoe
- Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Herbert Hooijkaas
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jacques J M van Dongen
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Menno C van Zelm
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Australia.
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Lock J, Raat H, Peters M, Scholten M, Beijlevelt M, Oostenbrink R, Leebeek FWG, Moll HA, Cnossen MH. Optimization of home treatment in haemophilia: effects of transmural support by a haemophilia nurse on adherence and quality of life. Haemophilia 2016; 22:841-851. [PMID: 27778434 DOI: 10.1111/hae.13043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transmural support by a haemophilia nurse may improve treatment and may empower parents and patients. AIM To measure the effect of structured home visits by a haemophilia nurse in (parents of) patient on aspects of prophylactic home treatment. METHODS A multicentre intervention study in two paediatric haemophilia treatment centres was performed. Primary outcome measures were: adherence to prescribed treatment, health-related quality of life and behavioural scores. Secondary outcome measures were: total clotting factor consumption, self-efficacy and number of joint bleeds. RESULTS Over a period of 22 months (median, IQR 21-23), four to seven home visits in 46 patients (mean age 9.4 ± 4.2 years) were made. No difference in adherence to prescribed treatment was seen after the home visits when compared to baseline measurements. Both the Child Health Questionnaire (CHQ) scales on 'Role functioning - Emotional/Behavioural' (P = 0.02, d = 0.53) and 'Parental Time Impact' (P = 0.04, d = 0.33) were reduced after intervention. The disease-specific Haemo-QoL questionnaire showed improvement in domains: 'Family' (P = 0.04, d = -0.14), 'Friends' (P = 0.03, d = -0.29) and 'Perceived support' (P = 0.03, d = -0.37). Significant improvement was observed with regard to domain 'Communication' of the VERITAS-Pro scale (P = 0.03, d = -0.28). CONCLUSIONS After a period of transmural care by a haemophilia nurse, significant but small positive effects were demonstrated with regard to communication and increase of perceived support between parents and haemophilia treatment centre. No improvement was observed in other outcome measures.
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Affiliation(s)
- J Lock
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M Peters
- Department of Paediatric Haematology, Emma Children's Hospital-Academic Medical Centre, Amsterdam, The Netherlands
| | - M Scholten
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Beijlevelt
- Department of Paediatric Haematology, Emma Children's Hospital-Academic Medical Centre, Amsterdam, The Netherlands
| | - R Oostenbrink
- Department of General Paediatrics, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - F W G Leebeek
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - H A Moll
- Department of General Paediatrics, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
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Beth SA, Jansen MAE, Elfrink MEC, Kiefte-de Jong JC, Wolvius EB, Jaddoe VWV, van Zelm MC, Moll HA. Generation R birth cohort study shows that specific enamel defects were not associated with elevated serum transglutaminase type 2 antibodies. Acta Paediatr 2016; 105:e485-91. [PMID: 27439586 DOI: 10.1111/apa.13533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 06/23/2016] [Accepted: 07/18/2016] [Indexed: 12/21/2022]
Abstract
AIM Coeliac disease can induce specific enamel defects (SED), but little is known about the consequences of antitissue transglutaminase (TG2A) autoimmunity. We investigated whether TG2A positivity in children and their mothers was associated with SED in the primary dentition. METHODS Maternal and child serum immunoglobulin A-TG2A levels were measured as part of the Generation R prospective cohort study. Clinical oral photographs of the primary dentition were taken, and SED and caries were recorded. We performed logistic regression analysis. RESULTS We analysed data on 4775 mothers and 4233 children (median age of 6.2 ± 0.5 years). SED and caries were not associated with maternal TG2A levels. The 59 TG2A-positive children tended to have more SED, particularly the 31 in the strongly positive subgroup, with odds ratio of 1.72 and 2.29, respectively. A positive linear trend was observed between higher TG2A levels and paediatric SED (p = 0.04), but this became nonsignificant after adjusting for ethnic and socio-economic background. No difference in caries was found between the groups. CONCLUSION TG2A did not play an independent role on SED in the primary dentition during pregnancy and childhood, and the relationship may be explained by ethnic and socio-economic background.
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Affiliation(s)
- Sytske A. Beth
- The Generation R Study Group; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Pediatrics; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Immunology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Michelle A. E. Jansen
- The Generation R Study Group; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Pediatrics; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Immunology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Maria E. C. Elfrink
- The Generation R Study Group; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Cariology, Endodontology and Pedodontology; Academic Center for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - Jessica C. Kiefte-de Jong
- Department of Epidemiology; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Global Public Health; Leiden University College; The Hague The Netherlands
| | - Eppo B. Wolvius
- The Dutch Cranofacial Centre; Department of Oral and Maxillofacial Surgery; Sophia's Children's Hospital; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study Group; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Pediatrics; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Menno C. van Zelm
- Department of Immunology and Pathology; Monash University; Melbourne Vic. Australia
| | - Henriëtte A. Moll
- Department of Pediatrics; Erasmus University Medical Center; Rotterdam The Netherlands
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Zachariasse JM, Kuiper JW, de Hoog M, Moll HA, van Veen M. Safety of the Manchester Triage System to Detect Critically Ill Children at the Emergency Department. J Pediatr 2016; 177:232-237.e1. [PMID: 27480197 DOI: 10.1016/j.jpeds.2016.06.068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/31/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the safety of the Manchester Triage System in pediatric emergency care for children who require admission to the intensive care unit (ICU). STUDY DESIGN Between 2006 and 2013, 50 062 consecutive emergency department visits of children younger than the age of 16 years were included. We determined the percentage of undertriage, defined as the proportion of children admitted to ICU triaged as low urgent according to the Manchester Triage System, and diagnostic performance measures, including sensitivity, specificity, and diagnostic OR. Characteristics of undertriaged patients were compared with correctly triaged patients. In a logistic regression model, risk factors for undertriage were determined. RESULTS In total, 238 (28.7%) of the 830 children admitted to ICU during the study period were undertriaged. Sensitivity of high Manchester Triage System urgency levels to detect ICU admission was 71% (95% CI 68%-74%) and specificity 85% (95% CI 85%-85%). Severity of illness was lower in undertriaged children than correctly triaged children admitted to ICU. Risk factors for undertriage were age <3 months, medical presenting problem, comorbidity, referral by a medical specialist or emergency medical services, and presentation during the evening or night shift. CONCLUSION The Manchester Triage System misclassifies a substantial number of children who require ICU admission. Modifications targeted at young children and children with a comorbid condition could possibly improve safety of the Manchester Triage System in pediatric emergency care.
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Affiliation(s)
- Joany M Zachariasse
- Department of General Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan Willem Kuiper
- Department of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Matthijs de Hoog
- Department of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of General Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Mirjam van Veen
- Department of General Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Pediatrics, Groene Hart Hospital, Gouda, The Netherlands.
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