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Eyre A, Cohen J, Funnell S, James L, Guglani S, Abi Haidar H, Samson L, Ward M, Jetty R, Harrison M, Lyons JS, Fraser-Roberts L, Bennett S, Archibald D, Khorsand S, Audcent T. Acceptability and feasibility of screening with a pediatric care provider-led social determinants of health identification tool. BMC Pediatr 2024; 24:300. [PMID: 38702643 PMCID: PMC11067211 DOI: 10.1186/s12887-024-04759-2] [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: 12/12/2023] [Accepted: 04/12/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Complex social determinants of health may not be easily recognized by health care providers and pose a unique challenge in the vulnerable pediatric population where patients may not be able to advocate for themselves. The goal of this study was to examine the acceptability and feasibility of health care providers using an integrated brief pediatric screening tool in primary care and hospital settings. METHODS The framework of the Child and Adolescent Needs and Strengths (CANS) and Pediatric Intermed tools was used to inform the selection of items for the 9-item Child and Adolescent Needs and Strengths-Pediatric Complexity Indicator (CANS-PCI). The tool consisted of three domains: biological, psychological, and social. Semi-structured interviews were conducted with health care providers in pediatric medical facilities in Ottawa, Canada. A low inference and iterative thematic synthesis approach was used to analyze the qualitative interview data specific to acceptability and feasibility. RESULTS Thirteen health care providers participated in interviews. Six overarching themes were identified: acceptability, logistics, feasibility, pros/cons, risk, and privacy. Overall, participants agreed that a routine, trained provider-led pediatric tool for the screening of social determinants of health is important (n = 10, 76.9%), acceptable (n = 11; 84.6%), and feasible (n = 7, 53.8%). INTERPRETATION Though the importance of social determinants of health are widely recognized, there are limited systematic methods of assessing, describing, and communicating amongst health care providers about the biomedical and psychosocial complexities of pediatric patients. Based on this study's findings, implementation of a brief provider-led screening tool into pediatric care practices may contribute to this gap.
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Affiliation(s)
- Alison Eyre
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Centretown Community Health Centre, Ottawa, ON, Canada.
| | - Janice Cohen
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Sarah Funnell
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, Queen's University, Kingston, ON, Canada
- Centre for Indigenous Health Research and Education, University of Ottawa, Ottawa, ON, Canada
| | - Lynsey James
- Centretown Community Health Centre, Ottawa, ON, Canada
| | - Sheena Guglani
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Hounaida Abi Haidar
- Department of Family Medicine, Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Lindy Samson
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michelle Ward
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Radha Jetty
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Megan Harrison
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - John S Lyons
- Centre for Innovation in Population Health, University of Kentucky, Lexington, KY, USA
| | - Leigh Fraser-Roberts
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Susan Bennett
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Douglas Archibald
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Soha Khorsand
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tobey Audcent
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Abstract
A variety of factors contribute to the complex course of inflammation. Microbiological, immunological and toxic agents can initiate the inflammatory response by activating a variety of humoral and cellular mediators. In the early phase of inflammation, excessive amounts of cytokines and inflammatory mediators are released. These factors activate, in addition to other signaling pathways, the lipid synthesis pathways, which play a crucial role in the pathogenesis of organ dysfunction. Arachidonic acid (AA), the precursor of pro-inflammatory eicosanoids, is released from membrane phospholipids by the action of phospholipase A(2) (PLA(2)), and is metabolized to prostaglandins (PGs) and leukotrienes (LTs) by the action of cyclooxygenase (COX) and lipoxygenase (LO) enzymes, respectively. Disordered activation of PLA(2), LO and COX enzymes have been implicated in many inflammatory diseases. PLA(2) is activated by phospholipase-A(2)-activating protein (PLAP) and LO by 5-lipoxygenase-activating protein (FLAP). The inducible form of COX-2 enzyme, which is usually not present under basal conditions, is induced in inflammation. In this article the function of these enzymes in eicosanoid synthesis, their regulation, and their implication in inflammatory disorders will be reviewed. The properties, function and regulation of the protein activators PLAP and FLAP will also be discussed.
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Affiliation(s)
- Fadia R Homaidan
- Department of Physiology, American University of Beirut, Beirut, Lebanon.
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Haidar JH, Bazarbachi A, Mahfouz R, Haidar HA, Jaafar H, Daher R. Serum Flt3 ligand variation as a predictive indicator of hematopoietic stem cell mobilization. J Hematother Stem Cell Res 2002; 11:533-8. [PMID: 12183838 DOI: 10.1089/15258160260090997] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Flt3 ligand (FL) is a good indicator of bone marrow (BM) cellularity, having a reciprocal relationship with white blood cell (WBC) count in aplastic anemia and chemotherapy-induced neutropenia. In this report, serum FL level was measured by enzyme-linked immunosorbent assay (ELISA), in 16 consecutive patients undergoing autologous peripheral stem cell transplantation, with an average of 12 selected levels for each patient based on major changes of WBC counts at different procedure stations. We found a significant increase of serum FL level at the WBC nadir after mobilization chemotherapy and a more dramatic increase at the WBC nadir post transplantation, consistent with a more profound BM aplasia after myeloablative chemotherapy as compared to high-dose cyclophosphamide used for mobilization. Hence, we reproduced the reciprocal relationship between serum FL and BM cellularity. A direct correlation between the increase of FL level after mobilization chemotherapy and the length of mobilization was also established, which may help physicians, at the individual patient level, to predict the time of stem cell collection. Finally, we showed a direct correlation between the peripheral CD34+ count at the time of stem cell collection and the peak FL level after transplantation, which can reflect BM stromal cell function. Our results suggest that variation of serum FL level may be used as predictive indicator of hematopoietic stem cell (HSC) mobilization.
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Affiliation(s)
- Joud H Haidar
- Department of Pathology and Laboratory Medicine, American University of Beirut, 113-6044 Beirut, Lebanon.
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El-Sabban ME, Merhi RA, Haidar HA, Arnulf B, Khoury H, Basbous J, Nijmeh J, de Thé H, Hermine O, Bazarbachi A. Human T-cell lymphotropic virus type 1-transformed cells induce angiogenesis and establish functional gap junctions with endothelial cells. Blood 2002; 99:3383-9. [PMID: 11964307 DOI: 10.1182/blood.v99.9.3383] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The role of angiogenesis in the growth and metastasis of solid tumors is well established. However, the role of angiogenesis in hematologic malignancies was only recently appreciated. We show that HTLV-I-transformed T cells, but not HTLV-I-negative CD4(+) T cells, secrete biologically active forms of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) and, accordingly, induce angiogenesis in vitro. Furthermore, fresh ATL leukemic cells derived from patients with acute ATL produce VEGF and bFGF transcripts and proteins. The viral transactivator Tax activates the VEGF promoter, linking the induction of angiogenesis to viral gene expression. Angiogenesis is associated with the adhesion of HTLV-I-transformed cells to endothelial cells and gap junction-mediated heterocellular communication between the 2 cell types. Angiogenesis, cell adhesion, and communication likely contribute to the development of adult T-cell leukemia-lymphoma and represent potential therapeutic targets.
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MESH Headings
- Aorta
- Cell Adhesion
- Cell Communication
- Cell Line, Transformed
- Endothelial Growth Factors/genetics
- Endothelial Growth Factors/metabolism
- Endothelium, Vascular/cytology
- Fibroblast Growth Factor 2/genetics
- Fibroblast Growth Factor 2/metabolism
- Gap Junctions/pathology
- Gene Products, tax/pharmacology
- Human T-lymphotropic virus 1
- Humans
- Leukemia-Lymphoma, Adult T-Cell/metabolism
- Leukemia-Lymphoma, Adult T-Cell/pathology
- Leukemia-Lymphoma, Adult T-Cell/physiopathology
- Lymphokines/genetics
- Lymphokines/metabolism
- Neovascularization, Pathologic/etiology
- Neovascularization, Pathologic/virology
- RNA, Messenger/metabolism
- T-Lymphocytes/metabolism
- T-Lymphocytes/physiology
- T-Lymphocytes/virology
- Tumor Cells, Cultured
- Vascular Endothelial Growth Factor A
- Vascular Endothelial Growth Factors
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Affiliation(s)
- Marwan E El-Sabban
- Department of Human Morphology, Faculty of Medicine, American University of Beirut, Lebanon
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