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Kogan CS, Garcia-Pacheco JA, Rebello TJ, Montoya MI, Robles R, Khoury B, Kulygina M, Matsumoto C, Huang J, Medina-Mora ME, Gureje O, Stein DJ, Sharan P, Gaebel W, Kanba S, Andrews HF, Roberts MC, Pike KM, Zhao M, Ayuso-Mateos JL, Sadowska K, Maré K, Denny K, Reed GM. Longitudinal Impact of the COVID-19 Pandemic on Stress and Occupational Well-Being of Mental Health Professionals: An International Study. Int J Neuropsychopharmacol 2023; 26:747-760. [PMID: 37531283 PMCID: PMC10586039 DOI: 10.1093/ijnp/pyad046] [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: 05/31/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Increased levels of occupational stress among health professionals during the COVID-19 pandemic have been documented. Few studies have examined the effects of the pandemic on mental health professionals despite the heightened demand for their services. METHOD A multilingual, longitudinal, global survey was conducted at 3 time points during the pandemic among members of the World Health Organization's Global Clinical Practice Network. A total of 786 Global Clinical Practice Network members from 86 countries responded to surveys assessing occupational distress, well-being, and posttraumatic stress symptoms. RESULTS On average, respondents' well-being deteriorated across time while their posttraumatic stress symptoms showed a modest improvement. Linear growth models indicated that being female, being younger, providing face-to-face health services to patients with COVID-19, having been a target of COVID-related violence, and living in a low- or middle-income country or a country with a higher COVID-19 death rate conveyed greater risk for poor well-being and higher level of stress symptoms over time. Growth mixed modeling identified trajectories of occupational well-being and stress symptoms. Most mental health professions demonstrated no impact to well-being; maintained moderate, nonclinical levels of stress symptoms; or showed improvements after an initial period of difficulty. However, some participant groups exhibited deteriorating well-being approaching the clinical threshold (25.8%) and persistently high and clinically significant levels of posttraumatic stress symptoms (19.6%) over time. CONCLUSIONS This study indicates that although most mental health professionals exhibited stable, positive well-being and low stress symptoms during the pandemic, a substantial minority of an already burdened global mental health workforce experienced persistently poor or deteriorating psychological status over the course of the pandemic.
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Affiliation(s)
- Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Tahilia J Rebello
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | | | - Rebeca Robles
- Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Kulygina
- Training and Research Centre, Mental-health clinic No.1 named after N.A. Alekseev, Moscow, Russian Federation
| | | | - Jingjing Huang
- Shanghai Mental Health Center and Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - María Elena Medina-Mora
- Faculty of Psychology, National Autonomous University of Mexico and Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience, Drug and Alcohol Abuse, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Dan J Stein
- Department of Psychiatry, Neuroscience Institute, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Observatory, South Africa
- SAMRC Unit on Risk and Resilience on Mental Disorders, Department of Psychiatry, University of Cape Town and Groote Schuur Hospital, Observatory, South Africa
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Shigenobu Kanba
- Kyushu University, Fukuoka and Japan Depression Center, Tokyo, Japan
| | - Howard F Andrews
- Departments of Biostatistics and Psychiatry, Columbia University and New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
| | - Michael C Roberts
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA
| | - Kathleen M Pike
- Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Min Zhao
- Shanghai Mental Health Center and Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Instituto de Salud Carlos III, Centro de Investigacíon Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Investigacíon Sanitaria La Princesa, Madrid, Spain
| | - Karolina Sadowska
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Karen Maré
- Department of Psychiatry, Neuroscience Institute, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Observatory, South Africa
| | - Keith Denny
- Department of Sociology and Anthropology, Carleton University, Ottawa, Ontario, Canada
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Avila ML, Feldman BM, Pullenayegum E, Lumia C, Montoya MI, Vincelli J, Williams S, Brandão LR. Post-thrombotic syndrome in children: Measurement properties of CAPTSure, a new diagnostic tool. Res Pract Thromb Haemost 2019; 3:652-657. [PMID: 31624784 PMCID: PMC6781925 DOI: 10.1002/rth2.12251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 04/26/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND CAPTsure (Clinical Assessment of PTS) is a new tool for diagnosis and severity rating of pediatric postthrombotic syndrome (PTS). Our objective was to test the reliability, measurement error, and minimal detectable change of CAPTSure. METHODS Children aged newborn to 18 years who sustained upper extremity or lower extremity deep vein thrombosis (DVT) were enrolled ≥ 6 months after DVT diagnosis. Patients were assessed by 2 raters to determine the reliability of the clinician assessment component (CC) of CAPTSure. Patients/proxies completed CAPTSure at baseline and approximately 2 weeks later to assess test-retest reliability of the symptoms component (SC). RESULTS Of 148 patients enrolled in the study; 30 had sustained either bilateral or both upper and lower extremity DVT. Hence, 178 extremities were assessed for PTS signs (86 upper extremity, 92 lower extremity). Intraclass correlation coefficient (ICC) for the CC was 0.89 (95% confidence interval [CI], 0.84-0.93) for upper extremity and 0.88 (95% CI, 0.83-0.92) for lower extremity. Nonclinicians performed 59% of measurements. Ninety-eight patients completed the SC at baseline and follow-up, for a total of 60 upper extremity and 61 lower extremity assessments. ICC for the SC was 0.89 (95% CI, 0.84-0.93) for upper extremity and 0.92 (0.87-0.95) for lower extremity. ICC for CAPTSure was 0.92 (95% CI, 0.87-0.95) for upper extremity and 0.93 (95% CI, 0.88-0.95) for lower extremity assessment. Measurement error ranged between 1.7 and 4.3 of 100 points. A change of approximately 11 of 100 points in CAPTSure score would be required to be confident that there was a change in PTS severity. CONCLUSION CAPTSure has excellent reliability and a small measurement error, even when applied by nonhematologists.
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Affiliation(s)
- Maria Laura Avila
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Brian M. Feldman
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
- Institute of Health Policy, Management and EvaluationDalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | | | - Celeste Lumia
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | | | - Jennifer Vincelli
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | - Suzan Williams
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
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Avila ML, Feldman BM, Williams S, Ward LC, Montoya MI, Stinson J, Kiss A, Vincelli J, Lumia C, Brandão LR. Assessment of limb edema in pediatric post-thrombotic syndrome. Res Pract Thromb Haemost 2018; 2:591-595. [PMID: 30046764 PMCID: PMC6046586 DOI: 10.1002/rth2.12082] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/12/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pediatric tools for diagnosis of post-thrombotic syndrome (PTS) include the assessment of limb edema as a symptom (patient/proxy-reported) and as a sign. However, it is unclear whether these two approaches refer to the same clinical aspect of PTS. This could result in overestimation of disease severity. We sought to evaluate the correlation among different techniques to assess limb edema as a sign and as a symptom in children who sustained upper extremity (UE) or lower extremity (LE) deep vein thrombosis (DVT) and were, therefore, at risk of PTS. METHODS Limb edema was cross-sectionally measured as a symptom (ie, patient- or proxy-reported) and as a sign (ie, clinician-assessed limb circumference difference, limb volume ratio, bioimpedance spectroscopy ratio (BIS), and durometry ratio) in 140 children at risk of PTS (n = 70 UE-DVT, n = 70 LE-DVT). Item-item correlations were estimated using Pearson or Spearman correlation coefficients, as appropriate, and separately for the UE and LE groups. RESULTS In the UE-DVT group, proxy-reported swelling correlated weakly to moderately with circumference difference and with volume ratio, but not with BIS ratio. In the LE-DVT group, proxy-reported swelling correlated moderately with thigh circumference difference and volume ratio, and patient-reported swelling correlated moderately with BIS ratio. CONCLUSION Our findings suggest that patient/proxy-reported and clinician-assessed limb edema measure slightly different aspects of PTS, justifying their inclusion in pediatric PTS tools. In addition, proxy-reported swelling was in closer agreement with clinician-assessed total limb size (ie, observed edema), and patient-reported swelling in the LE seemed to reflect limb fluid content (ie, perceived edema).
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Affiliation(s)
- Maria L. Avila
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | - Brian M. Feldman
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Suzan Williams
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | - Leigh C. Ward
- School of Chemistry and Molecular BiosciencesThe University of QueenslandSt. Lucia, BrisbaneAustralia
| | | | - Jennifer Stinson
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoONCanada
| | - Alex Kiss
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
- Department of Research Design and BiostatisticsSunnybrook Health Sciences CentreTorontoONCanada
| | - Jennifer Vincelli
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | - Celeste Lumia
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
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Avila ML, Stinson J, Lumia C, Williams S, Montoya MI, Feldman BM, Brandão LR. Characteristics of pain, other symptoms and function in pediatric post-thrombotic syndrome. Res Pract Thromb Haemost 2018; 2:334-338. [PMID: 30046736 PMCID: PMC6055484 DOI: 10.1002/rth2.12099] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/28/2018] [Indexed: 01/04/2023] Open
Abstract
ESSENTIALS BACKGROUND Symptoms and function in pediatric post-thrombotic syndrome (PTS) remain poorly characterized. METHODS The present cross-sectional study describes the characteristics of pain, other symptoms, and impaired function in pediatric PTS in a cohort of children with history of upper or lower limb deep vein thrombosis and PTS diagnosis. The frequency of clinical findings was compared between patients with and without pain, and between patients with upper and lower extremity PTS. RESULTS Seventy-eight children were included in the study. The most common PTS symptoms were pain, tired limb and heaviness. Symptoms were usually reported to occur at mid-day or later and were typically triggered by exercise. Half the patients reported impaired endurance. Pain was reported by 45% of patients and was usually mild-moderate. Heaviness, tightness, tired limb, paresthesia, self-reported limb edema, and impaired endurance were most common in patients with than in patients without pain. Conversely, activity and participation scores, skin redness, and clinician-assessed limb edema did not differ between patients with and without pain. Lastly, there was no difference in pain intensity or frequency of paresthesia, swelling, heaviness, or impaired endurance when comparing the upper and lower extremities. CONCLUSION Tired limb, heaviness, pain, and impaired endurance were the most frequent clinical findings in pediatric PTS. Frequency of symptoms and pain intensity did not differ between upper and lower extremities. Pain was associated with the presence of other symptoms and impaired function, but not with activity limitation and participation restriction. Better tools are needed to measure these two latter aspects of health.
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Affiliation(s)
- Maria L. Avila
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | - Jennifer Stinson
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoONCanada
| | - Celeste Lumia
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | - Suzan Williams
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | | | - Brian M. Feldman
- Department of PediatricsThe Hospital for Sick ChildrenTorontoONCanada
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoONCanada
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Avila ML, Brandão LR, Williams S, Montoya MI, Stinson J, Kiss A, Feldman BM. Development of CAPTSure TM - a new index for the assessment of pediatric postthrombotic syndrome. J Thromb Haemost 2016; 14:2376-2385. [PMID: 27709837 DOI: 10.1111/jth.13530] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/18/2016] [Indexed: 12/25/2022]
Abstract
Essentials We developed a discriminative and evaluative index for pediatric postthrombotic syndrome (PTS). A Delphi-survey was used for item reduction and multi-criteria decision analysis for item weighting. The new index assesses limb PTS based on the relative severity of each sign and symptom. Higher scores related to higher odds of parental dissatisfaction with their child's condition. SUMMARY Background Postthrombotic syndrome (PTS) is a complication of deep vein thrombosis defined by the presence of characteristic signs and symptoms. We developed a discriminative and evaluative index for the assessment of upper extremity (UE) and lower extremity (LE) pediatric PTS. Methods The items to be included in the index were voted for by 26 pediatric thrombosis experts invited to participate in a Delphi survey. Subsequent item weighting was based on item importance elicited by the use of multicriteria decision analysis (MCDA); 122 healthcare providers and patients/parents were invited to participate in item weighting. The implications of the overall scores were explored by comparison with PTS diagnosis (independently assessed by two clinical experts) and parental satisfaction/dissatisfaction with their child's current condition. Results Items voted for inclusion by at least 70% of the Delphi survey respondents (81% response rate) were pain, paresthesia, swelling, heaviness, endurance, collateral circulation and arm circumference difference for the UE, and pain, paresthesia, swelling, heaviness, tightness, tired limb, redness/purple or blotchy skin, endurance, ulcers and thigh/calf circumference difference for the LE. Items were then weighted by the use of MCDA (82% response rate). The index had excellent discrimination for patients with/without PTS. For every 10-point increase in index scores (with higher scores being indicative of worse PTS), the odds of parental dissatisfaction increased by 75% and 92% in the UE and LE, respectively. Conclusion We report the development of the CAPTSure™ (index for the Clinical Assessment of Postthrombotic Syndrome in children), which reflects collective judgement of the severity of pediatric PTS. We also provide information on the meaning of the scores.
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Affiliation(s)
- M L Avila
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - L R Brandão
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - S Williams
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - M I Montoya
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - J Stinson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - A Kiss
- Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - B M Feldman
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Montoya MI, Avila ML, Vincelli J, Williams S, Brandão LR. Understanding the barriers in compliance to elastic compression garments in the treatment of pediatric post-thrombotic syndrome: A qualitative study. Thromb Res 2016; 144:113-5. [DOI: 10.1016/j.thromres.2016.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/08/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
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Avila ML, Ward LC, Feldman BM, Montoya MI, Stinson J, Kiss A, Brandão LR. Normal values for segmental bioimpedance spectroscopy in pediatric patients. PLoS One 2015. [PMID: 25875618 DOI: 10.1371/hournal.pone.0126268] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Localized limb edema is a clinically relevant sign in diseases such as post-thrombotic syndrome and lymphedema. Quantitative evaluation of localized edema in children is mainly done by measuring the absolute difference in limb circumference, which includes fat and fat-free mass. Bioimpedance spectroscopy (BIS) provides information on the fluid volume of a body segment. Our objective was to determine normal ranges for segmental (arm and leg) BIS measurements in healthy children. Additionally, we determined the normal ranges for the difference in arm and ankle circumference and explored the influence of handedness and the correlation between techniques. METHODS Healthy children aged 1-18 years were recruited. The ratio of extracellular fluid content between contralateral limbs (estimated as the inter-arm and inter-leg extracellular impedance ratio), and the ratio of extracellular to intracellular fluid content for each limb (estimated as the intracellular to extracellular impedance ratio) were determined with a bioimpedance spectrometer. Arm and ankle circumference was determined with a Gulick II tape. RESULTS We recruited 223 healthy children (48 infants, 54 preschoolers, 66 school-aged children, and 55 teenagers). Normal values for arm and leg BIS measurements, and for the difference in arm and ankle circumference were estimated for each age category. No influence of handedness was found. We found a statistically significant correlation between extracellular impedance ratio and circumference difference for arms among teenagers. CONCLUSION We determined normal BIS ranges for arms and legs and for the difference in circumference between arms and between ankles in children. There was no statistically significant correlation between extracellular impedance ratio and difference in circumference, except in the case of arms in adolescents. This may indicate that limb circumference measures quantities other than fluid, challenging the adequacy of this technique to determine the presence of localized edema in most age groups.
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Affiliation(s)
- Maria Laura Avila
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Brisbane, Australia
| | - Brian M Feldman
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Madeline I Montoya
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Leonardo R Brandão
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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