Developmental health of Canadian kindergarten children with teacher-reported asthma between 2010 and 2015: A population-level cross-sectional study

Asthma can impact children's quality of life. It is unclear how asthma is associated with the developmental health (i.e. a broad range of skills and abilities associated with growth and development) of young children at school entry. The goals of this cross-sectional, population-level study were to: (1) investigate the association between teacher-reported asthma and children's concurrent indicators of developmental health (developmental vulnerability); and (2) explore whether school absences and functional impairments modified this association. Participants were a Canadian population-based sample of 564 582 kindergarten children (Mage = 5.71 years, SD = 0.32, 51.3 % male) with data on the Early Development Instrument (EDI) collected between 2010 and 2015. Adjusted binary logistic regressions were conducted to address the objectives. From the sample, 958 (0.2 %) children were identified as having a diagnosis of asthma. These children were absent on average 9.4 days and 53.5 % had functional impairments (vs. 6.7 days absent and 15.9 % with functional impairments in children without asthma). After controlling for demographic characteristics, children with asthma had between 1.51 and 2.42 higher odds of being developmentally vulnerable. Only the presence of functional impairments modified this relationship and only for physical health and well-being. In this large, population-based sample of Canadian kindergarten children, few teachers reported knowledge of their students' asthma diagnosis. Among teacher-reported cases, asthma was a risk factor for developmental vulnerability in the domain of physical health and well-being only. Functional impairments may therefore be more detrimental for child development at school entry than asthma alone.

111 The Prevalence of Asthma in Canadian Kindergarten Children and its Association with their Developmental Health: A Population-Level Cross-Sectional Study

Primary Subject area

Epidemiology

Background

Asthma, the most common chronic illness affecting Canadian youth, can profoundly and adversely impact a child’s quality of life. Previous studies have shown a diagnosis of asthma can influence a child’s physical and socio-emotional functioning. Current data on asthma prevalence rates among Canadian children is scarce, and it is still unclear how this diagnosis impacts their development at school entry.

Objectives

The goals of the current study were to 1) examine the prevalence of teacher-reported asthma in Canadian kindergarten children, and 2) investigate the association between asthma and children’s concurrent developmental health.

Design/Methods

A cross sectional, population-level study of kindergarten children diagnosed with asthma as reported on the Early Development Instrument (EDI), was carried out in Canada from 2010-2015. Children’s developmental health in kindergarten was measured with the EDI. This 103-item questionnaire is completed by teachers for their students aged 4-6 years and covers demographic information, as well as five different domains of development. Descriptive statistics were examined for children with and without asthma. The level of statistical significance was adjusted using a Bonferroni correction to account for multiple hypothesis testing. The chi-square and one-way ANOVA statistics, as well as effect sizes (Cramer’s V, and eta squared) were reported for all descriptive analyses.

Results

958 children (0.002% of the final analytical sample) were identified as having a teacher-reported diagnosis of asthma. Compared to their peers, children with asthma were significantly more likely to: be male (68.2% vs 51.2%); have a special needs designation (19.0% vs 3.6%); have a functional impairment (53.5% vs 15.9%); be identified by their teachers as needing further developmental assessment (32.3% vs. 13.1%); and miss, on average, 3 more days of school than their peers (9.44 vs. 6.71). They were also more likely to fall below a vulnerability threshold on one or more of the developmental domains (55.9% vs. 28.8%, Figure 1).

Conclusion

It is likely that the EDI captures only severe cases of asthma, as parents are more likely to disclose their child’s illness to teachers if it may influence their ability to function in a classroom. As such, children with asthma, especially those with severe forms, may require additional support. A partnership in which physicians provide preventative care, and teachers provide academic and classroom assistance, may help to ensure the optimal development of children with asthma, and close gaps between them and their peers.

An Advanced Nursing Directive for Children With Suspected Appendicitis: Protocol for a Quality Improvement Feasibility Study

Background

Pediatric appendicitis accounts for an estimated 7% to 10% of abdominal pain cases in the emergency department (ED). The diagnosis is time-consuming, and the investigative process depends on physician assessment, resulting in delays in diagnosis and therapeutic management. The utility of an advanced nursing directive (AND) to expedite this process is unclear and needs further exploration.

Objective

This study aims to describe key components of ED flow in patients with suspected appendicitis seen at a pediatric ED and pilot a directive that allows ED nurses to perform an order set that includes blood work, urine tests, analgesics, fluids, and an abdominal-pelvis ultrasound prior to physician assessment.

Methods

This study involves conducting a retrospective chart review alongside a quality improvement initiative to compare key ED flow metrics before and after AND implementation. Primary outcome measures include median time from ED triage assessment to ultrasound completion, analgesia administration, blood work results, and time to disposition (consult or discharge), alongside other key ED flow metrics for suspected appendicitis. Secondary outcomes will involve patient and caretaker satisfaction surveys. Descriptive statistics will be used to summarize the data. For differences in proportions, a chi-square test will be used. The Student t test will be used for continuous variables. A variable-controlled run chart will be performed to assess impact on ED flow metrics. Patient and family satisfaction surveys are administered immediately after the directive encounter and 7 days afterward.

Results

There are currently 3900 patients who have been screened, 344 patients who have been enrolled, and 90 patients who have received the medical directive since implementation in June 2020. Interim results on reduction of time to diagnostic and therapeutic ED flow parameters and satisfaction surveys are expected to be published in February 2022. The final study endpoint will be in June 2022.

Conclusions

This study proposes a novel protocol for improving the diagnosis and treatment of suspected pediatric appendicitis through implementation of an evidence-based AND. This model may provide a standardized, international pathway for management of common pediatric and adult emergencies.

International Registered Report Identifier (IRRID)

RR1-10.2196/33158

Targeted genome editing in vivo corrects a Dmd duplication restoring wild-type dystrophin expression

Tandem duplication mutations are increasingly found to be the direct cause of many rare heritable diseases, accounting for up to 10% of cases. Unfortunately, animal models recapitulating such mutations are scarce, limiting our ability to study them and develop genome editing therapies. Here, we describe the generation of a novel duplication mouse model, harboring a multi-exonic tandem duplication in the Dmd gene which recapitulates a human mutation. Duplication correction of this mouse was achieved by implementing a single-guide RNA (sgRNA) CRISPR/Cas9 approach. This strategy precisely removed a duplication mutation in vivo, restored full-length dystrophin expression, and was accompanied by improvements in both histopathological and clinical phenotypes. We conclude that CRISPR/Cas9 represents a powerful tool to accurately model and treat tandem duplication mutations. Our findings will open new avenues of research for exploring the study and therapeutics of duplication disorders.