1
|
Coscini N, Heyes P, Bedford H, Cohen E, D'Aprano A, Goldfeld S, Hargreaves D, Loveday S, Nejat S, Roberts G, Sarkadi A, Saunders NR, Woolfenden S, Milner K. Multicountry review: developmental surveillance, assessment and care by outpatient paediatricians. Arch Dis Child 2023; 108:153-159. [PMID: 35764409 DOI: 10.1136/archdischild-2021-322799] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups. METHODS Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0-5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points. RESULTS Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking. CONCLUSION Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.
Collapse
Affiliation(s)
- Nadia Coscini
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia .,Health Services Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Priya Heyes
- Department of Child Development Service, Government of Western Australia Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Helen Bedford
- Population, Policy and Practice Department, University College London Institute of Child Health, London, UK
| | - Eyal Cohen
- Department of Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Anita D'Aprano
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne Melbourne Medical School, Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Population Health Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Dougal Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sarah Loveday
- Health Services Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Sahar Nejat
- Department of Public Health and Caring Sciences, Uppsala Universitet Institutionen for euroasiatiska studier, Uppsala, Sweden
| | - Gehan Roberts
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Population Health Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Natasha Ruth Saunders
- Department of Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Susan Woolfenden
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Community Child Health, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Kate Milner
- Department of Neurodevelopment and Disability, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Neurodisability and Rehabilitation Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| |
Collapse
|
2
|
Draper CE, Klingberg S, Wrottesley SV, Milner K, Fisher J, Lakes KD, Yousafzai AK. Interventions to promote development in the next 1000 days: A mapping review. Child Care Health Dev 2022. [PMID: 36418186 DOI: 10.1111/cch.13084] [Citation(s) in RCA: 2] [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: 05/10/2022] [Revised: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
The next 1000 days - the period from 2 to 5 years of age - has been highlighted as a key developmental stage in the life-course. A mapping review was conducted to categorize existing literature on interventions in the next 1000 days that promote key developmental outcomes, including publications between 1990 and July 2020. A total of 805 intervention studies were included for data extraction in the review. The number of intervention studies has increased substantially from 2010. Most interventions were from high-income countries, with few (5%) from low- and lower-middle-income countries. Interventions including typically developing children (n = 593, 74%) were mostly (80%) implemented in early childhood care and education (ECCE) settings, with 15% taking place in the home or with families and 5% in community or healthcare settings. Children's literacy and language outcomes were the target of 27% of these interventions, while 25% of interventions targeted early childhood development more holistically or targeted multiple developmental domains. Social-emotional development and social skills were the target of 15% of interventions, motor development 13%, numeracy 8% and cognitive development 8%. For children with any developmental delay, disability, disease or exposure (n = 212), interventions frequently targeted Autism Spectrum Disorder (24%), language or literacy delays (21%), developmental delays or disability more generally (20%); 16% targeted behavioral (or conduct) problems; and 5% targeted attention deficit hyperactivity disorder. Almost half (49%) took place in ECCE settings; 24% occurred in the home or with families, or in community (13%) and/or healthcare (14%) settings. This review highlights the need for more intervention research in low- and middle-income countries and for interventions supporting development in the next 1000 days. While the evidence base for interventions to promote development in this age group continues to expand, the most vulnerable children are not benefiting from this evidence.
Collapse
Affiliation(s)
- Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie V Wrottesley
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Kate Milner
- Neurodisability and Rehabilitation Research Group, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kimberley D Lakes
- Department of Psychiatry and Neuroscience, School of Medicine, University of California, Riverside, Riverside, CA, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
3
|
Paul P, Chandna J, Procter SR, Dangor Z, Leahy S, Santhanam S, John HB, Bassat Q, Bramugy J, Bardají A, Abubakar A, Nasambu C, Libster R, Yanotti CS, Seedat F, Horváth-Puhó E, Hossain AT, Sadeq-ur Rahman Q, Jit M, Newton CR, Milner K, Gonçalves BP, Lawn JE. Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina. EClinicalMedicine 2022; 47:101358. [PMID: 35747160 PMCID: PMC9142788 DOI: 10.1016/j.eclinm.2022.101358] [Citation(s) in RCA: 2] [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: 10/24/2021] [Revised: 02/04/2022] [Accepted: 03/03/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Data are limited regarding long-term consequences of invasive GBS (iGBS) disease in early infancy, especially from low- and middle-income countries (LMIC) where most cases occur. We aimed to estimate risk of neurodevelopmental impairment (NDI) in children with a history of iGBS disease. METHODS A multi-country matched cohort study was undertaken in South Africa, India, Mozambique, Kenya, and Argentina from October 2019 to April 2021. The exposure of interest was defined as a history of iGBS disease (sepsis or meningitis) before 90 days of age, amongst children now aged 1·5-18 years. Age and sex-matched, children without history of GBS were also recruited. Age-appropriate, culturally-adapted assessments were used to define NDI across multiple domains (cognitive, motor, hearing, vision, emotional-behaviour, growth). Pooled NDI risk was meta-analysed across sites. Association of iGBS exposure and NDI outcome was estimated using modified Poisson regression with robust variance estimator. FINDINGS Amongst 138 iGBS survivors and 390 non-iGBS children, 38·1% (95% confidence interval [CI]: 30·0% - 46·6%) of iGBS children had any NDI, compared to 21·7% (95% CI: 17·7% - 26·0%) of non- iGBS children, with notable between-site heterogeneity. Risk of moderate/severe NDI was 15·0% (95% CI: 3·4% - 30·8%) among GBS-meningitis, 5·6% (95% CI: 1·5% - 13·7%) for GBS-sepsis survivors. The adjusted risk ratio (aRR) for moderate/severe NDI among iGBS survivors was 1.27 (95% CI: 0.65, 2.45), when compared to non-GBS children. Mild impairment was more frequent in iGBS (27.6% (95% CI: 20.3 - 35.5%)) compared to non-GBS children (12.9% (95% CI: 9.7% - 16.4%)). The risk of emotional-behavioural problems was similar irrespective of iGBS exposure (aRR=0.98 (95% CI: 0.55, 1.77)). INTERPRETATION Our findings suggest that iGBS disease is on average associated with a higher risk of moderate/severe NDI, however substantial variation in risk was observed between sites and data are consistent with a wide range of values. Our study underlines the importance of long-term follow-up for at-risk neonates and more feasible, standardised assessments to facilitate diagnosis in research and clinical practice. FUNDING This work was supported by a grant (INV-009018) from the Bill & Melinda Gates Foundation to the London School of Hygiene &Tropical Medicine.
Collapse
Affiliation(s)
- Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Corresponding author.
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Simon R. Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ziyaad Dangor
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hima B. John
- Neonatology Department, Christian Medical College, Vellore, India
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Azucena Bardají
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Carophine Nasambu
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | | | | | - Farah Seedat
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - A.K.M. Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Charles R. Newton
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Kate Milner
- Neurodisability & Rehabilitation Research Group, Murdoch Children's Research Institute
- Department of Paediatrics, University of Melbourne
| | - Bronner P. Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joy E. Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
4
|
Chandna J, Liu WH, Dangor Z, Leahy S, Sridhar S, John HB, Mucasse H, Bassat Q, Bardaji A, Abubakar A, Nasambu C, Newton CR, Sánchez Yanotti C, Libster R, Milner K, Paul P, Lawn JE. Emotional and Behavioral Outcomes in Childhood for Survivors of Invasive Group B Streptococcus Disease in Infancy: Findings From 5 Low- and Middle-Income Countries. Clin Infect Dis 2022; 74:S35-S43. [PMID: 34725686 PMCID: PMC8776308 DOI: 10.1093/cid/ciab821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Survivors of invasive group B Streptococcus (iGBS) disease, notably meningitis, are at increased risk of neurodevelopmental impairment. However, the limited studies to date have a median follow-up to 18 months and have mainly focused on moderate or severe neurodevelopmental impairment, with no previous studies on emotional-behavioral problems among iGBS survivors. METHODS In this multicountry, matched cohort study, we included children aged 18 months to 17 years with infant iGBS sepsis and meningitis from health demographic surveillance systems, or hospital records in Argentina, India, Kenya, Mozambique, and South Africa. Children without an iGBS history were matched to iGBS survivors for sex and age. Our primary outcomes were emotional-behavioral problems and psychopathological conditions as measured with the Child Behavior Checklist (CBCL). The CBCL was completed by the child's primary caregiver. RESULTS Between October 2019 and April 2021, 573 children (mean age, 7.18 years) were assessed, including 156 iGBS survivors and 417 non-iGBS comparison children. On average, we observed more total problems and more anxiety, attention, and conduct problems for school-aged iGBS survivors compared with the non-iGBS group. No differences were found in the proportion of clinically significant psychopathological conditions defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). CONCLUSIONS Our findings suggested that school-aged iGBS survivors experienced increased mild emotional behavioral problems that may affect children and families. At-risk neonates including iGBS survivors need long-term follow-up with integrated emotional-behavioral assessments and appropriate care. Scale-up will require simplified assessments that are free and culturally adapted.
Collapse
Affiliation(s)
- Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wan-Hsin Liu
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Division of General Paediatrics, Department of Paediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hima B John
- Neonatology Department, Christian Medical College, Vellore, India
| | | | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Azucena Bardaji
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI Wellcome Trust, Kilifi, Kenya
- Institute of Human Development, Aga Khan University, Nairobi, Kenya
| | - Carophine Nasambu
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI Wellcome Trust, Kilifi, Kenya
| | - Charles R Newton
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI Wellcome Trust, Kilifi, Kenya
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | | | | | - Kate Milner
- Neurodisability & Rehabilitation Research Group, Murdoch Children’s Research Institute 2, Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Proma Paul
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
5
|
Duttine A, Smythe T, Ribiero Calheiro de Sá M, Ferrite S, Zuurmond M, Moreira ME, Collins A, Milner K, Kuper H. Congenital Zika Syndrome-Assessing the Need for a Family Support Programme in Brazil. Int J Environ Res Public Health 2020; 17:ijerph17103559. [PMID: 32438700 PMCID: PMC7277658 DOI: 10.3390/ijerph17103559] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022]
Abstract
The Zika outbreak in Brazil caused congenital impairments and developmental delays, or Congenital Zika Syndrome (CZS). We sought to ascertain whether a family support programme was needed and, if so, could be adapted from the Getting to Know Cerebral Palsy programme (GTKCP) designed for children with cerebral palsy (CP). We conducted a systematic review of the needs of families of children with CZS or CP in low- and middle-income countries and reviewed the findings of the Social and Economic Impact of Zika study. We undertook a scoping visit to three facilities offering services to children with CZS in Brazil to understand potential utility and adaptability of GTKCP. The literature review showed that caregivers of children with CZS experience challenges in mental health, healthcare access, and quality of life, consistent with the CP literature. The scoping visits demonstrated that most support provided to families was medically orientated and while informal support networks were established, these lacked structure. Caregivers and practitioners expressed an eagerness for more structure community-based family support programmes. A support programme for families of children with CZS in Brazil appeared relevant and needed, and may fill an important gap in the Zika response.
Collapse
Affiliation(s)
- Antony Duttine
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
- Correspondence:
| | - Tracey Smythe
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| | - Míriam Ribiero Calheiro de Sá
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro 22250-020, Brazil; (M.R.C.d.S.); (M.E.M.)
| | - Silvia Ferrite
- Department of Speech and Hearing Sciences, Institute of Health Sciences, Federal University of Bahia, Salvador 40110-902, Brazil;
| | - Maria Zuurmond
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| | - Maria Elisabeth Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro 22250-020, Brazil; (M.R.C.d.S.); (M.E.M.)
| | - Anna Collins
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| | - Kate Milner
- Murdoch Children’s Research Institute and Department of Paediatrics, University of Melbourne, Parkville, Victoria 3052, Australia;
| | - Hannah Kuper
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| |
Collapse
|
6
|
Woolfenden S, Milner K, Tora K, Naulumatua K, Mataika R, Smith F, Lingam R, Kado J, Tuibeqa I. Strengthening Health Systems to Support Children with Neurodevelopmental Disabilities in Fiji-A Commentary. Int J Environ Res Public Health 2020; 17:ijerph17030972. [PMID: 32033233 PMCID: PMC7037281 DOI: 10.3390/ijerph17030972] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/17/2020] [Accepted: 01/31/2020] [Indexed: 12/27/2022]
Abstract
Supporting children with neurodevelopmental disabilities (NDDs) is recognized as an increasing priority in Fiji, a middle-income Pacific Island country. Our objective was to describe our approach to developing a model of care and strengthening local leadership in developmental paediatrics in Fiji to ensure high-quality identification, assessment and management of children with NDDs. Paediatric staff at Colonial War Memorial (CWM) Hospital in Suva have worked in partnership with Australian paediatricians to develop the model of care. The platform of continuing medical education during biannual 3 to 4 days of clinic-based teaching with visiting developmental paediatricians from Australia has been used. Since 2010, there have been 15 local and regional paediatric trainees trained. Since 2015, our two local lead paediatric trainees have run a weekly local developmental clinic. In total, 370 children aged 0 to 18 with NDDs have been comprehensively assessed with a detailed history and standardised tools. The model is extending to two divisional hospitals. Research engagement with the team is resulting in the development of a local evidence base. Local, regional and international leadership and collaboration has resulted in increased capacity in the Fijian health system to support children with NDDs.
Collapse
Affiliation(s)
- Sue Woolfenden
- Population Child Health Group, University of New South Wales, Sydney 2031, Australia;
- Department of Community Child Health, Sydney Children’s Hospital Network, Sydney 2031, Australia
- Correspondence:
| | - Kate Milner
- Neurodevelopment & Disability, Royal Children’s Hospital, Melbourne 3052, Australia;
- Neurodisability & Rehabilitation Research & Melbourne Children’s Global Health, Murdoch Children’s Research Institute, Melbourne 3052, Australia
| | - Kali Tora
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji; (K.T.); (K.N.); (R.M.); (J.K.); (I.T.)
| | - Kelera Naulumatua
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji; (K.T.); (K.N.); (R.M.); (J.K.); (I.T.)
| | - Reapi Mataika
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji; (K.T.); (K.N.); (R.M.); (J.K.); (I.T.)
| | - Fleur Smith
- Nossal Institute for Global Health, University of Melbourne, Melbourne 3000, Australia;
| | - Raghu Lingam
- Population Child Health Group, University of New South Wales, Sydney 2031, Australia;
- Department of Community Child Health, Sydney Children’s Hospital Network, Sydney 2031, Australia
| | - Joseph Kado
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji; (K.T.); (K.N.); (R.M.); (J.K.); (I.T.)
- Telethon Kids Institute, Perth 6009, Australia
| | - Ilisapeci Tuibeqa
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji; (K.T.); (K.N.); (R.M.); (J.K.); (I.T.)
| |
Collapse
|
7
|
Mackay J, McCallum Z, Ambler GR, Vora K, Nixon G, Bergman P, Shields N, Milner K, Kapur N, Crock P, Caudri D, Curran J, Verge C, Seton C, Tai A, Tham E, Musthaffa Y, Lafferty AR, Blecher G, Harper J, Schofield C, Nielsen A, Wilson A, Leonard H, Choong CS, Downs J. Requirements for improving health and well-being of children with Prader-Willi syndrome and their families. J Paediatr Child Health 2019; 55:1029-1037. [PMID: 31257692 PMCID: PMC6852695 DOI: 10.1111/jpc.14546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/15/2019] [Accepted: 06/02/2019] [Indexed: 12/16/2022]
Abstract
Prader-Willi syndrome (PWS) is a rare genetic condition with multi-system involvement. The literature was reviewed to describe neurodevelopment and the behavioural phenotype, endocrine and metabolic disorders and respiratory and sleep functioning. Implications for child and family quality of life were explored. Challenging behaviours contribute to poorer well-being and quality of life for both the child and caregiver. Recent evidence indicates healthy outcomes of weight and height can be achieved with growth hormone therapy and dietary restriction and should be the current target for all individuals with PWS. Gaps in the literature included therapies to manage challenging behaviours, as well as understanding the effects of growth hormone on respiratory and sleep function. New knowledge regarding the transition of children and families from schooling and paediatric health services to employment, accommodation and adult health services is also needed. Developing a national population-based registry could address these knowledge gaps and inform advocacy for support services that improve the well-being of individuals with PWS and their families.
Collapse
Affiliation(s)
- Jessica Mackay
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia,School of MedicineUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Zoe McCallum
- Department of Neurodevelopment and DisabilityRoyal Children's HospitalMelbourneVictoriaAustralia,Department of Gastroenterology and Clinical NutritionRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Geoffrey R Ambler
- Institute of Endocrinology and DiabetesChildren's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Komal Vora
- Department of Paediatric Endocrinology and DiabetesJohn Hunter Children's HospitalNewcastleNew South WalesAustralia
| | - Gillian Nixon
- Melbourne Children's Sleep CentreMonash Children's HospitalMelbourneVictoriaAustralia,The Ritchie CentreMelbourneVictoriaAustralia,Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
| | - Philip Bergman
- Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia,Department of Paediatric Endocrinology and DiabetesMonash Children's HospitalMelbourneVictoriaAustralia
| | - Nora Shields
- School of Allied HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Kate Milner
- Department of Neurodevelopment and DisabilityRoyal Children's HospitalMelbourneVictoriaAustralia,Centre for International Child HealthMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Nitin Kapur
- Respiratory and Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia,School of Clinical MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Patricia Crock
- Department of Paediatric Endocrinology and DiabetesJohn Hunter Children's HospitalNewcastleNew South WalesAustralia,Hunter Medical Research InstituteUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Daan Caudri
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia,Erasmus University Medical CenterRotterdamthe Netherlands
| | - Jaqueline Curran
- Department of EndocrinologyPerth Children's HospitalPerthWestern AustraliaAustralia
| | - Charles Verge
- Department of EndocrinologySydney Children's HospitalSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Chris Seton
- Department of Sleep MedicineChildren's Hospital WestmeadSydneyNew South WalesAustralia,Woolcock Institute of Medical ResearchSydney UniversitySydneyNew South WalesAustralia
| | - Andrew Tai
- Respiratory and Sleep DepartmentWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Elaine Tham
- Endrocrinology and Diabetes DepartmentWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Yassmin Musthaffa
- Diamantina Institute, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Translational Research InstituteUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Antony R Lafferty
- Department of Endocrinology and DiabetesCanberra HospitalCanberraAustralian Capital TerritoryAustralia,Medical SchoolAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Greg Blecher
- Department of Sleep MedicineSydney Children's HospitalSydneyNew South WalesAustralia
| | - Jessica Harper
- Department of EndocrinologySydney Children's HospitalSydneyNew South WalesAustralia
| | - Cara Schofield
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Aleisha Nielsen
- Respiratory and Sleep MedicinePerth Children's HospitalPerthWestern AustraliaAustralia
| | - Andrew Wilson
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia,Respiratory and Sleep MedicinePerth Children's HospitalPerthWestern AustraliaAustralia
| | - Helen Leonard
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Catherine S Choong
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia,Department of EndocrinologyPerth Children's HospitalPerthWestern AustraliaAustralia
| | - Jenny Downs
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia,School of Physiotherapy and Exercise ScienceCurtin UniversityPerthWestern AustraliaAustralia
| |
Collapse
|
8
|
Ribi E, Parker R, Milner K. Microparticulate gel chromatography accelerated by centrifugal force and pressure. Methods Biochem Anal 2006; 22:355-400. [PMID: 4612300 DOI: 10.1002/9780470110423.ch8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
9
|
Leonard JP, Mason K, Theriault T, Milner K, Sornasse T, Ingolia D, Mayo M, Denney DW. Preliminary immune response (IR) results of a phase 2 study with idiotype (Id) immunotherapy after treatment with CVP and rituximab for follicular non-Hodgkin’s lymphoma (FL). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7529 Background: Idiotype (Id) is a collection of unique immunogenic epitopes present on the surface of malignant B cells. Keyhole limpet hemocyanin (KLH) is a carrier protein used to increase antigen immunogenicity. MyVax Personalized Immunotherapy consists of the patient- and tumor-specific Id protein, produced using molecular techniques, conjugated to KLH and administered in a series of subcutaneous immunizations with the adjuvant GM-CSF. Idiotype vaccines were first studied in combination with various chemotherapeutic agents as part of initial treatment for FL. Given the widespread usage of rituximab in treating FL, the nature of IRs in patients immunized with MyVax Personalized Immunotherapy following rituximab treatment are of interest. CD19+ B cell counts following treatment with rituximab were analyzed for correlation with patient-specific Id-KLH induced humoral IR data. Methods: In a Phase 2 study, MyVax Personalized Immunotherapy following rituximab is being evaluated for patients who failed to achieve at least a PR and maintain the response over a 6 month rest period after 8 cycles of CVP chemotherapy. Eligible patients received 4 weekly doses of rituximab followed by a 13 or 26 week rest period. Patients who achieved and maintained a PR or better then received 8 immunizations with MyVax Personalized Immunotherapy over 14 weeks. CD19+ B cells and humoral IRs against Id and KLH were monitored during and 2, 8, 20, 32, 44 and 56 weeks post-immunizations. Results: 87 pts received rituximab. 52 pts went on to immunization. Median CD19 counts for all arms of the study were lower post-rituximab treatment (pre-treatment median = 76 cells/ul (N = 57) vs. post-treatment = 13 cells/ul (N = 51 evaluable); p < 0.0001). Positive results are defined as a titer >0.1 mcg/ml. 49/52 (94%) evaluable pts were able to mount anti-KLH humoral IRs post rituximab. The magnitude of the anti-KLH response was generally greater in pts with higher B cell counts when beginning immunizations. Anti-Id IRs were also observed. Conclusions: Humoral IRs to KLH occur in pts receiving MyVax Personalized Immunotherapy and correlate with regeneration of B cells post-rituximab but appear less robust than in rituximab-naïve pts. [Table: see text]
Collapse
Affiliation(s)
- J. P. Leonard
- Weill Medical College of Cornell University, New York, NY; Genitope Corporation, Redwood City, CA
| | - K. Mason
- Weill Medical College of Cornell University, New York, NY; Genitope Corporation, Redwood City, CA
| | - T. Theriault
- Weill Medical College of Cornell University, New York, NY; Genitope Corporation, Redwood City, CA
| | - K. Milner
- Weill Medical College of Cornell University, New York, NY; Genitope Corporation, Redwood City, CA
| | - T. Sornasse
- Weill Medical College of Cornell University, New York, NY; Genitope Corporation, Redwood City, CA
| | - D. Ingolia
- Weill Medical College of Cornell University, New York, NY; Genitope Corporation, Redwood City, CA
| | - M. Mayo
- Weill Medical College of Cornell University, New York, NY; Genitope Corporation, Redwood City, CA
| | - D. W. Denney
- Weill Medical College of Cornell University, New York, NY; Genitope Corporation, Redwood City, CA
| |
Collapse
|
10
|
Tandon R, Milner K, Jibson MD. Antipsychotics from theory to practice: integrating clinical and basic data. J Clin Psychiatry 1999; 60 Suppl 8:21-8. [PMID: 10335668] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The recent introduction of the atypical antipsychotics into the treatment arena for psychoses and related disorders comes with justifiable excitement. These newer antipsychotics offer several clinical benefits over the conventional antipsychotics, which have been the mainstays of care thus far. The primary advantage of these atypical agents is their superior side effect profiles, particularly with regard to extrapyramidal side effects (EPS). The implications from a reduction in EPS touch on virtually every aspect of pathology in schizophrenic illness, including short- and long-term movement disorders, negative symptoms, noncompliance, cognitive dysfunction, and dysphoria. It should be emphasized that while atypical antipsychotics share many clinical attributes, there are also substantial differences among them. This review will examine the pharmacology, clinical efficacy, and side effect profiles of the atypical antipsychotics and attempt to relate the attributes observed in clinical practice and clinical trials to their basic pharmacologic profiles. There is a fair, but not perfect, correspondence between the pharmacologic profiles of the different atypical antipsychotics and their respective clinical attributes. After a comparative overview of their receptor-binding profiles, a brief pharmacokinetic summary will be provided. Finally, the clinical profiles of these agents will be summarized with regard to both their efficacy and adverse effects.
Collapse
Affiliation(s)
- R Tandon
- University of Michigan Medical Center, Ann Arbor 48109-0120, USA.
| | | | | |
Collapse
|
11
|
Abstract
The properties of the vestibuloocular reflex (VOR) when the axis of rotation is behind the eyes and fixation of a near target is required were studied in the monkey. The magnitude of VOR gain in each eye was found to be above 1.0 and near the ideal value for stabilizing a retinal image. Evidence that this large VOR gain was not visually mediated was provided by the observations that no reduction in gain and no phase lag were observed at high frequencies of head rotation (2 Hz), large gain was observed in the dark, and large gain was observed within 10-20 ms of the start of head rotation. The magnitude of VOR gain was found to increase with increasing radius of head rotation and also to increase with decreasing target distance. When the distances from the two eyes to the target were different the instantaneous velocities and VOR gains of the eyes were also different. The dependence on radius of rotation indicates that the VOR is mediated by a combination of otolith and canal inputs. A general model for otolith-canal interaction is proposed in which VOR gain is based on a computation of target location relative to the head. This model simplifies to the classical VOR reflex when a cyclopean eye is subjected only to angular displacement.
Collapse
|
12
|
Schmidt KL, Milner K, Hilburn PJ, Schmidt WA. Ultrastructure of trypan blue-induced ocular defects II. Cornea and mesenchyme. Teratology 1984; 29:105-16. [PMID: 6422577 DOI: 10.1002/tera.1420290113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Using scanning and transmission electron microscopy, the histological and cytological alterations induced in the developing eye by trypan blue were examined. Microphthalmic and anophthalmic eyes were analyzed from 16-day rat fetuses whose dams had received a teratogenic dose of trypan blue. Cell and tissue damage within cornea and mesenchyme were assessed. Corneas from the treated groups were undulating and uneven owing to abnormal lens placement and corneal cell injury. Extensive extracellular spacing, few cell-to-cell contacts, patchy glycocalyces, and abnormal surface morphology characterized the corneal cells of treated tissues. Mesenchyme of severely malformed eyes typically filled the eye field in regions normally occupied by retina and lens. As a tissue, mesenchyme lacked organization and those surface features normally present in component cells were altered. Mesenchymal cells were packed so closely that extracellular spaces were nearly obliterated. Microvilli, filopodia, and lamellipodia, cell processes observed in normal mesenchyme, were altered in both number and structure. The cytoplasm of mesenchymal cells was condensed and decreased in volume. These data suggested that 1) in this trypan blue ocular model, virtually all major tissue types were morphologically altered; 2) because healthy mesenchyme and cornea are required for normal development of lens, optic vesicle and ocular adnexa it follows that abnormal cornea and mesenchyme also will compromise these tissues; and 3) since necrotic reminants were not present, this trypan blue model probably causes developmental arrest. The most likely teratogenic pathway is presented with emphasis on the cell surface as a probable site of dye action.
Collapse
|
13
|
Abstract
The histological and cytological basis of trypan blue-induced ocular defects were studied using scanning and transmission electron microscopy. Microphthalmic and anophthalmic eyes of 16-day rat fetuses were utilized from dams exposed to a teratogenic dose of trypan blue. Retinal and lenticular anlagen were specifically examined for architectural and cellular changes. Nearly all severely abnormal eyes showed no evidence of retina development: Of 41 such eyes, only two retinal rudiments were observed. Those eyes with mild microphthalmia always demonstrated retinae although architectural changes were present. In every abnormal eye, some degree of lenticular morphogenesis was always present. Lenses were small, displaced in the eye field, and arrested at the lens vesicle stage. Lens cells were markedly undifferentiated and thus lacked most of the cytological features normally present at this developmental stage. Neither retinal nor lenticular rudiments were necrotic despite major architectural and cytological disturbances. The data offer three conclusions: First, the absence of necrosis suggests that trypan blue causes developmental arrest in this eye model; second, absence of retinae is most likely due to primary failure of optic vesicle development; third, lack of lens differentiation is attributed to absence of the retina, the primary lens inducer.
Collapse
|
14
|
Christensen CE, Milner K, Christensen JE. An analysis of faculty perceptions of leadership qualities of male and female physical education departments. Res Q 1978; 49:269-77. [PMID: 725294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
15
|
Abstract
Hot phenol-water extraction of smooth
Brucella abortus
and
B. melitensis
cells yielded a toxic fraction which was recovered from the phenol phase (fraction 5). Chemically, fractions 5 from both
Brucella
species were lipid-carbohydrate-protein-2 keto-3-deoxyoctulosonic acid complexes which were stable to heat and resistant to Pronase digestion. Electron micrographs of the
Brucella
toxins were morphologically indistinguishable from those of enterobacterial endotoxins. Biologically,
Brucella
toxins were lethal for mice and immunogenic for rabbits. An intravenous injection of
Brucella
toxin induced severe leukopenia with subsequent leukocytosis in mice. Cross-tolerance experiments with mice demonstrated that pretreatment with
B. abortus
toxin lessened the hypoferremia produced by challenge with
Escherichia coli
endotoxin. Furthermore, fractions 5 from
B. abortus
and
B. melitensis
were able to form hybrids with
E. coli
and
Salmonella enteritidis
endotoxins and also with each other. Although
Brucella
toxins possess many structural and biological properties in common with endotoxins from the
Enterobacteriaceae
, some quantitative differences in their biological potencies were observed.
Brucella
toxins were relatively innocuous in tests for pyrogenicity in rabbits and lethality for chick embryos. In nonspecific protection tests,
Brucella
toxin had only 1/75 the potency of
E. coli
endotoxin in protecting mice against challenge with virulent
S. typhi
. However, on the basis of the data presented and on the work done previously, we concluded that the heat-stable toxins of
B. abortus
and
B. melitensis
were endotoxins.
Collapse
Affiliation(s)
- D Leong
- Rocky Mountain Laboratory, National Institute of Allergy and Infectious Diseases, Hamilton, Montana 59840
| | | | | | | | | |
Collapse
|
16
|
Ribi E, Brehmer W, Milner K. Specificity of resistance to tuberculosis and to salmonellosis stimulated in mice by oil-treated cell walls. Proc Soc Exp Biol Med 1967; 124:408-13. [PMID: 4960083 DOI: 10.3181/00379727-124-31752] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|