Browsing by Subject "child"
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Item Aesthetical perception of dental fluorosis in a Colombian low income community(Universidad CES, 2020-12) Fragelli, Camila; Restrepo, Manuel; Bussaneli, Diego Girotto; Jeremias, Fabiano; de Cássia Loiola Cordeiro, Rita; Escobar-Rojas, Alfonso; Martinez-Mier, E. Angeles; dos Santos-Pinto, Lourdes; Cariology, Operative Dentistry and Dental Public Health, School of DentistryIntroduction and objective : Dental fluorosis (DF) is a defect in the development of enamel as a result of overexposure to fluoride and can aesthetically compromise the patient. This study aims to investigate the relationship between aesthetic perception and dental fluorosis in a low-income community with a high prevalence of DF. Materials and methods: A cross-sectional study was carried out with 171 schoolchildren aged 8 to 12 who live in a low socioeconomic community (El Cedro, Ayapel district, Córdoba, Colombia). The students were examined for dental caries (DMFT and dmft indexes (WHO criteria) and for dental fluorosis (TF index). Aesthetic perception was verified with the questionnaire on children's perceptions of the appearance of teeth (CQATA) Data analysis was performed using descriptive statistics and chi-square tests, Student's t, one-way ANOVA and linear regression (p ≤ 0.05). Results: The prevalence of DF was 84.8% (n = 145). Only the presence of caries (DMFT / deft ≠ 0) had a significant impact on aesthetic perceptions. A significantly lower rate was found in girls for the pleasant color report. The number of teeth affected by FD had a significant positive correlation with the general perception of dental health. Conclusion : The presence of mild DF in children with low socioeconomic status, in a population with a high prevalence of this enamel defect, did not seem to have an impact on accepting the appearance of tooth color.Item Associations of a- and g-tocopherol during early life with lung function in childhood(Elsevier, 2020) Kumar, Rajesh; Ferrie, Ryan; Balmert, Lauren; Kienzi, Matthew; Rifas-Shiman, Sheryl L.; Gold, Diane R.; Sordillo, Joanne E.; Kleinman, Ken; Camargo, Carlos A., Jr.; Litonjua, Augusto A.; Oken, Emily; Cook-Mills, Joan; Pediatrics, School of MedicineBackground: Tocopherol isoforms may regulate child lung growth and spirometric measures. Objective: Our aim was to determine the extent to which plasma a-tocopherol (a-T) or g-tocopherol (g-T) isoform levels in early childhood or in utero are associated with childhood lung function. Methods: We included 622 participants in the Project Viva cohort who had lung function at a mid-childhood visit (age 6-10 years). Maternal and child tocopherol isoform levels were measured by HPLC at the second trimester and 3 years of age, respectively. Multivariable linear regression models (adjusted for mid-childhood body mass index z scores, maternal education, smoking in pregnancy, and prenatal particulate matter with diameter of <2.5 micrometers (PM2.5) particulate exposure) stratified by tertiles of child g-T level were used to assess the association of a-T levels with FEV1 and forced vital capacity (FVC) percent predicted. Similarly, models stratified by child a-T tertile evaluated associations of g-T levels with lung function. We performed similar analyses with maternal second trimester tocopherol isoform levels. Results: The median maternal second trimester a-T level was 63 mM (interquartile range 5 47-82). The median early-childhood level was 25 mM (interquartile range 5 20-33 mM). In the lowest tertile of early-childhood g-T, children with a higher a-T level (per 10 mM) had a higher mid-childhood FEV1 percent predicted (b 5 3.09; 95% CI 5 0.58-5.59 and a higher FVC percent predicted (b 5 2.77; 95% CI 5 0.47-5.06). This protective association of a-T was lost at higher g-T levels. We did not see any consistent associations of second trimester levels of either a-T or g-T with mid-childhood FEV1 or FVC. Conclusion: When g-T levels were in the lowest tertile, a higher early-childhood a-T level was associated with better lung function at mid-childhood. Second trimester maternal plasma a-T concentration was 3-fold higher than in the adult nonpregnant female population.Item Correspondence: transurethral catheter drainage in febrile urinary tract infection—practice patterns among specialized centers in North America and Europe(Elsevier, 2019-12) Salama, Amr K.; Haid, Bernhard; Strasser, Christa; Smith, Caroline; Spinoit, Anne-Françoise; Saad, Kahlil N.; Peycelon, Matthieu; Urology, School of MedicineItem Health outcomes associated with improvement in mouth breathing in children with OSA(Springer, 2021) Bandyopadhyay, Anuja; Slaven, James E.; Pediatrics, School of MedicinePurpose Children with mouth breathing (MB) report poor quality of life. It is unknown whether improvement in MB is associated with improvement in behavior or quality of life. We hypothesized that in children with MB and obstructive sleep apnea (OSA), improvement in MB is associated with improvement in behavior and quality of life, independent of improvement in OSA. Methods This is a retrospective post hoc analysis utilizing Childhood Adenotonsillectomy Trial (CHAT) dataset, a multicenter controlled study evaluating outcomes in children with OSA randomized into early adenotonsillectomy or watchful waiting. Children with OSA and MB at baseline (determined by reporting 2 or greater to OSA-18 questionnaire on mouth breathing) were divided into 2 groups: improved mouth breathing (IMB, determined by a lower score compared to baseline at follow up) and persistent mouth breathing (PMB, determined by an unchanged or higher score). Baseline characteristics, behavior (Conners GI score), sleepiness (Epworth Sleepiness Scale), and quality of life (PedsQL) were compared between the groups using appropriate statistical tests. ANCOVA models were used to analyze change in outcomes, adjusting for treatment arm and change in AHI. Results Of 273 children with OSA and MB at baseline, IMB (N = 195) had significantly improved score between visits for Conner’s GI Total T score, Epworth Sleepiness Scale, and PedsQL compared to PMB (N = 78), after adjusting for treatment arm and change in AHI. Conclusion Our study suggests an interesting association between mouth breathing and quality of life, independent of polysomnographic evidence. Future studies should explore the effect of mouth breathing on quality of life, in absence of OSA.Item Injustice perceptions about pain: parent–child discordance is associated with worse functional outcomes(Wolters Kluwer, 2018-06) Miller, Megan M.; Wuest, David; Williams, Amy E.; Scott, Eric L.; Trost, Zina; Hirsh, Adam T.; Psychology, School of SciencePain is experienced within and influenced by social environments. For children with chronic pain, the child–parent relationship and parental beliefs about pain are particularly important and may influence pain outcomes. Pain-related injustice perceptions have recently been identified as an important cognitive–emotional factor for children with pain. The current study aimed to better understand the pain-related injustice perceptions of children with chronic pain and their parents. The sample consisted of 253 pediatric chronic pain patients (mean age = 14.1 years, 74% female) presenting to a tertiary pain clinic. Patients completed measures of pain intensity, pain-related injustice perceptions, stress, functional disability, and quality of life. Parents completed a measure of pain-related injustice perceptions about their child's pain. Child–parent dyads were categorized into 1 of 4 categories based on the degree of concordance or discordance between their scores on the injustice measures. One-way analysis of variances examined differences in pain intensity, stress, functional disability, and quality of life across the 4 dyad categories. Our findings indicated that both the degree (concordant vs discordant) and direction (discordant low child–high parent vs discordant high child–low parent) of similarity between child and parent injustice perceptions were associated with child-reported pain intensity, stress, functional disability, and quality of life. The poorest outcomes were reported when children considered their pain as highly unjust, but their parents did not. These findings highlight the important role of parents in the context of pain-related injustice perceptions in pediatric chronic pain.Item Sacral Neuromodulation in Children(Springer, 2015-12) Strine, Andrew C.; Keenan, Alison C.; King, Shelly; Whittam, Benjamin M.; Department of Urology, IU School of MedicineSacral neuromodulation (SNM) has emerged as a treatment option for refractory lower urinary tract and bowel dysfunction in children. SNM is typically reserved for a select population of children who have failed an extended period of behavioral modification, biofeedback, and pharmacologic therapy. The surgical techniques for SNM in children are analogous to those in adults and include both one- and two-stage procedures as well as a peripheral nerve evaluation with the InterStim® system (Medtronic, Minneapolis, MN). Most studies have observed not only an improvement in symptoms and quality of life in children undergoing SNM for non-neurogenic and neurogenic lower urinary tract dysfunction but also a much higher reoperative rate than in adults. Further high-quality research is necessary to corroborate the results of earlier studies and to better define the indications for SNM in children.Item Structured review of post-cardiotomy extracorporeal membrane oxygenation: Part 2—pediatric patients(Elsevier, 2019) Lorusso, Roberto; Raffa, Giuseppe Maria; Kowalewski, Mariusz; Alenizy, Khalid; Sluijpers, Niels; Makhoul, Maged; Brodie, Daniel; McMullan, Mike; Wang, I-Wen; Meani, Paolo; MacLaren, Graeme; Dalton, Heidi; Barbaro, Ryan; Hou, Xaotong; Cavarocchi, Nicholas; Chen, Yih-Sharng; Thiagarajan, Ravi; Alexander, Peta; Alsoufi, Bahaaldin; Bermudez, Christian A.; Shah, Ashish S.; Haft, Jonathan; Oreto, Lilia; D’Alessandro, David A.; Boeken, Udo; Whitman, Glenn; Surgery, School of MedicineVeno-arterial extracorporeal membrane oxygenation (ECMO) is established therapy for short-term circulatory support for children with life-treating cardiorespiratory dysfunction. In children with congenital heart disease (CHD), ECMO is commonly used to support patients with post-cardiotomy shock or complications including intractable arrhythmias, cardiac arrest, and acute respiratory failure. Cannulation configurations include central, when the right atrium and aorta are utilized in patients with recent sternotomy, or peripheral, when cannulation of the neck or femoral vessels are used in non-operative patients. ECMO can be used to support any form of cardiac disease, including univentricular palliated circulation. Although veno-arterial ECMO is commonly used to support children with CHD, veno-venous ECMO has been used in selected patients with hypoxemia or ventilatory failure in the presence of good cardiac function. ECMO use and outcomes in the CHD population are mainly informed by single-center studies and reports from collated registry data. Significant knowledge gaps remain, including optimal patient selection, timing of ECMO deployment, duration of support, anti-coagulation, complications, and the impact of these factors on short- and long-term outcomes. This report, therefore, aims to present a comprehensive overview of the available literature informing patient selection, ECMO management, and in-hospital and early post-discharge outcomes in pediatric patients treated with ECMO for post-cardiotomy cardiorespiratory failure.Item Understanding Ethical Issues of Research Participation from the Perspective of Participating Children and Adolescents: A Systematic Review(Wiley, 2017-06) Crane, Stacey; Broome, Marion E.; School of NursingBackground The past twenty years have seen distinct shifts in the way the participation of children and adolescents in research is viewed. This has been emphasized by the growing pediatric research enterprise. Additional information on children’s and adolescents’ experiences during research participation is needed to better inform researchers on the ethical conduct of research with this vulnerable population. Aims The objective of this analysis was to examine ethical issues in research with children and adolescents from their perspective as participants, including: assent, parental consent, risk perception, impact of research participation, and incentives. Methods This systematic review was conducted per the Long et al. framework by means of an iterative searching process. Using the key words ‘research ethics’ and ‘child or pediatric or adolescent’, PubMed, CINAHL, and EBSCOhost databases were searched to identify articles. Limitations placed on the original searches were: English language, year of publication between 2003–2014, humans, abstract available, and age birth–18 years. Findings Twenty-three empiric studies were identified and formed the sample. Included studies represented a diverse range of areas of research, methods, settings, sample demographics, authors, and journals. Discussion Even young children demonstrated the ability to understand essential elements of research, although there is variability in children’s level of understanding. Trust was a significant contributing factor to children’s and adolescents’ participation in research, and also shaped their assessments of risk. Research participation was mainly beneficial for children and adolescents. Incentives were mainly viewed positively, although concerns of possible undue influence were expressed. Linking Evidence to Action This systematic review highlights the importance of including the perspectives of children and adolescents and provides researchers and nurse clinicians with best practices for involving children in research.Item Validation of QUALAS-T, a health-related quality of life instrument for teenagers with spina bifida(Polish Urological Association, 2017) Szymański, Konrad M.; Misseri, Rosalia; Whittam, Benjamin; Casey, Jessica T.; Yang, David Y.; Raposo, Sonia-Maria; King, Shelly J.; Kaefer, Martin; Rink, Richard C.; Cain, Mark P.; Urology, School of MedicineIntroduction We aimed to develop and validate a self-reported QUAlity of Life Assessment in Spina bifida for Teenagers (QUALAS-T). Material and methods We drafted a 46-question pilot instrument using a patient-centered comprehensive item generation/refinement process. A group of 13–17 years olds with spina bifida (SB) was recruited online via social media and in person at SB clinics (2013–2015). Healthy controls were recruited during routine pediatrician visits. Final questions were identified based on clinical relevance, factor analysis and domain psychometrics. Teenagers with SB completed the validated generic Kidscreen-27 instrument. Results Median age of 159 participants was 15.2 years (42.0% male, 77.4% Caucasian), similar to 58 controls (p ≥ 0.06). There were 102 online and 57 clinic participants (82.8% of eligible). Patients, parents and an expert panel established face and content validity of the 2-domain, 10-question QUALAS-T. Internal consistency and test-retest reliability were high for the Family and Independence and Bladder and Bowel domains (Cronbach's alpha: 0.76–0.78, ICC: 0.72–0.75). The Bladder and Bowel domain is the same for QUALAS-T , QUALAS-A for adults and QUALAS-C for children. Correlations between QUALAS-T domains were low (r = 0.34), indicating QUALAS-T can differentiate between distinct HRQOL components. Correlations between QUALAS-T and Kidscreen-27 were also low (r ≤0.41). QUALAS-T scores were lower in teenagers with SB than without (p <0.0001). Conclusions QUALAS-T is a short, valid HRQOL tool for adolescents with SB, applicable in clinical and research settings. Since the Bladder & Bowel domains for all QUALAS versions are the same, Bladder and Bowel HRQOL can be measured on the same scale from age 8 through adulthood.Item Variation in hospital admission from the emergency department for children with cancer: A Pediatric Health Information System study(Wiley, 2020-06) Mueller, Emily L.; Jacob, Seethal A.; Cochrane, Anneli; Carroll, Aaron E.; Bennet, William E., Jr.; Pediatrics, School of MedicineBackground Children with cancer experience a wide range of conditions that require urgent evaluation in the emergency department (ED), yet variation in admission rates is poorly documented. Procedure We performed a retrospective cohort study using the Pediatric Health Information System of ED encounters by children with cancer between July 2012 and June 2015. We compared demographics for admitted versus discharged using univariate statistics, and calculated admission rates by hospital, diagnosis, day of the week, and weekend versus weekday. We assessed the degree of interhospital admission rates using the index of dispersion (ID). Results Children with cancer had 60 054 ED encounters at 37 hospitals. Overall, 62.5% were admitted (range 43.2%-92.1%, ID 2.6) indicating overdispersed admission rates with high variability. Children with cancer that visited the ED for a primary diagnosis of fever experienced the largest amount of variability in admission with rates ranging from 10.4% to 74.1% (ID 8.1). Less variability existed among hospital admission rates for both neutropenia (range 60%–100%, ID 1.0) and febrile neutropenia (FN) (range 66.7%-100%, ID 0.83). Admission rates by day of the week did not demonstrate significant variability for any of the scenarios examined (overall P = 0.91). There were no differences by weekend versus weekday either (overall P = 0.52). Conclusion The percentage of children with cancer admitted through the ED varies widely by institution and diagnosis. Standardization of best practices for children with cancer admitted through the ED should be an area of continued improvement.