Diagnosis Of Children Research Articles

Economic Evaluation of the Thai Diagnostic Autism Scale for Autism Spectrum Disorder Diagnosis in Children Aged 1-5 Years Old.

The Thai Diagnostic Autism Scale (TDAS) was developed for autism spectrum disorder (ASD) diagnosis in Thai children aged 1-5 years. Previous studies have indicated its good performance; however, additional health resources and healthcare providers are necessary for evaluation. Therefore, this study aimed to assess the cost-effectiveness of TDAS compared to clinical diagnosis (ClinDx) for ASD diagnosis in Thai children aged 1-5 years from a societal perspective. The analysis employed a hybrid model consisting of a decision tree model for a diagnostic phase with a state transition model for a follow-up phase. A literature review was conducted to determine TDAS performance and the relative risk of death in patients with ASD. Direct medical costs were assessed through a retrospective medical records review, and a cross-sectional survey was conducted to determine direct nonmedical costs, ASD severities, and utility values. The cost of TDAS was derived from a healthcare provider interview (n = 10). The incremental cost-effectiveness ratio (ICER) compared the total lifetime cost and quality-adjusted life years (QALY) between TDAS and ClinDx. We found that TDAS could improve QALY by 1.96 but increased total lifetime cost by 5577 USD, resulting in an ICER of 2852 USD/QALY. Sensitivity analysis indicated an 81.16% chance that TDAS is cost-effective. The probabilities of different ASD severities were key influencing factors of the findings. In conclusion, TDAS is the cost-effective option for ASD diagnosis in Thai children aged 1-5 years compared to ClinDx, despite some uncertainties around inputs. Further monitoring and evaluation are warranted if TDAS is to be implemented nationwide.

Mental Health Care Utilization Among Parents of Children With Cancer

Caring for children diagnosed with cancer may adversely affect the mental health (MH) of parents. To characterize utilization of MH services among parents of children with vs without cancer using nationwide commercial claims data. For this cross-sectional study, the Merative MarketScan Commercial Claims Database was used to identify continuously insured families of children treated for cancer (aged ≤21 years at diagnosis) during 2010 to 2018, compared with families who matched eligibility criteria but did not have a child with a cancer history. Parents were assessed from 18 months before to 12 months after their child's cancer diagnosis. Analyses were conducted from February 2022 to September 2023. Children's cancer diagnosis. Outcomes included parents' MH-related visits during the first year following their child's cancer diagnosis. Logistic regressions compared outcomes between families of children with vs without cancer, adjusting for sociodemographic and clinical factors. This study included 4837 families of children with cancer (4210 mothers and 4016 fathers) and 24 185 families of children without cancer (21 444 mothers and 19 591 fathers) with continuous insurance enrollment. Most household leads were aged 35 to 54 years (3700 [76.5%] in families of children with cancer vs 17 812 [73.6%] in families of children without cancer) and resided in urban areas (4252 [87.9%] vs 21 156 [87.5%]). The probabilities of parents having anxiety-related visits (10.6% vs 7.0%), depression-related visits (8.4% vs 6.1%), and any MH-related visits (18.1% vs 13.3%) were higher in families of children with vs without cancer. Adjusted analyses showed absolute increases of 3.2 percentage points (95% CI, 2.3 to 4.0; 45.7% relative increase), 2.2 percentage points (95% CI, 1.4 to 3.0; 36.1% relative increase), and 4.2 percentage points (95% CI, 3.1 to 5.3; 31.3% relative increase) in the probabilities of 1 or both parents having anxiety-related visits, depression-related visits, and any MH-related visits, respectively, among families of children with vs without cancer. Such differences were greater in magnitude among mothers than fathers. In this cohort study of privately insured parents, those caring for children with cancer had a higher likelihood of utilizing MH care than other parents. These findings underline the importance of interventions toward targeted counseling and support to better meet MH care needs among parents and caregivers of children with cancer.

Exploring autism spectrum disorder (ASD) and attention deficit disorder (ADD/ADHD) in children exposed to polybrominated biphenyl.

Although the causes of attention-deficit/hyperactivity disorder (ADHD) and autism have not been identified, exposure to endocrine-disrupting chemicals, such as polybrominated biphenyl (PBB), during fetal development and early life has been suspected to impact neurological development. This study aims to investigate the association between prenatal and early life exposure to PBB and the development of ADHD and autism later in life. Data from the Michigan PBB Registry, a cohort of Michigan residents who had been exposed to PBB in a mass contamination event in 1973, was leveraged for this nested case-control analysis among two distinct samples: (1) Those who self-reported ADHD or autism diagnosis, and (2) mothers who reported their child's ADHD or autism diagnosis. PBB exposure was measured in participants of the PBB Registry, and the mother's PBB level was used in mother-reported analyses. Cases were matched with controls by sex and year of birth. Conditional logistic regression models were used to estimate the association between PBB level and case status. PBB levels were higher among those who were exposed in early life compared with those exposed in utero (geometric mean: 0.300 ng/ml vs. 0.016 ng/ml). Among women in this cohort, a higher than expected proportion of self-reported ADHD diagnosis (11.11%), compared with population estimates. PBB was not associated with ADHD or autism in either self-reported or mother-reported analyses. This study adds to the sparse literature about prenatal and early life exposure to PBB-153 and ADHD and autism. Future studies should examine potential effect modification by sex.

The association between psychopathology, childhood trauma, and emotion processing.

Childhood trauma is highly prevalent and can have a negative impact on the development of socioemotional processes resulting in a higher vulnerability for mental disorders in adulthood. Previous studies have associated the severity of childhood trauma with deficits in social functioning, such as a negative attention bias, suggesting altered social information processing as a mechanism underlying the association between childhood trauma and transdiagnostic psychopathologies. In a cross-sectional setup with a total of 103 participants (26 with major depressive disorder, MDD; 24 with posttraumatic stress disorder, PTSD; 22 with somatic symptom disorder, SDD; and 31 healthy volunteers, HV), this study applied eye tracking in an emotion recognition paradigm. Reaction times, accuracy, and gaze behavior were analyzed for 4 different facial expressions as a function of self-reported childhood trauma and diagnosis. The aim was to investigate to what extent emotion processing is associated with (a) childhood trauma, (b) psychopathology, and (c) respective interacting effects. Patients showed higher reaction times and error rates overall in classifying emotions than HVs, especially for the recognition of anger and fear. Individuals with a diagnosis of PTSD and MDD were particularly slow in their response to these emotions. Higher scores of reported childhood trauma were associated with faster responses for classifying anger and fear and slower initiation of eye movements for SSD, MDD, and HVs for anger. These findings indicate that childhood trauma may contribute to attentional and information-processing biases relevant for social interaction. Identifying individual social deficits offers implications for tailored therapeutic interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A mixed-method systematic review of the perspectives of young people, carers and professionals on psychiatric diagnosis in childhood and adolescence.

The significance and complexities of a psychiatric diagnosis have been well-documented in existing literature. Despite the reliability and accuracy of such diagnoses, the impact and use of diagnostic labelling on young people remains unclear. A systematic review was conducted using six databases, identifying 13 studies that explored psychiatric diagnosis experiences in professionals, caregivers, and young people. This review focuses on three main themes related to psychiatric diagnosis in young people. The first theme is diagnostic subjectivity, which explores the accuracy, usefulness, potential harm and alternatives (e.g. psychological formulation) to psychiatric diagnosis in this population. The second theme is the utility of psychiatric diagnosis, which considers whether it helps young people access appropriate support and gain a better understanding of themselves and their presenting issues. The third theme is stigma, which examines the negative experiences and discrimination that young people may face due to their psychiatric diagnosis. There is relatively limited literature which discusses the experience of psychiatric diagnosis in young people, caregivers and professionals. The available literature is difficult to compare due to discrepancies between methodologies and services, and there are several gaps i.e. a limited focus on the experience of young people themselves. Different views and experiences of psychiatric diagnosis among professionals, caregivers, and young people could impact young people's quality of life, access to healthcare, and identity development. The current literature needs to be more comprehensive to draw firm conclusions about young people's experiences with psychiatric diagnosis.

Assessment of pragmatic skills in adults with ADHD

Although Attention Deficit Hyperactivity Disorder (ADHD) is among the most common diagnoses in childhood, a formal diagnosis, frequently, is delayed until adulthood. As a result, the individuals who are not diagnosed in childhood miss out on the early treatment and may experience considerable social and pragmatic challenges, culminating in factors that impact their daily living, educational achievements and professional performance. Children and adolescents who do not receive an ADHD treatment carry their symptoms into adulthood, that typically result in functional and pragmatical difficulties. However, assessing pragmatic deficits in adults with ADHD presents challenges, stemming from various factors such as educational backgrounds, under-resourced family environments, compensatory mechanisms in individuals with high intelligence and the presence of other comorbid conditions. Consequently, overlooking pragmatic and functional difficulties can lead to significant social difficulties, which in turn may negatively impact their daily living, educational achievements and career progression. This study proposes a comprehensive and cost-effective approach to evaluating pragmatic skills in adults with ADHD, by adapting a systematic and standardized method, for the assessment of the pragmatic abilities, originally developed for neurotypical individuals by Acara and Bambini (2016). The results show the importance of incorporating this assessment tool into the diagnostic procedures for ADHD that can be further applied in the intervention programs. This assessment tool provides a valid onset criterion for advancing effective intervention programs that are focused on the pragmatic skills. Thus, this evaluation tool, first, can pinpoint pragmatic deficits within the ADHD community, and, second, can foster the development of the targeted intervention programs concentrated on enhancing pragmatic skills in the individuals with ADHD.

Reintegration into school, kindergarten and work in families of childhood cancer survivors after a family-oriented rehabilitation program.

To describe the situation of childhood cancer survivors and their parents before and one year after a family-oriented rehabilitation program (FOR) and to identify factors influencing reintegration. We included parents of children diagnosed with leukemia or central nervous system tumor. We assessed parental functioning using the functioning subscale of the Ulm Quality of Life Inventory for Parents (ULQIE) and children's school/kindergarten related quality of life (parental assessment, subscale KINDL-R). Descriptive analyses, group comparisons and multiple regression analyses on data of 285 parents of 174 children diagnosed with leukemia or central nervous system tumor. Parents reported changes in their work situation (e.g., reduction of working hours) due to their child's diagnosis. Parental functioning increased significantly over time. Children's leukemia diagnosis and shorter time since the end of treatment were associated with higher functioning in parents one year after FOR. Parents reported difficulties in the child's work pace, concentration, stress resilience and empathy. The school/kindergarten-related quality of life (QoL) of the children was lower than in the general population. One year after FOR, most children reintegrated fully in school/kindergarten, partly with support (e.g., integration assistant). No significant predictors for children's reintegration were identified. Parents and children experience major changes in their work/school/kindergarten life. One year after FOR most parents reported a reintegration of their children, however the children's school/kindergarten-related QoL remained below average compared to norm values. Even after rehabilitation families of childhood cancer survivors might benefit from psychosocial and practical support offers to support families with the reintegration into work/school/kindergarten.

The Role of Cultural Factors in Attention Deficit Hyperactivity Disorder (ADHD) Diagnosis in Children in Nigeria

This paper explores the influence of cultural factors on the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in Nigerian children. Examining traditional beliefs, societal norms, and the impact of stigma, the study addresses the challenges within the cultural context. Critiquing Western diagnostic criteria and exploring alternative explanatory models rooted in indigenous perspectives highlight the need for a culturally informed diagnostic approach. Additionally, the paper discusses the limited availability of mental health services, cultural barriers to seeking professional help, and the significance of cultural competence in ADHD diagnosis. Collaborative efforts with traditional healers and community leaders are emphasized. Ultimately, the study aims to contribute to a more inclusive and culturally sensitive approach to ADHD diagnosis in Nigeria.

Fever at Time of Leukemia Diagnosis in Children: Predictor of Bloodstream Infection or Catheter Removal?

PurposeTo assess the incidence of fever at diagnosis in children with leukemia and determine if fever at diagnosis is a predictor of bloodstream infection (BSI) or central venous access device (CVAD) removal for infection either within the first 30 days or between 30 and 90 days after CVAD insertion. Materials and MethodsOne hundred fifty-one patients with acute leukemia (July 1, 2018, to December 31, 2020) who underwent a CVAD insertion within 2 weeks of diagnosis were included. Patient data included demographic characteristics, fever at diagnosis, CVAD type, antibiotics before and/or on the day of CVAD insertion, BSI incidence, BSI rates per 1,000 catheter days, and need for catheter removal after CVAD insertion within 30 days and between 30 and 90 days. ResultsPatients with fever at diagnosis had a significantly higher incidence of BSI within the first 30 days after CVAD insertion (17/23) than that among patients without fever (6/23) (P = .046) at diagnosis. No statistically significant difference was observed in the incidence of BSI between 30 and 90 days after CVAD insertion between patients with fever (5/11) and those without fever at diagnosis (6/11) (P = .519). Fever at diagnosis was not a predictor of CVAD removal within 30 days (9 patients required CVAD removal; 7/9 had fever and 2/9 had no fever) (P = .181) or between 30 and 90 days (4 patients required CVAD removal; 1/4 had fever and 3/4 had no fever at diagnosis) (P = .343) after insertion. ConclusionsFever at diagnosis in patients with leukemia is not a predictor of CVAD removal for infection.

Acute otitis media diagnosis in childhood: still a problem in 2023?

BackgroundDiagnosis of acute otitis media (AOM) in children can be challenging, given that symptoms are often non-specific or absent, and that the direct observation of the tympanic membrane in its entirety through otoscopy can sometimes be difficult. The aim of this study is to assess the diagnostic concordance in detection of AOM episodes between primary care paediatricians and physicians especially trained in paediatric otoscopy, and to characterize the most misleading elements in diagnostic failure.MethodsConsecutive clinical charts of children regularly followed for recurrent AOM (RAOM, i.e.: >3 episodes in 6 months or > 4 episodes in 1 year) at our Otitis Media paediatric outpatient clinic were retrospectively screened, in order to collect any diagnosis of AOM episode (and the related clinical findings/middle ear complaints) performed by primary care paediatricians/emergency room paediatricians. Diagnosis of AOM episode was validated by the same experienced physician (FF) in case of otoscopic relief of a bulging eardrum with at least one of the following: hyperaemia or yellow-like colour. The diagnostic concordance in detection of AOM episodes between primary care/emergency room paediatricians and our internal validator was expressed as the percentage of matching diagnosis.ResultsOne hundred and thirty-four single AOM episodes occurring in 87 children (mean age: 26.9 +/- 18.9 months) were included in the analysis. Diagnostic concordance in detection of AOM episodes between primary care/emergency room paediatricians and our internal validator was reported in 72.4% of cases. The most common pitfall found in our study was the misleading diagnosis of AOM in case of hyperaemic tympanic membrane without bulging (32/37 out of non-validated diagnoses).ConclusionsAOM diagnosis still represents a relevant issue among paediatricians in our country, and the presence of tympanic membrane hyperaemia without concomitant bulging can be confusing.

Exploring Factors Affecting Parental Psychological Vulnerability During Their Child's PICU Admission: A Prospective Pilot Cohort Study

Parental psychological responses during their child's pediatric intensive care unit (PICU) admission are often overlooked. This study aimed to identify pre-existing and peri-traumatic factors explaining parental stress and anxiety during their child's PICU admission and one-month follow-up. A prospective pilot study included 60 PICU parents. Parental Stressors Scale and State-trait Anxiety Inventory measured stress and anxiety during PICU admission, and the State-trait Anxiety Inventory and Perceived Stress Scale at a one-month follow-up. During PICU admission, parental stress correlated with age, race, and adverse childhood experiences (ACEs), anxiety was linked to income. At one-month follow-up, anxiety related to child's health worries, perceived stress was linked to parental ACEs and education. Parental ACEs predicted perceived stress (b=0.83, p=.028). Children's diagnoses explained anxiety, particularly respiratory and cardiac diagnoses (b=-13.44, p=.023; -10.03, p=.045). Identifying factors helps teams understand parental vulnerability and provide appropriate support.

Neurobiology of cognitive abilities in early childhood autism.

This perspective considers complexities in the relationship between impaired cognitive abilities and autism from a maturational, developmental perspective, and aims to serve as a helpful guide for the complex and growing investigation of cognitive abilities and Autism Spectrum Disorder (ASD). Low Intelligence Quotient (IQ) and ASD are frequently co-occurring. About 37% of 8-year old children and 48% of 4-year old children diagnosed with ASD also have Intellectual Disability, with IQ below 70. And, low IQ in early infancy, including below 1year of age, carries a 40% greater chance of receiving ASD diagnosis in early childhood. We consider the evidence that may explain this co-occurrence, including the possibility that high IQ may "rescue" the social communication issues, as well as the possible role of critical periods during growth and development. We consider how early low IQ may subsume a part of a subgroup of individuals with ASD, in particular, those diagnosed with autism in very early childhood, and we provide neurobiological evidence in support of this subtype. Moreover, we distinguish the concept of early low IQ from the delay in speech onset in preschool and school-aged children, based on (i) age and (ii) impairments in both verbal and non-verbal domains. The etiology of these early-diagnosed, early low IQ ASD cases is different from later-diagnosed, average or higher-IQ cases, and from children with speech delay onset. Given recent interest in formulating new subtypes of autism, rather than continuing to conceive of ASD as a spectrum, as well as new subtypes that vary in the degree of severity along the spectrum, we identify gaps in knowledge and directions for future work in this complex and growing area.

Increased Risk of Long-Term Disabilities Following Childhood Bacterial Meningitis in Sweden

Few studies have examined the incidence of long-term disabilities due to bacterial meningitis in childhood with extended follow-up time and a nationwide cohort. To describe the long-term risks of disabilities following a childhood diagnosis of bacterial meningitis in Sweden. This nationwide retrospective registry-based cohort study included individuals diagnosed with bacterial meningitis (younger than 18 years) and general population controls matched (1:9) by age, sex, and place of residence. Data were retrieved from the Swedish National Patient Register from January 1, 1987, to December 31, 2021. Data were analyzed from July 13, 2022, to November 30, 2023. A diagnosis of bacterial meningitis in childhood recorded in the National Patient Register between 1987 and 2021. Cumulative incidence of 7 disabilities (cognitive disabilities, seizures, hearing loss, motor function disorders, visual disturbances, behavioral and emotional disorders, and intracranial structural injuries) after bacterial meningitis in childhood. The cohort included 3623 individuals diagnosed with bacterial meningitis during childhood and 32 607 controls from the general population (median age at diagnosis, 1.5 [IQR, 0.4-6.2] years; 44.2% female and 55.8% male, median follow-up time, 23.7 [IQR, 12.2-30.4] years). Individuals diagnosed with bacterial meningitis had higher cumulative incidence of all 7 disabilities, and 1052 (29.0%) had at least 1 disability. The highest absolute risk of disabilities was found for behavioral and emotional disorders, hearing loss, and visual disturbances. The estimated adjusted hazard ratios (HRs) showed a significant increased relative risk for cases compared with controls for all 7 disabilities, with the largest adjusted HRs for intracranial structural injuries (26.04 [95% CI, 15.50-43.74]), hearing loss (7.90 [95% CI, 6.68-9.33]), and motor function disorders (4.65 [95% CI, 3.72-5.80]). The adjusted HRs for cognitive disabilities, seizures, hearing loss, and motor function disorders were significantly higher for Streptococcus pneumoniae infection (eg, 7.89 [95% CI, 5.18-12.02] for seizure) compared with Haemophilus influenzae infection (2.46 [95% CI, 1.63-3.70]) or Neisseria meningitidis infection (1.38 [95% CI, 0.65-2.93]). The adjusted HRs for cognitive disabilities, seizures, behavioral and emotional disorders, and intracranial structural injuries were significantly higher for children diagnosed with bacterial meningitis at an age below the median. The findings of this cohort study of individuals diagnosed with bacterial meningitis during childhood suggest that exposed individuals may have had an increased risk for long-term disabilities (particularly when diagnosed with pneumococcal meningitis or when diagnosed at a young age), highlighting the need to detect disabilities among surviving children.

Structure of foreign bodies in the upper gastrointestinal tract and the frequency of their diagnosis in childhood

Foreign bodies (FB) of the gastrointestinal tract (GIT) are a common problem in childhood, especially among children of younger age groups, due to the peculiarities of children’s development during this period. Purpose. To analyze the characteristics of FB in the gastrointestinal tract and the frequency of their diagnosis in children. Materials and methods. The analysis of the medical documentation of 378 children with an established diagnosis of FB in the gastrointestinal tract was carried out. The diagnosis was based on the results of studies: esophagogastroduodenoscopy, radiography (standard and using a water-soluble contrast agent), ultrasound diagnostics, computed tomography. The results of the study. The distribution of children with FB by age: children under 1 year - 12%, from 1 year to 3 years - 59%, from 3 to 6 years - 24%, 6-12 years - 5%. By gender: boys - 68%, girls - 32%. By localization: FB of the esophagus - 17%, stomach - 80%, duodenum - 3% of children. Characteristics of the extracted items: various small objects (coins, balls, toys) - 53%, batteries - 27%, magnets - 20%. Endoscopic FB was removed in 88% of children, conservative (FB came out naturally) - 10.5%, surgical - 1.5%. Conclusions. FB was most often detected in children aged 1 to 3 years (59%). There are twice as many boys as girls (68% and 32%, respectively). The most frequent localization is the stomach (80%). FB is most often represented by small toy parts, coins (53%), one in five children (20%) has a magnet, and one in four (27%) has a battery. The most common method of FB removal is endoscopic (88%).

Associations between Medicaid enrollment and diagnosis stage and survival among pediatric cancer patients.

Medicaid-associated disparities in childhood and adolescent (pediatric) cancer diagnosis stage and survival have been reported. However, a key limitation of prior studies is the assessment of health insurance at a single time point. To evaluate Medicaid-associated disparities more robustly, we used Surveillance, Epidemiology, and End Results (SEER)-Medicaid linked data to examine diagnosis stage and survival disparities in those (i) Medicaid-enrolled and (ii) with discontinuous and continuous Medicaid enrollment. SEER-Medicaid linked data from 2006 to 2013 were obtained on cases diagnosed from 0 to 19years. Medicaid enrollment was classified as enrolled versus not enrolled, with further classifications as continuous when enrolled 6months before through 6months after diagnosis, and discontinuous when not enrolled continuously for this period. We used multinomial logistic and Cox proportional hazards regression models to determine associations between enrollment measures, diagnosis stage, and cancer death adjusted for covariates. Among 21,502 cases, a higher odds of distant stage diagnoses were observed in association with Medicaid enrollment (odds ratio [OR]=1.56, 95% confidence interval [CI]: 1.48-1.65), with the highest odds for discontinuous enrollment (OR=2.0, 95% CI: 1.86-2.15). Among 30,654 cases, any Medicaid enrollment, continuous enrollment, and discontinuous enrollment were associated with 1.68 (95% CI: 1.35-2.10), 1.66 (95% CI: 1.35-2.05), and 1.89 (95% CI: 1.54-2.33) times higher hazards of cancer death versus no enrollment, respectively. Medicaid enrollment, particularly discontinuous enrollment, is associated with a higher distant stage diagnosis oddsand risk of death. This study supports the critical need for consistent health insurance coverage in children and adolescents.

Improving the Communication of Dental Findings in Pediatric Dentistry by Using Intraoral Scans as a Visual Aid: A Randomized Clinical Trial.

The aim of this first randomized clinical trial (RCT) was to determine whether intraoral scans (IOS) can be used as a visual aid to improve the communication of dental findings in pediatric dentistry. Therefore, 60 children (mean age 10.1 ± 3.3 years) and their accompanying parents/primary caregivers were examined between July 2022 and February 2023. Patients were randomly allocated to two groups: half of the participants were informed of the children's dental findings including treatment plans by verbal explanation alone (control group, n = 30), while the other half were informed using IOS (Trios 4, 3Shape) as a visual aid to support the verbal explanation (study group, n = 30). Both groups then completed a questionnaire regarding their children's diagnosis, treatment needs, planned therapy, and oral hygiene. Statistical analysis was performed using a t-test (p < 0.05). Overall, there was a significant difference between the two groups (p < 0.001) in terms of understanding the current oral situation of their children. While 85.5 ± 17.3% (mean ± standard deviation) of the answers were correct in the study group, only 57.2 ± 17.8% of the participants in the control group were capable of answering the questions correctly. In particular, the control group had difficulties answering the questions about treatment needs and therapy correctly. Within the limitations of this first pilot study, IOS can be clearly recommended as a visual aid to improve the communication of dental findings with PGs in pediatric dentistry.

Suicide attempt and death by suicide among parents of young individuals with cancer: A population-based study in Denmark and Sweden.

The psychological toll on parents of a child receiving a cancer diagnosis is known to be high, but there is a knowledge gap regarding suicidal behavior among these parents. The aim of this study was to investigate the risk of suicide attempt and death by suicide in relation to having a child with cancer. We performed a binational population-based and sibling-controlled cohort study, including all parents with a child diagnosed with cancer in Denmark (1978 to 2016) or Sweden (1973 to 2014), 10 matched unexposed parents per exposed parent (population comparison), and unaffected full siblings of the exposed parents (sibling comparison). Suicide attempt was identified through the Patient Register and the Psychiatric Central Register in Denmark and the Patient Register in Sweden, whereas death by suicide was identified through the Danish Causes of Death Register and the Swedish Causes of Death Register. In population comparison, we used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of suicide attempt and death by suicide associated with cancer diagnosis of a child, adjusting for sex, age, country of residence, calendar year, marital status, highest attained educational level, household income, history of cancer, history of psychiatric disorder, and family history of psychiatric disorder. The sibling comparison was performed to assess the role of familial confounding in the studied associations. The population comparison consisted of 106,005 exposed parents and 1,060,050 matched unexposed parents, with a median age of 56 at cohort entry and 46.9% male. During the median follow-up of 7.3 and 7.2 years, we observed 613 (incidence rate [IR], 58.8 per 100,000 person-years) and 5,888 (IR, 57.1 per 100,000 person-years) cases of first-onset suicide attempt among the exposed and unexposed parents, respectively. There was an increased risk of parental suicide attempt during the first years after a child's cancer diagnosis (HR, 1.15; 95% CI, [1.03, 1.28]; p = 0.01), particularly when the child was 18 or younger at diagnosis (HR, 1.25; 95% CI, [1.08, 1.46]; p = 0.004), when the child was diagnosed with a highly aggressive cancer (HR, 1.60; 95% CI, [1.05, 2.43]; p = 0.03), or when the child died due to cancer (HR, 1.63; 95% CI, [1.29, 2.06]; p < 0.001). The increased risk did not, however, maintain thereafter (HR, 0.86; 95% CI: [0.75, 0.98]; p = 0.03), and there was no altered risk of parental death by suicide any time after the child's cancer diagnosis. Sibling comparison corroborated these findings. The main limitation of the study is the potential residual confounding by factors not shared between full siblings. In this study, we observed an increased risk of parental suicide attempt during the first years after a child's cancer diagnosis, especially when the child was diagnosed during childhood, or with an aggressive or fatal form of cancer. There was, however, no altered risk of parental death by suicide at any time after a child's cancer diagnosis. Our findings suggest extended clinical awareness of suicide attempt among parents of children with cancer, especially during the first few years after cancer diagnosis.

Accuracy of initial diagnostic impressions of autism in toddlers and behaviors that inform these impressions.

Clinicians form initial impressions about a child's diagnosis based on behavioral features, but research has not yet identified specific behaviors to guide initial diagnostic impressions. Participants were toddlers (N = 55, mean age 22.9 months) from a multi-site early detection study, referred for concern for ASD due to screening or parent/provider concern. Within 5 min of meeting a child, clinicians noted ASD or non-ASD impression, confidence in impression, and behaviors that informed their impression. These clinicians also determined final diagnoses for each child. When a child's final diagnosis was ASD (n = 35), senior clinicians formed an initial impression of ASD in 22 cases (63%) but missed 13 cases (37%). When final diagnosis was non-ASD (n = 20), senior clinicians made an initial impression of non-ASD in all cases (100%). Results were similar among junior clinicians. Senior and junior clinicians used the same behaviors to form accurate impressions of ASD and non-ASD: social reciprocity, nonverbal communication, and eye contact. Senior clinicians additionally used focus of attention when forming accurate impressions of ASD and non-ASD; junior clinicians used this behavior only when forming accurate non-ASD impressions. Clinicians' initial impressions of ASD are very likely to be consistent with final diagnoses, but initial impressions of non-ASD need follow-up. Toddlers who show all four atypical behaviors (social reciprocity, nonverbal communication, eye contact, and focus of attention) might receive expedited ASD diagnoses. However, presence of apparently typical behaviors should not rule out ASD; for some children a longer evaluation is necessary to allow for more opportunities to observe subtle social behavior.

Association between parental education level & outcomes for children with long-term ventilator dependence: Communication behaviors as moderating variables

PurposeThe purpose of this study was to examine the correlation between parental education level and outcomes for children with long-term ventilator dependence (LTVD) and their families and whether parent communication behaviors with hospital nurses moderated the relationship. Advances in medical technology and policy changes allow children with LTVD to be cared for at home. The child's diagnosis and disease severity affect their health outcomes, as do their family's social determinants of health (SDoH) such as parent education. Design and methodsThis secondary data analysis used chi-square tests to evaluate the correlation between parental education level and outcomes. Generalized linear mixed effect models were used to examine the moderation effect of parent communication behaviors. ResultsLower parental education level was associated with more child respiratory infections and more parental uncertainty within one month following hospital discharge. Lower parent education level was also associated with fewer unplanned contacts with providers within one week post-discharge. Additionally, parent use of Verifying Understanding communication behaviors moderated the relationship between parental education level and number of respiratory infections and amount of parental uncertainty. Finally, parent use of Negotiating Roles moderated the association between education level and number of unplanned visits. ConclusionsContradicting previous research, lower parental education level does not consistently correspond to adverse outcomes and may be explained by parents' determination to ensure optimal outcomes for their children with LTVD. Practice implicationsOverall, healthcare providers should not be concerned that children with LTVD will have different outcomes based on their parents' education level.

Risk factors contributing to Pennsylvania childhood asthma

Childhood asthma continues to present a significant clinical and economic challenge in the U.S. Implementing more proactive treatment and comprehensive asthma management programs is imperative to addressing this national financial and health burden. Understanding the importance of various risk factors in asthma hospitalization and diagnosis rates can aid in earlier identification, treatment, and prevention of asthma altogether. In this study, we hypothesized that population density was the greatest predictor of childhood asthma hospitalization rate and diagnosis rate. We examined a total of 18 demographic, socioeconomic, and environmental risk factors at Pennsylvania’s county level to identify the risk factors contributing to childhood asthma hospitalization and diagnosis rate. Using a multiple linear regression model, we found “population density” and “percentage of Hispanic population” to be most strongly correlated with both childhood asthma hospitalization rate and diagnosis rates. In addition, “tobacco retail density”, “number of high ozone days”, and “childhood lead poisoning rate” were important factors associated with asthma hospitalization rate, while “percentage of population living in a rural area” was associated with asthma diagnosis rate. Our study provides a greater understanding of the influence of certain demographic and environmental exposures on Pennsylvania’s childhood asthma and emphasizes the importance of prevention.