Childhood Chronic Conditions Research Articles

Type 1 diabetes and anxiety in adolescence. A case report

Introduction Type 1 diabetes (T1D) incidence is increasing around the world, being the third chronic medical condition in childhood. It is characterized by pancreatic β-cell loss which leads to insulin deficiency. Treatment includes insulin medication and lifestyle changes. Youngsters with T1D are at a high risk of psychological comorbidity (depression, anxiety, eating disorders), and especially anxiety symptoms have been correlated with worse diabetes control.ObjectivesOur purpose is to examine the impact of T1D in adolescence regarding a case report and literature review.MethodsWe present the case of a 14-year-old female with T1D onset and no psychiatric history. She is referred to our service three months after the T1D onset. Both her parents and the patient were anxious about the diagnostic implications and the treatment. The patient sometimes refused to follow insulin treatment and was angry and labile. Both family and individual assessment interviews were accomplished.ResultsRegarding our assessment and after coordination with endocrine service (doctor and nurse) we diagnosed an [F43.23] Adjustment Disorder (acute, with mixed anxiety and depressed mood). Following recent evidence Acceptance and Commitment Therapy and Family Therapy were the election treatment with good outcomes. The patient was released after 3 months of follow-up.Conclusions T1D treatment entails lifestyle changes and self-control, which may be stressful and challenging for adolescents and their families, causing mental health problems. Since learning self-care and emotional coping strategies can improve both psychological well-being and glucose management, an interdisciplinary approach including psychological care, especially on the onset, can be crucial.DisclosureNo significant relationships.

Multiancestral polygenic risk score for pediatric asthma

Asthma is the most common chronic condition in children and the third leading cause of hospitalization in pediatrics. The genome-wide association study catalog reports 140 studies with genome-wide significance. Apolygenic risk score (PRS) with predictive value across ancestries has not been evaluated for this important trait. This study aimed to train and validate a PRS relying on genetic determinants for asthma to provide predictions for disease occurrence in pediatric cohorts of diverse ancestries. This study applied a Bayesian regression framework method using the Trans-National Asthma Genetic Consortium genome-wide association study summary statistics to derive a multiancestral PRS score, used one Electronic Medical Records and Genomics (eMERGE) cohort as a training set, used a second independent eMERGE cohort to validate the score, and used the UK Biobank data to replicate the findings. Aphenome-wide association study was performed using the PRS to identify shared genetic etiology with other phenotypes. The multiancestral asthma PRS was associated with asthma in the 2 pediatric validation datasets. Overall, the multiancestral asthma PRS has an area under the curve (AUC) of 0.70 (95% CI, 0.69-0.72) in the pediatric validation 1 and AUC of 0.66 (0.65-0.66) in the pediatric validation 2 datasets. We found significant discrimination across pediatric subcohorts of European (AUC, 95% CI, 0.60 and 0.66), African (AUC, 95% CI, 0.61 and 0.66), admixed American (AUC, 0.64 and 0.70), Southeast Asian (AUC, 0.65), and East Asian (AUC, 0.73) ancestry. Pediatric participants with the top 5% PRS had 2.80 to 5.82 increased odds of asthma compared to the bottom 5% across the training, validation 1, and validation 2 cohorts when adjusted for ancestry. Phenome-wide association study analysis confirmed the strong association of the identified PRS with asthma (odds ratio, 2.71, PFDR= 3.71× 10-65) and related phenotypes. A multiancestral PRS for asthma based on Bayesian posterior genomic effect sizes identifies increased odds of pediatric asthma.

Population Impact of Sugar-Sweetened Beverages on Dental Caries and Overweight/Obesity in Australian Children.

The reported findings greatly consolidated evidence of detrimental effects of sugars intake on child oral health and overweight and obesity, some of the most prevalent chronic conditions in children. Evidence on population impact of sugars intake is directly informative to policy makers and the public about the potential impact of population-based programs targeting sugars intake to prevent dental caries and overweight and obesity.

Migraine and epilepsy: Social cognition skills in pediatric population.

The goal of the present study was to comparatively analyze Social Cognition skills in a pediatric population diagnosed with Migraine or Epilepsy, compared to Typically Developing children (TD). The secondary aim was to relate Social Cognition skills with other migraine- or epilepsy-related variables and with executive and cognitive functions. In our cross-sectional observational study 119 children and adolescents (aged 6-16) with Migraine or Focal Epilepsy and 61 TD peers were recruited. Both the clinical groups and TD peers performed a neuropsychological evaluation through standardized test to assess Theory of Mind (TM), Emotion Recognition through facial expression (ER), executive function and non-verbal cognitive abilities. Children and adolescents with Migraine or Focal Epilepsy showed comparable scores between each other, however their scores were significantly lower than their TD peers, in both ER and TM. Social Cognition skills were significantly related to executive functions. Our study suggests that some chronic neurological conditions in childhood, such as Migraine and Epilepsy, may be associated with difficulties in Social Cognition skills, and that these difficulties may be related to a deficit in executive functions. The relationship between these two higher cognitive abilities should be further explored in future studies. Our results also suggest the importance of monitoring cognitive abilities in pediatric patients with Migraine or Epilepsy, in order to detect early impairment and ensure the necessary support.

Why young people stop taking their attention deficit hyperactivity disorder medication: A thematic analysis of interviews with young people.

BackgroundAttention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that can persist into adulthood. Young people often stop taking ADHD medication during adolescence despite evidence that continuation would be beneficial. Increasingly, young people are restarting medication in early adulthood suggesting that cessation was premature. In this paper we explore the reasons given by young people for discontinuing ADHD medication.MethodsQualitative data from the Children and Adolescents with ADHD in Transition between Children's and Adult Services (CATCh‐uS) project was analysed to look for reasons for stopping medication. Semi‐structured interviews with three groups of young people were analysed using thematic and framework analysis; this included young people prior to transition (n = 21); young people that had successfully transitioned to adult services (n = 22); and young people who left children's services prior to transition but re‐entered adult services later (n = 21).ResultsReasons given by young people for stopping ADHD medication included the following: the perceived balance between benefits and adverse effects of medication; perceptions of ADHD as a childhood or educational disorder; life circumstance of the young person and challenges young people faced in accessing services.ConclusionsA multidimensional approach is needed to address discontinuation of ADHD medication in order to improve the long‐term prospects and quality of life for these young people. Possible approaches include access to non‐pharmacological treatments and improved psychoeducation. As many reasons given by young people are not unique to ADHD, these findings are also of relevance to medication adherence in other chronic childhood conditions.

GJB2-RELATED NON-SYNDROMIC HEARING LOSS VARIANTS’ SPECTRUM AND THEIR FREQUENCY IN TURKISH POPULATION

Objective: Hearing loss (HL) is one of the most prevalent chronic conditions in children and has consequences in speech, language, education, and social functioning which impede the quality of life. Due to the major involvement of the genetic factors in HL, especially non-syndromic HL (NSHL), genetic diagnosis and genetic counseling have a major impact on early management of the affected individuals and their families. Herein, we report the GJB2 gene variants and their frequencies in NSHL cohort at a tertiary health center between 2002-2021 to contribute for the future genetic counseling of Turkish NSHL patients. Materials and Methods: Two exons of the GJB2 gene were amplified in 402 NSHL patients by two separate PCR reactions and sequenced using the Sanger technique. Results: We found 13 different GJB2 variants in 35% (141/402) of the patients with NSHL. 53.9% were homozygous and 33.3% were compound heterozygous for the most common (59.21%) variant, c.35delG. Approximately 13% of the patients were found to carry the variants in the heterozygous state. The most frequent GJB2 variant c.35delG was followed by c.71G>A (6.38%), c.-23+1G>A (3.54%) and c.233delG (2.48%). We found heterozygous p.Asp50Glu (c.150C>A) alteration in four of eight patients with keratitis, ichthyosis, deafness (KID) and palmoplantar keratoderma (PPK) syndrome. Conclusion: Our results further emphasize the well-known prevalance of the GJB2 c.35delG alteration being the most predominant variant in the Turkish NSHL patients. The high rate of mono-allelic state could be considered as coincidental due to high allelic heterogeneity of NSHL, or possibly suggestive for digenic inheritance.

Mental health concerns and childhood chronic physical health conditions: a narrative review

Mental health concerns and childhood chronic physical health conditions: a narrative review

Spatial Clusters of Chronic Childhood Conditions in the State of Paraíba, Brazil

Introduction:chronic conditions are complex health problems that require continuous and multidisciplinary care. When they affect children/adolescents, they require hospitalizations and periodic and long-term follow-up. Understanding the geographical distribution of these conditions will provide greater visibility to the problem and support the decision-making process. Objective: detect the spatial clusters of chronic health conditions affecting children and adolescents in the state of Paraíba, Brazil. Methods: ecological, retrospective, study employing secondary data from the Information System of Children and Adolescents with Chronic Disease from a reference hospital in the state of Paraíba, Brazil, covering the period from 2015 to 2017. The Spatial Incidence Ratio and the Spatial Scan statistic were used for the data analysis. Results: a concentration of spatial clusters was observed in the Mata Paraibana mesoregion, an area where the public hospital service is located, which functions as a reference in the recurrent hospitalizations of this population with chronic conditions. Conclusion: the detection of spatial clusters can help public managers to recognize the priority areas for the monitoring of chronic conditions in children and adolescents.

Juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is an umbrella term for arthritis of unknown origin, lasting for >6 weeks with onset before 16 years of age. JIA is the most common chronic inflammatory rheumatic condition of childhood. According to the International League Against Rheumatism (ILAR) classification, seven mutually exclusive categories of JIA exist based on disease manifestations during the first 6 months of disease. Although the ILAR classification has been useful to foster research, it has been criticized mainly as it does not distinguish those forms of chronic arthritis observed in adults and in children from those that may be unique to childhood. Hence, efforts to provide a new evidence-based classification are ongoing. Similar to arthritis observed in adults, pathogenesis involves autoimmune and autoinflammatory mechanisms. The field has witnessed a remarkable improvement in therapeutic possibilities of JIA owing to the availability of new potent drugs and the possibility to perform controlled trials with support from legislative interventions and large networks availability. The goal of drug therapy in JIA is to rapidly reduce disease activity to inactive disease or clinical remission, minimize drug side effects and achieve a quality of life comparable to that of healthy peers. As JIA can influence all aspects of a child's and their family's life, researchers increasingly recognize improvement of health-related quality of life as a key treatment goal.

The association between dairy intake and migraine odds among pediatrics and adolescents: A case-control study.

ObjectiveMigraine is recognized as a disease with unknown etiology and various pathophysiologic pathways which are not fully understood. Due to the relation between dairy intake and various chronic conditions in children and also the paucity of data on the probable role of dairy intake on pediatrics’ odds of having migraine, this study was designed. Materials & Methods:The present study was a population-based case-control design that was accomplished in a tertiary headache clinic.290 child (aged from7 to 14 years old) was included in this study. A definite diagnosis of migraine was performed by a neurologist; concerning the 2018 international classification of headache disorder 3 (ICHD3) criteria. Also, demographic and anthropometric characteristics were obtained. In addition, the usual dietary intake of participants was evaluated using a validated semi-quantitative food frequency questionnaire (FFQ).ResultsThose children in the case group significantly had higher age and BMI means (P.value:0.000). In the second regression model, odds of migraine were 48% (OR: 0.52; 95%CI:0.27-1.00) diminished in the second tertile and 53% (OR:0.47;95%CI:0.24-0.92) in the third tertile of low-fat dairy intake (P-trend:0.03). In the fully adjusted model, the achieved migraine ORs were as followings:0.48 (95% CI:0.240.95) in the second tertile and 0.46 (95% CI:0.21-0.96) in the third tertile (P-trend:0.04), respectively. Children with more high-fat dairy intake also consumed higher amounts of energy, pastries, simple sugar, unhealthy snacks, and hydrogenated oil (P<0.05).Conclusion:This study results proposed that a greater amount of low-fat dairy intake may attenuate the odds of having migraine attacks in pediatrics and adolescents who might be at risk of headache, which can be attributed to the micronutrient and also to the bioactive content of these dietary components.

Digital Technologies for Children and Parents Sharing Self-Management in Childhood Chronic or Long-Term Conditions: A Scoping Review.

Worldwide, the prevalence of chronic (or long-term) conditions in children and young people from birth to 18 years (children) is increasing. Promoting competent and effective self-management skills early in the trajectory is important to improve adherence to treatment and optimise quality of life. Successful self-management, therefore, requires parents and children who are developmentally able to develop a range of complex skills, including the use of digital technologies. This scoping review aimed to identify primary research investigating digital technologies for children and parents sharing self-management in childhood chronic illnesses. A comprehensive search of electronic databases was conducted. Nineteen papers were included, assessed for quality and methodological rigour using the Hawker tool and thematically analysed. Three themes were identified: (i) the feasibility and acceptability of using technology, (ii) the usability of technologies and (iii) the effect of technologies on adherence and self-management skills. The results indicate that technologies such as mobile apps and websites can assist the management of long-term conditions, are an acceptable method of delivering information and can promote the development of effective self-management skills by parents and children. However, future technology design must include children and parents in all stages of development.

Childhood Disadvantage and Later-Life Multimorbidity: Demonstrating Robustness Under Imperfect Identification

This study assesses the relationship between indicators of early childhood disadvantage and later-life multimorbidity within a nationally representative sample of Brazilians aged 50 and over (n = 9,412). Data come from the baseline assessment (2015/2016) of the Brazilian Longitudinal Study of Aging (ELSI). We employed survey-weighted Ordinary Least Squares regression to estimate the effects of individual and combined measures of childhood disadvantage on the total number of chronic conditions in later life. Mediation analysis assessed whether adult socioeconomic status (SES) mediated the relationship between childhood disadvantage and chronic conditions. We found that individual and combined measures of childhood disadvantage were associated with the total number of chronic conditions, even after controlling for potential confounders. Mediation analysis suggested that part of the effect of childhood adversity is mediated by higher SES in adulthood (~10%). A formal strategy of sensitivity analysis showed that omitted variable bias is extremely unlikely. To rule out the observed effect, an unobserved hypothetical confounder would need the explanatory power of the residual variance of both the independent and the dependent variables that is at least 30 times larger than that of BMI or 5 times larger than the explanatory power of age. Results should inform efforts to strengthen interventions targeting early childhood development and to improve other key inputs (such as education) to enhance adult SES and lessen the impact of early life stressors on health in older adulthood.

Middle Ear Effusion in Intensive Care Unit Patients at Al-Sadder Teaching Hospital in Al-Najaf City-Iraq (A Prospective Randomized Comparative Clinical Study)

Background: Middle ear effusion (MEE) is one of the commonest chronic otological conditions in childhood but has a lower incidence in normal adult. By definition it is an accumulation of non-purulent fluid in the middle ear. It is an inflammatory effusion behind an intact tympanic membrane that is not associated with acute otological symptoms or systemic signs. Aim: To explore factors related to the occurrence of MEE in the intensive care unit (ICU) patients with prolonged oral endotracheal intubation in Al-Najaf city/Iraq. Methods: Forty patients (80 ears) with a prolonged endotracheal intubation (&gt; 5 days) in the ICU were studied. Information of the age, gender, level of consciousness, duration of endotracheal intubation and placement of nasogastric tube were retrospectively collected from history and patient`s data. All patients were subjected to otoscopic examination, tympanometry studies and acoustic reflectometry for evidences of MEE. Results: Out of the 80 ears examined, 46 ears had MEE (57.5%), 22 ears were normal (27.5%), and 12 ears (15%) had negative pressure in the middle ear by tympanometry. Patients who were intubated for more than 11 days and those with conscious disturbance had a significantly high incidence of MEE. No episodes of acute otitis media or systemic infection were encountered. Conclusion: Prolonged endotracheal intubation (more than 11 days), age advancing and conscious disturbance contribute significantly to the occurrence of MEE in adult ICU patients. Recommendation: Middle ear pathology like MEE in the ICU patients with prolonged intubation should not be underestimated.

Are Young Children With Asthma More Likely to Be Less Physically Active?

To investigate longitudinally whether asthma or wheeze at age 4 years of age was associated with lower physical activity levels at the age of 6 years.In the study, the researchers included 391 children from the Australian HealthNuts cohort who had follow-up at the ages of 4 and 6 years, agreed to wear an accelerometer, and returned valid data. At the age of 4 years, 8.7% had current asthma, and 14.6% had ever wheezed or had asthma.Asthma and wheeze data were collected by using a standardized, validated questionnaire at the ages of 4 and 6 years. Physical activity was measured through accelerometry after the age 6 visit. Participants wore an accelerometer watch on the wrist of their nondominant hand 24 hours per day for 8 consecutive days, even while sleeping, swimming, and bathing. Associations were investigated by using linear adjusted regression models. The primary outcome was daily minutes spent in moderate-to-vigorous physical activity (MVPA).There was no evidence of difference in time spent in MVPA at the age of 6 years between children with and without asthma at the age of 4. Children with asthma spent 8.3 minutes more time physically active per day (95% confidence interval [CI]: −5.6 to 22.1; P = .24) than children without asthma did. Children with current wheeze spent 5.8 minutes per day more than those without did (95% CI: −5.9 to 17.5; P = .33), and those who had ever experienced wheeze or asthma spent 7.7 minutes per day more than those who had never done so (95% CI: −4.8 to 20.2; P = .23). Null results were also observed in the cross-sectional analyses. Interaction with BMI could not be assessed. Earlier asthma or wheeze status and sex were not found to modify these associations.In this study, the researchers found no evidence of an association between asthma and reduced physical activity in young Australian children.Physical inactivity is a considerable risk factor for the development of a variety of illnesses. Asthma is the most common chronic condition in childhood and may result in unnecessary restrictions on physical activity in children, despite guidelines encouraging the opposite. With this prospective study, the authors provides evidence that there is no association between asthma or wheeze and decreased MVPA in Australian children. This reveals that Australian children are successfully maintaining physical activity despite asthma or wheezing. This success should be emulated in other settings and populations, to ensure that patients with asthma and their families are aware that physical activity is beneficial and should be encouraged in asthmatics.

Inequality in early childhood chronic health conditions requiring hospitalisation: A data linkage study of health service utilisation and costs.

The cost of socioeconomic inequality in health service use among Australian children with chronic health conditions is poorly understood. To quantify the cost of socioeconomic inequality in health service use among Australian children with chronic health conditions. Cohort study using a whole-of-population linked administrative data for all births in Queensland, Australia, between July 2015 and July 2018. Socioeconomic status was defined by an areas-based measure, grouping children into quintiles from most disadvantaged (Q1) to least disadvantaged (Q5) based on their postcode at birth. Study outcomes included health service utilisation (inpatient, emergency department, outpatient, general practitioner, specialist, pathology and diagnostic imaging services) and healthcare costs. Of the 238,600 children included in the analysis, 10.4% had at least one chronic health condition. Children with chronic health conditions in Q1had higher rates of inpatient (6.6, 95% confidence interval [CI] 6.4, 6.7), emergency department (7.2, 95% CI 7.0, 7.5) and outpatient (20.3, 95% CI 19.4, 21.3) service use compared to children with chronic health conditions in Q5. They also had lower rates of general practitioner (37.5, 95% CI 36.7, 38.4), specialist (8.9, 95% CI 8.5, 9.3), pathology (10.7, 95% CI 10.2, 11.3), and diagnostic imaging (4.3, 95% CI 4.2,4.5) service use. Children with any chronic health condition in Q1 incurred lower median out-of-pocket fees than children in Q5 ($0 vs $741, respectively), lower median Medicare funding ($2710, vs $3408, respectively), and higher median public hospital funding ($31, 052 vs $23, 017, respectively). Children of most disadvantage are more likely to access public hospital provided services, which are accessible free of charge to patients. These children are less likely to access general practitioner, specialist, pathology and diagnostic imaging services; all of which are critical to the ongoing management of chronic health conditions, but often attract an out-of-pocket fee.

Income support for parents of children with chronic conditions and disability: where do we draw the line? A policy review

ObjectiveThe aim of this review was to identify and describe whether parents who have had to stop paid employment to care for a child with a chronic condition or disability...

Patient generated health data: Benefits and challenges

Patient Generated Health Data (PGHD) is defined as data generated by and from patients.1 The use of PGHD has rapidly increased with the widespread availability of smart phone mobile health applications (mHealth apps) and wearable devices. Currently, the vast majority of PGHD is generated via the use of mHealth apps and wearables like "Fitbit" or medical devices such as a continuous glucose monitoring device. There are many benefits of PGHD including increased monitoring of children's chronic health conditions outside clinical care to supplement ambulatory clinic visits, improved health outcomes, increased patient awareness and engagement and improved patient-provider communication. When leveraged properly, PGHD can be a powerful tool in delivering safe, effective, patient centered, efficient and equitable care as outlined by the Institute of Medicine (IOM).2 The challenges that limit collection, use and acceptance of PGHD include limited access to the internet, inability to incorporate PGHD into clinical workflows, data privacy and security concerns and apprehension about accuracy and safety of mHealth apps. These issues can lead to a lack of use or compliance with devices or apps associated with PGHD. To ensure optimal health benefits, agreement to leverage PGHD should be a joint decision between the clinician and the patient/caregiver. Future steps to ensure safety and clinical relevance of PGHD include involving regulatory authorities, device manufacturers and professional bodies to develop standards for mHealth apps and wearables to promote uncomplicated PGHD integration into workflows, easy and secure sharing of PGHD. Wearable technology, medical devices and smart phone apps become more advanced and widespread among the population, there will be an increasing potential for PGHD to facilitate personalized, efficient, and collaborative care resulting in improved health outcomes for children and adolescent and young adult. More research and innovation is needed to facilitate this transition.

53 Health Outcomes of Siblings of Children with Chronic Health Conditions: A Systematic Review and Meta-Analysis

Abstract Primary Subject area Mental Health Background Chronic childhood health conditions are known to have an impact on the well-being of family members. Parental caregivers face well-defined adverse health outcomes, though less is known about the health impacts on siblings. Objectives To assess clinical health outcomes in siblings of children with chronic health condition(s) compared to siblings of healthy children or normative data. Design/Methods We searched Ovid MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, PsycInfo, and CINAHL through June 4, 2020. We included English-language studies that: (1) reported clinically diagnosable mental or physical health outcomes of siblings of children (0-18 years old) diagnosed with any childhood chronic health condition; (2) included a comparison group; and (3) used an experimental or observational study design. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results We included 28 studies of the 9053 screened, comprising 10 cohort studies and 18 cross-sectional studies. Studies from 11 different countries reported most commonly on siblings of children with disabilities (12 studies), cancer (8 studies), or psychiatric disorders (4 studies). Siblings of children with chronic conditions had greater depression rating scale scores than their comparison groups (standardized mean difference 0.49; 95% CI 0.33-0.65; P &amp;lt; .001 [5 studies]) (Fig. 1), whereas anxiety scores did not differ significantly (standardized mean difference 0.24; 95% CI -0.03-0.52; P = .08 [6 studies]) (Fig. 2). Studies that reported on prevalence of psychiatric diagnoses, rather than rating scale scores, had mixed results, either indicating increased risk (3 studies) or no increased risk (4 studies) among exposed siblings. We did not meta-analyze effects for mortality (3 studies) or physical health outcomes (dental caries [1 study], traumatic brain injury [1 study], sexually transmitted infection [1 study], overweightness/obesity [1 study]) given the limited number of studies and between-study heterogeneity. Included studies were rated as high quality (12 studies) or of moderate quality (16 studies). Conclusion Siblings of children with chronic health conditions may be at an increased risk of depression. Our findings suggest the need for targeted interventions to support the psychological well-being of siblings of children with chronic health conditions.

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Adverse drug reactions of leukotriene receptor antagonists in children with asthma: a systematic review

BackgroundAsthma is the most common chronic condition of childhood. Leukotriene receptor antagonists (LTRAs) are included in international guidelines for children and young people (CYP), but there have been highly publicised...