Chronic Health Conditions In Children Research Articles

Hospital-recorded chronic health conditions in children with and without Down syndrome in England: a national cohort of births from 2003 to 2019.

The objective is to describe age-specific cumulative incidence for hospital-recorded indicators of chronic health conditions (CHCs) in children with Down syndrome (DS) compared with children without DS. National birth cohort using hospital admission and death records. National Health Service (NHS)-funded hospitals in England. Liveborn, singleton infants born in NHS-funded hospitals between 2003 and 2019. Cumulative incidence of nine categories of hospital-recorded CHCs, multimorbidity and mortality. We identified 10 621 infants with DS among 9 631 646 liveborn, singleton infants (0.11%). Among children with DS, the cumulative incidence for any indicated CHC was 90.1% by age 16, as compared with 21.2% of children without DS. By age 16, a third of children (33.1%) with DS had CHCs affecting four or more body systems; only 6.0% of children without DS had CHCs indicated in more than one body system. The most common CHCs in children with DS were severe congenital heart defects, indicated in 57.2% (0.8% in children without DS). The estimated HR for mortality up to age 16 comparing children with versus without DS was 15.26 (95% CI: 14.15, 16.45). Children with DS had a higher cumulative incidence for CHCs in each body system category and subcategory, at all ages, than children without DS. Multimorbidity and mortality were higher among children with DS. Administrative data can be used to examine the health needs and healthcare use of children with DS throughout childhood and adolescence.

Psychosocial correlates of neurodevelopmental disabilities in 2- to 3-year-olds

RationaleCanada’s National Longitudinal Study of Children and Youth survey data provide insights into chronic health conditions in children. Children with neurodevelopmental disabilities (NDD) are at increased risk for adverse behavioral outcomes. MethodsWe examined data from 3 cycles of Canada’s National Longitudinal Survey of Children and Youth for the presence of epilepsy (Epi), cerebral palsy (CP), and intellectual disability (ID) in 2- to 3-year-olds. We then examined the relationship of NDD to composite measures of behavior: hyperactivity-inattention (HI), prosocial behaviors (PS), emotional disorder-anxiety (EA), physical aggression oppositional behavior (AO), and separation anxiety (SA). ResultsThere were 15 children with Epi, 25 with CP and 28 with ID in a sample of 10,879, which represented a population of 756,848 2- to 3-year-old Canadian children. Comparison of mean scores of the NDD groups and controls (Welch’s ANOVA), indicated statistically significant differences in HI, PS, EA, and SA at the p < 0.001 level. Post hoc analysis showed significant intergroup differences. Children with epilepsy did not differ from controls on any of the behavioral measures. However, in comparison to controls, children with intellectual disability had higher EA and SA scores and lower PS scores, and those with cerebral palsy had lower PS scores. ConclusionsChildren with NDD show differences in behavioral outcomes at a very early age when compared with controls. Screening for these behaviors and early intervention programs may help avoid longer term psychiatric comorbidity associated with these disabilities.

Education support services for improving school engagement and academic performance of children and adolescents with a chronic health condition.

Education support services for improving school engagement and academic performance of children and adolescents with a chronic health condition.

How common is fatigue across chronic health conditions in children and young people? A systematic review

Fatigue is a common experience for adults with chronic health conditions. Less is understood about the prevalence of fatigue in the paediatric population. This review aimed to synthesise what is known about the point prevalence of fatigue across chronic health conditions within children and young people. Three databases were searched, from January 2000 to July 2021, to identify studies reporting prevalence rates in chronic health conditions in under 18s. Methodological quality was assessed with a modified version of the Newcastle-Ottawa Scale for Cross-Sectional Studies. Twenty-five studies were included. Variations in the assessment of fatigue, across a range of conditions, and heterogenous reporting of prevalence precluded meaningful meta-analysis and so narrative synthesis was completed. Discrepancies in prevalence reports were noted within and across conditions and between child and parent reports but showed fatigue to be more prevalent in those with chronic health conditions compared to healthy peers. Despite discrepancy in prevalence rates of fatigue, some level of fatigue is present across chronic health conditions and tends to be higher in this population compared to healthy peers. Limitations alongside clinical implications and recommendations for future research are discussed.

How common is fatigue across chronic health conditions in children and young people? A systematic review

Fatigue is a common experience for adults with chronic health conditions. Less is understood about the prevalence of fatigue in the paediatric population. This review aimed to synthesise what is known about the point prevalence of fatigue across chronic health conditions within children and young people. Three databases were searched, from January 2000 to July 2021, to identify studies reporting prevalence rates in chronic health conditions in under 18s. Methodological quality was assessed with a modified version of the Newcastle-Ottawa Scale for Cross-Sectional Studies. Twenty-five studies were included. Variations in the assessment of fatigue, across a range of conditions, and heterogenous reporting of prevalence precluded meaningful meta-analysis and so narrative synthesis was completed. Discrepancies in prevalence reports were noted within and across conditions and between child and parent reports but showed fatigue to be more prevalent in those with chronic health conditions compared to healthy peers. Despite discrepancy in prevalence rates of fatigue, some level of fatigue is present across chronic health conditions and tends to be higher in this population compared to healthy peers. Limitations alongside clinical implications and recommendations for future research are discussed.

A randomized controlled trial evaluating the effectiveness of a self-management program for adolescents with a chronic condition: a study protocol

BackgroundSelf-management support is increasingly viewed as an integral part of chronic condition management in adolescence. It is well recognized that markers of chronic illness control deteriorate during adolescence. Due to the increasing prevalence of long-term chronic health conditions in childhood and improved survival rates of previously life-limiting conditions in children and adolescents, significant numbers of adolescents are having to manage their chronic condition effectively as they transition to adult health care. Therapy adherence has been identified as a major challenge for young people living with a chronic condition such as cystic fibrosis, diabetes, or asthma requiring long-term pharmacological therapy and/or lifestyle modifications. Most systematic reviews on self-management interventions address adult populations. Very few intervention studies are directed at adolescents with a chronic condition who are transitioning to adult health services. This protocol describes a prospective randomized controlled trial of a standardized self-management intervention program delivered to adolescents aged 15–18 years prior to their transfer to adult care. This study has been designed to provide evidence regarding self-management programs for adolescents and is the first study to use the Flinders Program with this important, under-researched age group.MethodsA randomized controlled trial is used to investigate the effectiveness of a modified adolescent-friendly version of an adult self-management program. This program is directed at improving self-management in an adolescent cohort 15–18 years of age with a chronic condition being treated in a specialist pediatric hospital. Participants will be randomized to either usual care or the modified Flinders Program plus usual care. Data collection will include measures of specific illness control, unscheduled hospital admissions, and questionnaires to record self-management competencies, quality of life, self-efficacy, and outcome measures specific to the chronic condition at baseline, 3 months, 6 months, and 12 months after delivery.DiscussionThis study will provide a better understanding of the elements required for effective self-management programs in adolescents with a chronic condition and address some important knowledge gaps in current literature. The study will be carried out in collaboration with the Discipline of Behavioural Health at Flinders University, Adelaide, Australia, in order to inform the development of an adolescent version of the successful and validated Flinders Program™.Trial registrationAustralian and New Zealand Clinical Trials Registry (ACTRN12621000390886). Registered on April 8, 2021.

The Intersection of Education and Healthcare: Supporting Children with Chronic Health Conditions

Objective: Chronic health conditions in childhood have been negatively associated with linguistic, academic, and occupational outcomes. Traditionally, categorical diagnostic approaches relying on exclusionary criteria are used in healthcare services. Methods: This literature review examines research from various fields to evaluate the effects of chronic illness in cognitive-linguistic development in children. We explore the implications for different conceptualizations of the term “chronic illness.” We compare categorical and non-categorical diagnostic approaches, specifically in relation to children’s academic performance. Results: We provide recommendations for bridging the gap between healthcare and education to provide children with chronic conditions the best chance of thriving medically and academically. Definitions of chronic illness that rely on inclusive criteria and acknowledge individual variability seem best suited for clinical practice and research. Conclusions: Effective supports for children with chronic illness require evidence-based treatment approaches that are tailored to the unique needs of each individual child. Educators, healthcare providers, families, and related service providers must have open lines of communication to serve children with chronic health conditions. Early identification and intervention is crucial.

Evaluating the Effectiveness of Education Support Programs for Hospitalized Students With Chronic Health Conditions: Protocol for a Feasibility Study of a Controlled Trial.

Chronic health conditions in children and young people can have a significant impact on their ability to maintain engagement in school, education, and learning. While this functional limitation affects only about 1.6% of all children and young people, the absolute number is not inconsequential. In Australia, for example, the number is in the order of 67,000 children and young people. Furthermore, research has shown that this group of young learners are at increased risk of lower academic, social, and emotional and quality of life outcomes than their healthy peers, both in the short and the longer term. For this reason, most pediatric hospitals in western developed countries have hospital-based schools that aim to prevent children and young people with a chronic health condition from disengaging from school, education, and learning. However, there is a lack of robust evidence of the effectiveness of these education support programs. This protocol for a feasibility study of the effectiveness of evaluating an education support program in Australia aims to identify a priori the methodological key features of a robust trial, including developing an answerable research question, choosing a controlled study design that compares the outcomes of both an intervention group and a well-matched non-intervention or control group, eligibility criteria, important and validated outcome measures such as quality of life, and how statistical data should be analyzed and reported. Lessons learned from the proposed feasibility study will be used to inform a larger-scale study.

Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review

BackgroundThe prevalence of chronic health conditions in childhood is increasing, and behavioral interventions can support the management of these conditions. Compared with face-to-face treatment, the use of digital interventions may be more cost-effective, appealing, and accessible, but there has been inadequate attention to their use with younger populations (children aged 5-12 years).ObjectiveThis systematic review aims to (1) identify effective digital interventions, (2) report the characteristics of promising interventions, and (3) describe the user’s experience of the digital intervention.MethodsA total of 4 databases were searched (Excerpta Medica Database [EMBASE], PsycINFO, Medical Literature Analysis and Retrieval System Online [MEDLINE], and the Cochrane Library) between January 2014 and January 2019. The inclusion criteria for studies were as follows: (1) children aged between 5 and 12 years, (2) interventions for behavior change, (3) randomized controlled trials, (4) digital interventions, and (5) chronic health conditions. Two researchers independently double reviewed papers to assess eligibility, extract data, and assess quality.ResultsSearches run in the databases identified 2643 papers. We identified 17 eligible interventions. The most promising interventions (having a beneficial effect and low risk of bias) were 3 targeting overweight or obesity, using exergaming or social media, and 2 for anxiety, using web-based cognitive behavioral therapy (CBT). Characteristics of promising interventions included gaming features, therapist support, and parental involvement. Most were purely behavioral interventions (rather than CBT or third wave), typically using the behavior change techniques (BCTs) feedback and monitoring, shaping knowledge, repetition and substitution, and reward. Three papers included qualitative data on the user’s experience. We developed the following themes: parental involvement, connection with a health professional is important for engagement, technological affordances and barriers, and child-centered design.ConclusionsOf the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise. Using qualitative methods during digital intervention development and evaluation may lead to more meaningful, usable, feasible, and engaging interventions, especially for this underresearched younger population. The following characteristics could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioral (rather than cognitive) approaches, and particular BCTs (feedback and monitoring, shaping knowledge, repetition and substitution, and reward). This review suggests a model for improving the conceptualization and reporting of behavioral interventions involving children and parents.

Long-Term Outcomes of Pediatric Enterovirus Infection in Taiwan: A Population-Based Cohort Study.

Introduction: The major burden of diseases in childhood has shifted from infectious diseases to chronic health conditions in recent decades. Although the rates of infectious diseases have decreased, the incidence of chronic diseases stemming from infectious agents continues to grow. Enterovirus is a major infectious disease of childhood and has been linked to numerous chronic diseases. We analyzed population-based data from Taiwan's National Health Insurance Research Database (NHIRD) to investigate the correlations between enterovirus infection and major chronic health conditions in children.Method: Children diagnosed with enterovirus (EV) infection during 1999–2003 were identified from the Longitudinal Health Insurance Database 2000 (LHID 2000), a subdataset of Taiwan's National Health Insurance Research Database (NHIRD). A total of 14,168 patients were selected after excluding patients with existing chronic diseases and missing data. Another 14,168 children matched by age and sex were selected as the control group. Five primary outcomes, including attention deficit and hyperactivity disorder (ADHD), epilepsy, asthma, allergic rhinitis, and atopic dermatitis, were recorded.Results: The risks of ADHD, asthma, allergic rhinitis, and epilepsy were significantly increased in the EV group compared with the control group. The risk of atopic dermatitis was significantly increased in the crude model. However, there were no significant differences in the adjusted model. The risks of ADHD, asthma, allergic rhinitis, and epilepsy were also significantly increased in patients with severe EV infection compared with patients with non-severe EV infection.Conclusion: Chronic diseases, such as ADHD, epilepsy, asthma, allergic rhinitis, and atopic dermatitis were shown to be associated with enterovirus infection during childhood. EV infection during early childhood might have long-term public health implications and thus prevention strategies should be implemented.

Effect of caring for children with type I diabetes on parent’s life

Introduction Type 1 diabetes mellitus is one of the commonest chronic health conditions in children. The risk of complications in diabetes is common, so parents live with constant worry about their child’s health. The condition requires also a higher degree of behavioral regulation than normal children of the similar age. The children naturally must rely on their parents for instruction, support, and daily help. Therefore, type 1 diabetes mellitus is ‘a family condition’ challenging the patient’s social and familial circle. Objective The aim was to assess parental stress and quality of life (QOL) in parents of diabetic children. Participants and methods A case–control study was done on 100 parents, recruited from endocrine department and clinic at Al Zahra University Hospital, who were classified in two groups: group I included 50 parents of diabetic children and group II included 50 control parents of nondiabetic children. They were subjected to the following: sociodemographic data, parent stress index questionnaire, and QOL questionnaire. Results Stress is significant among parents of diabetic children, with significant statistical relation between both groups regarding depression, attachment, sense of competence, role restriction, and social isolation. A significant statistical relation was also found regarding duration of diabetes and child age. QOL was also significantly diminished in parents of diabetic children. Conclusion Parents of diabetic children are at increased risk for stress, which in turn affects their QOL.

Depression and anxiety in children with epilepsy and other chronic health conditions: National estimates of prevalence and risk factors

ObjectiveThis study estimates the national prevalence of depression and anxiety among children with epilepsy and determines which demographic variables and comorbidities increase the risk of these psychopathologies. We also compare the rates of depression and anxiety in pediatric epilepsy with those of other chronic health conditions in childhood. MethodsWe used the 2009–2010 National Survey of Children with Special Health Care Needs to identify children with epilepsy with and without depression and anxiety. We assessed demographic factors and comorbidities associated with depression and anxiety using weighted multivariable logistic regressions. The rates of psychiatric comorbidity in children with chronic conditions other than epilepsy were also determined. ResultsThe final sample included 1042 children over the age of five with epilepsy. After applying the sampling weights, we estimated that 283,000 children between 5 and 17 years of age have epilepsy in the United States (U.S.). Among these children, 25% have depression and/or anxiety. This figure was not significantly different from the rates seen among children with asthma (16.5%) or allergies (21.6%) but was significantly lower than the rate seen among children with migraines (43.2%). In our analyses of children with epilepsy, low-income children (regardless of race) and children whose needs for specialist care were unmet (relative to those whose needs were met) were more likely to have depression. Low-income black children were less likely to have anxiety than high-income white children. Gender, age, and epilepsy severity were unrelated to depression or anxiety. ConclusionsOne in four U.S. children with epilepsy has depression and/or anxiety. Therefore, physicians should consider the various factors that are related to depression and anxiety in children with epilepsy so that at-risk children can be screened and managed appropriately.

The Dynamic Relationship Between Asthma and Obesity in Schoolchildren.

Asthma and obesity are among the most prevalent chronic health conditions in children. Although there has been compelling evidence of co-occurrence of asthma and obesity, it is uncertain whether asthma contributes to the development of obesity or obesity contributes to the onset of asthma or both. In this study, we used a joint transition modeling approach with cross-lagged structure to understand how asthma and obesity influence each other dynamically over time. Subjects for this study included 5,193 kindergarten and first-grade students enrolled from 13 communities in 2002-2003 in the Southern California Children's Health Study, with up to 10 years of follow-up. We found that nonobese children with diagnosed asthma at a study visit were at 37% higher odds of becoming obese by the next annual visit compared with children without asthma (odds ratio=1.38; 95% credible interval: 1.12, 1.71). However, the presence of obesity at the current visit was not statistically significantly associated with asthma onset in the next visit (odds ratio =1.25; 95% credible interval:0.94, 1.62). In conclusion, childhood asthma appears to drive an increase in the onset of obesity among schoolchildren, while the onset of obesity does not necessarily imply the future onset of asthma, at least in the short term.

The Burden and Social Determinants of Asthma Among Children in the State of Georgia.

Asthma is one of the most common chronic health conditions in children, and social determinants are thought to be important risk factors. We used Georgia data from the Behavioral Risk Factors Surveillance Survey (BRFSS), and data from the Georgia hospital and emergency department survey for children with a diagnosis of asthma. All data were from the years 2011 to 2016. SAS and SUDAAN were used to calculate weighted prevalence estimates and to perform univariate and multivariate analysis of the association between social determinants, demographic characteristics, other potential risk factors, and asthma-related outcomes. The prevalence of asthma is higher in African-American children and when the parental income is less than $75,000 per year. A multivariate analysis adjusting for ethnicity, parental income, and sex found that the strongest independent predictor of asthma was African-American race (aOR 2.9, 95% CI 1.5-5.8). African-American and multiracial children also experienced extremely high burdens due to asthma related hospitalizations and emergency department visits, with rates two to five times higher than children in other groups. The secular trend for ED visits and hospitalizations is declining. African-American race is an independent predictor of asthma in children in Georgia, and African-American and multiracial children experience a greater burden of asthma than children of other races. Programmatic efforts at the state and national level to improve access, adherence, and knowledge about asthma are important if we are to continue to improve outcomes for these children.

Integrated children\u2019s clinic care (ICCC) versus a self-directed care pathway for children with a chronic health condition: a multi-centre randomised controlled trial study protocol

BackgroundChildren with chronic health conditions have better health-related outcomes when their care is managed in a personalised and coordinated way. However, increased demand on Australian ambulatory care hospital services has led to longer waitlist times to access specialists and appropriate intervention services; placing vulnerable children at increased risk of poorer short-term (e.g. social difficulties) and long-term (e.g. convictions) health and social outcomes. Traditional approaches to increasing frequency and service of delivery are expensive and can have minimal impact on caregiver burden. A community based service-integration approach, rather than self-directed care is proposed as increased service linkages are more likely to occur and improve the health outcomes of children with a chronic health condition.MethodsAn open, unblinded, multi-centre randomised controlled trial in two Australian public hospitals. 112 children (0–16 years) fulfilling the inclusion criteria will be randomised to one of two clinical pathways for management of their chronic health condition: (1) integrated children’s care clinic (ICCC) or (2) self-directed care pathway. All children and caregivers will be interviewed at 1 week, and 3, 6 and 12 month time intervals. Primary outcome measures include the Pediatric Quality of Life (PedQOL) questionnaire, Subjective Units of Distress Scale, Child Behaviour Checklist (CBCL) and Rotter’s Locus of Control Scale. Secondary outcome measures include the total number of medical appointments, school days missed and quantity of services accessed. Our main objectives are to determine if the ICCC results in better health and economics outcomes compared to the self-directed care pathway.DiscussionThe success of a health systems approach needs to be balanced against clinical, mortality and cost-effectiveness data for long-term sustainability within a publicly funded health system. A clinical pathway that is sustainable, cost-effective, provides efficient evidence-based care and improves the quality of life outcomes for children with chronic health conditions has the potential to reduce waitlist times, improve access to health services, increase consumer satisfaction; and prevent costs associated with poorly managed chronic health conditions into adulthood. This study will be the first to provide clinical and health economics data on an integrated care pathway for the management of chronic health conditions in children. On a broader scale, results from this study will help guide care coordination frameworks for children with chronic health conditions; particularly with the introduction and implementation of a National Disability Insurance Scheme (NDIS) across Australia.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR) ACTRN12617001188325. Registered: 14th August, 2017.

A Systemic Approach to Pediatric Chronic Health Conditions: Why We Need to Address Parental Stress

Chronic health conditions in childhood are on the rise (Van Cleave et al. 2010). Associated psychological distress is not uncommon. The child does not experience these difficulties in isolation, but rather sits at the center of a network of systems; the most pertinent of which is the family. Childhood distress in relation to the chronic condition has an intimate bidirectional relationship with family functioning; caregiver distress is a key contributing factor to child outcomes. Parental suffering in relation to pediatric chronic conditions is likely to occur at three main time points. First, prior to the diagnosis, the family is likely to have struggled with managing the child’s ill health, and experienced disruption to idealized family life. Second, parents will experience a reaction to the diagnosis of the condition, which may include complex feelings of loss, guilt, fear and even shame. Third, parents will experience a period of adjustment, including challenges of condition management and supporting their child longer-term. It is unsurprising that high stress and burnout are consistently reported by parents of children with chronic conditions (Cousino and Hazen 2013). Parent distress predicts the child’s psychological adjustment and reduces the parent’s ability to effectively manage the condition (e.g. reduced vigilance and adherence) (Wood et al. 2015).

The Impact of Chronic Health Conditions on Length of Stay and Mortality in a General PICU.

Each year approximately 20,000 children are admitted to PICUs across the United Kingdom. It is highlighted in several international studies that 40-70% of children admitted to PICUs have at least one chronic health condition that leads to increased length of stay and higher mortality rates. The prevalence of chronic health conditions in children admitted to U.K. PICUs is unknown. The purpose of this study was to use existing clinical data to explore the prevalence and impact of chronic health conditions on length of stay and mortality in a tertiary U.K. PICU. Single-centre retrospective observational cohort study. Single, tertiary referral PICU. One thousand one hundred ninety-seven children 0-18 years old admitted between March 1, 2009, and February 28, 2013. None. Data were derived from the unit's data submitted to the Paediatric Intensive Care Audit Network, the U.K. national PICU dataset. Data included demographics, diagnosis, Pediatric Index of Mortality-2 score, PICU interventions, PICU outcomes, chronic health condition etiologies, admission, and discharge dates and times. In total, 554 of 1,197 (46.3%) had at least one chronic health condition. Of 554, 371 patients (67.1%) presented with a single chronic health condition, 126 (22.6%) with two chronic health conditions, and 57 (10.3%) with at least three chronic health conditions to a maximum of four chronic health conditions. There was a statistically significant difference in length of stay in those with a chronic health condition compared with those without (medians, 4 vs 3 d [interquartile range, 1-7 d]; Mann-Whitney U test, p < 0.001). The length of stay also increased significantly according to the number of chronic health conditions (Kruskal-Wallis test, p < 0.001). Mortality was significantly different between those with and without chronic health conditions (8.8% vs 5.4%; chi-square test, p = 0.024). Having two or at least three chronic health conditions significantly increased mortality compared with no chronic health conditions (odds ratio, 2.3 [CI, 1.2-4.55]; p = 0.013 and 2.95 [CI, 1.28-6.8]; p = 0.011), respectively. The increasing number of chronic healthcare conditions is associated with length of stay and mortality.

Prevalence and Costs of Five Chronic Conditions in Children.

The objective is to examine the prevalence and health-care costs associated with asthma, epilepsy, hypertension, food allergies, and diabetes in children aged 0-18 years. Prevalence was calculated using 2005-2012 Medical Expenditure Panel Survey (MEPS) data, a population-based, nationally representative sample. Using MEPS, two-part models estimated the cost of each condition for all children while controlling for sociodemographic categories. Prevalence rates varied by race and ethnicity across conditions. Females had higher prevalence of all chronic conditions, except epilepsy. An additional US$1,377.60-US$9,059.49 annually were spent on medical expenses for children aged 0-18 years, with asthma, diabetes, or epilepsy compared to children without these conditions. This is the first study to examine the costs and prevalence of chronic health conditions in children and adolescents using a single data set. Understanding the odds of having a condition by sociodemographic categories highlights disparities that can potentially inform school nurses on the best allocation of resources to serve students.

Effect of Standing or Walking at a Workstation on Cognitive Function: A Randomized Counterbalanced Trial.

In the present study, we examined the effect of working while seated, while standing, or while walking on measures of short-term memory, working memory, selective and sustained attention, and information-processing speed. The advent of computer-based technology has revolutionized the adult workplace, such that average adult full-time employees spend the majority of their working day seated. Prolonged sitting is associated with increasing obesity and chronic health conditions in children and adults. One possible intervention to reduce the negative health impacts of the modern office environment involves modifying the workplace to increase incidental activity and exercise during the workday. Although modifications, such as sit-stand desks, have been shown to improve physiological function, there is mixed information regarding the impact of such office modification on individual cognitive performance and thereby the efficiency of the work environment. In a fully counterbalanced randomized control trial, we assessed the cognitive performance of 45 undergraduate students for up to a 1-hr period in each condition. The results indicate that there is no significant change in the measures used to assess cognitive performance associated with working while seated, while standing, or while walking at low intensity. These results indicate that cognitive performance is not degraded with short-term use of alternate workstations.

Fatigue in Child Chronic Health Conditions: A Systematic Review of Assessment Instruments

Fatigue is common in chronic health conditions in childhood, associated with decreased quality of life and functioning, yet there are limited data to compare assessment instruments across conditions and childhood development. Our objective was to describe fatigue assessment instruments used in children with chronic health conditions and critically appraise the evidence for the measurement properties of identified instruments. Data sources included Medline, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO (using the EBSCOhost platform). Study selection included quantitative assessment of fatigue in children with health conditions. Data extraction was as follows: (1) study design, participant and fatigue instruments, (2) measurement properties of fatigue instruments, (3) methodological quality of included studies, and (4) synthesis of the quality of evidence across studies for the measurement properties of fatigue instruments. Twenty fatigue assessment instruments were identified (12 child reports, 7 parent reports, 1 staff report), used in 89 studies. Fatigue was assessed in over 14 health conditions, most commonly in children with cancer and chronic fatigue syndrome. Evidence for the measurement properties of instruments varied, and overall quality was low. Two fatigue instruments demonstrated strong measurement properties for use in children with diverse health conditions and children with cancer. The review is limited to children younger than 18 years and results are specific to health conditions described, limiting generalizability of findings to other populations. Evidence for the measurement properties of fatigue instruments varied according to the population in which instruments were used and informant. Further evidence is required for assessment of fatigue in younger children, and children with particular health conditions.