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Madigan S, Vaillancourt T, Dimitropoulos G, Premji S, Kahlert SM, Zumwalt K, Korczak DJ, von Ranson KM, Pador P, Ganshorn H, Neville RD. A Systematic Review and Meta-Analysis: Child and Adolescent Healthcare Utilization for Eating Disorders During the COVID-19 Pandemic. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00077-7. [PMID: 38431196 DOI: 10.1016/j.jaac.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/30/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To conduct a meta-analysis documenting healthcare service utilization rates for pediatric (age <19 years) eating disorders during compared to before the COVID-19 pandemic. METHOD PsycINFO, MEDLINE, Embase, and Web of Science Core Collection were searched for studies published up to May 19, 2023. Studies with pediatric visits to primary care, inpatient, outpatient, and emergency department for eating disorders before and during the pandemic were included. This preregistered review (PROSPERO CRD42023413392) was reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analyzed with random-effects meta-analyses. RESULTS A total of 52 studies reporting >148,000 child and adolescent eating disorder-related visits to >300 health settings across 15 countries were included (mean age, 12.7 years; SD = 4.1 years; 87% girls). There was strong evidence of an increase in healthcare use for eating disorders during the pandemic (rate ratio [RR] = 1.54, 95% CI = 1.38-1.71). Moderator analysis revealed larger rate increases among girls (RR = 1.48, 95% CI = 1.28-1.71) compared to boys (RR = 1.24, 95% CI = 1.06-1.45) and for adolescents (age ≥12 to 19 years) (RR = 1.53, 95% CI = 1.29-1.81) compared to children (RR = 0.87, 95% CI = 0.53-1.43). Moderator analysis demonstrated strong evidence of increased use of emergency department (RR = 1.70, 95% CI = 1.48-1.97), inpatient (RR = 1.56, 95% CI = 1.33-1.84), and outpatient (RR = 1.62, 95% CI = 1.35-1.95) services, as well as strong evidence of increased rates of anorexia nervosa (RR = 1.48, 95% CI = 1.24-1.75). CONCLUSION Healthcare use for pediatric eating disorders increased substantially during the COVID-19 pandemic, particularly among girls and adolescents. It is important to continue to monitor whether changes in healthcare use associated with acute pediatric mental distress are sustained beyond the COVID-19 pandemic. STUDY PREREGISTRATION INFORMATION Risk factors for eating disorders for youth during the COVID-19 pandemic; https://www.crd.york.ac.uk/; CRD42023413392. DIVERSITY & INCLUSION STATEMENT One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.
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Affiliation(s)
- Sheri Madigan
- University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
| | | | - Gina Dimitropoulos
- University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | | | | | | | - Daphne J Korczak
- Hospital for Sick Children, Toronto, Canada; and the University of Toronto, Toronto, Canada
| | - Kristin M von Ranson
- University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
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Silber AS, Platte S, Kumar A, Arora S, Kadioglu D, Schmidt M, Storf H, Chiocchetti AG, Freitag CM. Admission rates and clinical profiles of children and youth with eating disorders treated as inpatients before and during the COVID-19 pandemic in a German university hospital. Front Public Health 2023; 11:1281363. [PMID: 38098830 PMCID: PMC10720619 DOI: 10.3389/fpubh.2023.1281363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/22/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Children and youth at risk for mental health disorders, such as eating disorders (ED), were particularly affected by the COVID-19 pandemic, yet evidence for the most seriously affected and thus hospitalized youth in Germany is scarce. Methods This crosssectional study investigated anonymized routine hospital data (demographic information, diagnoses, treatment modalities) of patients admitted (n = 2,849) to the Department of Child and Adolescence Psychiatry, Psychosomatics and Psychotherapy (DCAPPP) of a German University Hospital between 01/2016 and 02/2022. Absolute and relative number of inpatients with or without ED prior to (01/2016-02/2020) and during the COVID-19 pandemic (03/2020-02/2022) were compared. The effect of school closures as part of social lockdown measures for COVID-19 mitigation on inpatient admission rate was explored as it has been discussed as a potential risk factor for mental health problems in youth. Results During the COVID-19 pandemic, ED inpatient admission rate increased from 10.5 to 16.7%, primarily driven by Anorexia Nervosa (AN). In contrast to previous reports, we found no change in somatic and mental disorder comorbidity, age or sexratio for hospitalized youth with ED. However, we did observe a shortened length of hospital stay (LOS) for hospitalized youth with and without ED. In addition, non-ED admissions presented with an increased number of mental disorder comorbidities. In contrast to our hypothesis, school closures were not related to the observed increase in ED. Discussion In summary, the COVID-19 pandemic was associated with an increased rate of inpatient treatment for youth suffering from AN, and of youth affected by multiple mental disorders. Accordingly, we assume that inpatient admission was prioritized for individuals with a higher burden of disease during the COVID-19 pandemic. Our findings pinpoint the need for adequate inpatient mental health treatment capacities during environmental crises, and a further strengthening of child and adolescence psychiatry services in Germany.
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Affiliation(s)
- Ann-Sophie Silber
- Department of Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Simeon Platte
- Department of Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Afsheen Kumar
- Department of Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Sukhdeep Arora
- Department of Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Dennis Kadioglu
- Institute of Medical Informatics (IMI), Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Marvin Schmidt
- Institute of Medical Informatics (IMI), Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Holger Storf
- Institute of Medical Informatics (IMI), Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Andreas G. Chiocchetti
- Department of Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Christine M. Freitag
- Department of Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
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Ramos La Cuey B, Saloni-Gomez N, Ilundain López de Munain A, Fernández-Montero A, Viguria N, López Fernández L, Herranz Aguirre M, Iceta A, Moreno-Galarraga L. The long-term boomerang effect of COVID-19 on admissions for non-COVID diseases: the ECIEN-2022 study. Eur J Pediatr 2023; 182:4227-4236. [PMID: 37452843 DOI: 10.1007/s00431-023-05101-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Since COVID-19 pandemic started, many changes have been seen in the cycling patterns of pediatric pathologies. On year 2020, we described the initial effects of COVID-19, with a significant decrease in emergency visits and admissions, but 2 years later the situation seems to be reversed. Our study bridges a literature gap by exploring the lasting effects of COVID-19 on pediatric non-COVID admissions, particularly the resurgence of respiratory illnesses. ECIEN-2022 is a single-center, retrospective, observational-study conducted 3 years after the pandemic onset, to describe the long-term effects of COVID-19 in pediatric admissions for non-COVID diseases. Admissions during year 2022 were compared with the Pre-Pandemic Period (PPP: 2015-2019). Pediatric Emergency Department (P-ED) visits, hospital, and Intensive Care Unit (P-ICU) admissions were compared across pre- and post-pandemic periods. Monthly distribution and year-waves are presented. P-ED monthly visits (mean and Standard deviation (SD) raised from 3521 (533) in the PPP to 3775 (996) in 2022 (p < 0.001). Monthly hospital admissions in the 3rd quarter of the Pre-Pandemic Period were 111.7/month (SD:29), dropped to 88.5(SD:6.5) in 2020 and raised to 149(SD:38.8) in 2022 (p = 0.036). An increase in respiratory illnesses was observed in 2022 compared to PPP; Bronchiolitis increased 38%, bronchitis 56%, and admissions for Respiratory Syncytial Virus 67%. Conclusion: COVID-19 pandemic has had a significant impact on the use and nature of pediatric health services. The initial decrease has been followed by a boomerang effect with an increase of cases, mainly due to an increase in respiratory infections when pandemic control measures and social restrictions have been lifted. It is essential to maintain an active surveillance and monitorization of these patterns to ensure appropriate healthcare access and utilization. What is Known: • COVID-19 pandemic initially led to a significant decrease in emergency visits and admissions for non-COVID diseases. What is New: • ECIEN-2022 study investigated the long-term effects of COVID-19 on pediatric admissions for non-COVID diseases, detecting a "boomerang effect" with an increase in pediatric admissions for non-COVID diseases in year 2022. • Pediatric Emergency Department visits and hospital admissions for non-COVID diseases, especially those due to respiratory infections, increased significantly in 2022 when compared to the Pre-Pandemic Period.
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Affiliation(s)
- Beatriz Ramos La Cuey
- Department of Pediatrics, HUN, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Neus Saloni-Gomez
- Department of Pediatrics, HUN, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | | | - Alejandro Fernández-Montero
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Navarra, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - Natividad Viguria
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Pediatric Pulmonology, HUN, Hospital Universitario de Navarra, C/ Irunlarrea No 8, 31008, Pamplona, Navarra, IdisNa, Spain
| | - Leyre López Fernández
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Pediatric Pulmonology, HUN, Hospital Universitario de Navarra, C/ Irunlarrea No 8, 31008, Pamplona, Navarra, IdisNa, Spain
| | | | - Ainhoa Iceta
- Department of Pediatrics, HUN, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Laura Moreno-Galarraga
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.
- Pediatric Pulmonology, HUN, Hospital Universitario de Navarra, C/ Irunlarrea No 8, 31008, Pamplona, Navarra, IdisNa, Spain.
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Oeffl N, Schober L, Faudon P, Schweintzger S, Manninger M, Köstenberger M, Sallmon H, Scherr D, Kurath-Koller S. Antiarrhythmic Drug Dosing in Children-Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050847. [PMID: 37238395 DOI: 10.3390/children10050847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Antiarrhythmic drugs represent a mainstay of pediatric arrhythmia treatment. However, official guidelines and consensus documents on this topic remain scarce. There are rather uniform recommendations for some medications (including adenosine, amiodarone, and esmolol), while there are only very broad dosage recommendations for others (such as sotalol or digoxin). To prevent potential uncertainties and even mistakes with regard to dosing, we summarized the published dosage recommendations for antiarrhythmic drugs in children. Because of the wide variations in availability, regulatory approval, and experience, we encourage centers to develop their own specific protocols for pediatric antiarrhythmic drug therapy.
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Affiliation(s)
- Nathalie Oeffl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Lukas Schober
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Patrick Faudon
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Sabrina Schweintzger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Martin Köstenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Hannes Sallmon
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
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Güzel Â, Mutlu NL, Molendijk M. COVID-19-related changes in eating disorder pathology, emotional and binge eating and need for care: a systematic review with frequentist and Bayesian meta-analyses. Eat Weight Disord 2023; 28:19. [PMID: 36805344 PMCID: PMC9941242 DOI: 10.1007/s40519-023-01547-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has been a leading cause of stress and feelings of loss of control, both of which have been related to eating disorder (ED) pathology onset and deterioration. We aim to estimate the magnitude of changes in the prevalence rates of, and indicators for, ED psychopathology in the face of the COVID-19 pandemic. METHOD Pre-registered systematic review with frequentist and Bayesian meta-analyses. Searches for eligible studies were performed in PubMed, Web of Science and pre-print servers until January 15 2023. RESULTS Our searches yielded 46 eligible studies reporting on a total of 4,688,559 subjects. These data provide strong evidence indicating increased rates of diagnosed and self-reported ED's and a concordant increased need for care in the face of the pandemic. ED symptom severity scores in patients were not elevated during the pandemic, except for those related to anorexia nervosa. On average, people in the general population report relatively high levels of emotional and binge eating during the pandemic, although the evidential strength for these associations is only anecdotal to moderate. Moderators of between-study heterogeneity were not detected. CONCLUSIONS Altogether, our results suggest that the COVID-19 pandemic is associated with a wide spread negative effect on ED pathology in patient samples and the general population. The development of online prevention and intervention programs for EDs during stressful times like a pandemic is encouraged. A limitation is that the results reported here may be prone to biases, amongst others, self-report bias. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis. PREREGISTRATION Prospero [ https://www.crd.york.ac.uk/prospero ] ID: CRD42022316105.
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Affiliation(s)
- Âmine Güzel
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands
| | - Naz Lâl Mutlu
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands
| | - Marc Molendijk
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands.
- Leiden Institute of Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands.
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