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Swaminathan K, Nanda PM, Yadav J, Malhi P, Kumar R, Sharma A, Sharma R, Dayal D. Cognitive Function in Early Onset Type 1 Diabetes in Children. Indian J Pediatr 2023:10.1007/s12098-023-04901-5. [PMID: 37930624 DOI: 10.1007/s12098-023-04901-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To assess cognitive function and factors affecting it in Indian children with early-onset type 1 diabetes (T1D) (less than 6 y). METHODS This cross-sectional, single-centre study recruited children diagnosed with T1D before 6 y of age and having a disease duration of at least 2 y, as cases. Controls were age- and sex-matched apparently healthy children or siblings. Children with birth asphyxia, intellectual disability, syndromic children, or pre-existing psychiatric illness were excluded. Enrolled children underwent cognitive assessment using Malin's Intelligence Scale for Indian Children (MISIC), and scores in various subtests were compared between cases and controls. RESULTS A total of 60 children were enrolled in each group. When compared to controls, cases had significantly lower scores on most subtests, verbal, performance and overall Intelligence Quotient (IQ- 100.62 ± 3.26 vs. 103.23 ± 1.22). HbA1c >9%, severe hypoglycemia and lesser duration since the last diabetic ketoacidosis (DKA) episode significantly correlated with lower neurocognitive scores. CONCLUSIONS Children with early onset T1D showed significant deficits in various cognitive domains and IQ. Poor glycemic control, higher glycemic variability and exposure to severe hypoglycemia are risk factors for poor cognitive outcomes in these children. Further longitudinal studies could potentially aid in a finer understanding of factors affecting cognitive functioning in T1D children in developing countries.
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Affiliation(s)
- K Swaminathan
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pamali Mahasweta Nanda
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Jaivinder Yadav
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Prahbhjot Malhi
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rakesh Kumar
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Akhilesh Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rajni Sharma
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Devi Dayal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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D'Amico RP, Pian TM, Buschur EO. Transition From Pediatric to Adult Care for Individuals With Type 1 Diabetes: Opportunities and Challenges. Endocr Pract 2022; 29:279-285. [PMID: 36528273 DOI: 10.1016/j.eprac.2022.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Type 1 diabetes (T1D) is a chronic disease with patients across the age spectrum that has high potential for morbidity and mortality. Unfortunately, patients transitioning from pediatric to adult care continue to demonstrate worsened glycemic control in part due to lack of understanding of transition of care best practices. METHODS This review highlights the impact of existing transition of care interventions, assessment tools, and other recently published strategies for providers to consider to improve care of adolescent and young adult (AYA) patients with T1D in both hospital- and clinic-based settings. RESULTS Many barriers impact patients with T1D during the transition period and disparities by race, sex, insurance status, and comorbid illness persist. As diabetic care continues to evolve and the prevalence of adolescents and young adults living with T1D increases, an intentional approach to transition of care is more pressing than ever. While current literature on transition of care models is limited, many show promise in improving clinic attendance and decreasing hospitalization. There are critical discussions that providers should lead with AYA patients to improve their outcomes and increase diabetes self-management, such as re-addressing carbohydrate counseling, sleep hygiene, and reproductive planning. CONCLUSION While further research on transition of care is needed, many care models offer the promise of improved T1D outcomes, enhancements in our approach to care, and increased value for our health care system at large.
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Affiliation(s)
- Rachel P D'Amico
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Timothy M Pian
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Elizabeth O Buschur
- Division of Endocrinology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
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Bauer KW, Hilliard ME, Albright D, Lo SL, Fredericks EM, Miller AL. The Role of Parent Self-Regulation in Youth Type 1 Diabetes Management. Curr Diab Rep 2020; 20:37. [PMID: 32638126 PMCID: PMC8018188 DOI: 10.1007/s11892-020-01321-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Youth with strong self-regulation (SR), or the ability to manage thoughts, emotions, and behaviors, engage in more effective type 1 diabetes (T1D) management. However, while parent support and engagement are critical to ensuring positive youth T1D outcomes, it is rarely considered that parents' SR may also influence youth T1D management. If this is the case, novel interventions to improve parents' SR or ensure adequate support for parents with SR challenges offer great potential to improve family functioning and youth T1D management. RECENT FINDINGS Theoretical and preliminary empirical evidence suggests that parental SR impacts family processes that support youth T1D treatment regimen adherence. Furthermore, parent and youth SR likely interact, with high parent SR enhancing the positive effects of high youth SR or compensating for low youth SR. Continued research is needed to better understand the ways in which parent SR matters to youth T1D management and identify how to support improvements in T1D management among families of parents with low SR.
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Affiliation(s)
- Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, 3854 SPH I, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA.
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Dana Albright
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sharon L Lo
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alison L Miller
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Rama Chandran S, Jacob P, Choudhary P. A systematic review of the effect of prior hypoglycaemia on cognitive function in type 1 diabetes. Ther Adv Endocrinol Metab 2020; 11:2042018820906017. [PMID: 32110374 PMCID: PMC7025428 DOI: 10.1177/2042018820906017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The effect of prior hypoglycaemia on cognitive function in type 1 diabetes is an important unresolved clinical question. In this systematic review, we aimed to summarize the studies exploring the impact of prior hypoglycaemia on any aspect of cognitive function in type 1 diabetes. METHODS We used a multidatabase search platform Healthcare Database Advanced Search to search Medline, PubMed, EMBASE, EMCARE, CINAHL, PsycINFO, BNI, HMIC, and AMED from inception until 1 May 2019. We included studies on type 1 diabetes of any age. The outcome measure was any aspect of cognitive function. RESULTS The 62 studies identified were grouped as severe hypoglycaemia (SH) in childhood (⩽18 years) and adult-onset (>18 years) diabetes, nonsevere hypoglycaemia (NSH) and nocturnal hypoglycaemia (NH). SH in early childhood-onset diabetes, especially seizures and coma, was associated with poorer memory (verbal and visuospatial), as well as verbal intelligence. Among adult-onset diabetes, SH was associated with poorer cognitive performance in the older age (>55 years) group only. Early versus late exposure to SH had a significant association with cognitive dysfunction (CD). NSH and NH did not have any significant association with CD, while impaired awareness of hypoglycaemia was associated with poorer memory and cognitive-processing speeds. CONCLUSION The effect of SH on cognitive function is age dependent. Exposure to SH in early childhood (<10 years) and older age groups (>55 years) was associated with a moderate effect on the decrease in cognitive function in type 1 diabetes [PROSPERO ID: CRD42019141321].
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Affiliation(s)
| | - Peter Jacob
- King’s College London, Weston Education Centre, London, UK
| | - Pratik Choudhary
- Department of Diabetes, King’s College Hospital, London, UK
- King’s College London, Weston Education Centre, London, UK
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Núñez M, Díaz S, Dilla T, Reviriego J, Pérez A. Epidemiology, Quality of Life, and Costs Associated with Hypoglycemia in Patients with Diabetes in Spain: A Systematic Literature Review. Diabetes Ther 2019; 10:375-392. [PMID: 30661221 PMCID: PMC6437233 DOI: 10.1007/s13300-019-0563-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To assess the burden of hypoglycemia in patients with diabetes mellitus (DM) in Spain, including epidemiological data and information relating to healthcare resource utilization (HRU) and costs, and patients' quality of life (QoL). METHODS A systematic literature review (SLR) was conducted to identify studies that included original information on epidemiology, HRU and costs, and/or QoL associated with hypoglycemia in patients with DM in Spain, published in either Spanish or English, between January 2007 and April 2017. RESULTS Fifteen articles, involving 14 studies, were identified in the SLR and included in the analysis. The estimated rate of severe hypoglycemia (SH) events per patient per year ranged from 0.90 to 1.50 in patients with type 1 DM (T1DM) and from 0.30 to 0.63 in patients with type 2 DM (T2DM). The data on HRU differed extensively between studies, making it difficult to draw a conclusion. Total costs per SH event ranged from €409.97 in patients with T1DM to €713.10 in patients with DM. Work absence was reported in 11.80-18% of the working patients. Further, patients who experienced hypoglycemic events expressed a higher fear and had a poorer QoL than those who did not report these events. CONCLUSION Although the data included in the SLR were difficult to synthesize due to heterogeneity of the study designs and patient characteristics in the 14 studies, our search identified a high burden associated with hypoglycemic events in terms of HRU and costs, and patients' QoL. Further research is recommended to reach a consensus on hypoglycemia definition and study design to provide robust evidence on the burden of hypoglycemia and to accurately weigh the impact of this acute complication in Spain. FUNDING Eli Lilly and Company.
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Affiliation(s)
| | | | | | | | - Antonio Pérez
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
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Abstract
OBJECTIVE The aims of the study were to examine the current evidence for executive function (EF) performance differences between groups with type 1 diabetes mellitus (T1DM) and nondiabetic control groups during adolescence and early adulthood and to explore the relationships between EF and diabetes-related risk factors. METHODS A systematic review of the literature examining EF performance in groups with T1DM was conducted according to the PRISMA guidelines. Electronic database searches for published and unpublished literature yielded a final set of 26 articles after application of inclusion and exclusion criteria. A meta-analysis was conducted on a subset of these articles (n = 17) comparing EF performance in T1DM and control groups, across a total sample size of 1619. RESULTS Sixteen of 26 studies found significantly lower EF on at least one task in groups with T1DM. Meta-analyses of the performance difference between T1DM groups and control groups without diabetes showed that inhibition (g = -0.28, p < .001), working memory (g = -0.34, p < .001), set-shifting (g = -0.31, p = .012), and overall EF performance across these domains (g = -0.42, p < .001) were all significantly lower in groups with T1DM. Performance on specific EF domains also seemed to be differentially associated with early age of diabetes onset, chronic hyperglycemia and its complications, and severe hypoglycemia. CONCLUSIONS T1DM and its associated risk factors are related to subtle impairments across the inhibition, working memory, and set-shifting domains of EF. Lower EF may be a key factor contributing to behavioral and clinical problems experienced by individuals with T1DM.
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Barriers to Addressing Social Determinants of Health in Pediatric Nursing Practice: An Integrative Review. J Pediatr Nurs 2017; 37:51-56. [PMID: 28676190 DOI: 10.1016/j.pedn.2017.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/17/2017] [Indexed: 12/26/2022]
Abstract
PROBLEM Despite a substantial body of knowledge regarding the importance of the social determinants of health, recognizing and responding to the psychosocial circumstances of seriously and chronically ill children and their families is not well established in routine pediatric nursing care. ELIGIBILITY CRITERIA The search process focused on psychological and social determinants and care in the healthcare setting. Searches were limited to research and review publications written in the English language. The quality of evidence was graded using the National Health and Medical Research Council evidence hierarchy. RESULTS Thirteen publications were identified for inclusion. Healthcare providers do recognize emotional distress experienced by patients, but feel unable to address psychosocial issues due to the lack of time, a lack of confidence in their own communication skills, and the perception that patients and their families prioritize physical care over psychosocial care. For patients and their families the main issue was that the healthcare system was focused on physical care with little opportunity to talk about psychosocial concerns. CONCLUSIONS The greatest barrier to addressing the social determinants of health in the pediatric context is the dominance of the 'medical model' of care. Also, many healthcare providers believe that they lack the communication skills necessary to talk about psychosocial issues. IMPLICATIONS The way forward will be to empower nurses through the sharing of knowledge of the social determinants of health, the development of skills in relationship building and therapeutic communication, and the mentorship of compassionate family-centered care.
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Hardy KK, Olson K, Cox SM, Kennedy T, Walsh KS. Systematic Review: A Prevention-Based Model of Neuropsychological Assessment for Children With Medical Illness. J Pediatr Psychol 2017; 42:815-822. [PMID: 28369473 PMCID: PMC7328686 DOI: 10.1093/jpepsy/jsx060] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective Many pediatric chronic illnesses have shown increased survival rates, leading to greater focus on cognitive and psychosocial issues. Neuropsychological services have traditionally been provided only after significant changes in the child's cognitive or adaptive functioning have occurred. This model of care is at odds with preventative health practice, including early identification and intervention of neuropsychological changes related to medical illness. We propose a tiered model of neuropsychological evaluation aiming to provide a preventative, risk-adapted level of assessment service to individuals with medical conditions impacting the central nervous system based on public health and clinical decision-making care models. Methods Elements of the proposed model have been used successfully in various pediatric medical populations. We summarize these studies in association with the proposed evaluative tiers in our model. Results and Conclusions This model serves to inform interventions through the various levels of assessment, driven by evidence of need at the individual level in real time.
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Affiliation(s)
- Kristina K. Hardy
- Division of Neuropsychology, Center for Neuroscience and Behavioral Medicine, Children’s National Health System
- Departments of Psychiatry & Behavioral Science and Pediatrics, The George Washington University School of Medicine
| | - Katie Olson
- Division of Hematology and Oncology, Center for Cancer and Blood Disorders, Children’s National Health System
| | - Stephany M. Cox
- Division of Neuropsychology, Center for Neuroscience and Behavioral Medicine, Children’s National Health System
| | - Tess Kennedy
- Division of Neuropsychology, Center for Neuroscience and Behavioral Medicine, Children’s National Health System
| | - Karin S. Walsh
- Division of Neuropsychology, Center for Neuroscience and Behavioral Medicine, Children’s National Health System
- Departments of Psychiatry & Behavioral Science and Pediatrics, The George Washington University School of Medicine
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Pourabbasi A, Larijani B. COGNITOMICS: a new approach for the evaluation of the relationship between diseases and cognition to be designed based on normal behavioral tendencies in real life, a conceptual framework. J Diabetes Metab Disord 2017; 16:20. [PMID: 28516067 PMCID: PMC5433245 DOI: 10.1186/s40200-017-0301-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 05/08/2017] [Indexed: 01/09/2023]
Abstract
The relationship between medical diseases and cognition has been a point of interest in the last decades. In recent years studies in this field have developed significantly applying various tools such as cognitive tests using psychometric assessments and brain imaging techniques. The main focus of cognitive function in this studies is the process through which this cognition is obtained. It seems a novel methodology is needed while assessing the impact of diseases such as diabetes on cognition based on heavenly religious teachings in which cognition is believed to be the main source of human bliss and not just some measurable quantitative components.
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Affiliation(s)
- Ata Pourabbasi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology & Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Shari'ati Hospital, North Kargar St., Tehran, Iran
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Wasserman R, Anderson BJ, Schwartz DD. Illness-Specific Risk-Taking in Adolescence: A Missing Piece of the Nonadherence Puzzle for Youth With Type 1 Diabetes? Diabetes Spectr 2017; 30:3-10. [PMID: 28270709 PMCID: PMC5309908 DOI: 10.2337/ds15-0060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Risky behavior is often at its lifetime peak in adolescence. Chronic illness creates additional opportunities for risk because nonadherence behaviors can jeopardize adolescents' health. Adolescents with type 1 diabetes could engage in risky behavior around insulin administration that would put them in danger of severe health consequences. It is possible that some nonadherence behaviors observed in adolescents with type 1 diabetes may result from youth taking risks with their medical treatment. Illness-specific risk-taking behaviors are not captured in most assessments of adherence, which primarily focus on frequency of adherence behaviors. This article reviews current models of general risk-taking and their implications for diabetes management. The authors argue that illness-specific risk-taking may be an important, understudied aspect of illness management that can inform future studies and treatment of nonadherence in adolescents with type 1 diabetes.
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Wasserman RM, Anderson BJ, Schwartz DD. Screening of Neurocognitive and Executive Functioning in Children, Adolescents, and Young Adults With Type 1 Diabetes. Diabetes Spectr 2016; 29:202-210. [PMID: 27899871 PMCID: PMC5111527 DOI: 10.2337/ds16-0037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Rachel M Wasserman
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Barbara J Anderson
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - David D Schwartz
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Klouda L, Franklin WJ, Saraf A, Parekh DR, Schwartz DD. Neurocognitive and executive functioning in adult survivors of congenital heart disease. CONGENIT HEART DIS 2016; 12:91-98. [DOI: 10.1111/chd.12409] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/24/2016] [Accepted: 05/27/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Leda Klouda
- Department of Pediatrics; Section of Cardiology, Baylor College of Medicine; Houston Texas USA
| | - Wayne J. Franklin
- Department of Pediatrics; Section of Cardiology, Baylor College of Medicine; Houston Texas USA
| | - Anita Saraf
- Department of Pediatrics; Section of Cardiology, Baylor College of Medicine; Houston Texas USA
- Department of Medicine, Division of Cardiology; Emory University; Atlanta Georgia USA
| | - Dhaval R. Parekh
- Department of Pediatrics; Section of Cardiology, Baylor College of Medicine; Houston Texas USA
| | - David D. Schwartz
- Department of Pediatrics; Section of Psychology, Baylor College of Medicine; Hoston Texas USA
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