1
|
Makhani N, Lebrun-Frenay C, Siva A, Shabanova V, Wassmer E, Santoro JD, Narula S, Brenton JN, Mar S, Durand-Dubief F, Zephir H, Mathey G, Rojas JI, de Seze J, Tenembaum S, Stone RT, Casez O, Carra-Dallière C, Neuteboom RF, Ahsan N, Arroyo HA, Cabre P, Gombolay G, Inglese M, Louapre C, Margoni M, Palavra F, Pohl D, Reich DS, Ruet A, Thouvenot E, Timby N, Tintore M, Uygunoglu U, Vargas W, Venkateswaran S, Verhelst H, Wickstrom R, Azevedo CJ, Kantarci O, Shapiro ED, Okuda DT, Pelletier D. The diagnostic workup of children with the radiologically isolated syndrome differs by age and by sex. J Neurol 2024:10.1007/s00415-024-12289-1. [PMID: 38564056 DOI: 10.1007/s00415-024-12289-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) and spinal MRIs are often obtained in children with the radiologically isolated syndrome (RIS) for diagnosis and prognosis. Factors affecting the frequency and timing of these tests are unknown. OBJECTIVE To determine whether age or sex were associated with (1) having CSF or spinal MRI obtained or (2) the timing of these tests. METHODS We analyzed children (≤ 18 y) with RIS enrolled in an international longitudinal study. Index scans met 2010/2017 multiple sclerosis (MS) MRI criteria for dissemination in space (DIS). We used Fisher's exact test and multivariable logistic regression (covariates = age, sex, MRI date, MRI indication, 2005 MRI DIS criteria met, and race). RESULTS We included 103 children with RIS (67% girls, median age = 14.9 y). Children ≥ 12 y were more likely than children < 12 y to have CSF obtained (58% vs. 21%, adjusted odds ratio [AOR] = 4.9, p = 0.03). Pre-2017, girls were more likely than boys to have CSF obtained (n = 70, 79% vs. 52%, AOR = 4.6, p = 0.01), but not more recently (n = 30, 75% vs. 80%, AOR = 0.2, p = 0.1; p = 0.004 for interaction). Spinal MRIs were obtained sooner in children ≥ 12 y (median 11d vs. 159d, p = 0.03). CONCLUSIONS Younger children with RIS may be at continued risk for misdiagnosis and misclassification of MS risk. Consensus guidelines are needed.
Collapse
Affiliation(s)
- Naila Makhani
- Department of Pediatrics, Yale University, LMP 3088, 333 Cedar Street, New Haven, CT, 06520, USA.
- Department of Neurology, Yale University, New Haven, CT, USA.
| | - Christine Lebrun-Frenay
- CRCSEP Neurologie Pasteur 2, CHU de Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice, France
| | - Aksel Siva
- Neuroimmunology Unit, Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Veronika Shabanova
- Department of Pediatrics, Yale University, LMP 3088, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Evangeline Wassmer
- Neurology Department, Birmingham Children's Hospital, Aston University, Birmingham, UK
| | - Jonathan D Santoro
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
- Division of Neurology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, USA
| | - Sona Narula
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
| | | | - Soe Mar
- Department of Neurology, Washington University School of Medicine, St. Louis, USA
| | - Francoise Durand-Dubief
- Service de sclérose en plaques, Pathologies de la myéline et Neuro-Inflammation, Hôpital Neurologique, Groupement Hospitalier Est, 59 Bd Pinel, 69677, BRON Cedex, France
| | - Helene Zephir
- Inserm UMR-S 1172 LilNcog, Lille University Hospital FHU Precise, Lille University, Lille, France
| | - Guillaume Mathey
- Department of Neurology, Nancy University Hospital, 54035, Nancy, France
| | - Juan I Rojas
- Hospital Universitario de CEMIC, Buenos Aires, Argentina
| | - Jerome de Seze
- Department of Neurology, Hospital Hautepierre, CHU de Strasbourg and Clinical Investigation Center (CIC) INSERM 1434, Strasbourg, France
| | - Silvia Tenembaum
- Department of Neurology, National Pediatric Hospital Dr. Juan P Garrahan, Buenos Aires, Argentina
| | | | - Olivier Casez
- Neurology MS Clinic Grenoble, Grenoble Alpes University Hospital, Grenoble, France
- T-RAIG, TIMC-IMAG, Grenoble Alpes University, Grenoble, France
| | - Clarisse Carra-Dallière
- Neurology MS Clinic, Montpellier University Hospital, 34295, Montpellier, France
- University of Montpellier (MUSE), 34295, Montpellier, France
| | - Rinze F Neuteboom
- Department of Neurology, Erasmus MC Rotterdam, Sophia's Children's Hospital, Rotterdam, The Netherlands
| | - Nusrat Ahsan
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
- Division of Neurology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, USA
| | - Hugo A Arroyo
- Department of Neurology, Hospital de Pediatría SAMIC. Prof. Dr. J.P. Garrahan, Buenos Aires, Argentina
| | - Philippe Cabre
- Centre Hospitalo Universitaire, Fort-de-France, Martinique
| | - Grace Gombolay
- Division of Neurology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Department of Neuroscience (DINOGMI), University of Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Celine Louapre
- Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Sorbonne Université, Paris Brain Institute - ICM, Paris, France
| | - Monica Margoni
- Department of Neurosciences, Multiple Sclerosis Center of the Veneto Region, University Hospital-School of Medicine, Padua, Italy
| | - Filipe Palavra
- Center for Child Development - Neuropaediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Daniela Pohl
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, USA
| | - Aurélie Ruet
- Department of Neurology, CHU Bordeaux, Bordeaux, France
- INSERM, Neurocentre Magendie, University of Bordeaux, U1215, Bordeaux, France
| | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital, Nîmes, France
- IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Niklas Timby
- Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden
| | - Mar Tintore
- Neurology Department, MS Center of Catalunya Cemcat, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), UVIC-Universitat Central de Catalunya, Barcelona, Spain
| | - Ugur Uygunoglu
- Neuroimmunology Unit, Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Wendy Vargas
- Department of Neurology, Columbia University Medical Center, New York, USA
| | | | - Helene Verhelst
- Division of Pediatric Neurology, Department of Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Ronny Wickstrom
- Neuropaediatric Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Christina J Azevedo
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Orhun Kantarci
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eugene D Shapiro
- Department of Pediatrics, Yale University, LMP 3088, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Darin T Okuda
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, USA
| | - Daniel Pelletier
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| |
Collapse
|
2
|
Wu B, Shabanova V, Taylor S, Hawley NL. Pre-pregnancy BMI, rate of gestational weight gain, and preterm birth among US Pacific Islander individuals. Obesity (Silver Spring) 2024; 32:798-809. [PMID: 38304993 DOI: 10.1002/oby.23979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/08/2023] [Accepted: 12/01/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The objective of this study was to examine the association between rate of gestational weight gain (GWG) and preterm birth (PTB) classified by pre-pregnancy BMI among Pacific Islander individuals in the United States. METHODS Pacific Islander mothers (n = 55,975) and singleton infants (22-41 gestational weeks) without congenital anomalies were included using data from the National Center for Health Statistics (2014-2018). PTB was compared by pre-pregnancy BMI among women in each stratum of rate of GWG using Cox proportional hazards models. RESULTS Compared with mothers with a rate of GWG within the guidelines, mothers with a rate of GWG below the guidelines and either pre-pregnancy underweight (adjusted hazard ratio [aHR] = 1.84, 95% CI: 1.10-3.06), healthy weight (aHR = 1.38, 95% CI: 1.15-1.65), obesity class I (aHR = 1.22, 95% CI: 0.97-1.52), or obesity class II (aHR = 1.43, 95% CI: 1.05-1.96) had an increased risk of PTB; mothers with a rate of GWG above the guidelines and either pre-pregnancy underweight (aHR = 1.57, 95% CI: 0.92-2.69) or obesity class II (aHR = 1.31, 95% CI: 0.98-1.76) had an increased risk of PTB. CONCLUSIONS The association between rate of GWG below or above the guidelines and PTB differs by pre-pregnancy BMI among Pacific Islander individuals.
Collapse
Affiliation(s)
- Bohao Wu
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sarah Taylor
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
3
|
Harris LM, Shabanova V, Martinez-Brockman JL, Leverette D, Dioneda B, Parker MG, Taylor SN. Parent and grandparent neonatal intensive care unit visitation for preterm infants. J Perinatol 2024; 44:419-427. [PMID: 37573462 DOI: 10.1038/s41372-023-01745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/11/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Characterize family NICU visitation and examine associations with maternal health and social factors and infant health outcomes. STUDY DESIGN Retrospective cohort study of 167 infants born ≤32 weeks at two urban NICUs 01/2019-03/2020. Average nurse-documented family member visitation and associations of visitation with maternal and infant factors and outcomes were compared. RESULTS Mothers visited 4.4 days/week, fathers 2.6 days/week, and grandparents 0.4 days/week. Older maternal age, nulliparity, and non-English primary language were associated with more frequent family visitation. Mothers with depression or anxiety history visited less. Maternal depression and public insurance were associated with fewer father visits. Low parental visitation was associated with lower odds of feeding any maternal milk at discharge and low maternal visitation with 11.5% fewer completed infant subspecialty appointments in the year following discharge (95% CI -20.0%, -3.0%). CONCLUSION Families with social disadvantage visited less often. Parental visitation was associated with infant feeding and follow-up.
Collapse
Affiliation(s)
- Leslie M Harris
- Yale School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | | | | | - Desiree Leverette
- Yale School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | - Brittney Dioneda
- Yale School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | - Margaret G Parker
- University of Massachusetts Chan School of Medicine, Department of Pediatrics, Worcester, MA, USA
| | - Sarah N Taylor
- Yale School of Medicine, Department of Pediatrics, New Haven, CT, USA.
| |
Collapse
|
4
|
McAdow ME, Tortal D, Shabanova V, Son M. Nipple stimulation therapy promotes uterine contractions at lower plasma oxytocin concentration than intravenous oxytocin during labor induction. Am J Obstet Gynecol MFM 2024; 6:101307. [PMID: 38331190 DOI: 10.1016/j.ajogmf.2024.101307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Molly E McAdow
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510.
| | - Danna Tortal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Biostatistics, Yale University School of Medicine, New Haven, CT
| | - Moeun Son
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
| |
Collapse
|
5
|
Fleiss N, Shabanova V, Murray TS, Gallagher PG, Bizzarro MJ. The diagnostic utility of obtaining two blood cultures for the diagnosis of early onset sepsis in neonates. J Perinatol 2024:10.1038/s41372-024-01914-6. [PMID: 38409330 DOI: 10.1038/s41372-024-01914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/08/2024] [Accepted: 02/16/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Noa Fleiss
- Yale School of Medicine, New Haven, CT, USA.
| | | | - Thomas S Murray
- Yale School of Medicine, New Haven, CT, USA
- Yale New Haven Children's Hospital, New Haven, CT, USA
| | - Patrick G Gallagher
- Nationwide Children's Hospital, Columbus, OH, USA
- Ohio State University, Columbus, OH, USA
| | - Matthew J Bizzarro
- Yale School of Medicine, New Haven, CT, USA
- Yale New Haven Children's Hospital, New Haven, CT, USA
| |
Collapse
|
6
|
Kisitu G, Shabanova V, Naiga F, Nakagwa M, Kekitiinwa AR, Elyanu PJ, Paintsil E. High prevalence of low high-density lipoprotein cholesterol and insulin resistance among children and adolescents living with HIV in Uganda: harbinger for metabolic syndrome? HIV Med 2024; 25:262-275. [PMID: 37879630 DOI: 10.1111/hiv.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Antiretroviral therapy-associated adverse effects and comorbidities are still pervasive in people living with HIV, especially metabolic syndrome (MetS). We investigated the age-dependent prevalence of components of MetS and insulin resistance in children and adolescents living with HIV (CALWH). METHODS A cross-sectional pilot study of CALWH treated at the Baylor Uganda Clinical Centre of Excellence in Kampala, Uganda, May to August 2021. The primary outcome of MetS was defined by both the International Diabetes Federation (IDF) and the Adult Treatment Panel (ATP III) criteria. We estimated the prevalence of MetS and its components for all participants and by the stratification factors. RESULTS We enrolled 90 children and adolescents, aged 6 to <10 years (n = 30), 10 to <16 years (n = 30), and ≥ 16 to <19 years (n = 30). Fifty-one percent were females. The estimated prevalence of MetS was 1.11% (1 of 90) using either IDF or ATPIII criteria for all participants, and 3.33% in the oldest age group. Notably, while only one among study participants met the criterion based on having central obesity or blood pressure, over 55% of participants had one or more IDF component, with 47% having low high-density lipoprotein (HDL) cholesterol. Two participants (6.67%) in the group aged 10 to <16 years met one of the definitions for insulin resistance (IR) using the Homeostatic Model Assessment (HOMA-IR) index. For every 1-year increase in age, HOMA-IR index increased by 0.04 (95% confidence interval: 0.01-0.08; p = 0.02). CONCLUSIONS With increasing survival of CALWH into adulthood, lifetime exposure to ART, the frequency of MetS in this population may rise, increasing the lifetime risk for associated health problems. There is a need to study the natural history of MetS in CALWH to inform preventative and treatment interventions as needed.
Collapse
Affiliation(s)
- Grace Kisitu
- Baylor College of Medicine Children's Foundation-Uganda, Block 5 Mulago Hospital, Kampala, Uganda
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Fairuzi Naiga
- Baylor College of Medicine Children's Foundation-Uganda, Block 5 Mulago Hospital, Kampala, Uganda
| | - Mary Nakagwa
- Baylor College of Medicine Children's Foundation-Uganda, Block 5 Mulago Hospital, Kampala, Uganda
| | - Adeodata R Kekitiinwa
- Baylor College of Medicine Children's Foundation-Uganda, Block 5 Mulago Hospital, Kampala, Uganda
| | - Peter J Elyanu
- Baylor College of Medicine Children's Foundation-Uganda, Block 5 Mulago Hospital, Kampala, Uganda
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
7
|
Shabanova V, Emuren L, Gan G, Antwi S, Renner L, Amissah K, Kusah JT, Lartey M, Reynolds NR, Paintsil E. Pediatric HIV Disclosure Intervention Improves Immunologic Outcome at 48 Weeks: The Sankofa Trial Experience. J Acquir Immune Defic Syndr 2023; 94:371-380. [PMID: 37643414 PMCID: PMC10617661 DOI: 10.1097/qai.0000000000003292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 07/10/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The World Health Organization recommends disclosure of HIV status to children and adolescents living with HIV (CALWH). HIV disclosure improves adherence to antiretroviral therapy and immunologic and virologic outcomes. However, the prevalence of HIV disclosure is low in sub-Saharan Africa. We assessed the longitudinal effect of the Sankofa Pediatric HIV disclosure intervention on immunologic and virologic outcomes among CALWH in Ghana. METHODS We conducted a secondary analysis of a two-arm site-randomized clinical trial among CALWH aged 7-18 years. Data were collected at baseline, 24, and 48 weeks. Generalized linear mixed models were used to compare immunologic (CD4) and virologic (viral load) outcomes as both continuous and categorical variables by disclosure status and by intervention group. RESULTS Among participants who had their HIV status disclosed during this study, the proportion with CD4 percent >25% increased from 56.5% at baseline to 75.4% at week 48 ( P = 0.03), with a slight increase in the undisclosed group (69.5% vs. 74.3%, P = 0.56). In the intervention arm, there was a steady increase in proportion with CD4 percent >25% from 47.1% at baseline to 67.8% at week 48 ( P = 0.01) while it remained unchanged in the control arm (80.5% vs. 81.3% [ P = 0.89]). Concurrently, declines in detectable viral load were observed in both disclosed (63.3% vs. 51.5%, P = 0.16) and undisclosed (69.9% vs. 62.0%, P = 0.17) groups while the intervention group experienced a meaningful drop from 72.9% to 57.6% at 24 weeks ( P = 0.04), which was maintained at 48 weeks. CONCLUSIONS A structured, culturally relevant disclosure intervention can improve clinical outcomes.
Collapse
Affiliation(s)
| | - Leonard Emuren
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Geliang Gan
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Sampson Antwi
- Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Lorna Renner
- Department of Child Health, University of Ghana Medical School and Korle-Bu Teaching Hospital Accra, Ghana
| | - Kofi Amissah
- Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Jonas Tettey Kusah
- Department of Child Health, University of Ghana Medical School and Korle-Bu Teaching Hospital Accra, Ghana
| | - Margaret Lartey
- Department of Medicine, University of Ghana Medical School and Korle-Bu Teaching Hospital Accra, Ghana
| | | | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
8
|
Buck CO, Shabanova V, Clark RH, Taylor SN. Diabetes in Pregnancy, Neonatal Morbidities, and Early Growth in Moderate or Late Preterm Infants. Pediatrics 2023; 152:e2023061285. [PMID: 37969002 DOI: 10.1542/peds.2023-061285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES To compare differences in short term morbidities and early growth among moderate and late preterm infants of mothers with and without diabetes (DM) in pregnancy. METHODS In a longitudinal analysis using data from the Pediatrix Clinical Data Warehouse of preterm infants (born 32 0/7 to 36 6/7 weeks) discharged from neonatal intensive care units from 2008 to 2019, health characteristics were compared between DM exposure groups. Change in growth from birth to discharge were compared using linear mixed effects modeling. RESULTS Among 301 499 moderate and late preterm infants in the analysis, 14% (N = 42 519) were exposed to DM in pregnancy. Incidence of congenital anomalies, hypoglycemia, and hyperbilirubinemia were higher in DM-group (P < .001), and DM-group was more likely to need respiratory support in the first postnatal days (P = .02). Percent weight change from birth differed by gestational age, such that 36-week DM-group infants remained on average 2% (95% confidence interval [CI]: 1.57 to 2.41) below birth weight on day 14, whereas 32-week DM-group infants were on average 2.1% (95% CI: 1.69 to 2.51) above birth weight on day 14. In the regression analysis, DM-group had faster weight loss in the first postnatal week when stratified by gestational age. The adjusted difference in weight velocity (g per day) from days 0 to 3 was -4.5 (95% CI: -5.1 to -3.9), -6.5 (95% CI: -7.4 to -5.7), and -7.2 (95% CI: -8.2 to -6.2) for infants born 34-, 35-, and 36-weeks, respectively. CONCLUSIONS In moderate or late preterm infants, diabetes in pregnancy is associated with common neonatal morbidities. Examination of intensive care nutritional practices may identify reasons for observed differences in weight trajectories by gestational age and diabetes exposure.
Collapse
Affiliation(s)
- Catherine O Buck
- Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut
| | - Veronika Shabanova
- Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut
| | - Reese H Clark
- Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, Florida
| | - Sarah N Taylor
- Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut
| |
Collapse
|
9
|
Nally LM, Sherr JL, Tichy E, Weyman K, Urban A, Shabanova V, McCollum S, Steffen A, Tamborlane WV, Van Name M. Impact of school-supervised ultra-long-acting basal insulin injections on ketosis in youth with T1D and elevated haemoglobin A1c: A pilot study. Diabet Med 2023; 40:e15123. [PMID: 37078999 PMCID: PMC10524154 DOI: 10.1111/dme.15123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/24/2023] [Accepted: 04/18/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND In youth with type 1 diabetes (T1D), high haemoglobin A1c (HbA1c) levels are associated with an increased risk for diabetic ketoacidosis (DKA). AIMS This study examined whether daily school-supervised basal insulin injections were feasible and if they reduced the risk of morning ketosis in children and adolescents with high HbA1c levels. We hypothesized that supervised glargine and degludec would reduce the risk of ketosis and that the prolonged action of degludec would protect from ketosis after consecutive days of unsupervised injections. MATERIALS & METHODS After a 2-4-week run-in, youth (10-18 years, HbA1c ≥ 8.5%) managing T1D with injections were randomized to school-supervised administration of degludec or glargine for 4 months. School nurses observed daily blood β-hydroxybutyrate (BHB) and glucose checks. During COVID closures, the research team supervised procedures remotely. RESULTS Data from 28 youth (age 14.3 ± 2.3 years, HbA1c 11.4 ± 1.9%, 64% F) were analysed. School-supervised injections of both basal insulins for 1-4 days progressively lowered the percent of participants with elevated BHB. The percent of participants with elevated BHB (≥0.6 mmol/L) after 2 days of unsupervised basal insulin doses at home was greater in the glargine than degludec group but had a high p-value (17.2% vs. 9.0%, p = 0.3). HbA1c was unchanged in both groups. DISCUSSION In youth with T1D at high risk for DKA, daily supervised long-acting insulin administration decreased the probability of elevated ketone levels on subsequent school days, regardless of basal insulin type. A larger sample size may have demonstrated that the longer action profile of degludec would offer additional protection from ketosis during days of not attending school. CONCLUSION Engaging school-based caregivers in management of youth with T1D on injected insulin may decrease clinically significant ketosis and minimize acute complications of diabetes.
Collapse
Affiliation(s)
- Laura M. Nally
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer L. Sherr
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Eileen Tichy
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Kate Weyman
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea Urban
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Veronika Shabanova
- Department of Biostatistics, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah McCollum
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Amy Steffen
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | | | - Michelle Van Name
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
10
|
Wu B, Shabanova V, Arslanian K, Nyhan K, Izampuye E, Taylor S, Muasau-Howard B, Ekeroma A, Hawley NL. Global prevalence of preterm birth among Pacific Islanders: A systematic review and meta-analysis. PLOS Glob Public Health 2023; 3:e0001000. [PMID: 37315035 PMCID: PMC10266634 DOI: 10.1371/journal.pgph.0001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/04/2023] [Indexed: 06/16/2023]
Abstract
The epidemiology of preterm birth among Pacific Islanders is minimally understood. The purpose of this study was to estimate pooled prevalence of preterm birth among Pacific Islanders and to estimate their risk of preterm birth compared to White/European women. We searched MEDLINE, EMBASE, Web of Science Core Collection, Cochrane Library, CINAHL, Global Health, and two regional journals in March 2023. Observational studies were included if they reported preterm birth-related outcomes among Pacific Islanders. Random-effects models were used to estimate the pooled prevalence of preterm birth with 95% confidence interval (CI). Bayes meta-analysis was conducted to estimate pooled odds ratios (OR) with 95% highest posterior density intervals (HPDI). The Joanna Briggs Institute checklists were used for risk of bias assessment. We estimated preterm birth prevalence among Pacific Islanders in the United States (US, 11.8%, sample size [SS] = 209,930, 95% CI 10.8%-12.8%), the US-Affiliated Pacific Islands (USAPI, SS = 29,036, 6.7%, 95% CI 4.9%-9.0%), New Zealand (SS = 252,162, 7.7%, 95% CI 7.1%-8.3%), Australia (SS = 20,225, 6.1%, 95% CI 4.2%-8.7%), and Papua New Guinea (SS = 2,647, 7.0%, 95% CI 5.6%-8.8%). Pacific Islanders resident in the US were more likely to experience preterm birth compared to White women (OR = 1.45, 95% HPDI 1.32-1.58), but in New Zealand their risk was similar (OR = 1.00, 95% HPDI 0.83-1.16) to European women. Existing literature indicates that Pacific Islanders in the US had a higher prevalence of preterm birth and experienced health inequities. Learning from New Zealand's culturally-sensitive approach to health care provision may provide a starting point for addressing disparities. The limited number of studies identified may contribute to higher risk of bias and the heterogeneity in our estimates; more data is needed to understand the true burden of preterm birth in the Pacific region.
Collapse
Affiliation(s)
- Bohao Wu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America
- Department of Biostatistics, Yale School of Medicine, New Haven, CT, United States of America
| | - Kendall Arslanian
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, United States of America
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | - Elizabeth Izampuye
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Sarah Taylor
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America
| | - Bethel Muasau-Howard
- Department of Obstetrics and Gynecology, Lyndon B Johnson Tropical Medical Center, Pago Pago, American Samoa
| | | | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| |
Collapse
|
11
|
Abstract
This cohort study assesses 5-year race-stratified neonatal mortality and prevalence of preterm births in the US using birth-based and fetuses-at-risk approaches.
Collapse
Affiliation(s)
- Bohao Wu
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut
| | - Sarah Taylor
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Veronika Shabanova
- Department of Biostatistics, Yale University School of Medicine, New Haven, Connecticut
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut
| |
Collapse
|
12
|
Slusher AL, Hu P, Samuels S, Tokoglu F, Lat J, Li Z, Alguard M, Strober J, Vatner D, Shabanova V, Caprio S. Rising NAFLD and metabolic severity during the Sars-CoV-2 pandemic among children with obesity in the United States. Obesity (Silver Spring) 2023; 31:1383-1391. [PMID: 36694381 PMCID: PMC10186584 DOI: 10.1002/oby.23728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Nonalcoholic fatty liver disease (NAFLD), the most common liver disease among youth with obesity, precedes more severe metabolic and liver diseases. However, the impact of the Sars-CoV-2 global pandemic on the prevalence and severity of NAFLD and the associated metabolic phenotype among youth with obesity is unknown. METHODS Participants were recruited from the Yale Pediatric Obesity Clinic during the Sars-CoV-2 global pandemic (August 2020 to May 2022) and were compared with a frequency-matched control group of youth with obesity studied before the Sars-CoV-2 global pandemic (January 2017 to November 2019). Glucose metabolism differences were assessed during an extended 180-minute oral glucose tolerance test. Magnetic resonance imaging-derived proton density fat fraction (PDFF) was used to determine intrahepatic fat content in those with NAFLD (PDFF ≥ 5.5). RESULTS NAFLD prevalence increased in participants prior to (36.2%) versus during the Sars-CoV-2 pandemic (60.9%), with higher PDFF values observed in participants with NAFLD (PDFF ≥ 5.5%) during versus before the pandemic. An increase in visceral adipose tissue and a hyperresponsiveness in insulin secretion during the oral glucose tolerance test were also observed. CONCLUSIONS Hepatic health differences were likely exacerbated by environmental and behavioral changes associated with the pandemic, which are critically important for clinicians to consider when engaging in patient care to help minimize the future risk for metabolic perturbations.
Collapse
Affiliation(s)
- Aaron L. Slusher
- Department of Pediatrics, Yale University School of
Medicine, New Haven, CT
| | - Pamela Hu
- Department of Pediatrics, Yale University School of
Medicine, New Haven, CT
| | - Stephanie Samuels
- Department of Pediatrics, Yale University School of
Medicine, New Haven, CT
| | - Fuyuze Tokoglu
- Radiology and Biomedical Imaging, Yale University School of
Medicine, New Haven, CT
| | - Jessica Lat
- Department of Pediatrics, Yale University School of
Medicine, New Haven, CT
| | - Zhongyao Li
- Department of Pediatrics, Yale University School of
Medicine, New Haven, CT
| | - Michele Alguard
- Department of Pediatrics, Yale University School of
Medicine, New Haven, CT
| | - Jordan Strober
- Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT
| | - Daniel Vatner
- Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of
Medicine, New Haven, CT
| | - Sonia Caprio
- Department of Pediatrics, Yale University School of
Medicine, New Haven, CT
| |
Collapse
|
13
|
Ananth P, Lindsay M, Mun S, McCollum S, Shabanova V, de Oliveira S, Pitafi S, Kirch R, Ma X, Gross CP, Boyden JY, Feudtner C, Wolfe J. Parent Priorities in End-of-Life Care for Children With Cancer. JAMA Netw Open 2023; 6:e2313503. [PMID: 37184834 PMCID: PMC10878399 DOI: 10.1001/jamanetworkopen.2023.13503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Importance Robust quality measures to benchmark end-of-life care for children with cancer do not currently exist; 28 candidate patient-centered quality measures were previously developed. Objective To prioritize quality measures among parents who lost a child to cancer. Design, Setting, and Participants This survey study was conducted using an electronic, cross-sectional discrete choice experiment (DCE) with maximum difference scaling from January to June 2021 in the US. In each of 21 questions in the DCE, participants were presented with a set of 4 quality measures and were asked to select the most and least important measures within each set. All 28 quality measures were presented an equal number of times in different permutations. In the volunteer sample, 69 eligible bereaved parents enrolled in the study; 61 parents completed the DCE (participation rate, 88.4%). Main Outcomes and Measures Using choices participants made, a hierarchical bayesian multinomial logistic regression was fit to derive mean importance scores with 95% credible intervals (95% Crs) for each quality measure, representing the overall probability of a quality measure being selected as most important. Importance scores were rescaled proportionally from 0 to 100, with the sum of scores for all quality measures adding up to 100. This enabled interpretation of scores as the relative importance of quality measures. Results Participants included 61 bereaved parents (median [range] age, 48 [24-74] years; 55 individuals self-identified as women [90.2%]; 1 American Indian or Alaska Native [1.6%], 1 Asian [1.6%], 2 Black or African American [3.3%], 1 Native Hawaiian or Pacific Islander, and 58 White [91.8%]; 58 not Hispanic or Latinx [95.1%]). Highest-priority quality measures by mean importance score included having a child's symptoms treated well (9.25 [95% Cr, 9.06-9.45]), feeling that a child's needs were heard by the health care team (8.39 [95% Cr, 8.05-8.73]), and having a goal-concordant end-of-life experience (7.45 [95% Cr, 6.84-8.05]). Lowest-priority quality measures included avoiding chemotherapy (0.33 [95% Cr, 0.21-0.45]), provision of psychosocial support for parents (1.01 [95% Cr, 0.57-1.45]), and avoiding the intensive care unit (1.09 [95% Cr, 0.74-1.43]). Rank-ordering measures by mean importance revealed that symptom management was 9 times more important to parents than psychosocial support for themselves. Conclusions and Relevance This study found that bereaved parents prioritized end-of-life quality measures focused on symptom management and goal-concordant care while characterizing quality measures assessing their own psychosocial support and their child's hospital resource use as substantially less important. These findings suggest that future research should explore innovative strategies to measure care attributes that matter most to families of children with advanced cancer.
Collapse
Affiliation(s)
- Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
| | - Meghan Lindsay
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
| | - Sophia Mun
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Sarah McCollum
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Sarah Pitafi
- University College London, London, United Kingdom
| | - Rebecca Kirch
- National Patient Advocate Foundation, Washington, District of Columbia
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Cary P Gross
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jackelyn Y Boyden
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia
- Justin Michael Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Justin Michael Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Departments of Pediatrics, Medical Ethics, and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Joanne Wolfe
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston
| |
Collapse
|
14
|
Werner KM, Mercurio MR, Shabanova V, Hull SC, Taylor SN. Pediatricians' Reports of Interaction with Infant Formula Companies. Breastfeed Med 2023; 18:219-225. [PMID: 36795978 DOI: 10.1089/bfm.2022.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Introduction: Seventy percent of countries follow the World Health Organization International Code of Marketing Breast Milk Substitutes that prohibits infant formula companies (IFC) from providing free products to health care facilities, providing gifts to health care staff, or sponsoring meetings. The United States rejects this code, which may impact breastfeeding rates in certain areas. Objective: We aimed at gathering exploratory data about interactions between IFC and pediatricians. Methods: We distributed an electronic survey to U.S. pediatricians asking about practice demographics, interactions with IFC, and breastfeeding practices. Using the zip code of the practice, we obtained additional information from the 2018 American Communities Survey, including median income, percent of mothers who had graduated college, percent of mothers working, and racial and ethnic identity. We compared demographic data for those pediatricians who had a formula company representative visit versus not and those who had a sponsored meal versus not. Results: Of 200 participants, the majority reported a formula company representative visit to their clinic (85.5%) and receiving free formula samples (90%). Representatives were more likely to visit areas with higher-income patients (median = $100K versus $60K, p < 0.001). They tended to visit and sponsor meals for pediatricians at private practices and in suburban areas. Most of the reported conferences attended (64%) were formula company-sponsored. Conclusion: Interactions between IFC and pediatricians are prevalent and occur in many forms. Future studies may reveal whether these interactions influence the advice of pediatricians or the behavior of mothers who had planned to exclusively breastfeed.
Collapse
Affiliation(s)
- Kelly M Werner
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mark R Mercurio
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.,Program for Biomedical Ethics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Biostatistics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sarah C Hull
- Program for Biomedical Ethics, Yale University School of Medicine, New Haven, Connecticut, USA.,Section of Cardiology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sarah N Taylor
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
15
|
Frye RE, Ittleman B, Shabanova V, Sugeng L, Steele J, Ferdman D, Karnik R. Left ventricular strain in pediatric patients with bicuspid aortic valves and aortopathy. Progress in Pediatric Cardiology 2023. [DOI: 10.1016/j.ppedcard.2023.101636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
|
16
|
Kaman K, Dhodapkar M, Shabanova V, McCollum S, Factor J, Leeds S. Validated anxiety assessments among pediatric patients with peanut allergy on oral immunotherapy. Ann Allergy Asthma Immunol 2023; 130:657-663. [PMID: 36738780 DOI: 10.1016/j.anai.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although efficacy, safety, and quality of life measures associated with peanut oral immunotherapy (OIT) have been studied, the relationship between peanut OIT and clinical anxiety has not yet been evaluated. The latter is important to help providers and families have an improved shared medical decision discussion around the benefits of initiating OIT. OBJECTIVE To investigate the relationship between undergoing OIT and anxiety in patients with peanut allergy. METHODS In this prospective cross-sectional cohort study, using validated and age-appropriate anxiety scales administered with electronic survey questionnaires, we used generalized linear regressions to compare anxiety between patients undergoing OIT and similar patients with peanut allergy but not on OIT (controls). RESULTS In the younger cohort (<7 years, n = 80), there was generally a low prevalence of diagnosable anxiety across patients on OIT and controls. In the older cohort (>7 years, n = 125), there was a higher prevalence of anxiety but no clinically meaningful difference between anxiety scores of patients on OIT and controls. In the older cohort, patients with asthma were more likely to have higher mean anxiety scores (P = .04), as were female patients compared with male patients (P = .004). A subanalysis of separation anxiety scores in the older cohort revealed that younger age (7-12 years vs >12 years, P < .001), non-White race (P = .04), and eczema (P = .02) were found to be meaningful predictors of higher scores. A subanalysis of social anxiety on the older cohort pointed toward non-White race as a meaningful predictor of higher scores (P < .02). CONCLUSION The clinical implications of these findings suggest that allergists should particularly consider screening children with food allergy for anxiety and anxiety subtypes among patients who are non-White, female, or have asthma.
Collapse
Affiliation(s)
- Kelsey Kaman
- Connecticut Asthma and Allergy Center, West Hartford, Connecticut.
| | | | | | | | - Jeffrey Factor
- Connecticut Asthma and Allergy Center, West Hartford, Connecticut; New England Food Allergy Treatment Center, West Hartford, Connecticut
| | | |
Collapse
|
17
|
Lee DT, Bruno CJ, Sharifi M, Shabanova V, Johnston LC. Assessing Barriers to Utilization of Premedication for Neonatal Intubation Based on the Theoretical Domains Framework. Am J Perinatol 2023. [PMID: 36646097 DOI: 10.1055/s-0042-1760449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study aimed to identify barriers and facilitators of premedication utilization for nonemergent neonatal intubations (NIs) in a level IV neonatal intensive care unit (NICU). STUDY DESIGN Between November 2018 and January 2019, multidisciplinary providers at a level IV NICU were invited to participate in an anonymous, electronic survey based on Theoretical Domains Framework to identify influences on utilization of evidence-based recommendations for NI premedication. RESULTS Of 186 surveys distributed, 84 (45%) providers responded. Most agreed with premedication use in the following domains: professional role/identity (86%), emotions (79%), skills (72%), optimism (71%), and memory, attention, and decision process (71%). Domains with less agreement include social influences (42%), knowledge (57%), intention (60%), belief about capabilities (63%), and behavior regulation (64%). Additional barriers include environmental context and resources, and beliefs about consequences. CONCLUSION Several factors influence premedication use for nonemergent NI and may serve as facilitators and/or barriers. Efforts to address barriers should incorporate a multidisciplinary approach to improve patient outcomes and decrease procedure-related pain. KEY POINTS · Premedication for NIs can optimize conditions and decrease rates of tracheal intubation adverse events but there is significant international and institutional variation for premedication use for NI.. · Guided by implementation science methods, the Theoretical Domains Framework was utilized to construct a novel assessment tool to determine potential barriers to and facilitators of the use of premedication for NI.. · Several factors influence premedication for nonemergent NI..
Collapse
Affiliation(s)
- Dianne T Lee
- Department of Pediatrics, Children's Mercy Kansas City Hospital, Kansas City, Missouri
| | - Christie J Bruno
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Mona Sharifi
- Department of Pediatrics, Center for Implementation Science, Yale University School of Medicine, New Haven, Connecticut
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Lindsay C Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
18
|
Liu EG, Zhang B, Martin V, Anthonypillai J, Kraft M, Grishin A, Grishina G, Catanzaro JR, Chinthrajah S, Sindher T, Manohar M, Quake AZ, Nadeau K, Burks AW, Kim EH, Kulis MD, Henning AK, Jones SM, Leung DYM, Sicherer SH, Wood RA, Yuan Q, Shreffler W, Sampson H, Shabanova V, Eisenbarth SC. Food-specific immunoglobulin A does not correlate with natural tolerance to peanut or egg allergens. Sci Transl Med 2022; 14:eabq0599. [PMID: 36383680 PMCID: PMC10219469 DOI: 10.1126/scitranslmed.abq0599] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ImmunoglobulinA (IgA) is the predominant antibody isotype in the gut, where it regulates commensal flora and neutralizes toxins and pathogens. The function of food-specific IgA in the gut is unknown but is presumed to protect from food allergy. Specifically, it has been hypothesized that food-specific IgA binds ingested allergens and promotes tolerance by immune exclusion; however, the evidence to support this hypothesis is indirect and mixed. Although it is known that healthy adults have peanut-specific IgA in the gut, it is unclear whether children also have gut peanut-specific IgA. We found in a cohort of non-food-allergic infants (n = 112) that there is detectable stool peanut-specific IgA that is similar to adult quantities of gut peanut-specific IgA. To investigate whether this peanut-specific IgA is associated with peanut tolerance, we examined a separate cohort of atopic children (n = 441) and found that gut peanut-specific IgA does not predict protection from development of future peanut allergy in infants nor does it correlate with concurrent oral tolerance of peanut in older children. We observed higher plasma peanut-specific IgA in those with peanut allergy. Similarly, egg white-specific IgA was detectable in infant stools and did not predict egg tolerance or outgrowth of egg allergy. Bead-based epitope assay analysis of gut peanut-specific IgA revealed similar epitope specificity between children with peanut allergy and those without; however, gut peanut-specific IgA and plasma peanut-specific IgE had different epitope specificities. These findings call into question the presumed protective role of food-specific IgA in food allergy.
Collapse
Affiliation(s)
- Elise G. Liu
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
- Department of Medicine, Section of Rheumatology, Allergy, and Immunology, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Biyan Zhang
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
- Singapore Immunology Network, Agency for Science, Technology, and Research, Singapore 138648, Singapore
| | - Victoria Martin
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Food Allergy Center, Massachusetts General Hospital, MGH Professional Office Building, Suite 530, 275 Cambridge Street, Boston, MA 02114, USA
- Food Allergy Science Initiative, Broad Institute, Cambridge, MA 02142, USA
| | - John Anthonypillai
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
- Department of Medicine, Section of Rheumatology, Allergy, and Immunology, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Magdalena Kraft
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Alexander Grishin
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Galina Grishina
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jason R. Catanzaro
- Section of Pulmonology, Allergy, Immunology, and Sleep Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - Tina Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - Monali Manohar
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - Antonia Zoe Quake
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - A. Wesley Burks
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Edwin H. Kim
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Michael D. Kulis
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | | | - Stacie M. Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, AR 72205, USA
| | - Donald Y. M. Leung
- Department of Pediatrics, Division of Pediatric Allergy-Immunology, National Jewish Health, Denver, CO 80206, USA
| | - Scott H. Sicherer
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Robert A. Wood
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Qian Yuan
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Food Allergy Center, Massachusetts General Hospital, MGH Professional Office Building, Suite 530, 275 Cambridge Street, Boston, MA 02114, USA
- Food Allergy Science Initiative, Broad Institute, Cambridge, MA 02142, USA
- Pediatrics at Newton Wellesley, Newton, MA 02462, USA
| | - Wayne Shreffler
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Food Allergy Center, Massachusetts General Hospital, MGH Professional Office Building, Suite 530, 275 Cambridge Street, Boston, MA 02114, USA
- Food Allergy Science Initiative, Broad Institute, Cambridge, MA 02142, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hugh Sampson
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Stephanie C. Eisenbarth
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
- Department of Medicine, Section of Rheumatology, Allergy, and Immunology, Yale University School of Medicine, New Haven, CT 06519, USA
| |
Collapse
|
19
|
Mew EJ, Nyhan K, Bonumwezi JL, Blas V, Gorman H, Hennein R, Quach K, Shabanova V, Hawley NL, Lowe SR. Psychosocial family-level mediators in the intergenerational transmission of trauma: Protocol for a systematic review and meta-analysis. PLoS One 2022; 17:e0276753. [PMID: 36378630 PMCID: PMC9665367 DOI: 10.1371/journal.pone.0276753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Family-level psychosocial factors appear to play a critical role in mediating the intergenerational transmission of trauma; however, no review article has quantitatively synthesized causal mechanisms across a diversity of trauma types. This study aims to systematically consolidate the epidemiological research on family-level psychosocial mediators and moderators to ultimately produce causal diagram(s) of the intergenerational transmission of trauma. METHODS We will identify epidemiological peer-reviewed publications, dissertations, and conference abstracts that measure the impact of at least one psychosocial family-level factor mediating or moderating the relationship between parental trauma exposure and a child mental health outcome. English, French, Kinyarwanda, and Spanish articles will be eligible. We will search MEDLINE, PsycINFO, PTSDpubs, Scopus, and ProQuest Dissertations and Theses and will conduct forward citation chaining of included documents. Two reviewers will perform screening independently. We will extract reported mediators, moderators, and relevant study characteristics for included studies. Findings will be presented using narrative syntheses, descriptive analyses, mediation meta-analyses, moderating meta-analyses, and causal diagram(s), where possible. We will perform a risk of bias assessment and will assess for publication bias. DISCUSSION The development of evidence-based causal diagram(s) would provide more detailed understanding of the paths by which the psychological impacts of trauma can be transmitted intergenerationally at the family-level. This review could provide evidence to better support interventions that interrupt the cycle of intergenerational trauma. TRIAL REGISTRATION Systematic review registration: PROSPERO registration ID #CRD42021251053.
Collapse
Affiliation(s)
- Emma J. Mew
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, United States of America
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Jessica L. Bonumwezi
- Department of Psychology, Montclair State University, Montclair, New Jersey, United States of America
| | - Vanessa Blas
- Yale College, Yale University, New Haven, Connecticut, United States of America
| | - Hannah Gorman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Rachel Hennein
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Kevin Quach
- Yale College, Yale University, New Haven, Connecticut, United States of America
| | - Veronika Shabanova
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Sarah R. Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| |
Collapse
|
20
|
Abstract
OBJECTIVE We examined weight loss patterns and feeding practices of infants hospitalized for neonatal opioid withdrawal syndrome (NOWS) managed by the eat, sleep, console approach, which emphasizes nonpharmacologic treatment. Although feeding practices during hospitalization vary widely, weight loss patterns for infants managed under this approach have not yet been described. METHODS Of 744 infants with NOWS born from 2014 to 2019 at our institution, 330 met inclusion criteria (≥35 weeks' gestation and no NICU transfer). We examined maximum weight loss and created weight loss percentile curves by delivery type using mixed effects quantile modeling with spline effect for hour of life; 95% confidence intervals (CI) were compared to published early weight loss nomograms. RESULTS In the cohort, the mean gestational age was 39.2 weeks, mean birth weight was 3.1 kg, and mean length of stay was 6.5 days; 94.6% did not require pharmacologic treatment. Median percent weight loss was significantly more compared to early weight loss nomograms for both vaginally-delivered infants at 48 hours (6.9% [95% CI: 5.8-8.5] vs 2.9%) and cesarean-delivered infants at 48 hours (6.5% [95% CI: 4.1-9.1] vs 3.7%) and 72 hours (7.2% [95%CI 4.7-9.9] vs 3.5%), all P < .001. Overall, 27.9% lost >10% birth weight. CONCLUSIONS We demonstrate weight loss patterns of infants with NOWS managed by the eat, sleep, console approach at a single center. Infants with NOWS lose significantly more weight than nonopioid exposed infants and are at increased risk of morbidity and health care use. Studies to address optimal feeding methods in these infants are warranted.
Collapse
|
21
|
Buck CO, Shabanova V, Taylor SN. Growth patterns among late preterm infants of mothers with diabetes. J Matern Fetal Neonatal Med 2022; 35:10116-10123. [PMID: 36075588 DOI: 10.1080/14767058.2022.2119125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Exposure to diabetes mellitus during pregnancy increases the risk of offspring obesity and cardiometabolic disease. Limited information exists regarding growth patterns among preterm infants exposed to maternal diabetes. This study describes growth differences during early childhood among late preterm infants of mothers with and without diabetes during pregnancy. MATERIALS AND METHODS In a retrospective longitudinal analysis, weight trajectories from birth to age 2 years were compared between diabetes exposure groups (N = 1554) using mixed effects modeling and adjusting for maternal and infant demographic covariates. RESULTS Overall, 134 (9%) infants were exposed to diabetes (DM-group). DM-group had higher average weight (adjusted difference 300 g [95% CI: 228, 371]) and weight z-score (adjusted difference 0.67 standard deviation scores (SDS) [95% CI: 0.50, 0.84]) compared with unexposed infants. DM-group infants had accelerated weight gain from birth to discharge (adjusted weight difference 31.8 g [95% CI: 12.5, 51.1], adjusted weight z-score difference 0.07 SDS [95% CI: 0.02, 0.11]) compared with unexposed infants, including in the first postnatal week (adjusted weight gain velocity difference, day 0-3: 6.07 g/day [95% CI: 0.88, 11.25]; day 3-7: 8.37 g/day [95% CI: 1.60, 15.13]). Through age two, infants in the DM-group maintained higher average weight (adjusted difference 185.7 g [95% CI: 37.2, 334.3]) and weight z-score (adjusted difference 0.32 SDS [95% CI: 0.09, 0.55]) than unexposed infants, with greater weight gain between 18 and 24 months (adjusted difference 28.5 g/week [95% CI: 2.6, 54.4]). CONCLUSIONS Maternal diabetes exposed late preterm infants had higher weight from birth to age two and greater weight gain in the first postnatal week than unexposed infants. Long term risk associated with weight trajectories in this population requires further study.
Collapse
Affiliation(s)
- Catherine O Buck
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Sarah N Taylor
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
22
|
Rosenberg J, Shabanova V, McCollum S, Sharifi M. Insurance and Health Care Outcomes in Regions Where Undocumented Children Are Medicaid-Eligible. Pediatrics 2022; 150:e2022057034. [PMID: 36004541 PMCID: PMC10171371 DOI: 10.1542/peds.2022-057034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Expansion of insurance eligibility is associated with positive health outcomes. We compared uninsurance and health care utilization for (1) all children, and (2) children in immigrant families (CIF) and non-CIF who resided inside and outside of the seven US states/territories offering public health insurance to children regardless of documentation status ("extended-eligibility states/territories"). METHODS Using the cross-sectional, nationally representative National Survey of Children's Health-2019, we used survey-weighted, multivariable Poisson regression to assess the association of residence in nonextended- versus extended-eligibility states/territories with uninsurance and with health care utilization measures for (1) all children, and (2) CIF versus non-CIF, adjusting for demographic covariates. RESULTS Of the 29 433 respondents, the 4035 (weighted 27.2%) children in extended- versus nonextended-eligibility states/territories were more likely to be CIF (27.4% vs 20.5%, P < .001), 12 to 17 years old (37.2% vs 33.2%, P = .048), non-White (60.1% vs 45.9%, P < .001), and have a non-English primary language (20.6% vs 11.1%, P < .001).The relative risk of uninsurance for children in nonextended- versus extended-eligibility states/territories was 2.0 (95% confidence interval 1.4-3.0), after adjusting for covariates. Fewer children in extended- versus nonextended-eligibility states/territories were uninsured (adjusted prevalence 3.7% vs 7.5%, P < .001), had forgone medical (2.2% vs 3.1%, P = .07) or dental care (17.1% vs 20.5%, P = .02), and had no preventive visit (14.3% vs 17.0%, P = .04). More CIF than non-CIF were uninsured, regardless of residence in nonextended- versus extended-eligibility states/territories: CIF 11.2% vs 5.7%, P < .001; non-CIF 6.1% vs 3.1% P < .001. CONCLUSIONS Residence in nonextended-eligibility states/territories, compared with in extended-eligibility states/territories, was associated with higher uninsurance and less preventive health care utilization.
Collapse
|
23
|
Tricò D, McCollum S, Samuels S, Santoro N, Galderisi A, Groop L, Caprio S, Shabanova V. Mechanistic Insights Into the Heterogeneity of Glucose Response Classes in Youths With Obesity: A Latent Class Trajectory Approach. Diabetes Care 2022; 45:1841-1851. [PMID: 35766976 PMCID: PMC9346992 DOI: 10.2337/dc22-0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In a large, multiethnic cohort of youths with obesity, we analyzed pathophysiological and genetic mechanisms underlying variations in plasma glucose responses to a 180 min oral glucose tolerance test (OGTT). RESEARCH DESIGN AND METHODS Latent class trajectory analysis was used to identify various glucose response profiles to a nine-point OGTT in 2,378 participants in the Yale Pathogenesis of Youth-Onset T2D study, of whom 1,190 had available TCF7L2 genotyping and 358 had multiple OGTTs over a 5 year follow-up. Insulin sensitivity, clearance, and β-cell function were estimated by glucose, insulin, and C-peptide modeling. RESULTS Four latent classes (1 to 4) were identified based on increasing areas under the curve for glucose. Participants in class 3 and 4 had the worst metabolic and genetic risk profiles, featuring impaired insulin sensitivity, clearance, and β-cell function. Model-predicted probability to be classified as class 1 and 4 increased across ages, while insulin sensitivity and clearance showed transient reductions and β-cell function progressively declined. Insulin sensitivity was the strongest determinant of class assignment at enrollment and of the longitudinal change from class 1 and 2 to higher classes. Transitions between classes 3 and 4 were explained only by changes in β-cell glucose sensitivity. CONCLUSIONS We identified four glucose response classes in youths with obesity with different genetic risk profiles and progressive impairment in insulin kinetics and action. Insulin sensitivity was the main determinant in the transition between lower and higher glucose classes across ages. In contrast, transitions between the two worst glucose classes were driven only by β-cell glucose sensitivity.
Collapse
Affiliation(s)
- Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sarah McCollum
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Stephanie Samuels
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Nicola Santoro
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT.,Department of Medicine and Health Sciences, "V. Tiberio" University of Molise, Campobasso, Italy
| | - Alfonso Galderisi
- Pediatric Endocrinology, Hôpital Necker-Enfants Malades, Paris, France
| | - Leif Groop
- Department of Clinical Sciences, Genomics, Diabetes and Endocrinology, Lund University, Malmö, Sweden
| | - Sonia Caprio
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
24
|
Shum M, Moreno C, Kamody R, McCollum S, Shabanova V, Loyal J. The Evolving Needs of Children Hospitalized for Eating Disorders During the COVID-19 Pandemic. Hosp Pediatr 2022; 12:696-702. [PMID: 35815415 DOI: 10.1542/hpeds.2022-006545] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Throughout the COVID-19 pandemic, there has been an increase in hospital admissions for adolescents with eating disorders (EDs). However, there is a paucity of information on how this increase has affected hospitalization courses and disposition planning. We sought to describe the changes in hospitalizations for EDs at our institution during the pandemic. METHODS We reviewed charts of patients admitted to our academic medical center for nutritional restoration from January 1, 2017, to June 30, 2021. We report differences in patient characteristics and hospitalization courses using descriptive statistics and Poisson regression. RESULTS We reviewed charts for 85 patients for 108 hospital admissions. Admissions increased from 1.4 per month prepandemic to 3.6 per month during the pandemic (P < .001). Most patients were female (91%), White (79%), had private insurance, (80%) and had restrictive eating behaviors (97%). During the pandemic, we found (1) an increase in the average length of stay (12.6 days vs. 18.0 days) with younger age associated with longer length of stay (P < .001); (2) more patients requiring psychotropic medication management (11% vs 31%, P = .01); and (3) fewer patients discharged from the hospital with outpatient therapy (43% vs 24%, P = .03). CONCLUSIONS In addition to an increase in hospital admissions for ED management during the pandemic, our study highlights the evolving needs of ED patients during their hospitalizations. The implications of longer admissions with higher acuity at discharge represent areas where appropriate adaptations in inpatient management and disposition planning may improve the quality of care for ED patients.
Collapse
Affiliation(s)
| | | | | | - Sarah McCollum
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | | | - Jaspreet Loyal
- Department of Pediatrics, Yale University, New Haven, Connecticut
| |
Collapse
|
25
|
Gorfinkel L, Hansen CE, Teng W, Shabanova V, Prozora S, Rodwin R, Qadri U, Manghi T, Emerson B, Riera A. Clinical decision rule for obtaining peripheral blood cultures in febrile oncology patients. Pediatr Blood Cancer 2022; 69:e29519. [PMID: 34939321 DOI: 10.1002/pbc.29519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The utility of peripheral blood cultures in pediatric oncology patients presenting with fever is controversial. A recent systematic review showed that about one in 40 bloodstream infections (BSIs) would be missed if only central venous line (CVL) cultures are obtained. OBJECTIVE To derive a clinical decision rule for obtaining peripheral blood cultures in pediatric oncology patients presenting to a pediatric emergency department (PED) with fever and a CVL. DESIGN/METHOD A retrospective chart review was performed on pediatric oncology patients referred to the PED for fever while on therapy. Logistic regression with a random intercept was used to determine independent predictors of BSI and generate a prediction model for obtaining peripheral blood cultures. The decision rule was generated from the best performance as measured by a receiver operator curve. Bootstrapping analysis was performed for internal validation. RESULTS Predictors that were significant and independently associated with positive peripheral blood cultures included vasopressor support (odds ratio [OR] 16.5, 95% confidence interval [CI]: 2.80-97.71), acute myeloid leukemia (AML) diagnosis (OR 6.9, 95% CI: 1.81-25.98), hypotension (OR 4.0, 95% CI: 1.05-15.17), mucositis (OR 8.2, 95% CI: 2.48-27.01), and maximum temperature in PED ≥39°C (OR 6.6, 95% CI: 2.36-18.20). The area under the curve (AUC) for this model was 0.90 (95% CI: 0.82-0.97) in the derivation cohort and 0.90 (95% CI: 0.81-0.98) after the internal validation. CONCLUSIONS We derived a clinical prediction model for deciding when to obtain peripheral blood cultures in febrile oncology patients with CVLs on active therapy. Future studies should focus on prospective and external validation of this diagnostic prediction tool.
Collapse
Affiliation(s)
- Lev Gorfinkel
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Caitlin E Hansen
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Wei Teng
- Yale New Haven Health, New Haven, CT, USA
| | - Veronika Shabanova
- Department of Biostatistics and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Stephanie Prozora
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Rozalyn Rodwin
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Umar Qadri
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Tomas Manghi
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Beth Emerson
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Antonio Riera
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
26
|
Valentino PL, Wang T, Shabanova V, Ng VL, Bucuvalas JC, Feldman AG, Gonzalez-Peralta RP, Gupta NA, Miloh TA, Mohammad S, Pace E, Sundaram SS, Yazigi NA, Soltys K. North American Biliary Stricture Management Strategies in Children After Liver Transplantation: A Multicenter Analysis From the Society of Pediatric Liver Transplantation (SPLIT) Registry. Liver Transpl 2022; 28:819-833. [PMID: 34837468 PMCID: PMC10167704 DOI: 10.1002/lt.26379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 01/09/2023]
Abstract
Biliary strictures affect 4%-12% of pediatric liver transplantations. Biliary strictures can contribute to graft loss if left untreated; however, there remains no consensus on the best course of treatment. Study objectives included analyses of outcomes associated with biliary stricture management strategies via percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP), or surgery. We identified pediatric liver transplantation recipients (2011-2016) with biliary strictures from the Society of Pediatric Liver Transplantation (SPLIT) registry and retrieved imaging, procedural, and operative reports from individual centers. Subanalyses were performed to specifically evaluate PTC and ERCP for "optimal biliary outcome" (OBO), defined as graft survival with stricture resolution and without recurrence or surgery. A total of 113 children with a median follow-up of 3.9 years had strictures diagnosed 100 days (interquartile range, 30-290) after liver transplantation; 81% were isolated anastomotic strictures. Stricture resolution was achieved in 92% within 101 days, more frequently with isolated anastomotic strictures (96%). 20% of strictures recurred, more commonly in association with hepatic artery thrombosis (32%). Patient and graft survival at 1 and 3 years were 99% and 98% and 94% and 92%, respectively. In a subgroup analysis of 79 patients with extrahepatic strictures managed by PTC/ERCP, 59% achieved OBO following a median of 4 PTC, and 75% following a median of 3 ERCP (P < 0.001). Among patients with OBO, those with ERCP had longer time intervals between successive procedures (41, 47, 54, 62, 71 days) than for PTC (27, 31, 36, 41, 48 days; P < 0.001). Allograft salvage was successful across all interventions. Stricture resolution was achieved in 92%, with 20% risk of recurrence. Resolution without recurrence was highest in patients with isolated anastomotic strictures and without hepatic artery thrombosis.
Collapse
Affiliation(s)
- Pamela L Valentino
- Section of Gastroenterology and Hepatology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Tianhao Wang
- Department of Statistics and Data Science, Yale University, New Haven, CT
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Vicky Lee Ng
- Transplant and Regenerative Medicine Center, Hospital for Sick Kids, University of Toronto, Toronto, ON, Canada
| | | | - Amy G Feldman
- Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO
| | - Regino P Gonzalez-Peralta
- Division of Pediatric Gastroenterology, Hepatology and Liver Transplantation, AdventHealth for Children, AdventHealth Transplant Institute, Orlando, FL
| | | | - Tamir A Miloh
- Division of Hepatology, Holtz Children's Hospital, University of Miami, Miami, FL
| | - Saeed Mohammad
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Erika Pace
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Shikha S Sundaram
- Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO
| | - Nada A Yazigi
- MedStar Georgetown Transplant Institute, Washington, DC
| | - Kyle Soltys
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | |
Collapse
|
27
|
Hatfield M, Ciaburri R, Shaikh H, Wilkins KM, Bjorkman K, Goldenberg M, McCollum S, Shabanova V, Weiss P. Addressing Mistreatment of Providers by Patients and Family Members as a Patient Safety Event. Hosp Pediatr 2022; 12:181-190. [PMID: 35102377 DOI: 10.1542/hpeds.2021-006267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Mistreatment of health care providers (HCPs) is associated with burnout and lower-quality patient care, but mistreatment by patients and family members is underreported. We hypothesized that an organizational strategy that includes training, safety incident reporting, and a response protocol would increase HCP knowledge, self-efficacy, and reporting of mistreatment. METHODS In this single-center, serial, cross-sectional study, we sent an anonymous survey to HCPs before and after the intervention at a 213-bed tertiary care university children's hospital between 2018 and 2019. We used multivariable logistic regression to examine the effect of training on the outcomes of interest and whether this association was moderated by staff role. RESULTS We received 309 baseline surveys from 72 faculty, 191 nurses, and 46 residents, representing 39.1%, 27.1%, and 59.7%, respectively, of eligible HCPs. Verbal threats from patients or family members were reported by 214 (69.5%) HCPs. Offensive behavior was most commonly based on provider age (85, 28.5%), gender (85, 28.5%), ethnicity or race (55, 18.5%), and appearance (43, 14.6%) but varied by role. HCPs who received training had a higher odds of reporting knowledge, self-efficacy, and experiencing offensive behavior. Incident reporting of mistreatment increased threefold after the intervention. CONCLUSIONS We report an effective organizational approach to address mistreatment of HCPs by patients and family members. Our approach capitalizes on existing patient safety culture and systems that can be adopted by other institutions to address all forms of mistreatment, including those committed by other HCPs.
Collapse
Affiliation(s)
| | | | - Henna Shaikh
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | | | - Kurt Bjorkman
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | | | - Sarah McCollum
- Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Pnina Weiss
- Pediatrics, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
28
|
Drago MJ, Shabanova V, Hochreiter D, Grossman M, Mercurio M. Does Maternal Incarceration Impact Infants with Neonatal Abstinence Syndrome? Matern Child Health J 2022; 26:1095-1103. [PMID: 35088297 DOI: 10.1007/s10995-021-03356-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Opioid exposed infants born to incarcerated women represent a vulnerable and understudied subset of infants with neonatal abstinence syndrome (NAS). The impact of maternal incarceration on length of stay (LOS) for infants with NAS is unknown. We hypothesized that infants with NAS born to incarcerated women have longer hospitalizations compared to infants with NAS born to non-incarcerated women. METHODS This is a retrospective cohort study of infants with NAS born between 2011 and 2018 at the primary delivery site for Connecticut's only women's prison. Opioid exposed infants were assessed by Finnegan Scores for withdrawal and received morphine as a first line agent and phenobarbital as a second line agent. LOS was compared using Poisson regression. RESULTS Of 206 infants identified, 166 were included in the analysis, with 28 born to incarcerated women and 138 to non-incarcerated women. Incarcerated women were more likely to report prenatal alcohol use, 14.3% vs 2.2% p = 0.016 and benzodiazepine use 21.4% vs 7.3% p = 0.032. Infants of incarcerated women were less likely to be fed breast milk at discharge, 3.6% vs 37% p < 0.001. Adjusted mean LOS was longer among infants born to incarcerated women, 18.5 vs 16.6 days (p = 0.009). CONCLUSIONS FOR PRACTICE Infants with NAS born to incarcerated women in Connecticut had longer LOS, lower rates of being fed breast milk, and different prenatal substance exposures than infants with NAS born to non-incarcerated women. Supporting the maternal-infant dyad until infant discharge may mitigate the potential negative impact of maternal incarceration on the care of infants with NAS.
Collapse
Affiliation(s)
- Matthew J Drago
- Department of Pediatrics, Section of Neonatology, Yale School of Medicine, New Haven, CT, USA. .,Division of Newborn Medicine, Icahn School of Medicine at Mount Sinai, 1176 Fifth Avenue, 3rd Floor, New York, NY, 10029, USA.
| | - Veronika Shabanova
- Department of Pediatrics, Section of General Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Daniela Hochreiter
- Department of Pediatrics, Section of Hospitalist Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Matthew Grossman
- Department of Pediatrics, Section of Hospitalist Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Mark Mercurio
- Department of Pediatrics, Section of Neonatology, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
29
|
Markowitz MA, Harper A, Rosenthal MS, Shabanova V, Cook E, Chen J, Rosenthal A, Shapiro ED, Horowitz S, Sude L. A Medical Financial Partnership in a Pediatric Medical Home. J Health Care Poor Underserved 2022; 33:136-148. [DOI: 10.1353/hpu.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
30
|
Abstract
OBJECTIVES Capnography has established benefit during intubation and cardiopulmonary resuscitation (CPR). Implementation within emergency departments (EDs) has lagged. We sought to address barriers to improve documented capnography use for patients requiring intubation or CPR. METHODS A controlled before- and after-implementation study was performed in 2 urban EDs. The control site had an existing policy for capnography use. Interventions for the experimental site included a 5-minute informational video, placement of capnography monitors with a shortened warm-up period in all resuscitation rooms, laminated reminder cards, and feedback during staff meetings. Staff members were surveyed about knowledge before and after the intervention. Records were reviewed for documented capnography use for 3 months before and 6 months after the intervention. Change in documented use at the experimental site was compared with the control site. RESULTS At the experimental site, 118 providers participated and 190 records were reviewed; 544 records were reviewed from the control site. There was a significant increase in the proportion of documented capnography use at the experimental site (8% versus 19%, P = 0.04) compared with the control site (64% versus 71%, P = 0.10). However, there was no significant trend over time at the experimental site after the intervention (P = 0.86). Despite high baseline knowledge about capnography, providers had improvements in survey responses regarding indications for intubation and CPR, normal values, and minimum effective values during CPR. CONCLUSIONS Documented capnography use increased with simple interventions but with no positive trend. Additional work is needed to improve use, including further evaluation of capnography's implementation in the ED.
Collapse
Affiliation(s)
- Rahul Shah
- From the Department of Pediatrics, Yale University School of Medicine
| | | | - Marc Auerbach
- Section of Pediatric Emergency Medicine, Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Melissa L. Langhan
- Section of Pediatric Emergency Medicine, Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
31
|
He M, Leone DM, Frye R, Ferdman DJ, Shabanova V, Kosiv KA, Sugeng L, Faherty E, Karnik R. Longitudinal Assessment of Global and Regional Left Ventricular Strain in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C). Pediatr Cardiol 2022; 43:844-854. [PMID: 34993558 PMCID: PMC8739007 DOI: 10.1007/s00246-021-02796-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is one of the most significant sequela of coronavirus disease 2019 (COVID-19) in children. Emerging literature has described myocardial dysfunction in MIS-C patients using traditional and two-dimensional speckle tracking echocardiography in the acute phase. However, data regarding persistence of subclinical myocardial injury after recovery is limited. We aimed to detect these changes with deformation imaging, hypothesizing that left ventricular global longitudinal (GLS) and circumferential strain (GCS) would remain impaired in the chronic phase despite normalization of ventricular function parameters assessed by two-dimensional echocardiography. A retrospective, single-institution review of 22 patients with MIS-C was performed. Fractional shortening, GLS, and GCS, along with regional longitudinal (RLS) and circumferential strain (RCS) were compared across the acute, subacute, and chronic timepoints (presentation, 14-42, and > 42 days, respectively). Mean GLS improved from - 18.4% in the acute phase to - 20.1% in the chronic phase (p = 0.4). Mean GCS improved from - 19.4% in the acute phase to - 23.5% in the chronic phase (p = 0.03). RCS and RLS were impaired in the acute phase and showed a trend towards recovery by the chronic phase, with the exception of the basal anterolateral segment. In our longitudinal study of MIS-C patients, GLS and GCS were lower in the acute phase, corroborating with left ventricular dysfunction by traditional measures. Additionally, as function globally recovers, GLS and GCS also normalize. However, some regional segments continue to have decreased strain values which may be an important subclinical marker for future adverse events.
Collapse
Affiliation(s)
- Michael He
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
| | - David M. Leone
- grid.47100.320000000419368710Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Richard Frye
- grid.47100.320000000419368710Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Dina J. Ferdman
- grid.47100.320000000419368710Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Veronika Shabanova
- grid.47100.320000000419368710Department of Pedatrics, Department of Biostatistics, Yale School of Medicine, New Haven, CT USA
| | - Katherine A. Kosiv
- grid.47100.320000000419368710Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Lissa Sugeng
- grid.47100.320000000419368710Department Medicine, Section of Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Erin Faherty
- grid.47100.320000000419368710Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Ruchika Karnik
- grid.47100.320000000419368710Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT USA
| |
Collapse
|
32
|
Lewis JB, Cunningham SD, Shabanova V, Hassan SS, Magriples U, Rodriguez MG, Ickovics JR. Group prenatal care and improved birth outcomes: Results from a type 1 hybrid effectiveness-implementation study. Prev Med 2021; 153:106853. [PMID: 34678329 DOI: 10.1016/j.ypmed.2021.106853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
To compare birth outcomes for patients receiving Expect With Me (EWM) group prenatal care or individual care only, we conducted a type 1 hybrid effectiveness-implementation trial (Detroit and Nashville, 2014-2016). Participants entered care <24 weeks gestation, had singleton pregnancy, and no prior preterm birth (N = 2402). Mean participant age was 27.1 (SD = 5.77); 49.5% were Black; 15.3% were Latina; 59.7% publicly insured. Average treatment effect of EWM compared to individual care only was estimated using augmented inverse probability weighting (AIPW). This doubly-robust analytic method produces estimates of causal association between treatment and outcome in the absence of randomization. AIPW was effective at creating equivalent groups for potential confounders. Compared to those receiving individual care only, EWM patients did significantly better on three of four primary outcomes: lower risk of infants born preterm (<37 weeks gestation; 6.4% vs. 15.1%, risk ratio (RR) 0.42, 95% Confidence Interval (CI) 0.29, 0.54), low birthweight (<2500 g; 4.3% vs. 11.6%, RR 0.37, 95% CI 0.24, 0.49), and admission to NICU (9.4% vs. 14.6%, RR 0.64, 95% CI 0.49, 0.78). There was no difference in small for gestational age (<10% percentile of weight for gestational age). EWM patients attended a mean of 5.9 group visits (SD = 2.7); 70% attended ≥5 group visits. Post-hoc analyses indicated EWM patients utilizing the integrated information technology platform had lower risk for low birthweight infants (RR 0.47, 95% CI 0.24, 0.86) than non-users. Future research is needed to understand mechanisms by which group prenatal care improves outcomes, best practices for implementation, and health systems savings. Trial registration: ClinicalTrials.govNCT02169024.
Collapse
Affiliation(s)
- Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America.
| | - Shayna D Cunningham
- Department of Public Health Sciences, UConn Health, Farmington, CT, United States of America
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America
| | - Sonia S Hassan
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, United States of America; Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, United States of America
| | - Urania Magriples
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States of America
| | - Marisa G Rodriguez
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
| |
Collapse
|
33
|
Tarabra E, Nouws J, Vash-Margita A, Hellerstein M, Shabanova V, McCollum S, Pierpont† B, Zhao D, Shulman GI, Caprio S. CIDEA expression in SAT from adolescent girls with obesity and unfavorable patterns of abdominal fat distribution. Obesity (Silver Spring) 2021; 29:2068-2080. [PMID: 34672413 PMCID: PMC8612981 DOI: 10.1002/oby.23295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/29/2021] [Accepted: 08/23/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study investigated whether variations in cell death-inducing DNA fragmentation factor alpha subunit-like effector A (CIDEA) mRNA expression and protein levels are modulated by the pattern of abdominal fat distribution in adolescent girls with obesity. METHODS This study recruited 35 adolescent girls with obesity and characterized their abdominal fat distribution by magnetic resonance imaging. Participants had only a periumbilical/abdominal (n = 14) or a paired abdominal and gluteal subcutaneous adipose tissue (SAT) biopsy (n = 21). CIDEA expression was determined by reverse transcription-polymerase chain reaction, CIDEA protein level by Western blot, and the turnover of adipose lipids and adipocytes by 2 H2 O labeling. In six girls, a second abdominal SAT biopsy was performed (after ~34.2 months) to explore the weight gain effect on CIDEA expression in abdominal SAT. RESULTS CIDEA expression decreased in abdominal SAT from participants with high visceral adipose tissue (VAT)/(VAT+SAT); CIDEA inversely correlated with number of small adipocytes, with the increase in preadipocyte proliferation, and with adipogenesis. A strong inverse correlation was found between CIDEA protein level with the newly synthetized glycerol (r = -0.839, p = 0.0047). Following weight gain, an increase in adipocytes' cell diameter with a decrease in CIDEA expression and RNA-sequencing transcriptomic profile typical of adipocyte dysfunction was observed. CONCLUSIONS Reduced expression of CIDEA in girls with high VAT/(VAT+SAT) is associated with adipocyte hypertrophy and insulin resistance.
Collapse
Affiliation(s)
- Elena Tarabra
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Jessica Nouws
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Marc Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California at Berkeley, Berkeley, CA, USA
| | - Veronika Shabanova
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Sarah McCollum
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Bridget Pierpont†
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Dejian Zhao
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | - Gerald I Shulman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Sonia Caprio
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
34
|
Wu B, Arslanian KJ, Nyhan K, Taylor S, Shabanova V, Muasau-Howard B, Hawley NL. Preterm birth among Pacific Islander women and related perinatal outcomes: a scoping review protocol. BMJ Open 2021; 11:e050483. [PMID: 34728448 PMCID: PMC8565552 DOI: 10.1136/bmjopen-2021-050483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Infants born alive <37 weeks are classified as premature. The global estimate of preterm birth in 2014 was 10.6%, and it is the leading cause of death of children under the age of 5 years. Preterm birth disproportionately affects women of minority populations, yet knowledge about the incidence and associated outcomes among Pacific Islanders is limited. The objectives of this scoping review are to identify studies that describe risk factors, maternal-child health outcomes and existing interventions to prevent preterm birth among Pacific Islanders, and to summarise the barriers and facilitators to decrease the burden. METHODS AND ANALYSIS We will follow the Joanna Briggs Institute Manual for Evidence Synthesis for scoping reviews and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) to conduct this scoping review. The Covidence web application will be used for data management and consensus review. We will search on MEDLINE ALL (Ovid), EMBASE (Ovid), Web of Science Core Collection (as licensed at Yale), the Cochrane Library, CINAHL (EBSCOhost) and two non-indexed regional journals (Pacific Journal of Reproductive Health and Pacific Health Dialog). Title-abstract and full-text screening of eligible studies will be performed by two authors, and data will be extracted by the first author. Outcomes extracted will be presented using evidence mapping. ETHICS AND DISSEMINATION Findings will drive suggestions for new data collection needed to fill knowledge gaps and improve future study designs to decrease the burden of preterm birth among Pacific Islanders. There are no ethical concerns. This protocol will be disseminated in related peer-reviewed journals.
Collapse
Affiliation(s)
- Bohao Wu
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Kendall J Arslanian
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
- Department of Environmental Health Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Sarah Taylor
- Division of Neonatal-Perinatal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bethel Muasau-Howard
- Department of Obstetrics and Gynecology, Lyndon B Johnson Tropical Medical Center, Pago Pago, American Samoa
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
35
|
Weiss PG, Hatfield M, Ciaburri R, Shaikh H, Wilkins KM, Bjorkman K, Goldenberg M, McCollum S, Shabanova V. Mistreatment of Providers by Patients and Family Members: Effect of an Organizational Strategy on Provider Knowledge, Self-Efficacy, and Patient Safety Incident Reporting of Mistreatment. Acad Med 2021; 96:S217-S218. [PMID: 34705720 DOI: 10.1097/acm.0000000000004279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Pnina G Weiss
- Author affiliations: P.G. Weiss, K.M. Wilkins, M. Goldenberg, S. McCollum, V. Shabanova, Yale University School of Medicine
| | | | | | | | - Kirsten M Wilkins
- Author affiliations: P.G. Weiss, K.M. Wilkins, M. Goldenberg, S. McCollum, V. Shabanova, Yale University School of Medicine
| | - Kurt Bjorkman
- K. Bjorkman, University of Iowa Stead Family Children's Hospital
| | - Matthew Goldenberg
- Author affiliations: P.G. Weiss, K.M. Wilkins, M. Goldenberg, S. McCollum, V. Shabanova, Yale University School of Medicine
| | - Sarah McCollum
- Author affiliations: P.G. Weiss, K.M. Wilkins, M. Goldenberg, S. McCollum, V. Shabanova, Yale University School of Medicine
| | - Veronika Shabanova
- Author affiliations: P.G. Weiss, K.M. Wilkins, M. Goldenberg, S. McCollum, V. Shabanova, Yale University School of Medicine
| |
Collapse
|
36
|
Galuppo B, Cline G, Van Name M, Shabanova V, Wagner D, Kien CL, Santoro N. Colonic Fermentation and Acetate Production in Youth with and without Obesity. J Nutr 2021; 151:3292-3298. [PMID: 34494088 PMCID: PMC8562084 DOI: 10.1093/jn/nxab277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/12/2021] [Accepted: 07/29/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In the last few years, there has been a growing interest in the role of gut microbiota in the development of obesity and its complications. OBJECTIVES In this study, we tested the following hypotheses: 1) lean youth and youth with obesity experience a different capability of their gut microbiota to ferment carbohydrates and produce acetate; and 2) colonic acetate may serve as a substrate for hepatic de novo lipogenesis (DNL). METHODS Nineteen lean youth [mean ± SE BMI (in kg/m2): 21.8 ± 0.521] and 19 youth with obesity (BMI: 35.7 ± 1.66), ages 15-21 y, frequency-matched by age and sex, underwent a fasting 10-h sodium [d3]-acetate intravenous infusion to determine the rate of appearance of acetate (Raacet) into the peripheral circulation before and after an oral dose of 20 g of lactulose. Pre- and post-lactulose Raacet values were determined at a quasi-steady state and changes between groups were compared using a quantile regression model. Acetate-derived hepatic DNL was measured in 11 subjects (6 youth with obesity) and its association with Raacet was assessed using Spearman correlation. RESULTS Mean ± SE Raacet was not different before lactulose ingestion between the 2 groups (7.69 ± 1.02 μmol · kg-1 · min-1 in lean youth and 7.40 ± 1.73 μmol · kg-1 · min-1 in youth with obesity, P = 0.343). The increase in mean ± SE Raacet after lactulose ingestion was greater in lean youth than in youth with obesity (14.7 ± 2.33 μmol · kg-1 · min-1 and 9.29 ± 1.44 μmol · kg-1 · min-1, respectively, P = 0.001). DNL correlated with Raacet, calculated as changes from the pre- to the post-lactulose steady state (ρ = 0.621; P = 0.046). CONCLUSIONS These data suggest that youth with obesity ferment lactulose to a lesser degree than youth without obesity and that colonic acetate serves as a substrate for hepatic DNL.This trial was registered at clinicaltrials.gov as NCT03454828.
Collapse
Affiliation(s)
| | - Gary Cline
- Yale University School of Medicine, New Haven, CT, USA
| | | | | | | | - C Lawrence Kien
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | | |
Collapse
|
37
|
Vu TT, Rose JA, Shabanova V, Kou M, Zuckerbraun NS, Roskind CG, Baghdassarian A, Levasseur K, Leonard K, Langhan ML. Milestones comparisons from residency to pediatric emergency medicine fellowship: Resetting expectations. AEM Educ Train 2021; 5:e10600. [PMID: 34124529 PMCID: PMC8171776 DOI: 10.1002/aet2.10600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/13/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pediatric emergency medicine (PEM) fellowships accept trainees who have completed a residency in either emergency medicine (EM) or pediatrics and have adopted 17 subcompetencies with accompanying set of milestones from these two residency programs. This study aims to examine the changes in milestone scores among common subcompetencies from the end of EM or pediatrics residency to early PEM fellowship and evaluates time to reattainment of scores for subcompetencies in which a decline was noted. METHODS This is a national, retrospective cohort study of trainees enrolled in PEM fellowship programs from July 2014 to June 2018. PEM fellowship program directors voluntarily submitted deidentified milestone reports within the study time frame, including end-of-residency reports. Descriptive analyses of milestone scores between end of residency and PEM fellowship were performed. RESULTS Forty-eight U.S. PEM fellowship programs (65%) provided fellowship milestone data on 638 fellows, 218 (34%) of whom also had end-of-residency milestone scores submitted. Of 218 fellows eligible for analysis, 210 (96%) had completed a pediatrics residency and eight (4%) had completed an EM residency. Pediatric-trained fellows had statistically significant decreases in mean milestone scores in all 10 shared subcompetencies. Reattainment of milestone scores across all common subcompetencies for both EM and pediatric-trained PEM fellows occurred by the end of fellowship. CONCLUSIONS This study demonstrated declines in milestone scores from the end of primary residency training in pediatrics to early PEM fellowship in shared subcompetencies, which may suggest that performance expectations are reset at the beginning of PEM fellowship. Changes in subcompetency milestone anchors to provide subspecialty-specific context may be needed to more accurately define skills acquisition in the residency-to-fellowship transition.
Collapse
Affiliation(s)
- Tien T. Vu
- Children's Hospital ColoradoUniversity of Colorado SOM (School of Medicine)DenverColoradoUSA
| | - Jerri A. Rose
- Rainbow Babies & Children's HospitalCase Western Reserve Univ SOMClevelandOhioUSA
| | | | - Maybelle Kou
- Inova Children's HospitalVirginia Commonwealth University SOMFalls ChurchVirginiaUSA
| | - Noel S. Zuckerbraun
- Children's Hospital of PittsburghUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | | | - Aline Baghdassarian
- Children's Hospital of RichmondVirginia Commonwealth University SOMRichmondVirginiaUSA
| | - Kelly Levasseur
- Beaumont Children's HospitalOakland University William Beaumont SOMRoyal OakMichiganUSA
| | - Kathryn Leonard
- Washington University in St. Louis School of MedicineSt. LouisMissouriUSA
| | | |
Collapse
|
38
|
Roskind CG, Leonard K, Baghdassarian A, Kou M, Levasseur K, Rose JA, Shabanova V, Vu T, Zuckerbraun NS, Langhan ML. Pediatric emergency medicine fellows' milestone evaluations: Do they all meet the targets for graduation? AEM Educ Train 2021; 5:e10620. [PMID: 34222754 PMCID: PMC8212389 DOI: 10.1002/aet2.10620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/09/2021] [Accepted: 02/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The ACGME Milestone Project created a competency-based trainee assessment tool. Subcompetencies (SCs) are scored on a 5-point scale; level 4 is recommended for graduation. The 2018 Milestones Report found that across subspecialties, not all graduates attain level 4 for every SC. OBJECTIVE The objective was to describe the number of pediatric emergency medicine (PEM) fellows who achieve ≥ level 4 in all 23 SCs at graduation and identify SCs where level 4 is not achieved and factors predictive of not achieving a level 4. METHODS This is a multicenter, retrospective cohort study of PEM fellows from 2014 to 2018. Program directors provided milestone reports. Descriptive analysis of SC scores was performed. Subanalyses assessed differences in residency graduation scores, first-year fellowship scores, and the rate of milestone attainment between fellows who did and did not attain ≥ level 4 at graduation. RESULTS Data from 392 fellows were obtained. There were no SCs in which all fellows attained ≥ level 4 at graduation; the range of fellows scoring < level 4 per SC was 7% to 39%. A total of 67% of fellows did not attain ≥ level 4 on one or more SC. While some fellows failed to attain ≥ level 4 on up to all 23 SCs, 26% failed to meet level 4 on only one or two. In 19 SCs, residency graduation and/or first year fellow scores were lower for fellows who did not attain ≥ level 4 at graduation compared to those who did (mean difference = 0.74 points). Among 10 SCs, fellows who did not attain ≥ level 4 at graduation had a faster rate of improvement compared to those who did attain ≥ level 4. CONCLUSION In our sample, 67% of PEM fellows did not attain level 4 for one or more of the SCs at graduation. Low scores during residency or early in fellowship may predict difficulty in meeting level 4 by fellowship completion.
Collapse
Affiliation(s)
| | - Kathryn Leonard
- St. Louis School of MedicineWashington UniversitySt. LouisMissouriUSA
| | - Aline Baghdassarian
- Children’s Hospital of Richmond at VCUVirginia Commonwealth University SOMRichmondVirginiaUSA
| | - Maybelle Kou
- Inova Children’s HospitalVCU SOMFalls ChurchVirginiaUSA
| | - Kelly Levasseur
- Beaumont Children’s HospitalOakland University William Beaumont SOMRoyal OakMichiganUSA
| | - Jerri A. Rose
- Rainbow Babies & Children’s HospitalCase Western Reserve Univ SOMClevelandOhioUSA
| | | | - Tien Vu
- Children’s Hospital ColoradoUniversity of Colorado SOMDenverColoradoUSA
| | - Noel S. Zuckerbraun
- UPMC Children’s Hospital of PittsburghUniversity of Pittsburgh SOMPittsburghPennsylvaniaUSA
| | | |
Collapse
|
39
|
Zuckerbraun NS, Levasseur K, Kou M, Rose JA, Roskind CG, Vu T, Baghdassarian A, Leonard K, Shabanova V, Langhan ML. Gender Differences Among Milestone Assessments in a National Sample of Pediatric Emergency Medicine Fellowship Programs. AEM Educ Train 2021; 5:e10543. [PMID: 34099991 PMCID: PMC8166301 DOI: 10.1002/aet2.10543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/12/2020] [Accepted: 09/30/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Understanding gender gaps in trainee evaluations is critical because these may ultimately determine the duration of training. Currently, no studies describe the influence of gender on the evaluation of pediatric emergency medicine (PEM) fellows. OBJECTIVE The objective of our study was to compare milestone scores of female versus male PEM fellows. METHODS This is a multicenter retrospective cohort study of a national sample of PEM fellows from July 2014 to June 2018. Accreditation Council for Medical Education (ACGME) subcompetencies are scored on a 5-point scale and span six domains: patient care (PC), medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills (ICS). Summative assessments of the 23 PEM subcompetencies are assigned by each program's clinical competency committee and submitted semiannually for each fellow. Program directors voluntarily provided deidentified ACGME milestone reports. Demographics including sex, program region, and type of residency were collected. Descriptive analysis of milestones was performed for each year of fellowship. Multivariate analyses evaluated the difference in scores by sex for each of the subcompetencies. RESULTS Forty-eight geographically diverse programs participated, yielding data for 639 fellows (66% of all PEM fellows nationally); sex was recorded for 604 fellows, of whom 67% were female. When comparing the mean milestone scores in each of the six domains, there were no differences by sex in any year of training. When comparing scores within each of the 23 subcompetencies and correcting the significance level for comparison of multiple milestones, the scores for PC3 and ICS2 were significantly, albeit not meaningfully, higher for females. CONCLUSION In a national sample of PEM fellows, we found no major differences in milestone scores between females and males.
Collapse
Affiliation(s)
- Noel S. Zuckerbraun
- From theUPMC Children’s Hospital of Pittsburgh/University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Kelly Levasseur
- theBeaumont Children’s Hospital/Oakland University William Beaumont School of MedicineRoyal OakMIUSA
| | - Maybelle Kou
- theInova Children’s Hospital/VCU School of MedicineFalls ChurchVAUSA
| | - Jerri A. Rose
- theRainbow Babies & Children’s Hospital/Case Western Reserve University School of MedicineClevelandOHUSA
| | | | - Tien Vu
- theChildren’s Hospital Colorado/University of Colorado School of MedicineDenverCOUSA
| | - Aline Baghdassarian
- theChildren’s Hospital of Richmond at VCU/Virginia Commonwealth University School of MedicineRichmondVAUSA
| | - Kathryn Leonard
- Washington University in St. Louis School of MedicineSt. LouisMOUSA
| | | | | |
Collapse
|
40
|
Kou M, Baghdassarian A, Rose JA, Levasseur K, Roskind CG, Vu T, Zuckerbraun NS, Leonard K, Shabanova V, Langhan ML. Milestone achievements in a national sample of pediatric emergency medicine fellows: impact of primary residency training. AEM Educ Train 2021; 5:e10575. [PMID: 34124521 PMCID: PMC8171745 DOI: 10.1002/aet2.10575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pediatric emergency medicine (PEM) fellowships recruit trainees from both pediatric and emergency medicine (EM) residencies. The Accreditation Council for Graduate Medical Education (ACGME) defines separate training pathways for each. The 2015 PEM milestones reflect a combination of subcompetencies from the two residencies. This project aims to compare the milestone achievement of PEM fellows based on their primary residency training. We hypothesize that fellows trained in pediatrics achieve PEM milestones at different rates than EM-trained fellows in the ACGME domains of patient care, medical knowledge, systems-based practice, practice-based learning, professionalism, and interpersonal and communication skills. METHODS This is a multicenter, retrospective cohort study of fellows from a national sample of U.S. PEM fellowship programs. Basic demographic information and deidentified, biannual milestone scores for 23 competencies were collected for fellows training between 2015 and 2018. Subcompetencies are scored on a 5-point milestone scale. Descriptive and multivariable analyses for longitudinal data were performed to compare milestone assessments by primary residency training. RESULTS Complete data were obtained for 600 fellows; 95% (570) and 5% (30) completed pediatric and EM residency, respectively. In both year 1 and year 2 of fellowship, the mean milestone scores of EM-trained fellows were statistically higher than pediatrics-trained fellows across the majority of subcompetencies. By the final year of training, there were no statistically significant differences in milestone scores for any of the subcompetencies. CONCLUSIONS Fellow milestone achievement between groups was not significantly different by graduation. However, fellows entering PEM training from an EM background attained higher scores on the milestones than fellows from a pediatric background in the first year of fellowship.
Collapse
Affiliation(s)
- Maybelle Kou
- Emergency MedicineInova Children’s Hospital/VCU SOMFalls ChurchVirginiaUSA
| | - Aline Baghdassarian
- Pediatrics and Emergency MedicineChildren’s Hospital of Richmond at VCU/Virginia Commonwealth University SOMRichmondVirginiaUSA
| | - Jerri A. Rose
- PediatricsRainbow Babies & Children’s Hospital/Case Western Reserve University School of MedicineClevelandOhioUSA
| | - Kelli Levasseur
- Emergency MedicineBeaumont Children’s Hospital/Oakland University William Beaumont School of MedicineRoyal OakMichiganUSA
| | - Cindy G. Roskind
- Emergency Medicine in PediatricsColumbia University Medical CenterNew YorkNew YorkUSA
| | - Tien Vu
- PediatricsChildren’s Hospital Colorado/University of Colorado School of MedicineDenverColoradoUSA
| | | | - Kathryn Leonard
- PediatricsWashington University in St. Louis School of MedicineSt. LouisMissouriUSA
| | | | - Melissa L. Langhan
- Pediatrics and Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| |
Collapse
|
41
|
Prozora S, Shabanova V, Ananth P, Pashankar F, Kupfer GM, Massaro SA, Davidoff AJ. Patterns of medication use at end of life by pediatric inpatients with cancer. Pediatr Blood Cancer 2021; 68:e28837. [PMID: 33306281 DOI: 10.1002/pbc.28837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/23/2020] [Accepted: 11/16/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe medication utilization patterns by pediatric inpatients with cancer during their last week of life. METHODS This retrospective study used data from the Vizient Clinical Database/Resource Manager, a national compilation of clinical and resource use data from over 100 academic medical centers and affiliates. Patients (0-21 years) with malignancy who died during hospitalization (2010-2017) were included (N = 1659). Medications were categorized as opioid, benzodiazepine, gastrointestinal related, chemotherapy, anti-infectives, or vasopressors. Exposure to each group was ascertained for all patients at 1 week and 1 day prior to death. Factors associated with exposure were examined using generalized estimating equations, and summarized using adjusted odds ratios (aORs). RESULTS Over the last week of life, there was increased use of opioids (76% to 82%, aOR = 1.55, P < .001) and benzodiazepines (53% to 66%, aOR = 1.36, P = .02), while gastrointestinal-related medication use decreased (92% to 89%, aOR = 0.69, P = .001). Patients had decreased exposure to chemotherapy (10% to 5%, aOR = 0.46, P < .001) and anti-infectives (82% to 73%, aOR = 0.41, P = .002). Vasopressor use increased as death approached (15% to 28%, aOR = 1.67, P = .04). Factors significantly associated with exposure varied with medication category, and included age, race, length of stay, malignancy type, death in the intensive care unit, history of hematopoietic stem cell transplant, and do-not-resuscitate status. CONCLUSION During the week preceding death, administration of symptom management medications increased for children with cancer, but use was not universal. Potentially life-sustaining medications were often continued. Variability in utilization suggests differences in provider/family decision making that warrant further study to develop an evidence-based approach to end-of-life care.
Collapse
Affiliation(s)
- Stephanie Prozora
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Farzana Pashankar
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Gary M Kupfer
- Department of Pediatrics, Georgetown University School of Medicine, Washington, District of Columbia
| | | | - Amy J Davidoff
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| |
Collapse
|
42
|
Faustino EVS, Raffini LJ, Hanson SJ, Cholette JM, Pinto MG, Li S, Kandil SB, Nellis ME, Shabanova V, Silva CT, Tala JA, McPartland T, Spinella PC. Age-Dependent Heterogeneity in the Efficacy of Prophylaxis With Enoxaparin Against Catheter-Associated Thrombosis in Critically Ill Children: A Post Hoc Analysis of a Bayesian Phase 2b Randomized Clinical Trial. Crit Care Med 2021; 49:e369-e380. [PMID: 33566465 PMCID: PMC7979442 DOI: 10.1097/ccm.0000000000004848] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We explored the age-dependent heterogeneity in the efficacy of prophylaxis with enoxaparin against central venous catheter-associated deep venous thrombosis in critically ill children. DESIGN Post hoc analysis of a Bayesian phase 2b randomized clinical trial. SETTING Seven PICUs. PATIENTS Children less than 18 years old with newly inserted central venous catheter. INTERVENTIONS Enoxaparin started less than 24 hours after insertion of central venous catheter and adjusted to anti-Xa level of 0.2-0.5 international units/mL versus usual care. MEASUREMENTS AND MAIN RESULTS Of 51 children randomized, 24 were infants less than 1 year old. Risk ratios of central venous catheter-associated deep venous thrombosis with prophylaxis with enoxaparin were 0.98 (95% credible interval, 0.37-2.44) in infants and 0.24 (95% credible interval, 0.04-0.82) in older children greater than or equal to 1 year old. Infants and older children achieved anti-Xa level greater than or equal to 0.2 international units/mL at comparable times. While central venous catheter was in situ, endogenous thrombin potential, a measure of thrombin generation, was 223.21 nM.min (95% CI, 8.78-437.64 nM.min) lower in infants. Factor VIII activity, a driver of thrombin generation, was also lower in infants by 45.1% (95% CI, 15.7-74.4%). Median minimum platelet count while central venous catheter was in situ was higher in infants by 39 × 103/mm3 (interquartile range, 17-61 × 103/mm3). Central venous catheter:vein ratio was not statistically different. Prophylaxis with enoxaparin was less efficacious against central venous catheter-associated deep venous thrombosis at lower factor VIII activity and at higher platelet count. CONCLUSIONS The relatively lesser contribution of thrombin generation on central venous catheter-associated thrombus formation in critically ill infants potentially explains the age-dependent heterogeneity in the efficacy of prophylaxis with enoxaparin.
Collapse
Affiliation(s)
| | - Leslie J Raffini
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Sheila J Hanson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Jill M Cholette
- Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester, NY
| | - Matthew G Pinto
- Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY
| | - Simon Li
- Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY
| | - Sarah B Kandil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Marianne E Nellis
- Department of Pediatrics, NY Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | | | - Cicero T Silva
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT
| | - Joana A Tala
- Pediatric Intensive Care Unit, Yale-New Haven Children's Hospital, New Haven, CT
| | - Tara McPartland
- Yale Center for Clinical Investigation, Yale School of Medicine, New Haven, CT
| | - Philip C Spinella
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| |
Collapse
|
43
|
Hanson SJ, Mahajerin A, Petty JK, Shabanova V, Faustino EVS. Risks of venous thrombosis and bleeding in critically ill adolescents after trauma or major surgery. J Pediatr Surg 2021; 56:302-308. [PMID: 32713711 DOI: 10.1016/j.jpedsurg.2020.06.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/10/2020] [Accepted: 06/23/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The risks of venous thromboembolism (VTE) and bleeding in critically ill adolescents based on interventions received and anatomic site of trauma or major surgery may identify a cohort eligible for enrollment in a trial of pharmacologic prophylaxis. METHODS This retrospective cohort study using the Virtual Pediatric Systems database included adolescents admitted to pediatric intensive care units after trauma or major surgery between 2013 and 2017. Mixed effects logistic regression was used to determine the adjusted risks of VTE and bleeding with central venous catheterization (CVC), mechanical ventilation (MV) and anatomic site of trauma or major surgery. The adjusted risks were used to identify the cohort eligible for enrollment. MEASUREMENTS AND MAIN RESULTS VTE developed in 212 (0.8%) of 27,647 adolescents. The adjusted risk of VTE was >2% with CVC and 2 or more of MV and trauma or major surgery to the brain or abdomen. Excluding those with bleeds present on admission or at high risk of bleeding, 375 (1.4%) adolescents would be eligible for enrollment. CONCLUSIONS VTE is generally uncommon in adolescents after trauma or major surgery. The small proportion of adolescents who are at high risk of VTE and at low risk of bleeding impacts the feasibility of a trial. LEVEL OF EVIDENCE Prognostic Study Level II.
Collapse
Affiliation(s)
- Sheila J Hanson
- Section of Critical Care, Department of Pediatrics, Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI.
| | | | - John K Petty
- Division of Pediatric Surgery, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Veronika Shabanova
- Section of General Pediatrics, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - E Vincent S Faustino
- Section of Critical Care, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| |
Collapse
|
44
|
Voliovitch Y, Leventhal JM, Fenick AM, Gupta AR, Feinberg E, Hickey EJ, Shabanova V, Weitzman C. Parenting Stress and its Associated Components Prior to an Autism Spectrum Disorder (ASD) Diagnostic Evaluation. J Autism Dev Disord 2021; 51:3432-3442. [PMID: 33387245 DOI: 10.1007/s10803-020-04804-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
Parents of children with autism spectrum disorder (ASD) show increased levels of parenting stress, but only one study has examined this association before a diagnostic evaluation. We conducted a cross-sectional study of parenting stress in 317 low SES parents with children at-risk for ASD before a diagnostic evaluation. Multiple regression modeling evaluated the associations between parenting stress and parent and child factors. Parenting stress was negatively associated with social support and positively associated with active avoidance coping and parental worry. However, parenting stress was not associated with the child's ASD symptom severity or adaptive functioning, except for self-direction. Findings suggest parenting stress among parents of children at risk of ASD should be assessed prior to diagnosis.
Collapse
Affiliation(s)
- Yair Voliovitch
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - John M Leventhal
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Ada M Fenick
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Abha R Gupta
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Emily Feinberg
- Division of General Academic Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Emily J Hickey
- Division of General Academic Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
- University Center for Excellence in Developmental Disabilities, Waisman Center, University of Wisconsin-Madison, Madison, USA
| | | | - Carol Weitzman
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
45
|
Du N, Forson-Dare Z, Sawyer T, Bruno C, Asnes A, Shabanova V, Ades A, French H, Johnston L. Procedural Competency for Pediatric Residents in the Contemporary Training Environment: An Unachievable Goal? MedEdPublish 2021. [DOI: 10.15694/mep.2021.000028.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
46
|
Simpson S, Seifer DB, Shabanova V, Lynn AY, Howe C, Rowe E, Caprio S, Vash-Margita A. The association between anti-Müllerian hormone and vitamin 25(OH)D serum levels and polycystic ovarian syndrome in adolescent females. Reprod Biol Endocrinol 2020; 18:118. [PMID: 33218348 PMCID: PMC7679991 DOI: 10.1186/s12958-020-00676-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High anti-Müllerian hormone (AMH) levels and 25-hydroxyvitamin D [25(OH)D] deficiency have been associated with polycystic ovarian syndrome (PCOS) in adult women, and implicated in its pathogenesis. Herein we determined if the level of both AMH and 25(OH)D are altered in adolescent females with clinical features of PCOS. METHODS This is a cross-sectional study utilizing a retrospective chart review of 128 patients aged 12-20 referred to an academic adolescent gynecology and endocrinology clinic for an evaluation of suspected PCOS. Unadjusted comparisons of AMH and 25(OH)D distributions between subjects with and without PCOS were performed using the Wilcoxon Rank Sum test. Quantile regression was used to compare the median AMH and 25(OH)D between subject groups; adjusting for race, ethnicity, BMI, insurance type, age, and season when bloodwork was performed. RESULTS Seventy-four subjects were classified as having PCOS by meeting ≥2 of the three Rotterdam diagnostic criteria, and 47 subjects met only one Rotterdam diagnostic criteria, and were used as the comparative non-PCOS group. There were statistically significant unadjusted differences in median levels of AMH and 25(OH)D. In the adjusted analyses, median AMH was significantly higher in the PCOS group compared to the non-PCOS group (+ 2.39 ng/mL, 95% CI 0.43, 4.35, p = 0.018); 25(OH)D was significantly lower in the PCOS group (- 9.01 ng/mL, 95% CI -14.49, - 3.53 p = 0.001). In our sample, adolescents in both groups had insufficient 25(OH)D level (22 ng/mL) and elevated BMI (32.2 kg/m2). CONCLUSIONS Adolescents with PCOS display high levels of AMH and low 25(OH)D levels. Since traditional clinical markers of PCOS may be physiologic in adolescents, AMH and 25(OH)D may be used as surrogate markers of PCOS risk in adolescents.
Collapse
Affiliation(s)
- Samantha Simpson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, 310 Cedar Street, New Haven, CT, 06520-8063, USA
| | - David B Seifer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, 310 Cedar Street, New Haven, CT, 06520-8063, USA
| | - Veronika Shabanova
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | | | - Catherine Howe
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, 310 Cedar Street, New Haven, CT, 06520-8063, USA
| | - Erin Rowe
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Sonia Caprio
- Department of Pediatric Endocrinology and Diabetes, Yale School of Medicine, New Haven, CT, USA
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, 310 Cedar Street, New Haven, CT, 06520-8063, USA.
| |
Collapse
|
47
|
Galderisi A, Tricò D, Pierpont B, Shabanova V, Samuels S, Dalla Man C, Galuppo B, Santoro N, Caprio S. A Reduced Incretin Effect Mediated by the rs7903146 Variant in the TCF7L2 Gene Is an Early Marker of β-Cell Dysfunction in Obese Youth. Diabetes Care 2020; 43:2553-2563. [PMID: 32788279 PMCID: PMC7510033 DOI: 10.2337/dc20-0445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/10/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The risk genotype for the common variant rs7903146 of the transcription factor 7-like-2 (TCF7L2) gene has been found to affect the incretin response in healthy and obese adults; however, whether a similar functional defect is also present in obese adolescents remains unexplored. Herein, we examined the functional effect of the rs7903146 variant in the TCF7L2 gene on the incretin effect and determined its translational metabolic manifestation by performing deep phenotyping of the incretin system, β-cell function relative to insulin sensitivity, the gastrointestinal-induced glucose disposal (GIGD) in obese youth with normal and impaired glucose tolerance. RESEARCH DESIGN AND METHODS Thirty-nine obese adolescents without diabetes (median age 15 [25th, 75th percentile 14, 18] years; BMI 37 [33, 43] kg/m2) were genotyped for the rs7903146 variant of TCF7L2 and underwent a 3-h oral glucose tolerance test (OGTT) followed by an isoglycemic intravenous glucose infusion (iso-intravenous glucose tolerance test [IVGTT]) to match the plasma glucose concentrations during the OGTT and a hyperglycemic clamp with arginine stimulation. The incretin effect was measured as 100 * (AUC-SROGTT - AUC-SRiso-IVGTT) / AUC-SROGTT, where AUC-SR = area under the curve of C-peptide secretion rate. Participants were grouped into tertiles according to the percentage incretin effect (high, moderate, and low) to describe their metabolic phenotype. RESULTS The presence of T risk allele for TCF7L2 was associated with a markedly reduced incretin effect compared with the wild-type genotype (0.3% [-7.2, 14] vs. 37.8% [12.5, 52.4], P < 0.002). When the cohort was stratified by incretin effect, the high, moderate, and low incretin effect groups did not differ with respect to anthropometric features, while the low incretin effect group exhibited higher 1-h glucose (P = 0.015) and a reduced disposition index, insulin sensitivity, and insulin clearance compared with the high incretin effect group. GIGD was reduced in the low incretin effect group (P = 0.001). The three groups did not differ with respect to intravenous glucose-induced insulin secretion and arginine response during the hyperglycemic clamp. CONCLUSIONS A reduced incretin effect and its association with the TCF7L2 variant rs7903146 identify an early metabolic phenotype in obese youth without diabetes, featuring a higher plasma glucose peak at 1 h; lower insulin secretion, sensitivity, and clearance; and GIGD.
Collapse
Affiliation(s)
- Alfonso Galderisi
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT.,Department of Woman and Child's Health, University of Padova, Padova, Italy
| | - Domenico Tricò
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Bridget Pierpont
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Veronika Shabanova
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT.,Yale School of Public Health, New Haven, CT
| | - Stephanie Samuels
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Brittany Galuppo
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Nicola Santoro
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Sonia Caprio
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| |
Collapse
|
48
|
Van Name MA, Savoye M, Chick JM, Galuppo BT, Feldstein AE, Pierpont B, Johnson C, Shabanova V, Ekong U, Valentino PL, Kim G, Caprio S, Santoro N. A Low ω-6 to ω-3 PUFA Ratio (n-6:n-3 PUFA) Diet to Treat Fatty Liver Disease in Obese Youth. J Nutr 2020; 150:2314-2321. [PMID: 32652034 PMCID: PMC7467848 DOI: 10.1093/jn/nxaa183] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/28/2020] [Accepted: 06/08/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Recent literature suggests that the Western diet's imbalance between high ω-6 (n-6) and low ω-3 (n-3) PUFA intake contributes to fatty liver disease in obese youth. OBJECTIVES We tested whether 12 wk of a low n-6:n-3 PUFA ratio (4:1) normocaloric diet mitigates fatty liver and whether the patatin-like containing domain phospholipase 3 (PNPLA3) rs738409 variant affects the response. METHODS In a single-arm unblinded study, obese youth 9-19 y of age with nonalcoholic fatty liver disease were treated with a normocaloric low n-6:n-3 PUFA ratio diet for 12 wk. The primary outcome was change in hepatic fat fraction (HFF%), measured by abdominal MRI. Metabolic parameters included alanine aminotransferase (ALT), lipids, measures of insulin sensitivity, and plasma oxidized linoleic acid metabolites (OXLAMs). Outcomes were also analyzed by PNPLA3 rs738409 genotype. Wilcoxon's signed rank test, the Mann-Whitney U test, and covariance pattern modeling were used. RESULTS Twenty obese adolescents (median age: 13.3 y; IQR: 10.5-16.4 y) were enrolled and 17 completed the study. After 12 wk of dietary intervention, HFF% decreased by 25.8% (P = 0.009) despite stable weight. We observed a 34.4% reduction in ALT (P = 0.001), 21.9% reduction in triglycerides (P = 0.046), 3.28% reduction in LDL cholesterol (P = 0.071), and a 26.3% improvement in whole body insulin sensitivity (P = 0.032). The OXLAMs 9-hydroxy-octadecandienoic acid (9-HODE) (P = 0.011), 13-HODE (P = 0.007), and 9-oxo-octadecadienoic acid (9-oxoODE) (P = 0.024) decreased after 12 wk. HFF% declined in both the not-at-risk (CC/CG) and at-risk (GG) PNPLA3 rs738409 genotype groups, with significant (P = 0.016) HFF% reduction in the GG group. Changes in 9-HODE (P = 0.023), 9-oxoODE (P = 0.009), and 13-oxoODE (P = 0.003) differed between the 2 genotype groups over time. CONCLUSIONS These data suggest that, independently of weight loss, a low n-6:n-3 PUFA diet ameliorates the metabolic phenotype of adolescents with fatty liver disease and that response to this diet is modulated by the PNPLA3 rs738409 genotype.This trial was registered at clinicaltrials.gov as NCT01556113.
Collapse
Affiliation(s)
| | - Mary Savoye
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer M Chick
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Ariel E Feldstein
- Division of Pediatric Gastrointestinal Diseases, Hepatology, and Nutrition, University of California San Diego, San Diego, CA, USA
| | - Bridget Pierpont
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Casey Johnson
- Division of Pediatric Gastrointestinal Diseases, Hepatology, and Nutrition, University of California San Diego, San Diego, CA, USA
| | | | - Udeme Ekong
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Grace Kim
- Seattle Children's Hospital, Seattle, WA, USA
| | - Sonia Caprio
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | |
Collapse
|
49
|
Fabrizio V, Shabanova V, Taylor SN. Factors in Early Feeding Practices That May Influence Growth and the Challenges that Arise in Growth Outcomes Research. Nutrients 2020; 12:nu12071939. [PMID: 32629763 PMCID: PMC7399918 DOI: 10.3390/nu12071939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022] Open
Abstract
Growth in preterm infants is associated with improved outcomes during both the initial hospitalization and long-term. A single center investigation evaluated preterm infant in-hospital growth trajectory and how it related to early nutritional practices as a way to identify areas for quality improvement. Infants born <34 weeks’ gestational age and with discharge at or prior to 40 weeks’ gestational age were included and were divided into quartiles based on their change in weight z-score through hospitalization. Early nutritional factors were compared between the lowest and highest growth quartiles. Although the highest growth quartile experienced less days of parenteral nutrition and higher enteral caloric density in the first week, as the data was analyzed, potential statistical pitfalls became apparent. Therefore, the aim of this study was to investigate selection bias and cohort effect related to both the inclusion criteria for this cohort as well as the inherent challenges in comparison of preterm infant growth trajectories by standard fetal growth charts.
Collapse
Affiliation(s)
- Veronica Fabrizio
- Connecticut Children’s, Division of Neonatology, Hartford, CT 06106, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT 06032, USA
- Correspondence:
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06443, USA; (V.S.); (S.N.T.)
| | - Sarah N. Taylor
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06443, USA; (V.S.); (S.N.T.)
| |
Collapse
|
50
|
Roberts A, Angoff NR, Brissette D, Dupee D, Fahs D, Honan L, Korbey S, Roessler E, Schwartz M, Shabanova V, Tetrault J, Wu B, Colson E, Encandela J. Burnout Among Beginning First-Year Students from Three Health Professional Training Programs. Med Sci Educ 2020; 30:879-883. [PMID: 34457745 PMCID: PMC8368543 DOI: 10.1007/s40670-020-00969-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The study objective was to learn about burnout prevalence among beginning first-year students from three health professional programs-Advance Practice Registered Nursing (APRN), Medicine, and Physician Associate (PA) training. All first-year students were invited to anonymously complete a survey measuring burnout. Subscales for exhaustion and disengagement together accounted for burnout. Means and frequencies were derived for categorical variables (gender, program, and direct entry from college). Subscales were summarized with means and standard deviations. Analysis of variance and post hoc t-tests compared unadjusted differences in means. Based on results, multivariable linear regressions for total burnout and exhaustion examined associations for the independent variables. With a 97% response rate, 70% were female (the APRN program is predominantly female), and 32% began training directly after college. Female students had significantly higher average total burnout and exhaustion than males. APRN and PA students had significantly higher total burnout and exhaustion than MD students. There were no other significant associations. In multivariable linear regressions, APRN students had significantly higher, and PA students had not quite significantly higher, burnout and exhaustion compared with medical students, with no moderation by any other variables. Burnout among first-year students in all three programs was more prevalent than anticipated. Consistent with previous literature, the programs with students who experienced higher burnout used more competitive, multi-tiered grading systems and introduced clinical expectations earlier in training. The implication is that educational leaders should consider effects of competitive grading and early clinical exposure on burnout among beginning health professional students.
Collapse
Affiliation(s)
| | | | - David Brissette
- Yale School of Medicine Physician Associate (PA) Program, New Haven, CT USA
| | | | | | | | | | - Elizabeth Roessler
- Yale School of Medicine Physician Associate (PA) Program, New Haven, CT USA
| | | | | | | | - Barry Wu
- Yale School of Medicine, New Haven, CT USA
| | - Eve Colson
- Washington University Medical School in St. Louis, St. Louis, IL USA
| | | |
Collapse
|