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Hudek N, Carroll K, Semchishen S, Vanderhout S, Presseau J, Grimshaw J, Fergusson DA, Gillies K, Graham ID, Taljaard M, Brehaut JC. Describing the content of trial recruitment interventions using the TIDieR reporting checklist: a systematic methodology review. BMC Med Res Methodol 2024; 24:85. [PMID: 38589803 PMCID: PMC11000410 DOI: 10.1186/s12874-024-02195-5] [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] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 03/03/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Recruiting participants to clinical trials is an ongoing challenge, and relatively little is known about what recruitment strategies lead to better recruitment. Recruitment interventions can be considered complex interventions, often involving multiple components, targeting a variety of groups, and tailoring to different groups. We used the Template for Intervention Description and Replication (TIDieR) reporting checklist (which comprises 12 items recommended for reporting complex interventions) to guide the assessment of how recruitment interventions are described. We aimed to (1) examine to what extent we could identify information about each TIDieR item within recruitment intervention studies, and (2) observe additional detail for each item to describe useful variation among these studies. METHODS We identified randomized, nested recruitment intervention studies providing recruitment or willingness to participate rates from two sources: a Cochrane review of trials evaluating strategies to improve recruitment to randomized trials, and the Online Resource for Research in Clinical triAls database. First, we assessed to what extent authors reported information about each TIDieR item. Second, we developed descriptive categorical variables for 7 TIDieR items and extracting relevant quotes for the other 5 items. RESULTS We assessed 122 recruitment intervention studies. We were able to extract information relevant to most TIDieR items (e.g., brief rationale, materials, procedure) with the exception of a few items that were only rarely reported (e.g., tailoring, modifications, planned/actual fidelity). The descriptive variables provided a useful overview of study characteristics, with most studies using various forms of informational interventions (55%) delivered at a single time point (90%), often by a member of the research team (59%) in a clinical care setting (41%). CONCLUSIONS Our TIDieR-based variables provide a useful description of the core elements of complex trial recruitment interventions. Recruitment intervention studies report core elements of complex interventions variably; some process elements (e.g., mode of delivery, location) are almost always described, while others (e.g., duration, fidelity) are reported infrequently, with little indication of a reason for their absence. Future research should explore whether these TIDieR-based variables can form the basis of an approach to better reporting of elements of successful recruitment interventions.
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Affiliation(s)
- Natasha Hudek
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Kelly Carroll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Seana Semchishen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Shelley Vanderhout
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
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Vanderhout S, Rosenfield D, Goldbloom EB. A Canadian Paediatric Surveillance Program study to guide safe integration of virtual care for children. Paediatr Child Health 2023; 28:468-469. [PMID: 38638541 PMCID: PMC11022864 DOI: 10.1093/pch/pxad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/15/2023] [Indexed: 04/20/2024] Open
Affiliation(s)
- Shelley Vanderhout
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - Daniel Rosenfield
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ellen B Goldbloom
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Vanderhout S, Richards DP, Butcher N, Courtney K, Nicholls SG, Fergusson DA, Potter BK, Bhalla M, Nevins P, Fox G, Ly V, Taljaard M, Macarthur C. Prevalence of patient partner authorship and acknowledgment in child health research publications: an umbrella review. J Clin Epidemiol 2023; 164:35-44. [PMID: 37871836 DOI: 10.1016/j.jclinepi.2023.10.012] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES Children and families are increasingly involved as equal partners in child health research, however, considerations around authorship have received little attention and there is limited guidance on the topic. Our objective was to determine the frequency and nature of patient partner authorship and/or acknowledgment among articles focused on patient engagement in child health research. STUDY DESIGN AND SETTING In this umbrella review, we searched MEDLINE, Embase, APA PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, and Web of Science for systematic/scoping reviews on patient engagement in child health research. Individual articles included in eligible reviews comprised the sample of articles for analysis and were examined to identify patient partner authorship. Descriptive statistics were used to quantify patient partner authorship and/or acknowledgment and to summarize article characteristics. RESULTS Twelve systematic/scoping reviews met eligibility criteria, from which 230 individual articles were examined. In 16/230 (7%) articles, there was at least one patient partner author, and in 6/230 (3%) articles, patient partners were included as group authors. Within article Acknowledgments sections, patient partners were acknowledged by name in 41/230 (18%) articles, and anonymously or as a group in 98/230 (43%) articles. Patient partner authorship and/or acknowledgment was more frequent among articles published more recently (after 2015) and among articles where patient engagement was explicitly reported in the article. CONCLUSION Patient partners were more likely to be acknowledged than listed as an author on articles on patient engagement in child health research. Understanding patient partner preferences about authorship and acknowledgment, examination of the unique aspects of child and youth authorship and developing supports to empower patient partner authorship are needed.
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Affiliation(s)
- Shelley Vanderhout
- Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, Ontario L5B 1B8, Canada.
| | - Dawn P Richards
- Patient Partner, Toronto, Ontario, Canada; Five02 Labs Inc., Toronto, Ontario, Canada
| | - Nancy Butcher
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College St, 8th floor, Toronto, Ontario M5T 1R8, Canada
| | - Kim Courtney
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario K1H 8L6, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario K1H 8L6, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, Ontario K1G 5Z3, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, Ontario K1G 5Z3, Canada
| | - Manav Bhalla
- University College Dublin School of Medicine, Health Sciences Centre, Belfield, Dublin, Ireland
| | - Pascale Nevins
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario K1H 8L6, Canada
| | - Grace Fox
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario K1H 8L6, Canada
| | - Valentina Ly
- University of Ottawa Library Services, 65 University Private, Ottawa, Ontario K1N 6N5, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario K1H 8L6, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, Ontario K1G 5Z3, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario M5S 1A1, Canada
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Baba A, Richards DP, Smith M, Pallone N, Vanderhout S, Prebeg M, Elsman EBM, Potter BK, Offringa M, Butcher NJ. Youth and family involvement in the development of a plain language trial results communication tool: CommuniKIDS. Res Involv Engagem 2023; 9:88. [PMID: 37777802 PMCID: PMC10544151 DOI: 10.1186/s40900-023-00499-2] [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] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Pediatric trials are possible through voluntary participation of children, youth (age ≤ 18 years), and their families. Despite important arguments for trialists to provide trial progress or results, and evidence that participants desire it, this information remains rarely shared with youth and their families. Little guidance exists on how trialists can best communicate trial results back to participants and their families. Guided by Liabo et al.'s framework, we describe how we developed a pediatric-specific, "plain language summary" clinical trial results template called CommuniKIDS with an adult patient partner, family partner (parent), youth advisors, and parent advisors, taking into account their unique knowledge needs and preferences. MAIN TEXT Patient and Public Involvement (PPI) was integrated in the development of the CommuniKIDS template. In collaboration with Clinical Trials Ontario, we used a generic trial results template as a starting point. The core project leadership team included a patient partner and a family partner from project inception to completion. Five youth (ages 13-18 years) and eight parent advisors were consulted at each point of the development process through three virtual workshops conducted separately; youth workshops were led by a youth facilitator. During these workshops, advisors agreed on the importance and value of sharing trial results, and expressed their preferences on content, format, and timing of sharing trial results. PPI-led improvements included the addition of three new sections to the CommuniKIDS template: "at a glance," "side effects," and "next steps." We reflect on our PPI strategy in the context of five "values" and six "practicalities" identified as good PPI principles, and summarize lessons learned when collaborating with youth and families from this project. CONCLUSION Involvement of a patient partner, a family partner, youth advisors, and parent advisors in the development of CommuniKIDS was critical to create a clinical trial results template that is useful and relevant to its end-users. To our knowledge, CommuniKIDS is the first to meaningfully engage youth and parents as advisors and partners in developing a plain language summary results template for pediatric trial participants and their families. Our experience of co-developing CommuniKIDS demonstrates that meaningful PPI can be achieved in trial results communication and knowledge translation practices. This report provides resources for those seeking to involve youth and families in their initiatives and in meaningfully sharing trial results.
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Affiliation(s)
- Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | | | - Maureen Smith
- Canadian Organization for Rare Disorders, Ottawa, ON, Canada
| | - Nicole Pallone
- CanPKU and Parent of a Child with an Inherited Metabolic Disease, Sparwood, BC, Canada
| | - Shelley Vanderhout
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Matthew Prebeg
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ellen B M Elsman
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada.
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
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Vanderhout S, Nevins P, Nicholls SG, Macarthur C, Brehaut JC, Potter BK, Gillies K, Goulao B, Smith M, Hilderley A, Carroll K, Spinewine A, Weijer C, Fergusson DA, Taljaard M. Patient and public involvement in pragmatic trials: online survey of corresponding authors of published trials. CMAJ Open 2023; 11:E826-E837. [PMID: 37726115 PMCID: PMC10516685 DOI: 10.9778/cmajo.20220198] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND There are few data on patient and public involvement (PPI) in pragmatic trials. We aimed to describe the prevalence and nature of PPI within pragmatic trials, describe variation in prevalence of PPI by trial characteristics and compare prevalence of PPI reported by trial authors to that reported in trial publications. METHODS We applied a search filter to identify pragmatic trials published from 2014 to 2019 in MEDLINE. We invited the corresponding authors of pragmatic trials to participate in an online survey about their specific trial. RESULTS Of 3163 authors invited, 2585 invitations were delivered, 710 (27.5%) reported on 710 unique trials and completed the survey; 334 (47.0%) conducted PPI. Among those who conducted PPI, for many the aim was to increase the research relevance (86.3%) or quality (76.5%). Most PPI partners were engaged at protocol development stages (79.1%) and contributed to the co-design of interventions (70.9%) or recruitment or retention strategies (60.5%). Patient and public involvement was more common among trials involving children, trials conducted in the United Kingdom, cluster randomized trials, those explicitly labelled as "pragmatic" in the study manuscript, and more recent trials. Less than one-quarter of trials (22.8%) that reported PPI in the survey also reported PPI in the trial manuscript. INTERPRETATION Nearly half of trialists in this survey reported conducting PPI and listed several benefits of doing so, but researchers who did not conduct PPI often cited a lack of requirement for it. Patient and public involvement appears to be significantly underreported in trial publications. Consistent and standardized reporting is needed to promote transparency about PPI methods, outcomes, challenges and benefits.
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Affiliation(s)
- Shelley Vanderhout
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont.
| | - Pascale Nevins
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Stuart G Nicholls
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Colin Macarthur
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Jamie C Brehaut
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Beth K Potter
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Kate Gillies
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Beatriz Goulao
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Maureen Smith
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Alicia Hilderley
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Kelly Carroll
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Anne Spinewine
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Charles Weijer
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Dean A Fergusson
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Monica Taljaard
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
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Vanderhout S, Goldbloom EB, Li A, Newhook D, Garcia M, Dulude C. Evaluation Strategies for Understanding Experiences With Virtual Care in Canada: Mixed Methods Study. J Med Internet Res 2023; 25:e45287. [PMID: 37647120 PMCID: PMC10500354 DOI: 10.2196/45287] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/04/2023] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Virtual care was rapidly integrated into pediatric health services during the COVID-19 pandemic. While virtual care offers many benefits, it is necessary to better understand the experiences of those who receive, deliver, and coordinate virtual care in order to support sustainable, high-quality, and patient-centered health care. To date, methods implemented to evaluate users' experiences of virtual care have been highly variable, making comparison and data synthesis difficult. OBJECTIVE This study aims to describe evaluation strategies currently used to understand personal experiences with pediatric virtual care in Canada. METHODS In this mixed methods environmental scan, we first distributed a web-based questionnaire to clinical, research, and operational leaders delivering and evaluating pediatric virtual care in Canada. The questionnaire collected information about how experiences with virtual care have been or are currently being evaluated and whether these evaluations included the perspectives of children or youth, families, providers, or support staff. Second, respondents were asked to share the questions they used in their evaluations, and a content analysis was performed to identify common question categories. Third, we conducted semistructured interviews to further explore our respondents' evaluation experiences across 4 domains-evaluation approaches, distribution methods, response rates, and lessons learned-and interest in a core set of questions for future evaluations. RESULTS There were 72 respondents to the web-based questionnaire; among those who had conducted an evaluation, we identified 15 unique evaluations, and 14 of those provided a copy of the tools used to evaluate virtual care. These evaluations measured the virtual care experiences of parents or caregivers (n=15, 100%), children or youth (n=11, 73%), health care providers (n=11, 73%), and support staff (n=4, 27%). The most common data collection method used was electronic questionnaires distributed by email. Two respondents used validated tools; the remainder modified existing tools or developed new tools. Content analysis of the 14 submitted questionnaires revealed that the most common questions were about overall participant satisfaction, the comparison of virtual care to in-person care, and whether participants would choose virtual care options in the future. Interview findings indicate respondents frequently relied on methods used by peers and that a standardized, core set of questions to evaluate experiences with virtual care would be helpful to improve evaluation practices and support pediatric health care delivery. CONCLUSIONS At our institution and elsewhere in Canada, experiences with pediatric virtual care have been evaluated using a variety of methods. A more consistent evaluation approach using standardized tools may enable more regular comparisons of experiences with virtual care and the synthesis of findings across health care settings. In turn, this may better inform our approach to virtual care, improve its integration into health systems, and facilitate sustainable, high-quality, patient-centered care.
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Affiliation(s)
- Shelley Vanderhout
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ellen B Goldbloom
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Amy Li
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dennis Newhook
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Meghan Garcia
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Catherine Dulude
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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7
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Dulude C, Sutherland S, Vanderhout S, King WJ, Zuijdwijk C, Major N, Audcent T, Howley H, Cloutier P, Buba M, Jain R, Litwinska J, Findlay L, Malic C, Macaulay K, Parker K, Kouri C, Goldbloom EB. A pediatric virtual care evaluation framework and its evolution using consensus methods. BMC Pediatr 2023; 23:402. [PMID: 37592246 PMCID: PMC10433580 DOI: 10.1186/s12887-023-04229-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The use of virtual care has increased dramatically in response to the COVID-19 pandemic, yet evidence is lacking regarding the impact of virtual care on patient outcomes, particularly in pediatrics. A standardized evaluation approach is required to support the integration of virtual care into pediatric health care delivery programs. The objective of this work was to develop a comprehensive and structured framework for pediatric virtual care evaluation. This framework is intended to engage and guide care providers, health centres, and stakeholders towards the development of a standardized approach to the evaluation of pediatric virtual care. METHODS We brought together a diverse multidisciplinary team, including pediatric clinicians, researchers, digital health leads and analysts, program leaders, a human factors engineer, a family advisor and our manager of health equity and diversity. The team reviewed the literature, including published evaluation frameworks, and used a consensus-based method to develop a virtual care evaluation framework applicable to a broad spectrum of pediatric virtual care programs. We used an iterative process to develop framework components, including domains and sub-domains, examples of evaluation questions, measures, and data sources. Team members met repeatedly over seven months to generate and provide feedback on all components of the framework, making revision as needed until consensus was reached. The framework was then applied to an existing virtual care program. RESULTS The resulting framework includes four domains (health outcomes, health delivery, individual experience, and program implementation) and 19 sub-domains designed to support the development and evaluation of pediatric virtual care programs. We also developed guidance on how to use the framework and illustrate its utility by applying it to an existing pediatric virtual care program. CONCLUSIONS This virtual care evaluation framework expands on previously developed frameworks by providing additional detail and a structure that supports practical application. It can be used to evaluate a wide range of pediatric virtual care programs in a standardized manner. Use of this comprehensive yet easy to use evaluation framework will inform appropriate implementation and integration of virtual care into routine practice and support its sustainability and continuous improvement.
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Affiliation(s)
- Catherine Dulude
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
| | - Stephanie Sutherland
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
| | - Shelley Vanderhout
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, Canada
| | - W James King
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Caroline Zuijdwijk
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Nathalie Major
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Tobey Audcent
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Heather Howley
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
| | - Paula Cloutier
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
| | - Melanie Buba
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute Family Leader Program, 401 Smyth Rd, Ottawa, ON, Canada
| | - Raagini Jain
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Justyna Litwinska
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Leanne Findlay
- Children's Hospital of Eastern Ontario Research Institute Family Leader Program, 401 Smyth Rd, Ottawa, ON, Canada
| | - Claudia Malic
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Karen Macaulay
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Kasey Parker
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Christine Kouri
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Ellen B Goldbloom
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada.
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada.
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Sharpe I, Kirkpatrick SI, Smith BT, Keown-Stoneman CDG, Omand JA, Vanderhout S, Warren C, Maguire JL, Birken CS, Anderson LN. Validation of a parent proxy-reported beverage screener compared to a 24-hour dietary recall for the measurement of sugar-containing beverage intake among young children. PLoS One 2023; 18:e0288768. [PMID: 37471316 PMCID: PMC10358879 DOI: 10.1371/journal.pone.0288768] [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: 10/05/2022] [Accepted: 07/05/2023] [Indexed: 07/22/2023] Open
Abstract
Measures that can provide reasonably accurate estimates of sugar-containing beverage (SCB) intake among children are needed. The primary objective of this study was to evaluate the relative validity of a short beverage screener (Nutrition and Health Questionnaire, NHQ) compared to a 24-hour recall (Automated Self-Administered 24-h (ASA24) Dietary Assessment Tool-Canada) for assessing parent proxy-reported daily SCB intake among children aged 4-14 years from the TARGet Kids! research network in Toronto, Canada. Children for whom a NHQ completed between March 2018 and June 2019 and an ASA24 completed within one year were included. A total of 471 parents who completed the NHQ beverage screener were also asked to complete the ASA24. One-hundred sixty-three completed the ASA24 and of this group, 109 were analyzed. Estimates of daily intake of 100% juices, sweetened drinks and soda, and total SCBs from the two measures were compared. The mean difference in beverage intake, Spearman correlations, and Bland-Altman plots were estimated for continuous measures. The kappa coefficient, sensitivity, and specificity were calculated for dichotomous measures of any daily intake versus none. The mean difference in total SCB intake between the NHQ and ASA24 was 0.14 cups/day (95% CI 0.01, 0.29) and the correlation was 0.43 (95% CI 0.26, 0.57). Sensitivity and specificity for any daily SCB intake were 0.63 and 0.76, respectively. Overall, parent proxy-reporting of children's total SCB intake from a beverage screener can provide reasonable estimates of SCB intake when detailed dietary assessment is not feasible.
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Affiliation(s)
- Isobel Sharpe
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sharon I Kirkpatrick
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Brendan T Smith
- Department of Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jessica A Omand
- Division of Child Health Evaluative Sciences (CHES), Sick Kids Research Institute, Toronto, Ontario, Canada
| | - Shelley Vanderhout
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Christine Warren
- Department of Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Catherine S Birken
- Division of Child Health Evaluative Sciences (CHES), Sick Kids Research Institute, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Child Health Evaluative Sciences (CHES), Sick Kids Research Institute, Toronto, Ontario, Canada
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9
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Vanderhout S, Potter BK, Smith M, Butcher NJ, Vaters J, Chakraborty P, Adams J, Inbar-Feigenberg M, Offringa M, Speechley K, Trakadis Y, Binik A. Ethical and practical considerations related to data sharing when collecting patient-reported outcomes in care-based child health research. Qual Life Res 2023:10.1007/s11136-023-03393-2. [PMID: 37002464 PMCID: PMC10329050 DOI: 10.1007/s11136-023-03393-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/03/2023]
Abstract
Abstract
Purpose
The collection and use of patient reported outcomes (PROs) in care-based child health research raises challenging ethical and logistical questions. This paper offers an analysis of two questions related to PROs in child health research: (1) Is it ethically obligatory, desirable or preferable to share PRO data collected for research with children, families, and health care providers? And if so, (2) What are the characteristics of a model best suited to guide the collection, monitoring, and sharing of these data?
Methods
A multidisciplinary team of researchers, providers, patient and family partners, and ethicists examined the literature and identified a need for focus on PRO sharing in pediatric care-based research. We constructed and analyzed three models for managing pediatric PRO data in care-based research, drawing on ethical principles, logistics, and opportunities to engage with children and families.
Results
We argue that it is preferable to share pediatric PRO data with providers, but to manage expectations and balance the risks and benefits of research, this requires a justifiable data sharing model. We argue that a successful PRO data sharing model will allow children and families to have access to and control over their own PRO data and be engaged in decision-making around how PROs collected for research may be integrated into care, but require support from providers.
Conclusion
We propose a PRO data sharing model that can be used across diverse research settings and contributes to improved transparency, communication, and patient-centered care and research.
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Vanderhout S, Nicholls S, Monfaredi Z, Hampel C, Ashdown L, Bilodeau M, Rich S, Shea B, Fergusson D. Facilitating and supporting the engagement of patients, families and caregivers in research: the "Ottawa model" for patient engagement in research. Res Involv Engagem 2022; 8:25. [PMID: 35672808 PMCID: PMC9172149 DOI: 10.1186/s40900-022-00350-0] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/20/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Patient engagement is increasingly being recognized as a critical component of health research; however, institutional models for building infrastructure and capacity for patient engagement in research are limited. There is an opportunity to create reproducible and scalable models of patient engagement in research and share best and promising practices. MAIN BODY In this article, we describe the development and features of the framework for the Ottawa Patient Engagement in Research Model at The Ottawa Hospital (TOH) and the Ottawa Hospital Research Institute (OHRI). Key components of the model include: a Patient and Family Engagement Program at TOH, which recruits, educates, and supports patients, families and caregivers to engage in clinical care, governance, and research; the Ottawa Methods Centre within the OHRI, which leads methodological research and provides support to investigators for patient engagement and patient-oriented research at TOH; and the Office of Patient Engagement in Research Activities, also within the OHRI, which facilitates collaborations between patients, researchers, clinicians and other stakeholders. Early success of this model can be attributed to aligned institutional priorities between TOH, OHRI and patients, the establishment of a patient engagement policy, ongoing education and support provided to patient partners and researchers, and innovative recruitment, tracking and evaluation procedures. Ongoing challenges and next steps include promoting diversity among patient partners, implementing an equitable compensation policy, engaging patients across a variety of roles and research areas, and developing resources to expand and sustain this program. CONCLUSION This model represents a unique effort of patients, clinicians, researchers, and policymakers across disciplines and institutions to produce a harmonized strategy and infrastructure for meaningful collaboration with patients and families in health research, and capacity building in patient-oriented research.
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Affiliation(s)
- Shelley Vanderhout
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada
| | - Stuart Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Zarah Monfaredi
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Claudia Hampel
- Patient Relations, The Ottawa Hospital, 1053 Carling Avenue, Box 133, Ottawa, ON, K1Y 4E9, Canada
| | - Lynn Ashdown
- Patient Partner Expert, Faculty of Medicine, University of Ottawa, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Maxime Bilodeau
- Patient Partner, The Ottawa Hospital, 1053 Carling Ave, Box 133, Ottawa, ON, K1Y 4E9, Canada
| | - Susan Rich
- Patient Partner Expert, The Ottawa Hospital, 1053 Carling Ave, Box 133, Ottawa, ON, K1Y 4E9, Canada
| | - Beverley Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada.
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada.
- Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada.
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11
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Lee DID, Vanderhout S, Aglipay M, Birken CS, Morris SK, Piché-Renaud PP, Keown-Stoneman CDG, Maguire JL. Delay in childhood vaccinations during the COVID-19 pandemic. Can J Public Health 2022; 113:126-134. [PMID: 35060107 PMCID: PMC8773389 DOI: 10.17269/s41997-021-00601-9] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES In many jurisdictions, routine medical care was reduced in response to the COVID-19 pandemic. The objective of this study was to determine whether the frequency of on-time routine childhood vaccinations among children age 0-2 years was lower following the COVID-19 declaration of emergency in Ontario, Canada, on March 17, 2020, compared to prior to the pandemic. METHODS We conducted a longitudinal cohort study of healthy children aged 0-2 years participating in the TARGet Kids! primary care research network in Toronto, Canada. A logistic mixed effects regression model was used to determine odds ratios (ORs) for delayed vaccination (> 30 days vs. ≤ 30 days from the recommended date) before and after the COVID-19 declaration of emergency, adjusted for confounding variables. A Cox proportional hazards model was used to explore the relationship between the declaration of emergency and time to vaccination. RESULTS Among 1277 children, the proportion of on-time vaccinations was 81.8% prior to the COVID-19 declaration of emergency and 62.1% after (p < 0.001). The odds of delayed vaccination increased (odds ratio = 3.77, 95% CI: 2.86-4.96), and the hazard of administration of recommended vaccinations decreased after the declaration of emergency (hazard ratio = 0.75, 95% CI: 0.60-0.92). The median vaccination delay time was 5 days (95% CI: 4-5 days) prior to the declaration of emergency and 17 days (95% CI: 12-22 days) after. CONCLUSION The frequency of on-time routine childhood vaccinations was lower during the first wave of the COVID-19 pandemic. Sustained delays in routine vaccinations may lead to an increase in rates of vaccine-preventable diseases.
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Affiliation(s)
- Da In Diane Lee
- Department of Paediatrics, St. Michael's Hospital, 61 Queen Street East, 2nd Floor, Toronto, ON, M5C 2T2, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shelley Vanderhout
- Department of Paediatrics, St. Michael's Hospital, 61 Queen Street East, 2nd Floor, Toronto, ON, M5C 2T2, Canada.,Department of Nutritional Sciences, Medical Sciences Building, University of Toronto, 1 King's College Circle, Room 5253, Toronto, ON, M5S 1A8, Canada
| | - Mary Aglipay
- Department of Paediatrics, St. Michael's Hospital, 61 Queen Street East, 2nd Floor, Toronto, ON, M5C 2T2, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Catherine S Birken
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Nutritional Sciences, Medical Sciences Building, University of Toronto, 1 King's College Circle, Room 5253, Toronto, ON, M5S 1A8, Canada.,Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, ON, Toronto, Canada
| | - Shaun K Morris
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, ON, Toronto, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
| | - Pierre-Philippe Piché-Renaud
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, ON, Toronto, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
| | - Charles D G Keown-Stoneman
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Jonathon L Maguire
- Department of Paediatrics, St. Michael's Hospital, 61 Queen Street East, 2nd Floor, Toronto, ON, M5C 2T2, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Department of Nutritional Sciences, Medical Sciences Building, University of Toronto, 1 King's College Circle, Room 5253, Toronto, ON, M5S 1A8, Canada. .,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, ON, Toronto, Canada. .,Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
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Vanderhout S, Fergusson DA, Cook JA, Taljaard M. Patient-reported outcomes and target effect sizes in pragmatic randomized trials in ClinicalTrials.gov: A cross-sectional analysis. PLoS Med 2022; 19:e1003896. [PMID: 35134080 PMCID: PMC8824332 DOI: 10.1371/journal.pmed.1003896] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Use of patient-reported outcomes (PROs) and patient and public engagement are critical ingredients of pragmatic trials, which are intended to be patient centered. Engagement of patients and members of the public in selecting the primary trial outcome and determining the target difference can better ensure that the trial is designed to inform the decisions of those who ultimately stand to benefit. However, to the best of our knowledge, the use and reporting of PROs and patient and public engagement in pragmatic trials have not been described. The objectives of this study were to review a sample of pragmatic trials to describe (1) the prevalence of reporting patient and public engagement; (2) the prevalence and types of PROs used; (3) how its use varies across trial characteristics; and (4) how sample sizes and target differences are determined for trials with primary PROs. METHODS AND FINDINGS This was a methodological review of primary reports of pragmatic trials. We used a published electronic search filter in MEDLINE to identify pragmatic trials, published in English between January 1, 2014 and April 3, 2019; we identified the subset that were registered in ClinicalTrials.gov and explicitly labeled as pragmatic. Trial descriptors were downloaded from ClinicalTrials.gov; information about PROs and sample size calculations were extracted from the manuscript. Chi-squared, Cochran-Armitage, and Wilcoxon rank sum tests were used to examine associations between trial characteristics and use of PROs. Among 4,337 identified primary trial reports, 1,988 were registered in CT.gov, of which 415 were explicitly labeled as pragmatic. Use of patient and public engagement was identified in 39 (9.4%). PROs were measured in 235 (56.6%): 144 (34.7%) used PROs as primary outcomes and 91 (21.9%) as only secondary outcomes. Primary PROs were symptoms (64; 44%), health behaviors (36; 25.0%), quality of life (17; 11.8%), functional status (16; 11.1%), and patient experience (10; 6.9%). Trial characteristics with lower prevalence of use of PROs included being conducted exclusively in children or adults over age 65 years, cluster randomization, recruitment in low- and middle-income countries, and primary purpose of prevention; trials conducted in Europe had the highest prevalence of PROs. For the 144 trials with a primary PRO, 117 (81.3%) reported a sample size calculation for that outcome; of these, 71 (60.7%) justified the choice of target difference, most commonly, using estimates from pilot studies (31; 26.5%), standardized effect sizes (20; 17.1%), or evidence reviews (16; 13.7%); patient or stakeholder opinions were used to justify the target difference in 8 (6.8%). Limitations of this study are the need for trials to be registered in ClinicalTrials.gov, which may have reduced generalizability, and extracting information only from the primary trial report. CONCLUSIONS In this study, we observed that pragmatic trials rarely report patient and public engagement and do not commonly use PROs as primary outcomes. When provided, target differences are often not justified and rarely informed by patients and stakeholders. Research funders, scientific journals, and institutions should support trialists to incorporate patient engagement to fulfill the mandate of pragmatic trials to be patient centered.
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Affiliation(s)
- Shelley Vanderhout
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A. Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jonathan A. Cook
- Centre for Statistics in Medicine & Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Li X, Vanderloo L, Maguire J, Keown-Stoneman C, Aglipay M, Anderson L, Cost K, Charach A, Vanderhout S, Birken C. 39 Physical and social distancing measures and child health behaviours during COVID-19: A cohort study. Paediatr Child Health 2021. [PMCID: PMC8689857 DOI: 10.1093/pch/pxab061.030] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Primary Subject area
Public Health and Preventive Medicine
Background
Various studies have examined the general impact of the COVID-19 outbreak on children’s health behaviours. The impact of public health measures practised by children during COVID-19 is relatively unknown.
Objectives
The primary objective was to determine the association between physical and social distancing measures and children’s outdoor time, sleep duration, and screen time during COVID-19.
Design/Methods
A longitudinal study using repeated measures of exposures and outcomes was conducted in healthy children (0 to 10 years) between April 14 and July 15, 2020. Parents were asked to complete questionnaires about isolation, physical distancing practices, and children’s health behaviours. The primary exposure was the average number of days that children practised physical and social distancing measures per week. The three outcomes were children’s outdoor time, total screen time, and sleep duration during COVID-19. Linear mixed effects models were fitted using repeated measures of primary exposure and outcomes.
Results
This study included 554 observations from 265 children. Physical and social distancing measures were associated with shorter outdoor time (-17.2; 95% CI -22.07, -12.40; p < 0.001) and longer total screen time (11.3; 95% CI 3.88, 18.79; p = 0.003) during COVID-19. The association with outdoor time was stronger in younger children (< 5 years), and the associations with total screen time were stronger in females and in older children (≥ 5 years).
Conclusion
Physical and social distancing measures during COVID-19 have resulted in negative impacts on the health behaviours of Canadian children living in a large metropolitan area.
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Sharpe I, Kirkpatrick SI, Smith BT, Keown-Stoneman CDG, Omand J, Vanderhout S, Maguire JL, Birken CS, Anderson LN. Automated Self-Administered 24-H Dietary Assessment Tool (ASA24) recalls for parent proxy-reporting of children's intake (> 4 years of age): a feasibility study. Pilot Feasibility Stud 2021; 7:123. [PMID: 34116723 PMCID: PMC8194205 DOI: 10.1186/s40814-021-00864-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Robust measurement of dietary intake in population studies of children is critical to better understand the diet-health nexus. It is unknown whether parent proxy-report of children's dietary intake through online 24-h recalls is feasible in large cohort studies. OBJECTIVES The primary objective of this study was to describe the feasibility of the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24) to measure parent proxy-reported child dietary intake. A secondary objective was to compare intake estimates with those from national surveillance. METHODS Parents of children aged 4-15 years participating in the TARGet Kids! research network in Toronto, Canada were invited by email to complete an online ASA24-Canada-2016 recall for their child, with a subsample prompted to complete a second recall about 2 weeks later. Descriptive statistics were reported for ASA24 completion characteristics and intake of several nutrients. Comparisons were made to the 2015 Canadian Community Health Survey (CCHS) 24-h recall data. RESULTS A total of 163 parents completed the first recall, and 46 completed the second, reflecting response rates of 35% and 59%, respectively. Seven (4%) first recalls and one (2%) second recall were excluded for ineligibility, missing data, or inadvertent parental self-report. The median number of foods reported on the first recall was 18.0 (interquartile range (IQR) 6.0) and median time to complete was 29.5 min (IQR 17.0). Nutrient intakes for energy, total fat, protein, carbohydrates, fiber, sodium, total sugars, and added sugars were similar across the two recalls and the CCHS. CONCLUSIONS The ASA24 was found to be feasible for parent proxy-reporting of children's intake and to yield intake estimates comparable to those from national surveillance, but strategies are needed to increase response rate and support completion to enhance generalizability.
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Affiliation(s)
- Isobel Sharpe
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Brendan T Smith
- Department of Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Omand
- Division of Child Health Evaluative Sciences (CHES), Sick Kids Research Institute, Toronto, Ontario, Canada
| | - Shelley Vanderhout
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Division of Child Health Evaluative Sciences (CHES), Sick Kids Research Institute, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
- Division of Child Health Evaluative Sciences (CHES), Sick Kids Research Institute, Toronto, Ontario, Canada.
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Copeland JK, Chao G, Vanderhout S, Acton E, Wang PW, Benchimol EI, El-Sohemy A, Croitoru K, Gommerman JL, Guttman DS. The Impact of Migration on the Gut Metagenome of South Asian Canadians. Gut Microbes 2021; 13:1-29. [PMID: 33794735 PMCID: PMC8023248 DOI: 10.1080/19490976.2021.1902705] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 02/04/2023] Open
Abstract
South Asian (SA) Canadian immigrants have a higher risk of developing certain immune-mediated inflammatory diseases compared to non-migrant SAs. We sought to investigate the effect of migration on the gut metagenome and to identify microbiological associations between migration and conditions that may influence the development of immune-mediated inflammatory diseases. Metagenomic analysis of 58 first-generation (GEN1) SA immigrants and 38 unrelated Canadian born children-of-immigrants (GEN2) determined that the time lived in Canada was associated with continued changes in gut microbial communities. Migration of GEN1 to Canada early in life results in a gut community with similarities to GEN2 SA Canadians and non-SA North Americans. Conversely, GEN1 immigrants who arrived recently to Canada exhibited pronounced differences from GEN2, while displaying microbial similarities to a non-migrating SA cohort. Multivariate analysis identified that community composition was primarily influenced by high abundance taxa. Prevotella copri dominated in GEN1 and non-migrant SAs. Clostridia and functionally related Bacteroidia spp. replaced P. copri dominance over generations in Canada. Mutually exclusive Dialister species occurred at differing relative abundances over time and generations in Canada. This shift in species composition is accompanied by a change in genes associated with carbohydrate utilization and short-chain fatty acid production. Total energy derived from carbohydrates compared to protein consumption was significantly higher for GEN1 recent immigrants, which may influence the functional requirements of the gut community. This study demonstrates the associations between migration and the gut microbiome, which may be further associated with the altered risk of immune-mediated inflammatory diseases observed for SA Canadians.
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Affiliation(s)
- Julia K. Copeland
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, CA, Canada
| | - Gary Chao
- Department of Immunology, University of Toronto, Toronto, CA, Canada
| | - Shelley Vanderhout
- Nutrigenomix, Department of Nutritional Sciences, University of Toronto, Toronto, CA, Canada
| | - Erica Acton
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, CA, Canada
| | - Pauline W. Wang
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, CA, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, CA, Canada
| | - Eric I. Benchimol
- Department of Pediatrics, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, CA, Canada
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, University of Toronto, Toronto, CA, Canada
| | - Ken Croitoru
- Department of Medicine, University of Toronto and Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, CA, Canada
| | | | - David S. Guttman
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, CA, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, CA, Canada
| | - the GEMINI Research Team
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, CA, Canada
- Department of Immunology, University of Toronto, Toronto, CA, Canada
- Nutrigenomix, Department of Nutritional Sciences, University of Toronto, Toronto, CA, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, CA, Canada
- Department of Pediatrics, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, CA, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, CA, Canada
- Department of Medicine, University of Toronto and Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, CA, Canada
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Vanderhout S, Keown-Stoneman C, Birken C, Thorpe K, O’Connor D, Maguire J. 61 Cow’s milk fat and child adiposity: a prospective cohort study. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa068.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
International guidelines recommend that children older than 2 years of age consume reduced fat (0.1-2%) instead of whole cow’s milk (3.25% fat) to prevent childhood obesity, but these guidelines are consensus-based and have a low GRADE level of evidence.
Objectives
The primary objective of this study was to evaluate the longitudinal relationship between cow’s milk fat (0.1-3.25%) intake and Body Mass Index z-score (zBMI) in children aged 9 months to 8 years. The secondary objective was to determine the relationship between cow’s milk fat intake and odds of overweight (zBMI >1) and obesity (zBMI > 2).
Design/Methods
A prospective cohort study of children 9 months to 8 years of age was conducted through the TARGet Kids! primary care research network. The primary exposure was cow’s milk fat consumption (skim (0.1%), 1%, 2%, or whole [3.25%]), measured by parental report. The primary outcome was zBMI, an age and sex adjusted measure of child adiposity. Height and weight were measured by trained research assistants and zBMI was determined according to the WHO growth standards. A linear mixed effects model and logistic generalized estimating equations were used to determine the longitudinal association between cow’s milk fat intake and child zBMI.
Results
Among children aged 9 months to 8 years of age (N= 7467), each 1% increase in cow’s milk fat consumed was associated with a 0.05 lower zBMI score (95% CI -0.07 to -0.03, p< 0.0001). Compared to children who consumed reduced fat (0.1-2%) cow’s milk, there was evidence that children who consumed whole cow’s milk had 16% lower odds of overweight (OR=0.84, 95% CI 0.77 to 0.91), p< 0.0001) and 18% lower odds of obesity (OR= 0.82, 95% CI 0.68 to 1.00, p= 0.047).
Conclusion
Guidelines for reduced fat instead of whole cow’s milk during childhood may not be effective in preventing overweight or obesity. Randomized controlled trial data is needed to understand which cow’s milk fat optimizes child growth, development and nutrition.
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Vanderhout S, Aglipay M, Maguire J, Juando-Prats C. 60 CoMFORT: Cow Milk Fat Obesity pRevention Trial Feasibility Study. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.059] [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: 11/13/2022] Open
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18
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Vanderhout S, Aglipay M, Maguire J, Birken C, Thorpe K, O’Connor D, Torabi N. 61 Cow’s milk fat & child adiposity: a systematic review and meta-analysis. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.060] [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: 11/14/2022] Open
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Sharp JR, Maguire JL, Carsley S, Abdullah K, Chen Y, Perrin EM, Parkin PC, Birken CS, Maguire JL, Lau E, Laupacis A, Parkin PC, Salter M, Szatmari P, Weir S, Abdullah K, Aglipay M, Ali Y, Anderson LN, Bayoumi I, Birken CS, Borkhoff CM, Carsley S, Chen S, Chen Y, Dai DW, Darmawikarta D, Dennis CL, Eny K, Erdle S, Furlong K, Kavikondala K, Koroshegyi C, Kowal C, Lee GJ, Maguire JL, Mason D, Omand J, Parkin PC, Persaud N, Plumptre L, van den Heuvel M, Vanderhout S, Wong P, Zabih W, Abdurrahman M, Anderson B, Anderson K, Arbess G, Baker J, Barozzino T, Bergeron S, Bhagat D, Blanchette N, Bloch G, Bonifacio J, Bowry A, Brown A, Bugera J, Calpin C, Campbell D, Cheema S, Cheng E, Chisamore B, Constantin E, Culbert E, Danayan K, Das P, Derocher MB, Do A, Dorey M, Doukas K, Egger A, Farber A, Freedman A, Freeman S, Fung K, Gazeley S, Goldenberg D, Guiang C, Ha D, Hafiz S, Handford C, Hanson L, Harrington L, Hatch H, Hughes T, Jacobson S, Jagiello L, Jansz G, Kadar P, Kiran T, Kitney L, Knowles H, Kwok B, Lakhoo S, Lam-Antoniades M, Lau E, Leung FH, Li A, Li P, Loo J, Louis J, Mahmoud S, Male R, Mascoll V, Moodie R, Morinis J, Nader M, Naymark S, Neelands P, Owen J, Parry J, Peer M, Pena K, Perlmutar M, Persaud N, Pinto A, Pitt T, Porepa M, Qi V, Ramji N, Ramji N, Rana J, Rosenthal A, Rouleau K, Saunderson J, Saxena R, Schiralli V, Sgro M, Shepherd S, Smiltnieks B, Srikanthan C, Taylor C, Turner S, Uddin F, Vaughan J, Weisdorf T, Wijayasinghe S, Wong P, Wormsbecker A, Ying E, Young E, Zajdman M, Bustos M, Camacho C, Dalwadi D, Jegathesan T, Malhi T, Thadani S, Thompson J, Thompson L, Allen C, Boodhoo B, Hall J, Juni P, Lebovic G, Pope K, Shim J, Thorpe K, Azad A. Temperament Is Associated With Outdoor Free Play in Young Children: A TARGet Kids! Study. Acad Pediatr 2018; 18:445-451. [PMID: 28842293 DOI: 10.1016/j.acap.2017.08.006] [Citation(s) in RCA: 8] [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: 03/09/2017] [Revised: 08/04/2017] [Accepted: 08/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Outdoor free play is important for preschoolers' physical activity, health, and development. Certain temperamental characteristics are associated with obesity, nutrition, and sedentary behaviors in preschoolers, but the relationship between temperament and outdoor play has not been examined. This study examined whether there is an association between temperament and outdoor play in young children. METHODS Healthy children aged 1 to 5 years recruited to The Applied Research Group for Kids (TARGet Kids!), a community-based primary care research network, from July 2008 to September 2013 were included. Parent-reported child temperament was assessed using the Childhood Behavior Questionnaire. Outdoor free play and other potential confounding variables were assessed through validated questionnaires. Multivariable linear regression was used to determine the association between temperament and outdoor play, adjusted for potential confounders. RESULTS There were 3393 children with data on outdoor play. The association between negative affectivity and outdoor play was moderated by sex; in boys, for every 1-point increase in negative affectivity score, mean outdoor play decreased by 4.7 minutes per day. There was no significant association in girls. Surgency was associated with outdoor play; for every 1-point increase in surgency/extraversion, outdoor play increased by 4.6 minutes per day. CONCLUSIONS Young children's temperamental characteristics were associated with their participation in outdoor free play. Consideration of temperament could enhance interventions and strategies to increase outdoor play in young children. Longitudinal studies are needed to elucidate the relationship between children's early temperament and physical activity.
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Affiliation(s)
- Julia R Sharp
- Department of Post-Graduate Medical Education, The Hospital for Sick Children (SickKids), University of Toronto, Canada
| | - Jonathon L Maguire
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada; Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Canada; The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada; Department of Paediatrics, St Michael's Hospital, Toronto, Canada
| | - Sarah Carsley
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada
| | - Kawsari Abdullah
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada
| | - Yang Chen
- The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Eliana M Perrin
- Department of Pediatrics, Division of Primary Care, Duke University, Durham, NC
| | - Patricia C Parkin
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada; Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Canada
| | - Catherine S Birken
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada; Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Canada; Child Health Evaluative Studies, SickKids Research Institute, Toronto, Canada; The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
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Vanderhout S, Maguire J, Birken C, Parkin P, Lebovic G, Chen Y, O'Connor D. The Relationship between Milk Fat Content, Vitamin D and Adiposity in Early Childhood. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e89c] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Fortified cow’s milk is the main dietary source of vitamin D and an important source of dietary fat for North American children. Current guidelines recommend reduced milk fat consumption to reduce childhood obesity, yet the relationship between lower milk fat, vitamin D stores and adiposity is unclear.
OBJECTIVES: The objective of this study was to determine the association between percent fat content of milk and both zBMI and 25-hydroxyvi-tamin D; secondly, to explore if volume of milk consumed modified this relationship.
DESIGN/METHODS: A cross-sectional study of healthy urban children 12-72 months of age was conducted. Bivariate multiple linear regression was used to test the association between percent milk fat content and child 25-hydroxyvitamin D and zBMI concurrently. The interaction between volume of milk consumed and percent milk fat content was examined to explore how milk volume might modify these relationships.
RESULTS: 2745 children were included in the analysis. Percent fat content of milk was positively associated with 25-hydroxyvitamin D (p=0.006), and negatively associated with zBMI (p<0.0001). Children who drank homogenized milk (3.25% fat) had 6.6 nmol/L (95% CI 5.49 to 7.71) higher median 25(OH)D concentration and 0.72 lower (95% CI 0.68 to 0.76) zBMI score than children who drank skim milk (0.1% fat). Volume of milk consumed potentiated the effect of percent fat content of milk on 25-hydroxyvitamin D (p=0.003) but not on zBMI (p=0.77). Children who drank 1 cup of homogenized milk each day had a similar 25-hydroxyvita-min D as children who drank 2.85 cups (95% CI 2.71 to 2.99) of skim milk, but had zBMI score 0.78 (95% CI 0.63, 0.93) units lower.
CONCLUSION: Homogenized milk may be more appropriate than reduced fat milk in maximizing serum 25-hydroxyvitamin D and minimizing adiposity in early childhood. Current guidelines for reduced milk fat consumption in childhood may require further study to achieve desired outcomes.
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