scholarly journals The impact of the COVID-19 pandemic on children with medical complexity

2021 ◽  
Author(s):  
Catherine Diskin ◽  
Francine Buchanan ◽  
Eyal Cohen ◽  
Tammie Dewan ◽  
Tessa Diaczun ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Family Caregiving ◽  
Healthcare Delivery ◽  
Respiratory Illness ◽  
List Type ◽  
Children With Medical Complexity ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Virtual Care ◽  
Medical Complexity

AbstractBackgroundDescriptions of the COVID-19 pandemic’s indirect consequences on children are emerging. We aimed to describe the impacts of the pandemic on children with medical complexity (CMC) and their families.MethodsA one-time survey of Canadian paediatricians using the Canadian Paediatric Surveillance Program (CPSP) was conducted in Spring 2021.ResultsA total of 784 paediatricians responded to the survey, with 70% (n=540) providing care to CMC. Sixty-seven (12.4%) reported an adverse health outcome due to a COVID-19 pandemic-related disruption in healthcare delivery. Disruption of the supply of medication and equipment was reported by 11.9% of respondents (n=64). Respondents reported an interruption in family caregiving (47.5%, n=252) and homecare delivery (40.8%, n=218). Almost 47% of respondents (n=253) observed a benefit to CMC due to COVID-19 related changes in healthcare delivery, including increased availability of virtual care and reduction in respiratory illness. Some (14.4%) reported that CMC were excluded from in-person learning when their peers without medical complexity were not.ConclusionCanadian paediatricians reported that CMC experienced adverse health outcomes during the COVID-19 pandemic, including disruptions to family caregiving and community supports. These results highlight the need for healthcare, community and education policymakers to collaborate with families to optimize their health.“What This Study Adds”Children with medical complexity experienced adverse health outcomes related to the direct and indirect effects of the COVID-19 pandemic.The COVID-19 pandemic has interrupted family caregiving, homecare support, access to education, and key supports for CMC and their families.Canadian paediatricians observed benefits associated with structural changes relating to the COVID-19 pandemic, including the expansion of virtual care and the reduced incidence of respiratory illness

scholarly journals The effects of assisted reproduction technologies on metabolic health and disease

2020 ◽  
Author(s):  
Maria Florencia Heber ◽  
Grażyna Ewa Ptak
Keyword(s):  
Metabolic Syndrome ◽  
Health Outcomes ◽  
Metabolic Diseases ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Postnatal Life ◽  
Metabolic Alterations ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
The Individual

Abstract Background The increasing prevalence of metabolic diseases places a substantial burden on human health throughout the world. It is believed that predisposition to metabolic disease starts early in life, a period of great susceptibility to epigenetic reprogramming due to environmental insults. Assisted reproductive technologies (ART), i.e., treatments for infertility, may affect embryo development, resulting in multiple adverse health outcomes in postnatal life. The most frequently observed alteration in ART pregnancies is impaired placental nutrient transfer. Moreover, consequent intrauterine growth restriction and low birth weight followed by catch-up growth can all predict future obesity, insulin resistance, and chronic metabolic diseases. Scope of the review In this review, we have focused on evidence of adverse metabolic alterations associated with ART, which can contribute to the development of chronic adult-onset diseases, such as metabolic syndrome, type 2 diabetes, and cardiovascular disease. Due to high phenotypic plasticity, ART pregnancies can produce both offspring with adverse health outcomes, as well as healthy individuals. We further discuss the sex-specific and age-dependent metabolic alterations reflected in ART offspring, and how the degree of interference of a given ART procedure (from mild to more severe manipulation of the egg) affects the occurrence and degree of offspring alterations. Major conclusions Over the last few years, studies have reported signs of cardiometabolic alterations in ART offspring that are detectable at a young age but that do not appear to constitute a high risk of disease and morbidity per se. These abnormal phenotypes could be early indicators of the development of chronic diseases, including metabolic syndrome, in adulthood. The early detection of metabolic alterations could contribute to preventing the onset of disease in adulthood. Such early interventions may counteract the risk factors and improve the long-term health of the individual.

scholarly journals Understanding the influence of socioeconomic status on the association between combinations of lifestyle factors and adverse health outcomes: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042212
Author(s):  
Hamish Foster ◽  
Peter Polz ◽  
Frances Mair ◽  
Jason Gill ◽  
Catherine A O'Donnell
Keyword(s):  
Systematic Review ◽  
Socioeconomic Status ◽  
Health Outcomes ◽  
Meta Analysis ◽  
Lifestyle Factors ◽  
Lifestyle Factor ◽  
Unhealthy Lifestyle ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
The Impact

IntroductionCombinations of unhealthy lifestyle factors are strongly associated with mortality, cardiovascular disease (CVD) and cancer. It is unclear how socioeconomic status (SES) affects those associations. Lower SES groups may be disproportionately vulnerable to the effects of unhealthy lifestyle factors compared with higher SES groups via interactions with other factors associated with low SES (eg, stress) or via accelerated biological ageing. This systematic review aims to synthesise studies that examine how SES moderates the association between lifestyle factor combinations and adverse health outcomes. Greater understanding of how lifestyle risk varies across socioeconomic spectra could reduce adverse health by (1) identifying novel high-risk groups or targets for future interventions and (2) informing research, policy and interventions that aim to support healthy lifestyles in socioeconomically deprived communities.Methods and analysisThree databases will be searched (PubMed, EMBASE, CINAHL) from inception to March 2020. Reference lists, citations and grey literature will also be searched. Inclusion criteria are: (1) prospective cohort studies; (2) investigations of two key exposures: (a) lifestyle factor combinations of at least three lifestyle factors (eg, smoking, physical activity and diet) and (b) SES (eg, income, education or poverty index); (3) an assessment of the impact of SES on the association between combinations of unhealthy lifestyle factors and health outcomes; (4) at least one outcome from—mortality (all cause, CVD and cancer), CVD or cancer incidence. Two independent reviewers will screen titles, abstracts and full texts of included studies. Data extraction will focus on cohort characteristics, exposures, direction and magnitude of SES effects, methods and quality (via Newcastle-Ottawa Scale). If appropriate, a meta-analysis, pooling the effects of SES, will be performed. Alternatively, a synthesis without meta-analysis will be conducted.Ethics and disseminationEthical approval is not required. Results will be disseminated via peer-reviewed publication, professional networks, social media and conference presentations.PROSPERO registration numberCRD42020172588.

scholarly journals Self-Reported Energy Trajectories Predict Adverse Health Outcomes in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 794-795
Author(s):  
Briana Sprague ◽  
Xiaonan Zhu ◽  
Rebecca Ehrenkranz ◽  
Qu Tian ◽  
Theresa Gmelin ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Outcomes ◽  
Mixed Models ◽  
Single Item ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Observational Cohort ◽  
Outcome Performance ◽  
Future Work ◽  
Mortality Hazard Ratio

Abstract Declining energy may indicate homeostatic dysregulation and predict adverse health outcomes. We hypothesized that declining energy would predict greater frailty (1-10), greater mortality, and faster mood (CES-D) and cognition (3MS) decline over time. This observational cohort studies included 2,443 older adults (mean age=74.6, 62.5% White, 47.8% men) from the Health ABC Study with up to eight years of data. Energy was assessed using a single-item question about prior month’s energy (baseline mean=6.7, SD=1.7, range=0–10, lower=less energy). We used linear mixed models to create energy change scores (mean=-.07 points/year, SD=.05, range=-0.32-0.21, negative=decreased energy). In regression models adjusting for baseline outcome performance and energy and demographics, declining energy predicted greater frailty (β=-2.72, 95%CI = -3.39,-2.06), greater mortality (hazard ratio=.07, p<.001), and faster CES-D (β=-.93, 95%CI=-1.10,-0.75) but not 3MS decline. Energy changes are easy to assess and predict clinically-relevant outcomes. Future work should consider mechanisms of declining energy on disability-related outcomes. Part of a symposium sponsored by Brain Interest Group.

scholarly journals Genome Sequences of 15 Gardnerella vaginalis Strains Isolated from the Vaginas of Women with and without Bacterial Vaginosis: TABLE 1 

2016 ◽  
Vol 4 (5) ◽  
Author(s):  
Lloyd S. Robinson ◽  
Justin Perry ◽  
Sai Lek ◽  
Aye Wollam ◽  
Erica Sodergren ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Health Outcomes ◽  
Bacterial Vaginosis ◽  
Draft Genome ◽  
Gardnerella Vaginalis ◽  
Genome Sequences ◽  
Predominant Species ◽  
Adverse Health ◽  
Adverse Health Outcomes

Gardnerella vaginalis is a predominant species in bacterial vaginosis, a dysbiosis of the vagina that is associated with adverse health outcomes, including preterm birth. Here, we present the draft genome sequences of 15 Gardnerella vaginalis strains (now available through BEI Resources) isolated from women with and without bacterial vaginosis.

scholarly journals Using logic regression to characterize extreme heat exposures and their health associations: a time-series study of emergency department visits in Atlanta

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shan Jiang ◽  
Joshua L. Warren ◽  
Noah Scovronick ◽  
Shannon E. Moss ◽  
Lyndsey A. Darrow ◽  
...  
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Health Outcomes ◽  
Simulation Study ◽  
Heat Exposure ◽  
Emergency Department Visits ◽  
Extreme Heat ◽  
Logic Regression ◽  
Adverse Health ◽  
Adverse Health Outcomes

Abstract Background Short-term associations between extreme heat events and adverse health outcomes are well-established in epidemiologic studies. However, the use of different exposure definitions across studies has limited our understanding of extreme heat characteristics that are most important for specific health outcomes or subpopulations. Methods Logic regression is a statistical learning method for constructing decision trees based on Boolean combinations of binary predictors. We describe how logic regression can be utilized as a data-driven approach to identify extreme heat exposure definitions using health outcome data. We evaluated the performance of the proposed algorithm in a simulation study, as well as in a 20-year time-series analysis of extreme heat and emergency department visits for 12 outcomes in the Atlanta metropolitan area. Results For the Atlanta case study, our novel application of logic regression identified extreme heat exposure definitions that were associated with several heat-sensitive disease outcomes (e.g., fluid and electrolyte imbalance, renal diseases, ischemic stroke, and hypertension). Exposures were often characterized by extreme apparent minimum temperature or maximum temperature over multiple days. The simulation study also demonstrated that logic regression can successfully identify exposures of different lags and duration structures when statistical power is sufficient. Conclusion Logic regression is a useful tool for identifying important characteristics of extreme heat exposures for adverse health outcomes, which may help improve future heat warning systems and response plans.

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