Search

Background: All longitudinal cohort studies strive for high participant retention, although attrition is common. Understanding determinants of attrition is important to inform and develop targeted strategies to improve study participation. We aimed to identify factors associated with research participation in a large children's primary care cohort study. Methods: In this longitudinal cohort study between 2008 and 2020, all children who participated in the Applied Research Group for Kids (TARGet Kids!) were included. TARGet Kids! is a large primary care practice-based pediatric research network in Canada with ongoing data collection at well-child visits. Several sociodemographic, health, and study design factors were examined for their associations with research participation. The primary outcome was attendance of eligible research follow-up visits. The secondary outcome was time to withdrawal from the TARGet Kids! study. Generalized linear mixed effects models and Cox proportional hazard models were fitted. We have engaged parent partners in all stages of this study. Results: A total 10,412 children with 62,655 total eligible research follow-up visits were included. Mean age at enrolment was 22 months, 52% were male, and 52% had mothers of European ethnicity. 68.4% of the participants attended at least 1 research follow-up visit. Since 2008, 6.4% of the participants have submitted a withdrawal request. Key factors associated with research participation included child age, ethnicity, maternal age, maternal education level, family income, parental employment, child diagnosis of chronic health conditions, certain study sites, and missingness in questionnaire data. Conclusions: Socioeconomic status, demographic factors, chronic conditions, and missingness in questionnaire data were associated with research participation in this large primary care practice-based cohort study of children. Results from this analysis and input from our parent partners suggested that retention strategies could include continued parent engagement, creating brand identity and communication tools, using multiple languages and avoiding redundancy in the questionnaires. [ABSTRACT FROM AUTHOR]

The article discusses the early detection of and intervention for hearing loss can maximize communication, reading and emotional development, resulting in optimized education and employment in later life. The article discusses that paediatricians are key to augmenting the efficacy of congenital or early-onset hearing loss detection and intervention, particularly in cases where infants fail or do not receive the screening test.

The article presents a case study of a 17-year-old male with syncope and cardiac arrest. Topics include a drug protocol and multiple defibrillations where spontaneous return of circulation being achieved in the emergency department; and left ventricular noncompaction cardiomyopathy (LVNC) being a relatively rare congenital condition with a heterogeneous age of presentation and clinical severity.

The infant mortality rate is the number of child deaths under 1 year of age/1000 live births. It is a central indicator of both health system effectiveness and socioeconomic conditions. However, Canada's infant mortality rate is unacceptably high for its level of healthcare and socioeconomic development. Canadians living in income-deprived areas and those experiencing health inequities have higher infant mortality rates than those in other areas. We introduce feasible healthcare practitioner activities that will promote improved social environments for children and contribute to bridging gaps in infant mortality. [ABSTRACT FROM AUTHOR]

In 1998, the Centers for Disease Control and Prevention Adverse Childhood Experiences study established the profound effects of early childhood adversity on life course health. The burden of cumulative adversities can affect gene expression, immune system development and condition stress response. A scientific framework provides explanation for numerous childhood and adult health problems and high-risk behaviours that originate in early life. In our review, we discuss adverse childhood experiences, toxic stress, the neurobiological basis and multigenerational and epigenetic transmission of trauma and recognized health implications. Further, we outline building resilience, screening in the clinical setting, primary care interventions, applying trauma-informed care and future directions. We foresee that enhancing knowledge of the far-reaching effects of adverse childhood events will facilitate mitigation of toxic stress, promote child and family resilience and optimize life course health trajectories. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 11-month-old male infant had isolated transaminitis on lab investigations obtained during a viral illness with clear nasal discharge, mild cough, and fever. Topics include repeated examination over the next 6 months continued to be unremarkable: at 17 months, the child appeared well and had no jaundice; and abdomen has soft and nontender, with no organomegaly.

A case study of 5-month-old boy suffering with bloody stools is presented. Topics discussed include mostly breastfed with occasional dairy protein formula supplementation; no history of vomiting, cellulitis, joint swelling, or eczema; and parents were nonconsanguineous and of European background and grandmother had irritable bowel syndrome.

Early childhood caries (ECC) is the most common chronic disease affecting young children in Canada. ECC may lead to pain and infection, compromised general health, decreased quality of life and increased risk for dental caries in primary and permanent teeth. A multidisciplinary approach to prevent and identify dental disease is recommended by dental and medical national organizations. Young children visit primary care providers at regular intervals from an early age. These encounters provide an ideal opportunity for primary care providers to educate clients about their children's oral health and its importance for general health. We designed an office-based oral health screening guide to help primary care providers identify ECC, a dental referral form to facilitate dental care access and an oral health education resource to raise parental awareness. These resources were reviewed and trialled with a small number of primary care providers. [ABSTRACT FROM AUTHOR]

Literacy is the ability to read, write and understand print. Proficiency in literacy is fundamental to social inclusion and strongly linked to health outcomes. Thus, improving literacy is important for lifelong health promotion. Poverty, inadequate hearing, speech and vision and learning disabilities may challenge literacy development. In our review, we explore these topics and suggest recommendations to: Mitigate the Effects of Poverty, Access Comprehensive Medical Assessments, Promote Early Childhood Education and Advocate for Early Intervention and Remediation Programs. [ABSTRACT FROM AUTHOR]

Blunt abdominal trauma can cause insidious liver injury and laceration. In particular, a subcapsular hepatic hematoma may result from bleeding in the parenchyma that is contained by the liver capsule. In some circumstances, a hepatic laceration may result in delayed blood collection. A growing body of evidence has also reported the occurrence of liver hematoma associated with abdominal trauma. We describe a 13-year-old female with a late-onset subcapsular hepatic hematoma after abdominal injury. She presented with worsening abdominal and lower back pain. Her management was conservative with fluid resuscitation and in-hospital monitoring. Our case highlights the importance of close follow-up and diagnostic imaging following blunt abdominal trauma. [ABSTRACT FROM AUTHOR]

Familial adenomatous polyposis is an autosomal dominant disease that results in numerous colonic polyps resulting in malignancy if left untreated. We report a case of a 15-year-old male with a strong family history of colon cancer who presented with refractory iron deficiency anemia and a mandibular mass. Colonoscopy revealed extensive large lobulated polyps and genetic testing confirmed familial adenomatous polyposis, while computed tomography scan revealed his mass to be a mandibular osteoma, a known extracolonic manifestation of familial adenomatous polyposis. The combination of colorectal and extracolonic manifestations is known as Gardner syndrome. In an adolescent with iron deficiency anemia refractory to adequate supplementation and a strong family history, the diagnosis of familial adenomatous polyposis should be considered. [ABSTRACT FROM AUTHOR]

A case study of 6-month-old boy presented with bowing of both lower legs. Topics include condition may present at birth and gradually resolve by the second year of life, without medical intervention; primary care protocol was constructed to differentiate pathological versus physiological genu varum; and growth disturbance in cartilage development localized to the postero-medial proximal tibial physis.

Introduction: We describe a boy with back pain accompanied by normal physical, hematological, and radiological findings prior to diagnosis of acute lymphocytic leukemia (ALL). Case: A previously healthy, 5-year-old boy presented on 2 occasions to the emergency department with isolated nocturnal lower back pain. His back and neurologic exams were normal. The child's investigations only showed low haemoglobin (99 g/L). Spine and chest x-rays were normal. The child's third presentation with back pain occurred two months later, accompanied by fatigue and episodic fever. His investigations showed an anemia (haemoglobin 37 g/L), thrombocytopenia (platelet count 200 X 109/L), and leukocytosis (leukocyte count 16.6 X 109/L) with neutropenia (neutrophil count 0.50 X 109/L). His blood smear showed 43% of circulating blasts. His bone marrow biopsy confirmed the diagnosis of early precursor B-ALL. Discussion: Clinical findings of ALL at diagnosis tend to be non-specific and include fever and infection caused by neutropenia, bruising and bleeding from thrombocytopenia, and fatigue and pallor from anemia. Isolated bone pain as the initial presentation of ALL is uncommon. Children with ALL who present with prominent bone pain have hematological values that are closer to normal, as compared to those with no or mild bone pain. More than half of children with ALL who present with musculoskeletal symptoms have no radiological findings. Conclusions: Given that the clinical presentation of ALL is non-specific and may precede hematological changes, a high index of suspicion for bone pain in young children may contribute to the early diagnosis of ALL. [ABSTRACT FROM AUTHOR]

The article informs about Baby-led weaning is an approach to introducing solid foods in which infants at least 6 months of age feed themselves all of their food from the start of complementary feeding. It mentions that approach has gained popularity and is recommended in some parenting books, websites, and blogs. It also informs that the term weaning refers to the transition from a diet of only milk feeds to introduction of solid foods; it does not refer to weaning the baby off the breast.