Metabolic dysregulation is an early event in carcinogenesis. Here, we examined the expression of ... more Metabolic dysregulation is an early event in carcinogenesis. Here, we examined the expression of enzymes involved in de novo lipogenesis (ATP-citrate lyase: ACLY), glucose uptake (Glucose Transporter 1: GLUT1), and folate–glutamate metabolism (Prostate-Specific Membrane Antigen: PSMA) as potential biomarkers of risk for early prostate cancer progression. Patients who were managed initially on active surveillance with a Gleason score of 6 or a low-volume Gleason score of 7 (3 + 4) were accrued from a prostate cancer diagnostic assessment program. Patients were asked to donate their baseline diagnostic biopsy tissues and permit access to their clinical data. PSMA, GLUT1, and ACLY expression were examined with immunohistochemistry (IHC) in baseline biopsies, quantitated by Histologic Score for expression in benign and malignant glands, and compared with patient time remaining on active surveillance (time-on-AS). All three markers showed trends for elevated expression in malignant compa...
Introduction: The use of telemedicine in critical care is emerging, however, there is a paucity o... more Introduction: The use of telemedicine in critical care is emerging, however, there is a paucity of information surrounding the costs relative to health gains in the pediatric population. This study aimed to estimate the cost-effectiveness of a pediatric tele-resuscitation (Peds-TECH) intervention compared to the usual care in five community hospital emergency departments (EDs). Using a decision tree analysis approach with secondary retrospective data from a 3-year time period, this cost-effectiveness analysis was completed. Methods: A mixed methods quasi-experimental design was embedded in the economic evaluation of Peds-TECH intervention. Patients aged <18 years triaged as Canadian Triage and Acuity Scale 1 or 2 at EDs were eligible to receive the intervention. Qualitative interviews were conducted with parents/caregivers to explore the out-of-pocket (OOP) expenses. Patient-level health resource utilization was extracted from Niagara Health databases. The Peds-TECH budget calculated one-time technology and operational costs per patient. Base-case analyses determined the incremental cost per year of life lost (YLL) averted, and additional sensitivity analysis confirmed the robustness of the results. Results: Odds ratio for mortality among cases was 0.498 (95% CI: 0.173, 1.43). The average cost of a patient receiving the Peds-TECH intervention was $2,032.73 compared to $317.45 in usual care. In total, 54 patients received the Peds-TECH intervention. Fewer children died in the intervention group resulting in 4.71 YLL. The probabilistic analysis revealed an incremental cost-effectiveness ratio of $64.61 per YLL averted. Conclusion: Peds-TECH appears to be a cost-effective intervention for resuscitating infants/children in hospital emergency departments.
241 Background: Surgery and radiotherapy are standard therapies for patients with early-stage pro... more 241 Background: Surgery and radiotherapy are standard therapies for patients with early-stage prostate cancer (PrCa). However, studies show that patients with low-risk localized PrCa (Gleason 6; Grade Group (GG) 1 and prostate-specific antigen (PSA) <10) could be safely monitored with active surveillance (AS), if intense patient follow up and re-biopsy schedules are utilized. Here, we reviewed clinical outcomes of AS of a program associated with the Niagara Health System (NHS) PrCa diagnostic program, which provides centralized diagnosis, systematic follow up, re-biopsy and multi-disciplinary consultation clinics for all patients in the Niagara region, Ontario, Canada. Methods: After receiving appropriate ethics approval, NHS databases were searched for patients that underwent more than one biopsy of the prostate in the period Jan. 2015 (program inception) to Dec. 2020. Cases were reviewed for clinical stage, biopsy results and treatment record data. Data were then codified for anonymity and analyzed. Criteria for inclusion into the analysis involved, i) a minimum of two PrCa biopsies before treatment and ii) detailed reporting of biopsy and clinical results (number of positive cores, % of core involvement, and PSA). Results: A total of 343 AS patient cases were identified in the initial search. Of those 52 cases did not meet inclusion criteria. The baseline GG score distribution in the 291 cases included in the analysis was, GG0: 27 (cases with negative biopsies but high PSA), GG1: 247 and GG2: 17 (patients refusing treatment). A total of 144 cases (49.5%) progressed at re-biopsy. Rates of progression to higher GG category in the three groups were 100%, has 46.5% and 50%, respectively. The average time to progression was 23.3+15.5 months. The rate of progression to treatment after entering AS was 39.17% (114/291). Average time from first biopsy to treatment was (28.4+14.5 months). Amongst those that received treatment the overall rate of progression to high-intermediate or high-risk PrCa, was 29.8%, with 20.8% of cases (30/144) progressing to GG>3 (Gleason Score 7: 4+3 or higher) and 9.0% (13/144) progressing to PSA > 20. Of the treated patients, 70 (61.4%) patients received radiotherapy, 42 (36.8%) combined radiotherapy and androgen deprivation therapy and (31.3%) underwent radical prostatectomy. Conclusions: This retrospective study provides contemporary real-world systematic AS outcomes from a Canadian program with unique features of systematic urological follow up and centralized diagnosis and multi-disciplinary patient assessment. We observe increased rates of disease progression and need for earlier utilization of treatment compared to those reported by other studies. Further analysis examines factors predicting increased risk for disease progression.
In hospitals, older patients are at increased risk of falling multiple times. This study incorpor... more In hospitals, older patients are at increased risk of falling multiple times. This study incorporated an epidemiologic cross-sectional design consisting of 4,348 older patients (≥65-year-old). Eight hundred eighty five (20.4%) in-patients experienced multiple falls while remaining participants had one fall incident. A patient fall event was recorded with age, sex, incident date, type of fall, and location. Logistic regression assessed risk factors found in patients with multiple falls compared to those with one fall. Significant differences were observed in the proportion of multiple falls: in a bed with no rails, standing, walking, and using a wheel/Geri chair ( p < .05). Overall, sex, type of fall, and location were significant in predicting multiple falls ( p < .05). Male patients were at 16.1% greater risk of multiple falls, when compared to females ( p < .05). A fall in complex care, mental health, or respirology were more likely to experience multiple falls ( OR = 2.6...
Background: Pain and agitation are closely linked to the development of delirium, which affects 6... more Background: Pain and agitation are closely linked to the development of delirium, which affects 60%-87% of critically ill patients. Delirium is associated with increased mortality and morbidity. Clinical guidelines that suggest routine assessment, treatment and prevention of pain, agitation and delirium (PAD) is crucial to improving patient outcomes. However, the adoption of and adherence to PAD guidelines remain suboptimal, especially in community hospitals. The aim of this quality improvement study is to evaluate the impact of a multifaceted and multidisciplinary intervention on PAD management in a Canadian community intensive care unit (ICU). Methods: This is a quality improvement, uncontrolled, before-and-after study of a multifaceted and multidisciplinary intervention targeting nurses (educational modules, visual reminders), family members (interviews, educational pamphlets and an educational video), physicians (multidisciplinary round script) and the multidisciplinary team as a whole (delirium poster). We will collect data every day for 6 weeks before implementing the intervention. Data collection will include clinical information and information on process of care. We will then implement the intervention. Four weeks after, we will collect data daily for 6 weeks to evaluate the effect of the intervention. On the basis of the volume of the ICU, we expect to enroll approximately 280 patients. We have obtained local ethics approval from the Hamilton Integrated Research Ethics Board (HiREB 18-040-C). Interpretation: The results of this quality improvement study will provide information on adherence to PAD guidelines in a Canadian community ICU setting. They will also supply information on the feasibility of implementing multifaceted and multidisciplinary PAD interventions in community ICUs.
BACKGROUND: Sudden death in the young is a tragic and devastating event for families and communit... more BACKGROUND: Sudden death in the young is a tragic and devastating event for families and communities. Characterization of the population that suffers sudden death would assist in understanding the scope and nature of the problem, and could potentially inform strategies targeting prevention. METHODS: We conducted a population-based retrospective cohort study of sudden death cases involving persons aged 2-40 years identified from the 2008 comprehensive database of the Office of the Chief Coroner, which contains data on all cases reported to and investigated by coroners in Ontario. Coroner’s reports including autopsy findings, description of circumstances and decedent medical history were reviewed and coded to establish cause of death. Of 1,741 coroner’s cases, 376 were considered potential sudden cardiac death cases and underwent further review. RESULTS: There were 174 cases of presumed sudden death from a population of 6,602,680 persons aged 2-40 years. Structural heart disease was present in 126 cases (72%), 78% of which was unrecognized (n 98). There was no identifiable cause of death in 48 cases (28%), representing definite primary arrhythmia syndromes. The majority of decedents were male (76%) over the age of 18 (90%). The overall incidence of sudden death was 2.6/100,000 person-years, increasing with age from 0.7/100,000 (2-18 years) to 2.4/100,000 (19-29 years) and 5.3/100,000 person-years (30-40 years). Persons experiencing sudden death under age 30 were more likely to have a primary arrhythmia syndrome than those 30 and older (OR 3.17, 95% CI 1.60-6.28; p 0.001). The majority of events occurred in the home (72%); 33% of events in children/ adolescents and 9% of events in adults occurred during reported moderate or vigorous exercise (9% and 33%, respectively, p 0.02). Organized, competitive sporting activity was not associated with SCD in this analysis. Premonitory symptoms were more frequent in females (61% vs. 41%, p 0.007), and in cases with underlying heart disease (54% vs. 25%, p 0.0001). CONCLUSIONS: The incidence of sudden cardiac death increases with age. Death typically occurs in a male at rest in the home with unrecognized underlying heart disease or a primary arrhythmia syndrome. Prevention strategies should consider targeting identification of unrecognized structural heart disease and primary arrhythmia syndromes.
Despite growing interest in the biomechanical mechanisms of sports-related concussion, ice hockey... more Despite growing interest in the biomechanical mechanisms of sports-related concussion, ice hockey and the youth sport population has not been studied extensively. The purpose of this pilot study was: 1) to describe the biomechanical measures of head impacts in youth minor ice hockey players; and, 2) to investigate the influence of player and game characteristics on the number and magnitude of head impacts. Data was collected from 13 players from a single competitive Bantam boy's (ages 13-14 years) AAA ice hockey team using telemetric accelerometers implanted within the players' helmets at 27 ice hockey games. The average linear acceleration, rotational acceleration, Gadd Severity Index and Head Injury Criterion of head impacts were recorded. A significantly higher number of head impacts per player per game were found for wingers when compared to centre and defense player positions (df=355, t=3.087, p=0.00218) and for tournament games when compared to regular season and playo...
Background-The frequency of, course of, and factors associated with cardiovascular abnormalities ... more Background-The frequency of, course of, and factors associated with cardiovascular abnormalities in pediatric HIV are incompletely understood. Methods and Results-A baseline echocardiogram (median age, 2.1 years) and 2 years of follow-up every 4 months were obtained as part of a prospective study on 196 vertically HIV-infected children. Age-or body surface area-adjusted z scores were calculated by use of data from normal control subjects. Although 88% had symptomatic HIV infection, only 2 had CHF at enrollment, with a 2-year cumulative incidence of 4.7% (95% CI, 1.5% to 7.9%). All mean cardiac measurements were abnormal at baseline (decreased left ventricular fractional shortening [LV FS] and contractility and increased heart rate and LV dimension, mass, and wall stresses). Most of the abnormal baseline cardiac measurements correlated with depressed CD4 cell count z scores and the presence of HIV encephalopathy. Heart rate and LV mass showed significantly progressive abnormalities, whereas FS and contractility tended to decline. No association was seen between longitudinal changes in FS and CD4 cell count z score. Children who developed encephalopathy during follow-up had depressed initial FS, and FS continued to decline during follow-up. Conclusions-Subclinical cardiac abnormalities in HIV-infected children are common, persistent, and often progressive. Dilated cardiomyopathy (depressed contractility and dilatation) and inappropriate LV hypertrophy (elevated LV mass in the setting of decreased height and weight) were noted. Depressed LV function correlated with immune dysfunction at baseline but not longitudinally, suggesting that the CD4 cell count may not be a useful surrogate marker of HIV-associated LV dysfunction. However, the development of encephalopathy may signal a decline in FS. (Circulation.
Developmental coordination disorder (DCD) is a neurodevelopmental condition that affects approxim... more Developmental coordination disorder (DCD) is a neurodevelopmental condition that affects approximately 5-6% of children (APA, 2000). DCD is a complex disorder resulting in significant impairments to both daily (self-care, school) and recreational activities. Children with DCD have consistently been found to be less physically active compared to typically developing (TD) children (Rivilis et al., 2011); yet, the psychological processes associated with moderate-to-vigorous physical activity (MVPA) for children with DCD are poorly understood. Using Azjen's (1991) Theory of Planned Behaviour, the purpose of this study was to examine physical activity motivations among children with DCD in comparison to TD children. Participants (N= 105, Mage= 13.25 +.46) were drawn from a larger prospective cohort study (PHAST II), and included children with DCD (n= 47) matched to TD peers (n= 58). As expected, the results found children with DCD scoring significantly lower in intentions F(1,103) = ...
Research in developmental disabilities, Jan 20, 2016
Children with cardiovascular disease risk factors demonstrate adverse arterial alterations that a... more Children with cardiovascular disease risk factors demonstrate adverse arterial alterations that are predictive of cardiovascular morbidity and mortality in adults. Children with developmental coordination disorder (DCD) are at cardiovascular risk as they are more likely to be obese and inactive. The purpose of this study was to assess arterial structure and function in children with and without probable DCD (p-DCD). A cross-sectional study of 33 children with p-DCD (22 male) and 53 without (30 male). The Movement Assessment Battery for Children was used to classify those with p-DCD. Adiposity was assessed using the BOD POD. Compliance, distensibility, and intima-media thickness were measured at the common carotid artery (CCA). ECG R-wave-to-toe pulse wave velocity (PWV) was also measured. Compared to controls, males with p-DCD had lower CCA distensibility (p=0.034) and higher PWV (p=0.001). No differences were evident in females. Body fat percent was a significant predictor of CCA d...
CONCLUSION: While we see jurisdictions strive to agree on surveillance standards, political, fina... more CONCLUSION: While we see jurisdictions strive to agree on surveillance standards, political, financial, and public health concerns often clash, impeding CDC's efforts in comparing data across jurisdictions. Measures that have been shown to increase success in collecting and reporting BLL in a standardized fashion across jurisdictions include use of: consensus building, financial support of program development, and guidance and training to improve the quality and completeness of reporting.
Metabolic dysregulation is an early event in carcinogenesis. Here, we examined the expression of ... more Metabolic dysregulation is an early event in carcinogenesis. Here, we examined the expression of enzymes involved in de novo lipogenesis (ATP-citrate lyase: ACLY), glucose uptake (Glucose Transporter 1: GLUT1), and folate–glutamate metabolism (Prostate-Specific Membrane Antigen: PSMA) as potential biomarkers of risk for early prostate cancer progression. Patients who were managed initially on active surveillance with a Gleason score of 6 or a low-volume Gleason score of 7 (3 + 4) were accrued from a prostate cancer diagnostic assessment program. Patients were asked to donate their baseline diagnostic biopsy tissues and permit access to their clinical data. PSMA, GLUT1, and ACLY expression were examined with immunohistochemistry (IHC) in baseline biopsies, quantitated by Histologic Score for expression in benign and malignant glands, and compared with patient time remaining on active surveillance (time-on-AS). All three markers showed trends for elevated expression in malignant compa...
Introduction: The use of telemedicine in critical care is emerging, however, there is a paucity o... more Introduction: The use of telemedicine in critical care is emerging, however, there is a paucity of information surrounding the costs relative to health gains in the pediatric population. This study aimed to estimate the cost-effectiveness of a pediatric tele-resuscitation (Peds-TECH) intervention compared to the usual care in five community hospital emergency departments (EDs). Using a decision tree analysis approach with secondary retrospective data from a 3-year time period, this cost-effectiveness analysis was completed. Methods: A mixed methods quasi-experimental design was embedded in the economic evaluation of Peds-TECH intervention. Patients aged <18 years triaged as Canadian Triage and Acuity Scale 1 or 2 at EDs were eligible to receive the intervention. Qualitative interviews were conducted with parents/caregivers to explore the out-of-pocket (OOP) expenses. Patient-level health resource utilization was extracted from Niagara Health databases. The Peds-TECH budget calculated one-time technology and operational costs per patient. Base-case analyses determined the incremental cost per year of life lost (YLL) averted, and additional sensitivity analysis confirmed the robustness of the results. Results: Odds ratio for mortality among cases was 0.498 (95% CI: 0.173, 1.43). The average cost of a patient receiving the Peds-TECH intervention was $2,032.73 compared to $317.45 in usual care. In total, 54 patients received the Peds-TECH intervention. Fewer children died in the intervention group resulting in 4.71 YLL. The probabilistic analysis revealed an incremental cost-effectiveness ratio of $64.61 per YLL averted. Conclusion: Peds-TECH appears to be a cost-effective intervention for resuscitating infants/children in hospital emergency departments.
241 Background: Surgery and radiotherapy are standard therapies for patients with early-stage pro... more 241 Background: Surgery and radiotherapy are standard therapies for patients with early-stage prostate cancer (PrCa). However, studies show that patients with low-risk localized PrCa (Gleason 6; Grade Group (GG) 1 and prostate-specific antigen (PSA) <10) could be safely monitored with active surveillance (AS), if intense patient follow up and re-biopsy schedules are utilized. Here, we reviewed clinical outcomes of AS of a program associated with the Niagara Health System (NHS) PrCa diagnostic program, which provides centralized diagnosis, systematic follow up, re-biopsy and multi-disciplinary consultation clinics for all patients in the Niagara region, Ontario, Canada. Methods: After receiving appropriate ethics approval, NHS databases were searched for patients that underwent more than one biopsy of the prostate in the period Jan. 2015 (program inception) to Dec. 2020. Cases were reviewed for clinical stage, biopsy results and treatment record data. Data were then codified for anonymity and analyzed. Criteria for inclusion into the analysis involved, i) a minimum of two PrCa biopsies before treatment and ii) detailed reporting of biopsy and clinical results (number of positive cores, % of core involvement, and PSA). Results: A total of 343 AS patient cases were identified in the initial search. Of those 52 cases did not meet inclusion criteria. The baseline GG score distribution in the 291 cases included in the analysis was, GG0: 27 (cases with negative biopsies but high PSA), GG1: 247 and GG2: 17 (patients refusing treatment). A total of 144 cases (49.5%) progressed at re-biopsy. Rates of progression to higher GG category in the three groups were 100%, has 46.5% and 50%, respectively. The average time to progression was 23.3+15.5 months. The rate of progression to treatment after entering AS was 39.17% (114/291). Average time from first biopsy to treatment was (28.4+14.5 months). Amongst those that received treatment the overall rate of progression to high-intermediate or high-risk PrCa, was 29.8%, with 20.8% of cases (30/144) progressing to GG>3 (Gleason Score 7: 4+3 or higher) and 9.0% (13/144) progressing to PSA > 20. Of the treated patients, 70 (61.4%) patients received radiotherapy, 42 (36.8%) combined radiotherapy and androgen deprivation therapy and (31.3%) underwent radical prostatectomy. Conclusions: This retrospective study provides contemporary real-world systematic AS outcomes from a Canadian program with unique features of systematic urological follow up and centralized diagnosis and multi-disciplinary patient assessment. We observe increased rates of disease progression and need for earlier utilization of treatment compared to those reported by other studies. Further analysis examines factors predicting increased risk for disease progression.
In hospitals, older patients are at increased risk of falling multiple times. This study incorpor... more In hospitals, older patients are at increased risk of falling multiple times. This study incorporated an epidemiologic cross-sectional design consisting of 4,348 older patients (≥65-year-old). Eight hundred eighty five (20.4%) in-patients experienced multiple falls while remaining participants had one fall incident. A patient fall event was recorded with age, sex, incident date, type of fall, and location. Logistic regression assessed risk factors found in patients with multiple falls compared to those with one fall. Significant differences were observed in the proportion of multiple falls: in a bed with no rails, standing, walking, and using a wheel/Geri chair ( p < .05). Overall, sex, type of fall, and location were significant in predicting multiple falls ( p < .05). Male patients were at 16.1% greater risk of multiple falls, when compared to females ( p < .05). A fall in complex care, mental health, or respirology were more likely to experience multiple falls ( OR = 2.6...
Background: Pain and agitation are closely linked to the development of delirium, which affects 6... more Background: Pain and agitation are closely linked to the development of delirium, which affects 60%-87% of critically ill patients. Delirium is associated with increased mortality and morbidity. Clinical guidelines that suggest routine assessment, treatment and prevention of pain, agitation and delirium (PAD) is crucial to improving patient outcomes. However, the adoption of and adherence to PAD guidelines remain suboptimal, especially in community hospitals. The aim of this quality improvement study is to evaluate the impact of a multifaceted and multidisciplinary intervention on PAD management in a Canadian community intensive care unit (ICU). Methods: This is a quality improvement, uncontrolled, before-and-after study of a multifaceted and multidisciplinary intervention targeting nurses (educational modules, visual reminders), family members (interviews, educational pamphlets and an educational video), physicians (multidisciplinary round script) and the multidisciplinary team as a whole (delirium poster). We will collect data every day for 6 weeks before implementing the intervention. Data collection will include clinical information and information on process of care. We will then implement the intervention. Four weeks after, we will collect data daily for 6 weeks to evaluate the effect of the intervention. On the basis of the volume of the ICU, we expect to enroll approximately 280 patients. We have obtained local ethics approval from the Hamilton Integrated Research Ethics Board (HiREB 18-040-C). Interpretation: The results of this quality improvement study will provide information on adherence to PAD guidelines in a Canadian community ICU setting. They will also supply information on the feasibility of implementing multifaceted and multidisciplinary PAD interventions in community ICUs.
BACKGROUND: Sudden death in the young is a tragic and devastating event for families and communit... more BACKGROUND: Sudden death in the young is a tragic and devastating event for families and communities. Characterization of the population that suffers sudden death would assist in understanding the scope and nature of the problem, and could potentially inform strategies targeting prevention. METHODS: We conducted a population-based retrospective cohort study of sudden death cases involving persons aged 2-40 years identified from the 2008 comprehensive database of the Office of the Chief Coroner, which contains data on all cases reported to and investigated by coroners in Ontario. Coroner’s reports including autopsy findings, description of circumstances and decedent medical history were reviewed and coded to establish cause of death. Of 1,741 coroner’s cases, 376 were considered potential sudden cardiac death cases and underwent further review. RESULTS: There were 174 cases of presumed sudden death from a population of 6,602,680 persons aged 2-40 years. Structural heart disease was present in 126 cases (72%), 78% of which was unrecognized (n 98). There was no identifiable cause of death in 48 cases (28%), representing definite primary arrhythmia syndromes. The majority of decedents were male (76%) over the age of 18 (90%). The overall incidence of sudden death was 2.6/100,000 person-years, increasing with age from 0.7/100,000 (2-18 years) to 2.4/100,000 (19-29 years) and 5.3/100,000 person-years (30-40 years). Persons experiencing sudden death under age 30 were more likely to have a primary arrhythmia syndrome than those 30 and older (OR 3.17, 95% CI 1.60-6.28; p 0.001). The majority of events occurred in the home (72%); 33% of events in children/ adolescents and 9% of events in adults occurred during reported moderate or vigorous exercise (9% and 33%, respectively, p 0.02). Organized, competitive sporting activity was not associated with SCD in this analysis. Premonitory symptoms were more frequent in females (61% vs. 41%, p 0.007), and in cases with underlying heart disease (54% vs. 25%, p 0.0001). CONCLUSIONS: The incidence of sudden cardiac death increases with age. Death typically occurs in a male at rest in the home with unrecognized underlying heart disease or a primary arrhythmia syndrome. Prevention strategies should consider targeting identification of unrecognized structural heart disease and primary arrhythmia syndromes.
Despite growing interest in the biomechanical mechanisms of sports-related concussion, ice hockey... more Despite growing interest in the biomechanical mechanisms of sports-related concussion, ice hockey and the youth sport population has not been studied extensively. The purpose of this pilot study was: 1) to describe the biomechanical measures of head impacts in youth minor ice hockey players; and, 2) to investigate the influence of player and game characteristics on the number and magnitude of head impacts. Data was collected from 13 players from a single competitive Bantam boy's (ages 13-14 years) AAA ice hockey team using telemetric accelerometers implanted within the players' helmets at 27 ice hockey games. The average linear acceleration, rotational acceleration, Gadd Severity Index and Head Injury Criterion of head impacts were recorded. A significantly higher number of head impacts per player per game were found for wingers when compared to centre and defense player positions (df=355, t=3.087, p=0.00218) and for tournament games when compared to regular season and playo...
Background-The frequency of, course of, and factors associated with cardiovascular abnormalities ... more Background-The frequency of, course of, and factors associated with cardiovascular abnormalities in pediatric HIV are incompletely understood. Methods and Results-A baseline echocardiogram (median age, 2.1 years) and 2 years of follow-up every 4 months were obtained as part of a prospective study on 196 vertically HIV-infected children. Age-or body surface area-adjusted z scores were calculated by use of data from normal control subjects. Although 88% had symptomatic HIV infection, only 2 had CHF at enrollment, with a 2-year cumulative incidence of 4.7% (95% CI, 1.5% to 7.9%). All mean cardiac measurements were abnormal at baseline (decreased left ventricular fractional shortening [LV FS] and contractility and increased heart rate and LV dimension, mass, and wall stresses). Most of the abnormal baseline cardiac measurements correlated with depressed CD4 cell count z scores and the presence of HIV encephalopathy. Heart rate and LV mass showed significantly progressive abnormalities, whereas FS and contractility tended to decline. No association was seen between longitudinal changes in FS and CD4 cell count z score. Children who developed encephalopathy during follow-up had depressed initial FS, and FS continued to decline during follow-up. Conclusions-Subclinical cardiac abnormalities in HIV-infected children are common, persistent, and often progressive. Dilated cardiomyopathy (depressed contractility and dilatation) and inappropriate LV hypertrophy (elevated LV mass in the setting of decreased height and weight) were noted. Depressed LV function correlated with immune dysfunction at baseline but not longitudinally, suggesting that the CD4 cell count may not be a useful surrogate marker of HIV-associated LV dysfunction. However, the development of encephalopathy may signal a decline in FS. (Circulation.
Developmental coordination disorder (DCD) is a neurodevelopmental condition that affects approxim... more Developmental coordination disorder (DCD) is a neurodevelopmental condition that affects approximately 5-6% of children (APA, 2000). DCD is a complex disorder resulting in significant impairments to both daily (self-care, school) and recreational activities. Children with DCD have consistently been found to be less physically active compared to typically developing (TD) children (Rivilis et al., 2011); yet, the psychological processes associated with moderate-to-vigorous physical activity (MVPA) for children with DCD are poorly understood. Using Azjen's (1991) Theory of Planned Behaviour, the purpose of this study was to examine physical activity motivations among children with DCD in comparison to TD children. Participants (N= 105, Mage= 13.25 +.46) were drawn from a larger prospective cohort study (PHAST II), and included children with DCD (n= 47) matched to TD peers (n= 58). As expected, the results found children with DCD scoring significantly lower in intentions F(1,103) = ...
Research in developmental disabilities, Jan 20, 2016
Children with cardiovascular disease risk factors demonstrate adverse arterial alterations that a... more Children with cardiovascular disease risk factors demonstrate adverse arterial alterations that are predictive of cardiovascular morbidity and mortality in adults. Children with developmental coordination disorder (DCD) are at cardiovascular risk as they are more likely to be obese and inactive. The purpose of this study was to assess arterial structure and function in children with and without probable DCD (p-DCD). A cross-sectional study of 33 children with p-DCD (22 male) and 53 without (30 male). The Movement Assessment Battery for Children was used to classify those with p-DCD. Adiposity was assessed using the BOD POD. Compliance, distensibility, and intima-media thickness were measured at the common carotid artery (CCA). ECG R-wave-to-toe pulse wave velocity (PWV) was also measured. Compared to controls, males with p-DCD had lower CCA distensibility (p=0.034) and higher PWV (p=0.001). No differences were evident in females. Body fat percent was a significant predictor of CCA d...
CONCLUSION: While we see jurisdictions strive to agree on surveillance standards, political, fina... more CONCLUSION: While we see jurisdictions strive to agree on surveillance standards, political, financial, and public health concerns often clash, impeding CDC's efforts in comparing data across jurisdictions. Measures that have been shown to increase success in collecting and reporting BLL in a standardized fashion across jurisdictions include use of: consensus building, financial support of program development, and guidance and training to improve the quality and completeness of reporting.
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Papers by Brent Faught