TABLE 2 - uploaded by Katrina Williams
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* Abbreviations:
RCT — : randomized controlled trial
SSRI — : selective serotonin reuptake inhibitor
It has long been an axiom in clinical pediatrics that “children are not just little adults.” It has also been recognized that there are many changes from birth through childhood and the adolescent years. However, the full implications of pediatric...
Citations
... The groups, 0-2, 3-17, 18-41, 42-66, and 67-95 represent ages of infancy/toddler, childhood/adolescence, early adulthood, late adulthood, and geriatric populations. This may indicate that current clinical parameters overvalue certain age delineations, i.e. the difference between ages 2-11 as childhood and 11-18 as adolescence 13 . Current clinical breakdowns may also undervalue further stratification in other age ranges, for example, the difference between early adulthood and late adulthood. ...
The objective of this study is to use statistical techniques for the identification of transition points along the life course, aiming to identify fundamental changes in patient multimorbidity burden across phases of clinical care. This retrospective cohort analysis utilized 5.2 million patient encounters from 2013 to 2022, collected from a large academic institution and its affiliated hospitals. Structured information was systematically gathered for each encounter and three methodologies - clustering analysis, False Nearest Neighbor, and transitivity analysis - were employed to pinpoint transitions in patients’ clinical phase. Clustering analysis identified transition points at age 2, 17, 41, and 66, FNN at 4.27, 5.83, 5.85, 14.12, 20.62, 24.30, 25.10, 29.08, 33.12, 35.7, 38.69, 55.66, 70.03, and transitivity analysis at 7.27, 23.58, 29.04, 35.00, 61.29, 67.03, 77.11. Clustering analysis identified transition points that align with the current clinical gestalt of pediatric, adult, and geriatric phases of care. Notably, over half of the transition points identified by FNN and transitivity analysis were between ages 20 and 40, a population that is traditionally considered to be clinically homogeneous. Few transition points were identified between ages 3 and 17. Despite large social and developmental transition at those ages, the burden of multimorbidities may be consistent across the age range. Transition points derived through unsupervised machine learning approaches identify changes in the clinical phase that align with true differences in underlying multimorbidity burden. These transitions may be different from conventional pediatric and geriatric phases, which are often influenced by policy rather than clinical changes.
... Age at death ranges from 0 to 20 years (upper limit selected according to Buikstra and Ubelaker, [1994] proposal), with a mean age of 13.2 years old (SD = 5.8). Considering the National Institute of Child Health and Human Development's recommendations (Williams et al., 2012), individuals were also divided into the following age groups: newborn (0-4 months, n = 3), infancy (5 months-2 years, n = 7), early childhood (3-5 years, n = 5), middle childhood (6-11 years, n = 24), early adolescence (12-16 years, n = 27), and late adolescence (17-20 years, n = 41). ...
Objectives
Search for possible associations between bone elemental concentration and the presence of porous skeletal lesions (PSLs), considering the sex, age, and cause of death (COD) of the individuals.
Materials and Methods
The sample comprised 107 non‐adult individuals (56 females, 51 males) aged 0–20 (x̄ = 13.2, SD = 5.8) from the Coimbra and Lisbon Identified Skeletal Collections. Cribra cranii, orbitalia, humeralis, and femoralis were recorded as present/absent, and elemental concentrations were assessed by portable x‐ray fluorescence (pXRF). A multivariate statistical approach was applied.
Results
Well‐preserved skeletons with minimal diagenesis showed no sex‐related elemental variations or PSL associations. In contrast, age‐at‐death correlated with elevated Ca, P, Sr, and Pb levels. Cribra cranii increased with age while other cribra declined post‐adolescence. Higher concentrations of Fe and lower of S were linked to cribra cranii. Respiratory infections as COD increased the odds of expressing cribra femoralis (OR = 5.25, CI = 1.25–15.14), cribra cranii (OR = 2.91, CI = 0.97–8.69), and cribra orbitalia (OR = 2.76, CI = 1.06–7.24).
Discussion
Feasible pXRF results and low cribra intraobserver error assure replicability. Elevated Ca, P, and Sr in older individuals may relate to skeletal growth, while increased Pb suggests bioaccumulation. Cribra's increase with age reflects different rates of marrow conversion and bone remodeling. Higher Fe and lower S in individuals with cribra cranii possibly reflects poor nutrition, early alcohol use, and sideroblastic anemia, aligning with 19th–20th‐century Portugal's living conditions. Respiratory infections increased cribra expression, revealing intricate interplays among inflammation, anemia(s), marrow expansion, and diet. This research highlights a complex scenario and blazes a new path for cribra interpretation.
... The median age was 3.3 years (IQR: 2.7-4.9). Samples were also stratified according to Eunice Kennedy Shriver National Institute of Child Health and Human Development age stage terminology [18]. By stratifying samples based on these categorical ages, most of them were from early childhood (2.1 to 5 years of age; N = 1028, 29.2%) and infants (29 days to 12 months; N = 770, 21.8%), followed by middle childhood (6 to 11 years of age; N = 579, 16.4%), toddlers (13 months to 2 years; N = 405, 11.5%), neonates (birth to 28 days; N = 377, 10.7%), and adolescents (12 to 18 years of age; N = 366, 10.4%). ...
Viral co-infections are frequently observed among children, but whether specific viral interactions enhance or diminish the severity of respiratory disease is still controversial. This study aimed to investigate the type of viral mono- and co-infections by also evaluating viral correlations in 3525 respiratory samples from 3525 pediatric in/outpatients screened by the Allplex Respiratory Panel Assays and with a Severe Acute Respiratory Syndrome-COronaVirus 2 (SARS-CoV-2) test available. Overall, viral co-infections were detected in 37.8% of patients and were more frequently observed in specimens from children with lower respiratory tract infections compared to those with upper respiratory tract infections (47.1% vs. 36.0%, p = 0.003). SARS-CoV-2 and influenza A were more commonly detected in mono-infections, whereas human bocavirus showed the highest co-infection rate (87.8% in co-infection). After analyzing viral pairings using Spearman’s correlation test, it was noted that SARS-CoV-2 was negatively associated with all other respiratory viruses, whereas a markedly significant positive correlation (p < 0.001) was observed for five viral pairings (involving adenovirus/human bocavirus/human enterovirus/metapneumoviruses/rhinovirus). The correlation between co-infection and clinical outcome may be linked to the type of virus(es) involved in the co-infection rather than simple co-presence. Further studies dedicated to this important point are needed, since it has obvious implications from a diagnostic and clinical point of view.
... Data related to patients' demographics including age were calculated based on their date of birth, categorized in this study into infants (6-12 months), toddlers (13 months-2 years), early childhood (2-5 years), middle childhood (6-11 years), and early adolescence (12¬-14 years) according to the National Institute of Child Health and Human Development. 8 Gender is presented as male or female, nationality is categorized as Saudi or non-Saudi, and economic status is documented as low if monthly income is <5300 riyals or good if monthly income is >5300 riyals. This information pertains to the average income in KSA. 9 Confidentiality was maintained for all participants throughout our study. ...
... The fusion stages of the skull bones [49], clavicles [50], humeri [50], ossa coxae [49], and femora [51] were also assessed. The individuals were placed in age groups following the suggestions of the US National Institute of Child Health and Human Development [52] and the European Medicines Agency [53] based on several biological and psychological indicators ( Table 1). ...
Portable X-ray fluorescence is a new tool in the study of human bone. This research aims to investigate if variations in bone elemental concentrations are related with porous skeletal lesions (PSLs). One hundred well-preserved non-adult skeletons aged 0–11 years were selected from the archaeological site Convent of São Domingos, Lisbon (18th–19th century). Measuring a standard reference material and calculating the technical error of measurement assured elemental data reliability. Moreover, measuring soil samples excluded possible contamination of bones with elements from the soil, except for Pb. Additionally, the Ca/P ratio indicates maintenance of bone integrity. Cribra cranii, orbitalia, humeralis, and femoralis were recorded as present/absent, and the estimated intra-/inter-observer errors were low. The multivariate analysis found higher odds of having cribra orbitalia (OR = 1.76; CI = 0.97–3.20) and cribra femoralis (OR = 1.42; CI = 0.73–2.74) in individuals with lower Fe and higher S. Furthermore, higher levels of P, Ca, and Sr increased the odds of individuals developing cribra femoralis (OR = 2.30; CI = 1.23–4.29). Age also correlated with increased odds of exhibiting cribra orbitalia (OR = 1.86; CI = 0.94–3.68), cribra femoralis (OR = 6.97; CI = 2.78–17.45), and cribra humeralis (OR = 8.32; CI = 2.71–25.60). These findings suggest a shared etiology for these three cribras, contrasting with the higher Fe levels in individuals with cribra cranii. Lower Fe and higher S levels in individuals with cribra suggest a complex etiology, possibly involving conditions like megaloblastic or chronic disease anemia(s). Age-related elemental changes support the hypothesis that age influences cribra frequencies. This study highlights PSL complexity and opens new avenues for research.
... The SES was stratified according to the established criteria in each of the included studies. Finally, the results were analyzed and charted for each age group defined according to the National Institute of Child Health and Human Development Pediatric Terminology (Williams et al., 2012), except for adolescents in which the age of majority set in Colombia (18 years) was adopted to establish the beginning of adulthood: toddlers: <2 years, early childhood: 2-5 years, middle childhood: 6-12 years, adolescents: 13-18 years, and adults: >18 years. ...
Background: The imminent increase in overweight and obesity prevalence constitutes a pervasive concern for the adult and pediatric Colombian population. Nonetheless, the unequal distribution across distinct social groups limits the imple- mentation of public health policies targeting these escalating rates. Aim: This study aimed to compile existing evidence regarding the prevalence of overweight and obesity in relation to the socioeconomic status (SES) of the Colombian popu- lation. Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews parameters in MEDLINE (PubMed), EMBASE, and LILACS databases for inclusion of investigations published up to January 2024. Results: Twenty-two cross-sectional studies were included. A higher prevalence of overweight and obesity was documented in adults with lower SES defined by social stratum and monetary income, while in particular for nonpregnant adult women, the prevalence of excess weight was higher in the medium-low socioeconomic stratum. In the pediatric population, higher SES defined by social stratum was directly related to an increased prevalence and risk of overweight and obesity. The ownership of household assets, however, was posi- tively related to the risk of overweight in both adult and pediatric populations. Conclusion: The findings of this inves- tigation disclose a socioeconomic gradient in overweight and obesity in Colombia that resembles the epidemiological distribution in high-income countries for adults, though similar to low-income countries for the pediatric population. Further intersectoral interventions aimed at the most vulnerable groups are imperative to mitigate the inequalities that condition their predisposition to overweight and obesity.
... Among the viral SARI cases, hospital stay was considered prolonged if the length of stay was equal to or greater than the mean length of stay of our study participants (seven days). Otherwise, it was considered short or normal.We used a modified version of the integrated age groups developed by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) in the United States [21] to categorize age into 0-3 month, 4-11 month, and 12-59 month. These age categorization aligns with the clinical practices observed in local hospitals and the particularity of acute respiratory infections in children. ...
Background
Viruses are the leading etiology of acute respiratory infections (ARI) in children. However, there is limited knowledge on drivers of severe acute respiratory infection (SARI) cases involving viruses. We aimed to identify factors associated with severity and prolonged hospitalization of viral SARI among children < 5 years in Burkina Faso.
Methods
Data were collected from four SARI sentinel surveillance sites during October 2016 through April 2019. A SARI case was a child < 5 years with an acute respiratory infection with history of fever or measured fever ≥ 38 °C and cough with onset within the last ten days, requiring hospitalization. Very severe ARI cases required intensive care or had at least one danger sign. Oropharyngeal/nasopharyngeal specimens were collected and analyzed by multiplex real-time reverse-transcription polymerase chain reaction (rRT-PCR) using FTD-33 Kit. For this analysis, we included only SARI cases with rRT-PCR positive test results for at least one respiratory virus. We used simple and multilevel logistic regression models to assess factors associated with very severe viral ARI and viral SARI with prolonged hospitalization.
Results
Overall, 1159 viral SARI cases were included in the analysis after excluding exclusively bacterial SARI cases (n = 273)very severe viral ARI cases were common among children living in urban areas (AdjOR = 1.3; 95% CI: 1.1–1.6), those < 3 months old (AdjOR = 1.5; 95% CI: 1.1–2.3), and those coinfected with Klebsiella pneumoniae (AdjOR = 1.9; 95% CI: 1.2–2.2). Malnutrition (AdjOR = 2.2; 95% CI: 1.1–4.2), hospitalization during the rainy season (AdjOR = 1.71; 95% CI: 1.2–2.5), and infection with human CoronavirusOC43 (AdjOR = 3; 95% CI: 1.2-8) were significantly associated with prolonged length of hospital stay (> 7 days).
Conclusion
Younger age, malnutrition, codetection of Klebsiella pneumoniae, and illness during the rainy season were associated with very severe cases and prolonged hospitalization of SARI involving viruses in children under five years. These findings emphasize the need for preventive actions targeting these factors in young children.
... To gain insight into whether there were differences between pediatric institutions with respect to laboratory procedures or clinical practice, we described the institution-and age group-specific reference ranges for abnormal lab results by SickKids and StanfordPeds. The pediatric age groups were defined by the National Institute of Child Health and Human Development [22] as infancy (28 days-12 months), toddler (13 months-2 years), early childhood (2-5 years), middle childhood (6-11 years) and early adolescence (12-17 years). In addition, we evaluated lab testing frequency calculated as the number of tests per inpatient day for each admission. ...
Background
Diagnostic codes are commonly used as inputs for clinical prediction models, to create labels for prediction tasks, and to identify cohorts for multicenter network studies. However, the coverage rates of diagnostic codes and their variability across institutions are underexplored. The primary objective was to describe lab- and diagnosis-based labels for 7 selected outcomes at three institutions. Secondary objectives were to describe agreement, sensitivity, and specificity of diagnosis-based labels against lab-based labels.
Methods
This study included three cohorts: SickKids from The Hospital for Sick Children, and StanfordPeds and StanfordAdults from Stanford Medicine. We included seven clinical outcomes with lab-based definitions: acute kidney injury, hyperkalemia, hypoglycemia, hyponatremia, anemia, neutropenia and thrombocytopenia. For each outcome, we created four lab-based labels (abnormal, mild, moderate and severe) based on test result and one diagnosis-based label. Proportion of admissions with a positive label were presented for each outcome stratified by cohort. Using lab-based labels as the gold standard, agreement using Cohen’s Kappa, sensitivity and specificity were calculated for each lab-based severity level.
Results
The number of admissions included were: SickKids (n = 59,298), StanfordPeds (n = 24,639) and StanfordAdults (n = 159,985). The proportion of admissions with a positive diagnosis-based label was significantly higher for StanfordPeds compared to SickKids across all outcomes, with odds ratio (99.9% confidence interval) for abnormal diagnosis-based label ranging from 2.2 (1.7–2.7) for neutropenia to 18.4 (10.1–33.4) for hyperkalemia. Lab-based labels were more similar by institution. When using lab-based labels as the gold standard, Cohen’s Kappa and sensitivity were lower at SickKids for all severity levels compared to StanfordPeds.
Conclusions
Across multiple outcomes, diagnosis codes were consistently different between the two pediatric institutions. This difference was not explained by differences in test results. These results may have implications for machine learning model development and deployment.
... While the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) for trial protocols [20] and Consolidated Standards of Reporting Trials (CONSORT) [21] for trial reports will be updated in early 2024 to include the most recent developments in trial (protocol) transparency and publishing [22,23], neither address the reporting of key details unique to conducting research in children and youth like age appropriate dosing and routing of drug interventions [24], developmentally appropriate (primary) outcome selection and measurement [25], sample size calculations [26,27], issues surrounding consent and assent [3,[28][29][30][31][32], and the need to consider heterogeneity of treatment effects in different age subgroups within pediatrics [3,33]. Thus, SPIRIT/ CONSORT 2024 do not account for recent advances in the field of pediatric clinical trials nor involved pediatric trial participants or their families to ensure that reporting items that are important to their decisionmaking are captured. ...
Background
Despite the critical importance of clinical trials to provide evidence about the effects of intervention for children and youth, a paucity of published high-quality pediatric clinical trials persists. Sub-optimal reporting of key trial elements necessary to critically appraise and synthesize findings is prevalent. To harmonize and provide guidance for reporting in pediatric controlled clinical trial protocols and reports, reporting guideline extensions to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and Consolidated Standards of Reporting Trials (CONSORT) guidelines specific to pediatrics are being developed: SPIRIT-Children (SPIRIT-C) and CONSORT-Children (CONSORT-C).
Methods
The development of SPIRIT-C/CONSORT-C will be informed by the Enhancing the Quality and Transparency of Health Research Quality (EQUATOR) method for reporting guideline development in the following stages: (1) generation of a preliminary list of candidate items, informed by (a) items developed during initial development efforts and child relevant items from recent published SPIRIT and CONSORT extensions; (b) two systematic reviews and environmental scan of the literature; (c) workshops with young people; (2) an international Delphi study, where a wide range of panelists will vote on the inclusion or exclusion of candidate items on a nine-point Likert scale; (3) a consensus meeting to discuss items that have not reached consensus in the Delphi study and to “lock” the checklist items; (4) pilot testing of items and definitions to ensure that they are understandable, useful, and applicable; and (5) a final project meeting to discuss each item in the context of pilot test results. Key partners, including young people (ages 12–24 years) and family caregivers (e.g., parents) with lived experiences with pediatric clinical trials, and individuals with expertise and involvement in pediatric trials will be involved throughout the project. SPIRIT-C/CONSORT-C will be disseminated through publications, academic conferences, and endorsement by pediatric journals and relevant research networks and organizations.
Discussion
SPIRIT/CONSORT-C may serve as resources to facilitate comprehensive reporting needed to understand pediatric clinical trial protocols and reports, which may improve transparency within pediatric clinical trials and reduce research waste.
Trial Registration
The development of these reporting guidelines is registered with the EQUATOR Network: SPIRIT-Children ( https://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-clinical-trials-protocols/#35 ) and CONSORT-Children ( https://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-clinical-trials/#CHILD ).
... We used four years of NHIS data (2019-22) on children aged 2-17 years (n = 27,378) to generate three age subgroups: 2-5 (n = 6222), 5-11 (n = 9298), and 11-17 (n = 11,858). Our stratification into distinct age subgroups reflects an acknowledgment of distinctive stages of child social and cognitive development that are linked to relatively unique set of vulnerabilities to stressors in child development [17]. The University of Nevada, Las Vegas Institutional Review Board determined that this study did not require IRB review because it used existing, anonymized, publicly available data. ...
... For children aged 5-17, we assessed whether the child had any difficulty being understood by people inside or outside their household. We dichotomized four survey items to capture any difficulty with learning (age 2-17), remembering things (age [5][6][7][8][9][10][11][12][13][14][15][16][17], and whether child seemed anxious and depressed at least every week (age [5][6][7][8][9][10][11][12][13][14][15][16][17]. Behavioral difficulties were measured by 6 items soliciting information about any difficulties with controlling behavior and concentrating (age 2-4), and difficulties in playing, violence toward peers, handling disruptions in routine, and making friends (age [5][6][7][8][9][10][11][12][13][14][15][16][17]. ...
... For children aged 5-17, we assessed whether the child had any difficulty being understood by people inside or outside their household. We dichotomized four survey items to capture any difficulty with learning (age 2-17), remembering things (age [5][6][7][8][9][10][11][12][13][14][15][16][17], and whether child seemed anxious and depressed at least every week (age [5][6][7][8][9][10][11][12][13][14][15][16][17]. Behavioral difficulties were measured by 6 items soliciting information about any difficulties with controlling behavior and concentrating (age 2-4), and difficulties in playing, violence toward peers, handling disruptions in routine, and making friends (age [5][6][7][8][9][10][11][12][13][14][15][16][17]. ...
We provide fresh estimates of a change in the nationwide prevalence of mental health symptoms among US children during the COVID-19 pandemic using National Health Interview Survey data (2019–22) on children aged 2–17 years (n = 27,378; age subgroups 2–5, 6–11, and 12–17) to assess overall mental distress and 19 specific outcomes related to developmental, communicative, cognitive, affective, and behavioral domains. Raw and adjusted (for socio-demographics) linear regressions estimated the change in prevalence for each outcome between 2019 (baseline year) and three succeeding years (2020–2022). Summary scores for mental distress rose between 2019 and 2020 (1.01 to 1.18 points, range of 0–15), declined slightly in 2021 (1.09), and climbed sharply again in 2022 (1.25). The declines primarily affected adolescents (1.11 at baseline, 1.24 in 2020, 1.30 in 2021, and 1.49 in 2022). Specific outcomes belonging to all domains of mental health showed similar increases in prevalence. US children suffered significant erosion of mental health during the COVID-19 pandemic that continued into 2022. Expansion of mental health programs aimed at school-going children will likely be needed to respond effectively to the ongoing crisis.
