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Freedman S.B.,Alberta Childrens Hospital Research Institute | Thull-Freedman J.,University of Calgary | Rumantir M.,Hospital for Sick Children | Eltorki M.,University of Calgary | Schuh S.,Hospital for Sick Children
Journal of Pediatric Gastroenterology and Nutrition | Year: 2014

OBJECTIVES: Limited knowledge exists surrounding the pharmacologic management of pediatric constipation in the emergency department (ED) setting and the success of interventions. Our primary objective was to determine whether enema administration is associated with 7-day ED revisits for persistent symptoms. Secondary objectives focused on assessing other predictors of ED revisits. METHODS: We conducted a retrospective cohort study of children <18 years old, diagnosed as having constipation (International Classification of Diseases-10 codes F98.1 nonorganic encopresis, K59.0 constipation) in a pediatric ED in Toronto, Canada, between November 2008 and October 2010. RESULTS: A total of 3592 visits were included; 6% (n = 225) were associated with a revisit. Children with revisits more frequently had vomiting (28% vs 17%, P = 0.001), more pain (5.7 ± 3.6 vs 4.6-3.6 of 10, P = 0.01), and underwent more blood tests (19% 05, 11%, 95% confidence interval [CI] of the difference 3%-14%] and diagnostic imaging (62% vs 47%, 95% CI of the difference 9%-22%). Children administered an enema were 1.54 times more likely to revisit the ED than those who did not receive an enema (8.6% vs 5.5%, 95% CI of the difference 1.1%-5.2%, P = 0.001). Type of enema administered varied by age (P < 0.001). Regression analysis identified the following independent predictors of revisits: diagnostic imaging (odds ratio [OR] 1.54, 95% CI 1.15-2.06), vomiting (OR 1.45, 95% CI 1.07-1.98), enema administration (OR 1.40, 95% CI 1.05-1.88), and significant medical history (OR 1.26, 95% CI 1.04-1.53). CONCLUSIONS: Enema administration and diagnostic imaging are associated with revisits in children diagnosed with constipation. Their role in the ED management of pediatric constipation requires further evaluation. © 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.


Ricketson L.J.,University of Calgary | Wood M.L.,University of Alberta | Vanderkooi O.G.,Alberta Childrens Hospital Research Institute | MacDonald J.C.,University of Calgary | And 5 more authors.
Pediatric Infectious Disease Journal | Year: 2014

BACKGROUND: We previously reported serotype-specific trends in pneumococcal nasopharyngeal colonization soon after introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in mid-2002. Our current aim is to describe later trends after PCV7 and early trends after PCV13 vaccine introduction in 2010. METHODS: The Calgary Area Streptococcus pneumoniae Epidemiology Research team conducted 10 point-prevalence surveys of pneumococcal nasopharyngeal colonization in healthy children aged 12 and 18 months and 4.5 years biannually from 2003 to 2005 (previously reported) and annually in 2006, 2010, 2011 and 2012. RESULTS: For surveys conducted during 2010-2012, the proportion colonized was 13.2% compared with 19.9% in surveys conducted during 2003-2006 (P < 0.001). Vaccination with 2 or more doses of PCV7 or PCV13, older age and recent antibiotic use reduced the odds of colonization with any pneumococcus. By 2012, 94% of all isolates were nonvaccine serotypes with 11A, 15A/B/C, 22F, 23A/B and 35B/F representing 75% of all isolates. CONCLUSIONS: Pneumococcal nasopharyngeal colonization has changed profoundly since the introduction of conjugate vaccines and overall colonization by pneumococcus has declined in recent years. By 2012, nonvaccine serotypes have nearly completely replaced vaccine serotypes. The impact on clinical disease remains to be seen. Copyright © 2014 by Lippincott Williams & Wilkins.


Mineyko A.,Alberta Childrens Hospital Research Institute | Kirton A.,Alberta Childrens Hospital Research Institute | Ng D.,University of Calgary | Wei X.-C.,Alberta Childrens Hospital
Neuroradiology | Year: 2013

Introduction: Large/medium vessel vasculitis is an important etiology of childhood stroke. Early research suggests vessel wall enhancement on postcontrast MRI may be a marker of intracranial vasculitis yet no systematic descriptions of normal periarterial enhancement exist in the literature. The aim was to describe normal periarterial enhancement in the pediatric population. Methods: We included all children who had an MR scan between January 2007 and December 2010, with normal parenchymal imaging, no clinical concern of vasculopathy, and axial and coronal postcontrast fat-saturated T1-weighted images with 3-mm slice thickness. Intensity of periarterial enhancement was graded on a three-point scale by two investigators for all intracranial large and medium arteries. Results: A total of 44 patients aged 4 months to 16 years were included. Inter- and intra-rater reliability in enhancement grading was high (all kappa >0.65). Thin, linear, noncircumferential periarterial enhancement was common and usually symmetrical. It was most commonly prominent in the cavernous and petrous segments of the internal carotid artery and the M1 segment of the middle cerebral artery. Periarterial enhancement was rarely observed at segments surrounded by CSF, including supraclinoid segments of the internal carotid arteries, P1 segments of the posterior cerebral arteries, V4 segments of the vertebral artery, and the basilar arteries. Conclusion: Normal periarterial enhancement is common and usually symmetrical along major intracranial arteries but rarely seen around arterial segments bordered by CSF. Knowledge of these findings may be useful for a sensitive and specific interpretation of MR scans of patients with clinical concerns of vasculitis. © 2013 Springer-Verlag Berlin Heidelberg.


Vinette S.A.,Alberta Childrens Hospital Research Institute | Vinette S.A.,University of Calgary | Vinette S.A.,Alberta Childrens Hospital | Bray S.,Alberta Childrens Hospital Research Institute | And 2 more authors.
Developmental Cognitive Neuroscience | Year: 2015

The intraparietal sulcus (IPS), a region in the dorsal attention network (DAN), has been implicated in multi-sensory attention and working memory. Working memory and attention develop across childhood; changes in functional connectivity within the DAN may relate to this maturation. Previous findings regarding fronto-parietal intrinsic functional connectivity age-effects were mixed. Our study aimed to circumvent limitations of previous work using a large cross-sectional sample, 183 typically developing participants 6.5-20 years, from the Autism Brain Imaging Data Exchange, and seed regions along the anterior-to-posterior axis of the IPS. These seeds, IPS0-4, were entered into functional connectivity models. Group-level models investigated differential connectivity along the IPS and relationships with age. Anterior IPS3/4 exhibited greater connectivity with sensorimotor/pre-motor regions. Posterior IPS0/1 demonstrated greater connectivity with dorsal and ventral visual regions. Positive age-effects were found between IPS3-4 and visual regions. Negative age-effects were found between IPS and superior parietal and medial orbitofrontal cortices. Follow-up region of interest analyses were used to estimate age-effects for DAN and anticorrelated default mode network regions. Results suggest age-effects on IPS functional connectivity are relatively modest, and may differ pre- and across-adolescence. Studying typical age-related connectivity variability within this network may help to understand neurodevelopmental disorders marked by impaired attention. © 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-NDlicense.


Rabi Y.,University of Calgary | Rabi Y.,Alberta Childrens Hospital Research Institute | Dawson J.A.,Royal Melbourne Hospital | Dawson J.A.,Murdoch Childrens Research Institute | Dawson J.A.,University of Melbourne
Seminars in Fetal and Neonatal Medicine | Year: 2013

Pulse oximetry is increasingly being used in the delivery room. Expert recommendations state that oxygen therapy during newborn resuscitation should be guided by pulse oximetry. Obtaining accurate and stable oxygen saturation and heart rate information from a pulse oximeter in the delivery room can be challenging. Understanding the properties of this device is important in overcoming these challenges. This article describes several aspects of pulse oximetry use in the delivery room ranging from technical issues with the device itself to clinical applications of the technology. © 2013.


Tomfohr L.M.,University of Calgary | Tomfohr L.M.,Alberta Childrens Hospital Research Institute | Pung M.A.,University of California at San Diego | Mills P.J.,University of California at San Diego | Edwards K.,University of Sydney
Journal of Behavioral Medicine | Year: 2014

Mindfulness based interventions have been associated with improvements in physical health; however, the mechanisms underlying these changes are unclear. The current study explored relationships between trait mindfulness, blood pressure (BP) and interleukin-6 (IL-6). Relationships between physical health variables and (1) a composite score of mindfulness, (2) individual facets of mindfulness and (3) interactions between theoretically relevant pairs of mindfulness subscales were investigated. One hundred and thirty healthy, young adults [M (SD) age = 21.7(2.7) years] reported trait levels of mindfulness (Five Facet Mindfulness Questionnaire, subscales include: observing, describing, acting with awareness (AWA), nonjudging and nonreactivity), had their resting BP measured and underwent a blood draw to assesses circulating IL-6 levels. Age, gender, body mass index, race/ethnicity, depression and perceived stress were obtained and used as covariates. A composite score of trait mindfulness was associated with lower BP and a trend suggested that it was also associated with lower IL-6. Investigation of individual facets of mindfulness revealed interactions between the subscales AWA and nonjudging, such that higher endorsement of AWA was associated with lower BP only when nonjudging was also high. A second interaction was observed between the subscales observing and nonreactivity, such that higher endorsement of observing was associated with lower IL-6 only when levels of nonreactivity were also high. Trait mindfulness was associated with both BP and IL-6. Examining interactions between facets of mindfulness variables may be important in understanding how mindfulness based interventions influence physiology. © 2014, Springer Science+Business Media New York.


Premji S.,University of Calgary | Premji S.,Alberta Childrens Hospital Research Institute
Maternal and Child Health Journal | Year: 2014

In low- and middle-income countries (LMIC), determinants of women’s and children’s health are complex and differential vulnerability may exist to risk factors of perinatal distress and preterm birth. We examined the contribution of maternal perinatal distress on preterm birth and infant health in terms of infant survival and mother–infant interaction. A critical narrative and interpretive literature review was conducted. Peer-reviewed electronic databases (MEDLINE, Embase, Global Health, CINHAL), grey literature, and reference lists were searched, followed by a consultation exercise. The literature was predominantly from high-income countries. We identify determinants of perinatal distress and explicate changes in the hypothalamic–pituitary–adrenal axis, sympathetic, immune and cardiovascular systems, and behavioral responses resulting in pathophysiological effects. We suggest cultural–neutral composite measures of allostatic mediators (i.e., several biomarkers) of maternal perinatal distress as objective indicators of dysregulation in body systems in pregnant women in LMIC. Understanding causal links of maternal perinatal distress to preterm birth in women in LMIC should be a priority. The roles of allostasis and allostatic load are considered within the context of the health of pregnant women and fetuses/newborns in LMIC with emphasis on identifying objective indicators of the level of perinatal distress and protective factors or processes contributing to resilience while facing toxic stress. We propose a prospective study design with multiple measures across pregnancy and postpartum requiring complex statistical modeling. Building research capacity through partnering researchers in high-income countries and LMIC and reflecting on unique ethical challenges will be important to generating new knowledge in LMIC. © 2014, The Author(s).


Kuczynski A.,University of Calgary | Crawford S.,Alberta Childrens Hospital Research Institute | Bodell L.,Alberta Childrens Hospital Research Institute | Dewey D.,University of Calgary | And 3 more authors.
Developmental Medicine and Child Neurology | Year: 2013

Aim: Post-traumatic headaches (PTHs) following mild traumatic brain injury (mTBI) are common; however, few studies have examined the characteristics of PTHs or their response to treatment. The aims of this study were (1) to describe the clinical characteristics of PTH in a prospective cohort of children presenting to a paediatric emergency department with mTBI, and (2) to evaluate the response of PTH to treatment. Method: The emergency department cohort was obtained from a prospective longitudinal cohort study of symptoms following mTBI (n=670; 385 males, 285 females) and a comparison group of children with extracranial injury (n=120; 61 males, 59 females). A retrospective chart review of a separate cohort of children from a brain injury clinic (the treatment cohort) treated for PTH was performed (n=44; 29 females, 15 males; mean age 14y 1mo, SD 3y 1mo). The median time since injury was 6.9 months (range 1-29mo). The mean follow-up interval after treatment started was 5.5 weeks (SD 4.3wks). Results: Among the emergency department cohort (n=39; 20 males, 19 females; mean age 11y 1mo, SD 4y 3mo) 11% of children were symptomatic with PTHs at a mean of 15.8 days (SD 11.6d) post injury. Three months post injury, 7.8% of children complained of headaches; of those, 56% had pre-existing headaches and 18% had experienced migraine before the injury. Although headache type varied, 55% met the criteria for migraine. A family or past medical history of migraine was present in 82% of cases. Among the treatment cohort, medications included amitriptyline, flunarizine, topiramate, and melatonin, with an overall response rate of 64%. Conclusion: This is the first prospective cohort study to describe the clinical characteristics of PTHs following mTBI in children. Migraine was the most common headache type seen; other headaches included tension-type, cervicogenic, and occipital neuralgias, and 64% responded to treatment. Referral to a headache specialist should be considered, especially when the features are not typical of one of the primary headache disorders. © 2013 Mac Keith Press.


Huang C.,University of Calgary | Chan J.A.,University of Calgary | Schuurmans C.,Alberta Childrens Hospital Research Institute
Current Topics in Developmental Biology | Year: 2014

Proneural genes encode evolutionarily conserved basic-helix-loop-helix transcription factors. In Drosophila, proneural genes are required and sufficient to confer a neural identity onto naïve ectodermal cells, inducing delamination and subsequent neuronal differentiation. In vertebrates, proneural genes are expressed in cells that already have a neural identity, but they are still required and sufficient to initiate neurogenesis. In all organisms, proneural genes control neurogenesis by regulating Notch-mediated lateral inhibition and initiating the expression of downstream differentiation genes. The general mode of proneural gene function has thus been elucidated. However, the regulatory mechanisms that spatially and temporally control proneural gene function are only beginning to be deciphered. Understanding how proneural gene function is regulated is essential, as aberrant proneural gene expression has recently been linked to a variety of human diseases-ranging from cancer to neuropsychiatric illnesses and diabetes. Recent insights into proneural gene function in development and disease are highlighted herein. © 2014 Elsevier Inc.


Ramasubbu R.,University of Calgary | Konduru N.,University of Calgary | Cortese F.,University of Calgary | Bray S.,University of Calgary | And 3 more authors.
Frontiers in Psychiatry | Year: 2014

Imaging studies of major depressive disorder (MDD) have demonstrated enhanced resting-state activity of the amygdala as well as exaggerated reactivity to negative emotional stimuli relative to healthy controls (HCs). However, the abnormalities in the intrinsic connectivity of the amygdala in MDD still remain unclear. As the resting-state activity and functional connectivity (RSFC) reflect fundamental brain processes, we compared the RSFC of the amygdala between unmedicated MDD patients and HCs. Seventy-four subjects, 55 adults meeting the DSM-IV criteria for MDD and 19 HCs, underwent a resting-state 3-T functional magnetic resonance imaging scan. An amygdala seed-based low frequency RSFC map for the whole brain was generated for each group. Compared with HCs, MDD patients showed a wide-spread reduction in the intrinsic connectivity of the amygdala with a variety of brain regions involved in emotional processing and regulation, including the ventrolateral prefrontal cortex, insula, caudate, middle and superior temporal regions, occipital cortex, and cerebellum, as well as increased connectivity with the bilateral temporal poles (p < 0.05 corrected). The increase in the intrinsic connectivity of amygdala with the temporal poles was inversely correlated with symptom severity and anxiety scores. Although the directionality of connections between regions cannot be inferred from temporal correlations, the reduced intrinsic connectivity of the amygdala predominantly with regions involved in emotional processing may reflect impaired bottom-up signaling for top-down cortical modulation of limbic regions leading to abnormal affect regulation in MDD. © 2014 Ramasubbu, Konduru, Cortese, Bray, Gaxiola-Valdez and Goodyear.

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