British Columbia Children's Hospital

Improved survival rates for childhood cancer have resulted in survivors experiencing increased physical and psychosocial late effects. Post-traumatic growth (PTG) refers to positive psychosocial changes in response to trauma, in this case, cancer diagnosis and treatment. The role of PTG in long-term follow-up care (LTFU) is unknown. The aim of this study was to examine the lived experiences of PTG in survivors of childhood cancer, specifically in the context of LTFU. We completed an exploratory qualitative study using patient-oriented research methods. Eligible participants were Canadian adult survivors of childhood cancer, at least 5 years post-diagnosis or 2 years post-treatment. Demographic data were gathered by digital survey and summarized using descriptive statistics. Virtual focus transcripts were analyzed using reflexive thematic analysis. Twenty-two survivors of childhood cancer (mean age 29.2years, predominantly female and white) participated across five virtual focus groups, with 4 to 6 participants per group. Four key themes emerged: Life Perspectives, Self-Advocacy/Empowerment, Career Choices, and Sharing the Lived Experience. Participants reported shifts in life outlook and priorities, with many pursuing health-related careers. Self-advocacy skills were gained from their cancer experiences, which were felt to be required in the LTFU setting. Finally, survivors valued and gained meaning from sharing their lived experiences. The PTG themes of Self-Advocacy/Empowerment and Sharing the Lived Experience are novel contributions to the literature. PTG may offer an avenue to improve patient engagement and adherence with LTFU, and future interventions should encourage its incorporation.

ABSTRACT Objective Preterm birth alters typical brain development due to complex exposures related to neonatal illness, pain management, and brain injury. Despite an increased understanding of neonatal brain injury on developmental outcomes, the association of cerebellar maturation with school‐age motor and cognitive function remains incompletely understood. The current study evaluated neonatal clinical factors associated with regionally specific cerebellar volumes and white matter pathways at 8 years of age in children born preterm (24–32 weeks of gestational age). Methods Neuroimaging, clinical, and behavioral data were collected from 130 children born very preterm (24–32 weeks' gestational age) at BC Women's Hospital. Cerebellar subregions were automatically segmented using CerebNet, and cerebellar white matter connectivity was assessed using tractography. The relationships between cerebellar subregion volumes and neonatal clinical factors were examined using constrained principal component analysis. Cognitive and motor neurodevelopmental outcomes related to cerebellar volume and connectivity were also investigated. Results Neonatal clinical factors including mechanical ventilation, number of invasive procedures, and opioid exposures were associated with reduced cerebellar volumes in specific subregions. Acute neonatal mortality risk (i.e., SNAPPE‐II) was negatively associated with cerebellar connectivity at 8 years. Reduced cerebellar volumes and structural connectivity were related to poorer cognitive and motor outcomes. Interpretation In very preterm children, neonatal illness severity and exposure to invasive procedures and opioids are associated with reduced cerebellar volumes, connectivity, and poorer neurodevelopmental outcomes at 8 years.

ABSTRACT Two new RSV immunization products exist for infants: a prenatal vaccine (RSVpreF) and a long-acting monoclonal antibody for infants (nirsevimab). While both showed promise in clinical trials, implementation has varied across jurisdictions. Before rollout in Canada, we conducted an anonymized, online survey with a nationally representative sample of 1,015 expectant and recent birth parents. The primary outcome was product acceptability (disagree, undecided, agree). Odds ratios (ORs) and 95% confidence intervals (CIs) identified factors associated with agreement or indecision versus disagreement. Approximately 49% (n = 499) were expecting; 51% (n = 516) had a baby in the past year. Overall, 72% (n = 727) agreed to receive a product: 61% (n = 624) for RSVpreF and 60% (n = 608) for nirsevimab. RSVpreF agreement was higher among older parents (e.g., OR = 3.64; 95% CI, 1.99–6.67 for age 25–34 versus 18–24 years), those with a university degree (OR = 3.65; 95% CI, 2.01–6.64 versus high school), higher income (OR = 2.31; 95% CI, 1.01–5.28 for ≥$150k versus <$40k), or receipt/intention for Tdap (OR = 3.76; 95% CI, 2.37–5.96 versus no receipt/intention) or influenza (OR = 2.04; 95% CI, 1.29–3.21) vaccines. Agreement was higher among parents of children without a high-risk medical condition compared to those with (OR = 2.32; 95% CI, 1.44–3.72). Similar trends were observed for nirsevimab, with lower agreement also noted among those who self-researched antibodies (OR = 0.51; 95% CI, 0.30–0.88 versus not). As most respondents rated product safety (76%), effectiveness (71%), and disease severity risk (70%) as important in decision-making, providing clear information on these, alongside communications targeted to subgroups with lower agreement, may optimize uptake as programs rollout.

Klebsiella pneumoniae is a gram-negative, opportunistic pathogen, with high rates of antimicrobial resistance, and is responsible for a wide range of infections of the urinary tract, lungs, and bloodstream, among others. Disease burden is particularly high in neonates, where K. pneumoniae is a leading cause of sepsis. Renewed interest in vaccine development against this critical priority pathogen has focused on this vulnerable population. Vaccination in pregnancy is a promising approach for prevention of neonatal sepsis, however efforts to understand the dynamics, specificity and function of maternally transferred antibodies is ongoing. We report here that K. pneumoniae-specific IgG is readily transferred from dam to pup following wild-type infection in mice, and that maternally-transferred immunity is protective against lethal infection in pups aged 6 weeks. Further work to investigate the mechanisms of protection and explore neonatal challenge models will advance the path to a maternal vaccine to protect against neonatal sepsis.

The minimally invasive repair of pectus excavatum (MIRPE), a surgical procedure done primarily in adolescence to correct pectus excavatum (PE), a congenital chest wall deformity, is associated with significant postoperative pain and opioid consumption. The use of an integrative medicine (IM) approach-combining complementary therapies with conventional treatments-can support postoperative pain management and potentially reduce opioid consumption in adolescent patients undergoing this procedure. This scoping review examines the published literature addressing the use of IM modalities in adolescent patients undergoing MIRPE. A comprehensive search of MEDLINE, EMBASE, Web of Science Core Collection, and Google Scholar was conducted from inception through January 2024. Studies were included if they addressed the inclusion of at least one IM modality during the MIRPE perioperative to support pain management. These modalities could be delivered at any time during that period and used alongside any conventional analgesic methods. Eleven studies met the inclusion criteria. Eight of these (72.7%) implemented an integrative modality in this population. Of these eight, the most common integrative modalities were mindfulness/purposeful relaxation (n = 5), self-hypnosis (n = 3), cognitive-behavioral therapy (CBT) (n = 2), music/music therapy (n = 2), aromatherapy (n = 1), and massage (n = 1). Only six studies described the use of an integrative modality as an experimental condition. Still, self-hypnosis (n = 3), CBT (n = 2), and virtual reality-guided relaxation (n = 1) all augment postoperative pain management. While these studies have low levels of evidence and/or small sample sizes, they still demonstrated reduced pain scores (n = 4) and opioid consumption (n = 2) without appreciable adverse effects. There is a paucity of literature examining the use of integrative modalities in adolescent patients undergoing MIRPE. The included studies demonstrate preliminary evidence of the positive outcomes associated with IM modalities overall and a low-risk profile. However, the small number of studies, observational and retrospective designs, limited sample sizes, and large heterogeneity across the studies demonstrate limited, low-level evidence, highlighting a need for further rigorous research to determine the efficacy of these modalities. Further investigation, especially in specific promising modalities such as hypnosis and guided relaxation, is warranted. Incorporating IM modalities into perioperative care for this population should be further explored.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with poorer mental well-being (e.g., anxiety, depressive symptoms and infection worry) and unfavorable changes in health behaviours (e.g., physical activity, healthy eating, and alcohol intake). Notably, trends in changes appear to differ between adult males and females (>18 years). To investigate these sex-based differences, we explored the impact of sex as a moderator on changes in health behaviours attributed to changes in mental well-being during SARS-CoV-2. Data from Canada, Columbia and Ireland collected through the International COVID-19 Awareness and Responses Evaluation (iCARE) Study was used. Participants (n = 17,880; 52.3% female) self-reported changes in their mental well-being and health behaviours attributed to SARS-CoV-2. Associations were explored using multi-variable logistic regression models stratified by country. Significance was determined by p < .01. In Canada and Ireland, increased psychological distress was significantly associated with ≥50% increase in the odds of an unfavourable change in healthy eating, physical activity and alcohol intake (minimum odds ratios (ORs)=1.50). In Columbia, increased psychological distress was significantly associated with unfavourable changes in only alcohol intake (OR=1.63). Increased infection worry was associated with unfavourable changes in physical activity (OR=1.21) in Columbia. Sex was found to significantly moderator associations in Columbia; Females experienced more unfavourable changes in their odds of healthy eating compared to males with increased psychological distress (p < .01). Given the lack of consistent sex-based trends across countries, geographic and cultural context are likely more salient to tailored future behavioural interventions intended to support adults' practice of health-protective behaviours during a pandemic than biological sex (e.g., public health campaign promoting culturally relevant physical activity in response to greater perceived psychological distress).

BackgroundPersonal statements play a large role in pediatric residency applications, providing insights into candidates’ motivations, experiences, and fit for the program. With large language models (LLMs) such as Chat Generative Pre-trained Transformer (ChatGPT), concerns have arisen regarding how this may influence the authenticity of statements in evaluating candidates. This study investigates the efficacy and perceived authenticity of LLM-generated personal statements compared to human-generated statements in residency applications.MethodsWe conducted a blinded study comparing 30 ChatGPT-generated personal statements with 30 human-written statements. Four pediatric faculty raters assessed each statement using a standardized 10-point rubric. We analyzed the data using linear mixed-effects models, a chi-square sensitivity analysis, an evaluation of rater accuracy in identifying statement origin as well as consistency of scores amongst raters using intraclass correlation coefficients (ICC).ResultsThere was no significant difference in mean scores between AI and human-written statements. Raters could only identify the source of a letter (AI or human) with 59% accuracy. There was considerable disagreement in scores between raters as indicated by negative ICCs.ConclusionsAI-generated statements were rated similarly to human-authored statements and were indistinguishable by reviewers, highlighting the sophistication of these LLM models and the challenge in detecting their use. Furthermore, scores varied substantially between reviewers. As AI becomes increasingly used in application processes, it is imperative to examine its implications in the overall evaluation of applicants.

Abstract Background Respiratory tract infections (RTI) are amongst the five leading causes of death in children in Canada. After relaxation of public health interventions for COVID-19, there was a significant increase in hospital admissions in children with RTI. The epidemiology of these cases, causative viral pathogens, severity of illness, and type of complications are poorly described. Objectives To describe the epidemiology and outcomes of children under 18 years with RTI between July 2022 and June 2023. Design/Methods A retrospective observational cohort study in hospitalized children at two tertiary Canadian centers with an acute RTI. The primary outcome was intensive care unit (ICU) admission. Characteristics of the cohort are described. Regression analyses for risk factors for ICU admission will be performed (data not presented in abstract) Results The median age of 2603 patients was 2.6 (IQR: 0.9-5.1) and 59% were males. Neurologic/genetic diagnoses were the most common comorbidity. Children presented after a median of 4 (IQR: 2-6) days of symptoms with a median of 5 (IQR: 4-6) symptoms. Common symptoms included cough (n=2157, 83%), fever (n=1814, 70%), and increased work of breathing (n=1780, 68%). Most patients had viral testing performed (88%); with one virus identified in 1451 children (63%), two in 288 patients (13%), and three or more in 48 children (2%). In those tested, positive tests for RSV (n=692, 30%) and Rhinovirus/Enterovirus (n=582, 25%) were most common. 653 (25%) patients required an ICU admission. RSV (n=223, 34%) and Rhinovirus/Enterovirus (n=156, 24%) were the most common etiologies in patients admitted to ICU. Median duration of PICU admission was 3 (IQR: 1-6) days, with 41% of patients remaining in ICU for 4 or more days. Three quarters (n=481) of the patients admitted to PICU required non-invasive/invasive mechanical ventilation. Acute respiratory distress syndrome and cardiac complications developed in 40 (2%) and 76 (3%) patients, respectively. Positive blood culture for bacteria implicated in pneumonias were detected in 58 (2%) children. Median length of hospital stay was 3 (IQR: 1-6) days. Only 7% of patients had an emergency department visit within 30 days after discharge. 39 patients (1%) died. Conclusion After the relaxation of public health interventions, RTI related hospital admissions were in young children and over half of patients were positive for RSV and Rhinovirus/Enterovirus. While most admissions were short, one-quarter of children were admitted to PICU.

The PIONIR (Preventing IBD ONset in Individuals at Risk) trial evaluates whether the Tasty&Healthy diet can reduce risk of Crohn's disease (CD) development in first-degree relatives (FDRs). The optimal preclinical stage of CD for enrolling subjects to prevention trials is unknown. We aimed to propose a framework for identifying high-risk participants for prevention trials by reporting the outcomes of the pre-PIONIR screening stage. Faecal calprotectin was measured in asymptomatic FDRs aged 6-38 years; those with persistent elevation, defined as >70 µg/g in at least two separate tests, were offered panenteric video capsule-endoscopy or ileocolonoscopy. Of 950 FDRs approached, 331 (35%) agreed to be screened: 63 (19%) had persistently elevated calprotectin, of whom 42 underwent further evaluation. Nine (2.7%) had endoscopic appearance compatible with presymptomatic CD, 22 (6.6%) had non-specific macroscopic mucosal changes and 11 (3.3%) had normal mucosa despite elevated calprotectin, suggesting probable histological inflammation. The 33 participants in the two latter groups were defined as 'potential pre-CD' (17.9% of all screened after adjusting for missing values). Calprotectin >225 µg/g predicted presymptomatic CD (area under the receiver operating characteristic curve 0.97 (95% CI 0.94 to 1.0; p<0.001; sensitivity 89%, specificity 94%). Of those with a single elevated calprotectin value, 22% normalised on repeat testing with significant variability (intraclass correlation coefficient 0.72 (95% CI 0.57 to 0.82)). Approximately one in five asymptomatic FDRs had persistently elevated calprotectin, which was able to differentiate those with presymptomatic CD. The findings highlight calprotectin's utility in identifying at-risk individuals during the potential pre-CD stage for enrolment in prevention trials.