Children

Editorial

Jump to: Research, Review, Other

3 pages, 173 KiB

Open AccessEditorial

Anti-Epileptic Drug Toxicity in Children

by Imti Choonara

Children 2018, 5(5), 57; https://doi.org/10.3390/children5050057 - 1 May 2018

Cited by 7 | Viewed by 5067

Abstract

Anti-epileptic drugs (AEDs) have had a major impact on children, improving their quality of life and significantly reducing both morbidity and mortality. They are, however, associated with significant toxicity. Behavioural problems and somnolence are the most frequent adverse drug reactions for many AEDs. [...] Read more.

Anti-epileptic drugs (AEDs) have had a major impact on children, improving their quality of life and significantly reducing both morbidity and mortality. They are, however, associated with significant toxicity. Behavioural problems and somnolence are the most frequent adverse drug reactions for many AEDs. Unfortunately, the comparative risk of drug toxicity for different AEDs has been inadequately studied. Drug toxicity is poorly reported in randomised controlled trials. Prospective cohort studies are the best way to study drug toxicity. There have been a few prospective cohort studies of children with epilepsy, but the numbers of children have been small. Systemic reviews of the toxicity of individual AEDs have been helpful in identifying the risk of drug toxicity. Parents of children with epilepsy and the children and young people who are due to receive AED treatment have the right to know the likelihood of them experiencing drug toxicity. Unfortunately, the evidence base on which health professionals can provide such information is limited. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

Research

Jump to: Editorial, Review, Other

10 pages, 213 KiB

Open AccessArticle

Causes of Morbidity and Mortality among Neonates and Children in Post-Conflict Burundi: A Cross-Sectional Retrospective Study

by Imelda K. Moise

Children 2018, 5(9), 125; https://doi.org/10.3390/children5090125 - 8 Sep 2018

Cited by 15 | Viewed by 5817

Abstract

The risk of a child dying before age five in Burundi is almost 1.6 times higher than that in the World Health Organization (WHO) African region. However, variations in the all-cause mortality rates across Burundi have not yet been measured directly at subnational [...] Read more.

The risk of a child dying before age five in Burundi is almost 1.6 times higher than that in the World Health Organization (WHO) African region. However, variations in the all-cause mortality rates across Burundi have not yet been measured directly at subnational levels, age group and by gender. The objective of this study was to describe the main causes of hospitalization and mortality in children during the neonatal period and at ages 1 to 59 months, for boys and girls, and to assess the total annual (2010) burden of under-five morbidity and mortality in hospitals using hospitalization records from 21 district hospitals. We found variation in the gender and regional distribution of the five leading causes of hospitalization and death of children under five. Although the five causes accounted for 89% (468/523) of all neonatal hospitalizations, three causes accounted for 93% (10,851/11,632) of all-cause hospitalizations for children ages 1 to 59 months (malaria, lung disease, and acute diarrhea), malaria accounted for 69% (1086/1566) of all deaths at ages 1 to 59 months. In Burundi, human malarial infections continue to be the main cause of hospitalization and mortality among under-five children. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

14 pages, 1820 KiB

Open AccessArticle

Fundamental Motor Skills of Children in Deprived Areas of England: A Focus on Age, Gender and Ethnicity

by Leanne Jaye Adeyemi-Walker, Michael Duncan, Jason Tallis and Emma Eyre

Children 2018, 5(8), 110; https://doi.org/10.3390/children5080110 - 13 Aug 2018

Cited by 16 | Viewed by 7310

Abstract

This study compared the mastery of fundamental motor skills (FMS) of males and females in early-childhood (four to five years, n = 170) and in middle-childhood (nine to ten years, n = 109) who attend schools in deprived and ethnically diverse areas of [...] Read more.

This study compared the mastery of fundamental motor skills (FMS) of males and females in early-childhood (four to five years, n = 170) and in middle-childhood (nine to ten years, n = 109) who attend schools in deprived and ethnically diverse areas of England. Process FMS (object control and locomotor skills) were observed using the Test of Gross Motor Development-2. Sprint speed over 10 meters and jump distance assessments were conducted using light gates and tape measures. A gender (male vs. female) by year-group (early-childhood vs. middle-childhood) interaction was shown for the process and product-oriented FMS measurements. Middle-childhood males and females demonstrated significantly greater FMS mastery, as compared to early-childhood (p < 0.05). Furthermore, middle-childhood males demonstrated significantly greater mastery of total FMS, object control skills, and product-oriented assessments, in comparison to females (p < 0.05). Children of Black and White ethnic groups achieved significantly greater mastery of locomotor skills, compared to Asian children, though this did not differ by year-group (p < 0.05). The results suggest that FMS development in deprived and ethnically diverse areas in England varies between genders during middle-childhood and ethnicity. Thus, interventions addressing the lack of FMS mastery achievement, shown in middle-childhood girls and children from Asian ethnic backgrounds, may be pivotal. Further exploration of the role of ethnicity would provide greater clarity in approaching interventions to improve FMS. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

8 pages, 528 KiB

Open AccessArticle

Adolescent Connectedness with Parents Promotes Resilience among Homeless Youth

by Kristen M. Aggerbeck Kessler, Debanjana Chatterjee, Rebecca Shlafer and Andrew J. Barnes

Children 2018, 5(7), 96; https://doi.org/10.3390/children5070096 - 16 Jul 2018

Cited by 10 | Viewed by 4535

Abstract

Youth who experience homelessness have worse health and well-being than housed youth. Internal assets, including social competency and positive self-identity, are factors that promote healthy development. This study compared internal assets between homeless and housed youth, and examined whether connectedness with parents moderates [...] Read more.

Youth who experience homelessness have worse health and well-being than housed youth. Internal assets, including social competency and positive self-identity, are factors that promote healthy development. This study compared internal assets between homeless and housed youth, and examined whether connectedness with parents moderates the association between homelessness and internal assets. Using data from a large population-based survey of middle- and high-school aged youth, we found that homelessness was associated with lower levels of internal assets. However, having high connectedness with a parent significantly predicted the strength of these assets, suggesting opportunities to promote health equity among homeless youth. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

16 pages, 254 KiB

Open AccessArticle

A Pilot Study of Iyengar Yoga for Pediatric Obesity: Effects on Gait and Emotional Functioning

by Keri R. Hainsworth, Xue Cheng Liu, Pippa M. Simpson, Ann M. Swartz, Nina Linneman, Susan T. Tran, Gustavo R. Medrano, Bryant Mascarenhas, Liyun Zhang and Steven J. Weisman

Children 2018, 5(7), 92; https://doi.org/10.3390/children5070092 - 4 Jul 2018

Cited by 11 | Viewed by 5063

Abstract

Obesity negatively impacts the kinematics and kinetics of the lower extremities in children and adolescents. Although yoga has the potential to provide several distinct benefits for children with obesity, this is the first study to examine the benefits of yoga for gait (primary [...] Read more.

Obesity negatively impacts the kinematics and kinetics of the lower extremities in children and adolescents. Although yoga has the potential to provide several distinct benefits for children with obesity, this is the first study to examine the benefits of yoga for gait (primary outcome) in youths with obesity. Secondary outcomes included health-related quality of life (HRQoL), physical activity, and pain. Feasibility and acceptability were also assessed. Nine youths (11–17 years) participated in an eight-week Iyengar yoga intervention (bi-weekly 1-h classes). Gait, HRQOL (self and parent-proxy reports), and physical activity were assessed at baseline and post-yoga. Pain was self-reported at the beginning of each class. Significant improvements were found in multiple gait parameters, including hip, knee, and ankle motion and moments. Self-reported and parent-proxy reports of emotional functioning significantly improved. Time spent in physical activity and weight did not change. This study demonstrates that a relatively brief, non-invasive Iyengar yoga intervention can result in improved malalignment of the lower extremities during ambulation, as well as in clinically meaningful improvements in emotional functioning. This study extends current evidence that supports a role for yoga in pediatric obesity. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

14 pages, 468 KiB

Open AccessArticle

Changes in Couple Relationship Dynamics among Low-Income Parents in a Relationship Education Program Are Associated with Decreases in Their Children’s Mental Health Symptoms

by Emma Sterrett-Hong, Becky Antle, Brianna Nalley and Monica Adams

Children 2018, 5(7), 90; https://doi.org/10.3390/children5070090 - 30 Jun 2018

Cited by 11 | Viewed by 5933

Abstract

Witnessing intimate partner violence (IPV) among parents negatively impacts millions of children in the United States each year. Low-income families are disproportionately affected by IPV compared to middle- and high-income individuals, and are beginning to be the focus of IPV secondary prevention interventions, [...] Read more.

Witnessing intimate partner violence (IPV) among parents negatively impacts millions of children in the United States each year. Low-income families are disproportionately affected by IPV compared to middle- and high-income individuals, and are beginning to be the focus of IPV secondary prevention interventions, including relationship education programs. Despite these developments, few studies have examined changes in psychosocial functioning among children of parents participating in relationship education programs. The current study examined the extent to which changes in specific couple dynamics among individuals from low-income backgrounds participating in a couple relationship education program, Within My Reach, were associated with changes in child mental health symptoms. A second purpose of this paper is to examine whether changes in parent–child relationship quality mediates the association between changes in couple dynamics and changes in child mental health difficulties. Participants (n = 347) were parents who participated in Within My Reach as part of programming offered at a large community agency. Decreases in negative couple conflict behaviors, including conflict engagement, withdrawal and compliance, over the course of the program were linked to decreases in child mental health difficulties. In addition, increases in parent–child relationship quality partially mediated the associations between decreases in compliance, as well as increase in overall couple relationship quality, and decreases in child symptoms. Community-based couple relationship education programs for low-income families can potentially have multiple positive impacts throughout the family system, including for children. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

10 pages, 546 KiB

Open AccessArticle

Evaluating the Nutritional Content of Children’s Breakfast Cereals in Australia

by Terence Tong, Anna Rangan and Luke Gemming

Children 2018, 5(7), 84; https://doi.org/10.3390/children5070084 - 21 Jun 2018

Cited by 12 | Viewed by 7095

Abstract

Breakfast is an important contributor to the daily dietary intake of children. This study investigated the nutritional composition of ready to eat (RTE) children’s breakfast cereals, which display fictional cartoon characters and themes, compared to other cereals available in Australia. Nutrient content claims [...] Read more.

Breakfast is an important contributor to the daily dietary intake of children. This study investigated the nutritional composition of ready to eat (RTE) children’s breakfast cereals, which display fictional cartoon characters and themes, compared to other cereals available in Australia. Nutrient content claims on packaging were also examined. Data were collected from RTE breakfast cereal packages (N = 347) from four major supermarkets in Sydney. Cereals were classified based on product type and promotional information displayed. Overall, 46% of children’s cereals were classified as “less healthy” as per nutrient profiling score criteria. Children’s cereals had a similar energy and sodium content per 100 g compared to other cereals but contained significantly higher levels of total sugar and lower levels of protein and dietary fibre compared to other varieties. Children’s cereals with nutrient content claims had improved (lower) nutrient profiling scores than those that did not (2 vs. 13, p = 0.021), but total sugar per 100 g was similar: 25 g (interquartile range (IQR) 14 g) vs. 32 g (IQR 19 g). In conclusion, RTE children’s breakfast cereals were found to be less healthy compared to other cereals on the market and the use of nutrient content claims on children’s cereals may mislead consumers regarding their overall nutrient profile. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

13 pages, 216 KiB

Open AccessArticle

The Role of Executive Functioning and Academic Achievement in the Academic Self-Concept of Children and Adolescents Referred for Neuropsychological Assessment

by Brittany A. Bailey, Sophia K. Andrzejewski, Sarah M. Greif, Adrian M. Svingos and Shelley C. Heaton

Children 2018, 5(7), 83; https://doi.org/10.3390/children5070083 - 21 Jun 2018

Cited by 15 | Viewed by 5505

Abstract

The current study evaluated a model of youth academic self-concept which incorporates practical executive functioning behaviors and academic achievement. Though greater academic achievement has been linked to both positive self-concept and better executive functioning, these constructs have not been examined simultaneously. It was [...] Read more.

The current study evaluated a model of youth academic self-concept which incorporates practical executive functioning behaviors and academic achievement. Though greater academic achievement has been linked to both positive self-concept and better executive functioning, these constructs have not been examined simultaneously. It was hypothesized that academic achievement would mediate the association between problems with executive functioning and academic self-concept such that youth with more problems with executive functioning would have lower academic achievement and, in turn, lower academic self-concept. Clinical data was analyzed from a diagnostically heterogeneous sample of youth (n = 122) who underwent neuropsychological evaluation. Problems with executive functioning were assessed using the Behavior Rating Inventory of Executive Function. Academic achievement was assessed using the Woodcock–Johnson Tests of Achievement or Wechsler Individual Achievement Test. Academic self-concept was assessed using the youth-report version of the Behavioral Assessment System for Children. Surprisingly, findings indicate that academic achievement is not significantly associated with problems with executive functioning or academic self-concept. However, greater problems with executive functioning are associated with decreased academic self-concept. The overall model included several covariates and accounted for 10% of the variance in academic self-concept. Findings suggest that executive skills may be essential for aligning academic achievement with classroom performance. Though various child characteristic covariates were included, the model accounted for a small amount of variance suggesting that future studies should examine contributing contextual factors. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

13 pages, 832 KiB

Open AccessArticle

The Unfavorable Alliance of Pain and Poor Sleep in Children with Life-Limiting Conditions and Severe Psychomotor Impairment

by Larissa Alice Dreier, Julia Wager, Markus Blankenburg and Boris Zernikow

Children 2018, 5(7), 82; https://doi.org/10.3390/children5070082 - 21 Jun 2018

Cited by 8 | Viewed by 3891

Abstract

A high prevalence of sleep problems exists in children and adolescents with life-limiting conditions (LLC) and severe psychomotor impairment (SPMI). This study aimed to compare the impacts of various child-related (pain, epilepsy, repositioning, medical care) and environment-related (light, noise, TV/radio, open door) factors [...] Read more.

A high prevalence of sleep problems exists in children and adolescents with life-limiting conditions (LLC) and severe psychomotor impairment (SPMI). This study aimed to compare the impacts of various child-related (pain, epilepsy, repositioning, medical care) and environment-related (light, noise, TV/radio, open door) factors on sleep in this vulnerable population. Data were obtained through the “Sleep Questionnaire for Children with Severe Psychomotor Impairment” (SNAKE) by proxy assessment. n = 212 children (mean age: 10.4 years) were included in the analyses. Logistic and linear regression models were used to compare child- and environment-related factors against the global rating of children’s sleep quality, five SNAKE scales, children’s sleep duration, and sleep efficacy. Pain increased the risk of sleeping poorly four-fold (OR (odds ratio) = 4.13; 95% CI (confidence interval): 1.87–9.13) and predicted four sleep problems as assessed by the SNAKE. Children who needed to reposition during the night were at three times greater risk of sleeping poorly (OR = 3.08; 95% CI: 1.42–6.69). Three of the five SNAKE scales were predicted through nocturnal repositioning. Repositioning and epilepsy predicted a reduced sleep duration and low sleep efficacy. None of the environment-related factors exhibited statistically significant results. This study emphasizes the urgent need for reliable pain detection in the context of sleep disturbances in severely ill children. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

14 pages, 220 KiB

Open AccessArticle

Family TXT: Feasibility and Acceptability of a mHealth Obesity Prevention Program for Parents of Pre-Adolescent African American Girls

by Chishinga Callender and Deborah Thompson

Children 2018, 5(6), 81; https://doi.org/10.3390/children5060081 - 19 Jun 2018

Cited by 7 | Viewed by 4592

Abstract

Obesity prevalence is greater in African American girls than their non-Hispanic white peers. Obesity prevention programs are needed to help parents create an obesity-preventive home environment. This paper reports the feasibility and acceptability of a mHealth child obesity prevention program consisting of self-determination [...] Read more.

Obesity prevalence is greater in African American girls than their non-Hispanic white peers. Obesity prevention programs are needed to help parents create an obesity-preventive home environment. This paper reports the feasibility and acceptability of a mHealth child obesity prevention program consisting of self-determination theory-grounded text messages promoting a healthy home food and activity environment to parents of 8–10-year-old African American girls. A one-group design with baseline and immediate post-intervention assessments was utilized. Mothers (n = 19) received 36 text messages over 12 weeks. Feasibility and acceptability were assessed through staff logs and post-intervention surveys and an interview. Feasibility and acceptability criteria were met. Mothers reported positive reactions to the intervention; they liked the program, used the information, and all but one gave it an A or B grade. The majority made changes and shared the text messages with others. This research provides evidence that a theoretically grounded mHealth child obesity prevention intervention is feasible and acceptable to parents of African American girls. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

13 pages, 258 KiB

Open AccessArticle

Understanding the Relative Contributions of Sensitive and Insensitive Parent Behaviors on Infant Vaccination Pain

by Shaylea Badovinac, Hannah Gennis, Rebecca Pillai Riddell, Hartley Garfield and Saul Greenberg

Children 2018, 5(6), 80; https://doi.org/10.3390/children5060080 - 18 Jun 2018

Cited by 13 | Viewed by 4152

Abstract

Parents play a critical role in supporting infants’ ability to manage strong emotions. Routine vaccinations provide an ideal context to observe the effect of parents’ behaviors on infants’ pain-related distress. Previous research in the vaccination context showed that parent sensitivity, operationalized by variables [...] Read more.

Parents play a critical role in supporting infants’ ability to manage strong emotions. Routine vaccinations provide an ideal context to observe the effect of parents’ behaviors on infants’ pain-related distress. Previous research in the vaccination context showed that parent sensitivity, operationalized by variables such as emotional availability and proximal soothing behaviors, is associated with infant pain-related distress behavior. However, the magnitudes of these relationships were smaller than expected given the established importance of parents in the development of distress regulation. In recent work, a reliable and valid measure to operationalize insensitive behaviors was developed. The objective of the current study was to examine the relative contribution of variables representing sensitive and insensitive behaviors to the prediction of infant pain-related distress behaviors during the reactivity and regulation phases of needle pain. Archival data was used to analyze a subsample of infants followed during their two-month, six-month, and 12-month vaccinations (n = 81). Results of regression analyses indicated that parent insensitive behaviors generally had the strongest relationships with pain outcomes across all ages, with a greater influence on regulation-phase pain-related distress behavior, rather than reactivity-phase pain-related distress behavior. Our findings support the utility of a measure of distress-promoting parent behaviors in a vaccination context, and highlight the potential value of this measure for clinicians and researchers. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

12 pages, 405 KiB

Open AccessArticle

Parent Attributions of Ambiguous Symptoms in Their Children: A Preliminary Measure Validation in Parents of Children with Chronic Pain

by Lauren C. Heathcote, Sara E. Williams, Allison M. Smith, Christine B. Sieberg and Laura E. Simons

Children 2018, 5(6), 76; https://doi.org/10.3390/children5060076 - 13 Jun 2018

Cited by 11 | Viewed by 4964

Abstract

How parents attribute cause to their child’s physical symptoms is likely important in understanding how the parent responds to the child, as well as the child’s health outcomes, especially within the context of chronic illness. Here, we adapt the Symptom Interpretation Questionnaire for [...] Read more.

How parents attribute cause to their child’s physical symptoms is likely important in understanding how the parent responds to the child, as well as the child’s health outcomes, especially within the context of chronic illness. Here, we adapt the Symptom Interpretation Questionnaire for parent report (SIQ-PR) and provide preliminary validation in a sample of parents of children with chronic pain (N = 311). Confirmatory factor analysis revealed that the SIQ-PR structure is consistent with the original measure, with three distinct attribution types: psychological (emotional/affective), somatic (illness/disease), and environmental (situational/transient) causes. All three subscales demonstrated satisfactory to good internal consistency, and temporal stability. Parents typically endorsed more than one attribution for each symptom, indicating that parents of children with chronic pain have a multidimensional interpretation of physical symptoms in their children. Further, parent psychological and somatic attributions, but not environmental attributions, were significantly associated with (i) parent protective responses towards their child, and (ii) the child’s self-reported somatic and psychological symptoms, indicating convergent and divergent validity. The SIQ-PR may be a useful measure for future studies investigating intergenerational and interpersonal models of pediatric chronic pain, and more broadly, to examine parent attributions of children’s ambiguous symptoms within the context of childhood chronic illness. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

5 pages, 424 KiB

Open AccessCommunication

Food Allergy Perceptions and Health-Related Quality of Life in a Racially Diverse Sample

by Alicia Toeruna Widge, Elizabeth Flory, Hemant Sharma and Linda Jones Herbert

Children 2018, 5(6), 70; https://doi.org/10.3390/children5060070 - 6 Jun 2018

Cited by 9 | Viewed by 5380

Abstract

This study examined caregiver perceptions of risk of food allergen exposure, and food allergy severity, worry, and health-related quality of life, and identified variations by race/ethnicity. Given the lack of data on racial/ethnic background in research on the psychosocial impacts of food allergy, [...] Read more.

This study examined caregiver perceptions of risk of food allergen exposure, and food allergy severity, worry, and health-related quality of life, and identified variations by race/ethnicity. Given the lack of data on racial/ethnic background in research on the psychosocial impacts of food allergy, this study meets a pressing need for research regarding food allergy-related experiences among diverse populations. This study found there were significant differences in perceived risk of allergen exposure among racial/ethnic groups with Asian Americans reporting significantly higher perceived risk of allergen exposure than Hispanic, Caucasian, and African American caregivers. There were no significant differences in food allergy severity, food allergy worry, or health-related quality of life among racial/ethnic groups; however, variability among racial/ethnic groups was apparent. Data may inform screening, counseling, and education practices for families from diverse backgrounds and aid in hypothesis generation for future research. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

8 pages, 225 KiB

Open AccessArticle

Development and Validation of a Nausea Severity Scale for Assessment of Nausea in Children with Abdominal Pain-Related Functional Gastrointestinal Disorders

by Alexandra C. Russell, Amanda L. Stone, Andi Wang and Lynn S. Walker

Children 2018, 5(6), 68; https://doi.org/10.3390/children5060068 - 1 Jun 2018

Cited by 15 | Viewed by 4924

Abstract

The objective of this study was to develop a pediatric measure of chronic nausea severity, the Nausea Severity Scale (NSS), and evaluate its reliability and validity in youth with abdominal pain-related functional gastrointestinal disorders (AP-FGID). Pediatric patients (aged 11–17 years-old, n = 236) [...] Read more.

The objective of this study was to develop a pediatric measure of chronic nausea severity, the Nausea Severity Scale (NSS), and evaluate its reliability and validity in youth with abdominal pain-related functional gastrointestinal disorders (AP-FGID). Pediatric patients (aged 11–17 years-old, n = 236) presenting to an outpatient clinic for evaluation of abdominal pain completed the NSS, Children’s Somatization Inventory (CSI), Functional Disability Inventory (FDI), Abdominal Pain Index (API), Patient-Report Outcomes Measurement Information System (PROMIS), Anxiety and Depression Scales and the Pediatric Rome III Questionnaire for FGIDs. The NSS demonstrated good concurrent, discriminant, and construct validity, as well as good internal consistency. One-third (34%) of AP-FGID patients reported experiencing nausea “most” or “every day” in the previous two weeks. The severity of nausea was higher in females than males and correlated significantly with the severity of somatic symptoms, functional disability, anxiety, and depression. The NSS is a valid and reliable measure of nausea in children with AP-FGID. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

12 pages, 600 KiB

Open AccessArticle

Pediatric Patients Receiving Specialized Palliative Home Care According to German Law: A Prospective Multicenter Cohort Study

by Silke Nolte-Buchholtz, Boris Zernikow and Julia Wager

Children 2018, 5(6), 66; https://doi.org/10.3390/children5060066 - 31 May 2018

Cited by 27 | Viewed by 5035

Abstract

In Germany, every child with a life-limiting condition suffering from symptoms that cannot sufficiently be controlled is eligible by law for specialized pediatric palliative home care (SPPHC). It is the aim of this study to describe the demographic and clinical characteristics of children [...] Read more.

In Germany, every child with a life-limiting condition suffering from symptoms that cannot sufficiently be controlled is eligible by law for specialized pediatric palliative home care (SPPHC). It is the aim of this study to describe the demographic and clinical characteristics of children referred to SPPHC and to compare patients with cancer and non-cancer conditions. The prospective multicenter study includes data on 75 children (median age 7.7 years, 50.7% male). The majority had non-cancer conditions (72%). The most common symptoms were cognitive impairment, somatic pain, impairment in communication or swallowing difficulties. Swallowing difficulties, seizures, and spasticity occurred significantly more often in non-cancer patients (p < 0.01). Cancer patients received antiemetics significantly more often (permanent and on demand) than non-cancer patients (p < 0.01). Significantly more non-cancer patients had some type of feeding tube (57.3%) or received oxygen (33.3%) (p < 0.01). Central venous catheters had been fitted in 20% of the patients, mostly in cancer patients (p < 0.001). Tracheostomy tubes (9.3%) or ventilation (14.7%) were only used in non-cancer patients. In conclusion, patients referred to SPPHC are a diverse cohort with complex conditions including a large range of neurologically originating symptoms. The care of pediatric palliative care patients with cancer is different to the care of non-cancer patients. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

5 pages, 170 KiB

Open AccessCommunication

Safety of Oral Food Challenges in Early Life

by Katherine Anagnostou

Children 2018, 5(6), 65; https://doi.org/10.3390/children5060065 - 30 May 2018

Cited by 4 | Viewed by 4163

Abstract

Oral food challenges are becoming more frequent in the allergy clinic due to an increased demand related to early food introduction in infants. We examined the safety of oral food challenges in 18 high-risk infants with prior allergic reactions, as well as infants [...] Read more.

Oral food challenges are becoming more frequent in the allergy clinic due to an increased demand related to early food introduction in infants. We examined the safety of oral food challenges in 18 high-risk infants with prior allergic reactions, as well as infants with no known exposure to the food, presenting consecutively in a dedicated food allergy clinic for an oral food challenge. Foods challenged included peanut, tree nuts, sesame, baked egg, baked milk, and soy. A total of 17/18 (94%) infants had a negative challenge. Only 1/18 (6%) had a positive challenge, and in this case, symptoms were mild and limited to the skin. Our results suggest that food challenges in infants and young children up to the age of 2 years are safe with symptoms limited to the skin when reactions occur. In our cohort, the large majority of food challenges were negative, with most infants being sensitized rather than allergic to the food. Larger studies are needed to confirm this finding. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

10 pages, 528 KiB

Open AccessArticle

Efficacy, Safety, and Usability of Remifentanil as Premedication for INSURE in Preterm Neonates

by Hadiyah Y. Audil, Sara Tse, Chad Pezzano, Amy Mitchell-van Steele and Joaquim M. B. Pinheiro

Children 2018, 5(5), 63; https://doi.org/10.3390/children5050063 - 22 May 2018

Cited by 6 | Viewed by 4219

Abstract

Background: We previously reported a 67% extubation failure with INSURE (Intubation, Surfactant, Extubation) using morphine as analgosedative premedication. Remifentanil, a rapid- and short-acting narcotic, might be ideal for INSURE, but efficacy and safety data for this indication are limited. Objectives: To [...] Read more.

Background: We previously reported a 67% extubation failure with INSURE (Intubation, Surfactant, Extubation) using morphine as analgosedative premedication. Remifentanil, a rapid- and short-acting narcotic, might be ideal for INSURE, but efficacy and safety data for this indication are limited. Objectives: To assess whether remifentanil premedication increases extubation success rates compared with morphine, and to evaluate remifentanil’s safety and usability in a teaching hospital context. Methods: Retrospective review of remifentanil orders for premedication, at a large teaching hospital neonatal intensive care unit (NICU). We compared INSURE failure rates (needing invasive ventilation after INSURE) with prior morphine-associated rates. Additionally, we surveyed NICU staff to identify usability and logistic issues with remifentanil. Results: 73 remifentanil doses were administered to 62 neonates (mean 31.6 ± 3.8 weeks’ gestation). Extubation was successful in 88%, vs. 33% with morphine premedication (p < 0.001). Significant adverse events included chest wall rigidity (4%), one case of cardiopulmonary resuscitation (CPR) post-surfactant, naloxone reversal (5%), and notable transient desaturation (34%). Among 137 completed surveys, 57% indicated concerns, including delayed drug availability (median 1.1 h after order), rapid desaturations narrowing intubation timeframes and hindering trainee involvement, and difficulty with bag-mask ventilation after unsuccessful intubation attempts. Accordingly, 33% of ultimate intubators were attending neonatologists, versus 16% trainees. Conclusions: Remifentanil premedication was superior to morphine in allowing successful extubation, despite occasional chest wall rigidity and unfavorable conditions for trainees. We recommend direct supervision and INSURE protocols aimed at ensuring rapid intubation. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

Review

Jump to: Editorial, Research, Other

12 pages, 696 KiB

Open AccessReview

Role of the Gut–Liver Axis in Driving Parenteral Nutrition-Associated Injury

by Christine Denton, Amber Price, Julie Friend, Chandrashekhara Manithody, Keith Blomenkamp, Matthew Westrich, Vindhya Kakarla, William Phillips, Joseph Krebs, Armando Salim Munoz Abraham, Hector Osei and Ajay Kumar Jain

Children 2018, 5(10), 136; https://doi.org/10.3390/children5100136 - 25 Sep 2018

Cited by 23 | Viewed by 5029

Abstract

For decades, parenteral nutrition (PN) has been a successful method for intravenous delivery of nutrition and remains an essential therapy for individuals with intolerance of enteral feedings or impaired gut function. Although the benefits of PN are evident, its use does not come [...] Read more.

For decades, parenteral nutrition (PN) has been a successful method for intravenous delivery of nutrition and remains an essential therapy for individuals with intolerance of enteral feedings or impaired gut function. Although the benefits of PN are evident, its use does not come without a significant risk of complications. For instance, parenteral nutrition-associated liver disease (PNALD)—a well-described cholestatic liver injury—and atrophic changes in the gut have both been described in patients receiving PN. Although several mechanisms for these changes have been postulated, data have revealed that the introduction of enteral nutrition may mitigate this injury. This observation has led to the hypothesis that gut-derived signals, originating in response to the presence of luminal contents, may contribute to a decrease in damage to the liver and gut. This review seeks to present the current knowledge regarding the modulation of what is known as the “gut–liver axis” and the gut-derived signals which play a role in PN-associated injury. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

9 pages, 194 KiB

Open AccessReview

Depression in Children and Adolescents with Autism Spectrum Disorder

by Melissa DeFilippis

Children 2018, 5(9), 112; https://doi.org/10.3390/children5090112 - 21 Aug 2018

Cited by 79 | Viewed by 17966

Abstract

Autism spectrum disorder (ASD) has a high rate of psychiatric comorbidity. The prevalence of comorbid depression seems to correlate with higher functioning forms of ASD and increasing age. Adolescence is a time when youth struggle with identity and interpersonal relationships, and a diagnosis [...] Read more.

Autism spectrum disorder (ASD) has a high rate of psychiatric comorbidity. The prevalence of comorbid depression seems to correlate with higher functioning forms of ASD and increasing age. Adolescence is a time when youth struggle with identity and interpersonal relationships, and a diagnosis of ASD further complicates this process. Adolescents with ASD may be more aware of the social communication deficits that come with the diagnosis than children with ASD, and it is theorized that higher functioning adolescents may experience this more acutely. While this may be true, the lack of reliable rating and diagnostic scales for depression in individuals with ASD makes it difficult to accurately measure rates of depression among individuals with more severe verbal deficits. While some research has focused on the prevalence of comorbid depression in children and adolescents with ASD and on the associated risk factors, there is very little evidence guiding treatment, including no empirical studies on psychopharmacology for depression in this population. Available evidence exists only in psychosocial approaches to treatment at this time and is mostly limited to adult studies. Current evidence will be presented in this review, including prevalence rates of depression in youth with ASD, various risk and protective factors, the use of diagnostic rating scales, and treatment studies. The lack of evidence supporting various treatment approaches will be highlighted, including challenges specific to the treatment of depression in ASD, which are not addressed in the current treatment studies in typically developing youth with depression. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

10 pages, 210 KiB

Open AccessReview

Pediatric Intestinal Failure Review

by Nisha Mangalat and Jeffrey Teckman

Children 2018, 5(7), 100; https://doi.org/10.3390/children5070100 - 20 Jul 2018

Cited by 25 | Viewed by 5677

Abstract

The term, ‘intestinal failure’, signifies the inability of the body to meet the digestive, absorptive and nutritive needs of the body. As such, these individuals require parenteral nutrition (PN) for survival. The subsequent nutritional, medical and surgical facets to the care are complex. [...] Read more.

The term, ‘intestinal failure’, signifies the inability of the body to meet the digestive, absorptive and nutritive needs of the body. As such, these individuals require parenteral nutrition (PN) for survival. The subsequent nutritional, medical and surgical facets to the care are complex. Improved care has resulted in decreased need for intestinal transplantation. This review will examine the unique etiologies and management strategies in pediatric patients with intestinal failure. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

17 pages, 982 KiB

Open AccessReview

Current and Emerging Therapies in the Management of Hypoxic Ischemic Encephalopathy in Neonates

by Jayasree Nair and Vasantha H.S. Kumar

Children 2018, 5(7), 99; https://doi.org/10.3390/children5070099 - 19 Jul 2018

Cited by 118 | Viewed by 21802

Abstract

Neonatal hypoxic ischemic encephalopathy (HIE) presents a significant clinical burden with its high mortality and morbidity rates globally. Therapeutic hypothermia (TH) is now standard of care for infants with moderate to severe HIE, but has not definitively changed outcomes in severe HIE. In [...] Read more.

Neonatal hypoxic ischemic encephalopathy (HIE) presents a significant clinical burden with its high mortality and morbidity rates globally. Therapeutic hypothermia (TH) is now standard of care for infants with moderate to severe HIE, but has not definitively changed outcomes in severe HIE. In this review, we discuss newer promising markers that may help the clinician identify severity of HIE. Therapies that are beneficial and agents that hold promise for neuroprotection are described, both for use either alone or as adjuncts to TH. These include endogenous pathway modifiers such as erythropoietin and analogues, melatonin, and remote ischemic post conditioning. Stem cells have therapeutic potential in this condition, as in many other neonatal conditions. Of the agents listed, only erythropoietin and analogues are currently being evaluated in large randomized controlled trials (RCTs). Exogenous therapies such as argon and xenon, allopurinol, monosialogangliosides, and magnesium sulfate continue to be investigated. The recognition of tertiary mechanisms of brain damage has opened up new research into therapies not only to attenuate brain damage but also to promote cell repair and regeneration in a developmentally disorganized brain long after the perinatal insult. These alternative modalities may be especially important in mild HIE and in areas of the world where there is limited access to expensive hypothermia equipment and services. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

10 pages, 209 KiB

Open AccessReview

The Role of Resilience in the Sibling Experience of Pediatric Palliative Care: What Is the Theory and Evidence?

by Wei Ling Chin, Tiina Jaaniste and Susan Trethewie

Children 2018, 5(7), 97; https://doi.org/10.3390/children5070097 - 16 Jul 2018

Cited by 15 | Viewed by 6573

Abstract

Siblings of children with life limiting conditions (LLC) are an important part of the broader family system and require consideration in the holistic care of the family. There can be considerable variation in the functioning and adjustment of these siblings. The current paper [...] Read more.

Siblings of children with life limiting conditions (LLC) are an important part of the broader family system and require consideration in the holistic care of the family. There can be considerable variation in the functioning and adjustment of these siblings. The current paper explores the resilience paradigm, particularly in the context of siblings of children with LLC and serious medical conditions. The potential impact of children living with a seriously ill brother or sister will be overviewed, and a range of functional outcomes considered. Factors contributing to sibling resilience are detailed, including individual, family, and broader external and social factors. Given the limited research with siblings of children with LLC, literature has also been drawn from the siblings of children with serious and/or chronic medical conditions. Implications for clinical practice and future research are considered. Pediatric palliative care services may be well placed to contribute to this body of research as they have commonly extended relationships with the families of children with LLC, which span across the child’s disease trajectory. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

16 pages, 2379 KiB

Open AccessReview

Interpretation of Cerebral Oxygenation Changes in the Preterm Infant

by Aisling A. Garvey, Elisabeth M. W. Kooi, Aisling Smith and Eugene M. Dempsey

Children 2018, 5(7), 94; https://doi.org/10.3390/children5070094 - 9 Jul 2018

Cited by 25 | Viewed by 5850

Abstract

Near-infrared spectroscopy (NIRS) allows for continuous, non-invasive monitoring of end-organ tissue oxygenation. The use of NIRS, cerebral NIRS (cNIRS) in particular, in neonatal care has increased significantly over the last few years. This dynamic monitoring technique provides real-time information on the cerebral and [...] Read more.

Near-infrared spectroscopy (NIRS) allows for continuous, non-invasive monitoring of end-organ tissue oxygenation. The use of NIRS, cerebral NIRS (cNIRS) in particular, in neonatal care has increased significantly over the last few years. This dynamic monitoring technique provides real-time information on the cerebral and haemodynamic status of the neonate and has the potential to serve as an important adjunct to patient care with some centres routinely utilising cNIRS to aid decision-making at the bedside. cNIRS values may be influenced by many variables, including cardiac, respiratory and metabolic parameters, and therefore it is essential to understand the pathophysiology behind alterations in cNIRS values. Correct interpretation is required to direct appropriate patient-specific interventions. This article aims to assist clinicians in deciphering cNIRS values by providing an overview of potential causes of fluctuations in cNIRS values, illustrated by common clinical scenarios, with particular emphasis on the preterm infant. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

19 pages, 3127 KiB

Open AccessReview

Fat Intake Reduction Strategies among Children and Adults to Eliminate Obesity and Non-Communicable Diseases in the Eastern Mediterranean Region

by Ayoub Al Jawaldeh and Hanin Al-Jawaldeh

Children 2018, 5(7), 89; https://doi.org/10.3390/children5070089 - 29 Jun 2018

Cited by 17 | Viewed by 7364

Abstract

Non-communicable diseases (NCDs) are the leading cause of mortality globally with an estimated 39.5 million deaths per year (72% of total death) in 2016, due to the four major NCDs: cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. In the Eastern Mediterranean Region [...] Read more.

Non-communicable diseases (NCDs) are the leading cause of mortality globally with an estimated 39.5 million deaths per year (72% of total death) in 2016, due to the four major NCDs: cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. In the Eastern Mediterranean Region (EMR), almost 68% of all deaths are attributed to NCDs commonly known as chronic or lifestyle-related diseases. Two-thirds of NCD premature deaths are linked to 4 shared modifiable behavioral risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. These unhealthy behaviours lead to 4 key metabolic/biological changes; raised blood pressure, overweight/obesity, high blood glucose levels/diabetes, and hyperlipidemia (high levels of fat in the blood), that increase the risk of NCDs. Globally, countries are already working towards agreed global goals on maternal and infant nutrition and on the prevention of NCDs. In both fields the goals include halting the increase in overweight and obesity and reducing NCD diet-related risk factors including reducing saturated fatty acids (SFAs) and trans fatty acids (TFAs) intake. The objective of this review is to present an up-to-date overview of the current fat (SFAs and TFAs) intake reduction initiatives in countries of the Eastern Mediterranean Region (EMR) by highlighting national and regional programs, strategies and activities aiming at decreasing the intakes of dietary fat (SFA and TFA). The literature review shows that the average intake of SFA is estimated to be 10.3% of the total energy intake (EI), exceeding the WHO (World Health Organization) upper limit of 10%. The average TFA intake is estimated at 1.9% EI, which also exceeds the WHO upper limit of 1% EI. The highest SFAs intake was reported from Djibouti, Kuwait, Saudi-Arabia, Lebanon and Yemen, while the highest TFAs intakes were reported from Egypt and Pakistan. If countries of the EMR receive immediate public health attention, that toll of NCD-related morbidity and mortality would be considerably decreased through the implantation of evidence-based preventive interventions. In this context, reductions in SFAs and TFAs intakes have been highlighted as cost-effectives strategies that may hamper the growth of the NCD epidemic. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

16 pages, 2747 KiB

Open AccessReview

Current State of Pediatric Heart Failure

by Bibhuti B. Das

Children 2018, 5(7), 88; https://doi.org/10.3390/children5070088 - 28 Jun 2018

Cited by 51 | Viewed by 15346

Abstract

Pediatric heart failure (HF) represents an important cause of morbidity and mortality in childhood. There is an overlapping relationship of HF, congenital heart disease, and cardiomyopathy. The goal of treatment of HF in children is to maintain stability, prevent progression, and provide a [...] Read more.

Pediatric heart failure (HF) represents an important cause of morbidity and mortality in childhood. There is an overlapping relationship of HF, congenital heart disease, and cardiomyopathy. The goal of treatment of HF in children is to maintain stability, prevent progression, and provide a reasonable milieu to allow somatic growth and optimal development. Current management and therapy for HF in children are extrapolated from treatment approaches in adults. There are significant barriers in applying adult data to children because of developmental factors, age variation from birth to adolescence, and differences in the genetic expression profile and β-adrenergic signaling. At the same time, there are significant challenges in performing well-designed drug trials in children with HF because of heterogeneity of diagnoses identifying a clinically relevant outcome with a high event rate, and a difficulty in achieving sufficient enrollment. A judicious balance between extrapolation from adult HF guidelines and the development of child-specific data on treatment represent a wise approach to optimize pediatric HF management. This approach is helpful as reflected by the increasing role of ventricular assist devices in the management of advanced HF in children. This review discusses the causes, epidemiology, pathophysiology, clinical manifestations, conventional medical treatment, clinical trials, and the role of device therapy in pediatric HF. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

17 pages, 22855 KiB

Open AccessReview

Respiratory Diagnostic Tools in Neuromuscular Disease

by Jackie Chiang, Kevan Mehta and Reshma Amin

Children 2018, 5(6), 78; https://doi.org/10.3390/children5060078 - 15 Jun 2018

Cited by 27 | Viewed by 6600

Abstract

Children with neuromuscular disease (NMD) are at risk of acquiring respiratory complications. Both clinical assessments and respiratory diagnostic tests are important to optimize the respiratory health and care of such children. The following respiratory diagnostic tools and their utility for evaluating children with [...] Read more.

Children with neuromuscular disease (NMD) are at risk of acquiring respiratory complications. Both clinical assessments and respiratory diagnostic tests are important to optimize the respiratory health and care of such children. The following respiratory diagnostic tools and their utility for evaluating children with NMD are discussed in this article: lung function testing (spirometry and lung volumes), peak cough flow (PCF), respiratory muscle strength testing, oximetry, capnography, and polysomnography. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

► Show Figures

Figure 1

Other

Jump to: Editorial, Research, Review

16 pages, 263 KiB

Open AccessCommentary

Resilience in Children: Developmental Perspectives

by Ann S. Masten and Andrew J. Barnes

Children 2018, 5(7), 98; https://doi.org/10.3390/children5070098 - 17 Jul 2018

Cited by 356 | Viewed by 66678

Abstract

Advances in developmental resilience science are highlighted with commentary on implications for pediatric systems that aspire to promote healthy development over the life course. Resilience science is surging along with growing concerns about the consequences of adverse childhood experiences on lifelong development. Resilience [...] Read more.

Advances in developmental resilience science are highlighted with commentary on implications for pediatric systems that aspire to promote healthy development over the life course. Resilience science is surging along with growing concerns about the consequences of adverse childhood experiences on lifelong development. Resilience is defined as the capacity of a system to adapt successfully to challenges that threaten the function, survival, or future development of the system. This definition is scalable across system levels and across disciplines, applicable to resilience in a person, a family, a health care system, a community, an economy, or other systems. Robust findings on resilience in childhood underscore the importance of exposure dose; fundamental adaptive systems embedded in the lives of individuals and their interactions with other systems; developmental timing; and the crucial role of healthcare practitioners and educators as well as family caregivers in nurturing resilience on the “front lines” of lived childhood experience. Resilience science suggests that human resilience is common, dynamic, generated through myriad interactions of multiple systems from the biological to the sociocultural, and mutable given strategic targeting and timing. Implications for pediatric practice and training are discussed. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

6 pages, 192 KiB

Open AccessBrief Report

Interval Outcomes of a Lifestyle Weight-Loss Intervention in Early Adolescence

by Christina Wei, Toby Candler, Elizabeth Crowne and Julian P. Hamilton-Shield

Children 2018, 5(6), 77; https://doi.org/10.3390/children5060077 - 15 Jun 2018

Cited by 4 | Viewed by 3454

Abstract

We undertook a feasibility study to reassess metabolic outcomes in young people with early onset obesity who attended a hospital-based lifestyle weight-loss intervention during adolescence. Comparisons of metabolic assessments, including body mass index standard deviation scores (BMI–SDSs), blood pressure (BP), oral glucose tolerance [...] Read more.

We undertook a feasibility study to reassess metabolic outcomes in young people with early onset obesity who attended a hospital-based lifestyle weight-loss intervention during adolescence. Comparisons of metabolic assessments, including body mass index standard deviation scores (BMI–SDSs), blood pressure (BP), oral glucose tolerance tests (OGTTs), lipid profile, and alanine transaminase (ALT), before and after treatment were made. Twenty-five subjects (10 males) with median ages (interquartile range, IQR) of 14.5 (12.6–15.4) years at the beginning of intervention and 18.2 (17.2–18.9) years at reassessment and who were 3.5 (2.4–6.5) years post-intervention were recruited. Twenty-eight percent had a ≥0.25 reduction in BMI–SDS from baseline (responders). Responders demonstrated significantly lower BMI–SDS, systolic BP, and glucose disposal at reassessment compared with baseline. They also showed significantly lower total fat percentage SDSs, trunk fat percentages, 120 min insulin, and ALT, as well as higher insulin sensitivity index (ISI_comp) than non-responders. Male gender and younger age at the initiation of intervention showed a non-significant trend towards greater success in weight loss. Long-term benefits were demonstrated in around one-quarter of obese adolescents after lifestyle modification treatment, with associated improvements in body composition and metabolic parameters. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

4 pages, 170 KiB

Open AccessCommentary

Specialized Care without the Subspecialist: A Value Opportunity for Secondary Care

by Eyal Cohen, C. Jason Wang and Barry Zuckerman

Children 2018, 5(6), 69; https://doi.org/10.3390/children5060069 - 4 Jun 2018

Cited by 4 | Viewed by 3682

Abstract

An underutilized value strategy that may reduce unnecessary subspecialty involvement in pediatric healthcare targets the high-quality care of children with common chronic conditions such as obesity, asthma, or attention deficit hyperactivity disorder within primary care settings. In this commentary, we propose that “secondary [...] Read more.

An underutilized value strategy that may reduce unnecessary subspecialty involvement in pediatric healthcare targets the high-quality care of children with common chronic conditions such as obesity, asthma, or attention deficit hyperactivity disorder within primary care settings. In this commentary, we propose that “secondary care”, defined as specialized visits delivered by primary care providers, a general pediatrician, or other primary care providers, can obtain the knowledge, skill and, over time, the experience to manage one or more of these common chronic conditions by creating clinical time and space to provide condition-focused care. This care model promotes familiarity, comfort, proximity to home, and leverages the provider’s expertise and connections with community-based resources. Evidence is provided to prove that, with multi-disciplinary and subspecialist support, this model of care can improve the quality, decrease the costs, and improve the provider’s satisfaction with care. Full article

(This article belongs to the Special Issue 5th Anniversary Issue)

Journal Menu

Journal Browser

5th Anniversary Issue

Share This Special Issue

Special Issue Editor

Special Issue Information

Benefits of Publishing in a Special Issue

Published Papers (29 papers)

Editorial

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI