ORCID Profile
0000-0002-5824-9402
Current Organisation
Kids Research
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Publisher: Wiley
Date: 04-06-2015
DOI: 10.1111/JPC.12933
Abstract: The aims were to identify in-home concerns about sleep in children and young people with cerebral palsy (CP) across age and Gross Motor Function Classification Scale (GMFCS) levels. This was a retrospective review of clinical notes of 154 children and young people with CP, aged 1-18 years (M = 7.8 standard deviation = 5.4) who received a home-based sleep service. Reported concerns were synthesised, for analysis according to age groups (1-5, 6-13, 14-18) and GMFCS levels. Sixteen factors of concern were derived from the home-based assessment reports. Most children and young people had multiple factors of concern. These varied across age groups and GMFCS levels. Body position was of concern across all age groups, for over 90% at GMFCS levels IV and V, and for 10% at GMFCS level I. Settling routines were of concern for more than 90% at GMFCS levels I and II, but for less than 50% at GMFCS levels IV and V. Settling routines were of concern to over 65% of those under 6 years but less than 25% of those over 14 years. Conversely, pain and pressure care concerned less than 10% of children under 6, and more than 35% of those over 14 years. Concerns about sleep vary across ages and GMFCS levels of children and young people with CP. Concerns relate to impairment of body structure and function, activity, environment, and personal supports. Multi-disciplinary, home-based assessment and interventions are recommended to address these concerns.
Publisher: SAGE Publications
Date: 2006
DOI: 10.1191/1479972306CD100OA
Abstract: Adherence to recommended aerosol medicines and airway clearance techniques (ACT) for children with cystic fibrosis (CF) requires self-management skills. A multi-centre, randomized, controlled trial was conducted to investigate the effectiveness of a self-management education programme called ‘Airways’ for six-to 11-year old children with CF and their caregivers. Assessments were conducted immediately before and after the intervention period, and six and 12 months after the post-intervention assessment. The pen and paper education programme was completed by the child and caregiver together at home. Participants in the intervention and control groups had similar baseline characteristics. A per-protocol analysis was conducted and for variables that changed significantly, an additional intention-to-treat analysis was performed that included data from participants in the intervention group who withdrew from the study during the intervention period. The intervention group increased the percentage of prescribed aerosols taken (P 0.001) and this was maintained at 12-month follow-up (P 0.001). There was no change in the percentage of prescribed ACT performed, although when the child was unwell, caregivers in the intervention group increased the frequency and/or duration of ACT (P = 0.028) in the perprotocol analysis but not in the intention-to-treat analysis. Children in the intervention group increased their knowledge of ACT (P 0.001) which was maintained at 12-month follow-up (P 0.001) and felt more positively about their chest treatment regimens immediately following the intervention (P = 0.017) but not at 12-month follow-up. There were no significant changes in the control group for these variables over time. No significant changes occurred in the caregivers' reports of self-management behaviours and self-efficacy in either group. The positive results suggest that ‘Airways’ is a valuable educational tool for primary school-aged children with CF and their caregiver.
Publisher: Elsevier BV
Date: 09-2020
DOI: 10.1016/J.JAAC.2020.01.006
Abstract: The behavioral phenotype of neurogenetic disorders associated with intellectual disability often includes psychiatric comorbidity. The objectives of this systematic review and meta-analysis were to systematically review the prevalence of psychiatric disorders and symptoms in children and adolescents with these disorders and compare phenotypic signatures between syndromes. MEDLINE and PsycINFO databases were searched for articles from study inception to December 2018. Eligible articles were peer reviewed, were published in English, and reported prevalence data for psychiatric disorders and symptoms in children and adolescents aged 4 to 21 years using a formal psychiatric assessment or a standardized assessment of mental health symptoms. Pooled prevalence was determined using a random-effects meta-analysis in studies with sufficient data. Prevalence estimates were compared with general population data using a test of binomial proportions. Of 2,301 studies identified for review, 39 articles were included in the final pool, which provided data on 4,039 children and adolescents. Ten syndromes were represented, and five were predominant: Down syndrome, 22q11.2 deletion syndrome, fragile X syndrome, Williams syndrome, and Prader-Willi syndrome. The Child Behavior Checklist was the most commonly used assessment tool for psychiatric symptoms. The pooled prevalence with total scores above the clinical threshold was lowest for Down syndrome (32% [95% confidence interval, 19%-44%]) and highest for Prader-Willi syndrome (74% [95% CI, 65%-82%]) with each syndrome associated with significantly higher prevalence than in the general population. Parallel trends were observed for the internalizing and externalizing domains and social subscale scores. Differential vulnerability for psychiatric phenotype expression across the disorders was observed. Syndromes with higher levels of social ability or competence appear to offer relative protection against developing psychopathology. This preliminary finding merits further exploration.
Publisher: Wiley
Date: 12-09-2020
Publisher: SAGE Publications
Date: 10-2005
DOI: 10.1191/0269216305PM1067OA
Abstract: Objectives: To develop a method for estimating the population who could potentially benefit from receiving palliative care in the last year of their lives, and then apply the estimates to the Western Australian population to ascertain characteristics of these people. Methods: Three estimates of the potential palliative care population, Minimal, Mid-range and Maximal, were developed through focus groups, interviews and the literature. These estimates were applied to the cohort of people who died in Western Australia between 1 July 2000 and 31 December 2002 by linking death records with hospital morbidity data through the Western Australian Data Linkage System. Results: Between 0.28% and 0.50% of people in the Western Australian population in any one year could potentially benefit from palliative care, many of whom die from conditions other than neoplasms. While neoplasms accounted for 59.5% of all underlying causes of deaths in the Minimal Estimate, heart failure (21.0%), renal failure (9.8%), chronic obstructive pulmonary disease (9.6%), Alzheimer’s disease (4.0%), liver failure (3.2%), Parkinson’s disease (1.3%), motor neurone disease (0.9%), HIV/AIDS (B-0.01%) and Huntington’s disease (B-0.01%) accounted for other conditions in this estimate. The study was expanded to include Mid-range and Maximal Estimates. Characteristics of the Western Australian population in these three estimates are described. Conclusions: Unlike traditional palliative care estimates that focus on malignant disease, this study included nonmalignant conditions in a set of three estimates of a potential palliative care population. By using population-based data to describe characteristics of people who compose palliative care populations, these results offer a tool for planning equitable healthcare services.
Publisher: MDPI AG
Date: 25-11-2022
DOI: 10.3390/JCM11236968
Abstract: (1) Background: Respiratory disease is a leading cause of morbidity, mortality, and poor quality of life in children with cerebral palsy (CP). This study describes the prevalence of CP-related respiratory disease and the non-modifiable risk factors for respiratory-related hospital admissions in the Aotearoa New Zealand population. (2) Methods: New Zealand Cerebral Palsy Register (NZCPR) participant data and de-identified data from the National Minimum Dataset and Pharmaceutical Dispensing Collections were linked to identify all respiratory-related hospital admissions and respiratory illness-related antibiotic exposure over 5 years in in iduals with CP (0–26 years). (3) Results: Risk factors for respiratory-related hospital admissions included being classified Gross Motor Function Classification System (GMFCS) IV or V compared to GMFCS I [OR = 4.37 (2.90–6.58), p 0.0001 OR = 11.8 (7.69–18.10), p 0.0001, respectively,] having ≥2 antibiotics dispensed per year [OR = 4.42 (3.01–6.48), p 0.0001] and being of Māori ethnicity [OR = 1.47 (1.13–1.93), p 0.0047]. Māori experienced health inequities compared to non-Māori, with greater functional disability, and also experienced greater antibiotic dispensing than the general population. (4) Conclusion: Māori children and young adults have a higher risk of respiratory-related illness. Priority should be given to the screening for potentially modifiable risk factors for all children with CP from diagnosis onwards in a way that ensures Māori health equity.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2022
Publisher: Elsevier BV
Date: 02-2023
DOI: 10.1016/J.HLC.2022.10.006
Abstract: To evaluate the long-term incidence of structural valve deterioration (SVD) in patients who underwent transcatheter aortic valve implantation (TAVI). Between 2008 and 2018, 693 underwent TAVI at two centres. Four hundred and twenty-one (421) patients (mean age 83.6±6.0 yrs) survived for ≥2 years post TAVI and had at least two consecutive transthoracic echocardiographies (TTEs) with the latest TTE no less than 2 years after TAVI, and were therefore included in the analysis for SVD. Median follow-up was 4.7 (3.6-6.0) years and median echocardiography follow-up 3 (3.0-4.0) years. All-cause mortality was 30.9% (130) with a median time to death of 4.1 (3.0-5.6) years. The cumulative incidence of SVD increased from 1.7% (95% CI, 0.4-2.9) at 3 years to 3.5% (95% CI, 1.5-5.8) at 5 years and 4.7% (95% CI, 1.6-7.9) at 10 years. The overall median time to SVD was 3 (2-4) years. Twelve (12) patients demonstrated SVD stage 2, and 1 patient stage 3. No SVD required re-intervention. All other patients showed no significant changes in valve parameters over time. Structural valve deterioration is an uncommon event, occurring in 5% over a total follow-up of 10 years. Most patients show stable valve parameters. However, the analysis is limited by the loss of follow-up (owing to patient mortality), which renders extrapolation of the data to a younger patient population difficult.
Publisher: Informa UK Limited
Date: 03-2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-09-2021
DOI: 10.1097/CCM.0000000000005310
Abstract: Current definitions of acute kidney injury use a urine output threshold of less than 0.5 mL/kg/hr, which have not been validated in the modern era. We aimed to determine the prognostic importance of urine output within the first 24 hours of admission to the ICU and to evaluate for variance between different admission diagnoses. Retrospective cohort study. One-hundred eighty-three ICUs throughout Australia and New Zealand from 2006 to 2016. Patients greater than or equal to 16 years old who were admitted with curative intent who did not regularly receive dialysis. ICU readmissions during the same hospital admission and patients transferred from an external ICU were excluded. One hundred and sixty-one thousand nine hundred forty patients were included with a mean urine output of 1.05 mL/kg/hr and an overall in-hospital mortality of 7.8%. A urine output less than 0.47 mL/kg/hr was associated with increased unadjusted in-hospital mortality, which varied with admission diagnosis. A machine learning model (extreme gradient boosting) was trained to predict in-hospital mortality and examine interactions between urine output and survival. Low urine output was most strongly associated with mortality in postoperative cardiovascular patients, nonoperative gastrointestinal admissions, nonoperative renal/genitourinary admissions, and patients with sepsis. Consistent with current definitions of acute kidney injury, a urine output threshold of less than 0.5 mL/kg/hr is modestly predictive of mortality in patients admitted to the ICU. The relative importance of urine output for predicting survival varies with admission diagnosis.
Publisher: Informa UK Limited
Date: 21-08-2018
DOI: 10.1080/09638288.2017.1367426
Abstract: The purpose of this study is to evaluate effects of a running intervention on running ability and participation in children with cerebral palsy. Children with cerebral palsy (9-18 years) with Gross Motor Function Classification System levels I-III were randomly assigned to a 12-week running intervention or usual care. Primary outcomes included improvement in running ability (assessed by Goal Attainment Scaling, high level mobility (assessed by the High-Level Mobility Assessment Tool) and participation (assessed by the Participation and Environment Measure for Children and Youth). Secondary outcomes were aerobic and anaerobic fitness and agility. Blinded assessments took place at baseline and 12 weeks. Regression analysis adjusting for baseline differences was used to determine between group differences. Forty-two participants (mean age 12.5 years, SD 2.8 years 15 female) completed the study. Statistically significant group differences at 12-weeks were found for improvements in running ability (86% treatment group versus 0% control group achieved or exceeded their running goals, p < 0.001), and participation in the school environment (Participation and Environment Measure mean difference 1.18: 95%CI 1.00-1.39, p = 0.045). A 12-week in idualized running training skills intervention results in achievement of running ability goals and participation in the school environment in children with cerebral palsy. Implications for Rehabilitation Children with cerebral palsy who can walk unaided demonstrate impairments in higher level mobility such as running. Running is a motor skill that can be trained in children with cerebral palsy. In idually tailored running skills intervention, delivered in a group context can improve goal-identified running ability and translate into a higher frequency of participation in school activities.
Publisher: Wiley
Date: 07-1998
DOI: 10.1046/J.1365-2648.1998.00776.X
Abstract: By using questioning and other appropriate teaching strategies, clinical teachers can facilitate the development of critical thinking, decision making and problem solving in students. This study examined clinical teachers' use of questioning and the variations in their use of questioning as a teaching strategy. Although there was a variation in the number of questions asked, predominantly low level questions were asked by 26 clinical teachers at two post-clinical conferences. Based on the findings of this study, it is recommended that clinical teachers are taught how to ask questions, particularly high level questions.
Publisher: Wiley
Date: 10-2007
DOI: 10.1111/J.1469-8749.2007.00781.X
Abstract: This systematic review examines the effects of casting, either alone or in combination with botulinum toxin type A (BTX-A), on equinus in children with cerebral palsy (CP). Comparisons are made between casting alone and no treatment, between casting alone and BTX-A alone, between combined casting and BTX-A and each treatment by itself, and between casting followed by BTX-A and BTX-A followed by casting. A search of PUBMED, CINAHL, Proquest Health and Medical Complete, Cochrane Database of Systematic reviews, Physiotherapy Evidence Database (PEDro), OTseeker, Database of Reviews of Effectiveness (DARE), and Infotrieve yielded 184 citations. Articles were included in the review if they reported the effects of an intervention using casting for equinus in particpants with CP aged 20 or less, if they appeared in a peer-reviewed scholarly journal in 1970 or later, with no language restriction, and if casting was not used in conjunction with surgery. Twenty-two articles were selected, including seven randomized controlled trials (RCTs). There is little evidence that casting is superior to no casting, but the protocols of casting in current use have not been compared with no treatment in any RCT. There is no strong and consistent evidence that combining casting and BTX-A is superior to using either intervention alone, or that either casting or BTX-A is superior to the other immediately after treatment. Finally, there is no evidence that order of treatment (casting before BTX-A versus BTX-A before casting) affects outcome. Much of the evidence both for and against differences is weak, and results may be explained by methodological limitations. Future research needs to use adequate s le sizes, long-term follow-ups, and broader and more global measures.
Publisher: Wiley
Date: 29-01-2022
DOI: 10.1002/AJMG.A.62671
Abstract: Prader‐Willi Syndrome (PWS) is a rare genetic disorder associated with emotional/behavioral disturbances. These difficulties are well documented in the literature, but the positive attributes of these in iduals are not described. Taking a strengths‐based approach, the aim of this study was to describe the emotional/behavioral strengths and difficulties in children and young people with PWS from their parent caregivers' perspectives. Parent caregivers of 52 in iduals with PWS aged 4–24 years (median = 12.1 years including 22 males) completed the parent form of the Developmental Behavior Checklist (DBC‐P), including its original two open‐ended questions regarding positive traits. Prevalences of emotional/behavioral disturbances were comparable to those reported in previous literature: common behaviors of concern across studies being skin‐picking (75%), impulsivity (69%), poor sense of danger (67%), lying (67%), and tantrums (54%). Total DBC‐P scores showed that just over half ( n = 28, 54%) had scores indicative of clinically significant behavior problems. However, thematic analysis of caregivers' written comments regarding their children's strengths resolved into three themes: warmth (94%), persistence (41%), and skills (41%). Warmth encompassed friendliness, happiness, and empathy. A strength‐based approach to behavioral difficulties in PWS provides a more balanced view of the children and a more holistic foundation for interventions.
Publisher: Wiley
Date: 09-08-2020
DOI: 10.1111/DMCN.14640
Publisher: BMJ
Date: 19-03-2018
DOI: 10.1136/ARCHDISCHILD-2017-314346
Abstract: To determine the early predictors of respiratory hospital admissions in young people with cerebral palsy (CP). A 3-year prospective cohort study using linked data. Children and young people with CP, aged 1 to 26 years. Self-reported and carer-reported respiratory symptoms were linked to respiratory hospital admissions (as defined by the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes) during the following 3 years. 482 participants (including 289 males) were recruited. They were aged 1 to 26 years (mean 10 years, 10 months SD 5 years, 11 months) at the commencement of the study, and represented all Gross Motor Function Classification Scale (GMFCS) levels. During the 3-year period, 55 (11.4%) participants had a total of 186 respiratory hospital admissions, and spent a total of 1475 days in hospital. Statistically significant risk factors for subsequent respiratory hospital admissions over 3 years in univariate analyses were GMFCS level V, at least one respiratory hospital admission in the year preceding the survey, oropharyngeal dysphagia, seizures, frequent respiratory symptoms, gastro-oesophageal reflux disease, at least two courses of antibiotics in the year preceding the survey, mealtime respiratory symptoms and nightly snoring. Most risk factors for respiratory hospital admissions are potentially modifiable. Early identification of oropharyngeal dysphagia and the management of seizures may help prevent serious respiratory illness. One respiratory hospital admission should trigger further evaluation and management to prevent subsequent respiratory illness.
Publisher: Wiley
Date: 30-07-2019
DOI: 10.1111/CCH.12703
Abstract: Respiratory disease is a leading cause of hospitalizations and deaths in young people with cerebral palsy (CP). It is insidious and multifactorial. Clinical management can be complex. This systematic review describes effects of interventions for the prevention and management of respiratory disease in young people with CP. Nine databases (Cochrane, CINAHL, Embase, EMCare, MEDLINE, PEDro, OpenGrey, ScienceDirect, and SpeechBITE) were searched. Eligibility criteria were as follows: the population included at least 50% in iduals with CP aged under 26 years, the intervention was for chronic respiratory illness, the outcomes were any measurable indicators of respiratory health or morbidity the study design could be any original study reporting effects of an intervention on measurable outcomes, and the study was published January 1998 or later. The American Academy for Cerebral Palsy and Developmental Medicine methodology guided study appraisal and synthesis. The review was registered with PROSPERO (reference number CRD42018086314). The search yielded 3,347 papers 37 papers (reporting 34 studies) of these met the eligibility criteria. They included 582 participants with CP (ranging from 1 to 77 across studies) with ages from 5 months to 25 years. Interventions were erse and included: airway clearance techniques, exercise, positioning, mealtime management, salivary management, upper airway interventions, antibiotics, gastro-intestinal interventions, and spinal surgery. There were no interventions aimed at prevention of respiratory disease in this population. Research designs were classified as Levels 2 (n = 3), 3 (n = 2), 4 (n = 25), and 5 (n = 4). Evidence for most respiratory interventions for young people with CP is absent or weak. No controlled trials demonstrated significant effects on respiratory morbidity, owing to their scarcity, weak designs, and inadequate power. There is an urgent need for well-designed prospective controlled studies investigating prevention and management of respiratory disease in young people with CP.
Publisher: SAGE Publications Ltd
Date: 2020
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.JPEDS.2015.09.064
Abstract: To describe associations between respiratory illness and its potential predictors in children and young adults with cerebral palsy (CP). Cross-sectional survey of self- and caregiver-reported respiratory symptoms for in iduals aged up to 26 years with CP. Respiratory illness was indicated by 2 outcomes: (1) ≥1 respiratory hospitalizations in the past year and (2) ≥2 courses of antibiotics for respiratory symptoms in the past year. ORs were calculated using univariate and multivariate logistic regression. There were 551 participants, aged 1-26 years, distributed across all gross motor function classification scale (GMFCS) levels. In univariate analyses, factors significantly associated with respiratory hospitalizations were weekly respiratory symptoms (OR 2.31, 95% CI 1.78-3.00), respiratory symptoms during meals (OR 3.23, 95% CI 1.50-5.80), gastroesophageal reflux (OR 3.01, 95% CI 1.71-5.31), coughing or choking on saliva (OR 4.36, 95% CI 2.38-8.01), current asthma (OR 3.56, 95% CI 1.97-6.42), age (0-3 years) (OR 3.24, 95% CI 1.19-8.80, compared with 13-17 years), seizures (OR 3.45, 95% CI 1.96-6.08), and scoliosis (OR 2.14, 95% CI 1.16-3.97). Nonambulatory in iduals (GMFCS IV-V) were at significantly increased risk of hospitalizations only if they had food modifications and/or nasogastric or gastrostomy tube feeds (OR 5.36, 95% CI 2.89-9.96, compared with GMFCS I-III with no food modifications and no tube). All factors, except seizures and scoliosis, were significantly associated with multiple courses of antibiotics in univariate analyses. Oromotor dysfunction is strongly associated with respiratory illness in patients with CP.
Publisher: SAGE Publications
Date: 30-05-2020
Abstract: Children and adolescents with intellectual disability are at risk of developing psychiatric symptoms and disorders yet, the estimates reported in the literature have been inconsistent, presenting a potential barrier for service planning and delivery. Sources of variability could arise from differences in measurement instruments as well as subgroup membership by severity of intellectual disability, gender and age. This systematic review aimed to address these gaps. MEDLINE and PsycINFO databases were searched from inception to 2018 and selected studies were reviewed. Studies were included if they reported point prevalence estimates of mental health symptomology or diagnoses in a general population of 6- to 21-year-old in iduals with intellectual disability. The Joanna Briggs Institute Prevalence Critical Appraisal Checklist was applied to eligible papers to appraise their scientific strength. Pooled prevalence for mental health symptomology was determined using a random-effects meta-analysis. A total of 19 studies were included, including 6151 children and adolescents. The pooled prevalence estimate captured by the Developmental Behaviour Checklist was 38% (95% confidence interval = [31, 46]), contrasting with 49% (95% confidence interval = [46, 51]) captured by the Child Behaviour Checklist both rates were higher than a non-intellectual disability population. Severity of intellectual disability did not significantly influence the Developmental Behaviour Checklist risks. Insufficient data were available to conduct statistical analyses on the effects of age, gender and socioeconomic status. Of diagnosed psychiatric disorders, attention deficit/hyperactivity disorder (30%), conduct disorder (3–21%) and anxiety disorders (7–34%) were the most prevalent conditions. This review consists of the largest s le hitherto evaluated. In the intellectual disability population, mental health comorbidities could be better detected by a symptom phenotype than a psychiatric diagnostic phenotype. Crucially, future research needs to address the effect of measurement validity in the intellectual disability population. Estimated prevalence rates were high compared to the general population, indicating the importance of systematic screening, case detection and appropriate management.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2019
DOI: 10.1097/PEP.0000000000000584
Abstract: To assess effects of adaptive bungee tr oline training for children with cerebral palsy. This was a single-subject intervention study, A-B-A, with 4 children aged 6 to 11 years. Measurements included muscle strength, balance, functional muscle strength, functional mobility, selected Gross Motor Function Measure items, heart rate, enjoyment, and for adverse effects—range of motion and spasticity. Goals were measured using the Canadian Occupational Performance Measure. Lower limb muscle strength improved in 3 children, and balance and functional strength in 2 children. The child who was not walking increased sitting and supported standing times. All participants had clinically significant increases on the Canadian Occupational Performance Measure. Adherence and enjoyment were high, with no adverse effects. Adaptive bungee tr oline training can improve strength, balance, and functional mobility in children with cerebral palsy.
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.MATH.2006.06.016
Abstract: This single-blind comparative group design aimed to investigate the sensitivity and specificity of the cervical flexion-rotation test in the diagnosis of C1/2-related cervicogenic headache. This study tested 23 cervicogenic headache, 23 asymptomatic controls and 12 migraine with aura subjects, all aged 18-66 years. In stage 1, an experienced manipulative physiotherapist who did not partake in the flexion-rotation test procedure identified C1/2 dysfunction using passive segmental mobility tests in the cervicogenic headache group. Those with C1/2 dysfunction participated in stage 2. In stage 2, using the flexion-rotation test, subjects were tested by two experienced manipulative physiotherapists blinded to the subjects' group allocation. Each therapist stated whether the test was positive or not based on the therapist's interpretation of range of motion. The sensitivity and specificity of the flexion-rotation test was 91% and 90%, respectively (P<.001), with an overall diagnostic accuracy of 91% (P<.001). The cervical flexion-rotation test significantly assists in the differential diagnosis of cervicogenic headache and in the identification of movement impairment at the C1/2 segment in patients with cervicogenic headache.
Publisher: Wiley
Date: 15-09-2017
DOI: 10.1111/DMCN.13555
Abstract: Mental health conditions and problems are often reported in children and adolescents with cerebral palsy (CP). A systematic review was undertaken to describe their prevalence. MEDLINE and PsycINFO databases from 1996 to 2016 were searched and reference lists of selected studies were reviewed. Studies were included if they reported point prevalence of mental health diagnoses or symptoms in a general population of children and/or adolescents with CP. Pooled prevalence for mental health symptoms was determined using a random effects meta-analysis. Of the 3158 studies identified, eight met the inclusion criteria. Mental health disorders were diagnosed by psychiatric interview in one study, giving a prevalence of 57% (32 out of 56 children). The remaining seven studies (n=1715 children) used parent-report mental health screening tools. The pooled prevalence for mental health symptoms using the Strengths and Difficulties Questionnaire (n=5 studies) was 35% (95% confidence interval [CI] 20-61) and using the Child Behavior Checklist (n=2 studies) was 28% (95% CI 22-36). Evidence was characterized by a moderate level of bias. More studies are needed to ascertain the prevalence of mental health disorders. Mental health symptoms are common and mental health evaluations should be incorporated into multidisciplinary assessments for these children. Children with cerebral palsy and intellectual disability have a higher risk of mental health symptoms. The prevalence of mental health symptoms for age and severity groups is unclear.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Wiley
Date: 29-08-2014
Abstract: The purpose of this study was to evaluate the reliability of the Neurological Hand Deformity Classification and use it to describe changes in hand deformity over time in children with cerebral palsy. We identified 114 video clips of 26 children with cerebral palsy, aged 1-18 years (mean = 8.4, SD = 4.2), performing upper-limb tasks at multiple time points (n = 3-8) at least 6 months apart. Using the Neurological Hand Deformity Classification, three observers classified hand deformity in the video clips. Inter- and intra-observer reliabilities were estimated using Fleiss and Cohen's kappa (κ) and the temporal changes in classification of hand deformity were investigated. Inter- and intra-observer reliability respectively were κ = 0.87 and κ = 0.91. Hand deformity was identified in all children at all time points, even before the age of 2 years. Ten children did not change hand classification, wrist flexion increased in eight, and eight showed changes from wrist flexion to extension or vice versa. The Neurological Hand Deformity Classification is a reliable tool to classify hand deformity in children with cerebral palsy. For more than one-third of children hand deformity classification did not change. For the remaining children, two patterns of change in hand deformity over time were identified. It is recommended that children with cerebral palsy involving their upper limbs be monitored regularly. This is the first study to document longitudinal changes in hand deformity in children with cerebral palsy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-10-2021
Abstract: Although a rapid rise in left atrial pressure during exertion is considered pathognomonic of heart failure with preserved ejection fraction (HFpEF), the fundamental circulatory determinants of this response are not clear, impacting upon the development of more effective therapies. We aimed to comprehensively describe the circulatory mechanics of patients with HFpEF at rest and during exercise in comparison with controls. We performed simultaneous right‐heart catheterization and echocardiography at rest and during exercise in 22 healthy control volunteers and 60 patients with confirmed HFpEF. Using detailed in idual patient‐level hemodynamic and left ventricular ejection fraction data we performed computer simulations to evaluate the circulatory parameters including the estimated stressed blood volumethat contribute to the resting and exercise pulmonary capillary pressure. At rest and during exercise, left ventricular stiffness (V 30 , the end‐diastolic pressure–volume relationship at a filling pressure of 30 mm Hg), left ventricular elastance, and arterial elastance were all significantly greater in HFpEF than in controls. Stressed blood volume was significantly greater in HFpEF (26.9±5.4 versus 20.2±4.7 mL/kg, P .001), becoming even more pronounced during exercise (40.9±3.7 versus 27.5±7.0 mL per 70 kg, P .001). During exercise, the magnitude of the change in stressed blood volume ( r =0.67, P .001) and left ventricular stiffness ( r =−0.44, P .001) were key determinants of the rise in pulmonary capillary wedge pressure. Further detailed modeling studies showed that the hemodynamic response to exercise results from a complex non‐linear interaction between circulatory parameters. The circulatory determinants of HFpEF physiology are complex. We identified stressed blood volume at rest and during exercise is a novel, key factor, therebyrepresenting an important potential therapeutic target.
Publisher: Springer Science and Business Media LLC
Date: 26-02-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 21-02-2023
Abstract: In patients with aortic stenosis (AS), the presence of mitral regurgitation (MR) can lead to underestimation of AS severity and worse clinical outcomes. The objective of this study was to characterize the magnitude of the effects of concomitant MR on hemodynamic indicators of AS severity using clinical data and a computational cardiovascular simulation. Echocardiographic data from 1427 patients with severe AS were used to inform a computational cardiovascular system model, and varying degrees of MR and AS were simulated. Hemodynamic data, including left ventricular and aortic pressure waveforms, were generated for all simulations. Simulated reduction in mean transaortic pressure gradient (MPG) associated with MR was then used to calculate the adjusted MPG in the clinical cohort. MR was present in 861 (60%) patients. Compared with patients without MR, patients with MR had a lower aortic‐valve area (0.83±0.2 cm 2 versus 0.75±0.2 P .001) and were more likely to have a low‐gradient pattern (MPG mm Hg) (45% versus 54% P .001). Simulations showed that the presence of concomitant mild, moderate, and severe MR with AS was accompanied by a mean reduction in MPG of 10%, 29%, and 40%, respectively. For patients with MR, their calculated adjusted MPG was on average 24% higher than their MPG (52±22 versus 42±16 mm Hg). Of the 467 patients with low‐gradient AS and MR, 240 (51%) would reclassify as high gradient based on their adjusted MPG. Concomitant MR results in lower MPG and reduced forward flow compared with isolated AS. Careful quantitation of MR should be factored into the assessment of AS severity to mitigate for potential underestimation.
Publisher: Wiley
Date: 09-1996
DOI: 10.1046/J.1365-2648.1996.02102.X
Abstract: This study was designed to determine whether a change from a task-oriented care approach to a client-oriented care approach affects (a) the level of agitation and (b) 24-hour sleep in residents suffering from dementia in a nursing home. The levels of dementia and sleep of 33 nursing home residents were measured four times over 12 weeks (twice before and twice after the change in care approach) using the Cohen-Mansfield agitation inventory and the dementia mood assessment scale. Verbal agitation levels significantly decreased 6 to 8 weeks following the change, whereas more infrequent agitated behaviours, which were classified as 'other', significantly increased. Daytime sleep increased initially after the change but then returned to baseline levels after 6 weeks. While the main focus of the study was on residents' behaviour following an environmental manipulation, anecdotal observations of staff members interactions with residents indicated that they felt less rushed and were more tolerant of residents' behaviour following the intervention.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2014
Publisher: Informa UK Limited
Date: 2006
Publisher: Mark Allen Group
Date: 03-2005
DOI: 10.12968/IJTR.2005.12.3.19553
Abstract: The aim of this research was to develop and trial a questionnaire to assess sources of stress in undergraduate students. The questionnaire was developed on the basis of research literature on sources of stress in students and was administered to 65 recent graduates and 320 undergraduates in physiotherapy and podiatry. The questionnaire was revised after each administration. On the basis of a factor analysis, three subscales emerged. The internal consistency of these subscales was moderate to good. The final Undergraduate Sources of Stress Questionnaire, which is reproduced in this article, consists of 18 items in three subscales – academic demands, financial issues and personal issues – and is suitable for undergraduates in various disciplines.
Publisher: Wiley
Date: 22-11-2021
DOI: 10.1111/APA.15658
Publisher: Informa UK Limited
Date: 26-01-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-06-2023
Abstract: Transesophageal echocardiography–guided direct cardioversion is recommended in patients who are inadequately anticoagulated due to perceived risk of left atrial appendage thrombus (LAAT) however, LAAT risk factors remain poorly defined. We evaluated clinical and transthoracic echocardiographic parameters to predict LAAT risk in consecutive patients with atrial fibrillation (AF)/atrial flutter undergoing transesophageal echocardiography before cardioversion between 2002 and 2022. Regression analysis identified predictors of LAAT, combined to create the novel CLOTS‐AF risk score (comprising clinical and echocardiographic LAAT predictors), which was developed in the derivation cohort (70%) and validated in the remaining 30%. A total of 1001 patients (mean age, 62±13 years 25% women left ventricular ejection fraction, 49.8±14%) underwent transesophageal echocardiography, with LAAT identified in 140 of 1001 patients (14%) and dense spontaneous echo contrast precluding cardioversion in a further 75 patients (7.5%). AF duration, AF rhythm, creatinine, stroke, diabetes, and echocardiographic parameters were univariate LAAT predictors age, female sex, body mass index, anticoagulant type, and duration were not (all P .05). CHADS 2 VASc, though significant on univariate analysis ( P .001), was not significant after adjustment ( P =0.12). The novel CLOTS‐AF risk model comprised significant multivariable predictors categorized and weighted according to clinically relevant thresholds (Creatinine .5 mg/dL, Left ventricular ejection fraction %, Overload (left atrial volume index mL/m 2 ), Tricuspid Annular Plane Systolic Excursion (TAPSE) mm, Stroke, and AF rhythm). The unweighted risk model had excellent predictive performance with an area under the curve of 0.820 (95% CI, 0.752–0.887). The weighted CLOTS‐AF risk score maintained good predictive performance (AUC, 0.780) with an accuracy of 72%. The incidence of LAAT or dense spontaneous echo contrast precluding cardioversion in patients with AF who are inadequately anticoagulated is 21%. Clinical and noninvasive echocardiographic parameters may identify patients at increased risk of LAAT better managed with a suitable period of anticoagulation before undertaking cardioversion.
Publisher: BMJ
Date: 29-06-2020
Publisher: Elsevier BV
Date: 2001
DOI: 10.1016/S0004-9514(14)60294-4
Abstract: This randomised controlled clinical trial investigated whether physiotherapy during the period of mechanical ventilation following cardiac surgery influenced subject outcomes. Two hundred and thirty-six subjects admitted to the intensive care unit (ICU) following elective or semi-urgent cardiac surgery were randomised to either a treatment group, which received physiotherapy during the intubated phase, or a control group where physiotherapy was commenced only once the subject was extubated. No significant differences between the two groups were detected for length of intubation period, length of ICU stay, length of hospital stay, maximal daily incentive spirometry values or the incidence of post-operative pulmonary complications. For in iduals following routine uncomplicated cardiac surgery, the provision of physiotherapy interventions during the post-operative intubation period does not improve outcomes.
Publisher: Cambridge University Press (CUP)
Date: 06-1995
DOI: 10.1017/S0305000900009855
Abstract: The study investigated the effects of using props to illustrate the meaning of sentences in a syntactic awareness task in which subjects were required to correct ungrammatical sentences. Forty preschool children (aged 4 to 5 ) were asked to correct 20 sentences, 10 of which were illustrated using props, and 10 of which were not. Children scored significantly higher in the props condition though the proportion of meaning-changing errors to total errors was not significantly lower in this condition. It is argued that the use of props, by providing contextual support, reduces the processing capacity required to complete the task.
Publisher: Wiley
Date: 25-07-2023
DOI: 10.1111/DMCN.15714
Abstract: To establish the burden of respiratory illness in cerebral palsy (CP) on the Western Australian health care system by quantifying the costs of respiratory hospitalizations in children with CP, compared with non‐respiratory hospitalizations. A 2‐year (2014–2015) retrospective study using linked hospital data (excluding emergency department visits), in a population of children with CP in Western Australia aged 18 years and under (median age at hospitalization 7 years interquartile range 5–12 years). In 671 in iduals (57% male) there were 726 emergency hospitalizations, and 1631 elective hospitalizations. Although there were more elective hospitalizations, emergency hospitalizations were associated with longer stays in hospital, and more days in an intensive care unit, resulting in a higher total cost of emergency hospitalizations than elective hospitalizations (total costs: emergency AU$7 748 718 vs elective AU$6 738 187). ‘Respiratory’ was the leading cause of emergency hospitalizations, contributing to 36% of all emergency admission costs. For a group of high‐cost inpatient users (top 5% of in iduals with the highest total inpatient costs) the most common reason for hospitalization was ‘respiratory’. Where non‐respiratory admissions were complicated by an additional respiratory diagnosis, length of stay was greater. Respiratory hospitalizations in CP are a significant driver of health care costs. In the paediatric group, they are a burden for a subgroup of children with CP.
Publisher: Wiley
Date: 16-06-2016
DOI: 10.1111/DMCN.13016
Publisher: Wiley
Date: 25-01-2006
DOI: 10.1111/J.1365-2214.2006.00604.X
Abstract: The value of family-centred principles in paediatric professional caregiving services is widely acknowledged. However, the degree to which such services adhere to these principles is not well documented. To examine the perceptions of both families and service providers of the extent to which family-centred services were being implemented by a paediatric disability service provider and to pinpoint areas for improvement. A s le of 158 families receiving services from the Cerebral Palsy Association of Western Australia completed the Measure of Processes of Care for families (MPOC-56) and 43 clinicians (most of them physiotherapists, speech pathologists and occupational therapists) completed the Measure of Processes of Care for service providers (MPOC-SP). As in previous studies, the families rated 'respectful and supportive care' highest and 'providing general information' lowest. Clinicians rated 'showing interpersonal sensitivity' highest and 'providing general information' lowest. Analysis of in idual items revealed that the following areas of family-centred services were in need of improvement: provision of general written information to families on a range of issues, continuity of care, greater involvement of the family in therapy and provision of more detailed information about therapy issues and provision of more general support to whole families. The MPOC tools have been found useful in enabling disability service providers to identify areas for improvement and move towards providing services that are more family centred.
Publisher: Wiley
Date: 25-10-2022
DOI: 10.1111/DMCN.15436
Abstract: To evaluate the effects of a physical activity programme on sedentary behaviour and physical activity in ambulant in iduals with Rett syndrome (RTT). In this multicentre randomized waitlist‐controlled trial, we recruited 43 ambulatory in iduals with RTT in Australia and Denmark. Adequate baseline data were obtained from 38 participants (mean age 20 years, range 6–41, SD 10 years 6 months, one male). All completed the trial. Participants received 12 weeks of usual care ( n = 19) or a goal‐based, telehealth‐supported programme in which activities occurred in their familiar environments ( n = 19). Sedentary time and daily steps were assessed at baseline, post‐test, and 12‐week follow‐up. The data analyst was blinded to group allocation. Sedentary time decreased in the intervention group by 2.7% (95% confidence interval [CI] −6.0 to 0.6) and increased in the control group by 1.3% (95% CI −4.8 to 7.4). Intervention and control groups increased the number of their steps per day by 264.7 (95% CI −72.2 to 601.5) and 104.8 (95% CI −178.1 to 387.7) respectively. No significant differences were found on any outcomes at post‐test. There were three minor adverse events. A goal‐based telehealth intervention seemed to produce small improvements in physical activity for in iduals with RTT. Families require more support to increase these in iduals' extremely low physical activity levels. A telehealth‐supported intervention may produce small changes in physical activity in Rett syndrome (RTT). Increasing physical activity in in iduals with RTT is challenging for caregivers. Families require substantial out‐of‐home support to increase their children's activity levels.
Publisher: Springer Science and Business Media LLC
Date: 19-04-2022
DOI: 10.1007/S10741-022-10236-8
Abstract: Heart failure with preserved ejection fraction is responsible for half of all heart failure and confers substantial morbidity and mortality, and yet to date, there have been no effective pharmacologic interventions. Although the pathophysiology is complex, the primary aetiology of exercise intolerance is due to an elevated left atrial pressure, particularly with exercise. In this context, device-based therapy has become a focus. Several companies have developed techniques to percutaneously create an iatrogenic left to right shunt at the atrial level, thereby reducing left atrial pressure and reducing transmitted pressures to the pulmonary circulation and reducing pulmonary congestion. In this review, we explore the pathophysiology, evidence base, benefits, and considerations of these devices and their place in the therapeutic landscape of heart failure with preserved ejection fraction.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.IJPORL.2019.05.044
Abstract: To describe the effects of salivary gland Botulinum Toxin-A (SG BoNT-A) on children with drooling due to neurological dysfunction. This was a 3½-year prospective observational case series design of children referred for SG BoNT-A injections at a pediatric hospital (2010-2014). Outcomes were parent-reported severity, frequency, impact of drooling, and respiratory morbidity and, from hospital records, number of respiratory hospital admissions. Out of 17 children treated, complete data were available for 15 (including 8 boys) aged 3-14 years (Mean = 9.9 years SD = 3.4), with a combined total of 71 injections. Most had cerebral palsy (n = 11), classified as Level V (n = 10) or IV (n = 1) on the Gross Motor Function Classification Scale (GMFCS). In almost all instances, parents reported reductions in severity, frequency, and impact of drooling, and parent-reported respiratory morbidity. Among those with posterior drooling (n = 12), most children (n = 10) did not have advanced respiratory disease. A trend towards reduced respiratory-related hospital admissions was observed during SG BoNT-A treatment periods. SG BoNT-A can improve severity, frequency, and impact of drooling. It can also reduce respiratory-related hospital admissions in children with posterior drooling without advanced respiratory disease. For children with advanced respiratory disease, it may reduce severity and impact of drooling.
Publisher: Mark Allen Group
Date: 02-2002
DOI: 10.12968/IJPN.2002.8.2.10244
Abstract: Nursing homes are one of the care settings in Western Australia where older people may spend their final years. Residents should be able to receive palliative care where appropriate, but this type of care is not always available at some nursing homes in the state. This study investigated nurses’ attitudes to palliative care in nursing homes by examining their cognitive, affective and behavioural information. A s le of 228 nurses working in nursing homes completed a questionnaire, using a free response methodology. Results showed that participants had either a positive or negative attitude to palliative care. Cognitive and affective information significantly and independently predicted the attitudes of nurses, whereas knowledge of palliative care did not contribute significantly to these attitudes. Nurses currently working in palliative care were more positively disposed towards such care, but this disappeared when they ceased working in the area. There is an emphasis on education in the literature which does not take into account the beliefs and emotions of the nurses. Therefore, there is a need to consider these in undergraduate and postgraduate training for nurses. Current experience is also important in palliative care education. The results obtained from nurses in this study should be incorporated into policy for introducing palliative care into nursing homes and used to provide support and assistance to nurses working in this field.
Publisher: Frontiers Media SA
Date: 24-06-2020
Publisher: Springer Science and Business Media LLC
Date: 22-03-2022
DOI: 10.1007/S00431-022-04439-2
Abstract: In iduals with Prader-Willi syndrome (PWS) often have excessive daytime sleepiness and emotional/behavioral disturbances. The objective of this study was to examine whether daytime sleepiness was associated with these emotional/behavioral problems, independent of nighttime sleep-disordered breathing, or the duration of sleep. Caregivers of in iduals with PWS (aged 3 to 25 years) completed the Pediatric Sleep Questionnaire (PSQ), Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), and the parent version of the Developmental Behavior Checklist (DBC-P). Sleep adequacy was adjusted for age by computing sleep duration against age-specific recommendations. The associations between ESS-CHAD and the total DBC and its subscale scores were evaluated by linear regression, adjusted for sleep-related breathing difficulties, sleep adequacy, and body mass index (BMI). There were 54 responses for in iduals with PWS (including 22 males) aged 4.4–24.0 (mean 12.5) years. Daytime sleepiness predicted a substantial proportion of the variance in total DBC-P scores in the unadjusted model (28% β = 0.028 p 0.001) and when adjusted for sleep adequacy, BMI, and sleep-related breathing difficulties (29% β = 0.023 p = 0.007). This relationship was not moderated by BMI Z -scores, but the relationship was more prominent for children younger than 12 years than for children older than 12 years. Conclusions : These findings provide preliminary novel evidence that daytime sleepiness may drive the expression of emotional/behavioral disturbances, and should be explored as a potential modifiable risk factor for these disturbances in PWS, particularly pre-adolescent children. What is Known: • In iduals with Prader-Willi syndrome (PWS) commonly experience excessive daytime sleepiness and exhibit emotional/behavioral disturbances. • In the typically developing population, sleepiness is associated with emotional/behavioral disturbances, independently of sleep-disordered breathing. . What is New: • This study found evidence for a direct link between daytime sleepiness and emotional/behavioral disturbances, independent of sleep-related breathing difficulties, sleep adequacy, and body mass index. • Excessive daytime sleepiness may be a modifiable risk factor for emotional/behavioral disturbances in PWS.
Publisher: Oxford University Press (OUP)
Date: 23-06-2023
DOI: 10.1093/EURHEARTJ/EHAD375
Abstract: Lifestyle risk factors are a modifiable target in atrial fibrillation (AF) management. The relative contribution of in idual lifestyle risk factors to AF development has not been described. Development and validation of an AF lifestyle risk score to identify in iduals at risk of AF in the general population are the aims of the study. The UK Biobank (UKB) and Framingham Heart Study (FHS) are large prospective cohorts with outcomes measured & years. Incident AF was based on International Classification of Diseases version 10 coding. Prior AF was excluded. Cox proportional hazards regression identified independent AF predictors, which were evaluated in a multivariable model. A weighted score was developed in the UKB and externally validated in the FHS. Kaplan–Meier estimates ascertained the risk of AF development. Among 314 280 UKB participants, AF incidence was 5.7%, with median time to AF 7.6 years (interquartile range 4.5–10.2). Hypertension, age, body mass index, male sex, sleep apnoea, smoking, and alcohol were predictive variables (all P & 0.001) physical inactivity [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.96–1.05, P = 0.80] and diabetes (HR 1.03, 95% CI 0.97–1.09, P = 0·38) were not significant. The HARMS2-AF score had similar predictive performance [area under the curve (AUC) 0.782] to the unweighted model (AUC 0.802) in the UKB. External validation in the FHS (AF incidence 6.0% of 7171 participants) demonstrated an AUC of 0.757 (95% CI 0.735–0.779). A higher HARMS2-AF score (≥5 points) was associated with a heightened AF risk (score 5–9: HR 12.79 score 10–14: HR 38.70). The HARMS2-AF risk model outperformed the Framingham-AF (AUC 0.568) and ARIC (AUC 0.713) risk models (both P & 0.001) and was comparable to the CHARGE-AF risk score (AUC 0.754, P = 0.73). The HARMS2-AF score is a novel lifestyle risk score which may help identify in iduals at risk of AF in the general community and assist population screening.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-07-2021
Abstract: Risk factors for heart failure with preserved ejection fraction (HFpEF) include hypertension, age, sex, and obesity. Emerging evidence suggests that the gut microbiota independently contributes to each one of these risk factors, potentially mediated via gut microbial‐derived metabolites such as short‐chain fatty acids. In this study, we determined whether the gut microbiota were associated with HFpEF and its risk factors. We recruited 26 patients with HFpEF and 67 control participants from 2 independent communities. Patients with HFpEF were diagnosed by exercise right heart catheterization. We assessed the gut microbiome by bacterial 16S rRNA sequencing and food intake by the food frequency questionnaire. There was a significant difference in α‐ ersity (eg, number of microbes) and β‐ ersity (eg, type and abundance of microbes) between both cohorts of controls and patients with HFpEF ( P =0.001). We did not find an association between β‐ ersity and specific demographic or hemodynamic parameters or risk factors for HFpEF. The Firmicutes to Bacteroidetes ratio, a commonly used marker of gut dysbiosis, was lower, but not significantly so ( P =0.093), in the patients with HFpEF. Compared with controls, the gut microbiome of patients with HFpEF was depleted of bacteria that are short‐chain fatty acid producers. Consistent with this, participants with HFpEF consumed less dietary fiber (17.6±7.7 versus 23.2±8.8 g/day P =0.016). We demonstrate key changes in the gut microbiota in patients with HFpEF, including the depletion of bacteria that generate metabolites known to be important for cardiovascular homeostasis. Further studies are required to validate the role of these gut microbiota and metabolites in the pathophysiology of HFpEF.
Location: Australia
Location: Australia
No related grants have been discovered for Marie Blackmore.