Research on postconcussive symptoms (PCS) following early childhood concussion has been hindered by a lack of measures suitable for this age group, resulting in a limited understanding of their ...evolution in young children.
To document PCS in the first 3 months after early childhood concussion using a developmentally appropriate measure.
This cohort study used data collected at 3 Canadian and 1 US urban pediatric emergency departments (EDs) and 8 Canadian daycares from December 2018 to December 2022 as part of the Kids' Outcomes and Long-Term Abilities (KOALA) project, a prospective, multicenter, longitudinal cohort study. Participants included children aged 6 to 72 months with early childhood concussion or orthopedic injury (OI) or uninjured children from the community to serve as controls. Data were analyzed from March 2023 to January 2024.
Concussion sustained between ages 6 and 72 months.
Primary outcomes were cognitive, physical, behavioral and total PCS assessed prior to injury (retrospectively), acutely (within 48 hours), and at 10 days, 1 month, and 3 months after injury or recruitment through caregiver observations using the Report of Early Childhood Traumatic Injury Observations & Symptoms inventory. Group comparisons were analyzed using ordinal regression models.
The study included 303 children (mean SD age, 35.8 20.2 months; 152 50.2% male). Of these, 174 children had a concussion (mean SD age, 33.3 19.9 months), 60 children had an OI (mean SD age, 38.4 19.8 months) and 69 children were uninjured controls (mean SD age, 39.7 20.8 months). No meaningful differences were found between the concussion and comparison groups in retrospective preinjury PCS. Significant group differences were found for total PCS at the initial ED visit (concussion vs OI: odds ratio OR, 4.33 95% CI, 2.44-7.69; concussion vs control: OR, 7.28 95% CI, 3.80-13.93), 10 days (concussion vs OI: OR, 4.44 95% CI, 2.17-9.06; concussion vs control: OR, 5.94 95% CI, 3.22-10.94), 1 month (concussion vs OI: OR, 2.70 95% CI, 1.56-4.68; concussion vs control: OR, 4.32 95% CI, 2.36-7.92), and 3 months (concussion vs OI: OR, 2.61 95% CI, 1.30-5.25; concussion vs control: OR, 2.40 95% CI, 1.36-4.24). Significant group differences were also found for domain-level scores (cognitive, physical, behavioral) at various time points.
In this early childhood cohort study, concussion was associated with more PCS than OIs or typical development up to 3 months after injury. Given the limited verbal and cognitive abilities typical of early childhood, using developmentally appropriate manifestations and behaviors is a valuable way of tracking PCS and could aid in concussion diagnosis in young children.
Headache is the most common symptom after pediatric concussion.
To examine whether posttraumatic headache phenotype is associated with symptom burden and quality of life 3 months after concussion.
...This was a secondary analysis of the Advancing Concussion Assessment in Pediatrics (A-CAP) prospective cohort study, conducted September 2016 to July 2019 at 5 Pediatric Emergency Research Canada (PERC) network emergency departments. Children aged 8.0-16.99 years presenting with acute (<48 hours) concussion or orthopedic injury (OI) were included. Data were analyzed from April to December 2022.
Posttraumatic headache was classified as migraine or nonmigraine headache, or no headache, using modified International Classification of Headache Disorders, 3rd edition, diagnostic criteria based on self-reported symptoms collected within 10 days of injury.
Self-reported postconcussion symptoms and quality-of-life were measured at 3 months after concussion using the validated Health and Behavior Inventory (HBI) and Pediatric Quality of Life Inventory-Version 4.0 (PedsQL-4.0). An initial multiple imputation approach was used to minimize potential biases due to missing data. Multivariable linear regression evaluated the association between headache phenotype and outcomes compared with the Predicting and Preventing Postconcussive Problems in Pediatrics (5P) clinical risk score and other covariates and confounders. Reliable change analyses examined clinical significance of findings.
Of 967 enrolled children, 928 (median IQR age, 12.2 10.5 to 14.3 years; 383 41.3% female) were included in analyses. HBI total score (adjusted) was significantly higher for children with migraine than children without headache (estimated mean difference EMD, 3.36; 95% CI, 1.13 to 5.60) and children with OI (EMD, 3.10; 95% CI, 0.75 to 6.62), but not children with nonmigraine headache (EMD, 1.93; 95% CI, -0.33 to 4.19). Children with migraine were more likely to report reliable increases in total symptoms (odds ratio OR, 2.13; 95% CI, 1.02 to 4.45) and somatic symptoms (OR, 2.70; 95% CI, 1.29 to 5.68) than those without headache. PedsQL-4.0 subscale scores were significantly lower for children with migraine than those without headache only for physical functioning (EMD, -4.67; 95% CI, -7.86 to -1.48).
In this cohort study of children with concussion or OI, those with posttraumatic migraine symptoms after concussion had higher symptom burden and lower quality of life 3 months after injury than those with nonmigraine headache. Children without posttraumatic headache reported the lowest symptom burden and highest quality of life, comparable with children with OI. Further research is warranted to determine effective treatment strategies that consider headache phenotype.
Abstract
Advanced diffusion-weighted imaging techniques have increased understanding of the neuropathology of paediatric mild traumatic brain injury (i.e. concussion). Most studies have examined ...discrete white-matter pathways, which may not capture the characteristically subtle, diffuse and heterogenous effects of paediatric concussion on brain microstructure. This study compared the structural connectome of children with concussion to those with mild orthopaedic injury to determine whether network metrics and their trajectories across time post-injury differentiate paediatric concussion from mild traumatic injury more generally. Data were drawn from of a large study of outcomes in paediatric concussion. Children aged 8–16.99 years were recruited from five paediatric emergency departments within 48 h of sustaining a concussion (n = 360; 56% male) or mild orthopaedic injury (n = 196; 62% male). A reliable change score was used to classify children with concussion into two groups: concussion with or without persistent symptoms. Children completed 3 T MRI at post-acute (2–33 days) and/or chronic (3 or 6 months, via random assignment) post-injury follow-ups. Diffusion-weighted images were used to calculate the diffusion tensor, conduct deterministic whole-brain fibre tractography and compute connectivity matrices in native (diffusion) space for 90 supratentorial regions. Weighted adjacency matrices were constructed using average fractional anisotropy and used to calculate global and local (regional) graph theory metrics. Linear mixed effects modelling was performed to compare groups, correcting for multiple comparisons. Groups did not differ in global network metrics. However, the clustering coefficient, betweenness centrality and efficiency of the insula, cingulate, parietal, occipital and subcortical regions differed among groups, with differences moderated by time (days) post-injury, biological sex and age at time of injury. Post-acute differences were minimal, whereas more robust alterations emerged at 3 and especially 6 months in children with concussion with persistent symptoms, albeit differently by sex and age. In the largest neuroimaging study to date, post-acute regional network metrics distinguished concussion from mild orthopaedic injury and predicted symptom recovery 1-month post-injury. Regional network parameters alterations were more robust and widespread at chronic timepoints than post-acutely after concussion. Results suggest that increased regional and local subnetwork segregation (modularity) and inefficiency occurs across time after concussion, emerging after post-concussive symptom resolve in most children. These differences persist up to 6 months after concussion, especially in children who showed persistent symptoms. While prognostic, the small to modest effect size of group differences and the moderating effects of sex likely would preclude effective clinical application in individual patients.
Increased regional and local subnetwork segregation (modularity) and inefficiency occurred across time after concussion, emerging after post-concussive symptoms resolved in most children and persisted up to 6 months after mild traumatic brain injury, especially in children with persistent symptoms 1-month post-injury.
Graphical Abstract
Graphical Abstract
Familles au temps de la COVID-19 Barthou, Evelyne; Bergeron-Leclerc, Christiane; Bruna, Yann ...
Enfances, familles, générations,
12/2022
Journal Article
In 2013, the TRAPPED-1 survey reported inconsistent availability of pain and distress management strategies across all 15 Canadian paediatric emergency department (PEDs). The objective of the ...TRAPPED-2 study was to utilize a procedural pain quality improvement collaborative (QIC) and evaluate the number of newly introduced pain and distress-reducing strategies in Canadian PEDs over a 2-year period.
A QIC was created to increase implementation of new strategies, through collaborative information sharing among PEDs. In 2015, 11 of the 15 Canadian PEDs participated in the TRAPPED QIC. At the end of the year, the TRAPPED-2 survey was electronically sent to a representative member at each of the 15 PEDs. The successful introduction of the chosen strategies by the QIC was assessed as well as the addition of new strategies per site. The number of new strategies introduced in the participating and nonparticipating QIC sites were described.
All 15 PEDs (100%) completed the TRAPPED-2 survey. Overall, 10/11 of QIC-participating sites implemented the strategy they had initially identified. All 15 Canadian PEDs implemented some new strategies during the study period; participants in the QIC reported a mean of 5.2 (1-11) new strategies compared to 2.5 (1-4) in the nonactively participating sites.
While all PEDs introduced new strategies during the study, QIC-participating sites successfully introduced the majority of their previously identified new strategies in a short time period. Sharing deadlines and information between centres may have contributed to this success.
Silicon, zirconium and aluminum sol–gels were investigated as suitable starting materials for tunable matrix calibration standards for laser-induced breakdown spectroscopy. A fast and simple ...preparation method was developed, using aluminum
i-propoxide as the precursor in the sol–gel synthesis, which allows one to quickly prepare solid calibration standards offering very homogenous analyte distribution in the matrix, low optical spectral background, as well as reproducible behavior towards laser ablation and vaporization. The surface of the calibration targets and the morphology of the ablation craters were examined by optical and scanning electron microscopy, and the material ejection process was observed by shadowgraph imaging. Low μg/g detection limits and 4–15% relative standard deviation were measured by laser induced breakdown spectroscopy for Pb, Cr and Be used as internal standards.
Laser ablation laser-enhanced ionization (LA-LEI) was used for the simultaneous measurement of lead and indium in pelletized graphite and coal samples. UV Laser ablation of the solid samples was ...performed in an ablation cell and the ablated material was carried by a flow of gas to a miniature LEI flame where lead was detected. The influence of parameters such as binder content of the solid pellets and dispersion of the analytes spiked in the sample material, as well as the number of ablation pulses per crater on signal repeatability and on the size and shape of ejected particles was examined. Measurement repeatability values of 2 to 5% of relative standard deviation were obtained using indium as an internal standard to correct for variations in the ablation rate. A limit of detection of 120 nanograms per gram was calculated for the determination of Pb in high-purity graphite. The Pb concentration in the NIST 1632c Bituminous Coal certified reference material was determined to within 1% of its certified value, using graphite as the matrix-matching material and In as the internal standard in pelletized solid samples.
Primary open-angle glaucoma (POAG) is a complex disorder characterized by a progressive and treatable degeneration of the optic nerve. TIGR/myocilin (MYOC) gene mutations are found in approximately ...4% of all POAG patients. Populations with frequent founder effects, such as the French-Canadians, offer unique advantages to implement genetic testing for the disorder. To assess molecular diagnosis for POAG in this population, we determined the prevalence of TIGR/MYOC mutations in 384 unrelated glaucoma patients, 38 ocular hypertensive subjects and 18 affected families (180 patients). We further analyzed the clinical features associated with these variations. Nine coding sequence variants were defined as mutations causing mostly, but not exclusively, POAG. Four families segregated distinct mutations (Gly367Arg, Gln368Stop, Lys423Glu and Pro481Leu), while 14 unrelated glaucoma patients harbored six known mutations (Thr293Lys, Glu352Lys, Gly367Arg, Gln368Stop, Lys423Glu and Ala445Val) and two novel (Ala427Thr and Arg126Trp). The frequencies of these mutations were respectively 3.8% and 22.2% in the unrelated and family studies. The Gly367Arg and Lys423Glu variants caused the earliest ages at onset. When achievable, assessment of relatives of unrelated mutation carriers showed the Arg126Trp and Gly367Arg to be familial. Characteristic allele signatures, indicative of specific founder effects, were observed for five of the six mutations conveyed by at least two patients. Recombination probability estimates suggested that the French-Canadian population had most probably inherited these six mutations from 7-10 Québec settlers. Our data demonstrated that genetic screening for TIGR/MYOC mutations should be offered to glaucoma families and to close relatives of unrelated patients aware of a family history for the disorder.
Ad libros Arnoux, Mathieu; Brabant, Annick; Cochelin, Isabelle ...
2010
eBook, Book
Odprti dostop
Ad libros ! « Aux livres ! », ce cri attribué à dom Guillaume de Raynald au moment où le feu ravageait la Grande Chartreuse lors de l'incendie de 1371 est à la fois une injonction et un élan que tout ...médiéviste peut reprendre à son compte : élan du chercheur vers ses sources, injonction du professeur à ses élèves. Ces deux mots latins, qui ont servi de devise à Denise Angers et Joseph-Claude Poulin, forment donc un titre idéal pour des mélanges qui célèbrent ce couple d'humanistes passionnés. Ce mantra est aussi un credo qui explique toute l'importance que Denise Angers et Joseph-Claude Poulin ont accordée dans leur pédagogie à cet aspect de la formation des jeunes médiévistes à Ottawa, à Québec ou à Montréal : cours sur les sources, introduction à la paléographie, à la codicologie ou à l'archéologie médiévale. Les études qui sont réunies dans ce livre rendent hommage à leur irréprochable engagement scientifique, dans un bouquet de contributions qui embrassent l'ensemble du Moyen Âge, du VIIIe au XVe siècle – avec une avancée jusqu'en Nouvelle-France –, mais dont le point commun réside dans l'attention aux sources.
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