The effectiveness and safety of centralized early rehabilitation care for critically ill children with severe acquired brain injury: A retrospective cohort and implementation study.

BACKGROUND: Most children with neurocritical illness are at risk of physical, neurocognitive, and psychosocial sequelae and need centralized early rehabilitation care. OBJECTIVE: To identify the effectiveness and safety of centralized early rehabilitation care for children with severe acquired brain injury. METHODS: This is a mixed methods study-an implementation study and single-center retrospective cohort study with historical control. All children with severe acquired brain injury hospitalized in a specialized rehabilitation center in a comprehensive tertiary pediatric hospital between September 2016 and August 2020 were included. Patients treated in the centralized early rehabilitation unit were compared to historical controls dispersed in the normal inpatient rehabilitation ward. The effectiveness outcomes were measured by the Pediatric Cerebral Performance Category (PCPC) scale and the incidence of newly onset comorbidities. The safety outcomes were indicated by the mortality rate and the incidence of unexpected referrals. RESULTS: One hundred seventy-five patients were included. The delta PCPC scores of the first 4 weeks of inpatient rehabilitation in the intervention group were significantly lower than the control group (Z = -2.395, p = 0.017). The PCPC scores at 1 year in the intervention group were significantly reduced as compared to the control group (Z = -3.337, p = 0.001). The incidence of newly onset pneumonia/bronchitis was also decreased in the intervention group (χ2 = 4.517, p = 0.034). No death of patients was recorded, and there was no significant difference in unexpected referral rate between the two groups (χ2 = 0.374, p = 0.541). CONCLUSIONS: The centralized pediatrics early rehabilitation unit is effective and safe for children with severe acquired brain injury. Further multicenter prospective implementation studies on effectiveness, safety, and economic evaluation are needed.

An Epidemiological Study of Chinese Children with Developmental Dyslexia.

OBJECTIVE: The epidemiological studies of Chinese developmental dyslexia (DD) in China are still limited. The current study aimed to investigate the prevalence rate, risk factors, and psychiatric comorbidities of Chinese DD in Guangzhou, a city in South China. METHOD: A total of 1661 students from second to fifth grades were recruited. The dyslexic students were identified by evaluating learning disability through the Pupil Rating Scale-Revised Screening for Learning Disability (PRS) scale by the head teachers and word recognition through the standard test. Students with a PRS score of <65 received the Raven's test, and those with intelligence quotient scores below 80 in the Raven's test were excluded. Psychiatric comorbidities were assessed by the Strength and Difficulties Questionnaire completed by parents. RESULTS: The prevalence rate of Chinese DD was 4.9% in Guangzhou city. There were significant differences in gender, the paternal educational level, and reading experience before the age of 6 years between the DD group and the non-DD group. Male gender (odds ratio [OR] = 4.17), low paternal educational level (p = 0.045), and lack of reading experience before the age of 6 years (OR = 1.99) were the risk factors for DD. The DD cases had a higher risk of hyperactivity and inattention (OR = 3.21). CONCLUSION: This study showed that the prevalence rate of DD was 4.9% in Guangzhou city. Male gender, low paternal educational level, and lack of reading experience before the age of 6 years were the risk factors for Chinese DD. The high comorbidity rate of hyperactivity and inattention in the Chinese DD population needs further evaluation.

Coping Styles Mediate the Relationship Between Self-esteem, Health Locus of Control, and Health-Promoting Behavior in Chinese Patients With Coronary Heart Disease.

BACKGROUND: Health-promoting behavior plays an important role in reducing the burden of coronary heart disease. Self-esteem and health locus of control may contribute to health-promoting behavior, and coping styles may mediate these associations. OBJECTIVE: The aims of our study were to examine whether self-esteem and health locus of control are associated with health-promoting behavior and examine the possible mediating effect of coping styles in patients with coronary heart disease. METHODS: Health-promoting behavior, self-esteem, health locus of control, and coping styles were assessed in 272 hospitalized patients (60 ± 12 years, 61% male) with coronary heart disease. Hierarchical regression analysis was conducted to analyze the relationships between health-promoting behavior and other variables. Mediation effect was examined according to the methods of Baron and Kenny. RESULTS: The mean score for health-promoting behavior was 2.57 ± 0.51; 38.2% of patients (n = 104) scored lower than 2.5. Self-esteem (ß = .139, P < .05), confrontation coping style (ß = .491, P < .001), disease duration (≥6 months, ß = .147, P < .05), and monthly income (≥1000 RMB [approximately US$154], ß = .111, P < .05) were positively associated with health-promoting behavior, accounting for 47.5% of its variance (F = 19.828). Confrontation partly mediated the association between self-esteem and health-promoting behavior and completely mediated the relationship between internal health locus of control and health-promoting behavior. CONCLUSIONS: Confrontation plays a mediating role in the association among self-esteem, internal health locus of control, and health-promoting behavior. Strategies should be undertaken to encourage the use of confrontation coping style, which will facilitate health-promoting behavior.

The mediation effect of health literacy between subjective social status and depressive symptoms in patients with heart failure.

OBJECTIVES: Depressive symptoms are prevalent and cause adverse outcomes in heart failure. Previous studies have linked depressive symptoms with socioeconomic status. However, little is known about the mechanisms underlying this relationship. This study aimed to evaluate the association between socioeconomic status and depressive symptoms, and to examine whether access to healthcare, health literacy and social support mediated this relationship in patients with heart failure. METHODS: Cross-sectional design was used to study 321 patients with heart failure recruited from a general hospital. Demographics, clinical data, depressive symptoms, socioeconomic status (i.e., education, employment, income, and subjective social status), access to healthcare, health literacy, and social support were collected by patient interview, medical record review or questionnaires. A series of logistic regressions and linear regressions were conducted to examine mediation. RESULTS: The mean age of patients with heart failure was 63.6±10.6years. Fifty-eight patients (18%) had depressive symptoms. Lower subjective social status (OR=1.321, p=0.012) and lower health literacy (OR=1.065, p<0.001) were separately associated with depressive symptoms. When subjective social status and health literacy were entered simultaneously, the relationship between subjective social status and depressive symptoms became non-significant (OR=1.208, p=0.113), demonstrating mediation. Additionally, lower social support was associated with depressive symptoms (OR=1.062, p=0.007). CONCLUSIONS: In patients with heart failure, health literacy mediated the relationship between subjective social status and depressive symptoms. Lower social support was associated with depressive symptoms. Interventions should take these factors into account.