Factors associated with future hospitalization among children with asthma: a systematic review.

OBJECTIVE: Asthma is a leading cause of emergency department (ED) visits and hospitalizations in children, though many could be prevented. Our study objective was to identify factors from the published literature that are associated with future hospitalization for asthma beyond 30 days following an initial asthma ED visit. DATA SOURCES: We searched CINAHL, CENTRAL, MEDLINE, and Embase for all studies examining factors associated with asthma-related hospitalization in children from January 1, 1992 to February 7, 2022.Selecting Studies: All citations were reviewed independently by two reviewers and studies meeting inclusion criteria were assessed for risk of bias. Data on all reported variables were extracted from full text and categorized according to identified themes. Where possible, data were pooled for meta-analysis using random effects models. RESULTS: Of 2262 studies, 68 met inclusion criteria. We identified 28 risk factors and categorized these into six themes. Factors independently associated with future hospitalization in meta-analysis include: exposure to environmental tobacco smoke (OR = 1.94 95%CI 0.67-5.61), pets exposure (OR = 1.67 95%CI 1.17-2.37), and previous asthma hospitalizations (OR = 3.47 95% CI 2.95-4.07). Additional related factors included previous acute care visits, comorbid health conditions (including atopy), allergen exposure, severe-persistent asthma phenotype, inhaled steroid use prior to ED visit, poor asthma control, higher severity symptoms at ED presentation, warmer season at admission, longer length of stay or ICU admission, and African-American race/ethnicity. CONCLUSIONS: We identified multiple factors that are consistently associated with future asthma hospitalization in children and could be used to identify those who would benefit from targeted preventative interventions.

Optimizing pediatric asthma education using virtual platforms during the COVID-19 pandemic.

BACKGROUND: We compared patient and caregiver knowledge and confidence for managing asthma, and participant experiences when comprehensive asthma education was delivered in person versus in the virtual setting. METHODS: We performed a multi-methods study using structured surveys and qualitative interviews to solicit feedback from patients and caregivers following participation in a comprehensive asthma education session between April 2018 and October 2021. We compared participant knowledge and confidence for managing asthma as well as user experience when the education was attended in-person or virtually. Quantitative responses were summarized descriptively, and qualitative feedback was analyzed for major themes. RESULTS: Of 100 caregivers/patients who completed post education satisfaction surveys and interviews, 52 attended in person and 48 virtually, with the mean age of patients being 6.7 years (range: 1.2-17.0). Participant reported gains in knowledge and confidence for asthma management were not different between groups and 65.2% preferred attending virtual asthma education. The majority of participants described virtual education as a safer modality that was more convenient and accessible. CONCLUSIONS: We demonstrated the successful implementation of a novel, virtual asthma education program for patients and caregivers of children with asthma. Both virtual and in-person delivered asthma education were equally effective for improving perceived knowledge and confidence for asthma self-management and virtual education was considered safer, more convenient and accessible. Virtual asthma education offers an attractive and effective option for improving the reach of quality asthma education programs and may allow more children/patients to benefit.

Moving on: Transition experiences of young adults with chronic pain.

Purpose: The purpose of this study was to explore the transition experience of young adults with chronic pain in Canada from the pediatric health care setting to the adult health care setting. Materials and Methods: A qualitative descriptive approach using semistructured interviews was used to capture the transition experiences of young people with chronic pain who have recently transferred from the pediatric setting to the adult health care setting. Participants were recruited from west, central, and the east coast of Canada to situate the findings within the context of Canada. Interviews were transcribed and analyzed using qualitative inductive content analysis. Results: Nine participants were interviewed, three from each part of Canada (west, central, and east). Five common categories were determined to describe the transition experience of young adults with chronic pain which include (1) independence (I can do it, maybe?), (2) pain trajectory (stress and pain along for the ride), (3) social support networks (need a shoulder to lean on), (4) parental support (obviously they are there), and (5) collaborative systems (the bridge). Conclusion: Young people with chronic pain experience unique challenges when faced with transitioning to the adult health care setting. Supporting the young person and his or her family in preparation and readiness and collaboration between the pediatric and adult health care settings are essential to ensure a smooth transition and avoid negative transition outcomes. Further research is needed to determine the best ways to prepare young people for transition and the care activities required in both pediatric and adult health care settings to improve pain-related outcomes posttransition.

But: Étudier l'expérience de transition des jeunes adultes souffrant de douleur chronique au Canada d'un établissement de soins pédiatriques à un établissement de soins pour adultes.Matériel et méthodes: Une approche descriptive qualitative ayant recours à des entrevues semi-structurées pour recueillir les expériences de transition de jeunes souffrant de douleur chronique qui ont récemment été transférés d'un établissement de soins pédiatriquse à un établissement de soins pour adultes. Les participants ont été recrutés sur la côte Est, dans l'Ouest et au centre du Canada pour que les résultats puissent être situés dans le contexte du Canada. Les entrevues ont été transcrites et analysées à l'aide d'une analyse de contenu inductive qualitative.Résultats: Neuf participants ont été interviewés, soit trois de chaque partie du Canada (ouest, centre et est). Cinq catégories communes ont été définies pour décrire l'expérience de transition des jeunes adultes souffrant de douleur chronique, soit i) l'indépendance; je suis capable, peut-être? ii) la trajectoire de la douleur: stress et douleur tout au long du parcours iii) les réseaux de soutien social; le besoin d'une épaule sur laquelle s'appuyer iv) le soutien parental; de toute évidence, ils sont présents et v) les systèmes de collaboration; le pont. Conclusion: Les jeunes souffrant de douleur chronique font face à des défis particuliers lorsqu'ils doivent faire la transition vers des établissements de soins de santé pour adultes. Il est essential de soutenir les jeunes et leur famille ainsi que d'établir une collaboration entre l'établissement pédiatrique et l'établissement pour adultes, afin que la transition se fasse en douceur et éviter que la transition entraine des effets négatifs. D'autres études sont nécessaires pour déterminer les meilleures façons de préparer les jeunes à la transition et les soins nécessaires dans les deux milieux, pédiatrique et pour adultes, afin d'obtenir de meilleurs résultats en ce qui concerne la douleur post-transition.

Moving on: A survey of Canadian nurses' self-reported transition practices for young people with chronic pain.

BACKGROUND: Practices to support the transition of a young person from the pediatric to the adult health care setting have been examined for many chronic illness populations. However, specific transition practices to support young people with chronic pain have not been examined. AIM: The aim of this study was to describe the current nursing practices used in the pediatric and the adult health care to support transition of young people with chronic pain in Canada. METHODS: An online survey of pediatric and adult chronic pain nurses' self-reported transition practices was conducted. RESULTS: Twenty-two nurses completed the survey, 10 (45.5%) from the pediatric chronic pain setting and 12 (54.4%) from the adult chronic pain setting. Of the pediatric nurses surveyed none reported using a psychometrically valid tool to assess a young person's readiness of general transition skills; however, one reported using a tool to assess understanding of chronic pain. Most health care facilities in which these pediatric nurses worked offered a general transition clinic, but only one of these facilities also had a chronic pain transition clinic. Nurses in both settings perceived that young people experience increased levels of distress during transition yet most did not report using formal transition practices in their care. CONCLUSION: Nursing practices and clinic resources to support the transition of young people with chronic pain may not meet the needs of this population. Practices may benefit from the use of psychometrically validated tools to assess general transition preparedness. Research is needed to adapt tools and determine best transition practices for the chronic pain population.

RÉSUMÉ Contexte: Les pratiques pour soutenir la transition d'un jeune d'un établissement de santé pédiatrique vers un établissement pour adultes ont été étudiées pour de nombreuses populations souffrant de maladies chroniques. Toutefois, les pratiques de transition visant particulièrement à soutenir les jeunes souffrant de douleur chronique n'ont pas été étudiées.Objectif: Décrire les pratiques infirmières actuellement utilisées en matière de soins de santé pédiatriques et de soins de santé pour adultes afin de soutenir la transition des jeunes souffrant de douleur chronique au Canada.Méthodes: Un sondage en ligne portant sur les pratiques de transition auto-déclarées par des infirmières pédiatriques spécialisées en douleur chronique et par des infirmières spécialisées en douleur chronique chez les adultes a été mené.Résultats: Vingt-deux infirmières ont répondu au sondage; 10 (45,5 %) provenaient du milieu de la douleur chronique pédiatrique et 12 (54,4 %) provenaient du milieu de la douleur chronique chez les adultes. Aucune des infimières pédiatriques ayant répondu au sondage n'a déclaré utiliser un outil psychométriquement valide pour évaluer le degré de préparation à la transition d'un jeune; toutefois, l'une d'entre elles a déclaré utiliser un outil pour évaluer la compréhension de la douleur chronique. La plupart des établissements de santé dans lesquelles ces infirmières pédiatriques travaillaient offraient une clinique de transition générale mais seulement l'un de ces établissements avait aussi une clinique de transition en matière de douleur chronique. Les infirmières des deux milieux percevaient que les jeunes avaient des niveaux plus élevés de détresse pendant la transition mais la plupart ont déclaré ne pas avoir recours à des pratiques de transition officielles au moment de prodiguer les soins.Conclusion: Les pratiques infirmières et les ressources cliniques pour soutenir la transition des jeunes souffrant de douleur chronique pourraient ne pas répondre aux besoins de cette population. Ces pratiques pourraient bénéficier de l'utilisation d'outils validés psychométriquement pour évaluer le degré de préparation générale à la transition. Davantage de recherche est nécessaire pour adapter les outils et déterminer les meilleures pratiques de transition pour la population souffrant de douleur chronique.

Departure from Pediatric Care: Transitioning of Adolescents with Chronic Pain to Adult Care.

Little is known about specific factors related to chronic pain that need to be considered to support successful transition from pediatric to adult health care settings. This is troubling because 1 in 5 adolescents may experience chronic pain and many will continue to live with pain into adulthood. This paper reviews what is known about successful transition processes for adolescents with various chronic conditions and the unique factors associated with chronic pain and includes a call for further research on transition. Transitioning from the pediatric to the adult health care setting is challenging for adolescents with chronic conditions and their families. Loss to follow-up and negative health outcomes are linked to poor transition processes. Despite studies examining factors associated with successful transition, not all of the findings are transferable to adolescents with chronic pain. We need to support adolescents, young adults, and their parents as they prepare for transition, engage pediatric and adult care providers in care, advocate for system change, and systematically examine the processes that support the successful health care transition of adolescents and young people with chronic pain.

Maternal smoking at first prenatal visit as a marker of risk for adverse pregnancy outcomes in the Qikiqtaaluk (Baffin) Region.

INTRODUCTION: In Nunavut, 60-80% of pregnant women report smoking in pregnancy, a rate five times the Canadian average. Nunavut also has the highest rates of preterm birth and low birth weight infants in Canada. The present study assessed whether the number of cigarettes smoked per day, as recorded in the first trimester, influenced birth outcomes. METHODS: Maternal-newborn charts were reviewed for infants born between 1 January 2003 and 31 December 2005 to at least one Inuit parent in the Qikiqtaaluk (Baffin) region of Nunavut. Smoking data, as reported by the mother at an early prenatal visit, were extracted from the prenatal record. Birth outcomes including birth weights (for term births), low birth weight, small for gestational age births and rates of preterm birth, were analysed according to category of reported number of cigarettes smoked (0, 1-5, 6-10, and >10 per day). Maternal age, alcohol and street drug use were also assessed for each category of smokers. Statistical analysis among groups was carried out. RESULTS: Of 918 births meeting the study criteria, more than 80% of women reported smoking. For 80% of those, the amount smoked per day was available. Non-smokers and women smoking less than 5 cigarettes daily had perinatal outcomes equal to or better than Canadian averages for low birth weight, small for gestational age, and preterm birth. Furthermore, average birth weights at term significantly decreased from 3681 g for non smokers to 3310 g for those smoking more than 10 cigarettes per day. Compared with non-smokers, women in the highest smoking category (>10 cigarettes daily) had a six-fold increase in low birth weight infants (OR 6.7, 95% CI 2.3-19.6), almost a four-fold increase for small for gestational age births (OR 3.7, 95% CI 1.6-8.8) and twice the chance of a premature birth compared with non-smokers (OR 2.14, 95% CI 1.1-4.2). Those in the highest smoking category were also most likely to report alcohol and other substance use. CONCLUSIONS: Inuit women who reported not smoking, or smoking less than 5 cigarettes per day had birth outcomes equal or superior to average Canadian outcomes in each category evaluated. Those women reporting smoking more than 10 cigarettes daily had significantly increased risk for preterm birth, low birth weight and small for gestational age infants. Because those in the highest smoking category also reported the highest rates of alcohol and other substance use, it is likely that a combination of factors assessed in this study influenced the outcomes. Along with public health preventative measures to reduce smoking directed to this high risk group, other contributing factors for adverse birth outcomes need to be assessed more fully to understand the complex interactions that lead to increased smoking, substance use and, therefore, adverse birth outcomes. Furthermore, evidence from this study suggests that smoking more than 10 cigarettes per day, reported at first prenatal visit, may provide a marker for those women at highest risk of poor outcomes, which could provide direction for focused public health efforts.