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Children with COVID-19 clear the virus when antibody titers reach a critical level. Until then (several weeks from onset), they continue to have detectable viral particles in their noses. James W. Mold, MD, MPH

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Abstract

Objectives: To improve understanding of transition from viral infection to viral clearance, and antibody response in pediatric patients with SARS-CoV-2 infection.

Study design: This retrospective analysis of children tested for SARS-CoV-2 by RT-PCR and IgG antibody at a quaternary-care, free-standing pediatric hospital between March 13, 2020 to June 21, 2020 included 6369 patients who underwent PCR testing and 215 patients who underwent antibody testing. During the initial study period, testing focused primarily on symptomatic children; the later study period included asymptomatic patients who underwent testing as preadmission or preprocedural screening. We report the proportion of positive and negative tests, time to viral clearance, and time to seropositivity.

Results: The rate of positivity varied over time due to viral circulation in the community and transition from targeted testing of symptomatic patients to more universal screening of hospitalized patients. Median duration of viral shedding (RT-PCR positivity) was 19.5 days and time from RT-PCR positivity to negativity was 25 days. Of note, patients aged 6 through 15 years demonstrated a longer time of RT-PCR positivity to negativity, compared with patients aged 16 through 22 years (median=32 versus 18 days, P = .015). Median time to seropositivity, by chemiluminescent testing, from RT-PCR positivity was 18 days while median time to reach adequate levels of neutralizing antibodies (defined as comparable to 160 titer by plaque reduction neutralization testing) was 36 days.

Conclusions: The majority of patients demonstrated a prolonged period of viral shedding after infection with SARS CoV-2. It is unknown whether this correlates with persistent infectivity. Only 17 of 33 patients demonstrated adequate neutralizing antibodies during the timeframe of specimen collection. It remains unknown if IgG antibody against spike structured proteins correlates with immunity, and how long antibodies and potential protection persist.

Author/s:

Bahar, Burak, Jacquot, Cyril, Mo, Yunchuan D., DeBiasi, Roberta L., Campos, Joseph, Delaney, Meghan

Human Papillomavirus Immunization in Rural Primary Care

Brian Desmarais — Thu, 20 Aug 2020 14:11:00 +0000

Date Added:

August 20, 2020

Journal/Publication:

American Journal of Preventive Medicine

Publication Date:

June 27, 2020

Issue:

Volume:

Pages:

377-385

URL:

Human Papillomavirus Immunization in Rural Primary Care

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.amepre.2020.03.018

MeSH

Papillomavirus Vaccines

Papillomaviridae

Papillomavirus Infections

Immunization Programs

Parents

vaccination

Surveys and Questionnaires

primary health care

An OKPRN-like study of high performing practices on HPV immunization. James W. Mold, MD, MPH

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Abstract

Introduction: Despite the safety and efficacy of the human papillomavirus vaccine, thousands are impacted by human papillomavirus and its related cancers. Rural regions have disproportionately low rates of human papillomavirus vaccination. Primary care clinics play an important role in delivering the human papillomavirus vaccine. A positive deviance approach is used to identify workflows, organizational factors, and communication strategies in rural clinics with higher human papillomavirus vaccine up-to-date rates. Positive deviance is a process by which exceptional behaviors and strategies are identified to understand factors that enable success.

Methods: Rural primary care clinics were rank ordered by human papillomavirus vaccine up-to-date rates using 2018 Oregon Immunization Program data, then recruited via purposive sampling of clinics in the top and bottom quartiles. Two study team members conducted previsit interviews, intake surveys, and 2-day observation visits with 12 clinics and prepared detailed field notes. Data were collected October-December 2018 and analyzed using a thematic approach January-April 2019.

Results: Four themes distinguished rural clinics with higher human papillomavirus vaccine up-to-date rates from those with lower rates. First, they implemented standardized workflows to identify patients due for the vaccine and had vaccine administration protocols. Second, they designated and supported a vaccine champion. Third, clinical staff in higher performing sites were comfortable providing immunizations regardless of visit type. Finally, they used clear, persuasive language to recommend or educate parents and patients about the vaccine's importance.

Conclusions: Positive deviance identified characteristics associated with higher human papillomavirus vaccine up-to-date rates in rural primary care clinics. These findings provide guidance for rural clinics to inform human papillomavirus vaccination quality improvement interventions.

Author/s:

Ferrara, Laura, K., Gunn, Rose, Dickinson, Caitlin, Stock, Isabel, Griffith-Weprin, Jennifer, Wiser, Amy, Hatch, Brigit, Fagnan, L.J., Carney, P.A., Davis, M.M.

Recognizing Axial Spondyloarthritis: A Guide for Primary Care

Brian Desmarais — Mon, 03 Aug 2020 15:25:32 +0000

Date Added:

August 3, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publication Date:

July 29, 2020

URL:

Recognizing Axial Spondyloarthritis: A Guide for Primary Care

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.190777

MeSH

low back pain

Spondylitis, Ankylosing

Rheumatologists

language

O,O-diisopropyl-S-benzylthiophosphate

Buttocks

Spondylarthritis

Back Pain

Anti-Inflammatory Agents, Non-Steroidal

PubMed

Inflammatory Bowel Diseases

Uveitis

Psoriasis

Education, Medical

A nice review of the recognition, diagnosis, and management of patients with axial spondyloarthritis (ankylosing spondylitis). James W. Mold, MD, MPH

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Axial spondyloarthritis (axSpA) is an important cause of chronic low back pain and affects approximately 1% of the US population. The back pain associated with axSpA has a characteristic pattern referred to as inflammatory back pain (IBP). Features of IBP include insidious onset before age 45 years, association with morning stiffness, improvement with exercise but not rest, alternating buttock pain, and good response to treatment with nonsteroidal anti-inflammatory drugs. In patients with IBP, it is essential to look for other features associated with spondyloarthritis (SpA), such as enthesitis, dactylitis, peripheral arthritis, extra-articular manifestations (eg, psoriasis, uveitis, or inflammatory bowel disease), human leukocyte antigen B27 positivity, and a family history of SpA. Axial SpA is underrecognized, and a delay of several years between symptom onset and diagnosis is common. However, with new and effective therapies available for the treatment of active axSpA, early recognition and diagnosis are of critical importance. For this narrative review, we conducted a literature search of English-language articles using PubMed. Individual searches were performed to identify potential articles of interest related to axSpA (search terms: ["axSpA" OR "axial SpA" OR "axial spondyloarthritis" OR "ankylosing spondylitis"]) in combination with terms related to IBP ("inflammatory back pain" OR "IBP" OR "chronic back pain" OR "CBP" OR "lower back pain" OR "LBP"), diagnosis (["diagn∗" OR "classification"] AND ["criteria" OR "recommend∗" OR "guidelines"]), and referral ("refer∗"). No date range was formally selected, as we were interested in providing an overview of the evolution of these concepts in clinical practice. We supplemented the review with insights based on our clinical expertise. Patients with chronic back pain should be screened for IBP and other SpA features; suspicion for axSpA should trigger referral to a rheumatologist for further evaluation.

Author/s:

Magrey, M.N., Danve, A.S., Ermann, J., Walsh, J.A.

Return to Sport Following Adolescent Concussion: Epidemiologic Findings From a High School Population

Brian Desmarais — Thu, 18 Jun 2020 18:52:31 +0000

Date Added:

June 18, 2020

Journal/Publication:

Orthopedics

Publication Date:

June 4, 2020

URL:

Return to Sport Following Adolescent Concussion: Epidemiologic Findings From a High School Population

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.3928/01477447-20200521-03

MeSH

Adolescent athletes with concussion require an average of 1 month recovery time before they are ready to return to their sport. James W. Mold, MD, MPH

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Abstract

High school athletes sustaining a concussion require careful attention when determining return-to-sport (RTS) readiness. The purpose of this study was to determine epidemiological and RTS data of a large cohort of high school athletes who sustained 1 or more concussions. Records of 357 consecutive youth patients who sustained concussions and presented to a single health care system between September 2013 and December 2016 were reviewed. Demographic data, RTS, and concussion-related variables were obtained via chart review. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores at baseline and following concussions were performed by neuropsychologists. The average age at injury was 15.5 years (range, 14-18 years), 61.9% of patients were male, 6.7% reported a loss of consciousness, and 14.3% reported amnesia, requiring 30.4±23.3 days of recovery prior to RTS. The most common sport of injury was football (27.7%). There was a high incidence of previous concussion (33.1%), and 32 athletes sustained a recurrent concussion. A multivariate model demonstrated that females, players with a history of concussion, and those diagnosed in-clinic rather than in-game required increased time to RTS. Memory ImPACT scores were found to increase as players had recurrent concussions. Visual motor speed and reaction time scores decreased with recurrent concussions. [Orthopedics. 2020;43(x):xx-xx.].

Author/s:

Jildeh, T.R., Okoroha, K.R., Denha, E., Eyers, C., Johnson, A., Shehab, R.

Pets Are Associated with Fewer Peer Problems and Emotional Symptoms, and Better Prosocial Behavior: Findings from the Longitudinal Study of Australian Children

Brian Desmarais — Wed, 22 Apr 2020 23:44:31 +0000

Date Added:

April 22, 2020

Journal/Publication:

Journal of Pediatrics

Publication Date:

February 21, 2020

URL:

Pets Are Associated with Fewer Peer Problems and Emotional Symptoms, and Better Prosocial Behavior: Findings from the Longitudinal Study of Australian Children

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.jpeds.2020.01.012.

Keywords

MeSH

Family Characteristics

social change

Surveys and Questionnaires

This study supports pet ownership to support healthy childhood development. James W. Mold, MD, MPH

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Abstract

OBJECTIVE:

To investigate the longitudinal association between pet ownership and children's social-emotionaldevelopment.

STUDY DESIGN:

Two time-points of data from the Longitudinal Study of Australian Children were analyzed for children at ages 5 (n = 4242) and 7 (n = 4431) years. The Strengths and Difficulties Questionnaire (SDQ) measured children's social-emotional development. Pet ownership status and type (dog, cat, other) as well as sociodemographic and other potential confounders were collected. Longitudinal panel regression models were used.

RESULTS:

Overall, 27% of children had abnormal scores on 1 or more SDQ scales. By age 7, 75% of children had pets with ownership highest in single-child households. Owning any type of pet was associated with decreased odds of abnormal scores for emotional symptoms (OR, 0.81; 95% CI, 0.67-0.99), peer problems (OR, 0.71; 95% CI, 0.60-0.84), and prosocial behavior (OR, 0.70; 95% CI, 0.38-0.70), compared with non-pet owners. Dog ownership was associated with decreased odds of abnormal scores on any of the SDQ scales (OR, 0.81; 95% CI, 0.71-0.93). For children without any siblings, only the prosocial behavior scale was significantly associated with pet ownership (OR, 0.21; 95% CI, 0.07-0.66). In longitudinal models, cat-only and dog-only groups were associated with feweremotional symptoms and peer problems compared with non-pet owners.

CONCLUSIONS:

Early school age is an important period for family pet acquisition. Pets may protect children from developing social-emotional problems and should be taken into account when assessing child development and school readiness. Children without siblings may benefit most in terms of their prosocial behavior.

Author/s:

Christian, H., Mitrou, F., Cunneen, R., Zubrick, S.R.