Do parental stimulation practices modify the effect of child’s health status on early developmental risk? Findings from a hospitalized cohort

The current study conducted in Pakistan aimed to test if parental stimulation practices modify the effect of general child health status on early developmental risks in hospitalized children. Development was assessed using the Survey of Well-being of Young Children. Child health status was a global rating on a Likert scale. Parental engagement was categorized based on the number of activities with their children (low ≤ 3, high > 3). A total of 231 children were assessed. Children with poor health status were reported to be 1.9 (95% Confidence Intervals [CI] 1.4–2.8, p = 0.000) times at risk of developmental delay by parents who had lower engagement and about 3 times (3.63 for mothers CI 1.79–7.37, p = 0.003; 2.96 for fathers CI 1.17–7.49, p = 0.027) significantly at risk of behaviour–emotional concerns by parents with higher engagement. The authors conclude that parental engagement and developmental screening can be incorporated as part of in-patient paediatric assessment.publishedVersio

COHESION: a core outcome set for the treatment of neonatal encephalopathy

BACKGROUND: Heterogeneity in outcomes reported in trials of interventions for the treatment of neonatal encephalopathy (NE) makes evaluating the effectiveness of treatments difficult. Developing a core outcome set for NE treatment would enable researchers to measure and report the same outcomes in future trials. This would minimise waste, ensure relevant outcomes are measured and enable evidence synthesis. Therefore, we aimed to develop a core outcome set for treating NE.METHODS: Outcomes identified from a systematic review of the literature and interviews with parents were prioritised by stakeholders (n = 99 parents/caregivers, n = 101 healthcare providers, and n = 22 researchers/ academics) in online Delphi surveys. Agreement on the outcomes was achieved at online consensus meetings attended by n = 10 parents, n = 18 healthcare providers, and n = 13 researchers/ academics.RESULTS: Seven outcomes were included in the final core outcome set: survival; brain injury on imaging; neurological status at discharge; cerebral palsy; general cognitive ability; quality of life of the child, and adverse events related to treatment.CONCLUSION: We developed a core outcome set for the treatment of NE. This will allow future trials to measure and report the same outcomes and ensure results can be compared. Future work should identify how best to measure the COS

Do parental stimulation practices modify the effect of child’s health status on early developmental risk? Findings from a hospitalized cohort

The current study conducted in Pakistan aimed to test if parental stimulation practices modify the effect of general child health status on early developmental risks in hospitalized children. Development was assessed using the Survey of Well-being of Young Children. Child health status was a global rating on a Likert scale. Parental engagement was categorized based on the number of activities with their children (low ≤ 3, high > 3). A total of 231 children were assessed. Children with poor health status were reported to be 1.9 (95% Confidence Intervals [CI] 1.4–2.8, p = 0.000) times at risk of developmental delay by parents who had lower engagement and about 3 times (3.63 for mothers CI 1.79–7.37, p = 0.003; 2.96 for fathers CI 1.17–7.49, p = 0.027) significantly at risk of behaviour–emotional concerns by parents with higher engagement. The authors conclude that parental engagement and developmental screening can be incorporated as part of in-patient paediatric assessment

COHESION: A core outcome set for the treatment of neonatal encephalopathy

Background: Heterogeneity in outcomes reported in trials of interventions for the treatment of neonatal encephalopathy (NE) makes evaluating the effectiveness of treatments difficult. Developing a core outcome set for NE treatment would enable researchers to measure and report the same outcomes in future trials. This would minimise waste, ensure relevant outcomes are measured and enable evidence synthesis. Therefore, we aimed to develop a core outcome set for treating NE.Methods: Outcomes identified from a systematic review of the literature and interviews with parents were prioritised by stakeholders (n = 99 parents/caregivers, n = 101 healthcare providers, and n = 22 researchers/ academics) in online Delphi surveys. Agreement on the outcomes was achieved at online consensus meetings attended by n = 10 parents, n = 18 healthcare providers, and n = 13 researchers/ academics.Results: Seven outcomes were included in the final core outcome set: survival; brain injury on imaging; neurological status at discharge; cerebral palsy; general cognitive ability; quality of life of the child, and adverse events related to treatment.Conclusion: We developed a core outcome set for the treatment of NE. This will allow future trials to measure and report the same outcomes and ensure results can be compared. Future work should identify how best to measure the COS.Impact: We have identified seven outcomes that should be measured and reported in all studies for the treatment of neonatal encephalopathy. Previously, a core outcome set for neonatal encephalopathy treatments did not exist. This will help to reduce heterogeneity in outcomes reported in clinical trials and other studies, and help researchers identify the best treatments for neonatal encephalopathy

Multi-round versus Real-Time Delphi survey approach for achieving consensus in the COHESION core outcome set: A randomised trial

Background: Delphi surveys are commonly used to prioritise critical outcomes in core outcome set (COS) development. This trial aims to compare a three-round (Multi-Round) Delphi (MRD) with a Real-Time Delphi (RTD) in the prioritisation of outcomes for inclusion in a COS for neonatal encephalopathy treatments and explore whether \u27feedback\u27, \u27iteration\u27, and \u27initial condition\u27 effects may occur in the two survey methods.Methods: We recruited 269 participants (parents/caregivers, healthcare providers and researchers/academics) of which 222 were randomised to either the MRD or the RTD. We investigated the outcomes prioritised in each survey and the \u27feedback\u27, \u27iteration\u27, and \u27initial condition\u27 effects to identify differences between the two survey methods.Results: In the RTD, n = 92 participants (83%) fully completed the survey. In the MRD, n = 60 participants (54%) completed all three rounds. Of the 92 outcomes presented, 26 (28%) were prioritised differently between the RTD and MRD. Significantly fewer participants amended their scores when shown stakeholder responses in the RTD compared to the MRD (\u27feedback effect\u27). The \u27iteration effect\u27 analysis found most experts appeared satisfied with their initial ratings in the RTD and did not amend their scores following stakeholder response feedback. Where they did amend their scores, ratings were amended substantially, suggesting greater convergence. Variance in scores reduced with subsequent rounds of the MRD (\u27iteration effect\u27). Whilst most participants did not change their initial scores in the RTD, of those that did, later recruits tended to align their final score more closely to the group mean final score than earlier recruits (an \u27initial condition\u27 effect).Conclusion: The feedback effect differed between the two Delphi methods but the magnitude of this difference was small and likely due to the large number of observations rather than because of a meaningfully large difference. It did not appear to be advantageous to require participants to engage in three rounds of a survey due to the low change in scores. Larger drop-out through successive rounds in the MRD, together with a lesser convergence of scores and longer time to completion, indicate considerable benefits of the RTD approach.Trial registration: NCT04471103. Registered on 14 July 2020

Molecular detection of Leishmania species in human and animals from cutaneous leishmaniasis endemic areas of Waziristan, Khyber Pakhtunkhwa, Pakistan

Objectives: To detect Leishmania species in human patients, animal reservoirs and Phlebotomus sandflies in Waziristan, Pakistan. Methods: Tissue smears and aspirates from 448 cutaneous leishmaniasis (CL) suspected patients were analyzed. To sort out role of the reservoir hosts, skin scrapings, spleen and liver samples from 104 rodents were collected. Furthermore, buffy coat samples were obtained from 60 domestic animals. Sandflies were also trapped. All human, animals and sandfly samples were tested by microscopy, kinetoplastic PCR and internal transcribed spacer 1 (ITS1) PCR followed by restriction fragment length polymorphism for detection of Leishmania species. Results: An overall prevalence of 3.83% and 5.21% through microscopy and ITS1 PCR respectively was found. However, the statistically non-significant correlation was found between area, gender, and number of lesions. The presence of rodents, sandflies, domestic animals and internally displaced people increased the risk of CL. Using ITS1-PCR-RFLP, Leishmania tropica (L. tropica) was confirmed in 106 samples while 25 of the isolates were diagnosed as Leishmania major (L. major). Similarly, 3/104 rodents were positive for L. major and 14 pools of DNA samples containing Phlebotomus sergenti sandflies were positive for L. tropica. None of samples from domestic animals were positive for leishmaniasis. Conclusions: In the present study, L. tropica and L. major are found to be the main causative agents of CL in study area. Movement of internally displaced people from CL endemic areas presents a risk for nearby CL free areas. To the best of our knowledge, we report for the first time L. major infection in rodents (Rattus rattus) and L. tropica in Phlebotomus sergenti sandflies trapped in Waziristan, Pakistan