The effects of daycare participation for children

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Sex differences in demographic and clinical characteristics of psychogenic nonepileptic seizures: A retrospective multicenter international study

Purpose Sex-related differences have been reported in patients with neurological and psychiatric disorders. It is also plausible to assume that there might be differences between females and males with psychogenic nonepileptic seizures (PNES). Methods In this retrospective study, we investigated patients with PNES, who were admitted to the epilepsy monitoring units at centers in Iran, the USA, Canada, Brazil, Argentina, and Venezuela. Age, sex, age at seizure onset, seizure semiology, factors potentially predisposing to PNES, and video-electroencephalography recording of all patients were registered routinely. Results Four hundred and fifty-one patients had PNES-only and were eligible for inclusion; 305 patients (67.6%) were females. We executed a logistic regression analysis, evaluating significant variables in univariate analyses (i.e., age, age at onset, aura, presence of historical sexual or physical abuse, and family dysfunction). The only variables retaining significance were historical sexual abuse (p = 0.005) and presence of aura (p = 0.01); physical abuse was borderline significant (p = 0.05) (all three were more prevalent among females). Conclusion Similarities between females and males outweigh the differences with regard to the demographic and clinical characteristics of PNES. However, notable differences are that females more often report lifetime adverse experiences (sexual and probably physical abuse) and auras. While social, psychological, and genetic factors may interact with lifetime adverse experiences in the inception of PNES, the link is not yet clear. This is an interesting avenue for future studies.Fil: Asadi Pooya, Ali A.. Shiraz University of Medical Sciences; Irán. Thomas Jefferson University; Estados UnidosFil: Myers, Lorna. Northeast Regional Epilepsy Group; Estados UnidosFil: Valente, Kette Dualibi Ramos. Universidade de Sao Paulo; BrasilFil: Daza Restrepo, Anilu. La Trinidad Medical Center; VenezuelaFil: D`alessio, Luciana. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; ArgentinaFil: Sawchuk, Tyson. Alberta Children's Hospital; Canadá. University of Nicosia; ChipreFil: Homayoun, Maryam. Shiraz University of Medical Sciences; IránFil: Bahrami, Zahra. Shiraz University of Medical Sciences; IránFil: Alessi, Rudá. Universidade de Sao Paulo; BrasilFil: Paytan, Angélica Aroni. La Trinidad Medical Center; VenezuelaFil: Kochen, Sara Silvia. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; ArgentinaFil: Buchhalter, Jeffrey. Alberta Children's Hospital; Canadá. University of Calgary; CanadáFil: Taha, Firas. Northeast Regional Epilepsy Group; Estados UnidosFil: Lazar, Lorraine M.. Northeast Regional Epilepsy Group; Estados UnidosFil: Pick, Susannah. Kings' College London; Reino UnidoFil: Nicholson, Timothy. Kings' College London; Reino Unid

Clinical characteristics of psychogenic nonepileptic seizures across the lifespan:An international retrospective study

Purpose: Previous studies from a few countries have reported semiological differences in younger children compared with adolescents or adults with psychogenic nonepileptic seizures (PNESs). This study tested the hypothesis that semiological, demographic, and historical risk factors vary with different ages of PNES onset in a large cohort from different countries. Methods: In this retrospective study, we investigated patients consecutively referred for PNES, who were admitted to epilepsy monitoring units in Iran, Brazil, Venezuela, Canada, Argentina, and USA. Age, gender, age at seizure onset, seizure semiology, and factors predisposing to PNES (abuse, stressors) were documented according to routine diagnostic practices at each center. Participants were grouped according to their age at onset (i.e., childhood, adolescence, or adulthood). Results: A total of 448 patients were studied. Female predominance was associated with adolescent- (85/122, 70%) and adult-onset (190/270, 70%) but not in childhood-onset PNES (28/56, 50%) (p = 0.011). Event frequency in the month preceding the diagnosis was higher in the childhood- [x¯ = 50, standard deviation (sd) = 82, p = 0.025] versus adolescent- (x¯ = 24, sd = 36) or adult-onset groups (x¯ = 29, sd = 61). Significant between-group differences were observed for generalized body movements (p = 0.0001) and ictal injury (p = 0.027), suggesting more severe ictal presentations in adult-onset PNES compared with younger ages. Adult-onset patients were also more likely to be taking an unnecessary antiepileptic medication (p = 0.010). Conclusion: While PNES may present at any age, there appear to be notable differences across the lifespan with respect to some of the clinical characteristics. Further international and cross-cultural studies may reveal other interesting characteristics of PNES.Fil: Sawchuk, Tyson. Alberta Children's Hospital. Children's Comprehensive Epilepsy Center; Canadá. University of Nicosia. School of Social Sciences. Department of Psychology; ChipreFil: Asadi Pooya, Ali A.. Shiraz University of Medical Sciences. Shiraz Medical School; Irán. Thomas Jefferson University. Jefferson Comprehensive Epilepsy Center. Department of Neurology; Estados UnidosFil: Myers, Lorna. Northeast Regional Epilepsy Group; Estados UnidosFil: Valente, Kette D.. Universidade de Sao Paulo; BrasilFil: Restrepo, Anilu Daza. Universidade de Sao Paulo; BrasilFil: D'Alessio, Luciana. La Trinidad Medical Center. Epilepsy Unit; VenezuelaFil: Homayoun, Maryam. Shiraz University of Medical Sciences. Shiraz Medical School; IránFil: Bahrami, Zahra. Shiraz University of Medical Sciences. Shiraz Medical School; IránFil: Alessi, Rudá. Universidade de Sao Paulo; BrasilFil: Paytan, Angélica Aroni. La Trinidad Medical Center. Epilepsy Unit; VenezuelaFil: Kochen, Sara Silvia. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Taha, Firas. Northeast Regional Epilepsy Group; Estados UnidosFil: Lazar, Lorraine M.. Northeast Regional Epilepsy Group; Estados Unidos. Hackensack University Medical Center. Hackensack Meridian School of Medicine; Estados UnidosFil: Pick, Susannah. King's College London; Reino UnidoFil: Nicholson, Timothy R.. Kings' College London. Institute of Psychiatry, Psychology and Neuroscience. Section of Cognitive Neuropsychiatry; Reino UnidoFil: Buchhalter, Jeffrey. Alberta Children's Hospital. Children's Comprehensive Epilepsy Center; Canadá. University of Nicosia. School of Social Sciences. Department of Psychology; Chipre. University of Calgary; Canad

Pediatric-onset psychogenic nonepileptic seizures: A retrospective international multicenter study

Purpose: We compared various clinical characteristics of pediatric-onset psychogenic nonepileptic seizures(PNES) between patients from fie countries. The purpose of this study was to advance our understanding ofpediatric-onset PNES cross-culturally.Methods: In this retrospective study, we compared consecutive patients with PNES with an age at onset of 16years and younger from epilepsy monitoring units in Iran, Brazil, the USA, Canada, and Venezuela. Age, gender,age at seizure onset, seizure semiology, predisposing factors, and video-EEG recordings of all patients wereextracted. Pearson Chi-Square, one-way ANOVA and Bonferroni correction tests were used for statistical analyses.Results: Two hundred twenty-nine patients were studied (83 from Iran, 50 from Brazil, 39 from Canada, 30 fromthe USA, and 27 from Venezuela). Mean age at the onset of seizures was 12.1 ± 3.2 years (range: 4?16 years).The sex ratio of the patients was 1.83: 1 (148 females and 81 males). Clinical characteristics of pediatric-onsetPNES showed some signifiant diffrences among the nations. However, factors associated with pediatric-onsetPNES in these fie nations were similar.Conclusion: This study underscores how international cross-cultural studies can make important contributions toour understanding of PNES. Patients with pediatric-onset PNES from diffrent countries were similar on manyrisk factors associated with PNES. This suggests universality in many features of PNES. However, intriguingdiffrences were also noted with regard to seizure semiology, which might be the result of cultural factors.Fil: Asadi Pooya, Ali A.. Universidad de Ciencias Médicas, Shiraz; Irán. Universidad Thomas Jefferson; Estados UnidosFil: Myers, Lorna. Grupo regional de epilepsia del noreste; Estados UnidosFil: Valente, Kette. Universidad de Sao Paulo; BrasilFil: Sawchuk, Tyson. Hospital de niños de Alberta, Calgary; Canadá. Universidad de Nicosia; ChipreFil: Daza Restrepo, Anilu. Centro Médico La Trinidad; VenezuelaFil: Homayouna, Maryam. Universidad de Ciencias Médicas, Shiraz; IránFil: Buchhalter, Jeffey. Universidad de Nicosia; Chipre. Universidad de Calgary; CanadáFil: Bahramia, Zahra. Universidad de Ciencias Médicas, Shiraz; IránFil: Taha, Firas. Grupo regional de epilepsia del noreste; Estados UnidosFil: Lazar, Lorraine M.. Grupo regional de epilepsia del noreste; Estados UnidosFil: Aroni Paytan, Angélica. Centro Médico La Trinidad; VenezuelaFil: D`alessio, Luciana. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; ArgentinaFil: Kochen, Sara Silvia. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; Argentina; ArgentinaFil: Alessi, Rudá. Universidad de Sao Paulo; BrasilFil: Pick, Susannah. Instituto de Psiquiatría, Psicología y Neurociencia, King's College London; Reino UnidoFil: Nicholson, Timothy R.. Instituto de Psiquiatría, Psicología y Neurociencia, King's College London; Reino Unid

Creation and implementation of an electronic health record note for quality improvement in pediatric epilepsy: Practical considerations and lessons learned.

ObjectiveTo describe the development of the Pediatric Epilepsy Outcome-Informatics Project (PEOIP) at Alberta Children's Hospital (ACH), which was created to provide standardized, point-of-care data entry; near-time data analysis; and availability of outcome dashboards as a baseline on which to pursue quality improvement.MethodsStakeholders involved in the PEOIP met weekly to determine the most important outcomes for patients diagnosed with epilepsy, create a standardized electronic note with defined fields (patient demographics, seizure and syndrome type and frequency and specific outcomes- seizure type and frequency, adverse effects, emergency department visits, hospitalization, and care pathways for clinical decision support. These were embedded in the electronic health record from which the fields were extracted into a data display platform that provided patient- and population-level dashboards updated every 36 hours. Provider satisfaction and family experience surveys were performed to assess the impact of the standardized electronic note.ResultsIn the last 5 years, 3,245 unique patients involving 13, 831 encounters had prospective, longitudinal, standardized epilepsy data accrued via point-of-care data entry into an electronic note as part of routine clinical care. A provider satisfaction survey of the small number of users involved indicated that the vast majority believed that the note makes documentation more efficient. A family experience survey indicated that being provided with the note was considered "valuable" or "really valuable" by 86% of respondents and facilitated communication with family members, school, and advocacy organizations.SignificanceThe PEOIP serves as a proof of principle that information obtained as part of routine clinical care can be collected in a prospective, standardized, efficient manner and be used to construct filterable process/outcome dashboards, updated in near time (36 hours). This information will provide the necessary baseline data on which multiple of QI projects to improve meaningful outcomes for children with epilepsy will be based

Creation and implementation of an electronic health record note for quality improvement in pediatric epilepsy: Practical considerations and lessons learned.

ObjectiveTo describe the development of the Pediatric Epilepsy Outcome-Informatics Project (PEOIP) at Alberta Children's Hospital (ACH), which was created to provide standardized, point-of-care data entry; near-time data analysis; and availability of outcome dashboards as a baseline on which to pursue quality improvement.MethodsStakeholders involved in the PEOIP met weekly to determine the most important outcomes for patients diagnosed with epilepsy, create a standardized electronic note with defined fields (patient demographics, seizure and syndrome type and frequency and specific outcomes- seizure type and frequency, adverse effects, emergency department visits, hospitalization, and care pathways for clinical decision support. These were embedded in the electronic health record from which the fields were extracted into a data display platform that provided patient- and population-level dashboards updated every 36 hours. Provider satisfaction and family experience surveys were performed to assess the impact of the standardized electronic note.ResultsIn the last 5 years, 3,245 unique patients involving 13, 831 encounters had prospective, longitudinal, standardized epilepsy data accrued via point-of-care data entry into an electronic note as part of routine clinical care. A provider satisfaction survey of the small number of users involved indicated that the vast majority believed that the note makes documentation more efficient. A family experience survey indicated that being provided with the note was considered "valuable" or "really valuable" by 86% of respondents and facilitated communication with family members, school, and advocacy organizations.SignificanceThe PEOIP serves as a proof of principle that information obtained as part of routine clinical care can be collected in a prospective, standardized, efficient manner and be used to construct filterable process/outcome dashboards, updated in near time (36 hours). This information will provide the necessary baseline data on which multiple of QI projects to improve meaningful outcomes for children with epilepsy will be based