Geographic Distribution of Pediatric Rheumatology Referrals in Southwestern Ontario: The Association of Travel Distance with Visit Frequency in Juvenile Idiopathic Arthritis
Notice bibliographique
Résumé
Objectives: Few studies in children with chronic illnesses/disability have reported challenges faced by patients at school.Therefore, the objective of this study is to identify barriers and their associated impact in juvenile idiopathic arthritis (JIA).Methods: A cross-sectional observational study of children aged 8 to 17 diagnosed with JIA followed at the Rheumatology Clinic/Alberta Children's Hospital was performed between July and October 2016.Demographics, diagnosis and disease course were obtained from health records.A survey was administered to the child/caregiver to assess the barriers experienced by JIA patients at school.The questionnaire collected information about school attendance/performance, impact of JIA symptoms (e.g.pain, fatigue), accommodations, communication, participation/peers, and school support.An overall rating for each domain was made.Descriptive statistics were used to analyze the data.Results: A total of 53 children were recruited into the study.The median age of participants was 13 (range 8-17).The most common subtypes were oligoarticular persistent JIA (31.4%) and rheumatoid factor negative polyarticular JIA (27.5%) with a median disease duration of 5 years (range 0-13).The treatment included DMARDS (71.1%),NSAIDS (41.5%), biologics (41.5%), steroids (5.7%) and no medication (3.8%).Appointments, illness and JIA symptoms had a minor impact on school attendance/performance.However, physical challenges (e.g.gym, writing, sitting for long periods of time) at school were a barrier for 42.2% (sometimes 28.8%, often 9.6%, almost always 3.8%).20% recorded using accommodations (e.g.accommodation letter, modified gym, computer access).Patients were unable to participate in activities in class/outside with their peers (total 40%: sometimes 36.4%,almost always 3.6%) and in gym (total 43.1%: sometimes 33.3%, often 9.8%).Challenges tend to be reported more often by patients with active disease.Patients told their teachers/gym teacher about their disease (86%) but most patients did not continue to update their teachers.10.9% of participants reported that their teachers did not understand their illness compared to 18.1% of gym teachers.85.2% of participants told their friends about their illness and 47% told their classmates.Social concerns included anxiety about being unable to participate in school related activities, being told they were faking their illness and looking like they weren't trying.The majority reported that the school was supportive of their illness (91.8%). Conclusion:The majority of JIA patients reported they experienced minimal impact on school attendance and performance.However, many patients experienced some impacting physical challenges.Additional barriers included teacher understanding, communication with classmates and social anxiety.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».