Geographic Distribution of Pediatric Rheumatology Referrals in Southwestern Ontario: The Association of Travel Distance with Visit Frequency in Juvenile Idiopathic Arthritis
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".