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Note: thesis: Thesis (M. P. H.)--Brown University, 2017
Genre (aat): theses
Abstract: Abstract 1: The Association of Length of Hospital Stays and Number of ED Visits with Executive Functioning Among Childhood Cancer Survivors Background: Childhood cancer survivors are at increased risk of executive dysfunction. Stimulating environment; whether at school, day care, or home results in cognitive growth. Children with complicated health issues visit Emergency Departments (ED) multiple times in a school year and spend a very high number of days in the hospital, which can interfere with normal development. Objective: The current study aims to understand the association of total of hospital days and number of ED visits with executive functioning of children with cancer. Methods: We used a cohort of 77 childhood cancer survivors for this study. Parents were asked to complete several surveys and additional information was collected from the medical record and administrative data sets. Total hospital days and number of ED visits and were derived from the medical record and administrative dataset and executive functioning was assessed by a parent-rated instrument, the Behavior Rating Inventory of Executive Functions (BRIEF). Multiple linear regressions were used to determine the relationship between total hospital days and BRIEF scores and number of ED visits and BRIEF scores. Results: There is a positive correlation between number of ED visits and executive functioning, as measured by the BRIEF parent report scale. Moreover, there is a positive correlation between total hospital days and global score of executive dysfunction on the BRIEF. In multiple linear regressions, children with higher number of ED visits had more problems reported in multiple aspects of executive functioning; moreover, children with higher number of total hospital days had more problems with Global Executive Composite (GEC) component of executive functioning after adjusting for co-variables. Conclusion: An association was found between ED visits and length of hospitalization on parent-reported executive functioning. ED visits and hospitalization are often related to medical complications, and may reflect severity of illness, but may also influence children’s ability to participate in school and other aspects of normal development. Follow-up prospective studies with a longer duration are needed to explore potential confounds and understand the course of this relationship. Abstract 2: The Association of Neighborhood Poverty Status and Executive Functioning Among Childhood Cancer Survivors. Background: Childhood cancer survivors are at increased risk of developing executive dysfunction. Low socioeconomic status (SES) has been associated with poor executive functioning in childhood cancer survivors previously, but all the previous studies have used traditional measures of SES, based on parents’ education level, family annual income and occupation. Objective: The current study aims to understand the association of resource-limited environment, as measured by percentage of households in neighborhood of residence below the federal poverty level with executive functioning among children with cancer. Methods: We used a retrospective cohort of 67 childhood cancer survivors. Relevant information was collected from the medical record, administrative data sets and parent-filled surveys. Address information was geocoded using ArcGIS 10.2 to obtain data on the neighborhood of residence (i.e. block group poverty status). A priori cut-points were set to represent neighborhoods with children living below poverty level at 0%, 0.1% to 9.9%, and ≥10.0%. Executive functioning were assessed through a parent-rated instrument, the Behavior Rating Inventory of Executive Functions (BRIEF). Multiple linear regressions were used to determine the relationship between neighborhood poverty status and the BRIEF scores. Results: The mean scores for GEC, MI and BRI are not related to poverty status of neighborhood of residence. There was no statistically significant association seen between block group poverty status and executive functioning after adjusting for co variables in the final model. Conclusion: Future prospective study with a bigger sample size, longer follow up period and more robust measures of the executive functioning like a clinician administered test are needed to understand the effect of neighborhood poverty status on executive functioning.
Subject (fast) (authorityURI="http://id.worldcat.org/fast", valueURI="http://id.worldcat.org/fast/00845411")
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Subject (fast) (authorityURI="http://id.worldcat.org/fast", valueURI="http://id.worldcat.org/fast/01893671")
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Identifier: DOI: 10.26300/ha82-1905
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