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Purpose/hypothesis: The purpose of this study was to use the National Survey of Children's Health 2011/2012 (NSCH 2011/12) data set to determine if children with diagnosed mental health disorders (MHD) (depression and/or anxiety) have delayed or missed preventative healthcare services (medical, dental, vision care), and if their parents reported difficulty getting them the care they need at a different rate than children without MHD. Population of interest: Children (0-18 years of age) and their guardians who completed the survey were included in the analyses. Methods: For both hypotheses, we defined subject’s exposure (having MHD) and outcome (missed or delayed care/problem getting care) based on parental response to interview questions (N = 73,632,881). Covariates adjusted for in our models included child/parent demographics, insurance status, household employment, and DHHS poverty level. Both research questions were evaluated using multi-variable logistic regression (adjusted as necessary using the correct sampling methods as suggested by the NSCH). Results: The odds of having missing or delayed care for a child with MHD were 2.24 times higher (95% CI: 1.82-2.77) than a child without MHD. The odds of the parent reporting problems getting care for a child with MHD were 2.11 times higher (95% CI: 1.74-2.60) than a child without MHD. Clinical Relevance: These findings highlight a need to focus on finding ways to promote and provide all of the healthcare that a child needs. Children with MHD have many healthcare needs that other children may not, but they still need adequate preventative care. This may bring the specific needs of a population needing extra help to the attention of healthcare providers and outreach programs. / Epidemiology

Introduction: Sepsis is a major source of morbidity and mortality in neonates; however, identification of the causative pathogens can be challenging. Next generation sequencing (NGS) is a high-throughput, parallel sequencing technique for DNA. Pathogen-targeted enrichment followed by NGS has the potential to be more sensitive and faster than current gold-standard blood culture. In this pilot study, we will test the feasibility and pathogen detection patterns of pathogen-targeted NGS in neonates with suspected sepsis. Additionally, the distribution and diagnostic accuracy of cell-free DNA and protein C levels at two time points will be explored. Methods: We will conduct a prospective, pilot observational study. Neonates over 1 kg with suspected sepsis from a single tertiary care children’s hospital will be recruited for the study. Recruitment will be censored at 200 events or 6 months duration. Two blood study samples will be taken: the first simultaneous to the blood culture (time = 0 hr, for NGS and biomarkers) via an exception to consent (deferred consent) and another 24 hours later after prospective consent (biomarkers only). Neonates will be adjudicated into those with clinical sepsis, culture-proven sepsis and without sepsis based on clinical criteria. Feasibility parameters (e.g. recruitment) and NGS process time will be reported. Analysis: NGS results will be described in aggregate, compared to the simultaneous blood culture (sensitivity and specificity) and reviewed via expert panel for plausibility. Pilot data for biomarker distribution and diagnostic accuracy (sensitivity and specificity) for distinguishing between septic and non-septic neonates will be reported. Study amendment and interim results: After obtaining ethics approval, study enrolment started October 15, 2020. Interim feasibility results showed successful deferred consent, but low enrolment. A study amendment was used to increase enrolment, create pre-packaged blood kits and implement a substitute decision maker Notification form. / Thesis / Master of Health Sciences (MSc)