Browsing by Author "Christakis, Dimitri A."

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    Digital Media and Developing Brains: Concerns and Opportunities
    (Springer, 2024) Hutton, John S.; Piotrowski, Jessica Taylor; Bagot, Kara; Blumberg, Fran; Canli, Turhan; Chein, Jason; Christakis, Dimitri A.; Grafman, Jordan; Griffin, James A.; Hummer, Tom; Kuss, Daria J.; Lerner, Matthew; Marcovitch, Stuart; Paulus, Martin P.; Perlman, Greg; Romeo, Rachel; Thomason, Moriah E.; Turel, Ofir; Weinstein, Aviv; West, Gregory; Hurst‑Della Pietra, Pamela; Potenza, Marc N.; Psychiatry, School of Medicine
    Purpose of review: The incorporation of digital technologies and their use in youth's everyday lives has been increasing rapidly over the past several decades with possible impacts on youth development and mental health. This narrative review aimed to consider how the use of digital technologies may be influencing brain development underlying adaptive and maladaptive screen-related behaviors. Recent findings: To explore and provide direction for further scientific inquiry, an international group of experts considered what is known, important gaps in knowledge, and how a research agenda might be pursued regarding relationships between screen media activity and neurodevelopment from infancy through childhood and adolescence. While an understanding of brain-behavior relationships involving screen media activity has been emerging, significant gaps exist that have important implications for the health of developing youth. Summary: Specific considerations regarding brain-behavior relationships involving screen media activity exist for infancy, toddlerhood, and early childhood; middle childhood; and adolescence. Transdiagnostic frameworks may provide a foundation for guiding future research efforts. Translating knowledge gained into better interventions and policy to promote healthy development is important in a rapidly changing digital technology environment.
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    EHR-based Case Identification of Pediatric Long COVID: A Report from the RECOVER EHR Cohort
    (medRxiv, 2024-05-23) Botdorf, Morgan; Dickinson, Kimberley; Lorman, Vitaly; Razzaghi, Hanieh; Marchesani, Nicole; Rao, Suchitra; Rogerson, Colin; Higginbotham, Miranda; Mejias, Asuncion; Salyakina, Daria; Thacker, Deepika; Dandachi, Dima; Christakis, Dimitri A.; Taylor, Emily; Schwenk, Hayden; Morizono, Hiroki; Cogen, Jonathan; Pajor, Nate M.; Jhaveri, Ravi; Forrest, Christopher B.; Bailey, L. Charles; RECOVER Consortium; Pediatrics, School of Medicine
    Objective: Long COVID, marked by persistent, recurring, or new symptoms post-COVID-19 infection, impacts children's well-being yet lacks a unified clinical definition. This study evaluates the performance of an empirically derived Long COVID case identification algorithm, or computable phenotype, with manual chart review in a pediatric sample. This approach aims to facilitate large-scale research efforts to understand this condition better. Methods: The algorithm, composed of diagnostic codes empirically associated with Long COVID, was applied to a cohort of pediatric patients with SARS-CoV-2 infection in the RECOVER PCORnet EHR database. The algorithm classified 31,781 patients with conclusive, probable, or possible Long COVID and 307,686 patients without evidence of Long COVID. A chart review was performed on a subset of patients (n=651) to determine the overlap between the two methods. Instances of discordance were reviewed to understand the reasons for differences. Results: The sample comprised 651 pediatric patients (339 females, M age = 10.10 years) across 16 hospital systems. Results showed moderate overlap between phenotype and chart review Long COVID identification (accuracy = 0.62, PPV = 0.49, NPV = 0.75); however, there were also numerous cases of disagreement. No notable differences were found when the analyses were stratified by age at infection or era of infection. Further examination of the discordant cases revealed that the most common cause of disagreement was the clinician reviewers' tendency to attribute Long COVID-like symptoms to prior medical conditions. The performance of the phenotype improved when prior medical conditions were considered (accuracy = 0.71, PPV = 0.65, NPV = 0.74). Conclusions: Although there was moderate overlap between the two methods, the discrepancies between the two sources are likely attributed to the lack of consensus on a Long COVID clinical definition. It is essential to consider the strengths and limitations of each method when developing Long COVID classification algorithms.
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    Real-world Effectiveness of BNT162b2 Against Infection and Severe Diseases in Children and Adolescent
    (medRxiv, 2023-11-13) Wu, Qiong; Tong, Jiayi; Zhang, Bingyu; Zhang, Dazheng; Chen, Jiajie; Lei, Yuqing; Lu, Yiwen; Wang, Yudong; Li, Lu; Shen, Yishan; Xu, Jie; Bailey, L. Charles; Bian, Jiang; Christakis, Dimitri A.; Fitzgerald, Megan L.; Hirabayashi, Kathryn; Jhaveri, Ravi; Khaitan, Alka; Lyu, Tianchen; Rao, Suchitra; Razzaghi, Hanieh; Schwenk, Hayden T.; Wang, Fei; Witvliet, Margot I.; Tchetgen Tchetgen, Eric J.; Morris, Jeffrey S.; Forrest, Christopher B.; Chen, Yong; Pediatrics, School of Medicine
    Background: The efficacy of the BNT162b2 vaccine in pediatrics was assessed by randomized trials before the Omicron variant's emergence. The long-term durability of vaccine protection in this population during the Omicron period remains limited. Objective: To assess the effectiveness of BNT162b2 in preventing infection and severe diseases with various strains of the SARS-CoV-2 virus in previously uninfected children and adolescents. Design: Comparative effectiveness research accounting for underreported vaccination in three study cohorts: adolescents (12 to 20 years) during the Delta phase, children (5 to 11 years) and adolescents (12 to 20 years) during the Omicron phase. Setting: A national collaboration of pediatric health systems (PEDSnet). Participants: 77,392 adolescents (45,007 vaccinated) in the Delta phase, 111,539 children (50,398 vaccinated) and 56,080 adolescents (21,180 vaccinated) in the Omicron period. Exposures: First dose of the BNT162b2 vaccine vs. no receipt of COVID-19 vaccine. Measurements: Outcomes of interest include documented infection, COVID-19 illness severity, admission to an intensive care unit (ICU), and cardiac complications. The effectiveness was reported as (1-relative risk)*100% with confounders balanced via propensity score stratification. Results: During the Delta period, the estimated effectiveness of BNT162b2 vaccine was 98.4% (95% CI, 98.1 to 98.7) against documented infection among adolescents, with no significant waning after receipt of the first dose. An analysis of cardiac complications did not find an increased risk after vaccination. During the Omicron period, the effectiveness against documented infection among children was estimated to be 74.3% (95% CI, 72.2 to 76.2). Higher levels of effectiveness were observed against moderate or severe COVID-19 (75.5%, 95% CI, 69.0 to 81.0) and ICU admission with COVID-19 (84.9%, 95% CI, 64.8 to 93.5). Among adolescents, the effectiveness against documented Omicron infection was 85.5% (95% CI, 83.8 to 87.1), with 84.8% (95% CI, 77.3 to 89.9) against moderate or severe COVID-19, and 91.5% (95% CI, 69.5 to 97.6)) against ICU admission with COVID-19. The effectiveness of the BNT162b2 vaccine against the Omicron variant declined after 4 months following the first dose and then stabilized. The analysis revealed a lower risk of cardiac complications in the vaccinated group during the Omicron variant period. Limitations: Observational study design and potentially undocumented infection. Conclusions: Our study suggests that BNT162b2 was effective for various COVID-19-related outcomes in children and adolescents during the Delta and Omicron periods, and there is some evidence of waning effectiveness over time.