Posters: Intervention/program description and/or evaluation
-
A Mixed Methods Study of a Family-paired Refugee Health Initiative Program on Medical Student Training
Presented by: Kendrew Wong (Medical Student, University of British Columbia)
Additional authors: Bader Al-Zeer (Medical Student, University of British Columbia); Vivian Ngo (Medical Student, University of British Columbia); Torin Halvorson (MD/PhD Student, University of British Columbia); Videsh Kapoor (Clinical Assistant Professor, Department of Family Practice, University of British Columbia)
The Refugee Health Initiative (RHI) is a program which pairs medical students with a refugee family for two years to help with resettlement and navigation of the Canadian healthcare system. The RHI program has not yet been evaluated for its benefit to medical students and their comfort in working with refugees, knowledge of refugee-related issues, using interpreter services, and cultural competency. As such, this study will describe the impact of RHI on UBC medical students. We hypothesize that students participating in the RHI program will demonstrate greater cultural competency and show heightened comfort levels or knowledge of refugee health issues.
-
CyPRESS: A CPR Training Program for Indigenous Youth in Rural BC
Presented by: Morgan Towriss (PhD Candidate, University of British Columbia); Marisa Dorling (Medical Student, University of British Columbia)
Additional authors: Rebekah Towriss (Nursing Student, Douglas College); Videsh Kapoor (Clinical Assistant Professor, Department of Family Practice, University of British Columbia)
cyPRESS is a project that provides CPR-training to Indigenous youth in communities in BC to increase healthcare capacity and reduce inequities. Indigenous communities often face disparities in accessing medical care, compounded by a history of medical discrimination. Building capacity within communities is an effective approach to Indigenous healthcare; cyPRESS aims to empower Indigenous youth with resources to respond to medical emergencies. The program has two objectives: to certify youth with Heartsaver-CPR-AED and to inspire interest in healthcare careers. The pilot project was conducted in April 2023, with 42 youth receiving certifications and demonstrating increased interest in first-aid-training and healthcare careers.
-
From top to bottom: Creating Equitable Change for Birthing People that Use Substances during their Birthing Experience in New Brunswick Hospitals.
Presented by: Sarah Lunney (Research Assistant/Student, NB Social Pediatrics/Horizon Health Network)
Additional authors: Sarah Gander (Pediatrician/Researcher, NB Social Pediatrics/Horizon Health Network); Sarah Campbell (Research Manager/Executive Director, NB Social Pediatrics/Horizon Health Network); Natalia Fana (Research Coordinator, NB Social Pediatrics/Horizon Health Network)
The poster discusses the way stigma towards birthing people who use substances (BPWUS) becomes embedded into provincial policies and regional health authority standards of care documents. Specifically, it presents the concept of birth alerts which were abolished by the New Brunswick (NB) provincial government in 2021. However, regional health authorities in NB did not update their Maternal and Newborn Standards to reflect the termination of the practice, resulting in clients in the Parent Child Assistance Program, a 3-year intervention for BPWUS during pregnancy, being exposed to the harmful and traumatizing practice of child apprehension immediately or soon after birth.
-
Healing the Hurt: Caring for Indigenous Moms and Babies—An Indigenous Community-Led Educational Resource on Culturally Safe Care for Healthcare Professionals
Presented by: Amy L. Wright (Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto); Rachel VanEvery (PhD Candidate. Department of Health, Aging and Society, McMaster University)
Additional authors: Era M. Ferron (Research Project Coordinator, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto)
An Advisory Board of Indigenous mothers, community members, and researchers developed an educational resource on culturally safe healthcare delivery for Indigenous families in Canada called, Healing the Hurt: Caring for Indigenous Moms and Babies. The resource features videos of Indigenous mothers recounting their hurtful and sometimes traumatic experiences while accessing healthcare. The videos, along with the other elements of the resource inform and educate healthcare professionals about the impact of discriminatory practices experienced by Indigenous Peoples and strategies on how to provide safer, warmer, and more accessible care.
Posters: Research Abstract
-
A Community-Based Participatory Approach to Expanding an Integrative Health Program for Street-Involved Youth
Presented by: Meagan McLaren (Senior Intern, Canadian College of Naturopathic Medicine); Samantha Helm (Senior Intern, Canadian College of Naturopathic Medicine)
Additional authors: June Zhang (Health Centre Manager, Evergreen Center for Street Involved Youth; Yonge Street Mission); Leslie Solomonian (Professor, Canadian College of Naturopathic Medicine)
Street-involved youth (SIY) encounter unique determinants of poor health, which compound and are compounded by decreased access to healthcare services. Predicated on the premise that health care is more than just management of disease, we seek to develop a youth-informed holistic, integrative health promotion program that extends beyond the “health center.” This poster describes a three-stage strategy to engage in a community-based participatory approach to designing, implementing and evaluating an expanded integrative program.
-
Adolescents’ and Their Parents’ Experiences & Perspectives of Genetic Testing and Its Personal Utility
Presented by: Daniel Assamad (Clinical Project Research Coordinator, SickKids Hospital)
Additional authors: Robin Hayeems (Scientist, SickKids Hospital); Tasha Wainstein (PhD Candidate, University of British Columbia); Alison Elliott (Associate Professor, University of British Columbia)
Personal utility of a diagnostic genetic test refers to its value from the perspective of the patient. We interviewed adolescents and their parents who received genetic testing to understand their perspectives on the personal utility of their results. We developed and tested a new outcome measure tool, the Adolescent-reported Genetic testing Utility InDEx (A-GUIDE). We demonstrate that genetic results can have significant personal utility and complex emotional implications. Adolescents and their parents seem to perceive personal utility differently. Highlighting that personal utility should be considered from the perspectives and adolescents and the need for validated population specific outcome measurement tools.
-
A Labour of Love: Consequences of Caregiving for an Autistic Child on Mothers’ Employment, Financial Status, and Well-being
Presented by: Janet McLaughlin (Associate Professor, Wilfrid Laurier University)
Additional authors: Vanessa Fong (Postdoctoral Fellow, University of British Columbia); Margaret Schneider (Associate Professor, Wilfrid Laurier University)
The current study sought to: 1) Compare the average annual incomes between mothers and fathers; 2) Examine the link between hours spent navigating services and emotional well-being in mothers; 3) Explore the impact of caregiving on mothers’ employment. Results from 900 mothers of autistic children showed that they report a significantly lower annual income when compared to fathers. The number of hours spent navigating/accessing services predicted emotional well-being for mothers. Qualitative findings revealed various impacts of caregiving on mothers’ employment. Policies are urgently needed which recognize the important contributions that caregivers provide to the health and social service system.
-
Asian-Canadian Youths’ Mental Health Barriers During the COVID-19 Pandemic: Exploring Intersecting Inequities Through Visual Arts-based Research Methods
Presented by: Attia Khan (Post-Doctoral Fellow, Faculty of Health, York University)
Additional authors: Nazilla Khanlou (Professor, School of Nursing, Women’s Health Research Chair in Mental Health, York University); Luz Maria Vazquez (Contract Faculty, Department of Social Science. Research Associate/Coordinator, Faculty of Health, York University); Nasteho Hasan (Research Assistant, Office of Women’s Health Research Chair in Mental Health, Faculty of Health, York University); Josephine Mary Viole Francis Xavier (Research Assistant, Office of the Women’s Health Research in Mental Health, Faculty of Health, York University); Lisa Seto Nielsen (Associate Professor School of Nursing, Faculty of Health, York University); Fernando Nunes (Associate Professor Department of Child & Youth Study, Mount Saint Vincent University); Deborah A Davidson (Associate Professor, Department of Sociology, York University); Michelle Skop (Associate Professor, Faculty of Social Work, Wilfrid Laurier University)
We report findings from an ongoing study exploring the pandemic-related mental health barriers of Asian-Canadian youth. Using visual arts-based method youth (16-24 years) of Chinese, Filipino and Indian background were interviewed in-person (n = 6) and virtually (n = 25). The impacts of the pandemic on youths’ mental health were: 1) Financial challenges; 2) Racism and xenophobia; and 3) Lack of mental health support. Recommendations include: 1) provision of culturally safe accessible mental health support specific to Asian-Canadian youth and families; and 2) more representation of Asian-Canadian voices in the media and highlighting the intersections of racism and mental health.
-
Assessing Vitamin D Levels Among African Canadian Children and Adults with Serological Evidence of COVID-19
Presented by: Nicole Wisener (Clinical Research Project Assistant, The Hospital for Sick Children)
Additional authors: Walter Byrne (Clinical Research Project Assistant, Hospital for Sick Children); Matthew Hwang (Clinical Research Project Assistant, Hospital for Sick Children); Alicia Polack (Paediatric Resident, The Hospital for Sick Children); Mariana Abdul-noor (Clinical Research Project Coordinator, The Hospital for Sick Children); Alice Litosh (Clinical Research Nurse Coordinator, Hospital for Sick Children); Maria Rosa La Neve (Clinical Research Nurse Coordinator, Hospital for Sick Children); Kimberly Thompson (Clinical Research Project Assistant, The Hospital for Sick Children); Carl James (Professor, York University); Upton Allen (Department Head of Infectious Diseases, Hospital for Sick Children)
Previous reports suggested a potential role of vitamin D in COVID-19 susceptibility and outcomes. Given that vitamin D deficiency is observed across different age groups in Canada, including among African (Black) Canadian populations, we sought to examine the relationships between vitamin D levels, COVID-19 serology, age, and race, and to compare vitamin D levels among children versus adults.
-
A Systematic Review of Community Engagement in Health Equity Research Published in High Impact Medical Journals
Presented by: Janavi Shetty (Research Coordinator, Edwin S.H. Leong Centre for Healthy Children)
Additional authors: Priscilla Medeiros (Knowledge Mobilization & Community Engagement Specialist, Edwin S.H. Leong Centre for Healthy Children); Luiza Lamaj (Student, Toronto Metropolitan University); Susitha Wanigaratne (Senior Research Associate, Edwin S.H. Leong Centre for Healthy Children); Astrid Guttmann (Co-Director, Edwin S.H. Leong Centre for Healthy Children); Eyal Cohen (Co-Director, Edwin S.H. Leong Centre for Healthy Children)
By conducting a systematic review, we aimed to assess the reporting of community engagement in health equity-focused research published in high impact medical journals. We defined “health equity-focused” using the PROGRESS-PLUS Criteria, and evaluated articles for community engagement at all stages of the research process. Our search yielded 625 health equity-focused articles published by the JAMA Network, NEJM Group, and The Lancet Group, of which 98 included community engagement. Our findings suggest that there is a need for increased community engagement in the design and conduct of health equity-focused research published in high impact medical journals.
-
Availability and Impact of Social Determinants of Health Data in the Electronic Health Record of Pediatric Ophthalmology Patients
Presented by: Omer Jamal (Masters of Science Candidate, Institute of Medical Sciences and the Hospital for Sick Children)
Additional authors: Helen Dimaras (Scientist and Director of Global Eye Health Research, The Hospital for Sick Children)
Children in a stage of rapid growth and development, are especially vulnerable to the negative effects of the Social Determinants of Health (SDOH). Currently, in pediatric ophthalmology there is a knowledge gap, especially at SickKids, as data on SDOH and health outcomes is less prevalent. The overall purpose of this study is to explore the relationship between the Social Determinants of Health (SDOH) and SickKids Department of Ophthalmology and Vision Sciences (DOVS) patients’ experiences of health inequities. Furthermore, the research seeks to investigate if the relationship between the SDOH and DOVS patients’ health inequities were influenced by the COVID-19 pandemic.
-
Exploring Indigenous Families’ Autism Service Needs and Priorities: A Step Towards Improving Equity
Presented by: Margaret Schneider (Associate Professor, Wilfrid Laurier University)
Additional authors: Janet McLaughlin (Associate Professor, Wilfrid Laurier University); Vanessa Fong (Postdoctoral Fellow, University of British Columbia)
The current study sought to explore the service needs and priorities of nine Indigenous families living in Ontario. The findings revealed five priority areas to address the service needs of this population: 1) Improved access to services in rural and remote areas; 2) Tailored information to better meet their needs; 3) Support for cultural revitalization efforts; 4) Strengths-based approaches; and 5) Culturally sensitive services and supports. These findings have important implications for promoting health service equity by delivering policies, programs, and practices that better address the unique service needs and priorities of Indigenous families.
-
Health of Black Preterm Infants in North America: A Scoping Review
Presented by: Mary Olukotun (PhD Student, University of Alberta)
Additional authors: Salwa Musa (PhD Student, University of Alberta); Ibukun Kayode (PhD Candidate, University of British Columbia); Bukola Salami (Professor, University of Alberta)
This review will provide insight into the nature, range, and extent of the literature on the health of Black preterm infants in North America. It will highlight where gaps exist in the current literature; it will also support the conceptualization of future research examining the health of Black preterm infants and the needs of families caring for Black preterm infants.
-
How Are We Addressing Health Equity in the Pediatric Tertiary Care Setting: An Environmental Scan of Approaches Across Canada
Presented by: Juliette St-Georges (Medical Student, McGill University)
Additional authors: Mariam Naguib (Pediatrics Resident, McGill University); Annie Chabot (Pediatrics Resident, McGill University); Catherine Korman (Medical Student, McGill University); Rislaine Benkelfat (Pediatrician, Montreal Children Hospital); Patricia Li (Pediatrician, Montreal Children Hospital)
Recognizing the urgent need for effective practices and policies to address child health inequities, we conducted an environmental scan to characterize the current approaches implemented in Canadian pediatric tertiary care centres. We interviewed at total of 42 stakeholders including pediatrics residents, staff pediatricians, allied health professionals and administrators involved in health equity at all 17 centres across Canada. With a thematic analysis approach, we identified five overarching themes from the interviews. We also identified barriers and facilitators to health equity initiatives. We believe learnings can be shared across institutions.
-
How Might Art or Music Therapy Be Complementary to Treating Depression and Anxiety Disorders Among Children and Youth?
Presented by: Jaspreet Kaur (Student, St. Lawrence College); Heli Kaka (Student, St. Lawrence College)
Additional authors: Sai Latha Kasturi (Student, St. Lawrence College); Ramandeep Kaur (Student, St. Lawrence College)
According to Statistics Canada (2022), 17% of children and youth aged 5 to 17 reported poor or fair mental health, and 5% reported a diagnosed anxiety disorder. In addition, 52% of youth aged 12 to 17 viewed their mental health differently, and 2/3 rated it less positively than their parents. This Poster emphasizes the significance of mental health in Canada and highlights that treatment options such as medication and Psychotherapy are essential; alternative therapies like art and music therapy should be considered. Art therapy uses artistic mediums for stress relief; music therapy utilizes music’s uplifting qualities for mental health improvement.
-
Impact of Remote Work and Time Spent on Childcare on Children Wellbeing During the Covid-19 Pandemic in Canada
Presented by: Joseph Kangmennaang (Assistant Professor, Queens University)
Additional authors: Mary Ajayi (Masters Student, Queens University)
Using a nationally survey, we explored perceptions of children wellbeing and child activities among Canadian families with young children. Importantly, we found that compared to parents who worked outside the home (OR = 1.14, p≤0.01) and those who mixed working from and outside the home (OR = 1.14, p≤0.01) were more likely to express concerns about their children psychosocial wellbeing. Non-visible minorities were 33% less likely to express concerns about their children’s psychosocial wellbeing. To optimally support Children’s wellbeing, we need to recognize the disproportionate impacts of the pandemic and work with stakeholders to promote equity in children wellbeing.
-
Investigating Maternal-Near Miss and Quality of Care in First-Level Referral Hospitals in Inhambane, Southern Mozambique – Mixed Methods Study
Presented by: Fernanda Andre (Ph.D. Candidate, University of Saskatchewan)
Additional authors: Nazeem Muhajarine (Professor of Community Health and Epidemiology, University of Saskatchewan)
Our team conducted a study in Southern Mozambique’s Inhambane province to evaluate obstetric care utilizing the Maternal Near-miss (MNM) approach. The study involved a quantitative cross-sectional study and semi-structured interviews with 43 participants. We will analyze the quantitative data using two statistical models and the qualitative data from interviews with a thematic approach. We are currently processing and analyzing the data to determine the prevalence and impact of MNM on the participants. We aim to develop a comprehensive theory on how women communicate their experiences of an MNM event to support our quantitative data findings. Data analyses – SPSS/STATA. NVivo-12
-
Medication Continuity Following Release from Juvenile Correctional Facilities: A Landscape Analysis of Canadian Policy
Presented by: Anmol Gupta (Medical Student/Public Policy Student, Baylor College of Medicine/McGill University)
Justice-involved youth have higher rates of health challenges compared to the general youth population. Federal and provincial/territorial (P/T) governments share jurisdiction over juvenile correctional institutions and the delivery of health care. At any time, there are close to 4,000 incarcerated juveniles in Canada. Most incarcerated juveniles are released back into society, where the continuation of medical care can be precarious. Of particular concern is the continuation of essential medication access after release. This research identifies the variations in federal and P/T policy on providing medications directly to juveniles when released from incarceration and establishes disparity in adult-specific and juvenile-specific policy.
-
Providing Access and Addressing Complex Health Profiles in Children and Youth: A Retrospective Review of Place-based, Inner-city Social Pediatrics Program
Presented by: Do Hee Kim (Medical Student, UBC Faculty of Medicine); Saina Nemati (Undergraduate Student, UBC Faculty of Science)
Additional authors: Judy So (Medical Student, UBC Faculty of Medicine); Sunny Sun (Medical Student, UBC Faculty of Medicine); Michelle Kim (Undergraduate Student, McMaster University Faculty of Science); Gwyneth McIntosh (Nurse Practioner, UBC School of Nursing); Kristina Pikksalu (Nurse Practioner, UBC School of Nursing); Christine Loock (Investigator and Medical Director, UBC Faculty of Medicine); Matthew Carwana (Investigator and General Pediatrician, UBC Faculty of Medicine)
Social pediatrics is an approach to address the many health equity disparities that families face, specifically regarding access to care. The aim of the study is to identify key demographic features and common diagnoses seen by a social pediatrics program’s primary and specialty care services. A total of 210 patient charts were reviewed. Mental health, neurodevelopmental, behavioural disorders or social challenges were found in 69% of charts. The study suggests that low barrier clinics can help address the complex needs of children and youth by providing community-based primary care services and outreach programs for marginalized families, ultimately improving health equity.
-
School-based Meal Programs and Nutrition in At-risk Children
Presented by: Saisujani Rasiah (Research Coordinator, St. Michael’s Hospital, Unity Health Toronto)
Additional authors: Sloane J. Freeman (Investigator, St. Michael’s Hospital, Unity Health Toronto); Justine Cohen-Silver (Investigator, St. Joseph’s Health Centre, Unity Health Toronto); Hallie Benjamin (Research Assistant, St. Michael’s Hospital, Unity Health Toronto); Jessica Omand (Investigator, Toronto Metropolitan University); Jonathon L. Maguire (Scientist, St. Michael’s Hospital, Unity Health Toronto)
School is an important environment that enables healthy child development particularly for children living in low-income households. With food insecurity on the rise, more children may be accessing school-based nutrition programs. Now is an opportune time to review and gain a better understanding of the relationship between school-based nutrition programs and health outcomes. The objective of this study is to understand the impact of school-based nutrition programs on children’s dietary intake, eating behaviours, and growth among children accessing school based health centre services located in inner-city Toronto communities.
-
Shades of Care: Understanding How Racially and Ethnically Diverse Mothers and Children Experience Paediatric Care in Ontario
Presented by: Raisa Ladha (PhD Student Health & Society (Systems, Services and Policy concentration), McMaster University)
Although race and ethnicity have been acknowledged as determinants of health which influence the quality of care and health outcomes for a child, the voices of racially and ethnically diverse families remain underrepresented in academic literature. This study utilized semi-structured interviews as a means of understanding how racially and ethnically diverse mothers and children experience paediatric care in Ontario. In the spirit of participatory care, this study found that mothers sought to be viewed as collaborators within the parent-provider relationship and that providers should become central figures in families’ communities of support, as opposed to simply existing on the periphery.
-
The Power of Linked Data: Investigating the Social Determinants of Child Health and Their Implications in Reducing Pediatric Traumatic Injury
Presented by: Hunter Goodon (Medical Student, Max Rady College of Medicine, University of Manitoba)
Additional authors: Justin Gawaziuk (Research Assistant, Department of Surgery, Max Rady College of Medicine, University of Manitoba); Rae Spiwak (Assistant Professor, Department of Surgery, Max Rady College of Medicine, University of Manitoba); Sarvesh Logsetty (Professor, Departments of Surgery and Psychiatry, Max Rady College of Medicine, University of Ma Max Rady College of Medicine, University of Manitoba; Firefighters Burn Unit, Health Sciences Centre, Winnipeg, Manitoba, Canada)
We conducted a 17-year retrospective case control study to identify social determinants of child health (SDoCH) that increase risk of physical injury in children ≤ 17 years of age in Manitoba, Canada. Specific SDoCH of interest were measured using population level administrative data at the Manitoba Centre for Health Policy (MCHP). Our study found that children living in a rural area, children in care, children with a parent(s) who has received income assistance, children with a parent(s) involved in the criminal justice system, and children of teenage mothers were at an increased risk of physical injury.
-
Use of and Patient Satisfaction with Virtual Care Among Adult Patients and Caregivers of Pediatric Patients Facing Language Barriers: A Systematic Review and Meta-analysis
Presented by: Erica Wennberg (Graduate Student, University of Toronto)
Additional authors: Safa Majeed (Graduate Student, University of Toronto); Zuhal Mohmand (Medical Student, Temerty Faculty of Medicine, University of Toronto); Manav Vyas (Assistant Professor, University of Toronto); Susitha Wanigaratne (Senior Research Associate, Edwin S.H. Leong Centre for Healthy Children); Astrid Guttmann (Senior Scientist, The Hospital for Sick Children)
Virtual care may not be equitable for families facing language barriers. We conducted a systematic review and meta-analysis of 1) virtual care use and 2) patient satisfaction with virtual care among adult patients and caregivers of pediatric patients in high-income countries by presence of language barriers. Forty-two studies met eligibility criteria; thus far, we have synthesized 5 studies on use of virtual primary care in adult patients. Results suggest lower use of virtual primary care among individuals facing language barriers. Our complete review will examine the relationship between language barriers and virtual care use and patient satisfaction with virtual care.
-
Vitamin D Levels Among Children with Sickle Cell Disease (SCD) with and Without Serological Evidence of COVID-19
Presented by: Matthew Hwang (Clinical Research Project Assistant, Hospital for Sick Children)
Additional authors: Nicole Wisener (Clinical Research Project Assistant, Hospital for Sick Children); Walter Byrne (Clinical Research Project Assistant, Hospital for Sick Children); Alice Litosh (Clinical Research Nurse Coordinator, Hospital for Sick Children); Maria Rosa La Neve (Clinical Research Nurse Coordinator, Hospital for Sick Children); Kimberly Thompson (Clinical Research Project Assistant, Hospital for Sick Children); Julia Upton (Staff Physician, Hospital for Sick Children); Peter Wong (Staff Physician, Hospital for Sick Children); Melanie Kirby-Allen (Associate Professor, Hospital for Sick Children); Upton Allen (Department Head of Infectious Diseases, Hospital for Sick Children)
Studies from the pre-pandemic era have suggested an association between low levels of vitamin D and an increased risk of respiratory tract infections. With respect to SARS-CoV-2, previous studies have suggested conflicting relationships between vitamin D levels and susceptibility to COVID-19. Individuals with Sickle Cell Disease (SCD) are more prone to have vitamin D deficiencies at all ages due to multiple factors, particularly nutrition status. This research study compared vitamin D levels among seropositive and seronegative children with SCD and a Black Canadian non-SCD pediatric population.
-
Weight Stigma in the Pediatric Diabetes Population: Evaluating Patient Level Factors and Diabetes Related Outcomes
Presented by: Supraja Rengan (Pediatric Endocrinology Fellow, BC Children’s Hospital)
Additional authors: Rachel Dunn (Research Coordinator, BC Children’s Hospital); Crystal Ng (Research Coordinator, BC Children’s Hospital); Shazhan Amed (Pediatric Endocrinologist, BC Children’s Hospital); Sanjukta Basak (Pediatric Endocrinologist, Clinical Assistant Professor, BC Children’s Hospital)
This research project aims to evaluate the impact of weight bias and experienced weight stigma experienced by youth with Type 1 and Type 2 Diabetes. Diabetes care involves complex balance between glycemic control and weight management. Weight stigma has been associated with poor medication adherence, lower trust and poor communication with healthcare professionals, avoidance, or delay of health services. These consequences of weight stigma may lead to higher risk of diabetes related complications. To our knowledge, there are no studies assessing or addressing weight stigma in the pediatric diabetes population.