背景:幼儿神经发育障碍(NDD)和产后抑郁症(PND)的诊断延迟是一个主要的公共卫生问题。在这两种情况下,早期干预至关重要,但在实践中很少实施。
目标:我们的目标是确定专用的移动应用程序是否可以改善5个NDD(自闭症谱系障碍[ASD],语言延迟,消化不良,诵读困难,和注意力缺陷/多动障碍[ADHD])并降低PND发生率。
方法:我们进行了观察,横截面,在法国的年轻父母中进行的基于数据的研究,在纳入时至少有1名年龄<10岁的儿童,并定期使用Malo,用于智能手机的“多合一”多领域数字健康记录电子患者报告结果(PRO)应用程序。我们纳入了符合标准并同意在2022年5月1日至2024年2月8日期间参与的前50,000名用户。父母通过该应用程序定期收到评估神经发育领域技能的问卷。母亲访问了一项预防PND的支持计划,并被要求回答常规的PND问卷。当任何PRO符合预定义的标准时,我们向家庭医生或儿科医生发送了应用程序内推荐,以预约预约.主要结果是通知可能的NDD时婴儿的中位年龄以及分娩后PND检测的发生率。一个次要结果是由卫生专业人员评估的NDD咨询通知的相关性。
结果:在55,618名中位年龄4个月的儿童中(IQR9),439(0.8%)患有至少1种急需咨询的疾病。可能的ASD的通知年龄中位数,语言延迟,消化不良,诵读困难,ADHD为32.5(IQR12.8),16(IQR13),36(IQR22.5),80(IQR5),和61(IQR15.5)个月,分别。多动症的可能性,ASD,诵读困难,语言延迟,并且在每个警报的检测限之间包括的该年龄段的儿童中的运动障碍为1.48%,0.21%,1.52%,0.91%,和0.37%,分别。医生评估的可疑NDD警报通知的敏感性为78.6%,特异性为98.2%。在完成PND问卷的8243名母亲中,在938例(11.4%)中检测到高度可能的PND,与我们之前没有支持计划的研究相比,减少了-31%。在分娩后的中位96天(IQR86)检测到疑似PND。在填写满意度调查的130名用户中,99.2%(129/130)发现该应用程序易于使用,70%(91/130)报告该应用程序改善了孩子的随访。该应用程序在Apple\的AppStore上的评分为4.8/5。
结论:基于算法的早期警报表明,根据现实生活中的从业者评估,NDD具有高度特异性和良好的敏感性。早期检测5个NDD和PND是有效的,并导致PND发生率可能降低31%。
背景:ClinicalTrials.govNCT06301087;https://www.临床试验.gov/研究/NCT06301087。
BACKGROUND: Delay in the diagnosis of neurodevelopmental disorders (NDDs) in toddlers and postnatal depression (PND) is a major public health issue. In both cases, early intervention is crucial but too rarely implemented in practice.
OBJECTIVE: Our goal was to determine if a dedicated mobile app can improve screening of 5 NDDs (autism spectrum disorder [ASD], language delay, dyspraxia, dyslexia, and attention-deficit/hyperactivity disorder [ADHD]) and reduce PND incidence.
METHODS: We performed an observational, cross-sectional, data-based
study in a population of young parents in
France with at least 1 child aged <10 years at the time of inclusion and regularly using Malo, an \"all-in-one\" multidomain digital health record electronic patient-reported outcome (PRO) app for smartphones. We included the first 50,000 users matching the criteria and agreeing to participate between May 1, 2022, and February 8, 2024. Parents received periodic questionnaires assessing skills in neurodevelopment domains via the app. Mothers accessed a support program to prevent PND and were requested to answer regular PND questionnaires. When any PROs matched predefined criteria, an in-app recommendation was sent to book an appointment with a family physician or pediatrician. The main outcomes were the median age of the infant at the time of notification for possible NDD and the incidence of PND detection after childbirth. One secondary outcome was the relevance of the NDD notification by consultation as assessed by health professionals.
RESULTS: Among 55,618 children median age 4 months (IQR 9), 439 (0.8%) had at least 1 disorder for which consultation was critically necessary. The median ages of notification for probable ASD, language delay, dyspraxia, dyslexia, and ADHD were 32.5 (IQR 12.8), 16 (IQR 13), 36 (IQR 22.5), 80 (IQR 5), and 61 (IQR 15.5) months, respectively. The rate of probable ADHD, ASD, dyslexia, language delay, and dyspraxia in the population of children of the age included between the detection limits of each alert was 1.48%, 0.21%, 1.52%, 0.91%, and 0.37%, respectively. Sensitivity of alert notifications for suspected NDDs as assessed by the physicians was 78.6% and specificity was 98.2%. Among 8243 mothers who completed a PND questionnaire, highly probable PND was detected in 938 (11.4%), corresponding to a reduction of -31% versus our previous
study without a support program. Suspected PND was detected a median 96 days (IQR 86) after childbirth. Among 130 users who filled in the satisfaction survey, 99.2% (129/130) found the app easy to use and 70% (91/130) reported that the app improved follow-up of their child. The app was rated 4.8/5 on Apple\'s App Store.
CONCLUSIONS: Algorithm-based early alerts suggesting NDDs were highly specific with good sensitivity as assessed by real-life practitioners. Early detection of 5 NDDs and PNDs was efficient and led to a possible 31% reduction in PND incidence.
BACKGROUND: ClinicalTrials.gov NCT06301087; https://www.clinicaltrials.gov/
study/NCT06301087.