Improving Malnutrition Screening among Hemodialysis Patients.

Individuals receiving hemodialysis are at increased risk of malnutrition; however, regular diagnosis of malnutrition using subjective global assessment (SGA) is time-consuming. This study aimed to determine whether the Canadian Nutrition Screening Tool (CNST) or the Geriatric Nutrition Risk Index (GNRI) screening tools could accurately identify hemodialysis patients at risk for malnutrition. A retrospective medical chart review was conducted for in-centre day shift hemodialysis patients (n = 95) to obtain the results of the SGA assessment and the CNST screener and to calculate the GNRI score. Sensitivity and specificity analyses showed only a fair agreement between the SGA and CNST (sensitivity = 20%; specificity 96%; κ = .210 (95% CI, -0.015 to .435), p < .05) and between the SGA and GNRI (sensitivity = 35%; specificity = 88%; κ = .248 (95% CI, .017 to .479), p < .05). There was no significant statistical difference between the accuracy of either tool in identifying patients at risk of malnutrition (p = .50). The CNST and GNRI do not accurately screen for risk of malnutrition in the hemodialysis population; therefore, further studies are needed to determine an effective malnutrition screening tool in this population.

[Use of neurodevelopmental disorder screening tool in primary care : A multicenter observational study]. / Utilisation en soins primaires d'un outil de repérage des troubles du neurodéveloppement : étude multicentrique observationnelle.

INTRODUCTION: Neurodevelopmental disorders (NDD) affect 5 to 15% of the population. Improved management largely depends on early detection in primary care. A screening tool was developed by an expert consensus and its use has been recommended since 2019. This tool has never been evaluated to date. The aim of this study was to investigate the prevalence and factors associated with the identification of neurodevelopmental disorders in primary care in children aged 6 months to 5 years. METHOD: This work is a multicentric observational study carried out in general practice in two regions of France: Île-de-France and Auvergne-Rhône-Alpes. A multivariate analysis was performed to identify the factors associated with the presence of abnormal signs on the grid. RESULTS: Five hundred and sixty-four (564) children aged 6 months to 4 years were included. The prevalence of children identified on the grid was 3.9%. The factors associated with the neurodevelopmental disorders identified in multivariate analysis were: low socio-professional status of the mother, male gender and parental concern about the child's neurodevelopment. Factors associated with identifying a developmental trajectory gap were male gender (OR = 2.10 (1.22-3.62)) and low socio-professional status of the mother (OR = 2.23 [1.05-4.70]). CONCLUSION: This original work allowed us to carry out first-line testing of a tool for the identification of NDD in primary care and to evaluate the prevalence of identification of these disorders. A complementary cohort study will be necessary to evaluate the sensitivity and specificity of this identification tool.

[Budget impact of self-testing in the national cervical cancer screening program]. / Impact budgétaire de l'utilisation de l'autotest dans le cadre du programme national de dépistage du cancer du col de l'utérus.

OBJECTIVES: A nationwide screening program for cervical cancer (CC) was organized in 2018 as part of the 2014-2019 French cancer plan, with the objective of reducing CC incidence and mortality in France by reaching an 80 % coverage rate. As an alternative to pap smear, vaginal self-sampling (VSS) aimed at identifying high-risk HPV carriage could help to achieve this goal. The objective of the present study is to compare the respective budgetary impacts of several self-sampling strategies. METHOD: A budget impact model was developed to compare non-use of self-sampling in CC screening to the 5-year costs of 5 VSS strategies viewed from an all-payer perspective. While the first strategy was based on mailing the VSS kit with a reminder to participate in the screening program, the second was based on accompanying the mailed kit with an invitation to participate. The third and fourth strategies were based on providing health professionals with the kit, and thereby offering self-sampling as an alternative to pap smears for women undergoing CC screening and having previously received the kits. Finally, the fifth strategy was based on self-sampling as the one and only CC screening modality. The parameters of the model were based on past screening participation data and experiments in France on organized screening and VSS use. The costs included those of procedures associated with screening and program organization. RESULTS: All in all, the costs associated with cervical cancer screening would represent approximately 1 billion euros over 5 years. All strategies would be associated with participation ranging from 81% to 84%, which would represent an increase of 4.7% to 5.2% of lesions diagnosed by screening and a cost reduction between €30M and €87M over 5 years, with the exception of the strategy based on sending the kit (with the reminder associated or not) to the health professionals offering this option (+€23M and +€6M). CONCLUSIONS: In conclusion, the use of self-sampling as an alternative to pap smears for non-participating women would increase participation, with only a moderate budgetary impact and could, in some cases, even induce savings.

[Évaluation de la gravité du cancer colorectal dépisté dans le contexte de la crise sanitaire liée au COVID19 en région Ile-de-France]. / Evaluation of the severity of screened colorectal cancer in the context of the health crisis linked to COVID19 in Ile-de-France region.

BACKGROUND: After the announcement in March 2020 of the COVID-19 pandemic, colorectal cancer (CRC) screening programs were suspended in several countries. Compared to the lesions detected during previous campaigns, this study aims to assess the severity of CRC detected during the 2020 screening campaign in Île-de-France, the French region most affected by the 1st wave of the pandemic. METHODS: The descriptive and etiological study included all faecal immunochemical test (FIT) results carried out between January 2017 and December 2020 on people aged 50-74, living in Île-de-France. First, the proportion of colonoscopies performed within one month (One-month-colo) following FIT; the yield of colonoscopy (proportion of colonoscopies with a neoplasm lesion among those performed) and CRC severity (TNM Classification, Level-0: T0/N0/M0, Level-1: T1/T2/N0/M0, Level-2: T3/T4/N0/M0; Level-3: T3/T4/N1/M0; Level-4: M1) were described in 2020 compared to previous campaigns (2017, 2018, and 2019). Subsequently, the link between the level of CRC severity and the predictive factors, including campaign year and time to colonoscopy, was analysed using polytomous multivariate regression. RESULTS: The one-month-colo (2017: 9.1% of 11,529 colonoscopies; 2018: 8.5% of 13,346; 2019: 5.7% of 7,881; 2020: 6.7% of 11,040; p < 0.001), the yield (65.2%, 64.1%, 62.4%, 60.8% respectively, p < 0.001) were significantly different between campaigns. The proportion of CRC level-4 (4.8% in 2017 (653 CRC); 7.6% in 2018 (674 CRC); 4.6% in 2019 (330 CRC) and 4.7% in 2020 (404 CRC); p < 0.29) was not significantly different between campaigns. The probability of having CRC with a high severity level was inversely related to the time to colonoscopy but not to the campaign year. Compared to patients having undergone colonoscopy within 30 days, the odds were significantly reduced by 60% in patients having undergone colonoscopy after 7 months (adjusted Odds-Ratio: 0.4 [0.3; 0.6]; p < 0.0001). CONCLUSIONS: The French indicators were certainly degraded before the first wave of the COVID-19. The delay in access to colonoscopy as well as its extension induced by the COVID-19 crisis had no impact in terms of cancer severity, due to a discriminatory approach prioritizing patients with evident symptoms.

Low attendance in cervical cancer screening, geographical disparities and sociodemographic determinants of screening uptake among adult women in Burkina Faso : results from the first nationwide population-based survey.

OBJECTIVE: To explore the level, geographical disparities and sociodemographic determinants of cervical cancer screening uptake among adult women in Burkina Faso by using data from the first national population-based survey. METHODS: This was a cross-sectional secondary analysis of primary data obtained by the 2013 World Health Organization (WHO) Stepwise Approach to Surveillance survey conducted in Burkina Faso. All 13 Burkinabè regions, with their different rates of urbanization, were surveyed. Lifetime cervical cancer screening uptake was explored. We included 2293 adult women for analyses and performed Student's t, chi-square and Fisher's exact tests, and logistic regression. RESULTS: Only 6.2% (95% CI: 5.3-7.3) of women had ever been screened for cervical cancer. For two regions ("Centre" and "Hauts-Bassins"), the pooled frequency was 16.6% (95% CI: 13.5-20.1) while in the other eleven regions it was significantly lower, 3.3% (95% CI: 2.5-4.2). In urban and rural areas, the respective frequencies for the screening uptake were 18.5% and 2.8% (p < 0.001), and in educated and un-educated women, frequencies were 27.7% and 3.3% (p < 0.001) respectively. The sociodemographic factors associated with screening uptake were being educated (adjusted odd-ratio [aOR] = 4.3; 95% CI: 2.8-6.7), urban residence (aOR = 3.8, 95% CI: 2.5-5.8) and having an occupation providing income (aOR = 3.1, 95% CI: 1.8-5.4). CONCLUSION: There was a significantly wide range in screening uptake between Burkina Faso regions, and the overall national as well as the region-specific levels were far below the WHO's target for cervical cancer elimination. Cervical cancer interventions should be tailored specifically for Burkinabè women with different educational levels, and prevention strategies based on community engagement integrating psychosocial considerations could be helpful.

The Evidence for Screening Older Adults for Nutrition Risk in Primary Care: An Umbrella Review.

It is not known if nutrition risk screening of older adults should be a standard practice in primary care. The evidence in support of nutrition risk screening of older adults in primary care was examined and critically analyzed using an umbrella review. The peer reviewed and grey literature were searched for clinical practice guidelines (CPGs) and systematic reviews (SRs). Titles and abstracts were independently screened by the two authors. Resources were excluded if they did not apply to older adults, did not discuss nutrition/malnutrition risk screening, or were in settings other than primary care. Full texts were independently screened by both authors, resulting in the identification of six CPGs and three SRs that met the review criteria. Guidelines were appraised with the AGREE II tool and SRs with the AMSTAR 2 tool. The quality of the CPGs was high, while the quality of the SRs was low. The CPGs and SRs acknowledged a lack of high-quality research on the benefits of regular nutrition risk screening for older adults in primary care; however, CPGs recommended annual screening for older adults in primary care practices or other community settings. High-quality research investigating nutrition risk screening of older adults in primary care is needed.

Cultural Adaptation and Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-up in Moroccan Arabic dialect.

BACKGROUND: The prevalence of autism spectrum disorder is increasing worldwide, making screening and early intervention necessary. Several screening instruments have been developed in recent years. The Modified Checklist for Autism in Toddlers Revised with Follow-up (M-CHAT-R/F) is considered to be one of the specific measures designed to identify toddlers at risk for autistic spectrum disorder. OBJECTIVE: The aim of the study was to translate and adapt the original version of M-CHAT-R/F from the English to the Moroccan Arabic language. STUDY DESIGN: Specialized translators and clinicians ensured forward and backward translation of the scale into Moroccan Arabic. Then, a two-stage screening of the M-CHAT-R/F-T was applied to a study sample comprised of 56 toddlers with autistic spectrum disorder (category I) and 96 toddlers with normal development (category II). "Kappa test", "Cronbach's alpha" test, the intra class correlation coefficient, and the area under the curve were determined. RESULT: The average score results of M-CHAT-R/F were 13.12 for category I, while it was 2.24 for category II. The Cronbach's alpha coefficient of the checklist was 0.929. The kappa values ranged from k=0.78 to k=0.97 with a confidence interval of 95% indicating good convergence. The intra-class correlation coefficient ranged from 0.97 to 0.99, which is excellent. The area under the curve in our study was 0.988, an excellent result. CONCLUSION: Efficiency of the Moroccan Arabic version of the MCHAT was demonstrated for screening in the general population.

La promotion de l'évolution optimale de la santé mentale chez les enfants et les adolescents.

Les dispensateurs de soins pédiatriques sont souvent le premier point de contact des enfants et des adolescents aux prises avec des problèmes de santé mentale, mais ils ne possèdent pas nécessairement les ressources (p. ex., l'accès à une équipe multidisciplinaire) ni la formation nécessaires pour procéder à leur dépistage ou à leur prise en charge. Le présent document de principes conjoint décrit les principaux rôles et les principales compétences à maîtriser pour évaluer et traiter les problèmes de santé mentale chez les enfants et les adolescents, de même que les facteurs qui optimisent le plus possible l'évolution de la santé mentale dans ces groupes d'âge. Il contient des conseils fondés sur des données probantes à propos du dépistage des préoccupations en matière de santé mentale chez les jeunes et leur famille ainsi qu'à propos des échanges sur le sujet. Les interventions préventives et thérapeutiques dont l'efficacité est démontrée en milieu communautaire sont abordées. Le présent document de principes, qui est fondamental, traite également des changements à l'enseignement de la médecine ainsi qu'aux systèmes et aux politiques de santé qui s'imposent pour améliorer la pratique clinique et les efforts de revendications au Canada, y compris les modèles de rémunération appropriés, les approches des soins abordées étape par étape, le financement gouvernemental ciblé, l'enseignement et la formation professionnelle.

[New recommendations for cervical cancer screening in France]. / Nouvelles recommandations pour le dépistage du cancer du col de l'utérus en France.

In France, recent advances in cervical cancer screening include an organized cervical cancer-screening program and the introduction of HPV testing as a first-line test for women aged 30-65 years. The HPV test, performed on a cervical smear taken by a health professional, could also be performed on a vaginal self-sample in certain indications. The detection kits used to test for HPV should target high-risk HPV, be validated for screening and meet the performance requirements for this indication. Although no longer used as a first-line test in women aged 30-65 years, cytological examination of cervical cells remains important, particularly in the triage of HPV positive women. The interest of other biological techniques, such as HPV genotyping, viral load, cellular expression of p16/Ki-67 proteins and the methylation of cellular or viral genes, still needs to be clarified, but they could help to refine the triage strategy of HPV-positive women and limit the need for colposcopy and unnecessary stress for patients.

[Early detection of prostate cancer: Towards a new paradigm?] / Détection précoce du cancer de la prostate : vers un nouveau paradigme ?

Prostate cancer (PCa) is a public health issue. The diagnostic strategy for PCa is well codified and assessed by digital rectal examination, PSA testing and multiparametric MRI, which may or may not lead to prostate biopsies. The formal benefit of organized PCa screening, studied more than 10 years ago at an international scale and for all incomers, is not demonstrated. However, diagnostic and therapeutic modalities have evolved since the pivotal studies. The contribution of MRI and targeted biopsies, the widespread use of active surveillance for unsignificant PCa, the improvement of surgical techniques and radiotherapy… have allowed a better selection of patients and strengthened the interest for an individualized approach, reducing the risk of overtreatment. Aiming to enhance coverage and access to screening for the population, the European Commission recently promoted the evaluation of an organized PCa screening strategy, including MRI. The lack of screening programs has become detrimental to the population and must shift towards an early detection policy adapted to the risk of each individual.

[The psychopathological dimension of female alcoholism]. / La dimension psychopathologique de l'alcoolisme féminin.

In France, as in other countries, more and more women are affected by alcoholism. Progress needs to be made in the early detection and management of their physical and psychological dependence on alcohol, as well as their psychopathological comorbidities.

[Alcohol and pregnancy: talking about it without taboos to prevent pregnancy]. / Alcool et grossesse, en parler sans tabou pour faire de la prévention.

From the earliest stages of adolescence, the question of alcohol consumption should be addressed by health professionals (GPs, midwives, gynecologists, pediatricians, nurses) working in the field of perinatal care or public health. All alcohol consumption is prohibited during pregnancy. In fact, a 2022 study showed that even low exposure to alcohol in utero has measurable effects on the structure of children's brains.

Colorectal cancer screening knowledge and uptake in lebanon: a national survey.

OBJECTIVE: The main aim of this national survey was to identify the levels of colorectal cancer screening knowledge and uptake in Lebanon. METHODS: A total of 1200 participants were enrolled in this cross-sectional household survey targeting the Lebanese population aged 50 years and above. The sample was recruited using a two-stage stratified cluster sampling approach. RESULTS: Of the total sample, 38.3% knew about any screening test for colorectal cancer but only 7.5% had ever used any. Thirty-nine percent of the participants rated their risk of getting colorectal cancer as very low or low, and only 53.5% were confident in their ability to undertake a screening test. Almost all participants agreed that medical advice and test reimbursement would encourage them to do a screening test. At the multivariate analysis level, hearing of an awareness campaign in the last two years showed the strongest association with the knowledge of a colorectal cancer screening test with an estimated ORadj = 5.12 (95%CI: 3.67 - 7.15). Other factors that were significantly associated with this knowledge variable included: a family history of colorectal cancer, a personal history of colorectal illness, having a health coverage, and knowledge of colorectal cancer signs and symptoms. DISCUSSION: This national study highlights an alarming lack of uptake and low levels of knowledge of colorectal cancer screening tests even though it is among the most prevalent cancers in Lebanon and its prevalence has been continuously increasing in the past years. The evidence suggests that people who had an experience with colorectal cancer diagnostic tests, either personally or through a family member, and those who have heard of an awareness campaign about colorectal cancer in the last two years are more likely to know its screening tests. CONCLUSION: Colorectal cancer screening knowledge and uptake in Lebanon are limited and justify the need for public health interventions. This study gives evidence that awareness campaigns, coupled with the involvement of medical providers and the reimbursement of screening test fees, would alleviate the burden of colorectal cancer in Lebanon.

Cervical cancer in Morocco: A systematic review.

BACKGROUND: This systematic review aims to determine the epidemiological profile, etiology and risk factors, prevention, diagnosis, treatment, cost-effectiveness, survival, and quality of life related to cervical cancer in Morocco. METHODS: This study was conducted according to the recommendations of the "preferred reporting items for systematic reviews and meta-analysis." The PubMed, ScienceDirect, Springer, Web of Science data bases were used, as was Google Scholar for the grey literature. The review protocol was registered in the PROSPERO register (CRD42021235241). RESULTS: Fifty studies were selected. The mean age was 49.31 ±6.3 years. HPV infection prevalence ranged from 13.30% to 76%, with a peak in HIV-positive women. Acceptability of the HPV vaccine was higher among parents (35% and 82%) than among adolescents (16.9% to 46.6%). Knowledge of the vaccine and its price are two key factors related to vaccine acceptability among parents. This systematic review highlights that the fact that few eligible women (not more than 11%) were participating in the cervical cancer screening program. Moroccan women's level of knowledge and awareness regarding cervical cancer screening was low, negatively impacting their use of such screening tools, as illustrated by the high percentage (mean 76.32% ± 17.21) of women who had never been screened for cervical cancer. Treatment was the most significant component of the global care budget (95.87%), with an annual cost of $13,027,609. Five-year overall survival ranged from 41.3% to 73.6%, with higher survival rates for patients diagnosed at an earlier stage (77.3-85% for stage I). Lastly, low quality of life was observed in women with tumors at an advanced stage who had received brachytherapy and lacked social support. CONCLUSIONS: Subjects that require further investigation include Moroccan women's knowledge, attitudes, and awareness, especially among those at high risk of developing cervical cancer, and its impact on their quality of life and survival.

Community perspectives on developmental screening of American Indian and Alaska Native children.

Children are highly regarded and treasured as the future of American Indian and Alaska Native (AIAN) communities. Developmental disorders, however, are more frequently undiagnosed and untreated in AIAN children compared to others in the United States. Developmental screening can help communities ensure that their children reach their full potential, but lack of culturally sensitive and valid screening measures complicates screening among AIAN children. This can, in turn, delay access to early intervention and undermine the ability of AIAN communities to support children's optimal development. This study explored families' and professionals' perceptions of screening systems and processes in AIAN communities and to identify gaps and opportunities. A total of 53 interviews and 23 focus groups were conducted with 157 parents and early childcare professionals in four AIAN communities. A conceptual framework to describe systems of screening for young children was developed by AIAN early childhood program partners and early childhood researchers working together on a Tribal Early Childhood Research Center Community of Learning; this framework guided study design and interview guides. Transcripts were coded for themes in alignment with the conceptual framework; 13 key themes and 81 subthemes were identified. Findings are discussed in terms of implications for enhancing screening efforts in Tribal communities.

Los niños son altamente considerados y apreciados como el futuro de las comunidades de Indios Americanos y Nativos de Alaska (AIAN). Los trastornos en el desarrollo, sin embargo, no son diagnosticados ni tratados a una frecuencia más alta que en el caso de otros en los Estados Unidos. La detección en cuanto al desarrollo puede ayudar a las comunidades a asegurar que sus niños logran su completo potencial, pero la falta de sensibilidad cultural y de válidas medidas de detección complica el proceso de detección entre niños AIAN. Esto puede, a la vez, retrasar el acceso a la temprana intervención y quebrantar la habilidad de las comunidades AIAN de apoyar el óptimo desarrollo de los niños. Este estudio exploró las percepciones que las familias y los profesionales tienen de los sistemas y procesos de detección en comunidades AIAN para identificar vacíos y oportunidades. 53 entrevistas y 23 grupos de enfoque se llevaron a cabo con 157 progenitores y profesionales del temprano cuidado infantil en cuatro comunidades AIAN. Se desarrolló un marco de trabajo conceptual para describir los sistemas de detección para niños pequeños por parte de los asociados de un programa AIAN de temprana niñez e investigadores de la temprana niñez que trabajaban en conjunto en un Centro Tribal Investigativo de la Temprana Niñez y Comunidad de Aprendizaje; este marco de trabajo marcó las pautas para el diseño del estudio y las guías de entrevista. Se codificaron las transcripciones por temas en alineamiento con el marco de trabajo conceptual; se identificaron 13 temas claves y 81 subtemas. Los resultados se discuten en términos de las implicaciones para mejorar los esfuerzos de detección en comunidades tribales.

Les enfants sont tenus en haute estime et précieux puisqu'ils sont l'avenir des communautés d'amérindiens des Etats-Unis et des autochtones d'Alaska (abrégé en anglaise AIAN). Cependant les troubles de comportement restent plus fréquemment non diagnostiqués et non traités chez les enfants AIAN que chez les autres enfants aux Etats-Unis. Le dépistage comportemental peut aider les communautés à s'assurer que leurs enfants atteignent leur plein potentiel mais le manque de mesures de dépistage culturellement adaptées et valides complique le dépistage chez les enfants AIAN. En retour cela peut retarder l'accès à une intervention précoce et compromettre la capacité des communautés AIAM à soutenir le développement optimal des enfants. Cette étude a exploré les perceptions des familles et des professionnels des systèmes de dépistage et des processus dans les communautés AIAN dans le but d'identifier les écarts et les opportunités. 53 entretiens et 23 groupes de discussion ont été organisés avec 157 parents et professionnels de garderies d'enfants dans quatre communautés AIAN. Un cadre conceptuel pour décrire les systèmes de dépistage pour les jeunes enfants a été développé par les partenaires de programmes de la petite enfance et des chercheurs sur la petite enfance travaillant ensemble dans le cadre d'une communauté d'apprentissage du Centre de Recherche sur la Petite Enfance Tribale. Ce cadre a guidé le plan d'étude et les guides de l'entretien. Les transcriptions ont été codées pour des thèmes se conformant au cadre conceptuel et 13 thèmes clés ainsi que 81 sous-thèmes ont été identifiés. Les résultats sont discutés dans le contexte des implications pour l'amélioration des efforts de dépistages dans les communautés tribales.

In-the-moment ratings on the Early Relational Health Screen: A pilot study of application in home visiting and primary care.

Early infant-parent interaction sets a critical foundation for young children's well-being, and evidence regarding the protective role of secure early relationships has led to increased interest in effective screening and promotion of early relational health in pediatric primary care and home visiting settings. We report findings from two pilot studies conducted in the United States that describe the reliability and validity of a relational health screening tool, the Early Relational Health Screen (ERHS), implemented in two different contexts: an innovative model of relational health promotion in pediatric primary care (Study 1) and an Infant Mental Health Home Visiting (IMH-HV) model (Study 2). Across both studies, a trained clinician rated the ERHS following real-time observation of interaction (i.e., "in-the-moment" ratings). Reliability was assessed by comparing "in-the-moment" ERHS ratings to subsequent coding of the same interaction from video by an independent evaluator. In addition, Study 2 data permitted evaluation of the validity of "in-the-moment" ERHS ratings. Results from both studies indicated reliability of "in-the-moment" ERHS ratings. In addition, Study 2 clinician "in-the-moment" ratings were associated with maternal depression and ratings of child-parent interaction derived from a separate observational task coded by independent evaluators using a different well-validated research-based measure. Discussion highlights the potential of the ERHS as a screening, promotion, and prevention tool that may be feasibly administered by providers across pediatric primary care and home visiting settings.

La temprana interacción infante-progenitor establece una fundación esencial para el bienestar de los niños pequeños, y la evidencia sobre el papel de protección de tempranas relaciones receptivas ha aumentado el interés en la efectiva detección y promoción de la salud de la relación en el cuidado pediátrico primario y los escenarios de visitas a casa. Reportamos los resultados de dos estudios experimentales que describen la confiabilidad y validez de la Temprana Detección de la Salud de la Relación (ERHS) implementada en dos contextos: un modelo innovador de promoción de la salud de la relación en el cuidado primario (Estudio 1) y un modelo de salud mental infantil de visitas a casa (Estudio 2). A lo largo de ambos, un profesional clínico entrenado evaluó ERHS siguiendo una observación de interacción en tiempo real (v.g. puntajes asignados "en el momento"). Se evaluó la confiabilidad por medio de una comparación entre los puntajes del profesional clínico y los subsecuentes puntajes de la misma interacción en video por un evaluador independiente. Adicionalmente, los datos del Estudio 2 permitieron la evaluación de la validez de los puntajes de ERHS. Los resultados de ambos estudios indicaron la confiabilidad de los puntajes ERHS "en el momento." Es más, los puntajes del profesional clínico del Estudio 2 se asociaron con la depresión materna y los puntajes de la interacción niño-progenitor derivados de una tarea separada usando una medida bien validada basada en la investigación. Las discusiones subrayan el potencial de ERHS como una herramienta de detección, promoción y prevención que puede ser administrada factiblemente por los proveedores tanto en el cuidado primario como en los casos de visitas a casa.

L'interaction précoce nourrisson-parent jette les bases essentielles du bien-être du jeune enfant et l'évidence concernant le rôle protecteur des relations précoces sécures a mené à un intérêt plus grand pour le dépistage efficace et la promotion de la santé relationnelle précoce dans les soins de santé primaire en pédiatrie ainsi que les contextes de visites à domicile. Nous rapportons ici les résultats de deux études pilotes faites aux Etats-Unis d'Amérique, qui décrivent la fiabilité et la validité d'un outil de dépistage de la santé relationnelle, le Dépistage Précoce de Santé Relationnelle (en anglais Early Relational Health Screen dont nous gardons l'abréviation ici, ERHS), mis en place dans deux contextes différents: un modèle innovateur de promotion de la santé relationnelle précoce en soin pédiatrique primaire (Etude 1) et un modèle de visite à domicile pour la santé mentale du nourrisson (Etude 2). Au travers de ces deux études un clinicien entraîné a évalué l'ERHS après une observation en temps réel de l'interaction (c'est-à-dire, des scores "sur le moment"). La fiabilité a été évaluée en comparant l'ERHS "sur le moment" au codage ultérieur de la même interaction à partir d'une vidéo, par un évaluateur indépendant. De plus les données de l'Etude 2 ont permis l'évaluation de la validité des scores ERHS "sur le moment." Les résultats des deux études ont indiqué la fiabilité des scores ERHS "sur le moment." De plus les scores "sur le moment" du clinicien de l'Etude 2 étaient liés à la dépression maternelle et aux scores d'interaction enfant-parent dérivés d'une tâche observationnelle séparée codée par des évaluateurs indépendants en utilisant une mesure basée sur les recherches différente et communément validée. La discussion met en lumière le potentiel de l'ERHS en tant qu'outil de dépistage, de promotion et de prévention qui peut être réalistement utilisé par les professionnels au sein des soins primaires pédiatriques et des contextes de visites à domicile.

Early relational health: Innovations in child health for promotion, screening, and research.

Relational experiences during infancy and early childhood are key drivers for building health, social emotional development, and learning capacities, each vital for wellbeing. The U.S. child health sectors share a commitment to universal health promotion, prevention and early intervention, and a growing enthusiasm for the research-affirmed primacy of caregiver-child interactions during the critical first 1000 days of life. Given our nation's growing children's mental health crisis, racial justice awakening and the need to reimagine equitable supports for young families post-COVID19, the child health sectors seek new tools and clinical approaches that blend science-to-practice innovations with co-developed activities that are meaningful to families. This special section brings together papers about a journey of co-discovery between researchers, clinicians, and parents during the development and refinement of new video- and interview-based dyadic relational screening and monitoring tools. The collection of papers addresses a range of topics including early relational health (ERH), development and validation of the Early Relational Health Screen, its application within research and clinical settings, and thoughtful discussions from multiple perspectives. Informed by the diversity informed tenets, this journey highlights not only science-informed approaches, but also co-development with families of equitable approaches to understanding and serving children and their caregivers.

Las experiencias en las relaciones durante la infancia y la temprana niñez son conductores claves para fortalecer la salud, el desarrollo socio-emocional y las capacidades de aprendizaje, todas las cuales son vitales para el bienestar. Los sectores de salud infantil en los Estados Unidos comparten un compromiso para promover globalmente la salud, la prevención y la temprana intervención, así como un creciente entusiasmo por la primacía de las interacciones entre quien presta el cuidado y el niño, tal como las reafirma la investigación, durante los críticos primeros mil días de vida. Dada la creciente crisis de salud mental infantil de nuestro país, el despertar de la justicia racial y la necesidad de volver a conceptualizar los apoyos equitativos para familias jóvenes después del Covid-19, los sectores de salud infantil, buscan nuevas herramientas y acercamientos clínicos que mezclan las innovaciones de la ciencia a la práctica con actividades desarrolladas en conjunto que resultan significativas para las familias. Esta sección especial presenta artículos acerca de una trayectoria de descubrimiento en conjunto entre investigadores, profesionales clínicos y padres durante el desarrollo y afinamiento de nuevas herramientas de detección y supervisión de la relación diádica basadas en videos y entrevistas. El grupo de artículos aborda un número de temas que incluyen la temprana saludable relación (ERH), el desarrollo y la validez de la Detección de la Temprana Saludable Relación, su aplicación dentro de los campos de la investigación y clínicos, así como sensatas discusiones a partir de múltiples perspectivas. Respaldada por principios basados en la diversidad, esta trayectoria subraya no sólo los acercamientos cuya información proviene de la ciencia, sino también el desarrollo en conjunto con familias de equitativos acercamientos para comprender y servirles a los niños y a quienes los cuidan.

Les expériences relationnelles le bas âge et la petite enfance sont des facteurs clés pour la construction de la santé, le développement socio-émotionnel et les capacités d'apprentissage, qui sont indispensables au bien-être. Les secteurs de la santé de l'enfant aux Etats-Unis d'Amérique partagent un engagement envers la promotion universelle de la santé, la prévention et l'intervention précoce, et un enthousiasme grandissant pour la primauté des interactions personne prenant soin de l'enfant-enfant, affirmée par les recherches, durant les 100 premiers jours critique de la vie. Au vu de la croissance de la crise de santé mentale des enfants dans notre pays, du réveil de la justice raciale et du besoin de réimaginer les soutiens équitables pour les jeunes familles après le Covid19, les secteurs de la santé mentale de l'enfant cherchent de nouveaux outils et des approches cliniques qui mélange des innovations science-à-pratique avec des activités élaborées conjointement qui sont utiles et ont un sens pour les familles. Cette section spéciale rassemble des articles sur un voyage de codécouverte entre des chercheurs, des cliniciens, et des parents durant le développement et le perfectionnement d'un nouveau dépistage relationnel dyadique à partir d'entretiens et de vidéos, et d'outils de suivi. Cette collection d'articles porte sur un éventail de sujets y compris la Santé Relationnelle Précoce (SRP), le développement et la validation du Dépistage de Santé Relationnelle Précoce, son application dans des contextes de recherche et dans des contextes cliniques, et des discussions attentionnées de perspectives multiples. Informé par des principes fondés sur la diversité, ce voyage met en évidence non seulement des approches scientifiques mais aussi des co-développements avec des familles d'approches équitables à la compréhension et au service des enfants ainsi que des personnes prenant soin d'eux.

Increased behavioral health needs and continued psychosocial stress among children with medical complexity and their families during the COVID-19 pandemic.

OBJECTIVE: Children with medical complexity (CMC) and their caregivers are at increased risk for multiple psychosocial stressors that can impact child and family well-being and health outcomes. During the COVID-19 pandemic, when access to supports diminished, psychosocial screening and integrated behavioral health (IBH) services in the primary care setting were crucial in identifying and addressing the unique needs of this population METHODS: Universal screening to identify psychosocial needs was implemented in a primary care clinic for CMC that includes IBH services. Data on the prevalence of psychosocial screening and IBH services for young children and their caregivers before and during the COVID-19 pandemic were evaluated RESULTS: Psychosocial screening levels remained stable during the pandemic. Psychosocial needs were identified for 36% of screeners prior to the COVID-19 pandemic and 33% during the COVID-19 pandemic. The need for IBH services increased during the COVID-19 time period resulting in a significant increase in IBH services CONCLUSIONS: For CMC and their caregivers, psychosocial needs identified through psychosocial screening remained high during the pandemic, demonstrating the importance of screening for this population. The need for IBH services during the COVID-19 pandemic increased, underscoring the value and demand for these services particularly during an unprecedented time.

Objetivo: Los niños con complejidades médicas (CMC) y quienes les cuidan están bajo un riesgo en aumento sobre múltiples factores sicosociales de estrés que pueden causar impacto en el bienestar y resultados de salud del niño y la familia. Durante la pandemia COVID-19, cuando disminuyó el acceso al apoyo, los servicios de detección sicosocial y la integrada salud del comportamiento (IBH) en escenarios de cuidado primario fueron cruciales para identificar y manejar las necesidades típicas de esta población. Métodos: La detección universal para identificar necesidades sicosociales se implementó en una clínica de cuidado primario para CMC que incluye servicios IBH. Se evaluó la información acerca de la prevalencia de los servicios de la detección sicosocial e IBH para niños pequeños y quienes les cuidaban antes y durante la pandemia COVID-19. Resultados: Los niveles de detección sicosocial se mantuvieron estables durante la pandemia. Se identificaron las necesidades sicosociales para el 36% de los examinados antes de la pandemia del COVID-19 y 33% durante la pandemia COVID-19. La necesidad de servicios IBH aumentó durante el período de tiempo del COVID-19, lo cual resultó en un aumento significativo en servicios IBH. Conclusiones: Para niños CMC y quienes les cuidan, las necesidades sicosociales identificadas a través de la detección sicosocial se mantuvieron altas durante la pandemia, lo que demuestra lo importante de la detección para este grupo de población. La necesidad de servicios IBH durante la pandemia COVID-19 aumentó, subrayando el valor y demanda de estos servicios en particular durante un momento sin precedente.

Objectif: Les Enfants avec une Complexité Médicale (abrégé ici en français ECM) et les personnes qui prennent soin d'eux sont à un risque plus élevé de facteurs de stress psychosociaux multiples qui peuvent impacter le bien-être de l'enfant et de la famille ainsi que la santé. Durant la pandémie du COVID-19, lorsque l'accès aux soutiens a diminué le dépistage psychosocial et les services de santé comportementale intégrée (SCI) dans les contextes de soins primaires se sont avérés cruciaux pour l'identification et la prise en charge des besoins uniques de cette population. Méthodes: Le dépistage universel afin d'identifier les besoins psychosociaux a été mis en place dans une clinique de soin primaire pour les ECM qui comporte des services SCI. Les données sur la prévalence du dépistage psychosocial et les services SCI pour les jeunes enfants et les personnes prenant soin d'eux avant et après la pandémie du COVID-19 ont été évalués. Résultats: Les niveaux de dépistage psychosocial sont restés stables durant la pandémie. Des besoins psychosociaux ont été identifiés pour 36% des dépistés avant la pandémie du COVID-19 et 33% durant la pandémie du COVID-19. Le besoin de services SCI a augmenté durant la période, résultant en une augmentation importante des services SCI. Conclusions: Pour les ECM et les personnes prenant soin d'eux, les besoins psychosociaux identifiés à travers le dépistage psychosocial est resté élevé pendant la pandémie, démontrant l'importance du dépistage pour cette population. Le besoin de services SCI durant la pandémie du COVID-19 a augmenté, ce qui souligne la valeur et le besoin de ces services surtout durant ces temps sans précédents.

Exploring the feasibility of validating early developmental screening tools for American Indian and Alaska Native children.

Screening children from birth through age 5 is critical to early identification of challenges and referral to intervention to support optimal development. Screening of American Indian and Alaska Native (AIAN) children lags behind that of other children, partly due to the lack of screening tools validated for this population. This study tested the feasibility of an online data collection strategy for use in a future study of the validity of existing screening instruments for AIAN children. Parents of AIAN children in four communities were recruited to complete screeners, provide demographic information, and provide feedback on experiences with online data collection. Participants were given the option of receiving screening results from the local early childhood program through which they were recruited. 240 participants began the process, 183 were enrolled in a partner program and reported a birthdate for at least one AIAN child, 157 had an age-eligible child, 81 began the consent process, 62 consented, and 39 fully completed data collection. Most participants were female and AIAN, the majority reported that online data collection was easy. Collecting screener validation data on a large sample of AIAN children may be able to utilize online data collection tools, with in-person support to facilitate participation.

Un examen de detección en los niños a partir del nacimiento hasta la edad de 5 años es esencial para la temprana identificación de retos y la referencia a intervenciones como apoyo a un desarrollo óptimo. El examen de detección en el caso de niños del grupo Indio Americano y Nativo de Alaska (AIAN) está muy por debajo del de otros niños, en parte debido a la falta de herramientas de detección validadas para esta población. Este estudio puso a prueba la posibilidad de una estrategia electrónica de recolección de datos para uso en un estudio futuro acerca de la validez de los existentes instrumentos de detección para niños AIAN. Se reclutaron progenitores de niños AIAN en cuatro comunidades para completar los exámenes de detección, proveer información demográfica, así como proveer información sobre las experiencias con la recolección electrónica de datos. A los participantes se les dio la opción de recibir los resultados de la detección de parte del programa local para la temprana niñez a través del cual habían sido reclutados. 240 participantes comenzaron el proceso; 183 estaban matriculados en un programa paralelo y reportaron la fecha de nacimiento de por lo menos un niño AIAN; 157 tenían un niño elegible según la edad; 81 comenzaron el proceso de consentimiento; 62 consintieron; 39 completaron en su totalidad la recolección de datos. La mayoría de los participantes eran mujeres y AIAN; la mayoría reportó que la recolección electrónica de datos fue fácil. La recolección de información de validación de la detección en un grupo muestra grande de niños AIAN pudiera ser capaz de utilizar herramientas electrónicas de recolección de datos, con un apoyo presencial para facilitar la participación.

Le dépistage des enfants de la naissance à l'âge de 5 ans est critique pour l'identification précoce des défis et problèmes et l'orientation vers l'intervention afin de soutenir le développement optimal. Le dépistage des enfants d'amérindiens des Etats-Unis et des autochtones d'Alaska est en retard par rapport à celui des autres enfants, en partie du fait du manque d'outils de dépistage validés pour cette population. Cette étude a testé la fiabilité de la stratégie de collecte de données en ligne pour son utilisation pour une étude à venir sur la validité d'instruments de dépistage existants pour les enfants AIAN. Les parents d'enfants AIAN de quatre communautés ont été recrutés afin de remplir des dépistages, d'offrir des renseignements démographiques, et d'offrir des commentaires sur les expériences de collecte de données en ligne. Les participants ont reçu l'option de recevoir les résultats de dépistage d'un programme de petite enfance local au travers duquel ils avaient été recrutés. 240 participants ont commencé le processus. 183 ont été inscrits dans un programme partenaire et ont fait état de la date de naissance d'au moins un enfant AIAN. 157 avait un enfant admissible par l'âge. 81 ont commencé le processus de consentement. 62 ont consenti. 39 ont fini la collecte de données en ligne. La collecte de données de validation du filtre de recherche sur un grand échantillon d'enfants AIAN pourrait utiliser des outils de collecte de données en ligne avec un soutien en personne afin de faciliter la participation.