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Background: Studies suggest perinatal infection with SARSCoV- 2 can induce adverse birth outcomes, but studies published to date have substantial limitations. Most have identified cases based upon their presentation for clinical care, and very few have examined pandemic-related stress which may also impact adverse birth outcomes. Objective(s): To evaluate the relationships between SARSCoV- 2 infection in pregnancy and pandemic-related stress with birth outcomes. Study Design: We conducted an observational study of 211 mother-newborn dyads in three urban cohorts participating in the Environmental Influences on Child Health Outcomes (ECHO) Program. Serology for SARS-CoV-2 was assessed in a convenience sample of prenatal maternal, cord serum or dried blood spots from births occurring between January 2020-September 2021. Specimens were assessed for IgG, IgM, and IgA antibodies to nucleocapsid, S1 spike, S2 spike, and receptor-binding domain. A Pandemic-related Traumatic Stress (PTS) scale was based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Acute Stress Disorder criteria. Result(s): 36% were positive for at least one antibody type, chiefly IgG. Self-report of infection was not significantly correlated with combined serology. There were no differences in gestational age (GA), birth weight, preterm birth (PTB), or low birth weight (LBW) among seropositive mothers. However, IgM seropositive mothers had children with lower BW (434g, 95% CI: 116- 752), BW Z score-for-GA (0.73 SD, 95% CI 0.10-1.36) and were more likely to deliver preterm (OR 8.75, 95% CI 1.22-62.4). Associations with LBW sustained in sensitivity analyses limited to pre-vaccine samples, and PTS symptoms were not associated with birth outcomes. The addition of PTS did not substantially change associations with BW, although associations with PTB attenuated to near-significance. Conclusion(s): We identified decreased birth weight and increased prematurity in mothers IgM seropositive to SARS-CoV-2, independent of PTS. Though there are limits to interpretation, the data support efforts to prevent SARS-CoV-2 infections in pregnancy.
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Neighbourhood design can have substantial impacts on children's physical and psychological well-being. COVID-19 lockdowns produced striking and unprecedented changes in how neighbourhoods functioned for children. The aim of this research was to explore what worked well for children during Alert Levels 3 and 4 (lockdown) in Aotearoa New Zealand (NZ), focusing in particular on the neighbourhood environment. Children (n = 192) aged between 5 and 13 years completed an online survey that collected information on neighbourhood walking and wheeling and what they liked about their neighbourhood during lockdown in NZ. Car-less neighbourhoods were important for supporting children's well-being. Community activities such as the NZ Bear Hunt were appreciated by children. Natural environments, being home, spending time with family, and simple activities were all liked by participants. Social connections were important but often required technology. Findings can help inform initiatives to support child well-being in the face of potential future lockdowns or new pandemics.
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The antibiotic amoxicillin is usually recommended as a first-line treatment for many common infections affecting children. Repeated lockdowns related to the coronavirus disease 2019 pandemic have contributed to supply difficulties for many drugs, including antibiotics. However, the risks associated with amoxicillin supply shortages appear not to have been sufficiently assessed, and the crisis we are facing today is serious and particularly dangerous for children's health. Without rigorous measures to prevent shortages related to drug production and distribution, populations could face a post-antibiotic era in which common infections and minor injuries can result in serious life-threatening situations. The availability of medicines declared by WHO as essential should be guaranteed not only in production but also in fair distribution. And this principle must be ensured by national and international regulatory agencies.Copyright © 2023 Medico e Bambino. All rights reserved.
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Lockdown is an important measure that has been globally adopted to reduce the spread of the contagious disease caused by SARS CoV-2. The imposed schedule and confinement led to extensive use of digital media and rise in sedentary activity drastically. The escalated duration of screen exposure causes disruption in sleep behavior. An online survey was conducted to comprehend the effect of lockdown on sleep behavior and screen exposure time on school children. Screen exposure time involved with various electronic gadgets was also analyzed. It was observed that the social jet lag and sleep debt were significantly less during lockdown than before it. Inertia during lockdown significantly increased. The difference between screen exposure time on weekdays before lockdown and weekends during lockdown was identified to be the highest. Three clusters based on sleep behavior and duration of screen time were identified of which Cluster 2 revealed simultaneous existence of high sleep duration and screen time. These baseline data on sleep parameters and duration of exposure to the screen will help us in devising approaches to mitigate the evident disruption this unprecedented phase has brought about. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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The world has not yet seen the end of COVID-19 or SARS-CoV-2. However, as the spate of infection, hospitalization, and death abates, we are limping back to what we used to know as being normal. A new world is emerging, and more of this newness is yet waiting to be discovered. Children are developing differently, parents are unable to provide the necessary psychological and social support, there is hardly any peer interaction yet, and adults in their lives are too preoccupied with their own distresses to give the kind of support a growing child needs. In many situations, children are being allowed to almost fend for themselves in social and familial areas and in the area of cognitive development and these will surely show their true colors in the years to come. On a positive note, the nearly-post-COVID-19 world has witnessed children displaying an array of coping mechanisms leading to post-traumatic growth (PTG). It is heartening to note that the human psyche has the ability to overcome distress and disaster and forge ahead in a positive manner. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Resumo Objetivo Analisar os fatores associados à restrição do acompanhamento de lactentes que nasceram prematuros e/ou baixo peso durante a pandemia da COVID-19 e a percepção de mães e profissionais de saúde quanto a essa realidade. Métodos Pesquisa de método misto com delineamento paralelo convergente, realizada com 14 mães de lactentes que nasceram prematuros e/ou baixo peso acompanhados no ambulatório de follow-up de uma maternidade em um município da Paraíba, e quatro profissionais de saúde desse serviço. A coleta de dados foi realizada no período de junho a julho de 2020, concomitantemente, em fonte de dados secundários, constituída de todos os 140 prontuários dos respectivos lactentes para abordagem quantitativa, por meio de entrevista semiestruturada, para abordagem qualitativa. A análise quantitativa ocorreu por estatística descritiva e inferencial, e a qualitativa, conforme análise temática indutiva. Resultados Houve associação significativa entre a idade dos lactentes e a restrição do seu acompanhamento no follow-up durante a pandemia, com priorização do atendimento presencial dos menores de seis meses, contatos pontuais com os familiares, via ligação telefônica ou aplicativo digital, e lacunas na atualização do calendário vacinal dos que tiveram o acompanhamento interrompido. Isso gerou insatisfação das mães e receio de prejuízos ao desenvolvimento dos lactentes. Também não houve continuidade do cuidado desses na unidade básica de saúde. Conclusão Houveram restrições no acompanhamento dos lactentes nascidos prematuros no serviço de follow-up durante a pandemia, gerando insatisfação materna e receio de prejuízos ao desenvolvimento de seus filhos.
Resumen Objetivo Analizar los factores asociados a la restricción del seguimiento de lactantes que nacieron prematuros o de bajo peso durante la pandemia de COVID-19 y la percepción de madres y profesionales de la salud respecto a esta realidad. Métodos Estudio de método mixto con diseño paralelo convergente, realizado con 14 madres de lactantes que nacieron prematuros o de bajo peso atendidos en consultorios externos de follow-up de una maternidad en un municipio del estado de Paraíba, y cuatro profesionales de la salud de este servicio. La recopilación de datos fue realizada en el período de junio a julio de 2020, simultáneamente en fuente de datos secundarios, compuesta por las 140 historias clínicas de los respectivos lactantes para el enfoque cuantitativo, por medio de entrevista semiestructurada, para el enfoque cualitativo. El análisis cuantitativo se llevó a cabo por estadística descriptiva e inferencial, y el cualitativo mediante análisis temático inductivo. Resultados Hubo relación significativa entre la edad de los lactantes y la restricción de su seguimiento en el follow-up durante la pandemia, con priorización de atención presencial a los menores de seis meses, contactos puntuales con los familiares, vía llamada telefónica o aplicación digital, y vacíos en la actualización del calendario de vacunación de los que tuvieron el seguimiento interrumpido. Esto generó insatisfacción de las madres y temor de perjudicar el desarrollo de los lactantes. Tampoco hubo continuidad del cuidado de estos en la unidad básica de salud. Conclusión Hubo restricciones en el seguimiento de los lactantes nacidos prematuros en el servicio de follow-up durante la pandemia, lo que generó insatisfacción materna y temor de perjudicar el desarrollo de sus hijos.
Abstract Objective To analyze the factors associated with restricting the follow-up of infants who were born premature and/or low birth weight during the COVID-19 pandemic and mothers' and health professionals' perception regarding this reality. Methods This is mixed methods research with a parallel convergent design, carried out with 14 mothers of infants who were born premature and/or low birth weight, followed up at a follow-up outpatient clinic of a maternity hospital in a municipality in Paraíba, and four health professionals from this service. Data collection was carried out from June to July 2020, concomitantly, in a secondary data source, consisting of all 140 medical records of the respective infants for a quantitative approach, through a semi-structured interview, for a qualitative approach. Quantitative analysis was performed using descriptive and inferential statistics, and qualitative analysis, according to inductive thematic analysis. Results There was a significant association between infant age and the restriction of their follow-up during the pandemic, with prioritization of one-to-one care for children under six months of age, occasional contacts with family members, via phone call or digital application, and gaps in updating the vaccination schedule of those whose follow-up was interrupted. This generated dissatisfaction on the part of mothers and fear of harm to the development of infants. There was also no continuity of care for these in the Basic Health Unit. Conclusion There were restrictions on follow-up of premature infants in the follow-up service during the pandemic, generating maternal dissatisfaction and fear of damage to the development of their children.
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Humans , Male , Female , Infant, Newborn , Infant , Breast Feeding , Infant, Premature , Maternal-Child Health Services , COVID-19 , Mothers , Child Health Services , Medical Records , Interviews as Topic , Evaluation Studies as TopicABSTRACT
INTRODUCTION: Globally, no person has been untouched by the COVID-19 pandemic. Yet, little attention has been given to children and adolescents in policy, provision and services. Moreover, there is a dearth of knowledge regarding the impact of COVID-19-associated orphanhood and caregiver loss on children. This study aims to provide early insights into the mental health and well-being of children and adolescents experiencing orphanhood or caregiver loss in South Africa. METHODS AND ANALYSIS: Data will be drawn from a quantitative longitudinal study in Cape Town, South Africa. A sample of children and adolescents between the ages of 9 and 18 years, experiencing parental or caregiver loss from COVID-19, will be recruited together with a comparison group of children in similar environments who did not experience loss. The study aims to recruit 500 children in both groups. Mental health and well-being among children will be explored through the use of validated and study-specific measures. Participants will be interviewed at two time points, with follow-up data being collected 12-18 months after baseline. A combination of analytical techniques (including descriptive statistics, regression modelling and structural equation modelling) will be used to understand the experience and inform future policy and service provision. ETHICS AND DISSEMINATION: This study received ethical approval from the Health Research Ethics Committee at Stellenbosch University (N 22/04/040). Results will be disseminated via academic and policy publications, as well as national and international presentations including high-level meetings with technical experts. Findings will also be disseminated at a community level via various platforms.
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COVID-19 , Humans , Child , Adolescent , Cohort Studies , COVID-19/epidemiology , Longitudinal Studies , Caregivers , Pandemics , South Africa/epidemiologyABSTRACT
BACKGROUND: The purpose of thispaper is to explore the experiences of parents and carers of children with chronic health conditions in accessing healthcare during the Covid-19 pandemic. Children with chronic conditions typically rely on both planned and unplanned care, and contact with healthcare professionals over extensive periods of time. Their distinct care needs render these children vulnerable to even to minor changes in healthcare provision. The wide-ranging care disruptions during the pandemic were therefore likely drastically to affect their health and wellbeing; an assessment of the effects of Covid-19 policies on healthcare access and quality of care delivered for this group is needed. METHODS: From 25/01/2022 to 25/05/2022, four focus groups were held with parents/carers of children with diabetes, neurodivergence, mental health conditions, and medical complexities to explore their experiences in navigating the healthcare system during the pandemic. Interviews were transcribed and then subjected to thematic analysis using NVivo qualitative research software. RESULTS: Our results indicate that children with chronic health conditions (and their parents/carers) experienced difficulties accessing healthcare during the pandemic. Problems with late diagnosis, prolonged waiting times, and deficiencies with telemedicine were identified, as were impacts of healthcare disruptions on children's wellbeing, and the wellbeing of wider families. We found that children with neurodivergence and those with mental health conditions were particularly affected with their health needs repeatedly de-prioritised. Furthermore, the loss of contact with multi-specialty clinical teams profoundly affected parents and carers, leaving them feeling isolated in managing their children's health. These diminished relationships became another vector for uncertainty in supporting children's health. CONCLUSION: The effects of healthcare disruptions on the welfare of children with chronic conditions (and their families), are well evidenced in this work, providing deeper understandings of the relationships between these children, their families and clinicians. The evidence in this paper aims to inform future policy and ethical guidelines so that the needs of children with long-term health conditions can be properly considered in times of crisis.
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COVID-19 , Telemedicine , Humans , Child , Caregivers , Pandemics , Health Services Accessibility , Chronic Disease , Parents , PolicyABSTRACT
Changes in research practice during the COVID-19 pandemic necessitates renewed attention to ethical protocols and reporting for data collection on sensitive topics. This review summarises the state of ethical reporting among studies collecting violence data during early stages of the pandemic. We systematically searched for journal publications from the start of the pandemic to November 2021, identifying 75 studies that collected primary data on violence against women and/or violence against children. We developed and applied a 14-item checklist of best practices to assess the transparency of ethics reporting and adherence to relevant global guidelines on violence research. Studies reported adhering to best practices on 31% of scored items. Reporting was highest for ethical clearance (87%) and informed consent/assent (84/83%) and lowest for whether measures to promote interviewer safety and support (3%), for facilitating referrals for minors and soliciting participant feedback were in place (both 0%). Violence studies employing primary data collection during COVID-19 reported on few ethical standards, obscuring stakeholder ability to enforce a 'do no harm' approach and to assess the reliability of findings. We offer recommendations and guidelines to improve future reporting and implementation of ethics within violence studies.
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COVID-19 , Pandemics , Child , Female , Humans , Checklist , Reproducibility of Results , Violence/prevention & controlABSTRACT
BACKGROUND: Despite the life-threatening presentation of multisystem inflammatory syndrome in children (MIS-C), the overall prognosis is favourable in centres with access to appropriate supportive care. In this study, we investigate the short-term outcomes in children with MIS-C in Cape Town, South Africa. METHODS: This prospective observational cohort study included children <13 years who fulfilled the WHO case definition of MIS-C and were admitted to Tygerberg Hospital in Cape Town, South Africa between 1 June 2020 and 31 October 2021. Clinical features were recorded at baseline and at follow-up at the 6-week cardiology and 3-month rheumatology-immunology clinics, respectively. FINDINGS: Fifty-three children with a median age of 7.4 years (IQR 4.2-9.9) were included. There was a slight male predominance (30/53; 56.6%) and the majority was of mixed ancestry (28/53; 52.83%) or black African ancestry (24/53; 45.3%). Fourteen children (14/53; 26.4%) had comorbid disease. The median length of hospital stay was 8 days (IQR 6-10). All children had an echocardiogram performed at baseline of which 39 were abnormal (39/53; 73.6%). All children were discharged alive. The median days from discharge to cardiology follow-up was 39 days (IQR 33.5-41.5) and for rheumatology-immunology clinic was 70.5 days (IQR 59.5-85.0). Eleven children (11/41; 26.8%) had a persistently abnormal echocardiogram at cardiology follow-up. Systemic inflammation and organ dysfunction resolved in most. INTERPRETATION: Although the short-term outcomes of MIS-C in our cohort were generally good, the cardiac morbidity needs further characterisation and follow-up.
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Background: Global routine childhood vaccine coverage has plateaued in recent years, and the COVID-19 pandemic further disrupted immunisation services. We estimated global and regional inequality of routine childhood vaccine coverage from 2019 to 2021, particularly assessing the impacts of the COVID-19 pandemic. Methods: We used longitudinal data for 11 routine childhood vaccines from the WHO-UNICEF Estimates of National Immunization Coverage (WUENIC), including 195 countries and territories in 2019-2021. The slope index of inequality (SII) and relative index of inequality (RII) of each vaccine were calculated through linear regression to express the difference in coverage between the top and bottom 20% of countries at the global and regional levels. We also explored inequalities of routine childhood vaccine coverage by WHO regions and unvaccinated children by income groups. Findings: Globally between January 1, 2019 and December 31, 2021, most childhood vaccines showed a declining trend in coverage, and therefore an increasing number of unvaccinated children, especially in low-income and lower-middle-income countries. Between-country inequalities existed for all 11 routine childhood vaccine coverage indicators. The SII for the third dose of diphtheria-tetanus-pertussis-containing vaccine (DTP3) coverage was 20.1 percentage points (95% confidence interval: 13.7, 26.5) in 2019, and rose to 23.6 (17.5, 30.0) in 2020 and 26.9 (20.0, 33.8) in 2021. Similar patterns were found for RII results and in other routine vaccines. In 2021, the second dose of measles-containing vaccine (MCV2) coverage had the highest global absolute inequality (31.2, [21.5-40.8]), and completed rotavirus vaccine (RotaC) coverage had the lowest (7.8, [-3.9, 19.5]). Among six WHO regions, the European Region consistently had the lowest inequalities, and the Western Pacific Region had the largest inequalities for many indicators, although both increased from 2019 to 2021. Interpretation: Global and regional inequalities of routine childhood vaccine coverage persisted and substantially increased from 2019 to 2021. These findings reveal economic-related inequalities by vaccines, regions, and countries, and underscore the importance of reducing such inequalities. These inequalities were widened during the COVID-19 pandemic, resulting in even lower coverage and more unvaccinated children in low-income countries. Funding: Bill & Melinda Gates Foundation.
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Introduction: The ParticipACTION Report Card on Physical Activity for Children and Youth is the most comprehensive national assessment of physical activity and related behaviors, characteristics, and opportunities for children and youth. The 2022 Report Card assigned grades based on data gathered during the COVID-19 pandemic to reflect this extraordinary time-period in Canada. Further, while not graded, efforts were made to summarize key findings for early years children and those identifying as: having a disability, Indigenous, 2SLGBTQ+, newcomers to Canada, racialized, or girls. The purpose of this paper is to summarize the 2022 ParticipACTION Report Card on Physical Activity for Children and Youth. Methods: The best available physical activity data captured during the whole COVID-19 pandemic was synthesized across 14 different indicators in four categories. The 2022 Report Card Research Committee assigned letter grades (i.e., A-F) based on expert consensus of the evidence. Synthesis: Grades were assigned for: Daily Behaviors (Overall Physical Activity: D; Active Play: D-; Active Transportation: C-; Organized Sport: C+; Physical Education: Incomplete [INC]; Sedentary Behaviors: F; Sleep: B; 24-Hour Movement Behaviors: F), Individual Characteristics (Physical Literacy: INC; Physical Fitness: INC), Spaces and Places (Household: C, School: B-, Community and Environment: B), and Strategies and Investments (Government: B-). Compared to the 2020 Report Card, the COVID-19 specific grades increased for Active Play and Active Transportation; and decreased for Overall Physical Activity, Sedentary Behaviors, Organized Sport, and Community and Environment. There were many data gaps for equity-deserving groups. Conclusion: During the COVID-19 pandemic, the grade for Overall Physical Activity decreased from a D+ (2020) to a D, coinciding with decreases in grades reflecting fewer opportunities for sport and community/facility-based activities as well as higher levels of sedentary behaviors. Fortunately, improvements in Active Transportation and Active Play during COVID-19 prevented a worse shift in children's health behaviors. Efforts are needed to improve physical activity for children and youth during and post-pandemic, with a greater emphasis on equity-deserving groups.
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COVID-19 , Sports , Female , Humans , Adolescent , Child , Pandemics , COVID-19/epidemiology , Exercise , Physical FitnessABSTRACT
Environmental factors are important causes that impair global pregnancy outcomes and are, importantly, responsible for maternal morbidity and mortality. However, apart from the direct reasons for maternal deaths, mainly obstetric and neonatal complications, such factors are ignored or given less importance. The recent surge in research on the impact of various environmental factors on pregnancy outcomes suggests the need for immediate attention to such factors and device-specific policies to counter the situation. Moreover, the recent coronavirus disease of 2019 (COVID-19) pandemic, global warming, and climate change showed a lack of preparedness to counter the impact of such events on maternal survival and safe and successful pregnancy outcomes. In the present review, we have emphasized the specific factors responsible for increased maternal and neonatal deaths and their association with specific environmental factors. Increased attention on maternal healthcare, preparedness to counter sudden environmental challenges and improvement of the conventional requirement for better maternal healthcare access and nutrition at a global level may improve the scenario.
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OBJECTIVES: This study aims to quantify the degree to which an underserved, Hispanic population in Los Angeles is impacted by SARS-CoV-2, and determine factors associated with paediatric seropositivity. DESIGN: Cross-sectional. SETTING: AltaMed, a Federally Qualified Health Center in Los Angeles. PARTICIPANTS: A random sample of households who had received healthcare at AltaMed Medical Group was invited to participate. Households with at least one adult and one paediatric participant between 5 and 17 years of age were eligible to participate. Consented participants completed a survey on social determinants of health and were tested for antibodies using Abbott Architect SARS-CoV-2-IgG and SARS-CoV-2-IgM tests. PRIMARY OUTCOME MEASURE: Seropositive status. RESULTS: We analysed 390 adults (mean age in years, 38.98 (SD 12.11)) and 332 paediatric participants (11.26 (SD 3.51)) from 196 households. Estimated seropositivity was 52.11% (95% CI 49.61% to 55.19%) in paediatric participants and 63.58% (95% CI 60.39% to 65.24%) in adults. Seropositivity was 11.47% (95% CI 6.82% to 14.09%) lower in paediatric participants, but high relative to other populations. A household member with type 2 diabetes (OR 2.94 (95% CI 1.68 to 5.14)), receipt of food stamps (OR 1.66 (95% CI 1.08 to 2.56)) and lower head-of-household education (OR 1.73 (95% CI 1.06 to 2.84)) were associated with paediatric seropositivity. CONCLUSIONS: SARS-CoV-2 seropositivity is high in Hispanic children and adolescents in Los Angeles. Food insecure households with low head-of-household education, and at least one household member with type 2 diabetes, had the highest risk. These factors may inform paediatrician COVID-19 mitigation recommendations. TRIAL REGISTRATION NUMBER: NCT04901624.
Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Adolescent , Adult , Humans , Child , SARS-CoV-2 , Los Angeles/epidemiology , COVID-19/epidemiology , Cross-Sectional Studies , Antibodies, Viral , Seroepidemiologic StudiesABSTRACT
BACKGROUND: Since March 2020, the COVID-19 pandemic has shocked health systems worldwide. This analysis investigated the effects of the pandemic on basic health services utilization in the Democratic Republic of the Congo (DRC) and examined the variability of COVID effects in the capital city Kinshasa, in other urban areas, and in rural areas. METHODS: We estimated time trends models using national health information system data to replicate pre-COVID-19 (i.e., January 2017-February 2020) trajectories of health service utilization, and then used those models to estimate what the levels would have been in the absence of COVID-19 during the pandemic period, starting in March 2020 through March 2021. We classified the difference between the observed and predicted levels as the effect of COVID-19 on health services. We estimated 95% confidence intervals and p-values to examine if the effect of the pandemic, nationally and within specific geographies, was statistically significant. RESULTS: Our results indicate that COVID-19 negatively impacted health services and subsequent recovery varied by service type and by geographical area. COVID-19 had a lasting impact on overall service utilization as well as on malaria and pneumonia-related visits among young children in the DRC. We also found that the effects of COVID-19 were even more immediate and stronger in the capital city of Kinshasa compared with the national effect. Both nationally and in Kinshasa, most affected services had slow and incomplete recovery to expected levels. Therefore, our analysis indicates that COVID-19 continued to affect health services in the DRC throughout the first year of the pandemic. CONCLUSIONS: The methodology used in this article allows for examining the variability in magnitude, timing, and duration of the COVID effects within geographical areas of the DRC and nationally. This analytical procedure based on national health information system data could be applied to surveil health service disruptions and better inform rapid responses from health service managers and policymakers.
Subject(s)
COVID-19 , Health Information Systems , Child , Humans , Child, Preschool , Democratic Republic of the Congo/epidemiology , Facilities and Services Utilization , Pandemics , COVID-19/epidemiologyABSTRACT
The final act of Philip Roth's achingly poignant novel, Nemesis, based on the 1944 polio epidemic condenses the trajectories of each of the main protagonists' lives as a result of events that sultry summer, Bucky Cantor, swapping life stories with a former pupil at his school. [...]the implications for long term (psychological and physical) health are arguably worse: late presentation for other febrile illness (EDs have never been so empty—something is wrong);fear of infection by dint of ‘exposure' to a health facility;interruption of standard health surveillance particularly vaccination;mental health;child abuse as a result of prolonged internment and loss of, at least the social side of, education. The reasons for less aggressive disease are still not completely understood, though there are a number of candidate explanators: host-response factors;lower infective dose (as most often from an adult household member);age related ACE receptor differences and more recent exposure to antigenically similar coronaviruses conferring relative immunity.
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BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, adolescents used various coping strategies to manage stress and loneliness. One such strategy was to engage in active coping, social relations coping and humour coping via social media. Such coping strategies can be helpful but can also reinforce stress and loneliness. AIM: To explore adolescents' use of social media to manage stress and loneliness at a time of restricted social contacts due to the COVID-19 pandemic, including potential differences between adolescents according to gender, age, area of residence and extent of social media use. METHOD: A cross-sectional design and an online questionnaire were used to survey a convenience sample of adolescents aged between 12 and 18 years in Jordan. Three data collection tools were used - the modified Brief Coping Scale, the six-item Revised UCLA Loneliness Scale and the Perceived Stress Scale. RESULTS: A total of 770 adolescents participated, half of whom were using social media more than before the pandemic. Increased use of active coping, social relations coping and humour coping was associated with decreases in stress and loneliness. Active coping contributed the most to reducing levels of stress while social relations coping contributed the most to reducing levels of loneliness. Younger participants made more use of active coping and humour coping than older participants. CONCLUSION: Social media use can be a positive coping strategy for adolescents to manage stress and loneliness during a crisis such as the COVID-19 pandemic.
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BACKGROUND: Kangaroo Mother Care (KMC) is an evidence-based intervention focused on premature and low-birth-weight (LBW) infants. In different healthcare systems, outpatient KMC programmes (KMCPs) have been pioneers in the follow-up of these high-risk newborns.Here, we describe an overview analysis performed in an unprecedented data set comprising Colombian infants and spanning 28 years. METHODS: Cohort study of 57 154 infants discharged home in kangaroo position (KP) for follow-up in four KMCPs between 1993 and 2021. RESULTS: At birth and at hospital discharge to a KMCP, median gestational age and weight were 34.5 and 36 weeks, 2000 g and 2200 g, respectively. Chronological age at admission was 8 days. Over time, anthropometric measures at birth and somatic growth during follow-up improved; on the other hand, percentages of mechanical ventilation, intraventricular haemorrhage and need for intensive care decreased as neuropsychomotor, sensory disorders and bronchopulmonary dysplasia incidence at 40 weeks. Risk of cerebral palsy and teenage mothers' frequency was higher in the poorest population. Early home discharge in KP in less than 72 hours was possible in 19% of the cohort. During the COVID-19 pandemic, we observed a more than twofold increase in exclusive breast feeding at 6 months and a reduction in readmission rates. CONCLUSION: This study provides a general overview of KMCPs follow-up during the last 28 years within the Colombian healthcare system. These descriptive analyses have allowed us to structure KMC as an evidence-based method. KMCPs allow close monitoring with regular feedback about preterm or LBW infants' perinatal care, quality of care over time and health status during their first year of life. Monitoring these outcomes is challenging but guarantees access to high-risk infants' care with equity.
Subject(s)
COVID-19 , Kangaroo-Mother Care Method , Female , Humans , Infant, Newborn , Pregnancy , Cohort Studies , Colombia/epidemiology , Follow-Up Studies , Infant, Low Birth Weight , Kangaroo-Mother Care Method/methods , PandemicsABSTRACT
The benefits of involving patients and the public in medical education are well documented, however there is a need to further explore how this can be translated to the setting of paediatric medical education. This article aims to identify how organisations can facilitate the involvement of paediatric patients and their parents/carers.While involving children in research can present challenges, we describe examples where organisations have successfully involved young people in clinical research and selection of research topics.Involving paediatric patients and their parents/carers in medical education helps develop a patient centred approach to practice for medical students. Participation of paediatric patients in objective structured clinical examination (OSCE) examinations is employed by many medical schools, however allowing them the ability to provide a 'global score' may have the potential to assess skills such as communication and empathy in addition to medical knowledge.The Royal College of Paediatrics and Child Health (RCPCH) have provided a framework on how to involve children in health services, addressing practical considerations such as funding and facilities. This framework could be applied by organisations seeking to actively involve children in paediatric medical education. Potential barriers and facilitators are explored in this article.During the COVID-19 pandemic, involving young people and their families in medical student teaching became challenging. We describe virtual bedside teaching sessions which actively involved paediatric patients and their families, which showed that many patients and parents prefer virtual consultations.Involving paediatric patients and their families in medical education is strongly advocated by the General Medical Council (GMC) and RCPCH. Organisations should actively seek out opportunities to become involved in the development of medical education resources as we describe in this paper.