Impact of a screen, triage and treat program for identifying chronic disease risk in Indigenous children.

BACKGROUND: The First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis project was a point-of-care screening program in rural and remote First Nations communities in Manitoba that aimed to identify and treat hypertension, diabetes and chronic kidney disease. The program identified chronic disease in 20% of children screened. We aimed to characterize clinical screening practices before and after intervention in children aged 10-17 years old and compare outcomes with those who did not receive the intervention. METHODS: This observational, prospective cohort study started with community engagement and followed the principles of ownership, control, access and possession (OCAP). We linked participant data to administrative data at the Manitoba Centre for Health Policy to assess rates of primary care and nephrology visits, disease-modifying medication prescriptions and laboratory testing (i.e., glycosylated hemoglobin [HbA1c], estimated glomerural filtration rate [eGFR] and urine albumin- or protein-to-creatinine ratio). We analyzed the differences in proportions in the 18 months before and after the intervention. We also conducted a 1:2 propensity score matching analysis to compare outcomes of children who were screened with those who were not. RESULTS: We included 324 of 353 children from the screening program (43.8% male; median age 12.3 yr) in this study. After the intervention, laboratory testing increased by 5.8% (95% confidence interval [CI] 1.1% to 10.1%) for HbA1c, by 9.9% (95% CI 4.2% to 15.5%) for eGFR and by 6.2% (95% CI 2.3% to 10.0%) for the urine albumin- or protein-to-creatinine ratio. We observed significant improvements in laboratory testing in screened patients in the group who were part of the program, compared with matched controls. INTERPRETATION: Chronic disease surveillance and care increased significantly in children after the implementation of a point-of-care screening program in rural and remote First Nation communities. Interventions such as active surveillance programs have the potential to improve the chronic disease care being provided to First Nations children.

Early Childhood Education and Adult Depression: An Attrition Reanalysis With Inverse Propensity Score Weighting.

In a previous study of the Child-Parent Centers (CPC) education program, preschool participation was linked to a 4.6 percentage point reduction (26%) in depressive symptoms at ages 22-24 over the matched comparison group enrolling the usual programs. The present study reanalyzed these data in the Chicago Longitudinal Study to address potential attrition bias since more than a quarter of the sample was missing on the outcome. Using inverse probability weighting (IPW) involving 32 predictors of sample retention, findings for the 1,142 participants growing up in high-poverty neighborhoods indicated that CPC participation was associated with a 7.1 percentage point reduction (95% CI = [-9.7, -5.4]) in one or more depressive symptoms (39% reduction over the comparison group). Although this marginal effect was within the confidence interval of the original study (95% CI = [-9.5, 0.3]), the 54% increase in the point estimate is substantial and of practical significance, suggesting underestimation in the prior study. Alternative analysis of different predictors and IPW models, including adjustments for program selection and attrition together, yielded similar results. Findings indicate that high-quality early childhood programs continue to be an important strategy for the prevention of depression and its debilitating effects on individuals and families.

The mediating role of social capital in the relationship between socioeconomic status and adolescent wellbeing: evidence from Ghana.

BACKGROUND: Social capital is generally portrayed to be protective of adolescents' health and wellbeing against the effects of socioeconomic inequalities. However, few empirical evidence exist on this protective role of social capital regarding adolescents' wellbeing in the low-and middle-income country (LMIC) context. This study examines the potential for social capital to be a protective health resource by investigating whether social capital can mediate the relationship between socioeconomic status (SES) and wellbeing of Ghanaian adolescents. It also examines how SES and social capital relate to different dimensions of adolescents' wellbeing in different social contexts. METHODS: The study employed a cross-sectional survey involving a randomly selected 2068 adolescents (13-18 years) from 15 schools (8 Senior and 7 Junior High Schools) in Ghana. Relationships were assessed using multivariate regression models. RESULTS: Three measures of familial social capital (family sense of belonging, family autonomy support, and family control) were found to be important protective factors of both adolescents' life satisfaction and happiness against the effects of socioeconomic status. One measure of school social capital (school sense of belonging) was found to augment adolescents' wellbeing but played no mediating role in the SES-wellbeing relationship. A proportion of about 69 and 42% of the total effect of SES on happiness and life satisfaction were mediated by social capital respectively. Moreover, there were variations in how SES and social capital related to the different dimensions of adolescents' wellbeing. CONCLUSION: Social capital is a significant mechanism through which SES impacts the wellbeing of adolescents. Social capital is a potential protective health resource that can be utilised by public health policy to promote adolescents' wellbeing irrespective of socioeconomic inequalities. Moreover, the role of the family (home) in promoting adolescents' wellbeing is superior to that of school which prompts targeted policy interventions. For a holistic assessment of adolescents' subjective wellbeing, both life evaluations (life satisfaction) and positive emotions (happiness) should be assessed concomitantly.

Analysis of psychiatric services provided to children and youth in 2010-2016 based on the National Health Fund data. / Analiza swiadczen psychiatrycznych udzielonych populacji rozwojowej w latach 2010­2016 na podstawie danych Narodowego Funduszu Zdrowia.

OBJECTIVES: In Poland, there is no systematic epidemiological research on mental disorders of children and adolescents in the general population, as well as a register dedicated to mental disorders. The aim of the presented study is to analyze psychiatric services reported to the National Health Fund that were provided to children and adolescents in the years 2010-2016. METHODS: The starting point of this study was report entitled Maps of health needs in mental disorders published by the Ministry of Health. The analysis concerns all mental health services provided to children and adolescents in the years 2010-2016. The analysis covers seven largest, in terms of the number of patients, groups of mental disorders according to ICD-10 in children and adolescents. RESULTS: In the years 2010-2016, both the number of psychiatric service users under the age of 18 years and the total number of healthcare services have increased in almost all of analyzed areas. Unusually high increase in the number of services provided in the ad hoc mode in A&E department was registered, with a very small share of services provided in home environment. In almost all analyzed groups of mental disorders, there was a greater number of boys, as well as residents of a town/city. Only in the group of neurotic disorders associated with stress and in the somatic form a slightly higher number of girls was noticed. CONCLUSIONS: In the years 2010-2016, an increase in the number of registered cases in the population of children and adolescents and the number of services in almost all of the analyzed areas was observed. High increase in services provided in the ad hoc mode in A&E department and a small share of services provided in the home environment indicates significant discrepancy between the needs and the availability of resources.

Follow-up on the diagnostic level of children covered by the Universal Neonatal Hearing Screening Program in Poland, divided into voivodships.

INTRODUCTION: Thanks to the Polish Universal Neonatal Hearing Screening Program (PUNHSP), all newborns in Poland undergo a free, screening hearing examination. Between 2006 and 2015, the average number of tested children per year was 373,477. According to the analysis of The Central Database (CDB), only 55.8% of the children attended the detailed hearing examinations at the second level of the Program. AIM: The aim of this study is to analyse the dates concerning the attendance of the children at the diagnostic level of PUNHSP in different regions of Poland. MATERIALS AND METHODS: To conduct an analysis of this fact and find out the reasons for low attendance at the second level in 2015, a telephone survey questionnaire was developed for parents who had not registered their babies for further consultation - 3,239 randomly selected parents. RESULTS: The analysis revealed that the number of children examined at the second diagnostic level of the program is in fact much higher than the results of The Central Database show. The actual number is 83.6% as opposed to 55.8%. As a result of the telephone questionnaire some inaccuracies in the input data to the CDB were detected. The main errors in gathering the information for the CDB were incorrect OAE test result and no examination performed. C onclusion: In Poland the worst results (i.e. questionnaire results compared to CDB) for the attendance at the diagnostic level were shown in Pomorskie, Lubelskie, Mazowieckie and Podlaskie regions. In many cases there was a large discrepancy between the reality and the information in the CDB. The improvement of clarity concerning the CDB application is important in order to minimise the possibility of malformation in the CDB.

Cross-sectoral integration in youth-focused health and social services in Canada: a social network analysis.

BACKGROUND: Youth with concurrent substance use and mental health concerns have diverse psychosocial needs and may present to a multitude of clinical and social service sectors. By integrating service sectors at a system level, the diversity of needs of youth with concurrent disorders can be addressed in a more holistic way. The objective of the present study was to quantify the level of cross-sectoral integration in youth-focused services in Canada. METHODS: Social network analysis (SNA) was used to examine the relationships between eight sectors: addictions, child welfare, education, physical health, housing, mental health, youth justice, and other social services. A total of 597 participants representing twelve networks of youth-serving agencies across Canada provided information on their cross-sectoral contacts and referrals. RESULTS: Overall, results suggested a moderate level of integration between sectors. The mental health and the addictions sectors demonstrated only moderate integration, while the addictions sector was strongly connected with the youth justice sector. CONCLUSIONS: Despite evidence of moderate integration, increased integration is called for to better meet the needs of youth with concurrent mental health and substance use concerns across youth-serving sectors. Ongoing efforts to enhance the integration between youth-serving sectors should be a primary focus in organizing networks serving youth with concurrent mental health and substance use needs.

Quality of Sick Child-Care Delivered by Community Health Workers in Tanzania.

BACKGROUND: Community health worker (CHW) interventions to manage childhood illness is a strategy promoted by the global health community which involves training and supporting CHW to assess, classify and treat sick children at home, using an algorithm adapted from the Integrated Management of Childhood Illness (IMCI). To inform CHW policy, the Government of Tanzania launched a program in 2011 to determine if community case management (CCM) of malaria, pneumonia and diarrhea could be implemented by CHW in that country. METHODS: This paper reports the results of an observational study on the CCM service delivery quality of a trial cohort of CHW in Tanzania, called WAJA. In 2014, teams of data collectors, employees of the Ministry of Health and Social Welfare trained in IMCI, assessed the IMCI skills rendered by a sample of WAJA on sick children who presented to WAJA with illness signs and symptoms in their communities. The assessment included direct observations of WAJA IMCI episodes and expert re-assessment of the same children seen by WAJA to assess the congruence between the assessment, classification and treatment outcomes of WAJA cases and those from cases conducted by expert re-assessors. RESULTS: In the majority of cases, WAJA correctly assess sick children for CCM-treatable illnesses (malaria, pneumonia, and diarrhea) and general danger signs (90% and 89%, respectively), but too few correctly assess for physical danger signs (39%); on classification in the majority of cases (73%) WAJA correctly classified illness, though more for CCM-treatable illnesses (83%). In majority of cases (78%) WAJA treated children correctly (84% of malaria, 74% pneumonia, and 71% diarrhea cases). Errors were often associated with lapses in health systems support, mainly supervision and logistics. CONCLUSION: CCM is a feasible strategy for CHW in Tanzania, who, in the majority of cases, implemented the approach as well as IMCI expert re-assessors. Nevertheless, for CCM to be effective, in Tanzania, a strategy to implement it must be coordinated with efforts to strengthen local health systems.

Forty years of research concerning children and youth in Greenland: a mapping review.

OBJECTIVE: This study undertakes a mapping review of mainly concerning children and youth in Greenland in the period 1976-2016 and reflects on how the research has been conducted and knowledge thereby created about children and youth in Greenland, as well as how the research has been developed over time. DESIGN: 16 online databases; five journals; publication lists originating from seven organisations and ten prominent researchers; and local network and references were used in the search and subsequently screened through the scoping criteria. 342 publications were included, encompassing knowledge based on empirical research on children and youth in Greenland within the broader field of psychology. RESULTS: The majority of studies, 71%, were conducted through quantitative methods. The qualitative research is represented in 22% of the studies and participatory and action-orientated research is represented in 7% of the studies. The most prominent themes in research concerning children and youth in Greenland were physical problems, which were found in 38% of the studies. CONCLUSIONS: The result reflects a consistent objectivity and quantitative methodology in health research in Greenland since 1991.The health research thus represents a united research community with a shared methodological research approach, while the local participatory action research projects all appear differentiated. While health research covers a spectrum of psychology related objectives, the methodology traditions reveal a specific kind of knowledge, which has come to determine how the mental health of the Greenlandic children is perceived. We believe that more qualitative and locally grounded approaches need to be organised in order to produce a more nuanced knowledge of the Greenlandic children and youth.

Community perceptions and practices of treatment seeking for childhood pneumonia: a mixed methods study in a rural district, Ghana.

BACKGROUND: The World Health Organization recommends community case management of malaria and pneumonia for reduction of under-five mortality in developing countries. Caregivers' perception and understanding of the illness influences the care a sick child receives. Studies in Ghana and elsewhere have routinely shown adequate recognition of malaria by caregivers. Similarly, evidence from Asia and some African countries have shown adequate knowledge on pneumonia. However, in Ghana, little has been documented about community awareness, knowledge, perceptions and management of childhood pneumonia particularly in the Dangme West district. Therefore this formative study was conducted to determine community perceptions of pneumonia for the purpose of informing the design and implementation of context specific health communication strategies to promote early and appropriate care seeking behaviour for childhood pneumonia. METHODS: A mixed method approach was adopted. Data were obtained from structured interviews (N = 501) and eight focus group discussions made up of 56 caregivers of under-fives and eight community Key Informants. Descriptive and inference statistics were used for the quantitative data and grounded theory to guide the analysis of the qualitative data. RESULTS: Two-thirds of the respondents had never heard the name pneumonia. Most respondents did not know about the signs and symptoms of pneumonia. For the few who have heard about pneumonia, causes were largely attributed to coming into contact with cold temperature in various forms. Management practices mostly were self-treatment with home remedies and allopathic care. CONCLUSION: The low awareness and inadequate recognition of pneumonia implies that affected children may not receive prompt and appropriate treatment as their caregivers may misdiagnose the illness. Adequate measures need to be taken to create the needed awareness to improve care seeking behaviour.

[Not Available]. / Mieszanki ziolowe o dzialaniu przeciwgoraczkowym jako przyklady tradycyjnego leku roslinnego stosowanego w populacji pediatrycznej.

Herbal medicines with antipyretic action have a long tradition of use in Polish phytotherapy. Over the years, they have proven both their efficacy and safety in a feverishness, which very often have accompanied the upper respiratory tract infections in children. Leading active ingredient of these products is the willow bark (Cortex salicis), which has been the active ingredient in both, the herbal mixture Pyrosan placed on the market in the 50's of last century and Pyrosal syrup marketed in the year 1989. Other herbal substances used in such preparations are elder flower, lime flower and meadowsweet flower. The usage of a pharmaceutical form of syrup is prerequisite when the main group of the patients are children. Such products are continuously in use for nearly 30 years in Poland.

Rational Therapy of Urinary Tract Infections in Children in Croatia

Resistance to chemotherapeutics used in the treatment of urinary tract infection is increasing throughout the world. Taking into account clinical experiences, as well as current bacterial resistance in Croatia and neighboring countries, the selection of antibiotic should be the optimal one. Treatment of urinary tract infection in children is particularly demanding due to their age and inclination to severe systemic reaction and renal scarring. If parenteral antibiotics are administered initially, it should be switched to oral medication as soon as possible. Financial aspects of antimicrobial therapy are also very important with the main goal to seek the optimal cost/benefit ratio. Financial orientation must appreciate the basic primum non nocere as a conditio sine qua non postulate as well.

The REFANI-N study protocol: a cluster-randomised controlled trial of the effectiveness and cost-effectiveness of early initiation and longer duration of emergency/seasonal unconditional cash transfers for the prevention of acute malnutrition among children, 6-59 months, in Tahoua, Niger.

BACKGROUND: The global burden of acute malnutrition among children remains high, and prevalence rates are highest in humanitarian contexts such as Niger. Unconditional cash transfers are increasingly used to prevent acute malnutrition in emergencies but lack a strong evidence base. In Niger, non-governmental organisations give unconditional cash transfers to the poorest households from June to September; the 'hunger gap'. However, rising admissions to feeding programmes from March/April suggest the intervention may be late. METHODS/DESIGN: This cluster-randomised controlled trial will compare two types of unconditional cash transfer for 'very poor' households in 'vulnerable' villages defined and identified by the implementing organisation. 3,500 children (6-59 months) and 2,500 women (15-49 years) will be recruited exhaustively from households targeted for cash and from a random sample of non-recipient households in 40 villages in Tahoua district. Clusters of villages with a common cash distribution point will be assigned to either a control group which will receive the standard intervention (n = 10), or a modified intervention group (n = 10). The standard intervention is 32,500 FCFA/month for 4 months, June to September, given cash-in-hand to female representatives of 'very poor' households. The modified intervention is 21,500 FCFA/month for 5 months, April, May, July, August, September, and 22,500 FCFA in June, providing the same total amount. In both arms the recipient women attend an education session, women and children are screened and referred for acute malnutrition treatment, and the households receive nutrition supplements for children 6-23 months and pregnant and lactating women. The trial will evaluate whether the modified unconditional cash transfer leads to a reduction in acute malnutrition among children 6-59 months old compared to the standard intervention. The sample size provides power to detect a 5 percentage point difference in prevalence of acute malnutrition between trial arms. Quantitative and qualitative process evaluation data will be prospectively collected and programme costs will be collected and cost-effectiveness ratios calculated. DISCUSSION: This randomised study design with a concurrent process evaluation will provide evidence on the effectiveness and cost-effectiveness of earlier initiation of seasonal unconditional cash transfer for the prevention of acute malnutrition, which will be generalisable to similar humanitarian situations. TRIAL REGISTRATION: ISRCTN25360839, registered March 19, 2015.

Dietary intake of vitamin D in obese children aged 1-3 years.

BACKGROUND: Obese children are predisposed to vitamin D deficiency. Most of the findings suggest that requirement for vitamin D is increased in obese children due to this vitamin sequestration in adipose tissue. OBJECTIVE: The aim of the study was to evaluate dietary intake of vitamin D in children with simple obesity in relation to nutritional standards. MATERIALS AND METHODS: The study included 73 children aged 1-3 years: 38 with simple obesity (group I) and 35 non-obese ones (group II - control). The inclusion criterion for the obese group was BMI z-score > +2.0, for the control group BMI z-score between -1.0 and +1.0.The intake of vitamin D was estimated using the Dieta 5.0 software on the basis of 3-days dietary record. Outcomes were related to nutritional standards. Differences in intake of energy and nutrients between both groups were assessed using the Mann-Whitney test (statistical significance was set at p = 0.05). RESULTS: Vitamin D intake in both groups was below the nutritional standards (10 µg/400 IU). Median values / interquartile ranges of results were 2.0 / 1.3-5.9 µg and 4.0 / 1.1-7.6 µg daily, for obese and non-obese children, respectively. The risk of deficient vitamin D intake was observed in 94.7% of obese children and in 82.4% of control group. The main dietary source of vitamin D in both groups was growing-up milk/Junior formula. The median intake of energy, protein, fat and carbohydrates in the obese children were significantly higher than in the control group (p<0.05). CONCLUSIONS: In obese children aged 1-3 years adequate dietary intake of vitamin D was not achieved. Similarly, the intake of vitamin D by normal weight children was lower than recommended. Consequently, it is necessary to provide products rich in vitamin D in the diet of toddlers, particularly obese.

Selected indices of health status in preschool children from Pila and their families as a risk factor of diet-related diseases.

BACKGROUND: Diet-related diseases have their origin as early as in childhood; therefore, preventing them should start from the first years of life. Each assessment of dietary intake should be preceded by assessment of health status indices, especially familial diet-related diseases prevalence. OBJECTIVE: The objective of this study was to analyse selected indices of health status in preschool children from Pila and their families in order to assess the risk of developing diet-related diseases. MATERIAL AND METHODS: The studied population comprised 128 children aged 4 to 6 years, 63 girls and 65 boys, who at- tended two preschools in Pila. Parents filled in questionnaires concerning selected indices of health status of the children and their families. Statistical analysis was carried out by means of the IBM SPSS Statistics 21.0 computer programme. The studied children were divided according to gender. RESULTS: Statistically significantly higher percentage of boys than girls took medicines, 41.5% vs 21.0%. As many as 49.6% of mothers and 33.1% of fathers had higher education and most of the parents assessed the economic status of the family either as good or very good. Most of the studied children took dietary supplements. The highest percentage of both girls and boys, 34.2% and 33.8%, respectively, took vitamin and mineral supplements. The prevalence of familial diet-related diseases ranged from 3.2% in the case of hyperlipidaemia to 65.6% in the case of hypertension. CONCLUSIONS: The high percentage of the studied preschoolers who took dietary supplements shows the need to educate parents about the adverse effects of excessive intake of these nutrients and about the necessity to take such supplements only on recommendation of the paediatrician. The analysed indices of health status of the studied children and their families show the need to pay much attention to balanced diet and daily physical activity in order to prevent diet-related diseases in the studied preschoolers and their families.

Adherence to multiple micronutrient powder among young children in rural Bangladesh: a cross-sectional study.

BACKGROUND: Multiple micronutrient powder (MMNP) can be sprinkled onto any semisolid food and can be given to young children to address iron deficiency anemia. The female community health volunteers of BRAC (an NGO) known as Shasthya Shebikas (SS) sell MMNP sachets during their regular household visits. Currently there are no data on adherence or real uptake of MMNP by children. The objective of the study was to assess adherence to MMNP and associated factors among children aged 6-59 months in rural Bangladesh. METHODS: A cross sectional study was conducted in Saturia Sub-district among 78 children aged 6-59 months who were fed MMNP supplied by BRAC SS in the past 60 days. A one stage cluster sampling technique was used to select mothers with eligible children. Semi-structured questionnaire was used for interviews. A logistic regression model was developed to obtain adjusted odds ratios (AOR) with 95% CI. RESULTS: Sample mean adherence was calculated to be 70%. In multivariate analysis, age of mother in years (AOR = 0.74, 95% CI: 0.61-0.88), households belonging to poorer (AOR = 0.01, 95% CI: 0.00-0.68), middle (AOR = 0.04, 95% CI: 0.00-0.35) and richer (AOR = 0.11, 95% CI: 0.01-0.84) wealth quintiles and mothers who prefer to feed flexibly (AOR = 0.03, 95% CI: 0.00-0.26) were significantly associated with high adherence. Further, for every one unit increase in visit by BRAC SS in the past 60 days, the odds of having high adherence significantly increased by 55% (AOR = 1.55, 95% CI: 1.09-2.20). CONCLUSIONS: SS are the key to improving adherence through regular visits to households of MMNP users. However, expanding coverage beyond the vicinity of the SS's household is a challenge. Perception of families whose children have low adherence should be studied.

Neighborhood adversity, child health, and the role for community development.

Despite medical advances, childhood health and well-being have not been broadly achieved due to rising chronic diseases and conditions related to child poverty. Family and neighborhood living conditions can have lasting consequences for health, with community adversity affecting health outcomes in significant part through stress response and increased allostatic load. Exposure to this "toxic stress" influences gene expression and brain development with direct and indirect negative consequences for health. Ensuring healthy child development requires improving conditions in distressed, high-poverty neighborhoods by reducing children's exposure to neighborhood stressors and supporting good family and caregiver functioning. The community development industry invests more than $200 billion annually in low-income neighborhoods, with the goal of improving living conditions for residents. The most impactful investments have transformed neighborhoods by integrating across sectors to address both the built environment and the social and service environment. By addressing many facets of the social determinants of health at once, these efforts suggest substantial results for children, but health outcomes generally have not been considered or evaluated. Increased partnership between the health sector and community development can bring health outcomes explicitly into focus for community development investments, help optimize intervention strategies for health, and provide natural experiments to build the evidence base for holistic interventions for disadvantaged children. The problems and potential solutions are beyond the scope of practicing pediatricians, but the community development sector stands ready to engage in shared efforts to improve the health and development of our most at-risk children.

Perinatal mental health: midwives and health visitors working together.

The Healthy Child Programme (HCP) focuses on the care offered to pregnant women and children in the first five years of life. It is delivered by a range of professionals, with the health visitor as lead. Effective delivery of the HCP depends on services for children and families being fully integrated, and partnership working between different agencies on a local level seems to be the key to success. This article focuses on how effective implementation of the HCP facilitates the recognition and care of women with anxiety, mild to moderate depression and other perinatal mental disorders during both the antenatal period and after the birth.