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4.
Curr Opin Clin Nutr Metab Care ; 24(3): 271-275, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33631771

RESUMEN

PURPOSE OF REVIEW: Undernutrition, including micronutrient deficiencies, continues to plague children across the world, particularly in low and middle-income countries (LMICs). The situation has worsened alongside the SARS-CoV-2 pandemic because of major systemic disruptions to food supply, healthcare, and employment. Large-scale food fortification (LSFF) is a potential strategy for improving micronutrient intakes through the addition of vitamins and minerals to staple foods and improving the nutritional status of populations at large. RECENT FINDINGS: Current evidence unquestionably supports the use of LSFF to improve micronutrient status. Evidence syntheses have also demonstrated impact on some functional outcomes, including anemia, wasting, underweight, and neural tube defects, that underpin poor health and development. Importantly, many of these effects have also been reflected in effectiveness studies that examine LSFF in real-world situations as opposed to under-controlled environments. However, programmatic challenges must be addressed in LMICs in order for LSFF efforts to reach their full potential. SUMMARY: LSFF is an important strategy that has the potential to improve the health and nutrition of entire populations of vulnerable children. Now more than ever, existing programs should be strengthened and new programs implemented in areas with widespread undernutrition and micronutrient deficiencies.


Asunto(s)
Salud del Niño/tendencias , Trastornos de la Nutrición del Niño/terapia , Alimentos Fortificados/provisión & distribución , Micronutrientes/administración & dosificación , Niño , Trastornos de la Nutrición del Niño/epidemiología , Países en Desarrollo/estadística & datos numéricos , Femenino , Humanos , Masculino , Estado Nutricional , Pobreza/estadística & datos numéricos
5.
Lancet Glob Health ; 9(3): e352-e360, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33308422

RESUMEN

BACKGROUND: Kyrgyzstan has made considerable progress in reducing child mortality compared with other countries in the region, despite a comparatively low economic standing. However, maternal mortality is still high. Given the availability of an established birth registration system, we aimed to comprehensively assess the trends and determinants of reproductive, maternal, newborn, and child health in Kyrgyzstan. METHODS: For this Countdown to 2030 country case study, we used publicly available data repositories and the national birth registry of Kyrgyzstan to examine trends and inequalities of reproductive, maternal, and newborn health and mortality between 1990 and 2018, at a national and subnational level. Coverage of newborn and maternal health interventions was assessed and disaggregated by equity dimensions. We did Oaxaca-Blinder decomposition to determine the contextual factors associated with the observed decline in newborn mortality rates. We also undertook a comprehensive review of national policies and programmes, as well as a prospective Lives Saved Tool analysis, to highlight interventions that have the potential to avert the most maternal, neonatal, and child deaths. FINDINGS: Over the past two decades, Kyrgyzstan reduced newborn mortality rates by 46% and mortality rates of children younger than 5 years by 69%, whereas maternal mortality rates were reduced by 7% and stillbirth rates by 29%. The leading causes of neonatal deaths were prematurity and asphyxia or hypoxia, and preterm small-for-gestational-age infants were more than 80 times more likely to die in their first month of life compared with those born appropriate-for-gestational age at term. Except for contraceptive use, coverage of essential interventions has increased and is generally high, with limited sociodemographic inequities. With scale-up of a few essential neonatal and maternal interventions, 39% of neonatal deaths, 11% of stillbirths, and 19% of maternal deaths could be prevented by 2030. INTERPRETATION: Kyrgyzstan has reduced newborn mortality rates considerably, with the potential for further reduction. To achieve and exceed the Sustainable Development Goal 3 targets for newborn survival and reducing stillbirths, Kyrgyzstan needs to scale up packages of interventions for the care of small and sick babies, assure quality of care in all health-care facilities with regionalised perinatal care, and create a linked national registry for mothers and neonates with rapid feedback and accountability. FUNDING: US Fund for UNICEF under the Countdown to 2015, UNICEF Kyrgyzstan Office.


Asunto(s)
Salud del Niño/tendencias , Salud del Lactante/tendencias , Mortalidad Infantil/tendencias , Salud Materna/tendencias , Asia Central/epidemiología , Preescolar , Femenino , Política de Salud , Humanos , Lactante , Recién Nacido , Kirguistán/epidemiología , Embarazo , Resultado del Embarazo/epidemiología , Estudios Prospectivos
6.
Artículo en Inglés | MEDLINE | ID: mdl-33207689

RESUMEN

The psychological impact of the COVID-19 pandemic has been widely discussed during the past few months, with scholars expressing concern about its potential debilitating consequences on youth mental health. Hence, this research aimed to provide a systematic review of the evidence on the COVID-19 pandemic's impact on youth mental health. We conducted a mixed methods integrated review to identify any empirical study that focused on young people ≤ 18 years old. Eight databases were systematically searched to identify studies of any type of research design. The selection procedure followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The protocol of this systematic review was registered with PROSPERO (protocol ID: CRD4202019375). Twelve studies deemed eligible for data extraction (n = 12,262). The findings show that COVID-19 has an impact on youth mental health and is particularly associated with depression and anxiety in adolescent cohorts. The quality appraisal indicated that all studies were of low or moderate methodological quality. The COVID-19 pandemic is affecting young people's lives, and thus generating robust research evidence to inform policy decisions is essential. Hence, the methodological quality of future research should be drastically improved.


Asunto(s)
Infecciones por Coronavirus/psicología , Salud Mental , Neumonía Viral/psicología , Adolescente , Salud del Adolescente/tendencias , Ansiedad/epidemiología , Betacoronavirus , Niño , Salud del Niño/tendencias , Depresión/epidemiología , Humanos , Salud Mental/tendencias , Evaluación de Resultado en la Atención de Salud , Pandemias
7.
Rev Paul Pediatr ; 39: e2020267, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33146295

RESUMEN

OBJECTIVE: Social isolation is currently identified as the best way to prevent the infection by the new coronavirus. However, for some social groups, such as children and adolescents, this measure carries a contradiction: the home, which should be the safest place for them, is also a frequent environment of a sad aggravation: domestic violence. This study aims to evaluate the notifications of interpersonal/self-inflicted violence available in the Information System for Notifiable Diseases in the State of Santa Catarina (southern Brazil), for the juvenile age group, before and during the new coronavirus pandemics. METHODS: Cross-sectional, descriptive study of violence against children and adolescents (from 0 to 19 years) notified by health professionals by completing and entering the occurrence in the Information System for Notifiable Diseases of the State of Santa Catarina in 11 weeks in which the social isolation measure was instituted as mandatory, comparing with the same period before this measure. RESULTS: During the study period, 136 municipalities in Santa Catarina made 1,851 notifications. There was a decrease of 55.3% of them in the isolation period, and the difficulties encountered in seeking protection and assistance institutions were listed. CONCLUSIONS: The society needs to be aware of possible cases of violence in the children and adolescent population. It is important to provide accessible, effective, and safe ways for complaints and notifications, as well as a quick response to the cases, aiming at protecting victims and minimizing damages to prevent the perpetuation of the violence.


Asunto(s)
Maltrato a los Niños , Bienestar del Niño , Infecciones por Coronavirus/epidemiología , Violencia Doméstica , Neumonía Viral/epidemiología , Adolescente , Salud del Adolescente/tendencias , Betacoronavirus , Brasil/epidemiología , Niño , Maltrato a los Niños/prevención & control , Maltrato a los Niños/estadística & datos numéricos , Salud del Niño/tendencias , Estudios Transversales , Recolección de Datos/métodos , Recolección de Datos/estadística & datos numéricos , Violencia Doméstica/prevención & control , Violencia Doméstica/tendencias , Femenino , Humanos , Masculino , Evaluación de Necesidades , Pandemias
10.
Lancet Diabetes Endocrinol ; 8(9): 793-800, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32822601

RESUMEN

Gestational diabetes, the most common medical disorder in pregnancy, is defined as glucose intolerance resulting in hyperglycaemia that begins or is first diagnosed in pregnancy. Gestational diabetes is associated with increased pregnancy complications and long-term metabolic risks for the woman and the offspring. However, the current diagnostic and management strategies recommended by national and international guidelines are mainly focused on short-term risks during pregnancy and delivery, except the Carpenter-Coustan criteria, which were based on the risk of future incidence of type 2 diabetes post-gestational diabetes. In this Personal View, first, we summarise the evidence for long-term risk in women with gestational diabetes and their offspring. Second, we suggest that a shift is needed in the thinking about gestational diabetes; moving from the perception of a short-term condition that confers increased risks of large babies to a potentially modifiable long-term condition that contributes to the growing burden of childhood obesity and cardiometabolic disorders in women and the future generation. Third, we propose how the current clinical practice might be improved. Finally, we outline and justify priorities for future research.


Asunto(s)
Salud del Niño/tendencias , Diabetes Gestacional/terapia , Salud Materna/tendencias , Niño , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiología , Femenino , Humanos , Hiperglucemia/diagnóstico , Hiperglucemia/epidemiología , Hiperglucemia/terapia , Obesidad Pediátrica/diagnóstico , Obesidad Pediátrica/epidemiología , Obesidad Pediátrica/prevención & control , Embarazo
12.
JAMA Netw Open ; 3(6): e206757, 2020 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-32520359

RESUMEN

Importance: Racial/ethnic disparities in quality of care among extremely preterm infants are associated with adverse outcomes. Objective: To assess whether racial/ethnic disparities in major outcomes and key care practices were changing over time among extremely preterm infants. Design, Setting, and Participants: This observational cohort study used prospectively collected data from 25 US academic medical centers. Participants included 20 092 infants of 22 to 27 weeks' gestation with a birth weight of 401 to 1500 g born at centers participating in the National Institute of Child Health and Human Development Neonatal Research Network from 2002 to 2016. Of these infants, 9316 born from 2006 to 2014 were eligible for follow-up at 18 to 26 months' postmenstrual age (excluding 5871 infants born before 2006, 2594 infants born after 2014, and 2311 ineligible infants including 64 with birth weight >1000 g and 2247 infants with gestational age >26 6/7 weeks), of whom 745 (8.0%) did not have known follow-up outcomes at 18 to 26 months. Main Outcomes and Measures: Rates of mortality, major morbidities, and care practice use over time were evaluated using models adjusted for baseline characteristics, center, and birth year. Data analyses were conducted from 2018 to 2019. Results: In total, 20 092 infants with a mean (SD) gestational age of 25.1 (1.5) weeks met the inclusion criteria and were available for the primary outcome: 8331 (41.5%) black infants, 3701 (18.4%) Hispanic infants, and 8060 (40.1%) white infants. Hospital mortality decreased over time in all groups. The rate of improvement in hospital mortality over time did not differ among black and Hispanic infants compared with white infants (black infants went from 35% to 24%, Hispanic infants went from 32% to 27%, and white infants went from 30% to 22%; P = .59 for race × year interaction). The rates of late-onset sepsis among black infants (went from 37% to 24%) and Hispanic infants (went from 45% to 23%) were initially higher than for white infants (went from 36% to 25%) but decreased more rapidly and converged during the most recent years (P = .02 for race × year interaction). Changes in rates of other major morbidities did not differ by race/ethnicity. Death before follow-up decreased over time (from 2006 to 2014: black infants, 14%; Hispanic infants, 39%, white infants, 15%), but moderate-severe neurodevelopmental impairment increased over time in all racial/ethnic groups (increase from 2006 to 2014: black infants, 70%; Hispanic infants, 123%; white infants, 130%). Rates of antenatal corticosteroid exposure (black infants went from 72% to 90%, Hispanic infants went from 73% to 83%, and white infants went from 86% to 90%; P = .01 for race × year interaction) and of cesarean delivery (black infants went from 45% to 59%, Hispanic infants went from 49% to 59%, and white infants went from 62% to 63%; P = .03 for race × year interaction) were initially lower among black and Hispanic infants compared with white infants, but these differences decreased over time. Conclusions and Relevance: Among extremely preterm infants, improvements in adjusted rates of mortality and most major morbidities did not differ by race/ethnicity, but rates of neurodevelopmental impairment increased in all groups. There were narrowing racial/ethnic disparities in important care practices, including the use of antenatal corticosteroids and cesarean delivery.


Asunto(s)
Corticoesteroides/efectos adversos , Disparidades en Atención de Salud/etnología , Mortalidad Hospitalaria/tendencias , Trastornos del Neurodesarrollo/etnología , Peso al Nacer , Estudios de Casos y Controles , Cesárea/estadística & datos numéricos , Salud del Niño/etnología , Salud del Niño/tendencias , Estudios de Cohortes , Grupos Étnicos , Femenino , Edad Gestacional , Humanos , Recien Nacido Extremadamente Prematuro , Recién Nacido , Morbilidad/tendencias , Trastornos del Neurodesarrollo/epidemiología , Embarazo , Atención Prenatal , Estudios Prospectivos , Estados Unidos/etnología
13.
Pediatrics ; 145(6)2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32409482

RESUMEN

OBJECTIVES: In this study, we present an epidemiological profile of middle childhood (children aged 6-11 years) using the 2016-2017 National Survey of Children's Health. METHODS: We used data from the 2016 and 2017 National Survey of Children's Health, a national cross-sectional, address-based survey administered annually. The study sample included 21 539 children aged 6 to 11 years. Survey items chosen to create this profile of middle childhood described sociodemographic and family characteristics, health status, and behaviors. Weighted descriptive and bivariate analyses were applied to examine the population and differences by subgroups. RESULTS: Most children aged 6 to 11 years were in excellent or very good physical health (89%) and oral health (73%). More than 20% were considered to have special health care needs, and 20% had at least 2 health conditions. Allergies and asthma were the most prevalent physical conditions, whereas attention-deficit/hyperactivity disorder and behavioral or conduct problems were the most prevalent of emotional, behavioral, and/or developmental disorders. More than half of children participated in sports or other activities for at least 60 minutes per day, whereas more than one-third of children had ≥4 hours of parent-reported screen time per day, and nearly two-thirds received ≥9 hours of sleep per night. We found several significant differences in screen time and activity behaviors as children aged and by sex. CONCLUSIONS: The middle-childhood population is generally healthy, yet several patterns observed with respect to age and sex indicate a need to examine the emergence and progression of select health-risk behaviors. In this study, we highlight opportunities to implement targeted interventions at earlier ages and different points along the life course.


Asunto(s)
Salud del Niño/tendencias , Conductas Relacionadas con la Salud/fisiología , Encuestas Epidemiológicas/tendencias , Factores de Edad , Niño , Estudios Transversales , Femenino , Conductas de Riesgo para la Salud/fisiología , Encuestas Epidemiológicas/métodos , Humanos , Masculino
14.
BMC Public Health ; 20(1): 564, 2020 May 19.
Artículo en Inglés | MEDLINE | ID: mdl-32423441

RESUMEN

BACKGROUND: To analyse the impact of austerity measures taken by European governments as a response to the 2008 economic and financial crisis on social determinants on child health (SDCH), and child health outcomes (CHO). METHODS: A systematic literature review was carried out in Medline (Ovid), Embase, Web of Science, PsycInfo, and Sociological abstracts in the last 5 years from European countries. Studies aimed at analysing the Great Recession, governments' responses to the crisis, and its impact on SDCH were included. A narrative synthesis of the results was carried out. The risk of bias was assessed using the STROBE and EPICURE tools. RESULTS: Fourteen studies were included, most of them with a low to intermediate risk of bias (average score 72.1%). Government responses to the crisis varied, although there was general agreement that Greece, Spain, Ireland and the United Kingdom applied higher levels of austerity. High austerity periods, compared to pre-austerity periods were associated with increased material deprivation, child poverty rates, and low birth weight. Increasing child poverty subsequent to austerity measures was associated with deterioration of child health. High austerity was also related to poorer access and quality of services provided to disabled children. An annual reduction of 1% on public health expenditure was associated to 0.5% reduction on Measles-Mumps-Rubella vaccination coverage in Italy. CONCLUSIONS: Countries that applied high level of austerity showed worse trends on SDCH and CHO, demonstrating the importance that economic policy may have for equity in child health and development. European governments must act urgently and reverse these austerity policy measures that are detrimental to family benefits and child protection.


Asunto(s)
Salud del Niño/tendencias , Recesión Económica , Política Pública , Determinantes Sociales de la Salud/tendencias , Niño , Europa (Continente) , Humanos
15.
Sci Rep ; 10(1): 4311, 2020 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-32152374

RESUMEN

The extensive literature has reported adverse effects on environmental tobacco smoke (ETS) on children's health. We aim to analyze associations of ETS with dry night cough, croup, pneumonia, and frequent common cold and to disentangle the effects of prenatal, infancy and childhood exposure by multilevel logistic regression. A cross-sectional study was conducted among 41,176 children aged 3-8 years in 8 major cities of China during 2010-2011, and obtained demographic information, smoke exposure information, and respiratory outcomes. Parents' smoking habit and indoor tobacco smoke odor were considered as two indicators of ETS. The prevalences of respiratory outcomes were 6.0% for croup, 9.5% for frequency common cold, 17.1% for dry night cough and 32.3% for pneumonia respectively in the study. The associations between respiratory outcomes and parental smoking were not obvious, while indoor tobacco smoke odor was clearly and strongly associated with most respiratory outcomes, with adjusted odds ratios ranging from 1.06 to 1.95. Both infancy and childhood exposure to tobacco smoke odor were independent risk factors, but infancy exposure had a higher risk. The results explore that ETS increased the risk of respiratory outcomes in children, highlighting the need for raising awareness about the detrimental effects of tobacco smoke exposure.


Asunto(s)
Contaminación del Aire Interior/efectos adversos , Salud del Niño/tendencias , Exposición a Riesgos Ambientales/efectos adversos , Efectos Tardíos de la Exposición Prenatal/etiología , Enfermedades Respiratorias/etiología , Contaminación por Humo de Tabaco/efectos adversos , Fumar Tabaco/efectos adversos , Niño , Preescolar , China/epidemiología , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Embarazo , Efectos Tardíos de la Exposición Prenatal/epidemiología , Efectos Tardíos de la Exposición Prenatal/patología , Prevalencia , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/patología , Factores de Riesgo
16.
PLoS Med ; 17(3): e1003054, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32176692

RESUMEN

BACKGROUND: Education and health are both constituents of human capital that enable people to earn higher wages and enhance people's capabilities. Human capabilities may lead to fulfilling lives by enabling people to achieve a valuable combination of human functionings-i.e., what people are able to do or be as a result of their capabilities. A better understanding of how these different human capabilities are produced together could point to opportunities to help jointly reduce the wide disparities in health and education across populations. METHODS AND FINDINGS: We use nationally and regionally representative individual-level data from Demographic and Health Surveys (DHS) for 55 low- and middle-income countries (LMICs) to examine patterns in human capabilities at the national and regional levels, between 2000 and 2017 (N = 1,657,194 children under age 5). We graphically analyze human capabilities, separately for each country, and propose a novel child-based Human Development Index (HDI) based on under-five survival, maternal educational attainment, and measures of a child's household wealth. We normalize the range of each component using data on the minimum and maximum values across countries (for national comparisons) or first-level administrative units within countries (for subnational comparisons). The scores that can be generated by the child-based HDI range from 0 to 1. We find considerable heterogeneity in child health across countries as well as within countries. At the national level, the child-based HDI ranged from 0.140 in Niger (with mean across first-level administrative units = 0.277 and standard deviation [SD] 0.114) to 0.755 in Albania (with mean across first-level administrative units = 0.603 and SD 0.089). There are improvements over time overall between the 2000s and 2010s, although this is not the case for all countries included in our study. In Cambodia, Malawi, and Nigeria, for instance, under-five survival improved over time at most levels of maternal education and wealth. In contrast, in the Philippines, we found relatively few changes in under-five survival across the development spectrum and over time. In these countries, the persistent location of geographical areas of poor child health across both the development spectrum and time may indicate within-country poverty traps. Limitations of our study include its descriptive nature, lack of information beyond first- and second-level administrative units, and limited generalizability beyond the countries analyzed. CONCLUSIONS: This study maps patterns and trends in human capabilities and is among the first, to our knowledge, to introduce a child-based HDI at the national and subnational level. Areas of chronic deprivation may indicate within-country poverty traps and require alternative policy approaches to improving child health in low-resource settings.


Asunto(s)
Desarrollo Infantil , Salud del Niño/tendencias , Países en Desarrollo , Escolaridad , Disparidades en el Estado de Salud , Indicadores de Salud , Determinantes Sociales de la Salud/tendencias , Factores de Edad , Salud del Niño/economía , Mortalidad del Niño/tendencias , Preescolar , Estudios Transversales , Países en Desarrollo/economía , Femenino , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Masculino , Evaluación de Necesidades/tendencias , Pobreza/tendencias , Estudios Retrospectivos , Determinantes Sociales de la Salud/economía
18.
Pharm. pract. (Granada, Internet) ; 18(1): 0-0, ene.-mar. 2020. tab, graf
Artículo en Inglés | IBECS | ID: ibc-195722

RESUMEN

OBJECTIVE: The aim of this study was to investigate the provision of community pharmacy services to children and young people with a focus on advanced services such as medicines use review. Perceptions and experiences of community pharmacists, pharmacy staff, young people and their parents or carers on the provision of such services were also explored. METHODS: Four different cross-sectional, self-administered questionnaires were distributed in parallel to pharmacists, pharmacy staff members, children and young people and parents in the United Kingdom. RESULTS: An outline of pharmacist's current involvement with children and young people was provided by 92 pharmacists. A different group of 38 community pharmacists and 40 non-pharmacist members of pharmacy staff from a total of 46 pharmacies provided information and views on the conduct of Medicines use review with children and young people. Experiences of advanced pharmacy service provision were collected from 51 children and young people and 18 parents. Most pharmacists offered public health advice to children and young people (73/92; 79.3%) and even more (83/92; 90.2%) reported that they often interacted with children and young people with long-term condition. Despite their high levels of interaction, and a majority opinion that medicines use reviews could benefit children (35/38; 92.1%), the number of pharmacies reporting to have conducted medicines use reviews with children was low (5/41). Pharmacists perceived the main barriers to recruitment as consent (17/29; 58.6%), guideline ambiguity (14/29; 48.3%) and training (13/29; 44.8%). A considerable proportion pharmacists (12/29; 41.4%) and other personnel (14/33; 42.4%) working in community pharmacies were unaware that children were potentially eligible for medicines use reviews. Only 29.4% of the 51 children and young people participants had received advice about their long-term condition from a pharmacist and the majority (46/51; 90.2%) had not taken part in an advanced service focused on adherence. CONCLUSIONS: While general engagement with children and young people appears high from the pharmacist's perspective, advice specific to children and young people with long-term conditions and the provision of advanced services in this group remains a challenge


No disponible


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Servicios Comunitarios de Farmacia/organización & administración , Administración del Tratamiento Farmacológico/organización & administración , Salud del Adolescente/tendencias , Salud del Niño/tendencias , Revisión de la Utilización de Medicamentos/organización & administración , Estudios Transversales , Autoinforme/estadística & datos numéricos , Cuidados a Largo Plazo/organización & administración , Reino Unido/epidemiología , Cuidadores/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos
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