Accountability in protection of children against violence: Monitoring and measurement.

Violence against children (VAC) is a pervasive and persistent injustice around the world. Thirty years after the adoption of the United Nations Convention on the Rights of the Child (CRC), the right of children to be protected against all forms of violence is still routinely violated. It is only within the last twenty years that the scope of this problem has been studied; as many point out, understanding the scope of the problem through comprehensive data collection is necessary to improve child protection. Data collection and data quality have improved drastically over this time. The Office of the High Commissioner on Human Rights recommends using comprehensive indicator systems that collect data on States Parties' structure- and process-related commitments to fulfil human rights, and on the outcomes of these commitments. However, most existing indicator sets on VAC fall short of this comprehensive approach, often focusing only on structural or outcome indicators. An international team of child rights experts is now developing GlobalChild, which will be an online platform consisting of comprehensive sets of structure-, process-, and outcome-related indicators for all 41 substantive rights of the CRC. This system will advance data collection, facilitate the monitoring function of the Committee on the Rights of the Child, and enable research on many rights of children, including their right to protection against violence. VAC is a complex problem, and protection against VAC is a right that is indivisible from other rights under the CRC. Therefore, a comprehensive and systematic approach is required to improve accountability to children around the world.

Thirtieth anniversary of the UN Convention on the Rights of the Child: advancing a child rights-based approach to child health and well-being.

Global challenges to children's health are rooted in social and environmental determinants. The UN Convention on the Rights of the Child (CRC) articulates the rights required to address these civil-political, social, economic and cultural determinants of child well-being. The principles of child rights-universality, interdependence and accountability-define the tenets of social justice and health equity required to ensure all rights accrue to all children, and the accountability of individuals and organisations (duty-bearers) to ensure these rights are fulfilled. Together, the CRC and child rights principles establish the structure and function of a child rights-based approach (CRBA) to child health and well-being-that provides the strategies and tools to transform child health practice into a rights, justice and equity-based paradigm. The 30th anniversary of the CRC is an opportune time to translate a CRBA to health and well-being into a global practice of paediatrics and child health.

Refugee and Asylum-Seeking Children: Interrupted Child Development and Unfulfilled Child Rights.

The 21st century phenomenon of "global displacement" is particularly concerning when it comes to children. Childhood is a critical period of accelerated growth and development. These processes can be negatively affected by the many stressors to which refugee and asylum-seeking children are subjected. The United Nations Convention on the Rights of the Child (CRC) is the most ratified human rights treaty in history, with 196 States Parties (SPs). The CRC provides a framework of 54 articles outlining government responsibilities to ensure the protection, promotion, and fulfillment of rights of all children within their jurisdictions. Among these are the rights of refugee and asylum-seeking children, declared under Article 22 of the CRC. Refugee and asylum-seeking children, similarly to all other children, are entitled to their rights under the CRC and do not forgo any right by virtue of moving between borders. The hosting governments, as SPs to the CRC, are the primary duty bearers to fulfill these rights for the children entering their country. This manuscript provides an overview of the health and developmental ramification of being displaced for refugee and asylum-seeking children. Then, an in-depth analysis of the provisions under Article 22 is presented and the responsibilities of SPs under this article are described. The paper provides some international examples of strengths and shortcomings relating to these responsibilities and closes with a few concluding remarks and recommendations.

Hair cortisol reflects socio-economic factors and hair zinc in preschoolers.

This study examined the relationship between children's hair cortisol and socioeconomic status of the family, as measured by parental education and income. Low family socioeconomic status has traditionally been considered a long-term environmental stressor. Measurement of hair cortisol provides an integrated index of cumulative stress exposure across an extended period of time. The present study is the first to examine the relationship between hair cortisol and parental education as well as parental income in a representative sample of preschoolers. Data on hair cortisol, family income, and parental education were collected for a representative sample of 339 children (Mean age=4.6 years; SD=.5 years) from across 23 neighbourhoods of the city of Vancouver, Canada. As maternal education was shown previously to be associated with hair zinc level, hair zinc measurements were included as well in order to explore potential relationships between hair zinc and hair cortisol. The relationship between hair cortisol and parental education was examined using hierarchical regression, with hair zinc, gender, age, and single parenthood included as covariates. Maternal and paternal education both were correlated significantly with hair cortisol (r=-0.18; p=.001). The relationship remained statistically significant even after controlling for all demographic covariates as well as for hair zinc and after taking the neighbourhood-level clustering of the data into account. Parental income, on the other hand, was not related significantly to children's hair cortisol. This study provides evidence that lower maternal and paternal education are associated with higher hair cortisol levels. As hair cortisol provides an integrated index of cortisol exposure over an extended time period, these findings suggest a possibly stable influence of SES on the function of the hypothalamic-pituitary-adrenal (HPA) axis. Cumulative exposure to cortisol during early childhood may be greater in children from low socio-economic backgrounds, possibly through increased exposure to environmental stressors.

Associations of socio-demographic and behavioral variables with hair zinc of Vancouver preschoolers.

Marginal zinc deficiency (MZD) exists in children of industrialized societies and impairs growth and development. MZD is believed to be one of the most common deficiencies, even though there is no data available on its global prevalence. This is partly because of the lack of sensitivity and specificity of serum zinc, the most commonly used biomarker of zinc status, to detect MZD. In children, MZD is always accompanied by a decrease in hair zinc. This cross-sectional study was designed to explore if there are any associations between some socio-demographic and behavioral variables with hair zinc status in an attempt to understand the social determinants of MZD and the profile of at risk children. Our citywide survey (n = 719) indicated a mean hair zinc of 116 ± 43 µg/g with 17% below the cutoff. Logistic regression analysis indicated that age, maternal education, number of adults at home, being described as "eating unhealthy", and Child Behavior Questionnaire scores of "activity level" as the significant predictors of hair zinc status. Our study provides important information on the hair zinc status of Vancouver preschoolers and some factors in children and their environment associated with hair zinc, which may help in better understanding of hair zinc as a biomarker of MZD.

Addressing social determinants of health inequities: what can the state and civil society do?

In this Health Policy article, we selected and reviewed evidence synthesised by nine knowledge networks established by WHO to support the Commission on the Social Determinants of Health. We have indicated the part that national governments and civil society can play in reducing health inequity. Government action can take three forms: (1) as provider or guarantor of human rights and essential services; (2) as facilitator of policy frameworks that provide the basis for equitable health improvement; and (3) as gatherer and monitor of data about their populations in ways that generate health information about mortality and morbidity and data about health equity. We use examples from the knowledge networks to illustrate some of the options governments have in fulfilling this role. Civil society takes many forms: here, we have used examples of community groups and social movements. Governments and civil society can have important positive roles in addressing health inequity if political will exists.

Age-based differences in hair zinc of Vancouver preschoolers.

Marginal zinc deficiency (MZD), the subclinical stage of zinc deficiency, is common in industrialized societies. Serum zinc, the most common biomarker of zinc status, lacks sensitivity and specificity to diagnose this deficiency. Hair zinc, however, is sensitive and specific enough to detect MZD in children. Differences in hair zinc associated with age and sex have been reported. These differences have not been investigated thoroughly; therefore, interpretation of the results of hair analyses is difficult. This cross-sectional study was designed to examine the hair zinc status of a group of Vancouver preschoolers (24-71 months) and assess the age- and sex-based differences in their hair zinc. Hair samples were obtained (n = 719) and analyzed for zinc using inductively coupled plasma mass spectrometry. Our results indicated a mean hair zinc of 115 +/- 43 microg/g with 17% below the low hair zinc cutoff (70 microg/g). Boys and girls had comparable mean hair zinc, while girls had a significantly higher occurrence of low hair zinc than boys (21% vs. 12%). Children <4 years of age had significantly lower mean hair zinc and higher rate of low hair zinc compared to children > or =4. Our study provides important reference values for the hair zinc of healthy North American preschoolers.

Increased levels of mercury associated with high fish intakes among children from Vancouver, Canada.

OBJECTIVE: To assess exposure to mercury (Hg) among children in population subgroups whose traditional dietary practices include fish. STUDY DESIGN: We determined blood Hg, red blood cell phosphatidylethanolamine omega-3 eicosapentaenoic acid as a marker of fish intake, and assessed indexes of childhood behavior in preschool children 1.5 to 5 years of age (n = 228) living in an ethnically diverse neighborhood in Vancouver, British Columbia, Canada. RESULTS: The median blood Hg was 4.6 nmol/L, range 0-67.9 nmol/L. Twelve (6%) children, all of whom were Chinese, had a blood Hg > 28.9 nmol/L. Blood Hg, total fish intake, and eicosapentaenoic acid were higher among Chinese than Caucasian children; however, higher fish intake did not predict blood Hg. Blood Hg was inversely associated with attentional focusing in children over 3 years of age after adjusting for confounding family variables, iron deficiency anemia, and zinc deficiency. Major sources of fish among Chinese children were imported fish rather than local fish. CONCLUSION: Children from population subgroups within populations not considered at risk may be at increased risk of neurotoxicity caused by Hg exposure from fish.

n-6 Docosapentaenoic acid is not a predictor of low docosahexaenoic acid status in Canadian preschool children.

BACKGROUND: The n-3 fatty acid docosahexaenoic acid (DHA; 22:6n-3) is important for neural and visual functional development. In animals, 22:6n-3 deficiency is accompanied by increased docosapentaenoic acid (DPA; 22:5n-6), which suggests that the ratio of 22:6n-3 to 22:5n-6 could be a useful biochemical marker of low n-3 fatty acid status. The n-3 fatty acid status of preschool children has not been described, and data are lacking on whether low 22:6n-3 is accompanied by high 22:5n-6 in humans. OBJECTIVE: We determined n-3 fatty acid status and investigated the relation between 22:6n-3 and 22:5n-6 in children. DESIGN: In Canadian children aged 18-60 mo (n = 84), the n-3 and n-6 fatty acid status of erythrocyte phosphatidylethanolamine was measured, and dietary fat intake was estimated by using a food-frequency questionnaire. RESULTS: The mean (+/- SEM) 22:6n-3 concentration in erythrocyte phosphatidylethanolamine among children was 3.06 +/- 0.13 g/100 g fatty acids (5th-95th percentiles: 1.43-5.79 g/100 g fatty acids). Concentrations of 22:5n-6 increased with increasing 22:6n-3 concentrations in erythrocyte phosphatidylethanolamine (P < 0.01). Mean intakes of linoleic acid (18:2n-6), linolenic acid (18:3n-3), and trans fatty acids were 3.6 +/- 0.2%, 0.7 +/- 0.5%, and 2.0 +/- 1.3%, respectively. Phosphatidylethanolamine 22:6n-3 and 22:5n-3 concentrations were inversely related to the intakes of 18:2n-6 and trans fatty acids, but not to those of total fat or n-3 fatty acids. CONCLUSIONS: The concentration of 22:5n-6 is not a useful biochemical marker of low n-3 fatty acid intake or status in the membrane phosphatidylethanolamine of preschool children. High intakes of 18:2n-6 and trans fatty acids could compromise the incorporation of 22:6n-3 into membrane phospholipids.