Lapse tervise jälgimise juhend (ajakohastatud) / Child health monitoring guide (updated)

In a small country, every person and their potential contribution to society is extremely important. The degree to which the welfare of children and families is invested will sooner or later be reflected in the health of the population, education, crime, employment and the economy. Healthy children can grow into healthy and full members of society. There are approximately a quarter of a million children under the age of 18 in Estonia. The topics covered in the Children's Health Monitoring Guide are extensive. The health check-up guide for children up to 18 years of age, which has been in force until now, was drawn up in 2009. Since a large part of the old guide is still suitable for use, the working group decided to supplement it with up-to-date evidence-based information that would help to make the necessary decisions and implement appropriate interventions when working with children and families. The main task of the primary level is to support the health and well-being of children, young people and families, i.e. the human capital of the Estonian state, and to prevent diseases. As a result of the establishment of primary health centers, it is possible to offer more versatile health services. These services should be equally available to all children in Estonia, regardless of place of residence, social background or financial means of the parents. The goal is to monitor the health of all children in Estonia based on the same rules: centrally, consistently, at the regional health center and at school for the child and his family. In order to organize work more efficiently, the division of labor of healthcare workers has been revised. In order to improve the child's health promotion, disease prevention and treatment management, it is necessary to expand and improve the exchange of information between the fields of family medicine, midwifery, school health, specialist medical care, study counseling and child protection. If children's development is monitored and health risks are assessed and screened by a primary health care worker, there is more time for specialist medical care to more effectively treat and monitor children with more serious health problems. A welfare society brings more and more problems with the abundance of opportunities. Therefore, the guide pays attention to the assessment of children's health risks and their screening based on both mental and somatic developmental disorders as well as the socially difficult growing environment. Early detection, diagnosis, timely intervention and treatment of risks can improve the quality of life of children and families and reduce healthcare costs. The update of the guide was initiated by the Department of Children and Families of the Ministry of Social Affairs in cooperation with the Department of Health System Development, whose priorities are prevention, early detection and the organization of appropriate and timely assistance. The update of the manual was started with the support of the Norwegian Financial Mechanism within the project "Integrated service concept for supporting children's mental health". Updating recommendations for child eye examination and visual acuity assessment Guidelines for a child's eye examination and visual acuity assessment differ from country to country. In particular, the eye examination of children differs in what age it is performed, what tests are used, and where and which specialist examines the child. In other parts of the world, a large part of the guidelines regarding a child's eye examination are based on expert opinions. In 2021, the Estonian Society of Family Physicians and the Estonian Society of Ophthalmologists agreed on the e-consultation referral and response requirements when referring a child up to the age of 15 to an ophthalmologist's e-consultation / ophthalmologist. As the options for seeing an ophthalmologist changed, there was a need to update the recommendations regarding eye examination and visual acuity in the "Child Health Monitoring Guide". The treatment manual gives recommendations on at what age the child should have an eye examination and visual acuity assessed, and which eye examination activities are important based on age. The updated information provides an opportunity to evaluate the child's eye examination practice on the same basis throughout the country, to analyze it, to correct and manage it if necessary. The implementation of the treatment manual helps to harmonize the competence of the target group of the treatment manual when performing a child's eye examination. The expected benefit and goal of the recommendations of the treatment guide is the earlier detection of childhood eye pathology and visual acuity decline.

Väikeses riigis on iga inimene ja tema võimalik panus ühiskonda erakordselt oluline. See, mil määral panustatakse laste ja perede heaolusse, kajastub varem või hiljem rahvastiku tervises, hariduses, kuritegevuses, tööhõives ja majanduses. Tervetest lastest saavad kasvada omakorda ühiskonna terved ja täisväärtuslikud liikmed. Eestis on ligikaudu veerand miljonit kuni 18-aastast last. Laste tervise jälgimise juhendis käsitletud teemad on ulatuslikud. Seni kehtinud kuni 18-aastaste laste tervisekontrolli juhend on koostatud 2009. aastal. Kuna suur osa vanast juhendist sobib endiselt kasutamiseks, otsustas töörühm seda täiendada ajakohase tõenduspõhise infoga, mis aitaks töös laste ja peredega teha vajalikke otsuseid ja rakendada sobivaid sekkumisi. Esmatasandi põhiülesanne on toetada laste, noorte ja perede ehk Eesti riigi inimvara tervist ja heaolu ning ennetada haigusi. Esmatasandi tervisekeskuste rajamise tulemusel on võimalik pakkuda mitmekülgsemaid tervishoiuteenuseid. Need teenused peaksid olema kõikidele Eesti lastele ühetaoliselt kättesaadavad, sõltumata elukohast, sotsiaalsest taustast või vanemate varalistest võimalustest. Eesmärk on kõikide Eesti laste tervist jälgida ühetaoliste reeglite alusel: lapse ja tema pere keskselt, järjepidevalt, piirkondlikus tervisekeskuses ja koolis. Töö tõhusamaks korralduseks on üle vaadatud tervishoiutöötajate tööjaotus. Lapse tervisedenduse, haiguste ennetamise ja ravikorralduse parandamiseks on vaja laiendada ja tõhustada infovahetust perearstiabi, ämmaemandusabi, koolitervishoiu, eriarstiabi, õppenõustamise ja lastekaitse valdkondade vahel. Kui laste arengut jälgib ning terviseriske hindab ja sõelub esmatasandi tervishoiutöötaja, jääb eriarstiabis enam aega tõhusamalt ravida ja jälgida raskemate terviseprobleemidega lapsi. Heaoluühiskond toob võimaluste külluses üha sagemini ka probleeme. Seetõttu on juhendis pööratud tähelepanu laste terviseriskide hindamisele ja nende sõelumisele, lähtudes nii psüühilistest ja somaatilistest arenguhäiretest kui ka sotsiaalselt raskest kasvukeskkonnast. Riskide varasema märkamise, diagnoosimise, õigeaegse sekkumise ja raviga on võimalik parandada laste ja perede elukvaliteeti ning vähendada tervishoiukulutusi. Juhendi uuendamise algatas Sotsiaalministeeriumi laste ja perede osakond koostöös tervisesüsteemi arendamise osakonnaga, kelle prioriteedid on ennetustegevus, varajane märkamine ning asjakohase ja õigeaegse abi korraldamine. Juhendi uuendamist alustati Norra finantsmehhanismi toetusel projekti "Integreeritud teenuste kontseptsioon laste vaimse tervise toetamiseks" raames. Lapse silmakontrolli ja nägemisteravuse hindamise soovituste ajakohastamine Lapse silmakontrolli ja nägemisteravuse hindamise juhendid erinevad riigiti. Eelkõige erineb laste silmakontroll selle poolest, millises vanuses seda tehakse, milliseid teste kasutatakse ning kus ja milline spetsialist lapse läbi vaatab. Mujal maailmas on suur osa lapse silmakontrolli puudutavatest juhistest antud eksperdiarvamuste põhjal. 2021. aastal leppisid Eesti Perearstide Selts ja Eesti Oftalmoloogide Selts kokku e-konsultatsiooni saatekirja ja vastuse nõuetes kuni 15-aastase lapse suunamisel silmaarsti e-konsultatsioonile / silmaarstile. Kuna võimalused silmaarsti vastuvõtule saatmiseks muutusid, tekkis vajadus ajakohastada "Lapse tervise jälgimise juhendi" silmakontrolli ja nägemisteravust puudutavaid soovitusi. Ravijuhendiga antakse soovitused selle kohta, millises vanuses tuleb lapsele silmakontrolli teha ja nägemisteravust hinnata ning millised silmakontrolli tegevused on vanusepõhiselt olulised. Ajakohastatud info annab võimaluse hinnata lapse silmakontrolli praktikat samadel alustel kogu riigis, seda analüüsida, vajaduse korral korrigeerida ja juhtida. Ravijuhendi rakendamine aitab ühtlustada ravijuhendi sihtrühma pädevust lapse silmakontrolli tegemisel. Ravijuhendi soovituste oodatav kasu ja eesmärk on lapseea silmapatoloogia ja nägemisteravuse languse varasem avastamine.

Relationship between maternal employment status and children's food intake in Japan.

BACKGROUND: Although long maternal working hours are reported to have a negative effect on children's dietary habits, few studies have investigated this issue in Japan. Healthy dietary habits in childhood are important because they may reduce the risk of future disease. Here, we examined the relationship between maternal employment status and children's dietary intake in 1693 pairs of Japanese primary school 5th and 6th graders and their mothers. METHODS: The survey was conducted using two questionnaires, a brief-type self-administered diet history questionnaire and a lifestyle questionnaire. The analysis also considered mothers' and children's nutrition knowledge, attitudes toward diet, and some aspects of family environment. RESULTS: Longer maternal working hours were associated with children's higher intake of white rice (g/1000kcal) (ß 11.4, 95%CI [1.0, 21.9]; working ≥8h vs. not working), lower intake of confectioneries (g/1000kcal) (ß -4.0 [-7.6, -0.4]), and higher body mass index (BMI) (kg/m2) (ß 0.62 [0.2, 1.0]). Although maternal employment status was not significantly associated with lower intake of healthy food (e.g., vegetables) or higher intake of unhealthy food (e.g., sweetened beverages) in the children, in contrast with previous studies, it may have affected children's energy intake through their higher intake of white rice. Further, children's nutrition knowledge and attitudes toward diet, mothers' food intake, and some family environment factors were significantly associated with intakes of vegetables and sweetened beverages in the children. CONCLUSIONS: Longer maternal working hours were significantly associated with higher intake of white rice and lower intake of confectioneries, as well as higher BMI among children. Even when a mother works, however, it may be possible to improve her child's dietary intake by other means such as nutrition education for children or enhancement of food environment.

An assessment of the construct validity of the Child Health Utility 9D-CHN instrument in school-aged children: evidence from a Chinese trial.

BACKGROUND: Although there is emerging data regarding the psychometric properties of the Child Health Utility-9D instrument, more evidence is required with respect to its validity for use in different country settings. The aim of this study was to examine the construct validity of the CHU-9D-CHN instrument in Chinese children. METHODS: Baseline Health-Related Quality of Life (HRQoL) and demographic data were collected from children recruited to the CHIRPY DRAGON obesity prevention intervention randomised controlled trial in China. HRQoL was measured using the Chinese version of the CHU-9D instrument (CHU-9D-CHN) and the PedsQL instrument. CHU-9D-CHN utility scores were generated using two scoring algorithms [UK and Chinese tariffs]. Discriminant validity, known-group validity and convergent validity were evaluated using non-parametric test for trend, Kruskal-Wallis test and Spearman correlation coefficient analysis respectively. RESULTS: Data was available for 1,539 children (mean age 6 years). The CHU-9D-CHN was sensitive to known group differences determined by the median PedsQL total score. Furthermore, the mean CHU-9D-CHN utility values decreased linearly with increasing levels of severity on each dimension of the PedsQL for emotional and social functioning domains. They decreased monotonically with increasing levels of severity on each dimension of the PedsQL for physical and school functioning domains (p < 0.001). Contrary to studies conducted in Western countries, and although not statistically significant, we found an indication that HRQoL, using both the CHU-9D-CHN and the PedsQL, was higher in children whose parents had lower levels of education, compared to those whose parents were university educated. The correlation between the CHU-9D-CHN utility values using UK and Chinese tariffs, and PedsQL total scores showed a statistically significant moderate positive correlation (Spearman's rho = 0.5221, p < 0.001 and Spearman's rho = 0.5316, p < 0.001), respectively. However, each CHU-9D-CHN dimension was either weakly, or very weakly correlated with each of the predetermined PedsQL domain functioning scores. CONCLUSIONS: Overall, the findings provide some support for the construct validity of the CHU-9D-CHN within a Chinese population aged 6-7 years. However, some uncertainty remains. We recommend future studies continue to test the validity of the CHU-9D in different country settings. TRIAL REGISTRATION: ISRCTN Identifier ISRCTN11867516, Registered on 19/08/2015.

Probiotics in Pediatrics. A Review and Practical Guide.

The potential benefit of the administration of probiotics in children has been studied in many settings globally. Probiotics products contain viable micro-organisms that confer a health benefit on the host. Beneficial effects of selected probiotic strains for the management or prevention of selected pediatric conditions have been demonstrated. The purpose of this paper is to provide an overview of current available evidence on the efficacy of specific probiotics in selected conditions to guide pediatricians in decision-making on the therapeutic or prophylactic use of probiotic strains in children. Evidence to support the use of certain probiotics in selected pediatric conditions is often available. In addition, the administration of probiotics is associated with a low risk of adverse events and is generally well tolerated. The best documented efficacy of certain probiotics is for treatment of infectious gastroenteritis, and prevention of antibiotic-associated, Clostridioides difficile-associated and nosocomial diarrhea. Unfortunately, due to study heterogeneity and in some cases high risk of bias in published studies, a broad consensus is lacking for specific probiotic strains, doses and treatment regimens for some pediatric indications. The current available evidence thus limits the systematic administration of probiotics. The most recent meta-analyses and reviews highlight the need for more well-designed, properly powered, strain-specific and dedicated-dose response studies.

Nature relatedness as a potential factor to promote physical activity and reduce sedentary behavior in Ecuadorian children.

BACKGROUND: Nature relatedness can be associated with health-related outcomes. This study aims to evaluate the associations of nature relatedness with physical activity and sedentary behavior. METHODS: A cross-sectional study involving 9-12 year old children living in Cuenca, Ecuador, was conducted between October 2018 and March 2019. Questionnaires were used to evaluate physical activity (PAQ-C), out-of-school sedentary behavior, nature relatedness and wellbeing. Associations of nature relatedness with physical activity, and sedentary behavior were evaluated using linear regression models or tobit regressions adjusted by age, sex, school type, wellbeing, and body mass index z-score. RESULTS: A total of 1028 children were surveyed (average age:10.4±1.22 years, 52% female.). Nature relatedness was positively associated with physical activity (ß = 0.07; CI 95%: 0.05-0.09; p < 0.001) and non-screen-related sedentary leisure (ß = 3.77 minutes; CI 95%: 0.76-6.68; p < 0.05); it was negatively associated with screen time (ß = -5.59 minutes; CI 95%: -10.53-0.65; p < 0.05). CONCLUSIONS: Findings suggest that nature relatedness is associated with physical activity and some sedentary behaviors among Ecuadorian school-age children. The promotion of nature relatedness has the potential to improve health.

Parental access to hospitalised children during infectious disease pandemics such as COVID-19.

The COVID-19 pandemic has resulted in many hospitals severely limiting or denying parents access to their hospitalised children. This article provides guidance for hospital managers, healthcare staff, district-level managers and provincial managers on parental access to hospitalised children during a pandemic such as COVID-19. It: (i) summarises legal and ethical issues around parental visitation rights; (ii) highlights four guiding principles; (iii) provides 10 practical recommendations to facilitate safe parental access to hospitalised children; (iv) highlights additional considerations if the mother is COVID-19-positive; and (v) provides considerations for fathers. In summary, it is a child's right to have access to his or her parents during hospitalisation, and parents should have access to their hospitalised children; during an infectious disease pandemic such as COVID-19, there is a responsibility to ensure that parental visitation is implemented in a reasonable and safe manner. Separation should only occur in exceptional circumstances, e.g. if adequate in-hospital facilities do not exist to jointly accommodate the parent/caregiver and the newborn/infant/child. Both parents should be allowed access to hospitalised children, under strict infection prevention and control (IPC) measures and with implementation of non-pharmaceutical interventions (NPIs), including handwashing/sanitisation, face masks and physical distancing. Newborns/infants and their parents/caregivers have a reasonably high likelihood of having similar COVID-19 status, and should be managed as a dyad rather than as individuals. Every hospital should provide lodger/boarder facilities for mothers who are COVID-19-positive, COVID-19-negative or persons under investigation (PUI), separately, with stringent IPC measures and NPIs. If facilities are limited, breastfeeding mothers should be prioritised, in the following order: (i) COVID-19-negative; (ii) COVID-19 PUI; and (iii) COVID-19-positive. Breastfeeding, or breastmilk feeding, should be promoted, supported and protected, and skin-to-skin care of newborns with the mother/caregiver (with IPC measures) should be discussed and practised as far as possible. Surgical masks should be provided to all parents/caregivers and replaced daily throughout the hospital stay. Parents should be referred to social services and local community resources to ensure that multidisciplinary support is provided. Hospitals should develop individual-level policies and share these with staff and parents. Additionally, hospitals should ideally track the effect of parental visitation rights on hospital-based COVID-19 outbreaks, the mental health of hospitalised children, and their rate of recovery.

A comparison of self-reported and proxy-reported health utilities in children: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to conduct a systematic review and meta-analysis to compare differences in health utilities (HUs) assessed by self and proxy respondents in children, as well as to evaluate the effects of health conditions, valuation methods, and proxy types on the differences. METHODS: Eligible studies published in PubMed, Embase, Web of Science, and Cochrane Library up to December 2019 were identified according to PRISMA guidelines. Meta-analyses were performed to calculate the weighted mean differences (WMDs) in HUs between proxy- versus self-reports. Mixed-effects meta-regressions were applied to explore differences in WMDs among each health condition, valuation method and proxy type. RESULTS: A total of 30 studies were finally included, comprising 211 pairs of HUs assessed by 15,294 children and 16,103 proxies. This study identified 34 health conditions, 10 valuation methods, and 3 proxy types. In general, proxy-reported HUs were significantly different from those assessed by children themselves, while the direction and magnitude of these differences were inconsistent regarding health conditions, valuation methods, and proxy types. Meta-regression demonstrated that WMDs were significantly different in patients with ear diseases relative to the general population; in those measured by EQ-5D, Health utility index 2 (HUI2), and Pediatric asthma health outcome measure relative to Visual analogue scale method; while were not significantly different in individuals adopting clinician-proxy and caregiver-proxy relative to parent-proxy. CONCLUSION: Divergence existed in HUs between self and proxy-reports. Our findings highlight the importance of selecting appropriate self and/or proxy-reported HUs in health-related quality of life measurement and economic evaluations.

Identifying factors that influenced wellbeing and learning effectiveness during the sudden transition into eLearning due to the COVID-19 lockdown.

BACKGROUND: The sanitary emergency due to COVID-19 virus obliged people to face up several changes in their everyday life becauseWorld Health Organisation (WHO) guidelines and countries' Health Systems imposed lockdown of activities and social distancing to flatten the infection curve. One of these rapid changes involved students and professors that had to turn the traditional "in presence" classes into online courses facing several problems for educational delivery. OBJECTIVES: This work aimed to investigate the factors that affected both teaching/learning effectiveness and general human comfort and wellbeing after the sudden transition from classrooms to eLearning platforms due to COVID-19 in Italy. METHODS: A workshop, involving students and experts of Human Factors and Ergonomics, has been performed to identify aspects/factors that could influence online learning. Then, from workshop output and literature studies, a survey composed of two questionnaires (one for students and one for teachers) has been developed and spread out among Italian universities students and professors. RESULTS: 700 people answered the questionnaires. Data have been analysed and discussed to define the most important changes due to the new eLearning approach. Absence of interactions with colleagues and the necessity to use several devices were some of the aspects coming out from questionnaires. CONCLUSIONS: The study shows an overview of factors influencing both teaching/learning effectiveness and general human comfort and wellbeing. Results could be considered as a basis for future investigation and optimization about the dependencies and correlations among identified factors and the characteristics of the products/interaction/environment during eLearning courses.

Case for change: a standardised inpatient paediatric early warning system in England.

Most children in hospital who are clinically deteriorating are monitored regularly, and their treatment is escalated effectively. However a small, but significant, number of deteriorating children experience suboptimal outcomes because of a failure to recognise and respond to acute deterioration early enough leading to unintended harm. Tragically this occasionally can have fatal consequences. Investigations into these rare events highlight common themes of missed early signs of deterioration in children, prompting regulatory agencies to suggest paediatric early warning systems (PEWS) to aid clinical practice. In England, track and trigger tools (TTT), which are one facet of PEWS have been widely rolled out but in a heterogeneous fashion. The evidence for TTT is mixed but they are complex interventions and current outcomes do not fully define the entirety of their potential impact. This article explains the rationale behind the decision of the NHS England and NHS Improvement, Royal College of Paediatrics and Child Health and Royal College of Nursing to implement a standardised inpatient PEWS as part of a system-wide paediatric observations tracking system in England and how this fits into a wider programme of activity.