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4.
Artigo em Inglês | MEDLINE | ID: mdl-31597246

RESUMO

With rapid economic development in China, cardiorespiratory fitness (CRF) of children and adolescents is on a decline. However, this appears to have slowed down, reaching stagnation in certain areas. However, it is unclear if the change in CRF is related to economic growth and development or not. This study describes trends in CRF of Chinese children and adolescents, and empirically tests the relationships between China's macro-economic developments and cardiorespiratory fitness of children and adolescents over the past 30 years using provincial panel data collected from one million samples. We used per capita disposable income as the economic indicator. CRF was assessed by using running tests: 50 m × 8 for boys and girls (7-12 years), 1000 m for boys (13-22 years), and 800 m for girls (13-22 years). The results show that economic growth has a U-shaped relationship with CRF of children and adolescents (both boys and girls). It appears that as incomes increased, CRF of urban male and female students in China gradually decreased to its lowest point, after which it showed an upward trend. From a horizontal perspective, it can be inferred that for low-developed provinces, increases in incomes cause a decrease in CRF levels. In contrast, for highly developed provinces, as incomes increase, CRF levels increase. This study provides the first empirical evidence of the relationship between macro-economy and CRF of youth, based on provincial panel data. The results presented here can be used to formulate health policies targeting the cardiorespiratory fitness of children and adolescents from middle-income provinces in China. This study also provides a reference for developing countries.


Assuntos
Aptidão Cardiorrespiratória , Saúde da Criança/estatística & dados numéricos , Saúde da Criança/tendências , Desenvolvimento Econômico/estatística & dados numéricos , Desenvolvimento Econômico/tendências , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Criança , China , Feminino , Previsões , Humanos , Masculino , Fatores Socioeconômicos , Adulto Jovem
5.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31331984

RESUMO

School readiness includes the readiness of the individual child, the school's readiness for children, and the ability of the family and community to support optimal early child development. It is the responsibility of schools to meet the needs of all children at all levels of readiness. Children's readiness for kindergarten should become an outcome measure for a coordinated system of community-based programs and supports for the healthy development of young children. Our rapidly expanding insights into early brain and child development have revealed that modifiable factors in a child's early experience can greatly affect that child's health and learning trajectories. Many children in the United States enter kindergarten with limitations in their social, emotional, cognitive, and physical development that might have been significantly diminished or eliminated through early identification and attention to child and family needs. A strong correlation between social-emotional development and school and life success, combined with alarming rates of preschool expulsion, point toward the urgency of leveraging opportunities to support social-emotional development and address behavioral concerns early. Pediatric primary care providers have access to the youngest children and their families. Pediatricians can promote and use community supports, such as home visiting programs, quality early care and education programs, family support programs and resources, early intervention services, children's museums, and libraries, which are important for addressing school readiness and are too often underused by populations who can benefit most from them. When these are not available, pediatricians can support the development of such resources. The American Academy of Pediatrics affords pediatricians many opportunities to improve the physical, social-emotional, and educational health of young children, in conjunction with other advocacy groups. This technical report provides an updated version of the previous iteration from the American Academy of Pediatrics published in 2008.


Assuntos
Experiências Adversas da Infância/métodos , Desenvolvimento Infantil/fisiologia , Saúde da Criança , Instituições Acadêmicas , Experiências Adversas da Infância/tendências , Criança , Saúde da Criança/tendências , Pré-Escolar , Humanos , Instituições Acadêmicas/tendências
6.
New York; UNICEF; July 03, 2019.
Não convencional em Inglês | ODS | ID: biblio-1046852

RESUMO

Using toilets and washing hands with soap is essential to keep children and families in good health. But in Guinea-Bissau, open defecation remains a deeply rooted practice. Going out in open spaces rather than using a toilet is a dangerous challenge: human waste near waterways and homes spreads diseases quickly, putting children and their families at risk. Diarrhoea, which is related to poor sanitation and hygiene, is one of the top killers of children in the country ─ accounting for 9 per cent of children who die before their fifth birthday. However, getting rid of open defecation is possible. Take Quinara, a region in the south of Guinea-Bissau. In 2018, Quinara was recognized as the first region to become 'open defecation free' (ODF) in Guinea-Bissau. This is a remarkable achievement in a country where nearly one in six people still go out in the open. So, how did Quinara do it? Ask families in a community to identify areas around the home they use as toilets. Use a combination of shock, shame, pride and disgust ─ instead of abstract health messages ─ to trigger behaviour change. And watch the community transform. This approach is called Community-Led Total Sanitation (CLTS). It typically takes three to six months for a whole community to give up defecating in the open. And this contributes to a healthier environment for everyone.


Assuntos
Treinamento no Uso de Toaletes , Saúde da Criança/tendências , Saneamento Básico/políticas , Riscos Ambientais , Defecação , Guiné-Bissau
7.
Qual Life Res ; 28(9): 2429-2441, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31154585

RESUMO

PURPOSE: Non-preference-based measures cannot be used to directly obtain utilities but can be converted to preference-based measures through mapping. The only mapping algorithm for estimating Child Health Utility-9D (CHU9D) utilities from Strengths and Difficulties Questionnaire (SDQ) responses has limitations. This study aimed to develop a more accurate algorithm. METHODS: We used a large sample of children (n = 6898), with negligible missing data, from the Longitudinal Study of Australian Children. Exploratory factor analysis (EFA) and Spearman's rank correlation coefficients were used to assess conceptual overlap between SDQ and CHU9D. Direct mapping (involving seven regression methods) and response mapping (involving one regression method) approaches were considered. The final model was selected by ranking the performance of each method by averaging the following across tenfold cross-validation iterations: mean absolute error (MAE), mean squared error (MSE), and MAE and MSE for two subsamples where predicted utility values were < 0.50 (poor health) or > 0.90 (healthy). External validation was conducted using data from the Child and Adolescent Mental Health Services study. RESULTS: SDQ and CHU9D were moderately correlated (ρ = - 0.52, p < 0.001). EFA demonstrated that all CHU9D domains were associated with four SDQ subscales. The best-performing model was the Generalized Linear Model with SDQ items and gender as predictors (full sample MAE: 0.1149; MSE: 0.0227). The new algorithm performed well in the external validation. CONCLUSIONS: The proposed mapping algorithm can produce robust estimates of CHU9D utilities from SDQ data for economic evaluations. Further research is warranted to assess the applicability of the algorithm among children with severe health problems.


Assuntos
Saúde da Criança/tendências , Qualidade de Vida/psicologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Inquéritos e Questionários
8.
Rev. andal. med. deporte ; 12(2): 121-127, jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184511

RESUMO

El incremento de la capacidad aerobia en prepúberes beneficia a la salud y favorece la iniciación deportiva. Sin embargo, existe controversia sobre sí tales mejoras y en qué medida pueden ser inducidas por un entrenamiento físico en prepúberes. El objetivo fue realizar una revisión sistemática para identificar los cambios en la capacidad aerobia por efecto del entrenamiento en prepúberes. Se revisaron seis bases de datos electrónicas, acorde al cumplimiento de la declaración PRISMA. Solo 11 artículos cumplieron con los criterios establecidos para su inclusión. Se encontró mejoría de la capacidad aerobia en el 73 % de los estudios; y solo en tres estudios no se observaron cambios debido a detalles metodológicos. Sin embargo, es necesario unificar los programas de entrenamiento, así como el diseño de los estudios para establecer con contundencia el entrenamiento de la capacidad aerobia en prepúberes


Increase of aerobic capacity in children and adolescents is associated with greater health benefits and promotes the sport initiation. However, it has not been determined whether these changes could be attributed to the physical training or are really induced by the natural maturation process in prepubertal children. The aim of this study was to do a systematic review to identify the changes in aerobic capacity by a physical training program in prepubescents. A systematic review in six electronic databases was performed, according to the accomplishment of the PRISMA declaration. Only 11 articles were selected. Increases in aerobic capacity were found in 73 % of the included articles in the present review; and only in three studies changes were not seen due methodological issues. However, it is necessary to unify training protocols, as well as studies design to establish the aerobic capacity training in prepubescents


A melhora da capacidade aeróbica em pré-púbere beneficia a saúde e favorece a iniciação esportiva. No entanto, existe controversia sobre essa possível melhoria e em que medida podem ser induzidas pelo treinamento físico em pré-púberes. O objetivo foi realizar uma revisão sistemática para identificar as mudanças na capacidade aeróbica por conta do efeito do treinamento físico em pré-púberes. Foram revisadas seis bases de dados eletrônicas, de acordo com o cumprimento da declaração PRISMA. Somente 11 artigos preencheram os critérios estabelecidos de inclusão. A melhora da capacidade aeróbica foi encontrada em 73% dos estudos; e somente em três estudos não foram observadas alterações devido aos detalhes metodológicos. No entanto, é necessário unificar os programas de treinamento, bem como o desenho dos estudos para estabelecer o treinamento da capacidade aeróbica em pré-púberes


Assuntos
Criança , Exercício/fisiologia , Treinamento de Resistência/métodos , Consumo de Oxigênio/fisiologia , Esportes/fisiologia , Educação Física e Treinamento/estatística & dados numéricos , Estilo de Vida Saudável , Saúde da Criança/tendências
9.
BMC Public Health ; 19(1): 491, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046729

RESUMO

BACKGROUND: Thirdhand smoke (THS) is the persistent residue resulting from secondhand smoke (SHS) that accumulates in dust, objects, and on surfaces in homes where tobacco has been used, and is reemitted into air. Very little is known about the extent to which THS contributes to children's overall tobacco smoke exposure (OTS) levels, defined as their combined THS and SHS exposure. Even less is known about the effect of OTS and THS on children's health. This project will examine how different home smoking behaviors contribute to THS and OTS and if levels of THS are associated with respiratory illnesses in nonsmoking children. METHODS: This project leverages the experimental design from an ongoing pediatric emergency department-based tobacco cessation trial of caregivers who smoke and their children (NIHR01HD083354). At baseline and follow-up, we will collect urine and handwipe samples from children and samples of dust and air from the homes of smokers who smoke indoors, have smoking bans or who have quit smoking. These samples will be analyzed to examine to what extent THS pollution at home contributes to OTS exposure over and above SHS and to what extent THS continues to persist and contribute to OTS in homes of smokers who have quit or have smoking bans. Targeted and nontargeted chemical analyses of home dust samples will explore which types of THS pollutants are present in homes. Electronic medical record review will examine if THS and OTS levels are associated with child respiratory illness. Additionally, a repository of child and environmental samples will be created. DISCUSSION: The results of this study will be crucial to help close gaps in our understanding of the types, quantity, and clinical effects of OTS, THS exposure, and THS pollutants in a unique sample of tobacco smoke-exposed ill children and their homes. The potential impact of these findings is substantial, as currently the level of risk in OTS attributable to THS is unknown. This research has the potential to change how we protect children from OTS, by recognizing that SHS and THS exposure needs to be addressed separately and jointly as sources of pollution and exposure. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02531594 . Date of registration: August 24, 2015.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar em Ambientes Fechados/efeitos adversos , Saúde da Criança/tendências , Política Antifumo/tendências , Poluição por Fumaça de Tabaco/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Cuidadores , Criança , Pré-Escolar , Poeira/análise , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Projetos de Pesquisa , Poluição por Fumaça de Tabaco/análise
10.
JAMA Pediatr ; 173(6): e190337, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31034019

RESUMO

Importance: Understanding causes and correlates of health loss among children and adolescents can identify areas of success, stagnation, and emerging threats and thereby facilitate effective improvement strategies. Objective: To estimate mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories. Design, Setting, and Participants: This study examined levels, trends, and spatiotemporal patterns of cause-specific mortality and nonfatal health outcomes using standardized approaches to data processing and statistical analysis. It also describes epidemiologic transitions by evaluating historical associations between disease indicators and the Socio-Demographic Index (SDI), a composite indicator of income, educational attainment, and fertility. Data collected from 1990 to 2017 on children and adolescents from birth through 19 years of age in 195 countries and territories were assessed. Data analysis occurred from January 2018 to August 2018. Exposures: Being under the age of 20 years between 1990 and 2017. Main Outcomes and Measures: Death and disability. All-cause and cause-specific deaths, disability-adjusted life years, years of life lost, and years of life lived with disability. Results: Child and adolescent deaths decreased 51.7% from 13.77 million (95% uncertainty interval [UI], 13.60-13.93 million) in 1990 to 6.64 million (95% UI, 6.44-6.87 million) in 2017, but in 2017, aggregate disability increased 4.7% to a total of 145 million (95% UI, 107-190 million) years lived with disability globally. Progress was uneven, and inequity increased, with low-SDI and low-middle-SDI locations experiencing 82.2% (95% UI, 81.6%-82.9%) of deaths, up from 70.9% (95% UI, 70.4%-71.4%) in 1990. The leading disaggregated causes of disability-adjusted life years in 2017 in the low-SDI quintile were neonatal disorders, lower respiratory infections, diarrhea, malaria, and congenital birth defects, whereas neonatal disorders, congenital birth defects, headache, dermatitis, and anxiety were highest-ranked in the high-SDI quintile. Conclusions and Relevance: Mortality reductions over this 27-year period mean that children are more likely than ever to reach their 20th birthdays. The concomitant expansion of nonfatal health loss and epidemiological transition in children and adolescents, especially in low-SDI and middle-SDI countries, has the potential to increase already overburdened health systems, will affect the human capital potential of societies, and may influence the trajectory of socioeconomic development. Continued monitoring of child and adolescent health loss is crucial to sustain the progress of the past 27 years.


Assuntos
Saúde do Adolescente/tendências , Saúde da Criança/tendências , Carga Global da Doença/tendências , Saúde Global/tendências , Morbidade/tendências , Ferimentos e Lesões/epidemiologia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Análise Espaço-Temporal , Ferimentos e Lesões/etiologia , Adulto Jovem
11.
PLoS One ; 14(3): e0211875, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30875380

RESUMO

BACKGROUND: Maternal and child health is one of the most important issues in a developing country like Bangladesh. This study evaluates the trends in maternal and child health indicators of Bangladesh. METHODS: The secondary data used in this study was extracted from the World Bank Dataset. The selected indicators were maternal mortality ratio (MMR), under-five children mortality and neonatal mortality rate, and prevalence of stunting and wasting of under-five children. Trend analysis technique and ARIMA forecasting models were used in this study to find currents trend and predict the future of selected indicators. RESULTS: This study revealed clear evidence that neonatal, under-five child and maternal mortality in Bangladesh had been gradually decreasing during the last two and half decades. The decreasing rate of these indicators suggests that it should be possible to achieve the national target of sustainable development goals (SDGs) of Bangladesh by 2021. While, it was observed that the prevalence of underweight, stunting and wasting among under-five children was still high, these indicators have been slowly decreasing over time. The decreasing rate of these indicators displayed that without guided measures, the Bangladesh government would not be able to achieve the target goal of child malnutrition by 2021 under SDG-2.2. CONCLUSION: It is recommended that the government, as well as non-government health organizations (NGOs), and other policy makers should provide programs that are effective so that the national target goals can be achieved by the year 2030. Consequently, our findings should assist in the achievement of the national goals in Bangladesh regarding these health issues.


Assuntos
Saúde da Criança/tendências , Saúde Materna/tendências , Bangladesh/epidemiologia , Mortalidade da Criança/tendências , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/prevenção & controle , Pré-Escolar , Feminino , Previsões , Transtornos do Crescimento/epidemiologia , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Mortalidade Materna/tendências , Prevalência , Síndrome de Emaciação/epidemiologia
13.
Int J Epidemiol ; 48(Suppl 1): i4-i15, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30883654

RESUMO

BACKGROUND: Few low-middle-income countries have data from comparable birth cohort studies spanning over time. We report on the methods used by the Pelotas cohorts (1982, 1993, 2004 and 2015) and describe time trends in sociodemographic characteristics of the participant families. METHODS: During the four study years, all maternity hospitals in the city were visited daily, and all urban women giving birth were enrolled. Data on socioeconomic and demographic characteristics were collected using standardized questionnaires, including data on maternal and paternal skin colour, age and schooling, maternal marital status, family income and household characteristics. The analyses included comparisons of time trends and of socioeconomic and ethnic group inequalities. RESULTS: Despite a near 50% increase in the city's population between 1982 and 2015, the total number of births declined from 6011 to 4387. The proportion of mothers aged ≥35 years increased from 9.9% to 14.8%, and average maternal schooling from 6.5 [standard deviation (SD) 4.2] to 10.1 (SD 4.0) years. Treated water was available in 95.3% of households in 1982 and 99.3% in 2015. Three-quarters of the families had a refrigerator in 1982, compared with 98.3% in 2015. Absolute income-related inequalities in maternal schooling, household crowding, household appliances and access to treated water were markedly reduced between 1982 and 2015. Maternal skin colour was associated with inequalities in age at childbearing and schooling, as well as with household characteristics. CONCLUSIONS: During the 33-year period, there were positive changes in social and environmental determinants of health, including income, education, fertility and characteristics of the home environment. Socioeconomic inequality was also reduced.


Assuntos
Saúde da Criança/tendências , Disparidades nos Níveis de Saúde , Saúde Materna/tendências , Adolescente , Adulto , Brasil , Criança , Estudos de Coortes , Escolaridade , Características da Família , Feminino , Fertilidade , Inquéritos Epidemiológicos , Humanos , Masculino , Idade Materna , Gravidez , Fatores Socioeconômicos , Adulto Jovem
15.
BMC Public Health ; 19(1): 139, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704442

RESUMO

BACKGROUND: Assessing disparities in health-related quality of Life (HRQoL) is important as a part of health-related disparities in the society. The aim of this study was to explore HRQoL among 12-year-olds in Sweden in terms of differences between years 2005 and 2009 and disparities related to sociodemographic background. METHODS: During the school years 2005 and 2009, a total of 18,325 sixth grade students in Sweden were invited to a celiac disease screening study; 13,279 agreed to participate. Jointly with the celiac screening, the children answered a questionnaire that included EuroQol 5 Dimensions-youth (EQ-5D-Y) and their parents responded to separate questionnaires about their own and their child's country of birth, family structure, their employment status, occupation, and education. In total 11,009 child-parent questionnaires were collected. Logistic regression was used to study differences in HRQoL between 2005 and 2009, and between various sociodemographic subgroups. RESULTS: Compared with 2005, children in 2009 reported more pain (OR: 1.20, 95% CI: 1.1-1.3) and more mood problems (OR: 1.35, 95% CI: 1.2-1.5). In general, girls reported more pain and mood problems and had more disparities than boys. There were no significant differences based on parents' occupation, however, children of parents with low or medium education levels reported less "mood problems" than those of parents with high education levels (OR: 0.65, 95% CI: 0.46-0.92) and (OR: 0.84, 95% CI: 0.73-0.96), respectively. A slight variation was seen in HRQoL between children with different migration background. Girls living in small municipalities reported more pain (OR: 1.51, 95% CI: 1.14-2.01), and problems performing usual activities (OR: 3.77, 95% CI: 2.08-6.84), compared to girls living in large municipalities. In addition, children living with two parents had less mood problems than children living in other family constellations. CONCLUSION: More children reported pain and mood problems in 2009 compared with 2005. To study future trends, health outcomes among children in Sweden should continue to be reported periodically. More efforts should be invested to increase the awareness of health-related disparities as highlighted in this study especially for girls living in small municipalities and children of parents with high education level.


Assuntos
Saúde da Criança/estatística & dados numéricos , Saúde da Criança/tendências , Disparidades nos Níveis de Saúde , Qualidade de Vida , Criança , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Inquéritos e Questionários , Suécia
16.
J Med Internet Res ; 21(2): e11268, 2019 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-30758296

RESUMO

BACKGROUND: Mobile technologies are emerging as tools to enhance health service delivery systems and empower clients to improve maternal, newborn, and child health. Limited evidence exists on the value for money of mobile health (mHealth) programs in low- and middle-income countries. OBJECTIVE: This study aims to forecast the incremental cost-effectiveness of the Mobile Technology for Community Health (MOTECH) initiative at scale across 170 districts in Ghana. METHODS: MOTECH's "Client Data Application" allows frontline health workers to digitize service delivery information and track the care of patients. MOTECH's other main component, the "Mobile Midwife," sends automated educational voice messages to mobile phones of pregnant and postpartum women. We measured program costs and consequences of scaling up MOTECH over a 10-year analytic time horizon. Economic costs were estimated from informant interviews and financial records. Health effects were modeled using the Lives Saved Tool with data from an independent evaluation of changes in key services coverage observed in Gomoa West District. Incremental cost-effectiveness ratios were presented overall and for each year of implementation. Uncertainty analyses assessed the robustness of results to changes in key parameters. RESULTS: MOTECH was scaled in clusters over a 3-year period to reach 78.7% (170/216) of Ghana's districts. Sustaining the program would cost US $17,618 on average annually per district. Over 10 years, MOTECH could potentially save an estimated 59,906 lives at a total cost of US $32 million. The incremental cost per disability-adjusted life year averted ranged from US $174 in the first year to US $6.54 in the tenth year of implementation and US $20.94 (95% CI US $20.34-$21.55) over 10 years. Uncertainty analyses suggested that the incremental cost-effectiveness ratio was most sensitive to changes in health effects, followed by personnel time. Probabilistic sensitivity analyses suggested that MOTECH had a 100% probability of being cost-effective above a willingness-to-pay threshold of US $50. CONCLUSIONS: This is the first study to estimate the value for money of the supply- and demand-side of an mHealth initiative. The adoption of MOTECH to improve MNCH service delivery and uptake represents good value for money in Ghana and should be considered for expansion. Integration with other mHealth solutions, including e-Tracker, may provide opportunities to continue or combine beneficial components of MOTECH to achieve a greater impact on health.


Assuntos
Saúde da Criança/tendências , Análise Custo-Benefício/métodos , Assistência à Saúde/métodos , Saúde Materna/tendências , Saúde Pública/métodos , Telefone Celular , Criança , Feminino , Gana , Humanos , Recém-Nascido , Gravidez
17.
Eur Child Adolesc Psychiatry ; 28(6): 795-805, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30390147

RESUMO

School engagement protects against negative mental health outcomes; however, few studies examined the relationship between school engagement and attention-deficit hyperactivity disorder (ADHD) using an ecological framework. The aims were to examine: (1) whether school engagement has an independent protective association against the risk of ADHD in children, and (2) whether environmental factors have an association with ADHD either directly or indirectly via their association with school engagement. This cross-sectional study used data from the 2011-2012 National Survey of Children's Health, which collected information about children's mental health, family life, school, and community. The sample contained 65,680 children aged 6-17 years. Structural equation modeling was used to estimate the direct association of school engagement and ADHD and indirect associations of latent environmental variables (e.g., family socioeconomic status (SES), adverse childhood experiences (ACEs), environmental safety, and neighborhood amenities) and ADHD. School engagement had a direct and inverse relationship with ADHD (ß = - 0.35, p < 0.001) such that an increase in school engagement corresponds with a decrease in ADHD diagnosis. In addition, family SES (ß = - 0.03, p = 0.002), ACEs (ß = 0.10, p < 0.001), environment safety (ß = - 0.10, p < 0.001), and neighborhood amenities (ß = - 0.01, p = 0.025) all had an indirect association with ADHD via school engagement. In conclusion, school engagement had a direct association with ADHD. Furthermore, environmental correlates showed indirect associations with ADHD via school engagement. School programs targeted at reducing ADHD should consider family and community factors in their interventions.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Modelos Psicológicos , Instituições Acadêmicas , Estudantes/psicologia , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Criança , Saúde da Criança/tendências , Estudos Transversais , Feminino , Humanos , Masculino , Características de Residência , Instituições Acadêmicas/tendências
19.
Pediatrics ; 143(1)2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30591616

RESUMO

OBJECTIVES: Nurse home visiting (NHV) may redress inequities in children's health and development evident by school entry. We tested the effectiveness of an Australian NHV program (right@home), offered to pregnant women experiencing adversity, hypothesizing improvements in (1) parent care, (2) responsivity, and (3) the home learning environment at child age 2 years. METHODS: A randomized controlled trial of NHV delivered via universal child and family health services was conducted. Pregnant women experiencing adversity (≥2 of 10 risk factors) with sufficient English proficiency were recruited from antenatal clinics at 10 hospitals across 2 states. The intervention comprised 25 nurse visits to child age 2 years. Researchers blinded to randomization assessed 13 primary outcomes, including Home Observation of the Environment (HOME) Inventory (6 subscales) and 25 secondary outcomes. REULTS: Of 1427 eligible women, 722 (50.6%) were randomly assigned; 306 of 363 (84%) women in the intervention and 290 of 359 (81%) women in the control group provided 2-year data. Compared with women in the control group, those in the intervention reported more regular child bedtimes (adjusted odds ratio 1.76; 95% confidence interval [CI] 1.25 to 2.48), increased safety (adjusted mean difference [AMD] 0.22; 95% CI 0.07 to 0.37), increased warm parenting (AMD 0.09; 95% CI 0.02 to 0.16), less hostile parenting (reverse scored; AMD 0.29; 95% CI 0.16 to 0.41), increased HOME parental involvement (AMD 0.26; 95% CI 0.14 to 0.38), and increased HOME variety in experience (AMD 0.20; 95% CI 0.07 to 0.34). CONCLUSIONS: The right@home program improved parenting and home environment determinants of children's health and development. With replicability possible at scale, it could be integrated into Australian child and family health services or trialed in countries with similar child health services.


Assuntos
Saúde da Criança/economia , Disparidades em Assistência à Saúde/economia , Serviços de Assistência Domiciliar/economia , Visita Domiciliar/economia , Enfermeiras de Saúde Comunitária/economia , Cuidado Pós-Natal/economia , Austrália/epidemiologia , Desenvolvimento Infantil/fisiologia , Saúde da Criança/tendências , Pré-Escolar , Feminino , Disparidades em Assistência à Saúde/tendências , Serviços de Assistência Domiciliar/tendências , Visita Domiciliar/tendências , Humanos , Masculino , Enfermeiras de Saúde Comunitária/tendências , Poder Familiar/tendências , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/tendências , Estudos Retrospectivos
20.
J Autism Dev Disord ; 49(4): 1652-1664, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30552540

RESUMO

Utilizing the 2016 National Survey of Children's Health, this study illustrates that children with ASD have nearly 4 times higher odds of unmet health care needs compared to children without disabilities, whereas children with other disabilities had nearly 2 times higher odds of unmet health care needs compared to children without disabilities. Applying Andersen's Behavioral Model of health care utilization, this study estimates that enabling factors (e.g., access to health insurance, quality of health insurance, access to family-centered care, family-level stress, exposure to adverse childhood experiences, and parental employment) improved prediction of regression model for unmet health care needs by 150%. Policy and program implications are discussed and a new framework for responding to observed disparities is discussed.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Saúde da Criança/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Inquéritos e Questionários , Adolescente , Experiências Adversas da Infância , Transtorno do Espectro Autista/terapia , Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Feminino , Acesso aos Serviços de Saúde/tendências , Humanos , Seguro Saúde , Masculino , Pais/psicologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia
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