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6.
Curr Opin Clin Nutr Metab Care ; 24(3): 271-275, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33631771

RESUMO

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.


Assuntos
Saúde da Criança/tendências , Transtornos da Nutrição Infantil/terapia , Alimentos Fortificados/provisão & distribução , Micronutrientes/administração & dosagem , Criança , Transtornos da Nutrição Infantil/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Humanos , Masculino , Estado Nutricional , Pobreza/estatística & dados numéricos
8.
J Med Internet Res ; 23(1): e21636, 2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33512318

RESUMO

BACKGROUND: Mobile health (mHealth) interventions offer great potential to reach large populations and improve public health. However, high attrition rates threaten evaluation and implementation of mHealth intervention studies. OBJECTIVE: We explored factors associated with attrition of study participants in an mHealth randomized controlled trial (RCT) evaluating an intervention to reduce unintentional child injury risk in China. METHODS: The cluster RCT compared two groups of an app-based intervention for caregivers of 3-6-year-old children (Bao Hu San). The intervention group received unintentional child injury and parenting education, whereas only parenting education was implemented in the control group. The trial included 2920 study participants in Changsha, China, and lasted 6 months. Data on participant engagement (using the app) were collected electronically throughout the 6-month period. Associations between participant attrition and demographic characteristics, and between attrition and intervention engagement were tested and quantified separately for the intervention and control groups using the adjusted odds ratio (aOR) based on generalized linear mixed models. RESULTS: In total, 2920 caregivers from 20 eligible preschools participated, with 1510 in the intervention group and 1410 in the control group. The 6-month attrition rate differed significantly between the two groups (P<.001), at 28.9% (437/1510) in the intervention group and 35.7% (503/1410) in the control group. For the intervention group, the only significant predictor of attrition risk was participants who learned fewer knowledge segments (aOR 2.69, 95% CI 1.19-6.09). For the control group, significant predictors of attrition risk were lower monthly login frequency (aOR 1.48, 95% CI 1.00-2.18), learning fewer knowledge segments (aOR 1.70, 95% CI 1.02-2.81), and shorter learning durations during app engagement (aOR 2.39, 95% CI 1.11-5.15). Demographic characteristics were unrelated to attrition. CONCLUSIONS: Engagement in the app intervention was associated with participant attrition. Researchers and practitioners should consider how to best engage participants in app-based interventions to reduce attrition. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-018-5790-1.


Assuntos
Saúde da Criança/tendências , Análise de Dados , Aplicativos Móveis/normas , Ferimentos e Lesões/prevenção & controle , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Telemedicina
9.
Lancet Glob Health ; 9(3): e352-e360, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33308422

RESUMO

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.


Assuntos
Saúde da Criança/tendências , Saúde do Lactente/tendências , Mortalidade Infantil/tendências , Saúde Materna/tendências , Ásia Central/epidemiologia , Pré-Escolar , Feminino , Política de Saúde , Humanos , Lactente , Recém-Nascido , Quirguistão/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos
10.
Artigo em Inglês | MEDLINE | ID: mdl-33207689

RESUMO

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.


Assuntos
Infecções por Coronavirus/psicologia , Saúde Mental , Pneumonia Viral/psicologia , Adolescente , Saúde do Adolescente/tendências , Ansiedade/epidemiologia , Betacoronavirus , Criança , Saúde da Criança/tendências , Depressão/epidemiologia , Humanos , Saúde Mental/tendências , Avaliação de Resultados em Cuidados de Saúde , Pandemias
11.
Rev Paul Pediatr ; 39: e2020267, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33146295

RESUMO

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.


Assuntos
Maus-Tratos Infantis , Bem-Estar da Criança , Infecções por Coronavirus/epidemiologia , Violência Doméstica , Pneumonia Viral/epidemiologia , Adolescente , Saúde do Adolescente/tendências , Betacoronavirus , Brasil/epidemiologia , Criança , Maus-Tratos Infantis/prevenção & controle , Maus-Tratos Infantis/estatística & dados numéricos , Saúde da Criança/tendências , Estudos Transversais , Coleta de Dados/métodos , Coleta de Dados/estatística & dados numéricos , Violência Doméstica/prevenção & controle , Violência Doméstica/tendências , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Pandemias
14.
Lancet Diabetes Endocrinol ; 8(9): 793-800, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32822601

RESUMO

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.


Assuntos
Saúde da Criança/tendências , Diabetes Gestacional/terapia , Saúde Materna/tendências , Criança , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Hiperglicemia/terapia , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Gravidez
16.
JAMA Netw Open ; 3(6): e206757, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32520359

RESUMO

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.


Assuntos
Corticosteroides/efeitos adversos , Disparidades em Assistência à Saúde/etnologia , Mortalidade Hospitalar/tendências , Transtornos do Neurodesenvolvimento/etnologia , Peso ao Nascer , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Saúde da Criança/etnologia , Saúde da Criança/tendências , Estudos de Coortes , Grupos Étnicos , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Morbidade/tendências , Transtornos do Neurodesenvolvimento/epidemiologia , Gravidez , Cuidado Pré-Natal , Estudos Prospectivos , Estados Unidos/etnologia
17.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32409482

RESUMO

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.


Assuntos
Saúde da Criança/tendências , Comportamentos Relacionados com a Saúde/fisiologia , Inquéritos Epidemiológicos/tendências , Fatores Etários , Criança , Estudos Transversais , Feminino , Comportamentos de Risco à Saúde/fisiologia , Inquéritos Epidemiológicos/métodos , Humanos , Masculino
18.
BMC Public Health ; 20(1): 564, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32423441

RESUMO

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.


Assuntos
Saúde da Criança/tendências , Recessão Econômica , Política Pública , Determinantes Sociais da Saúde/tendências , Criança , Europa (Continente) , Humanos
19.
Sci Rep ; 10(1): 4311, 2020 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-32152374

RESUMO

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.


Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Saúde da Criança/tendências , Exposição Ambiental/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/etiologia , Doenças Respiratórias/etiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Fumar Tabaco/efeitos adversos , Criança , Pré-Escolar , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/patologia , Prevalência , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/patologia , Fatores de Risco
20.
PLoS Med ; 17(3): e1003054, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32176692

RESUMO

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.


Assuntos
Desenvolvimento Infantil , Saúde da Criança/tendências , Países em Desenvolvimento , Escolaridade , Disparidades nos Níveis de Saúde , Indicadores Básicos de Saúde , Determinantes Sociais da Saúde/tendências , Fatores Etários , Saúde da Criança/economia , Mortalidade da Criança/tendências , Pré-Escolar , Estudos Transversais , Países em Desenvolvimento/economia , Feminino , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde/tendências , Pobreza/tendências , Estudos Retrospectivos , Determinantes Sociais da Saúde/economia
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