Availability of Child Care in Rural Communities: Implications for Workforce Recruitment and Retention.

The objective of this study was to identify differences in child care availability by rural-urban location for all counties in Wisconsin, and describe implications for recruitment and retention of health care workforce. We used data on licensed child care slots for young children (age <5), socio-demographic characteristics, women's and men's labor force participation, and household structure for all counties in Wisconsin in 2013 (n = 72). Data came from KIDS COUNT, County Health Rankings, and the American Community Survey. We used t tests to analyze bivariate differences in child care availability and community characteristics by metropolitan, micropolitan, and non-core rural location. We then used ordinary least squares regression to analyze the relationship between geographic location and child care slots, adjusting for labor force participation and household structure. Rural counties had significantly fewer licensed child care slots per child than metropolitan and micropolitan counties. These counties also had, on average, higher rates of poverty and higher unemployment than micropolitan and metropolitan counties. The association between geographic location and child care availability remained, even after adjusting for household structure and labor force participation. The number of hours men worked and the percentage of men not working were both negatively associated with available child care slots, whereas there was not a significant relationship between women's labor force participation and child care availability. Rural areas face health care workforce shortages. Recruitment strategies to overcome shortages must move beyond individual-level incentives to focus on community context and family support, including availability of child care in rural counties.

Community-based interventions for improving maternal health and for reducing maternal health inequalities in high-income countries: a systematic map of research.

BACKGROUND: This review is part of a European Commission project, MASCOT, aimed at reducing maternal and child health inequalities. The purpose was to identify and describe the literature on community-based interventions on maternal health in high-income countries (HIC) and conceptually map the literature according to country focus, topics addressed, nature of the intervention and the intervention provider, and interventions designed to address inequalities in maternal health. METHODS: The research protocol for this review was based on a low-income country (LMIC) systematic review protocol within the MASCOT Project. We searched PubMED and CINAHL databases for literature published between January 2000 and April 2013. OECD countries were used to determine the HIC and different terms were used to refer to community based interventions, defined as those "delivered in community settings or any activities occurring outside of health facilities". RESULTS: 119 publications were selected for inclusion in this mapping study. 95 (80%) were Randomised Control Trials (RCTs) and 24 (20%) were systematic reviews (SRs). We categorised the study topics according to the main interventions covered: breastfeeding assistance and promotion, preventing and treating post-natal depression, interventions to support and build capacity around parenting and child care, antenatal interventions preparing women for birth, postnatal planning of future births and control trials around changing maternal behaviours. The home was used as the most common setting to implement these interventions and health professionals accounted for the largest group of intervention providers. CONCLUSIONS: This review maps and brings knowledge on the type of studies and topics being addressed in community based interventions around maternal health in HICs. It opens the opportunity for further studies on interventions' effectiveness and knowledge transfer to LMICs settings.

Is something better than nothing? An evaluation of early childhood programs in Cambodia.

This study evaluated the relative effectiveness of home-based, community-based, and state-run early childhood programs across Cambodia. A total of 880 five-year-olds (55% girls) from 6 rural provinces in Cambodia attending State Preschools, Community Preschools, Home-Based Programs, or no programs were assessed twice using the Cambodian Developmental Assessment Test. Controlling for baseline differences, children who participated in any early childhood programs performed significantly better in posttest than those of children who did not participate in any programs. Children in State Preschools scored significantly higher than those in either Community Preschools or Home-Based Programs; scores did not differ as a function of attending Community Preschools or Home-Based Programs. The results indicate that some preschool experience is better than none at all.

The challenges faced by caregivers of children with impairments of psychological functions: a population-based cross-sectional study.

OBJECTIVE: To assess the challenges faced by caregivers of children with impairments of psychological functions (IPFs). METHOD: Data came from the 2001 Participation and Activity Limitation Survey, a post-census national survey of people with disabilities residing in the 10 Canadian provinces. Interviews of caregivers of children aged 5 to 14 years with a disability (n = 3908) were conducted between September 2001 and January 2002. RESULTS: Caregivers of children with IPFs who are severely limited in their everyday activities were more likely to: need respite care; be refused a child care program or service; not receive health services for their children when needed; and not take a job, quit work, and work fewer hours to care for their children. CONCLUSIONS: This highlights the importance of both removing barriers and obstacles to the full participation of children with IPFs in everyday activities and improving their caregivers' access to health and child care services. It also argues in favour of family-centred care that explicitly considers caregivers' concerns, identifies their needs and problems, and supports families in their caregiving roles.

A Mentee's Baby Registry: Supporting New Academic Parents in 2020.

The lack of childcare infrastructure in the COVID-19 pandemic has highlighted many systemic problems faced by academic caregivers, and particularly new parents. This commentary uses the lessons from the pandemic to highlight the potential role of mentors in supporting caregiver responsibilities.

Labs in the time of COVID: an early-career scientist's view.

The outbreak of COVID-19 has stalled both the basic, clinical and non-COVID medical research. The scientific community has shown extraordinary flexibility and resilience in responding to the pandemic. However, funding restructuring, risk of infection, cancelation of scientific conferences and delayed experiments have already proven detrimental to the career opportunities of early-career scientists. Moreover, school closures and a lack of systematic support for childcare have been additional challenges for early- and mid-career researchers who have young children. This Editorial describes an early-career researcher's experience and highlights how after efficiently contributing to 'flattening the curve' of COVID-19 infections, the research community has an opportunity for growth and re-structuring.

A service evaluation of parent adherence with dysphagia management therapy guidelines: reports from family carers supporting children with complex needs in Greece.

Purpose: Many children with complex needs exhibit eating, drinking, and/or swallowing disorders (dysphagia). These children often have associated learning needs, and require assistance from carers for daily tasks such as eating and drinking. The aim of this study was to identify which strategies to manage dysphagia were challenging for family carers, and reasons for any non-adherence.Method: In this service evaluation researchers observed carers during mealtimes, and investigated carer opinions of strategies used to minimise the risks of dysphagia. Eight children with complex needs aged 3.4-7.5 years and their primary family caregiver participated.Results: Adherence with speech and language pathologists' dysphagia recommendations overall was over 50% in all but one case. For specific strategies, the highest adherence was observed for diet modifications of foods (89%), communication during the mealtime (83%), amount of food to present (81%), and the pacing of fluids and foods (81%). Lower levels of adherence were identified in relation to postural management (58%), environmental changes (58%), utensils (56%), and preparatory strategies (49%).Conclusions: Adherence with use of strategies to support mealtimes was over 50% in all but one case. Findings suggest that support is essential to promote safe mealtimes, reduce family carers' stress and increase knowledge, confidence, and adherence in implementing dysphagia guidelines in the family home. Implications for rehabilitationDifficulties with eating, drinking and swallowing (dysphagia) can impact on the parent-child mealtime experience.Mealtime strategies as recommended by a speech-language pathologist can support children who have difficulties eating, drinking, and swallowing.Some strategies to support eating, drinking, and swallowing are easier for carers to adhere to than others.

Family Leave and Return-to-Work Experiences of Physician Mothers.

Importance: With the substantial increase in the proportion of women graduating from medical school, factors surrounding family leave require careful attention. Although many circumstances and experiences are unique to the training setting and specialty, a nationwide representation of physician mothers across all disciplines and all levels of training may reveal common themes and experiences among them, enable comparison across training setting and subspecialties, and identify best practices for supporting physician mothers throughout their careers. Objective: To characterize family leave and return-to-work experiences of physician mothers across subspecialties. Design, Setting, and Participants: This cross-sectional US nationwide survey study evaluating the experiences of 844 physician mothers was administered electronically via REDCap from September 2 to December 20, 2018. Main Outcomes and Measures: A survey was developed using a modified Delphi process with a panel of experts to characterize physician mothers' family leave and return-to-work experiences. The survey covered both negative and positive experiences of physician mothers for each child they conceived or adopted after medical school to identify areas for change and strategies for successfully supporting physician parents. Results: Of 1465 potentially eligible survey respondents, 844 (57.6%) were verified as unique respondents with complete surveys. Their mean (SD) age was 35.8 (5.2) years (range, 27-67 years), with most women (826 [97.9%]) currently practicing and 138 women (16.4%) currently in a residency program. Participants were included from 19 subspecialty groups. Of the women surveyed, 619 (73.3%) felt that leave time was insufficient. The majority (751 [89.0%]) would have preferred 11 weeks to 6 months of leave vs the 5 to 12 weeks (often not paid) most commonly available. The most frequently reported negative experiences when returning to work were associated with lack of facilities for breast pumping (range, 12 of 78 [15.4%] for the third child to 272 of 844 [32.2%] for the first child) and time for breast pumping (range, 27 of 78 [34.6%] for the third child to 407 of 844 [48.2%] for the first child), difficulty obtaining childcare (eg, for the first child, 298 of 844 [35.3%]), and discrimination (eg, for the first child, 152 of 844 [18.0%]). The most common positive experience was emotional support (eg, for the first child, 504 of 844 [59.7%]), primarily from colleagues. Conclusions and Relevance: The present study, capturing one of the largest and most heterogeneous samples of physician mothers, showed that a substantial number of women physicians working in a variety of specialties at all levels of training across the United States needed and wanted more support for maternity leave and return to work. Support at the institutional level, such as paid leave, adequate breast pumping time without penalty, on-site childcare, and schedule flexibility, would likely provide the greatest direct assistance to help physician mothers thrive in their careers.

Childcare Instability and Maternal Depressive Symptoms: Exploring New Avenues for Supporting Maternal Mental Health.

OBJECTIVE: We investigated links between childcare experiences-specifically, care instability and mothers' perceptions of care access-and maternal depressive symptoms in an effort to illuminate policy-amenable mechanisms through which childcare experiences can support maternal mental health. METHODS: Data were taken from the nationally representative Early Childhood Longitudinal Study-Birth Cohort. We used regression models with lagged dependent variables to estimate associations between aspects of childcare instability and perceptions of care availability and maternal depressive symptoms. We did so on the full sample and then on subgroups of mothers for whom childcare instability may be especially distressing: mothers who are low income, working, single, or non-native speakers of English. RESULTS: Childcare instability-length in months in the longest arrangement and number of arrangements-was not associated with maternal depressive symptoms. However, mothers' perceptions of having good choices for care were associated with a reduced likelihood of clinical depressive symptoms, even after controlling for prior depressive symptoms and concurrent parenting stress; this latter association was observed both in the full sample (adjusted odds ratio [AOR] = 0.77; 95% confidence interval [CI] = 0.63-0.96) and among subgroups of employed mothers (AOR = 0.71; CI = 0.57-0.87) and single mothers (AOR = 0.72; CI = 0.52-0.99). CONCLUSIONS: Although dimensions of care instability did not associate with maternal depressive symptoms, mothers' perceptions of available care options did. If replicated, findings would highlight a previously unconsidered avenue-increasing care accessibility and awareness of available options-for promoting maternal mental health in a population likely to experience depression but unlikely to be treated.

Determinantes sociais de saúde de crianças em consulta de puericultura: das condições socioeconômicas aos aspectos relacionados à saúde bucal / Social determinants of health of children in child care consultation: from socioeconomic conditions to aspects related to oral health / Determinantes sociales de la salud de los niños en la consulta infantil: de las condiciones socioeconómicas a los aspectos relacionados con la salud bucal

A imaturidade do sistema imunológico, associado a Determinantes Sociais de Saúde (DSS), promove doenças na infância. Especificamente, na cavidade oral, os DSS, representados pelo consumo elevado de açúcar, limitado acesso aos serviços de saúde e deficiência na higiene bucal, favorecem transtornos locais e sistêmicos. Assim, o estudo objetivou associar os DSS, no contexto das condições socioeconômicas, do acompanhamento pelo serviço de saúde e dos aspectos relacionados à saúde bucal de crianças atendidas em Unidades Básicas de Saúde (UBS) de um município cearense. Trata-se de estudo observacional, analítico, transversal e de abordagem quantitativa, conduzido com crianças e suas mães em Acarape - CE. Após consentimento, essas preencheram um questionário. Os dados foram analisados. Das 70 mães, 87,14% e 90,00% tinham idade inferior ou igual a 30 anos e renda de até um salário mínimo, respectivamente. Das 70 crianças, 87,14% tinham seus dentes/gengiva higienizados por seus pais ou responsável. Do total, 94,29% nunca se submeteram a atendimento odontológico. Observou-se associação significativa entre a mãe ter escolaridade superior ao ensino fundamental incompleto e higienizar os dentes/gengiva do filho com escova dental e dentifrício. Constatou-se associação significativa entre a criança ingerir bolacha doce/recheada, não consumir refrigerante e usar escova dental e dentifrício na higienização oral. Conclui-se que as crianças eram acompanhadas nas UBS regularmente; no entanto, esse serviço não esteve relacionado ao atendimento odontológico. Apesar da ausência desse tipo de acompanhamento e do consumo de alimentos cariogênicos, as mães se preocupavam com a saúde bucal das crianças, higienizando a cavidade oral diariamente, com meios adequados.

The immaturity of the immune system, associated with Social Determi- nants of Health (SDH), promotes diseases in childhood. Specifically, in the oral cavity, SDH, represented by high sugar consumption, limited access to health services, and poor oral hygiene, favors local and systemic disorders. Thus, the study aimed to associate the SDH, in the context of socioeconomic conditions, monitoring by the health service and aspects related to children's oral health assisted in Basic Health Units (BHU) of a muni- cipality in Ceará. This is an observational, analytical, cross-sectional study with a quan- titative approach conducted with children and their mothers in Acarape - CE. After con- sent, they filled out a questionnaire. Data were analyzed. Of the 70 mothers, 87.14% and 90.00% were aged less than or equal to 30 years and had income up to one minimum wage, respectively. Of the 70 children, 87.14% had their teeth/gums cleaned by their pa- rents or guardian. Of the total, 94.29% never underwent dental care. There was a signifi- cant association between the mother having higher education than incomplete elementary school and cleaning the child's teeth/gums with a toothbrush and toothpaste. A significant association was found between the child eating sweet/stuffed biscuits, not consuming soft drink, and using a toothbrush and dentifrice for oral hygiene. It is concluded that the chil- dren were regularly monitored at the BHU; however, this service was not related to dental care. Despite the absence of this type of follow-up and the consumption of cariogenic foods, the mothers were concerned about their children's oral health, cleaning the oral cavity daily with adequate means.

La inmadurez del sistema inmunológico, asociada a los Determinantes So- ciales de la Salud (DSS), promueve enfermedades en la infancia. Específicamente, en la cavidad bucal, los DSS, representados por el alto consumo de azúcar, el acceso limitado a los servicios de salud y la mala higiene bucal, favorecen los trastornos locales y sisté- micos. Así, el estudio tuvo como objetivo asociar el DSS, en el contexto de las condicio- nes socioeconómicas, el seguimiento por el servicio de salud y los aspectos relacionados con la salud bucal de los niños atendidos en las Unidades Básicas de Salud (UBS) de un municipio de Ceará. Se trata de un estudio observacional, analítico, transversal con enfo- que cuantitativo, realizado con niños y sus madres en Acarape ­ CE. Después del consen- timiento, completaron un cuestionario. Los datos fueron analizados. De las 70 madres, 87,14% y 90,00% tenían edad menor o igual a 30 años e ingresos hasta un salario mínimo, respectivamente. De los 70 niños, al 87,14% se les limpió los dientes/encías por sus pa- dres o tutores. Del total, el 94,29% nunca realizó atención odontológica. Hubo una aso- ciación significativa entre la madre con educación superior a la primaria incompleta y la limpieza de los dientes/encías del niño con cepillo y pasta dental. Se encontró una asoci- ación significativa entre el niño que come galletas dulces/rellenas, no consume gaseosas y usa cepillo de dientes y dentífrico para la higiene bucal. Se concluyó que los niños eran monitoreados periódicamente en la UBS; sin embargo, este servicio no estaba relacionado con el cuidado dental. A pesar de la ausencia de este tipo de seguimiento y del consumo de alimentos cariogénicos, las madres se preocupan por la salud bucal de sus hijos, reali- zando la limpieza de la cavidad bucal diariamente, con medios adecuados.

Demanda asistencial en un Servicio de Pediatría durante el estado de alarma secundario a la COVID-19 / Demand for care in a Pediatric Service during the state of alarm secondary to COVID-19

Antecedentes y objetivos. La COVID-19 es una enfermedad producida por el virus SARS-CoV-2. En España,entre el mes de marzo y junio de 2020 se declaró el primer Estado de Alarma con el fin de contener la pandemia.Nuestro objetivo es evaluar la demanda asistencial y lasenfermedades que acudieron a Urgencias Pediátricas y quefueron ingresadas durante el tiempo que duró el primer Estado de Alarma, comparando con los mismos meses delos años 2018 y 2019.Resultados. Existe una reducción del número de ingresosde 345 a 141, un incremento de la complejidad demostrada por una mayor duración de los ingresos hasta 7,3±12,4 días(6,2±8,6 días en 2018 y 4,8±6,9 en 2019). Las enfermedades infecciosas (principalmente las respiratorias) descendieron, permaneciendo estables los ingresos por neoplasias, patología psiquiátrica, apendicitis y enfermedades circulatorias. EnUrgencias Pediátricas, en los años 2018 y 2019 (de 1 marzoa 30 junio) se atendieron 9.075 y 8.525 pacientes, mientras que en el 2020 se atendieron 2.215, aumentando el porcentajede ingresos procedentes de urgencias del 3,6% y 3,4% al 6%en 2020. Las enfermedades que aumentaron de forma más importante fueron las lesiones traumáticas y las intoxicaciones. Tanto en los ingresos como en urgencias existe unincremento en la edad de los pacientes. Conclusiones. El Estado de Alarma influyó en la presión asistencial y en el tipo de enfermedades atendidas enel Servicio de Pediatría, con una disminución del número de Urgencias y de ingresos, un incremento de la edad y unamodificación del tipo de enfermedades atendidas.

Introduction and objectives. COVID-19 is a disease caused by the SARS-CoV-2 virus. In Spain, between March and June 2020, the first State of Alarm was declared in order to contain the pandemic. Our objective is to evaluate the health care demand and the diseases that came to the Pediatric Emergency Department and were admitted during the time that the first State of Alarm lasted, comparing with the same months of the years 2018 and 2019.Results. There is a reduction in the number of admissions from 345 to 141, an increase in complexity demonstrated by a longer duration of admissions to 7.3±12.4 days (6.2 ± 8.6 days in 2018 and 4, 8±6.9 in 2019). Infectious diseases (mainly respiratory) decreased, with admissions for neoplasms, psychiatric pathology, appendicitis and circulatory diseases remaining stable. In Pediatric Emergencies, in the years 2018 and 2019 (from March 1 to June 30), 9,075 and 8,525 patients were attended, while in 2020, 2,215 were attended, increasing the percentage of admissions from the emergency room of 3.6% and 3.4% to 6% in 2020. The diseases that increased most significantly were traumatic injuries and poisonings. Both in admissions and in emergencies there is an increase in the age of the patients. Conclusions. The State of Alarm influenced the care pressure and the type of diseases treated in the Pediatric Service, with a decrease in the number of Emergencies and admissions, an increase in age and a modification of the type of diseases treated (AU)