Child Care Research Articles

36 The long-term consequences of short-course systemic corticosteroid therapy for childhood acute asthma exacerbations

Abstract Background Paediatric emergency department (ED) asthma guidelines recommend the administration of short-course systemic corticosteroids (SCS) for moderate to severe asthma exacerbations. The potential adverse implications of frequent, short-course SCS in children are poorly characterized. Objectives To determine the risk of adverse outcomes in children with asthma who receive multiple short-courses of SCS for asthma exacerbation management. Design/Methods In this population-based, retrospective cohort study, we identified children aged 1-16 years with an ED asthma presentation/hospitalization between October 1, 2017, and February 28, 2020. We divided participants into an SCS-exposed and unexposed cohort. A minimum washout period of 3 years was applied to exclude any SCS use before the index date. During a 24-month follow-up period, we captured cumulative short-courses of SCS for acute asthma management and the primary outcome, development of steroid-associated complications. We excluded participants with steroid-treated comorbidities, non-asthma-related SCS exposure and development of adverse outcome(s) before the index visit. We compared baseline characteristics between cohorts using descriptive statistics. A Prentice-Williams-Peterson model was used to determine the risk of adverse outcomes amongst children receiving SCS for asthma management with results expressed as adjusted hazard ratios (HR) and 95% Wald confidence intervals (CI). Results We identified 1468 participants with an asthma ED visit who received ≥1 SCS course for acute management and 541 participants who did not receive SCS during our study window, after applying inclusion/exclusion criteria. Baseline demographics were balanced between cohorts aside from age at index, which was significantly younger (4.31 ± 3.71 vs 7.64 ± 4.21 p<0.001) in the SCS-exposed cohort. Overall, the risk of developing a recurrent SCS-associated adverse outcome was not increased in the SCS-exposed cohort (HR = 0.95, 95% CI: 0.74-1.23, p=0.7). However, when the number of SCS courses was considered, a significant risk of recurrent SCS-associated outcomes emerged, especially for those receiving 4+ SCS courses (HR = 2.30, 95% CI: 0.92-5.80). This potential dose-response effect was negated when patients who were likely on medium to high dose maintenance inhaled corticosteroids, were removed in a sensitivity analysis (HR = 1.38, 95% CI: 0.35-5.39). Conclusion At a tertiary care Canadian paediatric hospital, children and adolescents receiving short-course SCS for asthma exacerbation management overall do not demonstrate an increased risk of developing complications after two years follow-up. However, complication risk may be increased among those receiving 4+ cumulative SCS courses.

New Age Parenting and Its Impact on Child’s Oral Health: Cross-sectional Questionnaire Study

Abstract Background: With increased globalization, East culture is meeting West culture and parenting style has been completely changed. Children depend significantly on their parents for provision, instruction, and supervision of crucial preventive oral hygiene habits. The education level and awareness of parents regarding preventive oral health measures play a pivotal role in this aspect. Therefore, it becomes imperative to evaluate and educate parents about proper oral hygiene care for their children, ultimately contributing to the overall well-being of the child. Aim: The aim of this study was to assess an impact of new age parenting on oral health of their children. Methodology: A cross-sectional questionnaire study was conducted among 204 parents of children aged 5–10 years, consisting of 27-item questionnaires containing four domains of demographic data, knowledge, attitude, and practice, which was distributed among the participants. A descriptive analysis was done using IBM SPSS software (version 22.0 Chicago, IL, USA). Results: It was surprising to note that 32.84% of parents were unaware about the specialist dentist is available for children. About 65.69% of parents had low level of knowledge regarding oral health of their children. The correlation among knowledge, attitude, and practice was determined to be highly statistically significant (P = 0.0001). Conclusion: Our study concluded that knowledge, attitude, and practice of oral health care of children are low among new age parents and there is a need to educate these parents regarding the same.

24 Community provider perspectives on an autism learning health network: A qualitative study

Abstract Background Although autism is highly prevalent, no single care centre has a sufficient number of patients to produce generalizable knowledge; this slows the pace of quality improvement research. Learning health networks (LHNs) offer a promising solution to improve the quality and efficiency of healthcare by integrating clinical and research data. The Autism Care Network (ACNet) is an LHN composed of 20 clinics across the United States and Canada dedicated to developing the most effective approach to care for children with autism. In Canada, the majority of autistic patients receive a majority of their ongoing care in the community. Therefore, to make meaningful improvements in the continuum of care for patients and their families, it is essential that the ACNet be extended to include community physicians. Objectives The primary objectives were to (1) understand the current data collection practices, learning needs, clinic capacity, areas of improvement, and overall interest of community physicians in participating in a LHN and (2) identify community physicians’ perspectives on the benefits and disadvantages of participating in a LHN and ways in which their engagement in a LHN can be supported. Design/Methods In-depth semi-structured interviews were conducted participants who were purposively sampled from community providers who had previously participated in autism-focused educational programming. The interview guide was developed by the three ACNet sites based on experience with LHNs and working with community physicians. Data were analyzed using an interpretative phenomenological analysis approach with a social constructivist paradigm. Results Analysis of 29 interviews identified 5 primary themes: (1) “Navigating Administrative Challenges,” which highlighted the lack of time, resources, and administrative capacity in the community; (2) “Improving Data Collection Practices”, which emphasized the barriers to consistently collecting information from patients and families; (3) “Increasing Provider Confidence and Competence,” which explored the challenges of navigating the everchanging landscape of community autism care; (4) “Breaking Down Silos”, which focused on fragmented care and the lack of communication between allied health resources, diagnostic hubs, and community physicians; and (5) “Systemic and Societal Barriers to Achieving Best Practices,” which explored the systemic barriers that impact autism care for physicians and families. Conclusion This study provides an understanding of the experiences of community physicians regarding the challenges of community-based autism care. LHNs have the potential to address several of the issues highlighted by community physicians in autism care. Additionally, LHNs can play an important role in improving community care in fields beyond autism.

Working With Traumatised Children During Traumatic Times: Residential Child Care Educators' Compassion Fatigue and Work Engagement

Working With Traumatised Children During Traumatic Times: Residential Child Care Educators' Compassion Fatigue and Work Engagement

Gender Role of Household Decision Making (A case study Namobudda Kavre)

Gender roles in household decision making refer to the traditional division of responsibilities and decision-making power between men and women within a family or household. Historically, many societies have adhered to traditional gender roles, where men are often considered the primary decision-makers, particularly in matters related to finances and major family decisions. Women, on the other hand, have often been assigned the roles of managing the household, taking care of children, and dealing with domestic matters. However, it's important to recognize that gender roles are not fixed and vary significantly across cultures, regions, and individual households. Moreover, over time, many societies have witnessed a shift in traditional gender roles, with more emphasis on gender equality and shared decision making. The main purpose of this research was to understand the perception of people regarding the evolvement of gender roles in any household decision making. A Descriptive Cross Sectional study method was used. Altogether, 40 respondents were selected through purposive sampling method, questionnaires, Face to face interview, Informal focused group discussion; Key informant interview method was used using Structured Questionnaire to collect data from respondents. Data analysis was done through MS Excel. It is revealed from the research Gender roles in household decision making refer to the traditional division of responsibilities and decision-making power between men and women within a family or household. Historically, many societies have adhered to traditional gender roles, where men are often considered the primary decision-makers, particularly in matters related to finances and major family decisions. Women, on the other hand, have often been assigned the roles of managing the household, taking care of children, and dealing with domestic matters. However, it's important to recognize that gender roles are not fixed and vary significantly across cultures, regions, and individual households. Moreover, over time, many societies have witnessed a shift in traditional gender roles, with more emphasis on gender equality and shared decision making

Experiences and Perspective of Caretakers Working in Childcare Institutes in Delhi: A Qualitative Inquiry

Abstract Context: Institutional care is a common alternative for children who have been displaced from their homes due to a variety of socioeconomic factors. The quality of care and well-being of children in such institutions has been under research due to its long-lasting impacts on a child’s early development. However, the perspective of caregivers who are an important point of contact with the children is yet to be explored thoroughly. Aim: The current study aims to understand the experiences of caregivers in childcare institutes (CCIs) through a qualitative lens of inquiry. Settings and Design: The study has employed a qualitative, exploratory, inductive research design. Methodology: A semi-structured focus group discussion (FGD) schedule was developed, and FGDs were held with caregivers across seven CCIs in five districts of New Delhi. Qualitative Analysis: Using analysis software (QSR NVIVO 10), thematic analysis was conducted in two stages, namely, initial coding and focused coding to organize the data into meaningful themes. Results: The thematic analysis revealed a set of 4 main themes, 13 subthemes, and more than 200 codes emerging from the qualitative dataset. The themes threw light on key challenges and concerns that caretakers of children in institutional care often face. The caretakers’ current knowledge of psychological concerns and the gap in providing psychologically informed care for children is emphasized. Conclusion: The study highlights some key beliefs, such as stigma regarding mental health concerns and perceptions about their work as a “duty.” In addition, knowledge among caregivers about specific psychological issues such as self-harm and aggression may influence caring for children. Furthermore, prominent skillset challenges such as the management of children with emotional and behavioral concerns, and children with disability were highlighted. The findings reveal that the caregivers experience workplace burden due to a lack of adequate resources and specialized knowledge in childcare.

Gender Norms, Attitudes and Perceptions towards Male Involvement in Maternal Health in Kafue District, Lusaka

Male involvement in maternal health remains a major issue despite efforts by the international community. Despite the many benefits of male involvement in antenatal care there has been an observed low participation. Community gender norms, attitudes and perceptions towards male involvement in maternal health may affect the utilization of services offered by health facilities. The gap observed in many studies is that the attitude and perception of men regarding maternal health have largely been neglected. Therefore, this study sought to investigate the gender norms, attitudes and perceptions towards male involvement in maternal health in Kafue district of Zambia. The study adopted a descriptive research design. Both quantitative and qualitative paradigms were utilized in this study. A sample of 150 participants was used. Data was collected by the help of questionnaire and in-depth interviews. Results showed that respondents from Kafue were knowledgeable on antenatal care. Additionally, it was also revealed that respondents had a positive attitude towards male involvement in maternal health. However, due to gender norms their roles were limited when it came to delivery and child care. Nevertheless, the findings showed that men were involved in supporting their wives and helping out with house chores and providing money for antenatal care, skilled birth at a hospital, postnatal care, childcare and any necessities required for delivery. Men who were married were more likely to be involved in maternal health than men who were not married. The study also revealed that men were not comfortable with discussing their wives’ pregnancy with a health care provider due to lack of privacy. Findings suggested that there were many factors affecting male involvement in maternal health. Lack of messages and programs targeting men, health stuff attitude during delivery, gender norms such as men not being allowed to attend to women when in labor and hospital infrastructure were identified by the respondents as a cause to low male involvement. In this study, it was also revealed that men and women had a positive perception towards pregnancy being a shared responsibility, men supporting and caring for their wives during and after delivery. However, both men and women had a negative perception towards men’s presence in the delivery ward.

Twenty-five years of the United Nations General Comment number 12 on the human right to adequate food – malnutrition continues to surge

The human right to adequate food is one of the most fundamental human rights crucial for the sustenance of the planet, and the prosperity of all people. It is firmly established in international human rights instruments and is clarified in the United Nations’ General Comment 12 (GC 12). However, deep vulnerabilities and deprivation of the right to adequate food in the form of hunger, food insecurity and malnutrition have persisted in many parts of the world. The climate-induced disasters also continues to devastate many communities, thereby depriving them of their rights including adequate food. This commentary provides a broader perspective on the 25 years of the GC 12 to stimulate further debate and actions to entrench human rights, especially the right to adequate food, at the centre of the food systems transformation and overall sustainable development agenda. This year 2024, marks 25 years of the Global Compact 12 on the human right to adequate food. While it is an important opportunity to celebrate this great achievement of engraining this right into the wider sphere of global reference at the United Nations level, the domestication in countries into actions that concretely address the problem of hunger and malnutrition has been slow in many countries. The world is now faced with the grim realities of starving populations arising from unnecessary and unjust wars, and food continues to be used as a weapon of war against international law and human imagination. Worse still, in the current environment of climate change and its adverse effects on food systems, SDG2 (Zero hunger by 2030), seems unrealistic. Finally, it is no longer a question of providing carbohydrates, as the need to address quality, safety, nutrition and cultural acceptability is ever so pressing. Going forward, there is a need to accelerate advocacy efforts, research and policy formulation that fully operationalise GC 12 in country-level food systems and nutrition interventions. Realization of the right to adequate food benchmarks in GC 12 should certainly be the penultimate of such interventions as strategic food reserves, poverty and hunger reduction programmes, humanitarian disaster preparedness, contingency funding, social protection and child care among others.

Bereaved parents' perceptions of their cancer-ill child's last month with or without palliative care -a nationwide study.

Cancer is still the leading cause of non-accidental death in childhood, although the majority of children diagnosed in high-income countries survive their illness. In accordance with international standards, equal and early access to palliative care should be available to children and adults. Yet communication and prognostic disclosure may influence the timing of involvement in palliative care. Purpose: To investigate whether parents perceived that their child received palliative care and to what extent that contrasted parents' perceptions of their child's care and symptoms in the last month of life. A nationwide population-based parental questionnaire study in Sweden, one to five years after their child's death (n=226). Descriptive statistics were used. A majority of parents (70%) reported that they were aware that their child received palliative care and they were informed about the incurable disease (57%) within 3 months before the child died. The most common diagnosis among children receiving palliative care was a brain tumor (45%) with a disease related death (90%) and the care was often received at home (44%). Based on the reports of parents who felt that their child did not receive palliative care, 45% were informed within days or hours about the child's incurable disease, 45% of these children were diagnosed with leukemia, 60% died at the intensive care unit, and 49% died of treatment-related complications. It was most common for families who lived in urban areas (28%) to report their child received palliative care, in comparison to families living in sparsely populated areas (11%). A significant proportion of parents whose child received palliative care (96%) stated that the healthcare professionals were competent in caring for their child, for those who reported no palliative care it was slightly lower (74%). In both groups many children were affected by multiple symptoms the last month of life. The study findings highlight the role of understanding parental perceptions of pediatric palliative oncology care, the role of initiating palliative care early, the need of access to national equitable PC and professional competence across the lifespan, regardless of diagnosis and place of residence.

Is there a place for ‘community’? Transnational governance, post-socialist authoritarianism, and deinstitutionalization in a child protection NGO in Hungary

With a focus on processes of community building from above and deinstitutionalization, the paper explores how concepts of transnational policymaking become localized in particular societal contexts. Specifically, through a case of recent transformations in a child-protection NGO in Hungary, it inquires into professional discourses of ‘deinstitutionalization’ and ‘community-based care’ in the context of post-socialist authoritarianism. The analysis exposes how financial scarcity pressured the management of the NGO to redefine family-community-institution boundaries, to legitimize the downsizing of services and staff, and to reassign childcare duties to less-paid and less-recognized positions. Austerity measures disguised as emancipatory processes of deinstitutionalization have already been described in numerous European contexts. To nuance this picture, we show how discourses of the East-West slope of modernization emerging in Central-Eastern Europe, and recent discourses of familisation and carefare dominating pubic policies in Hungary enhance such discursive shifts. Through our case study we draw attention to the role of professional and political discourses, transnational and national, in reinforcing restricted imaginaries of care. We also formulate the call for empirical analyses on how the caring for children unfold into hybrid – state and civic dominated - contexts, in practice, beyond simplistic and essentialising ideological categorisations of ‘family’, ‘community’ and ‘institution’.

Receipt of social services intervention in childhood, educational attainment and emergency hospital admissions: longitudinal analyses of national administrative health, social care, and education data in Wales, UK

BackgroundResearch consistently finds poorer health and educational outcomes for children who have experienced out-of-home care relative to the general population. Few studies have explored differences between those in care and those in receipt of intervention from social services but not in care. Children receiving social services interventions often experience Adverse Childhood Experiences (ACEs), and deprivation, which are known to negatively impact outcomes. We aimed to estimate the association of different social services interventions with educational outcomes and hospital admissions, while adjusting for ACEs and deprivation.MethodsWe linked retrospective, routinely collected administrative records from health, education, and social care to create a cohort via the Secure Anonymised Information Linkage (SAIL) databank in Wales, UK. We analysed data for children and household members (N = 30,439) across four different groups: [1] no social care intervention; [2] children in need but not in care (CIN); [3] children on the Child Protection Register but not in care (CPR); [4] children in care - i.e. removed from the family home and looked after by the local authority (CLA). Our primary outcome was education outcomes at age 16 years. Secondary outcomes were all cause emergency hospital admissions, and emergency admissions for external causes/injuries.ResultsChildren in receipt of social services intervention were more likely to not attain the expected level upon leaving statutory education at age 16 after adjusting for ACEs and other characteristics (for children who had been in out-of-home care (conditional OR: 1·76, (95%CI) 1·25 − 2·48), in need (2·51, 2·00–3·15) and those at risk (i.e., on the child protection register) (4·04, 2·44 − 6·68). For all-cause emergency admissions, all social care groups were at greater risk compared to children in the general population (children in care (conditional HR: 1·31, 1·01–1·68), children in need (1·62, 1·38 − 1·90), and children at risk (1·51, 1·11 − 2·04).ConclusionsAll groups receiving social service intervention experience poorer educational and health outcomes than peers in the general population. Children who remain with their home parents or caregivers but are identified as ‘in need’ or ‘at risk’ by social care practitioners require further research. Integrated support is needed from multiple sectors, including health, educational and social care.

Clinical Outcomes of Pediatric Cancer Patients with COVID-19: A Cross-Sectional Study

Background: Considering the widespread COVID-19 pandemic and its impact, especially on children, particularly those with cancer, in terms of transmission risk, mortality, and the occurrence of the disease based on various studies in different countries, we decided to conduct this study to improve the care of children with cancer regarding COVID-19. Materials and Methods: A descriptive cross-sectional study with a confirmed diagnosis of COVID-19 consisted of obtaining 20 mL of blood samples from the participants in a random manner. Diagnostic examinations, including CT scans, chest X-rays, and a range of hematologic and blood tests, such as complete blood count, ESR, CRP, and D-Dimer, were performed on all patients. Results: This study contains 26 males and 12 females. The mean age of the patients was 3.81 ± 6.35 years. The majority of cancer patients with COVID-19 were diagnosed with Acute Lymphoblastic Leukemia (ALL) (47.7%). The most common symptoms of COVID-19 in the patients were fever (73.7%), cough (39.5%), and nausea/vomiting (21.1%). 40.4% of the patients had pathological findings suggestive of COVID-19 on their chest CT scans. 60.52% of the patients had an elevated Erythrocyte Sedimentation Rate (ESR), and 73.68% had an elevated C-reactive protein (CRP) level. Conclusion: Despite the outcomes of COVID-19 in most children with cancer in this study, children with cancer still experience risks from COVID-19, and it is unclear how delays and interruptions in cancer treatment and direct damage from the virus may impact long-term outcomes in these patients.

Adverse Childhood Experiences and Socioemotional Outcomes of Children Born Very Preterm

ObjectiveTo examine whether adverse childhood experiences (ACEs) confer risk for socio-emotional problems in children born very preterm (VPT) Study designAs part of a longitudinal study, 96 infants born VPT at 23-30 weeks of gestation were recruited from a level III neonatal intensive care unit and underwent follow-up at ages 2 and 5 years. Eighty-three full-term (FT, 37-41 weeks gestation) children were recruited from an adjoining obstetric service and the local community. ACEs were assessed with the Child Life Events Scale at age 2 and Preschool Age Psychiatric Assessment at age 5. At age 5, internalizing, externalizing, and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms were assessed with the Child Behavior Checklist and Conner’s Rating Scale-Revised, respectively. Covariates including socioeconomic disadvantage, maternal distress, and parent ADHD symptoms were assessed at the 2- and/or 5-year follow-up. Mediation and moderation analysis, accounting for family clustering, examined associations between birth group, ACEs, and socio-emotional outcomes. ResultsAfter covariate adjustment, children born VPT experienced more ACEs (p<0.001), particularly medical ACEs (p<0.01), and had worse ADHD and internalizing outcomes (p<.05) than FT children. ACEs mediated the association between birth group and ADHD outcomes (95% CIs: 0.11 – 4.08). There was no evidence of mediation for internalizing outcomes. Higher parent ADHD symptoms (p<.001) and maternal distress (p<.05) were associated with poorer internalizing outcomes. ConclusionsScreening for childhood ACEs should be embedded in the follow-up care of children born VPT and their families. Strategies to screen for and address parent psychosocial functioning may be important to support children’s socio-emotional development.

Core psychosocial insights, challenges, and opportunities in the orthopedic surgery care of children and adolescents.

This is the second phase in an investigation of the psychosocial impact of orthopedic surgery on adolescents. What are the core psychosocial factors that shape the experience of adolescent patients aged 11-18 who are undergoing orthopedic surgery? Two 43-question surveys (preoperative and postoperative) were developed as modified versions of the survey used in phase 1. The preoperative survey was administered 2 weeks before surgery. The postoperative survey was administered 6 weeks later. Responses were collected from free-response and Likert-scale questions exploring patient-physician relationships, office visits/hospital stays, family, peers, academics, sports, and surgical expectations. The survey was administered prospectively to patients aged 11-18 undergoing limb lengthening/reconstruction, pediatric, spine, sports, or hand/upper extremity orthopedic surgery. In all, 135 patients were identified; 105 were enrolled and completed both surveys. There were some statistically significant changes in responses to questions regarding office visits/hospital stays, patient-physician relationships, friends/community, academic performance, and expectations for surgical experience throughout the perioperative period. There were no statistically significant changes in responses to questions regarding the role of parent/family and sports. There was no statistically significant difference between the female and male genders or between age groups in any of the domains. Overall statistical significance in this study did not consistently correlate to clinical significance. Adolescents require psychosocial support from their surgeons, caregivers, and peers in addition to respect for their independence and personal needs. Level II.

Community Health Workers Linking Clinics and Schools and Asthma Control

Childhood asthma is characterized by pervasive disparities, including 3-fold higher hospitalization rates and 7-fold higher death rates for Black children compared with White children. To address asthma disparities, one must intervene in all lived environments. To determine if a community health worker (CHW) intervention to connect the primary care, home, and school for low-income minoritized school-aged children with asthma and their caregivers improves asthma control. This study was a hybrid effectiveness/implementation trial using a 2 × 2 factorial, cluster randomized clinical trial design of 36 schools crossed with participant-level randomization into a clinic-based CHW intervention. The study was conducted from May 2018 to June 2022. The intervention took place in primary care offices, homes, and 36 West Philadelphia, Pennsylvania, public and charter schools. Children aged 5 to 13 years with uncontrolled asthma were recruited from local primary care practices. Asthma management, trigger remediation, and care coordination occurred in school, home, and primary care settings. Children were followed up for 12 months. The Yes We Can Children's Asthma Program, Open Airways For Schools Plus, and school-based asthma therapy were implemented. Improvement in asthma control, as measured by the Asthma Control Questionnaire, comparing the mean difference between groups 1 year after randomization with their baseline (difference in differences). Both primary care and school interventions were dramatically disrupted by the COVID-19 pandemic; therefore, stratified analyses were performed to assess per-protocol intervention efficacy before the pandemic disruptions. A total of 1875 participants were approached, 1248 were excluded, and 1 was withdrawn. The 626 analyzed study participants (mean [SD] age, 8.7 [2.4] years; 363 male [58%]) self-identified as Black race (96%) and non-Hispanic ethnicity (98%). Although all groups had statistically significant improvements in asthma control from baseline to 12 months (P- group: -0.46; 95% CI, -0.58 to -0.33; P+ group: -0.57; 95% CI, -0.74 to -0.44; S- group: -0.47; 95% CI, -0.58 to -0.35; S+ group: -0.59; 95% CI, -0.74 to -0.44), none of the difference-in-differences estimates from the primary prespecified models showed a clinically meaningful improvement in asthma control. Analysis from the prepandemic interval, however, demonstrated that children in the combined clinic-school intervention had a statistically significant improvement in asthma control scores compared with control (-0.79; 95% CI, -1.40 to -0.18). This randomized clinical trial provides preliminary evidence that connecting all lived environments for care of children can be accomplished through linkages with CHWs.

Role of children's hospices in caring for children, young people and families.

Children's hospices are central to specialist palliative care provision for the increasing number of children and young people with life-limiting conditions and their families. These hospices provide holistic care through a range of services, including ongoing care from the point of diagnosis, at the end of life and into bereavement. This article outlines the services provided by children's hospices, while dispelling misconceptions that they exclusively provide care at the end of life. It also explains how these services have developed and evolved as a result of technological advances. It is useful for nurses to be aware of the role of children's hospices, so that they can support the effective care of children and young people with life-limiting conditions and their families.

Prediction values of fat-soluble vitamin of growth retardation in children aged 1-6 years.

Retardation among children is a persistent global health concern. Vitamin deficiency in childhood may contribute to growth retardation; however, its causal effects are not fully understood. Here, we aimed to explore the prediction values of fat-soluble vitamin levels on GR in children aged 1-6 years. 614 children aged from 1 to 6 years at Nantong Maternal and Child Care Health Hospital between January 2021 and December 2022 in this retrospective observational study participated in the assessment of developmental status and blood detection of vitamin from peripheral blood (PB). The relationship between vitamin levels and GR was analyzed by Multivariable logistic regression analysis. Developmental assessment results showed that 132 cases from 614 with growth retardation (21.50%). Statistical analysis showed children with GR were more likely to be males (59.45% vs. 40.55%, p = 0.191). The age of children with GR was significantly higher than those without GR (p < 0.01). Importantly, the levels of various fat-soluble vitamins in GR individuals were significantly lower than those in normal individuals. ROC analysis showed that vitamin E, vitamin A and 25(OH) D3 were less effective in predicting GR model (AUC: 0.87, 0.74, and 0.65,). However, the combination of vitamin E, vitamin A and 25(OH)D3 with age was effective in predicting GR. (AUC: 0.84, 0.77, 0.75). The combination of 25(OH)D3, Vitamin E, Vitamin A with age may have good predictive performance for children GR aged 1-6 years.

Collaborative Online International Learning With Prelicensure Nursing Students: Teaching Family-Centered Care Through a Global Perspective.

A Collaborative Online International Learning (COIL) experience was designed for prelicensure nursing students taking a pediatric course in the United States and in Brazil, to teach family-centered care to develop inclusive, global nursing practices. The purpose of this study is to describe prelicensure nursing student learning of family-centered care concepts facilitated by COIL. For data collection, six focus groups with 37 students were conducted across both universities. Data were analyzed using inductive qualitative analysis by each country separately and as a global team. Major themes included understanding the needs of families of children with chronic conditions as impacted by health systems, assigning meanings to family care of children with chronic conditions, applying concepts of family-centered care and self-reflection. Results suggest COIL is a feasible way for prelicensure nursing students to learn family-centered nursing care by operationalizing concepts, from real experiences and increasing cultural awareness.

Homoeopathy vs. conventional primary care in children during the first 24 months of life—a pragmatic randomised controlled trial

To compare the difference between primary homoeopathic and conventional paediatric care in treating acute illnesses in children in their first 24 months of life. One hundred eight Indian singleton newborns delivered at 37 to 42 weeks gestation were randomised at birth (1:1) to receive either homoeopathic or conventional primary care for any acute illness over the study period. In the homoeopathic group, conventional medical treatment was added when medically indicated. Clinicians and parents were unblinded. Children in the homoeopathic group experienced significantly fewer sick days than those in the conventional group (RR: 0.37, 95% CI: 0.24–0.58; p < 0.001), with correspondingly fewer sickness episodes (RR: 0.53, 95% CI: 0.32–0.87; p = .013), as well as fewer respiratory illnesses over the 24-month period. They were taller (F (1, 97) = 8.92, p = .004, partial eta squared = 0.84) but not heavier than their conventionally treated counterparts. They required fewer antibiotics, and their treatment cost was lower.Conclusion: Homoeopathy, using conventional medicine as a safety backdrop, was more effective than conventional treatment in preventing sick days, sickness episodes, and respiratory illnesses in the first 24 months of life. It necessitated fewer antibiotics and its overall cost was lower. This study supports homoeopathy, using conventional medicine as a safety backdrop, as a safe and cost-effective primary care modality during the first 2 years of life.Trial registration: Clinical Trial Registry-India (2018/09/015641). https://ctri.nic.in/Clinicaltrials/login.phpWhat is Known:• Due to their holistic nature, many Complementary and Alternative Medical (CAM) modalities are not readily amenable to assessment by head-to-head RCT for a given Indication.• We propose a pragmatic, RCT comparing homoeopathic with conventional medicine as a system.What is New:• Homoeopathic was apparently superior to conventional primary care in preventing sick days, sickness episodes, and respiratory illness episodes and was significantly associated with growth in height but not weight and required fewer antibiotics in children from birth to 24 months of age.

Housing and children’s social care in England: learning from embedded research

The UK housing crisis is having a detrimental impact on the lives of families. However, in England the links between housing and Children’s Social Care remain poorly understood. This paper draws upon 24 months of embedded research within Torbay Council, a Local Authority with comparatively high rates of children in care and acute housing challenges. It includes qualitative data from interviews/focus groups with parents (n = 66); Children’s Services professionals (n = 7), the housing department (n = 2); housing association (n = 2); and staff/volunteers from voluntary and community Sector organisations (n = 28). This study shows that housing circumstances can both trigger crisis situations leading to the involvement of Children’s Services and form a critical element of the complex needs many families in contact with Children’s Services confront. Parents described difficulties demonstrating their parenting abilities to Children’s Services and the Family Courts when living in inadequate housing, or indeed when homeless. This paper recommends better alignment of Housing and Children’s Social Care responses to ensure more effective support for families.