Child Health Care Research Articles

Parents' comprehensive health literacy and child health after attending extended home visiting in Swedish multicultural settings-A case-comparison study.

Parents' low health literacy (HL) has negative impacts on child health. Parental interventions may improve parents' HL and thus impact child health positively. This study aimed to gain knowledge about associations between parents' comprehensive HL (CHL) and child health after an extended postnatal home visiting program in Swedish multicultural, disadvantaged settings compared to parents receiving regular child healthcare (CHC). This quasi-experimental study used a case-control sampling method to recruit first-time parents through two CHC centres in Stockholm (2017-2020). Participants (N = 151) were interviewed twice through structured questionnaires when their child was <2 months and 15-18 months old. HLS-EU-Q16 assessed parents' CHL. Children's medical records (0-18 months) were reviewed regarding breastfeeding, children's exposure to smoking, language development and healthcare utilisation. Data were analysed with regression models and non-parametric tests. No significant association was found between parents' CHL and child health. However, significantly fewer unplanned visits to the CHC centre were observed among children (0-18 months) in the intervention group irrespective of CHL, compared with children to parents with improved CHL in the comparison group (F = 3.856, p = 0.011). Postnatal home visiting interventions practicing proportional universalism and family-centred care may reduce unplanned visits within CHC in disadvantaged settings despite parents' CHL. Further studies with long-term follow-up are suggested to explore associations between parents' CHL and child health. As a clinical study (not a clinical trial) with appropriate ethical permission with participants' consents, this study was retrospectively registered (18 February 2020) in the ISRCTN registry (ISRCTN10336603).

Predictive value of neck circumference for cardiometabolic risk in children

Objective: To investigate the predictive value of neck circumference on cardiometabolic risk in children. Methods: This was a cross-sectional study of natural sources. As the prediction cohort, clinical data were collected from 3 443 children aged 5-14 years who underwent physical examination in the Department of Child Healthcare, Children's Hospital of Nanjing Medical University from July 2021 to September 2022. As the validation cohort for external validation, clinical data were collected from 604 children aged 5-14 years who underwent physical examination in the Department of Child Healthcare, Children's Hospital of Nanjing Medical University from October 2022 to March 2023. Height, weight, neck circumference, waist circumference and body composition were measured in both groups, and body mass index, neck circumference to height ratio (NHtR), waist circumference to height ratio, body fat percentage and skeletal muscle percentage were calculated. Systolic blood pressure, diastolic blood pressure, fasting blood glucose, blood lipid and uric acid and other cardiovascular and metabolic risk indicators were collected in both groups. The prediction cohort was further stratified into clustered and non-clustered groups based on the clustering of cardiometabolic risk factors (CCRF). Various variables between these 2 groups were compared using the Mann-Whitney U test. Pearson correlation and binary Logistic regression were conducted to investigate the correlations between neck circumference and cardiovascular metabolic risk factors. The accuracy of NHtR in predicting the CCRF was evaluated using the area under the curve (AUC) of receiver operating characteristic (ROC). The cutoff value was determined using the Youden index. The validation cohort was then divided into groups above and below the cutoff value, and the detection rate of CCRF between the 2 groups was compared using the χ2 test for validation. Results: In the prediction cohort of 3 443 children (2 316 boys and 1 127 girls), 1 395 (40.5%) children were overweight or obese, and 1 157 (33.6%) children had CCRF. Pearson correlation analysis revealed all significant positive correlations (all P<0.01) between neck circumference and systolic blood pressure (r=0.47, 0.39), diastolic blood pressure (r=0.27, 0.21), uric acid (r=0.36, 0.30), and triglycerides (r=0.20, 0.20) after adjusting for age in both males and females. Among both males and females, neck circumference both showed significant negative correlation (both P<0.01) with high-density lipoprotein cholesterol (r=-0.27, -0.28), and no correlation with fasting glucose levels (r=0.03, -0.03, both P>0.05). After adjusting for gender, age, and body fat percentage, increased body mass index, neck circumference, or waist circumference increased the risks of hypertension (OR=1.23, 1.39, 1.07, all P<0.001), hyperuricemia (OR=1.16, 1.23, 1.05, all P<0.001), hypertriglyceridemia (OR=1.08, 1.16, 1.02, all P<0.01), low high-density lipoprotein cholesterol (OR=1.10, 1.27, 1.03, all P<0.01), and the CCRF (OR=1.51, 1.73, 1.15, all P<0.01). The areas under the ROC curves of NHtR in predicting CCRF was 0.73, with sensitivity and specificity at 0.66 and 0.71, respectively. The corresponding optimal cut-off value was 0.21. Validation with 604 children confirmed that the detection of CCRF in the NHtR≥0.21 group was 3.29 times (60.5% (112/185) vs. 18.7% (79/422),χ2=107.82, P<0.01) higher compared to the NHtR <0.21 group. Conclusions: Neck circumference is associated with cardiovascular metabolic risks such as hypertension, hyperlipidemia, hyperglycemia, and hyperuricemia in children. When the NHtR is ≥0.21, there is an increased likelihood of CCRF.

Alteration of Maternal Serum Ferritin in Pregnancy and Maternal-fetal Infections: A retrospective cohort study.

To investigate the association of altered serum ferritin during pregnancy with chorioamnionitis and neonatal sepsis. This retrospective cohort study included 78,521 pregnant women who attended antenatal check-ups at maternal and child health centers in Fujian Province, China. Study lasted from January 2014 to January 2019. A total of 59,812 pregnant women were followed up. Patients with suspected infection before the delivery were selected and divided into the chorioamnionitis and non-chorioamnionitis groups according to placental pathology. Differences in late and early pregnancy serum ferritin between the two groups were compared. Multiple logistics regression was used to adjust for confounding factors and to analyze the association between serum ferritin changes and pregnancy outcomes. Importance of altered serum ferritin during pregnancy was assessed by receiver operating characteristic (ROC) curve and net reclassification index (NRI). Clinical records of 8506 pregnant women were included in the study. there were 1010 (11.9%) cases of confirmed chorioamnionitis and 263 (3.1%) cases of neonatal sepsis. There was a significant difference in maternal serum ferritin changes between the groups with and without chorioamnionitis. No significant difference was detected in cases with or without neonatal sepsis. Multiple logistic regressions, corrected for confounding factors yielded similar conclusions. Maternal serum ferritin difference NRI 12.18% (p = 0.00014) was similar to the ROC results in predicting the occurrence of chorioamnionitis. Differential serum ferritin during pregnancy may predict chorioamnionitis but does not correlate well with neonatal sepsis.

Risk factors of children's low birth weight and infant mortality in Bangladesh: Evidence from binary logistic regression and Cox PH models.

Low birth weight is recognized as a pivotal risk factor affecting child survival and growth. Although Bangladesh has made commendable progress in public health, an infant mortality rate of 38 per 1000 live births and a 16% prevalence of low birth weight remain significant concerns compared to other developing countries. This situation poses a significant challenge for the formulation of future health policies in Bangladesh. As a result, this study aims to identify potential risk factors contributing to low birth weight and infant mortality among children in Bangladesh. The data is extracted from the 2014 Bangladesh Demographic and Health Survey. The response variables are infant mortality and low birth weight. In the bivariate analysis, Log-rank tests and Chi-square tests of independence were conducted. Cox proportional hazards and binary logistic regression models were utilized to determine the impact of risk factors on infant mortality and low birth weight. This study identified several significant factors associated with children's low birth weight, including wealth index, parental education, birth order, twin births, mother's body mass index, and child sex. Additionally, wealth index, parental education, twin status, media exposure, birth order, antenatal care visits, prenatal care assistance, and low birth weight were identified as potential risk factors for infant mortality in Bangladesh. This study revealed that maternal and child characteristics, along with knowledge about child health care during pregnancy, can potentially reduce the risk of low birth weight and infant mortality among children in Bangladesh. To improve child health and survival, policymakers should prioritize community-based health education programs, and encourage parents to seek healthcare information from institutional medical facilities during pregnancy and after birth.

Dr. Fe Del Mundo: The Pioneer Who Transformed Pediatrics and Child Healthcare in the Philippines.

Dr. Fe del Mundo was a female Filipino pediatrician, humanitarian, and advocate of Filipino children, dedicating her life to seven decades of service. Her programs on maternal and child health, preventive medicine, nutrition, vaccination, and family planning transformed the healthcare landscape in the Philippines. Overcoming adversity, she pursued a road less traveled for women of her time. After training in the United States of America, she returned to the Philippines to take care of sick children during the Second World War and later opened the first pediatric hospital in the country. Her research, inventions, and health programs set the groundwork for the improvement of pediatric and childhood outcomes in the country and the world. She is a woman of many firsts, being a beacon for generations of physicians and women. Her legacy endures through the programs she started, the lives she has saved, the doctors she trained, and the institutions she has founded for the welfare of the children she dearly cared for.

Utilizing the Summer Treatment Program Model to Promote School Readiness in Young Children Living in Urban Poverty: An Initial Effectiveness Open Trial

ABSTRACT Access to, and engagement in, quality mental health care for young children with externalizing behavior problems (EBPs) who are living in urban poverty is limited. Innovative efforts to engage families in early intervention are needed to ensure school success. The goals of the current study were to transport the Summer Treatment Program for Prekindergartners (STP-PreK, an adaptation of the Children’s Summer Treatment Program and evaluate the implementation and initial program promise for children living in urban poverty via an open trial. Participants were 115 preschool children (68.7% male; 84.3% Black) with EBPs and their caregivers. Nearly all the participating families were living with low to extremely low incomes. Participants received a 7-week STP-PreK, including a daily school readiness program and weekly behavioral parenting training. Implementation outcomes were measured via attendance records, satisfaction ratings, and fidelity measures. Program promise was measured via caregiver ratings and child assessments, collected pre-, post-, and at 6 months following the intervention. On average, results demonstrate strong feasibility and acceptability with high child attendance (90.56%) and caregiver satisfaction with services. Intervention effects across domains of child functioning reveal medium-to-large effects on academics (d’s = 0.46–1.95), overall impairment (d = 0.79), behavioral functioning (d’s = 0.38 – 0.84), and executive functioning (d = 0.58). Effects were largely maintained at 6-month follow-up (d’s = 0.13–1.86). Overall, the results support the promise of the STP-PreK model in enhancing school readiness outcomes for young children at-risk. Directions for continued adaptation and future research are discussed.

Health care-seeking behavior for childhood illnesses in western Kenya: Qualitative findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) Study.

Child mortality in Kenya is 41 per 1,000 live births, despite extensive investment in maternal, newborn, and child health interventions. Caregivers' health-seeking for childhood illness is an important determinant of child survival, and delayed healthcare is associated with high child mortality. We explore determinants of health-seeking decisions for childhood illnesses among caregivers in western Kenya. We conducted a qualitative study of 88 community members between April 2017 and February 2018 using purposive sampling in an informal urban settlement in Kisumu County, and in rural Siaya County. Key informant interviews, semi-structured interviews and focus group discussions were performed. We adopted the Partners for Applied Social Sciences model focusing on factors that influence the decision-making process to seek healthcare for sick infants and children. The discussions were audio-recorded and transcribed. Data management was completed on Nvivo® software. Iterative analysis process was utilized and themes were identified and collated. Our findings reveal four thematic areas: Illness interpretation, the role of social relationship on illness recognition and response, medical pluralism and healthcare access. Participants reported some illnesses are caused by supernatural powers and some by biological factors, and that the illness etiology would determine the health-seeking pathway. It was common to seek consensus from respected community members on the diagnosis and therefore presumed cause and necessary treatment for a child's illness. Medical pluralism was commonly practiced and caregivers would alternate between biomedicine and traditional medicine. Accessibility of healthcare may determine the health seeking pathway. Caregivers unable to afford biomedical care may choose traditional medicine as a cheaper alternative. Health seeking behavior was driven by illness interpretation, financial cost associated with healthcare and advice from extended family and community. These findings enrich the perspectives of health education programs to develop health messages that address factors that hinder prompt health care seeking.

A Secret Shopper Study of Language Accessibility of Community-based Behavioral Health Services for Children in Families Who Speak Spanish and English

To compare outpatient behavioral health scheduling for children in Spanish-speaking families in Pennsylvania with that for children in families who speak English. We made paired English and Spanish telephone calls to outpatient behavioral health facilities using a standardized script, describing a simulated, stable, Medicaid-insured child. Facilities were identified using the Pennsylvania Department of Human Services Online Provider Directory for Mental Health and Substance Abuse Services, which had 288 outpatient facilities with non-duplicate telephone numbers. An English-language caller following a script made up to two call attempts per facility from December 2019 through February 2020. The 126 facilities that did not answer the phone, accept Medicaid, or see children were removed. A Spanish-language caller then made up to two scripted call attempts to the 162 remaining facilities. The primary outcome was whether the facility tried to schedule an appointment for the simulated adolescent. 125 facilities answered both English- and Spanish-language calls. For the English-language caller, 71% of facilities attempted to schedule an appointment and 100% communicated in the caller's preferred language. For the Spanish-language caller, 24% attempted to schedule an appointment (P<0.001) and 25% communicated in the caller's preferred language (P<0.001). Among outpatient behavioral health facilities for Medicaid-insured children in Pennsylvania, there were inequities in access to appointments for families who speak Spanish compared with English. This a modifiable barrier to care. Community-based behavioral health care for children should strengthen language access training, contracting, and oversight.

Navigating Barriers to Oral Health Challenges Faced by Children With Autism Spectrum Disorder: A Scoping Review.

This article identifies the multifaceted challenges that hinder optimal oral health among children diagnosed with autism spectrum disorder (ASD). While dental care is a fundamental aspect of overall well-being, children with ASD encounter unique obstacles that often go unnoticed. Drawing from a comprehensive review of existing literature and insights from healthcare professionals, this article explores the sensory sensitivities, communication difficulties, and behavioral issues that contribute to suboptimal oral hygiene in this demographic. We also discuss the critical role of caregivers, dentists, and educators in addressing these challenges, emphasizing the importance of early intervention and tailored strategies to improve the oral health of children with ASD. By shedding light on these obstacles, this article aims to foster a more inclusive and holistic approach to oral healthcare for children with ASD, ultimately enhancing their overall quality of life.

Comparison of Clinical Response to D-Mannose with Behavioral Modifications Versus Behavioral Modifications Alone in Asymptomatic Pyuria During Pregnancy

The physiological and structural changes during pregnancy cause ureteral dilatation and urine stasis, which can lead to asymptomatic and symptomatic infections. Objective: To compare the clinical response between d-mannose with behavioral modifications versus behavioral modifications alone in asymptomatic pyuria during pregnancy. Methods: A quasi experimental study was conducted from April to September 2021, in the Department of Gynecology and Obstetrics Maternal and Child Health Center unit-1, PIMS, Islamabad. A total of 130 women with diagnoses of asymptomatic pyuria matching the inclusion criteria were recruited during study period and assigned to two groups by consecutive non-probability sampling method. Patients with urinary tract abnormalities, GDM, and antibiotic-treated symptomatic UTIs were excluded. Group A was instructed to take 1 g of D-mannose twice daily and follow the advises about behavioral changes.The group B was instrcucted to follow behavioral change only. pus cells in urine R.E.reports were used to evaluate response of treatments. Results: According to the study, the mean age of patients in group A was 27.69 ± 4.04 years, whereas group B had a mean age of 28.85 ± 4.12 years. The majority of patients (61.54%) were aged 15-30. Patients in group A had a mean gestational age of 23.72 ± 3.19 weeks, whereas group B had 24.26 ± 3.23 weeks. Patients had a mean BMI of 29.65 ± 3.55 kg/m2. In group A; 23 (35.18%) and in group B 11 (16.92%) cases of asymptomatic pyuria achieved reolution.Conclusions: This study found that D-mannose with behavioral adjustments resolves asymptomatic pyuria during pregnancy better than behavioral modifications alone.

Optimal prenatal genetic diagnostic approach for posterior fossa malformation: karyotyping, copy number variant testing, or whole-exome sequencing?

BackgroundPosterior fossa malformation (PFM) is a relatively uncommon prenatal brain malformation. Genetic diagnostic approaches, including chromosome karyotyping, copy number variant (CNV) testing, and whole-exome sequencing (WES), have been applied in several cases of fetal structural malformations. However, the clinical value of appropriate genetic diagnostic approaches for different types of PFMs has not been confirmed. Therefore, in this study, we aimed to analyze the value of different combined genetic diagnostic approaches for various types of fetal PFMs.MethodsThis retrospective study was conducted at Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital. Fifty-one pregnant women diagnosed with fetal PFMs who underwent genetic testing in our hospital from January 1, 2017 to December 31, 2022 were enrolled; women with an isolated enlarged cisterna magna were excluded. All participants were categorized into two groups according to the presence of other abnormalities: isolated and non-isolated PFMs groups. Different combined approaches, including karyotype analysis, CNV testing, and trio-based WES, were used for genetic analysis. The detection rates of karyotype analysis, CNV testing, and WES were measured in the isolated and non-isolated groups.ResultsIn isolated PFMs, pathogenic/likely pathogenic (P/LP) CNVs were detected in four cases (36.36%, 4/11), whereas G-banding karyotyping and WES showed negative results. In non-isolated PFMs, a sequential genetic approach showed a detection rate of 47.5% (19/40); karyotyping revealed aneuploidies in five cases (16.67%, 5/30), CNV testing showed P/LP CNVs in five cases (16.13%, 5/31), and WES identified P/LP variants (in genes CEP20, TMEM67, OFD1, PTPN11, ARID1A, and SMARCA4) in nine cases (40.91%, 9/22). WES showed a detection rate of 83.33% (5/6) in fetuses with Joubert syndrome. Only six patients (five with Blake’s pouch cyst and one with unilateral cerebellar hemisphere dysplasia) survived.ConclusionsWe recommend CNV testing for fetuses with isolated PFMs. A sequential genetic approach (karyotyping, CNV testing, and WES) may be beneficial in fetuses with non-isolated PFMs. Particularly, we recommend WES as the first-line genetic diagnostic tool for Joubert syndrome.

Kangaroo mother care enhances exclusive breastmilk feeding and shortens time to achieve full enteral feeding in extremely preterm infants requiring non-invasive assisted ventilation

BackgroundExtremely preterm infants (EPIs) frequently encounter challenges in feeding due to their underdeveloped digestive systems. Attaining full enteral feeding at the earliest possible stage can facilitate the removal of vascular catheters and decrease catheter-related complications.MethodsWe performed a retrospective cohort study comprising 145 extremely preterm infants with a gestational age < 28 weeks who underwent non-invasive mechanical ventilation at Shenzhen Maternity & Child Healthcare Hospital between January 2019 and June 2020. The KMC group received standard nursing care along with KMC, while the control group received standard nursing care without KMC. KMC initiation took place three weeks after admission and continued for a period of two weeks or more while maintaining stable vital signs. We evaluated the rate of exclusive breastmilk feeding within 24 h prior to discharge and the time to full enteral feeding throughout hospitalization. Additionally, we conducted a multiple linear regression analysis to identify the independent factors associated with exclusive breastmilk feeding rates and the time to full enteral feeding.ResultsThe KMC group exhibited a significantly higher rate of exclusive breastmilk feeding in the 24 h before discharge in comparison to the Non-KMC group (52.8% vs. 31.5%, OR 2.43; 95% CI 1.24, 4.78). Moreover, the KMC group achieved full enteral feeding in a shorter duration than the Non-KMC group (43.1 ± 9.6 days vs. 48.7 ± 6.9 days, p < 0.001). Multiple linear regression analysis revealed that KMC was an independent protective factor associated with improved exclusive breastmilk feeding rates (OR 2.43; 95% CI 1.24, 4.78) and a reduction in the time to full enteral feeding (β -5.35, p < 0.001) in extremely preterm infants.ConclusionKangaroo Mother Care (KMC) can expedite the achievement of full enteral feeding and enhance exclusive breastmilk feeding rates in extremely preterm infants receiving non-invasive assisted ventilation. These findings highlight the beneficial effects of KMC on the feeding outcomes of this vulnerable population, underscoring the importance of implementing KMC as a part of comprehensive care for extremely preterm infants.

Effect of the COVID-19 Lockdown on Mobile Payments for Maternal Health: Regression Discontinuity Analysis.

The COVID-19 pandemic resulted in the unprecedented popularity of digital financial services for contactless payments and government cash transfer programs to mitigate the economic effects of the pandemic. The effect of the pandemic on the use of digital financial services for health in low- and middle-income countries, however, is poorly understood. This study aimed to assess the effect of the first COVID-19 lockdown on the use of a mobile maternal health wallet, with a particular focus on delineating the age-dependent differential effects, and draw conclusions on the effect of lockdown measures on the use of digital health services. We analyzed 819,840 person-days of health wallet use data from 3416 women who used health care at 25 public sector primary care facilities and 4 hospitals in Antananarivo, Madagascar, between January 1 and August 27, 2020. We collected data on savings, payments, and voucher use at the point of care. To estimate the effects of the first COVID-19 lockdown in Madagascar, we used regression discontinuity analysis around the starting day of the first COVID-19 lockdown on March 23, 2020. We determined the bandwidth using a data-driven method for unbiased bandwidth selection and used modified Poisson regression for binary variables to estimate risk ratios as lockdown effect sizes. We recorded 3719 saving events, 1572 payment events, and 3144 use events of electronic vouchers. The first COVID-19 lockdown in Madagascar reduced mobile money savings by 58.5% (P<.001), payments by 45.8% (P<.001), and voucher use by 49.6% (P<.001). Voucher use recovered to the extrapolated prelockdown counterfactual after 214 days, while savings and payments did not cross the extrapolated prelockdown counterfactual. The recovery duration after the lockdown differed by age group. Women aged >30 years recovered substantially faster, returning to prelockdown rates after 34, 226, and 77 days for savings, payments, and voucher use, respectively. Younger women aged <25 years did not return to baseline values. The results remained robust in sensitivity analyses using ±20 days of the optimal bandwidth. The COVID-19 lockdown greatly reduced the use of mobile money in the health sector, affecting savings, payments, and voucher use. Savings were the most significantly reduced, implying that the lockdown affected women's expectations of future health care use. Declines in payments and voucher use indicated decreased actual health care use caused by the lockdown. These effects are crucial since many maternal and child health care services cannot be delayed, as the potential benefits will be lost or diminished. To mitigate the adverse impacts of lockdowns on maternal health service use, digital health services could be leveraged to provide access to telemedicine and enhance user communication with clear information on available health care access options and adherence to safety protocols.

Periconceptional Supplementation with Folic Acid or Multiple Micronutrients Containing Folic Acid and the Risk for Hypertensive Disorders in Pregnancy

Objective: The aim of this study was to investigate the association between supplementation containing folic acid only (FAO) or multiple micronutrients containing folic acid and the risk for hypertensive disorders in pregnancy (HDP). Subjects and Methods: The retrospective cohort study was based on data from women who gave birth from 2016 to 2018 at Tongzhou Maternal and Child Health Care Hospital of Beijing, China. The outcomes were HDP diagnosed after the 20th week of pregnancy, including gestational hypertension (GH), preeclampsia, and eclampsia. Associations between supplementation patterns and HDP were estimated by Poisson loglinear regression models. Sensitivity analyses were based on prepregnancy body mass index (BMI) and maternal age. Results: Among the 25,866 women included in the study, periconceptional use of FA supplementation marginally reduced the risk for HDP (adjusted risk ratio [aRR] = 0.87, 95% confidence interval [CI] 0.73–1.04). Women who began FAO supplementation before conception had a lower risk for GH compared to those who began after conception (aRR = 0.59, 95% CI: 0.45–0.78). The risk for HDP also reduced among FAO users who began supplementation before conception with a normal prepregnancy BMI (aRR = 0.64, 95% CI: 0.49–0.84) and users ≥30 years old (aRR = 0.75, 95% CI: 0.58–0.98). Conclusions: Periconceptional FAO supplementation may reduce the risk for HDP, especially GH. The protective effects are greater among women with a normal prepregnancy BMI and those ≥30 years old.

Young children’s screen habits and first-time parents’ reflections on screen use in socioeconomically disadvantaged Swedish settings: a mixed methods study

BackgroundDespite WHO’s recommendation of limited screen time for children < 2 years, they are worldwide established screen users. Several negative consequences are connected to excessive screen use among children. As parents are key actors in introducing screens to children, it is important to explore children’s screen habits and parents’ perspectives on screen in different populations, which could support the development of guidelines for healthier screen use. This study aimed to explore young children’s screen use habits and describe first-time parents’ reflections on children’s screen use in socioeconomically disadvantaged Swedish settings.MethodsThis mixed methods study was a part of larger studies within Stockholm County. The data were collected through semi-structured questionnaire-based interviews, among first-time parents (N = 386) of 15–18 months-olds at local Child Health Care centres during 2019–2022. Quantitative and qualitative data analyses conducted in parallel resulted in descriptive statistics and qualitative categories.ResultsMost children (92.4%) used screens by the age of 15–18 months, commonly for a maximum of 30 min (48.5%) per day. Participants stated the most suitable age for starting screen use to be after (41.7%) or at (37.9%) the age of two years. Parents’ reflections on screen use formed three main categories, each having two sub-categories: screen use patterns (screen-related time and reasons for screen use), perceived concerns with screen use (child development and social issues), and attitudes related to screen use (parents’ attitudes towards screens and child’s response to screens).ConclusionsFirst-time parents in socioeconomically disadvantaged settings expressed awareness of possible negative screen-related effects and recommendations but did not always focus on long-term consequences when using screens in everyday life. Screens used as a short distraction, time spent together with screens, infants’ contact with relatives overseas, and pedagogical children’s programs and apps can be regarded as screen-related benefits. Encouraging parents’ self-reflection on their screen use may be a way of contributing to healthier screen habits among young children. Future studies are suggested regarding parents’ and children’s excessive interest in screens and how to manage screen use as a family.Trial registrationRetrospectively registered 18 February 2020 (ISRCTN10336603) and 24 May 2021 (ISRCTN66190787) in ISRCTN registry.

Association between maternal lipid profiles and lipid ratios in early to middle pregnancy as well as their dynamic changes and gestational diabetes mellitus

BackgroundUnfavourable lipid and glucose levels may play a crucial role in the pathogenesis of gestational diabetes mellitus (GDM). However, there is a lack of prospective studies on the relationship between lipid profiles, lipid ratios and GDM during pregnancy.AimsTo prospectively investigate the relationship between lipid profile and lipid ratios in early and mid-pregnancy and their pattern of change from early to mid-pregnancy and the risk of GDM.MethodsThis nested case-control study was based on maternal and child healthcare hospitals from Fujian Province, China. We included pregnant women who delivered in the hospital from January 2021 to June 2023. Lipid profiles (TC, TG, ApoA1, ApoB, HDL-c, LDL-c) and fasting glucose were measured before 14 weeks of gestation and between 20 and 28 weeks of gestation, and lipid ratios (triglyceride glucose index, TG/HDL-c and TC/HDL-c) was constructed. Logistic regression was used to assess the relationship between lipid profile, lipid ratios and GDM.ResultsOf 1586 pregnant women, 741 were diagnosed with GDM. After adjusting for potential confounders, TG, ApoA1, ApoB, LDL-c, triglyceride glucose index, TG/HDL-c, and TC/HDL-c in early pregnancy were positively associated with the risk of GDM (odds ratios [95% CI] for extreme interquartile comparisons were 2.040 (1.468–2.843), 1.506 (1.091–2.082), 1.529 (1.110–2.107), 1.504 (1.086–2.086), 1.952 (1.398–2.731), 2.127 (1.526–2.971), and 2.370 (1.700-3.312), all trend P < 0.05). HDL-c was negatively associated with the risk of GDM (0.639: 0.459–0.889, trend P all less than 0.05). Similarly, in mid-pregnancy, lower levels of HDL-c, higher levels of triglyceride glucose index, TG/HDL-c ratio, and TC/HDL-c ratio were associated with increased risk of GDM (all trends P < 0.05). Stably high levels (both ≥ median for early and mid-pregnancy) of triglyceride glucose index, TG/HDL-c and TC/HDL-c were associated with increased risk of GDM (OR [95% CI]: 2.369 (1.438–3.940), 1.588 (1.077–2.341), 1.921 (1.309–2.829), respectively). The opposite was true for HDL-c, where stable high levels were negatively associated with GDM risk (OR [95% CI]: 0.599 (0.405–0.883)).ConclusionIncreases in triglyceride glucose index, TG/HDL-c ratio, and TC/HDL-c ratio in early and mid-pregnancy, as well as their stable high levels from early to mid-pregnancy, are associated with a higher risk of GDM. In contrast, increased levels of HDL-c, both in early and mid-pregnancy, and their stable high levels from early to mid-pregnancy were associated with a lower risk of GDM. That highlighted their possible clinical relevance in identifying those at high risk of GDM.

Neglect of Psychological Care for Children with Cerebral Palsy and Their Families and Its Impact on Their Occupational Engagement in Saudi Arabia.

Background and Objectives: Many children with (CP) and their families in Saudi Arabia struggle emotionally. Unfortunately, there have not been many studies conducted on how to help them with these challenges. This research aims to bring attention to this gap and to explore how a lack of proper mental health care might affect these children's ability to participate in everyday activities. Materials and Methods: In this cross-sectional descriptive study, a survey was conducted between August and October 2023. A total of 300 parents of CP children from Saudi Arabia participated in the study. The impact of psychological care negligence on the occupational engagement of CP children and their families was assessed by designing a valid questionnaire. Results: A total of 300 parents of children with CP participated in this study. The majority of the sample, 71% of parents, said that their children did not receive any psychological care, and 59.7% of the participants said that their children did not even receive a referral to a psychologist. However, 60.3% of parents of children noticed a significant decline in the occupational performance of their children, and 65.7% predicted an improvement in their children's performance with future psychological care. Conclusions: It is clear that there is a lack of awareness about the importance of mental health care for children with CP in Saudi Arabia. This lack of care hinders these children and their families' occupational engagement and social participation.

Value of combining targeted emergency nursing with psychological nursing in children with febrile convulsions.

Febrile convulsions are a common pediatric emergency that imposes significant psychological stress on children and their families. Targeted emergency care and psychological nursing are widely applied in clinical practice, but their value and impact on the management of pediatric febrile convulsions are unclear. To determine the impact of targeted emergency nursing combined with psychological nursing on satisfaction in children with febrile convulsions. Data from 111 children with febrile convulsions who received treatment at Nantong Maternal and Child Health Care Hospital between June 2021 and October 2022 were analyzed. The control group consisted of 44 children who received conventional nursing care and the research group consisted of 67 children who received targeted emergency and psychological nursing. The time to fever resolution, time to resolution of convulsions, length of hospital stays, Pittsburgh Sleep Quality Index, patient compliance, nursing satisfaction of the parents, occurrence of complications during the nursing process, and parental anxiety and depression were compared between the control and research groups. Parental anxiety and depression were assessed using the Hamilton Rating Scale for Depression (HAMD) and the Hamilton Rating Scale for Anxiety (HAMA). The fever resolution, convulsion disappearance, and hospitalization times were longer in the control group compared with the research group (P < 0.0001). The time to falling asleep, sleep time, sleep quality, sleep disturbance, sleep efficiency, and daytime status scores were significantly better in the research group compared with the control group (P < 0.0001). The HAMD and HAMA scores for parents of children in the research group were lower than the scores in the control group after nursing (P < 0.05). Compliance with treatment of children in the research group was higher than in the control group (P < 0.05). Parental satisfaction with nursing in the research group was higher than in the control group (P < 0.05). The total complication rate of children in the control group was higher than in the research group (P < 0.05). Combining psychological nursing with targeted emergency nursing improved the satisfaction of children's families and compliance with treatment and promoted early recovery of clinical symptoms and improvement of sleep quality.

School Nursing Practice in Education Settings in Spain.

School nurses and pediatric nurses play vital roles in providing healthcare for children and adolescents in educational and healthcare settings. School nurses operate within educational institutions, serving as caregivers and facilitating communication between the school, families, and the healthcare system. These professionals closely collaborate with pediatric nurses. The primary objective of this study was to examine the state of school nursing in Spain. The research comprised 27 nurses, including 18 school nurses and 9 pediatric nurses, chosen through theoretical sampling. These nurses participated in in-depth interviews as part of the data collection process. Grounded theory, following Charmaz's process, was employed for data analysis. The findings underscore the nurses' call for their mandated presence and regulation in all Spanish educational institutions to address contemporary health challenges and ensure inclusive education.

Comparing healthcare systems between the Netherlands and Australia in management for children with acute gastroenteritis.

Acute gastroenteritis is a highly contagious disease demanding effective public health and clinical care systems for prevention and early intervention to avoid outbreaks and symptom deterioration. The Netherlands and Australia are both top-performing, high-income countries where general practitioners (GPs) act as healthcare gatekeepers. However, there is a lower annual incidence and per-case costs for childhood gastroenteritis in Australia. Understanding the systems and policies in different countries can lead to improvements in processes and care. Therefore, we aimed to compare public health systems and clinical care for children with acute gastroenteritis in both countries. A cross-country expert study was conducted for the Netherlands and Australia. Using the Health System Performance Assessment framework and discussions within the research group, two questionnaires (public health and clinical care) were developed. Questionnaires were delivered to local experts in the Netherlands and the state of Victoria, Australia. Data synthesis employed a narrative approach with constant comparison. In Australia, rotavirus vaccination is implemented in a national program with immunisation requirements and legislation for prevention, which is not the case in the Netherlands. Access to care differs, as Dutch children must visit their regular GP before the hospital, while in Australia, children have multiple options and can go directly to hospital. Funding varies, with the Netherlands providing fully funded healthcare for children, whilst in Australia it depends on which GP (co-payment required or not) and hospital (public or private) they visit. Additionally, the guideline-recommended dosage of the antiemetic ondansetron is lower in the Netherlands. Healthcare approaches for managing childhood gastroenteritis differ between the Netherlands and Australia. The lower annual incidence and per-case costs for childhood gastroenteritis in Australia cannot solely be explained by the differences in healthcare system functions. Nevertheless, Australia's robust public health system, characterized by legislation for vaccinations and quarantine, and the Netherland's well-established clinical care system, featuring fully funded continuity of care and lower ondansetron dosages, offer opportunities for enhancing healthcare in both countries.