Child Visits Research Articles

Parental measurement of height in growth hormone–treated children in the hospital setting proves valid: an observational study - potential for replacement of outpatient clinic visits to the home setting

Reliable height measurement plays a pivotal role in evaluating the efficacy of costly growth hormone (GH) therapy in children. Currently, regularly outpatient clinic visits are needed to accurately measure height. The outpatient clinic visits are time-consuming for parents as well for health care professionals. This observational study aimed to investigate the validity of parentally performed height measurements compared to height measurements in the outpatient setting. An observational study was performed at the outpatient clinic of Amalia’s Children’s Hospital Nijmegen. A portable stadiometer (PS) was developed for height measurements at home. Measurements with the PS were performed by the researcher (PSR) and parents/caregivers (PSP). Measurements performed with the electronic digital ruler (EDS) were considered as the gold standard. The parents were potentially unblinded for the gold standard measurement (EDS). Descriptive statistics, Wilcoxon signed-rank, and Pearson’s correlation tests were performed. The Bland–Altman plots were made to illustrate the correlation of the PSR or PSP with the gold standard. The correlation between the height measurements with PSR or PSP compared to the EDS was substantial (PSR: r = 0.9998, R2 = 0.9996, P < 0.001; PSP: r = 0.9998, R2 = 0.9995, P < 0.001). However, a statistically significant underestimation of the PSR and PSP was observed (P < 0.001). The mean difference of the PSR and PSP was respectively − 0.21 cm ± 0.52 SD and − 0.30 cm ± 0.62 SD in comparison to the EDS. The Bland–Altman plots illustrated that 95% of the PSR measurements were between − 1.03 and 0.60 cm and 95% of the PSP measurements were between − 1.26 and 0.66 cm compared to the EDS. Conclusion: We found a strong correlation between the PSR or PSP and the EDS, with only a minor underestimation of approximately 0.2–0.3 cm. In our opinion, this underestimation is clinically irrelevant as it does not result in an adjustment in GH dose. To conclude, parental height measurements could be a promising tool as it partially replaces outpatient clinic visits needed for measurements of height. Further studies are required to confirm this statement.What is Known:• The immense impact of the coronavirus disease 2019 (COVID-19) pandemic on health care has increased telemedicine worldwide. For adequate integration of telemedicine in paediatric growth hormone treatment, reliable height and weight measurements in the home setting are required.• Earlier studies have shown that parents are capable to reliable perform height measurements in healthy children.What is New:• To our knowledge, this is the first study to show a strong correlation between the height measurements with a portable stadiometer by parents and those made with the electronic digital ruler (gold standard) in children treated with growth hormone. There was only a minor underestimation of approximately 0.2–0.3 cm, which we anticipated to be clinically irrelevant.• Therefore, home height measurements can at least partly replace costly outpatient visits for children being treated with growth hormone as part of an uncomplicated course. Moreover, these results may also be promising for implementation in other paediatric populations besides children treated with growth hormone.

Assessing caregivers’ perceptions of treatment-seeking for suspected severe malaria in the Democratic Republic of the Congo

BackgroundMalaria remains a major public health issue in the Democratic Republic of the Congo (DRC), accounting for 44% deaths among outpatient visits in children < 5 years of age, and 22% of facility deaths. Understanding determinants of caregivers’ treatment-seeking patterns and decision-making is crucial in reducing the malaria burden.MethodsIn the frame of the Community Access to Rectal Artesunate for Malaria (CARAMAL) project, cross-sectional household surveys that randomly sampled villages and households were carried-out in three rural DRC health zones prior to the rollout of pre-referral Rectal Artesunate (RAS) and then 9 and 19 months after RAS rollout (post-RAS). Data were captured electronically through face-to-face interviews with the main caregivers of children < 5 years. Capillary blood samples of the children were tested for malaria and anaemia. The main study outcome was whether caregiver “sought treatment outside home” when the child had fever. Multilevel mixed effects logistic regression models using village as random effect and health zone as a fixed effect was performed to assess treatment-seeking predictors.Results2439 household interviews were completed (pre-RAS 888 and post-RAS 1551), including 316 and 653 treatment-seeking interviews. Overall, 3499 children < 5 years were tested for malaria and anaemia (pre-RAS 1,315 and post-RAS 2184). Caregiver’s recognition of severe malaria signs was poor, while knowledge of symptoms of uncomplicated malaria seemed high. Despite this, danger signs significantly increased the odds of seeking treatment (aOR = 2.12, 95%CI 1.03–4.38), the same was found for the “least poor” quintile (aOR = 3.01, 95%CI 1.03–8.82), as well as residents of Kingandu (aOR = 2.78, 95%CI 1.01–7.65). “Doing something at home” against fever negatively affected treatment-seeking in both study phases. RAS acceptance was high, at almost 100%. Malaria prevalence was higher post-RAS (45.2%) compared to pre-RAS (34.4%), p = 0.003, but anaemia, although high (≥ 75%), was similar in both study phases (p = 0.92).ConclusionIn remote communities with high malaria prevalence in the DRC, malaria remains a major problem. Improving the recognition of danger signs of severe disease and introducing pre-referral RAS may improve treatment-seeking and contribute to reducing malaria-related mortality among children—if quality of care can be guaranteed.

Management of Pediatric Psoriasis: A U.S. Survey Based on Visits from the National Ambulatory Medical Care Survey (NAMCS).

Approximately one-third of psoriasis cases present in the first two decades of life. Many psoriasis treatments are approved by the U.S. Food and Drug Administration (FDA) for adults, including topical agents, systemic non-biologic agents, and systemic biologic agents. Only a handful of psoriasis treatments are FDA approved for children. Given the constantly evolving landscape of pediatric psoriasis management, our aim is to characterize how children with psoriasis are treated in the U.S. Data from the 2003-2016 and 2018 National Ambulatory Medical Care Survey (NAMCS) were used to evaluate patient demographics and treatment patterns for visits of children with psoriasis. Visits were stratified by those with a diagnosis of psoriasis and those for children with a diagnosis of psoriasis. Separate analyses for visits of children with a diagnosis of psoriasis were performed, including for sex, race, ethnicity, age, specialty of provider seen, and medications prescribed. Pediatric psoriasis visits accounted for 3.3% of visits with psoriasis from 2003 to 2016 and in 2018; about one-third of those visits were to primary care providers. Children with psoriasis were prescribed a variety of topical and systemic medications, of which the most frequently prescribed treatments were topical tacrolimus, followed by topical clobetasol and topical betamethasone dipropionate or betamethasone valerate. Etanercept was the only biologic prescribed to children. At least 59% of the visits for children with a diagnosis of psoriasis included a topical prescription while at least 5.3% of the visits included a systemic prescription. Use of off-label treatments was common for pediatric psoriasis. Most children with psoriasis were treated with topicals, of which tacrolimus, an unapproved treatment, was the most common. The frequent use of tacrolimus could indicate an avoidance of corticosteroids in children.

Research on the intelligent internet nursing model based on the child respiratory and asthma control test scale for asthma management of preschool children.

Childhood asthma is a common respiratory ailment that significantly affects preschool children. Effective asthma management in this population is particularly challenging due to limited communication skills in children and the necessity for consistent involvement of a caregiver. With the rise of digital healthcare and the need for innovative interventions, Internet-based models can potentially offer relatively more efficient and patient-tailored care, especially in children. To explore the impact of an intelligent Internet care model based on the child respiratory and asthma control test (TRACK) on asthma management in preschool children. The study group comprised preschoolers, aged 5 years or younger, that visited the hospital's pediatric outpatient and emergency departments between January 2021 and January 2022. Total of 200 children were evenly and randomly divided into the observation and control groups. The control group received standard treatment in accordance with the 2016 Guidelines for Pediatric Bronchial Asthma and the Global Initiative on Asthma. In addition to above treatment, the observation group was introduced to an intelligent internet nursing model, emphasizing the TRACK scale. Key measures monitored over a six-month period included the frequency of asthma attack, emergency visits, pulmonary function parameters (FEV1, FEV1/FVC, and PEF), monthly TRACK scores, and the SF-12 quality of life assessment. Post-intervention asthma control rates were assessed at six-month follow-up. The observation group had fewer asthma attacks and emergency room visits than the control group (P < 0.05). After six months of treatment, the children in both groups had higher FEV1, FEV1/FVC, and PEF (P < 0.05). Statistically significant differences were observed between the two groups (P < 0.05). For six months, children in the observation group had a higher monthly TRACK score than those in the control group (P < 0.05). The PCS and MCSSF-12 quality of life scores were relatively higher than those before the nursing period (P < 0.05). Furthermore, the groups showed statistically significant differences (P < 0.05). The asthma control rate was higher in the observation group than in the control group (P < 0.05). TRACK based Intelligent Internet nursing model may reduce asthma attacks and emergency visits in asthmatic children, improve lung function, quality of life, and the TRACK score and asthma control rate. The effect of nursing was significant, allowing for development of an asthma management model.

Evaluation of traditional methods applied by mothers in infant care: A comparison between Turkish and Lebanese mothers.

Objective: Traditional practices for infants vary across communities and may sometimes pose risks to infant health. Healthcare professionals must be aware of these practices during infant- child visits. This study aims to investigate the traditional practices of Turkish and Lebanese mothers on infants, explore the relationship between these practices and compare the similarities and differences between the two cultures. Methods: This study was a cross-sectional survey involving Turkish and Lebanese mothers living in Istanbul. Data was collected through face-to-face interviews using a questionnaire inquiring about sociodemographic information about the family, general information about the baby, and traditional practices performed by the mothers. Statistically, Pearson's chi-square test, Fisher's Exact test, and independent t-test were applied. Results: The study included 382 mothers, comprising 200 who were Turkish and 182 who were Lebanese. In both groups, the proportion of mothers who received information about infant care was approximately 90%. The most common source of information was the internet in both groups, 35% (63) of Turkish and 53.2% (92) of Lebanese mothers used the internet as a source of information. The second source of data used for baby care were the family elders in the Lebanese mothers (28%), and the health personnel in the Turkish mothers (24%). Turkish mothers practised celebrating the fortieth day, salting, using amber necklaces for teething, and giving pacifiers more frequently than Lebanese mothers. In the case of jaundice, Turkish mothers frequently breastfeed, while Lebanese mothers consult a doctor. The use of potentially risky practices is rare in both groups. No significant relationship was found between maternal education levels and the use of traditional practices. Conclusion: This study highlights the widespread use of traditional practices among both Turkish and Lebanese mothers during child-rearing. The study's results could inform health strategies to reduce the prevalence of potentially risky traditional practices among mothers and promote adopting safe, evidence-based child-rearing practices.

Extended prenatal and postnatal home visits in a vulnerable area in Sweden—a pilot study

Objective Despite close to all-embracing access to child healthcare, health divides exist among children in Sweden. Home visits to families with new-born babies are a cost-effective way to identify and strengthen vulnerable families. An extended postnatal home visiting programme has been implemented in a disadvantaged suburb in Stockholm with positive results. Design Longitudinal, prospective study and register study from medical records. Setting A vulnerable rural area in Sweden. Intervention A parent advisor from the social services and a midwife performed an extended home visiting programme during the end of pregnancy to mothers of children born between 1 May 2018 and 31 May 2019. During these children’s first 15 months, three additional home visits were made by a parent advisor and a child healthcare nurse. The aim of the study is to evaluate the effect of the intervention on the health of the children and the mothers. Subjects All firstborn children at the study site (N = 30 study, N = 55 control group). Main outcome measures The proportion participating in visits to the child and maternal healthcare services, children being breastfed and receiving childhood vaccinations. Results There were fewer absentees in the study group during routine check-up visits (93 vs. 84%). More mothers in the study group attended the check-up with the midwives (90 vs. 80%). More children in the study group were breastfed (90 vs. 67%) and received all vaccinations (100 vs. 96%). Conclusion Supplementing the extended home visiting programme with a visit at the end of pregnancy seems to contribute to fewer absentees at routine visits for both mothers and children; furthermore, more children were breastfed and vaccinated compared with the control group.

Supported remote video visits for children with incarcerated parents in the United States

ABSTRACT The Enhanced Visits Model (EVM) provides support to families in the United States, including technology to connect remotely with incarcerated parents, funding for video visits, and visit coaching for adults to support relationship building with children. Such support is intended to decrease barriers to traditional visits but not replace in-person visiting. The EVM is important for parents who are in local jails, rather than prisons, since jails typically incarcerate people for less time than prisons and lack programs that often exist in prisons. This paper focuses on development of the EVM and initial results of a feasibility and acceptability study. Although some challenges exist regarding engagement of children’s caregivers and the quality of sound and visual images, families and professionals provided positive feedback about the intervention. During video visits, children interacted with their incarcerated parents in creative ways, including showing toys, playing games, singing, reading, and doing homework. Moreover, incarcerated parents were virtually present at key times, including children’s mealtimes, bedtimes, holidays, and daily routines. This paper provides evidence that remote video visits are enjoyed by families and incarcerated parents and supports the recommendation to supplement (but not replace) in-person contact with remote video visits for children and incarcerated parents.

Association of Air Pollution with the Number of Common Respiratory Visits in Children in a Heavily Polluted Central City, China.

Children's respiratory health is vulnerable to air pollution. Based on data collected from June 2019 to June 2022 at a children's hospital in Zhengzhou, China, this study utilized Spearman correlation analysis and a generalized additive model (GAM) to examine the relationship between daily visits for common respiratory issues in children and air pollutant concentrations. Results show that the number of upper respiratory tract infection (URTI), pneumonia (PNMN), bronchitis (BCT), and bronchiolitis (BCLT) visits in children showed a positive correlation with PM2.5, PM10, NO2, SO2, and CO while exhibiting a negative correlation with temperature and relative humidity. The highest increases in PNMN visits in children were observed at lag 07 for NO2, SO2, and CO. A rise of 10 μg/m3 in NO2, 1 μg/m3 in SO2, and 0.1 mg/m3 in CO corresponded to an increase of 9.7%, 2.91%, and 5.16% in PNMN visits, respectively. The effects of air pollutants on the number of BCT and BCLT visits were more pronounced in boys compared to girls, whereas no significant differences were observed in the number of URTI and PNMN visits based on sex. Overall, air pollutants significantly affect the prevalence of respiratory diseases in children, and it is crucial to improve air quality to protect the children's respiratory health.

Five-year follow-up of a clinic-based sleep intervention for paediatric epilepsy: A randomized clinical trial.

Sleep disturbances in children with epilepsy are prevalent, and are associated with substantial adverse medical and psychosocial consequences. This study is a 5-year follow-up of a clinic-based sleep intervention study that randomized 100 toddlers and preschool-age children with epilepsy to a usual care group or a sleep intervention group. The intervention group received standard paediatric neurology care plus three education sessions during the child's routine clinic visit. The outcomes measured were: (1) child sleep by actigraphy and parental report; and (2) maternal sleep and depression. We aimed to evaluate the long-term benefits of a clinic-based sleep intervention for paediatric epilepsy. In total, 42 families (42.0%) participated. The average child's age at follow-up was 9.55 years. Thirty-eight (90.5%) children were not obtaining sufficient sleep at baseline, and 40 (95.2%) at the 5-year follow-up. The numbers of children with clinically significant sleep disturbances were 40 (95.2%) at baseline and 36 (85.7%) at the 5-year follow-up. Fourteen mothers (33.3%) had poor sleep quality and high depressive symptoms at both assessment time points. There were no differences (P > 0.05) in the child and maternal outcomes between the two trial arms. Overall, there was no evidence that a clinic-based sleep intervention that effectively improved multiple aspects of sleep in toddlers and preschool-age children with epilepsy had long-lasting beneficial effects. Our findings suggest that sleep interventions for families of children with epilepsy require ongoing reinforcement and monitoring during routine paediatric neurology care to prevent sleep problems from persisting or recurring.

Referral from well-child care clinics to dental clinics leads to earlier initiation of preventive dental visits: A quasi-experimental study.

An ealy first preventive dental visit for children is recommended no later than twelve months. However, still many children have their first dental visit relatively late. To evaluate whether active or passive referral by a well-child care (WCC) physician of babies for a first preventive dental visit leads to earlier initiation of dental care. From WCC clinics in two Dutch regions, 629 parents of babies participated. Parents received an active referral from a WCC physician for a dental visit for their babies (n = 204) or received care as usual (CAU) (n = 136) in one region and a passive referral (n = 143) or CAU (n = 146) in the other region. Active referral involved parents receiving a scheduled appointment at the dental practice, and passive referral involved parents making an appointment themselves. During the WCC visit, parents completed a baseline questionnaire. At age 2.5 years, parents received a follow-up questionnaire about dental attendance. Of the active referral intervention group, 59.3% had their first preventive dental visit in their first year compared with 3.7% in the CAU group (p < .001); for the passive referral group, 46.9% compared with 9.6% (p < .001). Referral of babies by WCC for their first preventive dental visit leads to earlier initiation of dental care. An active referral had a larger effect than passive referral.

Knowledge and Role of Paediatricians/Paediatric Residents in Infant Oral Healthcare and Dental Home across Saudi Arabia: A Cross-Sectional Study.

The prevention of oral diseases in children is highly achievable through providing early exposure to oral healthcare habits, which would make children more receptive towards dental services. A cross-sectional study used a structured, self-explanatory questionnaire to evaluate the knowledge and role of 190 paediatricians and paediatric residents towards infant oral healthcare and the dental home across Saudi Arabia. The authors sent a link to the questionnaire, comprising 36 questions, by email, as a Google e-form. The response rate obtained was 87.36%. A major proportion (95.8%) of the respondents considered that paediatricians play an important role in promoting oral health. Around 45.8% of the practitioners recommended tooth brushing after the eruption of the first tooth. About 38% of the practitioners were unaware of the children's first dental visit. The majority (95.2%) agreed that there should be an increased awareness regarding home dental habits. Most of them (78.3%) examined the oral cavity for dental problems as a part of routine childcare, and the majority (75.3%) admitted that they did not evaluate fluoride needs. A statistically significant higher mean knowledge score was observed for practitioners with more than 30 years of experience (9.35 ± 2.29), and there was a significant positive correlation (r = 0.486) between the knowledge score and mean score for the role of paediatric practitioners. Overall, the study concluded that the knowledge of paediatricians and paediatric residents in SA towards infant oral healthcare and the dental home was inadequate, and their role in maintaining oral health was found to be moderately satisfactory.

“Hui Laojia”: Children's visit experiences and geographical imagination

This study explores children's domestic visiting friends and relatives (VFR) travel experiences and their development of place meaning about their ancestral home or home village, “Laojia.” Using constructivist grounded theory, data were gathered through 19 drawings and photo-elicitation interviews with children aged 6–12. Findings revealed that “Laojia” was the central meaning of children's domestic VFR travel, built on their visit experiences and geographical imagination. Results indicated how place meaning arose from and interwove with geographical imagination in constructing “Laojia.” Children's domestic VFR travel in China represents a unique countryside journey, “Hui Laojia.” It is crucial to understand this culturally specific and geographically situated practice which integrates the ordinary and the novel. This study makes contributions to research on VFR and geographical imagination. Its findings help tourism managers and destination marketing organizations address the needs of children and families, informing government policies related to rural revitalization. Future directions are discussed.

Outpatient visits before and after Lyme disease diagnosis in a Maryland employer-based health plan

BackgroundInsurance claims data have been used to inform an understanding of Lyme disease epidemiology and cost of care, however few such studies have incorporated post-treatment symptoms following diagnosis. Using longitudinal data from a private, employer-based health plan in an endemic US state, we compared outpatient care utilization pre- and post-Lyme disease diagnosis. We hypothesized that utilization would be higher in the post-diagnosis period, and that temporal trends would differ by age and gender.MethodsMembers with Lyme disease were required to have both a corresponding ICD-9 code and a fill of an antibiotic indicated for treatment of the infection within 30 days of diagnosis. A 2-year ‘pre- diagnosis’ period and a 2-year ‘post-diagnosis period’ were centered around the diagnosis month. Lyme disease-relevant outpatient care visits were defined as specific primary care, specialty care, or urgent care visits. Descriptive statistics examined visits during these pre- and post-diagnosis periods, and the association between these periods and the number of visits was explored using generalized linear mixed effects models adjusting for age, season of the year, and gender.ResultsThe rate of outpatient visits increased 26% from the pre to the post-Lyme disease diagnosis periods among our 317-member sample (rate ratio = 1.26 [1.18, 1.36], p < 0.001). Descriptively, care utilization increases appeared to persist across months in the post-diagnosis period. Women’s care utilization increased by 36% (1.36 [1.24, 1.50], p < 0.001), a significantly higher increase than the 14% increase found among men (1.14 [1.02, 1.27], p = 0.017). This gender difference was mainly driven by adult members. We found a borderline significant 17% increase in visits for children < 18 years, (1.17 [0.99, 1.38], p = 0.068), and a 31% increase for adults ≥ 18 years (1.31 [1.21, 1.42], p < 0.001).ConclusionsAlthough modest at the population level, the statistically significant increases in post-Lyme diagnosis outpatient care we observed were persistent and unevenly distributed across demographic and place of service categories. As Lyme disease cases continue to grow, so will the cumulative prevalence of persistent symptoms after treatment. Therefore, it will be important to confirm these findings and understand their significance for care utilization and cost, particularly against the backdrop of other post-acute infectious syndromes.

Justice For Survivors of Intimate Partner Violence Conference Report

Domestic violence survivors seeking justice and safety in New York State’s family and supreme courts often encounter a deeply flawed, poorly functioning system that exposes them and their children to further harm. On October 13 and 14, 2022, a coalition of leading nonprofit agencies that serve and advocate for survivors convened a conference in New York City to address these systemic inequities and identify meaningful solutions. During the conference, Justice for Survivors of Intimate Partner Violence: Transforming an Inequitable Family Law System, attorneys, scholars, survivor leaders, members of the judiciary, social service professionals, psychologists and advocates identified key obstacles facing survivors and recommended needed reforms to New York State’s family law system.&#x0D; Specifically, the conference focused on widespread inequities in custody, visitation, and family offense cases, which proceed in both the family and supreme courts, and the devastating impact they have on survivors. Throughout the two days, panelists confronted the ways in which these courts fail to provide an effective and equitable system for domestic violence survivors seeking safety and protection for themselves and their families, and identified the most significant challenges they face. In family law proceedings, the stakes could not be higher for survivors and their children, as this inadequate and inequitable system of justice has led to tragic consequences, including death or injury at the hands of abusers, loss of child custody and/or visitation rights, and further trauma inflicted by the litigation itself. Panelists also addressed the egregious under-funding and poor functioning of the Family Courts and the endemic bias woven into these institutions. &#x0D; The Conference included ten keynote and panel presentations addressing significant systemic challenges and potential solutions for survivors of intimate partner violence in the family law system. The Conference featured first-hand accounts by survivors and practitioners, original research presented by renowned experts, and insights provided by prominent sitting and retired judges. Conference panelists drew from materials regarding the intersection of racism, misogyny, and other forms of oppression and its impact on systems, including groundbreaking reports on gender and racial bias in the court system. In addition, each panel provided relevant materials, including scholarly research, reports, studies, articles, statutes and proposed legislation, all of which remain available on the Conference website at https://www.familylaw2022.com/.

The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies.

Mental and behavioral health (MBH) visits of children and youth to emergency departments are increasing in the United States. Reasons for these visits range from suicidal ideation, self-harm, and eating and substance use disorders to behavioral outbursts, aggression, and psychosis. Despite the increase in prevalence of these conditions, the capacity of the health care system to screen, diagnose, and manage these patients continues to decline. Several social determinants also contribute to great disparities in child and adolescent (youth) health, which affect MBH outcomes. In addition, resources and space for emergency physicians, physician assistants, nurse practitioners, and prehospital practitioners to manage these patients remain limited and inconsistent throughout the United States, as is financial compensation and payment for such services. This technical report discusses the role of physicians, physician assistants, and nurse practitioners, and provides guidance for the management of acute MBH emergencies in children and youth. Unintentional ingestions and substance use disorder are not within the scope of this report and are not specifically discussed.

Examination of the Relationship Between the Virtual Bullying Awareness Levels and Communication Skills of Primary School Teachers

Cyberbullying is by an individual or a group by using resources such as e-mail, smart phone, pagers, short message services (SMS) and websites, Information and Communication technologies in order to harm a person; intentional, repetitive hostile behavior. When the literature is examined; it is seen that cyberbullying behaviors are carried out with the aim of intentionally harming, peer pressure, negative family-friendship relations, aggression, taking revenge for harming, and making the target person do an action that they do not want to do. According to the results of a study in which the percentage of performing cyberbullying behaviors was determined; According to the results of the study conducted with 160 adolescents between the ages of 14-18 in T&amp;uuml;rkiye; it has been determined that the rate of exposure to cyberbullying of young people is 83% and the severity of this rate is emphasized. When the negative effects of cyberbullying on the psychology of individuals, especially young people, are examined in the long term, depression and depression, fear and/or embarrassment of people, a constantly warned state, avoiding virtual environments and technology, avoiding responsibility, use of addictive harmful substances, negative behaviors such as being away from school draw attention. Communicating with other stakeholders in education (such as school administrators, class-branch teachers, guidance teachers, families) in order to prevent children and/or young people from being exposed to the stated negative effects of cyberbullying and in this context, it is foreseen that the collaborative work to be carried out between the stakeholders can be important and effective in terms of problem solving. Awareness behaviors such as supporting students to receive safe education in an academic sense, encouraging children and young people to use the internet safely, controlling the sites and shares that children visit, and drawing attention to abnormal and aggressive behaviors they display while using technology will support the prevention of cyberbullying. In this context, determining the cyberbullying awareness levels of the specified stakeholders and organizing trainings by the relevant institutions and organizations within the scope of the findings will contribute to raising the awareness of the stakeholders on this issue. In the light of all these, the aim of this study is to determine the cyberbullying awareness levels of primary school teachers and to associate it with the dependent variable of communication skills proficiency levels. In order to serve this purpose, research was conducted with a total of 154 teachers working in primary schools affiliated to the Ministry of National Education in Kars T&amp;uuml;rkiye. As a method in the research, mix method was used and the findings related to various statistical tests were revealed. It is predicted that the findings obtained in the study will contribute to the literature and researchers in order to raise awareness of cyberbullying to education stakeholders.

Association Between Insurance Type and Fluoride Varnish Application During Well-Child Visits in Massachusetts.

To compare rates of fluoride varnish (FV) applications during well-child visits for children covered by Medicaid and private medical insurance in Massachusetts. This cross-sectional study analyzed well-child visits for children aged 1 to 5 years paid by Medicaid and private insurance during 2016.Çô18 in Massachusetts. Multivariate regression models, with all covariates interacting with insurance type, were used to calculate odds ratios and adjusted predicted probabilities of fluoride varnish during well-child visits by calendar year and age. Across 957,551 well-child visits, 40.0% were paid by private insurers. Unadjusted rates of fluoride varnish were significantly lower among well-child visits paid by private insurers (6.6%) than visits paid by Medicaid (14.2%). In the fully interacted regression model, the odds of a visit including fluoride varnish were significantly lower for older children than for children aged 1 for visits paid by both insurance types. Adjusted rates of fluoride varnish increased significantly from 2016 to 2018 for both insurance types. Moreover, rates were higher among visits for children covered under Medicaid than privately insured children in all years, and the differences by insurance type declined over time (2016: 8.0% points, 95% confidence interval.á=.á.êÆ8.7 to .êÆ7.3, 2018: 5.3% points, 95% confidence interval.á=.á.êÆ6.6 to .êÆ3.9). Rates of fluoride varnish applications during well-child visits were low for both Medicaid and private insurance despite growth from 2016 to 2018 in Massachusetts. Low rates are concerning because this is a recommended service with the potential to help address racial, geographic, and income-based disparities in access and oral health outcomes.

Knowledge and attitude of parents toward child dental visits in a rural setting in Nigeria.

The study determined the proportion of rural parents with good knowledge about and good attitude toward children making their first dental visit by their first birthday. It also assessed the association among age, sex, level of education, past dental visits of parents, and knowledge about and good attitude toward children making their first dental visit by their first birthday. This was a cross-sectional study that collected data from 115 parents in a rural setting using an interviewer-administered questionnaire. Data on age, sex, level of education, past dental visits, knowledge about, and attitude toward children making their first dental visit by their first birthday were collected from one of the parents of children aged 16 years and below. Socio-demographic factors associated with knowledge about and attitude to a child's dental visit were considered significant at the level of P < 0.05 using the Chi-square test. Logistic regression was conducted to determine the predictor of good knowledge. The age of the study participants ranged from 15 years to 63 years with a mean of 40 ± 15.51 years. Only 25 (21.7%) parents had visited the dentist. More females 31 (40.3%) than males 6 (15.8%) significantly (P = 0.008) had good knowledge of child dental visits while more males 12 (31.6%) than females 6 (7.8%) (P = 0.001) and a greater percentage of those with past dental visits 8 (32.0%) had significantly (P = 0.02) good attitude to child dental visit. More mothers had good knowledge of child dental visits, while more fathers and those with past dental visits had a good attitude toward child dental visits.

Children’s injury database: development of an injury surveillance system in a pediatric emergency department

BackgroundInjuries are the leading cause of death in children and are also a leading cause of all emergency department (ED) visits for children. Obtaining epidemiologic data to define the wide range of childhood injuries for individual communities is challenging. The Children’s Injury Database (CID) is an injury surveillance system developed to collect data from injury-related visits to our tertiary care pediatric emergency department.ResultsDuring 2021, a total of 15,168 injury visits were analyzed representing 22% of total ED visits (68,834). A total of 2053 injury visits (13.5%) resulted in hospital admission. The 10 leading injury types included: falls, poisonings, motor vehicle collision (MVC), assault, dog bite, burns, sports, pedestrian, bicycle, and all-terrain vehicle (ATV). Admission rates varied by age group with children ages 13 years and older having the highest rate of admission (18.4%). The median length of stay (LOS) for all injured children requiring admission was 2 days while the median LOS for preschoolers was 1 day, the median LOS for school-age children was 2 days, and the median LOS for teenagers was 3 days. While MVCs were the most common cause of vehicle-related injuries, ATV-related injuries had the highest rate of admission (51%).ConclusionsIn this study, teenagers had significantly higher admission rates, lengths of stay, and hospital charges. Black and Hispanic children were under-represented in the number of visits for injuries compared to all ED visits. Further research should focus on disparities in injury-related visits based on race as well as gender. CID has demonstrated that injury surveillance systems can assist with reporting new injury patterns while also acting as a stimulus for new research ideas, planning interventions targeting the most at-risk populations, and evaluating the effectiveness of injury prevention interventions.

Children's Dental Fear: Occurrence Mechanism and Prevention Guidance.

Children's dental fear (CDF) has become one of the main reasons affecting the quality of dental treatment. In order to reduce the incidence of CDF in China before and after children's dental visits, this review applies literature analysis and empirical summary methods to analyze and summarize academic discussions on this topic, including occurrence mechanism, prevention guidance, and the conclusion that the occurrence and prevention of CDF is closely related with children's internal characteristics and external influences. In the end, we propose a breakthrough of combining the CFSS-DS scale and three-grade prevention theory together in the future to provide new ideas and hypotheses for the prevention of CDF.