Children In Intervention Group Research Articles

Serum vitamin D levels in children with vernal keratoconjunctivitis - A study from a tertiary care pediatric hospital of North India.

To study the levels of vitamin D serum levels in children with vernal keratoconjuctivits (VKC) and comparing vitamin D levels in after giving vitamin D supplements between intervention and control group. The study was conducted in population between 1 to 12 years in tertiary care hospital in North India. Amongst children with VKC, full ocular examination along with Boninis clinical grading of VKC and serum vitamin D levels were assessed. Whole study group was randomly divided into two groups. Intervention group had received vitamin D powder while control group kept under observation. A total of 88 children received vitamin D supplementation and 39 kept in control group. Our study suggests that children in intervention group showed improvement in serum vitamin D levels with the clinical improvement in VKC grading too.

The efficacy of finger puppets, distraction cards and kaleidoscope for reducing anxiety in children undergoing day surgery

AimThis study was conducted to determine the efficacy of finger puppets, distraction cards and kaleidoscope for reducing anxiety in children aged 6–12 years who undergoing day surgery in Turkey. MethodsThe study was conducted using the “pre-post test unmatched group model”, one of the quasi-experimental methods. The study was conducted between April 2023 and January 2024 with children aged 6–12 years who were admitted to the pediatric clinic of a hospital for day surgery in the Southern Marmara region of Turkey. A total of 85 children (including 20 children in the control group, 22 children in the finger puppet intervention group, 21 children in the distraction cards intervention group, and 22 children in the kaleidoscope intervention group) who were hospitalized in the pediatric clinic. ResultsIt was determined that there was a statistically significant difference between the pre- and post-intervention the Modified Yale Preoperative Anxiety Scale Child Form (m-YPAS) sub-dimension and total mean scores of the children in the kaleidoscope, finger puppet and distraction cards groups, while there was no difference in the control group children. ConclusionKaleidoscope, finger puppet and distraction cards interventions were found to be effective in reducing preoperative anxiety in children and contributed to the national and world literature. It is recommended that further studies be conducted on the effectiveness of the three methods and that other variables that may affect the child's anxiety be addressed. Contribution to nursing practiceThis finding can be interpreted as significant and positive in demonstrating that anxiety induced by surgical procedures in children can be effectively managed with non-pharmacological methods.

THE EFFECTS OF VIRTUAL REALITY TRAINING ON BALANCE AND SPEED-AGILITY IN OBESE CHILDREN: A RANDOMIZED CONTROLLED TRIAL

Purpose: The aim of the study was to examine the effects of virtual reality training on balance and speed-agility in obese children. Methods: The study included 34 obese children at the ages of 9-11. Participants were divided into training and control groups using the simple randomization method. The participants in the intervention group (n=17) were taken into virtual reality training for 6 weeks. No treatment was applied on the control group (n=17). Balance was assessed by the Flamingo and Y balance tests. Speed-agility was assessed by the Bruininks-Oseretsky Test of Motor Proficiency-Brief Form-speed-agility sub-test. The physical activity enjoyment levels of the children in intervention group were assessed by the Short Form-Physical Activity Enjoyment Scale. Results: Before the study, the groups were similar in terms of the investigated variables (p>0.05). Speed-agility scores and Y balance test anterior, posterior-lateral and mixed reaching distances of the children in intervention group significantly increased after the training in comparison to their pre-training results (p

Improving the social communication skills of preschoolers with autism spectrum disorder: robot-based intervention on Picture Exchange Communication System use

Objectives Children diagnosed with autism spectrum disorder (ASD) often exhibit challenges in social communication. Picture Exchange Communication System (PECS) is effective in enhancing the social skills of children with ASD, and interventions using social robots are potentially beneficial training tools. However, it is uncertain whether robots can facilitate more effective training for children with ASD compared to human therapists. Methods In the present study, we compared the effectiveness of robot-based and human-based interventions on enhancing the social communication behaviors in young children diagnosed with ASD. The feasibility and efficacy of integrating the PECS in robotic systems were evaluated using a single-case design. Eight children with ASD were randomly assigned to either a robot-based group (N = 4) or a human-based group (N = 4). Participants in the two groups underwent phases I–III of the PECS protocol facilitated by either a human therapist or a robot therapist. Changes in social communication behaviors were assessed in each child after intervention using a single-case design. Results Half of the participants in the robot-based intervention group showed significant improvement in both verbal and nonverbal communication behaviors after a two-month PECS intervention. A higher proportion of children in the robot-based intervention group showed significantly enhanced social communication skills encompassing both verbal and nonverbal behaviors than in the human-based intervention group. Conclusions This study demonstrates the effectiveness of robot-based PECS intervention in enhancing verbal and nonverbal communication behaviors in young children with ASD. These findings present novel intervention tools for early intervention educators engaged in supporting children with ASD.

A family-based and mobile-assisted intervention for lifestyle behaviors in youths: A randomized controlled trial.

This randomized controlled trial was conducted to assess the effectiveness of a family-based and mobile-assisted lifestyle intervention in reducing weight gain among school-age children with overweight and obesity. A total of 164 school-age children with overweight or obesity and their parents were randomized to the treatment intervention (n = 82) or an attention-control group (n = 82). The treatment intervention included three face-to-face education sessions, augmented by monthly text messages sent to parents on their mobile devices. The primary outcome was child BMI-for-age z-score. Secondary outcomes included child BMI, percent body fat, and actigraphy-assessed sleep as well as parental sleep quality. Outcomes were assessed at baseline, 3, 6, and 12 months after the intervention, with treatment effects analyzed using general linear models for repeated measures. Our results showed that children in the treatment intervention group had significantly lower BMI-for-age z score, BMI, and percent body fat than did those in the control group, with an adjusted mean difference of 0.31 units (95% CI: -0.59 to -0.03; p = 0.03), 1.34 kg/m² (95% CI, -2.42 to -0.26; p = 0.01), and 3.12% (95% CI, -5.93 to -0.30; p = 0.03), respectively. No treatment effects were observed for child and parental sleep. Our findings suggest that family-based and mobile-assisted lifestyle intervention results in significant and sustained benefits to enhanced weight management for school-age children with overweight and obesity. Nurses planning and delivering childhood overweight and obesity treatment interventions should consider a family-based approach with the assistance of mobile devices.

Parent-implemented interventions in Chinese families of children with autism spectrum disorder

This study aims to test the effects of the parent-implemented interventions (PIIs) on children with autism spectrum disorder (ASD) in China and to explore the effects of PIIs on the family quality of life of families of children with ASD in China. This study adopted a randomized controlled trial (RCT) design based on PIIs. Participants is divided into intervention group (N(parents) = 35, Age(M ± SD) = 35.69 ± 3.45; N(children) = 35, Age(M ± SD) = 5.49 ± 2.74) and control group (N(parents) = 35, Age(M ± SD) = 36.06 ± 4.28; N(children) = 35, Age(M ± SD) = 5.71 ± 3.25); parents in intervention group were trained with PIIs and required to implement family interventions for their children with ASD as they learned. This study will provide data to support the development and improvement of PIIs, and will also benefit the well-being and sustainability of children with ASD and their families. Compared to control group, the children in intervention group had a significant improvement in social communication ability (p < 0.05), and the families in intervention group had a significant enhancing in family quality of life (satisfaction) (p < 0.001). This study found that PIIs are effective in enhancing the social communication ability of children with ASD in China and the family quality of life (satisfaction) of their families. PIIs is a good and cost-effective complement to rehabilitation training in professional institutions, and have positive significance for the well-being and sustainability of children with ASD and their families.

Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study.

Tanzania is 1 of 20 countries where the majority of unvaccinated and undervaccinated children reside. Prior research identified substantial rural-urban disparities in the coverage and timeliness of childhood vaccinations in Tanzania, with children in rural settings being more likely to receive delayed or no vaccinations. Further research is necessary to identify effective and scalable interventions that can bridge rural-urban gaps in childhood vaccination while accounting for multifaceted barriers to vaccination. This protocol describes a type 1 effectiveness-implementation hybrid study to evaluate Chanjo Kwa Wakati (timely vaccination in Kiswahili), a community-based digital health intervention to improve vaccination timeliness. The intervention combines human resources (community health workers), low-cost digital strategies (electronic communication, digital case management, and task automation), a vaccination knowledge intervention, and insights from behavioral economics (reminders and incentives) to promote timely childhood vaccinations. The study will be conducted in 2 predominantly rural regions in Tanzania with large numbers of unvaccinated or undervaccinated children: Shinyanga and Mwanza. Forty rural health facilities and their catchment areas (clusters) will be randomized to an early or delayed onset study arm. From each cluster, 3 cohorts of mother-child dyads (1 retrospective cohort and 2 prospective cohorts) will be enrolled in the study. The timeliness and coverage of all vaccinations recommended during the first year of life will be observed for 1200 children (n=600, 50% intervention group children and n=600, 50% nonintervention group children). The primary effectiveness outcome will be the timeliness of the third dose of the pentavalent vaccine (Penta3). Quantitative surveys, vaccination records, study logs, fidelity checklists, and qualitative interviews with mothers and key informants will inform the 5 constructs of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. The results will be used to develop an implementation blueprint to guide future adaptations and scale-up of Chanjo Kwa Wakati. The study was funded in August 2022. Data collection is expected to last from February 2024 to July 2027. This study will address the lack of rigorous evidence on the effectiveness of community-based digital health interventions for promoting vaccination coverage and timeliness among children from sub-Saharan Africa and identify potential implementation strategies to facilitate the deployment of vaccination promotion interventions in low- and middle-income countries. ClinicalTrials.gov NCT06024317; https://www.clinicaltrials.gov/study/NCT06024317. PRR1-10.2196/52523.

Child Neurodevelopment After Multidomain Interventions From Preconception Through Early Childhood

Multidomain interventions in pregnancy and early childhood have improved child neurodevelopment, but little is known about the effects of additional preconception interventions. To evaluate the effect of a multifaceted approach including health; nutrition; water, sanitation, and hygiene (WASH); and psychosocial support interventions delivered during the preconception period and/or during pregnancy and early childhood on child neurodevelopment. In this randomized trial involving low- and middle-income neighborhoods in Delhi, India, 13 500 participants were assigned to preconception interventions or routine care for the primary outcome of preterm births and childhood growth. Participants who became pregnant were randomized to pregnancy and early childhood interventions or routine care. Neurodevelopmental assessments, the trial's secondary outcome reported herein, were conducted in a subsample of children at age 24 months, including 509 with preconception, pregnancy, and early childhood interventions; 473 with preconception interventions alone; 380 with pregnancy and early childhood interventions alone; and 350 with routine care. This study was conducted from November 1, 2000, through February 25, 2022. Health, nutrition, psychosocial care and support, and WASH interventions delivered during preconception, pregnancy, and early childhood periods. Cognitive, motor, language, and socioemotional performance at age 24 months, assessed using the Bayley Scales of Infant and Toddler Development 3 tool. The mean age of participants at enrollment was 23.8 years (SD, 3.0 years). Compared with the controls at age 24 months, children in the preconception intervention groups had higher cognitive scores (mean difference [MD], 1.16; 98.3% CI, 0.18-2.13) but had similar language, motor, and socioemotional scores as controls. Those receiving pregnancy and early childhood interventions had higher cognitive (MD, 1.48; 98.3% CI, 0.49-2.46), language (MD, 2.29; 98.3% CI, 1.07-3.50), motor (MD, 1.53; 98.3% CI, 0.65-2.42), and socioemotional scores (MD, 4.15; 98.3% CI, 2.18-6.13) than did controls. The pregnancy and early childhood group also had lower incidence rate ratios (RRs) of moderate to severe delay in cognitive (incidence RR, 0.62; 98.3% CI, 0.40-0.96), language (incidence RR, 0.73; 98.3% CI, 0.57-0.93), and socioemotional (incidence RR, 0.49; 98.3% CI, 0.24-0.97) development than did those in the control group. Children in the preconception, pregnancy, and early childhood intervention group had higher cognitive (MD, 2.60; 98.3% CI, 1.08-4.12), language (MD, 3.46; 98.3% CI, 1.65-5.27), motor (MD, 2.31; 98.3% CI, 0.93-3.69), and socioemotional (MD, 5.55; 98.3% CI, 2.66-8.43) scores than did those in the control group. Multidomain interventions during preconception, pregnancy and early childhood led to modest improvements in child neurodevelopment at 24 months. Such interventions for enhancing children's development warrant further evaluation. Clinical Trials Registry-India CTRI/2017/06/008908.

Effect of Benson's relaxation technique versus music intervention on physiological parameters and stress of children with thalassemia during blood transfusions: A randomized controlled trial

BackgroundChildren with thalassemia are generally dependent on blood transfusions and face a lot of stress and alteration in their physiological parameters through the procedure. AimThis study aimed to investigate the effect of Benson's relaxation technique versus music intervention on physiological parameters and stress of children with thalassemia during blood transfusions. DesignA randomized, controlled trial with three parallel groups. MethodsOne hundred and twenty preschool-age children with thalassemia who underwent blood transfusions were randomly assigned to three groups. Children of the control group received only routine hospital care through blood transfusions. Music intervention group children listened to recorded Mozart's music and children of Benson's relaxation group received relaxation intervention before and during the blood transfusions. Outcome measures were physiological parameters and behavioral distress levels. SettingHematology outpatient clinic of the Children's University Hospital at El-Shatby in Alexandria from October 2022 to February 2023. ResultsThe mean total score of children's behavioral responses to stress before the blood transfusions procedure was 19.32 ± 4.08, 14.20 ± 0.93, and 16.92 ± 4.74 in the control, music, and Benson groups, respectively. Beyond that, there was a decline in their physiological parameters and behavioral stress response during and after procedure among groups of study (P = 0.005 & <0.001, respectively). ConclusionMusic and Benson's relaxation interventions had a helpful effect on stabilizing the physiological parameters and reducing behavioral distress levels in children with thalassemia undergoing blood transfusions. Practice implicationsThis study directs paediatric nurses to apply Benson's relaxation and music interventions for children with thalassemia to enhance their responses.

Effect of the SPRING home visits intervention on early child development and growth in rural India and Pakistan: parallel cluster randomised controlled trials.

Almost 250 million children fail to achieve their full growth or developmental potential, trapping them in a cycle of continuing disadvantage. Strong evidence exists that parent-focussed face to face interventions can improve developmental outcomes; the challenge is delivering these on a wide scale. SPRING (Sustainable Programme Incorporating Nutrition and Games) aimed to address this by developing a feasible affordable programme of monthly home visits by community-based workers (CWs) and testing two different delivery models at scale in a programmatic setting. In Pakistan, SPRING was embedded into existing monthly home visits of Lady Health Workers (LHWs). In India, it was delivered by a civil society/non-governmental organisation (CSO/NGO) that trained a new cadre of CWs. The SPRING interventions were evaluated through parallel cluster randomised trials. In Pakistan, clusters were 20 Union Councils (UCs), and in India, the catchment areas of 24 health sub-centres. Trial participants were mother-baby dyads of live born babies recruited through surveillance systems of 2 monthly home visits. Primary outcomes were BSID-III composite scores for psychomotor, cognitive and language development plus height for age z-score (HAZ), assessed at 18 months of age. Analyses were by intention to treat. 1,443 children in India were assessed at age 18 months and 1,016 in Pakistan. There was no impact in either setting on ECD outcomes or growth. The percentage of children in the SPRING intervention group who were receiving diets at 12 months of age that met the WHO minimum acceptable criteria was 35% higher in India (95% CI: 4-75%, p = 0.023) and 45% higher in Pakistan (95% CI: 15-83%, p = 0.002) compared to children in the control groups. The lack of impact is explained by shortcomings in implementation factors. Important lessons were learnt. Integrating additional tasks into the already overloaded workload of CWs is unlikely to be successful without additional resources and re-organisation of their goals to include the new tasks. The NGO model is the most likely for scale-up as few countries have established infrastructures like the LHW programme. It will require careful attention to the establishment of strong administrative and management systems to support its implementation.

Evaluating a complex and sustained STEM engagement programme through the lens of science capital: insights from Northeast England

BackgroundSTEM education providers increasingly use complex intervention models to redress persistent under-representation in STEM sectors. These intervention models require robust evaluation to determine their effectiveness. The study examines a complex, sustained intervention intended to build science capital in young people aged 11–15 over 3 years, which drew on science capital theory and related research to inform intervention design and evaluation. When evaluation results differed from those anticipated, process evaluation supported authors to interpret these findings. By outlining challenges faced in the evaluation of a complex, sustained STEM outreach intervention, this paper addresses critique that outreach programmes focus too often on short-term and positive findings.ResultsIntervention outcomes were assessed using a quantitative questionnaire adapted from science capital research, issued to pupils at the intervention’s baseline (2015), midpoint (2017) and endpoint (2019). Adopting a cohort-based model, the 2015 questionnaire collected a baseline for the Year 7 intervention group (children aged 11–12, N = 464), and established baseline comparator groups for Year 9 (children aged 13–14, N = 556) and Year 11 (children aged 15–16, N = 342). The Year 7 intervention group was re-evaluated again in 2017 when in Year 9 (N = 556), and in 2019 when in Year 11 (N = 349). Analysis explored differences in science capital between the intervention and comparator groups and identified lower composite science capital scores and greater proportions of low- and medium-science capital in the intervention group when compared with the two comparator groups. A rationale for this emerged from the subsequent process evaluation.ConclusionsThis study’s main contribution is the provision of nuanced insight into the evaluation of STEM interventions for use by others evaluating in similar circumstances, particularly those adopting sustained or complex delivery models. This paper concludes that assessing the effectiveness of complex interventions cannot rely on quantitative evaluation of outcomes alone. Process evaluation can complement quantitative instruments and aid interventions to better understand variability and interpret results. While this study highlights the value of science capital when designing intervention models, it also illustrates the inherent challenges of using an outcome measure of ‘building science capital’, and quantifying levels over an intervention’s course.

Child-Owned Poultry Intervention Effects on Hemoglobin, Anemia, Concurrent Anemia and Stunting, and Morbidity Status of Young Children in Southern Ethiopia: A Cluster Randomized Controlled Community Trial.

Cereal-based diets contribute to anemia in Ethiopian children. Eggs have nutrients to boost hemoglobin levels as well as counter concurrent anemia and stunting (CAS) and morbidity status. A community trial, targeting 6-18 months old children, was conducted in Halaba. Two clusters were randomly selected and allocated to intervention (N = 122) and control (N = 121) arms. Intervention group (IG) children received egg-laying hens with caging in a cultural ceremony declaring child ownership of the chickens. Parents promised to feed eggs to the child. Health and agriculture extension workers promoted egg feeding, poultry husbandry, and sanitation to IG families. Control group (CG) had standard health and agriculture education. At baseline, groups were not different by hemoglobin, anemia, CAS, and morbidity status. Mean hemoglobin was 11.0 mg/dl and anemia prevalence was 41.6%. About 11.9% of children had CAS and 52.3% were sick. Using generalized estimating equations, the intervention increased hemoglobin by 0.53 g/dl (ß:0.53; p < 0.001; 95%CI: 0.28-0.79). IG children were 64% (p < 0.001; odds ratio [OR]:0.36; 95%CI: 0.24-0.54) and 57% (p = 0.007; OR: 0.43; 95%CI: 0.21-0.73) less likely to be anemic and have CAS, respectively, than CG, with no difference in morbidity. Child-owned poultry intervention is recommended in settings where anemia is high and animal-source food intake is low.

Effectiveness of Family Centered Art Intervention on Anxiety among Hospitalised Children in a Tertiary Care Hospital, Mangaluru, India: A Quasi-experimental Study

Introduction: Children become fearful, frightened, or unhappy when they attend the hospital. Art intervention can support their capacity to take responsibility and make decisions. It assists children and their families to explore and express their emotional reactions to the hospital admission, which can be difficult to explain. Aim: To find the effectiveness of family centred art intervention on anxiety among hospitalised children in selected tertiary care hospital, Mangaluru, Karnataka, India. Materials and Methods: A quasi-experimental study was conducted in Department of Paediatric, Yenepoya Medical College and Hospital, Mangaluru, Karnataka, India, from December 20, 2021, to April 10, 2022. A non probability purposive sampling technique was used to enlist study participants, who were then divided into the intervention (n=35) and control (n=35) groups. The level of anxiety was assessed on the first day of admission. Diversional activities were given to the hospitalised child in interventional group, for the first three days of admission, for a duration of 35-45 minutes per day and control group received routine care. The data was collected using the demographic performa, RMS (Raghavendra, Madhuri, Sujatha) pictorial scale and a parent report on their child’s anxiety. A post-test was done each day 30 minutes after the intervention. Analysis of Variance (ANOVA), Bonferroni posthoc test, Independent t-test and Chi-square-test were used for statistical analysis. Result: A total of 70 hospitalised children, aged between four to eight years, were split into two groups. There were 35 participants per group. The majority of the intervention group (25.7%) were seven-year-old, while the majority of the control group (34.3%) were four-year-old. A 60% of the intervention group participants and 74.3% of the control group participants were males, respectively. A comparison of anxiety scores at different points in the intervention group showed a significant decrease from pretest to post-test (p-value &lt;0.05). The control group showed no difference (p-value&gt;0.05), while at all the posttests, the difference in the anxiety level of children between groups was significant (p-value&lt;0.05). Conclusion: In present study, family centered art intervention significantly reduced the anxiety among children in intervention group as compared to control group.

Effect of soap bubbles technique, coughing and distraction cards on reducing pain and anxiety during phlebotomy in children.

This study aims to compare three techniques (soap bubbles, distraction cards, coughing) to reduce pain and anxiety in children during phlebotomy and collection with the use of a control group. Pain levels of children were assessed with the Wong-Baker FACES Pain Rating Scale and anxiety levels of children were assessed with the Children's Fear Scale. This randomized controlled study involved intervention groups and a control group. The population of this study consisted of 120 Turkish children (30 subjects in each of the four groups soap bubbles technique, distraction cards, coughing, and control groups) between the ages of 6 and 12. The study found that pain and anxiety levels of the children in intervention groups were lower than those of the children in the control group during phlebotomy procedure and this difference was statistically significant (P < .05). No difference was found among the three techniques (Soap bubbles, distraction cards, and coughing) to reduce pain and anxiety in children during the phlebotomy procedure (P > .05). Soap bubbles, distraction cards and coughing techniques were found to reduce pain and anxiety in children during phlebotomy. Nurses can play an effective role in reducing pain and anxiety by using these techniques.

Effect of General Practitioner Training in a Collaborative Child Mental Health Care Program on Children’s Mental Health Outcomes in a Low-Resource Setting

Integrated care for children is rarely studied, especially in low- and middle-income countries, where generalists often provide mental health care. To explore the effect of adding a child and youth component to an existing adult collaborative care program on mental health outcomes and receipt of care. This cluster randomized trial was conducted within an adult collaborative care program in Tehran, Iran. General practitioners (GPs), their 5- to 15-year-old patients, and patients' parents were included. Children and youths coming for routine medical visits who scored greater than the cutoff on the Strengths and Difficulties Questionnaire (SDQ) were followed up for 6 months. The study was conducted from May 2018 to October 2019, and analysis was conducted from March 2020 to August 2021. GPs were randomized to either a 2.5-day training on managing common child mental health problems (intervention) or refresher training on identification and referral (control). Primary outcome was change in SDQ total problems score; secondary outcomes included discussion of psychosocial issues by the GPs and receipt of mental health care during the follow-up period. Overall, 49 GPs cared for 389 children who scored greater than the cutoff on the SDQ (216 children in intervention group, 173 in control group). Patients' mean (SD) age was 8.9 (2.9) years (range, 5 to 15 years), and 182 (47%) were female patients. At 6 months, children in the intervention group had greater odds of receiving mental health care during the study (odds ratio [OR], 3.0; 95% CI, 1.1 to 7.7), parents were more likely to report that intervention GPs had discussed parent (OR, 2.1; 95% Cl, 1.1 to 3.8) and child (OR, 2.0; 95% Cl, 0.9 to 4.8) psychosocial issues, and intervention GPs were more likely to say they had provided counseling (OR, 1.8; 95% Cl, 1.02 to 3.3). However, there was no greater improvement in SDQ scores among children seen by intervention vs control GPs. Adjusted for clustering within GP, the variables used for balanced allocation (practice size, practice ownership, and study wave), and the other variables associated with change in SDQ scores over time, there was not a significant time-treatment interaction at either the 3- or 6-month follow-up points (linear combination of coefficients for intervention, 0.57 [95% CI, -1.07 to 2.22] and -0.08 [95%CI, -1.76 to 1.56], respectively). In a subgroup of GPs with practices composed of 50% or more children, children seen by intervention GPs improved to a significantly greater extent (-3.6 points; 95% CI, -6.7 to -0.46 points; effect size d = 0.66; 95% CI, 0.30 to 1.01) compared with those seen by control GPs. In this cluster randomized trial, GP training on managing common child mental health problems did not demonstrate greater improvement in child SDQ scores. Child mental health training for GPs in collaborative care can improve children's access to mental health care, but prior experience working with children and their families may be required for GPs to use a brief training in a way that improves child outcomes. ClinicalTrials.gov Identifier: NCT03144739.

Effect of a Virtual Reality Environment Using a Domed Ceiling Screen on Procedural Pain During Intravenous Placement in Young Children

Distraction using virtual reality (VR) has been found to provide a clinically significant reduction in the experience of pain during various painful procedures. Commercially available VR systems usually require the user to wear a head-mounted display helmet, which can be challenging for young children, and whether VR can reduce pain during intravenous (IV) placement in young children is currently unknown. To determine whether a VR environment using a novel domed ceiling screen reduces distress among children over the course of IV placement compared with standard care in a pediatric emergency department. This randomized clinical trial was conducted from June 3, 2020, to February 8, 2021, at an urban tertiary academic children's hospital. Included were children aged 6 months to 4 years undergoing IV placement in the pediatric emergency department. Children in the intervention group lay on a bed to experience a VR animation using a domed ceiling screen during the IV placement procedure, which was performed as usual. Children in the control group also lay on a bed during the procedure but did not view a VR animation. The primary outcome was pain scores measured using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale at 4 time points during IV placement: immediately after the child lay down on the bed (T1), the moment the tourniquet was applied (T2), the moment a sterile alcohol swab was applied (T3), and the moment the needle penetrated the skin (T4). Of the 88 children included in the final analysis, 44 received VR distraction (median [IQR] age, 24.0 [14.5-44.0] months; 27 boys [61.4%]), and 44 received standard care (median [IQR] age, 23.0 [15.0-40.0] months; 26 boys [59.1%]). The median [IQR] FLACC scores at T4 were 6.0 (1.8-7.5) in the intervention group and 7.0 (5.5-7.8) in the control group. The ordinal logistic regression model showed that children in the VR intervention group vs the control group had a lower probability of higher FLACC scores (odds ratio, 0.53; 95% CI, 0.28-0.99; P = .046). The findings of this trial indicate that displaying VR using a domed ceiling screen may be an effective distraction method that reduces distress in young children undergoing IV placement. isrctn.org Identifier: KCT0005122.

Weight outcomes of NU-HOME: a randomized controlled trial to prevent obesity among rural children

BackgroundRural children are at greater obesity risk than their urban peers. The NU-HOME study is an innovative collaborative effort to prevent childhood obesity in rural communities. Weight outcomes of the NU-HOME study, a family-meal focused randomized controlled trial (RCT) are described. We hypothesized that compared to control group children, intervention group children would have significantly lower weight-related post-intervention (PI) outcomes.MethodsParticipants were 114 dyads (7–10 year-old rural children and a parent). In 2017–2018 and 2018–2019, research staff measured height, weight and body fat at baseline (BL) and PI. Families were randomized to intervention (n = 58) or control (n = 56) groups without blinding. Designed with Social Cognitive Theory and community engagement, the NU-HOME program included seven monthly sessions delivered in community settings and four goal-setting calls. The program engaged entire families to improve healthy eating, physical activity, family meals and the home food environment. Multiple linear and logistic regression models tested PI outcomes of child BMIz-score, percent body fat, percent over 50th percentile BMI, and overweight/obesity status by treatment group, adjusted for BL values and demographics (n = 102).ResultsNo statistically significant intervention effects were seen for child BMIz or overweight/obesity status. However, a promising reduction in boys’ percent body fat (− 2.1, 95% CI [− 4.84, 0.63]) was associated with the intervention.ConclusionsAlthough our findings were in the hypothesized direction, making significant impacts on weight-related outcomes remains challenging in community trials. Comprehensive family-focused programming may require intensive multi-pronged interventions to mitigate complex factors associated with excess weight gain.Clinical trial registrationThis study is registered with NIH ClinicalTrials.gov: NCT02973815.

Effectiveness of music during cardiac catheterization on children's pain, fear, anxiety and vital signs: A randomized, blind controlled trial

PurposeThis study aims to examine the effectiveness of music during pediatric cardiac catheterization procedure on children's pain, fear, anxiety and vital signs. Design and methodsThis randomized, blind controlled study was conducted with the guidelines of Consolidated Standards of Reporting Trials (CONSORT). The sample of children was allocated to the Control Group, the Classic Music Group, and the Self-Selected Group. Pain, fear, and anxiety levels were measured before and after the pediatric cardiac catheterization procedure. Vital signs were measured before, during, and after the pediatric cardiac catheterization procedure. ResultsThere was no significant difference between the groups in terms of demographic status, pain, fear, or anxiety levels and vital signs before the procedure. In post pediatric cardiac catheterization measurement in the recovery phase, pain, fear levels, anxiety levels, heart rate, systolic and diastolic blood pressure of children in the musical intervention groups were lower than the control group. No statistical difference was found in terms of pain, fear and anxiety levels of the children in groups Classic and Self-Selected. Conclusion and practice implicationsThe result of this research reveals that musical intervention applied during the pediatric cardiac catheterization procedure in children affects the reduction of pain, fear and anxiety levels and stabilization of vital signs. This intervention could be an effective nonpharmacological method to improve outcomes.Nurses can improve children's comfort by using musical interventions.Clinical Registration: This study was registered at the U.S. National Library of Medicine Clinical Trials (code: NCT04316754).

Mite allergen avoidance decreases allergic symptoms in children in Ishinomaki city of Japan after natural disasters.

We investigated the prevalence of asthma, rhinitis, and atopic dermatitis in children, evaluated the mite allergen levels in their bedding after the Great East Japan Earthquake, and assessed changes in allergic symptoms in children and their families after allergen avoidance practices. We performed a survey for the International Study of Asthma and Allergies in Childhood (ISAAC) comprising 1109 children, aged 7-8 years, living in Ishinomaki, Japan. We collected responses from 464 children, and in 2016, measured the level of Dermatophagoides group 1 (Der 1) in the bedding of 202 of these children. The intervention group of children attended at least one allergen avoidance seminar. The levels of Der 1 in their bedding were measured, along with changes in allergic symptoms, in 17 children in 2017 and 14 children in 2018. The nonintervention group comprised children who did not attend an allergen avoidance seminar at any time. Of the 464 children who participated in the ISAAC, 50 (10.8%) reported having asthma, 179 (38.8%) allergic rhinitis, and 126 (27.3%) atopic dermatitis. The average level of Der 1 measured in the bedding of the 202 children in 2016 was 295.8 ng/m2. The levels of Der 1 in the intervention group-but not in the nonintervention group-significantly decreased in 2017 and 2018. The symptoms of asthma, allergic rhinitis, and atopic dermatitis in the children of intervention group and their families decreased after allergen avoidance practices. Allergen avoidance practices relieved allergic symptoms in school children after the Great East Japan Earthquake.

Association between household air pollution and nasopharyngeal pneumococcal carriage in Malawian infants (MSCAPE): a nested, prospective, observational study

SummaryBackgroundHousehold air pollution from solid fuels increases the risk of childhood pneumonia. Nasopharyngeal carriage of Streptococcus pneumoniae is a necessary step in the development of pneumococcal pneumonia. We aimed to assess the association between exposure to household air pollution and the prevalence and density of S pneumoniae carriage among children.MethodsThe Malawi Streptococcus pneumoniae Carriage and Air Pollution Exposure study was a nested, prospective, observational study of children participating in the cluster randomised controlled Cooking and Pneumonia Study (CAPS) in the Karonga Health and Demographic Surveillance System (HDSS) area in northern Malawi. CAPS compared the effects of a cleaner burning biomass-fuelled cookstove (intervention group) with traditional open-fire cooking (control group) on the incidence of pneumonia in children. Eligible children aged 6 weeks or 6 months (those recruited a 6 weeks were also followed up at age 6 months) were identified by the Karonga HDSS centre. Nasopharyngeal swabs were taken to detect S pneumoniae, and infant exposure to particulate matter with a diameter of ≤2·5 μm (PM2·5) exposure was assessed by use of a MicroPEM device. The primary outcome was the prevalence of nasopharyngeal S pneumoniae carriage in all children aged 6 months, assessed in all children with valid data on PM2·5. The effects of the intervention stoves (intention-to-treat analysis) and PM2·5 (adjusted exposure-response analysis) on the prevalence of S pneumoniae carriage were also assessed in the study children.FindingsBetween Nov 15, 2015, and Nov 2, 2017, 485 children were recruited (240 from the intervention group and 245 from the control group). Of all 450 children with available data at age 6 months, 387 (86% [95% CI 82–89]) were positive for S pneumoniae. Geometric mean PM2·5 exposure was 60·3 μg/m3 (95% CI 55·8–65·3) in S pneumoniae-positive children and 47·0 μg/m3 (38·3–57·7) in S pneumoniae-negative children (p=0·044). In the intention-to-treat analysis, a non-significant increase in the risk of S pneumoniae carriage was observed in intervention group children compared with control group children (odds ratio 1·36 [95% CI 0·95–1·94]; p=0·093). In the exposure-response analysis, a significant association between PM2·5 exposure and S pneumoniae carriage was observed; a one unit increase in decile of PM2·5 was found to significantly increase the risk of S pneumoniae carriage by 10% (1·10 [1·01–1·20]; p=0·035), after adjustment for age, sex, 13-valent pneumococcal conjugate vaccination status, season, current use of antibiotics, and MicroPEM run-time.InterpretationDespite the absence of effect from the intervention cookstove, household air pollution exposure was significantly associated with the prevalence of nasopharyngeal S pneumoniae carriage. These results provide empirical evidence for the potential mechanistic association between exposure to household air pollution and childhood pneumonia.FundingBill & Melinda Gates Foundation.