Guidance For Caregivers Research Articles

A Intervenção do Serviço de Atenção Domiciliar junto ao usuário e cuidador na rede de atenção à saúde

**Introduction**: Population aging drives the development of home care practices, expanding the role of healthcare teams. The Home Care Service (SAD) is characterized by comprehensive actions in health promotion, prevention, treatment, and rehabilitation performed at home, ensuring continuity of care and effective integration with healthcare networks and the user. **Objective**: To highlight the relationship between the Home Care Service (SAD) and healthcare networks. **Methodology**: This is a descriptive study in the form of a narrative literature review, which sought to highlight the relationship between the Home Care Service (SAD) and healthcare networks. The research was conducted through online access to the PubMed, Medline, and Scielo databases, using the descriptors "home care services," "SUS," and "healthcare networks." Inclusion criteria were: articles available in full text, in Portuguese and English, addressing the topic, and published between 2019 and 2023. **Results**: The results highlight the importance of home care services in assessing, identifying, and training caregivers, promoting self-care and user autonomy. The lack of professional guidance for caregivers presents an opportunity for improvement in care practices. Furthermore, SAD stands out as an innovative strategy in healthcare, surpassing primary care and emergency services, adopting a humanized approach aligned with SUS. By replacing or complementing hospital stays, it seeks equity in resource distribution for efficient access to home care, with active intervention in caregiver training, playing a crucial role in preventing complications, and consolidating itself as a key agent for a patient-centered approach within the SUS framework. **Conclusion**: The intervention of SAD with the user and caregiver is of utmost importance in training caregivers to assist users, avoiding unnecessary complications and ensuring continuity of care within SUS. Thus, the service complements the care provided in primary care and emergency services and substitutes or complements hospital stays.

Dietary Approaches for Complementary Feeding: The Greek Mediterranean Diet as a Model for Caregivers

Background/Objectives: Complementary feeding (CF), is defined as the process of providing foods in addition to milk when breast milk or milk formula alone are no longer adequate to meet nutritional requirements. CF affects not only growth but also the subsequent development of the child’s dietary preferences. The Mediterranean diet (MedDiet) is one of the most studied dietary patterns worldwide. The main purpose of this article is to provide practical guidance for CF to caregivers introducing the Greek MedDiet, summarizing the current different approaches. The evidence-based information provided could be used by developers to create a reliable digital app for CF based on Mediterranean foods and traditional dishes. Methods: An in-depth literature review of the existing guidelines and recently published research data on CF using PubMed, national recommendations, and grey literature were undertaken. Results: Practical, simple, evidence-based, comprehensive tables are presented. The tables serve as a guide to simplify the process of introducing Mediterranean foods in CF. Τhe tables consist of a total of more than 90 foods and day-to-day guidance for the first 13 weeks of CF. Furthermore, specific dietary guidance and suggestions regarding the order and content of meals during CF are given. Discussion: The tables are based on updated recommendations, summarizing the optimal feeding practices in a MedDiet-based perspective. Conclusions: Conclusively, there are significant contradictions among different organizations that present practical issues and cause confusion among caregivers. An effort was carried out to provide practical evidence-based guidance for caregivers introducing MedDiet during CF.

Care preparedness of family caregivers of maintenance hemodialysis patients: a cross-sectional study

With the increasing number of maintenance hemodialysis (MHD) patients, growing attention has been paid to the quality of care. Strengthening care preparedness of family caregivers is essential to improving the nursing quality. The purpose of this study is to explore the care preparedness level of family caregivers of MHD patients and its influencing factors, so as to provide guidance for the development of targeted care interventions. A total of 237 family caregivers of MHD patients were recruited from the hemodialysis room of two tertiary hospitals in Wuhan using the Convenience sampling method. They were surveyed by the general data questionnaire, Care Preparedness Scale and Positive Aspects of Caregiving. Statistical analysis was conducted using IBM SPSS software, version 21.0. The statistical tests conducted in this study were two-tailed, and a significance level of P < 0.05 was deemed as statistically significant. The care preparedness and positive aspects of caregiving scores of family caregivers of MHD patients were 19.05 ± 5.64 and 31.28 ± 7.28 points, respectively. The care preparedness level of family caregivers was significantly positively correlated with positive aspects of caregiving (P < 0.01). The results of multiple linear regression analysis showed that the total nursing time and whether family caregivers had chronic diseases and positive aspects of caregiving were the main factors influencing their care preparedness (all P < 0.05). These three factors accounted for 49.6% of the variance. The care preparedness of family caregivers of MHD patients remains to be continuously improved. Medical staff should emphasize the important role of total nursing time, whether the caregiver has a chronic disease, and positive aspects of caregiving in improving care preparedness in this population. To achieve this end, medical staff can provide targeted support and guidance for caregivers according to the influencing factors, such as implementing group psychological education, strengthening the training, offering social support, remote intervention (including family caregivers’ education through the media), and so on. Meanwhile, caregivers should be evaluated dynamically, and information and emotional support should be provided for them.

Post Discharge Assessment of Caregiver Guidance of Patients with Brain Injury Hospitalized in Acute Inpatient Rehabilitation at a Veterans Affairs Medical Center

Post Discharge Assessment of Caregiver Guidance of Patients with Brain Injury Hospitalized in Acute Inpatient Rehabilitation at a Veterans Affairs Medical Center

Public-Private Partnership and Early Childhood Education in Kasese District, Uganda

The article’s main purpose was to investigate the relationship between public-private partnership (PPP) and early childhood education in Kasese District, Uganda. The main objectives of the study were to establish the role played by public-private partnerships in making certain that children develop numerical skills and expressive communication abilities. The study was conducted through an Ex Post Facto design study design. The target population of the study was stakeholders for early childhood education in Kasese District, Western Uganda. To ensure fair representation, research subjects were selected from each stratum of stakeholders. The scholar thus used stratified and, later on, random sampling techniques. The sample selected had 312 respondents from an estimated total number of 1.417 ECD stakeholders in Kasese District. Primary data was collected by administering a questionnaire that was designed on a 5-point Likert Scale, ranging from strongly agree to strongly disagree. Face-to-face interviews and an observation checklist were also used in the collection of data. Data collected was presented and analysed with frequency distribution and percentages while the corresponding hypothesis was tested with Chi-square statistic at 0.05 alpha levels. It was found the PPP in ECDs helped in the improvement of numeracy among children. For instance, stakeholders’ work helped in improving children’s counting of fingers on one hand or even copying and drawing shapes amongst young ones. Similarly, respondents indicated that Policy Guideline Formulation due to PPP led children to sort objects by colour and shape. Also, results showed that PPP in ECD enhanced communication ability whereby children were able to put up two words together as per caregiver guidance. It also led a child to pay attention to a simple story being narrated and thereafter answer questions from the account. Similarly, it was also found that Institutional Factors for PPP supported expressive ability in children in that they were in a position to follow a simple command. Besides, the availability of suitable Home Environment Factors was also found to promote communication ability in children. Thus, the study concluded that public-private partnership plays a part in ensuring that children develop numerical concepts. It was also concluded that public-private partnership plays a role in making certain that children develop expressive communication abilities

A cultural perspective of action-based learning by infants and young children.

Decades of research have informed about ways in which infants and young children learn through action in connection with their sensory system. However, this research has not strongly addressed the issues of cultural diversity or taken into account everyday cultural experiences of young learners across different communities. Diversifying the scholarship of early learning calls for paradigm shifts, extending beyond the analysis at the individual level to make close connections with real-world experience while placing culture front and center. On the other hand, cultural research that specifies diversity in caregiver guidance and scaffolding, while providing insights into young learners' cultural experiences, has been conducted separately from the research of action-based cross-modal learning. Taking everyday activities as contexts for learning, in this chapter, we summarize seminal work on cross-modal learning by infants and young children that connects action and perception, review empirical evidence of cultural variations in caregiver guidance for early action-based learning, and make recommendations of research approaches for advancing the scientific understanding about cultural ways of learning across diverse communities.

Co-Design of a Reusable Learning Object (RLO) to Address Caregiver Responsive Infant Feeding Behaviours (CRIB) to Prevent Childhood Obesity: A Mixed-Method Protocol.

Responsive infant feeding is a key strategy for childhood obesity prevention. Responsive feeding involves caregivers responding to infant hunger and satiety cues in a timely and developmentally appropriate manner. There is a dearth of evidence-based information and guidance for caregivers on how to responsively feed their infants. The aim of this research is to co-design a Reusable Learning Object (RLO) and guidance infographic to improve caregiver awareness, understanding and use of responsive infant feeding behaviours. The Capability, Opportunity, Motivation and Behaviour (COM-B) model of behaviour change and the Aim, Storyboarding, Populate specification, Implement media, Review and release prototype, and Evaluate (ASPIRE) approach for digital intervention co-design will be utilised. Four co-design workshops with caregivers of infants and healthcare professionals (HCPs) will determine priority RLO content. Content analysis will enable RLO development and process reporting. Formative and summative surveys will be conducted to evaluate the usability of the RLO, its impact on caregivers and its potential implementation into NHS care pathways. The output will be a RLO on responsive feeding for caregivers and an infographic for HCPs/support workers which will contribute to a future obesity prevention intervention. The findings will be disseminated to stakeholders and submitted for publication in a peer-reviewed journal.

Community-Based Hip Screening for Up to Four-Month-Old Infants and Health Guidance for Their Caregivers in Japan: A Nation-Wide Survey.

Early detection of developmental dysplasia of the hip (DDH) in children is crucial. Due to COVID-19, maternal and child health services have been suspended temporarily, increasing the risk of late detection of DDH. This study aimed to reveal Japan's current situation regarding community hip screening for newborns and infants and to provide health guidance for caregivers regarding DDH. A web-based, nationwide cross-sectional survey was conducted between February and March 2023 (n = 1737). One public health nurse overseeing maternal and child health per municipality responded to the 2022 municipality hip screening system. Among the 436 municipalities that responded (response rate: 25.1%), 97.5% implemented hip screening within 4 months, and approximately 60% performed it during newborn home visits, while only 2.3% conducted hip ultrasound screening. Perfect checking of the risk factors for DDH during newborn home visits and training opportunities for home visitors must be improved. Educational programs regarding DDH for home visitors and caregivers are needed to prevent the late diagnosis of DDH. Furthermore, collaboration between pediatric orthopedic surgeons and nurses is crucial for developing effective community-based hip-screening systems by bridging the evidence and practice gap in the early detection of DDH.

Stability of the Gross Motor Function Classification System in children with cerebral palsy in the two to four year age band.

This study aimed to investigate the stability of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) in the two to four year age band, the frequency at which children were reclassified, and trends of reclassification to higher or lower ability. This retrospective study included 164 children with CP between 24 to 48 months old with two or more GMFCS ratings at least 12 months apart between their second and fourth birthdays. GMFCS ratings were captured closest to 24, 36, and 48 months. Stability and reclassification trends were analyzed using inferential statistics. Frequency of reclassification, age at ratings, duration between ratings, and corresponding change rate were analyzed using descriptive statistics. When comparing ratings closest to second and fourth birthdays, a linear weighted kappa of 0.726 was found. Of the total population, 46.95% changed GMFCS levels at any time between two to four years of age, the majority of which were reclassified to a higher level of ability. Findings suggest the GMFCS is less stable in the two to four year age band compared to older age bands. Due to the importance of providing accurate guidance for caregivers and high rate of reclassification, it is recommended GMFCS levels be reassessed every six months during this period of time.

Examining the Effectiveness of an Intensive Telemental Health Treatment for Pediatric Anxiety and OCD During the COVID-19 Pandemic and Pediatric Mental Health Crisis.

Despite research supporting the efficacy of weekly outpatient videoconferencing-based cognitive behavioral therapy (VCBT), limited evidence exists about the benefits of leveraging VCBT for brief intensive formats. We examined the effectiveness of an intensive outpatient VCBT targeting pediatric anxiety and OCD. Quasi-experimental design was used to compare outcomes of intensive, in-person, group-based cognitive-behavioral therapy with medication management and caregiver guidance pre-pandemic, to a similar VCBT peri-pandemic (n = 130). Pretreatment and posttreatment assessments included patient- and caregiver-report of anxiety and functional impairment. Analyses of covariance were conducted, examining changes in anxiety and impairment between treatment groups, controlling for admission levels. No significant differences in posttreatment anxiety or impairment were observed between conditions. This study illustrates that intensive, group-based treatment for pediatric anxiety and OCD using VCBT is associated with comparable reductions in anxiety and impairment. It marks a crucial step toward providing broader access to quality care for youth in need.

Integrating an innovative social work practice into a pediatric dental residency program

Summary This article describes the implementation and outcomes of a social work program in a university pediatric dental clinic serving low-income families. The goal was to decrease barriers to dental care access, decrease appointment failure, and improve interprofessional practice (IPP). Funding was obtained through a foundation to hire a social worker and two interns, and cover program costs. A survey identified barriers families faced to obtain and complete pediatric dental care. Residents, dental students, and faculty make referrals to the social workers who intervene to help families overcome challenges for their children's care. Findings The program started in January 2019 and outcomes are reported through June 2021. The largest barriers families identified were lack of a pediatric dentist near home accepting public insurance (91%), the dentist who saw their child only did exams and cleanings but not fillings (84%), and need for specialized dental care (77%). Five hundred and eleven families were referred to the social workers, most commonly for resources, information or other referrals (30.5%), dental insurance lapse (14.9%), caregiver guidance on oral health (10.6%), mental health concerns (10.4%), and poor treatment compliance (9.6%). Social workers provided 424 interventions, mostly about information regarding community resources (26.8%), transportation issues (15.9%), and telephone consults (14.2%). Appointment failure rates decreased from 17% to 13.5%, while the cancelation rate decreased from 19.2% to 14.3% from January 2019 to June 2021, respectively. Applications Social workers helped decrease barriers to pediatric dental care, improve attendance to dental appointments, and enhance IPP for pediatric dental residents, students, and faculty.

Basic Life Support Guidance for Caregivers of NICU Graduates: Evaluation of Skill Transfer after Training

Abstract Background Intensivists indeed discharge neonatal intensive care unit (NICU) graduates after a period of physiological stability. There is, however, a real risk of life-threatening events at home. Survival after such episodes depends on time from arrest to initiation of basic life support (BLS). It is rational to train parents who would be first responders. We sought to measure objectively and prospectively, effect of BLS training on parents of NICU graduates on the psychomotor, cognitive, and affective domains of human learning. Methods After face-to-face training sessions, proportion of home caregivers who obtained 100% marks on a pretested performance checklist for psychomotor skills of BLS on a mannequin were measured. Two other domains of learning and number of attempts required to obtain desirable results were also analyzed. Results Median (interquartile range [IQR]) birth weight of the high-risk neonates was 1,050 g (930, 1570) and median gestational age was 29 (IQR 28, 33) weeks. More than 75% of parents had no prior exposure to BLS training. Among 46 trained caregivers, 80.4% achieved the desired score of 5 in the psychomotor performance checklist on the first attempt. A maximum of two attempts was required to reeducate and achieve score of 5 in the remaining caregivers. Forty-two (91.3%) caregivers obtained full marks on cognitive domain test. All caregivers responded positively toward affective domain questionnaire. Conclusion It is possible to train parents in BLS measures and demonstrate their psychomotor skills on a mannequin effectively. No parents who were approached refused training or indicated anxiety in learning the skills required.

Neurobehavioural challenges experienced by HIV exposed infants: a study in South Africa

BackgroundThe newborn infant is a complexly organized, competent being, who plays an active role in shaping their environment through their increasing skills in autonomic regulation, motor control, regulation of state and social interaction. Infants born to HIV positive mothers, are exposed to HIV and antiretroviral therapy inutero, and may experience adverse effects from this.MethodsA cross-sectional study of 132 mother-infant dyads from a large public health hospital in South Africa. Infants were assessed using the Neonatal Behavioural Assessment Scale on day two of life, and mothers mental health assessed using the Edinburugh Postnatal Depression Scale. Medical and demographic data on mothers and infants was collected, including maternal age, HIV status, length of time on antiretrovirals, relationship status, employment status, gravid status, mode of delivery, infant anthropometrics and infant gender. Data was input into IBM SPSS statistics 21, where frequencies and percentages for descriptive analysis, and Chi-square and student’s two sample t-tests were run to compare data from HIV infected-exposed and HIV uninfected-unexposed mothers and infants.ResultsHIV exposed infants were smaller than HIV unexposed infants, even though low birth weight was an exclusion criteria. Statistically significant differences were found between HIV exposed and unexposed infants in neurobehavioiral items of social interaction (p = 0.00), motor system (p = 0.00) and state organization (p = 0.01), with HIV exposed infants performing less optimally in these domains. HIV exposed infants also presented with more abnormal reflexes. Infants born to depressed mothers showed superior motor skills, state organization and state regulation than infants born to mothers who did not score in the possibly depressed range.ConclusionsHIV exposed infants have inferior neurobehavioural functioning, which may affect their quality of life and ability to develop a reciprocal relationship with a primary caregiver. This may have an effect on development, behaviour and mental health in later childhood. HIV exposed infants shoud be monitored closely and their functioning in autonomic stability, motor control, resualtion of state and social interaction assessed regularly. Guidance for caregivers in incorporating strategies into the care of these infants is essential to buffer the possible long term negative effects on development.

Interprofessional Collaborative Practice in Long-Term Care: Swallow Training

Oropharyngeal dysphagia is common in elders living in long-term care facilities. Nasogastric tubes are used in place of normal eating when severe swallowing disorders affect oral intake. Swallowing training is usually delivered by a speech therapist who uses different food textures for training at different stages, depending on the severity and progression of the disorder. The amount and texture of foods are adjusted by the dietitian based on an elder's ability to eat. The current care model allows the specific preferences and experiences of the implementing specialist to guide delivery of swallowing training and thus lacks comprehensive discussion and planning, which may result in interventions failing to achieve their expected effect. In this study, we discuss how to implement the professional integration of dietitians and speech therapists, set goals for nutrition improvement and safe oral eating for the elderly with swallowing disorders in long-term care facilities. Swallowing training protocols and diet for each stage, texture adjustment, design, and caregiver guidance to prepare quantitative diets are provided to enhance the effectiveness of swallowing training. It is expected that implementation of the holistic care model presented in this study will improve quality of life in patients with oropharyngeal dysphagia, meet the expectations of both patients and family members, and help realize the professional core value of "case-centered".

The impact of SARS-CoV-2 vaccination in Dravet syndrome: A UK survey

BackgroundThe COVID-19 pandemic led to the urgent need for accelerated vaccine development. Approved vaccines have proved to be safe and well tolerated across millions of people in the general population. Dravet syndrome (DS) is a severe, early onset, developmental and epileptic encephalopathy. Vaccination is a precipitating factor for seizures. While there is no evidence that vaccine-precipitated seizures lead to adverse outcomes in people with DS, fear surrounding vaccination can remain for caregivers of people with DS, in some cases resulting in rejection of recommended vaccinations, leaving individuals more vulnerable to the relevant infections. A greater understanding of the safety profile of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in this vulnerable group will help provide guidance for caregivers and clinicians when considering vaccination. MethodsA cross‐sectional survey regarding COVID-19 and SARS-CoV-2 vaccine, in people with DS, was conducted by Dravet Syndrome UK (DSUK). Concomitantly, a review of individuals with DS who had recently received the SARS-CoV-2 vaccine, and who are resident at the Chalfont Centre for Epilepsy (CCE), or attend epilepsy clinics at the National Hospital for Neurology and Neurosurgery (NHNN), was undertaken. ResultsThirty-eight people completed the DSUK survey. Thirty-seven percent of caregivers reported being concerned about someone with DS receiving the SARS-CoV-2 vaccine; with some reporting that they would decline a vaccine when offered. Seventy-seven percent had not received any advice from a healthcare professional about the SARS-CoV-2 vaccination. 18/38 were eligible for SARS-CoV-2 vaccination, of whom nine had received their first vaccine dose. Combining the results of the DSUK survey and the review of individuals monitored at CCE or NHNN, fifteen people with DS had received their first dose of the SARS-CoV-2 vaccine. 11/15 (73%) reported at least one side effect, the most common being fatigue (6/15; 40%) and fever (6/15; 40%). Three individuals (20%) reported an increase in seizure frequency after the first vaccine dose. No increase in seizure frequency or duration was reported after the second dose. ConclusionOverall, these results suggest that SARS-CoV-2 vaccines are safe and well tolerated in individuals with DS, as they are in most people without DS. In most people with DS, SARS-CoV-2 vaccine does not appear to be associated with an increase in the frequency or duration of seizures, even in those who develop fever post-vaccination. Many caregivers are concerned about a person with DS receiving a SARS-CoV-2 vaccine, with some reporting that they would decline a SARS-CoV-2 vaccine when offered. It is crucial that healthcare professionals are proactive in providing accurate information regarding the risks and benefits of vaccination in this population, given the potential for serious outcomes from infection.

Effectiveness of Telehealth Direct Therapy for Individuals with Autism Spectrum Disorder.

The field of applied behavior analysis (ABA) has utilized telehealth for clinical supervision and caregiver guidance with research supporting the use of both modalities. Research demonstrating effectiveness is crucial, as behavior analysts must ensure the services they provide are effective in order to be ethical. With the increased need for patients to access more services via telehealth, due to the novel coronavirus (COVID-19) pandemic, the current study evaluated the efficacy of telehealth direct therapy to teach new skills to individuals with autism spectrum disorder (ASD). This study examined the utility of natural environment teaching and discrete trial training strategies provided over a videoconferencing platform to teach new skills directly to seven individuals with varying ASD severity levels. The targeted skills were taught solely through telehealth direct therapy with varying levels of caregiver support across participants and included skills in the language, adaptive, and social domains. In a multiple baseline design, all seven participants demonstrated mastery and maintenance for all targets; in addition, generalization to family members was assessed for some targets. The evidence suggests that telehealth is a modality that is effective and can be considered for all patients when assessing the appropriate location of treatment.

Everyday interactions support toddlers’ learning of conventional actions on artifacts

Children learn to perform actions on artifacts in their environments from infancy, but the ways caregivers support this learning during everyday interactions are relatively unexplored. This study investigated how naturalistic caregiver–child teaching interactions promoted conventional action learning in toddlers. Caregivers of 32 24- to 26-month-old children taught their children to perform novel target actions on toys. Afterward, an experimenter blind to the toys children had been taught tested children’s action learning. Results indicated that children’s propensities to assemble objects and vocabularies were positively associated with learning. Whereas caregivers’ speech did not directly support learning, caregivers’ action performance negatively related to children’s learning. Importantly, children’s own actions related to learning: Children who performed proportionally more actions relative to their caregivers with higher action accuracy demonstrated better learning of the taught material. Thus, children who “drove” the teaching session and were more accurate in their actions learned more. Caregivers contributed by supporting their children’s actions: Caregivers who provided more specific instructions and praise had children who were more active during instruction. Importantly, analyses controlled for child-level individual differences, showing that beyond children’s own skills, active experience supported by caregiver guidance related to conventional action learning. These findings highlight children as central agents in the learning process and suggest that caregivers contributed by coaching children’s actions.

Barriers and enablers to caregivers' responsive feeding behaviour: A systematic review to inform childhood obesity prevention.

Responsive infant feeding is a critical component of childhood obesity prevention. However, there is little guidance for caregivers on how to do this successfully. The first step to developing an intervention to promote responsive feeding is to systematically identify its barriers and enablers. Searches were conducted in CINAHL, Cochrane Library, Medline, Embase, PubMed, PsycINFO, Maternity, and Infant Care from inception to November 2020. All study designs were included if they reported a barrier or enabler to responsive feeding during the first 2 years of life. We used a "best fit" framework synthesis, with the Capacity, Opportunity, Motivation, and Behaviour (COM-B) model. The Mixed Method Appraisal Tool (MMAT) was used to assess study quality. Forty-three studies were included in the review. Barriers (n = 36) and enablers (n = 21) were identified across five COM-B domains: psychological capacity, physical and social opportunity, and reflective and automatic motivation. Enablers were recognition of infant feeding cues, feeding knowledge and family and friends. Caregiver attitude toward control of feeding was a barrier, together with health care professional advice about formula feeding and breastfeeding expectation. These barriers and enablers provide a comprehensive evidence base to guide intervention development to improve responsive feeding and prevent obesity across individual and population levels.

Intent, Substance, and Care: Characteristics of Adolescent Ingestion Hospitalizations.

To characterize the patient population of adolescents hospitalized at a tertiary center for ingestions and identify opportunities to improve health care delivered and resources offered to these adolescents. Retrospective study of a consecutive sample of adolescent patients (12-18 years old) discharged from the hospitalist service at a large academic pediatric tertiary care center from May 2017 through April 2018. Data were collected regarding patient and hospital encounter characteristics including length of stay, admission service, reason for ingestion, substance(s) ingested, previous suicidal ideation (SI) screening, sexual history documentation, pregnancy testing, disposition at discharge and follow-up with primary care physicians (PCPs). Most hospitalizations for ingestions were reported as intentional suicide attempts (79%). Most commonly, adolescents ingested exclusively prescription medications (45%) or over-the-counter medications (32%). Of adolescents with a reported suicide attempt for whom PCP records were available, 56% did not have SI screening documented in the medical record. One-quarter of adolescents hospitalized for an ingestion did not have a sexual history documented, and 11% of female patients were not tested for pregnancy before discharge. A majority (66%) of the adolescents with PCP records available did not follow-up with their PCP within 2 months after their hospitalization. On the basis of our study results, opportunities to improve adolescent health include increased screening for SI and mental health symptoms throughout medical environments, comprehensive risk assessment of all adolescents hospitalized for an ingestion and increased guidance for caregivers of adolescents regarding prescription and over-the-counter medication storage in the home.

SDG 4 and the COVID-19 emergency: Textbooks, tutoring, and teachers.

COVID-19 once again revealed the inherent weaknesses in relying on classroom-based schooling and ICT to sustain learning, a danger already familiar from earlier man-made and natural disasters. A lack of textbooks and lack of guidance for caregivers to support home-based learning limited the effectiveness of efforts to provide continuity of learning. These same elements are the key to preparing better for the next crisis and keeping SDG 4 on track.