Child Health Care System Research Articles

Promoting successful health care transitions for young people aging out of foster care.

Improving adolescent to adult health care transitions (HCTs) would benefit all young people in the United States but has particular importance for the more than 120,000 adolescents and young adults (AYA) placed in foster care. Leveraging clinical guidelines and evidence-based interventions, HCT efforts inclusive of and specific to AYA placed in foster care can be strengthened through greater collaboration between child welfare, health care, and other AYA-serving systems. This Health Policy Brief advances the importance of structured Health Care Transition services for adolescents and young adults placed in foster care. Additionally, it highlights opportunities for health care providers, youth-serving systems, and health policy stakeholders to collaborate with child-welfare involved young people in order to prioritize evidence-based health care transition interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clinical profile and associated comorbidities of cerebral palsy in children visiting Orotta National Referral Hospital, Eritrea: a cross-sectional study

BackgroundCerebral Palsy (CP) is one of the most common physical disabilities in children. This study aimed to explore the clinical spectrum of CP at Orotta National Referral and Teaching Hospital, including CP subtypes, gross motor function, patterns of associated comorbidities, and possible risk factors in children aged 2 to 12 years.MethodsA hospital-based cross-sectional study was conducted from January to April 2022 in 153 children with suspected motor symptoms. The Surveillance of CP in Europe (SCPE) decision tree was used as an inclusion criteria guideline and the evaluation of the participants was done using a standardized questionnaire and clinical examination. Descriptive statistics, chi-square test, and logistic regression were employed to statistically analyze the data.ResultsEighty-four children who fulfilled the clinical criteria were included in the study. The median age was 5-years [IQR: 3.8] with an equal distribution of males and females. Quadriplegic CP was the most common subtype (51.2%) followed by unilateral (hemiplegic) CP (22.6%), and dyskinetic CP (14.3%). Most children had severe gross motor impairment GMFCS level IV-V and females were almost three times more likely to have GMFCS level IV/V than males (AOR: 2.70; CI: 1.08–6.72; p-value = 0.033.) More than half (52.4%) of the neonates either did not cry within five minutes and/or needed breathing resuscitation, 55.3% had to be admitted to the NICU with a median of 5 days’ hospital stay. Between the first week of birth and the first year of life, 28.6% had trouble feeding, 26.2% had an infection, 10.7% had difficulty breathing, 20.2% had seizures and 6% had jaundice. Feeding problems (64.3%), speech problems of some sort (91.7%), and epilepsy (46.4%) were the most commonly associated comorbidities with CP.ConclusionsThe clinical profile of the CP patients was found to be dominated by the spastic subtype and moderate to severe disability. Since perinatal risk factors were found to be dominant, strengthening maternal and child healthcare systems is recommended to minimize incidents of preventable risk factors and the burden of the disability.

TYPES AND STRUCTURE OF SURGICAL DISEASES IN NEWBORNS ACCORDING TO DATA FROM A REGIONAL CENTER

Reducing perinatal morbidity and mortality is one of the main tasks of the maternal and child health care system. Congenital anomalies contribute significantly to these indicators and occupy leading positions in terms of prevalence. According to the World Health Organization, 25% of newborns are born with developmental defects. In light of this data, increasing the efficiency of early medical care and reducing growth and development-related disorders in newborns is crucial. Congenital anomalies of the digestive tract occupy a primary place, corresponding to 21.7%-25%. Currently, perinatal studies of the problem of mother and child with congenital digestive tract anomalies are considered separately, which is significant for perinatal diagnostics, the ability to predict congenital digestive tract anomalies, and determining tactics. This is of great importance for both pediatricians and surgeons. As a first step in creating a system for assessing and improving medical services provided to the younger generation, it is important to optimize medical care for newborns with surgical diseases.

A silent scream in the pediatric emergency department: child abuse and neglect.

Child abuse and neglect includes any behavior that harms the child or hinders the child's development. The aim of this study was to determine the demographic and clinical characteristics of patients with suspected child abuse or neglect in the pediatric emergency department. Between July 2017 and July 2022, patients admitted to our pediatric emergency department and consulted to the medical social services unit with a preliminary diagnosis of neglect and/or abuse were retrospectively scanned through the registry system. The patients were divided into five groups according to their victimization: physical, sexual, and emotional abuse; neglect; and medical child abuse (MCA)-Munchausen by proxy. A total of 371 children were included in the study. Two hundred twenty-two (59.8%) of the patients were female and the median age was 161months [IQR (46-192)]. Then, 56.3% of the patients were in the adolescent age group. The most common admission time period was between 16.00 and 24.00 (n 163, 43.9%). Then, 24.2% of the patients were exposed to physical abuse, 8.8% to sexual abuse, 26.1% to emotional abuse, 50.4% to neglect, and 3.2% to MCA. One hundred eight (29.1%) patients were followed up as inpatients in the pediatric intensive care unit. Four of the patients (1%) had out-of-hospital cardiac arrest, and the deaths were in patients under 2years of age. Conclusion: Pediatric emergency departments are one of the important units visited by child maltreatment patients. Victimized children may reflect their silent screams with various clinical presentations. Infants are at the greatest risk of suffering serious or fatal injuries. Health professionals working in the emergency department have an important role in detecting, treating, and preventing recurrence of child neglect and abuse. What is Known: • The pediatric emergency department is an important entry point in the health care system for children who experience maltreatment. • It has a wide spectrum of physical, sexual, emotional abuse and neglect. What is New: • A high index of suspicion is required to diagnose cases of child maltreatment. • Infants are at the greatest risk of suffering serious or fatal injuries.

Development and Testing of the School Healthcare Partnership Scale for Parents.

Cooperation between parents and school nurses is essential for the successful completion of school courses and a healthy school life for children with long-term conditions. Therefore, this study aimed to develop and test a scale to measure parental perceptions of partnerships between school nurses and parents in the school health care (SHC) system for children with type 1 diabetes (T1D). The content validity, factorial structure validity, convergent validity, discriminant validity, known-group validity, internal consistency reliability, and test-retest reliability of the School Healthcare Partnership Scale for Parents (SHCPS-P) were evaluated. Data were analyzed by performing exploratory factor analysis (EFA), Pearson's correlation, Cronbach's α, and independent t-tests. The total sample included 155 parents for the EFA and 49 parents for the stability test. Seventeen items, grouped into 3 dimensions, were extracted through principal axis factoring. The total variance explained by these factors was 53.57%. The scale demonstrated a high correlation with parental satisfaction regarding school nursing and a moderate correlation with diabetes-related safety, thereby showing convergent validity. A low correlation with empathy demonstrated discriminant validity. A significant difference existed in the partnership scores in known-group comparisons. Cronbach's α was 0.95, and the test-retest correlation coefficient was 0.95, which showed reliability. This study suggests that the SHCPS-P is a reliable and valid tool for measuring the perception of SHC partnership among parents of children with T1D and can be used as an indicator to measure parents' perspectives about SHC.

Disease Trends in Children and Adolescents in Japan: A Retrospective Observational Study Using the Nationwide Claims Data for 2012-2016.

This study aimed to clarify diseases that occur more frequently by age and identify the peaks and trends of each disease from infancy to adolescence for early detection and treatment. This retrospective observational study was conducted using Japan's National Database of Health Insurance Claims Specific Health Checkups from January 2012 to December 2016. Using peak ages and trends in the number of patients, we grouped diseases by the International Classification of Diseases chapters. Although diseases that peaked during infancy were the most common (10 disease chapters), other diseases peaked at school-going age and adolescence. Diseases in four chapters peaked during adolescence and continued to increase toward the age of 18. These four chapters included mental, behavioral, and neurodevelopmental disorders; diseases of the nervous system; the genitourinary system; and pregnancy, childbirth, and the puerperium. Childhood-onset diseases can affect long-term health and healthcare needs, and timely screening and guidance based on disease trends can provide an effective intervention. To establish a child healthcare system that provides preventive support for children and adolescents' physical, psychological, and social health, further research is needed to comprehensively understand the issues per age and developmental stage.

Rapid genome sequencing for critically ill infants: an inaugural pilot study from Turkey.

Rare and ultra-rare genetic conditions significantly contribute to infant morbidity and mortality, often presenting with atypical features and genetic heterogeneity that complicate management. Rapid genome sequencing (RGS) offers a timely and cost-effective approach to diagnosis, aiding in early clinical management and reducing unnecessary interventions. This pilot study represents the inaugural use of next-generation sequencing (NGS) as a diagnostic instrument for critically ill neonatal and pediatric ICU patients in a Turkish hospital setting. Ten infants were enrolled based on predefined inclusion criteria, and trio RGS was performed. The mean age of the participants was 124 days, with congenital abnormalities being the most common indication for testing. Three patients had consanguineous parents. The mean turnaround time from enrollment to delivery of results was 169 h, with a diagnostic yield of 50%. Three patients received a definitive molecular diagnosis, impacting their clinical management. Two patients benefited from the exclusion of Mendelian conditions, leading to alternative diagnoses. This study demonstrates the feasibility and results of RGS in Turkish hospital settings, emphasizing the importance of timely genetic diagnosis in reducing the diagnostic odyssey for families and improving patient care. Further research is needed to evaluate the cost-effectiveness and applicability of RGS in the Turkish healthcare system for children with diseases of uncertain etiology.

Digital child health: opportunities and obstacles. A joint statement of European Academy of Paediatrics and European Confederation of Primary Care Paediatricians.

The advancement of technology and the increasing digitisation of healthcare systems have opened new opportunities to transform the delivery of child health services. The importance of interoperable electronic health data in enhancing healthcare systems and improving child health care is evident. Interoperability ensures seamless data exchange and communication among healthcare entities, providers, institutions, household and systems. Using standardised data formats, coding systems, and terminologies is crucial in achieving interoperability and overcoming the barriers of different systems, formats, and locations. Paediatricians and other child health stakeholders can effectively address data structure, coding, and terminology inconsistencies by promoting interoperability and improving data quality and accuracy of children and youth, according to guidelines of the World Health Organisation. Thus, ensure comprehensive health assessments and screenings for children, including timely follow-up and communication of results. And implement effective vaccination schedules and strategies, ensuring timely administration of vaccines and prompt response to any concerns or adverse events. Developmental milestones can be continuously monitored. This can improve care coordination, enhance decision-making, and optimise health outcomes for children. In conclusion, using interoperable electronic child health data holds great promise in advancing international child healthcare systems and enhancing the child's care and well-being. By promoting standardised data exchange, interoperability enables timely health assessments, accurate vaccination schedules, continuous monitoring of developmental milestones, coordination of care, and collaboration among child healthcare professionals and the individual or their caregiver. Embracing interoperability is essential for creating a person-centric and data-driven healthcare ecosystem where the potential of digitalisation and innovation can be fully realized.

Modelling Infant Mortality Rate using Time Series Models

The world’s main indicator of children’s health and general development is the infant mortality rate for infant under the age of five. Infant mortality is the term used to describe the death of a child before their first birthday. The infant mortality rate (IMR), which is the number of deaths of infants under one year of age per 1,000 live births, can be used to describe the prevalence of infant mortality in a population. Comparing the death rate of children under the age of five is the child mortality rate, commonly referred to as the under-five mortality rate. Nigeria, one of the nations with a high under-five mortality rate of 117 per 1,000 live births in 2019, is among those nations. The nation is among the top five nations with the highest mortality rate for children under five in 2019. This study aims to model infant mortality(Live birth and Still birth) rate using time series models and to predict the mortality rate using these models. Adeoyo Maternity Hospital Yemetu in Ibadan provided the data for this study. The data set is a monthly data and also a secondary data span for a period of 12 years (2009 to 2020). The time plot showed visual inspection and non-stationarity. Differencing was done and the unit root test performed for the purpose of comparison thereafter. Augmented-Dickey Fuller test and Phillip Perron unit root test was further tested for the establishment of stationarity in order to the main objectives. Three time series methods are the Autoregressive Integrated Moving Average Model(ARIMA), Exponential Smoothing and the Holt-Winters Method were used to model and predict the infant mortality rate data. The result shows that ARIMA order=c(0,0,1) with zero (0) mean for stillbirth and ARIMA order=c(1,0, 2) for live birth with the smallest AIC = (9.102 and 13.991). Akaike Information Criterion(AIC) values of (9.289, 14.139) and (9.102, 13.991) for live birth and still birth, respectively, were derived by exponential smoothing and Holtwinters technique. This means that Holtwinters' technique, which yielded the lowest AIC when compared to ARIMA and exponential smoothing, is the most accurate predictor of both stillbirth and live birth data. Given the high mortality rate for children under the age of five, it is crucial for the government to place more of an emphasis on health issues and to solve the problems plaguing Nigeria's child health care system.

Economic and Social Implications of Negative Population Growth

With the rapid development of China’s socioeconomic status, the increasing life quality, and the changing attitudes on marriage and childbearing among people of childbearing age, China has entered an era of negative population growth since 2022. Although China has introduced various policies to encourage births since 2013, the number of births has not increased as expected, but has declined rapidly. Looking back at the historical trend of population change in some developed countries, population decline is an “inevitable” process that many countries have to go through in the process of social and economic development. For China, after more than 30 years of its one-child policy, its population situation has some unique features. Although the willingness of young couples to have children is declining and the number of births is decreasing, there are significant problems such as advanced pregnancy, infertility, and childbearing after caesarean section, which in turn pose a threat to the health of mothers and children and lead to heavy medical burdens. Therefore, how to improve the treatment effectiveness and safety of infertility, the quality of maternal and child health care and the ability to treat high-risk maternal and foetal complications are major issues that China’s maternal and child health care system has to face and deal with urgently.

Medicaid and the Children's Health Insurance Program: Optimization to Promote Equity in Child and Young Adult Health.

The American Academy of Pediatrics envisions a child and adolescent health care system that provides individualized, family-centered, equitable, and comprehensive care that integrates with community resources to help each child and family achieve optimal growth, development, and well-being. All infants, children, adolescents, and young adults should have access to this system. Medicaid and the Children's Health Insurance Program (CHIP) provide critical support and foundation for this vision. Together, the programs currently serve about half of all children, many of whom are members of racial and ethnic minoritized populations or have complex medical conditions. Medicaid and CHIP have greatly improved the health and well-being of US infants, children, adolescents, and young adults. This statement reviews key program aspects and proposes both program reforms and enhancements to support a higher-quality, more comprehensive, family-oriented, and equitable system of care that increases access to services, reduces disparities, and improves health outcomes into adulthood. This statement recommends foundational changes in Medicaid and CHIP that can improve child health, achieve greater equity in health and health care, further dismantle structural racism within the programs, and reduce major state-by-state variations. The recommendations focus on (1) eligibility and duration of coverage; (2) standardization of covered services and quality of care; and (3) program financing and payment. In addition to proposed foundational changes in the Medicaid and CHIP program structure, the statement indicates stepwise, coordinated actions that regulation from the Centers for Medicare and Medicaid Services or federal legislation can accomplish in the shorter term. A separate technical report will address the origins and intents of the Medicaid and CHIP programs; the current state of the program including variations across states and payment structures; Medicaid for special populations; program innovations and waivers; and special Medicaid coverage and initiatives.

KNOWLEDGE AND PRACTICE OF MOTHERS REGARDING NEWBORN CARE IN A RURAL COMMUNITY LAHORE, PAKISTAN

Pakistan had an infant mortality rate of 56.88 per 1,000 live births in 2022. According to the World Health Organization, Neonatal mortality is about 45% of all under-five deaths. This study aimed to determine the infant care knowledge and habits of mothers in rural Lahore, Pakistan. A structured questionnaire was used to gather information for a community-based cross-sectional investigation. A straightforward random method was used to determine who each survey respondent was. A grading method was used to determine the mother's level of expertise and actual practice in caring for their newborns. A basic random procedure was used to choose 98 participants. The umbilical cord was reportedly severed by a modern blade in 78% of the cases, while traditional chemicals were reportedly applied to the cord in 12%. While 66 percent of women said that colostrum should be given to their babies, 88 percent of moms knew that breastfeeding should begin within an hour of the baby's birth and that neonates should receive the exclusive feed. Only 5% of moms were unaware that newborns are completely immunized, and 95% had received all their recommended vaccinations. According to the study, it was common practice to apply traditional substances to the umbilical cord, throw away colostrum, delay starting nursing, and feed neonates exclusively. Particularly in rural areas, the Maternal Child Health (MCH) programs and healthcare delivery systems must focus urgently on preventing harmful care behaviors and adopting healthy practices.

Information Needed, Sources of Information, and Barriers of Acquiring Required Information by Pregnant Women in Southern Sri Lanka

Background: A correct understanding of pregnancy and related issues would facilitate pregnant women to manage their pregnancies well. The objective of this study was to assess the pregnancy-related information needed by pregnant women in Sri Lanka and the obstacles that they face when acquiring such information. Materials and Methods: A descriptive cross-sectional study was conducted among 420 pregnant women admitted to a teaching hospital in Southern Sri Lanka. Data related to demography, information needed, sources of information seeking, and barriers that they face in acquiring such information were collected using an interviewer-administered questionnaire. Mean scores of the information needed (ranges 0–4) in different areas and a total score of the information needed were calculated. Regression analysis was used to identify possible predictors of information needed by the target group. Results: Family members, visiting obstetrician and gynecologist, antenatal clinical staff, and midwives were the common sources of information for nearly 80% of the participants. Psychological and physical complications after delivery (2.61 ± 1.21), special tests during pregnancy (2.44 ± 1.26), development and growth of the fetus (2.40 ± 1.26), and nutrition during pregnancy (2.36 ± 1.26) were the main areas where accurate and more information was sought by the participants. Failures in making a distinction between correct and incorrect information received ( n = 113 [26.9%]) and poor interactions between healthcare providers and pregnant women ( n = 103 [24.5%]) were the main barriers identified in acquiring trustworthy information. About one-fourth of the participants had used pregnancy-related apps. Information needs were high among pregnant women with less number of children ( β = −0.14, p < .01). Age, income, and area of living (rural or urban) did not significantly predict information needs in this target population. Conclusion: The free maternal and child healthcare system prevailing in the country seems to be the main source of information gathering for pregnant mothers. Physical, psychological, and nutritional facts related to pregnancy and its management should be increased among pregnant mothers, and it is imperative to empower them in the identification of correct information from authenticated sources. Primigravida women need more educational support. Electronic platforms should be effectively used in the future to disseminate information required by pregnant women in the country.

A retrospective study on the physical growth of twins in the first year after birth.

This study analyzed the physical growth of small for gestational age (SGA) and appropriate for gestational age (AGA) twins up to one year after birth. Weight, length, and head circumference data of 0-1 year-old twins were collected from the Child Health Care System from 2010 to 2019. Physical data were presented as Z-scores. Five parameters - growth level of weight, body length, head circumference, growth velocity, and body proportion (weight for length) were compared in twins. A total of 3,909 cases were collected (22.61% SGA, 77.39% AGA). 1. In both groups, WAZ (Weight for age z-score), HCZ (Head circumference for age z-score), and LAZ (Length for age z-score) increased more rapidly in the first 6 months. By one year of age, WAZ, HCZ, and LAZ had reached the normal range, but none had reached the average level of normal singleton children. 2. The mean values of WAZ, HCZ, and LAZ in the AGA group were between -1 and 0, and between -2 and - 1 in the SGA group, in the first year after birth. The SGA group lagged significantly behind the AGA group. The LAZ score of SGA and AGA was lower than the WAZ and HCZ scores. 3. The proportion of preterm AGA was the largest in twins, and the growth rate of preterm AGA was the fastest. Preterm twins had greater growth potential than term twins. However, the growth level of preterm SGA was always low. 4. The WFLZ (Weight for length z-score) in each group was approximately close to 0. The WFLZ of SGA was smaller than that of AGA twins at most time points. After 4 months of age, the WFLZ of twins had a downward trend. The WFLZ of preterm SGA approached -1 at approximately 1 year old. The physical growth of SGA and AGA in twins in the first year can reach the normal range but cannot reach the average level of normal singleton children. More attention should be paid to SGA in twins, especially preterm SGA. We should give proper nutritional guidance after 4 months of age to ensure the appropriate body proportion (weight for length) of SGA in twins. www.chictr.org.cn, CTR2000034761.

Key developmental milestones helped to identify children with special educational needs and disabilities at an early stage.

Responding to developmental delay promptly is important, as it helps children to reach their full potential. This study investigated how developmental milestones predicted primary school children with special educational needs and disabilities (SEND) at an early stage. We obtained data about 36 milestones between 12 and 45 months using the Dutch Development Instrument. Development, primary school classification and background characteristics were collected from the Dutch Preventive Child Healthcare system in Utrecht from 2008 to 2016. We investigated SEND classifications and the primary schools that the children attended at 4-12 years of age. The findings include area under the curve (AUC) data. Data on 30 579 children in mainstream schools and 1055 children with SEND were available. Different milestones predicted SEND classifications. Fourteen milestones and parental education predicted attendance at special needs schools with smaller classes (AUC 0.913). Nine milestones, sex, migration background and parental education predicted attendance at schools for severe communication problems (AUC 0.963). Ten milestones and parental education predicted attendance at schools for severe learning difficulties (AUC 0.995). Milestones did not accurately predict attendance at schools for severe behavioural or psychiatric problems. Milestones at 12-45 months predicted most SEND classifications at primary school age, except severe behavioural or psychiatric problems.

Implementation of a quadratus lumborum regional block protocol with assessment of effectiveness for patients with appendicitis: a quality improvement project.

This study analyzes the implementation of the routine use of quadratus lumborum blocks (QLBs) on postoperative pain and opioid consumption among children undergoing laparoscopic appendectomy compared to those not receiving regional anesthesia. Children undergoing laparoscopic appendectomy within a multi-hospital children's healthcare system were retrospectively reviewed from 2017 to 2021. Patients were stratified by appendicitis type (uncomplicated vs. complicated). Pain scores and opioid consumption in the post-anesthesia care unit (PACU) and within the first 24h postoperatively were compared by block status (no block [NB] vs. QLB) and appendicitis type. 2033 patients were reviewed, and 610 received a QLB. The frequency of rescue opioid use was reduced in the PACU (uncomplicated: QLB 46.6% vs. NB 54.6%, p = 0.005; complicated: QLB 28.5% vs. NB 39.9%, p = 0.01) and postoperatively (complicated: QLB 33.7% vs. NB 52.9%, p < 0.001) for those who received a QLB. This resulted in reduced opioid consumption as measured by morphine milligram equivalents per kilogram postoperatively. QLBs can be safely administered in children and provide improvements in opioid consumption postoperatively. QLBs should remain a strongly favored regional anesthetic technique because of their wide applicability for abdominal surgeries to minimize rescue opioid analgesic use. Retrospective comparative study. Level III.

Reducing Retained Foreign Objects in the Operating Room: A Quality Improvement Initiative.

Although the incidence of pediatric retained foreign objects (RFOs) during surgery is diminutive (1/32,000), RFOs are often the most common sentinel events reported. In 2021, our institution noted an increase in RFOs evidenced by a substantial decrease in days between events. We aimed to minimize the incidence of RFO which was measured as an increase of days between events at our institution by implementation of a Quality Improvement initiative. This effort was conducted across 4 surgical centers within a tertiary children's healthcare system in December 2021. Patients undergoing surgery within this healthcare system across all surgical specialties were included. The quality improvement initiative was developed by a multidisciplinary team and included 6 steps focusing on quiet time, minimizing interruptions, and closed-loop communication during final surgical count. Seven Plan-Do-Study-Act cycles were used to test, refine, and implement the protocol. Adherence to the final surgical count protocol was monitored throughout the study period. In 2021, before protocol implementation, average time between RFO events was 29 days. After implementation of our quality initiative, the final surgical count protocol, we improved to 451 days between RFO events by February 2023, exceeding the upper control limit (235 days). After implementation, the number of RFO events dropped from 7 in 2021 to 0 in 2022. Adherence to the final surgical count protocol implementation was 96.4% by the end of cycle 7. RFOs during pediatric surgical procedures can be successfully reduced using quality improvement methodology focusing on standardizing the procedure of the final surgical count.

Health, social, and dental professionals’ experiences of working within an extended home-visit program in the child healthcare: a qualitative interview study in Sweden

BackgroundThe goal of the Swedish child healthcare system is to reach all children with health-promotive actions and to create equal health opportunities for all children. In that context, an extended home-visit program – called Grow Safely – for first-time parents, with an interprofessional collaboration between child healthcare nurses, midwives, social workers, and dental assistants, was initiated. The current study aims at illuminating and evaluating the health, social, and dental professionals’ experiences of working within this program and how such collaboration could benefit the professions.MethodsA qualitative method was chosen, and 13 interviews were carried out with professionals working within child healthcare centers that participated in an extended home-visit program in the southernmost part of Sweden. The interviews were analyzed via Burnard’s approach to content analysis.ResultsThe results showed that it was satisfying for the health, social, and dental professionals to work with the home-visit program and that they encountered positive feelings among the parents receiving it. The creation of deep conversations and parents opening up about feelings that could otherwise be shameful to express, was a positive aspect of the home visits. A negative aspect was the difficulty of handling the (sometimes necessary) interpretation over the phone during the visits, and another one was the fact that the visits were time-consuming and required logistical planning. Overall, the professionals were positive about the home-visit program in that they felt that they were able to give the families what they needed and to have discussions on sensitive issues. They also appreciated the fact that different professions collaborated in order to reach the same goal.ConclusionsThis study showed that the health, social, and dental professionals enjoyed working with the home-visit program and that they encountered positive feelings among the parents regarding the collaborative visits being conducted within the home, where the families felt safe and relaxed. The professionals expressed that the home visits, despite the extended time they required and the logistical challenges involved, created a deeper collaboration between the professionals.

Strategies for Improving Postpartum Contraception Compared With Routine Maternal Care: A Systematic Review and Meta-Analysis.

Objectives: This study aimed to systematically review the effectiveness of service interventions for improving postpartum contraception, including contraceptive use, prevention of repeat pregnancies and induced abortions. Methods: A systematic literature search was conducted in three databases until June 2022 (PROSPERO registration CRD42022328349). Estimates of intervention effects from meta-analyses were represented as odds ratios (OR) with 95% confidence intervals (CI). Results: 16 studies with 14,289 participants were included, with four kinds of interventions recognized. Interventions effect in increasing use of contraceptives and decreasing rates of repeated pregnancy for up to 6months postpartum (OR = 2.24, 0.06, 95% CI = 1.46-3.44, 0.02-0.22, respectively), with no significant associations with contraceptive use at 12months postpartum, prevention of postpartum repeat pregnancies and induced abortions during 1year after childbirth. Conclusion: We concluded that interventions impact the initiation of postpartum contraceptive use and prevention of repeat pregnancy with an overall certainty from low to moderate. These findings highlight the need for additional studies to integrate the beneficial effect of several interventions and then design more feasible strategies, which is important for the maternal and child healthcare systems.

The National Healthy People Initiative:: History, Significance, and Embracing the 2030 Oral Health Objectives.

Since 1979, the U.S. Department of Health and Human Services has worked with multiple subject matter experts and the public to develop and issue a set of ambitious, measurable objectives known as "Healthy People." These objectives are aimed at improving the health of the nation issued at the start of each decade, and feature specific targets to be achieved at the end of the decade. The fifth iteration, Healthy People 2030, consists 358 measurable public health objectives associated with evidence-based interventions. Oral health is represented by 11 specific objectives aimed at reducing dental caries in children and adolescents, reducing untreated decay and periodontal disease in adults, and promoting evidence-based prevention strategies, including community water fluoridation, dental sealants, oral cancer screenings, and, most importantly, increasing access to dental services. In fact, access to the oral health care system for children, adolescents, and adults is identified as a Healthy People 2030 Leading Health Indicator - a high-priority Healthy People 2030 objective selected to drive action toward improving health and well-being - for the second straight decade. With the continued promotion of multidirectional integration of oral health and overall health across multiple disciplines, many - including policymakers, oral health professionals, other healthcare professionals, dental and public health organizations, and community advocates - have a role in affecting the outcome of the Healthy People 2030 oral health objectives.