Child Health Care System Research Articles

Association of Urinary Albumin with Selected Cardiovascular Disease Risk Factors in Obese Adolescents

Background: Childhood obesity has become a growing health problem in Egyptand other countries in the world. The prevalence of albuminuria is higher in obesity,and could represent an early indicator for cardiovascular diseases (CVD) in obeseadolescents. Whether there is a real association between albuminuria and other CVDrisk factors remains a matter of debate.Purpose: In an attempt to answer this debate question, this study aims to assessthe association of urinary albumin with central obesity, blood pressure, fasting lipidprofile, and insulin resistance in obese adolescents.Methods: Forty obese adolescents aged 10-18 years, diagnosed with simple obesitywere recruited from the National Nutrition Institute in Egypt. Exclusion criteria wereadolescents with diabetes, kidney or liver prob-lems, and/or hormonal abnormalities.Measurements included anthropometric assess-ment, blood pressure measurement;and lab analysis for urinary albumin, fasting blood glucose, fasting insulin, and fastinglipid profile. The Spearman correlation coefficient was used for statistical analysis.Results: Statistically significant p ositive c orrelations h ave b een f ound o nly betweenalbuminuria and each of: duration of obesity (r=0.93, p= 0.00), waist/height ratio(r=0.65, p=0.00), and/or systolic blood pressure (r=0.33, p= 0.041).Conclusions: Urinary albumin has been significantly a ssociated w ith t he long-termexposure to excess body weight, central fatness, and systolic blood pressure, but notwith diastolic blood pressure, dyslipidemia or insulin resistance in obeseadolescents. Early detection of al-buminuria can have a protective role againstfuture hypertension and related target organ damage in this young population. Theobservations of our study may aid efforts directed to planning better health caresystem for obese children and/or adolescents in Egypt.

Factors associated with boarding and length of stay for pediatric mental health emergency visits

ObjectiveTo determine demographic and clinical risk factors associated with boarding (length of stay ≥24 h) for pediatric mental health emergency department (ED) visits. MethodsThis is a retrospective cross-sectional analysis of mental health visits identified by diagnosis codes for children 5–18 years old presenting to a tertiary pediatric ED in 2016. We performed multivariate logistic regression to identify demographic and clinical factors associated with boarding. ResultsThere were 1746 mental health visits and 386 (22%) visits had length of stay ≥24 h. In the multivariate logistic regression model, factors associated with boarding included: private insurance (OR 1.59, 95% CI 1.15, 2.19) and having both private and public insurance (OR 1.68, 95% CI 1.16, 2.43) relative to public insurance; presentation during a school month (OR 2.17, 95% CI 1.30, 3.63); physical or chemical restraint use (OR 4.80, 95% CI 2.61, 8.84); comorbid autism or developmental delay (OR 1.82, 95% CI 1.35, 2.46); prior psychiatric hospitalization (OR 2.55, 95% CI 1.93, 3.36); and reasons for presentation of agitation, aggression, or homicidal ideation (OR 2.76, 95% CI 1.40, 5.45), depression, self-injury, or suicidal ideation (OR 2.79, 95% CI 1.45, 5.40), and bipolar, mania, or psychosis (OR 5.78, 95% CI 2.36, 14.09) relative to anxiety. ConclusionsInsurance status, presentation month, restraint use, autism or developmental delay comorbidity, prior psychiatric hospitalization, and reason for presentation are associated with pediatric mental health ED boarding. Resources should be directed to improve the mental health care system for children with identified risk factors for boarding.

Stakeholders’ views on scenarios on EU child healthcare systems and how changes might be achieved

Stakeholders’ views on scenarios on EU child healthcare systems and how changes might be achieved

Stakeholders’ views on scenarios on EU child healthcare systems and how changes might be achieved

Stakeholders’ views on scenarios on EU child healthcare systems and how changes might be achieved

Association of early pregnancy body mass index and children's birth weight with risk of being overweight in childhood.

To examine the potential effects of mothers' early pregnancy body mass index (BMI) and children's birth weight on childhood overweight/obesity at 1-6 years of age. We performed a cohort study in Tianjin, China, using the health care records from the Tianjin maternal and child health care system with 36 719 mother-child pairs from early pregnancy to children at 6 years of age. Logistic regression analyses were used to assess the single and joint associations of maternal early pregnancy BMI and children's birth weight with the risks of children being overweight at 1-6 years of age in multivariable-adjusted models. Both maternal early pregnancy BMI and children's birth weight were positively associated with the risk of children being overweight at 1-6 years of age. Compared with children who were born to normal weight mothers and had low or normal birth weight (NBW; birth BMI < 85%), higher risks of being overweight at 1-6 years were found among children with low or NBW who were born to overweight mothers, and children with high NBW (BMI ≥ 85%) or macrosomia who were born to normal weight or overweight mothers. Lower risks of being overweight were found among those with low birth weight who were born to normal weight mothers. Maternal early pregnancy BMI may play a more important role than children's birth weight in the risk of being overweight from 4 to 6 years of age. Children with high or NBW need to be given more attention to prevent excessive weight gain.

Improving the early screening procedure for autism spectrum disorder in young children: Experience from a community-based model in shanghai.

Most children with autism spectrum disorder (ASD) are not diagnosed until the age of 4, thus missing the opportunity for early intervention. The objective of this study was to investigate the feasibility of an early screening program for ASD applied during well-child visits in a community-based sample. The study lasted for 4 years and was divided into two stages. Stage I involved the implementation of the basic screening model in 2014. Toddlers received level 1 screening via section A of the Chinese-validated version of the Checklist for Autism in Toddlers (CHAT-23) during 18- and 24-month well-child visits in Xuhui District, Shanghai, China. Screen-positive children were referred to receive section B of the CHAT-23 for level 2 screening, and those still screen-positive were referred to undergo diagnosis and evaluation. Stage II involved the implementation of the improved screening model from 2015 to 2017 with the following modifications: (a) an added observational component in level 1 screening; (b) telephone follow-ups with the screen-positive families; and (c) dissemination of information on ASD to families. The results showed that 42 of 22,247 screened children were diagnosed with ASD. The ASD diagnosis rates were 0.1% in Stage I and 0.21% in Stage II. The screen-positive rate and the show rate of referral for level 1 screening increased by 76.92% and 58.43%, respectively, in Stage II compared to Stage I. Our results suggest that with appropriate logistic support, this two-level screening model is feasible and effective for the early screening of ASD during well-child visits. Autism Res 2018, 11: 1206-1217. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Difficulty in the timely identification of autism spectrum disorder (ASD) results in missed opportunities for many ASD children to receive early intervention. In this study, we established an early screening model for ASD among children aged 18-24 months in the community by relying on the three-level child healthcare system in China. The results showed that this model can effectively identify and diagnose ASD in children at an early age and thus enable early intervention.

Delays in the health care system for children, adolescents, and young adults with bone tumors in Brazil

ObjectiveTo identify delays in the health care system experienced by children and adolescents and young adults (AYA; aged 0–29 years) with osteosarcoma and Ewing sarcoma using information from the Brazilian hospital-based cancer registries. MethodsPatient data were extracted from 161 Brazilian hospital-based cancer registries between 2007 and 2011. Hospital, diagnosis, and treatment delays were analyzed in patients without a previous histopathological diagnosis. Referral, hospital, and health care delays were calculated for patients with a previous histopathological diagnosis. The time interval was measured in days. ResultsThere was no difference between genders in overall delays. All delays increased at older ages. Patients without a previous histopathological diagnosis had the longest hospital delay when compared to patients with a previous histopathological diagnosis before first contact with the cancer center. Patients with Ewing sarcoma had longer referral and health care delays than those with osteosarcoma who had a previous histopathological diagnosis before first contact with the cancer center. The North and Northeast regions had the longest diagnosis delay, while the Northeast and Southeast regions had the longest treatment delay. ConclusionHealth care delay among patients with a previous diagnosis was longer, and was probably associated with the time taken for to referral to cancer centers. Patients without a previous histopathological diagnosis had longer hospital delays, which could be associated with possible difficulties regarding demand and high-cost procedures. Despite limitations, this study helps provide initial knowledge about the healthcare pathway delays for patients with bone cancer inside several Brazilian hospitals.

Medically Complex Children in Foster Care: Do Research “Protections” Make This “Vulnerable Population” More Vulnerable?

Children in foster care are considered a “vulnerable population” in clinical care and research, with good reason. These children face multiple medical, psychological, and social risks that obligate the child welfare and healthcare systems to protect them from further harms. An unintended consequence of the “vulnerable population” designation for children in foster care is that it may impose barriers on tracking and studying their health that creates gaps in knowledge that are key to their receipt of medical care and good outcomes. These gaps in knowledge have implications for justice, beneficence, and maleficence and serve to undermine “protection” of this population. Here we review the challenges of research regarding children in foster care, particularly medically complex children, and offer specific recommendations to include children in foster care in medical research.

The Impact of Disruption of the Care Delivery System by Commercial Laboratory Testing in a Children's Health Care System.

Disruption of outpatient laboratory services by routing the samples to commercial reference laboratories may seem like a cost-saving measure by the payers, but results in hidden costs in quality and resources to support this paradigm. To identify differences when outpatient tests are performed at the Children's Healthcare of Atlanta (Children's) Hospital lab compared to a commercial reference lab, and the financial costs to support the reference laboratory testing. Outpatient testing was sent to 3 different laboratories specified by the payer. Orders were placed in the Children's electronic health record, blood samples were drawn by the Children's phlebotomists, samples were sent to the testing laboratory, and results appeared in the electronic health record. Data comparing the time to result, cancelled samples, and cost to sustain the system of ordering and reporting were drawn from multiple sources, both electronic and manual. The median time from phlebotomy to result was 0.7 hours for testing at the Children's lab and 20.72 hours for the commercial lab. The median time from result posting to caregiver acknowledgment was 5.4 hours for the Children's lab and 18 hours for the commercial lab. The commercial lab cancelled 2.7% of the tests; the Children's lab cancelled 0.8%. The financial cost to support online ordering and reporting for testing performed at commercial labs was approximately $640,000 per year. Tangible monetary costs, plus intangible costs related to delayed results, occur when the laboratory testing system is disrupted.

The Design and Implementation of the 2016 National Survey of Children's Health.

Introduction Since 2001, the Health Resources and Services Administration's Maternal and Child Health Bureau (HRSA MCHB) has funded and directed the National Survey of Children's Health (NSCH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN), unique sources of national and state-level data on child health and health care. Between 2012 and 2015, HRSA MCHB redesigned the surveys, combining content into a single survey, and shifting from a periodic interviewer-assisted telephone survey to an annual self-administered web/paper-based survey utilizing an address-based sampling frame. Methods The U.S. Census Bureau fielded the redesigned NSCH using a random sample of addresses drawn from the Census Master Address File, supplemented with a unique administrative flag to identify households most likely to include children. Data were collected June 2016-February 2017 using a multi-mode design, encouraging web-based responses while allowing for paper mail-in responses. A parent/caregiver knowledgeable about the child's health completed an age-appropriate questionnaire. Experiments on incentives, branding, and contact strategies were conducted. Results Data were released in September 2017. The final sample size was 50,212 children; the overall weighted response rate was 40.7%. Comparison of 2016 estimates to those from previous survey iterations are not appropriate due to sampling and mode changes. Discussion The NSCH remains an invaluable data source for key measures of child health and attendant health care system, family, and community factors. The redesigned survey extended the utility of this resource while seeking a balance between previous strengths and innovations now possible.

Early detection of congenital anomalies of the kidney and urinary tract: cross-sectional results of a community-based screening and referral study in China

ObjectiveTo establish an effective screening model of congenital anomalies of the kidney and urinary tract (CAKUT) using ultrasound among neonates in Shanghai, China.DesignCross-sectional study.SettingA three-level screening model for CAKUT in...

Medical foster care for children with chronic critical illness: Identifying strengths and challenges

ObjectivesA growing population of children has chronic critical illness (CCI), defined as children with complex and chronic medical conditions who require repeated and prolonged ICU hospitalizations. Some of these children are unable to be cared for by their parents and are placed in medical foster care (MFC). We sought to better understand the potential strengths and challenges of MFC as a placement setting for children with CCI. MethodsAs part of a larger study exploring barriers to care for children with CCI, we conducted semi-structured interviews with healthcare professionals (inpatient; outpatient; home care; foster care) with extensive CCI experience. The subset of questions related to MFC was included in this analysis. Participants were recruited from 5 metropolitan areas across the US. ResultsContent analysis of 44 participant transcripts revealed the following themes: 1) why CCI children enter MFC; 2) transition from hospital into MFC; 3) potential strengths and 4) potential challenges of MFC for CCI children. Complicated hospitalizations commonly precede entrance into MFC for children with CCI, a transition complicated by delays in identifying need for MFC, limited MFC availability, and discharge training of foster parents. MFC strengths included quality MFC caregivers, MFC system supports, and a home environment. Challenges included separation from biological family, fragmented medical care, decision-making, variable quality, and transitioning out of MFC. ConclusionThe advantages of MFC for CCI children can be potentially improved through intentional child welfare and health care system collaboration, protocols for hospital-to-MFC transitions, consistent medical homes, alternative medical decision-making policies, greater MFC availability, and broader biological family supports.

Traditional Health Care (THC) and nutritional practices in Mother Child Health Care systems (MCHCs) in the tribal dominated areas of Rajasthan, India.

Plants and plants based products are frequently used by the tribals for their health and treatment right from human civilization. The present study was conducted in the tribal dominated areas of Rajasthan such as Banswara, Chittorgarh, Dungarpur, Pratapgarh and Udaipur which are mainly dominated by the Bhil, Meena, Garasia and Kathodia tribes. During study informations were collected from the Dais or Gunis, tribal health practitioners. In the present work 55 plant species belonging to 52 genera and 35 families have collected, identified and documented which are used to treat different types of mother child ailments after the birth and up to five years age of child. Similarly, informations were also documented about the plants their parts which were used for nutritional purposes during the lactation period of mother and for the amelioration of the health of mother and child.

Охрана материнства и младенчества в Российской империи и ее роль в становлении советской системы охраны здоровья детей

Охрана материнства и младенчества в Российской империи и ее роль в становлении советской системы охраны здоровья детей

Охрана материнства и младенчества в Российской империи и ее роль в становлении советской системы охраны здоровья детей

Охрана материнства и младенчества в Российской империи и ее роль в становлении советской системы охраны здоровья детей

STRATEGIC DIRECTIONS FOR RECONSTRUCTION OF THE HEALTH SYSTEM NEWBORNS AND CHILDREN OF UKRAINE

The article analyzes of the demographic situation in Ukraine in the context of preserving the health of newborns and children, as well as the content analysis of the recommendations of the UN, the Council of Europe in the field of health and WHO on stopping the preventive loss of newborns, providing access to the health care system for children in Ukraine . We discussed several generally recognized problem issues that require attention of politicians, state authorities and specialists: the demographic situation in Ukraine; morbility and mortality of children, adolescent health and proposals for the reconstruction of the area ofmedical care for the children of Ukraine. It is concluded that the direction of strategic development of events should be the introduction of nationwide activities aimed at early detection of pathology and health, to create conditions for a full life and development of the child from birth to adulthood. The state should coordinate resources and direct them to quality programs to support newborns and young children.For the successful implementation of innovations and the development of medical care for children, it is necessary to ensure the comprehensive and continuity of actions at the level of the state, the region and theadministrative territorial unit, to provide personalized assistance to each child, the use of effective technologies and the systematization of diagnostic and treatment processes, the implementation of a systematic and interdepartmental approach and the creation of space for the development of modern medical care for the children of Ukraine, the formation of analytical - traditional processes of planning medical care for children, as well as further study of existing challenges and needs.

Developing a Health Care System for Children in Foster Care.

In 2012, the Comprehensive Health Evaluations for Cincinnati's Kids (CHECK) Center was launched at Cincinnati Children's Hospital Medical Center to provide health care for over 1,000 children placed into foster care each year in the Cincinnati community. This consultation model clinical program was developed because children in foster care have been difficult to manage in the traditional health care setting due to unmet health needs, missing medical records, cumbersome state mandates, and transient and impoverished social settings. This case study describes the history and creation of the CHECK Center, demonstrating the development of a successful foster care health delivery system that is inclusive of all community partners, tailored for the needs and resources of the community, and able to adapt and respond to new information and changing systems.

The Outpatient Clinic for Adolescent Risk-taking and Self-harm behaviors (AtR!Sk) - A Pioneering Approach of Outpatient Early Detection and Intervention of Borderline Personality Disorder

The Outpatient Clinic for Adolescent Risk-taking and Self-harm behaviors (AtR!Sk) - A Pioneering Approach of Outpatient Early Detection and Intervention of Borderline Personality Disorder Self-harm and risk-taking behaviors are frequently occurring problems in adolescents' everyday life and commonly challenge the present child and adolescent health-care system. Those behaviors are typical features of borderline-personality disorder (BPD), a severe mental disorder that is associated with immense psychological strain, increased risk of mortality and poor psychosocial functioning. Despite controversy in the past, recent evidence shows that BPD is a valid and reliable diagnosis in adolescence. Consequently, specified and effective intervention programs for this age group are necessary. Instead, present health-care services for children and adolescents in Germany are usually characterized by long waiting periods for specialized outpatient treatments and unnecessary expanses of unnecessary long inpatient stays. Alternatively, and in order to prevent serious long-term consequences, new concepts - integrated in an ambulatory setting and close to patients' daily routines - should focus on early detection and treatment of adolescents at-risk presenting with borderline personality features. The specialist outpatient clinic AtR!Sk at the University Hospital Heidelberg ensures a low-threshold initial contact service, comprehensive and accurate diagnosis of BPD features, and rapidly "tailored" therapy for young people presenting with any types of risk-taking and self-harm behavior. AtR!Sk - as a pioneering approach in south Germany - provides evidence-based early detection and intervention for adolescent BPD.

An Airway Risk Assessment Score for Unplanned Extubation in Intensive Care Pediatric Patients.

As a result of a workshop to identify common causes of unplanned extubation, Children's Healthcare of Atlanta developed a scoring tool (Risk Assessment Score) to stratify patients into groups of low, moderate, high, and extreme risk. This tool could be used to institute appropriate monitoring or interventions for patients with high risks of unplanned extubation to enhance safety. The objective of this study is to test the hypothesis that the Risk Assessment Score will correlate with the occurrence rate of unplanned extubation in pediatric patients. Retrospective review of 2,811 patients at five ICUs conducted between December 2012 and July 2014. Five ICUs at two freestanding pediatric hospitals within a large children's healthcare system in the United States. All intubated pediatric patients. Data of intubations and Risk Assessment Score were collected. Extubation outcomes and severity levels were compared across demographic groups and with the maximum Risk Assessment Score of each intubation. Out of 4,566 intubations, 244 were unplanned extubations (5.3%). The occurrence rates of unplanned extubations in those less than 1, 1-6, and more than 6 years old were 6.7%, 3.6%, and 2.7%, respectively, corresponding to a rate of 0.59, 0.53, and 0.58 unplanned extubation every 100 ventilator days. The occurrence rates were 13.6% for patients weighing less than 1 kg (0.59 unplanned extubation per 100 ventilation days) and 3.8% for patients weighing greater than or equal to 1 kg (0.58 unplanned extubation per 100 ventilation days). For intubations with maximum risk score falling in risk categories of low, moderate, high, and extreme, the occurrence rates were 4.7%, 7.7%, 12.0%, and 8.3%, respectively, which corresponded to rates of 0.54, 0.62, 0.95, and 0.92 unplanned extubation per 100 ventilator days. Higher Risk Assessment Scores are associated with occurrence rates of unplanned extubation.

Immigrant parents\u2019 experience with the Swedish child health care system: A qualitative study

BackgroundImmigration, particularly when it is involuntary, is known to be an emotional stressor, regardless of the reason behind it. It is always a challenge to be removed from the habitual and cultural action pattern of the person or family. This can make children more vulnerable, because they often arrive with an increased risk of poor physical health. Because of that, it is crucial that immigrant children have access to ongoing health care. The aim of this study is to shed light on the experience of non-European immigrants with Sweden’s Child Health Care system.MethodsQualitative semi-structured interviews were conducted, with parents of children who were patients of one of the four child health care centres. The centres were in four areas in a town in southern Sweden in which there are substantial immigrant populations. The interviews were conducted, transcribed and then analyzed with content analysis.ResultsThe results were divided into two main categories: The first is “the sense of being cared for in another way,” which was divided into the following four subcategories: compare with the home country, getting a home visit, engagement and contentment and unfamiliarity with the language. The second main category. “The feeling of getting all the practical needs met through the child health care system” had the following four subcategories: The importance of advice and guidance, getting oral and written information, getting help when needed and getting support when needed.ConclusionsThe parents expressed contentment regarding the Swedish child health care and they were thankful for how it was organized, the engagement of the nurses, the information and advices given as well as for the opportunities of getting a home visit after birth. However, more research is needed in order to find out the extent to which the Swedish child health care system is culturally appropriate in the whole country.