Child Health Research Articles

Measuring and Valuing Health for Children

There has been significant progress in recent years in the development of instruments and methods for measuring and valuing child health. These advances are vital steps toward supporting the assessment of health technologies targeting pediatric conditions and resource allocation decisions about these technologies. However, there is a need for additional research comparing the impact of using child versus adult health-state preferences in cost-utility analyses; whether the same preference-based instruments should be used for children and adults; and the impact that different approaches to handling age transitions have when modelling over a lifetime horizon. The small number of identified studies precludes a robust discussion of the impact of spillover effects on economic evaluations, and there is currently no consensus in the literature as to best practices. Additional research is needed into the number and type of caregivers that could be included in the assessment of spillover effects and the ethical implications of including spillover in economic evaluations.

Parental migration, socioeconomic deprivation and hospital admissions in preschool children in England: national birth cohort study, 2008 to 2014

BackgroundA third of children born in England have at least one parent born outside the United Kingdom (UK), yet family migration history is infrequently studied as a social determinant of child health. We describe rates of hospital admissions in children aged up to 5 years by parental migration and socioeconomic group.MethodsBirth registrations linked to Hospital Episode Statistics were used to derive a cohort of 4,174,596 children born in state-funded hospitals in England between 2008 and 2014, with follow-up until age 5 years. We looked at eight maternal regions of birth, maternal country of birth for the 6 most populous groups and parental migration status for the mother and second parent (UK-born/non-UK-born). We used Index of Multiple Deprivation (IMD) quintiles to indicate socioeconomic deprivation. We fitted negative binomial/Poisson regression models to model associations between parental migration groups and the risk of hospital admissions, including interactions with IMD group.ResultsOverall, children whose parents were both born abroad had lower emergency admission rates than children with parents both born in the UK. Children of UK-born (73.6% of the cohort) mothers had the highest rates of emergency admissions (171.6 per 1000 child-years, 95% confidence interval (CI) 171.4–171.9), followed by South Asia-born mothers (155.9 per 1000, 95% CI 155.1–156.7). The high rates estimated in the South Asia group were driven by children of women born in Pakistan (186.8 per 1000, 95% CI 185.4–188.2). A socioeconomic gradient in emergency admissions was present across all maternal regions of birth groups, but most pronounced among children of UK-born mothers (incidence rate ratio 1.43, 95% CI 1.42–1.44, high vs. low IMD group). Patterns of planned admissions followed a similar socioeconomic gradient and were highest among children with mothers born in Middle East and North Africa, and South Asia.ConclusionsOverall, we found the highest emergency admission rates among children of UK-born parents from the most deprived backgrounds. However, patterns differed when decomposing maternal place of birth and admission reason, highlighting the importance of a nuanced approach to research on migration and health.

Association of lipid levels at different stages of pregnancy with gestational diabetes mellitus and the incidence of neonatal macrosomia: A retrospective study.

To investigate the correlation between lipid levels during gestation and the incidence rate of gestational diabetes mellitus (GDM) and macrosomia. Clinical records of 607 pregnant women with GDM (GDM group) who delivered in the Obstetrics Department of Fujian Maternal and Child Health Hospital from May to December 2018 and of 833 women with uncomplicated pregnancies (control group) were retrospectively analyzed. After delivery, the entire cohort was further grouped based on the weight of the neonates: women who delivered newborns with body mass <4 kg comprised the normal group (n = 1367), and pregnancies that resulted in delivery of neonates with body mass >4 kg were classified as the macrosomia group (n = 73). Fasting serum levels of triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and TG/HDL-C ratio were compared between the groups at the early (10-12 weeks), middle (24-28 weeks), and late (28 weeks-delivery) stages of pregnancy, and the correlation between the lipid indices and the rates of GDM and macrosomia were analyzed. There was a gradual increase in TC, TG, LDL-C, and TG/HDL-C levels with increasing gestational weeks in pregnant women. TG and TG/HDL-C levels were markedly higher, while HDL-C was lower in women with GDM compared with women of the same gestational age with uncomplicated pregnancies (p < 0.05). Lipid metabolism disorders exist in pregnant women with GDM at different gestational stages and are closely related to the higher incidence of macrosomia. TG, TG/HDL-C, and HDL-C in early and late pregnancy are independent risk factors for macrosomia in all trimesters, and TG/HDL-C ratio at different gestational stages has a good predictive value for macrosomia.

Effect of online infant care training and postpartum counseling based on Meleis' transition theory on mothers' readiness for care and breastfeeding: a randomized controlled trial.

Mothers must acquire the knowledge and skills needed to fulfill their responsibilities and take care of themselves and their babies. This study aimed to examine the effects of online baby care education and postpartum counseling based on Meleis' transition theory on mothers' readiness for baby care and breastfeeding. This randomized controlled trial was conducted between May 2022 and May 2023 at the pregnancy follow-up outpatient clinic of a state hospital. The study sample consisted of 102 pregnant women (52 in the intervention group, 50 in the control group). The mean scores of the intervention group compared to the control group were significantly higher immediately after birth and at 1, 2, and 3 months postpartum. Change over time was significantly higher in repeated measurements of National Institute of Child Health and Human Development scale scores of the intervention and control groups (P=0.001). In the first 24 hours, mothers in the intervention group breastfed more successfully than those in the control group (P<0.001). Mothers in the intervention group exclusively breast fed at a significantly higher rate immediately and at 1, 2, and 3 months postpartum compared to the control group (P<0.001). A statistically significant difference was noted in mean infant height and weight in the intervention group compared to the control group (P<0.05). Theory-based online education initiated during pregnancy and counseling continued up to 3 months postpartum positively affected the mothers' abilities to care for their infants. Mothers who received education and counseling breastfed their babies more successfully on the first day and breast fed exclusively at a higher rate in the first 3 months.

Clinical outcomes of patients with heterotopic pregnancy after laparoscopic surgery

ObjectiveThis retrospective study aims to analyze laparoscopic surgical management and clinical consequences of patients with heterotopic pregnancy (HP) who underwent in vitro fertilization and embryo transfer (IVF-ET) and laparoscopic surgical management. Material and methodsWe conducted a retrospective analysis of clinical characteristics and pregnancy results of patients with HP who underwent IVF-ET at the Affiliated Maternity and Child Health Care Hospital of Nantong University between January 2013 and December 2022. Results21 patients were diagnosed with HP, with an average diagnostic period of 49.1 ± 11.1 days. 11 cases (52.4 %) exhibited clinical manifestations such as abdominal pain and vaginal hemorrhage before the surgery, while 10 cases (47.6 %) were asymptomatic prior to diagnosis. All patients underwent laparoscopic surgery, resulting in 8 cases of miscarriage postoperatively (6.15 %), and all 13 neonates showed no anomalies at birth. ConclusionLaparoscopic surgery is a safe and effective treatment, and most patients can achieve satisfactory pregnancy outcomes after surgery.

Individual- and community-level predictors of healthcare-seeking behaviour for acute respiratory tract infections among children under five in 29 low- and middle-income countries: a multilevel analysis

ObjectivesThis study aimed to identify the individual- and community-level determinants of mothers’ healthcare-seeking behaviour for children under the age of 5 years with acute respiratory infection (ARI) symptoms in low-and middle-income countries (LMICs). Study designNationally representative Demographic and Health Survey datasets from 29 LMICs were used. MethodsThe study included 16,893 children aged under 5 years with ARI symptoms in the 2 weeks prior to the survey. A multilevel logistic regression model was used to examine associations between individual- and community-level factors with health-seeking behaviour for ARIs. The adjusted odds ratio (AOR) along with 95% confidence intervals (CIs) were reported as a measure of association. ResultsThe overall prevalence of healthcare-seeking behaviour for ARIs among children under 5 years in LMICs was 58.83% (95% CI: 58.08, 59.57). Findings showed that mothers with primary or higher education (AOR = 1.20; 95% CI: 1.08, 1.33), and those residing in rich households (AOR = 1.32; 95% CI: 1.18, 1.48), attending antenatal care (ANC) visits (AOR = 1.53; 95% CI: 1.31, 1.79) and delivering at a healthcare facility (AOR = 1.28; 95% CI: 1.16, 1.41) were more likely to seek healthcare for ARIs. A higher level of community maternal education (AOR = 1.44; 95% CI: 1.24, 1.68) was positively associated with seeking healthcare for ARIs, while a higher level of community poverty (AOR = 0.83; 95% CI: 0.72, 0.96) was negatively associated with healthcare seeking for ARIs. ConclusionsThis study revealed that mothers’ healthcare-seeking behaviour for ARIs was closely linked to modifiable risk factors, including maternal education, household wealth, use of maternal health services (e.g., ANC), as well as community poverty and literacy levels. Future interventions should consider these modifiable risk factors when developing strategies to improve child health outcomes in LMICs.

Validation of the Dutch Infant Crying and Parent Well-Being Screening Tool in Parents of Infants Less than 12 Months of Age

To evaluate reliability and validity of the Dutch version of the Infant Crying and Parent Well-Being (ICPW) tool in identifying parents struggling with infant crying in the first year of life. The original ICPW tool was translated into Dutch following established guidelines. The internal consistency and criterion validity of the Dutch ICPW tool were evaluated using a cross-sectional design. The translated ICPW tool and validated questionnaires on parental depression, stress, anxiety, and parenting balance were presented to parents of infants under 12months during child health care visits and online. The survey was completed by 488 parents, 400 mothers and 88 fathers. Of these, 172 participated after a child health care visit and 316 via online platforms. The Dutch ICPW showed satisfactory internal consistency (α=0.69) and excellent criterion validity with parental mental health measures (r=0.53-0.85). ICPW scores demonstrated positive correlations with parental depression, stress, and anxiety levels, and a negative correlation with parenting balance. Both mothers and fathers with a positive ICPW screen (≥3) reported significantly higher levels of parental mental health issues compared with those with a negative screen (P<.001). The ICPW was positive in 32% of the parents (n=155), with consistent total scores regardless of the infant's increasing age (r=-0.024, P=.59). The ICPW tool exhibited a strong negative predictive value (93%) for diagnosing postpartum depression. The Dutch ICPW tool is a reliable and valid screening instrument for identifying parents struggling with infant crying.

Association of Maternal Short Sleep Duration With Neurodevelopmental Delay in Offspring: A Prospective Cohort Study.

To investigate how short sleep duration (SSD) during pregnancy is related to neurodevelopmental delays in offspring, we aimed to inform pregnancy sleep guidelines and promote maternal health and child development. To identify the associations between SSD during pregnancy and offspring neurodevelopmental delay and to determine whether fetal glucose metabolism plays a role in SSD and neurodevelopmental delays. This cohort study followed 7059 mother-child pairs from the Maternal & Infants Health in Hefei cohort, and collected sleep data during pregnancy via the Pittsburgh Sleep Quality Index at weeks 24 to 28 and 32 to 36. Neurodevelopmental outcomes from 6 to 36 months postpartum were assessed via the Denver Developmental Screening Test-II and the Gesell Development Diagnosis Scale. Cox proportional hazard regression was used to analyze the link between maternal SSD and neurodevelopmental delay risk. Mediation analysis was used to evaluate the role of cord blood serum C-peptide levels. Three hospitals and children's health centers in Hefei were involved. The stratified analysis revealed a significant association between mothers with SSD during midpregnancy and neurodevelopmental delay in boys (adjusted HR 2.05, 95% CI 1.29, 3.25). Cord blood marker analysis revealed a positive relationship between cord blood serum C-peptide levels and neurodevelopmental delay in offspring (RR 0.04, 95% CI 0.00, 0.08). The proportion of the association between SSD and neurodevelopmental delay mediated by cord blood C-peptide was 11.05%. Maternal SSD during pregnancy was continuously associated with an increased incidence of neurodevelopmental delay with sex differences among offspring. This association may be mediated in part by increased higher levels of cord C-peptide.

Family Planning and Children's Human Capital: Experimental Evidence From Urban Malawi.

We conduct a randomized controlled trial that provides pregnant and immediate postpartum women with improved access to family planning through counseling, free transportation to a clinic, and financial reimbursement for family planning services over two years. We study the effects of our intervention on child growth and development outcomes among 1,034 children born to participating women directly before the intervention rollout. We find that children born to mothers assigned to the family planning intervention arm were 0.28-0.34 standard deviations taller for their age and 10.7-12.0 percentage points less likely to be stunted within a year of exposure to the intervention. Children born to mothers assigned to the intervention arm also scored 0.17-0.20 standard deviations higher on a caregiver-reported measure of cognitive development after two years of intervention exposure. Although the nonmeasurement of children is a challenge in our study, our estimates are robust to multiple methods of correcting for potential attrition bias. Our results are consistent with models of fertility that link couples' fertility decisions to child health and human capital. Our results also suggest that improved access to family planning might have positive downstream effects on child health beyond contraceptive use and fertility outcomes.

The association between neighborhood socioeconomic deprivation and mental health in low- and middle-income countries: A scoping review.

Environmental research on mental health primarily originates from high-income countries, while information about the rest of the world remains limited. This study examined: (1) the available published research evidence regarding the association between neighborhood-level deprivation and indicators of mental health and illness in low- and middle-income countries (LMICs), and (2) the gaps in the relevant research in LMIC settings that should be addressed in future studies. First, we systematically searched for relevant primary studies in electronic databases (Ovid Medline, Scopus, Socindex, and PsycINFO) and citations in the reference lists. Then, a two-stage screening procedure was employed to select the relevant studies by screening the titles and abstracts and reviewing the selected full texts by independent researchers. After charting the data from the selected study reports, we collated, summarized, and discussed the results. We retrieved 51 studies across 19 LMICs, with only one study originating from a low-income country. Most studies focused on adult mental health topics and few explored children's mental health. Notably, a significant majority of these studies (N = 37) reported a positive association between neighborhood deprivation and mental health/disorder. However, the research methods used varied significantly, and there were several methodological limitations. This review highlights the need for more original studies in LMICs on the association between neighborhood deprivation and mental health, employing stronger methodologies.

Psychological distress in the neonatal intensive care unit: a meta-review.

Parental psychological distress (PD) (anxiety, depression, stress and post-traumatic stress syndrome) can adversely affect parents' own physical and mental health as well as their children's long-term health and development. Numerous studies have addressed PD in mothers of infants admitted to NICU, with interventions proposed, but few have addressed the impact on fathers or other family members. The present review examined systematic reviews that addressed PD in NICU and potential interventions. A meta-review was performed by searching various databases between 2000 and May 2024. Fifty-four studies were included. The incidence of maternal PD varied depending on the screening tool used (13-93%), as did paternal PD (0.08-46%). The incidence of PD in sexual, racial and gender minorities, siblings, grandparents and those in lower-middle income countries is not known. Numerous screening tools were used with a wide variety of cut-off values. Various intervention programmes were evaluated and showed contradictory evidence regarding their effect on PD. Routine screening should be implemented together with acombination of interventional programmes, specifically family-centred interventions. More research is required for PD in siblings, sexual and genderminority parents as well as parents living in low middle income countries. Psychological distress is high in NICU, affecting parents and siblings. Maternal psychological distress may have long lasting effects on infant health and differs from that of fathers, who require as much attention as mothers Little is known about emotional stress in siblings and sex and gender minority group peoples Few interventions showed conclusive effectiveness in reducing psychological distress with combination interventions showing more effectiveness than single interventions.

Development and validation of asthma diagnostic scale for children.

To construct an asthma diagnostic scale for children under 6 years old. An electronic medical record database was used to develop the scale. Item pool was established through literature survey and expert opinion. Items were screened and optimized by using the Delphi method, t-test, reactivity analysis, Pearson correlation coefficient, factor analysis, reliability and validity test. The predictive probability of asthma was calculated using logistic regression, and receiver operating characteristic curve. Another childhood asthma database was used to validated the scale. The asthma diagnostic scale for children under 6 years old included five dimensions: dimension 1 (shortness of breath, three concave sign, cyanosis, moist rale, heart rhythm, heart sound and dyspnea), dimension 2 (respiratory sound, cough, sputum), dimension 3 (frequency of wheezing, allergic rhinitis, history of allergy in one or both parents), dimension 4 (sex, wheezing, atopic dermatitis), and dimension 5 (reversible airflow, positive in vitro or in vivo allergy test). The Cronbach's α coefficients for the five dimensions were 0.846, 0.459, 0.019, 0.202, and 0.024. The area under the ROC curve (AUC), sensitivity, and specificity were 0.737, 59.1%, and 81.2%. AUC, sensitivity, and specificity in the validation database were 0.614, 76.2%, and 46.7%. The scale has significant diagnostic value for asthma in children under 6 years old. 1. The aim of the study was to establish an asthma diagnosis scale for children younger than 6 years old. 2. Our study not only addresses the lack of diagnostic criteria of young children asthma, but also indicates the accuracy of the diagnostic scale. 3. The data may help to reduce the missed diagnosis and misdiagnosis rate of asthma, and improve the diagnostic accuracy of the disease, and thus reduces the harm of asthma to children's physical and mental health.

Rib-on-pelvis deformity: a modifiable driver of pain and poor health-related quality of life in cerebral palsy.

Cerebral Palsy (CP) often presents with a sweeping thoracolumbar scoliosis and pelvic obliquity. With severe pelvic obliquity, the ribs come into contact with the high side of the oblique pelvis, termed rib-on-pelvis deformity (ROP). ROP can result in costo-iliac impingement, or pain associated with ROP, and can also adversely affect breathing and sitting balance. The goal of this study was to evaluate whether CP patients with ROP have worse health-related quality of life (HRQOL) before surgery and a greater improvement in HRQOL after surgery. A retrospective analysis of a prospectively collected, multicenter, international registry was performed for all nonambulatory patients with CP treated with spinal fusion with at least two-year follow-up. HRQOL was measured via the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD) questionnaire domains (0 = most disability, 100 = least disability). ROP was defined as having a rib distal to the superior portion of the iliac crest on preop upright radiographs. The ROP group and control group without ROP were compared regarding six domain scores and total score of CPCHILD. Multiple linear regression was used to control for curve apex location, major coronal Cobb angle, type of tone, and pelvic obliquity. 340 patients met inclusion criteria (52% female, mean age 14.0years). The mean major coronal Cobb angle was 81 degrees and mean pelvic obliquity was 22 degrees. 176 patients (51.8%) had ROP while 164 patients (48.2%) did not. ROP was independently associated with worse preoperative Positioning/Transfers/Mobility (PTM), Comfort & Emotions (C&E), and total CPCHILD score via the CPCHILD questionnaire (p < 0.05). Patients with preoperative ROP experienced a greater improvement in the C&E and PTM domains as well as total CPCHILD score than patients without ROP (p < 0.05). CP patients with rib-on-pelvis deformity experience more pain and worse HRQOL than patients without this deformity. These patients experienced a greater improvement in HRQOL after spinal fusion measured via the CPCHILD questionnaire.

Assessment of Refractive Errors, Dental Caries, and Scoliosis in School Children Aged 6-14 Years: A Study in Durrës Schools

This study aims to assess the prevalence of refractive errors, dental caries, and scoliosis in children aged 6-14 years across several primary and secondary schools in the city of Durrës. The sample includes 370 students from "Vincenc Prendushi", "Nënë Tereza", "Vasil Ziu", "Abedin Dino", and "Bajram Curri" schools. Each school was selected randomly. From each school we have selected different classes and students for further evaluation. Each student underwent a clinical examination to evaluate vision, oral health, and postural status. Refractive errors were assessed using Snellen chart table placed in 6 meters. Dental caries was evaluated through clinical inspection of the teeth, using the DMFT index (Decayed, Missing, and Filled Teeth). Scoliosis was diagnosed through physical examination and the Adams forward bend test, done in physiotherapy lab of Aleksander Moisiu University. The results provide insight into the risk factors and the need for early interventions to improve the overall health of children in this age group. Out of the 370 students, 28% (104 students) were found to have refractive errors, with myopia being the most common condition, affecting 17% (63 students), followed by hyperopia in 9% (33 students), and astigmatism in 2% (8 students). A total of 42% (155 students) exhibited signs of dental caries, with an average DMFT score of 2.8, indicating a moderate level of oral health concerns. Additionally, 12% (45 students) were diagnosed with scoliosis, with mild curvature observed in 8% (30 students) and moderate to severe curvature in 4% (15 students). These findings suggest a significant need for vision correction, oral health education, and orthopedic monitoring in the student population. Early detection and preventive measures in schools are crucial to addressing these health issues effectively and ensuring the well-being of children during their developmental years.

Co-Design Model of Support for Child and Family Health Nurse Practice with Culturally and Linguistically Diverse Families

Culturally and linguistically diverse (CALD) mothers with young children face multiple inequities in accessing primary health services, such as language barriers, social isolation, low health literacy, and the availability of appropriate interpretation services. These inequities are persistent and indicate that child and family health nurse (CFHN) services, the providers of primary healthcare in many developed countries, require better support to address the needs of these families. This study engaged with CFHNs and healthcare interpreters to co-design a model of support for practice using workshops that included individual and collective brainstorming and visual representations. Transcripts of the discussion were analysed using thematic analysis. CFHNs and interpreters were able to articulate their perfect service model: a central multidisciplinary team of CFHNs, interpreters, and bilingual educators who could facilitate nurse–interpreter and nurse–interpreter–client relationships, allowing CFHNs and interpreters to do their jobs properly. This central structural component would support and be supported by rapport, trust, client choice and access, continuity of care, and cultural comfort. The study concluded that CALD mothers’ access and engagement require CFHNs to have support for their cultural comfort through the mechanism of bilingual educators and the expansion of healthcare interpreters’ role and scope in working with CFHNs in the delivery of services.

Caregivers of children with asthma alarmed by climate change: a cross-sectional study.

Climate change poses significant health risks, with children being particularly vulnerable to its adverse health effects. Children with asthma are expected to have worsening disease due to increased exposure to heat, air pollution, mold from flooding, and pollen. Understanding caregiver perspectives on these health harms is crucial for informing public health policy and education. Therefore, we aimed to explore caregiver perceptions of climate change-related health risks to children with asthma. In this cross-sectional study, a survey instrument was created and distributed to caregivers of children with asthma during their visits to pulmonology clinics located in an urban northeastern US setting and via email. Among 198 completed surveys, 78% of participants reported high levels of concern about climate change, with most respondents agreeing that climate change has already impacted their child's health. Examples provided by respondents included worsening asthma control due to air pollution, wildfire events, pollen exposure, and rapid changes in weather. Respondents who self-identified as female had greater concern. Most respondents agreed that these topics should be further discussed with their child's doctor. Although, barriers to such discussions were noted by the respondents. Caregivers of children with asthma have high levels of concern regarding climate change and report adverse impacts on their child's asthma. Clinicians caring for children with asthma should consider discussing the respiratory health impacts of climate change with caregivers. However, barriers to these discussions need further examination.

Identifying children at risk in Swedish Child Health Services.

Child Health Services plays an important role in identifying at-risk children and intervening early to break negative trends in child health. Sociodemographic risk factors can impact the workload of Child Health Services and affect the possibilities of providing the national child healthcare programme. This study aims to present the sociodemographic characteristics of families who are registered within the Child Health Services, as defined by the Child adjusted Care Need Index. By collecting personal identification numbers from children six years or younger registered at a child healthcare centre, and combining this with their caregiver's sociodemographic background, this study was able to create a sociodemographic index for each child healthcare centre in Sweden. The study included 687,543 children and 1,335,540 caregivers from 981 child healthcare centres in Sweden. Approximately 21% of all children in the study population had a caregiver born in Southern or Eastern Europe outside the European Union, or in Africa, Asia, or South America, 7% had single parents, 17% had at least one unemployed caregiver, and 9% had at least one caregiver who had not completed high school. The average input values and the average index values varied widely both between and within the regions. This study displays a large variation in sociodemographics for child healthcare centres both within and between regions. Since several regions and national agencies in Sweden use the Child adjusted Care Need Index, it is necessary to keep the dispersion in mind.

Deforestation and Children: Consequences for Paediatric Malaria and Educational Attainment in Indonesia

This study examines the effect of forest loss on child health and educational outcomes in Indonesia, a country that has experienced one of the highest deforestation rates in the world. In line with the findings in the medical and biological literature that deforestation can encourage the breeding of malaria-carrying mosquitoes through changes in local ecosystems, our estimation results show that deforestation significantly increases child fever but not other infectious diseases, implying an increased incidence of malaria infection due to deforestation. In addition, the results from the education analysis show that children exposed to larger-scale deforestation in early childhood are afterwards more likely to fall behind academically in terms of years of education. Various robustness checks suggest that these adverse health and educational effects are driven by forest loss but not by other possible preexisting trends or confounders.

DETERMINATION OF THE RISK FACTORS ASSOCIATED WITH PROBLEMATIC SOCIAL MEDIA USE AMONG ADOLESCENTS OF ALBANIAN AND MACEDONIAN DESCENT IN NORTH MACEDONIA

Problematic social media use turns out to have effects on many dimensions of teenagers' lives, including emotional well-being, social interactions, and interpersonal relationships. The focus of research is oriented directed towards identification, in addition to its effects, the predictive factors associated with problematic use of social media. The purpose of this study is to predict the effect of family support, school support and school well-being on the problematic social media use among adolescents in North Macedonia. The study included 5144 adolescents 11, 13 and 15 years old, of which 48.4% are boys and 51.6% are girls. Considering the structure of the population in the country, 66.6% are young Macedonians and 33.4% Albanians. The data presented are part of the cross-sectional study "Health and Behaviour of School-aged Children", collected during 2022. The results of the research showed that family support is a predictor of problematic social media use for Macedonian and Albanian girls and boys, whereas teacher support did not emerge as a determinant of problematic social media use. Prediction role of classmates’ support and school pressure are also discussed.

Quality of life, capability well-being, financial strain and physical activity in the short- and medium-term COVID-19 post-lockdown phases in the UK: a repeated cross-sectional study.

The COVID-19 lockdowns had negative effects on children's and adults' mental and physical health. There is, however, a paucity of research that explores differences in health-related quality of life (HRQL) and well-being over time after the COVID-19 lockdowns had been lifted. Furlough during lockdowns, increases in unemployment, and the emerging cost-of-living crisis all put pressure on family finances, which could have a detrimental effect on HRQL and well-being. This study, part of the wider Active-6 study, explored how HRQL, capability well-being and family financial strain changed after the lockdowns, the relationship between these outcomes, and whether physical activity had any mediating effect on differences in HRQL and capability well-being. Cross-sectional data were collected in May-December 2021 (Wave 1) and January-July 2022 (Wave 2). Children (aged 10-11) and their parent/carer were recruited from 23 to 27 schools in each wave, respectively, and completed validated questionnaires measuring HRQL (adults - EQ-5D-5L, children - CHU9D), capability well-being (adults - ICECAP-A) and family financial strain (adults - Family Economic Strain Scale, FESS). Children also completed questions on capability well-being. Weekday minutes of moderate-to-vigorous physical activity (MVPA) were measured using accelerometers. Mixed-effects regression models, adjusted for gender, age group (adults only), IMD and highest household education, were used to explore differences in HRQL and capability well-being between waves. In addition, the moderating effect of financial strain and the mediating effect of MVPA on HRQL and capability well-being were explored. Active-6 recruited 393 parent-child pairs in Wave 1 and 436 in Wave 2. There were no differences in HRQL (EQ-5D, CHU9D) and capability well-being (ICECAP-A) scores between waves, but financial strain was worse in Wave 2 compared to Wave 1 (FESS score difference 1.14 adjusted 95% CI 0.15 to 2.12). Increased financial strain was associated with lower (worse) EQ-5D-5L, CHU9D and ICECAP-A scores. There was no evidence of a mediating effect of MVPA. Pre-COVID-19 data on HRQL were not collected, so analysis was limited to post-lockdown only. Participating parents were predominantly female and participation was lower among lower socio-economic groups, limiting our ability to explore inequalities. Intervention planning to increase physical activity and health and well-being during the COVID-19 recovery should consider the financial strain families are experiencing and the negative implications of financial strain on HRQL. There were no differences in HRQL and capability well-being in children and adults after lockdowns lifted in 2021 and a year later in 2022. The results indicate increasing financial strain, which could reflect the UK's 'cost of living crisis'. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847.