Kids Project Research Articles

Supporting parents with acutely ill children: Environment scan and user evaluation of mobile applications (the SuPa kids project)

BackgroundChildren are one of the biggest users of emergency departments in the UK, sometimes utilising services when experiencing acute illnesses that can be managed at home. mHealth can be an efficacious way for parents/guardians to manage acute illnesses. It has also become a ubiquitous resource to promote public health interests within a resource constrained health system. However, to be effective, co-design is necessary with concepts such as usefulness, ease of use, trustworthiness and security underpinning the utility of mHealth interventions for acute childhood illness. ObjectiveThe objective of this study was to conduct an environmental scan of mHealth apps for parental assessment and management of acute childhood illnesses in 0- to 5-year-olds, review the content and functionality of each identified app against the list of desired attributes identified in previous research and synthesise publicly available reviews from end users to demonstrate the quality of current apps in the marketplace and identify areas for improvement. MethodApp characteristics were mapped to an a priori defined list of desirable attributes. End user reviews were mapped to a modified Technology Acceptance Model framework that included overarching themes of: Perceived Usefulness (PU), Perceived Ease of Use (PEU), Perceived Trustworthiness (PT) and Perceived Security (PS) using reflexive thematic analysis. ResultsOverall, 15 apps were included in the analysis (Table 2). Fourteen of the 15 apps were available on both the iOS and Android platforms. ‘Baby Illness, Prevention, Cure’ was only available on the Android store. All apps were free to download and did not restrict access to information or features via in-app purchases. Baby and child first aid (British Red Cross) was the earliest app to be released (2014). This app was updated annually, with the most recent update being 2022. The most recent apps to be released (2018) were ‘AskFirst’ (formerly Ask NHS), ‘Essex Child Health’ and ‘The Lullaby Trust Baby Check’, updated in 2022, 2020 and 2019, respectively. No individual app met all the desirable attributes highlighted by parents in previous research. Both ‘Healthier Together’, and ‘The Lullaby Trust Baby Check’ included all but one desirable attributes (video), as did the ‘’CATCH (Common Approach to Children’s Health), which did not utilise a traffic light system. Apps that were locality specific were not rated by users (Berkshire Child Health, Cheshire Child Health, Child Health Guide Newham, Child Health HMR, Oldham Child Illness and Walsall Healthy Child). All other apps were rated from 2/5 to 5/5 stars. When considering localities, the ‘CATCH’ app was only supported in Halton, Cheshire, Knowsley, Liverpool, St Helens and Vale Royal. Further investigation evidenced no correlation between inclusion of the desirable attributes and app rating. ConclusionOverall, this research has highlighted several aspects of best practise when developing mHealth apps for the management of acute childhood illnesses, for increasing PU, PEU, PT and PS; and also, places importance on co-design.

Association between sleep disorders and health care utilization in children with chronic medical conditions: a Medicaid claims data analysis.

To examine the risk of increased health care utilization (HU) linked to individual sleep disorders in children with chronic medical conditions. Medicaid claims data from a cohort of 16,325 children enrolled in the Coordinated Healthcare for Complex Kids (CHECK) project were used. Sleep disorders and chronic medical conditions were identified using International Classification of Diseases, Ninth, and 10th Revision, codes. Three HU groups were identified based on participants' prior hospitalizations and emergency department (ED) visits in the 12 months prior to enrollment: low (no hospitalization or ED visit), medium (1-2 hospitalizations or 1-3 ED visits), and high (≥ 3 hospitalizations or ≥ 4 ED visits). The odds of being in an increased HU group associated with specific sleep disorders after controlling for confounding factors were examined. Children with chronic medical conditions and any sleep disorder had nearly twice the odds (odds ratio = 1.83; 95% confidence interval: 1.67-2.01) of being in an increased HU group compared with those without a sleep disorder. The odds of being in the increased HU group varied among sleep disorders. Only sleep-disordered breathing (odds ratio = 1.51; 95% confidence interval : 1.17-1.95), insomnia (odds ratio = 1.46; 95% confidence interval : 1.06-2.02), and circadian rhythm sleep disorder (odds ratio = 2.45; 95% confidence interval : 1.07-5.64) increased those odds. Younger age and being White were also linked to increased HU. Sleep disorders are associated with increased risk of heightened HU (ED visits and/or hospitalizations) in children with chronic medical conditions. This risk varies by specific sleep disorders. These findings indicate the need for careful evaluation and management of sleep disorders in this high-risk cohort. Adavadkar PA, Brooks L, Pappalardo AA, Schwartz A, Rasinski K, Martin MA. Association between sleep disorders and health care utilization in children with chronic medical conditions: a Medicaid claims data analysis. J Clin Sleep Med. 2024;20(4):595-601.

GAMIFICATION OF EDUCATION IN ELEMENTARY SCHOOL IN DISTANCE LEARNING

The use of gamification in elementary school is a modern approach aimed at improving learning and increasing students' interest in the learning process. This approach makes it possible to improve the effectiveness of education, involve students in active participation and develop various important skills. Due to the use of modern technologies and changing approaches to education, gamification has become a powerful tool for stimulating the learning process in elementary school. This article examines methodological aspects of using gamification in the educational process of elementary school students. Considering the growing interest in the use of game elements in education, special attention is paid to the analysis of various methods and approaches to the implementation of gamification in the educational process. Strategies for developing gamified lessons, selecting appropriate game elements and integrating them into the curriculum to achieve optimal results are considered. The importance of a methodical approach to the introduction of gamification into the educational process of elementary school is analyzed in order to optimize the quality of education and attract students to active participation in educational activities. Theoretical sources from the pedagogical and psychological fields, as well as practical research on the use of gamification in education, are considered. The online platforms Matific, Learning.ua, Math Learning service, Smart Kids project and «Child Development» were used for the analysis. These tools allow students to be actively involved in learning, adapt the material to their needs, overcome geographical barriers and ensure more effective learning. When choosing educational services, elementary school teachers should take into account the age and development of children, as well as the coherence of the curriculum and values to ensure successful learning and development of students. The main requirements for the implementation of methodological aspects of gamification of the educational process of elementary school include: 1) clear identification of optimal strategies and methods of gamification, as well as 2) development of recommendations for teachers regarding their practical application in the educational process. Teachers can use the findings to create interesting and effective lessons, which contribute to the active involvement of students in the learning process and improve their learning results. In general, we note that the popularity of games among students is explained not only by the very fact of their existence, but also by the satisfaction of the game process itself, the quick feedback and the satisfaction of solving tasks. This can significantly increase the effectiveness of learning and the involvement of students in gaining new knowledge.

A social network analysis of perpetrators of child maltreatment reported by youth in foster care

ObjectivePrior research on child maltreatment has focused on distinct features of maltreatment (type, severity, chronicity) important for youth outcomes, yet perpetrators of child maltreatment reported by youth have gone largely unstudied. The present study examines connections between perpetrators, the total number and type of perpetrators reported, and the frequency at which each type of perpetrator was reported across 24 relationship types to provide a foundation for future research seeking to provide comprehensive measurement of perpetrator profiles. MethodsData from 503 youth in foster care (8–21 years old) were collected through the Studying Pathways to Adjustment and Resilience in Kids (SPARK) Project. Youth reported on their history of physical, sexual, and psychological maltreatment. Social Network Analysis (SNA) was used to visualize links between perpetrators within maltreatment type and paired samples t-tests were used to compare differences between network edge weights. ResultsFull sample SNA results were highly interconnected and variable across maltreatment types. Biological parents and peers were the most common perpetrators of physical and psychological abuse with peers and non-family adults being most common for sexual abuse. Family and community member groupings were most distinct in the physical and psychological abuse networks whereas in the sexual abuse network, ties between perpetrators were more equidistant. ConclusionsDifferences exist in perpetrator profiles across maltreatment types, adding a layer of complexity to how maltreatment experiences are captured, and variability in profiles might provide insight to differing youth outcomes. Understanding individual youth perpetrator profiles could be used to inform foster care placements and reduce the risk of revictimization.

22.4 Pharmacogenetic-Supported Prescribing for Kids (PGx-SParK)

Emerging evidence suggests that pharmacogenetic (PGx) information can assist with identifying individuals at greatest risk for poor response or adverse drug reactions to commonly prescribed psychotropic medications (particularly antidepressants and antipsychotics). In the Pharmacogenetic-Guided Prescribing for Kids (PGx-SParK) project, we are studying the implementation of PGx testing in Alberta, Canada using a low-cost customized genetic panel run at a publicly funded provincial laboratory and offered at no cost to the patient.

Rates of diagnoses of sleep disorders in children with chronic medical conditions.

This investigation examines sleep disorder (SD) diagnoses in a large population of children and adolescents with chronic medical conditions (CMCs). Little is known about SD diagnoses in this population. The large population used in this study allowed examination of SD rates by CMC type and demographics. Data were from the Coordinated Health Care for Complex Kids (CHECK) project designed for Medicaid-funded children and adolescents with at least 1 CMC from a large metropolitan area. The study population (n = 16,609) was limited to children and adolescents, 0 to 18 years of age. SD and CMC diagnoses were obtained from Medicaid claims data. Fourteen percent of the population (mean age of 9.1 years [standard deviation = 5.2]; 35.8% African American; 56.4% male; 77 with more than 1 CMC) received a sleep disorder diagnosis. The most frequent diagnosis was sleep-disordered breathing (11.2%), followed by nocturnal enuresis (1.2%) and insomnia (1%). SDs were diagnosed more frequently in those with multiple CMCs than in those with 1 CMC (19.7% vs 5.8%; P < .001). Insomnia rates in Hispanic/Latinx (1.2%) and African American (0.8%) children and adolescents were significantly lower (both P < .001) than in Caucasians (3.5%). Odds of receiving a sleep diagnosis varied among CMCs. Our analysis of Medicaid claims data of a large urban cohort offers detailed information about the rates of sleep diagnoses and suggests underdiagnosis of SDs in this vulnerable, high-risk, primarily ethnic minority population. Underrecognition of sleep disorders has short- and long-term health and economic consequences. Study results may help clinicians implement appropriate SD screening and management for children and adolescents with CMCs. Adavadkar PA, Pappalardo AA, Glassgow AE, etal. Rates of diagnoses of sleep disorders in children with chronic medical conditions. J Clin Sleep Med. 2022;18(8):2001-2007.

Birth outcomes affecting infants of mothers with intellectual and developmental disabilities.

Women with intellectual and developmental disabilities (IDD) face increased risk of adverse maternal pregnancy outcomes, yet less is known about infant outcomes. To examine birth outcomes of infants born to mothers with IDD and assess associations with demographics and IDD-type. We used data from the Big Data for Little Kids project, which links Wisconsin birth records to Medicaid claims for live births covered by Medicaid from 2007 to 2016. We identified IDD using maternal prepregnancy Medicaid claims and ran Poisson regression (with a log link function) with robust variance clustered by mother to compare prevalence of outcomes between singleton births with and without mothers with IDD. We adjusted the associations for demographic factors and estimated prevalence ratios (PR) as the effect measure. We assessed outcomes by IDD-type (intellectual disability, genetic conditions, cerebral palsy, and autism spectrum disorder) to explore differences by categories of IDD. Of 267,395 infants, 1696 (0.6%) had mothers with IDD. A greater percentage of infants with mothers with IDD were born preterm (12.8% vs 7.8%; PR 1.64, 95% confidence interval [CI] 1.42, 1.89), small for gestational age (8.5% vs 5.4%; PR 1.42, 95% CI 1.25, 1.61), and died within 12months of birth (3.2% vs 0.7%; PR 4.93, 95% CI 3.73, 6.43) compared to infants of mothers without IDD. Prevalence ratios were robust to adjustment for demographics factors. Estimates did not meaningfully differ when comparing different IDD-types. A greater porportion of infants born to mothers with IDD who were covered by Medicaid had poor outcomes compared to other infants. Prevalence of poor infant outcomes was greater for mothers with IDD even after accounting for demographic differences. It is imperative to understand why infants of mothers with IDD are at greater risk so interventions and management can be developed.

593 Odds of Receiving Sleep Diagnoses in Common Pediatric Chronic Medical Conditions

Abstract Introduction Sleep disorders (SD) are under-diagnosed in the general pediatric population. Children with chronic medical conditions (CMC) tend to have a higher prevalence rate of SD; however, the studies about the rates of diagnosis of SD are limited. We examined the odds of receiving SD diagnoses in children with various CMC and hypothesized that if this likelihood is established, screening tools can be developed to increase the rates of diagnoses and improve clinical outcomes. Methods Chi-square test and regression analysis were used to test the association between SD and CMC based on ICD-9 and -10 diagnosis codes retrieved from the Medicaid claims submitted for children (0 to 18 years) enrolled in the Centers for Medicare and Medicaid Services-funded Coordinated Health Care for Complex Kids (CHECK) project, at an urban, public tertiary care hospital. Children without a CMC were excluded. Results Among 16,609 children with CMC (mean [SD] age of 9.1 [5.3] years; 56.4% male; 77% with multiple CMC), 14.1% received a diagnosis of SD. Compared to the cohort without a particular CMC, children with attention deficit hyperactivity disorder (ADHD), obesity, developmental disorder, or asthma had following odds of receiving sleep diagnosis respectively (odds ratio (OR) [Confidence Interval]): insomnia (6.9 [5–9.5]; 2.4 [1.7–3.2]; 1.6 [1.2–2.3]; 0.7 [0.5–1]), circadian rhythm disorders (6.1[2.7–13.7]; 2.8 [1.3–2.6]; 3.0 [1.4–6.4]; 0.5* [0.2–1.1]), hypersomnia (2.9 [1.0–8.6]; 7.8 [3–20.2], 0.9* [0.3–2.6], 0.8* [0.3–2.2]), and sleep-related movement disorder (1.9* [0.9–4.3]; 4.4 [2.5–7.8]; 2.2 [1.2–3.9]; 0.6*[0.3–1.1]). (*=p value &amp;lt;0.05). Conclusion Odds of receiving sleep diagnoses vary across CMC. Among others, strong associations between obesity-hypersomnia and ADHD-insomnia were noted. This information may help clinicians implement appropriate screening interventions to improve early SD detection and management. Further studies to examine these associations are necessary. Support (if any):

A generative co-design framework for healthcare innovation: development and application of an end-user engagement framework

Plain English summaryBackgroundContinual improvements to health systems, products, and services are necessary for improvements in health. However, many of these improvements are not incorporated into everyday practice. When designing new health systems, products, and services, involving members of the healthcare community and the public with personal healthcare experience can help to make sure that improvements will be useful and relevant to others like them.MethodsTogether with healthcare workers and family members with healthcare experience, we developed and applied a step-by-step guide to involving those with personal experience in the design of health system improvements.ResultsOur guide has three phases— ‘Pre-Design’, ‘Co-Design’, and ‘Post-Design’. This paper describes each of these phases and illustrates how we applied them to our own project, which is to use virtual healthcare methods to improve care for children with chronic healthcare conditions and their families. In our own work, we found that healthcare workers and family members with personal healthcare experiences were able to use their knowledge and creativity to help us imagine how to improve care for children with chronic healthcare conditions and their families. We have created action items from these family member- and healthcare worker-identified needs, which we will use to shape our virtual healthcare system.ConclusionsThis paper may be useful for those seeking to involve members of the healthcare community and the public in the creation of better healthcare systems, products, and services.BackgroundChallenges with the adoption, scale, and spread of health innovations represent significant gaps in the evidence-to-practice cycle. In the health innovation design process, a lack of attention paid to the needs of end-users, and subsequent tailoring of innovations to meet these needs, is a possible reason for this deficit. In the creative field of health innovation, which includes the design of healthcare products, systems (governance and organization mechanisms), and services (delivery mechanisms), a framework for both soliciting the needs of end-users and translating these needs into the design of health innovations is needed.MethodsTo address this gap, our team developed and applied a seven-step methodological framework, called A Generative Co-Design Framework for Healthcare Innovation. This framework was developed by an interdisciplinary team that included patient partners.ResultsThis manuscript contributes a framework and applied exemplar for those seeking to engage end-users in the creative process of healthcare innovation. Through the stages of ‘Pre-Design’, ‘Co-Design’, and ‘Post-Design’, we were able to harness the creative insights of end-users, drawing on their experiences to shape a future state of care. Using an expository example of our own work, the DigiComp Kids project, we illustrate the application of each stage of the Framework.ConclusionsA Generative Co-Design Framework for Healthcare Innovation provides healthcare innovators, applied health science researchers, clinicians, and quality improvement specialists with a guide to eliciting and incorporating the viewpoints of end-users while distilling practical considerations for healthcare innovation and design.

Risk of developing active tuberculosis following tuberculosis screening and preventive therapy for Tibetan refugee children and adolescents in India: An impact assessment.

BackgroundTuberculosis (TB) rates among Tibetan refugee children and adolescents attending boarding schools in India are extremely high. We undertook a comprehensive case finding and TB preventive treatment (TPT) program in 7 schools in the Zero TB Kids project. We aimed to measure the TB infection and disease burden and investigate the risk of TB disease in children and adults who did and did not receive TPT in the schools.Methods and findingsA mobile team annually screened children and staff for TB at the 7 boarding schools in Himachal Pradesh, India, using symptom criteria, radiography, molecular diagnostics, and tuberculin skin tests. TB infection (TBI) was treated with short-course regimens of isoniazid and rifampin or rifampin. TB disease was treated according to Tibetan and Indian guidelines. Between April 2017 and December 2019, 6,582 schoolchildren (median age 14 [IQR 11–16] years) and 807 staff (median age 40 [IQR 33–48] years) were enrolled. Fifty-one percent of the students and 58% of the staff were females. Over 13,161 person-years of follow-up in schoolchildren (median follow-up 2.3 years) and 1,800 person-years of follow-up in staff (median follow-up 2.5 years), 69 TB episodes occurred in schoolchildren and 4 TB episodes occurred in staff, yielding annual incidence rates of 524/100,000 (95% CI 414–663/100,000) person-years and 256/100,000 (95% CI 96–683/100,000) person-years, respectively. Of 1,412 schoolchildren diagnosed with TBI, 1,192 received TPT. Schoolchildren who received TPT had 79% lower risk of TB disease (adjusted hazard ratio [aHR] 0.21; 95% CI 0.07–0.69; p = 0.010) compared to non-recipients, the primary study outcome. Protection was greater in recent contacts (aHR 0.07; 95% CI 0.01–0.42; p = 0.004), the secondary study outcome. The prevalence of recent contacts was 28% (1,843/6,582). Two different TPT regimens were used (3HR and 4R), and both were apparently effective. No staff receiving TPT developed TB. Overall, between 2017 and 2019, TB disease incidence decreased by 87%, from 837/100,000 (95% CI 604–1,129/100,000) person-years to 110/100,000 (95% CI 36–255/100,000) person-years (p < 0.001), and TBI prevalence decreased by 42% from 19% (95% CI 18%–20%) to 11% (95% CI 10%–12%) (p < 0.001). A limitation of our study is that TB incidence could be influenced by secular trends during the study period.ConclusionsIn this study, following implementation of a school-wide TB screening and preventive treatment program, we observed a significant reduction in the burden of TB disease and TBI in children and adolescents. The benefit of TPT was particularly marked for recent TB contacts. This initiative may serve as a model for TB detection and prevention in children and adolescents in other communities affected by TB.

Social Inequalities Negatively Impact SARS-CoV-2 Seroprevalence in Different Subgroups of Healthcare Workers in Rio De Janeiro

Background: COVID-19 has exacerbated health inequalities worldwide. Yet, such a perspective has not been investigated in specific healthcare workers and their resulting inclusion as a priority group for vaccination have been an important focus of political and social discussion. This study aimed at investigating whether SARS-CoV-2-seropositivity in healthcare workers in a public hospital in Rio de Janeiro, Brazil, was influenced by social determinants of health and the social vulnerability in subgroups of workers. Methods: A serological survey was conducted in 1,154 healthcare workers in June and July 2020. The association between the serological test results for detection of IgG antibodies to SARS-CoV-2 and socioeconomic, occupational characteristics and transportation used by the workers to commute was assessed using the Pearson´s chi-square test and Carmer’s V. Findings: Overall, the serum prevalence for the virus in the healthcare workers was 30%. Non-white workers with lower income and schooling, as well as users of the mass transportation system showed the highest infection rates. Importantly they mostly corresponded to hospital support workers, in particular the cleaning personnel. Accordingly, income, schooling and work modality appeared as negative predictors, as ascertained by forest plot analysis. Interpretations: The data clearly illustrate the inequality in SARS-CoV-2 infection in the Brazilian population, comprising even healthcare workers of the Brazilian unified health system.Funding Information: This study was financed by Fiocruz, CNPq, Faperj, Capes, FOCEM/Mercosur and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.Declaration of Interests: The authors declare no competing financial interests.Ethics Approval Statement: “Clinical and immunological characteristics of children, adolescents, and adults with COVID-19 diagnosis: COVID-19 Kids Project” was submitted to the Institutional Review Board of IFF (CEP/IFF) under identification number 30487120.2.0000.0008 and approved under review number 4.100.148. There was no discrimination in the selection of research subjects or exposure to unnecessary risks.

Measuring the Effects of a Demonstration to Reduce Childhood Food Insecurity: A Randomized Controlled Trial of the Nevada Healthy, Hunger Free Kids Project

BackgroundTo reduce childhood hunger, the US Department of Agriculture funded a set of demonstration projects, including the Nevada Healthy, Hunger-Free Kids (HHFK) project. ObjectiveThe study objective was to test whether the Nevada HHFK project reduced child food insecurity (FI-C) among low-income households with young children. DesignHouseholds were randomly assigned to treatment and control groups, with outcomes measured using household surveys and administrative data. Survey data were collected at baseline (n=3,088) and follow-up (n=2,074) 8 to 12 months into the project. Participants/settingEligible households in Las Vegas, NV, had children under age 5 years, received Supplemental Nutrition Assistance Program (SNAP) benefits, and had incomes below 75% of the federal poverty level. InterventionBetween June 2016 and May 2017, treatment households on SNAP received an additional $40 in monthly SNAP benefits per child under age 5 years. Main outcome measuresKey outcomes included FI-C (primary), food security among adults and households, and food expenditures (secondary). Statistical analyses performedDifferences between the treatment and control groups were estimated by a logistic regression model and controlling for baseline characteristics. Analyses were also performed on socioeconomic subgroups. ResultsThe Nevada HHFK project did not reduce FI-C (treatment=31.2%, control=30.6%; P=0.620), very low food security among children (P=0.915), or food insecurity among adults (P=0.925). The project increased households’ monthly food expenditures (including SNAP and out-of-pocket food purchases) by $23 (P<0.001). ConclusionsA demonstration project to reduce FI-C by increasing SNAP benefits to Las Vegas households with young children and very low income did not reduce FI-C or other food-insecurity measures. This finding runs counter to prior research showing that SNAP and similar forms of food assistance have reduced food insecurity. This project was implemented during a period of substantial economic growth in Las Vegas. Future research should explore the role of the economic context, children’s ages, and household income in determining how increases in SNAP benefits affect food insecurity. ClinicalTrials.gov identifierNCT 04253743 (http://www.clinicaltrials.gov) Funding/SupportThis article is published as part of a supplement supported by the US Department of Agriculture, Food and Nutrition Service.

A Consideration of the Evaluation of Demonstration Projects to End Childhood Hunger (EDECH)

A Consideration of the Evaluation of Demonstration Projects to End Childhood Hunger (EDECH)

Pregnancy complications and maternal birth outcomes in women with intellectual and developmental disabilities in Wisconsin Medicaid.

Women with intellectual and developmental disabilities (IDD) may face greater risk for poor pregnancy outcomes. Our objective was to examine risk of maternal pregnancy complications and birth outcomes in women with IDD compared to women without IDD in Wisconsin Medicaid, from 2007-2016. Data were from the Big Data for Little Kids project, a data linkage that creates an administrative data based cohort of mothers and children in Wisconsin. Women with ≥1 IDD claim the year before delivery were classified as having IDD. Common pregnancy complications and maternal birth outcomes were identified from the birth record. We calculated risk ratios (RR) using log-linear regression clustered by mother. We examined outcomes grouped by IDD-type and explored interaction by race. Of 177,691 women with live births, 1,032 (0.58%) had an IDD claim. Of 274,865 deliveries, 1,757 were to mothers with IDD (0.64%). Women with IDD were at greater risk for gestational diabetes (RR: 1.28, 95% CI: 1.0, 1.6), gestational hypertension (RR: 1.22, 95% CI: 1.0, 1.5), and caesarean delivery (RR 1.32, 95% CI: 1.2, 1.4) compared to other women. Adjustment for demographic covariates did not change estimates. Women with intellectual disability were at highest risk of gestational hypertension. Black women with IDD were at higher risk of gestational hypertension than expected under a multiplicative model. Women with IDD have increased risk of pregnancy complications and adverse outcomes in Wisconsin Medicaid. Results were robust to adjustment. Unique patterns by IDD types and Black race warrant further exploration.

Transforming learning with computers: Calculus for kids

The Calculus for Kids project was deliberately designed to use computers in the transformation of curriculum. The intervention used multi-media learning materials to assist teachers and Year 6 (aged 11–12 years) students understand the principles of integral calculus. They used Maple mathematics software to solve real-world problems using these principles and by employing conventional mathematics notation on their individual computers. Between June 2010 and April 2016, it was implemented in 23 classes at 19 schools involving 434 students. Two methods were used to calculate effect sizes of 22.19 (pre-test/post-test Cohen’s d) and 1.17 (age-maturation). Positive gains were also found in students’ attitudes, particularly in Technology confidence. This article discusses methods for calculating effect sizes for transformational education with computers and recommends further research in the field.

The Impact of Hearing Impairment on the Life Trajectories of Aboriginal Children in Remote Australia: Protocol for the Hearing Loss in Kids Project.

BackgroundPrevious studies have reported a high prevalence of chronic otitis media (OM) and hearing impairment (HI) in Aboriginal children in the Northern Territory (NT) of Australia. Children affected by these disorders are believed to be at increased risk for adverse outcomes in early childhood development, school attendance, academic performance, and child maltreatment and youth offending. However, to date, there have been no studies quantifying the association between HI and these outcomes in this population.ObjectiveThis study will investigate the association between HI and the 5 outcomes in Aboriginal children living in remote NT communities.MethodsIndividual-level information linked across multiple administrative datasets will be used to conduct a series of retrospective observational studies on selected developmental and school outcomes. The predictor variables for all studies are the results from audiometric hearing assessments. The outcome measures are as follows: Australian Early Development Census results, representing developmental readiness for school, assessed around 5 years of age; Year 1 school attendance rates; Year 3 school-based academic performance, assessed in the National Assessment Program—Literacy and Numeracy; incidence of child maltreatment events (including both notifications and substantiated cases); and incidence of a first guilty verdict for youth offenders. Confounding and moderating factors available for the analysis include both community-level factors (including school fixed effects, socioeconomic status, level of remoteness, and housing crowdedness) and individual-level factors (including maternal and perinatal health and hospital admissions in early childhood).ResultsThe study commenced in 2018, with ethics and data custodian approvals for data access and linkage. This has enabled the completion of data linkage and the commencement of data analysis for individual component studies, with findings expected to be published in 2019 and 2020.ConclusionsThis study will provide first evidence of the impact of OM-related HI on the developmental, educational, and social outcomes of Australian Aboriginal children. The findings are expected to have significant implications for policy development, service design, and resource allocation.International Registered Report Identifier (IRRID)RR1-10.2196/15464

Challenges and Principles to guide the linkage of government administrative data: Experiences from the Tassie Kids project

Background with rationale An overarching concern influencing models of data linkage for public good is the maintenance of personal privacy. This concern is at times so strong that it prevents or slows the progress of achieving worthwhile linked administrative datasets across allied government departments, and even between distinct units within a single department. Where linkage has succeeded it has generally produced data sets that, by design, are difficult or impossible to re-identify, therefore meeting the requirement to guard privacy at the costs of the resulting data’s value to government decision makers.&#x0D; Main Aim The main aim of this paper is to convey criteria to inform data linkage policy and practice in government that maintains a central role for privacy, but which can better deliver on the promise of high value data for policy.&#x0D; Methods/Approach This paper is informed by the Tassie Kids project, a longitudinal linked administrative data study using an embedded researcher model underway in Tasmania, Australia. Among other outcomes, the project was designed to assist allied government agencies to identify key policy leverage points across multiple services. Using the Tassie Kids project as a case study this paper asks why allied departments don’t routinely link administrative data. Several important linked administrative data design principles are drawn from discussion of this question.&#x0D; Results The paper explains the practice implications of these design principles relevant to policy analysis and information management units in government.&#x0D; Conclusion The paper concludes with the suggestion that high value linked administrative data is data that maximises its representation of the dynamic mechanisms that affect the outcomes desired by government, while simultaneously minimising the data’s distance from its point of origin.

Selective screening for familial hypercholesterolemia in Austrian children - first year results

BackgroundFamilial hypercholesterolemia (FH), the most frequent monogenetic hereditary disorder, is underdiagnosed and undertreated. Early identification of FH is essential because of the increased risk for premature cardiovascular diseases and childhood might be the optimal period for cholesterol screening. Aim of this selective screening was to detect familial hypercholesterolemia, the most frequent monogenetic hereditary disorder in children to guarantee early detection and treatment. The Austrian strategy for primary schools, to perform a pre-school examination by school physicians, allows to reach all children aged 5–7 years.MethodsThe screening was conducted within the school enrolment examinations in all 215 public primary schools in Vienna between January to May 2017. Positive cholesterol screening was defined by non-HDL-C > 160 mg/dL and/or LDL-C > 130 mg/dL.ResultsIn total, 18,152 children had their school enrolment examination. From 133 tested pre-school children, nine individuals were positive-screened with a mean LDL-C of 161 ± 26 mg/dL, non-HDL-C of 181 ± 24 mg/dL and total cholesterol (TC) of 239 ± 23 mg/dL. From 85 siblings, four individuals were positively screened with a mean LDL-C of 150 ± 7 mg/dL, non-HDL-C of 184 ± 8 mg/dL and TC of 231 ± 10 mg/dL. Patients did not have any xanthomas, xanthelasms, arcus lipoides, or any cardiovascular comorbidities.ConclusionsScreening at early childhood by school physicians seems to be a successful strategy and possible. With this Austrian selective screening method, FH Kids Austria, we could find nine patients with positive raised level LDL-cholesterol and/or non-HDL cholesterol out of 133 blood tests. Prevention of cardiovascular diseases is essential and it is our duty to increase the awareness of this disease. Limitations of the FH Kids project were reduced participation of school physicians and refusal of the parents.

Variable Uptake of Medicaid-Covered Prenatal Care Coordination: The Relevance of Treatment Level and Service Context.

Prenatal care coordination programs direct pregnant Medicaid beneficiaries to medical, social, and educational services to improve birth outcomes. Despite the relevance of service context and treatment level to investigations of program implementation and estimates of program effect, prior investigations have not consistently attended to these factors. This study examines the reach and uptake of Wisconsin's Prenatal Care Coordination (PNCC) program among Medicaid-covered, residence occurrence live births between 2008 and 2012. Data come from the Big Data for Little Kids project, which harmonizes birth records with multiple state administrative sources. Logistic regression analyses measured the association between county- and maternal-level factors and the odds of any PNCC use and the odds of PNCC uptake (> 2 PNCC services among thoseassessed). Among identified Medicaid-covered births (n = 136,057), approximately 24% (n = 33,249) received any PNCC and 17% (n = 22,680) took up PNCCservices. Any PNCC receipt and PNCC uptake varied substantially across counties. A higher county assessment rate was associated with a higher odds of individual PNCC assessment but negatively associated with uptake. Mothers reporting clinical risk factors such as chronic hypertension and previous preterm birth were more likely to be assessed for PNCC and, once assessed, more likely to received continued PNCC services. However, most mothers reporting clinical risk factors were not assessed for services. Estimates of care coordination's effects on birth outcomes should account for service context and the treatment level into which participants select.

Responsive In-situ Simulation in Kids (RISK) project: a novel approach to learning from clinical incident reporting.

The number of reported clinical incidents continues to rise in the UK, with 1.9 million incidents reported to the National Reporting and Learning System from July 2016 to June 2017, an increase of 6.9%.1 Despite this, there has not been a clear demonstrable improvement in patient safety. This is in part due to a failure to disseminate effective safety interventions into routine practice as well as the lack of a consistent tool to measure improvements in patient safety problems.2 Incident reporting in itself does not lead to improved patient safety without reflection, investigation and re-organisation,3 requiring us to find ways in which we can best respond to clinical incidents in a responsive and timely fashion to prevent recurrence. Regular in situ simulation has been shown to result in sustained improvements in the management of acutely unwell paediatric patients.4 In situ simulation is also a practical method of identifying latent safety threats, allowing implementation of system changes that contribute to improved patient care.5 We developed an in situ simulation programme—known as RISK (Responsive In-situ Simulation in Kids)—within the paediatric department of University College London …