Life In Children Research Articles

Feeling adequately heard by Adults, perceived safety and Children’s life Satisfaction: A multinational comparison of individualist and collectivist cultures across 18 countries

Feeling adequately heard by adults is a crucial factor in children's life satisfaction. Despite this, few studies have explored the underlying processes from an international perspective. The current study aimed to investigate the mediating effect of perceived safety and the moderating effect of collectivism. Using data from 22,688 children in 18 countries, the study found a positive association between being adequately heard by adults and children's life satisfaction. Furthermore, the relationship was mediated by perceived safety. The study also revealed that the impact of being adequately heard by adults on perceived safety and children's life satisfaction was moderated by collectivism. The findings of this study have significant theoretical and practical implications for improving children's life satisfaction.

Hollman Facilitations: a user-friendly tool of supporting children with visual impairment and their families in daily life

The Robert Hollman Foundation (RHF) designed “Hollman Facilitations” (HF), a user-friendly way of supporting children with visual impairment (VI) and their families on a daily basis. This tool consists of specifically designed pictures on simple A4 sheets, which highlight with images and captions the key aspects of these children's everyday lives. Professionals can easily modify Hollman Facilitations to customize them to the unique developmental needs of every single child with VI and to their individualized strengths and weaknesses. This type of support acts as a reminder, to help families keep in mind what is essential for their children with VI in everyday life. HF are also useful for professionals because they give a clear, at-a-glance overview of visually impaired children's needs, helping their communication with their families. In order to understand the perceived effectiveness of this tool, a questionnaire was designed and sent to 49 families, asking their opinions and satisfaction levels regarding its clarity, adequacy, usability and usefulness. 36 parents answered reporting overall very high satisfaction levels. A second questionnaire was sent to 29 RHF professionals to collect their opinions regarding HF usability and usefulness and the majority of them was very satisfied of its use in their daily work. This data supports overall this tool, which can be also easily replicated and also potentially used in other settings, beyond the field of visual impairment.• HF support children with VI and their families substantially and works as a reminder of what the professionals found in their consultations, to be fundamental for the children to promote the use of their functional vision and their strengths and to consequently improve the quality of their daily lives• HF favour a better communication between health professionals and families of children with VI, sharing therapeutic indications through the adoption of a customized, user-friendly, everyday tool by integrating pictures and text with oral communication• HF help professionals to identify strategies that best promote the overall development of children with visual impairment and to express them in an understandable way

EEG findings and clinical severity and quality of life in non-epileptic patients with autism spectrum disorders

ABSTRACT Electroencephalogram (EEG) abnormalities could be seen in up to 60% of non-epileptic children with autism spectrum disorder (ASD). They have been used as biomarkers of ASD severity. The objective of our study is to identify EEG abnormalities in children with different degrees of ASD severity based on the Autism Treatment Evaluation Checklist (ATEC). We also want to assess the quality of life for children with ASD. All of the children underwent at least one hour of sleep-deprived EEG. Forty-five children were enrolled, of whom 42 were male. EEG abnormalities were found in 10 (22.2%) children, predominantly in the bilateral frontal areas. There were no differences in EEG findings among the mild, moderate, and severe ASD groups. The severity of ASD was associated with female sex (p-value = 0.013), ASD with attention deficit hyperactivity disorder (ADHD) (p-value = 0.032), ASD children taking medications (p-value = 0.048), and a lower Pediatric Quality of Life Inventory (PedsQL) (p-value <0.001). Social and emotional domains were the most problematic for health-related quality of life in ASD children, according to parent reports of PedsQL. Further studies with a larger sample size will help to clarify the potential associations between EEG abnormalities and the severity of ASD, as well as the impact on quality of life.

Guest editorial: Generating evidence to improve quality of life and other outcomes for children and adults with intellectual and other developmental disabilities

Guest editorial: Generating evidence to improve quality of life and other outcomes for children and adults with intellectual and other developmental disabilities

Exploring the influence of instagram use on materialism and situational intrinsic learning motivation: An online experimental study

AbstractIn recent years, social media such as YouTube, TikTok, and Instagram have become an essential part of the everyday lives of children and young adults. Integrating elements of these social media into higher education may have the potential to enhance situational intrinsic learning motivation through the emotional design and proximity to students' lives, but this also poses the risk of fostering a situational materialistic focus due to the ubiquitous materialistic content on especially Instagram, undermining situational intrinsic learning motivation. In the present study, we examined if the primary use of Instagram is associated with higher materialism and how exposure to Instagram-framed pictures influences situational intrinsic learning motivation. The current study conducted an online experiment. Participants (N = 148) were randomly assigned to one of three groups after they rated items about general and problematic social media use and materialism. In the first two groups, participants were asked to rate the pleasantness of luxury or nature Instagram-framed pictures. A third group received no pictures. Afterwards, the situational intrinsic learning motivation was assessed through a mock working task. The findings prove that people who (primarily) use Instagram tend to be more materialistic than people who (primarily) use another social medium and that exposure to Instagram-framed pictures neither positively nor negatively influenced situational intrinsic learning motivation but moderated the relationship between problematic social media use and situational intrinsic learning motivation. Limitations, implications, and future directions for social media use inhigher education are discussed.

Assessment of Activity Daily Living of Children with Autism Spectrum Disorder

Daily living activities are very important for children with autism spectrum disorders to master so that they are independent, but there are still children with autism who have not fully mastered these daily living activity skills. This study aims to determine the abilities and disabilities of children with autism spectrum disorders in daily living activities. The focus of research in this study was a grade 4 autistic student at SDLB Al-Ishlah Purwadadi, Subang Regency. The research method used is a descriptive method in the form of a case study with a qualitative approach. The results of this research are that the abilities of autistic students in activity daily living have not been fully mastered by children, around 61% of activity daily living are still assisted by parents in doing it.

A Systematic Review and Meta-Analysis of Impairment and Quality of Life in Children and Adolescents with Anxiety Disorders.

Anxiety disorders are common, emerge during childhood, and pose a significant burden to society and individuals. Research evaluating the impact of anxiety on functional impairment and quality of life (QoL) is increasing; however, there is yet to be a systematic review and meta-analysis of these relationships in pediatric samples. This systematic review and meta-analysis were conducted to determine the extent of impairments in functioning and QoL that young people with anxiety disorders experience relative to their healthy peers, as well as sociodemographic and clinical moderators of these relationships. Studies were included when they compared young people (mean age range within studies 7-17years) with a primary clinical anxiety disorder to a healthy comparison group and measured impairment and/or QoL via a validated instrument. A total of 12 studies met criteria for this review (N = 3,129 participants). A majority of studies (K = 9) assessed impairment as an outcome measure, and three assessed QoL outcomes. Meta-analysis of nine studies (N = 1,457 children) showed large relationships between clinical anxiety and life impairment (g = 3.23) with the strongest effects seen for clinician report (g = 5.00), followed by caregiver (g = 2.15) and child (g = 1.58) report. The small number of studies and diversity in methodology prevented quantitative investigation of moderating factors. In the systematic review of QoL outcomes, all three studies reported significantly poorer QoL for youth with anxiety disorders relative to unaffected peers. Findings support the importance of measuring functioning and QoL as outcomes in clinical research and practice among anxious young people.This study is registered with PROSPERO under the identification number CRD42023439040.

Engaged fatherhood and new models of “nurturing care”: Lessons learnt from Austria, Italy, Lithuania and Portugal

AbstractResearch on gender‐based violence highlights the need to engage men in prevention work through social change programs that present care as a powerful antidote to violence. Implementation of such programs worldwide provides many examples of how education and support for fathers and fathers‐to‐be can promote healthy masculinities and relationships with an intimate partner and their children. This article aims to explore the findings and lessons learned from the pilot of the European Union‐funded Promotion, Awareness Raising and Engagement of men in Nurture Transformations (PARENT) project (PARENT) which sought to develop and pilot curricula adapted from the internationally tested Program P methodology. The PARENT pilot worked in four European countries to provide training activities for social, educational, and health professionals, as well as education groups for fathers and parents, with the overarching goal of preventing domestic violence through the promotion of engaged fatherhood. By reporting the results from mixed‐methods impact evaluations of pilot programs conducted with professionals and parents, this article discusses how gender‐synchronous father‐focused training can contribute to a shift toward increased positive engagement of fathers during the first 1000 days of a child's life. The article conveys the pilot's promising impact on the knowledge, attitudes, and behaviors of professionals and parents, and it examines some of the key contextual factors, limitations, and implementation approaches that plausibly contributed to the PARENT pilot outcomes, with the aim to formulate useful considerations for future scale‐up efforts or the future implementation of similar programs to engage fathers in nurturing care and violence prevention.

An analysis of health-related quality of life in children and adolescents after parotidectomy based on patient-reported outcomes.

To assess health-related quality of life (HRQoL) and its influencing factors in these pediatric patients undergoing parotidectomy. This was a cross-sectional study that included 37 children and adolescents (≤ 19years) with parotid gland tumors who were treated in Sichuan Cancer Hospital between January 2006 and November 2021. HRQoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). The Wilcoxon rank sum test was used to analyze the factors influencing patients' HRQoL. 37 children and adolescents were included in the study, including 22 cases of benign tumors and 15 cases of malignant tumors. All patients underwent surgery, and some patients with malignant tumors received radiotherapy or chemotherapy. Malignancy, permanent facial palsy, and Frey syndrome were associated with worse HRQoL in children and adolescents with parotid gland tumors. Radiotherapy and no cervical lymph node dissection were associated with worse HRQoL in pediatric patients with malignancy. The surgical approach of parotid is not a factor influencing HRQoL. Factors associated with HRQoL in children and adolescents with parotid gland tumors include pathological types, permanent facial palsy, and Frey syndrome. In addition, factors affecting patients with malignancy include lateral lymph node dissection and radiotherapy.

Tungiasis among children in Kenya is associated with poor nutrition status, absenteeism, poor school performance and high impact on quality of life.

Tungiasis is a highly neglected tropical skin disease caused by the sand flea, Tunga penetrans. The flea burrows into the skin inducing a strong inflammatory response, leading to pain and mobility restrictions with potential impacts on quality of life. Few countries implement control efforts and there are few data on the impact of the disease to support policy decisions. We conducted a survey to determine the impact of tungiasis among primary school children across nine counties of Kenya. A total of 10,600 pupils aged 8 to 14 years were randomly selected from 97 primary schools and examined for tungiasis. For 81 cases and 578 randomly selected controls, anthropometric measurements were made, and school attendance and exam scores were collected from school records. Of those with tungiasis, 73 were interviewed regarding their quality of life using a tungiasis-specific instrument. Mixed effect ordered logistic and linear models were used to assess associations between disease status and impact variables. Compared to uninfected pupils, those with tungiasis had lower weight-for-age z-scores (adjusted β -0.41, 95% CI: -0.75-0.06, p = 0.020), missed more days of school the previous term (adjusted Incidence Rate Ratio: 1.49, 95% CI: 1.01-2.21, p = 0.046) and were less likely to receive a high score in mathematics (aOR 0.18, 95% CI: 0.08-0.40, p<0.001) and other subjects. Pupils with severe disease (clinical score >10) were four times more likely to experience severe pain than those with mild disease (OR 3.96, 95% CI: 1.35-11.64, p = 0.012) and a higher impact on their quality of life than those with mild disease (aOR 3.57, 95% CI: 1.17-10.8, p = 0.025) when adjusted for covariates. This study has demonstrated tungiasis has a considerable impact on children's lives and academic achievement. This indicates the need for integrated disease management for school-aged children to protect their physical and cognitive development and their future prospects.

Digital addiction in children with end-stage kidney disease on regular hemodialysis: a cross-sectional study

BackgroundChronic kidney disease has a detrimental impact on the overall quality of life (QoL) in children. The regular visits to doctors, prolonged reliance on medication, frequent hospital stays, and changes in their physical appearance increase their vulnerability to developing psychiatric problems and hinder their daily activities and social interactions, resulting in isolation, poor peer relations, and low self-esteem. These factors may compel these children to depend on digital media to find connections, regulate emotions, and cope with their illnesses. The study aims to determine the prevalence of electronic addiction among minors undergoing regular hemodialysis for end-stage kidney disease (ESKD) while simultaneously assessing their parental styles and psychological adaptation.A total of 60 subjects were enrolled in the study and divided into two groups. Group A: Thirty patients undergoing regular hemodialysis for ESKD. Group B: Thirty healthy subjects of matching age and sex. All the recruited participants were subjected to semi-structured clinical interviews according to our institute’s sheets, Child Behavior Checklist (CBCL), Digital Addiction Scale for Children (DASC), Parent Authority Questionnaire (PAQ), and Psychological Adaptation Scale.ResultsPatients patients had a significantly higher prevalence of digital addiction compared to healthy subjects, with an average score of (87.00 ± 21.23) in dialysis patients against (53.00 ± 25.20) in normal participants, demonstrating significant differences (p< 0.001). There was a significant correlation between the duration of dialysis treatment and the prevalence of digital addiction (r = -0.415, p-value = 0.023). A significant inverse correlation was found between digital addiction and the emotional subtype of the psychological adaption rating (r= -0.375, p= 0.041).ConclusionThe findings revealed that dialysis patients have a higher incidence of digital addiction. Prolonged dialysis duration was significantly associated with increased digital addiction among patients.

From reflective practice to action research and positive change: securing high levels of wellbeing among learners with autism spectrum condition in the mainstream setting

ABSTRACT This article details and reflects on an action research project that explored the in-class wellbeing of children with autism within a mainstream primary school in Wales. It also sets out why reflective practice alone may be insufficient in the process of achieving positive change. Through the iterative reflective cycles of action research, drivers that promoted positive wellbeing in children with additional learning needs were identified, and barriers to these children’s happiness were confronted. Driven by a commitment to effective inclusion of all learners, the initial reconnaissance phase of the research recorded that episodes of in-class low wellbeing experienced by children with autism were higher than those of their fellow classmates in terms of their frequency and severity. This discovery inspired a collaborative process of pedagogic inquiry to find positive change. Teachers working across year groups developed, trialled, and reflected on interventions that aimed to improve the daily lived experiences of children with additional learning needs and enhance educational outcomes. The exponential growth of children identified as having autism makes research into the in-school positive wellbeing of this group both necessary and urgent. It is hoped that this study will inspire others, both in school and in wider contexts, to undertake action research to improve the lives of children with additional learning needs, such as autism.

Dental pain in Brazilian preschool children: association with the severity of dental caries and impact on oral health-related quality of life.

This study aimed to verify the association between dental pain and severity of dental caries (caries morbidity stages) and the impact on oral health-related quality of life (OHRQoL) in preschool children. A cross-sectional study with 199 children (2-5years old) enrolled at preschools in Capão do Leão-RS, Brazil. The self-report of mothers of children with a history of dental pain in the last 6months and perception of their child's OHRQoL (ECOHIS) were obtained through a structured questionnaire. This questionnaire also collected independent variables. Children's oral examination was performed using the CAST instrument to determine caries morbidity stage. Crude and adjusted Poisson regression analysis was performed. The prevalence of dental pain was 14.57%. The chance of the occurrence of dental pain was higher among children diagnosed in morbidity [Prevalence ratio-PR: 5.29 (95% confidence interval-95% CI 1.91-14.61); p = 0.001] and severe morbidity [RP = 6.12 (95 CI% 2.25-16.64); p < 0.001] stages. Children with dental pain presented higher scores in the total ECOHIS [rate ratio = 7.11 (95% CI 4.55-11.09); p < 0.001] and in all of the domains of this instrument. Furthermore, children with a history of dental trauma [PR = 2.41 (95% CI 1.15-5.04); p < 0.001] and those whose reason for last visit to the dental office was for restorative/endodontic/extraction treatment [PR = 1.29 (95% CI 1.01-6.19); p = 0.049] had a higher prevalence of dental pain. A substantial prevalence of dental pain in the last 6months and negative impact on children's OHRQoL was identified in this sample. Children diagnosed with carious dentin lesions and abscess and fistula were more likely to have dental pain.

Rhinosinusitis in children with acute respiratory infection: quality of life and features of drug therapy

BACKGROUND: The relevance of the study is due to limited information on the impact of various forms of rhinosinusitis that have arisen against the background of acute respiratory infection on the quality of life of children and effective treatment methods. AIM: To conduct a clinical assessment of the effect on the recovery time and quality of life in children with acute rhinosinusitis and exacerbation of polypous rhinosinusitis that occurred against the background of a respiratory infection, including antiviral drugs in complex treatment in the early stages. MATERIALS AND METHODS: A simple controlled randomized comparative clinical trial was conducted, involving 74 children aged 15 to 18 years. The clinical efficacy and safety of the use of antiviral drugs in complex therapy, which are neuraminidase inhibitors on the 5th, 7th and 10th days of treatment, were evaluated in comparison with groups receiving pentanedioic acid imidazolylethanamide. The inclusion criterion was acute rhinosinusitis and exacerbation of chronic polypous rhinosinusitis against the background of acute respiratory infection. To establish the diagnosis, an examination of ENT organs, computed tomography of the nose and paranasal sinuses were performed, patients subjectively assessed clinical complaints and quality of life in the Russian version of the standard form of the SF-36 questionnaire. RESULTS: Positive dynamics was noted in the early stages in the 2nd subgroup of the 1st group who took neuraminidase inhibitors in addition to complex therapy. Manifested by a decrease in the average score for VAS to 80.0%, difficulty in nasal breathing to 1.7 points on the 10th day of treatment, relative to those taking imidazolylethanamide pentanedioic acid, where there was a decrease in the average score for VAS by 22.4%, difficulty in nasal breathing to 2.54 points. A similar pattern was observed with nasal congestion, rhinorrhea, and quality of life indicators according to the SF-36 questionnaires. CONCLUSION: Improvement of clinical symptoms and quality of life indicators at an earlier date in children with polypous rhinosinusitis and acute rhinosinusitis against the background of a previous respiratory infection with the inclusion of neuraminidase inhibitors in complex therapy confirmed higher efficacy.

Examining the economic impacts of caregiving among families of children of medical complexity: A qualitative study to inform inclusive economic models.

Children with medical complexity (CMC) represent a heterogeneous group of children with multiple, chronic healthcare conditions. Caregivers of CMC experience a high intensity of caregiving that is often variable, extends across several networks of care, and often lasts for the entirety of the child's life. The economic impacts of caregiving are yet understudied in the CMC context. There have been recognized limitations to the sole use of quantitative methods when developing economic models of disease because they lack direct caregiver voice and context of caregiving activities and existing methods have been noted to be ableist. The purpose of this study was to explore the economic spillover impacts of caregiving among families of CMC using their own words and perspectives with the intent of expanding caregiver-centered perspectives when developing economic models. This study was a secondary analysis of a qualitative study that was conducted to examine family management practices among caregivers of CMC and their social networks. Caregivers of CMC were recruited through a Pediatric Complex Care clinic at an academic medical center in the mid-Atlantic region, USA. This study used inductive qualitative descriptive methods and the use of a template to define features of the person impacted and to define the economic construct as either a direct or indirect/spillover cost. Twenty caregivers were included in this study. Perspectives from the caregivers of CMC revealed several key themes: (1) time investment in caregiving - impacting the primary caregivers; (2) physical and mental health impacts - impacting the child themselves, siblings, and the primary caregivers; (3) impacts to leisure activities and self-care - impacting the child themselves, siblings, and the primary caregivers; (4) impacts to the social network/social capital. The themes described can be operationalized into inclusive family-centered models that represent the impacts of caregiving in the context of the family units of CMC. The use of qualitative methods to expand our development of quantitative economic models can be adapted to other populations where caregivers are involved in care. Caregivers can and should have an active voice in preference-based assessments that are operationalized in economic contexts to make them more inclusive. n/a. RR2-10.2196/14810.

Agreement between quality of life assessed using family proxy and child self-reports among children with hematologic malignancy.

Evidence-based literature recognizes that the different degrees of agreement between a child self-report and a proxy-report depend on the characteristics of the domains, the child's age and illness, the proxy's own perspective on QoL, and family attendance during the child's hospitalization. This study aims to determine the degree of agreement between proxy-reports and child self-reports on quality of life (QoL) for children with hematologic malignancy ranging in age from 5 to 18 years who are undergoing treatment.We retrieved clinical QoL data from a study titled "Dynamic change in QoL for Vietnamese children with hematologic malignancy" from April 2021 to December 2022. To evaluate the magnitude of agreement between self-reports and proxy-reports, intraclass correlation coefficients (ICCs) for 259 pairs of measurements were quantified. Using independent t tests, the mean differences between self-reports and proxy-reports were tested.Moderate agreement was consistent through all age groups for five subscales, including physical, psychosocial, pain, nausea, and procedural anxiety (ICCs ranged from 0.53 to 0.74). The weakest agreement appeared in two groups, subjects aged 5-7 years and 13-18 years on six domains (school, treatment anxiety, worry, cognitive problems, perceived physical appearance, and communication) (-0.01 to 0.49). Child self-rating was consistently higher than that of proxies for the physical, emotional, and nausea domains among children aged 5-7 years and for procedural anxiety, treatment anxiety, and cognitive problems among children aged 8-12 years. Conclusion: The agreement level of self-reports and proxy-reports was differently distributed by child age and the PedsQL domains. The proxy children agreement on QoL among children with hematologic malignancy was divergent according to the different age groups, which could potentially be explained by proxy-child bonding at different stages of childhood development. Our recommendation for future studies is to explore children's age as a potential factor influencing proxy agreement on QoL among children with cancer. What is Known: • Children and their proxies may think differently about quality of life (QoL). • Comparing two sources of data (i.e., child and proxy) on aspects of QoL can help identify the discrepancies between children's perceptions of their QoL and their parents' perceptions. This can be useful in terms of identifying potential areas for improvement or concern and may also be helpful in making decisions about treatment and care. What is New: • Our study results demonstrated that proxies who comprised children aged 5-7 years or 13-18 years reported differently among domains that cannot be expressed verbally or with body language, including cognitive problems, perceived physical appearance, and communication. • Children generally perceived their QoL to be better than their proxies. Therefore, a more comprehensive understanding of children's QoL may require the consideration of multiple sources of data from various perspectives.

The Management of a Moroccan Population of Medically Compromised Children: A Satisfaction Survey among Parents in the Pediatric Dentistry Service CCTD of Casablanca

Oral problems can have a considerable impact on the general health and quality of life of healthy children and even more those with physical or mental disabilities. And conversely, general status can affect oral status. In fact, the satisfaction assessment in the dental care field is mandatory toward both healthy and medically compromised children. Unfortunately, in Morocco, studies taking into account the needs of the Moroccan population and especially the medically compromised children in the field of dental care are very few, that’s why the main objective of this study was to measure the satisfaction of the parents of these children with their management of oral health. within the CCTD pediatric dentistry service in Casablanca.

The when, why, and how of using glycopyrronium to diminish drooling in children with neurodevelopmental disabilities: Implications for clinical practice

BackgroundDespite the established efficacy of glycopyrronium bromide in reducing drooling among children with neurodevelopmental disabilities, evidence on its impact on the daily lives of children and parents and effectiveness in a real-world setting are scarce, especially among long-term users. This study explored timing and duration of glycopyrronium treatment, effect and impact on daily life, and occurrence of side effects to inform clinical practice. MethodsThis was a retrospective cohort study at a national referral centre for drooling, including 61 children with nonprogressive neurodevelopmental disabilities, treated with glycopyrronium for anterior and/or posterior drooling between 2011 and 2021. Data were obtained from medical records and supplemented by structured telephone interviews with parents. ResultsAnterior drooling severity decreased in 82% of the included children. Changes in the impact of drooling on burden of care, social interaction, and self-esteem were reported in 55%, 31%, and 36%, respectively. Side effects were noted for 71% of cases, yet only 36% of parents deemed these as outweighing the positive impact of treatment. A substantial majority (77%) of the included children were long-term users (≥6 months). Among these, 38% of parents reported decreasing effectiveness and 27% noticed more prominent side effects over time. ConclusionsGlycopyrronium demonstrated potential in mitigating the impact of drooling on daily life, although variations were observed in the specific aspects and extent of improvement. The real-world context of our study provides important insights for refining clinical practices, emphasizing the need for balanced consideration of treatment benefits and potential side effects to facilitate shared decision-making.

Addressing the growing burden of obesity, diabetes and asthma in children and adolescents: The role of primary health care and the WHO Pocket book in Europe for a healthy future

The burden of obesity, diabetes mellitus and asthma remains a significant public health issue worldwide. These conditions are associated with premature deaths and a reduced quality of life. Primary health care plays a key role in the prevention, detection, and management of noncommunicable diseases in childhood, including diabetes and asthma. Health promotion is crucial for a healthy life from early childhood, preventing from obesity, a sedentary lifestyle, exposure to tobacco smoke, and other risk factors associated to noncommunicable diseases. Asthma and type 1 diabetes mainly begin in childhood; thus, recognition and early detection at the primary health care level are essential. In the long term, management of children with chronic diseases requires regular follow-up and cooperation with a specialized team. Care coordination by the primary health care provider is key for optimal control of the disease and development of the child or adolescent in the physical, emotional, and social spheres. Over-referral for diagnosis and follow-up is associated with unnecessary specialist overload, patient anxiety, and financial burden for the families and the health system. Clear criteria and referral pathways with efficient communication between the professional team members are essential to empower primary health care providers, avoid unnecessary referrals, and optimize the care and quality of life of children and adolescents with chronic diseases.The WHO Pocket book of primary health care for children and adolescents was recently developed to address knowledge gaps and improve the diagnosis and management of children and adolescents at the outpatient level. It dedicates an entire chapter to health promotion and disease prevention with counselling messages addressed to children, adolescents and their families; provides guidance for the diagnosis and management of asthma, diabetes and other chronic diseases; and includes additional considerations for adolescents living with chronic conditions.

Access to legacy-oriented interventions at end of life for pediatric oncology patients: A decedent cohort review.

Legacy-oriented interventions have the potential to offer pediatric oncology patients and families comfort at end of life and during bereavement. Certified child life specialists often provide these services, and presently little is known about whether disparities exist in the provision of legacy-oriented interventions. In this retrospective decedent cohort study, we examined demographic and clinical characteristics from a sample of 678 pediatric oncology patients who died between 2015 and 2019. Bivariate analysis assessed differences between patients who received any versus no legacy-oriented intervention. Uni- and multivariable logistic regression models assessed associations of baseline characteristics and likelihood of receiving legacy-oriented intervention. Further multivariable analysis explored joint effects of significant variables identified in the univariable analysis. Fifty-two percent of patients received a legacy-oriented intervention. Older adolescents (≥13years) were less likely (odds ratio [OR]: 1.73, p=.007) to receive legacy-oriented interventions than younger ones. Patients with home/hospice deaths were also less likely (OR: 19.98, p<.001) to receive interventions compared to patients who passed away at SJCRH locations. Hispanic patients (OR: 1.53, p=.038) and those in palliative care (OR: 10.51, p<.001) were more likely to receive interventions. No significant race association was noted. All children and adolescents with cancer deserve quality care at end of life, including access to legacy-oriented interventions, yet nearly half of patients in this cohort did not receive these services. By identifying demographic and clinical characteristics associated with decreased odds of receiving legacy-oriented interventions, healthcare professionals can modify end-of-life care processes to improve access. Introducing legacy-oriented interventions early and increasing exposure in community spaces may enhance access to legacy-oriented interventions for pediatric oncology patients.