Low Numbers Of Children Research Articles

Early impacts of the COVID-19 pandemic on children with pediatric rheumatic diseases.

The experiences of children with pediatric rheumatic diseases (PRD) during the initial phase of the COVID-19 pandemic have not been well-documented. We sought to determine the effects of the COVID-19 pandemic on protective behaviors, healthcare access, medication management, and education among an international cross-sectional parental survey of children with PRDs. The COVID-19 Global Rheumatology Alliance Patient Experience Survey was distributed online, and parents of children with parental-reported PRD, with or without COVID-19 infection, were eligible to enroll. Respondents described their child's demographics, adoptions of protective behaviors, healthcare access, changes to immunosuppression, and disruptions in schooling. A total of 427 children were included in the analyses. The most common rheumatic disease was juvenile idiopathic arthritis (40.7%), and most children were taking conventional synthetic diseasemodifying antirheumatic drugs (DMARDs) (54.6%) and/or biologic DMARDs (51.8%). A diagnosis of COVID-19 was reported in five children (1.2%), none of whom required hospitalization. Seventeen children (4.0%) had stopped or delayed their drugs due to concern for immunosuppression, most commonly glucocorticoids. Almost all families adopted behaviors to protect their children from COVID-19, including quarantining, reported by 96.0% of participants. In addition, 98.3% of full-time students experienced disruptions in their education, including cancelations of classes and transitions to virtual classrooms. Despite the low numbers of children with PRDs who developed COVID-19 in this cohort, most experienced significant disruptions in their daily lives, including quarantining and interruptions in their education. The drastic changes to these children's environments on their future mental and physical health and development remain unknown.

Pilot Study on the Current Management of Children with COVID-19 In Hospitals in Bangladesh; Findings and Implications

Objective: The focus on COVID-19 in children in low- and middle-income countries including Bangladesh has been on addressing key issues including poor vaccination rates as well as mental health issues, domestic violence and child labour. However, the focus on optimally managing children in hospitals is changing with new variants and concerns with the development of hyperinflammatory syndromes. There are also concerns with the overuse of antimicrobials to treat patients with COVID-19 in hospitals enhancing resistance rates. The Bangladesh Paediatric Association have developed guidelines to improve patient care building on national guidance. Consequently, there is a need to document the current management of children with COVID-19 in Bangladesh and use the findings for future guidance. Methods: Rapid analysis of the management of children with COVID-19 among eight private and public hospitals in Bangladesh with varying numbers of in-patient beds using purposely developed case report forms (CRFs). The CRFs were piloted before full roll-out. Results: Overall low numbers of children in hospital with COVID-19 (4.3% of in-patient beds). The majority were male (59.6%) and aged 5 years or under (63.5%). Reasons for admission included respiratory distress/ breathing difficulties with 94.2% of COVID-19 cases confirmed. All children were prescribed antibiotics empirically, typically those on the Watch list of antibiotics and administered parenterally, with only a small minority switched to oral therapy before discharge. There was appreciable prescribing of Vitamins (C and D) and zinc and encouragingly limited prescribing of other antimicrobials (antivirals, antimalarials and antiparasitic medicines). Length of stay was typically 5 to 10 days. Conclusion: Encouraging to see low hospitalisation rates and limited use of antimicrobials apart from antibiotics. Concerns with high empiric use of antibiotics and limited switching to oral formulations can be addressed by instigating antimicrobial stewardship programmes. We will be monitoring this. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.188-198

The perceived determinants and recommendations by mothers and healthcare professionals on the loss-to-follow-up in Option B+ program and child mortality in the Amhara region, Ethiopia

BackgroundThe third United Nations Sustainable Development Goal includes a commitment to end AIDS-related death by 2030. In line with the Goal, Option B+ programs hold a great promise for eliminating vertical transmission of HIV. Option B+ was introduced in 2013 in Ethiopia. The Global Plan identified Ethiopia as one of 22 high priority countries requiring improvement in prevention of mother to child HIV transmission services. Despite HIV treatment being free in Ethiopia, only 59% of children are on treatment. The discrepancies in high uptake of Option B+ and low numbers of children in Ethiopia can be attributed to Loss-to-follow-up, which is estimated from 16 to 80%. While LFTU is expected in the region, no-to-minimal evidence exists on the magnitude and its determinants, which hampers the development of interventions and strategies to reduce LFTU. The purpose of this study is to explore perception of mothers and healthcare providers on determinants of and recommendations to reduce LTFU and HIV exposed infants’ mortality.MethodExplorative, descriptive qualitative study conducted in five zones of Amhara region. The sample consisted of mothers enrolled to the option B+ programs at the five referral hospitals PMTCT departments, nurses and midwives working in those departments, and HIV officers in zonal departments. Data were collected in 2019 using in-depth interviews. Data were analyzed using content analysis and deduced to themes.ResultsOverall, nine themes were identified from the interviews. Five themes represented the determinants of LTFU and mortality while four themes addressed the recommendations to reduce LFTU among mothers and their infant mortality. The determinants themes centered on apathy, stigma and discrimination, poor access to services, healthcare providers behavior and attitudes, and social determinants of health. While recommendations themes suggested that improving access, capitalizing on psychosocial support, education and awareness, and empowerment.ConclusionsSocial and structural issues are major contributors to low retention of mothers and death of children due to HIV. A multi-stakeholder approach, including structural changes, are required to support women and their children to ensure that individuals, communities and country enjoy the full benefits of option B+ and lead to an HIV free generation.

Influence of schooling on the health-related quality of life of children with rare diseases

BackgroundAlthough participation of children with rare diseases in school is considered beneficial, it poses new challenges for the educational system, but also for the affected children and their families. The aim of this study is to identify which aspects of the schooling experience may have an impact on the health-related quality of life of children with rare diseases.MethodA qualitative study was conducted using the social-critical paradigm as theoretical perspective. Participants (n = 28) included children with rare diseases (n = 8), parents (n = 12) and school staff (n = 8). Data was obtained through in-depth interviews and focus groups and analysed through discourse analysis as methodological orientation.ResultsParticipants’ discourses placed value on the social benefits of inclusion of children with rare diseases in schooling. Discourses also highlighted how the low numbers of children with rare diseases and the delay, or lack, of a clear diagnosis are among the difficulties experienced in the pursuit of the adaptations that children and teachers need to promote a healthy and normalized school experience. The issues identified in their health-related quality of life were summarized in seven categories: Attendance, Knowledge, Participation, Acceptance, Discrimination, Safety, Health-Related Support.ConclusionChildren with rare diseases remain, in many cases, invisible at the educational level due to the low numbers of children affected, limiting the kind of resources available to the child and teaching staff. This situation requires inter-disciplinary and inter-sector measures between health services and educational environments to articulate a comprehensive approach focused on children’s clinical needs.

Prevalence of Meeting Physical Activity, Screen-Time, and Sleep Guidelines Among Children and Adolescents With and Without Visual Impairments in the United States.

The purpose of this study was to compare the degree to which children and adolescents with and without visual impairments (VIs) met national physical activity, screen-time, and sleep guidelines. This observational, cross-sectional analysis of the 2016 National Survey of Children's Health focused on children (age 6-12yr) and adolescents (age 13-17yr) with and without VIs. The sample included 241 (weighted n = 472,127) and 17,610 (weighted n = 28,249,833) children, and 255 (weighted n = 505,401) and 17,417 (weighted n = 20,071,557) adolescents with and without VIs, respectively. Chi-square statistics were computed to examine the degree to which participants with and without VIs met health-behavior guidelines. Children (p = .02) with VIs were less likely to meet screen-time guidelines, but adolescents with VIs were not (p = .87). VI status was not associated with the likelihood of meeting physical activity or sleep guidelines (p < .05). Low numbers of children and adolescents with and without VIs meeting health-behavior guidelines warrant targeted interventions aimed at enhancing engagement.

Executive summary of the Czech Republic's 2018 Report Card on Physical Activity for Children and Youth

Background: Regular physical activity (PA) is associated with numerous health benefits. However, the decreasing level of PA and increasing screen-time among Czech children and youth has been well documented in the last two decades. To build effective intervention and prevention programs, it is necessary to review all available sources of evidence. Objective: The aim is to summarize the results of the first Czech Report Card on Physical Activity for Children and Youth based on a synthesis of the most recently available evidence. Methods: The Report Card included 10 indicators. To inform the indicator grades, a multi-level search strategy was used to find all relevant sources that provide published/unpublished data collected from 2013 through 2018. The data were synthesised, and a set of standardized benchmarks was used to assign grades. Final grades were assigned upon consensus of all members of the national research work group. Results: We retrieved 724 records from database searches and 81 records identified through other sources. A total of 40 records were identified as eligible for data extraction. Overall PA in Czech children and youth was observed to be insufficient to support fitness and health, with high rates of excessive screen-time and low numbers of children and youth spending time in unstructured/unorganized play. On the other hand, some grades indicated promising foundations to build on in future. They are represented, for instance, by a relatively high number of children and youth participating in organized sports and/or PA programs, or generally PA-friendly setting (e.g., family and peers, school, and built environment). Conclusions: There is ample evidence that Czech children and youth are insufficiently active, and the prevalence of physical inactivity and excessive screen-time has increased in both sexes during the last two decades. Thus, PA in childhood and adolescence should be promoted intensively and effective intervention and prevention programs are needed.

Teachers’ views on recognising and using home languages in predominantly monolingual primary schools

ABSTRACTThe use of home languages has previously been advocated in highly multilingual UK classrooms. However, drawing on the home languages and cultural insight of children who use English as an Additional Language (EAL) may also have important social and academic benefits in contexts where monolingualism is the norm.Conducted in a small local authority in England with low numbers of children who use EAL, this study investigated (1) primary teachers’ views on implementing language awareness activities, using pupils who speak languages other than English as a linguistic and cultural resource, via interviews and questionnaires and (2) the amount and nature of references made to home languages during classroom observations. Although the teachers did not refer to or use home languages on a day-to-day basis, they generally showed willingness to consider implementing certain activities which incorporated them. However, largely, the teachers had not previously contemplated such practice. They did not reference any academic benefits to promoting linguistic diversity but were more aware of the potential social benefits. They also lacked confidence in particular areas (e.g. linguistic knowledge) as well as showing a strong awareness of issues such as the importance of English.

Music Preferences and Family Language Background

Turkish migrants are the largest national group in Germany. Nevertheless, neither in music psychology research nor in intercultural research can empirical data on the music preferences of Turkish-German primary schoolchildren in the migrational context be found. This study thus examined the music preference responses of children with Turkish language backgrounds, who were at the end of primary school education, to music examples representing the differences between occidental and oriental music systems. A total of 267 children participated in an investigation in the city of Ludwigshafen am Rhein that involved primary schools that had relatively high and relatively low numbers of children with migrational backgrounds. The data analysis indicated interesting coherences between the children’s family language backgrounds and their music preferences. In the context of migration, however, the children’s responses represented varied possibilities of locating in a local, transnational, or global music culture.

Improving the Health of Looked after Children in Scotland: 1. Using a Specialist Nursing Service to Improve the Health Care of Children in Residential Accommodation

The first of two studies reported here by Donna Hunter, Gerry McCartney, Susan Fleming and Fiona Guy investigated whether a specialist nursing service could improve the health care of 162 children in residential care in Renfrewshire, West Dunbartonshire and Argyll &amp; Bute. It found that after the introduction of the service, the proportion of children with completed carer-held health records (BAAF health record booklets) increased from three per cent to 77 per cent; the proportion receiving a ‘pre-admission medical’ increased from 38 per cent to 48 per cent; the proportion adequately immunised increased from nine per cent to 56 per cent; the proportion with at least one outstanding medical referral decreased by at least four per cent; the number registered with a dentist increased from 14 per cent to 62 per cent and the proportion who received a ‘comprehensive health assessment’ increased from 17 per cent to 58 per cent. Thematic analysis of free text journals suggested that universal health services were much more accessible in Argyll &amp; Bute due to well-developed interagency working, low numbers of children in residential care and low rates of staff turnover. In the more urban areas, the main advantage of the service was thought to be in the facilitation of interagency working. The service was received positively by residential care workers and children in residential establishments. This study suggests that the provision of a specialist nursing service can improve the health care of children in residential accommodation.

Caracterização do consumo alimentar, ambiente socioeconômico e estado nutricional de pré-escolares de creches municipais

OBJETIVO: Analisar o consumo alimentar, o ambiente socioeconômico, a freqüência de anemia ferropriva e o estado nutricional de pré-escolares. MÉTODOS: A população estudada constituiu-se de 89 crianças de 24 a 72 meses de idade, assistidas em creches municipais de Viçosa, MG. Foram avaliados: nível de hemoglobina, peso, estatura, presença de parasitose, consumo alimentar dos pré-escolares e o perfil biossocioeconômico de suas famílias. RESULTADOS: O estado nutricional do grupo foi considerado satisfatório, e a prevalência de anemia relativamente baixa (11,2%). Condições adequadas de saneamento, nível razoável de escolaridade dos pais, baixo número de filhos e ausência de parasitas envolvidos com a gênese da anemia podem justificar o perfil observado. Não foi observada associação da anemia ferropriva nem com desnutrição nem com parasitose. CONCLUSÃO: Apesar de alguns fatores biossocioeconômicos apresentarem-se favoráveis ao estado nutricional e à baixa prevalência de anemia, observa-se, entretanto, que a insuficiente renda per capita e a dieta deficiente poderão levar esse grupo de pré-escolares, no futuro, a um pior estado de saúde.

Complementary practitioners as part of the primary health care team: consulting patterns, patient characteristics and patient outcomes.

Complementary medicine is increasingly popular with patients and with GPs, although it still remains mainly in the private sector. Few data are available from the private sector about patient-consulting patterns and outcome. We aimed to describe detailed consulting patterns, help-seeking behaviour and outcome of care for patients attending a group of private complementary practitioners in a single general practice surgery. Prospective data on consulting patterns were collected from all 147 new patients attending complementary practitioners over a 12-month period. For the first 30 weeks of this period, additional information on help-seeking behaviour and outcome, as measured by the SF-36 health survey and Measure Yourself Medical Outcome Profile (MYMOP), was collected by questionnaires from 46 out of the 68 new patients. The same information was collected from a systematic one-in-seven sample of GP patients. Patients seen by complementary practitioners did not vary significantly in sex and age from GP patients, except in the low numbers of children. Almost half the patients had been symptomatic for over a year and musculoskeletal disorders accounted for 66% of problems; but there was much variation between the therapies. The average number of visits per patient was three for osteopathy and homeopathy but eight for acupuncture and reflexology. The change in MYMOP scores after four weeks showed a statistically significant improvement in both complementary and GP patients, which was to similar degrees except that the mean change in well-being was significantly greater for complementary patients. Prospective data collection in single settings adds valuable information to a little-researched area. This study illustrates how individual each complementary therapy is in its patient characteristics, problem category and length of treatment. The particular improvement in well-being with complementary therapy requires confirmation in other studies.

Instructional Supervision in Special Education: Strategies for Rural Programs

Instructional supervision in special education is a critical function of administrative units. However, providing instructional leadership in rural areas can be problematic due to low numbers of children with disabilities, few supervisory staff, greater teacher needs, and lack of perceived alternatives. This article provides a framework for supervisory tasks in special education, outlines funding and organizational alternatives for providing supervision in rural areas, and suggests specific strategies for dealing with barriers to supervision in rural programs.