Routine Care Of Children Research Articles

Involvement of public health nurses in supporting mothers after maternity health checkups

Objectives This study aimed to analyze and clarify the role of public health nurses (PHNs) in assisting mothers who need assistance during antenatal checkups.Methods This study was conducted in core city, A. The study participants were PHNs who experienced supporting at least three mothers who required support during maternity health checkups. We interviewed the respondents about their observations, decision points, difficulties in coordination, and other aspects of support. Data were extracted from verbatim transcripts and analyzed inductively.Results Sixteen PHNs participants had an average of 9.3 years of experience. The analysis included 10 categories, 43 subcategories, and four themes. PHNs connected with mothers early depending on the mothers' wants, based on information gathered during the gestational period (theme 1). PHNs make early telephone visits to mothers based on information obtained during the gestational period. If the mother did not respond to the initial visit, the PHNs attempted to establish contact through other means.PHNs carefully observed and assessed mothers' childcare routines and mental and physical conditions (theme 2). To assess the mothers' mental health status, they were interviewed in detail using the Edinburgh postnatal depression scale. Determining the mother's condition was challenging; therefore, several PHNs conducted multiple visits and repeated the observations to achieve accurate assessments.The PHNs stayed close to their mothers and carefully supported them toward independence while assessing their progress (theme 3). PHNs established trusting relationships with mothers.PHNs served as coordinators in resolving problems and provided ongoing support in cooperation with medical institutions and related organizations (theme 4). The PHNs carefully coordinated consultations and encouraged mothers to consult psychiatrists if appropriate. Conclusion Although PHNs provided attentive care to mothers requiring assistance, difficulties arise in accurately diagnosing postpartum depression and connecting mothers to psychiatric services. Guidelines that standardize the assessment of and responses to mental health issues are required. It is necessary to organize the problems faced by mothers and develop a system of cooperation among various organizations.

Prescriptions (Rx) for Prevention: Clinical Tools for Integrating Environmental Health into Pediatric Clinical Care

The integration of environmental health (EH) into routine clinical care for children is in its early stages. The vision of pediatric EH is that all clinicians caring for children are aware of and able to help connect families to needed resources to reduce harmful environmental exposures and increase health-enhancing ones. Environmental exposures include air pollution, substandard housing, lead, mercury, pesticides, consumer products chemicals, drinking water contaminants, industrial facility emissions and, increasingly, climate change-related extreme weather and heat events. An identified need is to simultaneously educate clinicians while connecting families to evidence-based EH interventions. Here, we describe a multi-decadal effort to create, refine, and disseminate a clinical tool called Prescriptions (Rxs) for Prevention that responds to that identified need. These tools are modeled on a risk communication framework and use a format that support clinicians when they screen their patients for EH concerns, to then counsel on those topics, and refer to EH resources if needed. Rxs for Prevention—tailored with local resources—are now in use at more than a dozen sites in multiple regions of the U.S. supporting the promotion of healthy homes, communities, and the broader environment for children. These Rxs are reducing barriers to EH integration by educating clinicians, linking families to community resources, and strengthening clinic and community connections. On-going evaluation can help further the implementation of the Rxs for Prevention to help achieve the long-term vision of integrating EH into routine clinical care.

Factors associated with pediatric ophthalmology follow-up adherence before and during the COVID-19 pandemic

BackgroundStudies describe poor follow-up among children in ophthalmology prior to the COVID-19 pandemic. Although the pandemic led to worse adherence for routine medical care in children, little information exists on pediatric ophthalmology follow-up adherence during COVID-19. The purpose of this study was to evaluate the effect of COVID-19 pandemic on follow-up adherence for children with eye disease, and identified characteristics associated with follow-up adherence. MethodsIn this single-center study, the medical records of 519 new pediatric (≤18 years of age) patients seen during January, April, August, and December 2019 and 2021 were reviewed retrospectively. Patients were classified into two groups: adherent (patients who followed up within 30 days of recommended appointment time) or less-adherent (patients who followed up >30 days after recommended follow-up or never). Main outcome measure was patient adherence status. ResultsFollow-up adherence was similar before and during the COVID-19 pandemic (50.4% for 2019 and 49.6% for 2021 [P = 0.40]). Patients that were less likely to be adherent in both univariate and multivariable analyses included those with public insurance (adjusted OR = 0.63 [95% CI, 0.40-1.00]; P = 0.05), and those recommended to follow-up ≥3 months (adjusted OR ≤ 0.10; P < 0.001). In addition, in univariate analysis, those who declined to self-report race (OR = 0.53 [95% CI, 0.29-0.95]; P = 0.04) and those seen by optometrists (OR = 0.42 [95% CI, 0.29-0.60]; P < 0.001) were less likely to be adherent, while patients who traveled ≥177 miles to their provider were more likely to be adherent (OR = 2.88 [95% CI, 1.17-7.55]; P = 0.02). ConclusionsFollow-up adherence for childhood eye care was low but remained relatively stable before and during the COVID-19 pandemic; >50% of children were less-adherent.

Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness: a randomised controlled trial and cost analysis.

Parental mental illness (PMI) is common and places children at high risk of developing psychological disorders. Family Talk (FT) is a well-known, whole-family, 7-session intervention designed to reduce the risk of transgenerational psychopathology. However, very few larger-scale evaluations of FT (across only a limited number of settings) have been conducted to date while there have been no cost analyses. This study aimed to assess the effectiveness and costs of delivering FT in improving child and family psychosocial functioning in families with PMI within routine mental health settings. A total of 83 families with PMI, with children aged 5-18 years, were randomly assigned on a 2:1 ratio to receive either the FT intervention (n=55 families) or usual services (n=28 families) across 10 adult, child and primary care mental health sites in Ireland. Parental disorders included anxiety/depression (57%), Bipolar Disorder (20%), Borderline Personality Disorder (12%), Post-Traumatic Stress Disorder (8%) and psychosis (2%). Detailed assessments with parents were conducted at baseline and 6-month follow up. FT led to significant improvements in family functioning and child behaviour at 6-month follow up when compared to usual services, with medium effect sizes indicated. Parent participants with lower mental health literacy at baseline also showed significant post-intervention improvements. Those parents with less severe mental illness at baseline, and families with more partner and economic supports, reported additional significant post-intervention improvements in child depression/anxiety and parental mental health symptoms. The cost of FT amounted to €761.50 per family, although this decreased to €415.31 when recurring costs only were included. The findings from this study, which was conducted within the context of a national programme to introduce family-focused practice in Ireland, demonstrate that FT is a low-cost intervention that improved child and family psychosocial functioning across different mental health disorders within routine adult, child and primary care mental health services. The findings contribute to the growing evidence base for FT, and provide a robust basis to inform practice and policy development for families with parental mental illness both in Ireland and elsewhere. https://www.isrctn.com/ISRCTN13365858, identifier ISRCTN13365858.

What are the anticipated benefits, risks, barriers and facilitators to implementing person-centred outcome measures into routine care for children and young people with life-limiting and life-threatening conditions? A qualitative interview study with key stakeholders

Background: There is a growing evidence-base underpinning implementation of person-centred outcome measures into adult palliative care. However evidence on how best to achieve this with children facing life-threatening and life-limiting conditions is limited. Aim: To identify the anticipated benefits, risks, barriers and facilitators to implementing person-centred outcome measures for children with life-limiting and life-threatening conditions. Design: Cross-sectional qualitative semi-structured interview study with key stakeholders analysed using Framework analysis informed by the adapted-Consolidated Framework for Implementation Research. Setting/participants: A total of n = 26 children with life-limiting or life-threatening conditions, n = 40 parents/carers, n = 13 siblings and n = 15 health and social care professionals recruited from six hospitals and three children’s hospices and n = 12 Commissioners of health services. Results: All participants were supportive of future implementation of person-centred outcome measures into care. Anticipated benefits included: better understanding of patient and family priorities, improved communication and collaborative working between professionals and families and standardisation in data collection and reporting. Anticipated risks included increased workload for staff and measures not being used as intended. Implementation barriers included: acceptability and usability of outcome measures by children; burden and capacity of parents/carers regarding completion; privacy concerns; and language barriers. Implementation facilitators included designing measures using language that is meaningful to children and families, ensuring potential benefits of person-centred outcome measures are communicated to encourage ‘buy-in’ and administering measures with known and trusted professional. Conclusions: Implementation of person-centred outcome measures offer potential benefits for children with life-limiting and life-threatening conditions. Eight recommendations are made to maximise benefits and minimise risks in implementation.

Preschoolers' Self-Regulation and Behavior Problems in the Midst of Caregiver Depression and Chaos.

Preschoolers' self-regulation is partially developed through home and child care routines. COVID-19-related child care closures increased caregiver depressive symptoms, household chaos, and children's behavior problems. This longitudinal study examined how preschoolers' prepandemic self-regulation was related to behavior problems early in the pandemic, including buffering against the adverse effects of caregiver depressive symptoms and household chaos. A sample of 264 caregivers of preschoolers reported on their children's self-regulation (Behavior Rating Inventory of Executive Function-Preschool Version Inhibitory Self Control Index) before the pandemic and caregiver depressive symptoms (Center for Epidemiological Studies), household chaos (Confusion, Hubbub, and Order Scale), and children's behavior problems (Behavior Rating Index for Children) during the pandemic. We used linear mixed models to examine predictors of children's behavior problems, including prepandemic self-regulation, and further examined moderation by pandemic-related caregiver depressive symptoms and household chaos. Children were 64% non-Hispanic White and 24% non-Hispanic Black, with mean pandemic age 5.9 years. Prepandemic self-regulation significantly predicted early pandemic behavior problems (β = -0.38 [95% confidence interval, -0.69 to -0.07]). This association was moderated by pandemic-related caregiver depressive symptoms and household chaos; the protective association was maintained at high levels of caregiver depressive symptoms or household chaos, although the association diminished when these co-occurred. The protective association between prepandemic self-regulation and subsequent behavior problems suggests longitudinal benefits of preschoolers' inhibitory and emotional control. Despite reduced protection associated with co-occurring caregiver and household challenges, self-regulation continued to demonstrate protection against subsequent behavior problems, even in the midst of a pandemic.

Paediatric Thoracic Imaging in Cystic Fibrosis in the Era of Cystic Fibrosis Transmembrane Conductance Regulator Modulation.

Cystic fibrosis (CF) is one of the most common progressive life-shortening genetic conditions worldwide. Ground-breaking translational research has generated therapies that target the primary cystic fibrosis transmembrane conductance regulator (CFTR) defect, known as CFTR modulators. A crucial aspect of paediatric CF disease is the development and progression of irreversible respiratory disease in the absence of clinical symptoms. Accurate thoracic diagnostics have an important role to play in this regard. Chest radiographs are non-specific and insensitive in the context of subtle changes in early CF disease, with computed tomography (CT) providing increased sensitivity. Recent advancements in imaging hardware and software have allowed thoracic CTs to be acquired in paediatric patients at radiation doses approaching that of a chest radiograph. CFTR modulators slow the progression of CF, reduce the frequency of exacerbations and extend life expectancy. In conjunction with advances in CT imaging techniques, low-dose thorax CT will establish a central position in the routine care of children with CF. International guidelines regarding the choice of modality and timing of thoracic imaging in children with CF are lagging behind these rapid technological advances. The continued progress of personalised medicine in the form of CFTR modulators will promote the emergence of personalised radiological diagnostics.

Comparison of Quality of Infant Care and Transition Difficulty to Motherhood Between Adolescent and Young Mothers

Background: Despite a lower teenage pregnancy rate in Iran compared to the global average, there is an anticipation of increased teenage pregnancy rates by 2025 due to changes in population policy programs. Objectives: This study aimed to compare the challenges faced during the transition to motherhood and the quality of infant care between adolescent mothers and young mothers in Karaj, Iran. Methods: This descriptive-analytical study was conducted in 2020, involving 160 adolescent and young mothers selected through multistage sampling in Karaj, Iran. The data were collected using demographic characteristics, a modified questionnaire assessing the challenges of the transition to parenthood, and an infant care checklist. Descriptive statistics, including frequency, percentage, mean, and standard deviation (SD), were reported. Data analysis was carried out using the chi-square test and Mann-Whitney U test. Results: The study showed no significant differences between adolescent and young mothers in terms of mean scores related to the challenges of the transition to parenthood, such as responsibility and commitment, pleasure and satisfaction, fondness and stability, and self-commitment (P ≥ 0.05). However, significant differences were observed between the 2 groups in the total score of infant care (33.07 ± 2.77 and 34.57 ± 2.65, P = 0.002), child disease care (10.63 ± 0.73 and 11.03 ± 1.20, P = 0.034), routine child care (5.38 ± 1.23 and 5.83 ± 1.28, P = 0.039), and maternal health (13.37 ± 1.60 and 14.29 ± 1.29, P &lt; 0.0001) for adolescents and young mothers, respectively. Conclusions: Based on the study’s results, teenage mothers might benefit from support programs provided by healthcare providers, particularly midwives and doctors, to enhance their abilities to care for their children.

Fathers’ experiences with domestic labor during the COVID-19 pandemic in the United States

ABSTRACT The COVID-19 pandemic disrupted family life as traditional institutions (e.g., work, schools, childcare) were altered to address public health safety. These changes required families to adapt to new work and childcare routines. Much of the research on domestic labor during the pandemic has rightly focused on mothering and relied on quantitative methods. Less is known about the experiences of fathers who participated in domestic labor during the pandemic. The current qualitative study focused on fathers’ (n = 24) experience with domestic labor during the pandemic. Data collection included demographic surveys and in-depth interviews. Phenomenological analysis was implemented, and four themes were identified: (a) Resource availability, (b) Communication and negotiation, (c) Work-life adaptations, and (d) Caring for children’s needs.

Management of Pediatric Foreign Body Injuries during the COVID-19 Pandemic: Results of an International Survey.

The COVID-19 pandemic has had direct and indirect effects on daily life. In hospitals, the impact of the pandemic was observed in the diagnostic and therapeutic workflow. In this work, we explored potential changes in activities related to the treatment of foreign body injuries (FBIs) in children and the behavioral habits of physicians during the first wave of the pandemic. An online survey was conducted among physicians of the Susy Safe network. The survey comprised items related to respondent information, reference center characteristics, the treatment of FBIs during the COVID-19 pandemic, and a modified COVID-19 Anxiety Scale (CAS). The survey was distributed among the Susy Safe project international network surveillance registry for FBIs. A total of 58 physicians responded to the survey, including 18 (32%) from Europe and 16 (28%) from South America. The respondents indicated that the estimated number of aspirated foreign bodies during the pandemic was lower than or the same as that before the pandemic (43, 74%), and the same was observed for ingested foreign bodies (43, 74%). In univariable logistic regression, no single predictor was associated with a delay in routine care for children or an increasing tendency of medical personnel to avoid procedures. The workflow of physicians involved in the management of FBIs in children has not changed drastically during the COVID-19 pandemic, especially in emergency departments.

The Importance of Screening for Food Insecurity in Children with Sickle Cell Anemia: An Ancillary Study to the Severe Acute Malnutrition Feasibility Trial in Nigeria

Introduction Household food insecurity-lacking access to, or having uncertain access to, food that meets a person's dietary needs-is a longstanding problem in Nigeria that has continued to worsen in recent years. One of its most severe consequences is malnutrition, particularly affecting children due to their high nutrient demand coupled with higher energy expenditure. Even in high-income countries, such as the United States, many children with sickle cell anemia have lower weights and heights than their healthy peers. Due to their elevated nutrient requirements, children with sickle cell anemia may be at an even greater risk of malnutrition when faced with limited access to adequate food. The relationship between childhood food insecurity and malnutrition has been previously studied in younger children in Nigeria, but rarely in older children, and to our knowledge, never in older children with sickle cell anemia. We tested the hypothesis that there is a direct association between increased food insecurity and more severe malnutrition (lower body mass index [BMI] z-score) in older children with sickle cell anemia in Nigeria. Methods This was a planned analysis of the data of children enrolled in a feasibility trial for managing severe acute malnutrition in older children with sickle cell anemia in Nigeria (SAMS trial; #NCT03634488). In this study, children 5-12 years old with sickle cell anemia and uncomplicated severe acute malnutrition (BMI z-score &amp;lt;-3.0) were randomly assigned to receive either supplemental ready-to-use therapeutic food (RUTF) only or RUTF combined with moderate fixed-dose hydroxyurea therapy for 12 weeks. Baseline anthropometric data were obtained for each participant. Upon enrollment in the trial, the participants' caregivers completed the US Household Food Security Survey Module (HFSSM). Using the eight questions in the childhood portion of this standardized survey, we categorized the participants into three food security statuses: food security (0-1), low food security (2-4), and very low food security (5-8). Childhood food security scores were also measured as a continuous variable on a scale of 0-8, with higher scores indicating greater food insecurity. We constructed a linear regression model to estimate the association between childhood food insecurity and baseline BMI z-score. Results Data were collected between August 2021 and May 2022. The median age of the 108 participants in the study was 10.3 years (IQR 8.8-11.5). Most participants had low (55%) or very low (34%) food security. BMI z-score was not associated with categorical food security status (p=0.108). However, higher food insecurity as a continuous variable was associated with a lower BMI z-score (Pearson correlation -0.23, p=0.015; Figure 1). In a multivariable linear regression with sex, age at study entry, total hemoglobin, employment status, and head of household educational status, the childhood food insecurity score was negatively associated with the BMI z-score (Beta coefficient = -.05, p=0.047). Conclusions Our study reveals a high prevalence of food insecurity among older children with sickle cell anemia in Nigeria. Moreover, children experiencing higher food insecurity also exhibited more severe malnutrition, as evidenced by their lower BMI z-scores. Based on these results, we have started implementing food insecurity assessment as routine medical care in children with sickle cell anemia at multiple clinics in northern Nigeria. Children experiencing higher levels of food insecurity are referred to nutritional counseling, where they receive guidance on locally available nutrient-dense foods and preparation strategies. Figure 1.The predicted baseline body mass index z-score with 95% confidence intervals based on childhood food insecurity scores from a linear regression model of the participants in the SAMS trial.

SAT126 Relationship Between Type I Diabetes And Depression In The Pediatric Population

Abstract Disclosure: L.B. Greenblatt: None. M. Epelman: None. S. Demissie: None. Introduction: Type 1 diabetes mellitus (T1DM) is one of the most common chronic illnesses in children. Depression in children and adolescents with T1DM has been associated with negative diabetes related health outcomes, such as recurrent diabetes ketoacidosis. These associations can be bidirectional, where poor glycemic control can worsen symptoms of depression. Adolescents with T1DM and depression pose additional challenges to health care providers due to non-adherence to diabetes management. Objective: The aim of this study is to investigate the relationship between depression and age of onset, duration and T1DM control. We hypothesized that duration of diabetes mellitus positively correlates with depression symptoms. Patients diagnosed with T1DM in adolescence have higher depression scores compared to individuals diagnosed at a younger age. Methods: Individuals with T1DM 11 to 21 years old enrolled in the study. Patients with known psychiatric illnesses and intellectual disabilities were excluded. After obtaining informed consent and assent, participants were asked to complete age specific depression screening form PHQ-9. Forms were immediately scored by the investigator. Patients with moderate symptoms (score of 10 to 14) are provided a list of local mental health resources and individuals with severe depressive symptoms (score &amp;gt; 15) were referred to a pediatric psychiatrist for evaluation. Data on age, sex, ethnicity, age at diagnosis, diabetes duration, recent glycosylated hemoglobin (HbA1C), treatment methods (insulin pump vs injections) and continuous glucose monitor use were collected from patients’ electronic health records. Results: 34 patients, 61.7% female, were screened thus far. The mean age was 16 years and average age at diagnosis was 8 years. 22% of patients were on multiple daily injections and 78% on insulin pump therapy. Most patients (88%) were using continuous glucose monitors. Despite long term care, the average HbA1c was 8%. Girls had higher average PHQ-9 score (7.24) compared to boys (3.69). As expected, high PHQ-9 score was associated with poor diabetes control (r=0.35, p=0.044). There was a positive correlation between PHQ-9 score and duration of T1DM and negative correlation between PHQ-9 score and age at onset (p&amp;gt;0.05). Conclusion: Children and adolescents with T1DM are at risk of depression. Younger age of onset and longer duration of T1DM was associated with higher severity of depression symptoms as evident by PQH-9 score. Poor control, defined by high HbA1C, is positively correlated with depression score. Screening for depression and proper referral should be integrated into routine care for children and adolescents with T1DM. Presentation: Saturday, June 17, 2023

Knowledge and Role of Paediatricians/Paediatric Residents in Infant Oral Healthcare and Dental Home across Saudi Arabia: A Cross-Sectional Study.

The prevention of oral diseases in children is highly achievable through providing early exposure to oral healthcare habits, which would make children more receptive towards dental services. A cross-sectional study used a structured, self-explanatory questionnaire to evaluate the knowledge and role of 190 paediatricians and paediatric residents towards infant oral healthcare and the dental home across Saudi Arabia. The authors sent a link to the questionnaire, comprising 36 questions, by email, as a Google e-form. The response rate obtained was 87.36%. A major proportion (95.8%) of the respondents considered that paediatricians play an important role in promoting oral health. Around 45.8% of the practitioners recommended tooth brushing after the eruption of the first tooth. About 38% of the practitioners were unaware of the children's first dental visit. The majority (95.2%) agreed that there should be an increased awareness regarding home dental habits. Most of them (78.3%) examined the oral cavity for dental problems as a part of routine childcare, and the majority (75.3%) admitted that they did not evaluate fluoride needs. A statistically significant higher mean knowledge score was observed for practitioners with more than 30 years of experience (9.35 ± 2.29), and there was a significant positive correlation (r = 0.486) between the knowledge score and mean score for the role of paediatric practitioners. Overall, the study concluded that the knowledge of paediatricians and paediatric residents in SA towards infant oral healthcare and the dental home was inadequate, and their role in maintaining oral health was found to be moderately satisfactory.

Real-World Evidence on the Prevalence of Molar Incisor Hypomineralization in School Children from Bucharest, Romania.

Molar incisor hypomineralization (MIH) is an understudied and underrecognized clinical entity occurring in children. We performed a cross-sectional study to determine the real-world prevalence of MIH among school children undergoing routine dental checkups at one primary and middle school in Bucharest, Romania. Our study cohort consisted of 266 children with evaluable data, of which 143 (53.8%) were males, with a median age of 10 years old (interquartile range: 8-11 years). In this study cohort, we have identified a prevalence of 14.3% (n = 38 cases) of MIH. Among patients diagnosed with MIH, hypomineralizations were present in 47.4% of children on the maxillary first molar, 92.1% on the mandibular first molar, 94.7% on the maxillary incisor, 36.8% on the mandibular incisor, and 5.3% on the deciduous second molar. We identified the maxillary incisor and the mandibular first molar as the most important examined sites significantly associated with the presence of MIH (p < 0.0001 each), highlighting the importance of paying focused attention to these sites during routine dental care in children. In order to establish the diagnosis of MIH, findings of hypomineralization should be present on at least one permanent first molar, according to the case definition currently in use; this definition does not include findings on the incisors. Thus, our finding that hypomineralization of the maxillary incisors is significantly associated with MIH is particularly important. While incisor hypomineralization is not diagnostic of MIH, based on our results, we conclude that it should raise the suspicion of MIH and lead to an attentive examination of the permanent molars in order to establish timely diagnosis.

Barriers to routine dental care for children with special health care needs.

The aim of this mixed method study was to identify barriers for children with special health care needs (SHCN) to receiving routine preventive dental care following restorative dental care with general anesthesia (GA). Electronic health records were reviewed for inclusion criteria and demographic data. Caregivers of children with SHCN were contacted to participate in qualitative interviews. Interview topics explored child, family, and community level influences to accessing routine dental care. Qualitative analysis identified key themes of barriers and enablers to care. A total of 1708 children received dental care with GA during the 2-year study period, of which 498 (29.16%) had a diagnosis of a SHCN. The most common type of SHCN was neurodevelopmental disorders (28.51%). The mean age at time of GA was 8.6 years. Fifty caregivers completed interviews. Identified barriers to obtaining routine dental care included child stress/anxiety, finding an accepting provider, dismissive providers, and proximity of provider/transportation to dental care. Enablers to obtaining care included effective behavior management, continuity of provider/care, positive provider attitude, and referral to an accepting provider. Adequately trained and local providers with an accepting attitude are essential to enabling children with SHCN to obtain equitable access to routine dental care.

Thrombophilia screening in the routine clinical care of children with arterial ischemic stroke.

Current guidelines recommend thrombophilia evaluation in childhood arterial ischemic stroke, but the impact of screening on management is unknown. The objective of the current study is to report the incidence of thrombophilia identified as part of routine clinical care in the context of available literature reports, and to describe the impact of a diagnosis of thrombophilia on patient management. We conducted a single-institution retrospective chart review for all children with arterial ischemic stroke occurring between January 1, 2009 and January 1, 2021. We collected thrombophilia screening results, stroke etiology, and management. We also reviewed the literature of thrombophilia testing in childhood arterial ischemic stroke published prior to June 30, 2022. Meta-analysis methods were used to assess prevalence rates. Among children with thrombophilia testing performed, 5% (six of 122 patients) were factor V Leiden heterozygous, 1% (one of 102 patients) were prothrombin gene mutation heterozygous, 1% (one of 122) had protein S deficiency, 20% (23/116 patients) had elevated lipoprotein(a), 3% (three of 110 patients) had elevated homocysteine levels, and 9% (10/112) had elevated antiphospholipid antibodies, only two of whom had persistently elevated levels. There was no change in stroke therapy due to these results. Literature review revealed a wide range of prevalence for most thrombophilia traits, with high cross-study heterogeneity in most cases. The rates of thrombophilia in our cohort were consistent with that expected in the general population. The identification of thrombophilia did not alter stroke care. However, some of the results were actionable, prompting evaluation for lipid disorders and patient-specific counseling on cardiovascular risk and risk for venous thrombosis.

‘Undoing gender’ or selection effects?: fathers’ uptake of leave and involvement in housework and childcare in South Korea

ABSTRACT A number of studies have documented a positive (causal) relationship between fathers’ uptake of parental leave and a more equitable division of unpaid labour in Western contexts, primarily where men contribute to a fair share of unpaid work and fathers’ uptake of leave is common. South Korea offers an apt and contrasting setting to explore this relationship, with its highly gendered division of unpaid labour and low use of fathers’ leave, despite recent increases. This study finds that fathers who have taken (long) leave contribute more to housework as well as both developmental and routine childcare than fathers with neither leave plan nor experience. For housework and developmental childcare, this difference is mostly explained by already involved fathers self-selecting into leave. For routine childcare, there is limited evidence to suggest that very long leave of one year or longer could potentially make fathers more involved. In short, the gender equalising impact of fathers’ uptake of parental leave in Korea appears to be restricted mainly to long leave and routine childcare, if there exists any significant effect at all. Overall, this paper suggests that the gender equalising effect of fathers’ leave may vary depending on the stage of the gender revolution.

Involving children and adolescents with type 1 diabetes in health care: a qualitative study of the use of patient-reported outcomes

BackgroundWithin pediatric health care services, Patient-reported Outcomes (PROs) regarding the patient’s health status are mainly used for research purposes in a chronic care setting. However, PROs are also applied in clinical settings in the routine care of children and adolescents with chronic health conditions. PROs have the potential to involve patients because they ‘place the patient at the center’ of his or her treatment. The investigation of how PROs are used in the treatment of children and adolescents and how this use can influence the involvement of these patients is still limited. The aim of this study was to investigate how children and adolescents with type 1 diabetes (T1D) experience the use of PROs in their treatment with a focus on the experience of involvement.ResultsEmploying Interpretive Description, 20 semi-structured interviews were conducted with children and adolescents with T1D. The analysis revealed four themes related to the use of PROs: Making room for conversation, Applying PROs under the right circumstances, Questionnaire structure and content, and Becoming partners in health care.ConclusionsThe results clarify that, to some extent, PROs fulfill the potential they promise, including patient-centered communication, detection of unrecognized problems, a strengthened patient-clinician (and parent-clinician) partnership, and increased patient self-reflection. However, adjustments and improvements are needed if the potential of PROs is to be fully achieved in the treatment of children and adolescents.

Effect of Buteyko Breathing Technique versus Diaphragmatic Breathing on Clinical Outcomes for Children with Lower Respiratory Tract Infection

the routine care for children with lower respiratory tract infection to improve their clinical outcomes

Diabetes Technology and the Human Factor.

Diabetes Technology and the Human Factor.