Social Paediatrics Research Articles

83 What is social paediatrics and how do we teach it? A scoping review of social medicine curricula in the child and youth health context across health disciplines

Abstract Background Social paediatrics is a field that focuses on addressing social and environmental factors that affect children’s health and wellbeing1. Over recent years in medical education, social paediatrics has become increasingly recognized as foundational to undergraduate and postgraduate paediatrics curricula. Paediatric residency programs worldwide have been developing and offering social paediatrics curricula, yet we lack understanding of effective strategies for teaching it to medical trainees. 1. Spencer N, Colomer C, Alperstein G, et al. Social paediatrics. J Epidemiol Community Health. 2005;59(2):106-108. doi:10.1136/jech.2003.017681 Objectives We conducted a scoping review to describe the various educational interventions used to teach content and practice related to social paediatrics. Design/Methods We conducted a scoping review to describe the various educational interventions used to teach content and practice related to social paediatrics. Our literature search first drew upon Ovid MEDLINE and MedEd PORTAL, with subsequent studies identified through reference searching in relevant articles. We included studies that described and/or evaluated educational interventions aimed to teach elements of social paediatrics. We excluded studies published before 2000. We extracted data from the selected articles and conducted thematic analysis. Results Our search yielded 443 articles. Initial screen by title and/or abstract and subsequent screen by abstract and/or full text yielded 28 papers. Where it was unclear if studies met inclusion criteria, two additional researchers reviewed the full text. With the addition of articles found in references of the provisional articles, a total of 36 papers were included in the review. Of those, 17 (47%) described curricular interventions at the level of paediatric residency, 7 (19%) described medical school curricula, and 8 (22%) included non-medicine fields such as dentistry, nursing, research, and others. Fifty percent of curricula required self-directed learning, while a different 50% subset had a formal reflection process as part of learning consolidation. We organized the literature thematically into the following themes: interdisciplinary collaboration, community partnership, advocacy training, and experiential learning. Conclusion Our scoping review describes a variety of curricular interventions aimed to teach elements of social paediatrics, with a large focus on social determinants of health, primarily poverty, and a relative lack of focus on the underlying structural, systemic, and social justice issues underpinning these health determinants. We need to consider how the pedagogical strategies on offer can be purposed towards the development of more robust social paediatrics curricula at the postgraduate level.

85 Improving children and families healthcare experiences through a Community Social Paediatrics model

Abstract Background The clinical presentation of children with referrals related for behavioral and school difficulties is often complex and involves environmental and psychosocial components in addition to medical considerations. Collaborative, team based, holistic and integrated approaches are standard of care for many medically complex conditions but less emphasized for what is considered more general presentations in Paediatrics. Given the complexity of patients presenting with challenging behaviors, an integrated approach should be considered as a patient centered and efficient model of care. Objectives The aim of this study was to determine if using a Community Social Paediatrics (CSP) model with an interdisciplinary team can improve experiences and outcomes for families of children being assessed for challenging behaviors who also have complex psychosocial considerations. Design/Methods This pre-post study recruited families with children who had received behaviour-related Paediatric referrals. Participants received the standard of care and additional resources typical to a CSP model, including support from a social worker, home visits, and referral/funding for clinically indicated therapeutic services such as occupational therapy. Three measures were used to evaluate the experience and outcomes of patients and families prior to intake and after 12 months of care: Paediatric Integrated Care Survey (PICS), Child Behaviour Checklist (CBCL), and Quality of Relationship Inventory (QRI). Descriptive analyses of demographics and subscale scores were conducted. Paired t-tests were conducted to detect significant changes in subscale scores across time points. Results In total, 31 caregivers completed the intake assessment and 26 of these completed the follow-up assessment for their children, who were between the ages of 5 to 14 at the time of intake. The QRI scores, which assessed the child-caregiver relationship, indicated a significant decrease in the conflict subscale between timepoints (M1=2.23, M2=1.87, p<0.005). Similarly, the CBCL scores indicated significant reductions in aggressive behaviour (M1= 68.65, M2= 64.77, p<0.05) and conduct problems (M1= 68.69, M2= 62.31, p<0.05). The PICS scores indicated families reported fewer access problems (M1= 3.35, M2= 1.19, p<0.005), and better communication with health care providers (M1= 14.53, M2= 16.92, p<0.05). Conclusion Findings indicate that aspects of the family experience and child outcomes were significantly improved after receiving care through the CSP model. In particular, the reduction of caregiver-child conflict, aggressive behaviour, and conduct problems may indicate that the child’s needs are being more effectively met, thus reducing conflict at home and school. Paediatricians should strongly consider an interdisciplinary model when seeing children for behavioral referrals. This may be especially true for those with complex psychosocial needs.

The association between ultra-processed food consumption and low-grade inflammation in childhood: A cross-sectional study.

This study aimed to investigate the relationship between the amount of ultra-processed food (UPF) in the diet and low-grade inflammation in children. This cross-sectional study was conducted in 50 healthy children recruited from children attending the Social Paediatrics Outpatient Clinic for follow-up of normal developmental stages. Low-grade inflammation was calculated by INFLA-score, dietary intake by three 24-h dietary recalls and dietary content analyses by BeBiS™ software. The mean age of the 50 children included in our study was 10.18 ± 3.98 years (5-17 years). UPF accounted for 24.5% of the total daily energy intake of children. In children with higher inflammation scores (INFLA-score ≥ 2), the amount in grams of UPF and the percentage of total energy from UPF were found to be significantly higher (p = 0.030 and p = 0.015, respectively). A weak positive correlation was found between the INFLA-score and the percentage of daily dietary energy intake coming from UPFs (r = 0.350, p < 0.01), the average daily energy intake from UPFs (r = 0.313, p < 0.05), and the average daily amount of UPF consumed (r = 0.260, p < 0.05). The linear regression model revealed that every one-unit increase (1%) in the percentage of total daily energy intake coming from UPF caused an increase in β = 0.154-unit in the INFLA-score. It was found that obesity was not a mediator in the association between the percentages of total energy intake from UPF on the INFLA-score, instead, the energy intake from UPF had a significant direct association with the INFLA-score. The average amount of UPF consumed daily showed an increasing pattern in parallel with inflammation-score quartile classes (Q1 to Q4) with 33.3% in Q1, 38.5% in Q2, 53.8% in Q3 and 66.7% in Q4 (p = 0.049). In conclusion, a positive association was found between low-grade inflammation and UPF consumption in children, independent of obesity.

Ha sido un placer, gracias y hasta pronto

&lt;/jats:p&gt; &lt;/jats:abstract&gt; &lt;publication_date media_type='online'&gt; &lt;month&gt;11&lt;/month&gt; &lt;day&gt;14&lt;/day&gt; &lt;year&gt;2023&lt;/year&gt; &lt;/publication_date&gt; &lt;doi_data&gt; &lt;doi&gt;10.60147/86158a6b&lt;/doi&gt; &lt;resource&gt;https://pap.es/articulo/14002/ha-sido-un-placer-gracias-y-hasta-pronto&lt;/resource&gt; &lt;/doi_data&gt; &lt;/journal_article&gt; &lt;!-- ============== --&gt;&lt;journal_article publication_type='full_text'&gt; &lt;titles&gt;&lt;title&gt;Reading promotion and its association with professional vocations and care settings &lt;/title&gt;&lt;original_language_title&gt;La promoción de la lectura y su relación con las vocaciones y entornos profesionales &lt;/original_language_title&gt; &lt;/titles&gt; &lt;contributors&gt; &lt;person_name sequence='first' contributor_role='author'&gt; &lt;given_name&gt;Ana&lt;/given_name&gt; &lt;surname&gt;Garach&lt;/surname&gt; &lt;/person_name&gt;&lt;person_name sequence='additional' contributor_role='author'&gt; &lt;given_name&gt;Iván&lt;/given_name&gt; &lt;surname&gt;Gutiérrez &lt;/surname&gt; &lt;/person_name&gt;&lt;person_name sequence='additional' contributor_role='author'&gt; &lt;given_name&gt;Antonio&lt;/given_name&gt; &lt;surname&gt;Molina&lt;/surname&gt; &lt;/person_name&gt;&lt;person_name sequence='additional' contributor_role='author'&gt; &lt;given_name&gt;Jesús L. &lt;/given_name&gt; &lt;surname&gt;Megías&lt;/surname&gt; &lt;/person_name&gt;&lt;/contributors&gt; &lt;jats:abstract xml:lang='en'&gt; &lt;jats:p&gt;Introduction: healthy lifestyle promotion is a common practice among paediatricians. Reading promotion is included in that practice. It has numerous benefits for children: it stimulates brain activity and cognitive reserve, improves concentration and language development and helps develop emotional skills. The aim of our study was to assess the implementation of reading promotion activities in real-world paediatric care practice, as well as its association with the underlying vocation for paediatrics (clinical, preventive or social) and the care setting (residency programme, hospital and primary care). Material and methods: cross-sectional, descriptive study of national scope through an online survey of paediatrics residents and hospital-based and primary care paediatricians carried out in March 2022. Results: 326 paediatricians participated, of who 16.8% worked in hospitals, 69.8% in primary care and were 13.4% paediatrics residents. Of this total, 18.8% reported a vocation for preventive care, 60.8% for clinical work and 20.5% for social paediatrics. In addition to carrying a detailed descriptive analysis of the type of reading promotion activities carried out in Spain, we found, firstly, that the vocation for medical practice was associated to the frequency of reading promotion (χ2(2)=13.11; p&lt;0.001), with a higher proportion of paediatricians with a social vocation reporting performance of these activities. Secondly, the care setting also seemed to be a determining factor for the performance of these activities (χ2(2)=19.0; p&lt;0.001), which were conducted more frequently in the primary care setting. Conclusion: activities to promote reading are carried out mainly by primary care professionals within the framework of other health promotion work, and their performance was mainly associated with the greater proportion of primary care professionals with a vocation for social paediatrics.

98 Seeing the Unseen– A Retrospective Review of the Demographic Characteristics of a Place-based, Inner-City Social Paediatrics Program

Abstract Background Social paediatrics is a holistic approach to child and youth health that considers the society and environment the child lives in, and aims to address social determinants of health (SDoH) to improve health equity. Place-based social paediatrics clinics minimize health disparities through outreach programs, navigational support, and facilitating access to specialty care services. This model of care was developed in the past few decades as it became widely accepted that SDoH and adverse childhood events have a direct impact on child health. Typical clinic demographics and most prevalent care needs are not well described. Objectives Identify key demographic features and common diagnoses seen by a social paediatrics program’s primary and specialty care services. Design/Methods Ethical approval was obtained from institutional REB. A retrospective chart review of patients accessing the program between Jan 1, 2018 and April 30, 2021, with no additional exclusion criteria, was conducted. Demographic information, factors influencing SDoH, and past medical history were collected. Basic descriptive statistics were used for analysis of the data collected. Results 144 charts have been reviewed to date. The mean age in years at initial assessment was 6.22 (0.07–25.84). The most commonly documented ethnicity was Indigenous (30%), followed by Latinx (8%) and Middle Eastern (8%); 45% of patients were unspecified, as race is not consistently collected in Canadian health records. Poverty was mentioned as an issue in 52 (36%) patients’ charts, ministry involvement noted in 29 (20%), and substance use in 45 (31%) of households. 74 (51%) of charts had evidence of at least one adverse SDoH (e.g. financial and/or housing instability, food insecurity) that could negatively influence health equity. The most frequently documented diagnoses were skin disorders (38%), ADHD (31%), upper respiratory tract infections (29%), learning disability (27%), and speech delay (25%). Developmental disorders were diagnosed in 79 (55%) patients and 45 (31%) had at least one incidence of being seen by a nurse practitioner or general paediatrician for a mental health concern. Conclusion Place-based, equity-oriented social paediatrics clinics see more socially and developmentally complex individuals than traditional paediatric clinics or community health programs. Data analysis of the population seen by our inner-city program found 55% and 31% of patients had developmental and mental concerns, respectively. This suggests that clinicians planning or working in similar programs should be prepared to support neurodevelopmental, mental health, and common medical conditions (e.g. skin disorders and infections).

Young Children’s Electronic Media Use and Parental Rules and Regulations

Today’s children are born and raised in media-saturated environments, surrounded by televisions, computers, tablets, smartphones, and other portable electronic devices. Because these devices have become an indispensable part of everyday life, they have a significant influence on children's entertainment and leisure, as well as their education. This study, therefore, examined how early and how much young children (from 0 to 6 years of age) use television, computers, and tablet/smartphones, specifically whether this media usage is directly affected by socio-demographic factors related to parents (i.e., their education, income, and age), the children themselves (i.e., their age, gender, and the presence and number of siblings), and the media environment in their homes (i.e., the availability of media, parental opinions about media, and regulation of media use). The sample for this study consisted of 412 parents of 0- to 6-year-old children who brought their children to the Social Paediatrics Department of the Faculty of Medicine in Ankara, Turkey, for developmental check-ups. The data for this study were collected through a questionnaire that was prepared by the researcher. The findings indicate that almost all children live in homes with different types of electronic media devices and the children’s home electronic media environments and their parents’ demographics are important predictors for their usage of electronic media.

Experience of Child Drivers of the Blind: Cases Observed on the Streets of the City of Kisangani in Democratic Republic of Congo (DRC)

Child drivers of the blind are the concern of many pioneers in social paediatrics. These children live a life dependent on the blind. Less publicised and more difficult to count in official reports, the exploitation of children by their parents is a real scourge in Africa. Begging on the streets for the benefit of adults involves major risks for the hygiene and health of minors - sometimes newborns - and keeps them further away from school. This is a situation that should worry the political and administrative authorities. This work proposes to determine the experiences child drivers of the blind in the city of Kisangani with a view to promoting the right of the child. To collect the data, this qualitative study used unstructured interviews with a casual sample of six child drivers of the blind available and accessible. We found that child drivers of the blind are forced to beg for their livelihoods. Their schooling and the satisfaction of their basic needs as well as those of their families depend on the income they find in begging. Thus, the need to put into perspective the living conditions of child drivers of the blind in order to determine the most appropriate responses to their socio-economic conditions.

Synopsis of Clients Seen at the Adolescent and Social Paediatrics Unit of a Tertiary Health Facility in South-East Nigeria: A Three-year Review

Background: The adolescent period is a unique and crucial period of growth and development, in which the child transits from childhood to adulthood. It is characterised by several changes, both physiological and psychological, in preparation for adulthood. Thus, their health needs and health challenges differ from that of other children. Hence, the need to pay special attention to them and provide health and social support tailored toward their needs. Aim: This study aimed to determine the pattern of cases that presented to the Adolescent and Social Pediatrics Unit (ASP) of the Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA) over a three-year period. Materials and Methods: This was a retrospective study done to determine the pattern of cases seen at the Adolescent and Social Paediatrics Unit of the Alex Ekwueme Federal University Teaching Hospital, Abakaliki, between 2017 and 2019. Case files of all patients seen within the study period were retrieved, and all were included in the study. Relevant information such as age, gender, social class, diagnosis for both adolescent and nonadolescent age groups, treatment modalities, clinical subspecialties involved in management, and the outcome were retrieved. Data were entered and analysed using SPSS version 25, and results were presented as ratios, means, and proportions, whereas comparisons were made with the Chi-square test or Fisher’s exact were applicable. P &lt; 0.005 was considered statistically significant. Results: A total of 220 clients were seen over the given period. The adolescents were 148 (67.3%), whereas nonadolescents were 72 (32.7%). Among the adolescents, common diagnoses include sexual assault (24.3%), acne (8.1%), Pelvic Inflammatory Disease (PID)/sexually transmitted infection (STI) (8.1%), HIV (8.1%), somatisation disorder (6.8%), suicide attempts (5.4%), oppositional deviant disorders (4.1%), and conduct disorder (2.7%). In nonadolescents, common diagnoses include sepsis (30.6%), Severe Acute Malnutrition (SAM) (30.6%), and malaria (11.1%). There was a significant difference between the adolescents and nonadolescents with respect to diagnosis (P &lt; 0.001), treatment modalities (P &lt; 0.001), type of care received (P &lt; 0.001), and outcome (P = 0.002). Conclusion: The study has portrayed that the common medical conditions seen among adolescents include sexual assault, acne, HIV, PID/STI, and somatisation. This will be useful in developing health-care services and program geared toward adolescent health.

Integrating social paediatrics through experiential and advocacy-based learning.

Medical EducationVolume 56, Issue 5 p. 573-574 REALLY GOOD STUFF Integrating social paediatrics through experiential and advocacy-based learning Andrea R. Ens, Andrea R. EnsSearch for more papers by this authorBreanna A. Chen, Breanna A. ChenSearch for more papers by this authorJill Sangha, Jill SanghaSearch for more papers by this authorJacqueline D. Ogilvie, Corresponding Author Jacqueline D. Ogilvie jacqueline.ogilvie@lhsc.on.ca orcid.org/0000-0001-7198-7410 Correspondence Jacqueline D. Ogilvie, 800 Commissioners Rd East, London, ON N6A 5W9, Canada. Email: jacqueline.ogilvie@lhsc.on.caSearch for more papers by this author Andrea R. Ens, Andrea R. EnsSearch for more papers by this authorBreanna A. Chen, Breanna A. ChenSearch for more papers by this authorJill Sangha, Jill SanghaSearch for more papers by this authorJacqueline D. Ogilvie, Corresponding Author Jacqueline D. Ogilvie jacqueline.ogilvie@lhsc.on.ca orcid.org/0000-0001-7198-7410 Correspondence Jacqueline D. Ogilvie, 800 Commissioners Rd East, London, ON N6A 5W9, Canada. Email: jacqueline.ogilvie@lhsc.on.caSearch for more papers by this author First published: 02 March 2022 https://doi.org/10.1111/medu.14768Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume56, Issue5May 2022Pages 573-574 RelatedInformation

Community Social Paediatrics Approach, an Innovative Healthcare Intervention: Implementation Fidelity in Atlantic Canada.

The Community Social Paediatrics approach (CSPA) is a comprehensive and personalized approach to care that is becoming more widely used throughout Canada. However, data on its implementation fidelity remain scarce. The purpose of this research was to assess the implementation fidelity of a CSPA established in 2017 in Canada. Data were collected through focus group interviews with the CSPA team using an implementation fidelity grid based on the Dr. Julien Foundation standard accreditation criteria. Results showed that on one hand, administrative and financial management and governance were among those domains with lower ratings. On the other hand, assessment/orientation and follow-up/support had high levels of fidelity of implementation. This research helps to better understand which factors are contributing to varying levels of fidelity of implementation. To reach an increased level of fidelity of implementation, it is recommended that adequate resources be in place.

Medical professional consultation for adolescents with deviations in health state as a professional trajectory into adulthood

The issues of adaptation and vocational guidance of children with disabilities during the transition from school to vocational training and employment are undoubtedly crucial for the socialization of children with various forms of chronic pathology. The aim of this work is to determine the possibilities of professional medical consultation (PMC) in the rehabilitation of adolescents with disabilities. Materials and methods. The issues of the history of the development of vocational guidance of children are considered. The personal experience of the medical professional consulting of 940 adolescents with various deviations in health conditions is presented. Results. The structure of diseases in adolescents who received professional advice was analyzed. Clinical examples of PMC of adolescents with various forms of pathology of the central nervous system, arterial hypertension and peptic ulcer disease are presented. The unfavourable factors of the working environment and the professions recommended for adolescents have been determined. The importance of the cooperating work of a doctor and a psychologist in the development of a professional trajectory for adolescents with various health deviations from risk groups is shown. Conclusion. The PMC of adolescents with deviations in health is one of the stages of medical, social and labour rehabilitation. It allows choosing a worthy profession and determining its successful implementation in adult life. The military-industrial complex for children is one of the critical areas of social paediatrics.

Rolf Zetterström: Discovered how bilirubin harms the brain in newborns with jaundice.

From the time I started school, I heard how brilliant Rolf Zetterström was from my father, who was also a paediatrician. Rolf had applied for a professorship in paediatrics at the Karolinska Hospital Children’s Clinic and was the favourite among the experts. He had among other things discovered how bilirubin harms the brains of newborns with jaundice. But the faculty likely considered him to be too young, which is why he was bypassed by the somewhat older Johnny Lind. As young as 38, Rolf was instead granted professorship at Gothenburg, where he quickly established distinguished research projects with adeptes such as Jan Winberg, Olov Celander and Johan Gentz. Four years later, he was called to the paediatric professorship at the Crown Princess Lovisa—later Saint Göran—Hospital. He had a fantastic ability to recruit research paediatricians, whereof several were from preclinical institutions. Several of them later became professors, such as Ove Broberger, Anita Aperia, Birgitta Strandvik, Ulla Berg, Agne Larsson and Gisela Dahlquist. Rolf was not just an influential researcher with over 400 publications but also a skilful clinician, who quickly could make the correct diagnosis in difficult cases. He was active for many years in the Nobel committee for physiology or medicine and the Royal Swedish Academy of Sciences. He was known in academic contexts for almost always asking relevant questions, if only after first giving a historical summary, before—in a somewhat crumpled way—reaching the point. For 40 years—between 1965 and 2005—he was editor-in-chief for Acta Paediatrica (Figure 1) and then continued as literature editor almost until his death in 2011. Owing to his encyclopaedic knowledge, he was competent to review articles within almost all paediatric subspecialties, even if he had associate editors to assist. I believe he read most of the articles himself and was very particular with the scientific quality. Manuscripts could be sent back and forth between the editorial office and the authors before they were accepted. Rolf was also recognised and respected internationally. It was therefore a challenge for me to succeed him in 2005, and he was not exactly happy to retire as editor-in-chief at 85 years of age. But we became very good friends. He came almost daily to the editorial office in an old villa between Karolinska Hospital’s main building and the Northern Cemetery. His office was cluttered with books and manuscripts. He continued to write, and engaged himself in all sorts of projects, on topics such as the environmental disasters around the polluted Aral Sea. I could always visit his office and discuss everything from Vitamin D, to BCG vaccination, to social paediatrics. He told me about several Nobel prize winners in physiology or medicine, which he had helped to judge. To a great extent, the conversations also surrounded the incompetence of most hospital directors. I was myself critical, but not nearly to Rolf’s degree. But when I met him in his later days, Rolf was not some hard authoritarian type of boss as the rumours went. He was then relatively humble and warm-hearted, and it was always rewarding to converse with him. The author has no conflicts of interest to declare.

Representation of the image of the minor in the publicity circulated via the Internet

The representation of the minor in advertisements is a topic that is scarcely studied and reflected in the bibliography, in social paediatrics as well as audio-visual communication. The aim of the present study is to describe how the minor is represented in the publicity that is conveyed through the internet, and whether or not that representation is adequate. An analysis was made of all the advertisements in which minors appeared during a period of two months, on three days a week, on the most visited web pages in Spain. The evaluation on how the minor was represented was carried out with an evaluation tool, constructed by the authors, based on European and Spanish legislation, which showed a high concordance between evaluators. A descriptive analysis was performed on the categorical variables, and the inter-dependent relationship was established between them using the chi-squared test. A total of 173 advertisements were identified in which at least one minor appeared, which was generally represented solo (63.5%), in a natural environment (36.9%) and of school age (44.5%). The web pages of the "general press" are those that most frequently show advertisement in which minors are represented, through the use of banners (82%). In the majority of cases the inadequate use of the figure of the minor takes place using tactical representation, and not just strategic. The image of the minor in the publicity that is conveyed via the most visited web pages in Spain is inadequate in 3 of every 3 advertisements. This misuse of the minor is usually seen in as unjustifiably strategic, and favouring non-positive values or that they favour situations of inequality.

Representation of the image of the minor in the publicity circulated via the Internet

IntroductionThe representation of the minor in advertisements is a topic that is scarcely studied and reflected in the bibliography, in social paediatrics as well as audio-visual communication. The aim of the present study is to describe how the minor is represented in the publicity that is conveyed through the internet, and whether or not that representation is adequate. Material and methodsAn analysis was made of all the advertisements in which minors appeared during a period of two months, on three days a week, on the most visited web pages in Spain. The evaluation on how the minor was represented was carried out with an evaluation tool, constructed by the authors, based on European and Spanish legislation, which showed a high concordance between evaluators. A descriptive analysis was performed on the categorical variables, and the inter-dependent relationship was established between them using the chi-squared test. ResultsA total of 173 advertisements were identified in which at least one minor appeared, which was generally represented solo (63.5%), in a natural environment (36.9%) and of school age (44.5%). The web pages of the “general press” are those that most frequently show advertisement in which minors are represented, through the use of banners (82%). In the majority of cases the inadequate use of the figure of the minor takes place using tactical representation, and not just strategic. ConclusionsThe image of the minor in the publicity that is conveyed via the most visited web pages in Spain is inadequate in 2 of every 3 advertisements. This misuse of the minor is usually seen in as unjustifiably strategic, and favouring non-positive values or that they favour situations of inequality.

Clinical profile and risk factors of enuresis in children

Background: Enuresis is a common problem in children and its incidence is multifactorial in nature. The aim of this study is to assess the etiological risk-factors in enuresis in the study population and also to compare the risk factors in enuresis subgroups.Methods: A total of 51 patients with enuresis presenting to the department of paediatrics, Institute of Social Paediatrics, Govt. Stanley Hospital, Chennai were included in the study. All children were sub classified as primary/secondary and the primary enuretics were sub classified into monosymptomatic/non monosymptomatic depending on the symptoms. The data was analyzed and the results presented.Results: Enuresis was common in boys. Statistically significant difference in the incidence of disorder between primary and secondary enuretic children was seen in relation to presence of storage symptoms (p=0.04), cystitis (p=0.013) sleep disordered breathing (p=0.0001) and low-income status (p=0.04). No statistically significant difference between into monosymptomatic nocturnal enuresis (MNE) and non-monosymptomatic nocturnal enuresis (NMNE) children was observed in terms of gender, difficulty in arousal, specific gravity, spina bifida, low bladder capacity and family history (p&gt;0.05).Conclusions: The findings of the study reported that risk factors related to the incidence is similar in both primary and secondary enuresis. MNE and NMNE have no differences in the presentation and probably represent the spectrum of a same disorder.

151 What Do We Mean When We Say “Social Paediatrics?”: Preliminary Results from a Critical Discourse Analysis

151 What Do We Mean When We Say “Social Paediatrics?”: Preliminary Results from a Critical Discourse Analysis

150 Cultivating Compassionate Care, Advocacy Skills and a Health Equity Lens in Resident Physicians: The Development of a Social Paediatrics Curriculum

150 Cultivating Compassionate Care, Advocacy Skills and a Health Equity Lens in Resident Physicians: The Development of a Social Paediatrics Curriculum

ADDRESSING ADVERSE CHILDHOOD EXPERIENCES (ACES) BY COMBINING PUBLIC HEALTH, SOCIAL PEDIATRIC AND RICHER COMMUNITY BASED APPROACHES

Abstract BACKGROUND The Canadian Social Pediatric Interest Group has developed emerging research partnerships over the past decade. In this multi-centre partnership, we characterize social paediatrics programs (SPPs) in three dimensions: 1) fostering health equity; 2) inter-professional integration, and 3) community embeddedness, all of which involve independently complex sets of interventions. The aim of the RICHER (responsive, interdisciplinary, community health, education and research) SPP is to provide timely access to prevention and intervention services for children and youth at higher risk due to multiple social determinants of health(SDoH) including adverse childhood experiences (ACEs) and material and social poverty. OBJECTIVES Our objectives are to 1) translate SPP knowledge and experience into policy and practice through formal literature reviews and mixed methods research, 2) further develop and integrate SPPs quality improvement(QI) and research, and 3) integrate trauma informed ACE research findings into primary care and paediatric practices in Canada. DESIGN/METHODS Following established realist synthesis methodology, built on earlier mixed methods research, a literature review was undertaken to identify key mechanisms linking context/environment to health outcomes. The study method included: (1) identifying the review question, (2) formulating the initial theory, (3) searching for primary studies, (4) selecting and appraising study quality, (5) extracting, analyzing and synthesizing relevant data, and (6) refining the theory. Using mixed methods approaches, the RICHER SPP research data was analyzed to identify outcomes, develop and update logic models. Health professional survey of paediatric specialists and surgeons has been developed to explore knowledge of ACEs and SDoH and how these impact practice. RESULTS Analyses of the literature for the realist synthesis resulted in semi-predictable patterns where outcomes could be linked to activities through mechanisms. Key mechanisms were 1) willingness to share power, 2) bridging trust and relationships 3) inter-professional knowledge support and 4) family/ community empowerment. Key features of RICHER SPPs included trust, equity and partnerships, leading to parental and community engagement, improved access to services and enriched environments. There was a measured ‘critical difference’ in vulnerability on the HELP Early Developmental Index (EDI) during the study period. An approach to integrating and evaluating ACEs in different SPP practice settings has been initiated through research and QI projects. CONCLUSION Our realist synthesis identified processes of care that were effective in improving health and developmental outcomes for children and youth with adverse social and material circumstances. ‘RICHER’ SPPs, distributed in neighbourhood spaces, link primary and specialist care for vulnerable children and youth, improve health and developmental outcomes and foster equitable access to health care and transition services. These approaches may be translated into other contexts to improve access for more socially vulnerable children and youth and better integrate our knowledge of ACES into paediatric and youth health practices.

Practising ‘social paediatrics’: what do the social determinants of child health mean for professionalism and practice?

Abstract Paediatrics stands at a turning point: today's health challenges are chronic, complex and connected, but health services are ill-prepared. Given the well-established epidemiological literature which shows that health status is heavily determined by social factors, the profession is now forced to redefine itself. What role should paediatricians play in the health systems of the future? How might the application of a ‘social lens' and development of ‘social paediatrics' help the profession to reconsider its roles and responsibilities? This paper represents a first attempt to respond to these questions. Using child poverty as an example of how socially conscious practice can broaden paediatric interventions for both the individual patient and wider population, it lays the ground for further work, which is both timely and necessary if practitioners are to be properly empowered and equipped to deal with child health in the 21st century.

Congenital cytomegalovirus infection in Central Germany: an underestimated risk.

This is the first study to determine the cytomegalovirus (CMV) seronegativity rate for women of childbearing age in Saxony-Anhalt and to determine the prevalence of clinically relevant congenital CMV (cCMV) infection in Central Germany, because there are no valid data available. The retrospective study was undertaken between January 2005 and December 2015. For the first time in Germany, the following seven data sources were used to analyze the prevalence of clinically relevant cCMV infection and the rate of CMV seronegative women of childbearing age: CMV Screening in maternity unit, University Women's Hospital, Social Paediatrics Centre (SPC), Malformation Monitoring Centre (MMC), Newborn Hearing Screening (NHS), Neonatal Intensive Care Unit (NICU), and In-house Doctor Department. Key parameters were anti-CMV IgG and IgM, CMV PCR of urine, and clinically relevant symptoms caused by CMV. Between 46 and 52% of women of childbearing age were CMV seronegative. The prevalence of clinically relevant cCMV infection was between 0.008 and 0.04%. The CMV seronegativity rate of women of childbearing age was confirmed to be in the middle range of estimated data from other sources in Germany. Data from the NICU, SPC, NHS, and MMC show the prevalence of clinically relevant cCMV infection. The risk of all cCMV infections is underestimated. Thus, the true prevalence of clinically relevant and subclinical cCMV infections is >0.04%.