Child Visits Research Articles

Migrant Identity: Maintenance of Lithuanianness, Language Attitudes and Language Policy in Lithuanian Diaspora

Abstract Ethnic, linguistic identity, heritage language maintenance and transmission, language attitudes and policies remain important topics in nowadays globalized world. The main purpose of this study, which is a part of a large-scale research on Lithuanian heritage language, was to analyze the linguistic and ethnic identity development within Lithuanian diaspora. The article investigates the linguistic attitudes, language practices and language policies within the Lithuanian diaspora in Ireland and Norway, paying extra attention to the younger (K2) generation of Lithuanian migrants. A specialized sociolinguistic questionnaire was developed for this study. A total of 74 first-generation Lithuanian emigrants based in Ireland (n = 18) and Norway (n = 56) participated in the online survey. All participants had children aged 4–17. The data from the questionnaire survey are also illustrated with examples from 5 semi-structured interviews. The study revealed that emigrants from both countries maintain a strong connection with their country of origin. Almost half of the respondents claim that their children visit Lithuania at least once a year, while more than a third of respondents’ children visit Lithuania twice a year or more often. A third of participants are planning to return to Lithuania. Most of the respondents enroll their children to Lithuanian Saturday schools. However, the younger generation seem to differ from their parents in their language attitudes and practices: Lithuanian children based in Ireland tend to feel a stronger connection with the majority language (English) than Lithuanian. Meanwhile, children in Norway are multilinguals, having more than two languages in their everyday repertoire. To summarize, the study demonstrated the main language attitudes and practices of Lithuanians abroad and also highlighted some differences between the first and the second generation of Lithuanian migrants. The results from this study might provide interesting insights for future studies in the fields of sociology, sociolinguistics, and diaspora studies.

Patient-centered medical homes and vision care for children: a cross-sectional analysis with data from the national survey of children’s health 2018–2019

BackgroundVision screening as part of well-child visits is recommended annually for US children 3 to 6 years. However, 63% of children do not get a vision screening in well-child visits. The Patient-Centered Medical Home (PCMH) improves the receipt of preventive care visits in other medical specialties but it is unknown if it improves receipt of vision screening. The objective of this study is to determine whether caregiver-reported receipt of care in a PCMH is associated with receiving a vision screening test in a well-child visit for children 3 to 6 years in a pediatrician/general doctor’s office (‘primary care’).MethodPopulation-based data for US children aged 3 to 6 years was derived from the National Survey of Children’s Health (2018–2019). Children were excluded if they did not have a well-child visit in the previous 12 months. The primary exposure was receipt of care in a PCMH (‘PCMH care’), and the primary outcome was receipt of a vision screening in primary care. Adjusted odds ratios (aOR) and predicted probabilities were computed for children with and without PCMH care.ResultsAmong 9,587 children with well-child visits, 4,984 (50.9%) were males. There were 1,107 (23.3%) Hispanic, 6704 (52.8%) White/Non-Hispanic and 545 (11.8%) Black/Non-Hispanic children. There were 5,482 (51.8%) children who received PCMH care. Of those with PCMH care, 2,629 (52.2%) received a vision screening in primary care. Those with PCMH care (52.2%) had a higher odds of receiving a vision screening (aOR, 1.31; 95% CI 1.11, 1.55) in primary care compared to children without PCMH care (42.8%). The predicted probability of vision screening in primary care was 50.8% (95% CI 48.2, 53.5) for children that received PCMH care, and 44.3% (95% CI 41.3, 47.3) without PCMH care.ConclusionsCaregiver-reported receipt of PCMH care was associated with a greater likelihood of vision screening for children 3 to 6 years in a well-child visit. Further studies are needed to understand the mechanisms through which PCMH care contributes to the greater odds of vision screening in primary care to inform the creation of strategic interventions to prevent vision loss and its long-term implications.

Registration and management of children with overweight by general practitioners in The Netherlands

Background General practitioners (GPs) form the gateway to healthcare in numerous European countries. Their role in addressing and managing overweight/obesity in children is crucial. In Dutch guidelines, GPs are encouraged to proactively address weight-related issues during patient consultations, regardless of the initial reason of the visit. Objective(s) To examine the frequency, management and follow-up of GP visits of children for overweight/obesity and the identification by GPs of these children presenting with other complaints. Methods A retrospective cohort study. Health records from 2012–2021 in the Rijnmond Primary Care Database (RPCD) of children aged 2–18 with overweight/obesity who visited the GP were analysed. Children were categorised into two groups: those visiting for weight-related issues (group 1) and those visiting for other complaints but identified as overweight or obese by GPs (group 2). Data on patient demographics, reasons for contact, and management strategies were extracted. Results From the 120,991 children, 3035 children with documented overweight or obesity were identified, 208 were excluded. The study population comprised 2827 individuals: 55% belonging to group 1, 45% to group 2. The frequency of first visits remained stable at approximately 0.5% visits per total person-years each year. Group 1 received more referrals (74%) and follow-up consultations (45.5%) than group 2 with 17% referrals and 19.7% follow-up consultations. Conclusion This study highlights a concerning difference in the management of the two groups. Strategies for effective management of overweight in children and the GP’s role, warrant further investigation. Especially when overweight is not the primary reason for visit.

Culturally Tailored Messages and Trial Registry Enrollment

Marginalized populations have lower levels of clinical trial representation than other populations. Tailoring recruitment materials and providing incentives may improve representation. To determine whether culturally tailored video improves parents' decision to enroll (DTE) Black children in a research registry. A randomized clinical trial, using mixed methods and consecutive sampling, was conducted in an urban primary care pediatric clinic. A post hoc study assessed the association of a monetary incentive with DTE. Ninety-three parents were recruited before their child's scheduled clinic visit. Participants completed a survey during which they were randomly assigned to review a paragraph (control group), generic video, or tailored video and received a gift card. Video watchers completed questions about its effectiveness. All participants were invited to join the registry. In the post hoc study, consenting participants followed the control group protocol and the coordinator promised them an ink pen for participating. The study was conducted between November 15, 2022, and August 29, 2023. A survey regarding the importance of being included in research studies was administered after participants watched a culturally tailored video. The primary outcome was DTE. Covariates were message effectiveness, clinical trial knowledge, and trust. Intention-to-treat analysis was performed. A total of 125 individuals were included. All groups had similar mean (SD) parent age (overall, 32.6 [7.35] years), gender (110 [88.0%] women), and race (116 [92.8%] Black or African American). There was no significant difference in the odds of DTE between the appeal video and control (odds ratio [OR], 1.19; 95% CI, 0.38-3.72) or between the generic video and control (OR, 1.91; 95% CI, 0.54-6.71). However, DTE was higher for all 3 gift card groups vs the ink pen incentive group (eg, control vs ink pen incentive: OR, 5.01; 95% CI, 1.68-14.95). After adjusting for trust, monetary incentives were associated with higher odds of DTE (adjusted OR, 5.92; 95% CI, 2.44-14.39). In this randomized clinical trial, targeted messaging was not associated with a higher decision to enroll in a pediatric clinical trial registry. There may be a role for combining holistic messaging with monetary incentives to improve enrollment. ClinicalTrials.gov Identifier: NCT06138145.

Impact of the COVID-19 pandemic and lockdown measures on clinical visits and subjective symptoms in childhood allergic rhinitis induced by house dust mites in Shanghai

BackgroundEstablishing the interaction between aeroallergens and air pollution in children with house dust mite induced allergic rhinitis (HDM-AR) remains challenging, especially in urban areas. The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown measures provided a valuable opportunity.MethodsWe analyzed the clinical data of HDM-AR children between March and August in 2018–2020, and classified the children according to the type and the degree of HDM sensitization. The records of patients’ hospital visits, allergic rhinitis symptoms assessments, and air pollution measurements in Shanghai were used to assess the differences before (2018–2019) and during the pandemic (2020), as well as during lockdown (March-June) and unlockdown (July-August) period in 2020.ResultsThe study included 1570 HDM-AR children aged 2 to 8 years old, 815 (51.9%) were monosensitized to HDM (mono-HDM-AR), and 755 (48.1%) were polysensitized to HDM (poly-HDM-AR). There was a significant increase in the rate of clinical visits among children with HDM-AR during the COVID-19 pandemic compared to pre-pandemic (P < 0.001), particularly among older children aged 7–8 years (P = 0.01). During the unlockdown period, there was a notable decrease in clinical visits for children with poly-HDM-AR (P < 0.001). Children with high levels of HDM sensitization exhibited significant symptom improvement in unlockdown period (P < 0.001). Although the air pollutants concentration had improved during the study, there was no effect on the improvement of HDM-AR children as expected.ConclusionsThe COVID-19 pandemic and its associated lockdown measures provided a unique context to observe the dynamics of management in children with HDM-AR. The findings underscore the complexity of managing allergic conditions in pediatric populations, highlighting the influence of environmental and lifestyle changes on disease presentation and the need for tailored approaches to treatment during periods of societal disruption.

Importance of medical home domains on emergency visits using a cross-sectional national survey of US children.

Receiving care at patient-centred medical homes (PCMH) is associated with reduced emergency department (ED) visits among children. Adverse social determinants of health (SDoH), such as lower socioeconomic status and household poverty, are associated with increased ED visits in children. The objective of this study is to use machine learning techniques to understand the relative importance of each PCMH component among different populations with adverse SDoH on the outcome of ED visits. This study used the 2018-2019 pooled data from the National Survey of Children's Health (NSCH), an annual survey of parents and caregivers of US children from birth to 17 years. PCMH components were operationalised by classifying parent/caregiver responses into five domains: care coordination (CC), having a personal doctor or nurse, having a usual source of care, family-centred care and ease of getting referrals. SDoH included five categories: (1) social and community context, (2) economic stability, (3) education access and quality, (4) healthcare access and quality and (5) neighbourhood and built environment. We used a split-improvement variable importance measure based on random forests to determine the importance of PCMH domains on ED visits overall and stratified by SDoH. Overall, between 3% and 28% experienced one or more gaps in PCMH domains. Models show that problems with referrals (rank, 2; Gini, 83.5) and gaps in CC (rank, 3; Gini, 81.0) were the two most important domains of PCMH associated with ED visits in children. This result was consistent among black and Hispanic children and among children with lower socioeconomic status. Our study findings underscore the importance of poor CC and referrals on ED visits for all children and those from disadvantaged populations. Initiatives for expanding the reach of PCMH should consider prioritising these two domains, especially in areas with significant minority populations.

Perceptions of roles of community healthcare workers in early childhood in Limpopo, South Africa.

As part of the Reengineering Primary Health Care initiative, the South African National Department of Health (NDoH) has committed to expanding access to home-based care provided by community health workers. The NDOH also prioritised Community Health Workers (CHWs) in their agenda to improve child development outcomes in South Africa. However, there is limited research on CHWs' experiences and knowledge of early childhood development. To explore CHWs' motivation for work, their background, training and scope of work around Early Child Development (ECD). The study was conducted in Mopani District, Limpopo province, South Africa, in 2017. Five focus group discussions (FGDs) were conducted with 41 CHWs participating within a large cluster-randomised study. Data were analysed thematically using an inductive approach. Community health workers' motivation to work was influenced by personal experiences, community needs and community service. In terms of knowledge, CHWs indicated that a nutritious diet with extended breastfeeding, immunisations and preschool education is imperative for a child to thrive. The Road to Health Booklet, weighing scales and the mid-upper arm circumference tape were used as screening tools for ECD. Community health workers perceived their knowledge around ECD to be insufficient. Community health workers play a crucial role in healthcare; therefore, capacity development on ECD and the provision of ECD screening tools to optimise their under-five child visits are necessary.Contribution:This study will potentially contribute to the improvement of the CHW programme in ensuring that children under 5 years of age are holistically cared for to ensure that they thrive.

Inequalities in the risk and prevention of invasive meningococcal disease in the United States – A systematic literature review

ABSTRACT Vaccination remains the most effective strategy to prevent invasive meningococcal disease (IMD), with MenACWY, MenB and MenABCWY recommended for adolescents/young adults in the United States (US). However, vaccination coverage remains suboptimal, which could be related to population inequalities. To understand the impact of IMD risk, prevention and control inequalities, a global systematic literature review (Medline, Embase, 2012–2022) was conducted on individual, socioeconomic, and environmental inequalities associated with IMD risk, prevention and control in all ages. Studies on IMD risk (n = 15) and prevention (n = 14) inequalities were identified. IMD incidence proportions were higher in Medicaid versus commercially insured populations, and IMD mortality was higher in poorer neighborhoods. White adolescents, adolescents from lower income families, and with lower maternal education were more likely to receive MenB vaccination; while Black and Hispanic adolescents, and adolescents with higher family incomes, were more likely to receive MenACWY vaccination. Meningococcal vaccination was associated with being up-to-date with other vaccinations, having multiple healthcare/well child visits, having a pediatrician as healthcare provider (HCP), and attending private facilities; while being uninsured was associated with lower vaccination. States with a MenACWY vaccination mandate and higher pediatrician-to-children ratios had higher vaccination rates. Important inequalities were due to individual differences, socioeconomic, and environmental factors. IMD prevention is suboptimal, especially among adolescents/young adults. To improve health equity, health policy makers could ameliorate meningococcal vaccination coverage across the US, with simplified and stronger meningococcal vaccine recommendations from public health authorities, and initiatives to enhance parental/patient and HCP knowledge of IMD and vaccine recommendations.

Predictors of Hospital Admissions and Return Visits in Children with Suspected Dehydration Presenting to the Emergency Department

Predictors of Hospital Admissions and Return Visits in Children with Suspected Dehydration Presenting to the Emergency Department

Assessing the impact of a gastrointestinal cancer diagnosis on mental health claims among coinsured household family members

BackgroundGastrointestinal (GI) cancer diagnosis can adversely affect the mental health (MH) of household members, including spouses and children. We sought to examine potential changes in MH claims in households following an index patient’s GI cancer diagnosis. MethodsHouseholds of patients with a GI cancer diagnosis were identified using the IBM MarketScan database (2014–2019) and matched with households of patients without cancer. MH-related visits of spouses and children were assessed in the 12 months before and after the index date of diagnosis. Changes were compared between the two cohorts using difference-in-difference (DID) analysis. ResultsAmong 40,650 households in the spouse analysis and 20,014 households in the child analysis, 25.1% (n = 10,210) and 26.8% (n = 5,368) were households in which there was a patient with a GI cancer. Univariable DID analysis demonstrated that households with a GI cancer had a greater increase in anxiety-related (spouses, 2.2% vs 0.7%; children, 2.0% vs 1.1%), mental illness (MI)–related (spouses, 3.2% vs 1.2%; children, 3.0% vs 1.6%), and overall MH-related visits (spouses, 3.3% vs 1.4%) versus the control group (all P < .05). In adjusted DID analysis, spouses, children, and households with a GI cancer diagnosis had a 2.1%, 1.6%, and 2.3% absolute risk increase of MI-related visits, respectively, compared with non-cancer households (all P < .05). ConclusionIn a cohort of privately insured households, coinsured spouses and children of patients with a GI cancer diagnosis had a higher risk of MH-related claims versus households without a GI cancer diagnosis. The data highlight the importance of family counseling and psychological support when a loved one is diagnosed with cancer.

Study protocol for Early Tracking of Childhood Health determinants (ETCHED): A longitudinal observational life course study

BackgroundThe prevalence of childhood obesity and diabetes continues to rise in the United States (US), especially among minority populations. The objective of the Early Tracking of Childhood Health Determinants (ETCHED) study is to investigate the role of adverse fetal and early-life risk exposures that contribute to the development of childhood obesity and metabolic risk.MethodsETCHED is a longitudinal observational study of American Indian/Alaska Native (AI/AN) and Hispanic pregnant woman and their offspring. Pregnant mothers ≥ 18 years old are enrolled at a large public hospital system in the southwestern US. Enrolled mothers are followed through pregnancy, delivery, and the maternal/offspring dyad will be followed until the child’s 18th birthday. At each maternal visit, questionnaires assessing medical history, diet, physical activity, sleep, perceived stress, and socioeconomic and sociocultural information are obtained. Standard laboratory tests during maternal visits include glycemic measures, lipids, and renal function. Additional bio samples obtained include venous blood samples and cord blood for obesity/metabolic biomarkers and genetic/epigenetic testing, urinalysis, placental tissue for examining functional pathways, breast milk for metabolomics, and stool for metabolites and microbiome analysis. The offspring will have 6 infant/toddler visits at 6–12 weeks, 4 months, 6 months, 18 months, 2 and 3 years respectively. Thereafter, they will undergo comprehensive research visits (major visits) at 4–5 years, 6–9 years, 10–13 years, and 14–17 years. The major visits in children include detailed medical history, anthropometry, developmental assessment, socioeconomic and environmental assessments (food insecurity, family structure, and childcare), feeding and activity, biochemical tests, genetics/epigenetic testing, and ultrasound elastography. Electronic health records will be reviewed for additional clinical information. The primary analysis will constitute estimation of correlation coefficients between continuous variables. The planned study duration in this ongoing study is 23-years.DiscussionThis is a life course study that that will examine biological and environmental risk factors for obesity and cardiometabolic risk from the intrauterine period to early childhood and adolescence in a population with high-risk of obesity and type 2 diabetes in the United States. The ETCHED study would also provide a unique opportunity to combine multi-omics and clinical data to create novel integrative models to predict the cardiometabolic risk associated with childhood obesity and possibly identify etiopathogenetic mechanisms and future targets of intervention.Trial registration numberClinicalTrials.gov identifier: NCT03481829. Updated July 19, 2024, https://clinicaltrials.gov/study/NCT03481829?cond=ETCHED&rank=1.

Acceptability and feasibility of trauma- and violence-informed care for intimate partner violence

Background/objectivesIntimate partner violence (IPV) and child physical abuse frequently co-occur, yet IPV-exposed children are not routinely evaluated for abuse. Furthermore, IPV survivors often seek care for their children but not for themselves, making pediatric visits an opportunity to address IPV. We developed a trauma- and violence-informed care (TVIC)-based model that 1) evaluated IPV-exposed children and 2) linked survivor-caregivers to an IPV advocate.We aimed to assess the feasibility and acceptability of the model. ParticipantsChildren < 3 who were reported to Child Protective Services (CPS) for exposure to IPV and their survivor-caregiver. MethodsTo examine feasibility, we calculated the percentage of 1) eligible children evaluated and 2) caregivers who met with an IPV advocate during the child's visit and followed up with the advocate. To assess acceptability, we conducted qualitative interviews with 30/41 caregivers about their perceptions of the model. ResultsFrom 7/1/20–6/30/22, 49 (22.7 %) of 216 eligible children were evaluated. Of 41 caregivers, six already were receiving IPV services; Of the remaining 35, 24 (68.6 %) met with an IPV advocate, and 22 (91.7 %) had ≥1 follow-up visit with an advocate.We identified three themes: 1) Motivations for the visit, 2) Engagement with the model, and 3) Benefits. Caregivers attended the visit due to behavioral concerns about the child and a desire to comply with CPS. Engagement occurred as medical providers established rapport and provided support without judgment. Benefits included recognizing the impact of IPV on the child and immediate linkage to advocacy services. ConclusionA TVIC-based model is feasible and acceptable and could improve caregivers' engagement with the evaluation of IPV-exposed children for abuse and with IPV services, which have the potential to improve safety and promote well-being.

Exploring the User Acceptability and Feasibility of a Clinical Decision Support Tool Designed to Facilitate Timely Diagnosis of New-Onset Type 1 Diabetes in Children: Qualitative Interview Study Among General Practitioners.

Up to half of the children with new-onset type 1 diabetes present to the hospital with diabetic ketoacidosis, a life-threatening condition that can develop because of diagnostic delay. Three-quarters of Australian children visit their general practitioner (GP) the week before presenting to the hospital with diabetic ketoacidosis. Our prototype, DIRECT-T1DM (Decision-Support for Integrated, Real-Time Evaluation and Clinical Treatment of Type 1 Diabetes Mellitus), is an electronic clinical decision support tool that promotes immediate point-of-care testing in general practice to confirm the suspicion of diabetes. This avoids laboratory testing, which has been documented internationally as a cause of diagnostic delay. In this investigation, we aimed to pilot and assess the feasibility and acceptability of our prototype to GP end users. We also explored the challenges of diagnosing type 1 diabetes in the Australian general practice context. In total, 4 GPs, a pediatric endocrinologist, and a PhD candidate were involved in conceptualizing the DIRECT-T1DM prototype, which was developed at the Department of General Practice and Primary Care at the University of Melbourne. Furthermore, 6 GPs were recruited via convenience sampling to evaluate the tool. The study involved 3 phases: a presimulation interview, simulated clinical scenarios, and a postsimulation interview. The interview guide was developed using the Consolidated Framework for Implementation Research (CFIR) as a guide. All phases of the study were video, audio, and screen recorded. Audio recordings were transcribed by the investigating team. Analysis was carried out using CFIR as the underlying framework. Major themes were identified among three domains and 7 constructs of the CFIR: (1) outer setting-time pressure, difficulty in diagnosing pediatric type 1 diabetes, and secondary care considerations influenced GPs' needs regarding DIRECT-T1DM; (2) inner setting-DIRECT-T1DM fits within existing workflows, it has a high relative priority due to its importance in patient safety, and GPs exhibited high tension for change; and (3) innovation-design recommendations included altering coloring to reflect urgency, font style and bolding, specific language, information and guidelines, and inclusion of patient information sheets. End-user acceptability of DIRECT-T1DM was high. This was largely due to its implications for patient safety and its "real-time" nature. DIRECT-T1DM may assist in appropriate management of children with new-onset diabetes, which is an uncommon event in general practice, through safety netting.

Pemeriksaan Setempat (Descente) Terhadap Anak dalam Sengketa Hak Asuh Anak: Analisis Putusan Hakim di Lingkungan Pengadilan Agama di Indonesia

Descente or site visit are usually carried out on material cases, such as inheritance cases, joint property, sharia economics and so on, with the aim of avoiding difficulties in carrying out the execution of decisions at a later date. However, in several decisions, site visit were also found in cases other than material things, including in disputes over child custody or hadhanah by examining Decision Number 1063/Pdt.G/2022/PA.Tgm, Decision Number 627/Pdt.G/2023/ PA.Prw and Decision Number 585/Pdt.G/2020/PA.Ppg. This research is normative legal research or library research with a conceptual approach which examines primary data from several judicial decisions in Indonesia such as the Tanggamus Religious Court, the Pringsewu Religious Court and the Pasir Pangaraian Religious Court. The results of the research show that the implementation of site visit of children is the same as site visit of material cases and there are two reasons why the panel of judges conducts site visit of site visit of these cases, namely: directly ensuring the objective condition of the child and the child's growth and development and also ensuring environmental conditions. around the child in order to realize the best interests of the child. Site visit of children, apart from fulfilling the best interests of the child, also fulfills the objectives of Islamic law in maqāṣid asy-syarīah, namely hifz al-nafs or soul.

Follow-up visits after pediatric concussion and the factors associated with early follow-up: a population-based study in British Columbia.

To explore the rates and timing of a first follow-up visit for children and adolescents with a concussive injury and to identify factors associated with follow-up timing. A descriptive, correlational design drawing on linked, population-based administrative data of concussed children and adolescents (ages 5-18 years) from the province of British Columbia (BC), Canada. Data were accessed through Population Data BC. Descriptive statistics and binary logistic regression were used to analyze the data. From January 1, 2016 to December 31, 2017, we retrieved 22,601 cases of concussion, of which 19% had an early follow-up visit (N = 4,294), 4.9% had later follow-up (N = 1,107), and 76.1% had no follow-up (N = 17,200). The factors of older age, living in a rural area, higher socioeconomic status, and seeing a specialist physician at an initial concussion diagnosis were more likely to have an early follow-up visit. Early follow-up is important for recovery, but most children and adolescents with a concussion do not receive follow-up in BC.

COVID-19 Pandemic School Disruptions and Acute Mental Health in Children and Adolescents

There are suggestions that school pressure may be stressful and a factor in child and adolescent mental health disturbances, but data about this association are scarce and inconclusive. To assess whether varying degrees of school interruption were associated with changes in emergency department (ED) psychiatric visits of children and adolescents before and after the COVID-19 outbreak. A cross-sectional observational study was conducted at 9 urban university hospitals in Italy. All ED visits from January 1, 2018, to December 31, 2021, for psychiatric reasons of patients younger than 18 years were examined for demographic characteristics and type of psychopathologic factors. Data analysis was conducted from July 1 to August 31, 2023. The disruption in the usual succession of school and holiday periods brought on by the COVID-19 pandemic at different times and with various degrees of intensity. Total number of pediatric ED visits, psychiatric ED visits, and psychiatric ED visits categorized by specific reasons (eg, psychomotor agitation, suicide ideation [SI] or suicide attempt [SA], and eating disorders) on a weekly basis. A total of 13 014 psychiatric ED visits (1.3% of all pediatric ED visits) were recorded (63.2% females; mean [SD] age, 13.8 [3.8] years). The number of ED psychiatric visits increased over time (incidence rate ratio [IRR], 1.19; 95% CI, 1.16-1.22 for each year). Significant increases in ED visits were observed for eating disorders (294.8%), SI (297.8%), and SA (249.1%). School opening, but not social lockdown restriction, was associated with an increase in the number of ED psychiatric visits (IRR, 1.29; 95% CI, 1.23-1.34), which was evident for females and for SI with SA. Socioeconomic status was associated with an increase in psychiatric visits for males (IRR, 1.12; 95% CI, 1.04-1.20) but not females (IRR, 1.04; 95% CI, 0.98-1.10). In this study, school opening was associated with an increased incidence of acute psychiatric emergencies among children and adolescents, suggesting that school can be a substantial source of stress with acute mental health implications.

Violence Risk or Writing Quality? Predicting Relief Outcomes from Protective Order Narratives.

Civil orders of protection (OPs) are the only victim-initiated legal intervention for intimate partner violence. The OP process is unique because victims write a narrative account of abuse to inform judges' decision-making. Historically, feminist scholars have considered OPs as empowering to victims, as they can signal strength-based change and requesting needed relief. OPs also serve as an important tool for some mothers who need temporary protection related to child custody and visitation. Studies of OP narratives have found that content related to future risk is associated with securing an OP, including allegations of physical and severe violence, suggesting that OPs provide needed protection. At the same time, the OP process is disempowering for some women. The content and quality of survivors' OP narratives vary greatly, and studies have found that well-written accounts are positively associated with securing OPs, uncovering the potential influence of judges' implicit biases. This study used logistic regression to explore how violence risk and writing quality related to the receipt of emergency OPs in a sample of 90 petitions filed by women with minor children in a large Midwest County. As expected, violence severity was positively associated with securing an OP, controlling for the mention of other cases/orders and legal representation. However, the association was no longer significant when writing quality was considered; specifically, greater readability was associated with being granted an OP. Linear structure and appearance of narratives were not related to OP outcomes. Findings underscore the ongoing need to explore how the written narrative requirement of the OP process (dis)empowers survivors and the role implicit biases may play in judicial decision-making in civil OP proceedings.

Adherence to iron supplementation during the first year of life infants in Izmir, Turkey.

To determine the prevalence of adherence to iron supplementation and the risk factors for incomplete adherence during the first year of life of infants in Izmir, Turkey. In this cross-sectional study, a total of 511 infants aged 2 to 12 months who presented to the Pediatrics outpatient clinics of Ege University Children's Hospital were included. Mothers (n = 511) who agreed to participate in the study were interviewed face-to-face and a comprehensive questionnaire including questions about the sociodemographic characteristics of the children and the family, and their adherence to iron supplementation was administered. The data obtained from 471 (92.2%) mothers who used iron supplements for their babies were subjected to further statistical analysis. Analyses were performed with SPSS 25.0. Chi-square test was used for univariate analysis and logistic regression analysis was used to determine the independent factors associated with incomplete adherence to iron supplementation. A total of 511 mothers were surveyed. Among the infants of mothers who participated in the study, 471 (92.2%) were taking iron supplementation. Of the infants who received iron supplementation, 58.3% were given iron supplementation with complete adherence. The percentage of complete adherence with iron supplementation was 35.1% between 2 and 4 months, 66.3% between 5 and 8 months, and 52.4% between 9 to 12 months. In univariate analysis, statistically significant differences were found between complete and incomplete adherence to iron supplementation in terms of infant age, time of birth, family income, maternal education, and maternal employment status (P < .001). When the data were analyzed using multivariate analysis, only maternal education level and infant age group were found to be statistically significant independent variables for complete and incomplete adherence to iron supplementation (P < .001). In populations with a high prevalence of ID, incomplete adherence to iron supplementation is a serious risk factor for ID/IDA. Although iron supplements are routinely given to infants by the Ministry of Health in Turkey, the prevalence of complete adherence to iron supplementation is low. Therefore, in order to increase the rate of complete adherence to iron supplementation, the iron supplementation status of infants should be reviewed in detail at each health child visit and families should be informed about the importance of supplementation to prevent iron deficiency.

Primary Care Quality Improvement Through Patient-Centered Medical Homes and the Impact on Emergency Department Utilization for Children With Autism and Mental Health Disorders.

To address health care spending growth, coordinated care, and patient-centered primary care, most states in the United States have adopted value-based care coordination programs such as patient-centered medical homes (PCMHs). The objective of this study was to understand the relationship between having access to PCMHs and emergency department (ED) utilization for high cost/need children with autism and children with mental health disorders (MHDs). This cross-sectional study included 87 723 children between ages 3 and 17 years in the 2016-2018 National Survey for Children's Health. Multivariate-adjusted logistic regression analyses were used to assess the association between ED and PCMH utilization for children with autism, with MHDs without autism, and others without autism or MHDs. Marginal predictions were used to examine whether PCMH utilization was moderated by health conditions. The results showed that children with a PCMH had a 16% reduction in the odds to visit the ED (adjusted odds ratio [aOR] = 0.84; confidence interval [CI], 0.77-0.92; P < .001). When compared with the reference group of children without autism and without MHDs, children with MHDs but without autism had 93% higher odds to visit the ED (aOR = 1.93; CI, 1.75-2.13; P < .001) and children with autism had 35% higher odds to visit the ED (aOR = 1.35; CI, 1.04-1.75; P = .023). Marginal effects results suggested that PCMHs reduced the odds of ED visits the most for children with MHDs without autism and reduced the predicted ED visits from 30.1% to 23.7% (P < .001). Primary care quality improvement through access to a PCMH reduced ED visits for children, but the effect varied by autism and MHD conditions. Future PCMH efforts should continue to support children with autism and address unmet needs for children with MHDs with a focus on needed care coordination, family-centered care, and referrals.

Higher temperatures are associated with increased asthma-related emergency department visits among children: a time series analysis of environmental exposures in Montreal, Canada

Asthma exacerbations are a leading cause of emergency department (ED) visits in children. Outdoor exposures such as air pollutants and meteorological factors have been associated with risk of asthma exacerbations. We evaluated the association between ambient temperature, relative humidity, and air quality on pediatric asthma-related ED visits in Montréal, Canada. In this retrospective study, we included children ≤ 17 years presenting with asthma to two pediatric EDs between January 1, 2017 and December 31st, 2020. Temperature and relative humidity data were obtained daily for Montréal through Weather Source™ and the Air Quality Health Index (AQHI) through Environment Canada. We evaluated the association between environmental exposures and the incidence of asthma-related ED visits using a quasi-Poisson regression analysis, adjusting for seasonality. We examined 21 201 asthma-related ED visits. Increased temperature was associated with an increased number of asthma-related ED visits. Compared to the reference decile (2.8 to 7.5⁰C), the strongest association with incident ED visits was for a temperature of 15.8 to 19.3⁰C, associated with a 37% increase in the number of asthma-related ED visits (IRR = 1.37, 95% CI 1.22, 1.54). Current day relative humidity, AQHI, and changes of the exposure levels over the previous 1 to 7 days did not have an effect on asthma-related ED visits. Adjusting for seasonality, higher temperatures were associated with an increased number of asthma-related ED visits among children while humidity and air quality were not. At a population level, this can inform hospitals of upcoming trends in ED visits.