Vulnerable Families Research Articles

IJCM_250A: Awareness and utilization of Ayushman Bharat Pradhan Mantri Jan Arogya Yojna in Chhattisgarh State - A cross Sectional study

Background: Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (PM-JAY) is the worlds largest health insurance/ assurance scheme fully financed by the government. It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empaneled hospitals in India. Over 12 crore poor and vulnerable entitled families are eligible for these benefits. As of now, the total number of ration cards allotted to the people of Chhattisgarh are 57,14,798. Objective: To assess awareness and utilization of Ayushman Bharat Pradhan Mantri Jan Arogya Yojna in Chhattisgarh State. Methodology: This community based cross-sectional study was conducted among the eligible beneficiaries in Chhattisgarh state. Multis stage cluster sampling used to select eligible beneficiaries. One district each from all five divisions of Chhattisgarh will be selected then 5 clusters (3 urban and 2 rural area) will be selected from each district. Data was collected face to face interview by using semi structured questionnaire. Data was managed in MS- Excel and analysed using suitable statistical software (SPSS v21) and P Value Results: The study shows 300 (80.9%), and 68(18.3%) participants are BPL & APL card holders respectively and 3(.8%) do not have any card. Out of 371 participants, 92(24.8%) are not enrolled in the scheme. Among study participants, only 90% were aware of the AB-PMJAY, and only 197 (53%) utilized the scheme and get benefitted. Conclusion: This study concluded that despite AB-PMJAY potentially providing cashless financial protection to beneficiaries, some of the study population is still unaware of AB-PMJAY. A quarter of the participants were not enrolled in the scheme, indicating potential gaps in the implementation or accessibility of the program.

Are Brazilian water auction prices affordable for vulnerable families?

A recent regulatory framework reform implemented in Brazil aims to universalize water and sanitation services by 2033. For financing and speeding up the construction of infrastructure, the new law encourages private sector participation through auctions promoted with the support of the Brazilian National Development Bank. However, the first auctions, with billions of dollars in price and investment effects, have raised concerns among practitioners over the impact on vulnerable families. We analyze the concessions in Alagoas and Rio de Janeiro states in Brazil to demonstrate how low-income families will struggle to pay their bills based on auction prices via the tariff, which may invite discontent. This research can inform subsequent water and sanitation auctions by highlighting that awards should not be based exclusively on auction prices, and affordability assessments should be mandatory.

Mitigating adverse social determinants of health in the vulnerable population: Insights from a home visitation programme.

Low-income families are exposed to adverse childhood experiences and psychosocial risks that impact child development. At the KK Women's and Children's Hospital in Singapore, Kids Integrated Development Service (KIDS0-3) is a home visitation programme that aims to optimise the development of children from low-income families. Data comprising family demographics, maternal psychosocial risks and outcomes of child development were collated through a chart review of 469 mother-child dyads enrolled from June 2014 to October 2022. Based on the Family and Adult Support Tool, 312 families (67%) were identified as moderate or high-risk. Children from moderate and high-risk families had poorer Bayley cognitive (mean 95.88 [SD 8.25] versus [vs] 98.44 [SD 8.72], P=0.014) and language scores (mean 87.38 [SD 10.35] vs 90.43 [SD 9.61], P=0.016] at 24 months of age, compared to the low-risk group. Children of teenage mothers had lower Bayley cognitive scores (mean 95.16 [SD 8.42] vs 97.76 [SD 8.55], P=0.037), and children of mothers who experienced sexual abuse had lower Bayley cognitive scores (mean 93.1 [SD 5.68] vs 99.7 [SD 8.17], P=0.013) and language scores (mean 82.3 [SD 12.87] vs 91.3 [SD 10.86], P=0.021]. Antenatal enrolment yielded better child language (mean 90.1 [SD 9.37] vs 87.13 [SD 10.79], P=0.04) and motor outcomes (mean 99.62 [SD 9.45] vs 94.72 [SD 9.51], P=0 .001) than postnatal enrolment. Psychosocial risks impact the development of children from low-income families in Singapore. Findings underscore the importance of early, integrated intervention for vulnerable families.

Mitigating adverse social determinants of health in the vulnerable population: Insights from a home visitation programme

Introduction: Low-income families are exposed to adverse childhood experiences and psychosocial risks that impact child development. At the KK Women’s and Children’s Hospital in Singapore, Kids Integrated Development Service (KIDS0-3) is a home visitation programme that aims to optimise the development of children from low-income families. Method: Data comprising family demographics, maternal psychosocial risks and outcomes of child development were collated through a chart review of 469 mother-child dyads enrolled from June 2014 to October 2022. Results: Based on the Family and Adult Support Tool, 312 families (67%) were identified as moderate or high-risk. Children from moderate and high-risk families had poorer Bayley cognitive (mean 95.88 [SD 8.25] versus [vs] 98.44 [SD 8.72], P=0.014) and language scores (mean 87.38 [SD 10.35] vs 90.43 [SD 9.61], P=0.016] at 24 months of age, compared to the low-risk group. Children of teenage mothers had lower Bayley cognitive scores (mean 95.16 [SD 8.42] vs 97.76 [SD 8.55], P=0.037), and children of mothers who experienced sexual abuse had lower Bayley cognitive scores (mean 93.1 [SD 5.68] vs 99.7 [SD 8.17], P=0.013) and language scores (mean 82.3 [SD 12.87] vs 91.3 [SD 10.86], P=0.021]. Antenatal enrolment yielded better child language (mean 90.1 [SD 9.37] vs 87.13 [SD 10.79], P=0.04) and motor outcomes (mean 99.62 [SD 9.45] vs 94.72 [SD 9.51], P=0 .001) than postnatal enrolment. Conclusion: Psychosocial risks impact the development of children from low-income families in Singapore. Findings underscore the importance of early, integrated intervention for vulnerable families.

The Urgency of Human Rights in Development Sustainable Family Resilience

Human rights have an important position in supporting the vulnerability of a family. This research examines human rights in sustainable family resilience. Vulnerable families generally result in divorce, domestic violence, and children living on the streets or abandoned. This research explores human rights and family resilience in Indonesia. However, in this context, human rights often become vulnerable. Problems such as gender discrimination, abuse of children's rights, and domestic violence can damage family resilience and destroy the basic rights of family members. Therefore, a strong understanding and protection of human rights is the key to building and maintaining family resilience. The method used in this research is literature review research. Research obtains literature sources from journals, books or articles. The research results show no urgency in dealing with family resilience problems. Meanwhile, Indonesia itself is a country that upholds human rights. A strong understanding and protection of human rights is key to building and maintaining family resilien.

An Analysis of Parental Quality of Life Following an Autism Diagnosis for their Children

The primary goal of this study's contents is to systematically review earlier studies on the quality of life in parents of autistic children and provide a significant analysis of the ways in which societal themes and facets influence the current state of affairs. Using the four dimensions of the quality of life—the physical, psychological, social, and environmental domains—as a guide, this analysis has attempted to address significant and noteworthy aspects as indicated by World Health Organization (2012).In the present study, I intend to explore the parents’ opinions regarding their quality of life towards diagnosis of their children with autism. This systematic review, which adhered to PRISMA principles, sought to find and evaluate pertinent studies on parents of autistic children's quality of life (QoL). Twenty-five studies were found to be potentially relevant after a preliminary search. 12 studies were eliminated after the preset inclusion and exclusion criteria were applied because they did not meet methodological requirements, did not focus on the same demographic, or did not fall within the relevant timeframe. As a result, six papers were left in the final pool for additional synthesis and analysis. According to this review, mothers reported lower levels of physical, psychological, and environmental comfort than fathers. In the psychological and physical dimensions of QOL level, mothers and fathers differ significantly from one another. The majority of parents expressed dissatisfaction over their family life and relationships being negatively impacted by their inability to obtain funds, specialist intervention programs, and prompt diagnosis. Nonetheless, parents concurrently expressed favourable views of transformation resulting from diagnosis and successful intervention. Families with children diagnosed with autism spectrum disorder may face additional stressors due to delays and challenges in diagnosis and service availability. Families' social and professional lives, as well as their connections with friends and relatives, are all impacted by raising a child with autism. The study suggests that raising awareness about the quality of life for families of children with autism is necessary. To protect the most vulnerable families, the state should enact laws and policies pertaining to disabilities and educate the public about the various kinds of disabilities. These initial results add to our understanding of the perspectives of parents of disabled children on their child's quality of life.

ANALYSIS OF HEALTH EDUCATION FAMILY DEVELOPMENT SESSION WITH STUNTING IN PANGKAJENE AND ISLANDS REGENCY, INDONESIA: CROSS-SECTIONAL STUDY

Background: Stunting is a growth disorder experienced by young people whose length or height is not appropriate to their age according to the standards set by the WHO. UNICEF data for 2018 showed that almost 3 out of 10 young children have stunts or are too short for their age. Pangkajene and the Islands Regency showed a stunting prevalence of 29.10% or the highest in South Sulawesi Province in 2018. The Hope Family Program (PKH) is a conditional social assistance program that aims to improve the standard of living of KPM through access to education, health and welfare services as well as reducing the burden of expenditure and increasing the income of poor and vulnerable families. Purpose: To find out the relationship between Family Development Session health education and stunting incidents in Family Hope Program recipients in Pangkajene and the Islands regency. Methods: This study used an observational research approach with a crosectional model. The data was collected using a questionnaire with Family Development Session variables, food management pattern and BBLR history. The data collected was then analyzed using chi-square analysis. Results: Out of 71 respondents who came from recipients of the Hope Family Program, 36 children (51%) suffered stunting and 35 children (49%) did not. Conclusion: There is a significant link between health education Family Development Session, food management pattern and LBW history with stunting incidents in Pangkajene and the Islands Regency (p < 0.05).

The effects of a large-scale home visiting programme for child development on use of health services in Brazil.

Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.

Application of Complementary Therapy as an Effort to Mitigate Health Crisis from Malnutrition Risk Factors in Vulnerable Groups

Introduction Malnutrition, a critical global health issue, continues to affect vulnerable populations despite advances in healthcare and nutrition science, highlighting the need for integrated intervention strategies that combine traditional nutritional support with complementary therapies. Objective: This research aimed to assess the effectiveness of a holistic intervention combining nutritional strategies and complementary therapies in mitigating malnutrition risks within vulnerable families, specifically those with toddlers or elderly members. Method: Conducted at a community health center in Purwomartani, Kalasan, Sleman, Yogyakarta, the study involved 43 families, with 24 having toddlers and the remainder with elderly members. Employing purposive sampling, participants were selected based on their regular attendance at the health center, literacy, and willingness to participate. The intervention, implemented through two sessions in October-November 2023, included measures to enhance access to nutritious food, provide nutritional supplements, offer educational outreach, monitor nutritional status, and administer personalized nutritional therapy. Result: Data, recorded on a scale of 0-5 for each indicator and sub-indicator, demonstrated significant improvements across all parameters. The results indicated positive shifts in food security, healthcare access, socioeconomic status, dietary diversity, and micronutrient intake. Conclusion: The integrated approach effectively addressed malnutrition risks, showcasing tangible improvements in key indicators. This study contributes valuable insights into holistic strategies for mitigating malnutrition in vulnerable populations.

Implementation of a Childcare-Based Obesity Prevention Program for Vulnerable Families During the COVID-19 Pandemic: Lessons for School Nurses.

COVID-19 brought significant changes to the role of school nurses, necessitating the development of remote health education programs. However, there is a lack of evidence and pedagogical lessons for digitally transforming education for socially vulnerable children. This qualitative study analyzes the health educational needs and barriers faced by children and service providers in a childcare-based obesity prevention program during the pandemic in South Korea. Through a thematic content analysis, four core themes emerged: (a) heightened concerns about obesity and the pandemic's impact on facilities, (b) unexpected positive outcomes of the program, (c) digital readiness gaps, and (d) insufficient program satisfaction (better than nothing). When designing a digital-based health education program for vulnerable children, assessing individual readiness and facility suitability is crucial. Additionally, school nurses should incorporate hybrid pedagogy, integrating technology-mediated activities. By leveraging technology effectively and considering individual and environmental factors, educators can provide comprehensive and accessible health education.

Community perceptions of community health worker effectiveness: Contributions to health behaviour change in an urban health district in South Africa.

Community health worker (CHW) programmes contribute towards strengthening adherence support, improving maternal and child health outcomes and providing support for social services. They play a valuable role in health behaviour change in vulnerable communities. Large-scale, comprehensive CHW programmes at health district level are part of a South African (SA) strategy to re-engineer primary healthcare and take health directly into communities and households, contributing to universal health coverage. These CHW programmes across health districts were introduced in SA in 2010 - 11. Their overall purpose is to improve access to healthcare and encourage healthy behaviour in vulnerable communities, through community and family engagements, leading to less disease and better population health. Communities therefore need to accept and support these initiatives. There is, however, inadequate local evidence on community perceptions of the effectiveness of such programmes. A cross-sectional descriptive study to determine community perceptions of the role and contributions of the CHW programme was conducted in the Ekurhuleni health district, an urban metropolis in SA. Members from 417 households supported by CHWs were interviewed in May 2019 by retired nurses used as fieldworkers. Frequencies and descriptive analyses were used to report on the main study outcomes of community acceptance and satisfaction. Nearly all the study households were poor and had at least one vulnerable member, either a child under 5, an elderly person, a pregnant woman or someone with a chronic condition. CHWs had supported these households for 2 years or longer. More than 90% of households were extremely satisfied with their CHW; they found it easy to talk to them within the privacy of their homes and to follow the health education and advice given by the CHWs. The community members highly rated care for chronic conditions (82%), indicated that children were healthier (41%) and had safer pregnancies (6%). As important stakeholders in CHW programmes, exploring community acceptance, appreciation and support is critical in understanding the drivers of programme performance. Community acceptance of the CHWs in the Ekurhuleni health district was high. The perspective of the community was that the CHWs were quite effective. This was demonstrated when they reported changes in household behaviour with regard to improved access to care through early screening, referrals and improved management of chronic and other conditions.

Chatbot for Social Need Screening and Resource Sharing With Vulnerable Families: Iterative Design and Evaluation Study.

Health outcomes are significantly influenced by unmet social needs. Although screening for social needs has become common in health care settings, there is often poor linkage to resources after needs are identified. The structural barriers (eg, staffing, time, and space) to helping address social needs could be overcome by a technology-based solution. This study aims to present the design and evaluation of a chatbot, DAPHNE (Dialog-Based Assistant Platform for Healthcare and Needs Ecosystem), which screens for social needs and links patients and families to resources. This research used a three-stage study approach: (1) an end-user survey to understand unmet needs and perception toward chatbots, (2) iterative design with interdisciplinary stakeholder groups, and (3) a feasibility and usability assessment. In study 1, a web-based survey was conducted with low-income US resident households (n=201). Following that, in study 2, web-based sessions were held with an interdisciplinary group of stakeholders (n=10) using thematic and content analysis to inform the chatbot's design and development. Finally, in study 3, the assessment on feasibility and usability was completed via a mix of a web-based survey and focus group interviews following scenario-based usability testing with community health workers (family advocates; n=4) and social workers (n=9). We reported descriptive statistics and chi-square test results for the household survey. Content analysis and thematic analysis were used to analyze qualitative data. Usability score was descriptively reported. Among the survey participants, employed and younger individuals reported a higher likelihood of using a chatbot to address social needs, in contrast to the oldest age group. Regarding designing the chatbot, the stakeholders emphasized the importance of provider-technology collaboration, inclusive conversational design, and user education. The participants found that the chatbot's capabilities met expectations and that the chatbot was easy to use (System Usability Scale score=72/100). However, there were common concerns about the accuracy of suggested resources, electronic health record integration, and trust with a chatbot. Chatbots can provide personalized feedback for families to identify and meet social needs. Our study highlights the importance of user-centered iterative design and development of chatbots for social needs. Future research should examine the efficacy, cost-effectiveness, and scalability of chatbot interventions to address social needs.

Parental Mental Illness and the Likelihood of Child Out-of-Home Care: A Cohort Study.

To detail the relationship between parental mental illness and the likelihood of out-of-home care (OHC) among their children, and to identify factors which modify this relationship. Using Swedish national registers, children born in 2000 to 2011 (n = 1 249 463) were linked to their parents. Time-dependent parental mental illness (nonaffective and affective psychosis, substance misuse, depression, anxiety and stress, eating disorders, personality disorders, attention deficit hyperactivity disorder, autism, and intellectual disability), was identified through International Classification of Diseases codes. After adjustment for socioeconomic factors, children living with mentally ill parents were 4 times as likely to be placed in OHC than children without (95% confidence interval [CI] 4.24-4.61). The highest hazard ratio (HR) was in the youngest children aged 0 to 1 year (5.77, 95% CI 5.42-6.14), exposed to maternal illness (HR 4.56, 95% CI 4.37-4.76), and parental intellectual disability (HR 4.73, 95% CI 4.09-5.46). Children with parental mental illness with multiple risk factors were at particularly high risk. Compared with children without parental mental illness, and those with university-educated parents, children whose parents had mental illness and only had education to age 16 had a 15 times higher risk of OHC (95% CI 13.75-16.54). Children with parental mental illness are considerably more likely to be removed from home into care during childhood, particularly during the first year of life and if they are from socially disadvantaged families. Greater knowledge of these risks should lead to increased support for vulnerable new families.

Infant 2 School: A structured health promotion programme for community nursery nurses

Infant 2 School (I2S) is a new, individualised family-centred early intervention, and health and development promotion programme that is designed to be delivered by community nursery nurses (CNN) from within health visiting teams. The programme aims to address identified service gaps by supporting and complimenting the work that health visitors do so that vulnerable families needing additional help have access to evidence-based interventions in a timely manner. I2S was recently launched in the UK and this paper provides an overview of the programme including its origin, structure, content, benefits and anticipated outcomes for children and families.

Examining the implementation of a community paediatric clinic in a socially disadvantaged Irish community: A retrospective process evaluation.

Understanding interventions and their implementation is essential for improving community initiatives. Kidscope is a community paediatric development clinic providing free health and developmental assessment and onward referral for children aged zero to six years in an urban area of southern Ireland where many children experience complex needs. Established in 2010, Kidscope developed an inter-disciplinary, multi-agency community team by drawing on the strengths of local services and practitioners to deliver holistic approaches to child health and development. Recent studies examining stakeholder engagement and Kidscope outcomes highlighted the need to examine implementation to better understand the processes and mechanisms of the clinic and how events have affected outcomes. Guided by the UK Medical Research Council Framework for Developing and Evaluating Complex Interventions, this study used a post-hoc qualitative process evaluation study design with multiple data sources; stakeholder perspectives (interviews, focus group, questionnaires) and document analysis (annual reports, meeting minutes, work plans). A diverse set of research questions were developed in conjunction with a Patient and Public Involvement Group. Guiding frameworks supported thematic analysis of primary data, document analysis of secondary data, and triangulation of findings across datasets. Data analysis yielded 17 themes and 18 sub-themes. Successful implementation hinged on developing a coalition of linked practitioners and services whose skills were utilised and enhanced within Kidscope to deliver a high-quality healthcare model to vulnerable children and families. Relational and multi-disciplinary working, innovative approaches to implementation and sustainability, training and education provision, and the accessible community location were among the mechanisms of change resulting in improved child, family, practitioner, and system-level outcomes. External factors such as COVID-19 and deficits in Ireland's disability services posed significant barriers to fidelity. This study provides evidence of the processes, mechanisms, and model of care employed by a community-based paediatric clinic to successfully engage society's most vulnerable families and promote health equity. This study makes an important contribution to the field of implementation research by offering an example of a robust approach to conceptualising and measuring implementation outcomes of community healthcare initiative in a changing, real-world context.

Locked down-locked in: experiences of families of young children with autism spectrum disorders in Delhi, India.

The onset of the COVID-19 pandemic and subsequent lockdowns in March 2020 disrupted the lives of families across India. The lockdown related restrictions brought forth a multitude of challenges including loss of employment, social isolation, school closures and financial burdens. Specifically, it also resulted in the restriction of health-care services for children with neurodevelopmental disabilities. This qualitative study was conducted as a part of a larger trial in India to understand the experiences of families of young children with autism during the pandemic. In-depth interviews were carried out with 14 caregivers residing in New Delhi, India. Our findings identified pandemic and lockdown's universal impacts on family life and financial stability stemming from job loss, business closure, and salary deductions, affecting quality of life of families. Furthermore, COVID-19 pandemic's impact on autistic children was evident through limited access to essential services and financial challenges related service interruptions even after resumption of services. The lockdown's novelty also affected children's behavior, with both challenging behavioral changes and positive impacts. Primary caregivers, predominantly mothers, assumed additional responsibilities in household tasks, schooling, and therapy administration. While some these experiences were universally experienced, a few of these improved outcomes for autistic children. Despite challenges, parents expressed gratitude for their family's safety and well-being during the difficult time. These findings inform service provision for vulnerable families and offer implications for designing interventions such as credit schemes for families, guidance and resources for establishing and maintaining routines of children with autism, adopting flexible and adaptable approaches to service delivery, and special provisions for children with autism to be able to maintain their routines outside of home. Furthermore, the study highlights the need for comprehensive support, including educational resources and stress management counselling to empower parents in supporting essential care and routines for their children during such unprecedented times.

Realizing an Evidence-Based Framework for the Management and Delivery of Family Support Services

ABSTRACT Purpose This paper reports on how service providers and academic researchers partnered to support the journey of a primary prevention organization in western Canada as they reviewed their programming against an evidence-based practice (EBP) framework. The process allows the organization to increase their EBP culture by encouraging staff understanding and uptake of their nine family support programs. It also informs service users and other stakeholders of the evidentiary status of different kinds of support services. In this way, the families become more informed and engaged partners who might easily evaluate the respective risks and benefits of the various applications. Method As part of the process, an evidence-based framework used a common language to assess the efficacy of the respective nine programs. Results All nine programs are now mapped into the EBP framework. Conclusions This review allows staff to become more intentional and informed about the EBPs they employ to support vulnerable families and to use this knowledge to better inform the families with whom they work. This paper and the process the agency followed can be a model for other organizations who serve families experiencing short-term housing crisis, provide infant nursery care, and other support services for families with young children.

Are community health agents the link to integrating care? Lesson from Brazil

Purpose This viewpoint piece will highlight the contribution of trained lay community health workers to the integrated workforce in rural, remote and island settings, drawing on experience from a system strengthening project involving community health agents (CHAs) in four municipalities in Litoral Norte, a remote coastal and island region in the state of São Paulo, Brazil.Design/methodology/approach This viewpoint reflects on experiential learning from a unique north–south collaboration that spanned the period of a global pandemic. It adds to the international literature on the value of community health workers in public health and chronic disease management and highlights their potential pivotal role as integrators at point of care.Findings CHAs took forward actions that touched the lives of thousands of vulnerable families with low income and complex needs in communities with high levels of social and health inequalities. They acted as a bridge between patients and families at home, primary healthcare professionals and wider community partners and services. Their valuable insight into the healthcare issues and social challenges experienced by the community informed and supported family centred practice and population health goals. The CHAs rapidly pivoted to became an essential public health workforce during the Covid-19 pandemic.Practical implications As the authors establish integrated care systems and embrace proactive care and population health, the conditions are favourable for introducing a similar role in the UK. For psychological safety and avoidance of burnout people in such new roles will require training, supervision and full integration within community teams.Originality/value This viewpoint reflects experiential learning from a unique north–south collaboration that spanned the period of a global pandemic. It adds to the international literature on the value of community health workers in public health and chronic disease management and highlights their potential pivotal role as integrators at point of care.

The effect of fertility treatment and socioeconomic status on neonatal and post-neonatal mortality in the United States

ObjectiveTo determine the association between fertility treatment, socioeconomic status (SES), and neonatal and post-neonatal mortality.Study designRetrospective cohort study of all births (19,350,344) and infant deaths from 2014–2018 in the United States. The exposure was mode of conception—spontaneous vs fertility treatment. The outcome was neonatal (<28d), and post-neonatal (28d–1y) mortality. Multivariable logistic models were stratified by SES.ResultThe fertility treatment group had statistically significantly higher odds of neonatal mortality (high SES OR 1.59; CI [1.5, 1.68], low SES OR 2.11; CI [1.79, 2.48]) and lower odds of post-neonatal mortality (high SES OR 0.87, CI [0.76, 0.996], low SES OR 0.6, CI [0.38, 0.95]). SES significantly modified the effect of ART/NIFT on neonatal and post-neonatal mortality.ConclusionsFertility treatment is associated with higher neonatal and lower post-neonatal mortality and SES modifies this effect. Socioeconomic policies and support for vulnerable families may help reduce rates of infant mortality.

Educational outcomes in siblings of childhood leukemia survivors: Factors associated with school difficulties and comparison with general population.

To investigate the educational outcomes of siblings of childhood leukemia survivors, explore determinants of school difficulties, and compare the rates of repeating grades between siblings and the general population. A cross-sectional study of childhood leukemia survivors' siblings recruited through the Leucémies de l'Enfant et de l'Adolescent cohort, a French long-term follow-up program, was conducted, and education-related data were obtained via self-report questionnaires. Adjusted logistic regression models were used to identify variables associated with school difficulties and time since diagnosis. Rates of repeating a grade in middle school were compared between siblings and the general population of the same generation. A total of 564 siblings with a mean time from diagnosis of 14.1 ± 6.4 years were included, among whom 139 (24.6%) repeated a grade, at an average of 6.4 ± 4.5 years after diagnosis. In multivariate analysis, the risk factors for repeating a grade were older siblings (odds ratio [OR] 2.3, p = 0.006), family financial difficulties (OR 2.8, p = 0.008), and history of repetition in survivors (OR, 2.5, p = 0.001). Sibling hematopoietic stem cell donors were at greater risk of repeating a grade long-term after diagnosis (p = 0.018). Overall, siblings did not have a higher risk of educational delays at the end of middle school than the general population. Although the results are reassuring, socioeconomic and cancer-related factors may have an impact on siblings' schooling long after diagnosis. Paying attention to siblings contributes to identifying the most vulnerable families, allowing more attention and appropriate resources to avoid long-term repercussions. Additionally, supportive and targeted interventions can be developed to improve the organization of education and the health care system.