Editorial

4 pages, 205 KiB

Open AccessEditorial

New and Old Challenges in Pediatric Health Policies

by Tonia Vassilakou

Children 2022, 9(8), 1196; https://doi.org/10.3390/children9081196 - 09 Aug 2022

Cited by 1 | Viewed by 1028

Pediatric Health Policies represent a complex context, which integrates various aspects of children’s health and well-being, along the continuum of fetal life, infancy, childhood and adolescence [...] Full article

(This article belongs to the Special Issue Pediatric Health Policy)

Research

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17 pages, 261 KiB

Open AccessArticle

The Relevance of the Adverse Childhood Experience International Questionnaire to Working Children: Knowledge Gaps and Implications for Policy Makers

by Alice Rutter

Children 2021, 8(10), 897; https://doi.org/10.3390/children8100897 - 09 Oct 2021

Cited by 4 | Viewed by 2295

Abstract

(1) Adverse childhood experiences (ACE) are a global challenge, prioritized in the United Nations’ Sustainable Development Goals. The ACE questionnaire is widely adopted in the USA as a tool for measuring population-level trends, such as negative health, behavioral, and economic outcomes. Intuitively, children [...] Read more.

(1) Adverse childhood experiences (ACE) are a global challenge, prioritized in the United Nations’ Sustainable Development Goals. The ACE questionnaire is widely adopted in the USA as a tool for measuring population-level trends, such as negative health, behavioral, and economic outcomes. Intuitively, children in resource-scarce settings are exposed to higher levels of trauma. To understand the global picture, the World Health Organization (WHO) adapted the ACE international questionnaire (ACE-IQ), to inform policy and target interventions. However, evaluation of whether the ACE-IQ captures the experiences of around 160 million working children remains limited. (2) I applied the ACE-IQ scoring tools to detailed case studies of working children, comparing issues highlighted by holistic assessment to those captured by the ACE-IQ. (3) The ACE-IQ struggles to capture nuance across cultural contexts. As a consequence, application of the ACE-IQ as a policy tool risks “policy failure”. The tool reflects prevalent Western concerns, such as school attendance and parental supervision, but global concerns affecting working children such as forced economic migration and famine are neglected. This limitation produces “policy myopia”, sidelining certain global challenges. (4) The ACE-IQ is a useful public health tool, increasingly used to define policy goals. However, given the limitations of the ACE-IQ, the consequences of prioritizing these particular policy goals need to be actively acknowledged and mitigated. Full article

(This article belongs to the Special Issue Pediatric Health Policy)

12 pages, 1389 KiB

Open AccessArticle

Maternal Age, the Disparity across Regions and Their Correlation to Sudden Infant Death Syndrome in Taiwan: A Nationwide Cohort Study

by Lin-Yi Huang, Wan-Ju Chen, Yung-Ning Yang, Chien-Yi Wu, Pei-Ling Wu, Shu-Leei Tey, San-Nan Yang and Hsien-Kuan Liu

Children 2021, 8(9), 771; https://doi.org/10.3390/children8090771 - 01 Sep 2021

Cited by 4 | Viewed by 2928

Abstract

Sudden infant death syndrome (SIDS) has always been a regrettable issue for families. After sleeping in the supine position was proposed, the incidence of SIDS declined dramatically worldwide. However, SIDS still accounts for the top 10 causes of infant deaths in Taiwan. Recognizing [...] Read more.

Sudden infant death syndrome (SIDS) has always been a regrettable issue for families. After sleeping in the supine position was proposed, the incidence of SIDS declined dramatically worldwide. However, SIDS still accounts for the top 10 causes of infant deaths in Taiwan. Recognizing the risk factors and attempting to minimize these cases are imperative. We obtained information on cases with SIDS from the National Health Insurance Research Database in Taiwan and interconnected it with the Taiwan Maternal and Child Health Database to acquire infant–maternal basal characteristics between 2004 and 2017. The SIDS subjects were matched 1:10 considering gestational age to normal infants. After case selection, a total of 953 SIDS cases were included. Compared with healthy infants, SIDS infants had younger parents, lower birth weight, and lower Apgar scores. After adjusting for potential confounders, infants with mothers aged <20 years had 2.81 times higher risk of SIDS. Moreover, infants in the non-eastern region had a significantly lower risk of SIDS than those in the eastern region. We concluded that infants of young mothers (especially maternal age <20 years) and infants in the eastern region of Taiwan had a higher risk of SIDS than their counterparts. Full article

(This article belongs to the Special Issue Pediatric Health Policy)

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16 pages, 2773 KiB

Open AccessArticle

Maintaining Essential Nutrition Services to Underfive Children in Yemen: A Programmatic Adaptation Amidst the COVID-19 Pandemic

by Ferima Coulibaly-Zerbo, Ayoub Al-Jawaldeh, Zita C. Weise Prinzo, Marina Adrianopoli, Eshrak Naji Mohammed Al-Falahi, Shafekah Alahnoumy, Nosheen Mohsan Usman, Fanda Ahmed Moqbel, Latifah Abbas Ali, Mohammed Shroh, Ensegam Mohammed Al-Sakkaf, Abdulrazzaq Musaed, Maison Al-Sakkaf, Mohammed Dahnan, Fahim Al-Hakimi, Doa Kutbi Omer, Moatsim Hael and Lara Nasreddine

Children 2021, 8(5), 350; https://doi.org/10.3390/children8050350 - 28 Apr 2021

Cited by 6 | Viewed by 3551

Abstract

The World Health Organization (WHO) acknowledged that, as health services divert their attention to the COVID-19 pandemic, the delivery of essential nutrition services may be compromised. This impact may be more pronounced in the context of humanitarian crises, such as the one currently [...] Read more.

The World Health Organization (WHO) acknowledged that, as health services divert their attention to the COVID-19 pandemic, the delivery of essential nutrition services may be compromised. This impact may be more pronounced in the context of humanitarian crises, such as the one currently unfolding in Yemen. In line with Pillar 9 of the WHO’s COVID-19 Strategic Preparedness and Response Plan, this paper reports on the nutrition program adaptations in Yemen to maintain the delivery of essential nutrition services to under-five children. The process of adaptation focused on the services provided within the nutrition surveillance system (NSS), therapeutic feeding centers (TFC), and isolation units (IU). It was conducted in five steps: (1) situation analysis; (2) development of guidance documents; (3) consultation process; (4) capacity-building programs; and (5) incorporation of programmatic adaptation within nutrition services. As of September 2020, NSS, TFC, and IUs services have shifted their standard operating procedures in line with the context-specific adaptations. The process described in this paper may serve as a case-study for other countries that intend to undertake similar adaptations in their nutrition program to contribute to the implementation of the WHO response plan and maintain the delivery of essential nutrition services to children. Full article

(This article belongs to the Special Issue Pediatric Health Policy)

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18 pages, 787 KiB

Open AccessArticle

Policy Rogue or Policy Entrepreneur? The Forms and Impacts of “Joined-Up Governance” for Child Health

by Celine Cressman, Fiona A. Miller, Astrid Guttmann, John Cairney and Robin Z. Hayeems

Children 2021, 8(3), 221; https://doi.org/10.3390/children8030221 - 13 Mar 2021

Cited by 1 | Viewed by 1785

Abstract

Joined-up governance (JUG) approaches have gained attention as mechanisms for tackling wicked policy problems, particularly in intersectoral areas such as child health, where multiple ministries that deliver health and social services must collaborate if they are to be effective. Growing attention to the [...] Read more.

Joined-up governance (JUG) approaches have gained attention as mechanisms for tackling wicked policy problems, particularly in intersectoral areas such as child health, where multiple ministries that deliver health and social services must collaborate if they are to be effective. Growing attention to the need to invest in early childhood to improve health and developmental trajectories, including through developmental screening, illustrate the challenges of JUG for child health. Using a comparative case study design comprised of the qualitative analysis of documents and key informant interviews, this work sought to explain how and why visible differences in policy choices have been made across two Canadian jurisdictions (Ontario and Manitoba). Specifically, we sought to understand two dimensions of governance (structure and process) alongside an illustrative example—the case of developmental screening, including how insiders viewed the impacts of governance arrangements in this instance. The two jurisdictions shared a commitment to evidence-based policy making and a similar vision of JUG for child health. Despite this, we found divergence in both governance arrangements and outcomes for developmental screening. In Manitoba, collaboration was prioritized, interests were aligned in a structured decision-making process, evidence and evaluation capacity were inherent to agenda setting, and implementation was considered up front. In Ontario, interests were not aligned and instead decision making operated in an opaque and siloed manner, with little consideration of implementation issues. In these contexts, Ontario pursued developmental screening, whereas Manitoba did not. While both jurisdictions aimed at JUG, only Manitoba developed a coordinated JUG system, whereas Ontario operated as a non-system. As a result, Manitoba’s governance system had the capacity to stop ‘rogue’ action, prioritizing investments in accordance with authorized evidence. In contrast, in the absence of a formal system in Ontario, policy ‘entrepreneurs’ were able to seize a window of opportunity to invest in child health. Full article

(This article belongs to the Special Issue Pediatric Health Policy)

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14 pages, 377 KiB

Open AccessArticle

The Moral Foundations of Child Health and Social Policies: A Critical Interpretive Synthesis

by Avram E. Denburg, Mita Giacomini, Wendy J. Ungar and Julia Abelson

Children 2021, 8(1), 43; https://doi.org/10.3390/children8010043 - 13 Jan 2021

Cited by 8 | Viewed by 2470

Abstract

Background: Allusions to the uniqueness and value of childhood abound in academic, lay, and policy discourse. However, little clarity exists on the values that guide child health and social policy-making. We review extant academic literature on the normative dimensions of child health and [...] Read more.

Background: Allusions to the uniqueness and value of childhood abound in academic, lay, and policy discourse. However, little clarity exists on the values that guide child health and social policy-making. We review extant academic literature on the normative dimensions of child health and social policy to provide foundations for the development of child-focused public policies. Methods: We conducted a critical interpretive synthesis of academic literature on the normative dimensions of child health and social policy-making. We employed a social constructivist lens to interpret emergent themes. Political theory on the social construction of target populations served as a bridge between sociologies of childhood and public policy analysis. Results: Our database searches returned 14,658 unique articles; full text review yielded 72 relevant articles. Purposive sampling of relevant literature complemented our electronic searches, adding 51 original articles, for a total of 123 articles. Our analysis of the literature reveals three central themes: potential, rights, and risk. These themes retain relevance in diverse policy domains. A core set of foundational concepts also cuts across disciplines: well-being, participation, and best interests of the child inform debate on the moral and legal dimensions of a gamut of child social policies. Finally, a meta-theme of embedding encompasses the pervasive issue of a child’s place, in the family and in society, which is at the heart of much social theory and applied analysis on children and childhood. Conclusions: Foundational understanding of the moral language and dominant policy frames applied to children can enrich analyses of social policies for children. Most societies paint children as potent, vulnerable, entitled, and embedded. It is the admixture of these elements in particular policy spheres, across distinct places and times, that often determines the form of a given policy and societal reactions to it. Subsequent work in this area will need to detail the degree and impact of variance in the values mix attached to children across sociocultural contexts and investigate tensions between what are and what ought to be the values that guide social policy development for children. Full article

(This article belongs to the Special Issue Pediatric Health Policy)

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12 pages, 714 KiB

Open AccessArticle

Publication Trends of Pediatric and Adult Randomized Controlled Trials in General Medical Journals, 2005–2018: A Citation Analysis

by Michael L. Groff, Martin Offringa, Abby Emdin, Quenby Mahood, Patricia C. Parkin and Eyal Cohen

Children 2020, 7(12), 293; https://doi.org/10.3390/children7120293 - 15 Dec 2020

Cited by 20 | Viewed by 2330

Abstract

Policy has been developed to promote the conduct of high-quality pediatric randomized controlled trials (RCTs). Whether these strategies have influenced publication trends in high-impact journals is unknown. We aim to evaluate characteristics, citation patterns, and publication trends of pediatric RCTs published in general [...] Read more.

Policy has been developed to promote the conduct of high-quality pediatric randomized controlled trials (RCTs). Whether these strategies have influenced publication trends in high-impact journals is unknown. We aim to evaluate characteristics, citation patterns, and publication trends of pediatric RCTs published in general medical journals (GMJs) compared with adult RCTs over a 13-year period. Studies were identified using Medline, and impact metrics were collected from Web of Science and Scopus. All RCTs published from 2005–2018 in 7 GMJs with the highest impact factors were identified for analysis. A random sample of matched pediatric and adult RCTs were assessed for publication characteristics, academic and non-academic citation. Citations were counted from publication until June 2019. Among 4146 RCTs, 2794 (67.3%) enrolled adults, 591 (14.2%) enrolled children, and 761 RCTs (18.3%) enrolled adult and pediatric patients. Adult RCTs published in GMJs grew by 5.1 publications per year (95% CI: 3.3–6.9), while the number of pediatric RCTs did not show significant change (−0.4 RCTs/year, 95% CI: −1.4–0.6). Adult RCTs were cited more than pediatric RCTs (median(IQR): 29.9 (68.5–462.8) citations/year vs. 13.2 (6.8–24.9) citations/year; p < 0.001); however, social media attention was similar (median(IQR) Altmetric Attention Score: 37 (13.75–133.8) vs. 26 (6.2–107.5); p = 0.25). Despite policies which may facilitate conduct of pediatric RCTs, the publishing gap in high-impact GMJs is widening. Full article

(This article belongs to the Special Issue Pediatric Health Policy)

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Review

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11 pages, 287 KiB

Open AccessReview

Telemedicine in Pediatric Infectious Diseases

by Marco Pappalardo, Umberto Fanelli, Vincenzo Chiné, Cosimo Neglia, Andrea Gramegna, Alberto Argentiero and Susanna Esposito

Children 2021, 8(4), 260; https://doi.org/10.3390/children8040260 - 28 Mar 2021

Cited by 14 | Viewed by 3852

Abstract

Telemedicine is the remote practice of medicine through the use of information and communication technologies for the prevention, diagnosis, treatment and management of diseases. In this narrative review, we illustrate how telemedicine technologies are increasingly integrated into pediatric infectious disease programs with the [...] Read more.

Telemedicine is the remote practice of medicine through the use of information and communication technologies for the prevention, diagnosis, treatment and management of diseases. In this narrative review, we illustrate how telemedicine technologies are increasingly integrated into pediatric infectious disease programs with the aim of facilitating access to specialist care and reducing costs. There is widespread use of telemedicine for the management of acute and chronic infectious diseases, particularly in countries in which the majority of the population lives in rural areas, far from third-level hospital centers located in large urban centers. Obviously, telemedicine is also used in developed countries, and its importance has been further increased recently given the COVID-19 pandemic. It has many advantages for patients, such as saving time, money and working hours, and reducing cancelled appointments and delays, while there are also many advantages for doctors, allowing collaborations with specialists and continuous updating. Among the disadvantages are the limitation in carrying out an objective examination, which is particularly important for children under 2 years of age, and the need for cutting-edge technology and reliable connectivity. Telemedicine increasingly represents the future and the beginning of a new healthcare system that also will redefine medical care for the treatment of infectious diseases, both acute and chronic. However, the majority of the experience has involved adults, and its validation in pediatric care, as well as its application in real-life practices, are urgently needed. Full article

(This article belongs to the Special Issue Pediatric Health Policy)

Other

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6 pages, 219 KiB

Open AccessBrief Report

Imaging Appropriateness in Pediatric Radiology during COVID-19 Pandemic: A Retrospective Comparison with No COVID-19 Period

by Giampiero Bottari, Giandomenico Stellacci, Davide Ferorelli, Alessandro Dell’Erba, Maurizio Aricò, Marcello Benevento, Giuseppe Palladino and Biagio Solarino

Children 2021, 8(6), 463; https://doi.org/10.3390/children8060463 - 01 Jun 2021

Cited by 11 | Viewed by 2444

Abstract

During the COVID-19 pandemic, the number of accesses to the Pediatric Emergency Department (pED) in Italy sharply decreased by 30%. The purpose of this study is to evaluate how this novel setting impacted on management of children with trauma, and the use and [...] Read more.

During the COVID-19 pandemic, the number of accesses to the Pediatric Emergency Department (pED) in Italy sharply decreased by 30%. The purpose of this study is to evaluate how this novel setting impacted on management of children with trauma, and the use and appropriateness of imaging studies in such patients at the pED. All imaging studies performed in patients with trauma at the pED of a tertiary children’s Hospital during the first wave of the COVID-19 pandemic (between March and May 2020) were reviewed, in comparison with a control time interval (March to May 2019). In the pre-COVID control era, 669 imaging studies documented bone fractures in 145/568 children (25.5%). In the COVID-era, 79/177 (44.6%) pediatric patients showed bone fractures on 193 imaging studies. Comparative analysis shows a 71% decrease in imaging studies, and the proportion of negative imaging studies (with no evidence of bone fractures) dropped in 2020 by 19% compared to the 2019 control era (p < 0.001). The sharp decrease of negative studies suggests that the rate of appropriateness was higher during COVID-era, suggesting some attitude toward defensive medicine in the previous control year, as a result of some degree of imaging inappropriateness. The impact of a pandemic on emergency medicine may offer a unique opportunity to revisit diagnostic and therapeutic protocols in pediatrics. Full article

(This article belongs to the Special Issue Pediatric Health Policy)

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