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What is health equity and why do children need it now more than ever? 什么是健康公平,为什么儿童现在比以往任何时候都更需要健康公平?
Q3 Medicine Pub Date : 2024-01-19 DOI: 10.1016/j.paed.2023.12.002
Abigail Knight, Dhanya Gardner, Cat Crook, Elizabeth Crabtree, Nicola Ennis, Douglas Simkiss, Jessica Allen

Health equity enables everyone to have the best possible opportunity for good health regardless of their social circumstance. In this article we set out why it is so vital that this begins in childhood, particularly at a time when increased costs of living in many countries are exacerbating health inequities further. We examine the impact of addressing the social determinants of health at individual, population and systems levels, and why this is the business of all partners involved in the local health economy. In the UK, integrated care systems (ICS) are early in their development. In this short article, we describe the work of the Children and Young People's Health Equity Collaborative: a collaboration between children's charity Barnardo's, the Institute of Health Equity, Birmingham and Solihull ICS, Cheshire and Merseyside ICS, and South Yorkshire ICS. This details a three-year programme designed to establish enablers for this whole systems approach. This includes a Children and Young People's Health Equity Framework, a dynamic data measurement tool to direct action for longer term outcomes and supporting child health equity interventions. Children and young people's voice is central to our work, combining academic evidence with lived experience of what really matters to them.

健康公平使每个人都能获得尽可能好的健康机会,无论其社会环境如何。在这篇文章中,我们阐述了为什么从儿童时期开始实现健康公平至关重要,尤其是在许多国家生活成本增加,进一步加剧了健康不平等的情况下。我们探讨了解决健康的社会决定因素在个人、人口和系统层面的影响,以及为什么这是当地健康经济中所有合作伙伴的事情。在英国,综合医疗系统(ICS)正处于发展初期。在这篇短文中,我们将介绍 "儿童与青少年健康公平合作组织"(Children and Young People's Health Equity Collaborative)的工作:该组织由儿童慈善机构巴纳多、健康公平研究所、伯明翰和索利赫尔综合护理系统、柴郡和默塞塞德郡综合护理系统以及南约克郡综合护理系统合作成立。该计划详细介绍了一项为期三年的计划,旨在为这一全系统方法创造有利条件。其中包括儿童和青少年健康公平框架,这是一个动态数据测量工具,用于指导行动以取得长期成果,并支持儿童健康公平干预措施。儿童和青少年的声音是我们工作的核心,我们将学术证据与他们的生活经验相结合,让他们了解什么对他们真正重要。
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引用次数: 0
Child and adolescent immunisation in the UK: current issues 英国儿童和青少年免疫接种:当前问题
Q3 Medicine Pub Date : 2024-01-10 DOI: 10.1016/j.paed.2023.12.001
Helen E Bedford, David AC Elliman

The UK immunisation programme for children and adolescents is highly successful with generally high uptake of vaccines and low rates of vaccine preventable diseases. However, for the past 10 years there has been a year on year small but concerning decrease in vaccine uptake. This was accelerated by the impact of the COVID-19 pandemic. In this article we consider the reasons for less-than-optimal vaccine uptake, discuss recent changes to the schedule and describe the significant further changes in prospect.

英国的儿童和青少年免疫计划非常成功,疫苗接种率普遍较高,疫苗可预防疾病的发病率较低。然而,在过去 10 年中,疫苗接种率逐年下降,降幅虽小,但令人担忧。COVID-19 大流行的影响加速了这一趋势。在这篇文章中,我们将探讨疫苗接种率不尽如人意的原因,讨论近期对疫苗接种计划的修改,并描述未来可能发生的重大变化。
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引用次数: 0
Early intervention to improve neurodevelopmental outcomes for high-risk infants 早期干预,改善高风险婴儿的神经发育结果
Q3 Medicine Pub Date : 2024-01-09 DOI: 10.1016/j.paed.2023.12.003
Andrew Elliot-Smith, Audrienne Sammut, Betty Hutchon, Nazakat Merchant, Frances O'Brien, Angela Huertas-Ceballos

Many babies cared for on a neonatal unit are at risk of adverse neurodevelopmental outcomes. The aim of early intervention (EI), therefore, is to support a child and their family to achieve the best outcome possible. Notably, EI is not one specific thing. The term encompasses a wide range of approaches and interventions that can vary in a number of ways, including who undertakes them, where they happen and when they start. There is debate as to the most effective approach, but the evidence supports the implementation of EI from soon after birth, continuing post-discharge. Furthermore, involving the parents in EI is critical, not only to ensure sustained effects throughout childhood, but also because of the beneficial impact on parental wellbeing. All in all, the evidence shows improved neurodevelopmental outcomes for children exposed to EI, particularly in the short-term. This review will explore what EI means in practice, considering the variations in application, as well as the evidence of benefit. It will also consider the limitations of current research.

新生儿病房护理的许多婴儿都有可能出现不良的神经发育结果。因此,早期干预(EI)的目的是为儿童及其家庭提供支持,以实现尽可能好的结果。值得注意的是,早期干预并不是一个特定的概念。它包括一系列广泛的方法和干预措施,这些方法和干预措施可能在很多方面存在差异,包括由谁实施、在哪里实施以及何时开始实施。关于最有效的方法还存在争议,但有证据支持从婴儿出生后不久就开始实施婴儿早期教育,并持续到出院后。此外,让父母参与儿童早期教育至关重要,这不仅是为了确保在整个童年期持续产生效果,而且还因为这对父母的健康产生有益的影响。总之,有证据表明,接受环境教育的儿童的神经发育结果会得到改善,尤其是在短期内。本综述将探讨平等教育在实践中的意义,考虑应用中的差异以及受益的证据。它还将考虑当前研究的局限性。
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引用次数: 0
The role of the school nurse in the UK: where are we now? 英国校医的作用:我们现在在哪里?
Q3 Medicine Pub Date : 2024-01-09 DOI: 10.1016/j.paed.2023.12.004
Sallyann Sutton, Sharon White

In the UK, school nurses play a crucial role in promoting the health and wellbeing of children and young people, giving them the best start in life and supporting them to sustain optimal health. They have a vital and unique link between education settings, home and the community. Their key role is within the public health arena, they are an important part of the primary health care team and a key link for acute and community paediatric teams and therapies. The onset of school nursing came in the Victorian era with a focus on improving the health of children living in poverty, this coincided with a report from the British army at the time which highlighted that young men joining the service were unfit for purpose. Now, in the 21st century, we are faced with widening health inequalities, shocking levels of poverty and increases in the number of people living with major illness and mental health problems. It is argued that the school nurse has never been more essential in supporting the health and well-being of children and young people which includes their integral role in safeguarding. In this article we will explore why this might be the case, the difficulties and opportunities and, importantly, how, alongside our paediatric colleagues in both community and acute settings, we can best garner our combined efforts to rise above and beyond the escalating challenges.

在英国,校医在促进儿童和青少年的健康和福祉、为他们的人生提供最好的开端以及帮助他们保持最佳健康状态方面发挥着至关重要的作用。他们在教育机构、家庭和社区之间建立了重要而独特的联系。她们在公共卫生领域发挥着关键作用,是初级卫生保健团队的重要组成部分,也是急诊和社区儿科团队及治疗的重要纽带。学校护理始于维多利亚时代,当时的重点是改善贫困儿童的健康状况,这与当时英国军队的一份报告不谋而合,该报告强调加入军队的年轻人不适合服役。21 世纪的今天,我们面临着日益扩大的健康不平等、令人震惊的贫困程度以及重大疾病和心理健康问题患者人数的增加。有观点认为,校医在支持儿童和青少年的健康和福祉方面从未像现在这样重要,其中包括他们在保护方面不可或缺的作用。在这篇文章中,我们将探讨为什么会出现这种情况、存在的困难和机遇,更重要的是,我们如何才能与社区和急诊环境中的儿科同事一起,以最佳方式共同努力,超越不断升级的挑战。
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引用次数: 0
Working for children in a Poverty Truth Commission 在贫困真相委员会中为儿童工作
Q3 Medicine Pub Date : 2024-01-05 DOI: 10.1016/j.paed.2023.12.005
Carol Hebden, Alicia Vernalls, Suwinder Hundal, Doug Simkiss

The social determinants of health are increasingly well understood by paediatricians. Policy and individual practitioner actions are emerging and have been described in previous Social Paediatrics symposia in this journal. This article describes a Poverty Truth Commission; an innovative approach to addressing the impact of poverty of children's health. This brings people who may not otherwise spend much time together, takes away job titles and uses the power of storytelling to effect change in the members of the commission and beyond.

儿科医生对健康的社会决定因素有了越来越深入的了解。政策和个体从业者的行动也在不断涌现,本刊以往的 "社会儿科 "专题讨论会对此进行了介绍。本文介绍了贫困真相委员会;这是一种解决贫困对儿童健康影响的创新方法。该委员会将原本可能不会花太多时间在一起的人聚集在一起,去掉了工作头衔,并利用讲故事的力量来改变委员会成员及其他成员。
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引用次数: 0
What do you do when you have no evidence? 没有证据时该怎么办?
Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.paed.2023.10.004
Bob Phillips, Sheena Mukkada

Evidence based medicine is all well and good, but what should you do when there is no evidence? How might you act differently if the absence of evidence relates to an acute problem, a complex chronic issue or a life-limiting situation? This is even more likely to be an issue when dealing with particular groups of patients. There is often a paucity of evidence when considering treatments or interventions for children and young people. This paper will guide the readers through various levels of absence of evidence, and while it won't be able to tell you what to do, it will give you different ways of looking at the problem.

循证医学固然很好,但在没有证据的情况下该怎么办?如果缺乏证据与急性问题、复杂的慢性问题或危及生命的情况有关,你该如何采取不同的行动?在面对特殊的病人群体时,这甚至更有可能成为一个问题。在考虑针对儿童和青少年的治疗或干预措施时,往往缺乏证据。本文将引导读者了解证据缺失的不同程度,虽然不能告诉你该怎么做,但会给你提供看待问题的不同方法。
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引用次数: 0
How to write a good research grant proposal 如何撰写优秀的研究补助金提案
Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.paed.2023.10.002
Elaine M. Boyle, Frances J. Mielewczyk

Research is increasingly important for the delivery of the best possible paediatric care and in the training of healthcare professionals. Many young clinicians are now looking for some way of becoming involved in research during their training, and some will wish to develop a formal academic component to their career or study for a higher postgraduate degree. Research funding is essential to enable high quality research, but training in how to apply for such funding is limited. While it is no substitute for detailed guidance and support from a trusted and experienced research colleague, this article aims to provide practical guidance for new researchers setting out to write their first grant proposal. It stresses the importance of being proactive in selecting the correct research environment, ensuring adequate support and supervision and identifying the necessary knowledge and expertise needed to deliver the project efficiently and effectively. It also highlights the important steps involved in developing a proposal, writing and submitting the application, and provides suggestions for maximizing chances of success. Whilst the focus of this article is based upon the authors' experience in the UK, the general principles are more widely applicable to healthcare professionals working with babies, children and young people everywhere.

研究对于提供尽可能最好的儿科护理和培训医疗保健专业人员越来越重要。现在,许多年轻的临床医生都在寻找在培训期间参与研究的途径,有些人则希望在职业生涯中发展正式的学术部分或攻读更高的研究生学位。要开展高质量的研究,研究经费是必不可少的,但有关如何申请此类经费的培训却很有限。本文旨在为准备撰写第一份基金申请书的新研究人员提供实用指导,虽然它无法取代值得信赖、经验丰富的研究同事提供的详细指导和支持。文章强调,必须积极主动地选择正确的研究环境,确保充分的支持和监督,并确定高效实施项目所需的必要知识和专业技能。文章还强调了制定建议书、撰写和提交申请所涉及的重要步骤,并就如何最大限度地提高成功机会提出了建议。虽然本文的重点是基于作者在英国的经验,但一般原则更广泛地适用于为世界各地的婴儿、儿童和青少年服务的医疗保健专业人员。
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引用次数: 0
Screen-time: ensuring excellence in online teaching 屏幕时间:确保卓越的在线教学
Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.paed.2023.10.007
Martina Larsson, Nadia Shad, Rebecca Hulbert, Alice Roueché, Chloe Macaulay

Online and virtual learning grew exponentially during the coronavirus pandemic in all areas, including medical education. It is now a well-established part of clinical teaching. This raises questions about which learning content should be delivered online; how it should be delivered and, crucially, how to engage learners in the online environment. We summarise a range of approaches and key considerations to enable appropriate clinical content to be delivered online and propose a number of teaching modalities for use within medical education. Preparation, including faculty training and development, is key to the ongoing effectiveness and success of online learning. We provide an online learning checklist and suggest ground rules to consider when approaching online teaching. Furthermore, we summarise a number of online platforms, applications and resources that aim to enhance learner engagement and encourage you to explore, innovate and reflect on your online teaching journey as an educator.

冠状病毒大流行期间,包括医学教育在内的所有领域的在线和虚拟学习都急剧增长。现在,它已成为临床教学的一个成熟部分。这就提出了以下问题:哪些学习内容应在线提供;如何提供;以及最重要的是,如何让学习者参与到在线环境中。我们总结了一系列方法和主要考虑因素,以便能够在线提供适当的临床内容,并提出了一些在医学教育中使用的教学模式。准备工作,包括教师培训和发展,是在线学习持续有效和取得成功的关键。我们提供了一份在线学习清单,并提出了在进行在线教学时应考虑的基本原则。此外,我们还总结了一些旨在提高学习者参与度的在线平台、应用程序和资源,并鼓励您作为教育工作者探索、创新和反思您的在线教学之旅。
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引用次数: 0
Involving children and young people as active partners in paediatric health research 让儿童和青少年作为积极的合作伙伴参与儿科健康研究
Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.paed.2023.10.003
Jennifer Preston, Elle Lappin, Jenny Ainsworth, Claire L. Wood, Paul Dimitri

Paediatric health research is fraught with both ethical and practical challenges that can hinder the successful completion of research studies. Listening to, and acting on, the voices of children and young people in the design and delivery of paediatric health research (otherwise known as Patient and Public Involvement) is one way to overcome such challenges. This paper describes our experiences of working directly with children and young people in various health research initiatives. We recount our journey of involving children and young people as partners and give examples to demonstrate the unique knowledge and insights gained in the production of high-quality research. This short review showcases the many benefits gained if meaningful involvement occurs, including greater understanding of children and young people's perspectives and the impact this has on research studies. We provide various practical resources for researchers on how to meaningfully involve children and young people as partners, how to develop age-appropriate information and guidance to support the ethical review process.

儿科健康研究充满了伦理和实际挑战,这些挑战可能会阻碍研究工作的顺利完成。在儿科健康研究的设计和实施过程中倾听儿童和青少年的声音并根据他们的意见采取行动(也称为 "患者和公众参与"),是克服这些挑战的方法之一。本文介绍了我们在各种健康研究活动中直接与儿童和青少年合作的经验。我们讲述了让儿童和青少年作为合作伙伴参与其中的历程,并举例说明了在开展高质量研究过程中获得的独特知识和见解。这篇简短的评论展示了有意义的参与所带来的诸多益处,包括更深入地了解儿童和青少年的观点以及这对研究工作的影响。我们为研究人员提供了各种实用资源,帮助他们了解如何让儿童和青少年作为合作伙伴进行有意义的参与,以及如何开发适合其年龄的信息和指导,以支持伦理审查过程。
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引用次数: 0
Data-driven quality improvement in child health 以数据为导向提高儿童健康质量
Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.paed.2023.10.006
Laura E. Duthie

Quality improvement (QI) is a systematic and co-ordinated approach to solving a problem (Quality improvement made simple. The Health Foundation, 2021) and is used to improve safety, effectiveness, and experience of care within healthcare. The approach to QI should be pro-active and patient centred. Within paediatrics this requires us to consider the voice of children and young people when designing improvement to ensure we are meeting their needs. Understanding the key principles and methodology of QI is essential to ensure success when bringing about change. However, formal training in this has been limited and variable amongst doctors in training. The use of data underlies every stage of QI from considering the problem, to the measurement of improvement. With the appropriate use of both quantitative and qualitative data being instrumental in bringing about meaningful change. This article highlights provides some helpful background for those considering their next QI project. It stresses the importance of undertaking data driven improvement, whilst also detailing best practise and challenges, particularly in relation to children and young people. It provides a practical guide on how to use data effectively within QI in a structured approach.

质量改进(QI)是一种系统的、协调的解决问题的方法(质量改进化繁为简。 健康基金会,2021 年),用于改善医疗保健的安全性、有效性和护理体验。质量改进的方法应积极主动,以患者为中心。在儿科领域,这要求我们在设计改进方案时考虑到儿童和青少年的意见,以确保满足他们的需求。了解质量改进的主要原则和方法对于确保成功实现变革至关重要。然而,在接受培训的医生中,这方面的正规培训非常有限,而且参差不齐。从考虑问题到衡量改进,数据的使用是质量改进的每个阶段的基础。适当使用定量和定性数据有助于实现有意义的变革。本文重点介绍了一些有用的背景知识,供考虑下一个质量改进项目的人员参考。文章强调了数据驱动改进的重要性,同时也详细介绍了最佳实践和挑战,特别是与儿童和青少年有关的挑战。文章还提供了一份实用指南,说明如何在质量改进中以结构化的方式有效使用数据。
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引用次数: 0
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Paediatrics and Child Health (United Kingdom)
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