Journal of Child Health Care最新文献

Under-five mortality (U5M) remains a global challenge, with Sub-Saharan Africa being the hardest hit. The coronavirus disease 2019 (COVID-19) has strained healthcare systems, threatening to reverse current gains in U5M health outcomes. It threatened progress made towards achieving United Nations Sustainable Development Goal 3 due to its strain on healthcare systems, resource reassignment and its prioritisation by health authorities globally. Low-resource settings inherently face unique challenges in fighting U5M and providing quality healthcare to under-fives, like understaffing, drug shortages, underfunding, skills gaps and lack of specialised healthcare equipment, contributing to high U5M rates. This study explored public health facilities' challenges in reducing U5M in a low-resource setting in Zimbabwe and public health workers' perceptions of emerging technologies' role in addressing those challenges. Twenty public health workers participated in interviews and a focus group. They perceived emerging technologies (ETs) as a panacea to the challenges by supporting data-driven healthcare, improving follow-up outcomes through automated reminders of medication and clinic visits, aiding diagnosis, continuous monitoring, health education, drug supply monitoring, critical supplies delivery and skills development. In this paper, emerging technology is any information and communication technology that has not been utilised to its full potential in Zimbabwe's public health domain. Findings indicate that public health workers in Makonde would welcome ETs to improve under-five health and well-being.

Food allergy prevalence is increasing among children; however, it is not clear how children's food allergy status impacts family mealtimes. This study's purpose was to systematically synthesize research regarding the relationship between children's food allergies, parental meal-centered stress, and family mealtime dynamics. Data sources for this study include peer-reviewed, English language sources from CINAHL, MEDLINE, APA PsycInfo, Web of Science, and Google Scholar. Five keyword categories (child, food allergies, meal preparation, stress, and family) were utilized to identify sources regarding how food allergies of children (from birth-12 years) relate to family mealtime dynamics or parental meal-centered stress. All 13 identified studies determined that pediatric food allergies relate to either increased parental stress, meal preparation issues, mealtime problems, or changes to family meals. Studies also indicate that meal preparation takes longer, requires more vigilance, and is more stressful due to children's food allergies. Limitations include that most studies were cross-sectional and based on maternal self-report. Children's food allergies are associated with parental meal-centered stress and mealtime issues. However, there is a need for research to account for specific changes to family mealtime dynamics and parent feeding behaviors so that pediatric health care professionals can alleviate parental meal-centered stress and provide guidance towards optimal feeding behaviors.

Client autonomy is important in Dutch youth care. It correlates positively with mental and physical health and can be strengthened by professional autonomy-supportive behaviour. Aiming for client autonomy, three youth care organisations co-developed a client-accessible youth health record (EPR-Youth). Currently, limited research is available on how client-accessible records contribute to adolescent autonomy. We investigated whether EPR-Youth strengthened client autonomy and whether professional autonomy-supportive behaviour reinforced this effect. A mixed methods design combined baseline and follow-up questionnaires with focus group interviews. Different client groups completed questionnaires about autonomy at baseline (n = 1404) and after 12 months (n = 1003). Professionals completed questionnaires about autonomy-supportive behaviour at baseline (n = 100, 82%), after 5 months (n = 57, 57%) and after 24 months (n = 110, 89%). After 14 months, focus group interviews were conducted with clients (n = 12) and professionals (n = 12). Findings show that clients using EPR-Youth experienced more autonomy than non-users. this effect was stronger among adolescents aged 16 and older than among younger adolescents. Professional autonomy-supporting behaviour did not change over time. However, clients reported that professional autonomy-supporting behaviour contributed to client autonomy, emphasising that professional attitude needs addressing during implementation of client-accessible records. Follow-up research with paired data needs to strengthen the association between using client-accessible records and autonomy.

We aimed to identify factors affecting pediatric nurses' perceptions of their development of partnerships with parents of hospitalized children based on Lazarus and Folkman's stress-coping adaptation model. This cross-sectional study included 209 pediatric nurses with over 1 year of clinical experience in South Korea. Data were collected using online-based self-report questionnaires containing items on nurses' perceived partnerships with parents, job stress, positive psychological capital, nursing professionalism, and a coping scale. Positive psychological capital, job stress, coping, hospital type, and unit type were significant factors in a hierarchical regression analysis using perceived partnership as a dependent variable. This study supports an efficient intervention program to improve pediatric nurses' partnership competency. Strategies to reduce pediatric nurses' job stress and improve their coping abilities and positive psychological capital will enhance their partnerships with parents of hospitalized children.

Facilitating children's understanding of their medical condition can improve health outcomes and psychosocial well-being. To inform how medical information is delivered, an interpretive qualitative approach was used to explore children's understanding of their brachial plexus birth injury. In-depth interviews of children with brachial plexus birth injuries (n = 8) and their caregivers (n = 10) were conducted individually and as a child-caregiver dyad. Thematic analysis of interview data found that children primarily understood their injury through lived experiences of functional and psychosocial concerns related to movement and appearance of the affected limb, rather than medical information. Children's ability to learn about diagnostic and prognostic information was influenced by age, emotional readiness, and background knowledge. In receiving information about their medical condition, children needed greater support in understanding their prognosis and its implications on their future. These narratives indicate the importance of addressing the primary functional and psychosocial concerns to contextualize medical information and ascertain the emotional readiness of children with brachial plexus birth injuries in information delivery approaches.

Esophageal Atresia/Tracheoesophageal Atresia (EA/TEF) is a multisystem congenital anomaly. Historically, children with EA/TEF lack coordinated care. A multidisciplinary clinic was established in 2005 to provide coordinated care and improve access to outpatient care. This single-center retrospective cohort study was conducted to describe our cohort of patients with EA/TEF born between March 2005 and March 2011, assess coordination of care, and to compare outcomes of children in the multidisciplinary clinic to the previous cohort without a multi-disciplinary clinic. A chart review identified demographics, hospitalizations, emergency visits, clinic visits, and coordination of outpatient care. Twenty-seven patients were included; 75.9% had a C-type EA/TEF. Clinics provided multidisciplinary care and compliance with the visit schedule was high with a median of 100% (IQR 50). Compared to the earlier cohort, the new cohort (N = 27) had fewer hospital admissions and LOS was reduced significantly in the first 2 years of life. Multidisciplinary care clinics for medically complex children can improve coordination of visits with multiple health care providers and may contribute to reduced use of acute care services.

This systematic review summarises evidence regarding oral nutritional supplement (ONS) use in children with, or at risk of, faltering growth (FG). Ten randomised controlled trials (RCTs), compared changes in outcomes amongst children receiving ONS versus control were included. Overall, 1116 children (weighted mean (WM) age 5 years; n658 (59%) male) were recruited, of which 585 (52%) received ONS (WM intake contribution 412 kcal, 16.3 g protein, 395 ml) for 116 days (WM). ONS use was associated with significantly greater gains in weight (mean difference (MD) 0.4 kg, 95% CI [0.36, 0.44]) and height (MD 0.3 cm, 95% CI [0.03, 0.57]), likely related to improvements in nutritional intake. Mean compliance to prescribed dose was 98%. Data suggested an association between ONS use and reduced infections. Further research is warranted to establish ONS dosage and effects upon other outcomes. This review provides evidence to support use of ONS in the management of children with, or at risk of, FG.

Cardiac procedures can be overwhelming for children and parents, with a lack of literature surrounding how healthcare professionals can assist parents in preparing young children for such procedures. This exploratory descriptive qualitative study sought to understand experiences of parents preparing and supporting their child with congenital heart disease, for an upcoming cardiac procedure. Parents of children, aged between three and eight years old, who had undergone a cardiac procedure at a tertiary paediatric hospital in Australia were invited to participate in an interview. Seven parents were interviewed, with recordings transcribed and analysed using reflexive thematic analysis. Four major themes identified were (1) evolving information needs; (2) anticipating anxiety; (3) honesty when delivering information; and (4) equipping parents with resources. Findings from this study emphasised that support for children prior to cardiac procedures must include empowering parents, as they know their child best. A key component of procedural preparation is helping parents navigate how to translate procedural information into explanations which are relatable and appropriate for their child. The development of interactive, relatable resources would allow parents to continue their child's preparation beyond the preadmission visit.

This cross-sectional study explores the types of preventive and chronic care survivors of childhood cancer and pediatric bone marrow transplant receive from their primary care providers. We also identified barriers perceived by survivors to utilization of primary care. Survivors were recruited from a large Midwestern pediatric hospital and completed a demographic and an eight-item semi-structured survey. Parents of survivors <18 years completed the survey for their child and survivors >18 years completed on their own. A total of 259 caregivers (55.7%) and 206 survivors (44.3%) participated. The mean survivor age was 19.76 (SD = 8.89). Most survivors reported having a PCP (n = 400, 87.1%). A subset of survivors self-reported visiting a PCP for chronic care (n = 79, 16.7%). Most common reasons for not having a PCP included unsure who to see (n = 27, 52.9%) and lack of insurance (n = 10, 19.6%). Annual family income (β = 1.53, 95% CI [1.26, 1.86]) and healthcare insurance (β = 6.02, 95%CI [1.25, 29.08]) were predictive of having a PCP. Despite having a PCP, few survivors visited them for chronic care. Interventions are needed to facilitate the transition of survivors to a PCP for management of chronic conditions after their cancer treatment.