Journal of Child Health Care最新文献

Effects of the Coronavirus disease 2019 (COVID-19) pandemic on children stem beyond immediate infectious and post-infectious risks. Our aim was to conduct a scoping review and produce an online Interactive Evidence Map (IEM) highlighting available literature around unintended effects of the pandemic on children's and adolescents' mental, psychosocial, and physical health. A search was run monthly in MEDLINE, PsycINFO, CENTRAL, and Cochrane COVID-19 Study Register from May 1^st 2021 through April 30^th 2022. All articles involving children and adolescents under 18 years of age relating to any unintended mental, psychosocial, and physical health consequences of the pandemic and resultant restrictions were included. Data were extracted and topics categorized, with corresponding data uploaded into EPPI-Reviewer and transferred to EPPI-Mapper for visualization. A total of 14,555 citations were screened and 826 (6%) articles included. Most articles reported on mental health outcomes, particularly anxiety (n = 309, 37%) and depression (n = 294, 36%). Psychosocial outcomes related to lockdowns such as loneliness (n = 120, 15%) and impact on adolescent relationships with others (n = 149, 18%) were also reported. Fewer articles examined physical consequences, but those that did mostly focused on child abuse (n = 73, 9%). Overall, currently mapped literature focuses on consequences related to mental health outcomes such as anxiety and depression.

Globally, the number of Children and Young People (CYP) that experience mental health crisis and access paediatric acute hospital settings continues to increase. Many of these CYP present with thoughts and behaviours of self-harm and/or suicide and often experience severe and fluctuating emotional states. It is therefore important that the risk of self-harm/suicide is assessed during an inpatient admission and strategies implemented to mitigate risk. This study aimed to identify self-harm and suicidality risk management pathways that have been developed and evaluated for use with CYP admitted to acute hospital settings with mental health crisis. A systematic review was conducted. Eight online academic database were searched up to February 2022. The critical appraisal skills programme tool was used to assess the methodological rigour of included studies. Online searches identified 120 potential studies. Five studies met the predefined inclusion criteria. Six risk mitigation strategies were identified; safety huddles, urgent full mental psychiatric review within 2-h of assessment, feedback on screening responses, motivational and barrier-reducing intervention, 1:1 constant observations and environmental safety. All included strategies targeted environmental, family, and individual CYP involving modifications to equipment, surveillance, and communication to enhance safety.

In Occupied Palestinian territory (OPT), which is in a complex political situation and has limited access to resources, there is a critical need to deepen the understanding of how children with life-limiting and life-threatening illnesses are cared for. This study explores the experiences of parents caring for more than one child with a chronic or serious illness. A qualitative descriptive method was adopted, with data collected from several paediatric units in two OPT cities, Tulkarm and Ramallah. Semi-structured, face-to-face interviews were conducted with 16 parents (each interview was of an individual parent). Data were analysed using thematic analysis, and the analysis unearthed seven major themes that reflected the parents' experiences. These were as follows: Significant life changes with the first child's illness; the second experience; becoming stronger; support systems; economic difficulties; social stigma; and social isolation. Data analyses suggest that there is a significant need for emotional and physical support to be provided to parents, and culturally salient social service provisions should be implemented to alleviate the burden placed on these parents.

This study aimed to describe parents' experiences of children with temporary feeding tubes by surveying parents whose children required tubes. This survey included three sections including; (A) Depression Anxiety Stress Scale (DASS-21); (B) Paediatric Assessment Scale for Severe Feeding Problems (PASSFP); and (C) open-ended questions on satisfaction and experiences. Data were analysed using descriptive statistics and inductive content analysis. A total of 44 parent participants completed the survey. Most participants reported satisfaction with their child's care, although for most, tube removal occurred after ≤5 days (n = 25, 57%). Children who were discharged home with a temporary feeding tube (n = 7, 16%) had more feeding difficulties. Two themes were identified: 1) navigating tube feeding and 2) health service experiences. Although parents were generally positive about their child's care, some described ongoing medical and psychosocial impacts. Many parents desired more involvement in decision-making and tube feeding care. Parents described varied experiences regarding temporary tube feeding both in hospital and after discharge home. Further studies are needed across all spectrums of temporary tube feeding care, especially those discharged home. These findings underscore a need for enhanced support and education for parents, which could improve outcomes for children with temporary feeding tubes.

Whether spoken language influences experiences of trans and non-binary youth (TNBY) with healthcare systems is unknown. We analyzed Quebec data from the Canadian Trans and Non-Binary Youth Health Survey to illustrate healthcare experiences of predominantly French-speaking TNBY aged 14-25 and influence of gender identity and language on those experiences. We included 220 participants of whom 71% identified as French-speaking. Up to 78% reported a mental health problem and 51% reported foregoing mental health care in the last year. Only 26% of non-binary versus 57% of trans youth were comfortable discussing healthcare needs with providers (OR 0.26; 95% CI [0.13-0.54]). English youth were less likely than French youth to be comfortable discussing healthcare needs (aOR 0.33, 95% CI [0.13-0.83]. They were also more likely to forgo care because of negative experiences (aOR 2.21, 95% CI [1.00, 4.87]) and out of fear (aOR 2.38, 96% CI [1.08, 5.28]). Our study found that TNBY had a high prevalence of foregone health care despite a great need. In Quebec, a predominantly French-speaking area within Canada, language-minority English TNBY were less comfortable than French TNBY discussing healthcare needs and accessing needed resources. Limited availability of language-specific resources may be an additional barrier to healthcare access for TNBY.

When pediatric services are not coordinated, children, youth, and their caregivers cannot always access the right services at the right time. Guidance is needed for how pediatric services should be planned and organized to improve integrated care. The objective of this rapid scoping review was to map and characterize current evidence on standards of care for integrated pediatric levels of service. This rapid scoping review was conducted in accordance with Cochrane Rapid Reviews Interim Guidance. We searched academic databases and gray literature in 2022, published in English from Canada, United States, United Kingdom, Australia, New Zealand, with no date parameter. Fifty-three sources met inclusion criteria and were included in this review. Levels of service frameworks categorized services into three, four, or six distinct levels. Eight sources described integrated levels of service. Most pediatric standards of care frameworks defined levels of service by roles and responsibilities. Differences were defined by transitions between levels of care, planning for services across urban and rural communities, and coordinating integrated levels of service. Future research is required to build evidence base of how levels of service frameworks can be used in practice, adapted to local contexts, and evaluated.

Children who have survived a cardiac arrest are at the highest risk of long-term impairment, collectively termed Post Intensive Care Syndrome (PICS). This study aimed to explore through participatory and creative methods, children and young people's (CYP) experiences post-cardiac arrest intensive care. Participatory research includes drawing, painting and small-world play. CYPs were recruited who had been admitted to intensive care post-cardiac arrest and had the cognitive and physical ability to talk, draw, paint or play out their experiences. Seven CYPs and families consented to participate. The median number of interviews was two (IQR2,3), with a median interview length of 24 minutes (IQR15,65 minutes). Themes that emerged: gratitude, distrust and extrasensory experiences. Four of the seven (57%) participants opted to paint or draw to convey their experiences. Two (28%) participants had no memories of their cardiac arrest or time in intensive care but used creative methods to express gratitude to the care team. Participatory research methods may be an effective way for CYPs to convey their experiences of post-cardiac arrest intensive care. CYPs who have been critically ill have expressed a need to make sense of their experiences in intensive care. Healthcare professionals should be aware that these experiences may be deemed as extrasensory and require sensitive exploration.

Medical cannabis (MC) has recently emerged as a potential treatment option for pediatric neurodevelopmental conditions and epilepsy. Medical cannabis within these conditions remains limited in evidence-based literature. Caregiver experience can play a valuable role in providing real-world evidence. Thus, this study sought to conceptualize primary caregivers' experiences using medical cannabis to treat neurological conditions in their children. A qualitative multiple-case study design was used to ascertain caregiver experiences. Twelve primary caregivers were interviewed to identify four themes: lack of support, perception of efficacy, positive impacts on children and caregivers, and contribution to real-world evidence from caregivers. Caregivers reported symptom improvement in their children and improved quality of life for their child and family. However, caregivers identified a lack of support from the healthcare system as a challenge. This study highlights that while medical cannabis shows promise as a potential treatment option, there is a great need for more research and subsequent healthcare provider education. Significant barriers to caregivers acquiring knowledge and healthcare provider support put patients at risk. The healthcare system must develop better educational programs regarding the potential role of MC (such as the benefits and side effects in different patient groups and regulatory framework for prescribing) to support children and their families better.

Central venous access devices (CVADs) play a vital role in the administration of anti-cancer therapy; however, skin injuries surrounding insertion sites can develop, resulting in pain and device failure. This review aimed to synthesise and critically appraise studies describing skin injuries related to CVADs in children being treated for cancer. This integrative literature review follows established methodology by Whittemore and Knafl's (2005) guidelines. Studies were included if they had paediatric participants (from birth to 18 years), being treated for a solid or haematological cancer, where the study outcomes measured skin integrity at the CVAD sites. Three databases (MEDLINE, Embase and CINAHL) yielded 613 articles, with six studies meeting the inclusion criteria. Exit site infection ranged from 2.35 per 1000 catheter days to 0 per 1000 catheter days. The rate of skin injury and complications are observed to be as high as 16% for exit site infection and 11% for dermatitis. Infection is an important outcome, but not the sole outcome to consider during CVAD site observation. Often a lack of knowledge and awareness of skin injury can cause device complications and failure which has a negative impact on paediatric cancer patients.

This study aims to understand mothers' dynamic experiences of caring for their children with liver transplant. A descriptive phenomenological qualitative approach was applied to this study. A total of seven mothers participated in this study. Data were collected from April 2020 to June 2020 through face-to-face interviews. Data analysis was performed using Giorgi's phenomenological method. By grouping general meaning units, 8 themes and 19 subthemes were derived. Eight themes are as follows: sorrow and distress of accepting a child's diagnosis; difficulties in deciding to undergo liver transplantation; negative emotions before and after transplant; the support system before and after liver transplantation; achieving a sense of trust toward healthcare providers; new concerns about the child's life after undergoing liver transplantation; appreciation of the experience; and new determination and expectations for future life. This study can contribute to the guideline that describes the role and daily life experiences of caregiving for other parents whose children undergo liver transplantation and nurses who work with impacted families. Healthcare providers can refer to the results to provide liver transplantation childcare and hospital-based support groups for child's family to improve nurses' communication skills.