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El objetivo fue examinar, desde una aproximación multi-informante, las medidas del Síndrome de Desconexión Cognitiva (SDC) de padres/madres e hijos/as y su relación con síntomas internalizantes y externalizantes. 279 niños/as (9-13 años), y sus padres/madres completaron las evaluaciones sobre SDC, la inatención del trastorno por déficit de atención e hiperactividad (TDAH) y otras medidas internalizadas y externalizadas. Los ítems de las tres medidas de SDC convergieron razonablemente bien en el factor SDC. Se aportaron pruebas discriminantes de la validez de las relaciones entre las puntuaciones de las pruebas y las medidas de los tres constructos diferentes (SDC, soledad y preferencia por la soledad). La asociación más estrecha estuvo entre la evaluación parental de las medidas de SDC con ansiedad y depresión, y entre inatención con hiperactividad/impulsividad y trastorno negativista desafiante. Se observó capacidad predictiva de la medida de SDC sobre la soledad y preferencia por estar solo autoinformadas. Se encontró una posible asociación entre la medida del SDC evaluado por padres/madres y sexo y edad de los niños. En conclusión, los datos apoyan la inclusión de medidas autoinformadas en la evaluación del SDC. Las medidas del SDC en niños se vinculan con medidas internalizantes y, la inatención con las externalizantes.(AU)

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BACKGROUND: School-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance. METHODS: The WISE cluster-randomised trial, conducted in 60 public primary schools in Addis Ababa, Ethiopia over one academic year, enrolled 2-4 randomly selected classes per school (~ 100 pupils) from grades 2 to 8 (aged 7-16) in an 'open cohort'. Schools were assigned 1:1 by stratified randomisation to receive the intervention during the 2021/2022 or the 2022/2023 academic year (waitlist control). The intervention included improvements to drinking water storage, filtration and access, handwashing stations and behaviour change promotion. Planned sanitation improvements were not realised. At four unannounced classroom visits post-intervention (March-June 2022), enumerators recorded primary outcomes of roll-call absence, and pupil-reported respiratory illness and diarrhoea in the past 7 days among pupils present. Analysis was by intention-to-treat. RESULTS: Of 83 eligible schools, 60 were randomly selected and assigned. In total, 6229 eligible pupils were enrolled (median per school 101.5; IQR 94-112), 5987 enrolled at study initiation (23rd November-22nd December 2021) and the remaining 242 during follow-up. Data were available on roll-call absence for 6166 pupils (99.0%), and pupil-reported illness for 6145 pupils (98.6%). We observed a 16% relative reduction in odds of pupil-reported respiratory illness in the past 7 days during follow-up in intervention vs. control schools (aOR 0.84; 95% CI 0.71-1.00; p = 0.046). There was no evidence of effect on pupil-reported diarrhoea in the past 7 days (aOR 1.15; 95% CI 0.84-1.59; p = 0.39) nor roll-call absence (aOR 1.07; 95% 0.83-1.38; p = 0.59). There was a small increase in menstrual care self-efficacy (aMD 3.32 on 0-100 scale; 95% CI 0.05-6.59), and no evidence of effects on other secondary outcomes. CONCLUSIONS: This large-scale intervention to improve school WASH conditions city-wide had a borderline impact on pupil-reported respiratory illness but no effect on diarrhoeal disease nor pupil absence. Future research should establish relationships between WASH-related illness, absence and other educational outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT05024890.

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BACKGROUND: The Ultra-Low Emission Zone (ULEZ), introduced in Central London in April 2019, aims to enhance air quality and improve public health. The Children's Health in London and Luton (CHILL) study evaluates the impact of the ULEZ on children's health. This analysis focuses on the one-year impacts on the shift towards active travel to school. METHODS: CHILL is a prospective parallel cohort study of ethnically diverse children, aged 6-9 years attending 84 primary schools within or with catchment areas encompassing London's ULEZ (intervention) and Luton (non-intervention area). Baseline (2018/19) and one-year follow-up (2019/20) data were collected at school visits from 1992 (58%) children who reported their mode of travel to school 'today' (day of assessment). Multilevel logistic regressions were performed to analyse associations between the introduction of the ULEZ and the likelihood of switching from inactive to active travel modes, and vice-versa. Interactions between intervention group status and pre-specified effect modifiers were also explored. RESULTS: Among children who took inactive modes at baseline, 42% of children in London and 20% of children in Luton switched to active modes. For children taking active modes at baseline, 5% of children in London and 21% of children in Luton switched to inactive modes. Relative to the children in Luton, children in London were more likely to have switched from inactive to active modes (OR 3.64, 95% CI 1.21-10.92). Children in the intervention group were also less likely to switch from active to inactive modes (OR 0.11, 0.05-0.24). Moderator analyses showed that children living further from school were more likely to switch from inactive to active modes (OR 6.06,1.87-19.68) compared to those living closer (OR 1.43, 0.27-7.54). CONCLUSIONS: Implementation of clean air zones can increase uptake of active travel to school and was particularly associated with more sustainable and active travel in children living further from school.

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Childhood obesity and associated metabolic abnormalities have become pressing public health concerns worldwide, significantly impacting cardiovascular health. Metabolic syndrome, characterized by a cluster of metabolic abnormalities including central obesity, altered glucose metabolism, dyslipidemia, and arterial hypertension, has emerged as a critical precursor to cardiovascular disease. Chronic systemic inflammation and oxidative stress seem to play pivotal roles in the pathogenesis of childhood obesity-related disorders such as early atherosclerosis. A significant distinction between the objective components of cardiovascular health metrics, including body mass index, blood pressure, cholesterol, and fasting glucose levels, and the definition of metabolic syndrome is evident in the identification of obesity. Whereas cardiovascular health metrics predominantly rely on body mass index percentiles to assess obesity, metabolic syndrome criteria prioritize waist circumference, specifically targeting individuals with a measurement ≥90th percentile. This discrepancy emphasizes the need for a nuanced approach in assessing the risks associated with obesity and underscores the importance of considering multiple factors when evaluating cardiovascular risk in children. By recognizing the complex interplay between various health metrics, obesity and metabolic syndrome criteria, clinicians can more accurately identify individuals at risk and tailor interventions accordingly to mitigate cardiovascular disease in children with obesity.

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BACKGROUND: The Elders Mentoring Program (EMP) is part of a strengths-based community-based participatory research partnership with the Cree communities of Maskwacîs, Alberta, Canada. The EMP objective is to promote maternal and child health through traditional Cree teachings and support from community Elders to pregnant women and their partners. During the COVID-19 pandemic, the Elders decided to shift the program to an online format in early 2021. The Elders continued to offer mentorship to program participants virtually by Zoom and telephone, and online workshops. The objective of this study was to qualitatively explore the experiences of women that took part in the virtual EMP. METHODS: We utilized qualitative description as our method, informed by our overarching community-led research partnership. Semi-structured phone interviews were conducted by Maskwacîs research assistants (RAs) with 11 women who participated in the virtual program. Interviews were conducted between December 2021 and June 2022. The participants were asked about their perceptions of the program and its benefits. The interviews were recorded, transcribed, and coded by four RAs using thematic analysis. RESULTS: Although cultural teachings are traditionally offered in person, the shift to the virtual platform was greatly appreciated by all the women. Technology can be a useful tool for cultural teachings and language to be shared among community members when they cannot be physically together. Four main themes emerged from the data, representing the participants' experiences, and learning through their interactions with the Elders from the EMP. The themes are: Ohpikihâwasowin (grounding and guiding on the path to be a healthy parent); Indigenous ways of healing; On the path of cultural learning; and Identity for self and baby. CONCLUSION: The virtual adaptation of the EMP allowed a space for Elders to offer support to women living in and out of the community to provide guidance with their pregnancies and into motherhood. The workshops and one-on-one calls allowed for cultural revitalization which is critical for Indigenous well-being. All the participants found that the teachings and interactions positively impacted their pregnancy and parenthood. Overall, the virtual program demonstrated a venue for intergenerational healing and resilience.

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BACKGROUND: Housing insecurity can be understood as experiencing or being at risk of multiple house moves that are not through choice and related to poverty. Many aspects of housing have all been shown to impact children/young people's health and wellbeing. However, the pathways linking housing and childhood health and wellbeing are complex and poorly understood. METHODS: We undertook a systematic review synthesising qualitative data on the perspectives of children/young people and those close to them, from the United Kingdom (UK). We searched databases, reference lists, and UK grey literature. We extracted and tabulated key data from the included papers, and appraised study quality. We used best fit framework synthesis combined with thematic synthesis, and generated diagrams to illustrate hypothesised causal pathways. RESULTS: We included 59 studies and identified four populations: those experiencing housing insecurity in general (40 papers); associated with domestic violence (nine papers); associated with migration status (13 papers); and due to demolition-related forced relocation (two papers). Housing insecurity took many forms and resulted from several interrelated situations, including eviction or a forced move, temporary accommodation, exposure to problematic behaviour, overcrowded/poor-condition/unsuitable property, and making multiple moves. Impacts included school-related, psychological, financial and family wellbeing impacts, daily long-distance travel, and poor living conditions, all of which could further exacerbate housing insecurity. People perceived that these experiences led to mental and physical health problems, tiredness and delayed development. The impact of housing insecurity was lessened by friendship and support, staying at the same school, having hope for the future, and parenting practices. The negative impacts of housing insecurity on child/adolescent health and wellbeing may be compounded by specific life circumstances, such as escaping domestic violence, migration status, or demolition-related relocation. CONCLUSION: Housing insecurity has a profound impact on children and young people. Policies should focus on reducing housing insecurity among families, particularly in relation to reducing eviction; improving, and reducing the need for, temporary accommodation; minimum requirements for property condition; and support to reduce multiple and long-distance moves. Those working with children/young people and families experiencing housing insecurity should prioritise giving them optimal choice and control over situations that affect them.

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BACKGROUNDS: This study delves into the risk perceptions of Italian pediatricians concerning climate change's impact on children's health. Given children's heightened vulnerability to climate-related health risks, comprehending these perceptions is crucial. A review of pertinent literature establishes the framework, emphasizing six key factors influencing children's susceptibility to climate-related health hazards. METHODS: Methodologically, the study utilized a survey tool developed collaboratively with the Italian Society of Pediatrics (SIP), garnering responses from a representative sample of Italian pediatricians. RESULTS: Findings indicate a high level of awareness among respondents regarding climate change and its health implications, with a majority attributing it primarily to human activity. Pediatricians recognize various current and anticipated health impacts of climate change, notably concerning illnesses linked to outdoor air quality. Despite acknowledging their role in addressing climate-related health concerns, respondents also cite barriers to engagement, including time constraints and knowledge gaps. However, they express interest in resources like professional training and policy statements to bolster their capacity for effective communication and advocacy. CONCLUSIONS: Comparisons with prior studies highlight the consistency of findings across diverse contexts and underscore the significance of integrating climate and environmental health education into medical training. Overall, this study sheds light on pediatricians' perspectives in tackling the convergence of climate change and children's health, pinpointing avenues for enhancing their involvement in climate advocacy and mitigation efforts.

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2024 is the 100th Anniversary of the Geneva Declaration of the Rights of the Child. Endorsed by the League of Nations in 1924 following World War I, the Geneva Declaration is the first international legal instrument recognizing the inherent rights of children worldwide-indeed, it is the first human rights document ever recognized by an intergovernmental organization, thus giving rise to the international human rights era that transformed policy, law, and ethics in the 20th century. As we approach the 100th anniversary of the Geneva Declaration, we have the opportunity to reflect on the progress we have made in the first century of intentional work recognizing and advancing the human rights of children internationally. This commentary looks at the international children's rights legal framework that was developed by the global community from 1924 to the present. It then highlights advancements and shortcomings in key thematic areas, such as child health and well-being, poverty, child labor, and education. It closes by focusing on the path and priorities before us as we enter our second century of advancing international children's rights. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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BACKGROUND: Maternal and neonatal deaths remain a major public health issue worldwide. Income Generation Associations (IGAs) could form a critical entry point to addressing poverty-related contributors. However, there have been limited practical interventions to leverage the power of IGAs in addressing the challenges associated with maternal care and childcare. OBJECTIVE: This study aims to co-design an intervention package with women in IGAs to improve their readiness and resilience to address maternal and child health (MCH) challenges using a human-centered design approach. METHODS: The study will use a qualitative descriptive design with purposefully selected women in IGAs and key MCH stakeholders in the Shinyanga and Arusha Regions of Tanzania. A 4-step adaptation of the human-centered design process will be used involving (1) mapping of IGAs and exploring their activities, level of women's engagement, and MCH challenges faced; (2) co-designing of the intervention package to address identified MCH challenges or needs considering the perceived acceptability, feasibility, and sustainability; (3) validation of the emerging intervention package through gathering insights of women in IGAs who did not take part in initial steps; and (4) refinement of the intervention package with MCH stakeholders based on the validation findings. RESULTS: The participants, procedures, and findings of each co-design step will be presented. More specifically, MCH challenges facing women in IGAs, a list of potential solutions proposed, and the emerging prototype will be presented. As of August 2024, we have completed the co-design of the intervention package and are preparing validation. The findings from the validation of the emerging prototype with a new group of women in IGAs and its refinement through multistakeholder engagement will be presented. A final co-designed intervention package with the potential to improve women's resilience and readiness to handle MCH challenges will be generated. CONCLUSIONS: The emerging intervention package will be discussed given relevant literature on the topic. We believe that subsequent testing and refinement of the package could form the basis for scaling up to broader settings and that the package could then be promoted as one of the key strategies in addressing MCH challenges facing women in low- and middle-income countries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54323.

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INTRODUCTION: In Ethiopia, more than half (57%) of children aged 6-59 months were estimated to be anemic in 2016 alone. The country had about 37% of under-five children suffering from stunting and under-five mortality rate of 59 deaths per 1000 live births in 2019. The main purpose of this paper was to estimate the proportion of under-five children prevented from childhood undernutrition, anemia, and under-five mortality by removing the risk factors or inequalities. METHOD: This cross-sectional study was based on a pooled total sample of 29,831 children aged 0-59 months drawn from three rounds of the Ethiopian Demography and Health Surveys (2005-2016). We employed multiple logistic regression analysis to identify the modifiable risk factors associated with childhood anemia, undernutrition, and under-five mortality among under-five children. We also used Population Attributable Fractions (PAFs) to estimate the proportion of under-five children that could be prevented from childhood undernutrition, anemia, and under-five mortality by removing inequalities. RESULT: PAF analyses of risk factors of childhood anemia confirmed that 38.5% of occurrence of childhood anemia was attributed to five selected risk factors, which include having a large household size (5+), being in a poor household, being born from anemic and unemployed mothers, and being breastfed for less than six months. About 45.6% of occurrences of childhood undernutrition were attributed to unimproved toilet facility, solid cooking fuel, and home delivery. About 72% of the reported under-five mortality could possibly be averted by removing the use of unimproved toilet facilities, early age childbirth (< 18 years old mothers), and a large number of children ever born to mothers and less than six months breastfeeding practice at the population level. CONCLUSION: The present study suggests that a substantial reduction in the prevalence of childhood anemia, undernutrition, and under-five mortality in the country is attainable if child survival-focused program interventions and policies target households and mothers with low socioeconomic status and those who have low awareness of child healthcare, including breastfeeding practice and use of safe sanitation facilities.

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Background: Parent-child separation raises concerns for the well-being of 69 million left-behind children (LBC) in China. However, the effects of parental migration status, timing of migration, and migration duration on the health of children remain unclear. This study aims to explore the association between different parent-child separation experience and a range of health outcomes in rural Chinese children. Method: A sample of 2,355 students, grades 5 to 8, from two provinces in China were recruited. Standardized self-report instruments collected data on demographics, separation status, and children's health conditions. Results: Full data were available for 274 children with both parents currently migrating (BLBC), 638 children with one parent currently migrating (SLBC), 658 children with parents previously migrated (PLBC) and 785 children with non-migrating parents (NLBC). Regression model results showed that, compared to the NLBC group, BLBC and PLBC exhibited lower self-rated health (p < 0.05), higher depression (p < 0.05), and higher rates of non-suicidal self-injury behaviors (p < 0.05) and suicidal ideation (p < 0.05). Children who experienced parental separation before the age of three were at a higher risk for four health indicators. Additionally, children left behind by parents for more than 7 years had significantly worse health outcomes. Conclusion: Children who have experienced both current and previous parental migration, as well as earlier parental migration age and longer migration duration, are at a disadvantage in terms of health. These findings highlight the need for targeted interventions focusing on the most vulnerable children.

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INTRODUCTION: Developmental outcomes for children and young people with fetal alcohol spectrum disorder (FASD) are optimised if their needs are identified early. Yet, health workers miss vital opportunities to identify and respond to FASD due to a lack of support, knowledge and skills. METHODS: Through surveys and interviews, our study investigated what child and family health workers in an Australian metropolitan local health district understand, already do and want to learn about FASD. RESULTS: The study provided evidence of low FASD knowledge and confidence and a lack of referral options with some workers 'patching together' care planning in a 'referral black hole'. Qualitative data provided insight into how skilled clinicians engage families in FASD assessment and negotiate gaps in clinical knowledge. DISCUSSION AND CONCLUSIONS: Health workers in this study requested high-quality training and the development of FASD practice guidelines to improve role clarity and clinical impact when working with FASD populations.

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The presence of children and adolescents in migratory flows is growing in Latin America and the Caribbean. Little is known about migration's effects on these groups' health. This article aims to investigate the evidence available on the access and use of healthcare services by migrant children and adolescents in Latin America and the Caribbean. We seek to explore the role of social determinants of health at different levels in the health conditions of these groups. Also, to identify potential recommendations for healthcare systems and public policy to address them. For this purpose, a narrative review of 52 publications was carried out based on a search of scientific literature in the Web of Science and Google Scholar databases. Five relevant topics were identified: use of emergency care associated with lack of healthcare access, preventive services, and other social determinants of health; exposure to preventable infectious diseases; mental health; sexual and reproductive health; and vaccinations and dental health. We conclude that the evidence shows the need to address the inequities and disadvantages faced by migrant children from a perspective of social determinants of health and policies that consider health as a human right regardless of the migratory status of children and adolescents, as well as that of their parents or primary caregivers.

En Latinoamérica y El Caribe la presencia de niños, niñas y adolescentes en los flujos migratorios internacionales es creciente. Los efectos que la migración genera sobre la salud de estos grupos han sido poco estudiados. El objetivo de este artículo es indagar en las principales evidencias reportadas respecto al acceso y uso de servicios de salud por parte de niños, niñas y adolescentes migrantes en América Latina y El Caribe. Esto, con la finalidad de reflexionar sobre el rol que cumplen los determinantes sociales de la salud de diverso nivel, en las condiciones de salud de estos grupos. También se busca identificar recomendaciones para su abordaje desde los sistemas de salud y la política pública. Para ello se realizó una revisión narrativa de 52 publicaciones sobre la base de un proceso de búsqueda de literatura científica de la base de datos y Google Académico. Se identificaron cinco temas relevantes: uso de urgencias asociado a falta de acceso a salud, a servicios preventivos y a otros determinantes sociales de la salud; exposición a enfermedades infecciosas prevenibles; salud mental; salud sexual y reproductiva; y vacunaciones y salud dental. Concluimos que la evidencia muestra la necesidad de abordar las inequidades y desventajas que están acumulando estos grupos, desde una óptica de determinantes sociales de la salud y de políticas que consideren la salud como derecho humano independiente de la situación migratoria de los niños, niñas y adolescentes, así como la de sus padres o cuidadores principales.

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OBJECTIVES: To examine the association between caregiver-perceived cultural sensitivity of health care providers and child health status in the United States. METHODS: We analyzed National Survey of Children's Health data (n = 145,226) from 2016-2020. Using logistic regression, we determined odds of reporting a better health status by level of caregiver-perceived provider cultural sensitivity while controlling for potential confounders. RESULTS: Children with providers perceived as more culturally sensitive by their caregivers had 2.38 times the odds (95% confidence interval: 1.73, 3.28) of enjoying a better caregiver-assessed health status compared with children whose providers were perceived as less culturally sensitive. Caregivers of BIPOC children in our sample were 1.99 times more likely (95% CI: 1.89, 2.10) to report their provider as only sometimes or never culturally sensitive. CONCLUSIONS: Cultural sensitivity of health care providers, as perceived by caregivers, was associated with caregiver-assessed child health status in our study. This association remained significant when controlling for various sociodemographic variables. Our findings highlight the need for more research around the potential positive impact that improving provider cultural sensitivity could have on the health of children who are Black, Indigenous, or other People of Color (BIPOC).

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This Medical News story examines the controversy surrounding the FDA's first authorization of flavored e-cigarettes, in this case menthol.

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INTRODUCTION: Unhealthy diets pose a significant public health risk among European children, contributing to the increasing prevalence of overweight and non-communicable diseases. Children spend a substantial amount of time at school daily, including lunchtime, so the school setting becomes crucial for promoting healthy diets and lifestyle habits. While there is a large body of literature on the impact of school food policies on health and non-health outcomes, it is essential to identify which policies are effective and can be recommended for implementation to ensure the efficient use of resources. This article presents a protocol for a scoping review that aims to map the current published literature on the effects of school food policies on health outcomes, acceptance and affordability in secondary school children in Europe. Moreover, the scoping review will map the measurements used to assess health outcomes, acceptance and affordability. METHODS AND ANALYSIS: The scoping review protocol and review follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. To identify eligible studies, we will search MEDLINE, PsycINFO, CINAHL and Web of Science. The reference lists of the included articles will be checked for additional studies. In addition, country-specific ministry reports from Member States of the European Union, the UK, Norway, Iceland and Switzerland will be identified. The WHO and European Commission websites will also be searched for relevant reports. The scoping review will include literature published until 20 September 2023. No restrictions to study design and language will be applied. Screening and data extraction will be carried out independently by three reviewers. Disagreements will be resolved by discussion. A pretested data charting table will be used to extract key information. Findings will be presented in tabular and visualised summaries and a narrative summary. ETHICS AND DISSEMINATION: This scoping review does not require ethical approval. Our dissemination strategy comprises peer-reviewed publications, conference presentations and recommendations to policy-makers.

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INTRODUCTION: Randomised controlled trials (RCTs) of early childhood home-visiting interventions led by nurses have been conducted mainly in Western countries, whereas such trials have been limited in non-Western cultures, including Asia. In South Korea, a national nurse home visit programme (Korea Early Childhood Home-visiting Intervention (KECHI)) was developed in 2020 and launched throughout the country. We designed a pragmatic RCT to evaluate the effectiveness of KECHI on child health and development and maternal health. METHODS AND ANALYSIS: Eligible participants will be pregnant women at <37 weeks of gestation with risk factor scores of 2 or over, who are sufficiently fluent in Korean to read and answer the questionnaire written in Korean and live in districts where the KECHI services are available. Eight hundred participants will be recruited from the general community and through the District Public Health Centres. The participants will be randomised 1:1 to KECHI plus usual care or usual care. KECHI encompasses 25-29 home visits, group activities and community service linkage. Participants will complete assessments at baseline (<37 weeks gestation), 6 weeks, 6 months, 12 months, 18 months and 24 months post partum. The six primary outcomes will be (1) home environment (assessed by Infant/Toddler Home Observation for Measurement of the Environment), (2) emergency department visits due to injuries, (3) child development (assessed using Korean Bayley Scales of Infant and Toddler Development-III), (4) breastfeeding duration, (5) maternal self-rated health and (6) community service linkage. ETHICS AND DISSEMINATION: This trial has received full ethical approval from the Institutional Review Board of the Seoul National University Hospital. Written consent will be obtained from the participants. The results will be reported at conferences, disseminated through peer-reviewed publications and used by the Korean government to expand the KECHI services. TRIAL REGISTRATION NUMBER: NCT04749888.

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