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Jo M, Oh I, Moon D, Kim S, Jung-Choi K, Chung H. Maternal socioeconomic position and inequity in child deaths: An analysis of 2012 South Korean birth cohort of 466,636 children. SSM Popul Health 2022; 21:101304. [PMID: 36544546 PMCID: PMC9762189 DOI: 10.1016/j.ssmph.2022.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/29/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Inequalities in child mortality occur via interactions between socio-environmental factors and their constituents. Through childhood developmental stages, we can observe changing patterns of mortality. By investigating these patterns and social inequalities by cause and developmental stage, we aim to gain insights into health policies to reduce and equalize childhood mortality. Methods Using vital statistics, we examined the Korean birth cohort of 2012, including all children born in 2012 up to five years of age (N = 466,636). The dependent variables were all-cause and cause-specific mortality by developmental stage (i.e., neonatal, post-neonatal, and childhood). A Cox proportional hazard regression model was built to compare child mortality according to maternal education. The distribution of inequalities in cause-specific mortality by child age was calculated using the slope index of inequality (SII). Results Inequalities in child mortality due to maternal education occur during the neonatal period and increase over time. After adjusting for covariates, the Cox proportional hazard models showed that "injury and external causes" (HR = 2.178; 95% CI = [1.283-3.697]) and "unknown causes" (HR = 2.299; 95% CI = [1.572-3.363]) in the post-neonatal period, and "injury and external causes" (HR = 2.153; 95% CI = [1.347-3.440]) in the childhood period significantly contributed to socioeconomic inequalities in child mortality. For each period, the leading causes of inequality were identified as follows: "congenital" (96.7%) for the neonatal period, "unknown causes" (58.2%) and "injury and external causes" (28.4%) for the post-neonatal period, and "injury and external causes" (56.5%) for the childhood period. Conclusion We confirmed that the main causes of death in mortality inequality vary according to child age, in accordance with the distinctive context of child development. Strengthening the health system and multisectoral efforts that consider families' and children's needs according to spatial contexts (e.g., home, community) may be necessary to address the social inequalities in child health.
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Affiliation(s)
- Minjin Jo
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea,BK21FOUR R&E Center for Learning Health Systems, Graduate School, Korea University, Seoul, Republic of Korea
| | - Inseong Oh
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea
| | - Daseul Moon
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea,People's Health Institute, Seoul, Republic of Korea
| | - Sodam Kim
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea,Health Insurance Research Institute, National Health Insurance Service, Wonju, Republic of Korea
| | - Kyunghee Jung-Choi
- Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Haejoo Chung
- BK21FOUR R&E Center for Learning Health Systems, Graduate School, Korea University, Seoul, Republic of Korea,Division of Health Policy & Management, College of Health Science, Korea University, Seoul, Republic of Korea,Corresponding author. B-365 Hana Science Hall, 145 Anam-ro, Seongbuk-gu, Seoul, 20841, Republic of Korea.
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Gaskin K, Kennedy F. Care of infants, children and adults with congenital heart disease. Nurs Stand 2020; 34:37-42. [PMID: 31468777 DOI: 10.7748/ns.2019.e11405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 12/13/2022]
Abstract
Congenital heart disease refers to an anatomical or physiological defect of the heart that is present at birth. Over the past three decades there have been significant advances in surgical, medical and nursing care for infants and children requiring cardiac surgery for congenital heart disease. This has meant that the number of adults with moderate and complex congenital heart disease now exceeds the number of children with the disease. This article details the background and diagnosis of congenital heart disease. It considers the implications for infants and children with congenital heart disease, as well as their parents, such as screening methods, risk factors, parental stress and psychosocial needs. This article also discusses the care of adults with congenital heart disease, including specialist monitoring and patient education.
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Affiliation(s)
- Kerry Gaskin
- Three Counties School of Nursing and Midwifery, University of Worcester, Worcester, England, and chairperson of the Congenital Cardiac Nurses Association
| | - Fiona Kennedy
- Barts Health NHS Trust, London, England, and member of the British Adult Congenital Cardiac Nurses Association
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Kosta L, Harms L, Franich-Ray C, Anderson V, Northam E, Cochrane A, Menahem S, Jordan B. Parental experiences of their infant's hospitalization for cardiac surgery. Child Care Health Dev 2015; 41:1057-65. [PMID: 25652039 DOI: 10.1111/cch.12230] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Parents are increasingly recognized as important partners in children's health care. Despite their involvement in care, parental experiences of their child's hospitalization have received little research attention. In this study we explored parents' perceptions of what they found difficult, what they would like to be different and what they found to be helpful during their infant's hospitalization and surgery for the treatment of congenital heart disease. METHODS Structured interviews were conducted with 154 parents (91 mothers, 63 fathers) whose infant underwent cardiac surgery (at <3 months of age) 1 month post discharge from hospital. Thematic and frequency analyses were performed. RESULTS Parents reported a range of difficulties from dealing with their baby's unfolding illness, surgery and recovery to the structural and systemic issues associated with the broader context of their experiences. In an effort to be near their baby, parents struggled to obtain the necessities for daily living at the hospital and negotiate transitions between their hospital and home lives throughout the admission. Domains parents identified for change included the availability of facilities and resources and the quantity and quality of information and emotional support. Parents reported relationships with hospital staff as the most common source of support during this challenging time. CONCLUSIONS Opportunities to improve parents' experiences when their infant is in hospital exist at an organizational level as well as at the clinical level. The significance of parents' relationship with hospital staff indicates the potential for each professional to impact on families' experiences on a daily basis. The range of challenges indicates the scope and need for allied health services.
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Affiliation(s)
- L Kosta
- Department of Social Work, The University of Melbourne, Melbourne, Vic., Australia
| | - L Harms
- Department of Social Work, The University of Melbourne, Melbourne, Vic., Australia
| | - C Franich-Ray
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
| | - V Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,School of Behavioural Science, The University of Melbourne, Melbourne, Vic., Australia.,Department of Psychology, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - E Northam
- School of Behavioural Science, The University of Melbourne, Melbourne, Vic., Australia.,Department of Psychology, The Royal Children's Hospital, Melbourne, Vic., Australia.,Cell Biology, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - A Cochrane
- MonashHeart, Monash Medical Centre, Clayton, Vic., Australia
| | - S Menahem
- MonashHeart, Monash Medical Centre, Clayton, Vic., Australia.,School of Psychology and Psychiatry, Monash University, Clayton, Vic., Australia
| | - B Jordan
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia.,Social Work Department, The Royal Children's Hospital, Melbourne, Vic., Australia
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Abstract
Anesthesia for adults with congenital heart disease has many challenging physiologic considerations. Collaborative relationships of a multidisciplinary team including cardiology, cardiac surgery, anesthesiology, and intensive care are essential to ensure positive outcomes in this population for noncardiac and cardiac surgery.
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Affiliation(s)
- Jane Heggie
- Department of Anesthesia, Toronto General Hospital, 3 Eaton North, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
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