[Evaluation of the strategy of parental support at primary health care as a reinforcement of the online course 'Gaining health and wellbeing from birth to three'.]

OBJECTIVE

E-parenting is an opportunity to provide parental support as a universal prevention strategy. This study analysed the extent to which the promotion actions improve universal use of the online course 'Positive parenting: Gaining health and wellbeing from birth to three' (GH&W) (http://aulaparentalidad-msssi.com/) at the primary care centers.

METHODS

The profile of participants and the adherence to the course in a national sample of families using the GH&W course were compared with another Canarian sample distributed in three groups: only GH&W (level 1), GH&W + face-to-face group activities (level 2), and users who also received individual support in the medical checking (level 3). It was carried out in 20 health centers on the islands of Tenerife and Gran Canaria randomly assigned to one of the three levels. Participants were 175 national parental figures and 160 parental figures users of the Canary Health Service, both with children from 0 to 3 years. The sociodemographic profile and the completion rate of the GH&W were registered, as well as a template of implementation quality indicators for innovative experiences. To compare the sociodemographic profile differences between groups, a Chi-square contingency analysis with standardized residuals was performed.

RESULTS

Compared to the national sample mainly of high educational level, primiparous mothers and 14% completion, the Canarian sample attracted different educational levels and multiparous mothers, with a higher completion rate at levels 2 and 3 (62.5% and 67.5%) than at level 1 (38.5%).

CONCLUSIONS

The universal use of the course and its adherence improve due to the inclusion of face-to-face activities. The implementation process in the selected health centers satisfactorily meets the quality indicators of an innovative initiative.

Supporting children and youth during the COVID-19 pandemic and beyond: A rights-centred approach

The COVID-19 pandemic is an unprecedented global crisis, affecting millions globally and in Canada. While efforts to limit the spread of the infection and ‘flatten the curve’ may buffer children and youth from acute illness, these public health measures may worsen existing inequities for those living on the margins of society. In this commentary, we highlight current and potential long-term impacts of COVID-19 on children and youth centring on the UN Convention of the Rights of the Child (UNCRC), with special attention to the accumulated toxic stress for those in difficult social circumstances. By taking responsive action, providers can promote optimal child and youth health and well-being, now and in the future, through adopting social history screening, flexible care models, a child/youth-centred approach to “essential” services, and continual advocacy for the rights of children and youth.

How do parents perceive adverse drug events of their children's anticonvulsant medication?

BACKGROUND

The main source of knowledge on adverse drug events (ADE) are physicians' reports in controlled clinical trials. In contrast, little is known about the parents' perception of ADE of anticonvulsants their children receive.

METHODS

After approval by the local ethics committee, we performed a survey in a neuropediatric outpatient clinic of a university hospital. Based on a structured questionnaire, we interviewed parents of children with current anticonvulsant treatment regarding (i) their fears about potential ADE, (ii) experienced ADE according to parents, and (iii) implications of ADE on the child's life.

RESULTS

Parents of 150 patients took part in the interview. (i) 95 (63.3%) parents expressed fears concerning ADE, mostly liver injury/liver failure (33 [22%]). (ii) 129 (86%) parents reported experienced ADE, mostly sedation (65 [43.3%]) and abnormal behavior (54 [36%]). (iii) Parents reported substantial implications of ADE on the child's daily life for 84 (56%) children, and 63 (42%) parents expressed a negative impact on the child's development.

CONCLUSION

We recognized a great discrepancy between those ADE that were feared and those that were experienced. Parents feared life-threatening ADE and experienced less severe ADE that nevertheless have a negative impact on the child's daily life.

Adverse childhood experiences: Basics for the paediatrician

In 1998, the Centers for Disease Control and Prevention Adverse Childhood Experiences study established the profound effects of early childhood adversity on life course health. The burden of cumulative adversities can affect gene expression, immune system development and condition stress response. A scientific framework provides explanation for numerous childhood and adult health problems and high-risk behaviours that originate in early life. In our review, we discuss adverse childhood experiences, toxic stress, the neurobiological basis and multigenerational and epigenetic transmission of trauma and recognized health implications. Further, we outline building resilience, screening in the clinical setting, primary care interventions, applying trauma-informed care and future directions. We foresee that enhancing knowledge of the far-reaching effects of adverse childhood events will facilitate mitigation of toxic stress, promote child and family resilience and optimize life course health trajectories.

Paediatric school-based clinics in Saskatoon: Providing equitable access to paediatric care

Paediatric school-based clinics (PSBCs) were established in Saskatoon (Saskatchewan) in 2007, to provide access to specialized paediatric health care as part of multidisciplinary and interdisciplinary teams, and alongside existing services. In its ninth year, the PSBCs have grown both in number and services offered, and in patient numbers - for both new patients and repeat follow-up visits. Viewing paediatric health consistently through the lens of the social determinants of health has been essential in delivering care, which require consideration and negotiation of these contexts in formulating management plans. The responsive relationships we continue to establish with our patients through the PSBCs have enabled us to work effectively with children and youth, and continue the growth of our successes.

Housing need in Canada: Healthy lives start at home

Housing affects the health of children and youth. One-third of households in Canada live in substandard conditions or in housing need. The present statement reviews the literature documenting the impacts of housing on personal health and the health care system. Types of housing need are defined, including unsuitable or crowded housing, unaffordable housing and inadequate housing, or housing in need of major repairs. The health effects of each type of housing need, as well as of unsafe neighbourhoods, infestations and other environmental exposures are outlined. Paediatricians and other physicians caring for children need to understand the housing status of patients to fully determine their health issues and ability to access and engage in health care. Recommendations and sample tools to assess and address housing need at the patient, family, community and policy levels are described. Canada is the only G8 country without a national housing strategy. Recommendations also include advocating for enhanced action at all levels of government and for housing-supportive policies, including a national housing strategy.

Child poverty. Ways forward for the paediatrician: A comprehensive overview of poverty reduction strategies requiring paediatric support

The harmful effects of child poverty are well documented. Despite this, progress in poverty reduction in Canada has been slow. A significant gap exists between what is known about eradicating poverty and its implementation. Paediatricians can play an important role in bridging this gap by understanding and advancing child poverty reduction. Establishment of a comprehensive national poverty reduction plan is essential to improving progress. The present review identifies the key components of an effective poverty reduction strategy. These elements include effective poverty screening, promoting healthy child development and readiness to learn, ensuring food and housing security, providing extended health care coverage for the uninsured and using place-based solutions and team-level interventions. Specific economic interventions are also reviewed. Addressing the social determinants of health in these ways is crucial to narrowing disparities in wealth and health so that all children in Canada reach their full potential.

Poverty during pregnancy: Its effects on child health outcomes

It is estimated that nearly 100,000 children are born into poverty each year in Canada. During pregnancy, their mothers are likely to face multiple stressful life events, including lone-mother and teenage pregnancies, unemployment, more crowded or polluted physical environments, and far fewer resources to deal with these exposures. The early child health consequences of poverty and pregnancy are multiple, and often set a newborn child on a life-long course of disparities in health outcomes. Included are greatly increased risks for preterm birth, intrauterine growth restriction, and neonatal or infant death. Poverty has consistently been found to be a powerful determinant of delayed cognitive development and poor school performance. Behaviour problems among young children and adolescents are strongly associated with maternal poverty. Sound evidence in support of policies and programs to reduce these disparities among the poor, including the role of health practitioners, is difficult to find. This is partly because many interventions and programs targeting the poor are not properly evaluated or critically appraised.

The health of Canada's children. Part III: Public policy and the social determinants of children's health

The health of Canada's children does not compare well with other wealthy industrialized nations. Significant inequalities in health exist among Canadian children, and many of these inequalities are due to variations in Canadian children's life circumstances - the social determinants of health. The present article describes the social determinants of children's health and explains how the quality of these social determinants is shaped, in large part, by public policy decisions. The specific public policies that shape the quality of Canadian children's health are examined, and Canadian approaches in comparison with other wealthy developed nations are described. Policy directions that would improve the quality of the social determinants of children's health are presented and barriers to their implementation are considered.

Is a pan-Canadian early child development system possible? Yes, when we redress what ails Canadian culture

Canada lags behind other countries when it comes to investing in families with children. Canada, therefore, fails to promote health by not optimizing early development. The authors diagnose the Canadian failure. The problem is not research or fiscal capacity, but rather a sickness in Canadian culture. Four ailments are identified: Canadians are convinced they cannot afford new social investments, tend to treat illness rather than promote health, ignore that good family policy requires gender equality, and discount intergenerational justice. In response, the authors propose four policy solutions. Their pan-Canadian framework would cost $22 billion annually, not even one-half of current elderly and pension benefits. The new investment would reduce child vulnerability from approximately 30% to just 10% of children within 10 years. This reduction in early vulnerability would increase gross domestic product 20% more over 60 years than if Canadians tolerate the status quo.

The health of Canada's children. Part IV: Toward the future

Canadian children's health is influenced, in large part, by the living circumstances that they experience. These living circumstances - also known as the social determinants of health - are shaped by public policy decisions made by governmental authorities. While public policy should be focused on providing all Canadian children with the living circumstances necessary for health, it appears that Canada is far from achieving this goal. Instead, there are programs directed at Canada's most severely disadvantaged families and children. While vital, these programs appear to achieve less than that which would be achieved if governmental action was designed to strengthen the social determinants of health for all children. Considering the governmental actions that would achieve this goal are well known - with rather little evidence of policy implementation - it is essential to understand the processes by which public policy is made. An important physician role - in addition to providing responsive health care services - is to become forceful advocates for public policy in the service of health. It is in the latter sphere that physician involvement may yield the strongest benefits for promoting children's health.

The health of Canada's children. Part II: Health mechanisms and pathways

The present article provides models that explain how exposures to differing quality living circumstances result in health inequalities among children. Living circumstances - the social determinants of health - operate through a variety of mechanisms to shape children's health and cognitive, emotional and social development. Specific processes set children off on trajectories such that these exposures - in interaction with their environments - not only shape their health as children but also provide the foundations for their health status as adults. In addition to specifying the mechanisms that mediate the relationship between living circumstances and health outcomes, the article also identifies some of the economic and political factors that shape the quality of the living circumstances to which Canadian children are exposed.