1
|
Hong Y, Xu W. Continuity and changes in grandchild care and the risk of depression for Chinese grandparents: new evidence from CHARLS. Front Public Health 2023; 11:1217998. [PMID: 37601176 PMCID: PMC10435994 DOI: 10.3389/fpubh.2023.1217998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives Although studies have researched the mental effects of intergenerational care, little is known about the impact of transformations in caregiving intensity on depression. This study explores grand-parents' depressive symptom outcomes in terms of changes over time in grandparental childcare, with considerations for subgroup differences. Method Using data from the 2015-2018 China Health and Retirement Longitudinal Study on grandparents aged 45 and older, we adopted generalized estimating equations to estimate the effects of seven category changes [(1) continued to provide high-intensity or (2) low-intensity care at both waves; (3) never provided care; (4) started caregiving; (5) ended caregiving; (6) provided less intensive care; and (7) provided more intensive care] over time in grandparental childcare on depressive symptoms among 17,701 grandparents with at least one grandchild, as well as how the impact varies by gender and urban/rural areas. Results Grandparents who decreased the intensity of care, stopped childcare, or offered continuous low-intensity care were associated with a lower level of depression compared with those providing no childcare. In addition, the benefit of continuous caregiving on mental health was especially noticeable in urban grandmothers. Conclusion Providing continuous low-intensity, decreased-intensity grandparenting and the cessation of caregiving were associated with a decreased level of depression for Chinese grandparents; however, there were complex interactions at play. Policies aimed at supporting grandparenting should consider caregiving intensity transitions relevant to gender and urban/rural residence.
Collapse
Affiliation(s)
| | - Wei Xu
- School of Sociology, Wuhan University, Wuhan, China
| |
Collapse
|
2
|
Murray TS, Malik AA, Shafiq M, Lee A, Harris C, Klotz M, Humphries JE, Patel KM, Wilkinson D, Yildirim I, Elharake JA, Diaz R, Reyes C, Omer SB, Gilliam WS. Association of Child Masking With COVID-19-Related Closures in US Childcare Programs. JAMA Netw Open 2022; 5:e2141227. [PMID: 35084484 PMCID: PMC8796014 DOI: 10.1001/jamanetworkopen.2021.41227] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE It is not known how effective child masking is in childcare settings in preventing the transmission of SARS-CoV-2. This question is critical to inform health policy and safe childcare practices. OBJECTIVE To assess the association between masking children 2 years and older and subsequent childcare closure because of COVID-19. DESIGN, SETTING, AND PARTICIPANTS A prospective, 1-year, longitudinal electronic survey study of 6654 childcare professionals at home- and center-based childcare programs in all 50 states was conducted at baseline (May 22 to June 8, 2020) and follow-up (May 26 to June 23, 2021). Using a generalized linear model (log-binomial model) with robust SEs, this study evaluated the association between childcare program closure because of a confirmed or suspected COVID-19 case in either children or staff during the study period and child masking in both early adoption (endorsed at baseline) and continued masking (endorsed at baseline and follow-up), while controlling for physical distancing, other risk mitigation strategies, and program and community characteristics. EXPOSURES Child masking in childcare programs as reported by childcare professionals at baseline and both baseline and follow-up. MAIN OUTCOMES AND MEASURES Childcare program closure because of a suspected or confirmed COVID-19 case in either children or staff as reported in the May 26 to June 23, 2021, end survey. RESULTS This survey study of 6654 childcare professionals (mean [SD] age, 46.9 [11.3] years; 750 [11.3%] were African American, 57 [0.9%] American Indian/Alaska Native, 158 [2.4%] Asian, 860 [12.9%] Hispanic, 135 [2.0%] multiracial [anyone who selected >1 race on the survey], 18 [0.3%] Native Hawaiian/Pacific Islander, and 5020 [75.4%] White) found that early adoption (baseline) of child masking was associated with a 13% lower risk of childcare program closure because of a COVID-19 case (adjusted relative risk, 0.87; 95% CI, 0.77-0.99), and continued masking for 1 year was associated with a 14% lower risk (adjusted relative risk, 0.86; 95% CI, 0.74-1.00). CONCLUSIONS AND RELEVANCE This survey study of childcare professionals suggests that masking young children is associated with fewer childcare program closures, enabling in-person education. This finding has important public health policy implications for families that rely on childcare to sustain employment.
Collapse
Affiliation(s)
- Thomas S. Murray
- Yale School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Amyn A. Malik
- Yale School of Medicine, New Haven, Connecticut
- Yale Institute for Global Health, New Haven, Connecticut
| | - Mehr Shafiq
- Yale Institute for Global Health, New Haven, Connecticut
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Aiden Lee
- Tobin Center for Economic Policy, Yale University, New Haven, Connecticut
| | - Clea Harris
- Yale School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Madeline Klotz
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | | | | | - David Wilkinson
- Tobin Center for Economic Policy, Yale University, New Haven, Connecticut
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Inci Yildirim
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Yale Institute for Global Health, New Haven, Connecticut
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Jad A. Elharake
- Yale School of Medicine, New Haven, Connecticut
- Yale Institute for Global Health, New Haven, Connecticut
| | - Rachel Diaz
- Tobin Center for Economic Policy, Yale University, New Haven, Connecticut
| | - Chin Reyes
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Saad B. Omer
- Yale School of Medicine, New Haven, Connecticut
- Yale Institute for Global Health, New Haven, Connecticut
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
- Yale School of Nursing, New Haven, Connecticut
| | - Walter S. Gilliam
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
3
|
Gildner TE, Uwizeye G, Milner RL, Alston GC, Thayer ZM. Associations between postpartum depression and assistance with household tasks and childcare during the COVID-19 pandemic: evidence from American mothers. BMC Pregnancy Childbirth 2021; 21:828. [PMID: 34903201 PMCID: PMC8666834 DOI: 10.1186/s12884-021-04300-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The early postpartum period is recognized cross-culturally as being important for recovery, with new parents receiving increased levels of community support. However, COVID-19-related lockdown measures may have disrupted these support systems, with possible implications for mental health. Here, we use a cross-sectional analysis among individuals who gave birth at different stages of the pandemic to test (i) if instrumental support access in the form of help with household tasks, newborn care, and care for older children has varied temporally across the pandemic, and (ii) whether access to these forms of instrumental support is associated with lower postpartum depression scores. METHODS This study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant persons in the United States. Participants completed postnatal surveys between April 30 - November 18, 2020 (n = 971). Logistic regression analysis tested whether birth timing during the pandemic was associated with odds of reported sustained instrumental support. Linear regression analyses assessed whether instrumental support was associated with lower depression scores as measured via the Edinburgh Postnatal Depression survey. RESULTS Participants who gave birth later in the pandemic were more likely to report that the pandemic had not affected the help they received with household work and newborn care (p < 0.001), while access to childcare for older children appeared to vary non-linearly throughout the pandemic. Additionally, respondents who reported that the pandemic had not impacted their childcare access or help received around the house displayed significantly lower depression scores compared to participants who reported pandemic-related disruptions to these support types (p < 0.05). CONCLUSIONS The maintenance of postpartum instrumental support during the pandemic appears to be associated with better maternal mental health. Healthcare providers should therefore consider disrupted support systems as a risk factor for postpartum depression and ask patients how the pandemic has affected support access. Policymakers seeking to improve parental wellbeing should design strategies that reduce disease transmission, while facilitating safe interactions within immediate social networks (e.g., through investment in COVID-19 testing and contact tracing). Cumulatively, postpartum instrumental support represents a potential tool to protect against depression, both during and after the COVID-19 pandemic.
Collapse
Affiliation(s)
- Theresa E Gildner
- Department of Anthropology, Washington University in St. Louis, St. Louis, MO, USA.
| | - Glorieuse Uwizeye
- Department of Anthropology, Dartmouth College, Hanover, NH, USA
- Society of Fellows, Dartmouth College, Hanover, NH, USA
| | | | - Grace C Alston
- Department of Anthropology, Dartmouth College, Hanover, NH, USA
| | - Zaneta M Thayer
- Department of Anthropology, Dartmouth College, Hanover, NH, USA
- Ecology, Evolution, Environment & Society Program, Dartmouth College, Hanover, NH, USA
| |
Collapse
|
4
|
Scheifele C, Steffens MC, Van Laar C. Which representations of their gender group affect men's orientation towards care? the case of parental leave-taking intentions. PLoS One 2021; 16:e0260950. [PMID: 34860838 PMCID: PMC8641870 DOI: 10.1371/journal.pone.0260950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/19/2021] [Indexed: 12/03/2022] Open
Abstract
Men are currently underrepresented in traditionally female care-oriented (communal) engagement such as taking parental leave, whereas they are overrepresented in traditionally male (agentic) engagement such as breadwinning or leadership. We examined to what extent different prototypical representations of men affect men's self-reported parental leave-taking intentions and more generally the future they can imagine for themselves with regard to work and care roles (i.e., their possible selves). We expected prototypes of men that combine the two basic stereotype dimensions of agency and communion to increase men's communal intentions. In two experiments (N1 = 132, N2 = 233), we presented male participants with contrived newspaper articles that described the ideal man of today with varying degrees of agency and communion (between-subjects design with four conditions; combined agentic and communal vs. agentic vs. communal vs. control condition). Results of Experiment 1 were in line with the main hypothesis that especially presenting a combination of agency and communion increases men's expectations for communal engagement: As compared to a control condition, men expected more to engage in caretaking in the future, reported higher parental leave-taking intentions, and tended to expect taking longer parental leave. Experiment 2 only partially replicated these findings, namely for parental leave-taking intentions. Both experiments additionally provided initial evidence for a contrast effect in that an exclusive focus on agency also increased men's self-reported parental leave-taking intentions compared to the control condition. Yet, exclusively emphasizing communion in prototypes of men did not affect men's communal intentions, which were high to begin with. We further did not find evidence for preregistered mechanisms. We discuss conditions and explanations for the emergence of these mixed effects as well as implications for the communication of gendered norms and barriers to men's communal engagement more broadly.
Collapse
Affiliation(s)
- Carolin Scheifele
- Center for Social and Cultural Psychology, University of Leuven, Leuven, Belgium
- PhD Fellow of the Research Foundation–Flanders, Brussels, Belgium
- Department of Social, Environmental, and Economic Psychology, University of Koblenz-Landau, Landau, Germany
| | - Melanie C. Steffens
- Department of Social, Environmental, and Economic Psychology, University of Koblenz-Landau, Landau, Germany
| | - Colette Van Laar
- Center for Social and Cultural Psychology, University of Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Kruszecka-Krówka A, Cepuch G, Gniadek A, Smoleń E, Piskorz-Ogórek K, Micek A. Selected predictors of parental satisfaction with child nursing care in paediatric wards in Poland-Cross-sectional study. PLoS One 2021; 16:e0260504. [PMID: 34797888 PMCID: PMC8604320 DOI: 10.1371/journal.pone.0260504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/10/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Assessment of parental satisfaction with child nursing is the key issue in evaluation of the care quality, enabling the adjustment of the services provided to the needs and expectations of recipients, and thus ensuring safety and achieving better long-term health effects. AIM Assessment of parental satisfaction with child nursing in paediatric wards including its determinants. MATERIAL AND METHODS The study covered 1030 parents of children hospitalised in paediatric and surgical wards of seven hospitals of different levels of health security in Poland. The Polish adaptation of the Empathic standardised questionnaire for assessment of the level of parents' satisfaction with nursing care, developed by Latour et al. and the self-constructed summary of socio-demographic data were applied in the study. RESULTS More than 90% of respondents expressed high level of satisfaction with nurses' Availability, the lowest, but still high score of respondents' satisfaction was observed for Parental Participation. The highest satisfaction was observed among the parents of children at the preschool, early school and puberty stage, admitted to the hospital on the elective basis, referred for diagnostic assessment and with the length of hospital stay less than 7 and longer than 28 days. Achieving preschool age was the strongest factor which increased assessment of satisfaction in most domains. CONCLUSIONS There is a need for optimising nursing care especially in the area of parental participation. The nursing care' quality improvement plan in paediatric departments should focus particularly on early childhood patients and their parents who are the most critical in satisfaction' assessment.
Collapse
Affiliation(s)
- Agnieszka Kruszecka-Krówka
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Grażyna Cepuch
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Gniadek
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Smoleń
- Chair and Department of Management in Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Krystyna Piskorz-Ogórek
- Department of Nursing, School of Public Health, Medical College, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Agnieszka Micek
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
6
|
Hughes RC, Kitsao-Wekulo P, Muendo R, Bhopal SS, Kimani-Murage E, Hill Z, Kirkwood BR. Who actually cares for children in slums? Why we need to think, and do, more about paid childcare in urbanizing sub-Saharan Africa. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200430. [PMID: 33938281 PMCID: PMC8090813 DOI: 10.1098/rstb.2020.0430] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 01/14/2023] Open
Abstract
The early years are critical and inform the developmental trajectory of children. This is justifiably attracting growing policy attention. Much of this attention is focused on interventions and policies directed at parents, especially mothers. Yet emerging evidence suggests that increasing numbers of children in rapidly urbanizing low- and middle-income countries are now spending much of their day with other formal and informal childcare providers, including largely unregulated paid childcare providers. This paper summarizes the limited literature about the use of such paid childcare in low- and middle-income countries in sub-Saharan Africa, before considering possible reasons behind the lack of research evidence. Finally, key research gaps and their implications for public health practice are explored, with reference to the ongoing British Academy funded Nairobi Early Childcare in Slums research programme in Nairobi, Kenya. We argue that improving childcare may be an under-explored strategy to help some of the world's most disadvantaged children in the most important period of their lives, and that interventions in this largely informal market should be built on a rigorous research base. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
Collapse
Affiliation(s)
- Robert C. Hughes
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Patricia Kitsao-Wekulo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Ruth Muendo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Sunil S. Bhopal
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Elizabeth Kimani-Murage
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Zelee Hill
- Epidemiology and Public Health, Institute of Global Health, University College London, London, UK
| | - Betty R. Kirkwood
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| |
Collapse
|
7
|
Morita M, Saito A, Nozaki M, Ihara Y. Childcare support and child social development in Japan: investigating the mediating role of parental psychological condition and parenting style. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200025. [PMID: 33938269 PMCID: PMC8090826 DOI: 10.1098/rstb.2020.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/12/2022] Open
Abstract
In humans, support from partners and alloparents is crucial for successful child-rearing and optimal child development. However, the complex relationships among childcare support, children's outcomes and parental characteristics have not been fully examined. We investigate how three sources of partner and alloparental support-partner's childcare participation, support from children's grandparents and support from non-kin-can be associated with child social development. We hypothesize that the associations between childcare support from partners/alloparents and child social development are partly mediated by parental psychological condition and parenting style. To test this, we conducted path analyses on online survey data collected in 2016 from parents of 3- to 5-year-old children in Japan. We found no evidence that childcare support had direct positive effects on child social development. Rather, the benefit of childcare support was mediated by its effects on parental psychological condition and parenting style, which in turn improved children's outcomes. At the same time, we found some evidence that greater availability of childcare support was directly associated with more behavioural difficulties in children. Our findings reveal the complex pathways between childcare support, parental characteristics and children's outcomes in Japan, showing potential mechanisms behind parental and alloparental effects in industrialized populations. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
Collapse
Affiliation(s)
- Masahito Morita
- Department of Biological Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Atsuko Saito
- Department of Psychology, Sophia University, 7-1 Kioi-cho, Chiyoda-ku, Tokyo 102-8554, Japan
| | - Mari Nozaki
- Faculty of Education, Hirosaki University, 1 Bunkyo-cho, Hirosaki-shi, Aomori 036-8560, Japan
| | - Yasuo Ihara
- Department of Biological Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| |
Collapse
|
8
|
Abstract
Providing for the needs of the vulnerable is a critical component of social and health policy-making. In particular, caring for children and for vulnerable older people is vital to the wellbeing of millions of families throughout the world. In most developed countries, this care is provided through both formal and informal means, and is therefore governed by complex policies that interact in non-obvious ways with other areas of policy-making. In this paper we present an agent-based model of social and child care provision in the UK, in which agents can provide informal care or pay for private care for their relatives. Agents make care decisions based on numerous factors including their health status, employment, financial situation, and social and physical distance to those in need. Simulation results show that the model can produce plausible patterns of care need and availability, and therefore can provide an important aid to this complex area of policy-making. We conclude that the model's use of kinship networks for distributing care and the explicit modelling of interactions between social care and child care will enable policy-makers to develop more informed policy interventions in these critical areas. "The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped." - Hubert Humphrey Jr.
Collapse
Affiliation(s)
- Umberto Gostoli
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Eric Silverman
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
9
|
Yerkes MA, André SCH, Besamusca JW, Kruyen PM, Remery CLHS, van der Zwan R, Beckers DGJ, Geurts SAE. 'Intelligent' lockdown, intelligent effects? Results from a survey on gender (in)equality in paid work, the division of childcare and household work, and quality of life among parents in the Netherlands during the Covid-19 lockdown. PLoS One 2020; 15:e0242249. [PMID: 33253238 PMCID: PMC7703961 DOI: 10.1371/journal.pone.0242249] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022] Open
Abstract
Objective The COVID-19 pandemic is more than a public health crisis. Lockdown measures have substantial societal effects, including a significant impact on parents with (young) children. Given the existence of persistent gender inequality prior to the pandemic, particularly among parents, it is crucial to study the societal impact of COVID-19 from a gender perspective. The objective of this paper is to use representative survey data gathered among Dutch parents in April 2020 to explore differences between mothers and fathers in three areas: paid work, the division of childcare and household tasks, and three dimensions of quality of life (leisure, work-life balance, relationship dynamics). Additionally, we explore whether changes take place in these dimensions by comparing the situation prior to the lockdown with the situation during the lockdown. Method We use descriptive methods (crosstabulations) supported by multivariate modelling (linear regression modelling for continuous outcomes; linear probability modelling (LPM) for binary outcomes (0/1 outcomes); and multinomial logits for multinomial outcomes) in a cross-sectional survey design. Results Results show that the way in which parents were impacted by the COVID-19 pandemic reflects a complex gendered reality. Mothers work in essential occupations more often than fathers, report more adjustments of the times at which they work, and experience both more and less work pressure in comparison to before the lockdown. Moreover, mothers continue to do more childcare and household work than fathers, but some fathers report taking on greater shares of childcare and housework during the lockdown in comparison to before. Mothers also report a larger decline in leisure time than fathers. We find no gender differences in the propensity to work from home, in perceived work-life balance, or in relationship dynamics. Conclusion In conclusion, we find that gender inequality in paid work, the division of childcare and household work, and the quality of life are evident during the first lockdown period. Specifically, we find evidence of an increase in gender inequality in relation to paid work and quality of life when comparing the situation prior to and during the lockdown, as well as a decrease in gender inequality in the division of childcare and household work. We conclude that the unique situation created by restrictive lockdown measures magnifies some gender inequalities while lessening others. Discussion The insights we provide offer key comparative evidence based on a representative, probability-based sample for understanding the broader impact of lockdown measures as we move forward in the COVID-19 pandemic. One of the limitations in this study is the cross-sectional design. Further study, in the form of a longitudinal design, will be crucial in investigating the long-term impact of the COVID-19 pandemic on gender inequality.
Collapse
Affiliation(s)
- Mara A. Yerkes
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- * E-mail:
| | - Stéfanie C. H. André
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Janna W. Besamusca
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter M. Kruyen
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | | | - Roos van der Zwan
- Amsterdam Institute for Labour Studies, University of Amsterdam, Amsterdam, The Netherlands
| | - Debby G. J. Beckers
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Sabine A. E. Geurts
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| |
Collapse
|
10
|
Tasic R, Rajovic N, Pavlovic V, Djikanovic B, Masic S, Velickovic I, Mostic D, Cumic J, Milcanovic P, Janicijevic V, Stanisavljevic D, Milic N. Nursery teachers in preschool institutions facing burnout: Are personality traits attributing to its development? PLoS One 2020; 15:e0242562. [PMID: 33216818 PMCID: PMC7679151 DOI: 10.1371/journal.pone.0242562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction The aim of the study was to assess the prevalence of burnout syndrome among nursery teachers in Belgrade's preschool institutions, and to assess the role of personality traits in its development. Materials and methods A cross-sectional study was conducted in all Belgrade’s preschool institutions. A stratified cluster sampling method was used to obtain a representative sample. Burnout was measured using the Maslach Burnout Inventory- General Survey (MBI-GS). The MBI-GS adaptation was based on an internationally accepted methodology for translation and cultural adaptation. Psychometric properties of the Serbian version of the MBI-GS were analyzed through the examination of factorial structure and internal consistency. A shortened version of Big Five Plus Two questionnaire was used to measure Personality traits. Results Three hundred two health care professionals were enrolled. The mean age was 38±9.2 years and all were female. Confirmatory factor analysis validated the three-factor structure of the questionnaire (exhaustion, cynicism and professional efficacy). Overall, 251 (83.1%) respondents were found to have moderate burnout. In multiple regression analysis, positive valence and conscientiousness were significantly associated with professional efficacy. Aggressiveness, neuroticism, openness, and age, were significantly associated with exhaustion. Aggressiveness, neuroticism and additional jobs showed association with cynicism. Conclusion Present study provided the evidence for the appropriate metric properties of the Serbian version of MBI-GS. Most nurses demonstrated moderate burnout level. Personality traits are characteristics that affect presence of burnout syndrome in healthcare professionals working in preschool institutions.
Collapse
Affiliation(s)
- Radica Tasic
- Medical School, College of Vocational Studies, Belgrade, Serbia
| | - Nina Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Vedrana Pavlovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Bosiljka Djikanovic
- Department for Public Health, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Srdjan Masic
- Department for Public Health, Faculty of Medicine University of East Sarajevo, Foca, Bosnia and Herzegovina
| | - Igor Velickovic
- Medical School, College of Vocational Studies, Belgrade, Serbia
| | | | | | - Petar Milcanovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | | | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, Belgrade, Serbia
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America
- * E-mail:
| |
Collapse
|
11
|
Beavis AL, Sanneh A, Stone RL, Vitale M, Levinson K, Rositch AF, Fader AN, Topel K, Abing A, Wethington SL. Basic social resource needs screening in the gynecologic oncology clinic: a quality improvement initiative. Am J Obstet Gynecol 2020; 223:735.e1-735.e14. [PMID: 32433998 PMCID: PMC8340269 DOI: 10.1016/j.ajog.2020.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/28/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Social determinants of health are known to contribute to disparities in health outcomes. Routine screening for basic social needs is not a part of standard care; however, the association of those needs with increased healthcare utilization and poor compliance with guideline-directed care is well established. OBJECTIVE In this study, we aimed to assess the prevalence of basic social resource needs identified through a quality improvement initiative in a gynecologic oncology outpatient clinic. In addition, we aimed to identify clinical and demographic factors associated with having basic social resource needs. STUDY DESIGN We performed a prospective cohort study of women presenting to a gynecologic oncology clinic at an urban academic institution who were screened for basic social resource needs as part of a quality improvement initiative from July 2017 to May 2018. The following 8 domains of resource needs were assessed: food insecurity, housing insecurity, utility needs, financial strain, transportation, childcare, household items, and difficulty reading hospital materials. Women with needs were referred to resources to address those needs. Demographic and clinical information were collected for each patient. The prevalence of needs and successful follow-up interventions were calculated. Patient factors independently associated with having at least 1 basic social resource need were identified using multivariable Poisson regression. RESULTS A total of 752 women were screened in the study period, of whom 274 (36%) reported 1 or more basic social resource need, with a median of 1 (range, 1-7) need. Financial strain was the most commonly reported need (171 of 752, 23%), followed by transportation (119 of 752, 16%), difficulty reading hospital materials (54 of 752, 7%), housing insecurity (31 of 752, 4%), food insecurity (28 of 752, 4%), household items (22 of 752, 3%), childcare (15 of 752, 2%), and utility needs (13 of 752, 2%). On multivariable analysis, independent factors associated with having at least 1 basic social resource need were being single, divorced or widowed, nonwhite race, current smoker, nonprivate insurance, and a history of anxiety or depression. A total of 36 of 274 (13%) women who screened positive requested assistance and were referred to resources to address those needs. Of the 36 women, 25 (69%) successfully accessed a resource or felt equipped to address their needs, 9 (25%) could not be reached despite repeated attempts, and 2 (6%) declined assistance. CONCLUSION Basic social resource needs are prevalent in women presenting to an urban academic gynecologic oncology clinic and can be identified and addressed through routine screening. To help mitigate ongoing disparities in this population, screening for and addressing basic social resource needs should be incorporated into routine comprehensive care in gynecologic oncology clinics.
Collapse
Affiliation(s)
- Anna Louise Beavis
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Awa Sanneh
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca L Stone
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Kimberly Levinson
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Anne F Rositch
- Department of Cancer Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amanda Nickles Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kristin Topel
- Department of General Pediatrics and Adolescent Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Stephanie L Wethington
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.
| |
Collapse
|
12
|
Abstract
Our study addresses whether working parents with young children living in childcare deserts experience greater work-family conflict and psychological distress compared to those in more resourced areas. We use 2011 individual-level data from Toronto matched to census and administrative childcare data. Results suggest that mothers experience greater conflict than fathers when in high-resourced areas. Fathers who work long hours and reside in a desert report greater psychological distress than fathers in nondeserts. These patterns are contrary to the observed results for mothers' distress by childcare availability. Our study underscores the impact of childcare options and the importance of access for all.
Collapse
|
13
|
Tervahartiala K, Karlsson L, Pelto J, Kortesluoma S, Hyttinen S, Ahtola A, Junttila N, Karlsson H. Toddlers' diurnal cortisol levels affected by out-of-home, center-based childcare and at-home, guardian-supervised childcare: comparison between different caregiving contexts. Eur Child Adolesc Psychiatry 2020; 29:1217-1229. [PMID: 31705206 PMCID: PMC7497366 DOI: 10.1007/s00787-019-01432-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/24/2019] [Indexed: 12/28/2022]
Abstract
Previous research suggests that attending non-parental out-of-home childcare is associated with elevated cortisol levels for some children. We aimed to compare diurnal saliva cortisol levels between children having out-of-home, center-based childcare or those having at-home, guardian-supervised childcare in Finland. A total of 213 children, aged 2.1 years (SD = 0.6), were drawn from the ongoing Finnish birth cohort study. Saliva samples were collected over 2 consecutive days (Sunday and Monday), with four samples drawn during each day: 30 min after waking up in the morning, at 10 am, between 2 and 3 pm, and in the evening before sleep. These results suggest that the shapes of the diurnal cortisol profiles were similar in both childcare groups following a typical circadian rhythm. However, the overall cortisol levels were on average 30% higher (95% CI: [9%, 54%], p = .004) with the at-home childcare in comparison with the out-of-home childcare group. Furthermore, a slight increase in the diurnal cortisol pattern was noticed in both groups and in both measurement days during the afternoon. This increase was 27% higher ([2%, 57%], p = .031) in the out-of-home childcare group during the out-of-home childcare day in comparison with the at-home childcare day. The elevated afternoon cortisol levels were partly explained by the afternoon naps, but there were probably other factors as well producing the cortisol rise during the afternoon hours. Further research is needed to define how a child's individual characteristic as well as their environmental factors associate with cortisol secretion patterns in different caregiving contexts.
Collapse
Affiliation(s)
- Katja Tervahartiala
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20520, Turku, Finland.
| | - Linnea Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20520, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Juho Pelto
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20520, Turku, Finland
| | - Susanna Kortesluoma
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20520, Turku, Finland
- Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Sirpa Hyttinen
- Finnish Institute of Occupational Health, Topeliuksenkatu 41a B, 00250, Helsinki, Finland
| | - Annarilla Ahtola
- Department of Psychology and Speech-Language Pathology, University of Turku, Assistentinkatu 7, 20500, Turku, Finland
| | - Niina Junttila
- Department for Teacher Education, University of Turku, Assistentinkatu 5, 20500, Turku, Finland
| | - Hasse Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20520, Turku, Finland
- Department of Psychiatry, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| |
Collapse
|
14
|
Abstract
OBJECTIVE To identify barriers, as perceived by parents, to good care for children with life-threatening conditions. DESIGN In a nationwide qualitative study, we held in-depth interviews regarding end-of-life care with parents of children (aged 1 to 12 years) who were living with a life-threatening illness or who had died after a medical trajectory (a maximum of 5 years after the death of the child). Sampling was aimed at obtaining maximum variety for a number of factors. The interviews were transcribed and analysed. SETTING The Netherlands. PARTICIPANTS 64 parents of 44 children. RESULTS Parents identified six categories of difficulties that create barriers in the care for children with a life-threatening condition. First, parents wished for more empathetic and open communication about the illness and prognosis. Second, organisational barriers create bureaucratic obstacles and a lack of continuity of care. Third, parents wished for more involvement in decision-making. Fourth, parents wished they had more support from the healthcare team on end-of-life decision-making. Fifth, parents experienced a lack of attention for the family during the illness and after the death of their child. Sixth, parents experienced an overemphasis on symptom-treatment and lack of attention for their child as a person. CONCLUSIONS The barriers as perceived by parents focussed almost without exception on non-medical aspects: patient-doctor relationships; communication; decision-making, including end-of-life decision-making; and organisation. The perceived barriers indicate that care for children with a life-threatening condition focusses too much on symptoms and not enough on the human beings behind these symptoms.
Collapse
Affiliation(s)
- Marije Brouwer
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Els L M Maeckelberghe
- Institute for Medical Education, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irma Hein
- Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Eduard Verhagen
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
15
|
Pannebakker NM, Kocken PL, van Dommelen P, van Mourik K, Reis R, Reijneveld SA, Numans ME. Care use and its intensity in children with complex problems are related to varying child and family factors: A follow-up study. PLoS One 2020; 15:e0231620. [PMID: 32374786 PMCID: PMC7202640 DOI: 10.1371/journal.pone.0231620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 03/27/2020] [Indexed: 11/19/2022] Open
Abstract
Background There is little evidence on the child and family factors that affect the intensity of care use by children with complex problems. We therefore wished to identify changes in these factors associated with changes in care service use and its intensity, for care use in general and psychosocial care in particular. Methods Parents of 272 children with problems in several life domains completed questionnaires at baseline (response 69.1%) and after 12 months. Negative binominal Hurdle analyses enabled us to distinguish between using care services (yes/ no) and its intensity, i.e. number of contacts when using care. Results Change in care use was more likely if the burden of adverse life events (ALE) decreased (odds ratio, OR = 0.94, 95% confidence interval, CI = 0.90–0.99) and if parenting concerns increased (OR = 1.29, CI = 1.11–1.51). Psychosocial care use became more likely for school-age children (vs. pre-school) (OR = 1.99, CI = 1.09–3.63) if ALE decreased (OR = 0.93, CI = 0.89–0.97) and if parenting concerns increased (OR = 1.26, CI = 1.10–1.45). Intensity of use (>0 contacts) of any care decreased when ALE decreased (relative risk, RR = 0.95, CI = 0.92–0.98) and when psychosocial problems became less severe (RR = 0.38, CI = 0.20–0.73). Intensity of psychosocial care also decreased when severe psychosocial problems became less severe (RR = 0.39, CI = 0.18–0.84). Conclusions Changes in care-service use (vs. no use) and its intensity (>0 contacts) are explained by background characteristics and changes in a child’s problems. Care use is related to factors other than changes in its intensity, indicating that care use and its intensity have different drivers. ALE in particular contribute to intensity of any care use.
Collapse
Affiliation(s)
- Noortje M. Pannebakker
- Department of Child Health, TNO, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- * E-mail:
| | - Paul L. Kocken
- Department of Child Health, TNO, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | - Krista van Mourik
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Sijmen A. Reijneveld
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Mattijs E. Numans
- Department of Public Health and Primary Care and LUMC Campus The Hague, The Hague, Netherlands
| |
Collapse
|
16
|
Magudia K. Parenting While in Training: A Comprehensive Needs Assessment of Residents and Fellows. J Grad Med Educ 2020; 12:162-167. [PMID: 32322349 PMCID: PMC7161335 DOI: 10.4300/jgme-d-19-00563.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/19/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Parenting issues can affect physicians' choice of specialty or subspecialty, as well as their selection of individual training programs, because of the distinctive challenges facing residents and fellows with children. Specific information about how residents perceive these challenges is limited. OBJECTIVE We sought to better understand the challenges associated with parenting during residency and fellowship training in order to inform policy and research. METHODS In 2017, a voluntary online questionnaire was distributed to all 2214 Partners HealthCare graduate medical education trainees across 285 training programs. The survey queried attitudes of and about trainees with children and assessed needs and experiences related to parental leave, lactation, and childcare. Responses were compared between subgroups, including gender, surgical versus nonsurgical specialty, parental status, and whether the respondent was planning to become a parent. RESULTS A total of 578 trainees (26%) responded to the questionnaire. Of these, 195 (34%) became parents during training. An additional 298 (52%) planned to become parents during training. Respondents overwhelmingly agreed that their institution should support trainees with children (95%) and that doing so is important for trainee wellness (98%). However, 25% felt that trainees with children burden trainees without children. Childcare access, affordability, and availability for sufficient hours were identified as key challenges, along with issues related to parental leave, lactation facilities, and effect on peers. CONCLUSIONS This survey highlights trainees' perspectives about parenting during their clinical training, signaling parental leave, lactation facilities, and childcare access and affordability as particular challenges and potential targets for future interventions.
Collapse
|
17
|
Abstract
Little is known about whether and how intergenerational relationships influence older adult mortality. This study examines the association between caring for grandchildren (i.e., grandparenting) and mortality and how the link differs by race-ethnicity. Drawing from the Health and Retirement Study (1998-2014, N = 13,705), I found different racial-ethnic patterns in the effects of grandparenting on mortality risk. White grandparents who provide intensive noncoresident grandparenting (i.e., over 500 hours of babysitting per two years) and multigenerational household grandparenting have a lower risk of mortality compared to noncaregiving grandparents. In contrast, black grandparents have a higher mortality risk than their noncaregiving counterparts when providing intensive noncoresident, multigenerational household, and skipped-generation household (i.e., grandparent-headed family) grandparenting. Caregiving Hispanic grandparents are not significantly different from their noncaregiving counterparts in mortality risk. These findings suggest that important variations in social and cultural contexts for racial-ethnic groups shape the consequences of grandparenting for older adult mortality.
Collapse
|
18
|
Luecking CT, Mazzucca S, Vaughn AE, Ward DS. Contributions of Early Care and Education Programs to Diet Quality in Children Aged 3 to 4 Years in Central North Carolina. J Acad Nutr Diet 2019; 120:386-394. [PMID: 31831384 DOI: 10.1016/j.jand.2019.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parents and early care and education (ECE) are the key influencers of young children's diets, but there is limited information about how each contribute to children's overall diet quality. OBJECTIVE This study aimed to determine what proportion of children's dietary intake occurs within the ECE setting and whether diet quality is higher at ECE centers and, consequently, on weekdays than weekends. DESIGN This cross-sectional analysis of a larger cluster randomized controlled trial used multiple 24-hour dietary intakes measured through a combination of the Dietary Observation in Child Care protocol and parent-reported food diaries. PARTICIPANTS/SETTING Participants (N=840) included children aged 3 to 4 years enrolled in ECE centers in central North Carolina for whom 24-hour dietary intake was captured via observation of meals and snacks consumed at ECE and parent-report of all remaining meals and snacks. Data were collected from 2015 to 2016. MAIN OUTCOME MEASURES Diet quality at ECE and elsewhere was evaluated using the Healthy Eating Index 2015. STATISTICAL ANALYSES PERFORMED Mixed-effects models were used to determine differences in mean Healthy Eating Index 2015 component and total scores. Models were adjusted for children's age and sex and accounted for clustering within ECE centers and families. RESULTS Children consumed approximately 40% of daily energy, nutrients, and food groups at ECE centers. The mean total Healthy Eating Index 2015 score was higher for foods and beverages consumed at ECE centers (58.3±0.6) than elsewhere (52.5±0.6) (P<0.0001). The mean total Healthy Eating Index 2015 score was also higher on weekdays (58.5±0.5) than on weekends (51.3±0.5) (P<0.0001). CONCLUSIONS Children consume a majority of dietary intake away from ECE centers. Overall, diet quality is low, but the quality of foods consumed by children at ECE centers is higher than that consumed elsewhere. ECE centers remain an important source of nutrition and further investigation is warranted to identify ways to support both ECE centers and families to provide healthier eating environments.
Collapse
|
19
|
Earnesty DS, Hourani M, Kerver JM, Weatherspoon LJ. Dietary Guidelines Are Not Met by In-Home Child Care Providers in Low-Income Areas. J Nutr Educ Behav 2019; 51:1150-1158. [PMID: 31492622 DOI: 10.1016/j.jneb.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The goals of this study were to describe (1) the dietary quality of foods and beverages served by in-home child care providers in low-income areas in Michigan and (2) the extent to which they align with the Dietary Reference Intakes and food group recommendations. DESIGN Cross-sectional, observational. Food and beverages served were examined using direct diet observation. SETTING Child care provider homes. PARTICIPANTS In-home child care providers (n = 116) from rural and urban Michigan counties (n = 24) were recruited from the Great Start to Quality child care database. MAIN OUTCOME MEASURES Dietary quality (food groups and nutrients) of food and beverages served by 116 providers to 378 children, aged 2-5 years, for 1 lunch and a snack. ANALYSIS Average food group and nutrient scores were compared with Dietary Reference Intakes and food group thresholds using the Wilcoxon rank sum test (significance at <.05). RESULTS Findings indicate overserving of refined grains, protein, carbohydrates, added sugars, and sodium and underserving of whole grains and vegetables. Nutrients exceeding recommendations included vitamins A, C, and D, folate, calcium, zinc, and magnesium, whereas iron and potassium were underserved. CONCLUSIONS AND IMPLICATIONS Tailored efforts are needed to address shortcomings in meeting dietary recommendations among in-home child care providers to enhance child nutrition.
Collapse
Affiliation(s)
- Dawn S Earnesty
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI; Michigan State University Extension, Saginaw, MI.
| | - Miya Hourani
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI
| | - Jean M Kerver
- Department of Epidemiology and Biostatistics, Michigan State University, College of Human Medicine, Traverse City Campus, Traverse City, MI
| | | |
Collapse
|
20
|
Tovar A, Benjamin-Neelon SE, Vaughn AE, Tsai M, Burney R, Østbye T, Ward DS. Nutritional Quality of Meals and Snacks Served and Consumed in Family Child Care. J Acad Nutr Diet 2019; 118:2280-2286. [PMID: 30497638 DOI: 10.1016/j.jand.2018.08.154] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 08/23/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Improving the nutritional quality of food, including beverages, served in early care and education settings should enhance children's diet quality. However, few studies have explored the relationship between what is served and consumed in family child-care homes (FCCHs). OBJECTIVE To describe the nutritional quality of food served to children in FCCHs and to assess the extent to which children eat what is served. DESIGN This study was a cross-sectional analysis using baseline data (n=166) from a cluster-randomized controlled trial (2013-2016). PARTICIPANTS/SETTING Eligible FCCHs in central North Carolina had to have at least two children between 18 months and 4 years, have been in business for at least 2 years, and serve at least one meal and one snack. MAIN OUTCOME MEASURES Food was captured using the Diet Observation at Child Care protocol. STATISTICAL ANALYSES Frequencies, means, and multivariate analysis were used to examine the relationship between food served and consumed by food groups and by Healthy Eating Index (HEI-2010). RESULTS Children consumed between 61% and 80% of what was served, with vegetables having the lowest percent consumed (61.0%). Total HEI-2010 score for food served was 63.6 (10.4) and for food consumed was 61.7 (11.5) out of a 100-point maximum. With regards to food served, FCCH providers came close to meeting HEI-2010 standards for dairy, whole fruit, total fruit, and empty calories. However, providers appeared to fall short when it came to greens and beans, seafood and plant proteins, total vegetables, whole grains, and fatty acids. They also exceeded recommended limits for sodium and refined grains. CONCLUSIONS Although FCCHs are serving some healthy food, mainly fruit, dairy, and few empty calories, there is room for improvement with regards to vegetables, grains, seafood and plant protein, fatty acids, and sodium. Future trainings should help providers find ways to increase the serving and consumption of these foods.
Collapse
|
21
|
Eke H, Janssens A, Downs J, Lynn RM, Ani C, Ford T. How to measure the need for transition to adult services among young people with Attention Deficit Hyperactivity Disorder (ADHD): a comparison of surveillance versus case note review methods. BMC Med Res Methodol 2019; 19:179. [PMID: 31429715 PMCID: PMC6700822 DOI: 10.1186/s12874-019-0820-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 08/13/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Health services have not provided adequate support for young people with long term health conditions to transfer from child to adult services. National Institute of Health and Care (NICE) guidance on transition has been issued to address these gaps. However, data are often sparse about the number of young adults who might need to transition. Using Attention Deficit Hyperactivity Disorder (ADHD) as an exemplar, this study used an existing surveillance system and a case note review to capture the incidence of the transition process, and compared and contrasted the findings. METHODS The Child and Adolescent Psychiatry Surveillance System (CAPSS) was used to estimate the incident transition of young people with Attention Deficit Hyperactivity Disorder (ADHD) from child to adult services. This involves consultant child and adolescent psychiatrists from the United Kingdom (UK) and Republic of Ireland (ROI) reporting relevant young people as they are seen in clinics. In parallel, a case note review was conducted using the Maudsley Biomedical Research Centre (BRC) Clinical Records Interactive Search (CRIS). The study period ran for twelve months with a nine month follow up to see how the transition proceeded. RESULTS CRIS identified 76 cases in the study period, compared to 18 identified using surveillance via CAPSS. Methodological issues were experienced using both methods. Surveillance issues; eligibility criteria confusion, reporting errors, incomplete questionnaires, difficulties contacting clinicians, and surveillance systems do not cover non-doctors and psychiatrists who are not consultants. Case note review issues using CRIS included the need for researchers to interpret clinical notes, the availability and completeness of data in the notes, and data limited to the catchment of one particular mental health trust. CONCLUSIONS Both methods demonstrate strengths and weaknesses; the combination of both methods in the absence of strong routinely collected data, allowed a more robust estimate of the level of need for service planning and commissioning.
Collapse
Affiliation(s)
- Helen Eke
- University of Exeter Medical School, South Cloisters 1.01, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Astrid Janssens
- University of Exeter Medical School, South Cloisters 1.01, St Luke’s Campus, Exeter, EX1 2LU UK
- User Perspectives, University of Southern Denmark, DK-5000 Odense C, Denmark
| | - Johnny Downs
- Kings College London, De Crespigny Park, Denmark Hill, London SE5 8AF UK
| | - Richard M. Lynn
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, 5-11 Theobalds Rd, London, WC1X 8SH UK
| | - Cornelius Ani
- Child and Adolescent Psychiatry Surveillance System, London, UK
- Surrey & Borders Partnership NHS Foundation Trust, Redhill, UK
- Centre for Psychiatry, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN UK
| | - Tamsin Ford
- University of Exeter Medical School, South Cloisters 1.01, St Luke’s Campus, Exeter, EX1 2LU UK
- Child and Adolescent Psychiatry Surveillance System, London, UK
| |
Collapse
|
22
|
Zamora-Sarabia AL, Guterman RH, Sanz-Barbero B, Rico Gómez A, Otero García L. Child health and the possibilities for childcare in a context of poverty and food insecurity: The narratives of parents attending a self-managed foodbank in Spain. Health Soc Care Community 2019; 27:953-964. [PMID: 30637811 DOI: 10.1111/hsc.12712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 12/02/2018] [Accepted: 12/05/2018] [Indexed: 06/09/2023]
Abstract
Food insecurity would influence children's health and development through its effects on nutrition and household stress in the context of broader poverty-related problems. This study contributes to research regarding the characterisation of food-insecure households with children under the age of 18. In particular, it highlights the social and institutional aspects which influence and interact with parents' attempts to protect their children from hunger and destitution. In this study, we document some aspects of the harsh realities faced by mothers and fathers with children under the age of 18 living in poverty who attended a self-organised foodbank in the city of Madrid in 2015. We used a qualitative methodology consisting of 7 months of participant observation and the conduction of 15 in-depth interviews. This study shows how the possibilities for the meaningful protection of children in food-insecure households can be influenced by parental coping strategies, community resources and availability and accessibility to public help. Foodbanks can help reduce both household hunger (although not meeting all nutritional requirements) and parental psychosocial distress, which might support parents to better protect their children. In particular, self-managed foodbanks appear to help parents cope with emotional distress by reducing feelings of powerlessness and self-blame through their active involvement, and thanks to the collective caring that occurs between members. Public services are of special relevance, since their absence or an active institutional discrimination has been shown to further damage impoverished households with children. We suggest that public policies in Spain are revised and reinforced to enable a more genuine protection of children and their families living under severe deprivation, and to prevent life-long damage. Public institutions could assume that people attending a foodbank are living in severe poverty and need access to adequate and supportive public resources to address it.
Collapse
Affiliation(s)
| | | | - Belén Sanz-Barbero
- National School of Health, National Institutes of Health "Carlos III", Madrid, Spain
- Ciber of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ana Rico Gómez
- National School of Health, National Institutes of Health "Carlos III", Madrid, Spain
| | - Laura Otero García
- Ciber of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Nursing Department, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
23
|
Zakria NM, Tengku Ismail TA, Wan Mansor WNA, Sulaiman Z. Validation of Infant and Young Child Feeding Questionnaire for the Assessment of Knowledge, Attitudes and Practices among Child Care Providers: The IYCF-CCPQ. Int J Environ Res Public Health 2019; 16:E2147. [PMID: 31213022 PMCID: PMC6617158 DOI: 10.3390/ijerph16122147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/01/2019] [Accepted: 06/13/2019] [Indexed: 12/04/2022]
Abstract
The validation of a new questionnaire is essential to improving its credibility in the assessment and collection of evidence. This study aimed to validate a newly developed infant and young child feeding questionnaire for child care providers (IYCF-CCPQ) to measure the knowledge, attitudes, and practices regarding infant and young child feeding among them. A cross-sectional study was conducted with 200 child care providers who were involved in handling children less than two years old in child care centers in the northeastern part of Peninsular Malaysia. The IYCF-CCPQ was self-administered and consists of three domains: Knowledge (104 items), attitude (90 items), and practice (42 items). The dichotomous-scale items in the knowledge domain were analyzed using a two-parameter logistic model of item response theory (2-PL IRT). The Likert-type-scale items in the attitude section were assessed using exploratory factor analysis (EFA). The items in the practice section were assessed descriptively. Internal consistency by marginal reliability was assessed in the knowledge domain, and Cronbach's alpha coefficient was used for the attitude domain. The marginal reliability values were 0.91 and 0.74 for the knowledge domains related to breastfeeding/formula feeding and complementary feeding, respectively, and the Cronbach's alpha values were 0.89 and 0.90 for the attitude domains related to breastfeeding/formula feeding and complementary feeding, respectively. The analysis showed good psychometric properties (discrimination, difficulty index, factor loading, and communalities) and good reliability. The IYCF-CCPQ is valid for use assessing the knowledge, attitudes, and practices among Malaysian child care providers regarding infant and young child feeding.
Collapse
Affiliation(s)
- Najihah Mahfuzah Zakria
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan 16150, Malaysia.
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan 16150, Malaysia.
| | - Wan Nor Arifin Wan Mansor
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan 16150, Malaysia.
| | - Zaharah Sulaiman
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan 16150, Malaysia.
| |
Collapse
|
24
|
Yu KP, Lee YC, Chen YC, Gong JY, Tsai MH. Evaluation of PM 1, PM 2.5, and PM 10 exposure and the resultant health risk of preschool children and their caregivers. J Environ Sci Health A Tox Hazard Subst Environ Eng 2019; 54:961-971. [PMID: 31177909 DOI: 10.1080/10934529.2019.1623598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 06/09/2023]
Abstract
Preschool children have a higher respiratory rate per unit body weight than adults, and their respiratory systems are not mature. Hence, children may have more health risks associated with particulate matter (PM) exposure. In this study, we assessed the exposure of preschool children and their caregivers to PM and the resulting health risks. The PM concentrations at heights of 60-80 cm (preschool children) and 150 cm (adults) were measured at ten indoor and eight outdoor sites in the Taipei metropolitan area from March 2015 to February 2017. Four PM2.5 and seven PM10 indoor measurements exceeded the indoor air quality standard of Taiwan, whereas only two PM2.5 outdoor measurements exceeded the ambient air quality standard. The outdoor PM concentrations were related to traffic emissions, whereas the indoor PM concentrations were associated with ventilation rate and occupant density. The chronic daily PM1, PM2.5, and PM10 intakes of preschool children were notably higher than those of adults. In addition, the hazard quotient resulting from PM2.5 exposure indicated a significant health risk for preschool children (93.74% greater than 1). Consequently, reducing the exposure of preschool children to PM2.5 is an emerging issue in the Taipei metropolitan area.
Collapse
Affiliation(s)
- Kuo-Pin Yu
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University , Taipei , Taiwan (ROC)
| | - Yu-Cheng Lee
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University , Taipei , Taiwan (ROC)
| | - Yen-Chi Chen
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University , Taipei , Taiwan (ROC)
| | - Jia-You Gong
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University , Taipei , Taiwan (ROC)
| | - Ming-Hsuan Tsai
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University , Taipei , Taiwan (ROC)
| |
Collapse
|
25
|
Abstract
BACKGROUND Child care settings play an important role in shaping children's eating behaviors; yet few studies have included family child care homes (FCCHs). We examined provider-reported nutrition-related practices in FCCHs and observed adherence to nutrition guidelines from the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC), exploring differences by provider ethnicity. METHODS We assessed baseline data from a cluster-randomized trial, including surveys with FCCH providers and observational data collected at the FCCH. We examined provider-reported nutrition-related practices and if providers met NAP SACC guidelines using observational data. Differences by ethnicity were assessed using chi-square and multivariate log-linear analysis adjusting for education. RESULTS Providers completed a telephone survey (n = 166, 100% female and 72% Hispanic) and participated in 2 full-day observations (n = 119). Many providers reported engaging in positive nutrition-related practices. Significant differences by ethnicity included the following: Hispanic providers less likely to report feeding practices that were responsive to children's self-regulation, but also less likely to report eating and drinking unhealthy foods/beverages in front of children and having screens on during meals and more likely to report seeking nutrition trainings. Using observational data, only 10 of 26 NAP SACC practices were met by >60% of providers. Few ethnic differences in meeting guidelines were found (7 of 26 practices). CONCLUSIONS While providers engage in some positive nutrition practices, improvement is needed to ensure that all providers actually meet evidence-based guidelines. Ethnic differences in certain practices underscore the need for culturally relevant trainings. TRIAL REGISTRATION NUMBER NCT02452645.
Collapse
Affiliation(s)
- Kim M. Gans
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Interventions and Policy, University of Connecticut, Storrs, CT
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Qianxia Jiang
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Interventions and Policy, University of Connecticut, Storrs, CT
| | - Jennifer Mello
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
| | - Augustine Kang
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Noereem Z. Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Vanessa Palomo
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
| | - Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| |
Collapse
|
26
|
Luoto JE, Lopez Garcia I, Aboud FE, Fernald LCH, Singla DR. Testing means to scale early childhood development interventions in rural Kenya: the Msingi Bora cluster randomized controlled trial study design and protocol. BMC Public Health 2019; 19:259. [PMID: 30832624 PMCID: PMC6399811 DOI: 10.1186/s12889-019-6584-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Forty-three percent of children under five in low and middle-income countries (LMICs) experience compromised cognitive and psychosocial development. Early childhood development (ECD) interventions that promote parent-child psychosocial stimulation and nutrition activities can help remediate early disadvantages in child development and health outcomes, but are difficult to scale. Key questions are: 1) how to maximize the reach and cost-effectiveness of ECD interventions; 2) what pathways connect interventions to parental behavioral changes and child outcomes; and 3) how to sustain impacts long-term. METHODS Msingi Bora ("good foundation" in Swahili) is a multi-arm cluster randomized controlled trial across 60 villages and 1200 households in rural Western Kenya that tests different, potentially cost-effective and scalable models to deliver an ECD intervention in biweekly sessions lasting 7 months. The curriculum integrates child psychosocial stimulation with hygiene and nutrition education. The multi-arm study will test the cost-effectiveness of two models of delivery: a group-based model versus a mixed model combining group sessions with personalized home visits. Households in a third study arm will serve as a control group. Each arm will have 20 villages and 400 households with a child aged 6-24 months at baseline. Primary outcomes are child cognitive and socioemotional development and home stimulation practices. In a 2 × 2 design among the 40 treatment villages, we will also test the role of including fathers in the intervention. We will estimate intention-to-treat and local average treatment effects, and examine mediating pathways using Mediation Analysis. One treatment arm will receive quarterly booster visits for 6 months following the end of the sessions. A follow-up survey 2 years after the end of the main intervention period will examine sustainability of outcomes and any spillover impacts onto younger siblings. Study protocols have been approved by the Maseno Ethics Review Committee (MUERC) in Kenya (00539/18) and by RAND's institutional review board. This study is funded by the National Institute for Child Health and Human Development (R01HD090045). DISCUSSION Results can provide policymakers with rigorous evidence of how best to design ECD interventions in low-resource rural settings. TRIAL REGISTRATION Clinical Trial NCT03548558 registered June 7, 2018 at clinicaltrials.gov; AEA-RCT registry AEARCTR-0002913.
Collapse
Affiliation(s)
| | | | | | | | - Daisy R. Singla
- Department of Psychiatry, Sinai Health System and University of Toronto, Toronto, Canada
| |
Collapse
|
27
|
Abstract
Objectives We examined biologic and social determinants of school readiness in an urban population and whether childcare altered these associations. Methods A retrospective cohort study was conducted using school readiness data linked to birth certificates of first-time kindergarten students (n = 39,463) in a large, urban public-school district during 2002-2012. Multivariate linear regression models compared mean readiness scores (MRS) for students born low birthweight (LBW) or preterm (PTB) and by childcare type, adjusting for other student and parent risk factors. Results MRSs for moderately LBW (1000-2499 g), extremely LBW (< 1000 g), moderately PTB (28-36 weeks), early-term (37-38 weeks) and post-term (42 + weeks) students were significantly lower than scores for their normal weight or full-term peers, adjusting for childcare type and other student and parent characteristics. Childcare was an important predictor of MRSs. MRSs were highest for district prekindergarten (PK) students and for students of mothers with greater years of education. Conclusions for Practice Social and biologic differences in MRSs for children entering school in a large urban public-school district suggest the need for greater attention to family and child health backgrounds. Increased enrollment in formal childcare may improve school readiness in these settings.
Collapse
Affiliation(s)
- Lawrence D Reid
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Donna M Strobino
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| |
Collapse
|
28
|
Arhab A, Messerli-Bürgy N, Kakebeeke TH, Lanzi S, Stülb K, Zysset AE, Leeger-Aschmann CS, Schmutz EA, Meyer AH, Munsch S, Kriemler S, Jenni OG, Puder JJ. Childcare Correlates of Physical Activity, Sedentary Behavior, and Adiposity in Preschool Children: A Cross-Sectional Analysis of the SPLASHY Study. J Environ Public Health 2018; 2018:9157194. [PMID: 30651743 PMCID: PMC6311763 DOI: 10.1155/2018/9157194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/25/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
Abstract
Background The childcare (CC) environment can influence young children's physical activity (PA), sedentary behavior (SB), and adiposity. The aim of the study was to identify a broad range of CC correlates of PA, SB, and adiposity in a large sample of preschoolers. Methods 476 preschool children (mean age 3.9 yrs; 47% girls) participated in the Swiss Preschoolers' Health Study (SPLASHY). PA and SB were measured by accelerometry. Outcome measures included total PA (TPA), moderate-to-vigorous PA (MVPA), SB, body mass index (BMI), and skinfold thickness (SF). PA measures consisted of both daily PA during CC attendance days and overall daily PA (CC and non-CC days). Results We identified the following CC correlates for higher TPA and/or higher MVPA or lower SB during CC attendance days: older age, sex (boys), more frequent child-initiated interactions during CC, mixing different ages within a group, and the presence of a written PA policy in the CC (all p ≤ 0.02). The CC correlates for overall TPA and/or MVPA or lower overall SB including both CC and non-CC days were the following: older age, sex (boys), more frequent child-initiated interactions during CC, mixing different ages within a group, less parental PA involvement in the CC, and having a larger surface area in CC (all p ≤ 0.046). Correlates for lower SF were sex (boys) and parental PA involvement in the CC (all p ≤ 0.02), and, for lower BMI, only increased age (p=0.001) was a correlate. Conclusions More frequent child-initiated interactions and mixing different ages in CC, the presence of a written PA policy, and a larger CC surface are correlates of PA and SB during CC attendance days and/or of overall PA. Parental involvement in CC PA projects was a correlate for reduced body fat. These novel factors are mostly modifiable and can be tackled/addressed in future interventions.
Collapse
Affiliation(s)
- Amar Arhab
- Obstetric Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Nadine Messerli-Bürgy
- Obstetric Service, Lausanne University Hospital, Lausanne, Switzerland
- Department of Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Tanja H. Kakebeeke
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Stefano Lanzi
- Obstetric Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Kerstin Stülb
- Department of Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Annina E. Zysset
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Einat A. Schmutz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Andrea H. Meyer
- Department of Psychology, University of Basel, Basel, Switzerland
| | - Simone Munsch
- Department of Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Oskar G. Jenni
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jardena J. Puder
- Obstetric Service, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
29
|
Ruiz-Casares M, Nazif-Muñoz JI. Non-adult child supervision practices in Lao People's Democratic Republic. Child Abuse Negl 2018; 84:217-228. [PMID: 30118971 DOI: 10.1016/j.chiabu.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/22/2018] [Accepted: 08/01/2018] [Indexed: 06/08/2023]
Abstract
Researchers have paid little attention to non-adult child supervision and the prevalence and factors influencing this practice in low-income countries. A better understanding of this phenomenon is needed to inform the development and implementation of policies and interventions to enhance child supervision in those settings. This study explores the prevalence and factors associated with young children being home alone or under the care of another young child in Lao People's Democratic Republic. Using the 2011-2012 Lao Social Indicator Survey (N = 10,740 for the subsample of 'child was home alone' and N = 10,539 for the subsample of 'child cared by another child < 10 years of age'), multi-level Poisson regressions were performed to determine the number of days children under five years of age were home alone or under the care of another child younger than 10 years of age. Large discrepancies across provinces and between urban and rural populations within each province were found. Children living in rural areas were more than five times more likely to be unsupervised than children living in urban settings (incidence rate ratio, IRR 5.2; 95% CI: 1.8-15.2), and children living in rural areas were nearly twice more likely to be under the care of another child than children living in urban settings (IRR 1.9; 95% CI: 1.3-2.8). Age was also a common factor in explaining variation in both dependent variables. Policies aimed at facilitating adequate child care and supervision should consider rurality to increase children's protection.
Collapse
|
30
|
Ly DP, Jena AB. Sex Differences in Time Spent on Household Activities and Care of Children Among US Physicians, 2003-2016. Mayo Clin Proc 2018; 93:1484-1487. [PMID: 29673711 PMCID: PMC8099448 DOI: 10.1016/j.mayocp.2018.02.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
Limited data exist on differences in time spent on household activities and child care between male and female physicians, which may influence sex differences in hours worked professionally. We studied sex differences among married physicians in time spent on household activities (eg, cleaning and cooking) and child care (eg, bathing and homework) from 2003 through 2016 using the American Time Use Survey, a detailed time use survey administered by the US Census. Overall, we found that female physicians with children spent 100.2 minutes (95% CI, 67.0-133.3 minutes) more per day on household activities and child care than did male physicians, a finding that was qualitatively similar after adjustment for work hours outside the home of both spouses. These patterns may reflect societal norms that ultimately influence physician sex differences in hours worked professionally.
Collapse
Affiliation(s)
- Dan P Ly
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA.
| |
Collapse
|
31
|
Meggiolaro S. Childcare by grandparents in married and cohabiting couples: evidence from Italy. Br J Sociol 2018; 69:580-600. [PMID: 28783219 DOI: 10.1111/1468-4446.12292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The process of union formation and the context of childrearing have profoundly changed with the spread of cohabitation in the last few decades. It is only recently that some attention has been paid to the implications of these changes for family ties. This study considers, with reference to Italy, a specific relationship between individuals in couples and their family of origin - childcare by grandparents. The aim of the paper is twofold. First, we investigate whether children of cohabiting couples are cared for by their grandparents to a lower extent compared to children of married couples. Second, the current study examines whether potential differences decrease over time. The data used are from two rounds of cross-sectional and nationally representative survey conducted in Italy in 2003 and in 2009. Our results show that in 2003 both in the provision and the intensity of grandparents' childcare, children of cohabiting parents were less likely to have their grandparents involved than children of married parents. However, the differences between marriages and cohabitations disappear in recent years.
Collapse
|
32
|
Abstract
With its sociocultural, institutional, and demographic contexts, India offers a unique opportunity to study the dynamics and experiences of aging, especially as it is poised to have a large increase in the number of persons aged 60 and above in the next half a century. In this paper, we focus on the concept of productive aging that emphasizes the active participation of older persons in society. We examine the correlates of productive aging in India, drawing on data from the Building Knowledge Base on Population Aging (BKPAI) survey of 9852 men and women aged 60 years and above in seven states of India in 2011. The productive activities that we examine pertain to four domains: work, contribution to household financial matters, grandparenting, and social engagement. The findings highlight the importance of gender, family structure, and socio-economic status in these different aspects of productive aging. Importantly, the findings show that the effect of the correlates is not the same across the different measures of productive aging. We find that women are less likely than men to engage in all productive activities except for grandparenting, and that living with children and adverse health reduce the likelihood of current employment or financial contributions, but not of social engagement or grandparenting. Greater wealth at older ages reduces the likelihood of employment but increases the likelihood of social engagement and ties. The study contributes to the understanding of opportunities and constraints of productive aging in India and has implications for intergenerational relationships, support and dependencies in old age.
Collapse
Affiliation(s)
- Abhijit Visaria
- Centre for Ageing Research and Education, Duke-NUS Medical School, 8 College Drive, 169857, Singapore.
| | - Premchand Dommaraju
- Sociology, School of Social Sciences, Nanyang Technological University, 14 Nanyang Drive, 637332, Singapore.
| |
Collapse
|
33
|
Schlinkmann KM, Bakuli A, Karch A, Meyer F, Dreesman J, Monazahian M, Mikolajczyk R. Transmission of respiratory and gastrointestinal infections in German households with children attending child care. Epidemiol Infect 2018; 146:627-632. [PMID: 29478420 PMCID: PMC9134537 DOI: 10.1017/s0950268818000316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/25/2017] [Accepted: 01/30/2018] [Indexed: 11/06/2022] Open
Abstract
Transmission of acute respiratory infections (ARI) and acute gastroenteritis (AGE) often occurs in households. The aim of this study was to assess which proportion of ARI and AGE is introduced and transmitted by children in German households with children attending child care. We recruited families with children aged 0-6 years in Braunschweig (Germany), for a 4 months prospective cohort study in the winter period 2014/2015. Every household member was included in a health diary and used nasal swabs for pathogen identification in case of ARI. We defined a transmission if two persons had overlapping periods with symptoms and used additional definitions for sensitivity analyses. In total, 77 households participated with 282 persons. We observed 277 transmission events for ARI and 23 for AGE. In most cases, the first infected person in a household was a child (ARI: 63%, AGE: 53%), and the risk of within-household transmission was two times higher when the index case was a child. In 26 ARI-transmission events, pathogens were detected for both cases; hereof in 35% (95% confidence interval (17-56%)) the pathogens were different. Thus, symptomatic infections in household members, apparently linked in time, were in 2/3 associated with the same pathogens.
Collapse
Affiliation(s)
- K. M. Schlinkmann
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- PhD Programme Epidemiology, Hannover Medical School, Braunschweig-Hannover, Germany
| | - A. Bakuli
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- PhD Programme Epidemiology, Hannover Medical School, Braunschweig-Hannover, Germany
| | - A. Karch
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - F. Meyer
- Helmholtz Centre for Infection Research, KOM – Microbial Communication, Braunschweig, Germany
| | - J. Dreesman
- Governmental Institute of Public Health of Lower Saxony, Hannover, Germany
| | - M. Monazahian
- Governmental Institute of Public Health of Lower Saxony, Hannover, Germany
| | - R. Mikolajczyk
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Braunschweig-Hannover, Germany
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Halle (Saale), Germany
| |
Collapse
|
34
|
Abstract
OBJECTIVE To investigate whether men and women who were looked-after (in public care) or adopted as children are at increased risk of adverse psychological and social outcomes in adulthood. DESIGN, SETTING Prospective observational study using the Avon Longitudinal Study of Parents and Children, which recruited pregnant women and their male partners in and around Bristol, UK in the early 1990s. PARTICIPANTS 8775 women and 3654 men who completed questionnaires at recruitment (mean age: women 29; men 32) and 5 years later. EXPOSURE Childhood public care status: looked-after; adopted; not looked-after or adopted (reference group). OUTCOMES Substance use (alcohol, cannabis, tobacco) prepregnancy and 5 years later; if ever had addiction; anxiety and depression during pregnancy and 5 years later; if ever had mental health problem; social support during pregnancy; criminal conviction. RESULTS For women, 2.7% were adopted and 1.8% had been looked-after; for men, 2.4% and 1.4%, respectively. The looked-after group reported the poorest outcomes overall, but this was not a universal pattern, and there were gender differences. Smoking rates were high for both the looked-after (men 47%, women 58%) and adopted (men 44%, women 40%) groups relative to the reference group (both 28%). The looked-after group were at increased risk of a high depression score (men: 26% vs 11%, OR 2.9 (95% CI 1.5 to 5.6); women: 24% vs 9%, 3.4 (2.2 to 5.0)). A high anxiety score was reported by 10% of the reference women, compared with 26% of those looked-after (3.0 (2.0 to 4.5)) and 17% of those adopted (1.8 (1.2 to 2.6)). Looked-after men and women reported the lowest social support, while criminal convictions and addiction were highest for looked-after men. Adjustment for adult socioeconomic position generally attenuated associations for the looked-after group. CONCLUSIONS The needs of those who experience public care as children persist into adulthood. Health and social care providers should recognise this.
Collapse
Affiliation(s)
- Alison Teyhan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - John Macleod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
35
|
Petrowski N, Cappa C, Gross P. Estimating the number of children in formal alternative care: Challenges and results. Child Abuse Negl 2017; 70:388-398. [PMID: 28578826 DOI: 10.1016/j.chiabu.2016.11.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/01/2016] [Accepted: 11/23/2016] [Indexed: 06/07/2023]
Abstract
Given the relatively large body of literature documenting the adverse impacts of institutionalization on children's developmental outcomes and well-being, it is essential that countries work towards reducing the number of children in alternative care (particularly institutional care), and, when possible, reunite children with their families. In order to do so, reliable estimates of the numbers of children living in such settings are essential. However, many countries still lack functional administrative systems for enumerating children living outside of family care. The purpose of this paper is to provide a snapshot of the availability and coverage of data on children living in residential and foster care from some 142 countries covering more than 80 per cent of the world's children. Utilizing these country-level figures, it is estimated that approximately 2.7 million children between the ages of 0 and 17 years could be living in institutional care worldwide. Where possible, the article also presents regional estimates of the number of children living in residential and foster care. This work represents an important step to systematically identify and compile sources of data on children in alternative care and provides updated global and regional estimates on the magnitude of the issue. Its findings contribute to raising awareness of the urgent need to strengthen the capacity of countries to improve national systems for counting, monitoring and reporting on these vulnerable children.
Collapse
Affiliation(s)
- Nicole Petrowski
- Consultant (N. Petrowski) and Statistics Specialist (C. Cappa), Data and Analytics Section, Division of Data, Research and Policy, United Nations Children's Fund (UNICEF), 3 UN Plaza, New York, NY, 10017, USA.
| | - Claudia Cappa
- Consultant (N. Petrowski) and Statistics Specialist (C. Cappa), Data and Analytics Section, Division of Data, Research and Policy, United Nations Children's Fund (UNICEF), 3 UN Plaza, New York, NY, 10017, USA.
| | - Peter Gross
- Former Child Protection Specialist, Child Protection Section, Programme Division, United Nations Children's Fund (UNICEF), 3 UN Plaza, New York, NY, 10017, USA.
| |
Collapse
|
36
|
Larson N, Ayers Looby A, Frost N, Nanney MS, Story M. What Can Be Learned from Existing Investigations of Weight-Related Practices and Policies with the Potential to Impact Disparities in US Child-Care Settings? A Narrative Review and Call for Surveillance and Evaluation Efforts. J Acad Nutr Diet 2017; 117:1554-1577. [PMID: 28774504 DOI: 10.1016/j.jand.2017.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/12/2017] [Indexed: 01/30/2023]
Abstract
Child-care settings and the combination of policies and regulations under which they operate may reduce or perpetuate disparities in weight-related health, depending on the environmental supports they provide for healthy eating and activity. The objectives of this review are to summarize research on state and local policies germane to weight-related health equity among young children in the United States and on how federal policies and regulations may provide supports for child-care providers serving families with the most limited resources. In addition, a third objective is to comprehensively review studies of whether there are differences in practices and policies within US child-care facilities according to the location or demographics of providers and children. The review found there is growing evidence addressing disparities in the social and physical child-care environments provided for young children, but scientific gaps are present in the current understanding of how resources should best be allocated and policies designed to promote health equity. Additional research is needed to address limitations of prior studies relating to the measurement of supports for weight-related health; complexities of categorizing socioeconomic position, ethnicity/race, and urban and rural areas; exclusion of legally nonlicensed care settings from most research; and the cross-sectional nature of most study designs. There is a particularly great need for the development of strong surveillance systems to allow for better monitoring and evaluation of state policies that may impact weight-related aspects of child-care environments, implementation at the program level, and needed implementation supports.
Collapse
|
37
|
Rizzoli-Córdoba A, Vargas-Carrillo LI, Vásquez-Ríos JR, Reyes-Morales H, Villasís-Keever MÁ, O'Shea-Cuevas G, Aceves-Villagrán D, Muñoz-Hernández O, García-Aranda JA. [Association between time of permanence at early education program (Estancias Infantiles) and developmental level for children in situation of poverty]. Bol Med Hosp Infant Mex 2017; 74:98-106. [PMID: 29382503 DOI: 10.1016/j.bmhimx.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 11/29/2016] [Accepted: 01/05/2017] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Early education program (EEP) was created to support parents with 1 to 3 year olds living in poverty situation in Mexico, and includes education and child daycare for 8h five days per week. The objective of this study was to evaluate the association between length of stay in EEP and the level of development in children. METHODS Cross sectional, population-based study conducted in two Mexican states. All children aged between 12 to 48 months enrolled in EEP from November 2014 to January 2015 were included. Child Development Evaluation (CDE) test was used to screen early development in every child. Normal early development prevalence odds ratio (OR) was calculated adjusted by gender, impairment and state, using as a reference those children with less than 30 days in the program. RESULTS The study included 3,387 children from 177 EEP nurseries, from which 53% were male; age by group was divided in 12-24 months (22.3%), 25-36 months (37.6%) and 37-42 months (40.1%). Normal development adjusted OR by age was 1.9 (CI95%: 1.30-2.78) for 6-11 months, 2.36 (CI95%: 1.60-3.50) for 12-17 months, 2.78 (CI95%: 1.65-4.65) for 18-23 months and 3.46 (CI95%: 2.13-5.60) for >24 months. By area of development, a greater probability of having a normal result for language and social areas was observed after 6 months in the program, and for motor (both gross and fine) and knowledge areas after 12 months. CONCLUSION The length of the stay in the EEP after 6 months significantly and progressively increases the probability of normal development regardless of gender and age.
Collapse
Affiliation(s)
- Antonio Rizzoli-Córdoba
- Unidad de Investigación en Neurodesarrollo, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
| | | | - Jorge Rodrigo Vásquez-Ríos
- Unidad de Investigación en Neurodesarrollo, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Hortensia Reyes-Morales
- Subdirección de Gestión de la Investigación, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Miguel Ángel Villasís-Keever
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Daniel Aceves-Villagrán
- Dirección General de PROSPERA Programa de Inclusión Social, Comisión Nacional de Protección Nacional en Salud, Ciudad de México, México
| | | | | |
Collapse
|
38
|
Tatah L, Delbiso TD, Rodriguez-Llanes JM, Gil Cuesta J, Guha-Sapir D. Impact of Refugees on Local Health Systems: A Difference-in-Differences Analysis in Cameroon. PLoS One 2016; 11:e0168820. [PMID: 27992563 PMCID: PMC5161383 DOI: 10.1371/journal.pone.0168820] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/06/2016] [Indexed: 11/19/2022] Open
Abstract
Hosting refugees may represent a drain on local resources, particularly since external aid is frequently insufficient. Between 2004 and 2011, over 100,000 refugees settled in the eastern border of Cameroon. With little known on how refugee influx affects health services of the hosting community, we investigated the impact of refugees on mother and child health (MCH) services in the host community in Cameroon. We used Cameroon's 2004 and 2011 Demographic and Health Surveys to evaluate changes in MCH indicators in the refugee hosting community. Our outcome variables were antenatal care (ANC) coverage, caesarean delivery rate, place of delivery and child vaccination coverage; whereas the exposure variable was residence in the refugee hosting community. We used a difference-in-differences analysis to compare indicators of the refugee hosting community to a control group selected through propensity score matching from the rest of the country. A total of 10,656 women were included in our 2004 analysis and 7.6% (n = 826) of them resided in the refugee hosting community. For 2011, 15,426 women were included and 5.8% (n = 902) of them resided in the hosting community. Between 2004 and 2011, both the proportion of women delivering outside health facilities and children not completing DPT3 vaccination in the refugee hosting community decreased by 9.0% (95% Confidence Interval (CI): 3.9-14.1%) and 9.6% (95% CI: 7.9-11.3%) respectively. However, ANC attendance and caesarean delivery did not show any significant change. Our findings demonstrate that none of the evaluated MCH service indicators deteriorated (in fact, two of them improved: delivery in health facilities and completing DPT3 vaccine) with the presence of refugees. This suggests evidence disproving the common belief that refugees always have a negative impact on their hosting community.
Collapse
Affiliation(s)
- Lambed Tatah
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Health and Human Development (2HD) Research Group, Douala, Cameroon
| | - Tefera Darge Delbiso
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Jose Manuel Rodriguez-Llanes
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Julita Gil Cuesta
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|
39
|
Di Gessa G, Glaser K, Tinker A. The Health Impact of Intensive and Nonintensive Grandchild Care in Europe: New Evidence From SHARE. J Gerontol B Psychol Sci Soc Sci 2016; 71:867-79. [PMID: 26315046 PMCID: PMC4982385 DOI: 10.1093/geronb/gbv055] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 05/27/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Grandparents are an important source of childcare. However, caring for grandchildren may affect grandparents' health in both positive and negative ways. Our study examines the association between grandparental childcare and grandparents' health at 2- and 4-year follow-up. METHOD Our study is based on grandparents aged 50 and older from Waves 1-4 of the Survey of Health, Ageing and Retirement in Europe (SHARE). Using multivariate analyses, we investigated associations between intensive and nonintensive grandparental childcare at Wave 2 and subsequent health (self-rated health, depressive symptoms, and disability) controlling for covariates and health at baseline. Associations between changes over time in grandparental childcare and health at follow-up were also explored. Multiple imputation techniques and sensitivity analyses were undertaken to investigate possible biases arising from sample attrition. RESULTS Grandparents looking after grandchildren, whether intensively or nonintensively, experienced some health benefits. Associations strengthened when attrition was accounted for, particularly if it is assumed that those who dropped out of the study were in poor health. DISCUSSION Our results show better health among grandparents who provided grandchild care in the European countries studied. These results are important given the widespread provision of grandchild care in Europe.
Collapse
Affiliation(s)
- Giorgio Di Gessa
- Institute of Gerontology, Department of Social Science, Health and Medicine, School of Social Science and Public Policy, King's College London.
| | - Karen Glaser
- Institute of Gerontology, Department of Social Science, Health and Medicine, School of Social Science and Public Policy, King's College London
| | - Anthea Tinker
- Institute of Gerontology, Department of Social Science, Health and Medicine, School of Social Science and Public Policy, King's College London
| |
Collapse
|
40
|
Ding L, Sun Q, Sun W, Du Y, Li Y, Bian X, He G, Bai H, Dyar OJ. Antibiotic use in rural China: a cross-sectional survey of knowledge, attitudes and self-reported practices among caregivers in Shandong province. BMC Infect Dis 2015; 15:576. [PMID: 26689294 PMCID: PMC4687375 DOI: 10.1186/s12879-015-1323-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 12/12/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To improve antibiotic use globally, we must deepen our understanding of the public's knowledge, attitudes and practices (KAP) concerning antibiotics. Children are frequent users of antibiotics, and their caregivers play important roles in determining how antibiotics are used. The purpose of this study was to describe caregivers' KAP in a rural province in eastern China, and to identify socio-demographic factors associated with inappropriate antibiotic use. METHODS A cross-sectional questionnaire based survey was conducted in 12 villages in one county in Shandong Province. A total of 727 individuals who were the primary day-to-day caregiver for a child aged 0-7 years were randomly selected and invited to participate. All caregivers were surveyed face-to-face using a semi-structured questionnaire focusing on the use of antibiotics in children. RESULTS Almost all invited caregivers (99.3 %) completed the questionnaire in full. Caregivers expressed high levels of over-expectation for antibiotics for common childhood symptoms, stating that antibiotics were always or usually necessary when a child has a fever (46 %) or dry cough (42 %). Most caregivers (93 %) were aware that they should follow the doctor's advice when giving their children antibiotics. Many, however, reported that they had previously deviated from advice; this was most commonly through using antibiotics intermittently rather than regularly, but also by increasing and decreasing doses. Caregivers that were older and that had less formal education had higher levels of self-reported adherence (p < 0.01). A third of caregivers admitted to storing leftover antibiotics at home, and almost all of these caregivers (97 %) had used the antibiotics on a second occasion for their child. CONCLUSION We have identified important gaps in knowledge, attitudes and practices concerning antibiotics among this rural population of caregivers. There is a clear need for multifaceted interventions that target village doctors, to improve prescribing and communication, as well as the general public, to improve health-seeking behaviours and promote responsible individual use of antibiotics.
Collapse
Affiliation(s)
- Lilu Ding
- School of Health Care Management, Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of Health, Shandong University, Jinan, Shandong Province, 250012, China.
- Global health - Health Systems and Policy: Improving the use of medicines, Department of Public Health Sciences, Karolinska Institutet, Stockholm, 17171, Sweden.
| | - Qiang Sun
- School of Health Care Management, Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of Health, Shandong University, Jinan, Shandong Province, 250012, China.
| | - Weishuai Sun
- School of Health Care Management, Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of Health, Shandong University, Jinan, Shandong Province, 250012, China.
| | - Yihui Du
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China.
| | - Yue Li
- School of Health Care Management, Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of Health, Shandong University, Jinan, Shandong Province, 250012, China.
| | - Xuefeng Bian
- Jinan Center for Disease Control and Prevention, Jinan, Shandong Province, 250021, China.
| | - Guiqin He
- Yanggu County Center for Disease Control and Prevention, Liaocheng city, Shandong Province, 252300, China.
| | - Huidong Bai
- Yanggu County Center for Disease Control and Prevention, Liaocheng city, Shandong Province, 252300, China.
| | - Oliver J Dyar
- Global health - Health Systems and Policy: Improving the use of medicines, Department of Public Health Sciences, Karolinska Institutet, Stockholm, 17171, Sweden.
| |
Collapse
|
41
|
Hesketh KR, Griffin SJ, van Sluijs EMF. UK Preschool-aged children's physical activity levels in childcare and at home: a cross-sectional exploration. Int J Behav Nutr Phys Act 2015; 12:123. [PMID: 26410252 PMCID: PMC4583748 DOI: 10.1186/s12966-015-0286-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young children are thought to be inactive in childcare, but little is known about location-specific activity levels. This observational study sought to describe the in-care and out-of-care activity patterns of preschool-aged children and explore differences in physical activity level by childcare attendance. METHODS Three to four-year-old children were recruited from 30 preschool and nursery 'settings' in Cambridgeshire, UK. Average minutes per hour (min/h) spent sedentary (SED), in light physical activity (LPA) and in moderate-to-vigorous PA (MVPA) were measured by accelerometry for up to 7 days (mean: 6.7 ± 1.1). Weekly childcare attendance patterns were reported by parents. The within-child association between childcare attendance and outcomes was assessed using two- and three-level hierarchical regression; sex by care (in/out) interactions were considered. RESULTS Two hundred and two children (51% female) had valid activity data for ≥2 days. Children, and particularly boys, were less sedentary and more active when in care compared to at home (SED: Boys: β (SE): -6.4 (0.5) min/h, Girls: -4.8 (0.5); LPA: Boys: 0.6 (0.4), Girls: 1.8 (0.4); MVPA: Boys: 5.7 (0.5); Girls: 3.0 (0.4)). Differences between in-care and at-home activity were largest in the (early) mornings and early evenings for boys; no compensation in at-home activity occurred later in the day. On days when children were in care part-time (1-5 h) or full-time (>5 h), they were significantly less sedentary and more active compared with non-care days. CONCLUSIONS Young children, and particularly boys, accumulate more MVPA in care compared to at home. Future research should identify factors accounting for this difference and consider targeting non-care time in intervention efforts to increase higher-intensity activity and decrease sedentary time in preschoolers.
Collapse
Affiliation(s)
- Kathryn R Hesketh
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
- UCL Institute of Child Health, 30 Guilford Street, London, WC1N1EH, UK.
| | - Simon J Griffin
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
- Primary Care Unit, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0SR, UK
| | - Esther M F van Sluijs
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| |
Collapse
|
42
|
Gialamas A, Mittinty MN, Sawyer MG, Zubrick SR, Lynch J. Time spent in different types of childcare and children's development at school entry: an Australian longitudinal study. Arch Dis Child 2015; 100:226-32. [PMID: 25204736 DOI: 10.1136/archdischild-2014-306626] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate whether the total amount of time in childcare through the first 3 years of life was associated with children's receptive vocabulary, externalising and internalising problem behaviours at age 4-5 years, and whether this association varied for different types of childcare. METHODS We used data from the prospective, population-based Longitudinal Study of Australian Children (n=3208-4066, depending on outcome). Parental reports of the time spent in different types of childcare were collected at face-to-face interviews at age 0-1years and at age 2-3 years. Children's receptive vocabulary was directly assessed in the child's home, and externalising and internalising behaviours were measured by questionnaire, completed by parents and teachers at age 4-5 years. RESULTS At 3 years of age, 75% of the sample spent regular time in the care of someone other than the parent. After adjustment, more time in childcare was not associated with children's receptive vocabulary ability but was associated with higher levels of parent-reported (β=0.10 (95% CI 0.00 to 0.21)) and teacher-reported (β=0.31 (0.19 to 0.44)) externalising problem behaviours and lower levels of parent-reported internalising problem behaviours (β=-0.08 (-0.15 to -0.00)). Compared with children who did not attend any type of childcare, children in centre-based care had higher parent-reported and teacher-reported externalising and lower internalising problem behaviours. CONCLUSIONS More time in centre-based childcare (but not other types of care) through the first 3 years of life was associated with higher parent-reported and teacher-reported externalising problem behaviours, and lower parent-reported internalising problem behaviours but not with children's receptive vocabulary ability at school entry.
Collapse
Affiliation(s)
- Angela Gialamas
- School of Population Health, University of Adelaide, Adelaide, Australia
| | - Murthy N Mittinty
- School of Population Health, University of Adelaide, Adelaide, Australia
| | - Michael G Sawyer
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, Australia Discipline of Paediatrics, University of Adelaide, Adelaide, Australia
| | - Stephen R Zubrick
- The University of Western Australia, Telethon Institute for Child Health Research, Perth, Australia
| | - John Lynch
- School of Population Health, University of Adelaide, Adelaide, Australia School of Social and Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
43
|
Abstract
The sociopolitical context of Norway includes low poverty rates and universal access to subsidized and regulated Early Childhood Education and Care (ECEC). In this context, the association between family income dynamics and changes in early child behavior problems was investigated, as well as whether high-quality ECEC buffers children from the effects of income dynamics. In a population-based sample (N = 75,296), within-family changes in income-to-needs predicted changes in externalizing and internalizing problems (from ages 18 to 36 months), particularly for lower income children. For internalizing problems, ECEC buffered the effect of income-to-needs changes. These findings lend further support to the potential benefits of ECEC for children from lower income families.
Collapse
Affiliation(s)
- Henrik D Zachrisson
- Norwegian Institute of Public Health and The Norwegian Center for Child Behavioral Development
| | | |
Collapse
|
44
|
Hesketh KR, van Sluijs EMF, Blaine RE, Taveras EM, Gillman MW, Benjamin Neelon SE. Assessing care providers' perceptions and beliefs about physical activity in infants and toddlers: baseline findings from the Baby NAP SACC study. BMC Public Health 2015; 15:100. [PMID: 25886506 PMCID: PMC4334406 DOI: 10.1186/s12889-015-1477-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/27/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND As children now spend increasing amounts of time in out-of-home care, care providers play an important role in promoting positive health behaviors. Little is currently known about providers' perceptions and beliefs about physical activity, particularly for very young children. This study describes providers' perceptions and beliefs about infants' and toddlers' physical activity, and assesses their knowledge of physical activity guidelines, to establish if and where providers may need support to promote physical activity in child care settings. METHODS We analyzed baseline data from a pilot randomized-controlled trial conducted in 32 child care centers in Massachusetts, USA. Providers completed physical activity-related questionnaires from which we compared twenty perception and belief questions for infant and toddler care providers. RESULTS 203 care providers (96% female, mean ± SD age: 32.7 ± 11.2 years) from 29 centers completed questionnaires. A large proportion of providers (n = 114 (61.9%)) believed that infants should be active for 45 minutes or less each day, and only 56 providers (29.7%) perceived toddlers to require more than 90 minutes of activity per day. 97% of providers perceived it was their job to ensure children engaged in a healthy amount of physical activity and most (94.1%) perceived physical activity to be important to own their health, despite 13.3% finding it hard to find the energy to be physically active. CONCLUSIONS This study is the first to assess the physical activity perceptions and attitudes of providers caring for infants and toddlers. Though all providers believed toddlers should engage in more physical activity than infants, most providers believed that young children require only a short amount of physical activity each day, below recommended guidelines. How provider perceptions influence children's physical activity behavior requires investigation.
Collapse
Affiliation(s)
- Kathryn R Hesketh
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
- UCL Institute of Child Health, 30 Guilford Street, London, WC1N1EH, UK.
| | - Esther M F van Sluijs
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | - Rachel E Blaine
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
| | - Elsie M Taveras
- Division of General Pediatrics, Pediatric Population Health Management, Mass General Hospital for Children, Boston, MA, USA.
| | - Matthew W Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Sara E Benjamin Neelon
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
- Department of Community and Family Medicine, Duke University Medical Center and Duke Global Health Institute, Durham, NC, USA.
| |
Collapse
|
45
|
Thompson C. Health Information Needs for Child-in-Care. Stud Health Technol Inform 2015; 216:886. [PMID: 26262188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
When a child is taken into care the State is legally required to provide healthcare. Six forms were reviewed by medical care providers, foster parents and government social workers to understand their health information needs in caring and planning for child-in-care. The qualitative study used a sociotechnical systems framework and NVivo 10 for encoding. Interview findings include that the forms, if completed and available, meet most basic health information needs with additional forms used for complex health needs. The majority of participants indicate interest in electronic options. Focus groups will enable further study.
Collapse
Affiliation(s)
- Cori Thompson
- School of Health Information Science, University of Victoria, BC, Canada
| |
Collapse
|
46
|
Abstract
OBJECTIVE Molar-Incisor Hypomineralization (MIH) is a common developmental enamel defect characterized by demarcated opacities in permanent molars and incisors. Its etiology still remains unclear. The aim of this retrospective cohort study was to assess if the socioeconomic environment of the child is associated with MIH. MATERIALS AND METHODS The study was located in two rural towns and three urban cities in Finland. A total of 818 children, between 7-13 years old, were examined for MIH using the evaluation criteria in line with those of the European Academy of Paediatric Dentistry, but excluding opacities smaller than 2 mm in diameter. The mothers filled in a questionnaire which included questions related to the family's way of living (e.g. area of residency, farming, day care attendance) and socioeconomic status (family income, number of mother's school years, level of maternal education). RESULTS The prevalence of MIH in the study population was 17.1%. Family income, urban residency and day care attendance were associated with MIH in the univariate analysis. In the multivariate analysis using binary logistic regression, only urban residency during a child's first 2 years of life remained associated with MIH. The prevalence of MIH in urban areas was 21.3% and in rural areas 11.5% (OR = 2.18, CI = 1.35-3.53, p = 0.001). CONCLUSIONS The prevalence of MIH was related to urban residency and could not be explained by any other factor included in the study.
Collapse
Affiliation(s)
- Emma Wuollet
- Department of Pediatric and Preventive Dentistry, Institute of Dentistry, University of Helsinki , Helsinki , Finland
| | | | | | | | | |
Collapse
|
47
|
Velásquez Hurtado JE, Solís Alcedo L, Vigo Valdez WE, Rosas Aguirre AM, Giusti Hundskopf P, Alfaro Fernandez P, Cabrera Arredondo H. [Evaluating maternal child care practices in extreme poverty areas in Peru, 2012]. Rev Peru Med Exp Salud Publica 2014; 31:243-253. [PMID: 25123861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/12/2014] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES To evaluate maternal and child care practices in areas with extreme poverty in Peru. MATERIALS AND METHODS Cross-sectional study conducted between August and September 2012; with probabilistic, three-stage stratification by "department" (geographic region) sampling. 540 households were selected that had at least one child younger than 36 months (475 households) and/or a pregnant women (80 households), in rural areas of Cajamarca, Amazonas, Huanuco, Ayacucho, Huancavelica, Apurimac, Cusco, Puno and Ucayali. RESULTS Regarding the last pregnancy, 69.0% of the mothers reported having had their first prenatal care in the first trimester; 65.3% reported having completed more than six check-ups throughout the pregnancy; 81.1% reported having given birth in a health facility, and only 31.0% chose a method of family planning within 42 days postpartum. With regard to the last child under 3 years old, 64.1% had early mother-infant contact, and 62.8% initiated breastfeeding within one hour of birth. In addition, 89.6% of children under 6 months old exclusively received breastfeeding and 89.1% of children aged 6-8 months old already had received complementary feeding. Fever, diarrhea, vomiting and breathing difficulty were the most mentioned warning signs for seeking care for children. CONCLUSIONS Through this study, a baseline has been established on which a strategy can be designed and implemented to improve best practices for maternal and child care as part of the "Programa de Apoyo" within the Health Sector Reform.
Collapse
|
48
|
Abstract
Family structure change can disrupt the settings of children's daily lives. Most scholarship focuses on disruption in the home environment. Moving beyond the home, this study explores the association between changes in family structure and changes in several dimensions of early child care. With longitudinal data from the NICHD Study of Early Child Care and Youth Development (n = 1,298), first-difference models reveal that family structure transitions are associated with changes in the type and quantity of early care as well as the number of care arrangements used, especially during the latter part of infancy. Given prior evidence linking these child care dimensions to behavioral and cognitive outcomes, these results suggest a policy-relevant mechanism by which family change may create inequalities among children.
Collapse
Affiliation(s)
- Robert Crosnoe
- Population Research Center, University of Texas at Austin, 305 E. 23rd Street, G1800, Austin, TX, 78712-1699, USA,
| | | | | | | |
Collapse
|
49
|
Embleton L, Ayuku D, Kamanda A, Atwoli L, Ayaya S, Vreeman R, Nyandiko W, Gisore P, Koech J, Braitstein P. Models of care for orphaned and separated children and upholding children's rights: cross-sectional evidence from western Kenya. BMC Int Health Hum Rights 2014; 14:9. [PMID: 24685118 PMCID: PMC4021203 DOI: 10.1186/1472-698x-14-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 03/24/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children's basic human rights were being upheld in institutional vs. community- or family-based care settings in Uasin Gishu County, Kenya. METHODS The Orphaned and Separated Children's Assessments Related to their Health and Well-Being Project is a 5-year cohort of orphaned children and adolescents aged ≤18 year. This descriptive analysis was restricted to baseline data. Chi-Square test was used to test for associations between categorical /dichotomous variables. Fisher's exact test was also used if some cells had expected value of less than 5. RESULTS Included in this analysis are data from 300 households, 19 Charitable Children's Institutions (CCIs) and 7 community-based organizations. In total, 2871 children were enrolled and had baseline assessments done: 1390 in CCI's and 1481 living in households in the community. We identified and described four broad models of care for orphaned and separated children, including: institutional care (sub-classified as 'Pure CCI' for those only providing residential care, 'CCI-Plus' for those providing both residential care and community-based supports to orphaned children , and 'CCI-Shelter' which are rescue, detention, or other short-term residential support), family-based care, community-based care and self-care. Children in institutional care (95%) were significantly (p < 0.0001) more likely to have their basic material needs met in comparison to those in family-based care (17%) and institutions were better able to provide an adequate standard of living. CONCLUSIONS Each model of care we identified has strengths and weaknesses. The orphan crisis in sub-Saharan Africa requires a diversity of care environments in order to meet the needs of children and uphold their rights. Family-based care plays an essential role; however, households require increased support to adequately care for children.
Collapse
Affiliation(s)
- Lonnie Embleton
- Department of Medicine, Moi University, College of Health Sciences, Eldoret, Kenya
| | - David Ayuku
- College of Health Sciences, Department of Behavioral Sciences, Moi University, Eldoret, Kenya
| | | | - Lukoye Atwoli
- College of Health Sciences, Department of Mental Health, Moi University, Eldoret, Kenya
| | - Samuel Ayaya
- College of Health Sciences, Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Rachel Vreeman
- Department of Pediatrics, Indiana University, Indianapolis, USA
| | - Winstone Nyandiko
- College of Health Sciences, Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Peter Gisore
- College of Health Sciences, Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Julius Koech
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Paula Braitstein
- Department of Medicine, Moi University, College of Health Sciences, Eldoret, Kenya
- Department of Medicine, Indiana University, 1001 West 10th Street, OPW M200 Indianapolis, IN, USA
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Regenstrief Institute Inc., Indianapolis, USA
| |
Collapse
|
50
|
Abstract
The study examined the relationship between the number of concurrent child care arrangements and children's incidence of communicable illnesses throughout the first 4½ years of life, and whether this association is mediated by the total number of children across care settings. Within-child fixed effects regression models were used to relate changes in the numbers of concurrent nonparental arrangements to changes in children's illnesses using longitudinal data from the NICHD's Study of Early Child Care and Youth Development (N = 1,265). 52 % of children attended multiple child care arrangements at least once from 3 to 54 months. Increases in the number of arrangements were associated with a 15 % increase in respiratory problems among children 3-54 months of age, and a 25 % increase in otitis media among children 36-54 months. Associations were smaller among African American children compared to European American and other-race children. Findings suggest that the number of peers with which a child comes into contact at child care mediates the association between increases in number of arrangements and increases in reported respiratory problems. Children attending multiple child care arrangements prior to kindergarten entry experience slightly more contemporaneous communicable diseases, relative to attending single nonparental arrangements, through exposure to more peers.
Collapse
Affiliation(s)
- Taryn W Morrissey
- Department of Public Administration and Policy, School of Public Affairs, American University, 4400 Massachusetts Ave NW, Washington, DC 20016, USA.
| |
Collapse
|