Highlights from this issue

The final act of Philip Roth's achingly poignant novel, Nemesis, based on the 1944 polio epidemic condenses the trajectories of each of the main protagonists' lives as a result of events that sultry summer, Bucky Cantor, swapping life stories with a former pupil at his school. [...]the implications for long term (psychological and physical) health are arguably worse: late presentation for other febrile illness (EDs have never been so empty—something is wrong);fear of infection by dint of ‘exposure' to a health facility;interruption of standard health surveillance particularly vaccination;mental health;child abuse as a result of prolonged internment and loss of, at least the social side of, education. The reasons for less aggressive disease are still not completely understood, though there are a number of candidate explanators: host-response factors;lower infective dose (as most often from an adult household member);age related ACE receptor differences and more recent exposure to antigenically similar coronaviruses conferring relative immunity.

A final review: How are our children doing right now?

In caring for our pediatric patients, we will continue to live with the fact that the disruptions have not been uniformly felt, with increased impact on Black and Brown children and those living in poverty;additionally, levels of access to routine pediatric health services have varied throughout the pandemic.1 For all children, though, we have to make up much lost time when it comes to physical, mental, and academic concerns, as well as socialization issues. Because schools provide another resource for identifying and addressing mental health concerns, the complete or partial shift to virtual learning likely compounded the mental health crisis. According to one study, "the prevalence of depression and anxiety symptoms during the COVID-19 pandemic has doubled, compared with prepan-demic estimates. Early childhood: A profound degree of development takes place from birth to 5 years of life. Because of the pandemic, children 5 years and younger have spent all or a significant portion of their lives in social isolation alongside parents or caregivers.

WHO hospital care for children guidelines: what do users need?

[...]they needed to be able to carry a book around with them. [...]the broader scope and pocket-size of the pocketbook of Hospital Care for Children. A training course was developed on how to use the guidelines in everyday clinical practice, based on principles of adult learning.3 4 WHO developed the Emergency Triage, Assessment and Training (ETAT) course, focused on the first 24 hours of admission, and in Africa, ETAT+ was a modified version which included admission care.5 Many quality improvement assessments and initiatives occurred, supported by WHO regional offices or initiated by countries.4 In 2013, the Pocketbook of Hospital Care for Children was revised, with updates in many areas. An app was produced, and training materials updated.6 By 2015, at least two-thirds of low-income and middle-income countries adopted the Hospital Care for Children guidelines, and ran training courses or other quality improvement initiatives.7 The Pocketbook of Hospital Care for Children has been used as the basis for paediatric curricula for medical students and nurses in many low-income and middle-income countries, and has been translated into at least 18 languages.3 A number of country and regional adaptations of the book have been achieved to reflect differences in disease epidemiology and local needs.

Atoms

The probability that staying away or presenting reflects public health messages so often, by necessity, reflex responses to a new infectious problem but simultaneously, frequently pendular and inconsistent. Over the SDG era to date, there has been a subtle, but tangible shift in emphasis beyond survival to the tacit assumption that infancy and early childhood will (for most) be navigated and that quality of life (in its broadest sense) or fulfilment of potential (as the WHO defines health) is the new hard currency. With this backdrop, Maria Neocleous and colleagues in Liverpool present the findings from their systematic review and analysis of user friendliness of the currently available early child development screening tools, the emphasis being on training provision.

Health needs of vulnerable children and young people: the role of health in child protection conferences and representation in child protection plans

ObjectivesOver 50,000 children and young people in England are subject to a child protection plan.1 It is well established that abuse is detrimental to many aspects of child health in the short-, medium- and long-term.2 This project sought to build on existing knowledge to further understand the role health plays in child protection conferences. Specifically it sought to understand the health needs of vulnerable children and young people subject to child protection plans, how health needs are discussed at child protection conferences and which professionals are advocating for children and young people's health through the child protection process.MethodsRetrospective cohort study of case notes relating to 24 families (40 children) who underwent initial and review child protection conferences from January 2019-February 2021 in one local authority. This included accessible NHS notes and minutes from child protection meetings. Conference notes were reviewed to understand why conferences were taking place, which professionals were present, what health needs were discussed and what steps were taken in child protection plans to address health needs.ResultsHealth needs were almost universally addressed in child protection plans (23/24), with plans most commonly reporting on the need for school nurse assessment or health visitor monitoring. Health visitors and school nurses attended almost all conferences. Only seven children in this cohort were offered a Child Protection Medical Assessment with a paediatrician. High BMI and emotional distress were the most common health needs discussed. Emotional health was regularly commented on in conferences, particularly when domestic abuse was a factor. Plans commented on the need for CAMHS referral or to access emotional support in school. Access to emotional support in school was limited by school closures due to Covid-19 restrictions.Eighteen adolescents (10–17 years old) were involved in the analysis, many of whom had emotional health needs (14/18) or physical health needs (13/18);3 had contextual safeguarding needs. School nurses played an important role during and between conferences in identifying and managing the health needs of this vulnerable cohort of young people. Fourteen adolescents had school nurse assessments as part of their child protection plan, which provided an opportunity for health promotion and enabled identification of new health needs. School nurses were also able to offer psychosocial support, particularly to young people with contextual safeguarding concerns.ConclusionsHealth was well addressed in child protection conferences and plans. Health needs were almost exclusively represented by health visitors and school nurses. Emotional health needs were recognised and discussed in conferences, with limited avenues for children and young people to access support, particularly when support available through school was affected by Covid-19-related school closures. School nurses played a particularly important role for vulnerable adolescents subject to child protection plans as they were able to identify health needs, take appropriate steps to ensure management was in place and provide psychosocial support in the school setting.ReferencesChild protection plan statistics: England 2017–2021. NSPCC, 2021.State of Child Health. Royal College of Paediatrics and Child Health, 2020.

Atoms

The probability that staying away or presenting reflects public health messages so often, by necessity, reflex responses to a new infectious problem but simultaneously, frequently pendular and inconsistent. Over the SDG era to date, there has been a subtle, but tangible shift in emphasis beyond survival to the tacit assumption that infancy and early childhood will (for most) be navigated and that quality of life (in its broadest sense) or fulfilment of potential (as the WHO defines health) is the new hard currency. With this backdrop, Maria Neocleous and colleagues in Liverpool present the findings from their systematic review and analysis of user friendliness of the currently available early child development screening tools, the emphasis being on training provision.

IN IT FOR THE LONG HAUL: THE JOURNAL OF THE HEALTH VISITORS' ASSOCIATION

It is three years since a cluster of cases of pneumonia of unknown cause was reported in Wuhan in China. Little did many know how soon lives around the world would be upended. Many people now feel that the pandemic is behind them, and very few are still testing regularly, but in reality, Covid is still with them. In fact, a spike with new variants is predicted with some unease by researchers in the field for this winter: quite possibly combined with influenza, to constitute a 'twindemic'. Alongside this, there is an increasing awareness that 'long Covid' can keep people ill or disabled for a considerable length of time. So for any clients sinking into Covid vaccination apathy, it's worth reminding them of the realities, and that studies have suggested vaccination can reduce the risk of long Covid. Research into the immunity required to protect against long Covid, as well as the role of new variants, continues.

A SHOT IN THE ARM FOR CHILD HEALTH: THE JOURNAL OF THE HEALTH VISITORS' ASSOCIATION

Childhood vaccination rates are generally high in the UK, but there is considerable room for improvement. Two major issues are currently a cause for concern. The first is a small but gradual decline in uptake each year since 2012/13, and the other, persistent inequalities in uptake, with large variation between geographic areas and population groups. Here, Bedford reviews the current vaccine uptake and the possible causes of the decline.

COVID-19 and Religion: Pandemic Lessons and Legacies

The essay draws on a multiyear project to assess how religious communities worldwide experienced the COVID-19 pandemic and how they have in turn shaped responses to the pandemic. It focuses on religious public health responses, religious gatherings, and practices such as funerals, and the remarkable responses, especially at community level, offering social safety nets to people devastated by lockdowns and economic crises. Stigma, violence against specific groups, effects on women and children, and mental health are central challenges. The pandemic casts new light on contemporary forms of religious practice, community, mobilization, and engagement.

Rapid changes to paediatric services in the pandemic early days – what went well? What can we learn? A qualitative study with paediatricians and other child health professionals conducted in mid-2020

517 Table 1Perceived positive and negative impacts of early Covid-19 response on Paediatric services in North of Scotland and North of EnglandConclusionDespite serious challenges experienced by staff during the first wave of the pandemic, there was also opportunity for positive change. As services ‘build back’, in the context of the NHS long-term plan, our findings suggest opportunities for change for the benefit for children and young people.

A proposed pilot to integrate health and social care to tackle child inequality: the Sparkbrook Children’s Zone, Birmingham

1066 Figure 1Maps showing infant mortality in Sparkbrook area (in red) on left, and inappropriate attendances to ED on right[Figure omitted. See PDF] 1066 Figure 2Priorities identifies during community engagement fro the pilot Sparkbrook Children’s Zone (number of response)[Figure omitted. See PDF]ConclusionWith funding from NHS England and Birmingham Children’s Trust, a weekly clinic is in set-up in the Sparkbrook ward, which will open after school, where community groups, Early Help, GPs, dental services and paediatricians will work alongside each other to deliver place-based health and social care to a population of 14,000 children, prioritising early intervention programmes, health promotion (immunisations, healthy weight) and common chronic conditions (asthma, eczema and constipation).ReferencesMcHale P, Wood S, Hughes K, Bellis MA, Demnitz U, Wyke S. Who uses emergency departments inappropriately and when - a national cross-sectional study using a monitoring data system. BMC Medicine. 2013 Dec 13;11(1):258.Williams M, Franklin J. Children and young people’s services: Spending 2010-11 to 2019-20. 2021 Jul.Royal College Of Paediatrics and Child Health. Paediatrics 2040: Our vision for the future of paediatrics in the UK. London;2021 Feb.Montgomery-Taylor S, Watson M, Klaber R. Child Health General Practice Hubs: a service evaluation. Archives of Disease in Childhood. 2016 Apr;101(4):333–7.Birmingham Public Health Intelligence Team. Birmingham Health Profiles: Hall Green Constituency 2019. Birmingham;2018.

Child vaccination rates fall to decade low amid pandemic

“Multiple disease outbreaks would be catastrophic for communities and health systems already battling COVID-19, making it more urgent than ever to invest in childhood vaccination and ensure every child is reached,” he said in a statement released on July 15. The pandemic has highlighted the importance of developing data systems that are timely and high quality in providing equitable access to immunisation for all, and allow real-time tracking of immunisation efforts, according to Jonathan Mosser, an assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine, who was an author on The Lancet report. See PDF] Winluck Shayo, the chief executive officer of AfyaTrack, a health tech organization that tracks maternal and child health among Swahili-speaking communities in Africa, says the COVID-19 pandemic should serve as a lesson for governments across the world on how to sustain essential health services – such as childhood immunization – during the pandemic.

Overcoming Vaccine Hesitancy is a Team Sport

In 2014, the New England Journal of Medicine conducted a study where they discovered that only 30% of patients trusted "medical leadership" but in the same study 70% of patients felt their physicians had high integrity and could be trusted (Natbony & Genies, 2019). Arizona's legislative body also signed into law a bill that prohibited mask mandates for students and teachers in public schools, effectively hampering schools' ability to provide additional measures to stop the spread of COVID-19. The law led school districts to file suit against the state and eventually led a Superior Court judge to rule the House bill was unconstitutional (Billeaud & Christie, 2021). There are five different predictors of vaccine hesitancy: 1) Risk conceptualization. 2) Mistrust of pharmaceutical companies. 3) How vaccines are scheduled. 4) How the vaccines might overwhelm the immune system. 5) The risk of vaccinating.

Working Together for Health Equity: How a Multidisciplinary, Community-Engaged Partnership Reframed Our Understandings of Pittsburgh's Maternal-Child Health Crisis

Appelt et al discusses how a multidisiplinary, community-engaged partnership reframed their understanding of Pittsburg PA's maternal-child health crisis. In spring 2020, COVID-19 quickly and disproportionately swept across the US' unequal and racially segmented social landscape, claiming the lives of many Black Americans. Amid this deepening public health crisis, the brutal murder of George Floyd by police sparked widespread protests and increased support for the Black Lives Matter movement (BLM). BLM calls the attention to structural racism and its many devastating effects, including the high numbers of US maternal and infant deaths disproportionately affecting African American and Black families. While recent discussions related to racial justice have primarily focused on urgent issues related to policing, the need for racial health equity, too, is dire.

Prevalence of Diabetes among Young and Adolescent Population in Australasian Region

Most of the results are restricted to single center reports with regard to the T1D. [...]there is the need for the wide scale assessment of the current models of prevention and treatment whether they are delivering the desired results for the reduction of the societal and the individual burden of type 1 diabetes. [...]a research was designed for the extraction of the clinical data from the Australasian region diabetes data network prospective diabetes registries and the inclusion criteria were the individuals with the t1D in the age group of 16 to 25 years at their last recorded healthcare visit with t1D duration of the one year. The study concluded that there was widespread and persistent sub-optimal glycemic control in the young people with t1d in the Australasian region and highlighted the imminent need for the better comprehension of the situation and devise ways and strategies for the healthcare services to support the improvement in the glycemic control in this group of the population4.

PROFESSIONAL UPDATE: THE JOURNAL OF THE HEALTH VISITORS' ASSOCIATION

The president of the Royal College of Paediatrics and Child Health, Dr Camilla Kingdon, said paediatricians were pleased that the government recognises that 'long delays can have a particularly significant impact on children as many treatments are age or developmental stage critical'. bit.ly/WAL_recovery_plan_NHS NEW STRATEGY FOR HEALTH AND SOCIAL CARE WORKFORCE Training, wellbeing, job satisfaction and fair work principles are at the heart of a new plan to shape Scotland's health and social care workforce over the next decade. Other recent attempts to boost NHS Scotland have seen more than 1000 additional healthcare support staff and almost 200 registered nurses from overseas recruited by Scottish health boards. bit.ly/SCT_HSC_ workforce_strategy MAKE NURSING AN ATTRACTIVE CAREER, SAYS CNO This was one of five priorities laid out by chief nursing officer (CNO) for Wales Sue Tranka at the CNO conference in Wales in April. The CNO also spoke about her visions and goals in the March/April issue of Community Practitioner. bit.ly/WAL_CNO_priorities 22,505 children feared to have suffered abuse and neglect in 2021-22 'We will engage with clinicians and the wider scientific community in Scotland to ensure that our work informed by a range of expertise'

‘It was a chance for us to remember why we became health visitors in the first place’: Award-winning nurse Emma Carey’s projects to support isolated families during the pandemic show the positive impact that health visitors have on vulnerable parents and their children

A nurse who set up innovative projects to support isolated families during the pandemic has demonstrated the hugely positive impact that the health visiting service can have on vulnerable parents and their children.

Covid-19 Pandemic and Impact On India's FP2020 Goals: Estimates and Reality

Family planning is now viewed as a developmental behavior. It not only improves maternal and infant health but also is directly linked to the overall well-being of the family. India has a high unmet need and the use of modern contraceptives is not satisfactory though it has improved a lot currently. Achieving the FP 2020 goals an important activity of the government. Covid 19 pandemic has stood as a barrier in family planning service delivery. Experts voiced concerns about rising unwanted pregnancies, unsafe abortions during the pandemic, and the rise of maternal and infant mortality during the post covid period due to falls in contraceptive services. Perceived thoughts and reality is discussed.

Heated tobacco product use and hypertensive disorders of pregnancy and low birth weight: analysis of a cross-sectional, web-based survey in Japan

ObjectivesKnowledge on the impact of heated tobacco product (HTP) use in pregnant women with associated maternal and neonatal risks for hypertensive disorders of pregnancy (HDP) and low birth weight (LBW) is limited. We aimed to assess the status of HTP use among pregnant women in Japan and explore the association of HTP use with HDP and LBW.DesignCross-sectional study.SettingData from the Japan ‘COVID-19 and Society’ Internet Survey study, a web-based nationwide survey.ParticipantsWe investigated 558 postdelivery and 365 currently pregnant women in October 2020.Primary and secondary outcome measuresInformation on HDP and LBW was collected from the postdelivery women’s Maternal and Child Health Handbooks (maternal and newborn records). We estimated the age-adjusted ORs and 95% CIs of ever HTP smokers for HDP and LBW and compared them with those of never HTP smokers in a logistic regression analysis.ResultsThe prevalence of ever and current HTP use were 11.7% and 2.7% in postdelivery women and 12.6% and 1.1% in currently pregnant women, respectively. Among currently pregnant women who were former combustible cigarette smokers, 4.4% (4/91) were current HTP smokers. Among postdelivery women, ever HTP smokers had a higher HDP incidence (13.8% vs 6.5%, p=0.03;age-adjusted OR=2.48, 95% CI 1.11 to 5.53) and higher LBW incidence (18.5% vs 8.9%, p=0.02;age-adjusted OR=2.36, 95% CI 1.16 to 4.87).ConclusionsIn Japan, the incidence of ever HTP use exceeded 10% among pregnant women, and HTP smoking may be associated with maternal and neonatal risks.