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Background: In the COVID-19 epidemic, pregnant women, fetuses, and newborns are a high-risk population that is more susceptible than the general population. These groups are more susceptible to serious respiratory illnesses and pneumonia because of their weakened immune systems. This study compared maternal and neonatal outcomes in postpartum women with COVID-19 with similar healthy women at the hospital. Method(s): In this retrospective cohort study, the characteristics of 100 pregnant women with COVID-19 (confirmed by a positive PCR test during pregnancy) were compared to 150 healthy pregnant women who were referred to Fatemieh Hospital in Hamadan from March, 2020 to February, 2021. The maternal and neonatal outcomes were collected from the medical record of patients and analyzed using SPSS software (Ver. 26). Result(s): No significant differences were observed in the average ages (+/- standard deviation) of the two groups of COVID-19 (30.25 +/- 6.24 years) and healthy (29.48 +/- 6.73 years) women. In this study, pregnant women were infected with COVID-19 from weeks 7 to 41 of gestation, with a median infection time of 35 weeks. The odds ratio (95% confidence interval) of pre-eclampsia and preterm birth was significantly higher in women with COVID-19 than in healthy women with the following values 2.79 (1.61, 7.34) and 22.26 (2.86, 173.33), respectively. Conclusion(s): Pregnant women suffering from COVID-19 had considerably greater rates of gestational issues, neonatal difficulties, pre-eclampsia, and premature delivery, according to the findings of this study. During epidemics, it is advised that pregnant women and their newborns receive more basic care.Copyright © 2023 Bentham Science Publishers.
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Study Objective: Global burden on healthcare system by COVID-19 patients had a significant impact on non-COVID diseases treatment.1-3 This study compares the characteristics of adnexal masses surgery in girls and adolescents during the 2020 and 2021 COVID-19 pandemic with the homologous non-COVID-19 period in 2018 and 2019. Design(s): A retrospective observational study using medical records of girls under 19 years of age with surgery of adnexal masses. Patients with neonatal cysts and patients with differences of sex development were excluded from the study. Setting(s): Mother and Child Health Care Institute of Serbia 'Dr Vukan Cupic' (Belgrade, Serbia). The study was approved by the Clinical Research Committee of the Institution. Participant(s): Patients (N=130) who had surgery for adnexal masses, of whom 49 with ovarian torsion. Interventions and Main Outcome Measure(s): Patients were diagnosed in the Institute, but also in other health institutions that referred them for final treatment to the Institute. Surgery was usually performed by gynecologists, and sometimes by pediatric surgeons as urgent abdominal operations. Open or minimally invasive approaches were used, depending on the medical indications, surgeon's experience, and the circumstances related to the organization of work in the COVID-19 period. Results and Discussion: All data of the main outcome measures are shown in Table 1. In the COVID-19 period, the time from the onset of symptoms to diagnosis is statistically significantly longer than in the non-COVID-19 period (t=2,151;p=0,034). In the COVID-19 period, there were statistically significantly fewer adnexal masses surgery than in non-COVID-19 period (chi2=8,892;p=0,003). There was also decrease in number of surgically treated patients with twisted adnexal masses, but without statistical significance. Ovarian preservations in benign adnexal processes were statistically more frequent in the non-COVID-19 period (chi2=6,575;p=0,01). There was increase in percentage of adnexectomies in the COVID-19 period. During the COVID-19 period, the number of laparoscopic procedures decreased significantly, which could be associated with the technical issues and deficit in medical staff during that period (chi2=50,915;p < 0,001). Conclusion(s): Advice on reducing non-necessary visits to the doctor given to patients during the COVID-19 pandemic led to a decrease in number of surgical procedures for adnexal masses in girls and adolescents. This also caused prolonged time to diagnosis, but did not affect the interval from the symptoms onset to operation. Reduction of number of laparoscopic procedures and ovarian preservation in benign adnexal diseases indicates a decline in the quality of health care during COVID-19 pandemic. [Formula presented]Copyright © 2023
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Introduction. The quality and availability of medical care for children of country depends on the quantity of pediatricians and the quality of their training. This is especially important in the context of the COVID-19 pandemic. Purpose. To assess the state of staffing and training of pediatricians in healthcare institutions of Ukraine in comparison with same world and European indicators and determine the necessary measures for improvement. Materials and methods. For this research we have used methods of the system approach and epidemiological analysis of data from GU "Center of medical statistics of the Ministry of Health of Ukraine" for eleven years (2009-2020). Results. According to the level of training of doctors, including pediatricians, Ukraine has reached total rank of 38th in the European region. Such dynamics of changes in the availability of human resources for healthcare is accompanied by reductions in the volume of training of pediatricians since 2017. According to the Center for Medical Statistics from 31.12.2020 the Ministry of Health of Ukraine provided medical care in pediatric health care institutions of all forms of ownership with the help of 8812 pediatricians, of whom 7925 (90%) were worked in primary health care centers, clinics and hospitals of the Ministry of Health of Ukraine. This numbers are significantly lower than in 2009, when there were 12 450 practicing pediatricians. As we see, the number of pediatricians has decreased by 15.4% for the last 7 years. Conclusion. Importance of the problems with personnel in pediatric healthcare had shown us a necessity of radical government management decisions for improvement of the situation with the training of pediatricians and preventing of risks of limitations of access to pediatric medical assistance and deterioration of quality of medical care for children in the country. This might be possible with rational planning of the state necessity in the training of pediatricians and significant improvement of their social protection and working conditions. Possible steps should include increasing pediatrics necessity state order up to 1000 pediatricians in state medical universities annually by targeted regional medical personnel necessity order, taking into account the needs of the regions and reviewing their training programs in accordance with the modern requirements.Copyright © 2022, Professionalnye Izdaniya. All rights reserved.
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Introduction. The quality and availability of medical care for children of country depends on the quantity of pediatricians and the quality of their training. This is especially important in the context of the COVID-19 pandemic. Purpose. To assess the state of staffing and training of pediatricians in healthcare institutions of Ukraine in comparison with same world and European indicators and determine the necessary measures for improvement. Materials and methods. For this research we have used methods of the system approach and epidemiological analysis of data from GU "Center of medical statistics of the Ministry of Health of Ukraine" for eleven years (2009-2020). Results. According to the level of training of doctors, including pediatricians, Ukraine has reached total rank of 38th in the European region. Such dynamics of changes in the availability of human resources for healthcare is accompanied by reductions in the volume of training of pediatricians since 2017. According to the Center for Medical Statistics from 31.12.2020 the Ministry of Health of Ukraine provided medical care in pediatric health care institutions of all forms of ownership with the help of 8812 pediatricians, of whom 7925 (90%) were worked in primary health care centers, clinics and hospitals of the Ministry of Health of Ukraine. This numbers are significantly lower than in 2009, when there were 12 450 practicing pediatricians. As we see, the number of pediatricians has decreased by 15.4% for the last 7 years. Conclusion. Importance of the problems with personnel in pediatric healthcare had shown us a necessity of radical government management decisions for improvement of the situation with the training of pediatricians and preventing of risks of limitations of access to pediatric medical assistance and deterioration of quality of medical care for children in the country. This might be possible with rational planning of the state necessity in the training of pediatricians and significant improvement of their social protection and working conditions. Possible steps should include increasing pediatrics necessity state order up to 1000 pediatricians in state medical universities annually by targeted regional medical personnel necessity order, taking into account the needs of the regions and reviewing their training programs in accordance with the modern requirements.Copyright © 2022, Professionalnye Izdaniya. All rights reserved.
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Background: The COVID-19 pandemic has had wide effects on child health globally. Increased prevalence of childhood obesity has been observed during the pandemic. The absence of a formal societal lockdown during the pandemic, made Sweden stand out compared to other countries. Several studies have shown increases in obesity in children during the COVID-19 pandemic. These studies mainly focused on school age children and adolescents in countries that underwent periods of societal lockdown. Child health nurses in socioeconomically deprived areas in Sweden have signalled a rise in childhood obesity during the pandemic, however not yet analysed scientifically. This study hence aimed to examine changes in BMI among pre-school children in Sweden before and during the COVID-19 pandemic. Method(s): Retrospective population based cross-sectional study, with longitudinal follow-up for a portion of the children, data was obtained from the national quality register for child health care, BHVQ. The study included 25049 children from three Swedish regions, with growth measures at three- (n=16237), four- (n=14437) and five-years of age (n=11 711). Care Need Index was used as a socioeconomic parameter at health centre level. BMI was calculated and categorized based on sex-specific BMI-for-age in months (IOTF body mass index cut-offs for thinness, overweight and obesity). Result(s): There was an increase in BMI in children aged three (p=0.028), and four (p <.001) during the COVID-19 pandemic. Obesity in three-year-old girls increased from 2.8% to 3.9%. Fouryear- olds increased in obesity (both sexes), overweight (girls) and the prevalence of underweight decreased in boys. A lower proportion of girls had a normal weight status during (80.9 %), compared to before the COVID-19 pandemic (82.6 %) (p=0.049), while no difference in normal weight status was found in boys the same age (p = 0.977). No change in BMI was observed in five-year-olds. Children in areas with the lowest socioeconomic status had higher risk of obesity, increasing from 2.4% to 4.4% during the pandemic, overweight increased in these areas from 9.5% to 12.4%. Conclusion(s): Overweight and obesity increased among threefour year old Swedish children, especially for children attending child health centres in areas with lower socioeconomic status. The COVID-19 pandemic is likely to have affected health behaviours negatively in Swedish pre-school children. Our results expose the need for extended efforts directed to prevent childhood obesity, especially targeting lower socioeconomic areas.
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BACKGROUND AND AIM: The novel coronavirus disease 2019 (COVID-19) can be transmitted to clinicians involved in their care, in spite centers for disease control and prevention (CDC) had put standards for precaution but unfortunately several health care providers had lost their lives around the world. OBJECTIVE(S): To Evaluate virtual/ in-person medical simulation training about airway management of suspected/ confirmed COVID-19 pediatric patients on pediatric health care provider in KFMC METHOD: cross section study done on health care providers at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia through google form questioner. Inclusion criteria: health care providers involved in pediatric airway management for confirmed/suspected Covid 19 patients, whether they attended virtual/ in-person simulation training courses. So we decided to transmit the guideline on airway management into simulation training courses to be run into in-situ simulation, then when in situ area was converted into covid 19 care area we video taped it and added as QR barcode to the guideline. RESULT(S): 85 responders, 55.4% nurses, 12.3% consultant, 14% fellows and asistant consultants, 2% medical residents, and 2% respiratory therapist. 91% used proper PPE, 80% followed learned precautions during intubation while 91% during extubation, 75.8% used video laryngoscope. 91.3% confirmed that simulation training/video demonstration had helped them in airway management. CONCLUSION(S): Simulation training either hands on or video demonstration on proper PPE precautions and Airway management for confirmed/suspected COVID-19 Plus Adding the video demonstration barcode to the guideline of institute, had safely improved the knowledge and the skills for medical practitioner. further larger studies are recommended to measure sustainability.
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The Covid-19 pandemic has affected all aspects of our lives. Women in the perinatal period have unique needs, demanding health and safety guidelines regarding the risks associated to social isolation. The objective was to know the women's experience during pregnancy or puerperium in the pandemic while being cared at a hospital. Qualitative study referenced on concepts of integrality of care and daily life. Eighteen pregnant and postpartum participated. Three themes emerged: Repercussions on pregnancy and puerperium, repercussions on practical life, and coping strategies created by women. The reports reveal different repercussions of the pandemic in the lives of women and their families, also the strategies and precautions used to mitigate its adverse effects. We suggest directing preventive measures and public health policies to prioritize pregnant and postpartum women, recognizing and embracing subjective issues involved at this moment in women's lives. Copyright © 2022, Fundacao UNI Botucatu/UNESP. All rights reserved.
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Background: Tanzania as other parts of the world experienced several waves of Corona Virus Disease (COVID-19). However, little is known on the extent to which the disease has affected access and delivery of maternal and child health services. The study aims to explore and measure the effects of COVID-19 and of the related response measures on access and utilization of maternal and child health services in Tanzania. Method(s): This cross-sectional study was conducted in Mjini Magharibi and Chake Chake in Zanzibar and Ilala districts in the mainland, representing urban as well as rural areas in Tanzania. It employed a mixed methods study design using both quantitative and qualitative data collection techniques where we conducted 34 in-depth interviews with key informants and influential community persons, 60 semi-structured interviews with household members, complemented with 11 focus group discussions with community leaders, members, and health care providers. Result(s): Study participants from both settings reported to have observed the effects of COVID-19 on maternal and child health attributed to measures that were taken to contain the pandemic. COVID-19 prevention and treatment services were given more priorities which jeopardized other services. Scarcity of medical commodities were widely reported, including vaccines, equipment, and other medical supplies due to ban of international travels. There was rescheduling of medical appointments;shorter time for delivering mothers to stay in the health facility;rescheduling of reproductive and child health clinic from monthly to quarterly appointments and reduced time for health education and child growth monitoring. Fear of getting infected with corona virus was reported by mothers and care providers. Our informants linked such effects to a lower uptake of antenatal and postnatal, postnatal, family planning and immunisation services and institutional deliveries. Conclusion(s): The effect of directing efforts to COVID-19 and its measures taken to restructuring the health system led to reduction in Reproductive and Child Health (RCH) services delivery. Hence, preparedness plan for balancing maternal and child health (MCH) service provision need to be worked out ready for implementation to maintain standards and quality of service provided to mothers and children in future pandemics in order to meet defined international and national goals.
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Background: Millions of children in low- and middle-income countries (LMICs) die each year from preventable illness. Evidence-based guidelines (EBGs) from the World Health Organization reduce this amenable burden of disease, but utilization among healthcare workers is variable. Existing inperson training strategies like Emergency Triage Assessment and Treatment (ETAT) improve provider knowledge, adherence to EBG, and patient outcomes but are limited by labor intensity and implementation costs. Leveraging increasing mobile internet access in LMICs could speed dissemination of EBG to medical providers in a way that overcomes the limitations of in-person training. Adaptive electronic learning (AEL), which uses digital algorithms to deliver custom activities to individual learners, is shown to outperform traditional training among healthcare workers in high-income countries but is yet to be evaluated in LMICs. We propose to address the existing gap in LMIC healthcare worker training through a mixed-methods feasibility trial of an AEL curriculum designed to deliver EBG training to medical providers in Tanzania. Methods: Curriculum development: We sought to create a multi-module AEL course addressing context-specific gaps in healthcare worker training. A review of leading regional causes of pediatric mortality was performed to identify priority content areas. Source material was. selected to reflect EBG use at our study site. Training modules were created by pediatricians with expertise in both AEL and EBG. Module approval occurred through an iterative process of review by local stakeholders and international EBG experts. Mixed-methods feasibility trial: We are undertaking a parallelgroup, double-blinded randomized trial to evaluate our AEL curriculum (Figure 1). 30 medical interns will be randomized to either an adaptive or a non-adaptive electronic learning curriculum. The primary outcome is knowledge acquisition, defined by standard mean difference in pre- and postknowledge assessments scores between groups. Qualitative evaluation of the implementation process will be based on normalization process theory. All aspects of recruitment, quantitative, and qualitative data collection will be done remotely in accordance with local social distancing standards and international travel restrictions. Results: Curriculum publication: Our process of content identification, topic selection, and module development yielded an 11-module AEL curriculum. Priority content areas include the triage of acutely-ill children as well as the assessment, diagnosis, and management of pediatric pneumonia and hypovolemic shock based on current World Health Organization and Tanzanian guidelines (Figure 2). Mixed-methods feasibility trial: At present, we have enrolled 17 medical interns. Pre-knowledge assessment scores range from 6-60%. One intern has completed the curriculum to date and experienced a 30% increase in knowledge. Conclusion: We expect to complete this feasibility trial by August of 2021. Findings will inform the design of a large-scale implementation trial that will support the development of innovative solutions and low-cost implementation strategies for improving the care of seriously-ill children worldwide.
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Background: Children are more vulnerable to natural disasters. They depend on adults for protection, prevention, and mitigation of adverse effects. From the preparedness stages to the response and mitigation, the pediatricians can play an important leadership role identifying and prioritizing the immediate and long-term needs of this population and helping to implement strategies to mitigate the impact of natural and anthropogenic disasters on the health and well-being of children and their families. Puerto Rico has experienced multiple challenges during in the last 4 years, including 2 major hurricanes, a prolonged earthquake sequence, and the COVID pandemic, to which pediatricians actively responded collaborating in recovery, mitigation, and preparedness. Methods: The leadership of the Puerto Rico Chapter of the American Academy of Pediatrics (PRAAP) coordinated activities to identify the needs and priorities of infant, children, adolescents, and their families. These activities included visits to the affected communities and matching the needs with healthcare services and basic needs donations. For the need's assessment, in-person visits were performed, to several official and improvised shelters. Pediatricians interviewed families and children and met with government officials and response personnel for the initial assessment and to advocate for children's health. Multiple PRAAP meetings were performed to develop strategies and ideas and coordinate the response. Results: In collaboration with stakeholders, pediatricians helped in the development and implementation of multiple response, recovery, and mitigation strategies. PRAAP established innovative communication venues among its members (including chats and electronic media platforms);conducted and delivered, temporary in-kind pediatric health care clinics in the most affected communities;offered guidance on best practices to groups working on disaster relief and mitigation efforts;offered guidance, and established collaboration with local and federal response agencies;and provided support and opportunities to increase capacity to pediatricians and other healthcare providers. Multiple educational activities were conducted in-person and virtually to clinicians, health and government officials, educators and caretakers and families. In addition, the PRAAP Chapter developed and distributed evidence-based educational materials to facilitate the education process. Some topics addressed include management and prevention of common conditions which may occur living in overcrowded conditions after a disaster, safe sleep, safe infant feeding, use of sunscreen and mosquito repellent in children, injury prevention, management of asthma, infection control and prevention, and the management of stress, among others. These efforts impacted families in all regions of the island. Conclusion: The initiatives of the PRAAP leadership in response to the emergent disasters, helped families with children, community leaders and other collaborators identify critical strategies that contributed to mitigate the challenges. Pediatricians have the knowledge to advocate for children's needs and guide in identifying priorities to address.
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Relational experiences during infancy and early childhood are key drivers for building health, social emotional development, and learning capacities, each vital for wellbeing. The U.S. child health sectors share a commitment to universal health promotion, prevention and early intervention, and a growing enthusiasm for the research-affirmed primacy of caregiver-child interactions during the critical first 1000 days of life. Given our nation's growing children's mental health crisis, racial justice awakening and the need to reimagine equitable supports for young families post-COVID19, the child health sectors seek new tools and clinical approaches that blend science-to-practice innovations with co-developed activities that are meaningful to families. This special section brings together papers about a journey of co-discovery between researchers, clinicians, and parents during the development and refinement of new video- and interview-based dyadic relational screening and monitoring tools. The collection of papers addresses a range of topics including early relational health (ERH), development and validation of the Early Relational Health Screen, its application within research and clinical settings, and thoughtful discussions from multiple perspectives. Informed by the diversity informed tenets, this journey highlights not only science-informed approaches, but also co-development with families of equitable approaches to understanding and serving children and their caregivers.
Las experiencias en las relaciones durante la infancia y la temprana niñez son conductores claves para fortalecer la salud, el desarrollo socio-emocional y las capacidades de aprendizaje, todas las cuales son vitales para el bienestar. Los sectores de salud infantil en los Estados Unidos comparten un compromiso para promover globalmente la salud, la prevención y la temprana intervención, así como un creciente entusiasmo por la primacía de las interacciones entre quien presta el cuidado y el niño, tal como las reafirma la investigación, durante los críticos primeros mil días de vida. Dada la creciente crisis de salud mental infantil de nuestro país, el despertar de la justicia racial y la necesidad de volver a conceptualizar los apoyos equitativos para familias jóvenes después del Covid-19, los sectores de salud infantil, buscan nuevas herramientas y acercamientos clínicos que mezclan las innovaciones de la ciencia a la práctica con actividades desarrolladas en conjunto que resultan significativas para las familias. Esta sección especial presenta artículos acerca de una trayectoria de descubrimiento en conjunto entre investigadores, profesionales clínicos y padres durante el desarrollo y afinamiento de nuevas herramientas de detección y supervisión de la relación diádica basadas en videos y entrevistas. El grupo de artículos aborda un número de temas que incluyen la temprana saludable relación (ERH), el desarrollo y la validez de la Detección de la Temprana Saludable Relación, su aplicación dentro de los campos de la investigación y clínicos, así como sensatas discusiones a partir de múltiples perspectivas. Respaldada por principios basados en la diversidad, esta trayectoria subraya no sólo los acercamientos cuya información proviene de la ciencia, sino también el desarrollo en conjunto con familias de equitativos acercamientos para comprender y servirles a los niños y a quienes los cuidan.
Les expériences relationnelles le bas âge et la petite enfance sont des facteurs clés pour la construction de la santé, le développement socio-émotionnel et les capacités d'apprentissage, qui sont indispensables au bien-être. Les secteurs de la santé de l'enfant aux Etats-Unis d'Amérique partagent un engagement envers la promotion universelle de la santé, la prévention et l'intervention précoce, et un enthousiasme grandissant pour la primauté des interactions personne prenant soin de l'enfant-enfant, affirmée par les recherches, durant les 100 premiers jours critique de la vie. Au vu de la croissance de la crise de santé mentale des enfants dans notre pays, du réveil de la justice raciale et du besoin de réimaginer les soutiens équitables pour les jeunes familles après le Covid19, les secteurs de la santé mentale de l'enfant cherchent de nouveaux outils et des approches cliniques qui mélange des innovations science-à-pratique avec des activités élaborées conjointement qui sont utiles et ont un sens pour les familles. Cette section spéciale rassemble des articles sur un voyage de codécouverte entre des chercheurs, des cliniciens, et des parents durant le développement et le perfectionnement d'un nouveau dépistage relationnel dyadique à partir d'entretiens et de vidéos, et d'outils de suivi. Cette collection d'articles porte sur un éventail de sujets y compris la Santé Relationnelle Précoce (SRP), le développement et la validation du Dépistage de Santé Relationnelle Précoce, son application dans des contextes de recherche et dans des contextes cliniques, et des discussions attentionnées de perspectives multiples. Informé par des principes fondés sur la diversité, ce voyage met en évidence non seulement des approches scientifiques mais aussi des co-développements avec des familles d'approches équitables à la compréhension et au service des enfants ainsi que des personnes prenant soin d'eux.