How Has The COVID-19 Pandemic Affected Child Health Tracks?

Objective: It is aimed to detect the disruptions experienced in Healthy Child Follow-ups in the COVID-19 Pandemic. Material and Methods: The files of the patients who applied to the Healthy-Child Outpatient Clinic of our hospital from March 14, 2020, when the curfews began in Turkey, until March 31, 2021, were reviewed retrospectively. Results: During this period, 5036 patients applied for healthy-child follow-ups. It was found that 1.44% (n=73) of these patients missed some of their follow-ups. Of these patients, 35.6% were citizens of the Republic of Turkey, 32.9% were Syrian, and 31.5% were Iraqi refugees. 78.1% of the patients were not taking iron prophylaxis. Hip ultrasonography was not performed in 72.6% of the patients. It was found that 80.8% of the patients were missing vaccination and other follow-ups, while 31.5% were only missing vaccination while other follow-ups were complete. It was determined that 38.3% of the patients did not have more than one vaccination, and 12.3% did not have any vaccination since birth due to vaccine rejection. There was no difference between Turkish citizens and Syrian or Iraqi citizens in terms of missing follow-ups (p=0.213). In terms of missing vaccinations, it was determined that Syrian and Iraqi refugees missed more vaccinations (p<0.001). Conclusion: In order to raise healthy children, it is thought that public should be informed about the importance of followups, and patients should be guided without delay in every case of missing follow-ups.

Zinc deficiency: an overlooked cause of poor health

Micronutrient deficiencies are common globally. George Winter looks at the effect of zinc deficiency on health in various groups of people

202. A Mixed Method Investigation of Parent-Adolescent Communication about Mental Health

Purpose: The purpose of this study is to explore how adolescents and their parents/guardians communicate about mental health in order to generate ideas for potential interventions that seek to improve parent-adolescent communication. Methods: Twenty adolescents aged 12 to 19 with a history of depression and/or anxiety were recruited from an adolescent and young adult medical clinic affiliated with an academic medical center in Pittsburgh, PA. Adolescent participants were asked to enroll in the study alongside one parent or guardian. Following enrollment, both adolescents and their parents/guardians completed a survey including a Barriers to Adolescents Seeking Help Scale and Parent-Adolescent Communication Scale. Two sample t-tests were performed to determine if a significant difference existed between overall adolescent and parent/guardian scores. Separate, semi-structured interviews were conducted in person and via Zoom for both adolescents and parents/guardians. Interviews were transcribed verbatim and separate, data-driven codebooks for adolescents and parents/guardians were developed based upon themes that emerged after initial read-through of interview transcripts. Qualitative data was analyzed via template analysis. Double coding was utilized for half of the adolescent and parent/guardian interviews and Cohen's Kappa scores were calculated for each code;the average score was 0.90, indicating substantial agreement. The rest of the interviews were coded by one coder. Results: Qualitative analysis revealed themes concerning adolescents' reluctance to communicate with parents about mental health, including fear of judgement, apprehension about parents' dismissal or misinterpretation of mental health symptoms, and worry about burdening parents. Additionally, a theme of adolescents' preference for communicating with peers was identified, often due to shared experiences. Several themes were identified that promoted parent-adolescent communication, including the disclosure of familial mental health conditions, which led to greater mutual understanding, as well as reduced mental health stigma: "She [mother] talks to me about her own mental health, which makes me feel comfortable talking to her about mine”. Psychotherapy was described by both parents and adolescents as promoting the development of more effective communication strategies. A theme of increased communication about mental health during the COVID-19 pandemic was found, many times due to a greater amount of family time. Both parents and adolescents indicated that an established, trusting relationship was critical to the success of a conversation about mental health. Quantitative analysis revealed that parents reported a significantly higher quality of communication with their child (79.80, p = 0.04) than adolescents reported with their parent (71.75). Additionally, parents reported significantly lower barriers to help seeking (18.60, p = 0.002) than adolescents (24.00). Conclusions: The themes identified in this study lend insight into how communication between parents and adolescents about mental health might be improved and provide targets for potential educational interventions. Anti-stigma campaigns directed at parents may assist in disclosure of familial mental health history and assist in diminishing adolescents' apprehension of parents' dismissal or misinterpretation of mental health symptoms. For parents and adolescents with poor communication, targeted combined psychotherapy sessions can be encouraged as a means to facilitate conversation about mental health and establish trust. Sources of Support: National Institute of Mental Health K23MH111922

Preliminary evaluation of a multicomponent youth development program for siblings separated by foster care: pandemic related impacts to service delivery and youth well-being

A preliminary evaluation of a multicomponent youth development program for siblings in foster care was conducted prior to and during the COVID-19 pandemic. Pretest posttest measures of youth well-being were collected from sixteen youth, caregivers, and caseworkers over a six-month period. Caregivers reported increased internalizing and externalizing behaviors, sibling relationship difficulties, prosocial behavior, and resilience during the study period. Youth reported reduced school engagement, increased resilience, and prosocial behavior. In-person sibling programming was associated with increased prosocial behavior. Virtual sibling programming was associated with lower hyperactivity, increased prosocial behavior, and increased emotional problems. Implications for research and practice are discussed.

Food Insecurity and Food Allergy in Children of an Urban Minority Community: A Cross-Sectional Study

Rationale: Childhood food insecurity was exacerbated during the COVID-19 pandemic, with burdens falling disproportionately on minority children. This study aims to describe the prevalence of food insecurity in food-allergic children of an urban minority community and examine the association between food insecurity and food allergy. Methods: We conducted a retrospective review of electronic medical records of all patients aged 6 months to 18 years seen in a primary care pediatric clinic at NYC Health + Hospitals/Kings County, from 10/2020 to 06/2022. Pediatricians at this clinic in Central Brooklyn routinely screen for food insecurity using the Hunger Vital Sign™, a validated tool recommended by the American Academy of Pediatrics. Data was collected based on ICD-10 diagnosis codes for food insecurity (Z59.41) and food allergy (Z91.01). Logistic regression was used for analysis. Results: Among 7,856 children included in the study, 84.9% were Black or African American, 6.0% Hispanic/Latinx, 1.2% white, and 1.1% were Asian/Pacific Islander. Of 275 children diagnosed with a food allergy by a primary care pediatrician, 4.7% screened positive for food insecurity. Of 7,581 children without a diagnosed food allergy, 2.6% screened positive for food insecurity (p=0.029). Children with food allergy (adjusted odds ratio: 2.14, 95% confidence interval: 1.19-3.85) were significantly more likely to be food insecure than those without a food allergy, adjusted for age, gender, and race/ethnicity. Conclusions: Childhood food allergy is associated with increased odds of food insecurity. This study highlights the importance of assessing and addressing food insecurity in children with food allergies.

Challenges to social work professionalism during the COVID-19 pandemic: a qualitative analysis of child protective workers' perspectives

The pandemic of the Coronavirus disease 2019 (COVID-19) has affected millions of children and families worldwide, disrupting their daily lives and impacting the ability of Child Protective Services (CPS) to respond to children in need. This small-scale study involving 23 child protective workers from local governments in different regions of Estonia used in-depth, semi-structured interviews to explore child protection work with children in need during the COVID −19 pandemic. Issues resulting from the pandemic that could cause detriment to children was identified. For some children, the COVID-19 crisis has eliminated the possibility of any investigation due to social distancing, which led to information deficit, regardless of the character or level of apparent risk to the child. Children's rights to protection and continuity of care have been threatened, as urgently needed services and other CPS protective measures have been hindered or postponed due to lockdown. Examples of some services that continued online were provided. Furthermore, COVID-19 pandemic created new expectations and roles for CPS, questioning the fundamental goals of child protection work. Nevertheless, child protective workers have demonstrated creativity in finding ways to reach children in need during the pandemic, for example by setting up a crisis hotline, a crisis home. © 2023 GAPS.

Coronavirus Disease 2019 in Pediatric Emergency Room: The Dilemma of Cycle Threshold Value

Objective The havoc caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic could not have been predicted, with children being affected worldwide. Testing for SARS-CoV-2 infection helped to define the interventions against the spread of the disease. A polymerase chain reaction (PCR) test has been the mainstay of diagnostic testing. Cycle threshold (Ct) is a semiquantitative value that indicates approximately how much viral genetic material was in the sample. The aim of this study was to evaluate the impact of Ct values among children with SARS-CoV-2 infection. Methods Between May 3, 2020 and August 3, 2020, clinical laboratory input and the data of patients with positive SARS-CoV-2 PCR tests were retrospectively studied. Results There was no statistical significance between Ct values and the patient's status, symptoms other than fever, or other laboratory findings. However, the Ct value of patients who had symptoms at the time of admission to the hospital was significantly lower. Conclusion In this study, symptomatic patients had lower Ct than asymptomatic patients that reflected higher viral loads. In evidence-based medicine applications, it might be useful to correlate the clinical history with laboratory test results. Even symptomatic patients with high Ct value coinfections, or an alternative acute infection, should be considered. © 2022. Thieme. All rights reserved.

The Feasibility of a Pediatric Distance Learning Curriculum for Emergency Nurses During the COVID-19 Pandemic: An Improving Pediatric Acute Care Through Simulation Collaboration

To develop and evaluate the feasibility and effectiveness of a longitudinal pediatric distance learning curriculum for general emergency nurses, facilitated by nurse educators, with central support through the Improving Acute Care Through Simulation collaborative. Kern's 6-step curriculum development framework was used with pediatric status epilepticus aimed at maintaining physical distancing, resulting in a 12-week curriculum bookended by 1-hour telesimulations, with weekly 30-minute online asynchronous distance learning. Recruited nurse educators recruited a minimum of 2 local nurses. Nurse educators facilitated the intervention, completed implementation surveys, and engaged with other educators with the Improving Pediatric Acute Care through Simulation project coordinator. Feasibility data included nurse educator project engagement and curriculum engagement by nurses with each activity. Efficacy data were collected through satisfaction surveys, pre-post knowledge surveys, and pre-post telesimulation performance checklists. Thirteen of 17 pediatric nurse educators recruited staff to complete both telesimulations, and 38 of 110 enrolled nurses completed pre-post knowledge surveys. Knowledge scores improved from a median of 70 of 100 (interquartile range: 66-78) to 88 (interquartile range: 79-94) (P =.018), and telesimulation performance improved from a median of 60 of 100 (interquartile range: 45-60) to 100 (interquartile range: 85-100) (P =.016). Feedback included a shortened intervention and including physician participants. A longitudinal pediatric distance learning curriculum for emergency nurses collaboratively developed and implemented by nurse educators and Improving Pediatric Acute Care through Simulation was feasible for nurse educators to implement, led to modest engagement in all activities by nurses, and resulted in improvement in nurses' knowledge and skills. Future directions include shortening intervention time and broadening interprofessional scope.

Asthma Management Among Children With Food Allergy in the FORWARD Study During COVID-19

Rationale: Asthma remains a significant comorbidity among children with food allergy (FA). Longitudinal data on the course of asthma in this population, particularly during the COVID-19 pandemic, is lacking. This study aims to describe asthma management and control among children with FA during the COVID-19 pandemic. Methods: Children with FA (≤12 years old at enrollment) were enrolled into FORWARD, a prospective, observational cohort study. Data from participants with FA and asthma who completed a 12-month and 24-month post-enrollment asthma therapy assessment were included (n=125). Surveys were administered between January 2019 - July 2022, which includes the onset and duration of COVID-19. Responses to the same questions at the two time points were analyzed using tests of exact symmetry. Results: Compared to the 12-month survey, caregivers at the 24-month survey more frequently reported that their children were not using their inhaler for quick relief (1.6% vs. 9.4%, p = 0.008) and were using their medication incorrectly (3.2% vs. 8.7%, p = 0.003). They less frequently reported that they were unsure whether their medications were useful (3.2% vs. 0.0%, p = 0.016). A similar distribution was observed when non-Hispanic Black and non-Hispanic White participants were compared. No significant differences were evident when comparing symptoms. Conclusions: The symptom burden of asthma remained stable even during the pandemic. However, during this time, children with asthma were less likely to need a rescue inhaler and to be adherent to their maintenance regimen. Further longitudinal research on asthma management is necessary to better understand the potential impact of COVID-19.

Safe In and Out of the Car

Our cars make our everyday life much easier. With their help, in a day full of programs, we can get anywhere on time without carrying our packages on our own. In our rushing world, there is the probability that even if we have enough time to get there somewhere, we will hurry, which leads to inattention or worse case an accident. Car manufacturers have a huge amount of research projects to install driver-assistance safety electronics into our cars that, even if they are not driving, instead of the driver, alert to an accident and help to avoid a stutter or a life-threatening accident. According to the Hungarian Central Statistical Office (KSH), research on car manufacturers has brought significant results, as while in 1990 there were nearly 37,000 accidents involving personal injuries on the roads, in 2020 there were only 18,000 such accidents. However, in addition to these active and passive safety features, we need to be aware of and follow the written and unwritten rules of road safety. However, the number of passenger cars has increased so significantly in the last 20–25 years—but especially in the last two years due to the coronavirus epidemic—as roads are characterized by such a high degree of congestion that pedestrians and cyclists require much more attention from participants. This way it is important children receive proper education on the rules of walking or cycling at nursery school and preschool age. The aim of the study is to enumerate and present the platforms that help children to learn, know and deepen the rules of safe traffic. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Development of respirator design for children using bamboo-based activated carbon filter and bipolar ionization

This paper proposes a respirator for children integrated with bamboo-based activated carbon filters and bipolar ionization as the sterilizer to increase protection from Covid-19 and other pathogens. The respirator, named as Bion-Kids, was designed based on the children's head-and-face anthropometry from direct measurement. The duration of sterilization process is controlled based on the activities, which are classified using the Recurrent Neural Network (RNN) model with dataset acquired from the accelerometer. Manufacturing process of the main body prototype comprises heat bending and 3D printing. The bamboo-based activated carbon filter was synthesized by applying heat and pressure at the strewed activated carbon particles on the N95 filter. Observation using scanning electron microscope showed the ability of the bamboo-based activated carbon filter to adsorb and trap the particles. Result of the qualitative fit test and questionnaire survey indicated that Bion-Kids is suitable and comfortable for the children's face. The result of filtration and bipolar ionization sterilization system analysis have also met the ISO14698 standard by not showing any infiltration of microorganisms on the blood agar media. This device may become an early-stage personal protective equipment against the transmission of Covid-19 and other pathogens. © 2022 THE AUTHORS

Safety of and antibody response to the BNT162b2 COVID-19 vaccine in adolescents and young adults with underlying disease

Background: Data are limited regarding the safety of and antibody response to the BNT162b2 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger ribonucleic acid vaccine in adolescents and young adults with underlying disease. Methods: This prospective observational study enrolled patients age 12–25 years with chronic underlying disease who received 2 doses of BNT162b2. A 18-item questionnaire was used to assess adverse events within 7 days post-vaccination, and data regarding severe adverse events were collected from electronic medical records. An antibody titer for the receptor-binding domain of the spike protein in SARS-CoV-2 was used to assess antibody response after the second vaccine dose. Results: Study participants were 429 patients (241 [56.2%] age 12–15 years;188 [43.8%] age 16–25 years). The most common underlying diseases were genetic or chromosomal abnormalities and/or congenital anomalies, followed by endocrine or metabolic diseases;32% of participants were immunocompromised. Severe adverse events were observed after the second dose in 1 (0.4%) patient age 12–15 years and in 2 (1.1%) patients age 16–25 years;all patients recovered. Seropositivity after the second vaccine dose was 99.0%. The geometric mean antibody titer was higher in patients age 12–15 years versus 16–25 years (1603.3 [1321.8–1944.7] U/mL vs. 949.4 [744.2–1211.0] U/mL). Compared with immunocompetent patients, immunocompromised patients had a lower antibody titer (2106.8 [1917.5–2314.7] U/mL vs. 467.9 [324.4–674.8] U/mL). Conclusions: Vaccination with BNT162b2 was acceptably safe and immunogenic for adolescents and young adults with underlying disease. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases