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1.
JMIR Pediatr Parent ; 2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1183772

ABSTRACT

BACKGROUND: The COVID-19 pandemic and containment measures have severely affected families around the world. It is frequently assumed that digital technologies can supplement and perhaps even replace services for families. This is challenging in conditions of high device and data costs as well as poor internet provision and access, raising concerns about widening inequalities in availability of support and consequent effects on child and family outcomes. Very few studies have examined these issues, including in low- and middle-income countries. OBJECTIVE: The study objectives were twofold, the first was to gather data on the impact of COVID-19 on families of young children using an online survey. The second was to assess the feasibility of using a data-free online platform to conduct regular surveys and, potentially, to provide support for parents and families of young children in South Africa. METHODS: We used a data-free mobile messenger platform to conduct a short digital survey of the impact of COVID-19 on caring for young children in South Africa. We report on the methodological processes and preliminary findings of the online survey. RESULTS: More than 44,000 individuals accessed the survey link and 16,217 consented to the short survey within 96 hours of it being launched. Respondents were predominantly from lower- and lower-middle classes, representing the majority of the population, with urban residential locations roughly proportionate to national patterns, and some under-representation of rural households. Mothers comprised 70% of respondents and fathers 30%, representing 18,672 children 5 years and younger. Response rates per survey item ranged from 75% at the start of the survey to 50% at completion. Eighty-two percent of parents experienced at least one challenge during the pandemic and 53% did not receive help when needed from listed sources. Aggregate and individual findings in the form of bar graphs were made available to participants to view and download once they had completed the survey. Participants were also able to download contact details for support and referral services at no data cost. CONCLUSIONS: Data-free survey methodology breaks new ground and demonstrates potential not previously considered. Reach is greater than achieved through phone surveys and some social media platforms, men are not usually included in parent surveys, costs are lower than phone surveys, and the technology allows for immediate feedback to respondents. These factors suggest that zero-rated services could provide a feasible, sustainable and equitable basis for ongoing interactions with families of young children.

2.
JMIR Form Res ; 2021 Apr 13.
Article in English | MEDLINE | ID: covidwho-1183751

ABSTRACT

BACKGROUND: In December 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, China. It rapidly spread due to strong evidence of human-to-human transmission, resulting in a pandemic throughout the world. Almost all countries around the world, including Qatar, have established guidelines and regulations to limit the spread of the virus and to preserve the health of societies. Unfortunately, these procedures were often associated with some negative effects on individuals' psychological and intellectual well-being, including children and adolescents. OBJECTIVE: The objective of this study was to screen the psychological influence of home isolation and social distancing on children and adolescents during COVID-19 pandemic, and the strategies used to cope with it. METHODS: This was a cross-sectional study that was undertaken using an online questionnaire administered through SMS. All home-isolated children and adolescents registered in Primary Health Care Corporation aged 7-18 years old were invited to participate in the study. Children and adolescents with intellectual disadvantages were excluded. A P value .05 (two tailed) was considered statistically significant. RESULTS: Data were collected from 6608 participants through the period of June 23rd to July 18th, 2020. Almost all the participants followed the official regulations during the period of home isolation and social distancing, however 69.1% of parents expressed their children or adolescents were vulnerable to the virus compared to 25% who expressed they were not vulnerable at all. Higher levels of anger, depression and general anxiety were prevalent amongst 1.3%, 3.9% and 1.6% of participants respectively. The mean score of the emotional constructs anger and depression decreased with the increase of following official instructions, with P value of .04 and .11 respectively. The difference in mean score of all psychological and coping strategies used among participants across the three levels of vulnerability to coronavirus, were statistically significant. The mean score trend varied little with the escalation of the level of vulnerability to the virus. This mild variation can make a difference when sample size is large as in case of this study. CONCLUSIONS: Screening for psychological and social disruptions is of importance to develop strategies by schools and healthcare providers to assess and monitor behavioral changes and negative psychologically during reintegration post-COVID-19. Participants experiencing higher levels of anxieties should be given extra attention during reintegration and transitional phases in schools. Although electronic devices and social media platforms may have lowered the level of anxiety in some cases, it is important to address how electronic devices and social media platforms are used and how content is tailored for children and adolescents. It is also important to maintain an active lifestyle for children and young adults, and encourage them not to neglect their physical health, as it promotes better psychological state of mind.

3.
JMIR Form Res ; 5(1): e19413, 2021 Jan 26.
Article in English | MEDLINE | ID: covidwho-1183723

ABSTRACT

BACKGROUND: Cystic fibrosis (CF) is an inherited chronic condition that requires extensive daily care and quarterly clinic visits with a multidisciplinary care team. The limited exchange of information outside of the quarterly clinic visits impedes optimal disease self-management, patient engagement, and shared decision making. OBJECTIVE: The aim of this study is to adapt a mobile health (mHealth) app originally developed in Sweden to the needs of patients, families, and health care providers in a CF center in the United States and to test it as a platform for sharing patient-generated health data with the CF health care team. METHODS: Focus groups with health care providers of patients with CF, adolescents with CF, and caregivers of children with CF were conducted to determine what modifications were necessary. Focus group data were analyzed using a thematic analysis, and emergent themes were ranked according to desirability and technical feasibility. The mHealth platform was then modified to meet the identified needs and preferences, and the flow of patient-generated health data to a secure Research Electronic Data Capture database was tested. Protocols for data management and clinical follow-up were also developed. RESULTS: A total of 5 focus groups with 21 participants were conducted. Recommended modifications pertained to all functionalities of the mHealth platform, including tracking of symptoms, treatments, and activities of daily care; creating and organizing medication lists and setting up reminders; generating reports for the health care team; language and presentation; sharing and privacy; and settings and accounts. Overall, health care providers recommended changes to align the mHealth platform with US standards of care, people with CF and their caregivers requested more tracking functionalities, and both groups suggested the inclusion of a mental health tracker as well as more detailed response options and precise language. Beta testers of the modified platform reported issues related to translatability to US environment and various bugs. CONCLUSIONS: This study demonstrated the importance of identifying the needs and preferences of target users and stakeholders before adopting existing mHealth solutions. All relevant perspectives, including those of clinicians, patients, and caregivers, should be thoroughly considered to meet both end users' needs and evidence-based practice recommendations.

5.
Neurol Neuroimmunol Neuroinflamm ; 8(4)2021 Jul.
Article in English | MEDLINE | ID: covidwho-1183599

ABSTRACT

OBJECTIVE: Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a severe immune-mediated disorder. We aim to report the neurologic features of children with PIMS-TS. METHODS: We identified children presenting to a large children's hospital with PIMS-TS from March to June 2020 and performed a retrospective medical note review, identifying clinical and investigative features alongside short-term outcome of children presenting with neurologic symptoms. RESULTS: Seventy-five patients with PIMS-TS were identified, 9 (12%) had neurologic involvement: altered conciseness (3), behavioral changes (3), focal neurology deficits (2), persistent headaches (2), hallucinations (2), excessive sleepiness (1), and new-onset focal seizures (1). Four patients had cranial images abnormalities. At 3-month follow-up, 1 child had died, 1 had hemiparesis, 3 had behavioral changes, and 4 completely recovered. Systemic inflammatory and prothrombotic markers were higher in patients with neurologic involvement (mean highest CRP 267 vs 202 mg/L, p = 0.05; procalcitonin 30.65 vs 13.11 µg/L, p = 0.04; fibrinogen 7.04 vs 6.17 g/L, p = 0.07; d-dimers 19.68 vs 7.35 mg/L, p = 0.005). Among patients with neurologic involvement, these markers were higher in those without full recovery at 3 months (ferritin 2284 vs 283 µg/L, p = 0.05; d-dimers 30.34 vs 6.37 mg/L, p = 0.04). Patients with and without neurologic involvement shared similar risk factors for PIMS-TS (Black, Asian and Minority Ethnic ethnicity 78% vs 70%, obese/overweight 56% vs 42%). CONCLUSIONS: Broad neurologic features were found in 12% patients with PIMS-TS. By 3-month follow-up, half of these surviving children had recovered fully without neurologic impairment. Significantly higher systemic inflammatory markers were identified in children with neurologic involvement and in those who had not recovered fully.

6.
Eur Neurol ; : 1-8, 2021 Apr 14.
Article in English | MEDLINE | ID: covidwho-1183420

ABSTRACT

BACKGROUND AND AIM: Although anyone can be affected by the COVID-19 pandemic, it may cause additional concern for people with chronic conditions. Epilepsy is the most common neurological disease in childhood and adolescence. The aim of this study was to determine anxiety levels among the mothers of children under follow-up for epilepsy in our clinic during the COVID-19 pandemic. METHODS: The study group consisted of the mothers of epilepsy patients who were under follow-up in the pediatric neurology outpatient clinic of the tertiary care center and were scheduled for a routine examination during the COVID-19 pandemic. The mothers' anxiety levels according to the Beck Anxiety Inventory and their opinions about COVID-19 in relation to their child were assessed and compared based on whether the mother/patient attended their appointments in person and whether the child had frequent or infrequent seizures. RESULTS: There was no statistically significant difference in anxiety level between the mothers of 64 children with epilepsy who attended their appointment during the pandemic and those of the mothers of 52 who did not attend their appointment. However, the mothers of children with frequent seizures had significantly higher anxiety levels. CONCLUSION: Anxiety level of mothers whose children have frequent seizures was significantly higher compared to mothers whose children have infrequent seizures. It is important to be aware about this point and using telemedicine approach in suitable population and postpone routine outpatient follow-up appointments as much as possible.

7.
BMJ Open ; 11(4): e048001, 2021 Apr 13.
Article in English | MEDLINE | ID: covidwho-1183356

ABSTRACT

INTRODUCTION: The current coronavirus (SARS-CoV-2) pandemic has placed unprecedented restrictions on people's lives and routines. To counteract the exponential spread of this virus, a lockdown was implemented in Germany in March 2020. Infected persons and their contacts were also quarantined. Compliance with quarantine measures is essential for containing the spread of the virus and avoiding incalculable consequences in terms of morbidity and mortality. On the other hand, prolonged homestays, particularly quarantining, may lead to fear, panic, anxiety and depression. Hence, determining the psychological response in people during quarantine and their coping strategies is relevant for the counselling and support of affected persons by healthcare workers. METHODS AND ANALYSIS: The CoCo-Fakt-Survey (Cologne-Corona-Beratung und Unterstützung Für Index- und KontAKt-Personen während der Quarantäne-ZeiT; Cologne-Corona counselling and support for index and contacts during the quarantine period-author's translation) will examine a cohort of persons in Cologne quarantined since the beginning of the SARS-CoV-2 outbreak during March 2020. The questionnaire will include demographic data, transmission route, health status, knowledge of and adherence to quarantine measurements, psychological impact on individuals and their family members including children, mental health status, and lifestyle (physical activity/sedentary behaviour, relaxation techniques, nutrition, smoking). All Cologne residents who needed to be quarantined due to a coronavirus infection and the individuals with whom they had contact will be surveyed. ETHICS AND DISSEMINATION: No risks have been identified and no complications are expected. Ethics approval was obtained from the Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen Human Ethics Research Committee (351/20), and the research will be conducted in accordance with the approved protocol. The results will be disseminated through peer-reviewed journals and social medicine conferences.

8.
J R Soc Interface ; 18(177): 20200970, 2021 04.
Article in English | MEDLINE | ID: covidwho-1183109

ABSTRACT

School closures may reduce the size of social networks among children, potentially limiting infectious disease transmission. To estimate the impact of K-12 closures and reopening policies on children's social interactions and COVID-19 incidence in California's Bay Area, we collected data on children's social contacts and assessed implications for transmission using an individual-based model. Elementary and Hispanic children had more contacts during closures than high school and non-Hispanic children, respectively. We estimated that spring 2020 closures of elementary schools averted 2167 cases in the Bay Area (95% CI: -985, 5572), fewer than middle (5884; 95% CI: 1478, 11.550), high school (8650; 95% CI: 3054, 15 940) and workplace (15 813; 95% CI: 9963, 22 617) closures. Under assumptions of moderate community transmission, we estimated that reopening for a four-month semester without any precautions will increase symptomatic illness among high school teachers (an additional 40.7% expected to experience symptomatic infection, 95% CI: 1.9, 61.1), middle school teachers (37.2%, 95% CI: 4.6, 58.1) and elementary school teachers (4.1%, 95% CI: -1.7, 12.0). However, we found that reopening policies for elementary schools that combine universal masking with classroom cohorts could result in few within-school transmissions, while high schools may require masking plus a staggered hybrid schedule. Stronger community interventions (e.g. remote work, social distancing) decreased the risk of within-school transmission across all measures studied, with the influence of community transmission minimized as the effectiveness of the within-school measures increased.

9.
Curr Opin Pediatr ; 2021 Apr 14.
Article in English | MEDLINE | ID: covidwho-1183078

ABSTRACT

PURPOSE OF REVIEW: Severe Acute Respiratory Syndrome Coronavirus 2 presents as symptomatic coronavirus disease 2019 (COVID-19) disease in susceptible patients. Severe pediatric COVID-19 disease is rare, limiting potential data accumulation on associated respiratory failure in children. Pediatric intensivists and pulmonologists managing COVID-19 patients look to adult guidelines and pediatric-specific consensus statements to guide management. The purpose of this article is to review the current literature and recommended strategies for the escalation of noninvasive and invasive respiratory support for acute respiratory failure associated with COVID-19 disease in children. RECENT FINDINGS: There are no prospective studies comparing COVID-19 treatment strategies in children. Adult and pediatric ventilation management interim guidance is based on evidence-based guidelines in non-COVID acute respiratory distress syndrome, with considerations of (1) noninvasive positive pressure ventilation versus high-flow nasal cannula and (2) high versus lower positive end expiratory pressure strategies related to lung compliance and potential lung recruitability. SUMMARY: Management of acute respiratory failure from COVID-19 requires individualized titration of noninvasive and invasive ventilation modalities with consideration of preserved or compromised pulmonary compliance. Research regarding best practices in the management of pediatric severe COVID-19 with respiratory failure is lacking and is acutely needed as the pandemic surges and vaccination of the pediatric population will be delayed compared to adults.

10.
Lancet ; 397(10280): 1204-1212, 2021 03 27.
Article in English | MEDLINE | ID: covidwho-1182741

ABSTRACT

BACKGROUND: The degree to which infection with SARS-CoV-2 confers protection towards subsequent reinfection is not well described. In 2020, as part of Denmark's extensive, free-of-charge PCR-testing strategy, approximately 4 million individuals (69% of the population) underwent 10·6 million tests. Using these national PCR-test data from 2020, we estimated protection towards repeat infection with SARS-CoV-2. METHODS: In this population-level observational study, we collected individual-level data on patients who had been tested in Denmark in 2020 from the Danish Microbiology Database and analysed infection rates during the second surge of the COVID-19 epidemic, from Sept 1 to Dec 31, 2020, by comparison of infection rates between individuals with positive and negative PCR tests during the first surge (March to May, 2020). For the main analysis, we excluded people who tested positive for the first time between the two surges and those who died before the second surge. We did an alternative cohort analysis, in which we compared infection rates throughout the year between those with and without a previous confirmed infection at least 3 months earlier, irrespective of date. We also investigated whether differences were found by age group, sex, and time since infection in the alternative cohort analysis. We calculated rate ratios (RRs) adjusted for potential confounders and estimated protection against repeat infection as 1 - RR. FINDINGS: During the first surge (ie, before June, 2020), 533 381 people were tested, of whom 11 727 (2·20%) were PCR positive, and 525 339 were eligible for follow-up in the second surge, of whom 11 068 (2·11%) had tested positive during the first surge. Among eligible PCR-positive individuals from the first surge of the epidemic, 72 (0·65% [95% CI 0·51-0·82]) tested positive again during the second surge compared with 16 819 (3·27% [3·22-3·32]) of 514 271 who tested negative during the first surge (adjusted RR 0·195 [95% CI 0·155-0·246]). Protection against repeat infection was 80·5% (95% CI 75·4-84·5). The alternative cohort analysis gave similar estimates (adjusted RR 0·212 [0·179-0·251], estimated protection 78·8% [74·9-82·1]). In the alternative cohort analysis, among those aged 65 years and older, observed protection against repeat infection was 47·1% (95% CI 24·7-62·8). We found no difference in estimated protection against repeat infection by sex (male 78·4% [72·1-83·2] vs female 79·1% [73·9-83·3]) or evidence of waning protection over time (3-6 months of follow-up 79·3% [74·4-83·3] vs ≥7 months of follow-up 77·7% [70·9-82·9]). INTERPRETATION: Our findings could inform decisions on which groups should be vaccinated and advocate for vaccination of previously infected individuals because natural protection, especially among older people, cannot be relied on. FUNDING: None.


Subject(s)
Polymerase Chain Reaction , /immunology , /immunology , Adolescent , Adult , Aged , Child , Child, Preschool , Cohort Studies , Databases, Factual , Denmark/epidemiology , Female , Humans , Infant , Male , Middle Aged
11.
Environ Res ; : 111160, 2021 Apr 11.
Article in English | MEDLINE | ID: covidwho-1182495

ABSTRACT

Public health measures necessary to counteract the coronavirus disease 2019 (COVID-19) pandemic have resulted in dramatic changes in the physical and social environments within which children grow and develop. As our understanding of the pathways for viral exposure and associated health outcomes in children evolves, it is critical to consider how changes in the social, cultural, economic, and physical environments resulting from the pandemic could affect the development of children. This review article considers the environments and settings that create the backdrop for children's health in the United States during the COVID-19 pandemic, including current threats to child development that stem from: A) change in exposures to environmental contaminants such as heavy metals, pesticides, disinfectants, air pollution and the built environment; B) changes in food environments resulting from adverse economic repercussion of the pandemic and limited reach of existing safety nets; C) limited access to children's educational and developmental resources; D) changes in the social environments at the individual and household levels, and their interplay with family stressors and mental health; E) social injustice and racism. The environmental changes due to COVID-19 are overlaid onto existing environmental and social disparities. This results in disproportionate effects among children in low-income settings and among populations experiencing the effects of structural racism. This article draws attention to many environments that should be considered in current and future policy responses to protect children's health amid pandemics.

12.
Skeletal Radiol ; 2021 Apr 13.
Article in English | MEDLINE | ID: covidwho-1182241

ABSTRACT

OBJECTIVE: During the COVID-19 pandemic, the number of patients presenting in hospitals because of emergency conditions decreased. Radiology is thus confronted with the effects of the pandemic. The aim of this study was to use natural language processing (NLP) to automatically analyze the number and distribution of fractures during the pandemic and in the 5 years before the pandemic. MATERIALS AND METHODS: We used a pre-trained commercially available NLP engine to automatically categorize 5397 radiological reports of radiographs (hand/wrist, elbow, shoulder, ankle, knee, pelvis/hip) within a 6-week period from March to April in 2015-2020 into "fracture affirmed" or "fracture not affirmed." The NLP engine achieved an F1 score of 0.81 compared to human annotators. RESULTS: In 2020, we found a significant decrease of fractures in general (p < 0.001); the average number of fractures in 2015-2019 was 295, whereas it was 233 in 2020. In children and adolescents (p < 0.001), and in adults up to 65 years (p = 0.006), significantly fewer fractures were reported in 2020. The number of fractures in the elderly did not change (p = 0.15). The number of hand/wrist fractures (p < 0.001) and fractures of the elbow (p < 0.001) was significantly lower in 2020 compared with the average in the years 2015-2019. CONCLUSION: NLP can be used to identify relevant changes in the number of pathologies as shown here for the use case fracture detection. This may trigger root cause analysis and enable automated real-time monitoring in radiology.

13.
Pediatr Pulmonol ; 2021 Apr 14.
Article in English | MEDLINE | ID: covidwho-1182212

ABSTRACT

INTRODUCTION: Preschool wheezers are at high risk of recurrent attacks triggered by respiratory viruses, sometimes exacerbated by exposure to allergens and pollution. Because of the COVID-19 infection, the lockdown was introduced, but the effects on preschool wheezers are unknown. We hypothesized that there would be an improvement in outcomes during the lockdown, and these would be lost when the lockdown was eased. MATERIALS AND METHODS: Patients underwent medical visits before and after the COVID-19 lockdown. We recorded the childhood Asthma Control Test (cACT) and a clinical questionnaire. Data on symptoms, the need for medications and the use of healthcare resources were recorded. We compared these data with retrospective reports from the preceding year and prospectively acquired questionnaires after lockdown. RESULTS: We studied 85 preschool wheezers, mean age 4.9 years. During the lockdown, cACT score was significantly higher (median 25 vs. 23); families reported a dramatic drop in wheezing episodes (51 vs. none), significant reductions in the day and nighttime symptoms, including episodes of shortness of breath (p < .0001); the use of salbutamol and oral corticosteroids (OCS) dropped significantly (p < .0001) and 79 (95%) patients needed no OCS bursts during the lockdown. Finally, patients had significantly fewer extra medical examinations, as well as fewer Emergency Room visits (p < .0001). All were improved compared with the same time period from the previous year, but outcomes worsened significantly again after lockdown (cACT median: 22). CONCLUSIONS: During the national lockdown, children with persistent preschool wheeze showed a significant clinical improvement with reduction of respiratory symptoms, medication use for exacerbations, and use of healthcare resources. This trend reversed when lockdown restrictions were eased.

15.
Translational Pediatrics ; 10(3):616-624, 2021.
Article in English | WHO COVID | ID: covidwho-1184109

ABSTRACT

Background: The novel coronavirus disease 2019 (COVID-19) epidemic has spread globally, along with its incidence among children The purpose of this study was to evaluate the clinical characteristics and outcomes of children infected with COVID-19 and to provide a reference for clinical work Methods: The study retrospectively reviewed the clinical characteristics and prognosis of 7 children diagnosed with COVID-19 infection at The First People's Hospital of Jingzhou between January 30 and February 29, 2020 Results: Of the 7 cases, 2 were male and 5 were female, aged 3 months and 14 days to 12 years old (median age 3 years old) There was 1 asymptomatic carrier, 5 cases with mild type infection, which had the main symptoms of cough (4/5) and fever (4/5), and 1 case of moderate type Among the 7 cases, serum white blood cell count was increased in 1 case, decreased in 1 case, liver transaminase was increased in 1 case, lactate dehydrogenase was increased in 3 cases, creatine kinase MB (CK-MB) was increased in 2 cases, and C-reactive protein was elevated in 2 cases A total of 4 cases were complicated with mycoplasma pneumoniae and/or influenza B virus infection A single case of chest computed tomography (CT) showed viral pneumonia With routine antiviral and symptomatic support therapy, the median time taken for the results of nucleic acid testing by pharyngeal swab to become negative was 14 days (6-26 days) and the median hospital stay was 15 days (8-31 days) All participants were cured and subsequently discharged from hospital Only 1 case was positive for nucleic acid testing by pharyngeal swab 1 month after being discharged, and the anal swab of 1 case for nucleic acid testing was positive 2 months after being discharged Conclusions: All children with COVID-19 who were included in this study in Jingzhou were infected via family clustering, and the laboratory examinations were not specific Fever and cough were common symptoms, but all cases were mild and had good prognoses

16.
Translational Pediatrics ; 10(3):560-568, 2021.
Article in English | WHO COVID | ID: covidwho-1184108

ABSTRACT

Background: Telemedicine is becoming an emerging innovative supplement to the traditional medical system in China In the present study, we described the rapid implementation of the telemedicine in pediatrics during the coronavirus disease 2019 (COVID-19) outbreak and explored its value in response to the demand for pediatric medical services during the epidemic Methods: An Internet-based platform for multidisciplinary online medical consultation was established on February 8, 2020, by a national children's medical center in China The medical data of the traditional hospital visits and novel online visits from the first two months (February 8 to March 31) after the establishment of the platform were collected and analyzed The demographic features, changes in the disease spectrum and characteristics of online medical services were described Results: The total number of visits was significantly lower (by 75 3%) than that of in the same period in the previous year The disease spectrum was different with a significant decrease of >95% in the number of patients with infectious or contagious diseases The online visits accounted for 14 7% of all visits Online patients came from all over the country, covering 91% of the administrative regions of China, and the largest proportion of inquiries were for infants (33 7%) (P<0 01) The response rate of experts to requests for online consultations was 100% During the study period, 266 experts from 25 pediatric specialties completed 12,318 effective consultations, proving different degrees of online supplementation for various specialties (4 3-168 4%) Online consultations mainly addressed two types of problems: (I) accessibility of the traditional hospital visits and (II) consultations regarding an illness Data from pediatric nephrology showed that 96% of the patients with stable chronic kidney disease successfully received follow-up medication adjustment guidance through the online platform Conclusions: The traditional hospital medical services have been affected by the COVID-19 outbreak The multidisciplinary online medical consultation system is a strategy to actively respond to the medical needs of children during unique periods

17.
Rev Lat Am Enfermagem ; 29:e3414, 2021.
Article in English, Portuguese, Spanish | WHO COVID | ID: covidwho-1183707

ABSTRACT

OBJECTIVE: to analyze elements of the follow-up care provided to premature children amidst the COVID-19 pandemic METHOD: qualitative study from the perspective of philosophical hermeneutics, interpreting experiences with childcare provided at home Twelve mothers and 14 children aged two years old were interviewed online via a text messaging application Data were analyzed by interpreting meanings RESULTS: weaknesses stood out in the follow-up care provided to children such as gaps of communication, lack of guidance and delayed immunizations, while care intended to meet health demands was interrupted Vulnerability aspects affecting child development included: social isolation measures that impeded the children from socializing with their peers, increased screen time, the manifestation of demanding behaviors and irritation and the mothers experiencing an overload of responsibilities The elements that strengthened maternal care included the mothers being attentive to contagion, enjoying greater experience and satisfaction with the maternal role, spending more time with their children, and recognizing respiratory signs and symptoms, especially fever CONCLUSION: follow-up care provided to children in stressful situations implies implementing practices that support the wellbeing of children and families, decreasing the likelihood of children being exposed to development deficits, and detecting signs and symptoms timely The use of nursing call centers can break the invisibility of longitudinal needs and promote health education actions at home

18.
BMJ Paediatrics Open ; 5(1), 2021.
Article in English | WHO COVID | ID: covidwho-1183364

ABSTRACT

Background Epidemiological studies in Kawasaki disease (KD) have suggested infectious aetiology During the COVID-19 pandemic, measures for mitigating SARS-CoV-2 transmission also suppress the circulation of other contagious microorganisms The primary objective is to compare the number and incidence of KD before and during the COVID-19 pandemic in Japan, and the secondary objective is to investigate temporal association between the KD epidemiology and activities of SARS-CoV-2 and other viral and bacterial infections Methods A retrospective cohort study was conducted between 2016 and 2020 in Kobe, Japan We collected information of hospitalised KD children in Kobe Child population was identified through the resident registry system Activity of COVID-19 and 11 other infectious diseases was derived from a public health monitoring system Monthly change of KD incidence was analysed using a difference-in-difference regression model Results Throughout the study period, 1027 KD children were identified KD had begun to decline in April 2020, coinciding with the beginning of the COVID-19 pandemic The number of KD cases (n=66) between April and December 2020 was 40% of the average in the same period in 2016-2019 (165/year) Annual KD incidence was 315, 300, 353, 347 and 188/100 000 children aged 0-4 years in 2016-2020, respectively The difference-in-difference value of KD incidence was significantly reduced in the fourth quarter in 2020 (-15 8, 95% CI -28 0 to -3 5), compared with that in 2016-2019 Sentinel surveillance showed a marked decrease of all infectious diseases except exanthema subitum after the beginning of the COVID-19 pandemic There were 86 COVID-19 cases aged <10 years and no KD children associated with COVID-19 Conclusion This study showed that the number and incidence of KD was dramatically reduced during the COVID-19 pandemic in Japan This change was temporally associated with decreased activities of various infectious diseases other than COVID-19, supporting the hypothesis of infection-triggered pathogenesis in KD © Author(s) (or their employer(s)) 2021 Re-use permitted under CC BY-NC No commercial re-use See rights and permissions Published by BMJ

19.
Preprint | medRxiv | ID: ppmedrxiv-21255139

ABSTRACT

Epidemiological evidence that COVID-19 manifests as a milder disease in children compared to adults has been reported by numerous studies, but the mechanisms underlying this phenomenon have not been characterized. It is still unclear how frequently children get infected, and/or generate immune responses to SARS-CoV-2. We have performed immune profiling of pediatric and adult COVID-19 patients in Brazil, producing over 38 thousand data points, asking if cellular or humoral immune responses could help explain milder disease in children. In this study, pediatric COVID-19 patients presented high viral titers. Though their non-specific immune profile was dominated by naive, non-activated lymphocytes, their dendritic cells expressed high levels of HLA-DR and were low in CX3CR1, indicating competence to generate immune responses that are not targeted to inflamed tissue. Finally, children formed strong specific antibody and T cell responses for viral structural proteins. Children s T cell responses differed from adults in that their CD8+ TNF+ T cell responses were low for S peptide but significantly higher against N and M peptide pools. Altogether, our data support a scenario in which SARS-CoV-2 infected children may contribute to transmission, though generating strong and differential responses to the virus that might associate with protection in pediatric COVID-19 presentation.

20.
Preprint | medRxiv | ID: ppmedrxiv-21255499

ABSTRACT

Background: Further evidence is needed to understand the contribution of schools and daycares to the spread of COVID-19 in the context of diverse transmission dynamics and continually evolving public health interventions. The Enfants et COVID-19: Etude de seroprevalence (EnCORE) study will estimate the seroprevalence and seroconversion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among school and daycare children and personnel. In addition, the study will examine associations between seroprevalence and socio-demographic characteristics and reported COVID-19 symptoms and tests, and investigates changes in health, lifestyle and well-being outcomes. Methods: This study includes children and personnel from 62 schools and daycares in four neighbourhoods in Montreal, Canada. All children age 2-17 years attending one of the participating schools or daycares and their parents are invited to participate, as well as a sample of personnel members. Participants respond to brief questionnaires and provide blood samples, collected via dried blood spot (DBS), at baseline (October 2020-March 2021) and follow-up (May-June 2021). Questionnaires include socio-demographic and household characteristics, reported COVID-19 symptoms and tests, potential COVID-19 risk factors and prevention efforts, and health and lifestyle information. Logistic regression using generalized estimating equations will be used to estimate seroprevalence and seroconversion, accounting for school-level clustering. Discussion: The results of the EnCORE study will contribute to our knowledge about SARS-CoV-2 transmission in schools and daycares, which is critical for decisions regarding school attendance and the management of school outbreaks through the remainder of this school year and beyond. Keywords SARS-CoV-2; COVID-19; Children; School; Serology; Protocol; Canada

21.
Minerva Pediatr (Torino) ; 2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1181860

ABSTRACT

Inevitably, along with other healthcare specializations, pediatric surgery was affected by the Coronavirus disease-19 (COVID-19) pandemic. Children were reported to manifest mild to moderate symptoms and mortality was primarily observed in patients aged <1 year and having underlying comorbidities. The majority of the cases were asymptomatic in children, hence, posing a challenge for pediatric surgery centers to take drastic measures to reduce the virus transmission. Telemedicine was introduced and outpatient consultations were conducted online as out-patient clinics were closed. Elective surgeries were postponed with delayed appointments while the healthcare sector was diverted towards tackling COVID-19. Case urgency was classified and triaged, leading to limited surgeries being performed only in COVID-19 negative patients following an extensive screening process. The screening process consisted of online history taking and RT-PCR tests. Newer practices such as mouth rinse, video laryngoscopy, and anesthesia were introduced to restrict patients from crying, coughing, and sneezing, as an attempt to avoid aerosolization of viral particles and safely conduct pediatric surgeries during the pandemic. Surgical trainees were also affected as the smaller number of surgeries conducted reduced the clinical experience available to medical enthusiasts. There is still room for advanced practices to be introduced in pediatric surgery, and restore all kinds of surgeries to improve the quality of life of the patient.

23.
Nutr Hosp ; 2021 Apr 13.
Article in Spanish | MEDLINE | ID: covidwho-1181843

ABSTRACT

AIM: to determine the relationship between perceived loneliness, happiness, and health, and quality of diet, observing the moderator role of weight status in elementary school children during the state of alarm decreed for COVID-19. METHODS: a descriptive, cross-sectional study in a sample of 116 Spanish schoolchildren. The perception of loneliness, happiness, and health was assessed using three items of the Health Behavior in School-aged Children questionnaire. The quality of their Mediterranean diet was assessed using the Mediterranean Diet Quality Index quetsionnaire for children and adolescents. Anthropometric variables were collected through a self-reported questionnaire, and for the calculation of body mass index the Quetelet index (kg/m2) was used. RESULTS: the descriptive analysis showed no differences in the perception of loneliness, happiness, or health, quality of diet, or anthropometric variables (p > 0.005), except for weight (p < 0.005), according to sex. The inferential analysis showed that higher values in quality of diet are correlated with higher scores in perceived happiness and health (p < 0.005). In turn, the linear regression test showed an association between quality of diet and perception of happiness after the model was adjusted for normal weight (R2 = 0.382; p < 0.005). Likewise, it showed a significant association between quality of diet and perception of health after the model was adjusted for overweight schoolchildren (R2 = 0.455; p < 0.005). CONCLUSION: the association between perceived health and happiness with quality of diet seems to be moderated by weight status.

24.
JMIR Pediatr Parent ; 2021 Apr 09.
Article in English | MEDLINE | ID: covidwho-1181301

ABSTRACT

UNSTRUCTURED: Type 1 diabetes (T1D) management can be challenging for children and their families. To address psychosocial concerns for parents of youth with T1D, we developed two parent-focused interventions to reduce their diabetes distress and fear of hypoglycemia. Our team conducted several of these interventions during the early spread of COVID-19 and recognized a need to make timely adjustments to our interventions. In this viewpoint article, we describe our experience conducting these manualized treatment groups during the pandemic, the range of challenges and concerns specific to COVID-19 that parents expressed, and how we adjusted our approach to better address parents' treatment needs.

25.
BMC Infect Dis ; 21(1): 338, 2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1181090

ABSTRACT

BACKGROUND: As COVID-19 vaccine distribution efforts continue, public health workers can strategize about vaccine promotion in an effort to increase willingness among those who may be hesitant. METHODS: In April 2020, we surveyed a national probability sample of 2279 U.S. adults using an online panel recruited through address-based sampling. Households received a computer and internet access if needed to participate in the panel. Participants were invited via e-mail and answered online survey questions about their willingness to get a novel coronavirus vaccine when one became available. The survey was completed in English and Spanish. We report weighted percentages. RESULTS: Most respondents were willing to get the vaccine for themselves (75%) or their children (73%). Notably, Black respondents were less willing than White respondents (47% vs. 79%, p < 0.001), while Hispanic respondents were more willing than White respondents (80% vs. 75%, p < 0.003). Females were less likely than makes (72% vs. 79%, p < 0.001). Those without insurance were less willing than the insured (47% vs. 78%, p < 0.001). Willingness to vaccinate was higher for those age 65 and older than for some younger age groups (85% for those 65 and older vs. 75% for those 50-64, p < 0.017; 72% for those 35-49, p < 0.002; 70% for those 25-34, p = NS and 75% for ages 18-24, p = NS), but other groups at increased risk because of underlying medical conditions or morbid obesity were not more willing to get vaccinated than their lower risk counterparts. CONCLUSIONS: Most Americans were willing to get a COVID-19 vaccine, but several vulnerable populations reported low willingness. Public health efforts should address these gaps as national implementation efforts continue.

26.
J Clin Invest ; 2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1181000

ABSTRACT

Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare but deadly new disease in children that rapidly progresses to hyperinflammation, shock, and can lead to multiple organ failure if unrecognized. It has been found to be temporally associated with the COVID-19 pandemic and is often associated with SARS-CoV-2 exposure in children. In this issue of the JCI, Porritt, Paschold, and Rivas et al. identify restricted T cell receptor (TCR) ß-chain variable domain (Vß) usage in patients with severe MIS-C indicating a potential role for SARS-CoV-2 as a superantigen. These findings suggest that a blood test that determines the presence of specific TCR beta variable gene segments (TRBV) may identify patients at risk for severe MIS-C.

27.
BMJ Case Rep ; 14(4)2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1180949

ABSTRACT

Since the emergence of SARS-CoV-2, clinicians have been challenged with a wide spectrum of disease severity. One of the serious complications associated with the virus is multisystem inflammatory syndrome in children (MIS-C). It is characterised by inflammation leading to organ damage, in the setting of positive SARS-CoV-2 infection. MIS-C is thought to be a postviral reaction where most children are negative on PCR testing but are positive for SARS-CoV-2 antibodies. The Centers for Disease Control and Prevention recently defined the same phenomenon occurring in adults as multisystem inflammatory syndrome in adults (MIS-A) and emphasised on the use of antibody testing in this population. Here we describe an adult woman with an exposure to SARS-CoV-2 who presented with unexplained organ failure and shock. Positive antibody testing was the only clue to the diagnosis of MIS-A. We stress the importance of SARS-CoV-2 antibody detection in order to identify these cases.

28.
Science ; 2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1180894

ABSTRACT

Vaccination and infection promote the formation, tissue distribution, and clonal evolution of B cells, which encode humoral immune memory. We evaluated convergent antigen-specific antibody genes of similar sequences shared between individuals in pediatric and adult blood, and deceased organ donor tissues. B cell memory varied for different pathogens. Polysaccharide antigen-specific clones were not exclusive to the spleen. Adults had higher clone frequencies and greater class-switching in lymphoid tissues than blood, while pediatric blood had abundant class-switched convergent clones. Consistent with reported serology, pre-pandemic children had class-switched convergent clones to SARS-CoV-2 with weak cross-reactivity to other coronaviruses, while adult blood or tissues showed few such clones. The results highlight the prominence of early childhood B cell clonal expansions and cross-reactivity for future responses to novel pathogens.

29.
J Clin Rheumatol ; 2021 Apr 09.
Article in English | MEDLINE | ID: covidwho-1180690

ABSTRACT

OBJECTIVES: The aims of this study were to evaluate the role of biological agents in the treatment of severe multisystem inflammatory syndrome in children (MIS-C) and to assess the current application, outcomes, and adverse effects in patients who are followed up in a pediatric intensive care unit (PICU). PATIENTS AND METHODS: This observational, descriptive, medical records review study was performed on patients with MIS-C admitted to the PICU between September 1 and November 1, 2020. Through medical records review, we confirmed that patients were positive for current or recent SARS-CoV-2 infection or for COVID-19 exposure history within the 4 weeks before the onset of symptoms. RESULTS: A total of 33 patients with severe MIS-C were included (21 male) with a median age of 9 years. The most common signs and symptoms during disease course were fever (100%) and abdominal pain (75.5%). Clinical features of 63.6% patients were consistent with Kawasaki disease/Kawasaki disease shock syndrome, and 36.4% were consistent with secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. Myocardial dysfunction and/or coronary artery abnormalities were detected in 18 patients during the PICU stay. Intravenous immunoglobulin and corticosteroids were given to 33 patients. Anakinra was administered to 23 patients (69.6%). There was a significant increase in lymphocyte and platelet counts and a significant decrease in ferritin, B-type natriuretic peptide, and troponin levels at the end of the first week of treatment in patients who were given biological therapy. Two patients were switched to tocilizumab because of an insufficient response to anakinra. The mortality rate of MIS-C patients admitted in PICU was 6.0%. CONCLUSIONS: Management of systemic inflammation and shock is important to decrease mortality and the development of persistent cardiac dysfunction in MIS-C. The aggressive treatment approach, including biological agents, may be required in patients with severe symptoms and cardiac dysfunction.

30.
J Pediatr Gastroenterol Nutr ; 72(5): 718-722, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1180675

ABSTRACT

ABSTRACT: Infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can lead to coronavirus-induced disease 2019 (COVID-19). The gastrointestinal (GI) tract is now an appreciated portal of infection. SARS-CoV-2 enters host cells via angiotensin-converting enzyme-2 (ACE2) and the serine protease TMPRSS2. Eosinophilic gastrointestinal disorders (EGIDs) are inflammatory conditions caused by chronic type 2 (T2) inflammation. the effects of the T2 atopic inflammatory milieu on SARS-COV-2 viral entry gene expression in the GI tract is poorly understood. We analyzed tissue ACE2 and TMPRSS2 gene expression in pediatric eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), and in normal adult esophagi using publicly available RNA-sequencing datasets. Similar to findings evaluating the airway, there was no difference in tissue ACE2/TMPRSS2 expression in EoE or EG when compared with control non-EoE/EG esophagus/stomach. ACE2 gene expression was significantly lower in esophagi from children with or without EoE and from adults with EoE as compared with normal adult esophagi. Type 2 immunity and pediatric age could be protective for infection by SARS-CoV-2 in the gastrointestinal tract because of decreased expression of ACE2.

31.
Medicine (Baltimore) ; 100(15): e25230, 2021 Apr 16.
Article in English | MEDLINE | ID: covidwho-1180669

ABSTRACT

ABSTRACT: Pediatric cases of coronavirus disease 2019 (COVID-19) have been reported. This meta-analysis was aimed at describing the clinical, laboratory, and imaging characteristics of children with COVID-19 based on published data of pediatric COVID-19 cases.Search of PubMed, Embase, Web of Sciences, Science Direct, and Google Scholar for articles published until December 14, 2020, that described the clinical, laboratory, and imaging features of children with COVID-19. Data were extracted independently by 2 authors. Random-effects meta-analysis models were used to report pooled results.Clinical data from 2874 children with COVID-19 from 37 articles were finally included for quantitative analyses. Fever (48.5%, 95% CI: 41.4%-55.6%) and cough (40.6%, 95% CI: 33.9%-47.5%) were the most common symptoms; asymptomatic infection and severe cases, respectively, accounted for 27.7% (95% CI: 19.7%-36.4%) patients and 1.1% of the 1933 patients included. Laboratory tests showed 5.5% (95% CI: 2.8%-8.9%) of the patients had lymphopenia. The pooled prevalence of leukopenia was 7.3% (95% CI: 3.4%-12.2%), and the C-reactive protein level was high in 14.0% (95% CI: 6.8%-22.8%). Chest computed tomography showed unilateral and bilateral lesions, and ground-glass opacity in 29.4% (95% CI: 24.8%-34.3%) and 24.7% (95% CI: 18.2%-31.6%), and 32.9% (95% CI: 25.3%-40.9%), respectively, and normal in approximately 36.0% (95% CI: 27.7%-44.7%).We found that children with COVID-19 had relatively mild disease, with quite a lot of asymptomatic infections and low rate of severe illness. Data from more regions are needed to determine the prevention and treatment strategies for children with COVID-19.

32.
Pediatr Infect Dis J ; 40(5): e202-e204, 2021 May 01.
Article in English | MEDLINE | ID: covidwho-1180652

ABSTRACT

This cross-sectional study, including children hospitalized for severe acute respiratory syndrome coronavirus 2 infection, demonstrates for the first time that nonhealthcare worker parents perform similarly to healthcare workers in the administration to their children of an unsupervised nasal swab for severe acute respiratory syndrome coronavirus 2 detection by following written instructions and video tutorials.

33.
Pediatr Infect Dis J ; 40(5): 385-388, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1180650

ABSTRACT

BACKGROUND: Real-time reverse transcription-quantitative polymerase chain reaction (RT-qPCR) is the reference laboratory method to diagnose SARS-CoV-2 infection then requires equipment and is time-consuming. There is a crucial demand for rapid techniques such as antigen detection test. Considering the different diagnostic accuracy of tests with other respiratory viruses in adults and children, SARS-CoV-2 antigen test must be evaluated specifically in children. METHODS: The purpose of this study was to evaluate the performance of Panbio COVID-19 Ag Rapid Test Device (Abbott) as a point-of-care test for diagnosis of SARS-CoV-2 in comparison to RT-qPCR in a pediatric population. RESULTS: Four hundred forty nasopharyngeal swabs were tested. Amongst the 18 positive RT-qPCR samples, 14 were detected by the rapid antigen test, given an overall sensitivity of 77.7%. All the samples detected positive with the antigen rapid test were also positive with RT-qPCR. CONCLUSION: The sensitivity of Panbio COVID-19 Ag Rapid Test Device is lower in children than in adults. Nevertheless, considering the good values of specificity, negative and positive predictive values this test could be used as a frontline test to obtain quick results, although the negative values with COVID-19 high clinical suspicion should be confirmed using RT-qPCR.

34.
Pediatr Infect Dis J ; 40(5): e197-e199, 2021 May 01.
Article in English | MEDLINE | ID: covidwho-1180647

ABSTRACT

Children and adolescents with severe acute respiratory syndrome coronavirus 2 infection usually have a milder illness, lower mortality rates and may manifest different clinical entities compared with adults. Acute effusive pericarditis is a rare clinical manifestation in patients with COVID-19, especially among those without concurrent pulmonary disease or myocardial injury. We present 2 cases of acute pericarditis, in the absence of initial respiratory or other symptoms, in adolescents with COVID-19.

35.
Pediatr Infect Dis J ; 40(5): e173-e178, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1180646

ABSTRACT

BACKGROUND: Acute myocarditis (AM) is defined as inflammation of the myocardium. The aim of our study is a comparative analysis of the differences between AM related and unrelated to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: The retrospective study included children with AM treated from January 2018 to November 2020. RESULTS: The study included 24 patients; 7 of 24 had AM related to SARS-CoV-2 and they were older than 7. They were more likely to have abdominal pain (P = 0.014), headache (P = 0.003), cutaneous rash (P = 0.003), and conjunctivitis (P = 0.003), while fulminant myocarditis was commonly registered in AM unrelated to SARS-CoV-2 (P = 0.04). A multisystem inflammatory syndrome in children associated with COVID-19 was diagnosed in six adolescents. Patients with AM related SARS-CoV-2 had lower serum cardiac troponin I (cTnI) (P = 0.012), and platelets (P < 0.001), but had a higher C-reactive protein (CRP) value (P = 0.04), and N-terminal-pro hormone BNP in comparison to patients with AM unrelated to SARS-CoV-2. The patients with AM related to SARS-CoV-2 had significant reduction of CRP (P = 0.007). Inotropic drug support was used for shorter durations in patients with AM related to SARS-CoV-2, than in others (P = 0.02). Children with AM related to SARS-CoV-2 had significant improvement of left ventricle systolic function on the third day in hospital (P = 0.001). Patients with AM unrelated to SARS-CoV-2 AM had more frequent adverse outcomes (P = 0.04; three died and four dilated cardiomyopathy). CONCLUSIONS: In contrast to patients with AM unrelated to SARS-CoV-2, patients with AM related to SARS-CoV-2 had a higher CRP value, polymorphic clinical presentation, shorter durations of inotropic drugs use as well as prompt recovery of left ventricle systolic function.

37.
Pediatr Infect Dis J ; 40(5): e185-e188, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1180644

ABSTRACT

BACKGROUND: Data on SARS-CoV-2 transmission among children living with healthcare workers (HCWs) are scarce. METHODS: A cross-sectional study was performed at a tertiary Hospital in Madrid, including children of HCW who suffered from SARS-CoV-2 infection between March and May 2020. Children underwent enzyme-linked immunosorbent serological study for detecting SARS-CoV-2 antibodies: VIRCELL IgG assay. RESULTS: One hundred thirteen children from 69 HCWs with confirmed SARS-CoV-2 infection were recruited: 47 children had positive IgG (41.6%). Children secondary attack rate was 43.7% (25% if both parents have had asymptomatic infection; 39.5% if one parent was symptomatic; and 47% when both parents had symptoms). Having a positive sibling was associated with a positive IgG result (odds ratio = 12.2; 95% confidence interval: 4.4-33.7, P < 0.001). Median age was higher in IgG positive children (P = 0.022). Children who referred anosmia presented higher IgG titles (P < 0.04). CONCLUSIONS: We observed a very high SARS-CoV-2 transmission in children of HCW during the first pandemic wave, especially when both parents were symptomatic. Having a positive sibling was associated with seroconversion, supporting the important role of family clusters in the transmission of SARS-CoV-2.

38.
Public Health Nutr ; : 1-18, 2021 Apr 13.
Article in English | MEDLINE | ID: covidwho-1180204

ABSTRACT

OBJECTIVE: This study aimed to address the key areas of concern for child nutrition, both during and after the COVID-19 pandemic, and proposes strategic responses to reduce child undernutrition in the short and long term. DESIGN: A descriptive literature review was performed. The search of the literature was conducted through using electronic databases including PubMed, Web of science, google scholar, and Cochrane library. SETTING: A wide range of published articles focused on child malnutrition were reviewed. PARTICIPANTS: The study was focused on children especially those under five years. RESULTS: This study proposes strategic responses to reduce child undernutrition. These responses include strengthening access to community-based nutrition services that support the early detection and treatment of undernourished children and emergency food distribution, including fortified foods with vitamins and minerals, to vulnerable households, particularly those with children under five years. Moreover, counseling and promotion programs should be reinforced to revitalize community nutrition education in areas such as gestation, exclusive breastfeeding, and complementary feeding, and hygienic practices involving handwashing, proper sanitation, and other basic behavioral changes. CONCLUSIONS: The COVID-19 pandemic has affected many countries especially those in the regions of South Asia and sub-Saharan Africa in which there has been an ongoing burden of child undernutrition. However, malnutrition is preventable and can be eliminated through a multisectoral strategic approach. The effective execution of a multisectoral approach toward preventing childhood malnutrition will require not only a financial investment but also the collective efforts from different ministries of the governments, UN-affiliated agencies, and nongovernmental organizations.

40.
Lancet Child Adolesc Health ; 5(4): 256-264, 2021 04.
Article in English | MEDLINE | ID: covidwho-1180151

ABSTRACT

BACKGROUND: The extent to which very young children contribute to the transmission of SARS-CoV-2 is unclear. We aimed to estimate the seroprevalence of antibodies against SARS-CoV-2 in daycare centres that remained open for key workers' children during a nationwide lockdown in France. METHODS: Children and staff who attended one of 22 daycare centres during a nationwide lockdown in France (between March 15 and May 9, 2020) were included in this cross-sectional, multicentre, seroprevalence study. Hospital staff not occupationally exposed to patients with COVID-19, or to children, were enrolled in a comparator group. The primary outcome was SARS-CoV-2 seroprevalence in children, daycare centre staff, and the comparator group. The presence of antibodies against SARS-CoV-2 in capillary whole blood was measured with a rapid chromatographic immunoassay. We computed raw prevalence as the percentage of individuals with a positive IgG or IgM test, and used Bayesian smoothing to account for imperfect sensitivity and specificity of the assay. This study is registered with ClinicalTrials.gov, NCT04413968. FINDINGS: Between June 4 and July 3, 2020, we enrolled 327 children (mean age 1·9 [SD 0·9] years; range 5 months to 4·4 years), 197 daycare centre staff (mean age 40 [12] years), and 164 adults in the comparator group (42 [12] years). Positive serological tests were observed for 14 children (raw seroprevalence 4·3%; 95% CI 2·6-7·1) and 14 daycare centre staff (7·7%; 4·2-11·6). After accounting for imperfect sensitivity and specificity of the assay, we estimated that 3·7% (95% credible interval [95% CrI] 1·3-6·8) of the children and 6·8% (3·2-11·5) of daycare centre staff had SARS-CoV-2 infection. The comparator group fared similarly to the daycare centre staff; nine participants had a positive serological test (raw seroprevalence 5·5%; 95% CI 2·9-10·1), leading to a seroprevalence of 5·0% (95% CrI 1·6-9·8) after accounting for assay characteristics. An exploratory analysis suggested that seropositive children were more likely than seronegative children to have been exposed to an adult household member with laboratory-confirmed COVID-19 (six [43%] of 14 vs 19 [6%] of 307; relative risk 7·1 [95% CI 2·2-22·4]). INTERPRETATION: According to serological test results, the proportion of young children in our sample with SARS-CoV-2 infection was low. Intrafamily transmission seemed more plausible than transmission within daycare centres. Further epidemiological studies are needed to confirm this exploratory hypothesis. FUNDING: Assistance Publique-Hôpitaux de Paris; Mairie de Paris, Conseil Départemental de Seine Saint Denis. TRANSLATIONS: For the French translation of the abstract see Supplementary Materials section.


Subject(s)
Antibodies, Viral/blood , Child Day Care Centers , /immunology , Adult , Child, Preschool , Cross-Sectional Studies , France/epidemiology , Humans , Immunoassay , Immunoglobulin G/blood , Immunoglobulin M/blood , Infant , Seroepidemiologic Studies
41.
Pediatr Pulmonol ; 2021 Apr 13.
Article in English | MEDLINE | ID: covidwho-1179016

ABSTRACT

BACKGROUND: Collection of respiratory cultures for airway microbiology surveillance is an essential component of routine clinical care in cystic fibrosis (CF). The COVID-19 global pandemic has necessitated increased use of telehealth, but one limitation of telehealth is the inability to collect respiratory specimens. We initiated a protocol for at-home collection of oropharyngeal (OP) swabs from children with CF. METHODS: Home respiratory specimen collection was offered during telehealth encounters. Home OP swab kits were sent to participating families via mail with instructions for collection and return. Specimens were returned by overnight shipping or dropped off at a hospital lab for processing and culture. We evaluated demographic data and compared culture results from the home-collected specimen to the most recent specimen collected in clinic. We also tracked the frequency of newly identified Pseudomonas aeruginosa. RESULTS: Home OP swab kits were sent to families of 33 children with CF (range 1.5-19 yrs). OP swab kits were successfully returned from 19 children (range 1.5-19 yrs). One or more CF pathogens grew from 79% of the specimens. For 4 individuals, the home collected specimen demonstrated new growth of P. aeruginosa. CONCLUSIONS: Home collection of OP swabs for bacterial culture is feasible in children with CF across a range of ages. Most home-collected specimens demonstrated growth of one or more CF pathogens and results were similar to recent in-clinic specimens, suggesting acceptable sample collection technique. Anti-pseudomonal therapy was initiated for 4 children based on growth of P. aeruginosa from the home respiratory specimen. This article is protected by copyright. All rights reserved.

42.
Journal of Clinical and Diagnostic Research ; 15(3):4, 2021.
Article in English | WHO COVID | ID: covidwho-1181792

ABSTRACT

Introduction: During the Corona Virus Disease (COVID-19) pandemic, Health Care Workers (HCWs) have experienced an unexpected increase in workload which leads to feelings of uncertainty, anxiety, and isolation Furthermore, they are more vulnerable to contract the infection and transmit it to their family and colleagues Aim: To evaluate the effect of COVID-19 pandemic on doctors life in term of personal and professional changes Materials and Methods: The present observational, cross-sectional study was conducted on doctors in various institutes of Udaipur, Rajasthan, India The study comprised an online questionnaire survey which consisted of three parts;the first part constituted demographic data, the second one constituted questions on the personal life status and changes, and the third part constituted questions regarding the professional life and some miscellaneous questions gauging the doctor's knowledge of the current scenario The collected data were entered in a Microsoft excel sheet, and the results were calculated Results: Most of the participants were between 25-34 years (47 8%) and male (71%) A majority of the doctors had a family with children (44 2%) and a spouse who was a HCW too (59 8%) A majority of the practitioners worked with patients with coronavirus (52 3%) and thus felt worried about their family members (93 3%) Although most participants knew about telemedicine ( 89 3%), most of the practitioners did not practice it (76 8%) Conclusion: Although HCWs do not face harassment, they suffer anxiety regarding contracting COVID-19 themselves and transmitting it to their family members

43.
Revista Chilena de Infectologia ; 37(6):756-761, 2020.
Article in Spanish | WHO COVID | ID: covidwho-1181698

ABSTRACT

BACKGROUND: SARS-CoV-2 virus infection responsible for de pandemic in course, is a new clinical and physiopathological entity, whose control is still uncertain till we can provide an effective and universal vaccine In the beginning it was described as a respiratory disease which affects mainly adults, children can have the disease too and in this group the disease can be different than the adult disease Acute infection in children is mostly mild and when it requires hospital assistance it resolves with support therapy and without complications most of the time However, in the Pediatric Inflammatory Multisystemic Syndrome is vital the early clinical suspect and refers to a tertiary center to bring support and properly treatment AIM: To describe the clinical spectrum of SARS-CoV-2 virus disease in a pediatric referral center with the pandemic still in development METHOD: A case series of 537 patients with SARS-CoV-2 infection treated between March 1 and July 15, 2020 is presented with a description of those who were hospitalized RESULTS: 127 (23%) of them were hospitalized and of these 69% were symptomatic Twenty-six patients (20%) of those hospitalized presented PIMS, only one died for complications of his chronic diseases

44.
Pediatric Health Medicine and Therapeutics ; 12:101-109, 2021.
Article in English | WHO COVID | ID: covidwho-1181242

ABSTRACT

Background: The worldwide COVID-19 pandemic is overstressing health systems and Essential health services and vaccination services are disrupted Immunization is a confirmed gizmo for governing and even eliminating communicable diseases Objective: This study aims to assess the challenge and status of immunization during COVID-19 and associated factors among children aged 10-23 months south Nation Nationality and People Region Ethiopia Methods and Materials: community-based mixed quantitative and qualitative cross-sectional study was done in southwest Ethiopia Data was collected using semi-structured questionnaires and in-depth interviews After that, the data were edited, coded, and move in into Epi info version 7 2 for data management then transported to SPSS version 25 for analysis The analyzed data were presented by tables, graphs, figures, and text form Results: According to this study, the prevalence of incomplete immunization was found to be 809 (62 2%) with (95% CI: 59 5, 64 8) In multivariable analysis waiting time at a health facility (AOR=0 04, 95% CI 0 0001,0 004), education (AOR=5 08,95% CI2 31,11 14), place of delivery (AOR=2 34,95% CI 4 96,6 089), fearing of COVID-19 (AOR=3 62,95% CI 1 72,7 64) and do not understand the separation care of COVID-19 and other health services (AOR=2 85,95% CI1 38,5 9) were significantly associated factors Conclusion: The prevalence of incomplete immunization among children aged 10-23 months was very high in this study as compared to the other studies done in a different pocket of Ethiopia Consecutively, reducing waiting time at a health facility, avoiding unnecessary fear of COVID-19, and promoting immunization in a different area of southwest Ethiopia along with health extension workers are recommended

45.
Infectious Diseases in Clinical Practice ; 29(2):E78-E81, 2021.
Article in English | WHO COVID | ID: covidwho-1180657

ABSTRACT

Coronavirus disease 2019 pandemic has spread rapidly to the world The disease can vary from mild cases to severe respiratory distress;this may increase rapidly and overwhelm the pediatric intensive care units Lately, there have been various reports about a de novo multisystem inflammatory syndrome in children or pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 infection We classified the disease into 2 spectrums: the acute phase in severely ill patients and the postinflammatory phase Neither of them could be classified as mild because there is enough evidence that supports a wide range of complications The goals of this brief review were to summarize available literature and to give some awareness about the current status of the coronavirus disease 2019 in the severely ill patients during the active phase and postinflammatory phase

46.
Journal of Physics: Conference Series ; 1823(1), 2021.
Article in English | WHO COVID | ID: covidwho-1180494

ABSTRACT

During the current covid 19 pandemic, fourth grade students of SDN Sumbermulyo 02 Winong District Pati Regency are learning online Initially during the covid 19 pandemic, grade IV SDN Sumbermulyo 02 Winong District Pati Regency students had a little difficulty learning social studies online Because the fourth grade students of SDN Sumbermulyo 02 Winong District Pati Regency before covid 19 were used to learning face-to-face (outside the network) Based on these problems, researchers conducted research on the use of internet media in social studies learning for grade IV SDN Sumbermulyo 02 Winong District Pati Regency during the covid 19 pandemic This study aims to describe the use of internet media in social studies learning for grade IV SDN Sumbermulyo 02 Winong District Pati Regency during the covid 19 pandemic Therefore, the method used is a qualitative method with data collection techniques of observation, interviews, and documentation Based on data and analysis, there are two kinds of impact of internet media in social studies learning for class IV SDN Sumbermulyo 02 Winong District Pati Regency during the covid 19 pandemic, namely positive and negative The positive impact of internet media for social studies learning for grade IV SDN Sumbermulyo 02 Winong District Pati Regency for the covid 19 pandemic is that children quickly find out information about social studies and children can quickly complete assignments Then, the impact of internet media on social studies learning for fourth grade students of SDN Sumbermulyo Winong District Pati Regency in the covid 19 pandemic Currently, students’ eye health is reduced because they often stare at the screen of a smartphone or tab or notebook or laptop or computer when looking for information about social science Social studies learning using internet media for class IV SDN Sumbermulyo 02 Winong District Pati Regency during the covid 19 pandemic became effective and efficient

47.
Journal of Physics: Conference Series ; 1823(1), 2021.
Article in English | WHO COVID | ID: covidwho-1180490

ABSTRACT

Covid-19 pandemic had a significant impact on many aspects of life, including in the world of education Pandemic conditions make the learning process adapt to new conditions, one of which is changing the form of face-to-face learning into online learning The online learning process for teachers at Special School (SLB) faces challenges in delivering learning materials to students with special needs, especially in using appropriate learning media This article discusses the training provided to special school teachers in Yogyakarta to make learning media utilizing non-B-3 waste as a support for the online learning process for children with special needs The method used is a qualitative method with data collection techniques using interviews, observation, and performance evaluation The results of this study indicate that the training in making learning media based on non-B-3 waste is significant in helping teachers solve online classroom learning problems for children with special needs The reason for choosing non-B-3 waste for learning media are easy to get, and teachers can make media according to students abilities and learning objectives

48.
Social Science & Medicine ; : 113930, 2021.
Article in English | WHO COVID | ID: covidwho-1180035

ABSTRACT

Rationale Immunization is a critical tool in the fight against infectious disease epidemics Understanding hesitancy towards immunization is even more important nowadays, with the continuous threat of COVID-19 pandemic Medical conspiracy beliefs, scientific skepticism, as well as low trust in governmental institutions, and evidence-based knowledge all have troubling effects on immunization Objective To examine how these factors cross-react to influence vaccine behavior against any vaccine preventable disease (VPD), we hypothesized a model consisting of the belief in conspiracy theories as the predictor, and as the mediators subjective and objective vaccine knowledge, and trust in the health care system and science The model was tested by examining the vaccine intentions for the children and self for any VPD Methods Two separate studies were conducted on the representative samples of Serbian population;the first study investigated the intentions for child vaccination and the second study examined the vaccine intentions against any VPD, including adult vaccination We used path analysis followed by logistic regression to analyze the data Results The results revealed high vaccine hesitancy motivated by the belief in the vaccine conspiracy theories, through its effect on reduced trust in medical science and institutions, and low objective vaccine knowledge Conclusions The results of this study may be used to implement appropriate policy changes and implementation of the public health campaigns to promote immunization with a wide range of vaccines against common diseases, such as measles, human papillomaviruses, or pertussis, and novel diseases, such as COVID

49.
Journal of Ayurveda and Integrative Medicine ; 2021.
Article in English | WHO COVID | ID: covidwho-1179712

ABSTRACT

Globally, the psychological health of the people is affected due to COVID-19 Given the fact that numerous systematic reviews already exist on yoga and mental health, it becomes vital to undertake an overview The objective of the overview was to summarise the evidence from different systematic review of distinct yoga interventions used to improve mental health and recommend yoga practices for the same The protocol was registered on PROSPERO (CRD42020185221) MEDLINE via Pubmed, Cochrane Database of Systematic Reviews and Google scholar were searched Search term used were “Yoga practice, mental health and systematic review” Reviews from earliest possible date till May 2020 including those examining the effects of any single or combination of yoga interventions on mental health reported on children, youth and adults were selected AMSTAR tool was used to evaluate the evidence of the included reviews Out of the 90 reviews found, eight unique reviews were selected for the overview Overall, 243 studies were analyzed, with overlap of only 6 studies across the reviews Out of 8 reviews, only 2 were of high quality and the rest were moderate Owing to heterogeneity of the included studies, only descriptive analysis was possible The results of the review indicate moderate to positive effects of yoga on the mental health parameters Practicing yoga (Physical postures, Bhramary Pranayam, mindfulness meditation, Sahaj yoga and Laughter therapy) can be beneficial to improve psychological health of the people during the COVID-19 pandemic

50.
Journal of Adolescent Health ; 2021.
Article in English | WHO COVID | ID: covidwho-1179710

ABSTRACT

Purpose The benefits of helplines are particularly valuable during a pandemic when face-to-face services and natural supports are difficult to access Kids Helpline, Australia's national youth helpline, provides children and young people with free 24/7 information and counseling through telephone, WebChat, and e-mail We aimed to examine the use of Kids Helpline during the COVID-19 pandemic Methods We analyzed monthly and weekly time trends of demand for and response by the Kids Helpline The frequency of counseling contacts by common concern types, age, and gender were also examined We used Joinpoint regression Results Analyses of weekly demand for Kids Helpline showed an increase when the pandemic was declared, followed by a gradual decline A second rise from 12 July 2020 when parts of Australia experienced a second wave of infections, followed by another decline, occurred more recently Increased demand was almost entirely in the WebChat modality Most answered counseling contacts were from girls and those aged 13–18 years The number of contacts about mental health, suicide/self-harm, and family relationships increased, with mental health contacts also increasing as a proportion of total contacts COVID-19–related concerns were the most common reason for contact in April 2020 Conclusions In Australia, the COVID-19 pandemic saw a rapid increase in demand for Kids Helpline, mainly by WebChat, with the virus itself, mental health, suicide/self-harm, and relationships common reasons for contact Responding to rapid changes in demand for particular modalities is challenging and understanding of the use and effectiveness of different modalities is needed

51.
Immunity ; 2021.
Article in English | WHO COVID | ID: covidwho-1179682

ABSTRACT

Summary Multisystem inflammatory syndrome in children (MIS-C) is a life-threatening post-infectious complication occurring unpredictably weeks after mild or asymptomatic SARS-CoV-2 infection We profiled MIS-C, adult COVID-19, and healthy pediatric and adult individuals using single-cell RNA sequencing, flow cytometry, antigen receptor repertoire analysis, and unbiased serum proteomics, which collectively identified a signature in MIS-C patients that correlated with disease severity Despite no evidence of active infection, MIS-C patients had elevated S100A-family alarmins and decreased antigen presentation signatures, indicative of myeloid dysfunction MIS-C patients showed elevated expression of cytotoxicity genes in NK and CD8+ T cells and expansion of specific IgG-expressing plasmablasts Clinically severe MIS-C patients displayed skewed memory T cell TCR repertoires and autoimmunity characterized by endothelium-reactive IgG The alarmin, cytotoxicity, TCR repertoire, and plasmablast signatures we defined have potential for application in the clinic to better diagnose and potentially predict disease severity early in the course of MIS-C

52.
Archives de Pédiatrie ; 2021.
Article in English | WHO COVID | ID: covidwho-1179243

ABSTRACT

Summary Context: The emergence and rapid spread of coronavirus disease 2019 (COVID-19) have shaken the planet, both in terms of health and economical aspects, constituting a real challenge for the scientific community Problem: At the time of the arrival of the epidemic in France, there were limited data regarding how COVID-19 could affect children A lesser severity compared with adults was described, but knowledge concerning clinical forms and screening strategies was missing Methodology: In this retrospective and non-interventional epidemiological study, we aimed to describe the epidemiology and the clinical features of COVID-19 pediatric disease in the first university hospital affected by the epidemic in France We included all underage patients who tested positive for SARS-CoV-2 by polymerase chain reaction (PCR) assays on nasopharyngeal smears performed between February 25, 2020 and April 30, 2020 Results: The presence of fever and respiratory signs was frequent (> 50%), as was the presence of general or digestive signs, but patients were also frequently asymptomatic, making the discovery of a positive smear fortuitous There were no deaths in our cohort Conclusion: No patient with a serious form of COVID-19 was treated in the pediatrics departments of Strasbourg University Hospital during the first 2 months of the epidemic Diagnostic strategies have evolved over the course of the epidemic, ranging from exploring relevant symptoms to systematic screening

53.
Journal of Indian Association for Child & Adolescent Mental Health ; 17(2):219-229, 2021.
Article in English | WHO COVID | ID: covidwho-1178700

ABSTRACT

Digitalization has changed the way children learn and grow in the contemporary society Also, COVID-19 has ushered in a 'new normal' as a means of prevention and safety, necessitating children and adolescents to stay at home for educational and recreational purposes This 'Position Statement' addresses the issue of conceiving a balance with respect to exposure to digital media and the 'new normal' in mind Individualized evidence-based family plans remain the cornerstone of ensuring effective management [ABSTRACT FROM AUTHOR] Copyright of Journal of Indian Association for Child & Adolescent Mental Health is the property of Indian Association for Child & Adolescent Mental Health and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

54.
Journal of Indian Association for Child & Adolescent Mental Health ; 17(2):72-86, 2021.
Article in English | WHO COVID | ID: covidwho-1178696

ABSTRACT

Background: COVID-19 pandemic and subsequent lockdown has disrupted the daily routine and required an adjustment to 'new normal' The psychological impact of 'lockdown' as a social distancing strategy among children needs to be studied well Aim: To assess the psychological impact of 'lockdown' on behaviour of children and adolescents Methods: An online survey was conducted among parents of 3-15-year-old children by using Google Form A 35-item self-designed questionnaire was used for the purpose of the study Total 645 responses were received by the stipulated time Results: The mean age of the children was 8 3 years (± 3 5) Majority of the children were male (51 6%), 1st born child (82 2%), and studying in primary school (44 8%) Near about onethird Conclusion: Index survey suggested that one-third of the children and adolescents were adversely affected due to lockdown on the children became irritable (35 3%), hyperactive (33 3%), defiant/disobedient (38%), anxious (29 9%), and crying often (32 7%) during the period of lockdown Near about two-third of the children engaged more in mobile phones (63 4%) and watched television (58 1%) compared to their usual self during lockdown Near about two-third (58 3%) and onethird (32 2%) of the children reported change in their sleeping and feeding habit respectively Majority of the male (38 7%) and female (42 6%) children coped well with the lockdown [ABSTRACT FROM AUTHOR] Copyright of Journal of Indian Association for Child & Adolescent Mental Health is the property of Indian Association for Child & Adolescent Mental Health and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

55.
Preprint | medRxiv | ID: ppmedrxiv-21255098

ABSTRACT

While the majority of children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) display mild or no symptoms, rare individuals develop severe disease presenting with multisystem inflammatory syndrome (MIS-C). The reason for variable clinical manifestations is not understood. Here, we carried out TCR sequencing and conducted comparative analyses of TCR repertoires between children with severe (n=12) or mild (n=8) COVID-19. We compared these repertoires with unexposed individuals (samples collected pre-COVID-19 pandemic: n=8) and with the Adaptive Biotechnologies MIRA dataset, which includes over 135,000 high-confidence SARS-CoV-2-specific TCRs. We show that the repertoires of severely ill children are characterised by the expansion of TRBV11-2 chains with high junctional and CDR3 diversity. Moreover, the CDR3 sequences of TRBV11-2 clones shift away from SARS-CoV-2 specific T cell clones, resulting in distorted TCR repertoires. In conclusion, our study reports that CDR3-independent expansion of TRBV11-2+ cells, lacking SARS-CoV-2 specificity, defines severity of disease in children.

56.
Preprint | medRxiv | ID: ppmedrxiv-21255100

ABSTRACT

Background In England, hospitalisations and deaths due to SARS-CoV-2 have been falling consistently since January 2021 during the third national lockdown of the COVID-19 pandemic. The first significant relaxation of that lockdown occurred on 8 March when schools reopened. Methods The REal-time Assessment of Community Transmission-1 (REACT-1) study augments routine surveillance data for England by measuring swab-positivity for SARS-CoV-2 in the community. The current round, round 10, collected swabs from 11 to 30 March 2021 and is compared here to round 9, in which swabs were collected from 4 to 23 February 2021. Results During round 10, we estimated an R number of 1.00 (95% confidence interval 0.81, 1.21). Between rounds 9 and 10 we estimated national prevalence has dropped by ~60% from 0.49% (0.44%, 0.55%) in February to 0.20% (0.17%, 0.23%) in March. There were substantial falls in weighted regional prevalence: in South East from 0.36% (0.29%, 0.44%) in round 9 to 0.07% (0.04%, 0.12%) in round 10; London from 0.60% (0.48%, 0.76%) to 0.16% (0.10%, 0.26%); East of England from 0.47% (0.36%, 0.60%) to 0.15% (0.10%, 0.24%); East Midlands from 0.59% (0.45%, 0.77%) to 0.19% (0.13%, 0.28%); and North West from 0.69% (0.54%, 0.88%) to 0.31% (0.21%, 0.45%). Areas of apparent higher prevalence remain in parts of the North West, and Yorkshire and The Humber. The highest prevalence in March was found among school-aged children 5 to 12 years at 0.41% (0.27%, 0.62%), compared with the lowest in those aged 65 to 74 and 75 and over at 0.09% (0.05%, 0.16%). The close approximation between prevalence of infections and deaths (suitably lagged) is diverging, suggesting that infections may have resulted in fewer hospitalisations and deaths since the start of widespread vaccination. Conclusion We report a sharp decline in prevalence of infections between February and March 2021. We did not observe an increase in the prevalence of SARS-CoV-2 following the reopening of schools in England, although the decline of prevalence appears to have stopped. Future rounds of REACT-1 will be able to measure the rate of growth or decline from this current plateau and hence help assess the effectiveness of the vaccination roll-out on transmission of the virus as well as the potential size of any third wave during the ensuing months.

57.
Front Pediatr ; 8: 577174, 2020.
Article in English | MEDLINE | ID: covidwho-1178013

ABSTRACT

A new pandemic caused by SARS-CoV-2 raised new challenges for the worldwide healthcare system, involving the pediatric field since children own certain peculiarities that caused a different reaction to this infection as compared to adults. We report two cases of COVID-19 in two pediatric patients, a 6-month-old male infant and a 15-year-old female teenager in order to underline the age-related differences in terms of clinical manifestations. Thus, the 6-month-old male infant was admitted in our clinic presenting fever, rhinorrhea and diarrhea for ~24 h. Taking into account that both parents presented respiratory manifestations, nasopharyngeal/oropharyngeal swab-based polymerase chain reaction tests for SARS-CoV-2 were performed, and the test came back positive for the parents and inconclusive for the infant. Nevertheless, the infection was confirmed also in the child by the second test. The symptoms resolved in the 2nd day of admission with symptomatic treatment. The 2nd case, a 15-year-old female teenager, presented to the emergency department with fever, cough and shortness of breath (O2 saturation 84%). The chest radiography pointed out multilobar impairment. The nasopharyngeal/oropharyngeal swab-based polymerase chain reaction test for SARS-CoV-2 infection was positive. She was admitted to the intensive care unit for 3 days, and the evolution was favorable with anti-viral therapy. The pediatrician's awareness regarding both asymptomatic and atypical cases is vital for decreasing the transmission of this novel life-threatening condition.

58.
Turk J Med Sci ; 2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1178470

ABSTRACT

BACKGROUND/AIM: This study aimed to analyze the serum melatonin levels and changes in sleep patterns in pediatric patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: This study was designed as a descriptive, cross-sectional study. Serum melatonin levels and sleep parameters of children with the diagnosis of COVID-19 who had mild and moderate disease (i.e., COVID-19 group) were compared with those of children admitted with non-COVID-19 non-specific upper respiratory tract infection (i.e., control group). The Sleep Disturbance Scale for Children (SDSC) questionnaire was applied to the participants' primary caregivers to analyze their sleep patterns at present and six months before symptom onset and to investigate the impact of COVID-19 on sleep patterns. RESULTS: The entire study cohort consisted of 106 patients. The COVID-19 group included 80 patients, while the control group consisted of 26 patients. The mean serum melatonin levels were 136.72 pg/mL and 172.63 pg/mL in the COVID-19 and control groups, respectively (p=0.16). There was no significant difference between the groups in terms of 6 subcategories of the SDSC questionnaire regarding the present time and six months before symptom onset. The total SDSC scores were also similar in two different evaluation time points described above (p=0.99). CONCLUSIONS: We conclude that COVID-19 did not impact the sleep parameters of children. Serum melatonin levels of all patients were higher than the reference range; however, they were higher in the non-COVID-19 patient group than the COVID-19 group. Since serum melatonin levels were higher than the reference values in children with COVID-19, and this disease is significantly less morbid in children, melatonin may have protective effects against COVID-19.

59.
Front Immunol ; 12: 654587, 2021.
Article in English | MEDLINE | ID: covidwho-1177981

ABSTRACT

Background: SARS-CoV-2 occurs in the majority of children as COVID-19, without symptoms or with a paucisymptomatic respiratory syndrome, but a small proportion of children develop the systemic Multi Inflammatory Syndrome (MIS-C), characterized by persistent fever and systemic hyperinflammation, with some clinical features resembling Kawasaki Disease (KD). Objective: With this study we aimed to shed new light on the pathogenesis of these two SARS-CoV-2-related clinical manifestations. Methods: We investigated lymphocyte and dendritic cells subsets, chemokine/cytokine profiles and evaluated the neutrophil activity mediators, myeloperoxidase (MPO), and reactive oxygen species (ROS), in 10 children with COVID-19 and 9 with MIS-C at the time of hospital admission. Results: Patients with MIS-C showed higher plasma levels of C reactive protein (CRP), MPO, IL-6, and of the pro-inflammatory chemokines CXCL8 and CCL2 than COVID-19 children. In addition, they displayed higher levels of the chemokines CXCL9 and CXCL10, mainly induced by IFN-γ. By contrast, we detected IFN-α in plasma of children with COVID-19, but not in patients with MIS-C. This observation was consistent with the increase of ISG15 and IFIT1 mRNAs in cells of COVID-19 patients, while ISG15 and IFIT1 mRNA were detected in MIS-C at levels comparable to healthy controls. Moreover, quantification of the number of plasmacytoid dendritic cells (pDCs), which constitute the main source of IFN-α, showed profound depletion of this subset in MIS-C, but not in COVID-19. Conclusions: Our results show a pattern of immune response which is suggestive of type I interferon activation in COVID-19 children, probably related to a recent interaction with the virus, while in MIS-C the immune response is characterized by elevation of the inflammatory cytokines/chemokines IL-6, CCL2, and CXCL8 and of the chemokines CXCL9 and CXL10, which are markers of an active Th1 type immune response. We believe that these immunological events, together with neutrophil activation, might be crucial in inducing the multisystem and cardiovascular damage observed in MIS-C.

60.
J Appl Gerontol ; : 7334648211006978, 2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1177693

ABSTRACT

This study explored older adults' technology use patterns and attitudes toward virtual volunteering during the COVID-19 pandemic. A 22-item survey was administered to 229 volunteers in the St. Louis region who tutor children through the Oasis Intergenerational Tutoring program. Although most respondents are familiar with technology and expressed that they are likely to volunteer virtually, their responses varied significantly by age, education, gender, income, and school districts. Some tutors expressed that virtual volunteering may eliminate barriers to in-person volunteering, while others were concerned with establishing a personal connection with students online. These findings suggest that tutors anticipate both benefits and challenges with virtual volunteering and that efforts to engage older adults during the pandemic should factor in prior use of technology and ensure that different subgroups are not marginalized.

61.
J Dev Behav Pediatr ; 2021 Apr 07.
Article in English | MEDLINE | ID: covidwho-1177345

ABSTRACT

OBJECTIVE: This study examines the media use of children from low-income homes during school closings during the COVID-19 pandemic. METHODS: Caregivers of 151 kindergarteners from low-income homes completed questionnaires as part of a larger study. Caregivers reported how much time children spent watching television/videos and using apps on the most recent weekday and weekend days. Caregivers also reported how their child's current use of media for several different purposes compared with how much the child usually uses media for that purpose. RESULTS: Weekly average media use was 46.3 hours or 6.6 hours per day. Counter to previous research, weekday media use was higher than weekend media use, suggesting that media was likely used as a replacement for time usually spent in school. Caregivers reported increased child media use for positive purposes, such as education and maintaining relationships with family and friends outside of the home, and potentially useful but less socially valued purposes, such as occupying the child's time while caregivers were completing other tasks. Having more children in the household was related to higher media use, and girls used media for maintaining remote relationships more than boys. CONCLUSION: These findings provide reason for both concern and optimism for the impacts of pandemic closures on low-income children. High levels of media use seem to be prevalent in this population. However, the diverse purposes for media use suggest that caregivers relied on media to supplement children's academic and social growth at a time when school and socializing were not safe in their typical forms.

62.
J Pediatr ; 231: 17-23, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1176841

ABSTRACT

Mandatory school vaccination policies with exclusion of unvaccinated students can be a powerful tool in ensuring high vaccination rates. Some parents may object to mandatory vaccination policies, claiming exemptions based on medical, religious, or philosophical reasons. Individual schools, school systems, or local or regional governments have different policies with respect to whether, and what kind of, exemptions may be allowed. In the setting of the current pandemic, questions regarding the acceptability of exemptions have resurfaced, as schools and local governments struggle with how to safely return children to school. Anticipating that school attendance will be facilitated by the development of a vaccine, school systems will face decisions about whether to mandate vaccination and whether to permit exemptions. The American Academy of Pediatrics promulgates policy favoring the elimination of nonmedical exemptions generally in schools. This discussion considers whether schools should eliminate nonmedical exemptions to vaccination as proposed in the American Academy of Pediatrics policy, ultimately concluding that broad elimination of exemptions is not justified and advocating a more nuanced approach that encourages school attendance while promoting vaccination and broader public health goals.

63.
Cureus ; 13(3):4, 2021.
Article in English | WHO COVID | ID: covidwho-1178565

ABSTRACT

During the course of this year, scientific research has revolved around coronavirus disease 2019 (COVID-19), with much uncertainty surrounding its pathogenesis, complications, and mortality as well as limited pediatric evidence The exact relationship between COVID-19 and new-onset type 1 diabetes, especially in children, remains an unresolved issue Our case exhibited a unique presentation of diabetic ketoacidosis (DKA) triggering COVID-19 diagnosis at this age A three-year-old Moroccan boy was admitted with a history of acute dyspnea accompanied by vomiting and weight loss, leading to a diagnosis of DKA However, evident respiratory distress signs did not disappear, even though glycemic levels were normalized and acidosis resolved The boy subsequently tested positive for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), with specific biological and radiological findings Our clinical case potentially augmented the global registry of COVID-19-related diabetes (CoviDiab project) cases and provides a basis for further studies that seek to elucidate the correlation between new-onset type 1 diabetes and SARS-CoV-2 in the pediatric population

64.
Respiratory Case Reports ; 10(1):1-7, 2021.
Article in English | WHO COVID | ID: covidwho-1178541

ABSTRACT

The clinical features of Covid-19 have been described in adults and infants younger than 1 year of age, although there is little data on the characteristics and the potential of intrauterine transmission in newborns A case of infection was identified in a baby born in Cancún Quintana Roo, in a regional hospital at the beginning of the epidemic The patient did not require intensive care, nor were there any serious complications The mother was infected with SARSCoV-2, showing mild respiratory symptoms Although 10 mothers with symptoms of SARS-CoV-2 have been observed to date, only one case of a positive newborn has been identified in the hospital In summary, newborns are susceptible to SARS-CoV-2 infection The SARS-CoV-2 PCR-positive newborn had no symptoms, and so SARS-Cov2 may be considered less severe in neonates than in adults Vertical intrauterine transmission in women who develop COVID-19 pneumonia is possible, although evidence is still lacking in Latin America and around the world

65.
Vaccines ; 9(4):371, 2021.
Article in English | WHO COVID | ID: covidwho-1178461

ABSTRACT

This study aimed to evaluate the acceptability of coronavirus disease of 2019 (COVID-19) vaccination among ophthalmology residents in Poland An online, self-administered, anonymous survey was distributed among Polish ophthalmology residents in early 2021 Of 126 residents who completed the survey, 71 4% indicated that they would get vaccinated, 17 5% were unsure, and 11 1% would refuse vaccination Married respondents with children (p = 0 036) and respondents living with their families (p = 0 310) were more likely to accept vaccination, believing that the vaccine is effective (p = 0 002 and p = 0 001, respectively), and fearing for themselves (p = 0 031 and p = 0 023, respectively) or their families (p = 0 032 and 0 055, respectively) getting infected Respondents who contracted COVID-19 often reported the expected relief in sanitization (p = 0 011) as their reason for vaccination, and the previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (p = 0 050) as their reason for not vaccinating Unmarried residents and residents living alone often declared that they were waiting for the effectiveness and long-term complications of the vaccine to be assessed (p = 0 005, both) Residents living with their families were significantly less likely to report COVID-19 as the reason for refusing vaccination (p = 0 022) In conclusion, most ophthalmology residents expressed a willingness to get vaccinated Marital status and cohabitants affect vaccination acceptance People with COVID-19 have different reasons for accepting or refusing vaccination Medical authorities should persuade citizens more to vaccinate

66.
Vaccines ; 9(4):366, 2021.
Article in English | WHO COVID | ID: covidwho-1178460

ABSTRACT

In the near future, COVID-19 vaccine efficacy trials in larger cohorts may offer the possibility to implement child and adolescent vaccination The opening of the vaccination for these strata may play a key role in order to limit virus circulation, infection spreading towards the most vulnerable subjects, and plan safe school reopening Vaccine hesitancy (VH) could limit the ability to reach the coverage threshold required to ensure herd immunity The aim of this study was to investigate the prevalence and determinants of VH among parents/guardians toward a potentially available COVID-19 vaccination for children and adolescents An online survey was performed in parents/guardians of children aged <18 years old, living in Bologna Overall, 5054 questionnaires were collected A vast majority (60 4%) of the parents/guardians were inclined to vaccinate, while 29 6% were still considering the opportunity, and 9 9% were hesitant Highest vaccine hesitancy rates were detected in female parents/guardians of children aged 6–10 years, ≤29 years old, with low educational level, relying on information found in the web/social media, and disliking mandatory vaccination policies Although preliminary, these data could help in designing target strategies to implement adherence to a vaccination campaign, with special regard to web-based information

67.
Sustainability ; 13(8):4234, 2021.
Article in English | WHO COVID | ID: covidwho-1178420

ABSTRACT

This qualitative inquiry explores how, during the early stage of the COVID-19 pandemic in Lithuania (European Union), the stakeholders in the education system—university teachers, general education teachers, students, and children’s parents—coped with the encountered challenge and what was important to them under the changed conditions This paper uses a communication management objective to describe how participants in the education system responded to the emerging distance learning situation and its challenges The phenomenographic research approach was chosen to carry out the qualitative study The 37 interviews from higher education teachers, university students, school teachers, and parents of minor school-aged children were conducted during the early stage of COVID-19 quarantine The research allows for concluding that, after a successful transition to distance learning, the dimensions of communion and supportive collaboration acquired importance among stakeholders in education Starting new activities, a need for communion and mobilization for joint activities under the crisis emerged The research showed that the adaptation period was necessary at the beginning of these new activities Competent leadership was expected from the teacher Additionally, the preparation of all the actors in the education process was needed The data offer a window into the dynamics of online teaching in crisis and experiences with a new activity that are key to success Although research on technology-mediated learning has increased in recent years, it still lags behind developments in practice

68.
Pediatric Reports ; 13(2):168-176, 2021.
Article in English | WHO COVID | ID: covidwho-1178376

ABSTRACT

The COVID-19 pandemic is affecting healthcare services worldwide We investigated the impact of a strict lockdown policy on the characteristics of neonatal and pediatric attendances to our pediatric emergency department (PED) The clinical features of PED visits in March–April 2020 (COVID-19) and March–April 2019 (non-COVID-19) were analyzed During the COVID-19 lockdown period, visits reduced by 67%, from 3159 to 1039 Neonatal access decreased from 78 to 59, mainly due to fewer pathological conditions, with a complete disappearance of respiratory infections On the other hand, minor neonatal clinical conditions rose from 44 (56 4%) to 48 (81 4%), mostly due to feeding-related issues Communicable diseases, particularly respiratory infections and gastroenteritis, dropped from 1552 (49 1%) to 288 (27 7%) Accident-related visits also decreased during COVID-19, from 535 (16 9%) to 309 (29 7%), becoming the most common cause of PED access Hospital admissions reduced from 266 to 109, while PICU (pediatric intensive care unit) admissions decreased from 27 to 11, with a comparable rate of 10 1% in both periods The lockdown due to COVID-19 had a substantial impact on our PED visits, which markedly decreased, mainly due to fewer respiratory infections Unexpectedly, neonatal visits for minor conditions did not decline, but rather slightly increased Among the children admitted to the PICU, none had respiratory disease

69.
Pathogens ; 10(4):449, 2021.
Article in English | WHO COVID | ID: covidwho-1178374

ABSTRACT

An interesting Perspective article recently published in the New England Journal of Medicine offers an insightful overview on the benefits provided by the mass vaccination of children against Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2), the betacoronavirus responsible for the dramatic CoronaVirus Disease-2019 (COVID-19) pandemic [ ]

70.
Journal of Clinical Medicine ; 10(8):1640, 2021.
Article in English | WHO COVID | ID: covidwho-1178317

ABSTRACT

The COVID-19 pandemic has impacted healthcare systems worldwide Little is known about the impact of the pandemic on medical and psycho-social aspects of children with rare diseases such as pulmonary arterial hypertension and their parents The study is based on children registered in The Database of Pulmonary Hypertension in the Polish Population and a parent-reported survey deployed during the first 6 months of the pandemic The questionnaire consisted of six question panels: demographic data, fear of COVID-19, General Anxiety Disorder-7 (GAD-7), social impact of pandemic, patients’ medical status, and alarming symptoms (appearance or exacerbation) Out of 80 children registered, we collected 58 responses (72 5% response rate) Responders (parents) were mostly female (n = 55;94 8%) at a mean age of 40 6 ± 6 9 years Patients (children) were both females (n = 32;55%) and males with a mean age of 10 0 ± 5 1 years Eleven (19%) children had symptoms of potential disease exacerbation Eight parents (72 7%) decided for watchful waiting while others contacted their GPs or cardiologists (n = 6;54 5%) Three children had to be hospitalized (27 3%) Most planned hospitalizations (27/48;56 2%) and out-patient visits (20/35;57 1%) were cancelled, delayed, or substituted by telehealth services Among the participating parents, the study shows very high levels of anxiety (n = 20;34 5%) and concern (n = 55;94 8%) and the need for detailed information (52;89 6%) regarding COVID-19 and medical service preparedness during the pandemic The COVID-19 pandemic has influenced child healthcare and caused high levels of anxiety among parents

71.
International Journal of Environmental Research and Public Health ; 18(8):3919, 2021.
Article in English | WHO COVID | ID: covidwho-1178247

ABSTRACT

Since December 2019, coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread, becoming the first pandemic of the 21st century by number of deaths (over 2,000,000 worldwide) Many aspects of SARS-CoV-2 infection in children and adolescents remain unclear, and optimal treatment has not yet been defined Therefore, our goal was to develop a consensus document, practically synthesizing the accumulated data and clinical experience of our expert group Literature research was carried out using the keywords “COVID-19” or “SARS-CoV-2” and “children” or “pediatrics” and “prevention” or “diagnosis” or “MIS-C” or “treatment” in electronic databases (MEDLINE, PUBMED), existing guidelines and gray literature The fact that the majority of the problems posed by SARS-CoV-2 infection in pediatric age do not need hospital care and that, therefore, infected children and adolescents can be managed at home highlights the need for a strengthening of territorial pediatric structures The sharing of hospitalization and therapeutic management criteria for severe cases between professionals is essential to ensure a fair approach based on the best available knowledge Moreover, the activity of social and health professionals must also include the description, management and limitation of psychophysical-relational damage resulting from the SARS-CoV-2 pandemic on the health of children and adolescents, whether or not affected by COVID-19 Due to the characteristics of COVID-19 pathology in pediatric age, the importance of strengthening the network between hospital and territorial pediatrics, school, educational, social and family personnel both for strictly clinical management and for the reduction in discomfort, with priority in children of more frail families, represents a priority

72.
Infectious Disease Reports ; 13(2):340-347, 2021.
Article in English | WHO COVID | ID: covidwho-1178167

ABSTRACT

The numbers of novel coronavirus cases continue to grow at an unprecedented rate across the world Attempts to control the growth of the virus using masks and social-distancing, and, recently, double-masking as well, continue to be difficult to maintain, in part due to the extent of asymptomatic cases Analyses of large datasets consisting of 219,075 individual cases in Ontario, indicated that asymptomatic and pre-symptomatic cases are substantial in number Large numbers of cases in children aged 0–9 were asymptomatic or had only one symptom (35 0% and 31 4% of total cases, respectively) and resulted in fever as the most common symptom (30 6% of total cases) COVID-19 cases in children were more likely to be milder symptomatic with cough not seen as frequently as in adults aged over 40, and past research has shown children to be index cases in familial clusters These findings highlight the importance of targeting asymptomatic and mild infections in the continuing effort to control the spread of COVID-19 The Pearson correlation coefficient between test positivity rates and asymptomatic rates of −0 729 indicates that estimates of the asymptomatic rates should be obtained when the test positivity rates are lowest as the best approach

73.
Brain Sciences ; 11(4):477, 2021.
Article in English | WHO COVID | ID: covidwho-1178109

ABSTRACT

The effects of COVID-19 containment measures on the emotional and behavioral development of preschoolers are not clear We investigated them within an ongoing longitudinal project including typically developing children (TD) and children at high familial risk for neurodevelopmental disorders (HR-NDD) who were potentially more vulnerable The study included ninety children aged 2–6 years (TD = 48;HR-NDD = 42) Before the emergency phase (T0), all children received a clinical assessment, including the parent questionnaire Child Behavior Checklist for Ages 1 5–5 (CBCL 1 5–5) The same questionnaire was filled out again during the emergency (T1), together with an ad-hoc questionnaire investigating environmental factors characterizing the specific period Changes in the CBCL profiles between T0 and T1 were evaluated Overall, irrespective of familial risk, the average T-scores on specific CBCL scales at T1 were higher than at T0 Associations emerged between delta scores reflecting worsening scores on specific CBCL scales and clinical and environmental factors Our results confirmed the negative impact of the lockdown on preschool children’s emotional/behavioral profiles, and highlight the need for strategic approaches in the age range of 2–6 years, especially for more susceptible children owing to environmental factors and pre-existing emotional problems

74.
Frontiers in Psychology ; 12:633499, 2021.
Article in English | WHO COVID | ID: covidwho-1178029

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has had profound effects on all aspects of society Families were among those directly impacted by the first measures imposed by health authorities worldwide to contain the spread of the Sars-CoV-2 virus, where social distancing and mandatory quarantine were the main approaches implemented Notably, little is yet known about how social distancing during COVID-19 has altered families' daily routines, particularly regarding music-related behaviors The aim of this study was 2-fold: (i) to explore changes in families' daily routine and caregivers' levels of well-being and stress during the COVID-19 outbreak in Brazil and (ii) to investigate whether musical behaviors of caregivers and the children under their care (aged from 3 to 6 years old) changed during social distancing One hundred and eighty-eight caregivers residing in Brazil participated in an online cross-sectional study conducted between July and August 2020 Our findings suggest significant changes in families' dynamics during the COVID-19 outbreak, with parents (especially mothers) spending more time on childcare and a substantial decrease in caregiver's well-being Regarding music-related behaviors, our results revealed considerable changes in caregivers' and children's musical activities at home during social distancing, including an increase in child-only musical behaviors and shared caregiver-child activities Moreover, sociodemographic factors such as caregiver background and well-being as well as the child's disability status significantly influenced musical engagement at home during social distancing This study captured some features of the home musical environment of middle-class families in Brazil in the first stages of social distancing restrictions during the pandemic and caregivers' role in providing an environment where musical experiences are nurtured Further research is needed to better understand aspects such as the long-term impact of the changes of musical behaviors at home on musical parenting and families' well-being

75.
Pediatrics ; 147(3):673-674, 2021.
Article in English | WHO COVID | ID: covidwho-1177846

ABSTRACT

Background Studies show that historically marginalized populations, such as racial/ethnic minorities, thoseliving in poverty, and those with limited English prociency are less likely to utilize patient portals that arebecoming increasingly integrated into clinical care In March 2020, nearly all in-person clinical operations forour large primary care network were ordered to cease due to COVID-19 In order to pivot quickly whileensuring our most vulnerable children and families were not left behind, we leveraged an equity-focusedquality improvement (QI) framework As we rolled out increased telehealth capacity we concurrently sought toreduce existing disparities in patient portal activation and utilization Methodology We executed ourintervention in a large primary care network that cares for over 270,000 children in southeastern PA/NJ,including over 90,000 Medicaid-insured children To determine baseline data, we queried our data warehouseand identied the patient portal activation status of all patients with a primary care visit between January 2018 - December 2019 We then stratied the data by sociodemographic variables: race/ethnicity, insurance type(private or government), preferred language, and the percent of households in their neighborhoods(approximated by census tract) living below the federal poverty line This analysis revealed disparities inactivation status, which prompted assembly of a multidisciplinary task force to ensure that barriers werequickly removed for families to access telehealth We used an equity-focused QI approach to carry out cyclesof sequential interventions Discussion During the two-year pre-intervention period, nearly 300,000 patientswere seen in our primary care practices Notable disparities were observed across all four demographiccategories examined (Figure 1) Differential patient portal activation status was noted by: race/ethnicity (69%among non-Hispanic white vs 42% among non-Hispanic black patients);insurance types (67% amongprivately-insured vs 42% among Medicaid patients);language (60% among English speaking vs 22% among ofnon-English speaking patients);and poverty (66% in the lowest poverty neighborhoods vs 38% in the highestpoverty neighborhoods) After iterative innovative interventions to remove technological and process barriersto portal utilization, rates of activation for the entire primary care population increased by 16% overall Additionally, we observed marked improvement in activation rates among Medicaid-insured children (26%increase);among Spanish-speaking families (36% increase), and African-American families (23% increase) Conclusion We demonstrated signicant narrowing in baseline disparities in electronic patient portalutilization by race, ethnicity, insurance type, and language This improvement was accomplished through useof an equity-focused QI framework that resulted in interventions focused on removing as many barriers aspossible and creating a value-add for patients Next steps include demonstrating sustained improvement,evaluating patient satisfaction, and ascertaining which of our interventions were most contributory to our improvement

76.
Pediatrics ; 147(3):656-657, 2021.
Article in English | WHO COVID | ID: covidwho-1177845

ABSTRACT

Background: Prior to COVID-19, two out of ve people in the US could not cover a $400 emergency Now,many more families are struggling nancially Families with low income often don't seek needed healthcare,risking poor health outcomes Minority families, in particular, suffer health inequities stemming fromdisparities in social capital, income, and education Higher education improves long-term economic success,but low-income families have difficulty saving for their children's futures Children's Savings Account (CSA)programs, which provide higher education savings to children in early childhood, have increased families'college expectations and improved mothers' mental health and children's socio-emotional development Methods: We assessed parents' perceptions of and access to preventive healthcare, as well as the educationalgoals they have for their children We conducted qualitative interviews with 13 parents meeting the followingcriteria: (1) at least one child age 3 or younger, (2) maximum income at 185% of the federal poverty level, and(3) no parent with an advanced degree (e g master's) We will interview seven more parents by December 2020 Meanwhile, we designed Early Bird, a rst-of-its-kind health clinic-based CSA program that rewardsfamilies for achieving healthy milestones-such as attending pediatrician and dentist appointments, meetingwith a nancial coach, and enrolling in pre-Kindergarten-with scholarship funds in their children's CSAs Weare launching a 3-year longitudinal randomized study to evaluate this novel model Results: All parentsinterviewed would participate in a milestone-based CSA program through their health clinic All hoped theirchild(ren) would attend college, 85% perceived nancial barriers to higher education, and 69% worried thatnot attending college would limit their child's career Only 23% of participants had savings for college Participants' self-described ethnicities were 85% Hispanic or Latino, 7 5% Black or African American, 7 5%American Indian or Alaska Native, and 7 5% White/Caucasian (1) Philanthropic funds were raised to supportthe launch of Early Bird's pilot serving 300 children, including scholarships up to $500 per child Contractedpartners include a federally-qualied health center, a nancial coaching service provider, a 529 accountmanagement system provider, and a local nonprot that will administer the scholarship accounts Theprogram will launch in 2020 Discussion: Parents with low income desire higher education for their childrenbut struggle to save money This new model aligns short-term achievements during early childhood in health,education, and family nances with long-term goals for higher education and career success This studyinforms a replicable model with potential to improve health, education, and nancial outcomes nationally Early Bird aligns many milestone achievements with the priorities of health insurance payers, which may aidlong-term nancial sustainability Feasibility studies are needed to further assess the model's viability indiffering clinical settings (1) Totals more than 100% due to multi-select answer format

77.
Pediatrics ; 147(3):570-572, 2021.
Article in English | WHO COVID | ID: covidwho-1177842

ABSTRACT

Introduction The COVID-19 pandemic of 2020 had caused a significant surge of hospital admissionsoverwhelming health care systems in China, Italy and Spain Previous outbreaks such as the 2009 H1N1influenza pandemic created a similar surge to the pediatric in-patient units Although there were reports oflower rate of hospitalizations in children, ability to manage hospital capacity was legitimate concern Inanticipation of the surge and in accordance with New York state mandate, the capacity of our pediatric unitwas increased by 50% It is unclear if such a surge would occur in pediatric units Objective: The objective ofthis study is to assess the impact of COVID-19 pandemic on the in-patient services of a NY city communityhospital We postulate that the pandemic may have an opposite effect in decreasing the usual census inpediatric admissions Methods We reviewed the medical records of all pediatric patients (<21 years) admittedto the in-patient unit between February 1st-April 30th, 2020 Records of admitted children for the same periodduring 2019 were reviewed to serve as historical controls Data related to patient demographics, length of stay and diagnosis was collected The results were tabulated into weeks, and the variables compared using the chi-square test with significance at p< 0 05 Results There were a total of 272 admissions during the study periodin 2019 compared to 194 in 2020 for a decline of 29% The weekly admission trend with COVID related eventsis shown in the figure The steepest decline (80%) occurred around the 7th week when New York statelockdown was initiated There were significantly fewer admissions during the month of April compared to theother months (p<0 05) The average length of stay was similar during the study periods and there no statisticalassociation with age, gender or type of diagnosis The most common diagnoses were status asthmaticus,sickle cell crisis, and dehydration Nine COVID-19 positive patients were treated during the study period withno COVID related mortalities Discussion: Unlike previous pandemics, COVID-19 had the opposite effect ofdecline in pediatric unit volumes rather than the surge The declaration of emergency along with the New Yorkpause implemented by the state may have influenced families to stay home rather than seek medical help School closures, lack of overcrowding and less pollution during the lockdown may have also contributed to thereduction of infectious illnesses injuries and allergic illnesses Conclusion Our pediatric in-patient unit did notexperience the anticipated surge during the current COVID-19 pandemic, rather a significant decline in thenumber of patients This led to increasing the patient age to 30 years in the pediatric unit and redeploymentof some pediatric staff to other areas in need of help

78.
Pediatrics ; 147(3):453-454, 2021.
Article in English | WHO COVID | ID: covidwho-1177838

ABSTRACT

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for coronavirus disease2019 (COVID-19) started in December 2019 in Wuhan, Hubei Province of China In multiple countries affectedby COVID-19, children are a small proportion of those affected by the disease In children who are affected,symptoms often range from absent to mild or moderate The exact mechanism by which children are affectedless severely is not yet understood, but adults may have more severe presentations secondary to immunedysregulation There remains limited data regarding COVID-19 infections in pediatric patients with underlyingmedical conditions, including immunodeficiency syndromes Myeloid differentiation factor 88 (MyD88)deficiency is a rare immunodeficiency characterized by increased susceptibility to infections caused bypyogenic bacteria with only 24 cases discussed in medical literature We present a case series of three siblingswith MyD88 deficiency with COVID-19 who had various presentations and courses The patients had closecontact with a family member who recently traveled and developed fever and cough SARS-CoV-2 PCR testing of nasopharyngeal specimens from all three patients was positive In case 1 and 2, the two females (16 y o and 15 y o ) presented with fevers, labs significant for lymphocytopenia and elevated inflammatory markersand chest x-rays (CXR) with lobar pneumonia They had persistent fevers and tachypnea with worseninghypoxia With worsening clinical condition and progression of radiologic evidence to multifocal pneumonia,they were transferred to the ICU They were initially started on NIV but rapidly progressed to moderate ARDSrequiring invasive mechanical ventilation The 16 y o remained on mechanical ventilation for 9 days andtransitioned to high-flow nasal cannula (HFNC) for 3 days The 15 y o progressed to severe ARDS and startedon veno-venous extracorporeal membrane oxygenation (VV-ECMO), which she remained on for 7 days Shewas subsequently extubated within 1 day to HFNC In case 3, the 13 y o male presented with cough withoutfevers, labs significant for mildly elevated inflammatory markers and CXR without consolidation Withworsening clinical condition and progression of radiologic evidence to multifocal pneumonia he wastransferred to the ICU for close monitoring He had no hypoxia and required no supplemental oxygen orventilatory support During hospitalization in the ICU, all three patients received hydroxychloroquine The twopatients on mechanical ventilation received tocilizumab and a 10-day course of remdesivir All three patientsrecovered from their respiratory illness COVID-19 in the pediatric population remains an area to be studied Patients with immunodeficiency may be at increased risk for infection not just secondary to the underlyingdisease pathology, but also from increased susceptibility to immune dysregulation This case series describesthe variability in illness severity in the context of the same underlying medical condition

79.
Pediatrics ; 147(3):443-444, 2021.
Article in English | WHO COVID | ID: covidwho-1177837

ABSTRACT

Introduction: Kawasaki disease (KD), an acute syndromic systemic vasculitis of unknown cause, usually followsa viral infection However, the link between KD and COVID-19 is not well established Here, we report a 5-year-old girl who developed KD during convalescent phase of COVID-19 infection Case Description: A 5-year-old girlwith no past medical history presented with a 10-day-history fever (Tmx 104 3F) associated with abdominalpain, dry cracked lips, conjunctivitis, generalize erythematous macular rash involving palms and soles, andswelling of hands and feet On admission, patient's vital signs were stable except for fever (T 102) She fulfilledthe diagnostic criteria for KD Her laboratory screen showed WBC, 5,000/ul;platelet, 483,000/ul;ESR, 81 mm/h;CRP;22 mg/dl;Sars-Cov-2 RNA (RT-PCR) negative Echocardiogram revealed left coronary artery ectasia Patient received a single dose of intravenous immunoglobulin (IVIG) and aspirin with a good response Despitenegative history of sick contact, COVID-19 serology test was performed which showed a positive IgG and anegative IgM titer, suggestive of convalescent phase of the viral infection Discussion: Recent data showed thatmany children with KD were tested negative for COVID-19, suggesting no increased incidence or susceptibilityto COVID-19 infection for patient with KD With increasing utilization of COVID-19 serology testing, evidence of association between the virus and KD may start emerging Both COVID-19 infection and KD can exhibithyperinflammatory state involving multi-systems Our patient's positive serology, fever and gastrointestinalsymptoms indicated that her development of KD was preceded with COVID-19 infection, portending apotential role of systemic immune response triggered by the virus in KD pathogenesis Conclusion: Cliniciansshould be vigilant for this possible new association between COVID-19 and KD Clinical criteria for testing forCOVID-19 must not be restricted to those with respiratory symptoms We recommend both RT-PCR based andserology test for the virus be utilized in patient with KD

80.
Pediatrics ; 147(3):429-430, 2021.
Article in English | WHO COVID | ID: covidwho-1177836

ABSTRACT

In December 2019, the world witnessed an outbreak of COVID-19 caused by the severe acute respiratorysyndrome coronavirus 2 (SARS-CoV-2) Although children and adolescents comprise approximately 22% of theUS population, only 1 7% of total Covid-19 cases have occurred in patients <18 years of age with 3-deaths asreported recently by the CDC Case: We report on a case of a 17-year old Hispanic female who was previouslydiagnosed with T2DM and presented with diabetic ketoacidosis (DKA) and Covid-19 pneumonia The patient'smedical history was significant for T2DM diagnosed a year earlier, she had tested negative for insulinautoantibodies and glutamic acid decarboxylase autoantibodies The patient experienced cough and fever 1-day prior to presentation that worsened progressively with multiple vomiting episodes and altered sensoriuma few hours prior to presentation On arrival at the emergency department the patient was lethargic, illappearing with dry mucous membranes Vital signs: temperature: 36 3 °C, heart rate: 128/min, bloodpressure: 136/85 mmHg, and Kussmaul respirations with a rate of 28/min Chest auscultation revealed clear breath sounds with no adventitious sounds and her oxygen saturation was 100% by pulse oximetry Initialvenous blood gas analysis showed profound metabolic acidosis (pH, 6 84;PCO2, 22 0 mmHg;PO2, 48 mmHg;HCO3, 6 5 mmol/L) She had significant hyperglycemia (526 mg/dl) and her urinalysis showed ketonuriaindicative of DKA with poorly controlled T2DM (HbA1c: 15 3%) Chest X-ray showed a patchy infiltrate on theright upper lobe that was suspicious for Covid-19 pneumonia (Figure 1 ) Patient was administeredintravenous fluids and a continuous infusion of insulin as per DKA protocol and was transferred to theintensive care unit with precautions for Covid-19 Patient's hospitalization was significant for a positive resulton the Covid-19 PCR test Her respiratory status remained stable and she required oxygen supplementationby nasal cannula Although her metabolic acidosis improved within 48-72 hours, she had persistenthypokalemia and hypophosphatemia (Figure 2) that required correction with potassium phosphate andpotassium chloride She also had a relatively slow improvement in her mental status and had diarrhea duringhospitalization The patient was discharged on day-6 of hospitalization with no complications Discussion: Afew recent studies have shown that infection with Covid-19 in adults with diabetes is associated with poorclinical outcomes and higher mortality rates In a smaller study, Covid-19 infection was shown to induceketoacidosis in adult T2DM patients However, comparable studies in children with T2DM and Covid-19 areunavailable Although DKA is uncommon in T2DM, it can occur secondary to stressors such as an infectionwith Covid-19 that increases secretion of catabolic hormones like glucagon in a setting of insulin deficiency Ours is the first study to report Covid-19 infection induced DKA in an adolescent with poorly controlled T2DM (Figure Presented)

81.
Pediatrics ; 147(3):337-338, 2021.
Article in English | WHO COVID | ID: covidwho-1177833

ABSTRACT

Background Cardiac MRI is often an essential component for the diagnosis and follow-up of cardiac disease in both children and adults These studies can be time intensive and often require anesthesia support Unlled cardiac MRI appointments therefore unnecessarily delay availability and decrease productivity At our institution, we recognized a backlog of cases due to a high number of patients canceling 2-4 days before the appointment during the pre-procedural telephone screening or simply not keeping their appointments Such late cancelations were often unable to be lled due to a variety of barriers This quality improvement project sought to increase the utilization of cardiac MRI by implementing new communication procedures prior the patient's study Methodology A cardiology nurse was tasked with contacting each scheduled patient 21 days prior to their MRI and requiring conrmation within 7 days that the patient would be able to attend In cases where a patient was unable to conrm, they were rescheduled, and their spot lled with another patient from the wait list who was able to conrm To evaluate this intervention, we tracked service utilization for the 7 months before implementation of this policy, and for 10 months afterwards, up until the routine outpatientservice was suspended due to the COVID-19 pandemic Monthly utilization was charted on a statistical processcontrol X-chart with control limits set at +/- 2 66 moving range averages Consecutive data points above orbelow the mean indicated special cause variation, resulting in a shift of the mean line Results and DiscussionThere was special cause variation associated with the new communication procedure, resulting in a signicantincrease in the average number of monthly studies from 18 to 24 3 Our utilization of available appointmentsalso increased from 59 4% to 75 3% following the policy change A second shift back to baseline occurred onceour patient backlog was exhausted, though the utilization of available appointments remained slightly higherthan baseline at 64 2% These results suggest that with this new policy, our cardiac MRI service can be run at autilization rate which exceeds our current demand Future directions for improvement may include re-allocating cardiac MRI slots for other services, or adding other types of MRI into our waiting list ConclusionOur policy intervention of calling all patients 21 days prior to their cardiac MRI studies to conrm theirappointments, resulted in a signicant improvement in service utilization This persisted until our backlog of cases was exhausted, and suggests that this intervention allows our service to run at a utilization rate whichexceeds our current demand

82.
Pediatrics ; 147(3):213, 2021.
Article in English | WHO COVID | ID: covidwho-1177828

ABSTRACT

Background/Purpose: The COVID-19 pandemic took effect on the US and the US schooling system in earlyMarch 2020 Over 290 5 million children and youths who normally attend pre-primary to upper-secondaryclasses have been displaced from their schools Due to this, following along with the regularly scheduledcurriculum has been taxing on many educators, thus students may not be directly learning about the topic of COVID-19 from a reliable source In this era of ubiquitous information, students may have various sourcesthey are getting their news in regards to COVID-19 The content knowledge of COVID-19 with in the adolescentpopulation as well as its effects on their mental health has yet to be studied The purpose of this study is toassess where students are obtaining their knowledge of COVID-19, if online learning is effective in increasingcomprehension of the pandemic, and the influence this event has had on their mental health Methods:Participants must be between 13- and 18-years-old and involved in online education All materials are given to the students by their educators and de-identified Participants will be asked to fill out the pre-survey assessing their knowledge of COVID-19 and from where they currently receive their information They will then be givena researcher-written, evidence-based lecture by their educator regarding COVID-19 pathogenesis and publichealth measures Following the lecture, they will complete the same survey to assess if the subjects improvedaccuracy in their knowledge from the presentation and if this medium is effective The students will then begiven a mental health survey based on the Pediatric Symptom Checklist - Y and Beck Depression Inventory - IIto gauge the perceived effect of this pandemic on their wellbeing Expected Results: The researchers areexpecting that students will have a general knowledge regarding the virus from the media or conversations with family and friends We are expecting an improvement in COVID-19 related knowledge between the pre-and post-survey results We expect the mental health survey to show a perceived change in mental healthstatus due to the drastic shift in environment during a key time for development Conclusion: The COVID-19pandemic has affected students in many ways, ranging from their education to their mental health Data inregards to their knowledge of this pandemic and their mental health status will allow pediatric professionalssuch as providers, therapists, and teachers to inform their interactions appropriately It will also helpprofessionals understand what structural changes need to be made if a similar situation arises in the future

83.
Pediatrics ; 147(3):105-106, 2021.
Article in English | WHO COVID | ID: covidwho-1177827

ABSTRACT

BACKGROUND: The leading cause of preventable death after injury is uncontrolled bleeding Stop the Bleed(STB) is a national rst-response training campaign shown to effectively train civilians in the basic skills ofexternal bleeding control To improve trauma mortality and reduce bystander response disparities,widespread training of high school students has been proposed, and many states have passed legislation toinclude basic life support training in schools Prior to implementation of STB training, it is important tounderstand parental attitudes regarding training of high school students Here we report an evaluation ofparent attitudes towards implementing STB training from three high schools in Seattle, Washington METHODS: We distributed an electronic survey to a random sample of 759 parents of students from threeurban high schools (one private, two public) in the Seattle area We asked participants about their awarenessof STB, the acceptability of training high school students in STB, and reasons why parents would or would notwant their children involved Fisher's exact test was used to assess for differences in responses between parents who did or did not report experiencing trauma RESULTS: We received 120 total responses (responserate 16%) Most parents were between the ages of 40-59 years (88%) and 44% of parents were parents ofchildren from a public school The majority of parents (86%) were not aware of STB prior to the survey and47% reported they themselves were interested in becoming trained in STB after completing our survey Most(93%) parents reported they would want their child trained in STB, and 88% of parents felt their child wouldlikely need to use this training one day Of parents who responded to the statement “A trauma or seriousinjury has impacted my family,” 42% agreed, and there were no signicant differences between parents'trauma experience and preferences regarding training (Table 1) Nearly all parents (93%) disagreed with thestatement, “I don't think high school students should have to try to save someone's life ” CONCLUSION: Amongthis sample of Seattle area high school parents, awareness of STB training was low but the majority afterlearning about it indicated wanting their child trained in STB Few parents were worried about potentialadverse effects of the training and most believed that their child would need to use it sometime in their lives Past experience of trauma or injury was not associated with differences in responses Little is known abouthigh school parent attitudes towards STB, and these ndings suggest parents are generally supportive ofimplementing STB training programs for high school students These results were limited by low response,partly due to data collection coinciding with the COVID-19 pandemic, which impacts the generalizability of our results

84.
Pediatrics ; 147(3):103-105, 2021.
Article in English | WHO COVID | ID: covidwho-1177826

ABSTRACT

Introduction: Firearms are the second leading cause of death for those under age 19 in the United States Themajority of unintentional gun-related deaths occur in the home while parents/guardians are absent, and over1 in 3 children in America live in a household with a gun Previous research has demonstrated that rearm-related injuries and fatalities are more prevalent for children who live in homes with guns, as well as in stateswith higher rates of gun ownership The COVID-19 pandemic has caused unprecedented change in Americansociety, including closures of over 124,000 schools, affecting over 55 million students across all 50 states Wesought to analyze the impact of pandemic-related public health measures implemented since March 2020 -including school shutdowns and “Stay at Home” orders - on pediatric rearm-related injuries and fatalities We also investigated if ndings were modulated by state-level differences in legislation around Safe Storage(SS) of rearms Methods: Firearm-related injury and fatality data for victims aged 0-17 years from January 1,2019 to April 26, 2020 was obtained from the Gun Violence Archive Information about state adoption of SS laws was obtained from the Giffords Law Center Difference-in-differences estimates were calculated in Statausing ordinary least squares with heteroskedasticity robust standard errors Results: Preliminary resultsdemonstrate several changes in pediatric rearm-related injuries and fatalities in the United States sinceMarch 2020 Daily pediatric rearm-related injuries and fatalities appear largely unchanged on weekdays(Monday through Friday) in 2020 relative to 2019 However, daily pediatric rearm-related injuries andfatalities appear to have decreased by 9 27 (p = 0 005) on weekends (Saturday and Sunday) in 2020 comparedto 2019 This decrease in weekend pediatric rearm-related injuries and fatalities appears to be larger instates without Safe Storage laws Conclusions: These preliminary results suggest that public health measuresadopted in response to COVID-19 are associated with a decrease in pediatric rearm-related injuries andfatalities on weekends This pattern may be consistent with the likely increased presence of parents/guardiansin the home on weekends when compared with the pre-pandemic era, potentially limiting minors' access torearms Firearm-related violence may be stable during the pandemic on weekdays because youth are undersimilar levels of supervision whether in school prior to the pandemic or at home with a parent/guardianduring the pandemic Further investigation is needed to expand upon these results, delineate potential sub-group differences between various types of rearm-related injuries and fatalities (unintentional injuries,homicides, mass/school shootings, or suicides), and follow these trends while pandemic-related policiesremain in place Our ndings may help inform physician counseling strategies for injury prevention andsuggest future directions for advocacy and research

85.
Pediatrics ; 147(3):85-87, 2021.
Article in English | WHO COVID | ID: covidwho-1177825

ABSTRACT

Background: Adolescents placed in the foster care system are a vulnerable population where socialdeterminants lead to health disparities that greatly impact their health and wellbeing into adulthood Betweenthe ages of 18 and 21, these young adults age out of the foster care system and must also transition frompediatric to adult models of care Unstructured transitions lead to poor health outcomes, however only 14-17% of youth meet health care transition performance measures Objective: To assess transition readinessamong adolescents in foster care and use that data to incorporate a structured transition using the Six CoreElements into our Children in Foster and Kinship Care Clinic Methods: We are currently performing a needsassessment among adolescents in foster care, aged 12 - 18, who receive care at a medical home for youth infoster care in a large, western US city from 3/1/2020 - 4/30/2020 To date, 12 adolescents have completed theTransition Readiness Assessment (TRA)-part of the Six Core Elements that have been validated using QImethodologies in a variety of care settings Initially, participants completed the TRA in person;however,responses were collected by phone after COVID-19 physical distancing measures became mandatory Results:The Mean age of patients that completed the TRA was 15 3 years (SD 2 0) Importance in preparing andconfidence in ability to change to an adult doctor were moderate overall However, adolescents age16-18 hadsimilar importance (mean 5 8, SD 1 6, 95% CI 4 0 - 7 4), but much lower confidence measures (mean 2 5, SD2 7, 95% CI -0 4 - 5 4) The majority of our patients indicated they knew their personal health information,however their understanding of health care privacy and decision-making were much lower Similarly, ourpatients have a perceived inability to manage the logistics of accessing health care Alarmingly, a very smallportion of our patients have a plan to keep health insurance after age 18 despite the ACA's expansion ofMedicaid to this population until age 26 Conclusions: Our results suggest that our adolescent patients haveinsufficient education regarding changes in health care privacy and decision-making and perceived inability tomanage their own health care Together, these indicate a strong need for a structured transition to adultmodels of care for adolescents in out of home care Going forward, we plan to incorporate transitions into theworkflow of our clinic using a tool within the EMR, therefore consistently addressing transitions for all ouradolescent patients For patients greater than 18 years, we have developed a Transition of Care clinicspecifically for young adults leaving foster care led by an internal medicine-pediatrics trained physician, thusimproving continuity for young adults who have aged out of foster care

86.
Pediatrics ; 147(3):60-61, 2021.
Article in English | WHO COVID | ID: covidwho-1177824

ABSTRACT

The COVID-19 pandemic has caused a signicant loss of life and dramatically upended the livelihood of communities across the world However, as with other health crises, the pandemic has hit low-income communities particularly hard Epidemiological data have shown that individuals in poorer communities are not only at a higher risk for severe COVID-19 illness and fatality, but are also at a heightened risk of suffering long-term economic and social consequences as indirect effects of the pandemic, highlighting the need for community-wide interventions As community-based institutions, whose primary role is to provide primary care and divert patients from emergency care, Federally Qualied Health Centers (FQHCs) have a particularly important role to play The purpose of this presentation is to describe the efforts of a FQHC located in the South Bronx, to prevent the disruption of health care services during the COVID-19 pandemic, and to facilitate critical continuity of care for medically and socially vulnerable patients in an eeffort to mitigate adverse health outcomes Our FQHC mobilized a COVID-19 response to address two primary goals: 1) to prevent disruption inprimary care during a pandemic and shelter-in-place mandate through targeted outreach and telehealthservices to medically and socially vulnerable populations, and 2) to identify and address the increased socialneeds of families adversely impacted by the pandemic through referrals to in-house and communityresources Our data team compiled lists of patients for outreach based on the aforementioned goals anddistributed them to clinical teams Priorities for outreach included patients who rely on continuous clinicalcare and families at increased economic and social risk, such as newly-arrived immigrant families and familiesexperiencing homelessness Telehealth and in-person visits were systematically prioritized to include infants 0to 2 years for well-child visits and vaccinations, children with persistent asthma, and adolescents withcontraceptive needs (e g depo provera) Additional outreach was done to patients at heightened risk ofadverse outcomes from a disruption of clinical care, specically pregnant women, patients 70 years of age andolder, and patients with comorbid medical conditions Social needs were addressed through the expansion ofan existing emergency food pantry to offer household cleaning supplies, personal hygiene products, facemasks, and health education material, and through referrals to community resources Contactless delivery ofthese supplies was provided for homebound patients As this work is ongoing, future analysis will describe theextent of need during the COVID-19 pandemic and the impact of our efforts through analysis of clinicaloutcomes including timely immunizations, asthma outcomes, and adherence to reproductive healthtreatments Lessons learned in our systematic response to this pandemic may be valuable for other healthcenters in planning for how to provide care for children and families during this, and future crises

87.
Pediatrics ; 147(3):52-53, 2021.
Article in English | WHO COVID | ID: covidwho-1177823

ABSTRACT

Background: Over 700,000 children experience abuse in the US annually Reported and substantiated cases ofchild abuse increase in the months following disasters The COVID-19 pandemic has increased known riskfactors for child abuse, including financial hardship, unemployment, increased anxiety, increased caregiverresponsibilities, and decreased access to behavioral health services and community resources Children andfamilies already facing homelessness prior to the pandemic may be at especially heightened risk of childmaltreatment The Homeless Health Initiative (HHI) was developed by pediatrics residents and is now amultifaceted advocacy network supporting local, urban homeless shelters that is funded and staffed by ourinstitution PriCARE is a positive parenting program also funded and staffed by our institution Both HHI andPriCARE had to suspend in-person services due to the COVID-19 pandemic at a time when families may mostneed additional support Online parenting support programs have demonstrated significant reductions innegative parent-child interactions, problematic child behaviors, negative disciplinary methods, parent stressand depression, and child anxiety Therefore, the multidisciplinary team members that serve families throughHHI and PriCARE sought to develop a virtual platform to provide their support Methodology: The goal of thisinitiative is to establish a multidisciplinary virtual program for families experiencing homelessness thatprovides trauma-informed, positive parenting support, promotion of healthy parent-child relationships,relevant illness and injury prevention tips, and anticipatory guidance for families coping during a pandemic We completed a needs assessment through ongoing communication with families and workers at the shelters Various stakeholders, including experts in child abuse prevention, intimate partner violence, and positiveparenting, worked together to develop supportive materials for families related to the above topics Weconducted virtual sessions including members of each participating stakeholder in an open-ended formatguided by participants' concerns, both previously submitted and in real-time, to provide support and developfamily-centered programming Our platform was compatible with phones distributed to shelter residents bythe city during the pandemic to facilitate open access To supplement virtual content, we also distributedaccompanying resources for reinforcement Further development of this initiative is ongoing with iterativeplan/do/study/act (PDSA) cycles Anonymous feedback from shelter residents and session leader debriefs areintegral in guiding our modifications Discussion: The delivery of our material via video conferencing andwritten handouts is practical, feasible, and respectful of physical distancing recommendations We arecontinuing to improve this initiative in response to feedback In addition, we plan to integrate thisinterdisciplinary model focusing on positive parenting into our in-person sessions when it is appropriate toresume them Conclusions: By working with all relevant stakeholders, we developed a plan to provide servicesto families living in homeless shelters via a virtual platform that responds to and is flexible to their needs

88.
Pediatrics ; 147(3):50-52, 2021.
Article in English | WHO COVID | ID: covidwho-1177822

ABSTRACT

Background: Daily outdoor play for children has been encouraged by the American Academy of Pediatrics,which has long recognized the importance of play for promoting children's health and social-emotionaldevelopment The COVID-19 related school closures and activity restrictions have highlighted potentialinequities in opportunities for children to play outdoors There is increasing evidence, of varying quality, thatoutdoor environments containing elements of nature may offer benets for children's health that comespecically from the nature contact experienced However, one barrier to increasing support for naturecontact from the health care community has been the lack of systematically and rigorously reviewedaccessible evidence on this topic Objective: Our goal was to conduct a systematic review to evaluate andaggregate the evidence regarding the impacts of nature contact on children's health and well-being Methods:We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines forsystematic reviews The database search was conducted using PubMed, CINAHL, PsychInfo, ERIC, Scopus, andWeb of Science in June 2018 In all searches, the rst element included nature terms (exposure occurring birth to 18 years) and the second element included child health outcome terms (physical, mental, andcognitive/learning outcomes) Studies that focused only on outdoor time or play, without nature elements,were excluded Two reviewers evaluated each study and reached consensus for: 1) review inclusion;2)determination of nature exposure category;and 3) quality assessment using the Mixed Methods AppraisalTool (MMAT) The MMAT is a reliable and valid quality assessment metric;a summary score ≥ 80% wasconsidered high quality Results: Of the 8756 studies initially identied, 163 were included in the review Moststudies included were observational (n=159) and examined the presence of natural environments (greenspace) around residential or school locations (n=89) Our quality assessment suggested that several high-quality studies were present within each nature exposure category We categorized studies into one of thefollowing types of nature exposure: green space/park proximity to home (n=74, 83% high quality), green spaceactivity (n=27, 37% high quality), green space/park proximity to school (n=14, 93% high quality), wildernessexposure (n=11, 9% high quality), gardening (n=6;25% high quality), greening intervention (n=5, 40% highquality), outdoor classroom (n=5, 0% high quality), and nature walks (n=2, 0% high quality), and other (n=19,27% high quality) Studies focused on a range of outcomes including physical health (n=111, 68%), mentalhealth (n=36;22%), and cognitive/learning outcomes (n=16, 10%) Conclusions: Our systematic reviewsummarizes literature available regarding the impact of nature exposure on health outcomes in children, withan emphasis on high quality studies Ultimately, we seek to make this evidence accessible to pediatricians tobase clinical recommendations, develop health-promoting programs and policies, and guide future research

89.
Pediatrics ; 147(3):1056, 2021.
Article in English | WHO COVID | ID: covidwho-1177820

ABSTRACT

Background: In individuals affected with Hemoglobin SC (HbSC) disease, one β globin gene is affected by thesickle mutation (position 6, a single-base pair change encodes valine instead of glutamine) while the other βglobin gene contains a mutation for hemoglobin C (position 6, lysine is encoded instead of glutamine) In thiscompound heterozygous state individuals typically present with a milder sickle cell disease (SCD) coursecompared to those with homozygous HbS (HbSS) disease Although children with HbSC disease experience asignificant incidence of silent cerebral infarcts, acute stroke presentation is exceptionally rare Herein wedescribe a case of an adolescent male with historically uncomplicated HbSC disease, and otherwiseunremarkable sickle cell surveillance labs on admission presenting with new acute onset stroke CasePresentation: Our patient is a 16 year old male with uncomplicated HbSC disease and no history ofhospitalizations for vasoocclusive crisis He presented with 48 hours of difficulty focusing out of his left eye Physical exam revealed impaired right eye adduction, left eye nystagmus on lateral left gaze, and decreased sensation to touch to the left hemi face and left arm Strength and deep tendon reflexes were normal Normalgait was observed and he had no dysdiadochokinesia STAT MRI orbit and brain with contrast revealedmultiple foci of acute infarct involving the pons and left cerebral peduncle Vessel imaging with MRA wasconcerning for internuclear ophthalmoplegia secondary to stenosis in the posterior cerebral circulation Vitalsigns were normal for age and labs were overall mild and unchanged from his baseline (WBC 8750/mcL,Hemoglobin 13 5g/dL, Platelets 290,000/mcL, Reticulocyte 2 11%, CRP <0 30mg/dL) Initial thrombophilia workup demonstrated no increase in antiphospholipid antibodies, normal homocysteine levels and fibrinogenlevels Fibrin D-dimer was mildly elevated at 0 55mcg/mL Further thrombophilia evaluation is ongoing Arespiratory viral panel and COVID-19 testing were performed and were negative The patient was treated withemergent complete exchange transfusion Discussion: This case highlights the importance recognizing the riskfor acute stroke in patients with HbSC Prior to this acute presentation of stroke, this patient had mild disease with no history of prior transfusions and mild vasooclussive crises managed as an outpatient Earlyrecognition, imaging and management for those who present with focal neurologic deficits is essential inpreventing considerable morbidity and mortality It is imperative that as a general pediatrician, one must bevigilant and not rely on reassuring labs or prior histories of mild disease presentations in patients with SCD Unlike with HbSS, there is limited data and consensus guidelines for secondary stroke prevention in patients with HbSC, thus emphazing clinical judgement in initiation of exchange transfusion We did proceed withexchange transfusion taking into consideration the data that supports improved outcomes in HbSS patients

90.
Pediatrics ; 147(3):1045-1046, 2021.
Article in English | WHO COVID | ID: covidwho-1177819

ABSTRACT

BACKGROUND: Military Health System (MHS) beneciaries have historically reported greater dissatisfaction with access to care than their civilian counterparts At Osan Air Base in South Korea, the pediatric clinic of1,200 patients is staffed by a single pediatrician, making improvements in access challenging Commandinterest in increasing the number of command-sponsored children on base made improving access to carecrucial OBJECTIVE: Our objective was to improve third-next-available future appointment booking time to 4 0days and acute to 1 5 days without decreasing the average number of relative value units (RVUs) per week METHODS: We conducted plan-do-study-act (PDSA) cycles aimed at increasing access to care for future andacute visits Baseline pre-intervention data was obtained via chart reviews of medical records from August toSeptember 2019 We based initial clinical interventions on RESET for Pediatrics developed by Fairchild ABPediatrics, including turning off cross-booking and scrubbing appointments Subsequent interventionsincluded switching acutes to the afternoon, offering virtual visits, and changing the future/acute appointment ratio to 70/30 from 60/40 We implemented these interventions in four PDSA cycles and followed third-next-available dates in clinic from October 2019 to February 2020 To analyze the benet of improved access, wenoted changes in patient satisfaction and tracked RVUs earned per week RESULTS: The baseline third-next-available appointment was an average of 10 7 days for future and 2 9 days for acute appointments After thefull intervention period, the third-next-available future appointment had decreased to 4 0 days for future and1 1 for acute visits Third-next-available decreased in a step-wise fashion with each intervention until January,when the provider was out of clinic for two weeks, but continued to decline in February Average number ofRVUs per week pre- and post-intervention were not signicantly different, at 19 45±3 95 and 19 01±0 91,respectively Patient satisfaction with ease of making an appointment increased from 68 9% pre-interventionto 87 6% post-intervention CONCLUSIONS The interventions improved access in our single-provider clinic andthe goal for third-next-available future and acute appointments was met in December 2019 and February2020, respectively Both measures increased signicantly in January, when the provider was out for two weeks,but quickly continued to decline in February The number of RVUs per week was maintained despite openingup access signicantly in clinic and switching many appointments to virtuals Patient satisfaction increasedsignicantly during the study period Limitations on this data include that 132 patients were redistributed tofamily medicine in October;however, the proportional decrease in empaneled patients was small comparedto the signicant decreases in third-next-available appointment times Additionally, the post-intervention data was only collected until February due to the COVID-19 outbreak in March This data indicates that in access tocare can be improved signicantly in single-provider clinic without decreasing reimbursement

91.
Pediatrics ; 147(3):991-992, 2021.
Article in English | WHO COVID | ID: covidwho-1177818

ABSTRACT

Telehealth is an expanding eld and facilitates the ability to connect with the patients, when physicalencounters are not possible However, its use in pediatric services remains limited In light of the COVID-19pandemic, telehealth is the only available option to provide continuity of care American Academy of Pediatricsalso has issued guidance in order to ensure continued care for children during this crisis We assess thefeasibility of web-based platforms and explore the challenges and barriers to telehealth implementation in asmall primary care setting Methods A video-conference using web-based applications is used for historytaking and visual examination to assess child activity in a pediatric practice serving over 400 children Weasked parents to rate their experience and degree of satisfaction Results We summarize our experienceintegrating telehealth technology into the practice of pediatrics: Limited Evaluation;Although telehealth maybe equivalent to face-to-face evaluation in many regards;it lacks the opportunity to perform a physicalexamination This is particularly concerning in examining children with medical complexities It is therefore important to pre-screen which children should be seen, in person Time Management: The visits often exceedtime allotted particularly in infants and younger children Initially it took signicant time to obtain andadequate history We started pre-brieng regarding virtual visit and what to expect Technical Challenges: Lackof familiarity with telehealth and the equipment is an important challenge, particularly in disadvantagedpopulation Physicians also facing technical issues as there was insufficient time to prepare Concern for Over-treatment: The treatment may simply be based on symptoms such as child touching the ears and attributed tootitis media;or a fever and cough may be treated as pneumonia Also, because of the ambiguity of thesituation, many parents may simply prefer to obtain a prescription for an antibiotic, or other medications Threat to Privacy: This issue is more relevant to the adolescent We believe adolescents would be betterserved, if they were permitted to use their personal cell phone Reimbursement: An inadequatereimbursement is a most important issue For sustainability, a sincere effort is needed to establish adequatepayment mechanism for telehealth services Liability Issues: Since telehealth mediated medical care is limitedregarding a physical examination, physicians are anxious whether they are missing certain importantdiagnosis This raises a concern for medicolegal liability There is a need to set clear guidelines for liabilityprotections Conclusion Although telehealth is widely accepted by the parents, it is important to understandthe limitations of telehealth The nature of such limitations should be conveyed to parents Since the health ofchildren cannot wait for a normalization of health care delivery;we need to be able to modify, adapt and try todo what is feasible

92.
Pediatrics ; 147(3):987, 2021.
Article in English | WHO COVID | ID: covidwho-1177814

ABSTRACT

The COVID19 pandemic brought telemedicine from pilot project to mainstream practice in the matter of a fewweeks The natural progression to move from a well-researched clinical trial to a self-supported clinicalenterprise has proven to be perilous for most programs This talk will review the steps required to successfullyjump this chasm and point out the unexpected pitfalls along the way Capturing and sustaining some benefitsafter the COVID19 pandemic will require practices to reflect, recognize and quantify the value thattelemedicine can bring to their patients and families Rightsizing your program is the key to achieving financialsustainability and being able to offset the fixed costs of your equipment, connectivity and telepresenters Withnew accountable care reimbursement plans, using telemedicine to help your organization achieve pay forperformance measures may be more lucrative than the traditional fee for service models Quality of carestandards recommend routine health maintenance visits every three months for children with a variety ofchronic conditions including asthma, attention deficit hyperactivity disorder, diabetes and obesity Many urbanprimary care practices experience a no-show rate of close to 50% for these health supervision visits Barriersto access, competing demands for parents' and students' time, and financial constraints are all cited as reasons for this poor adherence rate Direct to patient telemedicine within the patient centered medical homemay offer solutions to most of these issues as long as service can be safely and conveniently brought to thechild either at home or at school

93.
Pediatrics ; 147(3):978-979, 2021.
Article in English | WHO COVID | ID: covidwho-1177809

ABSTRACT

Background: The unprecedented impact of SARS-CoV-2/COVID-19 worldwide pandemic on healthcare hasbeen profound At our large quaternary care pediatric healthcare system, in response to change how wedeliver care, a telemedicine strategy was rapidly developed with a priority to address the needs of patientsrequiring specialty time sensitive ambulatory care One obvious opportunity was to rapidly expandtelemedicine capabilities to address the impact quarantines and stay at home orders would have on thedelivery of care to children with chronic conditions We had some telemedicine capabilities in certainpopulations, however when our community shut down we responded with an immediate plan to expandtelemedicine services in a large multi-specialty practice During the first week of the stay at home order, ourambulatory volumes drop by 69% reinforcing concerns regarding delays care (Fig 1) Methods: We establisheda leadership model, task forces, and communication plan We rapidly adapted to ongoing changes andaddressed specific needs including clinic workflow, patient populations, patient capabilities to utilize telehealth, education of clinical teams, and daily visible tracking tools We measured daily telemedicinevolumes by practice, total visits, and proportion of telemedicine visits Results: The 69% decrease inambulatory volume was countered with a 42,300% increase in telemedicine visits Prior to COVID-19, weaveraged 4 telemedicine visits weekly and currently complete over 2,000 Through telemedicine, we aremaintaining a clinic volume of 57% of expected with 68% of all those visits being provided throughtelemedicine (Figure 2) All specialty services provide telemedicine Certain specialty clinics adapted totelemedicine easier than others;allergy/asthma (98%;n = 581), pulmonary (97%;n = 390), neurology (96%;n =1,004), dermatology (95%;1,175), and otolaryngology (91%;n = 1,314) clinics experienced the greatest degreesof success over the past month while ophthalmology (55%;n = 531), cardiology (35%;n = 576) and orthopedics(14%;n = 1,713) faced challenges Additionally, 30% of all completed telemedicine visits were for new referralvisits Conclusion: We rapidly expanded telemedicine to provide time sensitive care in a large ambulatoryspecialty practice Certain specialties were more amenable to telehealth for various reasons--vital signsavailable from home monitoring, ability to assess neurologic function in natural settings, etc We realized thatevery specialty could do some aspect of telemedicine yet for others it was more challenging due to the needfor ancillary tests (Echocardiogram, x-rays, ophthalmology adjuncts, etc ) or lack of a good substitute forphysical exam findings (murmurs, abdominal exams, etc ) We successfully completed new referral visits (aprevious concern in specialty practices) Future steps to sustain our telemedicine practice are to continue torefinine best telemedicine practices, identifying appropriate populations and visit types, track financial impact,and measure patient outcomes

94.
Pediatrics ; 147(3):975-976, 2021.
Article in English | WHO COVID | ID: covidwho-1177806

ABSTRACT

Background The COVID-19 pandemic has shifted the nature of medical care in pediatric primary care Tomitigate transmission SARS-COV-2 and to preserve the supply of personal protective equipment, CDCguidelines advise limiting non-essential medical visits However, administering vaccinations, facilitatingdevelopmental screening, managing acute medical illness, and identifying and treating mental illness remainof paramount importance to the health of children Objectives This program evaluation explores how a singleprivate primary care clinic shifted over the course of a few weeks from standard on-site ambulatory care to apredominantly telemedicine-based format, with specic protocols for in-person sick visits and well child care(WCC) for infants and toddlers Methods A descriptive survey was undertaken of practice changes occurring ina single, private pediatric primary care clinic during the COVID-19 pandemic Regulatory changes, paymentpolicy updates, and ethical considerations guided decisions about the utilization of telehealth Infants sixmonths and under continued to undergo routine on-site WCC Families of children 9-18 months old were offered a choice of either hybrid telemedicine interviews followed by open-air exam and vaccinationconducted in the clinic parking lot, versus routine on-site WCC Families of children 2 years and older wereoffered telehealth WCC with on-site exam and vaccination scheduled for 3-4 months ahead All sick visits wereinitiated via telehealth, with open-air exam and testing performed if deemed indicated by the provider Weeklyvisit number, percentage of well child checks, percentage of acute sick visits, and percentage of mental healthvisits were assessed through the clinic's electronic medical record Results Advanced Pediatrics (AP) is aprivate, suburban pediatric primary care clinic AP serves approximately 8,000 patients from birth through age22 years and averages 2000 patient visits per month In the month prior to the COVID-19 pandemic, >99% ofvisits were on-site;28% percent of visits were for WCC, 65% percent for acute illness, and 7% percent formental health In the month following the implementation of the COVID-19 telemedicine strategy, the totalnumber of visits decreased by 45% Telemedicine comprised 82% of visits WCC accounted 37% of visits, acutemedical care 55%, and mental health 8% of visits At the time of submission, the number and proportion ofvisits that were WCC as compared to acute medical care visits appeared to be increasing each week Conclusion Utilizing existing technologies and adapting to rapid changes in regulatory and billing policies, asingle private practice shifted the provision of pediatric care to a predominantly telemedicine based format,with specic protocols for in-person visits for well and sick children By sharing lessons learned from thisexperience, pediatricians may craft universal procedures that can be mobilized in case of future interruptionsto the standard model of medical care Impact of COVID Plan on the Location of Care In the month prior to the COVID-19 pandemic, >99% of visits were on-site;in the month following the implementation of the COVID-19 telemedicine strategy, 82% of visits were conducted via telemedicine, with only 28% of visits occurring on-site Impact of COVID Plan on the Distribution of Visits by Visit Type Despite a shift to telemedicine, the proportionsof well child care, acute sick visits, and mental-health related visits did not differ greatly in the pre- and post-COVID Plan periods

95.
Pediatrics ; 147(3):969-970, 2021.
Article in English | WHO COVID | ID: covidwho-1177803

ABSTRACT

Telemedicine is utilized in the United States, but its acceptance has been limited In the environment of apandemic, the healthcare industry is forced to alter the delivery of care to contain the virus' spread Utilizingtelemedicine in small community settings may ensure continuity of care and deliver healthcare advice whilereducing the risk of exposure Program Goals: review the challenges, benets, and limitations of rapidlyimplementing telemedicine into one small Pediatric Allergy practice in response to the COVID-19 pandemic Implementation resources included education via online webinars and online research Evaluation: Care wasdelivered by a physician and nurse practitioner via real-time audiovisual teleconference Platforms utilizedincluded Zoom and Doxy me Preparation included evaluating telemedicine platforms, staff training, andpatient education in the setting of quickly changing regulatory and nancial policies During the rst month oftelemedicine implementation, clinicians perceived several frustrations These included reviewing test results without parents possessing the test result copies Concerns of HIPAA privacy limited document sharing withfamilies Parents were also visualized writing their child's results which may have impaired their ability toabsorb information provided by the clinician It was also perceived that direct interaction with the pediatricpatient was decreased due to a lack of engagement with the child Many younger children were distracted bytheir home setting and did not stay focused on the conversation Adolescents did actively engage Despitethese limitations, within 2 weeks, the office successfully provided care for disorders including food allergy,allergic rhinitis, asthma, urticaria and atopic dermatitis Partial physical exams were conducted, includingassessments of patient appearance, quality of conversation, face/eyelid/skin, chest excursion & chest wallsymmetry, respiratory effort, mental status, and mood/affect Counseling, education and gross patientassessments were effectively accomplished with parents expressing satisfaction with remote care Limitations were noted in the setting of an acute asthma exacerbation These included restrictions in patient assessment,such as vital signs and auscultation of breath sounds Despite counseling and medication prescriptionprovided via telemedicine, the patient later sought emergency care via ED Discussion: rapid deployment wasachieved in a community small-office setting Successes included effective patient counseling and educationand delivery of patient care for non-emergent conditions These could be accomplished with the partialphysical exam available through audiovisual interface Limitations included decreased engagement of youngerchildren and the lack of document sharing, which can be addressed via other HIPAA-compliant technologyplatforms Asthma exacerbation was not effectively managed and illustrates the limitations of remotehealthcare in acute situations However, many patient encounters can be effectively managed with theassistance of telemedicine and may allow for maintaining healthcare delivery in the setting of an acutepandemic

96.
Pediatrics ; 147(3):965-966, 2021.
Article in English | WHO COVID | ID: covidwho-1177801

ABSTRACT

The covid-19 pandemic has forced us to reevaluate how we deliver care to our patients How do we balanceShelter in Place orders with the need to provide well child care and vaccines? We work in an FQHC and serve alargely immigrant Hispanic community, many of our patients' parents are migrant and seasonal farmworkers We made many changes in our clinic to adapt to covid-19: an outdoor respiratory clinic and covid testing,telephone and telehealth visits to keep patients who are sick out of clinic, telephone outreach to addresssocial determinants of health (mainly food insecurity and housing), administering of free medications forthose uninsured patients who could no longer afford their medications Throughout these changes to addressimmediate needs, we limited our well child visits to 2 years and under to protect our patients, our staff andour limited clinic resources However, as we settled into this 'new normal', we quickly realized we needed arecovery plan to address the backlog of well child visits for all ages and vaccines that could be nimble enoughto withstand possibly repeated rounds of social distancing over the months to come That is how the hybrid clinic model came into fruition Our pediatrics team was committed to keeping our patients immunized and tosupport their growth and development during covid-19 We began reaching out to colleagues across the stateand country to nd out what others were doing, joined one of the AAP Covid-19 ECHO groups and researchingemerging best practices for how to deliver well child care during a pandemic We brought the model to ourCovid-19 incident command team and to our frontline medical providers for feedback and ideas Our currentwell child check model is in pilot stage and involves a combination of telephone and in person components We are learning and innovating how to best serve our patients As a Level 3 Patient Centered Medical Homeand a Federally Qualied Health Center, we already do quality improvement and quality assurance tracking onmany topics, including vaccines and well child visit adherence We will continue to use data to monitor oursuccess with this model and make adjustments along the way as needed The covid-19 pandemic is a globalchallenge affecting us all Technology, specically telephone and telehealth services have allowed us toinnovate quickly on how to deliver care-both acute and preventive- to vulnerable populations This time inhistory is highlighting the advances of hospital and ICU medicine to treat people suffering a new disease and,at the same time, it puts primary care into sharp focus as a critical safety net that must remain intact, evenduring a pandemic, to support our children An initial overview to train medical providers on how we will approach well child visits in clinic during shelter inplace orders related to covid-19 Summary of Well Child Visits Table depicting how telephone technology will be used to limit the amount oftime the patient is physically in clinic while attempting to maximize adherence to Bright Futures

97.
Pediatrics ; 147(3):961-962, 2021.
Article in English | WHO COVID | ID: covidwho-1177799

ABSTRACT

Program Goals: During the COVID-19 pandemic, anticipatory guidance, developmental surveillance andimmunizations may be postponed At Fair Haven Community Health Care (FHCHC), a multi-site communityhealth center (CHC) in New Haven, CT, serving approximately 18,000 patients (9,000 children), weimplemented cohorting during the period of greatest local impact of the pandemic Our goals were to (1)prioritize well-child care for children due for immunizations, (2) increase the capacity for telemedicine forpatients with chronic illness or acute complaints, and (3) implement on-site COVID-19 testing with socialdeterminants screening Evaluation: We implemented cohorting for pediatric patients at FHCHC on March 12,2020 (for reference, Connecticut's stay-at-home order was signed March 23) Previously scheduled well childcare (WCC) for key age groups - birth to 24 months and 4 to 5 years - were moved to a “clean” site where onlyWCC and prenatal care were offered All other children received telemedicine visits, which could be converted to same-day in-person visits at the discretion of the clinician School-based health center providers were re-purposed to call patients with asthma in need of follow-up using a chronic care model On April 22, 2020,shortly after the neighborhood surrounding FHCHC's main site was identied as a COVID-19 “hot-spot,” weimplemented on-site testing regardless of symptoms, exposure, or prior use of FHCHC services Patientstested on-site were seen prior to their test via telemedicine for symptom assessment and to be screened forsocial determinants using the Accountable Health Communities instrument They were given locally-specicinformation to meet social needs generated by the NowPow platform From March 12 through April 30, wecompleted 3,302 visits for children 0 through 22 years;1,595 (48%) were via telemedicine Younger childrenages 0-5 years had a greater proportion of visits in-person (634, 60%) than children 6-12 years (438, 46%) oradolescents 12-22 years (635, 49%) Visit counts by time, stratied by visit-type, are shown in the Figure FromApril 22 through 30, 2020, we have scheduled 317 visits for on-site testing, 243 (77%) of which werecompleted, 36 of whom were children, all of whom were screened for social determinants of health Discussion: CHCs can cohort children to ensure that preventive care and vaccinations happen in a timelyfashion in the context of an epidemic Responding to local epidemiologic data, CHCs can provide trustingenvironments for surveillance testing Testing for COVID-19 represents a feasible opportunity to screen forsocial determinants of health and facilitate community linkages to meet social needs using electronicplatforms After the COVID-19 pandemic has subsided, CHCs can offer episodic telemedicine visits for children,and can screen for social determinants at various points of contact with families

98.
Pediatrics ; 147(3):956-957, 2021.
Article in English | WHO COVID | ID: covidwho-1177797

ABSTRACT

Introduction: Gliomas are the most common primary CNS tumors making up 50-60% of brain tumors inchildren Prognosis for gliomas depends on histologic grade and location of tumor Impingement on normalbrain tissue or increase in intracranial pressure is caused by either obstruction of CSF flow or by direct masseffect Symptoms can include lethargy, headache and vomiting Signs of slow growing CNS tumors can includeirritability, poor school performance and loss of developing milestones Most arise with no known underlyingrisk factor or disorder Case Presentation: 7-year-old male with no significant past medical history presented with left sided weakness that began 8 weeks prior to admission Initially mother noticed the patient to have anasymmetric smile Patient was seen by PCP and was referred to ophthalmology and neurology at that time 4weeks later, he was noted to have left arm weakness and difficulty writing with his left hand A week later hebegan having weakness in his left leg and was noticed to have increased instability Patient was reevaluated byPCP who instructed him to complete a 5-day course of steroids and follow-up with neurology On the day of admission he was seen by an outpatient neurologist using telemedicine due to COVID outbreak It was notedthe patient had left sided paralysis, a dilated left pupil, weakness of the left arm and leg with elevation Afterseeing the physical exam findings through a webcam, the neurologist suggested for the patient to have urgentevaluation in the emergency department CT brain with contrast revealed a heterogenous, complex mass inthe region of the right hypothalamus MRI brain showed mass that involved the right and left cerebralhemisphere, with infiltration of the left optic tract A brain biopsy was performed by neurosurgery andpathology was GFAP positive confirming astrocytoma in the brainstem Discussion: About 25% ofastrocytomas are aggressive or high grade Brainstem gliomas make up 10-20% of CNS tumors in children lessthan 15 years old Diffuse midline gliomas are infiltrative tumors, usually with astrocytic morphology and arelocated in the pons, thalamus or spinal cord Most cases have high grade features and are histologicallyconsistent with Grade 4 Treatment includes surgery, radiotherapy and chemotherapy For high grade tumorssurgery can be performed as well as radiotherapy and chemotherapy But without reasonable resectionchemotherapy is palliative Brainstem gliomas cannot be removed, and therefore have a poor outcome Conclusion: Despite lack of in person evaluation, this case highlights the importance of prompt recognitionand action when performing history and physical exams even in this new era of telemedicine In the setting ofthe COVID-19 pandemic, the use of telemedicine proved to be prominent in the diagnosis of this patient

99.
Pediatrics ; 147(3):954-956, 2021.
Article in English | WHO COVID | ID: covidwho-1177796

ABSTRACT

Background/Purpose: As the COVID-19 pandemic continues to spread worldwide, children may account foronly 2 16% of conrmed cases Previous studies may underestimate the true incidence of COVID-19 in childrenas they are more likely to be asymptomatic, and thereby less likely to be tested We aimed to determine theincidence of COVID-19 in pediatric patients presenting for surgery Methods: After universal preoperativescreening for COVID-19 was instituted at the Children's Hospital of Philadelphia, Seattle Children's, and TexasChildren's Hospital, children <19 years age without known COVID-19 were tested using a reverse-transcriptasepolymerase chain reaction (RT-PCR) assay to detect the SARS-CoV-2 virus Patient characteristics wereevaluated to determine factors associated with positive testing Results: 1,295 pediatric surgical patients werescreened (mean age 7 35 years) The overall incidence of COVID-19 was 0 93% (12/1,295), but ranged from0 22% to 2 65% across hospitals (p=0 001) At one institution, 5/9 positive patients presented from a singletownship with a positive risk rate of 55 6% vs 1 51% in all other patients (p=0 001) 50% of COVID-19 patients presented with preoperative symptoms vs 12 24% in negative patients (p=0 002) (Table 1) Fever (25 0% vs 6 7%, p=0 044), rhinorrhea (16 7% vs 2 8%, p=0 005), and known COVID-19 exposure (20 0% vs 1 7%, p=0 014) were more common in COVID-19 patients After multivariate regression, age (OR 1 10, p=0 048) and ASA emergent classication (OR 5 66, p=0 001) were associated with COVID-19 Conclusion: The overall incidence of COVID-19 in children undergoing preoperative universal screening was <1% However, this varied greatly between the regions represented by our hospitals, and even by township within the catchment area of a single hospital The value of universal COVID-19 screening appears greatest in areas with higher prevalence As elective surgery resumes, it will be important to consider universal testing in the context of regional prevalence, local testing capability, and availability of personal protective equipment

100.
Pediatrics ; 147(3):868-869, 2021.
Article in English | WHO COVID | ID: covidwho-1177795

ABSTRACT

Introduction: Currently the United States is the most affected country worldwide with COVID-19 Initial data found the majority of pediatric cases to be mild or asymptomatic, with decreased hospitalizations compared to adults Recently there are reports demonstrating systematic inflammatory illnesses in children with COVID- 19, including toxic shock syndrome and Kawasaki Disease (KD) The following case describes a pediatric patient with incomplete KD and evidence of previous COVID-19 infection Case: A healthy 2-year-old female presented with 5 days of fever, polymorphous rash, and conjunctivitis She was found to have elevated CRP 19 2mg/dL and ESR 115mm/hr Echocardiogram noted mild dilation of the right coronary artery (z-score +2 1) She received IVIG and aspirin Repeat echocardiogram showed a small fusiform RCA aneurysm (z-score +3 1) and LAD aneurysm (z-score +5 0) An S3 gallop was appreciated on exam BNP was elevated (max 2,100pg/mL) and CXR showed a right sided pleural effusion She received infliximab for refractory KD with resolution of fever and rash BNP remained elevated warranting continued Lasix with improvement Initial infectious workup on admission was negative, including SARS-CoV-2 RT-PCR testing from nasopharyngeal swab Anti- SARS-CoV-2 serum IgG Antibody testing was sent and resulted positive A repeat echocardiogram demonstrated a small, stable RCA aneurysm with normal function She was discharged home on low dose aspirin and Lasix Discussion: Kawasaki Disease is a systemic, inflammatory illness that affects medium-sized arteries and causes coronary artery aneurysms if untreated The etiology remains unknown, despite decades of investigation An infectious trigger leading to a systemic inflammatory response has been theorized however data is inconsistent There is some evidence that infection with a novel RNA virus may be linked to a KD agent Diagnosis requires fever >5 days and 4 of the following: conjunctivitis, mucositis, polymorphous exanthem, peripheral extremities swelling, cervical lymphadenopathy Incomplete KD can be considered in patients with prolonged fevers, 2-3 exam findings, supporting laboratory evidence or echocardiogram abnormalities Our patient met criteria for incomplete KD with prolonged fevers, conjunctivitis, polymorphous rash, elevations in CRP/ESR and positive echocardiogram findings The clinical significance of IgG antibodies to COVID-19 remains unknown Our patient initially tested negative with RT-PCR suggesting no active infection during symptom onset The family denied antecedent illness or known contacts infected with COVID-19 Positive antibodies suggest our patient may have been an asymptomatic carrier, however a false positive (received IVIG prior to testing or reaction from another coronavirus) cannot be ruled out Conclusion: The effects of COVID-19 on children is not well understood Children appear to be less affected than adults, and symptoms tend to be very mild There is increasing evidence that a post-viral inflammatory response may contribute to systemic illness in children and more information is needed for clinicians to approach affected patients moving forward

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