La pediatría social. Herramienta necesaria para combatir la pandemia de COVID-19 en Cuba / Social Pediatrics: A Necessary Tool to Combat the COVID-19 Pandemic in Cuba

Introducción: La pediatría social se orienta hacia la atención integral del niño. Estudia las causas sociales que alteran su salud y también los problemas de esta índole que repercuten en su entorno social. En el contexto de la actual pandemia, caracterizada por alta morbilidad y mortalidad, se produjeron significativas consecuencias psicosociales. Objetivo: Describir el impacto de la pediatría social sobre la salud infanto-juvenil durante la pandemia de COVID-19. Métodos: Se realizó una revisión en las bases de datos bibliográficas PubMed y BVS. Se empleó el Google Académico como motor de búsqueda. Se utilizaron, en español y en inglés, los siguientes descriptores: pediatría social, pandemia COVID-19, aislamiento social, bienestar psicológico, salud mental y población pediátrica. Análisis y síntesis de la información: Se expusieron argumentos desde la mirada psicosocial del pediatra, relacionados con el desarrollo y el bienestar socioemocional de los niños, y la repercusión sobre ellos del aislamiento social; además, se describió el impacto de la pandemia en la infancia, y el papel desempeñado por el especialista y otros profesionales vinculados con la atención pediátrica. Conclusiones: La pandemia se caracterizó por afectar todas las esferas de la vida del niño. La pediatría social resultó indispensable en el enfrentamiento de las consecuencias médico-biológicas, psicológicas y sociales que ocasionó el azote de la COVID-19, por lo que su rol influyó en el restablecimiento del equilibrio biopsicosocial de la población infantil(AU)

Introduction: Social pediatrics is oriented towards the comprehensive care of children. It studies the social causes that alter their health, and also the problems of this nature that affect their social environment. In the context of the current pandemic, characterized by high morbidity and mortality, there were significant psychosocial consequences. Objective: To describe the impact of social pediatrics on children and adolescents health during the COVID-19 pandemic. Methods: A review was conducted in the bibliographic databases PubMed and VHL. Google Scholar was used as a search engine. The following descriptors were used in Spanish and English: social pediatrics, COVID-19 pandemic, social isolation, psychological well-being, mental health and pediatric population. Analysis and synthesis of information: Arguments were presented from the psychosocial perspective of the pediatrician, related to the development and socio-emotional well-being of children, and the impact on them of social isolation. In addition, the impact of the pandemic on children was described, and the role played by the specialists and other professionals linked to pediatric care. Conclusions: The pandemic was characterized by affecting all spheres of the child's life. Social pediatrics was indispensable in confronting the medical-biological, psychological and social consequences caused by the scourge of COVID-19, so its role influenced the restoration of the biopsychosocial balance of the children population(AU)

Community Social Paediatrics Approach, an Innovative Healthcare Intervention: Implementation Fidelity in Atlantic Canada.

The Community Social Paediatrics approach (CSPA) is a comprehensive and personalized approach to care that is becoming more widely used throughout Canada. However, data on its implementation fidelity remain scarce. The purpose of this research was to assess the implementation fidelity of a CSPA established in 2017 in Canada. Data were collected through focus group interviews with the CSPA team using an implementation fidelity grid based on the Dr. Julien Foundation standard accreditation criteria. Results showed that on one hand, administrative and financial management and governance were among those domains with lower ratings. On the other hand, assessment/orientation and follow-up/support had high levels of fidelity of implementation. This research helps to better understand which factors are contributing to varying levels of fidelity of implementation. To reach an increased level of fidelity of implementation, it is recommended that adequate resources be in place.

Caregiver's Perspectives on the Healthcare Experiences of Children With Behaviour-Related Disorders.

OBJECTIVE: Social Pediatrics focuses on targeting and mitigating the effects of the social determinants of health on a child's well-being and development. Negative health outcomes have been seen in children who have faced poverty, food insecurity, inadequate housing, and traumatic events. In particular, children who come from socioeconomically disadvantaged households are more likely to develop behavioural problems. The purpose of this study is to explore the experiences of caregivers for children with a behaviour-related disorder. This includes children affected by attention, academic, and social issues (e.g. attention-deficit hyperactivity disorder, autism spectrum disorder). This study will aim to understand the strengths, barriers, and social limitations to accessing and receiving care for children with behavioural disorders.  Methods: A qualitative descriptive design was used to conduct three focus groups. Of the 64 caregivers contacted, a total of 13 participants agreed to be in the study. All focus groups were analyzed using inductive thematic analysis.  Results: Preliminary findings suggest that caregivers value pediatricians who spend time, communicate, and make a human connection with their patients. Barriers included physician turnover, long wait times for referrals, and a lack of knowledge regarding services and programs available in their area. Three major themes emerged from this study including (1) timeliness to care, (2) advocacy, and (3) relationship building. CONCLUSION: Findings suggested that caregivers valued pediatricians who spend time to make a human connection with their patients. Barriers included physician turnover, long wait times for referrals, and a lack of knowledge of available services. Caregivers who were young mothers felt an added layer of judgement when accessing the necessary care for their children. This study is important as it contributes to our knowledge on the role Social Pediatrics can play in the care of children with behaviour-related disorders.

More than Just Soup: Use of a Student-Led COVID-19 Social Pediatrics Initiative to Propose the Integration of Social Medicine Electives in Undergraduate Medical Education.

INTRODUCTION: The need to educate medical students on the social forces shaping disease and health patterns is paramount in preparing incoming physicians with the aptitudes to address health inequities. Despite its well-documented merit as a model of practice, social medicine remains underrepresented at the undergraduate medical education level. We hypothesize that the success of this student-led COVID-19 initiative proposes a tangible and innovative solution to address the lack of social medicine exposure in undergraduate medical education. METHODOLOGY: We sought to evaluate the impact of sustaining clinical learning during the pandemic using the social pediatrics model as a didactic vector for clerkship students. We extracted learning objectives relevant to the teaching of social medicine from the Royal College of Physicians and Surgeons of Canada's CanMEDS framework and developed a survey aimed at evaluating the attainability of each of those objectives. The survey was distributed to students enrolled in the social pediatrics COVID-19 initiative after 6 weeks (April-May), as well as a control group. RESULTS: Completing the survey were 19 students from the University of Ottawa Faculty of Medicine, 7 in the intervention group and 12 in the control group. Students that participated in the social pediatrics initiative yielded significantly higher values for the achievement of 6 out of 9 social medicine learning objectives when compared to the control group. Although the values followed a similar trend for the remaining 3 objectives, favoring the intervention group, they were not statistically significant. CONCLUSION: The positive results from this study and the COVID-19 student-led initiative template can serve as a catalyst for curricular change so as to ensure graduates are adequately trained to contend with the realities of the social landscape in which they will practice. Future plans include the incorporation of interactive social medicine experiences throughout all 4 years of medical school.

Codifying explicit and tacit practitioner knowledge in community social pediatrics organizations: Evaluation of the first step of a knowledge transfer strategy.

In this article, we the present the evaluation of the first phase of a KT initiative, the codification of the tacit and explicit knowledge of community social pediatrics (CSP) practitioners. As increasing numbers of professionals began working in the CSP field, it became necessary to capture the know-how to make it better understood. This first phase of the initiative took advantage of one of the KM stages, the codifying process that is absent from KT models. The evaluation aim to answer the question: "What is the CSPs practitioners level of familiarity with the codification document, as well as their perceptions of its utility and its contribution to the understanding of the CSP model". The results, show that most respondents had consulted the codification document and were able to describe in detail parts of it. The results also show that they considered it to be a useful and necessary tool to guide practices and helpful in understanding the model. The results of this evaluation is paving the way for the next steps of the KT initiative.

Examining the Importance of Family History in Pediatric Behavioural Referrals.

In recent years, there has been a substantial increase in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children. Without appropriate management of symptoms and care, ADHD has been associated with a variety of negative child and adult outcomes. Environmental and familial factors that may contribute to three different pediatric referral types (academic, behavioural, and attentional) associated with ADHD were examined in the current study. In total, data from 477 families who were interviewed as a part of the intake process to a pediatric clinic were included in this study. Data for the current study was extracted from the intake questionnaires and included information on family history of mental health issues, socioeconomic status, and family relationships. The sample included children between the ages of three and 17 and mostly comprised males (n = 340). A frequency analysis of the data demonstrated relatively high rates of mental health issues within families (61.4%); almost half of the mothers reported some post-secondary education (46.1%) and most reported having normal relationships with their children (mothers, 78%; fathers, 62.9%). Finally, three stepwise regression analyses were conducted to predict referral type. All three regressions yielded significant models. Fifteen percent of the variability of the academic referral type was predicted by being male, age at the time of referral, mother's education level, and mother's learning. The behavioural referral types were predicted by a family history of depression, being male, mother-child relationship, and age at the time of referral; these accounted for 23% of the variance. Attentional referral type was predicted only by mother-child relationship that captured 6% of the variance. Overall, this study describes a population of parents of children with academic, behavioural, and attention-related referrals to pediatrics. Results indicate that mothers have a profound influence on their child's referral types, something that may transfer into later diagnosis and perhaps prognosis. Clinicians and researchers alike should focus their efforts toward developing integrative service assessment and treatment approaches that include important people in the child's life. The implementation of Community Social Pediatrics (a streamlined, inclusive approach to care) should be considered in urban centres like this one, where referrals like this are prevalent.

[Discriminative Validity of the Wechsler Intelligence Scale for Children - IV (WIS) in a Social-Pediatric Sample]. / Diskriminative Validität der Wechsler Intelligence Scale for Children ­ IV (WISC-IV) in einer sozialpädiatrischen Stichprobe.

Discriminative Validity of the Wechsler Intelligence Scale for Children - IV (WIS) in a Social-Pediatric Sample This study presents data on the discriminative validity of the Wechsler Scale of Intelligence for Children - IV (WIS) for clinical diagnoses, different types of schooling, and variables related to migration. The sample comprises 631 children aged 6 to 13 who were tested with the WIS core tests in German centers of social pediatrics (Sozialpädiatrische Zentren) which offer interdisciplinary assessment and intervention for children and youth with developmental disorders, disabilities, and psychological problems. Large effects were found for clinical diagnoses and types of schooling that are related to intellectual abilities: Children with intellectual developmental disorders and pupils of special schools for children with intellectual disability obtained low or very low IQ-scores. Children with migration background scored relatively lower only on the Verbal Comprehension Index.

Everyday memory difficulties in children and adolescents with Fetal Alcohol Spectrum Disorder.

Purpose: To investigate whether significant differences exist in everyday memory between youth with Fetal Alcohol Spectrum (FASD) compared with a nonexposed (NE) control group, while controlling for socioeconomic status and other comorbidities. Methods: Caregiver ratings using the Everyday Memory Questionnaire were obtained for 105 youth (9-17 years of age). Scores were compared between youth with a FASD diagnosis (N = 41; 56% male) and the NE group (N = 64; 53% male) using multivariate analysis of variance. Results: Significantly poorer scores were found across all domains of everyday memory in youth with FASD (p<0.01 for all comparisons). Findings maintained significance after controlling for group differences in socioeconomic status, presence of learning, and attention disorders, as well as exposure to other teratogens. Conclusions: This study provides important insights regarding the memory issues that underlie daily functional challenges faced by youth with FASD and the need for future intervention research.

It takes a village: a realist synthesis of social pediatrics program.

OBJECTIVES: To better understand how social pediatric initiatives (SPIs) enact equitable, integrated, embedded approaches with high-needs children and families while facilitating proportionate distribution of health resources. METHODS: The realist review method incorporated the following steps: (1) identifying the review question, (2) formulating the initial theory, (3) searching for primary studies, (4) selecting and appraising study quality, (5) synthesizing relevant data and (6) refining the theory. RESULTS: Our analysis identified four consistent patterns of care that may be effective in social pediatrics: (1) horizontal partnerships based on willingness to share status and power; (2) bridged trust initiated through previously established third party relationships; (3) knowledge support increasing providers' confidence and skills for engaging community; and (4) increasing vulnerable families' self-reliance through empowerment strategies. CONCLUSIONS: This research is unique because it focused on "how" outcomes are achieved and offers insight into the knowledge, skills and philosophical orientation clinicians need to effectively deliver care in SPIs. Research insights offer guidance for organizational leaders with a mandate to address child and youth health inequities and may be applicable to other health initiatives.

Social pediatrics: weaving horizontal and vertical threads through pediatric residency.

BACKGROUND: Social pediatrics teaches pediatric residents how to understand disease within their patients' social, environmental and political contexts. It's an essential component of pediatric residency training; however there is very little literature that addresses how such a broad-ranging topic can be taught effectively. The aim of this study was to determine and characterize social pediatric education in our pediatric residency training in order to identify strengths and gaps. METHODS: A social pediatrics curriculum map was developed, attending to 3 different dimensions: (1) the intended curriculum as prescribed by the Objectives of Training for Pediatrics of the Royal College of Physicians and Surgeons of Canada (RCPSC), (2) the formal curriculum defined by rotation-specific learning objectives, and (3) the informal/hidden curriculum as reflected in resident and teacher experiences and perceptions. RESULTS: Forty-one social pediatric learning objectives were extracted from the RCPSC Objectives of Training for Pediatrics, most were listed in the Medical Expert (51%) and Health Advocate competencies (24%). Almost all RCPSC social pediatric learning objectives were identified in more than one rotation and/or seminar. Adolescent Medicine (29.2%), Pediatric Ambulatory Medicine (26.2%) and Developmental Pediatrics (25%) listed the highest proportion of social pediatric learning objectives. Four (10%) RCPSC social pediatric objectives were not explicitly named within learning objectives of the formal curriculum. The informal curriculum revealed that both teachers and residents viewed social pediatrics as integral to all clinical encounters. Perceived barriers to teaching and learning of social pediatrics included time constraints, particularly in a tertiary care environment, and the value of social pediatrics relative to medical expert knowledge. CONCLUSIONS: Despite the lack of an explicit thematic presentation of social pediatric learning objectives by the Royal College and residency training program, social pediatric topics are integrated, taught and learned throughout the entire curriculum. Special attention needs to be given to the hidden curriculum and system barriers that may impede social pediatric education.

Evaluation of a social pediatrics elective: transforming students' perspective through reflection.

OBJECTIVE: The aim of this study was to examine aspects of a social pediatrics elective that led to student self-reflection and transformation. METHODS: To assess student learning from our social pediatric elective, we retrospectively evaluated self-reflection papers. We focused on the effectiveness of the educational approach to inspire students to incorporate the social determinants of health into their practice. Furthermore, in each reflection paper, we looked for evidence of different phases of transformation. RESULTS: The social determinants of health were the most commonly described theme. Poverty was mentioned directly or described implicitly in almost all papers. For many students, seeing the social context of patients in real life, whether in a special clinic or at a home visit, was a disturbing and disorienting experience that triggered transformation. CONCLUSION: The use of reflection papers in the evaluation of a social pediatric elective documented transformative learning.

Una respuesta institucional colombiana a niños/as que viven con VIH/SIDA / A Colombian institutional response to Colombian children infected with HIV/AIDS

El VIH/SIDA en la niñez es un problema social y su abordaje trasciende al sector de la salud. Las respuestas normativas, políticas, institucionales y de servicios tienen particularidades para la infancia. Un acercamiento propuesto se basa en los siguientes ejes: salud, nutrición, educación, condiciones socioeconómicas familiares, repercusiones psicosociales, protección, vivienda y estigmatización y discriminación. Desde estos lineamientos se exploró una institución usando la Teoría Bioecológica del Desarrollo Humano. Se describe y analiza la vida de niños/as en la institución. Es un estudio etnográfico y participaron 31 niños/as y 30 adultos/as. La respuesta institucional es satisfactoria en salud, alimentación, educación y cuidados básicos. La no revelación del diagnóstico, la estigmatización y discriminación contra los niños/as, la validación de la institucionalización, el manejo de las repercusiones psicoemocionales y del estigma y los costos del programa fueron las principales falencias. Los niños/as aprecian la respuesta institucional sobre el cubrimiento de sus necesidades básicas y rechazan algunas prácticas que ellos/as identifican como coercitivas y estigmatizantes. El reintegro de los niños/as a sus familias se recomienda como una estrategia de trabajo futuro sustentada en evidencias que demuestran mejores resultados biopsicosociales y bajo costo.

Children with HIV/AIDS is a social issue,the approach to which transcends the health sector. The normative, political, institutional and service sector responses have specificities related to children. A proposed approach is based on the following points: health care, nutrition, education, family-socioeconomic status, psychosocial repercussions, protection, housing, stigmatization and discrimination. Based on these guidelines,a survey was conducted of an institutional responseapplying the Bioecological Model of Human Development. Life of children in the institution is described and analyzed. A group of 31 children and 30 adults participated in this ethnographic study. The institutional response concerning health, nutrition, education and basic care, is satisfactory. The main weaknesses identified were nondisclosure of the diagnosis, stigmatization and discrimination, institutionalization validation, psychoemotional repercussions and stigmatization management, and the research budget. The children acknowledge that the institution satisfies their basic-needs and disapprove of some stigmatizing and coercive practices. The reintegration of the children with their families is recommended as a future strategy based on evidence that shows it has better bio-psychosocial results and lower costs.

Determinación de puntos de corte para la circunferencia de cintura a través de curvas ROC en población pediátrica de tres regiones de venezuela evaluada en el senacredh / Determination of cutoff points for waist circumference through ROC curves in the pediatric population in three regions of Venezuela evaluated in senacredh

En el contexto del Segundo Estudio Nacional de Crecimiento y Desarrollo Humano de la República Bolivariana de Venezuela(SENACREDH), se establecen por primera vez dentro de valores oficiales y de representatividad nacional, curvas ROC para determinar puntos de corte para la circunferencia de cintura en población pediátrica. Determinar puntos de corte para la circunferencia de cintura, a través de curvas ROC, en población pediátrica. Se evaluaron factores de riesgo para síndrome metabólico en 4.387 individuos de 5 a 19,99 años en las regiones: Centro Norte Costera, Orinoco y Andina (11 estados), los cuales representaron para la ponderación de los datos 1.066.864 habitantes. Con dichos datos se validaron en un modelo de regresión lineal múltiple las variables de mayor importancia que explican la circunferencia de cintura. Luego usándolas en conjunto como definitorias de riesgo para síndrome metabólico al tener más de una condición, se procedió a emplearlas como variable dependiente para generar curvas ROC y sus coordenadas con la circunferencia de cintura (CCI). Del total de niños, niñas y adolescentes, 54,80% correspondió a varones y 45,20% a hembras. El promedio de la circunferencia de cintura fue 66,896cm. (±10,49 cm., rango 44,4 a 127,2 cm., p25=59,5 cm., p50=65,7 cm., p75=72,8 cm.). Los valores de la media (±DE) de CCI se incrementaroncon la edad, en ambos sexos, y se asociaron significativamente utilizando el modelo de regresión lineal múltiple, en los coeficientes, área grasa (ag)(p<0,001), HDL colesterol (hdl) (p=0,005), peso (p<0,001), triglicéridos (trig) (p=0,004), suma de pliegues (sdp) (p<0,001) e IMC (imc) (p<0,001).Se encontró con un solo factor el 35,6%, y el resto con más de un factor (39,7%). Se generaron 6 curvas ROC por edad y sexo, observando que lospuntos de corte son consistentes con mayores valores en varones que en hembras y valores más altos a mayores edades

In the context of the Second National Study on Human Growth and Development of the Bolivarian Republic of Venezuela (SENACREDH), for the first time and within official and nationally representative data, ROC curves have been established for waist circumferencein a pediatric population. Determinate cut-off levels for waist circumference using ROC curves, in a pediatric population. Risk factors for metabolic syndrome were evaluated in 4,387 individuals, 5 through 19.99 y-old of the regions: North Central Coastal, Orinoco andAndean (11 states). They represented in the weight of data 1,066,864 pop. With those data a multiple linear regression model for those variables ofhigher importance explaining waist circumference, was validated. Then, using them jointly as defining for metabolic syndrome risk when more thanone of them was present, we used them as dependent variable in order to generate ROC curves and its coordinates for the waist circumference (WC). From the total of children and adolescents, 54.80% were males and 45.20% females. Mean waist circumference was 66.896 cm. (±10.49cm., range 44.4 through 127.2 cm., p25=59.5 cm., p50=65.7 cm., p75=72.8 cm.). Mean values of WC (±DE) increased with age, in both genders, and were significantly associated at the multiple linear regression model, regard the coefficients, with fat area (ag) (p<0.001), HDL cholesterol (hdl)(p=0.005), weight (p<0.001), triglycerides (trig) (p=0.004), sum of skin-folds (sdp) (p<0.001) and BMI (imc) (p<0.001). With one factor of the only was found 35.6%, and the rest with more than one (39.7%). Six ROC curves were generated by age and sex, observing that the cut-off points wereconsistent with higher values in males than in females and at higher ages