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15,273 reports · page 596 of 1528
This study compares age-specific rates of suicide between black and white youths using data from the Web-based Injury Statistics Query and Reporting System (WISQARS) of the Centers for Disease Control and Prevention.
Jeffrey A. Bridge, Lisa M. Horowitz, Cynthia A. Fontanella et al.
Importance: There is a growing body of high-quality cohort-based research that has examined changes in child and adolescent mental health during the COVID-19 pandemic vs before the pandemic. Some studies have found that child and adolescent depression and anxiety symptoms have increased, while others have found these symptoms to have remained stable or decreased. Objective: To synthesize the available longitudinal cohort-based research evidence to estimate the direction and magnitude of changes in depression and anxiety symptoms in children and adolescents assessed before and during the pandemic. Data Sources: Medline, Embase, and PsycInfo were searched for studies published between January 1, 2020, and May 17, 2022. Study Selection: Included studies reported on depression and/or anxiety symptoms, had cohort data comparing prepandemic to pandemic estimates, included a sample of children and/or adolescents younger than 19 years, and were published in English in a peer-reviewed journal. Data Extraction and Synthesis: In total, 53 longitudinal cohort studies from 12 countries with 87 study estimates representing 40 807 children and adolescents were included. Main Outcomes and Measures: Standardized mean changes (SMC) in depression and anxiety symptoms from before to during the pandemic. Results: The analysis included 40 807 children and adolescents represented in pre-COVID-19 studies and 33 682 represented in during-COVID-19 studies. There was good evidence of an increase in depression symptoms (SMC, 0.26; 95% CI, 0.19 to 0.33). Changes in depression symptoms were most conclusive for study estimates among female individuals (SMC, 0.32; 95% CI, 0.21 to 0.42), study estimates with mid to high income (SMC, 0.35; 95% CI, 0.07 to 0.63), and study estimates sourced from North America (SMC, 0.25; 95% CI, 0.15 to 0.36) and Europe (SMC, 0.35; 95% CI, 0.17 to 0.53). There was strong evidence that anxiety symptoms increased slightly during the pandemic (SMC, 0.10; 95% CI, 0.04 to 0.16), and there was some evidence of an increase in study estimates with mid to high income. Conclusions: This systematic review and meta-analysis of longitudinal studies including children and adolescents found an increase in depression symptoms during the COVID-19 pandemic, particularly among female individuals and those from relatively higher-income backgrounds.
Sheri L. Madigan, Nicole M. Racine, Tracy Vaillancourt et al.
Importance: Childhood and adolescence self-regulation (SR) is gaining importance as a target of intervention because of mounting evidence of its positive associations with health, social and educational outcomes. Objective: To conduct a systematic review and meta-analysis of rigorously evaluated interventions to improve self-regulation in children and adolescents. Data Sources: Keyword searches of the PsycINFO, PubMed, EMBASE, CINAHL Plus, ERIC, British Education Index, Child Development and Adolescent Studies, and CENTRAL were used to identify all studies published through July 2016. Study Selection: To be eligible for this review, studies had to report cluster randomized trials or randomized clinical trials, evaluate universal interventions designed to improve self-regulation in children and adolescents aged 0 to 19 years, include outcomes associated with self-regulation skills, and be published in a peer-reviewed journal with the full text available in English. Data Extraction and Synthesis: A total of 14 369 published records were screened, of which 147 were identified for full-text review and 49 studies reporting 50 interventions were included in the final review. Results were summarized by narrative review and meta-analysis. Main Outcomes and Measures: Self-regulation outcomes in children and adolescents. Results: This review identified 17 cluster randomized trials and 32 randomized clinical trials evaluating self-regulation interventions, which included a total of 23 098 participants ranging in age from 2 to 17 years (median age, 6.0 years). Consistent improvement in self-regulation was reported in 16 of 21 curriculum-based interventions (76%), 4 of the 8 mindfulness and yoga interventions (50%), 5 of 9 family-based programs (56%), 4 of 6 exercise-based programs (67%), and 4 of 6 social and personal skills interventions (67%), or a total of 33 of 50 interventions (66%). A meta-analysis evaluating associations of interventions with self-regulation task performance scores showed a positive effect of such interventions with pooled effect size of 0.42 (95% CI, 0.32-0.53). Only 24 studies reported data on distal outcomes (29 outcomes). Positive associations were reported in 11 of 13 studies (85%) on academic achievement, 4 of 5 studies on substance abuse (80%), and in all studies reporting on conduct disorders (n = 3), studies on social skills (n = 2), studies on depression (n = 2), studies on behavioral problems (n = 2), and study on school suspensions (n = 1). No effect was seen on 2 studies reporting on academic achievement, 1 study reporting on substance abuse, and 1 additional study reporting on psychological well-being. Conclusions and Relevance: A wide range of interventions were successful in improving self-regulation in children and adolescents. There was improvement in distal academic, health, and behavioral outcomes in most intervention groups compared with controls.
Anuja Pandey, Daniel R. Hale, Shikta Das et al.
Elsa* is a one-year-old girl from Tsitsika Town in Ziquala Woreda, Wag Himra Zone, Amhara Region. She lost her mother during childbirth and has since been under the care of her maternal aunt, who assumed full responsibility for her upbringing and well-being. The absence of maternal care affected her feeding and nurturing needs during a critical stage of early childhood. At the same time, her family’s limited economic capacity made it difficult for her caregiver to provide adequate nutrition, hygiene supplies, clothing, and other essential childcare items. Despite her commitment to caring for the child, Elsa*’s aunt struggled to meet the increasing costs associated with infant feeding, including the purchase of milk and other age-appropriate nutritional supplements. The family also lacked sufficient resources to access basic hygiene materials and necessities required to ensure a safe and healthy environment for the child’s growth and development. Recognizing her vulnerability and the challenges faced by her caregiver, community members, child protection structures, and relevant stakeholders referred Elsa*’s case for support. Given her age and the socioeconomic pressures affecting the household, she was identified as a child requiring targeted assistance and continuous follow-up. Through community outreach activities under the Joining Forces for Food Security and Child Protection in Emergencies (JF-FS&CPIE) Project and Elsa’s* referral, a Save the Children Child Protection Officer conducted a comprehensive assessment. Her case was subsequently prioritized, and an individualized care plan was developed in collaboration with her caregiver, the regional Women and Children Affairs Office, and community child protection structures. The project provided an integrated package of support that included milk powder, diapers, lotion, and other hygiene supplies. Her caregiver was also linked to livelihood opportunities and received Emergency Cash Assistance (CVA) to strengthen her capacity to provide sustainable care. In addition, regular case management follow-up, home visits, and referrals to relevant health, nutrition, and child protection services were conducted to support Elsa*’s wellbeing and development. Within one year of receiving support, significant improvements were observed in Elsa*’s wellbeing. According to her caregiver, her feeding practices improved considerably, and her overall health condition became more stable. The nutrition and hygiene support helped address her immediate needs, while the economic assistance reduced pressure on the household and improved the family’s ability to meet basic necessities. Continued case management follow-up and caregiver-strengthening interventions contributed to creating a safer, more stable, and nurturing environment for Elsa*. As a result, she is now benefiting from improved care, better nutrition, and stronger protection within her family setting. Elsa*’s experience demonstrates the importance of early identification, comprehensive case management, and integrated support for caregivers in improving outcomes for children. Reflecting on the support received, Elsa*’s aunt shared: “After receiving support from the project, I feel more confident in caring for Elsa*. The milk and hygiene materials helped me meet her immediate needs, while the income-generating activity and CVA support reduced the economic challenges affecting our family. The regular follow-up visits also gave me encouragement, guidance, and hope. I believe Elsa* will continue to grow healthy and strong.” *Not her real name. This publication was produced with the financial support of the German Humanitarian Assistance Its contents are the sole responsibility of Joining Forces and do not necessarily reflect the views of the German Humanitarian Assistance. The post Elsa appeared first on Joining Forces.
josemoriano
Mirte*, a 37-year-old mother of four children, lives in Sekota Town, Wag Himra Zone, Ethiopia. Her husband works as a daily laborer, but his earnings are irregular and insufficient to meet the family’s basic needs. As a result, the household had been struggling to provide food, clothing, education, and healthcare for the children. The family faced an even greater challenge when Mirte*’s youngest daughter, Kal*, developed Blount disease, a condition that causes the lower leg to bend inward and makes walking difficult. The child required regular medical care and follow-up treatment, but the family’s financial constraints prevented them from accessing the services she needed. To improve the family’s situation, Mirte* started a small business. However, the income generated was not enough to cover household expenses or the costs associated with her daughter’s healthcare. Mirte*’s situation began to change when she was identified by the community committee and selected as a participant in the Income Generating Activity (IGA) component of the Joint Force for Food Security and Child Protection in Emergency (JF-FS&CPIE) project. At the same time, her daughter was linked to medical care and follow-up services supported through the project. Through the project, Mirte* was able to establish a local staple cereals selling business, creating a more reliable source of income for her household. She also participated in financial literacy training, which strengthened her knowledge and skills in money management and informed financial decision-making. In addition, her children received non-food items (NFI) support, helping them attend school regularly. The integrated support provided through the project has significantly improved the well-being of Mirte*’s family. Her business has become an important source of income, helping her meet daily household needs, contribute to her children’s education, and reducing the financial burden on her husband. She is also better able to provide nutritious meals for her children. Most importantly, Kal* has received the medical care and follow-up treatment she needed. According to Mirte*, her daughter’s health has improved considerably. She can now walk more comfortably, participate in daily activities, and spend time playing with her sisters. These positive changes have restored hope and confidence within the family. Today, Mirte* looks to the future with optimism. Improved household income enhanced financial management skills, and access to healthcare have strengthened the family’s resilience and reduced their vulnerability. She hopes to continue expanding her business and providing her children with opportunities for a healthier and more secure future. Reflecting on the support, Mirte* shared: “As a mother, my greatest wish is to see my youngest daughter walk without pain and live a healthy life. As a mother I will continue striving tirelessly because my child Kal* deserves the chance to grow and play.” *Not their real names. This publication was produced with the financial support of the German Humanitarian Assistance Its contents are the sole responsibility of Joining Forces and do not necessarily reflect the views of the German Humanitarian Assistance. The post Mirte appeared first on Joining Forces.
josemoriano
Importance: In young febrile infants, serious bacterial infections (SBIs), including urinary tract infections, bacteremia, and meningitis, may lead to dangerous complications. However, lumbar punctures and hospitalizations involve risks and costs. Clinical prediction rules using biomarkers beyond the white blood cell count (WBC) may accurately identify febrile infants at low risk for SBIs. Objective: To derive and validate a prediction rule to identify febrile infants 60 days and younger at low risk for SBIs. Design, Setting, and Participants: Prospective, observational study between March 2011 and May 2013 at 26 emergency departments. Convenience sample of previously healthy febrile infants 60 days and younger who were evaluated for SBIs. Data were analyzed between April 2014 and April 2018. Exposures: Clinical and laboratory data (blood and urine) including patient demographics, fever height and duration, clinical appearance, WBC, absolute neutrophil count (ANC), serum procalcitonin, and urinalysis. We derived and validated a prediction rule based on these variables using binary recursive partitioning analysis. Main Outcomes and Measures: Serious bacterial infection, defined as urinary tract infection, bacteremia, or bacterial meningitis. Results: We derived the prediction rule on a random sample of 908 infants and validated it on 913 infants (mean age was 36 days, 765 were girls [42%], 781 were white and non-Hispanic [43%], 366 were black [20%], and 535 were Hispanic [29%]). Serious bacterial infections were present in 170 of 1821 infants (9.3%), including 26 (1.4%) with bacteremia, 151 (8.3%) with urinary tract infections, and 10 (0.5%) with bacterial meningitis; 16 (0.9%) had concurrent SBIs. The prediction rule identified infants at low risk of SBI using a negative urinalysis result, an ANC of 4090/µL or less (to convert to ×109 per liter, multiply by 0.001), and serum procalcitonin of 1.71 ng/mL or less. In the validation cohort, the rule sensitivity was 97.7% (95% CI, 91.3-99.6), specificity was 60.0% (95% CI, 56.6-63.3), negative predictive value was 99.6% (95% CI, 98.4-99.9), and negative likelihood ratio was 0.04 (95% CI, 0.01-0.15). One infant with bacteremia and 2 infants with urinary tract infections were misclassified. No patients with bacterial meningitis were missed by the rule. The rule performance was nearly identical when the outcome was restricted to bacteremia and/or bacterial meningitis, missing the same infant with bacteremia. Conclusions and Relevance: We derived and validated an accurate prediction rule to identify febrile infants 60 days and younger at low risk for SBIs using the urinalysis, ANC, and procalcitonin levels. Once further validated on an independent cohort, clinical application of the rule has the potential to decrease unnecessary lumbar punctures, antibiotic administration, and hospitalizations.
Nathan Kuppermann, Peter S. Dayan, Deborah A. Levine et al.
Importance: Ensuring the well-being of the 73 million children in the United States is critical for improving the nation's health and influencing children's long-term outcomes as they grow into adults. Objective: To examine recent trends in children's health-related measures, including significant changes between 2019 and 2020 that might be attributed to the COVID-19 pandemic. Design, Setting, and Participants: Annual data were examined from the National Survey of Children's Health (2016-2020), a population-based, nationally representative survey of randomly selected children. Participants were children from birth to age 17 years living in noninstitution settings in all 50 states and the District of Columbia whose parent or caregiver responded to an address-based survey by mail or web. Weighted prevalence estimates account for probability of selection and nonresponse. Adjusted logistic regression models tested for significant trends over time. Main Outcomes and Measures: Diverse measures pertaining to children's current health conditions, positive health behaviors, health care access and utilization, and family well-being and stressors. Results: A total of 174 551 children were included (annual range = 21 599 to 50 212). Between 2016 and 2020, there were increases in anxiety (7.1% [95% CI, 6.6-7.6] to 9.2% [95% CI, 8.6-9.8]; +29%; trend P < .001) and depression (3.1% [95% CI, 2.9-3.5] to 4.0% [95% CI, 3.6-4.5]; +27%; trend P < .001). There were also decreases in daily physical activity (24.2% [95% CI, 23.1-25.3] to 19.8% [95% CI, 18.9-20.8]; -18%; trend P < .001), parent or caregiver mental health (69.8% [95% CI, 68.9-70.8] to 66.3% [95% CI, 65.3-67.3]; -5%; trend P < .001), and coping with parenting demands (67.2% [95% CI, 66.3-68.1] to 59.9% [95% CI, 58.8-60.9]; -11%; trend P < .001). In addition, from 2019 to 2020, there were increases in behavior or conduct problems (6.7% [95% CI, 6.1-7.4] to 8.1% [95% CI, 7.5-8.8]; +21%; P = .001) and child care disruptions affecting parental employment (9.4% [95% CI, 8.0-10.9] to 12.6% [95% CI, 11.2-14.1]; +34%; trend P = .001) as well as decreases in preventive medical visits (81.0% [95% CI, 79.7-82.3] to 74.1% [95% CI, 72.9-75.3]; -9%; trend P < .001). Conclusions and Relevance: Recent trends point to several areas of concern that can inform future research, clinical care, policy decision making, and programmatic investments to improve the health and well-being of children and their families. More analyses are needed to elucidate varying patterns within subpopulations of interest.
Lydie A. Lebrun‐Harris, Reem M. Ghandour, Michael D. Kogan et al.
Nathan*, a 15-year-old boy from a remote village in Ziquala Woreda, Wag Himra Zone, was living in a community heavily affected by conflict and instability. The ongoing insecurity disrupted normal community life and exposed children and adolescents to various protection risks, including neglect, violence, psychosocial distress, and other harmful coping mechanisms. Nathan* soon became increasingly disengaged from education. He frequently missed school and spent much of his time on the streets during school hours, exposing him to negative peer pressure and unsafe environments. His prolonged absence from school affected his academic performance and increased the risk of dropping out altogether. The conflict-related stress and limited availability of child protection services also negatively affected his emotional well-being. Although community members and local stakeholders were aware of his situation, there were insufficient coordinated mechanisms to identify, refer, and support children. As part of the Joining Forces for Food Security and Child Protection in Emergency (JF-FS & CPiE) Project, Nathan* was identified as a child exposed to multiple protection risks. A Child Protection Officer (CPO) conducted a comprehensive assessment to understand his educational, psychosocial, and protection needs. Based on the findings, an individualized care plan was developed in collaboration with his family and relevant community stakeholders. Nathan* was subsequently enrolled in a Child-Friendly Space (CFS) supported by the project. The CFS provided a safe and supportive environment where he participated in structured recreational, educational, and psychosocial support activities aimed at strengthening resilience, improving emotional well-being, and promoting positive peer interactions. In addition, Nathan* received regular follow-up and counseling support through the case management process. His caregivers learned about the importance of education, child protection, and positive parenting practices to strengthen family support for his growth and development. The project’s team also worked closely with school authorities and community structures to encourage regular school attendance and monitor his progress. Following the intervention, Nathan* demonstrated significant improvements in his overall well-being and development. His school attendance became more regular, and he showed renewed commitment to his education. Participation in Child-Friendly Space activities and psychosocial support services helped him build self-confidence, develop positive coping mechanisms, and improve his relationships with peers and others around him. At the same time, support from his family and community for his education and protection became stronger. Regular follow-up and case management ensured that his needs continued to be addressed and that progress was maintained over time. Nathan*’s story demonstrates how timely identification, individualized case management, family engagement, and access to Child-Friendly Space services can significantly reduce protection risks and improve the well-being of children affected by conflict and instability. Today, he feels safer, more confident, and more hopeful about achieving his future aspirations. Reflecting on the changes in his life, Nathan* shared: “Before joining the Child-Friendly Space, I often missed school and spent most of my time on the streets. Now I feel safe, attend school regularly, and I am working hard to achieve my dream of becoming a doctor in the future.” *Not his real name. This publication was produced with the financial support of the German Humanitarian Assistance Its contents are the sole responsibility of Joining Forces and do not necessarily reflect the views of the German Humanitarian Assistance. The post Nathan appeared first on Joining Forces.
josemoriano
Samrawit* is a 16-year-old Grade 6 student living in Sekota Town, Wag Himra Zone. Due to concerns about her safety, her parents strictly limited her movement outside the home. They believed that girls were particularly vulnerable to harassment, violence, and other forms of abuse, and therefore restricted her participation in community activities and social interactions. While these measures were intended to protect her, they reduced her opportunities to build confidence, develop social skills, and exercise independence. Samrawit*’s mother, Tadelech*, was a housewife who rarely participated in community activities or family decision-making processes. Out of fear for her daughter’s safety, she closely monitored and restricted Samrawit*’s interactions outside the home. Communication within the family was limited, and Samrawit* had little opportunity to openly discuss her concerns, experiences, or aspirations. In addition, Samrawit* had limited knowledge of her rights, personal safety, and how to recognize and respond to potentially unsafe situations. This left her less prepared to navigate risks and advocate for herself within her community. Samrawit* was selected to participate in life skills training organized in her (local administration) kebele, while her mother attended Positive Parenting Without Violence (PwV) sessions conducted by Save the Children through the Joint Force for Food Security and Child Protection in Emergency (JF-FS&CPIE) project. Through the parenting sessions, Samrawit*’s mother learned about gender equality and positive, non-violent parenting practices. The training encouraged her to communicate more openly with her children, involve her in discussions, and participate more actively in family decision-making. At the same time, Samrawit*’s life skills training provided information about children’s rights, personal safety, emotional management, healthy relationships, and strategies for identifying unsafe places and situations. She also learned how to seek support from trusted adults when facing risks and how to make informed decisions that protect her well-being. The Child Friendly Space at her school further provided a safe and supportive environment where she could express herself creatively and build confidence. The combined impact of the Life Skills and Positive Parenting Without Violence sessions brought meaningful changes to both Samrawit* and her family. Samrawit* gained confidence, strengthened her understanding of her rights, and became more aware of how to identify and avoid risks within her community. She learned to recognize unsafe situations, seek help when needed, and express her opinions with greater confidence. The intervention also transformed family relationships. Communication between Samrawit* and her parents improved significantly, creating an environment where concerns and ideas could be discussed openly. Her mother became more supportive and less protective, allowing Samrawit* greater freedom to interact with others, participate in social activities, and engage with her community. As a result of these changes, Samrawit* became more active both socially and academically. She now participates confidently in public meetings and shares her views openly. Inspired by what she learned, she also began sharing key messages from the Life Skills sessions with friends and neighbors, encouraging them to understand their rights, protect themselves from harm, and believe in their abilities. Today, Samrawit* and her mother describe themselves as more confident and empowered. Their strengthened relationship and improved family environment have created greater support, mutual understanding, and opportunities for Samrawit* to pursue her future with confidence and hope. As Samrawit*’s mother reflected: “The Parenting Without Violence and life skills sessions changed our family. As a mother I learned that gender equality begins at home, and my daughter gained the confidence to identify unsafe situations/places and speak up when she feels at risk.” *Not her real name. This publication was produced with the financial support of the German Humanitarian Assistance Its contents are the sole responsibility of Joining Forces and do not necessarily reflect the views of the German Humanitarian Assistance. The post Samrawit appeared first on Joining Forces.
josemoriano
Importance: The magnitude of the association of intrauterine growth restriction (IUGR) and small for gestational age (SGA) status with cognitive outcomes in preterm and term-born children has not been established. Objective: To examine cognitive outcomes of preterm and term-born children who had IUGR and were SGA compared with children who were appropriate for gestational age (AGA) during the first 12 years of life. Data Sources: For this systematic review and meta-analysis, the Scopus, PubMed, Web of Science, Science Direct, PsycInfo, and ERIC databases were searched for English-language, peer-reviewed literature published between January 1, 2000, and February 20, 2020. The following Medical Subject Heading terms for IUGR and SGA and cognitive outcomes were used: intrauterine growth restriction, intrauterine growth retardation, small for gestational age AND neurodevelopment, neurodevelopmental outcome, developmental outcomes, and cognitive development. Study Selection: Inclusion criteria were assessment of cognitive outcomes (full-scale IQ or a cognitive subscale), inclusion of an AGA group as comparison group, and inclusion of gestational age at birth and completion of cognitive assessment up to 12 years of age. Data Extraction and Synthesis: The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. Data were double screened for full-text articles, and a subset were independently coded by 2 authors. Standardized mean differences (SMDs) and odd ratios from individual studies were pooled by applying random-effects models. Main Outcomes and Measures: Cognitive outcomes, defined as mental, cognitive, or IQ scores, estimated with standardized practitioner-based cognitive tests or as borderline intellectual impairment (BII), defined as mental, cognitive, or IQ scores at least 1 SD below the mean cognitive score. Results: In this study of 89 samples from 60 studies including 52 822 children, children who had IUGR and were SGA had significantly poorer cognitive outcomes (eg, cognitive scores and BII) than children with AGA in childhood. For cognitive scores, associations are consistent for preterm (SMD, -0.27; 95% CI, -0.38 to -0.17) and term-born children (SMD, -0.39; 95% CI, -0.50 to -0.28), with higher effect sizes reported for term-born IUGR and AGA group comparisons (SMD, -0.58; 95% CI, -0.82 to -0.35). Analyses on BII revealed a significantly increased risk in the preterm children who had IUGR and were SGA (odds ratio, 1.57; 95% CI, 1.40-1.77) compared with the children with AGA. Conclusions and Relevance: Growth vulnerabilities assessed antenatally (IUGR) and at the time of birth (SGA) are significantly associated with lower childhood cognitive outcomes in preterm and term-born children compared with children with AGA. These findings highlight the need to develop interventions that boost cognitive functions in these high-risk groups.
Chiara Sacchi, Claudia Marino, Chiara Nosarti et al.
