To calculate the prevalence of developmental coordination disorder at 7 years of age by using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria in a large UK birth ...cohort.
Cases of developmental coordination disorder were defined by using data from the Avon Longitudinal Study of Parents and Children, a UK birth cohort. The motor coordination of >7000 children was assessed by using tests that measured manual dexterity, ball skills, and balance. The 5th percentile of the derived Avon Longitudinal Study of Parents and Children coordination impairment score was used to define severe motor coordination difficulties. Data from national handwriting tests and an activities-of-daily-living scale quantified the impact of poor coordination on daily life. Children with known neurologic conditions or an IQ of <70 were excluded.
Complete data were available from 6990 children aged 7 to 8 years who attended the coordination session and completed the writing test or activities-of-daily-living scale. One hundred nineteen children met criteria for developmental coordination disorder, resulting in a prevalence of 17 of 1000 children at a mean age of 7.5 years (SD: 2.9 months). An additional 222 children were considered as having "probable developmental coordination disorder" by using broader cut-offs for coordination testing and activities of daily living. There was an increased risk of developmental coordination disorder in families from lower socioeconomic backgrounds, in children with a birth weight of <2500 g, and those born before 37 weeks' gestation.
This is the first study to use strict criteria to define the prevalence of developmental coordination disorder in a representative cohort of UK children. A prevalence of 1.7% is lower than studies that have not taken into account the impact of poor motor coordination on daily living but indicates that poor coordination is an important, and often hidden, cause of disability in childhood.
Aim
To assess the relationship between developmental coordination disorder (DCD) and mental health outcomes in late adolescence.
Method
Data were analyzed from the Avon Longitudinal Study of Parents ...and Children. Moderate‐to‐severe DCD was defined at 7 to 8 years according to the DSM‐IV‐TR criteria. Mental health was assessed at 16 to 18 years using self‐reported questionnaires: Strengths and Difficulties Questionnaire, Short Moods and Feelings Questionnaire, and the Warwick–Edinburgh Mental Well‐being Scale. Logistic and linear regressions assessed the associations between DCD and mental health, using multiple imputation to account for missing data. Adjustments were made for socio‐economic status, IQ, and social communication difficulties.
Results
Adolescents with DCD (n=168) had an increased risk of mental health difficulties (total Strengths and Difficulties Questionnaire score) than their peers (n=3750) (odds ratio 1.78, 95% confidence interval 1.12–2.83, adjusted for socio‐economic status and IQ). This was, in part, mediated through poor social communication skills. Adolescent females with DCD (n=59) were more prone to mental health difficulties than males. Greater mental well‐being was associated with better self‐esteem (β 0.82, p<0.001).
Interpretation
Individuals with DCD, particularly females, had increased risk of mental health difficulties in late adolescence. Interventions that aim to promote resilience in DCD should involve improving social communication skills and self‐esteem.
Impacto del trastorno del desarrollo de la coordinación (TDC) en la salud mental en la adolescencia tardía
Objetivo
Evaluar la relación entre el trastorno del desarrollo de la coordinación (TDC) y parámetros de salud mental en la adolescencia tardía.
Método
Se analizaron datos del Estudio Longitudinal Avon de Padres e Hijos. TDC moderado a severo se definió a los 7 a 8 años según los criterios del DSM‐IV‐TR. La salud mental se evaluó a los 16‐18 años mediante cuestionarios autoadministrados: SDQ (Cuestionario de Fortalezas y Dificultades), SMFQ (Cuestionario Corto de Emociones y Estado de Ánimo) y Escala de bienestar mental de Warwick‐Edimburgh. La asociación entre TDC y parámetros de salud mental fue evaluada por medio de regresiones logísticas y lineales. Se utilizó la imputación múltiple para dar cuenta de los datos faltantes. Se hicieron ajustes en base a situación socioeconómica, coeficiente intelectual y dificultades de comunicación social.
Resultados
Los adolescentes con TDC (n = 168) tuvieron un mayor riesgo de dificultades de salud mental (puntuación total del Cuestionario de Fortalezas y Dificultades) que sus pares (n = 3750) (odds ratio 1,78, intervalo de confianza del 95%: 1,12‐2,83; ajustado por situación económica y coeficiente intelectual). Esto fue, en parte, mediado por dificultades en la comunicación social. Las mujeres adolescentes con TDC (n = 59) fueron más propensas a tener dificultades de salud mental que los hombres con TDC. Mayor bienestar mental se asoció con una mayor autoestima β 0,82, p <0,001.
Interpretación
Las personas con TDC, en particular las mujeres, tuvieron un mayor riesgo de dificultades de salud mental en la adolescencia tardía. Las intervenciones que tienen por objeto promover la resiliencia en la TDC deberían implicar el mejoramiento de las habilidades de comunicación social y de la autoestima.
Resumo
Resultados em saúde mental do Transtorno do Desenvolvimento da Coordenação na adolescência tardia
Objetivo
Avaliar a relação entre o Transtorno do Desenvolvimento da Coordenação (TDC) e resultados de saúde mental no final da adolescência.
Método
Os dados foram analisados a partir do Estudo Longitudinal Avon de Pais e Crianças. O TDC moderado a grave foi definido entre 7 e 8 anos de acordo com os critérios do DSM‐IV‐TR. A saúde mental foi avaliada dos 16 aos 18 anos usando questionários autoaplicáveis: Questionário de Força e Dificuldades (SDQ), Questionário Curto sobre Humor e Sentimentos (SMQF) e Escala de Bem‐Estar Mental de Warwick‐Edinburgh. Regressões logísticas e lineares avaliaram as associações entre TDC e saúde mental, usando a imputação múltipla para dar conta de dados faltantes. Ajustes foram feitos para o status socioeconômico, QI, e dificuldades de comunicação social.
Resultados
Os adolescentes com TDC (n = 168) tiveram um risco aumentado de dificuldades de saúde mental (pontuação total do Questionário de Força e Dificuldades) do que os seus pares (n = 3750) (odds ratio 1,78, intervalo de confiança de 95% 1,12‐2,83, ajustado para status econômico e QI). Isso foi, em parte, mediado por pobres habilidades de comunicação social. Adolescentes do sexo feminino com TDC (n = 59) foram mais propensas a problemas de saúde mental do que os homens. Maior bem‐estar mental foi associado com melhor autoestima β 0,82, p <0,001.
Interpretação
Indivíduos com TDC, particularmente mulheres, tiveram maior risco de dificuldades em saúde mental no final da adolescência. As intervenções que visam promover a resiliência no TDC devem envolver o aprimoramento das habilidades de comunicação social e auto‐estima.
What this paper adds
Mental health difficulties in developmental coordination disorder persist into late adolescence.
Adolescent females with developmental coordination disorder may have greater risk of mental health difficulties.
Social communication difficulties mediate the relationship between developmental coordination disorder and mental health.
This article is commented on by Wagner on pages 891–892 of this issue.
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The Strengthening Care for Children (SC4C) is a general practitioner (GP)-paediatrician integrated model of care that consists of co-consulting sessions and case discussions in the general practice ...setting, with email and telephone support provided by paediatricians to GPs during weekdays. This model was implemented in 21 general practices in Australia (11 Victoria and 10 New South Wales). Our study aimed to identify the factors moderating the implementation of SC4C from the perspectives of GPs, general practice personnel, paediatricians and families. We conducted a qualitative study as part of the mixed-methods implementation evaluation of the SC4C trial. We collected data through virtual and in-person focus groups at the general practices and phone, virtual and in-person interviews. Data was analysed using an iterative hybrid inductive-deductive thematic analysis. Twenty-one focus groups and thirty-seven interviews were conducted. Overall, participants found SC4C acceptable and suitable for general practices, with GPs willing to learn and expand their paediatric care role. GPs cited improved confidence and knowledge due to the model. Paediatricians reported an enhanced understanding of the general practice context and the strain under which GPs work. GPs and paediatricians reported that this model allowed them to build trust-based relationships with a common goal of improving care for children. Additionally, they felt some aspects, including the lack of remuneration and the work and effort required to deliver the model, need to be considered for the long-term success of the model. Families expressed their satisfaction with the shared knowledge and quality of care jointly delivered by GPs and paediatricians and highlighted that this model of care provides easy access to specialty services without out-of-pocket costs. Future research should focus on finding strategies to ensure the long-term Implementation of this model of care with a particular focus on the individual stressors in general practices.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
COVID-19 public health measures altered respiratory syncytial virus (RSV) epidemiology. We examined age-stratified trends in RSV-related disease in Australian children in 2020 compared with previous ...years.
Lead and mercury are freely transferred across the placenta, while cadmium tends to accumulate in the placenta. Each contributes to adverse neurological outcomes for the child. Although prenatal ...heavy metal exposure has been linked with an array of neurodevelopmental outcomes in childhood, its association with the development of motor skills in children has not been robustly studied.
The aim of the present study was to investigate the association between prenatal exposure to lead, cadmium and mercury, measured as maternal blood concentrations during pregnancy, and motor skills, measured as subtests of the Movement Assessment Battery for Children (Movement ABC) at age 7 years in a large sample of mother–child pairs enrolled in a UK observational birth cohort study (Avon Longitudinal Study of Parents and Children, ALSPAC).
Whole blood samples from pregnant women enrolled in ALSPAC were analysed for lead, cadmium and mercury. In a complete case analysis (n = 1558), associations between prenatal blood concentrations and child motor skills assessed by Movement ABC subtests of manual dexterity, ball skills and balance at 7 years were examined in adjusted regression models. Associations with probable developmental coordination disorder (DCD) were also investigated.
The mean prenatal blood levels were: lead 3.66 ± 1.55 μg/dl; cadmium 0.45 ± 0.54 μg/l; mercury 2.23 ± 1.14 μg/l. There was no evidence for any adverse associations of prenatal lead, cadmium or mercury exposure with motor skills measured at age 7 years with Movement ABC subtests in adjusted regression models. Further, there were no associations with probable DCD.
There was no evidence to support a role of prenatal exposure to heavy metals at these levels on motor skills in the child at age 7 years measured using the Movement ABC. Early identification of symptoms of motor skills impairment is important, however, to enable investigation, assessment and treatment.
•The association of in utero heavy metal exposure with motor skills in children is unclear.•Whole blood samples from pregnant women were analysed for lead, cadmium and mercury.•Motor skills were assessed by manual dexterity, ball skills and balance ability at 7 years.•There was no evidence for a role of prenatal exposure on motor skills in the child.•Early identification of symptoms of motor skills impairment is still important.
One in every two cases of caries in deciduous teeth occurs in low- and middle-income countries (LMICs). The aim of the World Health Organisation's (WHO) Healthy Schools Program is to improve the oral ...health of children. This study explored perceptions of implementation of the Ugandan oral health schools' program in Gulu district, northern Uganda. Semi-structured interviews were conducted with a purposive sample of 19 participants including health and education officials, community leaders, policy makers, teachers, and parents. All interviews were transcribed verbatim and analysed thematically. Our study identified three themes: (1) components of oral health promotion, (2) implementation challenges of oral health promotion, and (3) development of an oral health policy. The components of oral health promotion in schools included engagement of health workers, the community, companies, skills-based education, and oral health services. Participants were concerned about insufficient funding, unsatisfactory skills-based education, and inadequate dental screening. Participants reported that there was an urgent need to develop oral health policy to guide implementation of the program at scale. Schools provided oral health promotion that aligned with existing features of the WHO's health-promoting school framework. Implementation of this strategy could be enhanced with increased resources, adequate oral health education, and explicit development of oral health policy.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
ObjectivesTo examine the changing health needs of refugee children and young people (CYP) entering Australia, in relation to key government policy changes.Study designRetrospective analysis of health ...service use data over 11 years.SettingPaediatric refugee clinics in South Western Sydney (SWS), the Australian region with the largest annual resettlement of refugees.ParticipantsRefugee CYP (≤25 years) attending the SWS paediatric refugee clinics for their first visit between 2009 and 2019.MeasuresClinician defined health conditions categorised as communicable and non-communicable disease (NCD).ResultsData were analysed for 359 CYP, mean age 9.3 years; 212 male (59.1%). Most CYP (n=331, 92.2%) had health problems identified; 292 (81.3%) had ≥1 NCD and 24 (6.7%) had ≥1 communicable disease. The most frequent individual NCDs were dental disease (n=128, 35.7%) and vitamin D deficiency (n=72, 20.1%). Trend analysis showed increased odds of identifying an NCD from 2013 onwards (crude OR 1.77, 95% CI 1.06 to 2.96). Neurodevelopmental problems, especially Global Developmental Delay (n=31, 8.6%), emerged as more prevalent issues in the latter half of the decade. There were significantly increased odds of identifying a neurodevelopmental problem in 2016–2019, especially in 2016–2017 (adjusted OR 2.93, 95% CI 1.34 to 6.40). Key policy changes during this period included acceptance of refugees with disabilities from 2012, additional Australian Humanitarian Programme intake from the Eastern Mediterranean region and mandatory offshore processing for those seeking asylum by boat from 2013. In response to the changing needs, local health services adopted nurse-led primary healthcare screening, early childhood services, youth and disability clinics.ConclusionsRefugee CYP in Australia are presenting with a growing burden of NCDs, with neurodevelopmental problems contributing. Government policy changes affect the sociodemographics of resettled populations, influencing health profiles. Paediatric refugee health services need to be responsive to the changing needs of these populations to optimise well-being.
For over two years, the global COVID-19 pandemic has forced major transformations on health, social, and educational systems, with concomitant impacts on mental health. This study aimed to understand ...the unique and additional challenges faced by children with chronic illness and their families during the COVID-19 era. Parents of children receiving treatment for a chronic illness within the neurology, cancer, renal and respiratory clinics of Sydney Children's Hospital were invited to participate. We used qualitative methodology, including a semi-structured interview guide, verbatim transcription, and thematic analysis supported by QSR NVivo. Thirteen parents of children receiving tertiary-level care, for nine chronic illnesses, participated. Parents reported intense fears relating to their ill child's additional vulnerabilities, which included their risk of developing severe COVID-19 disease and the potential impact of COVID-19-related disruptions to accessing clinical care, medications, allied health support and daily care protocols should their parent contract COVID-19. Parents perceived telehealth as a highly convenient and preferred method for ongoing management of less complex healthcare needs. Parents reported that the accrual of additional stressors and responsibilities during the pandemic, experienced in combination with restricted social interaction and reduced access to usual support networks was detrimental to their own mental health. Hospital-based visitation restrictions reduced emotional support, coping, and resilience for both parents and children and in some cases led to marital discord, sibling distress, and financial loss. Supportive factors included increased time spent together at home during the pandemic and improved hygiene practices at school, which dramatically reduced the incidence of non-COVID-19-related communicable illnesses in chronically ill children. For families caring for a chronically ill child, COVID-19 made a difficult situation harder. The pandemic has highlighted the need for targeted psychosocial intervention for vulnerable families, to mitigate current mental health burden and prevent chronic psychological distress.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
ObjectiveTo assess the effect of digital health (DH), biomarker feedback (BF) and nurse or midwife-led counselling (NoMC) interventions on abstinence in pregnant smokers during pregnancy and ...postpartum.SettingsAny healthcare setting servicing pregnant women, including any country globally.ParticipantsPregnant women of any social, ethnic or geographical background who smoke.MethodsWe searched Embase, Medline, Web Of Science, Google Scholar, PsychINFO, CINAHL and PubMed between 2007 and November 2021. We included published original intervention studies in English with comparators (usual care or placebo). Two independent assessors screened and abstracted data. We performed a random-effects meta-analysis, assessed risk of bias with the Cochrane Tool and used Grading of Recommendations Assessment, Development and Evaluation to assess the quality of evidence.ResultsWe identified 57 studies and included 54 in the meta-analysis. Sixteen studies assessed DH (n=3961), 6 BF (n=1643), 32 NoMC (n=60 251), 1 assessed NoMC with BF (n=1120) and 2 NoMC with DH interventions (n=2107). DH interventions had moderate certainty evidence to achieve continuous abstinence (CA) at late pregnancy (4 studies; 2049 women; RR=1.98, 95% CI 1.08 to 3.64, p=0.03) and low certainty evidence to achieve point prevalence abstinence (PPA) postpartum (5 studies; 2238 women; RR=1.46, 95% CI 1.05 to 2.02, p=0.02). NoMC interventions had moderate certainty evidence to achieve PPA in late pregnancy (15 studies; 16 234 women; RR=1.54, 95% CI 1.16 to 2.06, p<0.01) and low certainty evidence to achieve PPA postpartum (13 studies; 5466 women; RR=1.79, 95% CI 1.14 to 2.83, p=0.01). Both DH and BF interventions did not achieve PPA at late pregnancy, nor NoMC interventions achieve CA postpartum. The certainty was reduced due to risk of bias, heterogeneity, inconsistency and/or imprecision.ConclusionNoMC interventions can assist pregnant smokers achieve PPA and DH interventions achieve CA in late pregnancy. These interventions may achieve other outcomes.
Background:
Between 5% and 30% of children in high-income countries live with a substance misusing parent, the majority of which is below dependent levels. However, little is understood about the ...impact of nondependent parental substance misuse upon children.
Methods:
We searched the international literature using rigorous systematic methods to identify studies examining parental substance misuse and adverse outcomes in children. The inclusion criteria were cross-sectional, longitudinal, case-control, and cohort studies; of children aged 0–18 years whose parents are high-risk substance misusers; reporting on their health, psychological, substance use, educational, and social outcomes.
Results:
We identified 36 papers (from 33 unique studies), most of which were assessed as being of medium to high methodological quality (N= 28). Parental nondependent substance misuse was found to be associated with adversity in children, with strong evidence of an association with externalizing difficulties (N = 7 papers, all finding an association) and substance use (N = 23 papers, all finding an association) in adolescents and some evidence of adverse health outcomes in early childhood (N = 6/8 papers finding an association). There is less evidence of an association between parental substance misuse and adverse educational and social outcomes. The body of evidence was largest for parental alcohol misuse, with research examining the impact of parental illicit drug use being limited.
Conclusion:
Methodological limitations restrict our ability to make causal inference. Nonetheless, the prevalence of adverse outcomes in children whose parents are nondependent substance misusers highlights the need for practitioners to intervene with this population before a parent has developed substance dependency.
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