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Objectives: Caring for children in low- and middle-income countries (LMIC) can be challenging. This review article aims to explore role of telemedicine in supporting pediatric care in LMIC. Methodology: A narrative review of existing English and Spanish literature was conducted to assess role of telemedicine to support pediatric care in LMIC. Results: Beside medical education and direct pediatric care, telemedicine can provide sub-specialties consultations without extra burden on families. Additionally, telemedicine can help in lowering under-5 mortality by supporting neonatal care, infectious illnesses, and non-communicable diseases (NCDs). Telemedicine can be a gate for universal coverage for all children at a lower cost. For over a decade, it has been implemented successfully and sustained in a few LMIC. However, challenges in implementing telemedicine are enormous. Still, opportunities arise by using simpler technology, low-width band internet, smartphones, instant messaging applications and solar energy. COVID-19 pandemic facilitated acceptance and applicability of telemedicine worldwide including LMIC. Nevertheless, governments must regulate telemedicine by issuing policies and ensuring employment of local experts when possible to meet local resources and cultural competency. Conclusion: Telemedicine has proven successful in improving pediatrics care. Many LMIC should take advantage of this innovation to promote equity and access to high quality pediatric care.

Objective This study aimed to describe the social determinants of health (SDoH) for patients receiving multidisciplinary team care in a Cleft Palate-Craniofacial program, develop responsive and consistent processes to include trauma-informed psychosocial histories, promote discussions about additional “non-medical” factors influencing health and surgical outcomes, and demonstrate that these activities are feasible in the context of multidisciplinary patient-provider interactions.Design Single-site, cross-sectional study using a questionnaire.Setting Participants were recruited from a provincial quaternary care Cleft Palate-Craniofacial program at British Columbia Children's Hospital in Vancouver, BC, Canada.Participants 290 families completed the questionnaire.Results 34% of families experience significant barriers to accessing primary health care, 51% struggle financially, and 11% scored four or more on the Adverse Childhood Experiences scale. Furthermore, 47% reported not having adequate social support in their lives, and 5% reported not feeling resilient at the time of the survey.Conclusion Patients with cleft and craniofacial anomalies have complex needs that extend beyond the surgical and medical care they receive. It is critical that all Cleft and Craniofacial teams incorporate social histories into their clinic workflow and be responsive to these additional needs. Discussions surrounding SDoH and adversity are welcomed by families; being involved in the care and decision-making plans is highly valued. Healthcare providers can and should ask about SDoH and advocate for universal access to responsive, site-based, social work support for their patients.

Introduction/Objectives: Exposure to adverse social determinants of health (SDoH) in childhood is associated with poorer long-term health outcomes. Within structurally marginalized populations, there are disproportionately high rates of developmentally vulnerable children. The RICHER (Responsive, Intersectoral, Child and Community Health, Education and Research) social pediatric model was designed to increase access to care in marginalized neighborhoods. The purpose of this study was to describe the children and youth engaged with the RICHER model of service and characterize the needs of the population.Methods: A retrospective chart review was conducted on children and youth who accessed primary care services through the program between January 1, 2018 and April 30, 2021. Basic descriptive data analysis was done using Stata v15.1.Results: A total of 210 charts were reviewed. The mean age in years at initial assessment was 6.32. Patients most commonly identified their race/ethnicity as Indigenous (33%) and 15% were recent newcomers to Canada. Evidence of at least 1 adverse SDoH was noted in 41% of charts; the most common included material poverty (34%), food insecurity (11%), and child welfare involvement (20%). The median number of diagnoses per patient was 4. The most frequently documented diagnoses were neurodevelopmental disorders (50%) including developmental delay (39%), ADHD (32%), and learning disability (26%). The program referred 72% of patients to general pediatricians and/or other subspecialists; 34% were referred for tertiary neuropsychological assessments and 35% for mental health services.Conclusions: Our data suggests that this low-barrier, place-based primary care RICHER model was able to reach a medically, developmentally, and socially complex population living in disenfranchised urban neighborhoods. Half of the patients identified in our review had neurodevelopmental concerns and a third had mental health concerns, in contrast to an estimated 17% prevalence for mental health, behavioral, or developmental disorders in North American general pediatric aged populations. This highlights the impact adverse SDoH can have on child health and the importance of working with community partners to identify developmentally vulnerable children and support place-based programs in connecting with children who may be missed, overlooked, or disadvantaged through traditional models of care.

The COVID-19 pandemic is an unprecedented global crisis, affecting millions globally and in Canada. While efforts to limit the spread of the infection and ‘flatten the curve’ may buffer children and youth from acute illness, these public health measures may worsen existing inequities for those living on the margins of society. In this commentary, we highlight current and potential long-term impacts of COVID-19 on children and youth centring on the UN Convention of the Rights of the Child (UNCRC), with special attention to the accumulated toxic stress for those in difficult social circumstances. By taking responsive action, providers can promote optimal child and youth health and well-being, now and in the future, through adopting social history screening, flexible care models, a child/youth-centred approach to “essential” services, and continual advocacy for the rights of children and youth.

Objective: A 2016 review of the BC Children’s Hospital Cleft Palate - Craniofacial Program (CPP) revealed that one-third of patients met the program’s care recommendations and half met the American Cleft Palate-Craniofacial Association guidelines. This study reviews patients on the CPP waitlist and determines median wait times and missed clinical assessments as well as identifies how wait times are influenced by medical complexity, specialized speech service needs, vulnerability, and distance from clinic.Design: Cross-sectional.Setting: BC Children’s Hospital Cleft Palate—Craniofacial Program.Patients: Five hundred seventy-six waitlisted patients.Main Outcome Measures: Additional wait time after recommended appointment date. Correlation of additional wait time with diagnosis, number of specialists required, speech services needed, vulnerability, and distance from the clinic. Missed plastic surgery, speech, and orthodontic assessments according to CPP team recommendations and ACPA guidelines.Results: Patients had a median additional wait time of 11 months (interquartile range: 5-27). Longer additional wait times were associated with a craniofacial diagnosis (P= .019), a need for formal speech assessments or evaluations (P< .001), or a requirement to see multiple specialists (P< .001). Vulnerability and distance from clinic did not affect wait times. Plastic surgery assessments were not available at the preschool and preteen time points for 45 (8%) patients, 355 (62%) patients were unable to access speech assessments, and 120 (21%) were unable to complete an orthodontic assessment.Conclusion: Patients wait up to an additional year to be seen by the CPP and miss speech, orthodontic, and surgical assessments at key developmental milestones. Additional resources are required to address these concerns.

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. 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. 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. 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.

Prenatal alcohol exposure (PAE) is linked to alterations of cerebral white matter, including volume and nonspecific diffusion magnetic resonance imaging (MRI) indices of microstructure in humans. Some animal models of PAEhave demonstrated myelination deficiencies, but myelin levels have not yet been evaluated in individuals with PAE. Multiecho T2MRIoffers a quantitative method to estimate myelin water fraction (MWF; related to myelin content) noninvasively, which was used here to evaluate brain myelination in children with PAE. Participants with PAE(n =10, 6 females, mean age 13.9 years, range 7 to 18 years) and controls (n =14, 11 females, mean age 13.2 years, range 9 to 16 years) underwent 3T MRIof the brain. T2images (15 minutes acquisition for 32 echoes) were used to create MWFmaps from which mean MWFwas measured in 12 regions of interest (ROIs) including 8 in white matter and 4 in deep gray matter. As expected, across the combined sample, MWFwas highest for major white matter tracts such as the internal capsule and genu/splenium of the corpus callosum (10 to 18%) while the caudate and putamen had MWFless than 5%. Mean MWFwas similar across 11/12 brain white and gray matter regions for the PAEand control groups (L/R internal capsule, major forceps, putamen, caudate nucleus, L minor forceps, genu and splenium of corpus callosum). In the PAEgroup, MWFwas positively correlated with age in the genu of corpus callosum and right minor forceps, notably 2 frontal tracts. Given comparable MRI‐derived myelination fraction measures in PAErelative to controls, white matter alterations shown in other imaging studies, such as diffusion tensor imaging, may reflect microstructural anomalies related to axon caliber and density. A novel Magnetic Resonance Imaging (MRI) method was used to assess myelin water fraction in children and adolescents with prenatal alcohol exposure (PAE) compared to controls. The myelin water fraction was similar between PAE and controls, suggesting that white matter alterations shown in other brain imaging studies may reflect micro‐structural anomalies related to axon caliber and density.

Children and adolescents with fetal alcohol spectrum disorder (FASD) experience significant impairments in cognitive functioning, though substantial within-group heterogeneity is often observed. The purpose of this study was to characterize the cognitive profile of children and adolescents with FASD with a special focus on examining moderators of functioning and cognitive strengths. Children and adolescents with FASD (n= 87) and controls (n =110), ages 5 to 18 years completed a cognitive test battery. MANOVA was used to evaluate between-group cognitive differences, as well as the role of age and gender as potential moderators. Relative strengths were evaluated using both within-subject and between-group methods. Participants with FASD were found to show significant impairment on all cognitive tasks relative to controls, with substantial deficits evident on a measure of mathematical skill. Though neither age nor gender emerged as moderators, significant three-way interactions between age, gender, and group were evident on measures of executive functioning (inhibition), verbal memory, and word identification. Tasks measuring higher-order complex attention and visuospatial processing emerged as possible relative strengths in the FASD group. Children and adolescents with FASD had significant cognitive impairment across multiple domains confirming high need for interventions. Differences in the cognitive functioning for boys and girls with FASD at different developmental periods, along with relative strengths, may serve to inform interventions and future longitudinal research.

AbstractThis paper builds upon insights from a programme of research on culture and health that is informed by critical theoretical perspectives. The evidence generated through this research programme is drawn upon to critically examine the assumptions about the prevailing understandings of the links between culture, health, and health inequalities and to illustrate the need for new paradigms of practice. Using the case of children at risk because of their social, cultural, and material circumstances, the tenets of an alternative model of health care practice, the RICH-ER (Responsive, Intersectoral-Interdisciplinary, Child Health – Education and Research) model was introduced and studied.

The pharmacokinetics and bacteriologic efficacy of four β-lactam antibiotics were studied in the serum and cerebrospinal fluid (CSF) of rabbits using two test strains, Escherichia coli type Kl and group B Streptococcus type III, and 24 gram-positive isolates. Although moxalactam, cefotaxime, cefoperazone, and rocephin are active in vitro against gram-negative bacilli, the gram-positive bacteria Listeria monocytogenes and Streptococcus faecalis were resistant to all four drugs; group B streptococci were resistant to moxalactam. In rabbit CSF, moxalactam had the greatest concentration and penetration, but rocephin had the longest half-life and duration of bactericidal activity. These two drugs were most effective in the CSF of E. coli K1-infected rabbits. Except for moxalactam, the four drugs were comparable to ampicillin in reducing counts of group B Streptococcus type III in CSF. Drug accumulation in CSF and appreciable bacterial killing were observed in E. coli K1-infected animals given moxalactam either periodically or by constant infusion.