Conditions for Change for Children and Young People��s Participation in Evaluation: ��Change-Scape��

Under what conditions does participatory monitoring and evaluation with children result in positive outcomes and transformational change on a personal, institutional and broader societal level? Using cases from Nepal and UK, the ‘Changescape’ structures the conditions that determine whether evidence from children participating in evaluation is utilised by decision-makers to shape services and inform strategic processes. The emerging model links context with the process of children’s participation and is grounded in case study research in which three evaluations were revisited: DFID funded ‘Rights through Evaluation’ research with ActionAid and a community-based organisation in Nepal; the evaluation of the Saying Power scheme, run by Save the Children across the UK; and the Croydon Children’s Fund evaluation in London. The discussion highlights how conditions for change and mechanisms of communication and collaboration can facilitate or block change in response to children’s participation in evaluation. The Change-scape helped to structure findings on how: context can affect the way in which policy makers and community members respond to children’s perspectives; capacity, confidence, and champions for children can affect decision-makers responses to children’s evidence; mechanisms of communication and collaboration can create more space for dialogue and increase commitment to change.     

Tracheoesophageal fistula in the developing world: are we ready for thoracoscopic repair?

Tracheoesophageal fistula (TEF) is a bellwether for a country’s ability to care for sick newborns. We aim to review the existing literature from low- and middle-income countries in regard to management of those newborns and the possible approaches to improve their outcomes. A review of the existing English literature was conducted with the aim of assessing challenges faced by providers in LMIC in terms of diagnostic, preoperative, operative and post-operative care for TEF patients. We also review the limited literature for performing thoracoscopic repair in the developing world context and suggest methods for introduction of advanced thoracoscopic procedures including techniques for providing anesthesia to these challenging babies. While outcomes related to technique from LMIC are comparable to the developed world, rates of secondary complications like sepsis and pneumonia are higher. In many areas, repairs are conducted in a staged fashion with minimal utilization of thoracoscopic approach. The paucity of resources creates strain on intraoperative and post-operative management. Clearly, not all developing world contexts are ready to attempt thoracoscopic repair but we outline suggestions for assessing the existing capabilities and a stepwise gradual implementation of advanced thoracoscopy when appropriate.     

Vaccines for COVID-19: Where do we stand in 2021?

As of July 2021, over 3 billion doses of a COVID-19 vaccines have been administered globally, and there are now 19 COVID-19 vaccines approved for use in at least one country. Several of these have been shown to be highly effective both in clinical trials and real-world observational studies, some of which have included special populations of interest. A small number of countries have approved a COVID-19 vaccine for use in adolescents or children. These are laudable achievements, but the global vaccination effort has been challenged by inequitable distribution of vaccines predominantly to high income countries, with only 0.9% of people in low-income countries having received at least one dose of a COVID-19 vaccine. Addressing this inequity is of critical importance and will result in better control of SARS-CoV-2 globally. Other challenges include: the reduced protection from COVID-19 vaccines against some strains of SARS-CoV-2, necessitating the development of variant specific vaccines; and uncertainties around the duration of protection from vaccine-induced immunity.     

Arthropod-borne disease in Canada: A clinician��s perspective from the ��Cold Zone��

Arthropod-borne diseases do not occur commonly in Canada. Nevertheless, Canadians run the risk of contracting certain infections within the country during arthropod season, as well as when travelling abroad. Therefore, it is important that clinicians are aware of the possible occurrence of arthropod-borne diseases, and consider them in their differential diagnoses. The present review is divided into two sections: arthropod-borne diseases or disease agents documented in Canada, and imported arthropod-borne diseases. The review also provides brief overviews of these diseases.     

Percutaneous Device Closure of a Bifurcated Inferior Vena Cava and Completion of the Kawashima Procedure for the ��Difficult�� Univentricular Heart

Azygos continuation of inferior venacava (IVC) is well known in association with interrupted IVC. We report azygos connection of uninterrupted IVC in a young child with complex univentricular heart. This peculiar anatomy was made suitable for univentricular repair by combining percutaneous device closure of prehepatic right limb of IVC and bidirectional Glenn shunt. The azygos vein acted as a conduit for IVC flow to superior venacava as in Kawashima’s operation. This case highlights a rare IVC morphology. Also this innovative strategy allowed simple solution to a challenging problem and is first time described in the literature.     

The AP diameter of the pelvis: a new criterion for continence in the exstrophy complex?

Objective: Reconstructive surgery of bladder exstrophy remains a challenge. By using CT of the pelvis, we suggest a new pre- and post-operative investigative procedure to define the AP diameter (APD) as a predictive criterion for continence in this anomaly. Patients and methods: Three axial CT slices were selected in nine children with exstrophy who had undergone neonatal reconstructive surgery. The three levels selected were the first sacral plate, the mid acetabular plane and the superior pubic spine. We used combined slices to measure: • APD = distance between the first sacral vertebra and the pubic symphysis. • Pubic diastasis (PD) • Three angles defined on the transverse plane of the first sacral vertebra – iliac wing angle, sacropubic angle and acetabular version. Results: In exstrophy, the angles demonstrate opening of the iliac wings and the pubic ramus, and acetabular retroversion compared to controls. Comparisons between controls, continent and incontinent patients reveal that in continent patients, APD increases with growth and seems to be a predictive criterion for continence, independent of diastasis of the pubic symphysis. Conclusions: We believe that CT of the pelvis with measurements of the APD should be performed in all neonates with bladder exstrophy before reconstructive surgery and for better understanding of the malformation. The APD seems to be predictive and may be a major criterion for continence, independent of PD. Received: 16 September 1999 Revised: 26 June 2000 Accepted: 26 July 2000     

Environmental contaminants and children��s health: Cause for concern, time for action

The present paper provides an outline of the developmental and behavioural characteristics that make children, especially the fetus and young child, more vulnerable to contaminants than adults. The major categories of contaminants are briefly described. The evidence for their possible effects on neurobehavioural development; immune, endocrine and respiratory systems; childhood cancer based on research studies with animals; children exposed to catastrophic ‘accidents’ involving overdose exposures; and pregnant women and children from communities with high ‘background’ levels of contamination who participated in studies is reviewed. While the data are worrisome, especially for children living in northern and certain urban communities, much remains to be learned about possible subtle effects and the potential for long term effects of the current background contamination experienced by the majority of Canadian children before its significance to their health can be fully evaluated. The present regulatory processes, which are based on risk assessment, are so cumbersome and costly that the great majority of chemicals in use have not been fully evaluated, and the ingenuity of new chemical production continually exceeds the capacity to test the new chemicals. Moreover, despite past insistence on scientific proof of adverse effects and safety, unanticipated effects have occurred that will threaten the sustainability of human life unless more effective control measures are taken to limit the release of toxic substances and persistent chemicals into the environment. Therefore, the shortcomings of risk assessment are discussed, and the precautionary principle, which is used in some countries and is proposed for use internationally as an alternative measure that may offer improved control for the future, is outlined. Finally, opportunities for physician action are suggested.     

Editorial: ‘The early bird catches the worm’—the need for even earlier intervention and targeted prevention for mental illnesses

Intervening early during childhood and adolescence to prevent mental health problems from becoming chronic, or even to prevent them occurring at all, has become an increasingly popular approach within the field of mental health over the past three decades. The importance of, and potential for, early preventive interventions in infancy, the pre-natal period and even pre-conception is highlighted by several of the papers featured in the current issue of the Journal, which are summarised in this editorial. Identifying children most at risk of mental illness in order to selectively target preventive efforts and carefully testing the effectiveness of these interventions, particularly in low-and middle-income country contexts, are crucial next steps as we move towards an era of more personalised and earlier prevention and intervention in mental health.     

The ��Golden Keys�� to health �C a healthy lifestyle intervention with randomized individual mentorship for overweight and obesity in adolescents

OBJECTIVE:

To conduct a pilot study designed to measure the impact of a healthy lifestyle intervention with or without individualized mentorship on adiposity, metabolic profile, nutrition and physical activity in overweight teens.

METHODS:

A total of 38 overweight adolescents (body mass index above the 85th percentile) 12 to 16 years of age, who were enrolled in a healthy lifestyle intervention program for six months, were randomly assigned to a nonmentored or individualized mentored intervention.

RESULTS:

For the entire cohort (final n=32), there was a nonstatistically significant reduction in mean (± SD) body mass index z score (2.08±0.38 to 2.01±0.47, P=0.07) and waist circumference (98±10 cm to 96±11 cm, P=0.08), and significant improvements in high-density lipoprotein level (1.08±0.24 mmol/L to 1.20±0.26 mmol/L, P<0.001), and low-density lipoprotein/high-density lipoprotein ratio (2.55±0.84 to 2.26±0.87, P<0.001) from baseline to the end of the intervention. Subjects consumed fewer high-calorie foods (3.9±1.9 to 3.0±1.5 servings/day, P=0.01) and snacks (9.7±5.5 to 6.8±4.0 servings/day, P=0.02), made fewer fast food restaurant visits (1.4±1.3 to 0.8±0.9 visits/week, P=0.02), and had less screen time (8.3±3.8 to 6.9±3.6 h/day, P=0.01). In addition, mentorship was found to be a feasible approach to supporting weight management in obese teens. Our study was underpowered to determine treatment effect, but promising modifications to lifestyle were observed despite the absence of statistically significant improvements in outcomes.

CONCLUSIONS:

The healthy lifestyle intervention improved subjects’ lifestyles and lipid profiles, and the addition of mentorship in this context is feasible. A larger study with a longer intervention time is required to determine whether behavioural changes are associated with clinical improvement and to determine the role of mentorship in promoting lifestyle change.     

The neutropenic diet: what's the evidence?

Despite improved survival of children with cancer, opportunistic infections remain a significant cause of morbidity and mortality in this population. Several interventions have been tried to decrease the incidence of infection by reducing patients' exposure to bacteria during neutropenia. The neutropenic diet is one such intervention that was intended to limit the introduction of bacteria into the host's gastrointestinal tract. The only studies evaluating this diet have used this strategy in combination with multiple other interventions, and the independent effect of this diet remains unknown. More research about the neutropenic diet is needed to establish its effectiveness in clinical practice.