Canada’s history of failing to provide medical care for Indigenous children

In December 2007, the House of Commons unanimously supported Jordan’s Principle, a commitment that all First Nations children would receive the health care products, social services, and supports, and education they need, in memory of Jordan River Anderson. However, the process of applying for Jordan’s Principle was convoluted and not transparent, leaving several cases not being responded to. The Canadian Human Rights Tribunal found the definition and implementation of Jordan’s Principle to be racist and discriminatory in 2016, ordering the Canadian government to make immediate changes. Failing to make changes to Jordan’s Principle, the Canadian government was found to be noncompliant with the Canadian Human Rights Tribunal orders in 2018. This article provides one case example of Jordan’s Principle that was not responded to, details on the current status of Jordan’s Principle, and information on the recent implementation of the Act respecting First Nations, Inuit and Métis children, youth and families.     

Feasibility study on the Model Schools Paediatric Health Initiative pilot project

OBJECTIVES:

To assess the feasibility and efficacy of a school-based health centre (SBHC) established at an inner-city elementary school to help alleviate barriers to accessing health care.

METHODS:

A retrospective chart review of the first year of the SBHC was conducted. Feasibility metrics included the number of children who enrolled at the SBHC. Efficacy metrics included the proportion of enrolled children who attended and received new diagnoses and treatment plans.

RESULTS:

A total of 379 children enrolled at the SBHC and 127 children attended. Of the SBHC users, 74.0% received a new diagnosis and 90.6% received a treatment plan; 79.6% were from families with an annual income <$30,000, and 91.6% were from families whose first language was not English.

CONCLUSION:

The SBHC represents a feasible and efficacious way to enhance the delivery of health care to inner-city children.     

Creating a student-led health magazine with an urban,multicultural, resource-restricted elementary school: Approach,process and impact

BACKGROUND:Health magazines effectively deliver health information. No data regarding student-led magazines to promote health exist.OBJECTIVE:To evaluate whether children’s health knowledge, interests and lifestyle choices improve following distribution of a student-led health magazine.METHODS:Elementary students worked with teachers and paediatric residents to publish a health magazine. A healthy lifestyle challenge page promoted reduction in soda pop consumption. Pre- and poststudent questionnaires explored knowledge, interests and behaviours related to health.RESULTS:Sex and grade distributions were similar in pre- and post-questionnaires. Ninety-seven percent of children reported the magazine helped them learn about health. Pre- and postknowledge scores did not differ (P=0.36). Following distribution, the percentage of students who reported drinking no soda increased from 43% to 67% (P=0.004), and those who reported drinking <2 glasses of soda per day increased from 66% to 85% (P=0.01).CONCLUSIONS:A student-led health magazine was effective in motivating short-term student-reported behavioural change.     

Housing need in Canada: Healthy lives start at home

Housing affects the health of children and youth. One-third of households in Canada live in substandard conditions or in housing need. The present statement reviews the literature documenting the impacts of housing on personal health and the health care system. Types of housing need are defined, including unsuitable or crowded housing, unaffordable housing and inadequate housing, or housing in need of major repairs. The health effects of each type of housing need, as well as of unsafe neighbourhoods, infestations and other environmental exposures are outlined. Paediatricians and other physicians caring for children need to understand the housing status of patients to fully determine their health issues and ability to access and engage in health care. Recommendations and sample tools to assess and address housing need at the patient, family, community and policy levels are described. Canada is the only G8 country without a national housing strategy. Recommendations also include advocating for enhanced action at all levels of government and for housing-supportive policies, including a national housing strategy.     

Youth justice and health: An argument against proposed changes to the Youth Criminal Justice Act

The Canadian Paediatric Society is deeply concerned about the negative effects on the developmental, psychological and emotional health of young offenders if the Youth Criminal Justice Act is amended as proposed. Changing Canada's youth crime law to achieve stiffer sentences for youth 14 years of age and older who are convicted of serious violent offences is contrary to the United Nations Convention on the Rights of the Child. Treating adolescents as adults puts them at serious health and human rights risks - including trauma, violence and abuse - and interferes with their overall development. Furthermore, rates of mental illness are higher among youth in custody. Youth should only serve their sentence in a facility that is exclusively limited to youth, and considers the rights of youth as well as their mental, physical, developmental and educational needs.     

Effects of sexual orientation-based bullying on feelings of loneliness and sleeping difficulty among Brazilian middle school students

ObjectiveTo investigate the extent to which sexual orientation-based bullying relates to self-reported feelings of loneliness and sleeping difficulty among Brazilian middle school students.MethodThis is a cross-sectional study using data from the 2015 PeNSE (Pesquisa Nacional de Saúde do Escolar), a survey designed to monitor the health of children and adolescents enrolled in the ninth grade in public and private Brazilian schools. Multiple linear regressions stratified by sex were used on a sample of 101,646 students, considering as reference students who had not experienced bullying, as well as students who had experienced other causes of bullying; a significance level of p < 0.05 was accepted.ResultsWhen the reference group was composed of students who had not experienced bullying, the associations between sexual orientation-based bullying and feelings of loneliness and between sexual orientation-based bullying and sleeping difficulty were positive (p < 0.05) for both male and female students, with magnitudes about twice as large as those found among those who reported having experienced other cause s of bullying. However, when the reference group was composed of students who had experienced other causes of bullying, only the association between sexual orientation-based bullying and feelings of loneliness was positive (p < 0.05) for both male and female students.ConclusionThis study highlights that sexual orientation-based bullying is a predictor of feelings of loneliness.     

From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice

Previous research has highlighted the importance of addressing the social determinants of health to improve child health outcomes. However, significant barriers exist that limit the paediatrician’s ability to properly address these issues. Barriers include a lack of clinical time, resources, training and education with regard to the social determinants of health; awareness of community resources; and case-management capacity. General practice recommendations to help the health care provider link patients to the community are insufficient. The objective of the current article was to present options for improving the link between the office and the community, using screening questions incorporating physician-based tools that link community resources. Simple interventions, such as routine referral to early-year centres and selected referral to public health home-visiting programs, may help to address populations with the greatest needs.     

World Health Organization growth charts for monitoring the growth of Australian children: time to begin the debate

The recently released World Health Organization growth charts are methodologically robust, as well as clinically useful tools for monitoring the growth of children. They have been endorsed by premier organisations such as the Royal College of Paediatrics and Child Health (UK), Canadian Pediatric Society, Australian Breastfeeding Association, United Nations Standing Committee on Nutrition, International Union of Nutrition Sciences, International Pediatric Association and the European Childhood Obesity Group. The Centers for Disease Control and Prevention (CDC) as well as the American Academy of Pediatrics have also recently endorsed these charts for the 0- to 24-month age group in USA. These growth charts have been adopted by many countries including Canada, UK and New Zealand. Nearly 140 countries are at various stages of implementing them. They offer significant advantages over the currently used CDC 2000 growth charts. They have the potential to contribute in reducing the worldwide incidence of obesity as well as under nutrition in children. Except Northern Territory, Australia continues to use the CDC 2000 growth charts. Paediatricians need to initiate and lead robust debate involving key stakeholders about the implementation of World Health Organization growth charts for monitoring the growth of Australian infants and children.     

Health beliefs among New Zealand adolescents

A modified version of the Multidimensional Health Locus of Control (MHLC) scale was administered to 837 adolescents, aged 15 years, to assess their beliefs about health. There were significant sex differences on the total scores of the internal and powerful others dimensions of the scale. MHLC beliefs were not significantly associated with self-reported ratings of general health or mental health. Significantly more distress due to the experience of negative life events was reported by females with a strong internal locus of control. Maternal health beliefs showed stronger associations with daughters' health beliefs than sons'. For males, strong beliefs in an internal locus of control and weak beliefs in chance were significantly associated with aspects of attachment, social support and self-perceived strengths. There were weak correlations for the majority of associations between health beliefs and health measures and most of the adolescents reported either good or very good health. The findings suggest that adolescents' health beliefs may be quite different from those of adults.     

Reproductive health problems and help seeking behavior among adolescents in urban India

Objective To assess their reproductive health problems and help seeking behaviour among urban school going adolescents. Method A sample of 300 urban school going adolescents between 11–14 years were chosen at random and assessed using four tools namely, self administered questionnaire: provision of adolescent friendly services; medical screening and focus group discussions. Results Seventy two percent girls and 56% boys reported health problems during survey with an average of 1.93 complaints per girl and 0.5 complaints per boy. However, only 43% girls and 35% boys reported to the clinic voluntarily to seek help and only one fifth the amount of problems were reported at the clinic in comparison to the quantum of problems reported in survey, which probably reflects a poor health seeking behaviour. A medical checkup with emphasis on assessment of reproductive health and nutritional status helped in detecting almost the same number of reproductive health problems as reported by them in survey. This intervention helped to increase the client attendance in subsequent period of next one year from 43% to 60% among girls and from 35% to 42% among boys. Conclusion Our study shows that to increase help seeking behaviour of adolescents, apart from health and life skill education, their medical screening with a focus on reproductive health by trained physicians, parental involvement, supported by adolescent friendly centers (AFC) for counseling, referral and follow up are essential.     

Using rising tides to lift all boats: Equity-focused quality improvement as a tool to reduce neonatal health disparities

Evidence of health disparities affecting newborns abounds. Although quality improvement (QI) methodology is often suggested as a tool to advance health equity, the impact of QI initiatives on disparities is variable. QI work may mitigate, worsen, or perpetuate existing disparities. QI projects designed without an intentional focus on equity promotion may foster intervention-generated inequalities that further disadvantage vulnerable groups. This article reviews disparities in perinatal and neonatal care, the impact of QI on health disparities, and the concept of “Equity-Focused Quality Improvement” (EF-QI). EF-QI differs from QI with an equity lens in that it is action-oriented and centered around equity. EF-QI initiatives purposely integrate equity throughout the fabric of the project and are inclusive, collaborative efforts that foreground and address the needs of disadvantaged populations. EF-QI principles are applicable at every stage of project conception, execution, analysis, and dissemination, and may provide opportunities for reducing disparities in neonatal care.     

Awareness and health care seeking for newborn danger signs among mothers in peri-urban Wardha

Objective  To find out awareness of mothers about newborn danger signs and their health care seeking behavior for sick newborns in the peri urban field practice area of Urban Health Centre in Wardha. Methods  Triangulated study of quantitative (survey) and qualitative (mapping, pair-wise ranking exercise) methods were undertaken. 72 identified mothers of children (0–11 months) in social mapping exercise were interviewed by trained social workers using pre-designed and pre-tested questionnaire and by paying house to house visits. The structured questionnaire covered information on newborn danger signs, health care seeking and socio-demographic information. The data was analyzed by using Epi_info software package. A pair-wise ranking exercise for assessment of preferred health care facility for sick newborn was undertaken with the group of purposively selected mothers. Results  Out of 72 mothers, 29 (40.3%), 16 (22.2%) and 10 (13.9%) identified difficulty in breathing, poor sucking and lethargy/unconsciousness as newborn danger signs respectively. Only 7(9.7%) and 2 (2.8%) identified convulsion and hypothermia as newborn danger signs respectively. About 27 (37.5%) babies were sick during newborn period. About 11(15.3%) and 8 (11.1%) were reported to have poor sucking and difficulty in breathing respectively. All sick newborns with danger signs were taken to the doctor and only two mothers consulted faith healer for treatment. Conclusion  Considering the poor awareness of mothers regarding newborn danger signs, there is need for raising awareness building which required for early recognition and prompt treatment. Apart from strengthening government health facilities, the capacity of intermediate non government health care providers should be developed for newborn care.     

Ambient air pollution and children��s health: A systematic review of Canadian epidemiological studies

BACKGROUND

There is growing concern about the health effects of ambient air pollution (AP) in children. The present article summarizes and compares local information regarding the adverse effects of AP on the health of Canadian children with reports from elsewhere.

METHODS

PUBMED, MEDLINE and EMBASE databases were searched for epidemiological studies, published between January 1989 and December 2004, on the adverse health effects of criteria air pollutants among Canadian children.

RESULTS

Eleven studies investigated the association between AP and various respiratory health outcomes, while one study assessed the effect of AP on sudden infant death syndrome. Another study examined the effects of AP on pregnancy outcomes. Most of the available information was from Ontario and British Columbia. Despite inconsistencies among study results and data from elsewhere, evidence from Canadian studies suggest that AP may cause adverse respiratory health effects in children and adverse pregnancy outcomes, and may contribute to infant mortality in Canada.

INTERPRETATION

AP has detrimental health effects among Canadian children. Paediatricians and other health care workers with an interest in child health should encourage parents and children to adhere to smog (AP) advisories. Existing regulatory practices should be reviewed to reduce current levels of ambient air pollutants in Canada.