Literature Collection

Down syndrome is the most commonly diagnosed chromosomal abnormality, occurring in 1 in 640 live births in the United States each year. Prenatally, cell-free DNA screening or integrated screening (combined first and second trimester screening) for aneuploidy is highly sensitive for identifying Down syndrome. The diagnosis should be confirmed at birth with fluorescence in situ hybridization followed by chromosomal karyotyping. Children with Down syndrome have varied degrees of intellectual disability and more health complications than typical children. Newborns with Down syndrome require a cardiac evaluation including echocardiography. Children with Down syndrome should have annual vision and hearing screenings, and laboratory tests for subclinical thyroid disease and hematologic disorders. Clinicians should provide unbiased and comprehensive culturally sensitive information regarding available services and support for children with Down syndrome and caregivers. Enrollment in comprehensive early intervention programs (eg, speech, visual, physical and occupational therapy, and child psychology) enhances development.

OBJECTIVES: Adverse childhood experiences (ACEs) are significant contributors to the burden of disease and remain a serious concern for the health and wellbeing of children in Australia. To address ACEs, we co-designed and implemented two integrated health and social care hubs (Child and Family Hubs [CFHs]). This study explores the experiences of caregivers who received care from the CFHs, including the way they were asked about ACEs and the services offered to address identified ACEs. DESIGN: A qualitative study design was used. Using a semistructured interview guide, 29 in-depth interviews were conducted with caregivers of children who were experiencing a range of adversities, including maltreatment and household dysfunction, child neglect, parent mental illness, domestic violence, family conflict, community dysfunction, discrimination, poverty or financial hardship. A thematic analysis approach was used to analyse textual data. Triangulation of investigators and sources of data improved validation of the findings. NVivo (V.12) was used to organise, index and retrieve data. SETTINGS: This study was conducted in two Child and Family Hubs (CFHs) in Australia-IPC Health, Wyndham Vale, Melbourne, and Marrickville Health Centre, Sydney, between May and October 2023. PARTICIPANTS: Participants (n=29) were the caregivers of children living with adverse childhood experiences (ACEs). RESULTS: Four themes were identified which reflected the caregivers' experiences of being asked about adversities and how they linked to the support and services both in the CFHs and outside the CFH. These themes were as follows: (i) trusting relationships are fundamental; (ii) expectations play a role in talking about adversities; (iii) barriers to open discussion of adversities and (iv) barriers to accessing services. CONCLUSIONS: Consultations between caregivers and hub practitioners can effectively identify and address ACEs despite certain barriers. Establishing a trusting relationship where caregivers feel heard and supported is vital, highlighting the hub model's potential impact in Australia and similar contexts. Enhancing consultation duration, and service availability and accessibility may further improve caregivers' experiences in identifying and addressing adversity.

INTRODUCTION: This study implements the School-Family-Research Integrated Health Promotion Program for Overweight and Obesity (SFR-OO), which combines exercise and dietary interventions to combat adolescent obesity. It aims to enhance body composition, exercise motivation, SE, and physical fitness. By using a cross-lagged model, the study will explore causal relationships between self-esteem (SE), exercise self-efficacy (ESE), physical activity, and body composition. METHODS: Ninety-eight adolescents were randomly assigned to either the intervention group or the control group. The intervention group received the SFR-OO intervention for 12 weeks. Assessments included physical fitness tests, body composition, and psychological indicators. RESULTS: While both groups showed a time effect (p < 0.001), the intervention resulted in a significant decrease in body fat percentage (BFP) compared to the control group (p < 0.001, p < 0.038). Improvements were greater for knee push-ups, standing long jump, 4 x 10 meters round trip run and supine trunk raise time as well as psychometric measures (p < 0.001). In the intervention group, higher baseline MVPA significantly predicted greater reductions in BFP at 12 weeks (β = -0.169), whereas no such predictive relationship was found in the control group. DISCUSSION: The 12-week SFR-OO effectively enhanced adolescents' body composition, physical fitness, and psychological outcomes. However, SE and ESE did not significantly predict MVPA or BFP. MVPA modestly predicted reduced BFP only within the intervention group, suggesting a context-dependent effect. This study was registered with ClinicalTrials.gov under the registration number NCT06524908.

OBJECTIVE: This study aimed to characterize trends in office-based, mental health-related physician visits of children and adolescents. METHODS: This descriptive, repeated cross-sectional study analyzed visits (unweighted N=43,790) of children and adolescents, ages 4-17, in the 2005-2019 waves of the National Ambulatory Medical Care Survey, an annual nationally representative survey of U.S. office-based physician visits. The analysis estimated changes in the proportion of visits involving any psychiatric diagnosis, specific diagnoses, and psychiatric medications. RESULTS: The average yearly number of all pediatric visits fell over the study period, whereas the yearly percentage of visits addressing mental health increased among children and adolescents, from 9.3% in 2005-2011 to 13.6% in 2012-2019. The proportion of primary care physician visits addressing mental health increased by 44.7% across the study period. The increase in psychiatric diagnoses was driven by anxiety disorders, which increased the most among female patients. Psychiatric diagnoses increased by 65.9% in visits with adolescents ages 13-17 and 30.9% in visits with children ages 4-12. The authors detected increases in mental health visits among non-Hispanic White and Hispanic youths but not among non-Hispanic Black youths. No statistically significant changes were found in psychiatric medication prescription or continuation at mental health visits. CONCLUSIONS: Office-based physicians increasingly address mental health concerns, reflecting the increasing demand among children and adolescents. Psychiatric diagnoses at office-based physician visits differ by patients' sex and race-ethnicity. Many primary care physicians provide mental health care, highlighting the need for rigorous mental health training for pediatricians.

BACKGROUND: Pregnant women and their unborn children are often overlooked in the opioid crisis, despite increased rates of both maternal complications and neonatal opioid withdrawal syndrome. Although medications for opioid use disorder (MOUD) are considered the gold standard for pregnant women, many either do not have access to or are not offered MOUD as an option. OBJECTIVES: To describe the characteristics of MOUD care models and assess the effectiveness of MOUD Care Models on initiation, adherence, and engagement in treatment for pregnant women with OUD. DATA SOURCES: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol directed the process of this scoping review. A search for English, peer-reviewed, quantitative studies, published between 2012 and 2023 was conducted in eight scholarly databases. The Joanna Briggs Critical Appraisal tools were used to assess study quality. CONCLUSIONS: The integrated care models included medication management, psychotherapy support, behavioral health care, and medical care management, with added focus on prenatal and postpartum care. Synthesis revealed that treatment engagement, medication adherence, breastfeeding rates, and postdelivery MOUD referrals were higher in integrated care models compared with nonintegrated care models. Pregnant women with OUD in integrated care models have better outcomes compared with those in nonintegrated care models. IMPLICATIONS FOR PRACTICE: Improvements in care models are necessary to tackle provider shortages, stigma, and financial, geographic, and technological barriers. Addressing these issues will enhance nurse practitioners' ability to provide comprehensive and accessible care to this vulnerable population.