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Children, Volume 6, Issue 7 (July 2019) – 5 articles

Cover Story (view full-size image): The article describes the role of the pharmacist within a pediatric accountable care organization (ACO) for patients with Managed Medicaid. Pharmacists at the ACO perform population health management and medication management to improve health and quality outcomes for the overall population served. Pharmacists are engaged in quality improvement initiatives, conduct medication therapy management, publish prescribing guidelines, perform academic detailing, and assist with clinical decision support to deliver high-value health care to its patients. The article details initiatives that pharmacists lead or collaborate on aimed at improving health outcomes in behavioral health and asthma management for its pediatric patients. View this paper.

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5 pages, 168 KiB

Open AccessCase Report

The Use of Age Assessment in the Context of Child Migration: Imprecise, Inaccurate, Inconclusive and Endangers Children’s Rights

by Ranit Mishori

Children 2019, 6(7), 85; https://doi.org/10.3390/children6070085 - 23 Jul 2019

Cited by 12 | Viewed by 5360

Abstract

Anecdotal reports suggest migrant children at the US border have had to undergo age assessment procedures to prove to immigration officials they qualify for special protections afforded to those under age 18. There are a variety of methods to assess the chronological ages of minors, including imaging studies such as X-rays of the wrist, teeth, or collarbone. However, these procedures have come under great scrutiny for being arbitrary and inaccurate, with a significant margin of error, because they are generally based on reference materials that do not take into account ethnicity, nutritional status, disease, and developmental history, considerations which are especially relevant for individuals coming from conflict and/or resource-constrained environments. Using these procedures for migration purposes represent an unethical use of science and medicine, which can potentially deprive minors with the protections that they are owed under US and international laws, and which may have devastating consequences. We should advocate for the creation special protocols, educate law enforcement and legal actors, ensure such procedures are carried out only as a last resort and by independent actors, emphasize child protection and always put the child’s best interest at the core. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

13 pages, 542 KiB

Open AccessBrief Report

Immediate Effect of a Yoga Breathing Practice on Attention and Anxiety in Pre-Teen Children

by Shirley Telles, Ram Kumar Gupta, Kumar Gandharva, Babita Vishwakarma, Niranjan Kala and Acharya Balkrishna

Children 2019, 6(7), 84; https://doi.org/10.3390/children6070084 - 22 Jul 2019

Cited by 16 | Viewed by 12015

Abstract

Pre-teen children face stressors related to their transition from childhood to adolescence, with a simultaneous increase in academic pressure. The present study compared the immediate effects of 18 min of (i) high frequency yoga breathing with (ii) yoga-based breath awareness and (iii) sitting quietly, on (a) attention and (b) anxiety, in 61 pre-teen children (aged between 11 and 12 years; 25 girls). Attention was assessed using a six letter cancellation task and Spielberger’s State Trait Anxiety Inventory STAI-S was used to measure anxiety before and after the three practices, practiced on separate days. Repeated measures ANOVA, followed by Bonferroni adjusted post-hoc analyses showed an increase in total attempts and net scores after high frequency yoga breathing (p < 0.05), while wrong attempts increased after yoga based breath awareness (p < 0.05). Anxiety decreased comparably after all three interventions. The 25 girls in the group had the same trend of results as the whole group with respect to the attention-based cancellation task, while boys showed no, how since change. For both girls and boys, anxiety decreased after all three 18min interventions. The results suggest that high frequency yoga breathing could be a short, useful school based practice to improve attention and reduce anxiety. Full article

(This article belongs to the Special Issue Complementary and Integrative Movement Therapies for Children)

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5 pages, 194 KiB

Open AccessEditorial

Constructing Invisible Walls through National and Global Policy

by Stephanie Ettinger de Cuba, Allison Bovell-Ammon and Diana Becker Cutts

Children 2019, 6(7), 83; https://doi.org/10.3390/children6070083 - 17 Jul 2019

Cited by 4 | Viewed by 4256

Abstract

Worldwide 37,000 people are forced to flee their homes every day due to conflict and persecution. The factors that lead people to leave their home countries often originate with economic deprivation and violence, escalated to a level that becomes a struggle for survival. Climate change, as it has accelerated over the last three to four decades and negatively impacted natural resources, contributes to a parallel increase in strife and migration. The US response to migration has been to construct an “Invisible Wall” of isolationist and xenophobic policies, many of which are especially harmful to children and their families. The southern US border is perhaps the most high profile location of the Invisible Wall’s construction, fortified by federal policies and a withdrawal from international cooperation. Global reengagement on climate change and migration, US ratification of the Convention on the Rights of the Child, and destruction of the Invisible Wall will help to create a world where children can thrive. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

9 pages, 1146 KiB

Open AccessReview

Pharmacist Involvement in Population Health Management for a Pediatric Managed Medicaid Accountable Care Organization

by Catherine Kuhn, Brigid K. Groves, Chester Kaczor, Sonya Sebastian, Ujjwal Ramtekkar, Joshua Nowack, Christina Toth, Olivia Valenti and Charitha Gowda

Children 2019, 6(7), 82; https://doi.org/10.3390/children6070082 - 4 Jul 2019

Cited by 7 | Viewed by 7844

Abstract

Accountable care organizations (ACOs) have emerged as an effective healthcare delivery model for managing quality and cost at a population level. Within ACOs, pharmacists are critical for the delivery of high-value health care, offering patients and health care providers medication-related training, resources, and guidance that can improve quality of care at lower costs. Partners For Kids (PFK), one of the oldest and largest pediatric ACOs in the country, has successfully leveraged pharmacists to provide population health management and medication management to promote health outcomes for individual patients and the overall population it serves. This review explores how the inclusion of pharmacists in the development and execution of various quality improvement initiatives within PFK has positively impacted outcomes for patients while also lowering overall spend. A catalog of interventions is provided to offer various ways that pharmacists can intersect as providers in the triad of patient/family, payor, and provider. By providing enhanced training and education, on-site guidance, medication management, and population-level data analysis, pharmacists are able to identify and improve inefficiencies in care. Moving forward, ongoing engagement of pharmacists in health care operations will be a necessary feature to maximize health care value. Full article

(This article belongs to the Special Issue Development of a National Pediatric Pharmacotherapy Collaborative Practice Network)

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15 pages, 1283 KiB

Open AccessArticle

Effects of Gestational Age and Early Parenting on Children’s Social Inhibition at 6 Years

by Lucia M. Reyes, Julia Jaekel and Dieter Wolke

Children 2019, 6(7), 81; https://doi.org/10.3390/children6070081 - 28 Jun 2019

Cited by 5 | Viewed by 5465

Abstract

Preterm birth (<37 weeks’ gestation) has been associated with problems in social functioning. Whether social inhibition is specifically related to preterm birth and whether early parenting may protect against social inhibition difficulties is unknown. To explore effects of gestational age and early parent–infant relationships on social inhibition, 1314 children born at 26–41 weeks gestational age were studied as part of the prospective Bavarian Longitudinal Study. Early parent–infant relationship quality was assessed postnatally with the parent–infant relationship index. Social inhibition was assessed at age 6 years using an experimental procedure, in which nonverbal and verbal responses were coded into social inhibition categories (disinhibited, normally responsive, inhibited). Multinomial logistic regressions indicated that children with lower gestational age showed more socially disinhibited (nonverbal: OR = 1.27 [95% CI = 1.17–1.40], verbal: OR = 1.23 [95% CI 1.13–1.35]) and inhibited (nonverbal: OR = 1.21 [95% CI = 1.11–1.32], verbal: OR = 1.11 [95% CI = 1.01–1.21]) responses. Good early parent–infant relationships were associated with less verbal disinhibition (OR = 0.70 [95% CI = 0.52–0.93]). Findings suggest that children with lower gestational age are at greater risk to be both socially inhibited and disinhibited. Early parenting affected risk of abnormal social responses. Supporting early parent–infant relationships may reduce preterm children’s risk for social difficulties. Full article

(This article belongs to the Special Issue Neurodevelopment of Survivors Born Very Preterm)

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