This chapter reviews global health education and research within a community-oriented framework emphasizing social accountability of these 2 academic spheres. The rationale for this approach is the understanding that in low-, lower-middle–, upper-middle–, and high-income/ resource countries throughout the world, research should be guided by translational steps that ultimately lead to improvement in the care of individuals and contribute to the health of populations locally and globally. Additionally, professional education, profoundly affected by the available environment for clinical training, must display alignment with a valid and socially responsible clinical venue; for example, one based on ethical practice, responsiveness to health needs,1 and broad epidemiological principles of community pediatrics.
Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. In 2020, firearms resulted in 10,197 deaths (fatality rate 9.91/100,000 youth 0-24 years old). Firearms are the leading mechanism of death in pediatric suicides and homicides. Increased access to firearms is associated with increased rates of firearm deaths. Substantial disparities in firearm injuries and deaths exist by age, gender, race, ethnicity, and sexual orientation and gender identity and for deaths related to legal intervention. Barriers to firearm access can decrease the risk to youth for firearm suicide, homicide, or unintentional shooting injury and death. Given the high lethality of firearms and the impulsivity associated with suicidal ideation, removing firearms from the home or securely storing them-referred to as lethal means restriction of firearms-is critical, especially for youth at risk for suicide. Primary care-, emergency department-, mental health-, hospital-, and community-based intervention programs can effectively screen and intervene for individuals at risk for harming themselves or others. The delivery of anticipatory guidance coupled with safety equipment provision improves firearm safer storage. Strong state-level firearm legislation is associated with decreased rates of firearm injuries and death. This includes legislation focused on comprehensive firearm licensing strategies and extreme risk protection order laws. A firm commitment to confront this public health crisis with a multipronged approach engaging all stakeholders, including individuals, families, clinicians, health systems, communities, public health advocates, firearm owners and nonowners, and policy makers, is essential to address the worsening firearm crisis facing US youth today.
Abstract Background Injuries, the leading cause of death in children 1–17 years old, are often preventable. Injury patterns are impacted by changes in the child’s environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic. Methods This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children < 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00–T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020. Results The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31 years vs 7.31 in 2019), more commonly White (54% vs 50%, p < 0.001), non-Hispanic (72% vs 69%, p < 0.001) and had private insurance (35% vs 32%, p < 0.001). Injury hospitalizations increased 2.2% ( p < 0.001) and deaths increased 0.03% ( p < 0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p < 0.001) between 2019 and 2020. Injuries declined for struck by/against (− 4.9%) and overexertion (− 1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019. Conclusions The proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives.
The discussion of global child health should include consideration of the economic and political realities of different countries. These realities will certainly reflect on the health profession educational systems and research capabilities of each country. The categorization of countries is usually based on income: low, lower-middle, upper-middle, and high income/resource. However, in this chapter, we propose that income is not the only determinant of how each category of countries proceeds or should proceed to address health imperatives. Through technologies not available even a decade ago, all countries, regardless of income level, have greatly increased internal and external connectivity. One example is the availability of cell phones in the most impoverished countries. These technologies have not only quickened the pace of development but also allowed for a rethinking of the progress possible and the just-in-time response to health emergencies, scientific advancements, and the sharing of best practices across borders. This information revolution can, we propose, lead to recognition of the mistakes of high-income, industrialized nations and, thus, avoidance of repeating those mistakes. Disaggregation of health data reflects health disparities within each of the country income categories, signifying a need for a more complex analysis of educational and research approaches to resolving health concerns. For low-income countries it may be possible to tackle basic survival problems resulting from extreme poverty, while concurrently applying 21st-century solutions to improve health outcomes more quickly. Thus, we propose a new matrix for the development of child health that embraces new-century transformation of educational and research efforts (Figure 5-1). Illustrative case examples will demonstrate the application of this matrix in educational efforts in each country income/resource category. At the root of this analysis is the recognition that economic inclusion and social justice must drive changes to improve the health of individuals and populations in all countries.
Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. They are also an important cause of injury with long-term physical and mental health consequences. A multipronged approach with layers of protection focused on harm reduction, which has been successful in decreasing motor vehicle-related injuries, is essential to decrease firearm injuries and deaths in children and youth. Interventions should be focused on the individual, household, community, and policy level. Strategies for harm reduction for pediatric firearm injuries include providing anticipatory guidance regarding the increased risk of firearm injuries and deaths with firearms in the home as well as the principles of safer firearm storage. In addition, lethal means counseling for patients and families with individuals at risk for self-harm and suicide is important. Community-level interventions include hospital and community-based violence intervention programs. The implementation of safety regulations for firearms as well as enacting legislation are also essential for firearm injury prevention. Increased funding for data infrastructure and research is also crucial to better understand risks and protective factors for firearm violence, which can then inform effective prevention interventions. To reverse this trend of increasing firearm violence, it is imperative for the wider community of clinicians, public health advocates, community stakeholders, researchers, funders, and policy makers to collaboratively address the growing public health crisis of firearm injuries in US youth.
When we first drafted the outline for this book, we did not factor in an Epilogue, we did not envision the pandemic – the uncertain and virtual world this would create – nor did we envision the racial reckoning to which we would all bear witness. So, journeying through each of our stories within the context of these ongoing challenges created the desire to directly link the messages and learnings with final thoughts and feelings. Also, while we have tried to keep the tone conversational, a number of the chapters ask troubling questions in our quest for racial and gender equity in healthcare and science. For example, whose intentions are genuine, have been tested, and proven to be trustworthy in support of the vision and mission of equity? So, we choose to collect our thoughts in closing and end with hope.
This ground-breaking resource focuses on primary and secondary prevention, guiding pediatric care clinicians in incorporating mental health screening and surveillance into well child visits and provides evidence-based interventions to care for children and adolescents with mental health issues.https://shop.aap.org/promoting-mental-health-in-children-and-adolescents-paperback/
'%3e%3cg id='b'%3e%3cpath id='a' d='M0-8v8h4z' transform='rotate(18 0 -8)'/%3e%3cuse xlink:href='%23a' transform='scale(-1 1)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(72)'/%3e%3cuse xlink:href='%23b' transform='rotate(144)'/%3e%3cuse xlink:href='%23b' transform='rotate(216)'/%3e%3cuse xlink:href='%23b' transform='rotate(288)'/%3e%3c/g%3e%3c/svg%3e)