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- PublicationIncreased Mental Health Presentations by Children Aged 5-15 at Emergency Departments during the first 12 months of COVID-19Aims To determine changes in mental health (MH) attendance at Emergency Departments (ED) by children aged five to 15 during the COVID-19 pandemic. Methods Analysis of MH presentations during the first year of the pandemic compared with prior year for three public paediatric EDs serving the greater Dublin area with a paediatric population of 430,000. Results Overall, ED attendance during the 12 months to 28th February 2021 was 34.3% below prior year, while MH presentations were 8.9% above prior year. MH attendances initially decreased by 26.8% (2020: 303; 2019: 414) during the first four months of the pandemic (March to June), lower than the corresponding decrease of 47.9% for presentations for any reason (2020: 11,530; 2019: 22,128). However, MH presentations increased by 52.4% in July and August (2020: 218; 2019: 143), and by 45.6% in September to December (2020: 552 ;2019: 379), dropping 28.1% below prior year in January (2021: 87; 2020: 121) before returning to prior year levels in February 2021 (2021: 107; 2020: 106). Conclusion Following the initial COVID-19 lockdown, ED presentations by children for acute MH care increased significantly over prior year, with this increase sustained throughout 2020. Long-term stressors linked to the pandemic may be leading to chronic MH problems, warranting increased funding of MH services as part of the response to COVID-19.
- PublicationUnderstanding the Impact of Public Health Advice on Paediatric Healthcare Use During COVID-19: A Cross-sectional Survey of ParentsBackground: Hospital avoidance during the COVID-19 pandemic has been reported with a significant decrease in attendance at emergency departments among paediatric populations with potential increased morbidity and mortality outcomes. The present study sought to understand parents’ experiences of healthcare during the initial public health stages of the COVID-19 pandemic. Methods: A cross-sectional survey of parents of children under the age of 16 (N = 1044). The survey collected demographic information to profile parents and children, capture relevant health information such as pre-existing conditions and/or chronic illness or disability, and health service usage during the pandemic. Descriptive statistics, chi-square tests and regression analyses were used to determine the factors that influenced avoidance and hesitancy. Results: 23% of parents stated that they were much more hesitant to access health services upon implementation of the initial public health restrictions. Parents with a higher perception of risk of their children contracting COVID-19 ( χ2 (3) =33.8618, p < 0.000), and stronger levels of concern regarding the effects of COVID-19 ( χ2 (3) =23.9189, p < 0.000) were more likely to be hesitant. Stress also appeared to be a factor in hesitancy with higher than normal stress levels significantly associated with hesitancy (RRR= 2.31, CI: 1.54 - 3.47), while those with severe/extremely severe stress were over three times more likely to be hesitant (RRR:3.37, CI:1.81 - 6.27). Approximately one third of the sample required healthcare for their children during the public health restrictions to delay the spread of COVID-19, however, one in five of these parents avoided accessing such healthcare when needed. Of those that required healthcare, parents who avoided were more likely to report that the services were needed more by others ( χ2 (1) 20.3470, p <0.000). Those who felt that the government advice was to stay away from health services were 1.7 times more likely to be much more hesitant (RRR:1.71, CI; 1.10 – 2.67). Conclusion The misinterpretation of government public health advice, stress and the perception of risk each contributed to parental avoidance of or hesitancy to utilize healthcare services during the public health measures imposed to combat COVID-19.
- PublicationCUPID COVID-19: emergency department attendance by paediatric patients during COVID-19 - project protocol [version 1; peer review: 2 approved]Background: Measures introduced to delay the spread of COVID-19 may result in avoidance of emergency departments (EDs) for non-COVID related illness. Clinicians and medical representative bodies such as the Irish Association for Emergency Medicine (IAEM) have expressed concern that some patients may not seek timely urgent medical intervention. Evidence from previous epidemics found that hospital avoidance during outbreaks of MERS and SARS was common. While ED attendance returned to normal following SARS and MERS, both outbreaks lasted 2-3 months. As the COVID-19 pandemic is forecast to extend into 2021, little is known about the impact COVID-19 will have on paediatric attendance at EDs as the pandemic evolves. Aims: This project aims to assess the impact of COVID-19 on paediatric emergency healthcare utilisation, to understand how the health seeking behaviour of parents may have altered due to the pandemic, and to identify how any barriers to accessing care can be removed. Methods: Administrative data records from five EDs across Ireland and one Urgent Care Centre will be analysed to identify changes in attendances at emergency healthcare. Qualitative inquiry will be utilised to capture the experience of staff providing emergency healthcare to paediatric patients during COVID-19, and their feedback on identified trends will inform the interpretation of findings. A cross-sectional survey of parents will capture experiences, concerns and decision-making on accessing healthcare for their children during the pandemic. Results and Conclusion: This information will help decision makers respond rapidly to meet the clinical needs of paediatric patients as the circumstances of the pandemic unfold and reduce the disruption to normal paediatric ED services during the onset of COVID-19. As the health of a child can deteriorate more rapidly than that of an adult, any delay in seeking care for an acutely ill child may have serious consequences. Keywords
- PublicationMaternal Employment, Childcare and Childhood Overweight during InfancyThis paper examines the relationship between maternal employment, childcare during infancy and the overweight status of pre-school children. Using data from the Infant Cohort of the Growing-Up in Ireland Survey, propensity score matching addresses the issue of potential selection bias, quantile regression allows the impact of both maternal employment and childcare to be examined throughout the weight distribution and multiple imputation is used to address the problem of missing data due to item non-response. The results suggest that both full-time and part-time maternal employment when a child is 9 months old increase the likelihood of being overweight at 3 years old, but only for children of mothers with higher levels of education. Informal childcare at 9 months also has harmful effects on child weight, but again only for children of more educated mothers. Quantile regression finds that the children most impacted by maternal employment are those at the upper percentiles of the weight distribution. When selection on observables is used to assess bias arising from selection on unobservables, maternal employment estimates are determined to be a lower bound, while informal childcare results could be attributed to selection bias. Overall findings are consistent with research from North America and the United Kingdom, and are in contrast to recent findings from the rest of Europe, suggesting the possible role of institutional factors.
- PublicationNon-cognitive development in infancy: the influence of maternal employment and the mediating role of childcare(University College Dublin. Geary Institute, 2016-02)This paper examines the relationship between maternal employment during infancy and the non-cognitive development of pre-school children. Noncognitive skills such as self-control, emotional regulation, empathy and patience are at least as important as cognitive skills for personal development and later labour market success. Drawing on recent advances in the economics literature on the theory of skill formation, this study uses data on Irish pre-school children (Growing Up in Ireland, Infant Cohort) to examine the influence of maternal employment in infancy on children’s non-cognitive skills. Propensity score matching addresses the issue of potential selection bias and mediation analysis is used to investigate possible mechanisms for the effect of maternal employment, in particular the role of childcare, parental stress, quality of parent-child attachment and income. Using the score derived from the Strengths and Difficulties Questionnaire (SDQ) to identify a problematic behavioural score at 3 years, no significant effects are found for maternal employment at 9 months. However, when heterogeneity is investigated, effects are identified for children from less advantaged backgrounds, as measured by maternal education, with full-time maternal employment at 9 months having a significant and detrimental effect on non-cognitive development at 3 years old. This effect is primarily mediated by childcare choices, such that children in informal childcare at 9 months, particularly unpaid grandparental arrangements, are more likely to have behavioural difficulties at 3 years. While parent-child attachment plays a modest role, income and parental stress do not explain the effect of maternal employment on child socio-emotional scores. When selection on observables is used to assess bias arising from selection on unobservables, maternal employment estimates are determined to be a lower bound. As no adverse effects are found for children from more advantaged backgrounds, policies that support less advantaged families during this sensitive period, such as adequate paid maternity leave and access to quality affordable childcare, should be considered in order to address this inequality.
- PublicationFactors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocolThere is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents' and families' preferences and decision making when seeking unscheduled paediatric healthcare. Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies such as Sláintecare that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients' behaviour.
- PublicationThe impact of the COVID-19 pandemic on child health and the provision of Care in Paediatric Emergency Departments: a qualitative study of frontline emergency care staffBackground: The COVID-19 pandemic and subsequent public health guidance to reduce the spread of the disease have wide-reaching implications for children’s health and wellbeing. Furthermore, paediatric emergency departments (EDs) have rapidly adapted provision of care in response to the pandemic. This qualitative study utilized insight from multidisciplinary frontline staff to understand 1) the changes in paediatric emergency healthcare utilization during COVID-19 2) the experiences of working within the restructured health system. Methods: Fifteen semi-structured interviews were conducted with frontline staff working in two paediatric EDs and two mixed adult and children EDs. Participants included emergency medicine clinicians (n = 5), nursing managerial staff (n = 6), social workers (n = 2) and nursing staff (n = 2). Thematic Analysis (TA) was applied to the data to identify key themes. Results: The pandemic and public health restrictions have had an adverse impact on children’s health and psychosocial wellbeing, compounded by difficulty in accessing primary and community services. The impact may have been more acute for children with disabilities and chronic health conditions and has raised child protection issues for vulnerable children. EDs have shown innovation and agility in the structural and operational changes they have implemented to continue to deliver care to children, however resource limitations and other challenges must be addressed to ensure high quality care delivery and protect the wellbeing of those tasked with delivering this care. Conclusions: The spread of COVID-19 and subsequent policies to address the pandemic has had wide-reaching implications for children’s health and wellbeing. The interruption to health and social care services is manifesting in myriad ways in the ED, such as a rise in psychosocial presentations. As the pandemic continues to progress, policy makers and service providers must ensure the continued provision of essential health and social services, including targeted responses for those with existing conditions.
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