Lee Ford-Jones

Eosinophilic Myocarditis Temporally Associated With Conjugate Meningococcal C and Hepatitis B Vaccines in Children

We report the first cases of tissue-proven eosinophilic myocarditis after single vaccine administration of conjugate meningococcal C and hepatitis B vaccine, respectively. The nature of histopathologic findings strongly supports hypersensitivity reaction and negates viral etiology, which is typically characterized by a lymphocytic infiltrate. Both episodes resolved with corticosteroid therapy. To enhance discussion of our cases, we performed a systematic review of the literature on postimmunization myocarditis or pericarditis, and identified 37 publications, reporting 269 cases during the search period (1966–2007). Time of onset of cardiac symptoms in all patients ranged from 1 to 30 days postimmunization.

Poverty and Pediatric Palliative Care: What Can We Do?

It has been recognized that families of children with life-limiting health conditions struggle with significant financial demands, yet may not have awareness of resources available to them. Additionally, health care providers may not be aware of the socioeconomic needs of families they care for. This article describes a mixed-methods study examining the content validity and utility for health care providers of a poverty screening tool and companion resource guide for the pediatric palliative care population. The study found high relevance and validity of the tool. Significant barriers to implementing the screening tool in clinical practice were described by participants, including: concerns regarding time required, roles and responsibilities, and discomfort in asking about income. Implications for practice and suggestions for improving the tool are discussed. Screening and attention to the social determinants of health lie within the scope of practice of all health care providers. Social workers can play a leadership role in this work.

A New Social Pediatrics Elective—A Tool for Moving to Life Course Developmental Health

All rights reserved. 10.1016/j.jpeds.2011.11.043 T he World Health Organization defines the social determinants of health as ‘‘the conditions in which people are born, grow, live, work, and age, including the health system.’’ In the world’s poorer countries, the challenges presented by these social conditions are obvious: insufficient food and clean water, inadequate housing, lack of access to education and healthcare, and exposure to conflict. In the richer countries, the challenges to health are usually less stark, yet can have a devastating impact on the lives of children and their families. The importance of the social context of health was recognized years ago by giants from the history of medicine and pediatrics, including Virchow (1821-1902), the father of pathology and an ‘‘impassioned advocate for social and political reform,’’ and Abraham Jacobi (1830-1919), the first professor of childhood disease in the USwho was recognized as ‘‘the quintessential physician advocate.’’ However, it was not until 1977 that the European Society of Social Pediatrics— dedicated to the study of the social determinants of health and their effects—was founded in Sweden. Although the social context of children receiving care for serious acute or chronic conditions in a tertiary/quaternary children’s hospital is given attention in didactic lectures and bedside or clinic teaching, few institutions have formalized a clinical experience that focuses specifically on the broader context of the social determinants of health. We contend that strengthened partnerships with community agencies and healthcare professionals, such as social workers, nurses, and early child development experts, and new, formalized collaborations with legal experts and child public health workers are essential in helping the pediatrician provide needed patient support and ‘‘upstream’’ health prevention/promotion. As such, the social determinants of child health are relevant to all branches of pediatrics, because they are part of either the causal or outcome pathways of much of childhood disease. Access to high-quality healthcare, even within a universal healthcare system such as that in Canada, is also, at least in part, socially determined. In 2008, we undertook the job to enrich the educational experience of medical students and residents of our pediatric program by developing a social pediatrics initiative. The aim was to broaden their perspective to include the contribution of the social determinants of health, especially as applied to disadvantaged, dispossessed, and discarded children and youth and their families. The first objective was to develop an elective experience that would provide our medical students with actual, in-depth exposure to the often stark realities of disadvantaged children and youth in our society, beyond the scope of the usual clinical care elective experience. Partnerships were forged with community healthcare professionals who agreed to provide students with an experience that emphasized exposure to families in a variety of urban and suburban clinical settings and during in-home assessments. After a year of planning, a 3-week elective for thirdand fourth-year medical students in social pediatrics was offered in 2009. The essential element of the elective is for students to observe, first-hand, the assessment and management of the complex issues faced by disadvantaged infants, children, and youth, with the objective of gaining in-depth clinical exposure to the factors that contribute to suboptimal life trajectories (Table; available at www.jpeds.com). Coherence and congruence across elective sites are encouraged and facilitated through twice-weekly preparatory meetings, debriefing meetings, or both, with the elective coordinator. In addition, the students are provided with a list of recommended articles (available upon request). As time permits, students are encouraged to request exposures that amplify specific experiences that have caught their attention. At the end of the rotation, each student is required to submit a oneto two-page reflective paper focusing on one or more sentinel experiences of the rotation. The early outcomes of the first 2 years of this elective have been most encouraging. It has been exceptionally popular. Applications have come not only from University of Toronto students, but also from students enrolled in other universities throughout Canada. Several applicants have had to be turned down for lack of capacity. More than 20 students have completed the elective in its first 24 months; their reviews have been uniformly highly favorable. A number of the student reflection papers have been published in medical journals. Our faculty members and the staff of the various involved organizations also have been enthusiastically engaged in

Literacy promotion by health care professionals: A comprehensive biomedical and psychosocial approach

Literacy is the ability to read, write and understand print. Proficiency in literacy is fundamental to social inclusion and strongly linked to health outcomes. Thus, improving literacy is important for lifelong health promotion. Poverty, inadequate hearing, speech and vision and learning disabilities may challenge literacy development. In our review, we explore these topics and suggest recommendations to: Mitigate the Effects of Poverty, Access Comprehensive Medical Assessments, Promote Early Childhood Education and Advocate for Early Intervention and Remediation Programs.

Adverse childhood experiences: Basics for the paediatrician

In 1998, the Centers for Disease Control and Prevention Adverse Childhood Experiences study established the profound effects of early childhood adversity on life course health. The burden of cumulative adversities can affect gene expression, immune system development and condition stress response. A scientific framework provides explanation for numerous childhood and adult health problems and high-risk behaviours that originate in early life. In our review, we discuss adverse childhood experiences, toxic stress, the neurobiological basis and multigenerational and epigenetic transmission of trauma and recognized health implications. Further, we outline building resilience, screening in the clinical setting, primary care interventions, applying trauma-informed care and future directions. We foresee that enhancing knowledge of the far-reaching effects of adverse childhood events will facilitate mitigation of toxic stress, promote child and family resilience and optimize life course health trajectories.

Three hundred babies born to underhoused mothers in Toronto—understanding the problem and how we can help

Little is known about pregnancy in underhoused women, possibly because the number of underhoused mothers with babies in Toronto has been significantly underestimated. Using a novel data collection method, it has been found that there are approximately 300 babies being born each year to underhoused women in Toronto. This finding has significant public health implications, as these women are at increased risk of multiple issues related to physical health, mental health, child protection, poverty and safety. This commentary presents a new data collection strategy, highlights the importance of accurate data collection and offers suggestions for supports for this over-looked population.