Use and safety of prophylactic endoscopy from a single center serving urban and rural children with portal hypertension

Prophylactic endoscopy is routine in adults with portal hypertension (PHTN), but there is limited data in pediatrics. We sought to describe our experience with prophylactic endoscopy in pediatric PHTN. This is a retrospective study of 87 children who began surveillance endoscopy prior to gastrointestinal bleeding (primary prophylaxis) and 52 who began after an episode of bleeding (secondary prophylaxis) from 01/01/1994 to 07/01/2019. Patients who underwent primary prophylaxis had a lower mean number of endoscopies (3.897 vs 6.269, p = 0.001). The primary prophylaxis group was less likely to require a portosystemic shunt (6% vs 15%, p < 0.001) with no difference in immediate complications (1% vs 2%, p = 0.173) or 2-week complications (1% vs 2%, p = 0.097). No deaths were related to variceal bleeding or endoscopy. Kaplan–Meier Survival Curve suggests improved transplant and shunt free survival in the primary prophylaxis group (log-rank p < 0.001). Primary and secondary endoscopic prophylaxis should be considered safe for the prevention of variceal hemorrhage in pediatric portal hypertension. There are differences in outcomes in primary and secondary prophylaxis, but unclear if this is due to patient characteristics versus treatment strategy. Further study is needed to compare safety and efficacy to watchful waiting.

Child Poverty in Rural Areas

Evidence from around the world suggests that children experience poverty as a condition that is damaging to their mental, physical, emotional, and spiritual development. This chapter sheds light on the ways in which poverty impacts rural children and what poverty reduction means in the lives of African children. While children suffer the worst outcomes overall, children in rural areas are significantly more deprived than urban children. The three deprivations which overlap to impact rural children under two years old the most are water, protection (i.e., security), and housing. For these reasons, there are compelling economic, social, and moral grounds that compel us to evaluate child poverty in rural areas in order to understand its severity and urgently find relevant policy solutions.

Pediatric End-of-Life Care in Rural America: A Systematic Review

Background: Families increasingly desire to bring their children home from the acute care setting at end of life. This transition includes home to rural or remote areas. Little is known about the end-of-life care for children who reside in rural areas. Objective: The purpose of this study was to comprehensively review and summarize the evidence regarding end-of-life care for children living in rural areas, identify key findings and gaps in the literature, and make recommendations for future research. Methods: A systematic review was conducted from 2011 to 2021 using MEDLINE and CINAHL databases. Results: Nine studies met inclusion criteria. Key themes from the literature included: barriers, facilitators, and needs. Three articles identified barriers to end-of-life care for children in rural communities, which included access to end-of-life care and clinicians trained to provide pediatric care. Three studies identified and evaluated the facilitators of end-of-life care for rural children. The articles identified technology and additional training as facilitators. Four studies reported on the needs of rural children for end-of-life care with serious illness. Conclusions: We found major barriers and unmet needs in the delivery of rural pediatric end-of-life care. A few facilitators in delivery of this type of care were explored. Overall research in this area was sparse. Future studies should focus on understanding the complexities associated with delivery of pediatric end-of-life care in rural areas.

Noise Exposure and Use of Hearing Protection Among Adolescents in Rural Areas

Purpose: Noise-induced hearing loss (NIHL) has been found in rural children, potentially due to occupational and recreational noise exposure without consistent use of hearing protection devices (HPDs). However, questions remain regarding the specifics of rural adolescents' noise exposure and use of hearing protection around different types of noise. As such, the purpose of the current study was to provide preliminary results on rural adolescents' noise exposure and use of hearing protection for gunfire, heavy machinery, power tools, all-terrain vehicles (ATVs), and music. Method: A questionnaire was administered to 197 students (seventh to 12th grade) from rural schools in West Texas. Questions were related to noise exposure and use of HPDs for specific categories of noise. Testing was performed at the schools, with an investigator recording each student's responses. Results: Approximately 18%–44% of adolescents reported exposure 12 or more times a year to gunfire, heavy machinery, power tools, and ATVs. Only 1%–18% of the adolescents reported never being exposed to such noise sources. Almost half of rural adolescents never used hearing protection around gunfire, and 77%–91% reported never wearing hearing protection when exposed to heavy machinery, power tools, and ATVs. Conclusions: The current study revealed that rural adolescents are exposed to noise sources that could damage their hearing. However, the majority of rural adolescents do not consistently wear hearing protection. Additional research is now needed to extend these findings by assessing rural adolescents' duration of exposure to different noise sources, in addition to investigating prevention of NIHL in this population. Supplemental Material https://doi.org/10.23641/asha.17139335

Be a Good Listener — Exploration of Education Transformation Strategies for Left-behind Children

The education of left-behind children is an important issue in the development of education at present. The emergence of left-behind children is caused by economic transformation and social development. Rural people have always be willing to change their living conditions and improve their living standards, so the parents of rural children have to leave their hometown and come to the city to find a better chance to make a living, but some rural parents are still engaged in the rural orchards, small workshops and other self-employed business. Whether migrant workers or start a small business, or stay in the countryside to operate small business, child's education is bound to be affected to some extent, as a result, the vast majority of the seventy percent of the rural parents wish their children to be looked after by old people, and the parents are not at home for a long time, so they can't take care of the children in learning and life. As a compulsory education worker, we should understand the characteristics of left-behind children and carry out an analysis and research on the education of left-behind children.

Pola Asuh Ibu dalam Pendidikan Religius Anak

The family has a very important role, because the family as the first place the creation of personality and family is the best field in seeding values the value of religious education for children. The role of a mother is so vital in the religious education of children, for a mother to be a figure close to the child in terms of both social and emotional. This study aims to describe how the role of a mother figure in a multi-faith religious education of rural children. This study uses qualitative-phenomenological method. Subject of research are three families. Data was collected by purposive sampling. The results showed the role of a mother multi Religion in the religious education of children in the village Umbulsari there are four stages, namely: a) Educate with etiquette habituation and Training (Parenting), b) Educate the ketauladanan, c) Educate with advice, and d) Educate with supervision