Completeness and accuracy of anthropometric measurements in electronic medical records for children attending primary care

Background: Electronic medical records (EMRs) from primary care may be a feasible source of height and weight data. However the use of EMRs in research has been impeded by lack of standardization of EMRs systems, data access and concerns about the quality of the data.Objectives: The study objectives were to determine the data completeness and accuracy of child heights and weights collected in primary care EMRs, and to identify factors associated with these data quality attributes.Methods: A cross-sectional study examining height and weight data for children <19 years from EMRs through the Electronic Medical Records Administrative data Linked Database (EMRALD), a network of family practices across the province of Ontario. Body mass index z-scores were calculated using the WHO Growth Standards and Reference.Results: A total of 54,964 children were identified from EMRALD. Overall, 93% had at least 1 complete set of growth measurements to calculate a BMI z-score. 66.2% of all primary care visits had complete BMI z-score data. After stratifying by visit type 89.9% of well-child visits and 33.9% of sick visits had complete BMI z-score data; incomplete BMI z-score was mainly due to missing height measurements. Only 2.7% of BMI z-score data were excluded due to implausible values.Conclusions: Data completeness at well-child visits and overall data accuracy were greater than 90%. EMRs may be a valid source of data to provide estimates of obesity in children who attend primary care

Parental use of routines, setting limits, and child screen use during COVID-19: findings from a large Canadian cohort study

BackgroundAn increase in child screen time has been observed throughout the COVID-19 pandemic. Home environment and parenting practices have been associated with child screen time. The purpose of this study was to examine associations between parental use of routines, limit setting, and child screen time during the (COVID-19) pandemic to inform harm-reducing strategies to limit the potential harms ensued by excessive screen use.MethodsA cohort study was conducted in 700 healthy children (3,628 observations) aged 0–11 years though the TARGet Kids! COVID-19 Study of Children and Families in Toronto, Canada from May 2020-May 2021. The independent variables assessed were parent-reported use of routines and setting limits. Outcomes were parent-reported child daily screen time in minutes and whether the Canadian 24-Hour screen time guideline was met, defined as 0 for &lt;1 years, 60 or less for 1–5 years, and 120 or less for &gt;5 years. Linear and logistic mixed-effects models were fitted using repeated measures of independent variables and outcomes with a priori stratification by developmental stages (&lt;3, 3–4.99, ≥5 years).ResultsA total of 700 children with 3,628 observations were included in this study [mean age = 5.5 (SD = 2.7, max = 11.9) years, female = 47.6%]. Mean change in child screen time before vs. during the pandemic was +51.1 min/day and level of parental use of routines and setting limits remained stable. Lower use of routines was associated with higher child screen time (β = 4.0 min; 95% CI: 0.9, 7.1; p = 0.01) in ages ≥5 years and lower odds of meeting the screen time guideline in ages &lt;3 years and ≥5 years (OR = 0.59; 95% CI: 0.38, 0.88; p = 0.01; OR = 0.76; 95% CI: 0.67, 0.87; p &lt; 0.01). Lower use of limit setting was associated with higher child screen time and lower odds of meeting the screen time guideline in ages ≥5 years (β = 3.8 min; 95% CI: 0.69, 6.48; p &lt; 0.01; OR = 0.86; 95% CI: 0.78, 0.94; p &lt; 0.01).ConclusionsLower parental use of routines and limits during the COVID-19 pandemic were associated with higher screen time and lower odds of meeting the screen time guideline among school-age children. Results may help inform strategies to promote healthy screen use in this age group

Using Electronic Medical Records to Examine Childhood Obesity Outcomes in Community-Based Primary Care

Childhood obesity has become a global public health priority. Obesity leads to increased risk of several co-morbid health conditions such as hypertension, type 2 diabetes, and mental health problems. Growth monitoring is the long-standing child health practice to identify children who fall outside healthy growth parameters. It has been proposed as a key activity for prevention of obesity in children. Growth data is now predominantly stored in primary care electronic medical records (EMRs). However concerns about data quality have limited its use for public health and research. Five inter-related studies were conducted to better understand the feasibility of using routinely collected anthropometric data from primary care EMRs for childhood obesity surveillance and outcomes. In our survey on current growth monitoring practices, only 21% of primary care providers reported using a length board to measure length in infants less than two years of age. Growth measurements were reported to be performed most often during scheduled well-baby/child visits, but rarely during sick visits. Encouragingly, intra- and inter-observer reliability of height/length, and weight was found to be acceptable when using appropriate equipment and measurement methods. Body mass index z-score data in EMRs was found to be 90% complete and 97% accurate. The main inaccuracies were due to recording measurements with inconsistent units and data entry errors. Using reliable data from EMRs, it was found that preschool-aged children (2 toPh.D

Digital Interventions to Promote Healthy Eating in Children: Umbrella Review

BackgroundeHealth and web-based service delivery have become increasingly common during the COVID-19 pandemic. Digital interventions may be highly appealing to young people; however, their effectiveness compared with that of the usual face-to-face interventions is unknown. As nutrition interventions merge with the digital world, there is a need to determine the best practices for digital interventions for children. ObjectiveThe aim of this study is to examine the effectiveness of digital nutrition interventions for children on dietary outcomes compared with status quo interventions (eg, conventional face-to-face programming or nondigital support). MethodsWe conducted an umbrella review of systematic reviews of studies assessing primary research on digital interventions aimed at improving food and nutrition outcomes for children aged <18 years compared with conventional nutrition education were eligible for inclusion. ResultsIn total, 11 systematic reviews published since 2015 were included (7/11, 64%, were of moderate quality). Digital interventions ranged from internet, computer, or mobile interventions to websites, programs, apps, email, videos, CD-ROMs, games, telehealth, SMS text messages, and social media, or a combination thereof. The dose and duration of the interventions varied widely (single to multiple exposures; 1-60 minutes). Many studies have been informed by theory or used behavior change techniques (eg, feedback, goal-setting, and tailoring). The effect of digital nutrition interventions for children on dietary outcomes is small and inconsistent. Digital interventions seemed to be the most promising for improving fruit and vegetable intake compared with other nutrition outcomes; however, reviews have found mixed results. ConclusionsOwing to the heterogeneity and duration of digital interventions, follow-up evaluations, comparison groups, and outcomes measured, the effectiveness of these interventions remains unclear. High-quality evidence with common definitions for digital intervention types evaluated with validated measures is needed to improve the state of evidence, to inform policy and program decisions for health promotion in children. Now is the time for critical, robust evaluation of the adopted digital interventions during and after the COVID-19 pandemic to establish best practices for nutrition interventions for children

Exploring the Enforceability of Refugees’ Right to Education: A Comparative Analysis of Human Rights Treaties

Three international treaties form the backbone of refugees’ legal right to education: The Convention on the Rights of the Child, the 1951 Convention Relating to the Status of Refugees, and the International Covenant on Economic, Social, and Cultural Rights. Nevertheless, a wide gap persists between these favorable international laws and the actual school enrollment of refugee children. This paper presents an empirical analysis of the so-called policy-practice gap in refugee education in order to answer two fundamental questions: What enforcement mechanisms are present in the three international treaties that form the backbone of refugees’ right to education? How do these enforcement mechanisms differ from the enforcement mechanisms in four other international human rights treaties that do not focus specifically on refugees or education? The authors find that the three treaties that address refugees’ right to education are some of the least enforceable in international human rights law. We posit that this finding may be explained by the historic lack of priority given to economic, social, and cultural rights in international law and argue that the unenforceability of the right to an education contributes to the policy-practice gap in refugee education in a direct and significant way

How can we support best practice? A situational assessment of injury prevention practice in public health

Abstract Background To effectively impact the significant population burden of injury, we completed a situational assessment of injury prevention practice within a provincial public health system to identify system-wide priorities for capacity-building to advance injury prevention in public health. Methods A descriptive qualitative study was used to collect data on the current practice, challenges and needs of support for injury prevention. Data was collected through semi-structured interviews (n = 20) and focus groups (n = 19). Participants included a cross-section of injury prevention practitioners and leadership from public health units reflecting different population sizes and geographic characteristics, in addition to public health researchers and experts from academia, public health and not-for-profit organizations. Thematic analysis was used to code all of the data by one reviewer, followed by a second independent reviewer who coded a random selection of interview notes. Major codes and sub codes were identified and final themes were decided through iterations of coding comparisons and categorization. Once data were analysed, we confirmed the findings with the field, in addition to participating in a prioritization exercise to surface the top three needs for support. Results Major themes that were identified from the data included: current public health practice challenges; capacity and resource constraints, and; injury as a low priority area. Overall, injury prevention is a broad, complex topic that competes with other areas of public health. Best practices are challenged by system-wide factors related to resources, direction, coordination, collaboration, and emerging injury public health issues. Injury is a reportedly under prioritized and under resourced public health area of practice. Practitioners believe that increasing access to data and evidence, and improving collaboration and networking is required to promote best practice. Conclusions The results of this study suggest that there are several system level needs to support best practice in public health injury prevention in Ontario including reducing research to practice gaps and supporting opportunities for collaboration. Our research contributes to the literature of the complexity of public health practice, and presents several mechanisms of support to increase capacity at a system level to improve injury prevention practice, and eventually lessen the population burden of injury

Completeness and accuracy of anthropometric measurements in electronic medical records for children attending primary care

Background: Electronic medical records (EMRs) from primary care may be a feasible source of height and weight data. However, the use of EMRs in research has been impeded by lack of standardisation of EMRs systems, data access and concerns about the quality of the data. Objectives: The study objectives were to determine the data completeness and accuracy of child heights and weights collected in primary care EMRs, and to identify factors associated with these data quality attributes. Methods: A cross-sectional study examining height and weight data for children <19 years from EMRs through the Electronic Medical Record Administrative data Linked Database (EMRALD), a network of family practices across the province of Ontario. Body mass index z-scores were calculated using the World Health Organization Growth Standards and Reference. Results: A total of 54,964 children were identified from EMRALD. Overall, 93% had at least one complete set of growth measurements to calculate a body mass index (BMI) z-score. 66.2% of all primary care visits had complete BMI z-score data. After stratifying by visit type 89.9% of well-child visits and 33.9% of sick visits had complete BMI z-score data; incomplete BMI z-score was mainly due to missing height measurements. Only 2.7% of BMI z-score data were excluded due to implausible values. Conclusions: Data completeness at well-child visits and overall data accuracy were greater than 90%. EMRs may be a valid source of data to provide estimates of obesity in children who attend primary care.This research was supported by a Team Grant in Bariatric Care (Team to Address Bariatric Care in Canadian Children – Team ABC3) from the Canadian Institutes of Health Research (Institute of Nutrition, Metabolism and Diabetes). Partnership funding was also provided generously by Alberta Health Services, Alberta Innovates - Health Solutions, Canadian Obesity Network, and The Ontario Ministry of Health and Long-Term Care. Funding agencies had no role in the design, collection, analyses or interpretation of the results of this study or in the preparation, review or approval of this article

Using EMRALD to assess baseline body mass index among children living within and outside communities participating in the Ontario, Canada Healthy Kids Community Challenge.

ObjectivesThe Healthy Kids Community Challenge is a large-scale, centrally-coordinated, community-based intervention in Ontario, Canada that promotes healthy behaviours towards improving healthy weights among children. With the goal of exploring tools available to evaluators, we leveraged electronic medical records from primary care physicians to assess child weights prior to launch of the Healthy Kids Community Challenge. This study compares the baseline (i.e. pre-intervention) prevalence of overweight and obesity in children 1-12 years of age living within and outside Healthy Kids Community Challenge communities.DesignCross-sectional analysis of a primary care patient cohort.SettingElectronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada.ParticipantsA cohort of 19 920 Ontario children who are rostered to an EMRALD physician. Children were 1-12 years of age at a primary care visit with recorded measured height and weight, between January 1, 2014 and December 31, 2015.Outcome measureOverweight and obesity as determined by age- and sex-standardized body mass index using World Health Organization's Growth Standards.ResultsIn Healthy Kids Community Challenge communities, 25.6% (95% CI 24.6-26.6%) of children had zBMI above normal (i.e. >1) compared to 26.7% (95% CI 25.9-27.5%) for children living outside of Healthy Kids Community Challenge communities.ConclusionsDespite some differences in sociodemographic characteristics, zBMI of children aged 1-12 years were similar inside and outside of Healthy Kids Community Challenge community boundaries prior to program launch