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Our study sought to explore the experiences of caregivers of urban Inuit children with respect to child health knowledge acquisition to develop community-specific best practices for health promotion initiatives. A needs assessment was conducted to understand how caregivers access child health knowledge and services; what child health issues require improved knowledge mobilisation; and how caregivers would like to access this knowledge. Four focus groups were held with twenty-four parents and caregivers of Inuit children. Child health knowledge acquisition was influenced by dynamics of trust and discrimination, making caregivers' social networks and Indigenous health services highly valued sources. Health topics identified as requiring improved knowledge mobilisation were those in which caregivers faced tensions between Indigenous and non-Indigenous ways of knowing. Such topics included parenting and development, adolescent mental and sexual health, common childhood illnesses, infant care, and nutrition. Caregivers preferred a multi-modal approach to health promotion, highlighting importance of in-person gatherings while also valuing accessible multi-media components. The presence of Elders as facilitators was especially important for child development, parenting, and nutrition. For health promotion to be effective, it must consider community-specific health knowledge sharing processes; tensions between Indigenous and non-Indigenous ways of knowing; and community ownership in health promotion endeavors.

We aimed to characterise the medical and social complexities experienced by Inuit children and their families from Nunavut who were cared for at a general paediatrics clinic at an urban tertiary-level hospital located in Eastern Ontario. A retrospective chart review of this cohort was completed between 2016 and 2019. Two independent reviewers extracted data from charts. The cohort included 36 children, median (interquartile range [IQR]) age 13.5 (6.8, 28.2) months and full age range (1,140) months. They had a median (IQR) of 12.5 (7.8, 18.0) comorbidities, 11 (8.0, 14.2) healthcare services accessed and 3 (2, 5) medications. Almost all children (97.2%) had been hospitalised and the median number of days spent as an inpatient was 31.5. With respect to social complexity variables, 51.9% of clinical interactions (14 of 27 charts reviewed) at any point would have benefitted from an interpreter and 96.7% of 30 patient escorts/companions showed evidence of having difficulty in coping with homesickness. Improving social history taking and integrating screening for social determinants of health within the clinic should be considered. A dedicated interdisciplinary team approach focused on integrative care could be an effective method to improve communication and collaboration between service providers and with Inuit children and their families to reduce systemic health and social inequities.

Children from circumpolar regions must travel long distances to southern tertiary care centres for specialised care. While there are initiatives underway to support care closer to home, medical travel remains a necessity for many families. The Aakuluk clinic has been operating since 2019 at a tertiary hospital in Ottawa, Canada, to provide care to children from Nunavut. The clinic team includes nurse case managers, physicians, social workers, interpreters, and several community partners. This project aimed to identify the strengths and the challenges of the clinic from the perspectives of parents and healthcare providers. The study was conducted in collaboration with healthcare professionals and community members and was guided by Inuit research approaches. Fifty-one participants (parents and healthcare providers) in Nunavut and Ottawa were interviewed. The main strengths and challenges of the clinic that were reported are related to the following themes: access to holistic care, supporting the role of Inuit professionals as part of the care team, and resources needed to continue offering programmes such as Aakuluk to Inuit families. From the perspectives of parents and healthcare providers, there are several components of the Aakuluk model that can be considered when developing services for Inuit families in other tertiary care centres.

The incidence of hospitalizations for acute respiratory infections (ARI) among young Indigenous children from Northern Canada is consistently high. ARIs requiring urgent air transfer can be life-threatening and costly. We aimed to describe their epidemiology, estimate age-specific incidences, and explore factors associated with level of care required. We undertook a retrospective cohort study of children <5 years old from Northern Canada transferred by urgent air transport for ARI from 2005 through 2014 to 5 pediatric tertiary care centers in Vancouver, Edmonton, Winnipeg, Ottawa and Montreal. Admissions were identified via ARI-related ICD-9/10 coding and forward sortation area. Descriptive statistics and univariable analyses were performed. Among 650 urgent air transfers, the majority were from Nunavut (n = 349, 53.7%) or Nunavik (n = 166, 25.5%), <6 months old (n = 372, 57.2%), and without underlying comorbidity (n = 458; 70.5%). Estimated annual tertiary care ARI admission rates in infants <1 year old from Nunavut (40.7/1000) and Nunavik (44.5/1000) were tenfold higher than in children aged 1 to 4 years. Bronchiolitis (n = 333, 51.2%) and pneumonia (n = 208, 32.0%) were the most common primary discharge diagnoses. Nearly half required critical care (n = 316, 48.6%); mechanical ventilation rates ranged from 7.2% to 55.9% across centres. The most common primary pathogen was respiratory syncytial virus (n = 196, 30.1%). Influenza A or B was identified in 35 cases (5.4%) and vaccine-preventable bacterial infections in 27 (4.1%) cases. Urgent air transfers for ARI from Northern Canada are associated with high acuity. Variations in levels of care were seen across referral centers, age groups and pathogens.

Background Complex social determinants of health may not be easily recognized by health care providers and pose a unique challenge in the vulnerable pediatric population where patients may not be able to advocate for themselves. The goal of this study was to examine the acceptability and feasibility of health care providers using an integrated brief pediatric screening tool in primary care and hospital settings. Methods The framework of the Child and Adolescent Needs and Strengths (CANS) and Pediatric Intermed tools was used to inform the selection of items for the 9-item Child and Adolescent Needs and Strengths-Pediatric Complexity Indicator (CANS-PCI). The tool consisted of three domains: biological, psychological, and social. Semi-structured interviews were conducted with health care providers in pediatric medical facilities in Ottawa, Canada. A low inference and iterative thematic synthesis approach was used to analyze the qualitative interview data specific to acceptability and feasibility. Results Thirteen health care providers participated in interviews. Six overarching themes were identified: acceptability, logistics, feasibility, pros/cons, risk, and privacy. Overall, participants agreed that a routine, trained provider-led pediatric tool for the screening of social determinants of health is important ( n  = 10, 76.9%), acceptable ( n  = 11; 84.6%), and feasible ( n  = 7, 53.8%). Interpretation Though the importance of social determinants of health are widely recognized, there are limited systematic methods of assessing, describing, and communicating amongst health care providers about the biomedical and psychosocial complexities of pediatric patients. Based on this study’s findings, implementation of a brief provider-led screening tool into pediatric care practices may contribute to this gap.

Abstract First Nations, Inuit and Métis people in Canada continue to be disproportionately affected by tuberculosis (TB), a disparity rooted primarily in factors such as poverty, crowded and inadequate housing, food insecurity, and inequitable health care access. Historical TB control practices in Canada have contributed to stigma and discrimination toward those with the disease, as well as fear and mistrust of the health system. These individual and system-level factors result in delays in TB diagnoses, ongoing transmission, poorer outcomes, and lower treatment completion rates. Children are especially vulnerable, as they are more likely to develop disease once infected with TB bacteria and to experience life-threatening conditions such as TB meningitis. Paediatric health professionals can help to increase TB awareness and literacy, reduce stigma and discrimination, and ultimately, improve the quality and uptake of services for treatment and prevention in families and communities at risk. They can also advocate for sustainable, community-driven TB elimination strategies that incorporate First Nations, Inuit and Métis principles of wellness, healing and self-determination.

Background Only a small minority of children with heart murmurs have cardiac pathology. The American Academy of Family Practitioners (AAFP) has published a set of criteria for low-risk murmurs that do not require referral to pediatric cardiology. However, these criteria are not consistently followed, in part because they rely on specific auscultatory judgements with which many care providers are uncomfortable. The resultant superfluous referrals represent an opportunity to improve care from both patient-centred and resource utilization perspectives. Objectives - Evaluate the non-auscultatory AAFP criteria alone as a risk stratification tool for pediatric murmurs. - Identify characteristics of situations in which low-risk murmurs are actually pathological. - Assess the utility of ECG in evaluating low-risk murmurs. Design/Methods A retrospective chart review of all children (0–18 years) seen as new outpatient referrals in our pediatric cardiology clinic between January 1, 2016 and June 30, 2018 whose primary reason for referral was a murmur. Referrals were characterized as “low-risk” if they met all of the AAFP criteria aside from findings on auscultation: otherwise normal physical exam; asymptomatic; no risk factors for structural heart disease; age over 6 months. Results The AAFP criteria had a sensitivity of 95.9% and negative predictive value of 96.3% for pathology. The pathology rate was significantly different between the high-risk and low-risk groups (p<0.00001) with relative and absolute risk reduction of 84.4% and 20.0%, respectively. 245 of 915 total referrals (26.8%) met the low-risk criteria. Echocardiogram was deemed necessary for only 67 of these 245 after auscultation by the cardiologist. Of the 9 lesions present in low-risk patients, all were categorized as either “tiny”, “small”, or “mild”. All were documented as sounding pathological to the auscultating cardiologist. None has required intervention since diagnosis. 7 of the 9 had normal ECGs (sensitivity 22.2%). Conclusion Children meeting low-risk clinical criteria represent a significant proportion of murmur referrals to pediatric cardiology. Even excluding any qualitative assessment of the murmur, these criteria are highly sensitive for pathology, and pathologies are minor when present. If a low-risk patient is nevertheless under consideration for referral, ECG should not guide the referral decision as it has poor sensitivity in this population. Future research should examine ways to enhance auscultatory technique (eg. computer-aided auscultation), which may be more helpful.

Résumé Le tabac est sacré dans bien des cultures autochtones, mais la consommation de tabac commercial à des fins récréatives est nuisible et hautement toxicomanogène. Le tabagisme est la principale cause évitable de décès prématuré dans le monde. Le taux de tabagisme chez les jeunes Autochtones est au moins trois fois plus élevé que chez leurs homologues non autochtones, ce qui représente une statistique alarmante à plusieurs égards. Les ravages d’une forte consommation de tabac sur la santé varient entre un taux démesurément élevé de mortalité et de morbidité et un lourd fardeau socioéconomique pour les communautés autochtones. Les dispensateurs de soins pédiatriques sont dans une position idéale pour collaborer avec des intervenants communautaires afin de prévenir et de traiter le tabagisme chez les jeunes et leur famille, tout en comprenant la valeur culturelle du tabac pour de nombreux peuples autochtones. Des interventions ciblées peuvent avoir des répercussions positives sur la durée et la qualité de vie, améliorer la santé globale et réduire les immenses coûts sociaux et humains liés au tabagisme.

Abstract Background Healthy children with likely innocent heart murmurs are frequently referred to cardiologists for reassurance. Existing guidelines that advise against these referrals are not consistently followed partly because they involve subjective auscultatory judgements with which many care providers are uncomfortable. Here, we investigate whether clinical criteria with no subjective auscultatory component are sensitive for cardiac pathology. Methods A retrospective chart review was performed of all new patients seen in our paediatric cardiology clinic for assessment of a murmur from January 1, 2016 through June 30, 2018. Patients were characterized as “low-risk” if they met all of the following criteria: asymptomatic; normal physical examination other than the murmur; no risk factors for congenital heart disease; and age over 12 months. The primary outcomes were the sensitivity for ruling out pathology and the negative predictive value of the proposed criteria. Results Of 915 total patients, 214 met the low-risk criteria. The sensitivity of our criteria for ruling out pathology was 97.2% (95% confidence interval 94.1% to 99.0%) and the negative predictive value was also 97.2% (95% confidence interval 94.0% to 98.7%). Six of the 214 low-risk patients had pathology (2.8%; 95% confidence interval 1.3% to 6.0%), none of which has required intervention since diagnosis. Each of these six children had a murmur that sounded pathological to the auscultating cardiologist. Conclusions Basic clinical criteria that do not require auscultation are highly sensitive for ruling out significant cardiac pathology in children over 12 months of age.