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Background and aim: The evidence about the acceptability and effectiveness of innovative paediatric models of care for Type 1 diabetes is limited. To address this gap, we synthesised literature on implemented models of care, model components, outcomes, and determinants of implementation and sustainability. Methods: A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches of Medline, CINAHL, EMBASE and Scopus were conducted. Empirical studies focused on Type 1 diabetes paediatric models of care, published from 2010 to 2022 in English were included. Results: Nineteen extant studies reported on models and their associations with health and psychosocial outcomes, patient engagement with healthcare, and healthcare costs. Thirteen studies described multidisciplinary teamwork, education and capacity building that supported self-care. Four studies involved shared decision making between providers and patients, and two discussed outreach support where technology was an enabler. Fourteen studies reported improvements in health outcomes (e.g. glycaemic control), mostly for models that included multidisciplinary teams, education, and capacity building (11 studies), outreach support or shared care (3 studies). Four studies reported improvements in quality of life, three reported increased satisfaction for patients and carers and, and one reported improved communication. Four of five studies describing shared care and decision-making reported improvements in quality of life, support and motivation. Outreach models reported no negative outcomes, however, accessing some models was limited by technological and cost barriers. Eight studies reported on model sustainability, but only half reported implementation determinants; none reported applying a theoretical framework to guide their research. Conclusion: Some health and psychosocial benefits were associated with newer models. To address knowledge gaps about implementation determinants and model sustainability, longitudinal studies are needed to inform future adoption of innovative models of care for children with Type 1 diabetes. [ABSTRACT FROM AUTHOR]

Background: Missed or delayed child healthcare caused by the COVID-19 lockdown has threatened young children's health and has had an unpredictable influence on caregivers' child healthcare preferences. This study investigated caregivers' child healthcare preferences and the factors that influence them among families with young children (0–3 years) during the lockdown in Shanghai. Methods: Participants in this cross-sectional study were enrolled through random encounter sampling. Questionnaires were distributed online from June 1 to November 10, 2022, in Shanghai. A total of 477 valid questionnaires were received. The demographics of caregivers and their families, children's characteristics, COVID-19-related information, and caregivers' healthcare preferences were analyzed. The statistical analyses included frequency and percentage, chi-square tests, and multinomial logistic regression. Results: Caregivers preferred child healthcare professionals in the community health service system (CHS; 47.6%) followed by hospital pediatricians (40.0%) during lockdown. Caregivers with the following characteristics preferred CHS: those with an annual household income of CNY 200,000–300,000, those whose youngest children were aged 8–12 months, and those who experienced early childhood physical development issues. Caregivers preferred hospitals if they had experienced healthcare-seeking-related difficulties in accessing professional guidance from hospital pediatricians. Conclusions: During pandemic lockdowns, policymakers should allocate more resources to CHS to meet caregivers' childcare demands. Moreover, special attention should be given to the healthcare needs for CHS among families with specific demographics. Trial registration: Approval was obtained from the Ethics Committee of Shanghai Jiao Tong University School of Medicine School of Public Health (SJUPN-202,109; June 1, 2022). [ABSTRACT FROM AUTHOR]

Background: Mental health and health-related quality of life (HRQoL) in children and adolescents deteriorated during the COVID-19 pandemic. The aim of this population-based longitudinal study was to explore whether distinct mental health trajectories in youths can be identified over the course of the pandemic. Methods: Mental health problems (MHP), psychosomatic symptoms and HRQoL were assessed at five time points between May 2020 and October 2022 in 744 children and adolescents aged 7 to 20 years using established instruments. We used generalized mixture modeling to identify distinct mental health trajectories and fixed-effects regressions to analyse covariates of the identified profiles of change. Results: We found five distinct linear latent trajectory classes each for externalising MHP and psychosomatic symptoms and four trajectory classes for internalising MHP. For HRQoL, a single-class solution that indicates a common development process proved to be optimal. The largest groups remained almost stable at a low internalising and externalising symptom level (64 to 74%) and consistently showed moderate psychosomatic symptoms (79%), while 2 to 18% showed improvements across the pandemic. About 10% of the youths had consistently high internalising problems, while externalising problems deteriorated in 18% of youths. Class membership was significantly associated with initial HRQoL, parental and child burden, personal resources, family climate and social support. Conclusions: The mental health of most children and adolescents remained resilient throughout the pandemic. However, a sizeable number of youths had consistently poor or deteriorating mental health. Those children and adolescents need special attention in schools and mental health care. [ABSTRACT FROM AUTHOR]

Introduction: Since the majority of hospitalisations due to RSV occur in young children, the illness profoundly influences the entire family. However, comprehensive evidence regarding its overall effects remains limited. The ResQ Family study aims to investigate the burden of RSV-induced pediatric hospitalisation on affected families. Methods: Spanning the 2022–2023 RSV season, an interdisciplinary, observational study was conducted in Germany, France, Italy and Sweden. Using an online questionnaire, parents and caregivers of children (< 24 months of age) with an RSV-induced hospitalisation were recruited. Information was gathered on topics related to RSV and parental health-related quality of life (HRQoL) during the acute infection phase (t0) and 6 weeks later (t1). Descriptive evaluations of the data set were performed during t0 and regarding a potential change over the observation period (t0 vs. t1). Subgroup analysis aimed to further identify differences across the countries. Results: A total set of 138 affected parents/caregivers were included in the study, with 59 participants responding to the follow-up survey (t1). Particularly during the acute infection phase, parental HRQoL was shown to be negatively influenced by the child's RSV infection [total score (p < 0.001, d = 0.54), parent HRQoL summary score (p < 0.001, d = 0.67) and family functioning summary score (p = 0.007, d = 0.33)]. Significant disparities in disease awareness and support structures were observed across Europe, with France and Sweden showing notably higher levels. Conclusion: The ResQ Family study provides convincing evidence that RSV-associated hospitalisations in young children across Europe generate a multifaced burden for the entire family, partly even beyond the acute infection phase. Standardised approaches for disease prevention at societal, educational and policy levels are needed to guarantee every newborn the best possible start into life. Trial Registration: ClinicalTrials.gov, identifier, NCT05550545. [ABSTRACT FROM AUTHOR]

Severe acute malnutrition (SAM) is the most serious form of acute malnutrition and is associated with high mortality risk among children under 5. While the Community‐based Management of Acute Malnutrition (CMAM) approach, recommended for treating cases of uncomplicated SAM, has increased treatment coverage and recovery outcomes, high relapse rates have been reported. Several risk factors for SAM relapse, such as insufficient food intake and high infectious disease burden in the community, have been identified. However, the role of household water, sanitation and hygiene (WASH) conditions remains unclear. This systematic review: (1) assesses the effectiveness of WASH interventions on preventing SAM relapse and (2) identifies WASH‐related conditions associated with relapse to SAM among children aged 6–59 months discharged as recovered following SAM CMAM treatment. We performed electronic searches of six databases to identify relevant studies published between 1 January 2000 and 6 November 2023 and assessed their quality. After deduplication, 10,294 documents were screened by title and abstract, with 13 retrieved for full‐text screening. We included three studies ranging from low‐ to medium‐quality. One intervention study found that providing a WASH kit during SAM outpatient treatment did not reduce the risk of relapse to SAM. Two observational studies found inconsistent associations between household WASH conditions—unimproved sanitation and unsafe drinking water—and SAM relapse. Despite the paucity of evidence, the hypothesised causal pathways between WASH conditions and the risk of relapse remain plausible. Further evidence is needed to identify interventions for an integrated postdischarge approach to prevent relapse. Key messages: This systematic review highlights a paucity of evidence on the relationship between household water, sanitation and hygiene (WASH) conditions and the prevention of severe acute malnutrition (SAM) relapse.There are limited high‐quality studies assessing the effectiveness of household‐level WASH interventions in preventing uncomplicated SAM relapse among children 6–59 months discharged from outpatient programmes.Equally, there are very few studies and of limited quality on household WASH risk factors associated with relapse to SAM.While it is biologically plausible that household WASH conditions could influence the risk of SAM relapse, additional and high‐quality research is needed to investigate if and how postdischarge WASH interventions might reduce this risk. [ABSTRACT FROM AUTHOR]

Background: Food insecurity significantly impacts children's health, affecting their development across cognitive, physical, and socio-emotional dimensions. This study explores the impact of food insecurity among children aged 6 months to 5 years, focusing on nutrient intake and its relationship with various forms of malnutrition. Methods: Utilizing machine learning algorithms, this study analyzed data from 819 children in the West Bank to investigate sociodemographic and health factors associated with food insecurity and its effects on nutritional status. The average age of the children was 33 months, with 52% boys and 48% girls. Results: The analysis revealed that 18.1% of children faced food insecurity, with household education, family income, locality, district, and age emerging as significant determinants. Children from food-insecure environments exhibited lower average weight, height, and mid-upper arm circumference compared to their food-secure counterparts, indicating a direct correlation between food insecurity and reduced nutritional and growth metrics. Moreover, the machine learning models observed vitamin B1 as a key indicator of all forms of malnutrition, alongside vitamin K1, vitamin A, and zinc. Specific nutrients like choline in the "underweight" category and carbohydrates in the "wasting" category were identified as unique nutritional priorities. Conclusion: This study provides insights into the differential risks for growth issues among children, offering valuable information for targeted interventions and policymaking. [ABSTRACT FROM AUTHOR]

Background: Digital behaviour change interventions aiming to improve dietary intakes; specifically fruit and vegetable intake, in low-socioeconomic children are being developed and tested. However there is currently no synthesis of the characteristics or reported effectiveness of these interventions. This systematic review aims to: (1) identify existing digital interventions targeting fruit and vegetable intake in low-socioeconomic status children, (2) identify and synthesise characteristics and reported effectiveness of these interventions using the Behaviour Change Intervention Ontology. Method: CINAHL, ERIC, PubMed, Cochrane Library, ACM Digital Library and Scopus were searched in December 2021 – February 2022 and in February–March 2024. Inclusion criteria for studies were: 1) children of low-SES families, aged between 5–11 years old; 2) Digital intervention to improve fruit and vegetable intake; 3) Comparison groups could be digital or non-digital; 4) Outcome measures were fruit and vegetable intake and antecedents to diet behaviours; 5) Randomised controlled trials (cluster and parallel designs). Characteristics of identified studies were coded using the Behaviour Change Techniques Taxonomy and Modes of Delivery, Setting and Source ontologies of the Behaviour Change Intervention Ontology. Results: Five studies met all inclusion criteria, with majority reporting significant effects of interventions on improving fruit and vegetable intake. Most common Behaviour Change Techniques found were Goal Setting (k = 4), Problem Solving (k = 3), Instruction on how to perform a Behaviour (k = 3), and Prompts and Cues (k = 3). Characteristics relating to intervention source were unclear. Conclusions: Digital interventions had positive outcomes in fruit and vegetable intake in children; particularly more for fruit than vegetable intake. Characteristics in digital interventions which have direct effects on child fruit and vegetable intake in low-socioeconomic families should be further investigated. Furthermore, clearer reporting on intervention characteristics is needed. [ABSTRACT FROM AUTHOR]

INTRODUCTION Children are vulnerable to secondhand smoke (SHS) exposure, especially those with lower socioeconomic status. This study assesses the changes in prevalence and socioeconomic inequalities in SHS exposure in children younger than 12 years old in Spain between 2016 and 2019. METHODS We conducted two cross-sectional studies among representative samples of households with children aged <12 years in Spain, in 2016 (n=2411) and 2019 (n=2412). Families were interviewed to assess children's SHS exposure in private settings and outdoor public venues and their adoption of home and car smoke-free rules. We used the education level of the home main earner as a proxy for socioeconomic position. Changes over time in the prevalence and socioeconomic inequalities of SHS exposure and smoke-free rules were estimated through adjusted Poisson regression models with robust variance according to sociodemographic covariates (adjusted prevalence ratios, APRs). RESULTS In 2019, 70.5% of children were exposed to SHS in Spain. No changes between 2016 and 2019 were found for overall SHS exposure, exposure at home, and at school entrances. SHS exposure increased at public transport stations (APR=1.24; 95% CI: 1.03-1.49) and outdoor hospitality venues (APR=1.17; 95% CI: 1.07-1.29) while it decreased in cars (APR=0.74; 95% CI: 0.56-0.98) and parks (APR=0.87; 95% CI: 0.77-0.98). Households with lower education level had higher prevalence of SHS exposure at home in 2019 compared with those with university studies (primary: APR=1.30; 95% CI: 1.11-1.51; secondary: APR=1.12; 95% CI: 1.00-1.25) and were less likely to adopt home indoor smoke-free rules (primary: APR=0.88; 95% CI: 0.79-0.99; secondary: APR=0.95; 95% CI: 0.89-1.02). Socioeconomic inequalities in SHS exposure at home persisted between 2016 and 2019 (p>0.05), while decreased in smoke-free rules in cars (p=0.039). CONCLUSIONS Reported SHS exposure among children in Spain remained high between 2016 and 2019. Inequalities persisted at home, highlighting the need for measures to reduce such exposure with an equity perspective. [ABSTRACT FROM AUTHOR]

Throughout the COVID-19 period, families were forced to stay indoors, adapting to online schooling, remote work, and virtual social engagements, inevitably altering the dynamics within households. There was a notable increase in mental health challenges in terms of anxiety and depression in children and adolescents. This study intended to explore the psychosocial effects of the COVID-19 pandemic on Italian families by adopting self- and proxy-report questionnaires on anxiety, anger, and health-related quality of life. The results showed that approximately 20% obtained a clinical anxiety score and only 10% obtained a clinical anger score. There was a difference in the perception of the quality of life reported by the child and that perceived by the parent. A stepwise regression model showed that total anxiety scores were predicted by sex, quality of life scores from the parents' self-report version, and the total anger score. Another stepwise regression model identified physiological and social anxiety as the best predictors that impact quality of life. Parental well-being actively influences the well-being of children, so it is fundamental to implement preventive programs and promote child well-being by providing parents the most adequate support possible. [ABSTRACT FROM AUTHOR]

Growing up in socio-economic disadvantage has important and long-lasting effects on children's lives. Children from disadvantaged households often fall behind in many areas of well-being and development, with effects that continue to limit their opportunities and outcomes – including their health and labour market outcomes – long after they reach adulthood. Drawing on Europe-wide survey data from 27 countries, this paper explores how childhood socio-economic disadvantage affects later adult labour market and health outcomes and evaluates the country-level GDP-equivalent cost of childhood disadvantage due to lost employment, lost earnings, and lost health, as well as the costs of lost government revenue and extra benefit spending. Results point to large costs for societies from childhood socio-economic disadvantage, totalling on average the equivalent of 3.5% of GDP annually. We also show that the labour market penalties linked to childhood disadvantage are often smaller in countries with lower absolute levels of disadvantage. While not causal evidence, these associations suggest much of the impact of childhood disadvantage in adulthood can be mitigated with the right environment and policy set up in childhood. [ABSTRACT FROM AUTHOR]

Parent–child patterns in objectively measured movement behaviours were the highlight of this study. A total of 381 families (337 mothers, 256 fathers, 190 daughters, and 191 sons) from 36 randomly selected schools and kindergartens provided valid accelerometer data. Sedentary behaviour and physical activity (PA) were assessed using ActiGraph accelerometers. Spearman's rho was used to evaluate parent–child associations, while logistic regression analysis (the backward LR method) was used to recognize factors related to children's achievement of PA recommendations. Results indicated that girls engaged more in light PA, while boys showed higher levels of moderate and vigorous PA. Mothers spent less time sitting and more time in light PA compared to fathers, resulting in higher total PA levels. Father–son pairs showed a stronger association in total PA than mother–son pairs. Children aged 6–10 years and those with mothers who engaged in more vigorous PA were more likely to meet PA recommendations compared to younger children and those with less active mothers. [ABSTRACT FROM AUTHOR]

This study delves into the dynamics of parenting styles and their impact on the cognitive and social–affective development of children within diverse family populations, contextualized within the framework of Sustainable Development Goals (SDGs). Drawing from a sample population comprising families from various socio-economic backgrounds and cultural contexts, the research explores the nuanced interactions between parenting approaches—ranging from authoritarian/permissive to democratic—and children's developmental trajectories. By examining families with different numbers of children, this study elucidates the differential effects of parenting styles on cognitive adaptability and social–emotional skills across varying family structures. Democratic parenting emerges as a critical factor in promoting children's well-being, equitable access to education, and the fostering of peaceful societies, aligning with SDGs 3, 4, and 16. Furthermore, the research addresses disparities in child development outcomes, shedding light on issues of gender equality (SDG 5) and reduced inequalities (SDG 10) within the context of family dynamics. Through a comprehensive analysis of diverse family populations, this study underscores the significance of inclusive and nurturing parenting practices in advancing sustainable development objectives, advocating for collaborative efforts (SDG 17) to support families in fostering optimal child development outcomes for all. [ABSTRACT FROM AUTHOR]

This empirical research on children's poverty and the accompanying risk behavior was conducted in the Baktalórántháza micro-region, in one of the most disadvantaged micro-regions of Hungary. The study, completed in 2023, was conducted utilizing three methods, a questionnaire for families, interviews, and focus group interviews with social professionals working in the settlements. The region is one of the ten micro-regions with the highest poverty rate in the country. The majority of the population only has an elementary education, and the proportion of graduates is much lower than the national average. The proportion of households with three or more children is higher than the national average and the proportion of unemployed people in households with children is twice as high as the national average. Based on the experience of social workers working in the area, in addition to smoking and drinking alcohol, the consumption of psychoactive and psychotropic substances has increased among adolescents and young adults. Based on various indicators, children regularly consume illegal drugs. The origin and composition of these drugs are typically unknown. According to the reports by drug users, everyday life is easier, and they can escape from problems when under the influence of drugs. Based on the observations of experts, the consumption of various psychoactive substances has harmful effects on behavior, health, learning, and family life. School performance and the ability to think and learn decrease. Drug users are dissatisfied with their lives, have problems with social relationships, engage in partner violence, and may develop antisocial behavior in their lives. [ABSTRACT FROM AUTHOR]

Abstract Background and aim The evidence about the acceptability and effectiveness of innovative paediatric models of care for Type 1 diabetes is limited. To address this gap, we synthesised literature on implemented models of care, model components, outcomes, and determinants of implementation and sustainability. Methods A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches of Medline, CINAHL, EMBASE and Scopus were conducted. Empirical studies focused on Type 1 diabetes paediatric models of care, published from 2010 to 2022 in English were included. Results Nineteen extant studies reported on models and their associations with health and psychosocial outcomes, patient engagement with healthcare, and healthcare costs. Thirteen studies described multidisciplinary teamwork, education and capacity building that supported self-care. Four studies involved shared decision making between providers and patients, and two discussed outreach support where technology was an enabler. Fourteen studies reported improvements in health outcomes (e.g. glycaemic control), mostly for models that included multidisciplinary teams, education, and capacity building (11 studies), outreach support or shared care (3 studies). Four studies reported improvements in quality of life, three reported increased satisfaction for patients and carers and, and one reported improved communication. Four of five studies describing shared care and decision-making reported improvements in quality of life, support and motivation. Outreach models reported no negative outcomes, however, accessing some models was limited by technological and cost barriers. Eight studies reported on model sustainability, but only half reported implementation determinants; none reported applying a theoretical framework to guide their research. Conclusion Some health and psychosocial benefits were associated with newer models. To address knowledge gaps about implementation determinants and model sustainability, longitudinal studies are needed to inform future adoption of innovative models of care for children with Type 1 diabetes.

Exploring Bereavement in Pediatric Nursing: A Systematic Review

Abstract Background 16p11.2 proximal deletion and duplication syndromes (Break points 4–5) (593KB, Chr16; 29.6-30.2mb - HG38) are observed to have highly varied phenotypes, with a known propensity for lifelong psychiatric problems. This study aimed to contribute to a research gap by qualitatively exploring the challenges families with 16p11.2 deletion and duplication face by answering three research questions: (1) What are parents’ perceptions of the ongoing support needs of families with children who have 16p11.2 living in the UK?; (2) What are their experiences in trying to access support?; (3) In these regards, do the experiences of parents of children with duplication converge or vary from those of parents of children with 16p11.2 deletion? Methods 33 parents with children (aged 7–17 years) with 16p11.2 deletion or duplication participated in structured interviews, including the Autism Diagnostic Interview– Revised (ADI-R). Their answers to the ADI-R question ‘what are your current concerns’ were transcribed and subsequently analysed using Braun and Clarke’s six step reflexive thematic analysis framework. Results Three themes were identified: (1) Child is Behind Peers (subthemes: developmentally; academically; socially; emotionally); (2) Metabolism and Eating Patterns and; (3) Support (subthemes: insufficient support available; parent has to fight to access support; COVID-19 was a barrier to accessing support; 16p11.2 diagnosis can be a barrier to support, child is well-supported). Conclusions Parents of children with either 16p11.2 deletion or duplication shared similar experiences. However, metabolism concerns were specific to parents of children with 16p11.2 deletion. The theme Child is Behind Peers echoed concerns raised in previous Neurodevelopmental Copy Number Variant research. However, there were some key subthemes relating to research question (2) which were specific to this study. This included parents’ descriptions of diagnostic overshadowing and the impact of a lack of eponymous name and scant awareness of 16p11.2.

Simple Summary: This cross-sectional study analyzed how multilevel social factors affect patient-reported outcomes in children under 18 who survived cancer. Study participants include 293 pairs of these survivors who received survivorship care at a U.S.-based comprehensive cancer center between 2017 and 2018 and their primary caregivers. Findings indicate that higher caregiver anxiety is linked to worse depression, stress, fatigue, sleep problems, and lower positive affect in survivors of pediatric cancer. The study also found that family conflicts are associated with sleep issues in childhood cancer survivors. Furthermore, survivors living in socioeconomically deprived areas experience poorer sleep quality, and those residing in environments with high physical deprivation experience more psychological stress and fatigue, alongside reduced positivity and mobility. These results highlight the significant impact of parental, familial, and neighborhood factors on a range of patient-reported outcomes among young cancer survivors, suggesting these social factors as crucial targets for intervention. In this study, the social determinants of patient-reported outcomes (PROs) in young survivors of childhood cancer aged <18 years are researched. This cross-sectional study investigated social determinants associated with poor PROs among young childhood cancer survivors. We included 293 dyads of survivors receiving treatment at St. Jude Children's Research Hospital who were <18 years of age during follow-up from 2017 to 2018 and their primary caregivers. Social determinants included family factors (caregiver-reported PROs, family dynamics) and county-level deprivation (socioeconomic status, physical environment via the County Health Rankings & Roadmaps). PROMIS measures assessed survivors' and caregivers' PROs. General linear regression tested associations of social determinants with survivors' PROs. We found that caregivers' higher anxiety was significantly associated with survivors' poorer depression, stress, fatigue, sleep issues, and reduced positive affect (p < 0.05); caregivers' sleep disturbances were significantly associated with lower mobility in survivors (p < 0.05). Family conflicts were associated with survivors' sleep problems (p < 0.05). Residing in socioeconomically deprived areas was significantly associated with survivors' poorer sleep quality (p < 0.05), while higher physical environment deprivation was associated with survivors' higher psychological stress and fatigue and lower positive affect and mobility (p < 0.05). Parental, family, and neighborhood factors are critical influences on young survivors' quality of life and well-being and represent new intervention targets. [ABSTRACT FROM AUTHOR]

Background: Children with neurodevelopmental disorders (NDD) can have emotional and behavioral symptoms affecting not only the child, but the whole family. Since family members have a strong impact on each other, studies highlight the need to offer effective family interventions to strengthen the wellbeing of the family. The aim of the current study is to clarify whether there is a difference between parents' opinions regarding their child's emotional and behavioral condition immediately after Dialogical Family Guidance (DFG) has ended and after a three and six month follow-up. Method: Fifty families with a child with NDD were randomized into two groups. Group 1 received DFG with an immediate starting point, and Group 2 received DFG after a three-month waiting period. Parent experiences of treatment response regarding their children's emotional and behavioral symptoms were estimated before and after DFG using the parent version of the Strengths and Difficulties Questionnaire (SDQ-p) at baseline, and after three and six months. Additionally, comparisons between boys and girls, and the age of the child were analyzed. Results: The total difficulties score between Group 1 and Group 2 showed no difference immediately after DFG, or after three months. Regarding subdomains boys had more peer problems than girls, and at baseline, children between 3 and 6 years appeared to have more conduct problems than children between 7 and 13 years. Subdomain prosocial behavior increased statistically significantly during the study period in Group 1. Other SDQ-p subdomains remained constant in both groups between baseline and three and six month follow-up. Conclusions: The result does not show any differences between parents' opinions regarding their child immediately after or three months after DFG regarding SDQ-p total difficulties scores in either group. The difference between younger and older children regarding conduct problems at baseline, and the difference between boys and girls regarding peer problems is worth paying attention to in the clinical setting. Because of the small sample, it is not possible to draw relevant conclusions regarding the intervention's effect regarding the child's mental health dimensions, gender, or age. Nevertheless, Dialogical family Guidance represents one intervention that can be used. Trial registration: ClinicalTrials.gov NCT04892992 (retrospectively registered May 18th 2021). [ABSTRACT FROM AUTHOR]

Children in care of the state are amongst the most disadvantaged in society. They have often experienced adverse childhood experiences leading to their care entry including abuse and neglect. Longitudinal data suggests problems children in care of the state experience within adolescence persist into adulthood, showing "a continuing legacy of adversity." Emerging literature shows that edge of care interventions can bring about benefits. These interventions support families to meet their child's needs and prevent, or reduce, the likelihood of children going into care. However, it is not clear how or why these interventions work. It is important to develop this understanding to inform the development of effective, theory-informed practice to benefit this population. We reviewed and synthesised published literature to expose mechanisms by which interventions may promote and support family preservation for children at the edge of care. Our synthesis uses a realist approach to examine mechanisms by which interventions, in various contexts, can promote and support family preservation for children at the edge of care. Previous work by the team shaped the initial search strategy and in line with RAMESES realist review guidelines, no restrictions were placed on the types of study to be included in the synthesis. From 7,530 potentially relevant references identified, 61 papers were included in final extraction. Extracted data was themed, prior to developing narrative and formulating programme theories. Effective edge of care service operation seemed to be based on four core programme theories pertaining to the need for family skills training, home-based delivery, dedicated worker, and rapid response to need. [ABSTRACT FROM AUTHOR]

Introduction: The environment poses an important risk in the causation of injuries in children. Simple measures in improving the safety of the domestic and peri-domestic environment can go a long way in preventing injuries. This study was conducted to assess the effect of training of the adolescents in the families, on the household environmental safety regarding childhood injuries. Materials and Methods: A pre- and post-intervention study was conducted over 16 months, on 116 families of two villages of Delhi. Data were collected regarding domestic and peri-domestic environments along with danger points with respect to injuries, of the enrolled houses, during the pre- and post-intervention phases of 4 months each. The intervention comprised training of the eldest adolescent of the family, on causes of common injuries and role of environment in injury causation. Scores were assigned to all relevant aspects, and the total environmental safety scores were calculated. The comparison was made between pre- and post-intervention scores of the two areas. Results: Environmental safety scores were more than 70% in both areas at the baseline with no difference between the two areas. In the intervention area, there was statistically significant improvement of scores after the intervention, in the domestic environment and danger signs within the houses. Conclusion: Training adolescents about the prevention of injuries and motivating them to remain vigilant over domestic environment are effective in bringing about significant change in the household environment with regard to safety from injuries in children. Repeated visits by health workers also increase awareness and change the household environment making it safer for children. [ABSTRACT FROM AUTHOR]

Household food insecurity (HFI) during childhood is associated with poor dietary diversity and malnutrition, placing children's growth at risk. Children with growth disorders, such as stunting, are more likely to have poor cognition and educational performance, lower economic status, and an increased risk of nutrition‐related chronic diseases in adulthood. Our study aimed to systematically review and conduct a meta‐analysis of cohort studies investigating the association between HFI and stunting in children aged 0−59 months. Peer‐reviewed and grey literature were systematically searched in electronic databases with no language or date restrictions. Two reviewers independently assessed the studies for pre‐established eligibility criteria. Data were extracted using a standard protocol. Random‐effects meta‐analysis models were used, and I2 > 40% indicated high heterogeneity across studies. We used the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of the evidence. Nine cohort studies comprising 46,300 children were included. Approximately 80% (n = 7) of the studies found a positive association between HFI and stunting. Pooled odds ratio was 1.00 (95% confidence interval [CI]: 0.87−1.14; I2: 76.14%). The pooled hazard ratio between moderate and severe HFI and stunting was 1.02 (95% CI: 0.84−1.22; I2: 85.96%). Due to high heterogeneity, the quality of evidence was very low. Individual studies showed an association between HFI and stunting in children aged 0–59 months; however, this association was not sustained in the pooled analysis, possibly because of high heterogeneity across studies. Key messages: Household food insecurity (HFI) was associated with stunting in children aged 0–59 months; however this association was not observed in a pooled analysis.Based on the scientific evidence in the literature to date, HFI alone does not explain growth problems in the 0–59 months age group.Because other factors were found to be associated with delayed linear growth in light of the available evidence, it is recommended that another systematic review be conducted to expand this investigation.There is a need for continued and effective monitoring of factors affecting child growth. [ABSTRACT FROM AUTHOR]

Background: Long COVID, the patient-preferred term, describes symptoms persisting after an acute episode of COVID-19 infection. Symptoms in children and young people (CYP) can affect daily routine, with broader impacts on education, health-related quality of life, and social activities, which may have long-term effects on health and wellbeing. Aim: To explore the lived experiences and care needs of CYP with long COVID from the perspectives of CYP with long COVID, their parents, and professionals associated with the care of children and families living with the condition. Design & setting: CYP and their parent or carer were invited for interview following participation in a cohort study, which recruited the sample from a primary care setting. Method: Interviews were carried out with four CYP with long COVID (all female, aged 10-17 years); three interviews included a parent. Two focus groups were conducted, which included seven professionals involved with care of CYP or long COVID, from a range of disciplines. Interviews and focus groups were transcribed verbatim, and data analysed thematically using constant comparison techniques. Results: The three main themes presented are as follows: living with long COVID; uncertainty surrounding long COVID; and seeking help for symptoms. Conclusion: Long COVID can severely impact the lives of CYP and their families. CYP and their families need to be listened to by professionals and have any uncertainties acknowledged. It is imperative that agencies working with them understand the condition and its impact, and are able to offer support where needed. [ABSTRACT FROM AUTHOR]

Malnutrition among in-school children is a complex issue influenced by socio-economic, environmental, and health-related factors, posing significant challenges to their well-being and educational trajectories in developing countries. This review synthesized evidence on the multifaceted aspects of child malnutrition within the educational setting in developing countries. This review followed the six steps outlined by Arksey and O'Malley's framework. Four main databases (PubMed, CENTRAL, JSTOR, and Scopus) were searched. Additional searches were conducted in WHO Library, ProQuest, HINARI, Google Scholar, and Google. Reference lists of eligible papers were checked. This review found that low family income, varying family sizes, parental employment status, and educational levels significantly impact malnutrition among in-school children and adolescents. Environmental elements, including rural/urban residence, household sanitation, and living conditions, also influence malnutrition. In addition, nutrition knowledge, dietary habits, nutrient deficiencies, physical activity, and prevalent health conditions compound the risk of malnutrition. This study underscores the extensive health impact of malnutrition on general health, specific nutrient deficiencies, fetal/maternal health concerns, and overall morbidity. Also, malnutrition affects school performance and attendance, impacting cognitive abilities, and academic achievements. Addressing these challenges requires comprehensive policy actions aligned with Sustainable Development Goals, emphasizing poverty alleviation, health literacy, and gender equity. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 serology may be helpful to retrospectively understand infection dynamics in specific settings including kindergartens. We assessed SARS-CoV-2 seroprevalence in individuals connected to kindergartens in Berlin, Germany in September 2021. Children, staff, and household members from 12 randomly selected kindergartens were interviewed on COVID-19 history and sociodemographic parameters. Blood samples were collected on filter paper. SARS-CoV-2 anti-S and anti-N antibodies were assessed using Roche Elecsys. We assessed seroprevalence and the proportion of so far unrecognized SARS-CoV-2 infections. We included 277 participants, comprising 48 (17.3%) kindergarten children, 37 (13.4%) staff, and 192 (69.3%) household members. SARS-CoV-2 antibodies were present in 65.0%, and 52.7% of all participants were vaccinated. Evidence of previous infection was observed in 16.7% of kindergarten children, 16.2% of staff, and 10.4% of household members. Undiagnosed infections were observed in 12.5%, 5.4%, and 3.6%, respectively. Preceding infections were associated with facemask neglect. In conclusion, two-thirds of our cohort were SARS-CoV-2 seroreactive in September 2021, largely as a result of vaccination in adults. Kindergarten children showed the highest proportion of non-vaccine-induced seropositivity and an increased proportion of previously unrecognized SARS-CoV-2 infection. Silent infections in pre-school children need to be considered when interpreting SARS-CoV-2 infections in the kindergarten context. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: In 2022, 1 in 6 households with children experienced food insecurity (FI) in the United States. The negative impact of FI on child health is well documented and pediatric clinicians are encouraged to actively screen and intervene in clinical settings. This study aims to evaluate the feasibility and impact of a FI management protocol implemented in 2017 at a pediatric primary care health network serving patients who are Medicaid-eligible in Washington, DC. Methods: In 2019, an 18-item electronic survey was sent to a convenience sample of 42 pediatric clinicians within the health network to understand their knowledge, attitudes, and behaviors surrounding implementation. Both quantitative and qualitative responses were collected and analyzed. We report frequencies of the Likert-type responses, including perceived compliance with protocol components and intervention efficacy. We evaluated the relationship between FI knowledge level and rates of clinician documentation compliance by chi square and Cramer's V statistic for effect size. Open-ended responses were reviewed, and common themes were identified and used to provide context for quantitative results. Results and Conclusions: Out of 42 clinicians invited to complete the survey, 35 completed responses. All respondents reported universal screening for FI (100%) at routine examinations, 80% reported frequently electronically documenting FI in medical records, and 91% of clinicians reported frequently referring families who screened positive for FI to at least one FI resource, with 24% reporting that resources met families' needs. Open-ended responses revealed increased awareness of FI prevalence and of patient experiences in households experiencing FI, increased satisfaction with clinical management of FI, but also concerns around having limited clinical time to do the protocol and the usefulness and accessibility of referred resources. In conclusion, implementing this pilot FI protocol was feasible, but clinicians perceived limited impact of the protocol on alleviating FI and desired more robust intervention options. Further improvements include shifting the burden of performing the protocol away from the clinician, such as by streamlining the protocol or identifying a resource staff member, and establishing more accessible and effective FI interventions such as "Food as Medicine" offerings in partnership with community organizations. [ABSTRACT FROM AUTHOR]

(1) Background: Atopic dermatitis (AD) is one of the most common inflammatory skin conditions, thus having a significant impact on the quality of life (QoL) of patients and their families. We performed a survey to gather more data to help describe the burden of AD in Lithuania and to help expand the treatment plan to this important aspect of the disease. (2) Methods: A cross-sectional study was conducted involving healthy and AD pediatric patients. The assessment instruments used were the Patient-Oriented Eczema Measure (POEM), QoL, and original questionnaires (the original questionnaire was designed by the authors to determine the demographics, medical history, and treatment methods of the respondents). (3) Results: This study included 302 participants in total: 247 AD patients (51% boys) and 55 non-AD patients (51% boys). The mean age for AD patients was 6.8 ± 4.4. years, and this was 10.5 ± 3.1 years for the control patients. A significant difference was found between the QoL questionnaire scores and the Family Dermatology Life Quality Index (FDLQI) score for the atopic dermatitis group (QoL: 6.3 ± 5.6; FDLQI: 7.1 ± 6.9) and controls (QoL 0.5 ± 1.1; FDLQI 2.1 ± 5.9) (p = 0.000). The mean QoL questionnaire score for severe AD was 14.3 ± 6.2 (very large effect), that for moderate AD was 6.9 ± 4.4 (moderate effect), and that for mild AD was 4.4 ± 4.2 (small effect) (p = 0.000). (4) Conclusions: Our study revealed a moderate effect of AD on dermatology-related QoL in patients and their families. It has been shown that increased disease severity was associated with a greater impairment of QoL in both patients and patient's parents. The burden of AD in children and their parents is considerable and should be taken into account in the management of atopic dermatitis. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the level of fasting plasma glucose (FPG), the prevalence of impaired fasting glucose (IFG), and the associated factors among children and adolescents in urban China. Based on a cross-sectional study conducted in three Chinese metropolises during 2013–2014, this analysis included 7,143 participants aged 7–18 years. Information on demographics, family environment, diet, and physical activity was collected by questionnaires. Anthropometric parameters and blood biochemical indicators were measured. Logistic regression models were applied to assess risk factors of glucose level. Results revealed that the average FPG level was 4.81 ± 0.53 mmol/L, and the prevalence of IFG was 3.3%. Trends of these two variables varied significantly with age increasing (all p < 0.001), reaching double peaks at 10–12 and 15–17 years. IFG was positively associated with the male sex, age increasing, obesity, higher triglyceride (TG) levels, and living in northern China. When stratified by sex, family history of diabetes, elevated total cholesterol levels, and higher intake of sugar-sweetened beverages were positively associated with IFG only in females, suggesting these parameters were female-specific risk factors of IFG. We concluded that the prevalence of IFG among children and adolescents aged 7–18 years in urban China was higher than that reported in previous regional studies and was associated with obesity and higher levels of TG. Therefore, sex-specific lifestyle interventions should be provided to promote healthy weight and lipids and stem the upward trend of IFG. [ABSTRACT FROM AUTHOR]

Background: 16p11.2 proximal deletion and duplication syndromes (Break points 4–5) (593KB, Chr16; 29.6-30.2mb - HG38) are observed to have highly varied phenotypes, with a known propensity for lifelong psychiatric problems. This study aimed to contribute to a research gap by qualitatively exploring the challenges families with 16p11.2 deletion and duplication face by answering three research questions: (1) What are parents' perceptions of the ongoing support needs of families with children who have 16p11.2 living in the UK?; (2) What are their experiences in trying to access support?; (3) In these regards, do the experiences of parents of children with duplication converge or vary from those of parents of children with 16p11.2 deletion? Methods: 33 parents with children (aged 7–17 years) with 16p11.2 deletion or duplication participated in structured interviews, including the Autism Diagnostic Interview– Revised (ADI-R). Their answers to the ADI-R question 'what are your current concerns' were transcribed and subsequently analysed using Braun and Clarke's six step reflexive thematic analysis framework. Results: Three themes were identified: (1) Child is Behind Peers (subthemes: developmentally; academically; socially; emotionally); (2) Metabolism and Eating Patterns and; (3) Support (subthemes: insufficient support available; parent has to fight to access support; COVID-19 was a barrier to accessing support; 16p11.2 diagnosis can be a barrier to support, child is well-supported). Conclusions: Parents of children with either 16p11.2 deletion or duplication shared similar experiences. However, metabolism concerns were specific to parents of children with 16p11.2 deletion. The theme Child is Behind Peers echoed concerns raised in previous Neurodevelopmental Copy Number Variant research. However, there were some key subthemes relating to research question (2) which were specific to this study. This included parents' descriptions of diagnostic overshadowing and the impact of a lack of eponymous name and scant awareness of 16p11.2. [ABSTRACT FROM AUTHOR]

The doctrine of undue influence has long been the problem child of inheritance law. Undue influence, a hazy combination of fraud and duress, supposedly invalidates bequests that a beneficiary obtained by overriding the volition of a vulnerable testator or settlor. But because relationships are complex, concepts like free will are slippery, and challenges to donative transfers are litigated after the owner dies, courts struggle to apply the rule. Making matters worse, factfinders exploit the principle's vagueness to protect a decedent's family at the expense of non-traditional relationships. As a result, scholars have criticized undue influence for decades, with some even calling for its abolition. Yet this Article examines a little-noticed trend that is cutting in the opposite direction. Responding to the epidemic of elder abuse, several jurisdictions have started to experiment with a supercharged version of the undue influence doctrine. These states have realized that because the cost of pursuing undue influence allegations often dwarfs the contestant's potential recovery, the traditional rule does not do enough to deter pernicious misconduct. Thus, as Congress often creates bounties to encourage plaintiffs to enforce statutes, these lawmakers have incentivized "probate attorneys general" to file undue influence claims. They have done so by recognizing novel presumptions of undue influence, a civil claim for undue influence as a form of elder abuse, and enhanced remedies for undue influence committed in bad faith. We call these updates of the ancient rule the "new undue influence." The Article then offers a ground-level assessment of this phenomenon by analyzing a dataset of nearly 7,000 recent probate and trust cases from California, which has been a pioneer in the new undue influence movement. The Article reaches three main conclusions. First, policymakers have successfully changed the economics of undue influence litigation. Indeed, the Article finds that heirs and beneficiaries who invoke the new undue influence achieve a higher "success rate"--the amount of damages or settlement proceeds divided by the maximum possible recovery--than those who only seek relief under traditional law. Second, contrary to scholars' assumptions, judges and juries no longer seem to manipulate the undue influence doctrine to protect a decedent's family. In fact, there appears to be no meaningful link between case results and the parties' relationship to the testator or settlor. Third, permitting contestants to repackage probate cases as civil claims for elder abuse creates anomalies. Challengers often file probate petitions and civil complaints, opening the door for duplicative litigation, doctrinal inconsistency, and procedural gamesmanship. The Article therefore suggests ways for courts and policymakers to harness the benefits of the new undue influence while minimizing these costs. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the acceptability, feasibility and potential effectiveness of a group‐based instrumental musical training programme in improving resilience, depressive symptoms, self‐esteem and quality of life among school‐aged children from low‐income families. Design: Assessor‐blinded pilot randomised waitlist controlled trial with process evaluation. Methods: This study was conducted in the community from January 2022 to July 2023. Sixty‐four children from low‐income families (aged 8–12 years) were randomised (1:1) to intervention and waitlist control groups. The intervention group (n = 32) received weekly 1‐hour instrumental musical training for 6 months in groups of four to five from professionally qualified musicians at a music centre. The participants in the waitlist control group (n = 32) received the same intervention as the participants in the intervention group after the completion of all outcome assessments. The primary outcome was the children's levels of resilience, measured using the Resilience Scale for Children – 10. The secondary outcomes were depressive symptoms, self‐esteem and quality of life. Assessments were conducted at baseline (T0) and immediately post‐intervention (T1). An intention‐to‐treat analysis was performed. Results: The 64 participants had a mean (SD) age of 9.5 (1.44) years, and 37 (57.8%) were boys. Compared with the waitlist control group, participants in the intervention group showed significantly greater improvements in resilience levels from baseline to T0 (group‐by‐time interaction coefficient β = 4.41; 95% CI, 1.82–6.99; p = 0.001), depressive symptoms (β = −6.42; 95% CI, −11.12 to −1.71; p = 0.008), self‐esteem (β = −2.60; 95% CI, 0.28–4.92; p = 0.028) and quality of life (β = 6.69; 95% CI, 0.18–13.2; p = 0.044). Conclusion: The group‐based instrumental musical training programme was feasible and acceptable for school‐aged underprivileged children and showed the potential to improve the resilience and quality of life of this vulnerable population. [ABSTRACT FROM AUTHOR]

While schools provide one opportunity to encourage physical activity, caregivers play an exceedingly important role in creating an environment conducive to preschool children's physical activity. Yet, little is known regarding the perceptions of caregivers, important choice agents for young children's physical activity behavior after participating in a motor skill program. The purpose of this study was to examine caregivers' perceptions of facilitators and barriers to children's physical activity at home among rural, low-income families who participated in a school-based early childhood physical activity program, SKIPping with PALS, designed to increase physical activity and improve motor development. Eleven caregivers consented to participate in a semi-structured interview regarding their perceptions of physical activity and their experience after six months of participation in the program. An inductive, naturalistic evaluation approach was utilized for qualitative data analysis, following the six recursive phases of thematic analysis. A review of the interview transcripts revealed that all caregivers valued physical activity and encouraged their children to be active. Four major facilitators, four major barriers, and an overarching theme of parental support for childhood physical activity were identified. These factors are largely circumstantial and attitudinal and, thus, are difficult to modify but are important to be cognizant of when designing interventions. [ABSTRACT FROM AUTHOR]

Introduction: Fever stands out as the predominant clinical indicator in infancy. Pediatricians encounter fever routinely in their daily practice, playing a crucial role in their interactions with children and families. Objective: The aim is to examine pediatricians' viewpoints, understanding, and approaches regarding childhood fever in two healthcare settings: pediatric hospitalization (emergency and inpatient ward) and primary care. Methods: A qualitative study was conducted using an ethnomethodological approach. Pediatricians working in the specified pediatric settings participated in in-depth interviews where theoretical clinical cases were presented for analysis. Results: Following the examination of the discourses, the codes were organized into eight categories: Understanding of fever, Significance ascribed to fever, Therapeutic strategies, Engagement with the evidence, Family apprehensions regarding fever, Influence of the COVID-19 Pandemic, Inter- and intra-professional relationships, and Suggestions for change: Conclusions: Pediatricians acknowledge the importance of addressing discomfort in the treatment of fever, but express challenges in implementing these recommendations. Pediatricians in inpatient settings emphasize the need for enhanced parental education from primary care, while those in primary care recognize the potential for improvement. Inpatient pediatricians are open to implementing changes in their daily practices, particularly concerning the administration of antipyretics. [ABSTRACT FROM AUTHOR]

Background Childhood chronic pain is a widespread public health issue. We need to understand how children with chronic pain and their families experience chronic pain and its management. Objectives To conduct a meta-ethnography on the experiences and perceptions of children with chronic pain and their families of chronic pain, treatments and services. We investigated how children and their families conceptualise and live with chronic pain; what they think of and want from health and social care services; and what they conceptualise as ‘good’ pain management. Design Meta-ethnography with stakeholder and patient and public involvement in the design, search and sampling strategies, analysis and dissemination. Review strategy: comprehensive searches of 12 bibliographic databases and supplementary searches in September 2022, to identify qualitative studies with children aged 3 months to 18 years with chronic non-cancer pain and their families. We included studies with rich explanatory data; appraised methodological limitations using the Critical Appraisal Skills Programme tool; and extracted, analysed and synthesised studies’ findings. We used Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research to assess confidence in review findings. We integrated findings with 14 Cochrane treatment effectiveness reviews on children’s chronic non-cancer pain. Results We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Studies had minor (n = 24) or moderate (n = 19) methodological limitations. Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research assessments of review findings were high (n = 22), moderate (n = 13) or very low confidence (n = 1). Moderate and severe chronic pain had profound adverse impacts on family members’ well-being, autonomy and self-identity; family dynamics; parenting approaches; friendships and socialising; children’s education and parental paid employment. Most children and families sought a biomedical cure for pain. They experienced difficulties seeking and receiving support from health services to manage pain and its impacts. Consequently, some families repeatedly visited health services. Cochrane reviews of intervention effects and trials did not measure some outcomes important to children and families, for example effects of pain on the family and resolution of pain. Reviews have mainly neglected a biopsychosocial approach when considering how interventions work. Limitations There were limited data on common pain conditions like migraine/headache, abdominal pain; some rarer conditions; children with learning disabilities and under-fives; siblings; fathers and experiences of treatments/services. We excluded studies on cancer, end-of-life pain and experiences of healthcare professionals. Conclusions We developed the family-centred theory of children’s chronic pain management, integrating health and social care with community support. Future work Future research should explore families’ experiences of services and treatments, including opioids, and social care services; experiences of children with autism and learning disabilities, under 5 years old and with certain common pain conditions. We need development and testing of family-centred interventions and services. Study registration This study is registered as PROSPERO (CRD42019161455) and Cochrane Pain, Palliative and Supportive Care (623). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128671) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 17. See the NIHR Funding and Awards website for further award information. Plain language summary Chronic pain lasting 3 months or more affects at least 8% of children in the UK. It causes difficulties with many aspects of children’s lives including relationships, school attendance and use of National Health Services. In the UK, there are few specialist services and a lack of high-quality research for managing children’s chronic pain. Our study aimed to locate and pull together existing research on the experiences and views of children with chronic pain and their families. We wanted to find out how they think about and live with chronic pain, and their views and experiences of services and treatments, and what they want to achieve from them. We conducted this study alongside children with chronic pain and their families, charities, healthcare professionals and academic experts. They helped us to conduct the study and to ensure our findings are relevant to children, families and the National Health Service. We pulled together data from 43 studies that best answered our questions. We found that moderate and severe children’s chronic pain that was not well managed affected the whole family, including their relationships and social lives. Families found it difficult to get help and a diagnosis from health services. Most families wanted a medical cure for pain. Families had long waits for answers and treatment but gradually realised there may be no cure, so they focused on living well with pain or gave up hope. Children and families from ethnic minority groups or with a learning disability experienced discrimination. Few studies focused on children under 5 years old, children with learning disabilities or experiences of services. Families need a pain management approach tailored to the whole family’s needs involving schools, social care and health services. Our findings could improve treatment guidelines, training of health and social care professionals and service design and treatments. Scientific summary Background Chronic pain in childhood is widespread, affecting at least 8% of children and young people (CYP) in the UK. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on children’s lives and quality of life and leads to increased use of healthcare services and medication. Treating adolescent pain alone has an annual cost of around 4 billion pounds in the UK. Provision of, and access to, services for managing children’s chronic pain is limited. We also do not know which treatment outcomes children and families value. To design and deliver services and treatments, which meet the needs of patients and their families, it is vital that we understand how children with chronic non-cancer pain and their families experience chronic pain, pain treatments and services, and which outcomes are important to them. Qualitative research addressing these urgent, important issues exists but must be synthesised to interpret the body of evidence. Existing qualitative evidence syntheses have focused on either a narrow chronic pain population or topic and none produced a theory. Therefore, we conducted a qualitative evidence synthesis using meta-ethnography, which is ideal for synthesising the diverse contexts of children’s chronic pain research and developing theory. We refer to the meta-ethnography by the acronym ‘CHAMPION’ (Children And young people’s Meta-ethnography on Pain). The meta-ethnography was conceived as a Cochrane review to inform and supplement existing Cochrane reviews of intervention effectiveness for children’s chronic pain. Cochrane requires qualitative evidence syntheses to be integrated with intervention effects reviews to further understanding of patient experiences, acceptability and implementation of interventions, which outcomes are important to children and their families, and inform further intervention development. Aim To conduct a meta-ethnography on the experiences and perceptions of CYP with chronic pain, and their families, of chronic pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. Review questions How do children with chronic pain and their families conceptualise chronic pain? How do they live with chronic pain? What do they think of how health and social care services respond to and manage their/their child’s chronic pain? What do they conceptualise as ‘good’ chronic pain management and what do they want to achieve from chronic pain management interventions and services? Objectives Conduct comprehensive searches to identify qualitative research literature on the experiences and perceptions of children with chronic pain and their families to address review questions 1–4. Select and synthesise relevant studies using meta-ethnography. Ensure salience of findings via involvement of children with chronic pain and their families in study design, analysis and interpretation. Assess how much confidence can be placed in our synthesised findings using GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research) in order to facilitate use of our findings for NHS decision-making. Identify research gaps regarding review questions 1–4 in order to inform future research directions. Integrate our findings with existing relevant Cochrane treatment effectiveness reviews in order to determine if programme theories and outcomes of interventions match children and their families’ views. Inform the selection and design of patient-reported outcome measures for use in chronic pain studies and interventions and care provision to children and their families. Disseminate findings to academic, clinical, lay and policy audiences to influence childhood chronic pain policy and practice. Methods Design We conducted a meta-ethnography, a seven-phase interpretive methodology, which takes into account the contexts and meanings of the original studies. Patient and public involvement Patient and public involvement (PPI) of children with chronic non-cancer pain and their families was fundamental to all aspects of our meta-ethnography conduct from study inception to dissemination. We also worked with a Project Advisory Group of wider stakeholders. The groups approved the aim and design and search strategy. They participated in workshops to decide study inclusion and sampling criteria decisions, how to group studies for analysis, data interpretation, identification of research gaps and to develop outputs. They also informed and assisted with dissemination of findings. Review strategy We carried out comprehensive searches of 12 bibliographic databases including MEDLINE (medical literature analysis and retrieval system online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycInfo and 9 others, with iterative supplementary searches, including citation tracking. We searched for studies that had been published up to September 2022. Selection criteria To identify qualitative research studies with children aged 3 months to 18 years with chronic non-cancer pain, and their families, which focused on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with our PPI group. We included qualitative research studies of any design using recognisable qualitative methods of data collection, in any language, with no date restrictions. We did not include children with chronic pain related to cancer or end of life because they have distinct care pathways; Cochrane reviews of effects also synthesise non-cancer pain separately. Data collection and analysis Eligible studies were purposively sampled to ensure we could conduct an in-depth, synthesis of the data most relevant to answering our review questions. Sampling, organising studies for synthesis and analysis and interpretation involved our PPI group via two workshops and additional communication by teleconference, e-mail and social media. ‘Conceptually rich’ and ‘thick’ studies, that is, those with in-depth explanatory/interpretive findings and contextual details, were included. Sampling was guided by Cochrane Qualitative and Implementation Methods Group Guidance, and our advisory and involvement groups who agreed we should include non-UK studies and studies with moderately rich data to ensure a wider range of pain conditions were represented. We assessed methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus and characteristics into Microsoft Excel® and findings using NVivo software. We compared these study data to determine how studies related to one another and decided how to order and group them for synthesis. Stakeholders and our PPI group agreed we should group studies by pain condition. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Our PPI group clarified the meaning of ambiguous study findings and identified and addressed gaps in the data. We used the GRADE-CERQual approach to assess our confidence in each key review finding and used a matrix approach to integrate our findings with 14 existing Cochrane reviews on treatment effectiveness for children’s chronic non-cancer pain. Results One hundred and seventy studies met inclusion criteria. We sampled and synthesised 43 most relevant conceptually rich and thick studies, which had minor (n = 24) or moderate (n = 19) methodological limitations overall. Using GRADE-CERQual, we rated 36 descriptive-level review findings as high (n = 22) or moderate (n = 13) confidence with only one very low confidence. Twenty-three included studies were conducted in the UK, 17 in other high-income countries and 4 in low- to middle-income countries (there is a three-country study, so the total does not add to 43 studies). Included studies involved 325 CYP with chronic pain, most aged 10 years or older, and 308 family members, mostly mothers. The studies covered chronic pain conditions including complex regional pain syndrome, juvenile idiopathic arthritis, sickle cell disease, headache, migraine, abdominal pain, musculoskeletal pain, epidermolysis bullosa, dysmenorrhoea, neurological conditions such as cerebral palsy, unspecified chronic pain or a mix of conditions. Moderate and severe children’s chronic pain had profound adverse impacts on the whole family, family life and their wider social connections. Pain affected all aspects of an individual’s and a family’s functioning: family dynamics and relationships; family members’ emotions, well-being, autonomy and a sense of self-identity; parenting strategies; friendships and socialising; children’s education and future employment prospects; and parental employment. Families experienced difficulties in seeking and getting help and support from health services to manage their child’s pain and its impacts. Most pain management occurred outside of health services supervised by parents, especially mothers who were usually the main caregivers. Children and young people and their families were aware of the biopsychosocial (physical/biological, psychological and social) impacts of chronic pain on their lives. However, most CYP and parents understood the cause of chronic pain as having solely an underlying biological cause. This influenced their expectations of, and interactions with, health services. However, families’ conceptualisations of pain were dynamic and could change over time influenced by experiences of treatments, services and interactions with healthcare professionals. Interactions with healthcare professionals were frequently negative and stressful. CYP and parents, particularly mothers, felt they were not listened to and believed, and thus felt unsupported. For instance, CYP’s experiences of living with pain were ignored or their pain was disbelieved, and mothers felt blamed for their child’s pain. Parents of younger children and of children with communication difficulties, in particular, perceived that healthcare professionals did not always recognise their expertise in assessing their child’s pain. A key challenge for children and their families was that they found health services fragmented and very difficult to navigate. Consequently, it was difficult to achieve satisfactory pain management. Families often entered a lengthy cycle, which could last many years, of attending then reattending health services, and awaiting referral. In addition to these navigation challenges, CYP and their families, particularly CYP with sickle cell disease and those with chronic pain and learning disabilities, such as Down syndrome, experienced prejudice and discrimination in health services. We created a model of how families navigate chronic management with two key routes labelled Path A and B. On Path A, families seek a cure from services but often repeatedly seek services without pain resolution. When their expectations of services are not met, they try to deal with pain alone, often unsuccessfully, which can dominate family life. Psychological treatments are only used as a last option. Path B depicts effective communication and expectation management by healthcare professionals which can help families to shift their focus from a cure to trying to live well despite the pain. Families might also realise independently over time that a cure is unlikely. Families on Path B tend to be more receptive to biopsychosocial approaches for pain management, due to lack of other options. Families can move between the paths depending on input from services and if pain worsens. We developed new interpretive findings resulting in the family-centred theory of children’s chronic pain and its management, which incorporates how children and families conceptualise pain, their experiences of living with pain and of pain management services, and defines ‘good’ pain management and services. Our mid-range theory describes good pain management and services as holistic, biopsychosocial, family-centred pain management which acknowledges the impact of CYP’s chronic pain on all aspects of family life and their social relationships. In the theory, pain management strategies are tailored to the family’s needs. Schools, social services, social care and healthcare services function as inter-related aspects in a whole system approach. This approach aims to reduce service fragmentation making services more intuitive for families. Empathetic communication is a core component of this approach, and it is fundamental for building trust between families and services. The theory includes assessment of chronic pain and of families’ psychosocial needs to enable effective triage and trigger appropriate actions from/referrals to different services (schools, social care and health services). Cochrane systematic reviews of intervention effects and trials did not measure some outcomes important to children and families, including effects of chronic pain on the family and resolution of pain. Reviews have mainly neglected a biopsychosocial approach when considering how interventions work. Limitations There were few conceptually rich qualitative studies focusing on common pain conditions like migraine, headache, abdominal pain; some rarer conditions; children with learning disabilities and under 5 years old; siblings; boys with chronic pain; fathers; and experiences of treatments/services for chronic pain. Our findings may not well represent the experiences and perceptions of the poorly represented groups and there were gaps in the evidence regarding experiences and perceptions of treatments/services. Three per cent (n = 1) of our findings were assessed as very low confidence, none were low confidence and 36% (n = 13) were moderate confidence, using GRADE-CERQual. Additional evidence could increase our confidence in those findings. We excluded studies focusing on chronic cancer pain, end-of-life pain management and experiences of healthcare professionals. Conclusions Currently, children’s chronic pain management does not involve holistic, biopsychosocial health and social care tailored for children and integrated with support in the community, which considers the needs of the entire family and the impact on the family life. The theory and findings developed in this meta-ethnography have the potential to contribute to the development and updating of existing clinical guidelines on children’s chronic non-cancer pain; inform training of health and social care professionals regarding children’s chronic pain management; and inform service, treatment and intervention design and delivery. Ultimately, this could improve the care provided and thus the health and quality of life of children with chronic non-cancer pain and their families, which in turn could reduce the burden on health and social care services. Findings are being disseminated widely to academic, lay, clinical and policy audiences. Outputs include a short, animated film on YouTube for children (https://youtu.be/Oz5I7xKYf5o), academic journal articles, a webinar, a lay podcast, an infographic, a policy briefing and other social media outputs. In addition, we have delivered eight conference presentations. Future work Family-centred outcomes should be included in future trials of chronic pain interventions. Conceptually rich, primary qualitative studies are needed to explore families’ experiences of services and treatments, including pain management plans, pain assessment, opioid use in children and social care services; experiences of children with autism and learning disabilities, under 5 years old, and with certain common pain conditions, such as headache, migraine and abdominal pain and with some rarer conditions such as Ehlers–Danlos syndrome; experiences of siblings and fathers of children with chronic pain; and healthcare professionals’ experiences and perceptions of chronic pain management. A qualitative evidence synthesis on chronic pain management for children with cancer is needed. Development and testing of family-centred children’s chronic pain interventions, services and treatments are needed. Study registration This study is registered as PROSPERO, the International Prospective Register of Systematic Reviews (reference: CRD42019161455) and Cochrane Pain, Palliative and Supportive Care (review number 623). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128671) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 17. See the NIHR Funding and Awards website for further award information.

Based on longitudinal qualitative research involving twenty families with at least one child aged eight or younger, the article provides an account of how families, as distinctive communicative figurations, adopt, use and make sense of smart speakers through diverse socially situated practices. Findings show that parents and children enter in a communicative relationship with smart speakers based on their attribution of human-like or machine-like traits to the device, and the device response to their expectations. Moreover, engaging in communicative practices through and with smart speakers, family members subvert or reinforce existing power relations. However, smart speakers acquire new agency by intensifying the datafication and algorithmification of everyday life, thus entailing a shift in power dynamics between humans and machines.

Abstract Background As unhealthy lifestyle habits have been found to be established early in life and often track into adulthood, early preventive initiatives are important. ‘Saga Stories in health talks’ is a newly developed material that is intended to be used as a support for nurses at child health care (CHC) centers in their health talks with children and parents in Sweden. The aim of this study is to explore how CHC nurses experience the usability of the ‘Saga Stories in health talks’ material. Methods This study used a qualitative design. The material ‘Saga Stories in health talks’ was tested by 33 CHC nurses working in 11 CHC centers in three regions in Sweden. All CHC nurses were invited to participate in the interviews and 17 agreed. The interviews were transcribed and analysed using content analysis. Results Three categories and eight sub-categories emerged. The categories were: (1) An appreciated tool suitable for health talks, (2) Illustrations to capture children’s interest in the conversation with families, and (3) Barriers and facilitators. Saga Stories in health talks’ was experienced by the CHC nurses as an appreciated tool with content highly relevant to what should be discussed during the health talks. The CHC nurses described the material as well-designed with illustrations that helped them capture the child’s interest and increase their participation, while still involving the parents. Support from colleagues, the researchers, and managers were seen as important facilitators. Challenges included structural factors such as how and when to best use the material, especially concerning that the 4-year visit contained many other mandatory parts. Conclusions This pilot study show that the material ‘Saga Stories in health talks’ was highly appreciated by CHC nurses and facilitated their health talks with families in CHC. Important aspects with the material were the relevant content and the focus on healthy living habits, as well as the child friendly illustrations. These findings can be used when similar material is developed to facilitate health talks with families in other contexts. Our results also highlight the importance to adjust the implementation of a new material with already established practice and routines.

This study examined, from the perspective of health professionals, the potential benefits of intervention measures promoting proper food intake and healthy living among children aged 5 to 12 years. Survey methodology was utilized for this study. The entire health staff of the Warri South Local Government Area in Delta State, Nigeria, comprising 291 individuals, comprised the study population. 165 respondents constituted the study's sample. A structured questionnaire using a four-point rating scale—Very High Extent (VHE), High Extent (HE), Low Extent (LE), and Very Low Extent (VLE)—with values of 4, 3, 2, and 1 was the instrument for data collection. For data analysis pertaining to the research questions, mean and standard deviation were utilized. A mean score of 2.5 represented the decision level. Results revealed that campaigns opposing excessive cassava flakes consumption could help to reduce the risk of eye problems and cancer in children, prevent inadequate nutrient intake, decrease the likelihood of obesity, and promote healthy growth, among others. Effective campaigns against improper food intake should be spearheaded by churches, community-based groups and organizations, and conducted in collaboration with families, particularly parents.

Among young children, parents are a main factor in children's preferences for food served as they are responsible for purchasing and providing functional foods (FFs) and they are role models for them. This review study was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and aimed at reviewing the recent data about the consumption of FFs in families as part of a balanced diet. The literature search was conducted via the online academic search engines PubMed, ResearchGate and Google Scholar. The search process was restricted to research papers published in English in reviewed journals from 2012 to 2023. Thirty-six articles were ultimately included in the present review. The findings indicated a relationship between several sociodemographic factors and a higher likelihood of purchasing FFs for children. Higher household annual income, education levels and purchase frequencies among females are all positively correlated with higher levels of nutritional knowledge and confidence in the validity of scientific research on FFs. Also, parents' sociodemographic factors affect the children's fruit/vegetable consumption. This study concludes that parents are role models for their children's eating behavior and eating habits. [ABSTRACT FROM AUTHOR]

Background The obligation to pay for asthma medication in a country with universal healthcare might lead to increased asthma exacerbations and inequitable healthcare access for children from low-income households. Thus, the aim of this study was to examine the association between household income and childhood/preschool asthma regarding hospitalization and medication receipt. Methods In this nationwide register-based cohort study, we encompassed all 3-year-old children residing in Denmark, born between 2000 and 2014, along with their linked parents and followed them until their sixth birthday. Household income was divided into quartiles. Asthma was categorized in two mutually exclusive groups as either the redemption of two prescriptions for asthma medication or receiving a hospital diagnosis. We utilized Poisson regression to estimate the risk ratio (RR). Results The analysis included 834 422 preschool children. The prevalence of asthma dependent on medication alone was 7.3%, while 1.8% of children necessitated asthma-related hospitalization. Income inequality was evident across all income quartiles. Notably, children from the lowest income quartile had a RR of 0.95 (95% CI: 0.92–0.98) of redeeming asthma medication and conversely a RR of 1.18 (95% CI: 1.14–1.23) of asthma-related hospitalization. Conclusions Despite universal healthcare, income inequality has a dual impact on children from low-income households. They face a diminished risk of redeeming asthma medication and a higher susceptibility to asthma-related hospitalizations indicating an unequal access to healthcare. Prioritizing efforts to reduce childhood health inequalities is crucial. However, further research, particularly qualitative studies, is needed to better comprehend the underlying mechanisms to address the complexities of income inequality. [ABSTRACT FROM AUTHOR]

Background: Obsessive-compulsive disorder (OCD) is a debilitating mental health condition usually presenting with a high degree of comorbid symptoms in the majority of cases. Although face-to-face cognitive-behavioral therapy (CBT) is considered the therapeutic golden standard for pediatric OCD, its accessibility, availability, and consistency in delivery are still limited. To address some of these challenges, an enhanced CBT (eCBT) package was created and introduced. This study explored eCBT’s broad-based impact on OCD-related comorbid symptoms, functional impairment, quality of life and family accommodation among youth with OCD. Methods: This open trial involved 25 pediatric patients with OCD (7−17 years), assessed between January 2018 to February 2020. All patients received eCBT for 14 weeks. Secondary outcomes were assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-up co-occurring symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ), Screen for Child AnxietyRelated Emotional Disorders (SCARED), and Mood and Feelings Questionnaire (MFQ). Quality of life was measured using the KINDL-R, functional impairment through the Child Obsessive-Compulsive Impact Scale Revised (COIS-R), and family accommodation by the Family Accommodation Scale (FAS). Linear mixed-effects models were applied to analyze treatment effects. Results: Results indicated a significant decrease in OCD-related comorbid symptoms post-treatment, with SDQ mean reduce of 3.73 (SE = 1.10, child) and 4.14 (SE = 1.19, parent), SCARED mean reduce of 10.45 (SE = 2.52, child) and 8.40 (SE = 2.82, parent), MFQ mean reduce of 3.23 (SE = 1.11, child) and 2.69 (SE = 1.18, parent). Family accommodation declined with clinician scored FAS mean reduction of 13.25 (SE = 2.31). Quality-of-Life improved significantly posttreatment, with KINDL mean increase of 8.15 (SE = 2.87, children), and 10.54 (SE = 3.07, parents). These positive improvements were further amplified at the 3-month follow-up and remained consistent at the 12-month follow-up.Conclusion: A significant reduction was observed in all secondary outcomes employed and OCD-related functional impairments from baseline to posttreatment, which was maintained through 12-month follow-up. These results imply that after receiving eCBT, children and adolescents experienced substantial decrease in the negative impacts of OCD-related symptoms on their daily life, including home, school, and social interactions. [ABSTRACT FROM AUTHOR]

Background: Cancer affects patients and their families, but few data are available on factors associated with diversity of family structures among patients with cancer. Family is a source of both support and responsibility that must be understood to support patients and their families. Methods: Pooled data (2004–2015) from the National Health Interview Study were used to compare characteristics of cancer survivors with and without minor children and differences by sex and race/ethnicity among survivors with minor children. Results: 13.9% of cancer survivors have minor children in the household, and this experience is more likely for women and people who identify as other than non‐Hispanic White. Conclusion: There are considerable differences by sex and race/ethnicity in the characteristics of cancer survivors with minor children. Clinicians should make consideration of family circumstances a routine part of their history. Doing so will help to identify potential sources of support and responsibility that may affect adherence. [ABSTRACT FROM AUTHOR]

Stunting is influenced by family and household factors that affect toddler nutrition. As the primary provider of both physical and psychological resources to prevent health problems, the family has a significant role in preventing stunting. Family resilience in supporting child health is mediated by family functioning. A qualitative descriptive study explored the influence of family resilience in fulfilling the nutritional needs of stunted children. This study involved in-depth interviews with 23 mothers of stunted children aged 24 to 59 months. Through content analysis, we identified three main themes: (1) family belief that stunting is hereditary, (2) family belief that stunted children will "grow up," and (3) lack of communication between family members in discussing stunting. Future studies should explore intervention models to increase family resilience and prevent stunting in children under five. [ABSTRACT FROM AUTHOR]

Background: Exposure to earthquakes can cause adverse effects on the mental health of survivors, including an increased risk of PTSD. Objective: This systematic review aims to analyse the previous secondary studies to identify the risk factors for PTSD from children to elderly earthquake survivors. In addition, it aims to consider the complexity of the joint effects of the individual, relational, and contextual risk factors, to also detect the most at-risk families. Method: After reviewing and screening studies from the literature search through PubMed, Web of Science, Scopus, and EBSCO under the guidance of PRISMA guidelines, ten eligible secondary studies were identified that examine the risk factors for PTSD in individuals (from children to elderly) affected by worldwide earthquakes. Results: The analysis of the included studies allowed the identification of a series of sociodemographic, pre-traumatic, peri-traumatic, and post-traumatic PTSD risk factors in children, adolescents, youth, adults, and elderly survivors. The results represent the complexity of the joint effects of these risk factors at individual, relational, and contextual levels. Conclusions: The consideration of the PTSD risk factors highlights the importance of individual characteristics and the type of experiences and exposure in the period before, during, and after the earthquake. This knowledge could allow the early identification of at-risk individuals of different ages and families and the implementation of intervention programmes. [ABSTRACT FROM AUTHOR]

Background: As unhealthy lifestyle habits have been found to be established early in life and often track into adulthood, early preventive initiatives are important. 'Saga Stories in health talks' is a newly developed material that is intended to be used as a support for nurses at child health care (CHC) centers in their health talks with children and parents in Sweden. The aim of this study is to explore how CHC nurses experience the usability of the 'Saga Stories in health talks' material. Methods: This study used a qualitative design. The material 'Saga Stories in health talks' was tested by 33 CHC nurses working in 11 CHC centers in three regions in Sweden. All CHC nurses were invited to participate in the interviews and 17 agreed. The interviews were transcribed and analysed using content analysis. Results: Three categories and eight sub-categories emerged. The categories were: (1) An appreciated tool suitable for health talks, (2) Illustrations to capture children's interest in the conversation with families, and (3) Barriers and facilitators. Saga Stories in health talks' was experienced by the CHC nurses as an appreciated tool with content highly relevant to what should be discussed during the health talks. The CHC nurses described the material as well-designed with illustrations that helped them capture the child's interest and increase their participation, while still involving the parents. Support from colleagues, the researchers, and managers were seen as important facilitators. Challenges included structural factors such as how and when to best use the material, especially concerning that the 4-year visit contained many other mandatory parts. Conclusions: This pilot study show that the material 'Saga Stories in health talks' was highly appreciated by CHC nurses and facilitated their health talks with families in CHC. Important aspects with the material were the relevant content and the focus on healthy living habits, as well as the child friendly illustrations. These findings can be used when similar material is developed to facilitate health talks with families in other contexts. Our results also highlight the importance to adjust the implementation of a new material with already established practice and routines. [ABSTRACT FROM AUTHOR]

Background: Immunization is a cost-effective weapon against vaccine preventable diseases. Children of migrant workers suffer from lack of immunization because of frequent shift of places, poor knowledge, and low socioeconomic status. To assess the immunization status of children 12--36 months of age of migrant workers and factors associated it. To identify the reasons for non-immunization or partial immunization among these children. Material and Methods: A cross-sectional study was conducted among 500 migrant workers' children aged 12--36 months residing in Urban Bangalore east from February 2019 to August 2020. A cluster sampling method was incorporated. The data were collected using pre-tested semi-structured questionnaire. Data were analyzed using Epi-info™ Version 7.2.1 and SPSS version-21. Data were summarized in percentages, mean, standard deviation, and logistic regression. Results: The mean age of the children was 25.2340 ± 8.42 months. Out of 500 children, 88.60% were fully immunized, 11.40% were partially immunized, and no child was unimmunized. Significant predictors of immunization status of children were education of father and immunization card. Common reasons for dropout were inconvenient time (80.70%), unaware of need (77.19%), and busy schedule of parents (75.44%). The dropout rate of BCG to MR-1, Penta-1 to Penta-3, and Penta1to MR-1 was 6.49%, 0.85%, and 2.12%, respectively. Conclusions: Immunization coverage in the present study was 88.60%. Inconvenient time was the main reason behind partial immunization. [ABSTRACT FROM AUTHOR]

Objective To describe children's unhealthy eating behavior, to explore the influence of individual and family factors on children's unhealthy eating behavior, and to provide suggestions for children's health education and promotion. Methods By using the method of random cluster sampling, a questionnaire survey was conducted among 2 452 fifth-grade students and their parents from 16 medium-sized primary schools in 4 administrative regions of Beijing. Results The percentage of consumption frequency of sugary beverages, sweets, and fried puffed foods 4 days per week was 13.1%, 19.3%, and 11.0%, respectively. The results of multiple linear regression showed that the stronger ability of perceptual behavior control in personal factors (B=-0.17, P<0.01), stronger subjective supervision in family factors (B=-0.15, P<0.01), less food reserve (B=-0.14, P<0.01), and better parents' dietary behavior (B=0.14, P<0.01) were associated with better eating behavior. Conclusion Children's unhealthy eating behavior is affected by many family factors. Health education for parents and control and intervention of children's unhealthy eating behavior should be strengthened. [ABSTRACT FROM AUTHOR]

Chronic illness in a child affects all aspects of family life and all family members. In the present study, the aim is to investigate the effectiveness of treatment based on acceptance and commitment to the life satisfaction of mothers of children with cancer. The study population was all mothers who had a child with cancer. In this study, which was conducted as a semi-experimental type of post-test and pre-test with a control group, 32 people were chosen using available sampling and randomly divided into two groups (16 people in the experimental group and 16 people in the control group). A Denier questionnaire was used to evaluate life satisfaction. SPSS version 21 software was applied for statistical analysis of data. The obtained results showed that treatment based on acceptance and commitment increases life satisfaction in mothers of children with cancer. The effect size obtained indicated that a significant percentage of improvement and increase in life satisfaction of mothers of children with cancer can be attributed to treatment based on acceptance and commitment. According to the results obtained regarding the effectiveness of acceptance-based treatment and commitment on life satisfaction in mothers of children with cancer, it can be concluded that many mothers deny the fact that acceptance-based treatment and Commitment lead to improved life satisfaction through acceptance of unavoidable unpleasant feelings. [ABSTRACT FROM AUTHOR]

This study aimed to identify the perception of parents of students attending private schools in the city of Tubarão, SC, Brazil, about the influence of community-wide quarantine due to COVID-19 on the interactions with their children. This exploratory and qualitative field research included semi-structured interviews held with ten families. Several aspects related to the quarantine were investigated, such as changes in the families' routine, feelings the parents experienced in the interactions with their children, difficulties faced in these interactions, and positive aspects. The interviews were assessed according to content analysis, from which categories of research emerged. The results revealed changes in the families' routine caused by distance education, less social contact, task overload, and impacts on professional life. The feelings the parents experienced included fatigue, guilt, stress, and emotional responses, adaptation to the change of roles, difficulty in implementing distance education, and more dependent children. A few positive aspects were mentioned: closeness, more mature children, and more affectionate interactions. A few families did not identify positive aspects. The results show the parents' lack of preparation to deal with the new contingencies, the importance of providing preventive parental guidance, and the need to assess the impact of the methods adopted to implement distance education. [ABSTRACT FROM AUTHOR]