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We explore how organisations working on parenting programmes and other types of family support and violence prevention in low-resource settings experienced the pandemic. In August 2020–May 2021, we interviewed (1) staff from three community-based organisations delivering evidence-informed parenting interventions and other psychosocial services for families in Cape Town, South Africa, (2) staff from a parenting programme training organisation and (3) staff from two international organisations supporting psychosocial services in South Africa. Interviews (22) were thematically analysed, with findings in three areas. First, respondents noted changes in the context, including the job losses, food insecurity, and stress experienced by local communities, and reductions in organisational funding. Second, we found that in response to these context changes, the organisations shifted their focus to food provision and COVID prevention. Parenting and psychosocial programmes were adapted – e.g. by changing the physical delivery settings, reducing group sizes, and taking up digital and phone implementation. Participants reported improved perceptions of remote delivery as a feasible approach for working with families – but internet and phone access remained challenging. Third, the pandemic brought new responsibilities for staff, and both the challenges of working from home and the health risks of in-person work. [ABSTRACT FROM AUTHOR]

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Background Stunting rates remain unacceptably high in many regions, including sub-Saharan Africa. Agricultural programs have led to increased yields and household incomes but showed limited success in improving nutritional status. Objectives We assessed whether linear growth could be improved through a potentially scalable, integrated program adding nutrition-specific and nutrition-sensitive components to an existing agricultural program. Methods In this cluster-randomized controlled trial in rural Western Kenya, we randomized children aged 6–35 months from farming families to an agricultural intervention without (control group) or with a bundle of interventions (intervention group), including distribution of micronutrient powders (MNP), poultry to increase egg consumption, seeds of greens and onions, and soap and chlorine solution, as well as provision of monthly behavior change trainings. The primary outcome was the change in height-for-age z -score (HAZ) over 2 years of follow-up. We assessed safety through active morbidity and passive adverse event monitoring. We conducted an intention-to-treat analysis, followed by per-protocol and prespecified subgroup analyses. Results From March to April 2018, we enrolled 1927 children from 126 clusters (control, 942 children in 63 clusters; intervention, 985 children in 63 clusters). Data on HAZ were available for 1672 (86.6%) children after 2 years. Adherence was >80% for use of MNP, chlorine, and greens and receipt of soap, and ∼40% for egg and red onion consumption. The intention-to-treat analysis indicated a greater change in HAZ over 2 years in the intervention group (adjusted effect size, 0.11; 95% CI: 0.02–0.19). We found a slightly stronger effect in the per-protocol analysis (adjusted effect size, 0.15; 95% CI: 0.06–0.24). Dietary diversity and consumption of iron-rich foods were improved in the intervention group, and reported instances of fever, lower respiratory tract infections, and diarrheal episodes were lower in the intervention group. Conclusions This study found a modest improvement in linear growth, indicating the need for multiple, integrated interventions to achieve benefits. The trial was registered with clinicaltrials.gov as NCT03448484. [ABSTRACT FROM AUTHOR]

Background: Children with osteogenesis imperfecta (OI) live in fear of fracturing their bones. As fractures are unpredictable, there is a need for tools and knowledge to immobilize a fracture during emergencies. Inspired by a patient with OI recognized for fracture management, the aim of this patient-initiated project was to establish best practices for the safe splinting of fractures during emergencies, including the creation of an evidence-informed OI Splint Kit. Methods: A clinical practice guideline study was conducted to create an evidence-informed splint kit for patients. A systematic review of the literature was conducted to identify kits and materials used to immobilize fractures with splints during emergencies. An expert Task Force was convened to review the results and a timeline was established to create a splint kit. The prototype underwent iterative cycles of modifications based on feedback from the Task Force. Results: Four electronic databases were searched (Medline, CINHAL, PsychInfo, and Scopus), revealing zero publications pertaining to fracture immobilization kits. The Task Force used their clinical expertise and experiences to develop the OI Splint Kit. The following itemswere included: splinting tools, bilingual educational material, instructional cards, video tutorials, and memory card game. Conclusion: A gap remains in terms of validated kits to assist in fracture immobilization during emergencies. A portable and practical OI Splint Kit was developed to assist in fracture immobilization emergencies, based on interprofessional clinical expertise and patient experiential knowledge. The kit is subject to ongoing testing quality evaluations to ensure its suitability for use in various contexts. [ABSTRACT FROM AUTHOR]

Child poverty remains a persistent problem in Canada and is well known to lead to poor health outcomes. The Canada Child Benefit (CCB) is a cash transfer program in effect since 2016, which increased both the benefit amount and number of families eligible for the previous child benefit. While the CCB has decreased child poverty rates, not all eligible families have participated. Clinicians can play an important role in screening for uptake of the program and helping families navigate the application process through several free resources. While prior research on past programs has shown benefit of similar cash transfer programs to both child and parental outcomes (both health and social), the CCB has not yet been extensively studied. Research would be valuable in both assessing the cost effectiveness of the program, especially across different income groups, and improving implementation in hard-to-reach populations. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorder implies adjustments in the daily care of the child. In this scenario, animal-assisted interventions seem to act as a facilitator in maintaining the quality of life of these individuals. Objective: To develop an animal-assisted intervention program for children with autism spectrum disorder (AAIPC-ASD). Methodology: Methodological study for the construction of a program of animal-assisted interventions, applicable to children with autism spectrum disorder, based on the model of complex interventions of the Medical Research Council that consists of four stages: identifying the evidence base, identifying/ developing theory, modeling process, and assessing effectiveness. Results: The AAIPC-ASD development process has resulted in the construction of Version 1 of the program, consisting of the following items: program planning, session planning, implementation, field notes, and final evaluation. Conclusion: The structure of Version 1 of the AAIPC-ASD is aligned with the characteristics of its target group, based on primary field research data and updated bibliographic data. Its effectiveness and validation will be assessed in later stages. [ABSTRACT FROM AUTHOR]

Background: Childhood overweight and obesity is a major public health concern. Community-based interventions have the potential to reach caregivers and children. However, the overall health impact of these programs is rarely comprehensively assessed. This study evaluated a physical activity and healthy eating family program (Healthy Together; HT) using the RE-AIM framework. Methods: Ten sites implemented the 5-week program. Thirty-nine staff members and 277 program participants (126 caregivers [Mage = 35.6] and 151 children [Mage = 13]) participated in the evaluation. Each RE-AIM dimension was assessed independently using a mixed-methods approach. Sources of data included archival records, interviews and surveys. Effectiveness outcome variables were assessed at pre- and post-intervention and 6-month follow-up. Results: Reach: HT participants were almost entirely recruited from existing programs within sites. Effectiveness: Caregivers' nutrition related efficacy beliefs increased following HT (ps < .03). Participation in HT was not associated with significant changes in physical activity or nutrition behaviour or perceived social support (ps > .05). Knowledge surrounding healthy diets and physical activity increased in children and caregivers (ps < .05). Adoption: Thirty-five percent of sites approached to implement HT expressed interest. The 10 sites selected recruited existing staff members to implement HT. Implementation: Program objectives were met 72.8% of the time and 71 adaptations were made. HT was finance- and time-dependent. Maintenance: Two sites fully implemented HT in the follow-up year and 5 sites incorporated aspects of HT into other programs. Conclusions: Working alongside organizations that develop community programs to conduct comprehensive, arms-length evaluations can systematically highlight areas of success and challenges. Overall HT represents a feasible community-based intervention; however further support is required in order to ensure the program is effective at positively targeting the desired outcomes. As a result of this evaluation, modifications are currently being implemented to HT. [ABSTRACT FROM AUTHOR]

Background. Within a tertiary care pediatric medical center, the largest number of inpatient falls (8.84 falls per 1,000 patient days) occurred within a 14-bed rehabilitation/transitional care unit between February and September 2009. An interdisciplinary fall prevention program, called "Red Light, Green Light," was developed to better educate all staff and family members to ensure safety of transfers and ambulation of children with neurological impairments. Objective. The purpose of this study was to develop and implement an interdisciplinary pediatric fall prevention program to reduce total falls and falls with family members present in this population. Design. Preintervention 2009 data and longitudinal data from 2010-2014 were obtained from retrospective review of event/incident reports. This quality improvement project was based on inpatient pediatric admissions to a rehabilitation care unit accommodating children with neurological impairments. Methods. Data extraction included: total falls, falls with caregiver (alone versus staff versus family), type of falls, and falls by diagnosis. Descriptive statistics were obtained on outcome measures; chi-square statistics were calculated on preintervention and postintervention comparisons. Results. Total falls decreased steadily from 8.84 falls per 1,000 patient days in 2009 to 1.79 falls per 1,000 patient days in 2014 (x1² = 3.901, P=.O48). Falls with family members present decreased 50% postintervention. (x1² = 6.26, P=.012). Limitations. Limitations included unit size nearly doubled postintervention, event reporting changed to both uncontrolled and controlled therapy falls (safely lowering patient to bed, chair, or floor), and enhanced reporting increased numbers of postintervention falls. Conclusions. The Red Light, Green Light program has resulted in reductions in overall fall rates, falls with family members present, increased staff collaboration, heightened staff and family safety awareness, and a safer environment for patients at high risk for neurological or musculoskeletal impairments. [ABSTRACT FROM AUTHOR]