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Carers of adults on the autism spectrum often experience high levels of stress, worry, and caregiver burden. There are few studies identifying the predictors of carer mental well-being and none have been conducted in Australia. Data from the Autism Cooperative Research Centre for Living with Autism's Australian Longitudinal Study of Autism in Adulthood was used to test the conceptual model by Sonido et al. (Rev J Autism Dev Disord, 2019, https://doi.org/10.1007/s40489-019-00177-8) by (a) identifying the predictors of mental well-being for carers of adults on the spectrum, (b) using model selection to determine which predictors contribute to the model of best fit, and (c) testing for mediating relationships between the predictors. Several predictors were directly associated with carer psychological quality of life, including carer age, care recipient intellectual disability, and carer intolerance of uncertainty. Model selection strongly supported the inclusion of most clusters from the conceptual model. Some mediating relationships were found, such as care recipient depressive behaviours mediating the relationships between caregiver burden and psychological quality of life. Future studies of the conceptual model will improve understanding of the predictors of carer mental well-being and enable tailored interventions to improve the psychological health of carers of adults on the autism spectrum., Author(s): Marisse T. Sonido [sup.1] [sup.2] , Ye In Hwang [sup.3] , Preeyaporn Srasuebkul [sup.1] , Julian N. Trollor [sup.1] [sup.2] , Samuel R. C. Arnold [sup.1] [sup.2] Author Affiliations: [...]

Introduction: The COVID-19 pandemic has altered access to health care: it remains unclear how patients with chronic illness and disability and their family caregivers are adapting to these changes. In this study, we examined changes in family caregiver roles helping care recipients with chronic illness and disability navigate health care needs during the COVID-19 pandemic. Methods: From April 15 to May 27, 2020, we distributed online and telephone surveys to family caregiver members of a population-based regional research registry. Caregivers reported whether they were helping 'more,' 'less,' or the 'same' with ten health care activities (e.g., filling prescriptions, attending medical appointments) now, compared to before the coronavirus pandemic. Using multivariable logistic regression models, we examined caregiver and caregiving context characteristics associated with helping more with 1 or more health care activities. Results: Of 561 caregiver respondents, mean age was 59 years, 76% were women, and 56% co-resided with care recipients. Many caregivers (59%) reported increased help with 1 or more health care activities since the pandemic. Caregivers reported greater help getting medical supplies (31%) and attending care recipients' phone (21%) and video (16%) medical appointments. Women (OR 1.55; 95% CI 1.02-2.36) and caregivers assisting with short-term physical conditions were more likely to help more with 1 or more health care activities (OR 2.81; 95% CI 1.20-6.59). Discussion: Family caregivers reported their responsibilities helping care recipients with chronic conditions and disabilities stay engaged with health care increased since the pandemic. Providers and health systems should consider targeted strategies to support caregivers helping vulnerable patients access necessary care. Keywords: caregiving, family caregivers, COVID-19, healthcare activities, telehealth, The COVID-19 pandemic has significantly impacted health care access due to restrictions on in-person visits and competing demands on health care workers. These changes disproportionately affect patients with chronic illness [...]

Purpose: The purpose of this study was to (a) review methods used to assess quality of life (QOL) in caregivers, partners, and spouses of those who have undergone total laryngectomy (TL); (b) identify patterns in caregiver QOL changes postoperatively; and (c) review previously proposed interventions for caregivers. Method: PubMed, EMBASE, and CINAHL Complete were searched using the Medical Subject Heading terms laryngectomy, spouse, caregiver, and partner. Two reviewers independently screened and identified records meeting inclusion criteria. This scoping review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Initial search returned 143 results and 12 met inclusion criteria. Eight studies assessed postoperative QOL changes in categories such as psychological health, physical health, sexuality, and interpersonal relationships. Four studies proposed interventions for caregivers perioperatively. There were no consistently used inventories, and only one intervention was formally tested. Conclusions: The literature available on TL caregiver QOL contains inconsistent inventories and study design. There are few interventions available, and it would be beneficial to develop a standardized QOL inventory for this population to better target caregiver needs. Supplemental Material: https://doi.org/10.23641/asha.19287887, Total laryngectomy (TL) is a surgical therapy often reserved for advanced stage tumors of the larynx or hypopharynx. Removal of the larynx and/or hypopharynx causes disconnection of the upper and [...]

Despite improvements in food production and healthcare services, the burden of malnutrition in Uganda has for the last 30 years remained unacceptably high with rates of stunting (chronic undernutrition) and anemia (proxy for micronutrient deficiency) currently estimated at 29% and 53%, respectively among young children aged 6-59 months. Considering that both undernutrition and over nutrition are greatly attributed to monotonous diets characterized by limited dietary diversity and overdependence on starchy refined grains or roots as staples, there is need to improve the population's awareness of appropriate dietary practices. To improve nutrition education, the Infant and Young Child-feeding national counseling cards for community volunteers (IYCF cards) that were developed by United Nations Children's Fund (UNICEF), are currently the standard package used in Uganda's health sector to educate caregivers on appropriate child-feeding practices. In this study, the effectiveness of a three-group food guide was evaluated against IYCF cards. A randomized, controlled intervention trial engaged three randomly selected distant groups of child-caregiver pairs (n=40) concurrently in one of three treatments namely: (i) nutrition education using a threefood group guide (FG), (ii) nutrition education using age-appropriate IYCF cards, and (iii) negative control group that engaged in hair-plaiting sessions. At baseline, all groups had randomly selected caregivers of children aged 6-14 months and were met once a week for five consecutive weeks during the intervention. Caregivers were interviewed at baseline and 2 months after the interventions to determine changes in child-feeding practices while their children were concurrently measured to determine changes in their nutritional status. At baseline, caregivers in the three treatment arms exhibited inappropriate child-feeding practices indicated by low child-feeding index (CFI) scores, which were also related to poor nutritional status of their children. After the interventions, children in FG group were given more varied animal-source foods than those in IYCF cards group (p = 0.02). Compared to controls, caregivers in FG group gave their children significantly more snacks (p = 0.01), their child-feeding practices indicated by CFI scores significantly improved (p = 0.001) and their children exhibited better growth patterns indicated by weight-for-age (p = 0.02) and MUAC-forage (p = 0.03) Z-scores. These findings, therefore, indicate that the three-group food guide is more likely to improve child-feeding practices and growth patterns than IYCF cards. Hence, there is need to integrate the food guide into IYCF materials to foster child-feeding practices and growth. Key words: Dietary guidance, three-group food guide, Infant and Young Child Feeding counseling cards, nutrition education Trial Registration: Pan African Clinical Trial Registry (PACTR202002810799672), INTRODUCTION Globally, malnutrition is a major underlying cause of childhood mortality [1-4] and is associated with impaired physical and mental development [5-7]. Undernutrition manifests as underweight, wasting, and stunting and [...]

This field study assessed the risk factors of pneumonia among under-5 male and female Sudanese children. The study was conducted in Omdurman Teaching Hospital within the duration 2016-2018. Children from both sexes (50 males and 50 females) who were diagnosed with pneumonia were included in the study. Data was collected using a questionnaire and interview with 100 care givers and mothers. Of those, sixty percent (60%) were illiterate or had primary school education. Forty percent (40%) had secondary or university education (p-value=0.034). Families who depend on natural ventilation were 60% compared to other methods (40%) with p- value=0.000. Children six months to one year were 42%, compared to other age groups (58%) with p-value= 0.000. Immunized children for pneumonia were 84% compared to the non-immunized (p-value=0.000). Vitamin A supplement was received by 86% with p value=0.000. Of the children, 61% were from families with less than 3 children compared to other families (14%) were p-value = 0.000. Unlike others, 62% of the care givers used traditional medicines with p-value = 0.009. Lack of exclusive breast feeding among infected children accounted for 80% compared to others with p-value = 0.000. Fever, cough and shortness of breath accounted for 46% compared to other symptoms with p-value = 0.000. It was concluded that poor educational level of care givers, low age group children, type of home ventilation, recurrent attacks, symptoms, lack of exclusive breast feeding and non-allopathic treatment are risk factors for contraction of pneumonia by under 5 children. Early presentation of the patients to hospital is a preventive measure for avoidance of contraction of pneumonia. Keywords: Pneumonia, risk factors, Sudanese children under 5 years, care givers., Introduction Pneumonia is the single largest infectious cause of death in children worldwide. It killed an estimated 920.136 under the age of five in 2015, accounting for 16% of all [...]

Objective To examine associations between maternal experiences of discrimination and child biomarkers of toxic stress in a multiethnic, urban sample of mothers and children (4-9 years). Methods Data were drawn from a cross-sectional study of maternal-child dyads (N = 54) living in low-income neighborhoods in New Haven, Connecticut, USA. Mothers reported experiences of discrimination. Noninvasive biomarkers of toxic stress were collected to assess neuroendocrine (hair cortisol), immune (salivary cytokines, c-reactive protein), and cardiovascular (blood pressure) functioning in children. Results Maternal experiences of discrimination were associated with increased log-transformed salivary interleukin-6 (IL-6) levels in children ([beta] = 0.15, p = 0.02). Conclusions Vicarious racism, or indirect exposure to discrimination experienced by caregivers, is associated with poor health outcomes for children. Immune pathways may be a biological mechanism through which racial discrimination 'gets under the skin,' but additional research is needed to fully understand these relationships. Uncovering the physiological mechanisms linking vicarious racism with child health is an important step towards understanding possible early roots of racial and ethnic health inequities., Author(s): Eileen M. Condon [sup.1] , Margaret L. Holland [sup.1] , Arietta Slade [sup.2] , Nancy S. Redeker [sup.1] , Linda C. Mayes [sup.2] , Lois S. Sadler [sup.1] [sup.2] [...]

Reading aloud to children is a valued practice to promote emergent literacy and language skills that form the foundation for future reading success. We conducted a descriptive study of shared book reading practices between caregivers and their children with autism spectrum disorder (n = 17) and caregivers and their typically developing children (n = 20) to identify factors that can promote or inhibit children's engagement in reading. Caregivers and their children read nine books (familiar, non-fiction, fiction). Children with ASD demonstrated lower levels of passive engagement (looking at the book) and higher levels of non-engaged behavior compared to typically developing children. Caregiver reading quality and book type contributed to joint engagement during reading. Implications of these findings for intervention development are discussed., Author(s): Veronica P. Fleury [sup.1] , Maria L. Hugh [sup.2] Author Affiliations: (Aff1) 0000 0004 0472 0419, grid.255986.5, University of Minnesota, Florida State University, , 1114 W. Call Street, 32306, [...]

Objectives The purpose of this study was to evaluate the efficacy of an innovative early childhood mental health intervention, Massachusetts Project LAUNCH. Early childhood mental health clinicians and family partners (paraprofessionals with lived experience) were embedded within community pediatric medical homes. Methods A longitudinal study design was used to test the hypotheses that (1) children who received services would experience decreased social, emotional and behavioral problems over time and (2) caregivers' stress and depressive symptoms would decrease over time. Families who were enrolled in services and who consented to participate in the evaluation study were included in analyses (N = 225). Individual growth models were used to test longitudinal effects among MA LAUNCH participants (children and caregivers) over three time points using screening tools. Results Analyses showed that LAUNCH children who scored in age-specific clinically significant ranges of social, emotional and behavioral problems at Time 1 scored in the normal range on average by Time 3. Caregivers' stress and depressive symptoms also declined across the three time points. Results support hypotheses that the LAUNCH intervention improved social and emotional health for children and caregivers. Conclusions for Practice This study led to sustainability efforts, an expansion of the model to three additional communities across the state and development of an online toolkit for other communities interested in implementation., Author(s): Beth E. Molnar [sup.1] [sup.5] , Kristin E. Lees [sup.1] , Kate Roper [sup.3] , Natasha Byars [sup.2] , Larisa Méndez-Peñate [sup.3] , Christy Moulin [sup.2] , William McMullen [...]

Objectives In this large scale, mixed methods evaluation, we determined the impact and context of early childhood home visiting on rates of child abuse-related injury. Methods Entropy-balanced and propensity score matched retrospective cohort analysis comparing children of Pennsylvania Nurse-Family Partnership (NFP), Parents As Teachers (PAT), and Early Head Start (EHS) enrollees and children of Pennsylvania Medicaid eligible women from 2008 to 2014. Abuse-related injury episodes were identified in medical assistance claims with ICD-9 codes. Weighted frequencies and logistic regression odds of injury within 24 months are presented. In-depth interviews with staff and clients (n = 150) from 11 programs were analyzed using a modified grounded theory approach. Results The odds of a healthcare encounter for early childhood abuse among clients were significantly greater than comparison children (NFP: 1.32, 95% CI [1.08, 1.62]; PAT: 4.11, 95% CI [1.60, 10.55]; EHS: 3.15, 95% CI [1.41, 7.06]). Qualitative data illustrated the circumstances of and program response to client issues related to child maltreatment, highlighting the role of non-client caregivers. All stakeholders described curricular content aimed at prevention (e.g. positive parenting) with little time dedicated to addressing current or past abuse. Clients who reported a lack of abuse-related content supposed their home visitor's assumption of an absence of risk in their home, but were supportive of the introduction of abuse-related content. Approach, acceptance, and available resources were mediators of successfully addressing abuse. Conclusions for Practice Home visiting aims to prevent child abuse among high-risk families. Adequate home visitor capacity to proactively assess abuse risk, deliver effective preventive curriculum with fidelity to caregivers, and access appropriate resources is necessary., Author(s): M. Matone [sup.1] [sup.2] [sup.3] [sup.8] , K. Kellom [sup.1] , H. Griffis [sup.1] , W. Quarshie [sup.1] , J. Faerber [sup.1] , P. Gierlach [sup.1] , J. Whittaker [...]

This paper investigates the role of caregiver mental health and parenting practices as predictors of attachment in children with intellectual disability/developmental delay, comparing between children with ASD (n = 29) and children with other developmental disabilities (n = 20). Parents reported that children with ASD had high levels of anxiety and stress, and attachment insecurity in children (less closeness and more conflict in attachment relationships, and more inhibited attachment behaviours) compared with children with other developmental disabilities. Children's attachment quality was associated with parenting practices and the presence of an ASD diagnosis. These results highlight the bidirectional nature of the quality of caregiving environments and attachment in children with ASD, and also provide a strong rationale for targeting children's attachment quality in early interventions., Author(s): Samantha J. Teague [sup.1] , Louise K. Newman [sup.1] [sup.2] , Bruce J. Tonge [sup.1] [sup.3] , Kylie M. Gray [sup.1] [sup.3] Author Affiliations: (Aff1) 0000 0004 1936 7857, [...]

Introduction This paper describes the care coordination training program and results of an evaluation from its pilot in seven states. Despite the importance of practice-based care coordination, only 42.3% of children with special health care needs (CYSHCN) met all needed components of care coordination as defined by the Maternal Child Health Bureau. Recognizing that children with medically complex conditions often have lower rates of achieving care coordination within a medical home, the Region 4 Midwest Genetics Collaborative worked with families to develop a training to empower families in care coordination. The Care Coordination: Empowering Families(CCEF) training provides families with the knowledge, tools, and resources to engage with health, education and family support systems. This article gives an overview of the training and comprehensive evaluation. Methods Participants were family caregivers of children with genetic conditions and other special health care needs recruited in one of seven pilot states. Evaluation data were collected from 190 participants prior to and immediately following the training. An additional follow-up assessment one full year post training was completed by 80 participants (a response rate of 42%). Results Families who attended the training report being the primary source of care coordination for their children and 83.7% see their role in their child's healthcare changing as a result of the training. The findings suggest that peer support and communication with providers increased as a result of the training over the course of the study. The data suggest that the training impacted how the family interacts with the child's doctor, including initiating conversations to prepare their child for transition to adult health care. Further, families report system-level improvements 1 year later compared to the pre-training assessment. Discussion CCEF training is a promising practice for facilitating medical home use among CYSHCN., Author(s): Lisa Gorman Ufer [sup.1] [sup.2] , Julie A. Moore [sup.1] [sup.2] , Kristen Hawkins [sup.1] [sup.2] , Gina Gembel [sup.1] [sup.2] , David N. Entwistle [sup.2] [sup.3] , David [...]

Research has demonstrated that caregivers' use of intervention strategies can support their children's social engagement and communication. However, it is not clear to what degree caregivers must master the strategies to effectively support gains in social communication, specifically, core challenges such as joint attention language (comments). Twenty-two minimally verbal school-age children with autism received a social communication intervention with caregiver coaching. Through 10 min caregiver-child play interactions at eight time points, significant increase were found in children's spontaneous language. Further, children's spontaneous language was associated with caregivers' implementation. Minimum benchmarks for caregivers' total intervention implementation are discussed., Author(s): Stephanie Y. Shire [sup.1] , Wendy Shih [sup.2] , Connie Kasari [sup.2] Author Affiliations: (Aff1) 0000 0004 1936 8008, grid.170202.6, Special Education and Clinical Sciences, University of Oregon, , [...]

The objective was to examine the frequency, correlates, and overlap of school disciplinary actions, psychiatric hospitalizations, and police contact among children and adolescents with autism. Survey results from 2525 caregivers of individuals with autism in elementary through high school were examined. Logistic regression was used to examine predictors of each outcome. Youth with autism most frequently experienced school disciplinary action (15.0%), followed by police contact (7.9%) and hospitalization (7.8%). Experiencing any one of the three events increased risk of experiencing either of the other events. Strong associations between traumatic experiences such as police contact and hospitalizations (OR 9.2), need to be explored to determine risk factors for potential intervention. Further research is needed to determine the temporal ordering of these outcomes., Author(s): Paul Turcotte [sup.1] , Lindsay L. Shea [sup.1] , David Mandell [sup.2] Author Affiliations: (Aff1) A.J. Drexel Autism Institute, ASERT Collaborative, , 3020 Market St., Suite 560, 19104, Philadelphia, [...]

The study assessed the diagnostic validity of the diagnostic behavioral assessment for autism spectrum disorders-revised (DiBAS-R; 19-item screening scale based on ratings by caregivers) in a clinical sample of 381 adults with ID. Analysis revealed a sensitivity of 0.82 and a specificity of 0.67 in the overall sample (70.3% agreement). Sensitivity (0.79) and specificity (0.84) were balanced in individuals with mild to moderate ID (83.3% agreement), while specificity was lower in individuals with severe to profound ID (sensitivity: 0.83, specificity: 0.34, 51% agreement). The level of ID as well as its interaction with ASD explained a significant proportion of the variance in the DiBAS-R scores. The DiBAS-R is an adequate screening tool, especially in individuals with mild to moderate ID., Author(s): Manuel Heinrich [sup.1] [sup.2] , Julia Böhm [sup.2] [sup.3] , Tanja Sappok [sup.2] Author Affiliations: (1) Department of Education and Psychology, Clinical-Psychological Intervention, Freie Universität Berlin, 0000 0000 9116 [...]

Objectives African American maternal caregiver support for prevention of childhood obesity may be a factor in implementing, monitoring, and sustaining children's positive health behaviors. However, little is known about how perceptions of childhood obesity risk factors and health complications influence caregivers' support of childhood obesity prevention strategies. The objective of this study was to determine if childhood obesity risk factors and health complications were associated with maternal caregivers' support for prevention initiatives. Methods A convenience sample of maternal caregivers (N = 129, ages 22-65 years) completed the childhood obesity perceptions (COP) survey. A linear regression was conducted to determine whether perceptions about childhood obesity risk factors and subsequent health complications influenced caregivers' support for prevention strategies. Results Caregivers' perceptions of childhood obesity risk factors were moderate (M = 3.4; SD = 0.64), as were their perceptions of obesity-related health complications (M = 3.3; SD = 0.75); however, they perceived a high level of support for prevention strategies (M = 4.2; SD = 0.74). In the regression model, only health complications were significantly associated with caregiver support ([beta] = 0.348; p < 0.004). Conclusions Childhood obesity prevention efforts should emphasize health complications by providing education and strategies that promote self-efficacy and outcome expectations among maternal caregivers., Author(s): Dayna S. Alexander [sup.1] [sup.2] , Moya L. Alfonso [sup.2] , Chunhua Cao [sup.3] , Alesha R. Wright [sup.2] Author Affiliations: (1) Division of Pharmaceutical Outcomes and Policy, UNC [...]

Children with autism spectrum disorder (ASD) exhibit high rates of challenging behaviors that impair functioning and represent the primary presenting problem in mental health (MH) services. Obtaining symptom reports from multiple informants is critical for treatment planning. This study evaluated caregiver-teacher concordance of ratings of the intensity of challenging behaviors in children with ASD receiving MH services, and identified child clinical factors associated with concordance. This sample included 141 children (M = 9.07 years), their caregivers, and teachers. Caregiver-teacher concordance of challenging behaviors was low and impacted by the degree and type of child psychiatric comorbidity. Findings support need for increased attention to the range of psychiatric problems children with ASD present to tailor treatment recommendations and service delivery., Author(s): Nicole Stadnick [sup.1] [sup.2] , Colby Chlebowski [sup.1] [sup.2] , Lauren Brookman-Frazee [sup.1] [sup.2] Author Affiliations: (1) 0000 0001 2107 4242grid.266100.3Department of Psychiatry, University of California, 9500 Gilman Drive, [...]

Introduction We have all been taught to tell the truth; to live honestly and with integrity. Honesty is a message prevalent in American society, from the 'George Washington and the [...]

Objective Background television (TV) exposure is harmful to young children, yet few studies have focused on predictors of exposure. This study's objectives were to elucidate demographic, environmental, and behavioral correlates of background TV exposure in low-income Mexican-American preschoolers and to explore caregiver beliefs about the impact of such exposure. Methods A convenience sample of low-income Mexican-American female primary caregivers of preschoolers (3-5 years old, n = 309), recruited in safety-net clinics, were surveyed by phone. Caregivers reported the frequency of their child's exposure to background TV and responded to questions on the home media environment, TV use, and whether they had thought about background TV exposure and its impact on their child. Results Background TV exposure was common; 43 % reported that their child was often, very often, or always exposed to background TV. More hours of TV viewing by the caregiver and greater frequency of TV viewing during meals were associated with an increased frequency of exposure to background TV. Only 49 % of participants had ever thought about the impact of background TV. Believing that background TV is not harmful was associated with higher levels of background TV exposure. Conclusions Findings suggest that background TV exposure is frequent and caregiver awareness of its potential impact is low in low-income Mexican-American families. Beliefs that background TV is not harmful may predict risk of exposure. Potential targets for interventions focused on reducing background TV exposure in this population include increasing caregiver awareness of the potential negative impact of such TV exposure., Author(s): Darcy A. Thompson[sup.1] , Jeanne M. Tschann[sup.2] Author Affiliations: (1) Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Anschutz Medical Campus - Mail Stop F561, [...]

Purpose: This qualitative study explores and compares the views of participants with schizophrenia and their family caregivers on the impact of Integrated Supported Employment (ISE) program in mainland China on their recovery. Focus has been put on the participants' motivation to join the program; the difficulties encountered and the solutions; the gains; and the meaning of work before and after the program. Methods: With interview guides, individual face-to-face semi-structured interviews were conducted among 15 participants and 15 caregivers respectively. All interviews were audio-recorded, transcribed, and analyzed using an inductive approach. Results: The findings revealed commonalities and discrepancies on the views of two groups of respondents on various aspects of ISE contributing to positive employment outcomes including enlightenment on meaning of work in relation to recovery, empowerment to taking responsibilities in the return-to-work process, the step-wise nature of the training protocol, and the crucial role of the case workers in the continuous follow-up. Conclusions: The policy and service implications based on the results to promote psychiatric rehabilitation and recovery of the 7.8 million of people with schizophrenia through ISE and related programs in China are generated. With careful consideration of potential socio-cultural differences, the findings may also serve as good references for researchers and clinicians in other Chinese societies such as Hong Kong, Taiwan, and Singapore., Severe mental illness (SMI) leads to short-term and long-term disabilities worldwide (Royal College of Psychiatrists, 2009a). In China, more than 7.8 million people have schizophrenia (Xinhua News Agency, 2007) who [...]

Objectives This study of primarily Latino caregivers and Latino child welfare-involved children had the following aims: (1) explore the return appointment adherence patterns at a pediatric medical clinic; and (2) determine the relationship of adherence to return appointments and caregiver, child, and clinic variables. Methods The sample consisted of caregivers of child welfare-involved children who were asked to make a pediatric outpatient clinic return appointment (N = 87). Predictors included caregiver demographics, child medical diagnoses and age, and clinic/convenience factors including distance from the clinic to caregiver's home, days until the return appointment, reminder telephone call, Latino provider, and additional specialty appointment. Predictors were examined using [chi].sup.2 and t tests of significance. Results Thirty-nine percent of all caregivers were nonadherent in returning for pediatric appointments. When return appointments were scheduled longer after the initial appointment, caregivers were less likely to bring children back for medical care. Conclusions The 39 % missed return appointment rate in this study is higher than other similar pediatric populations. Better coordination between pediatricians and caregivers in partnership with child welfare case workers is needed to ensure consistent follow-up regarding health problems, especially when appointments are not scheduled soon after the initial appointment., Author(s): Janet U. Schneiderman[sup.1] , Caitlin Smith[sup.2] , Janet S. Arnold-Clark[sup.3] , Jorge Fuentes[sup.3] , Andrea K. Kennedy[sup.1] Author Affiliations: (1) School of Social Work, University of Southern California, 669 [...]

Background Community-based management of acute malnutrition (CMAM) has been widely adopted to treat childhood acute malnutrition (AM), but its effectiveness in program settings is often limited by implementation constraints, low screening coverage, and poor treatment uptake and adherence. This study addresses the problem of low screening coverage by testing the impact of distributing small-quantity lipid-based nutrient supplements (SQ-LNSs) at monthly screenings held by community health volunteers (CHVs). Screening sessions included behavior change communication (BCC) on nutrition, health, and hygiene practices (both study arms) and SQ-LNSs (one study arm). Impact was assessed on AM screening and treatment coverage and on AM incidence and prevalence. Methods and findings A two-arm cluster-randomized controlled trial in 48 health center catchment areas in the Bla and San health districts in Mali was conducted from February 2015 to April 2017. In both arms, CHVs led monthly AM screenings in children 6-23 months of age and provided BCC to caregivers. The intervention arm also received a monthly supply of SQ-LNSs to stimulate caregivers' participation and supplement children's diet. We used two study designs: i) a repeated cross-sectional study (n = approximately 2,300) with baseline and endline surveys to examine impacts on AM screening and treatment coverage and prevalence (primary study outcomes) and ii) a longitudinal study of children enrolled at 6 months of age (n = 1,132) and followed monthly for 18 months to assess impact on AM screening and treatment coverage and incidence (primary study outcomes). All analyses were done by intent to treat. The intervention significantly increased AM screening coverage (cross-sectional study: +40 percentage points [pp], 95% confidence interval [CI]: 32, 49, p < 0.001; longitudinal study: +28 pp, 95% CI: 23, 33, p < 0.001). No impact on treatment coverage or AM prevalence was found. Children in the intervention arm, however, were 29% (95% CI: 8, 46; p = 0.017) less likely to develop a first AM episode (incidence) and, compared to children in comparison arm, their overall risk of AM (longitudinal prevalence) was 30% (95% CI: 12, 44; p = 0.002) lower. The intervention lowered CMAM enrollment by 10 pp (95% CI: 1.9, 18; p = 0.016), an unintended negative impact likely due to CHVs handing out preventive SQ-LNSs to caregivers of AM children instead of referring them to the CMAM program. Study limitations were i) the referral of AM cases by our research team (for ethical reasons) during monthly measurements in the longitudinal study might have interfered with usual CMAM activities and ii) the outcomes presented by child age also reflect seasonal variations because of the closed cohort design. Conclusions Incorporating SQ-LNSs into monthly community-level AM screenings and BCC sessions was highly effective at improving screening coverage and reducing AM incidence, but it did not improve AM prevalence or treatment coverage. Future evaluation and implementation research on CMAM should carefully assess and tackle the remaining barriers that prevent AM cases from being correctly diagnosed, referred, and adequately treated. Trial registration ClinicalTrials.gov NCT02323815., Author(s): Lieven Huybregts *, Agnes Le Port, Elodie Becquey, Amanda Zongrone, Francisco M. Barba, Rahul Rawat, Jef L. Leroy, Marie T. Ruel Introduction Globally, an estimated 52 million children suffer [...]

Objective To measure the benefits to household caregivers of a psychotherapeutic intervention for adolescents and young adults living In a war-affected area. Methods Between July 2012 and July 2013, we carried out a randomized controlled trial of the Youth Readiness Intervention--a cognitive--behavioural intervention for war-affected young people who exhibit depressive and anxiety symptoms and conduct problems--in Freetown, Sierra Leone. Overall, 436 participants aged 15-24 years were randomized to receive the intervention (n=222) or care as usual (n=214). Household caregivers for the participants in the intervention arm (n=101) or control arm (n=103) were interviewed during a baseline survey and again, if available (n = 155), 12 weeks later In a follow-up survey. We used a burden assessment scale to evaluate the burden of care placed on caregivers in terms of emotional distress and functional Impairment. The caregivers' mental health--i.e. Internalizing, externalizing and prosocial behaviour--was evaluated using the Oxford Measure of Psychosocial Adjustment. Difference-in-differences multiple regression analyses were used, within an intention-to-treat framework, to estimate the treatment effects. Findings Compared with the caregivers of participants of the control group, the caregivers of participants of the intervention group reported greater reductions In emotional distress (scale difference: 0.252; 95% confidence interval, CI: 0.026-0.4782) and greater improvements in prosocial behaviour (scale difference: 0.249; 95% CI: 0.012-0.486) between the two surveys. Conclusion A psychotherapeutic intervention for war-affected young people can improve the mental health of their caregivers. Objectif Mesurer les avantages pour les aidants familiaux d'une Intervention psychotherapeutique destinee aux adolescents et aux jeunes adultes qui vivent dans une region touchee par la guerre. Methodes Entre juillet 2012 et juillet 2013, nous avons realise a Freetown, en Sierra Leone, un essai controle randomise de la Youth Readlness Intervention--une intervention cognltlvo-comportementale destinee aux jeunes touches par la guerre qui presentent des symptomes de depression et d'anxiete ainsi que des troubles du comportement. Au total, 436 participants ages de 15 a 24 ans ont ete selectionnes de maniere aleatoire pour beneficier soit de l'intervention (n = 222), soit d'une prise en charge standard (n = 214). Les aidants familiaux des participants du groupe experimental (n = 101) ou du groupe de controle (n = 103) ont ete Interroges a l'occasion d'une etude de base, puis ceux qui etalent disponibles (n = 155) l'ont de nouveau ete 12 semaines plus tard dans le cadre d'une etude de suivi. Nous avons utilise une echelle d'evaluation pour estimer la charge qui pese sur les aidants familiaux en matiere de soins lies a la detresse psychique et a la deficience fonctionnelle. La sante mentale-c'est-a-dire l'Interiorisation, l'exteriorisation et le comportement prosocial--des aidants familiaux a ete evaluee a l'aide de la Oxford Measure of Psychosocial Adjustment. Des analyses par regression multiple de l'ecart des differences ont ete utilisees, dans le cadre d'une Intention de traiter, afin d'estimer les effets du traitement. Resultats Compares aux aidants familiaux des participants du groupe de controle, les aidants familiaux des participants du groupe experimental ont fait part d'une reduction plus Importante de la detresse psychique (difference d'echelle: 0,252; intervalle de confiance, IC, a 95%: 0,026-0,4782) et d'ameliorations plus significatives en matiere de comportement prosocial (difference d'echelle: 0,249; IC a 95%: 0.012-0.486) entre les deux etudes. Conclusion Les Interventions psychotherapeutiques destinees aux jeunes touches par la guerre peuvent ameliorer la sante mentale des aidants familiaux. Objetivo Medir los beneficios para los cuidadores del hogar de una intervencion psicoterapeutica para adolescentes y adultos jovenes que viven en una zona afectada por la guerra. Metodos Entre julio de 2012 y julio de 2013, se llevaron a cabo ensayos controlados aleatorizados de la Youth Readiness Intervention (una intervencion cognitivo-conductual para jovenes afectados por la guerra que presentan sintomas de depresion y ansiedad y problemas de conducta) en Freetown, Sierra Leona. En terminos generales, 436 participantes de 15 a 24 anos fueron aleatorizados para recibir la intervencion (n=222) o los cuidados habituales (n = 214). Se entrevisto a los cuidadores del hogar de los participantes en el grupo de intervencion (n=101) o el grupo de control (n=103) durante un estudio de referenda y de nuevo, si estaban disponibles (n=155), 12 semanas despues en un estudio de seguimiento. Se utilizo una escala de valoracion de la carga para asi evaluar la carga de los cuidados de los cuidadores en terminos de angustia emocional y discapacidad funcional. Se evaluo la salud mental de los cuidadores, es decir, el comportamiento de internalizacion, externalizacion y prosocial, mediante el uso de la medida de ajuste psicosocial de Oxford. Los analisis de diferencias en diferencias basados en regresiones multiples se utilizaron, dentro de un marco de intention de tratar, para estimar los efectos del tratamiento. Resultados En compaction con los cuidadores de los participantes del grupo de control, los cuidadores de los participantes del grupo de intervention registraron una mayor reduction en la angustia emocional (diferencia en la escala: 0,252; intervalo de confianza (IC) del 95%: 0,026-0,4782) y mayores mejoras en el comportamiento prosocial (diferencia en la escala: 0,249 (IC del 95%: 0,012-0,486) entre los dos estudios. Conclusion Una intervencion psicoterapeutica para los jovenes afectados por la guerra puede mejorar la salud mental de sus cuidadores., Introduction Although, globally, psychiatric disorders account for a larger disease burden than human immunodeficiency virus and malaria combined, (1) more than three-quarters of individuals living in low- and middle-income countries [...]