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In children and youth with disability, the risk of obesity is higher and is associated with lower levels of physical activity, inappropriate eating behaviors, and chronic health conditions. We determined the effectiveness of a program in managing weight, through changes in physical activity and nutrition behaviors in overweight and obese New Zealand children and youth with intellectual disability or autism. Twenty-two children and youth 14 plus or minus 4 y (mean plus or minus SD) and their families participated in a 10-week school-based program. The program consisted of 18 sessions focusing on physical activity and nutrition. Changes were measured immediately after completion of the program (post 1) and at 24 weeks (follow up). Fitness was assessed with the six-minute walk-test (6MWT) and body fatness via waist circumference and BMI. Physical activity and nutrition changes were measured by means of proxy reporting and interviews with parents. Individual interviews were conducted with school teachers and program leaders at 24 weeks to gain feedback regarding the program. Most quantitative outcomes were either unclear or trivial. The only possible change was observed in the six-minute walk-test where 24 weeks post program where participants walked 51 m further. There was however, a substantial reduction in the consumption of confectionery and chocolate at the two measurement points. Parents commented that during the program there were less hospital visits and absences from school related to illness. The program assisted in the development of a supportive community network and participants' abilities to partake in family and community activities. This the first study to report on the results of a physical activity and nutrition program targeted in children and youth with intellectual disability and autism. The results of this study may support and inform future developments of an integrated weight management and prevention program to enhance the health and well being in children and youth with disabilities. (Contains 6 tables.)

This article examines the ethical and practical challenges of undertaking a study using art-based methods with children/young people. It is argued that an important component of qualitative research and research with children/young people is researcher reflexivity and flexibility, particularly when the anticipated and actual implemented methods of a study differ. We draw on a study with 175 children/young people aged 5–16 years in a children's outpatients department where 'draw-and-tell' and 'letter writing' were used to elicit children/young people's perceptions of the outpatient environment. The challenges that arose during the study are critically reflected on including recruitment, the physical and social environment, time restrictions and interviewing. Recommendations for researchers using art-based methods to carry out research with children/young people are offered. [ABSTRACT FROM AUTHOR]

Maternal and reproductive health (MRH) needs are particularly heightened during disasters, affecting the long-term maternal morbidity and mortality. This single case study, drawing on the 2013 eruption of Mount Sinabung, Indonesia, aimed to investigate the experiences of pregnant women and the perspectives of community leaders on the accessibility and the provision of MRH services during the emergency response phase. The study was conducted between August 2017 and April 2018 in the newly relocated villages in Siosar Kabanjahe, Karo district. Data were collected from two stakeholder groups over two phases. Phase 1 with 10 women who were pregnant at the time of the eruption. Phase 2 with 16 community leaders. Data were thematically analysed and utilised NVivo software. While there were considerable efforts to provide MRH services following the eruption, these were described as inadequate. The activation of local disaster management authorities and provision of free-of-charge MRH services were seen as imperative to improving the disaster responses. To improve responses in future disasters, health authorities are recommended to upscale health information systems in emergencies, educate health professionals on Disaster Risk Management (DRM), improve guidelines related to temporary shelter and improve multi-sectoral coordination to ensure MRH provision is aligned with DRM policies. [ABSTRACT FROM AUTHOR]

Duty of care is a legal, ethical and professional obligation and commitment for nurses to provide quality care and protect patient safety. Although 'giving care' and 'to care' has been discussed widely in nursing literature, less attention has been given to 'duty of care' as a fundamental basis for practice. This narrative review, through a critical analysis of peer reviewed literature, legislation, codes, professional prescribed competencies and cases upheld by commissions and courts of law, explores the historical origins and development of 'duty of care', alongside nurse's legal, ethical and professional parameters associated with duty to care. Major concepts identified include legal and common law definitions of a duty of care which are relevant to nursing, medicine and midwifery; duty of care as an evolving principle; duty of care that goes beyond legal definitions to include a moral commitment to care; and the relevance of duty of care to nursing practice in New Zealand. This paper concludes that although the origins of a duty to care may have begun in servitude, current expectations of a duty to care are based on outcomes -- that of do good and do no harm. Nursing's duty of care is regulated by legal, ethical and professional obligations but equally includes a moral commitment to care. These findings suggest duty to care lies at the heart of nursing practice. [ABSTRACT FROM AUTHOR]

Meeting and planning for maternal and reproductive health (MRH) needs during post-disaster scenarios is paramount, however, not without considerable challenges. This study was aimed at understanding the provision of MRH services in Siosar, a relocation site for a population displaced by the volcanic eruption in 2013 of Mount Sinabung, Indonesia. A qualitative case study approach was used, and data were collected through focus group discussions and individual interviews with women of reproductive age, community leaders, health personnel, and policymakers. The findings show that while considerable efforts were made to provide MRH services, these were described as "unfinished," due to challenges such as changes to funding, inadequate provision of supplies and health personnel, and geographical location. Recommendations are that health and other sectors design a relocation site that counts physical, psychological, and social needs of a community and policymakers integrate humanitarian and development plans that include MRH services into World Health Organization's Building Blocks of Health System.

Children undergoing clinical procedures can experience fear, uncertainty, and anxiety which can cause them to become upset and resist procedures. This study aimed to capture an international perspective of how health professionals report they would act if a child was upset and resisted a procedure. An online questionnaire, distributed through network sampling, used three vignettes to elicit qualitative open text responses from health professionals. Seven hundred and twelve professionals participated, resulting in 2072 pieces of text across the three vignettes. Many professionals reported that they would use distraction and spend time to inform and engage children in making choices about their procedure. However, most professionals indicated that if a child became uncooperative they would hold or instruct the holding of the child in order to get the procedure done 'as quickly as possible'. The findings demonstrate that professionals experience difficulty in balancing the different agendas, rights and priorities within the momentum which can build during a clinical procedure, often resulting in the child's voice and rights being undermined. A more balanced approach could be facilitated by a 'clinical pause' that would equip professionals with the time to consider children's expressed wishes and explore alternative approaches to holding.