Search Results (459)

Background: Financial stress can lead to emotional and psychosocial distress among informal caregivers of older adults and can have a profound impact on their overall well-being. While social support may buffer financial stress, the role of gender in moderating these relationships is less understood. This study examined whether gender moderates the associations between psychosocial distress, social support, and financial well-being among informal caregivers of older adults. Methods: A cross-sectional survey was conducted between December 2023 and March 2024 among 589 informal caregivers of older adults residing in twelve rural states in the North Central United States. After applying listwise deletion for missing data, 533 caregivers with complete responses were retained for the final analysis. Financial well-being was measured using the Consumer Financial Protection Bureau (CFPB) Financial Well-Being Scale, psychosocial distress with a five-item distress scale, and social support with the OSSS-3. Gender, sociodemographic characteristics, and caregiving status were also collected. Independent t-tests, ANOVA, Pearson correlations, and multivariable linear regressions with interaction terms were used to assess the relationships among the study variables. Results: Male caregivers reported significantly higher financial well-being than females (52.66 vs. 50.12, p = 0.036). Stronger social support was associated with greater financial well-being (mean difference = 11.80, p < 0.001). Psychosocial distress was negatively correlated with financial well-being (r = –0.49, p < 0.001). Regression analyses revealed significant gender moderation: distress reduced financial well-being more sharply for males, while strong social support benefited females more substantially than males. Older age, higher income, and better self-rated health were also positively associated with financial well-being. Conclusions: Findings highlight gender-specific patterns in how psychosocial distress and social support influence financial well-being among informal caregivers. Future programs should consider gender-specific needs while addressing psychosocial and financial well-being of informal caregivers of older adults. Full article

Background: Early relational health is critical for childhood development, and disruptions in infant-caregiver trust can heighten risk. MERTIL for Parents is a brief, universal, online program designed to build parental understanding of relational trust and its role in infant development. This pilot study is the first evaluation of the program. Objectives: To evaluate the acceptability and short-term outcomes of MERTIL for Parents. Methods: Seventy-three parents (n = 69 mothers) of children aged 0–5 years, referred by practitioners, completed the program and online questionnaires at baseline (N = 73), post-intervention (n = 50), and three-month follow-up (n = 25). Results: The program demonstrated high acceptability: 98% of parents who engaged with the program found the content useful, 92% felt the length was appropriate, and all would recommend it to others. Program completion and satisfaction did not vary by sociodemographic or psychosocial characteristics. At three-month follow-up, parents reported significant improvements in their enjoyment of the parent–child relationship (p < 0.001), attunement to their child (p < 0.001), parenting confidence/competence (p = 0.004 and p = 0.003), help-seeking amenability (p < 0.001), and a reduction in irritability toward the child (p < 0.001), with medium to large effect sizes. No significant changes were observed for items assessing reflective functioning or perceived rejection. Conclusions: MERTIL for Parents shows strong acceptability and promising preliminary outcomes as a scalable, attachment and trauma-informed intervention supporting early relational health. Future research should examine long-term impacts and evaluate broader implementation across diverse families and service contexts. Full article

Background: Informed consent and assent are fundamental ethical and legal requirements in paediatric healthcare, yet their application in paediatric dentistry is complex and underexplored in clinical practice. Objective: This study aimed to analyse the implementation of informed consent and assent processes in paediatric dental care within a Spanish population, identifying key characteristics and factors that influence communication, understanding, and decision-making. Methods: An observational, descriptive, cross-sectional study was conducted in Spanish Paediatric Dentistry Clinics (January–June 2023). Participants included 520 child-caregiver pairs and 52 dental students. Data were collected via a semi-structured observational protocol and interviews, assessing information provided, decision-making conditions, and influencing factors. Statistical analysis was performed using SPSS v23.0, employing Chi-square, Cochran’s Q, and Kendall’s W tests. Results: The information most frequently provided was the nature of the dental problem (92%), treatment details (88%), and benefits (85%). Information on risks (64%), alternatives (37%), and the right to withdraw consent (41%) was less consistently communicated. After multivariable adjustment, child schooling remained independently associated with the disclosure of risks and alternatives (p < 0.01), whereas caregiver education showed no independent effect. Kendall’s concordance coefficient showed moderate agreement (W = 0.62, 95% CI: 0.54–0.69, p < 0.01) among operators, caregivers, and patients, which decreased in adolescents aged 16–18 years (W = 0.41, 95% CI: 0.28–0.55, p = 0.07). Conclusions: The processes of informed consent and assent in paediatric dentistry are more strongly linked to the child’s cognitive maturity and schooling than to parental education. While communication of treatment benefits is adequate, critical aspects like risks and alternatives are often overlooked. The findings underscore the need for standardized protocols and enhanced bioethical training to ensure consistent, ethical, and participatory practices that respect the progressive autonomy of minors. Full article

Background and objectives: This study examines how sociodemographic, clinical, and psychological factors within the patient–caregiver dyad affect caregiver burden and health-related quality of life (HRQoL) in cognitive impairment. By comparing baseline data with a 1-year follow-up, the research aims to identify key predictors of caregiver burden and well-being. Methods: A longitudinal observational study was conducted in an Italian rehabilitation hospital, recruiting 132 outpatients and their caregivers at baseline, categorized as (a) Mild Cognitive Impairment (MCI, n = 33); (b) dementia (DEM, n = 58); (c) healthy subjects (No-CI, n = 41). One year after baseline assessment (T0), patients were contacted and invited for an in-person follow-up re-evaluation (T1). Most attrition was related to the COVID-19 pandemic. Statistical analyses included non-parametric tests for group comparisons and stepwise multiple linear regression to identify predictors of burden, adjusting for confounders (e.g., age, gender, education, employment, co-residence). Results: A total of 51 subjects (age: 80.0 ± 6.1) and 34 caregivers (age: 58.8 ± 15.9) were evaluated. Patients were balanced by gender (53% males); most were retired (96%), married (62.7%), and cared for by sons (47%) or wife–husband (47%). Caregivers (females: 85%) were married (68.3%) and active workers (46.4%). Over one year, 17 No-CI subjects developed MCI or DEM; 15 MCI patients progressed to DEM. Caregiver HRQoL negatively correlated with distress and burden in MCI and DEM groups. Patient cognitive status, functional abilities, neuropsychiatric symptoms, and gender predicted caregiver burden, emphasizing the interplay between clinical and demographic factors. Conclusions: It is essential to monitor psychosocial factors in both the patient and the caregiver to develop effective prevention and support strategies. Full article

In the past decades, outbreaks of food poisoning have been a significant concern in Hong Kong. Under the stressful workplace culture, people nowadays overlook the importance of food safety and food handling practices. Elderly people are at a higher risk of foodborne illness among the infected groups due to weakened immunity. It is important for the elderly’s caregivers to be equipped with good food safety knowledge and food handling practices in order to ensure the food safety of the elderly. An online questionnaire was distributed in Hong Kong using online platforms with the aim of investigating the sociodemographic characteristics, attitudes, knowledge, and handling practices with respect to elderly food safety among 390 participants who are the elderly’s caregivers. These factors represent different backgrounds of the elderly’s caregivers, and the questionnaire provides evidence to support how food safety knowledge and attitudes of elderly’s caregivers associate with elderly food safety. By investigating them, it helps the public understand the significance of preventing food poisoning outbreaks. Thus, the public health of the elderly can be improved. It was observed that the elderly’s caregivers with a higher level of education had better knowledge of food safety in elderly care and better food handling practices. Their attitudes had a strong positive correlation with their knowledge and handling practices towards food safety. This study emphasized that food safety knowledge and practices of the elderly’s caregivers in Hong Kong should be improved effectively by enforcing stricter regulations on elderly food safety protocols, raising public awareness on elderly food safety and implementing tailored educational programmes according to the background of the elderly’s caregivers. Full article

Background: Hospital-at-home (HAH) programs deliver hospital-level care in patients’ homes, improving satisfaction and optimizing resource use. While widely adopted in adults, pediatric HAH remains limited. At Sant Joan de Déu Hospital (Barcelona, Spain), the pediatric HAH program for acutely ill children has expanded to include more clinically complex cases. Family involvement is essential, as caregivers are trained to administer treatments, monitor clinical status, and support telematic follow-ups, supporting the healthcare team’s workload. Objective: To identify patient characteristics influencing healthcare workload and develop a predictive model to enhance resource allocation. Methods: This single-center, prospective cohort study included all patients admitted to the pediatric HAH program for one year. Primary variables were caregiver training time, home visiting time, patient age, type of care provided, and clinical complexity. Secondary variables included referral specialty and team composition. Data were collected using digital time-tracking, manual records, and clinical databases. Analyses included Kruskal–Wallis and Dunn’s multiple comparison tests. Results: All variables showed significant differences in training and visiting times. Training time ranged from 19 to 157 min; visiting time from 6.2 to 157 min. A predictive model using five key variables estimated visiting time, and another model based on care type estimated training time were created. Conclusions: Patient characteristics and caregiver involvement significantly affect direct care workload. These findings can inform strategies to optimize staffing and scale pediatric HAH programs effectively. Full article

Background/Objectives: This study aims to investigate the association between health literacy (HL) and stress among family caregivers of older adults with dementia. Methods: Older adults and their caregivers were recruited from the geriatric outpatient memory clinic of an Italian hospital. Caregiver stress was assessed using the General Health Questionnaire-12 items (GHQ-12). HL was measured using the Newest Vital Sign (NVS) and the Short Form of the Test of Functional Health Literacy in Adults (S-TOFHLA). Results: A total of 170 (71% females) caregivers, including spouses and offspring, were included in the analysis. According to the NVS, 53% demonstrated adequate HL, while 83% achieved adequate scores on the S-TOFHLA. The median GHQ-12 score was 15, with 48% presenting a score above 14, indicating higher stress levels; women reported significantly higher GHQ-12 scores than men. In a multivariate linear regression analysis adjusted for sex, education, and number of care tasks provided, the S-TOFHLA score showed a borderline association with the GHQ-12 score (B = −1.45; p = 0.064). When characteristics of the care-recipient were added to the model, the S-TOFHLA score emerged as an independent predictor of the GHQ-12 score (B = −1.41; p = 0.048), along with female caregiver sex and behavioral and psychological symptoms in the care-recipients. Exploratory analysis suggested that the association between HL and stress was present among male but not female caregivers. Conclusions: HL was associated with psychological stress in caregivers of older adults with dementia, with the relationship appearing more pronounced among male caregivers. Full article

Background: Early childhood caries (ECC) remains a critical public health challenge, yet recent prevalence data and risk factors are scarce in rapidly urbanizing regions like Shenzhen City, China. Objectives: This study aimed to assess ECC prevalence and identify risk factors among 5-year-old children in Shenzhen City. Methods: This cross-sectional survey was conducted in Shenzhen City in 2024, recruiting 5-year-old children through multistage sampling from kindergartens. Self-administered parental questionnaires were distributed to collect data such as demographic characteristics, socioeconomic background and oral health-related behaviors. One trained dentist conducted the oral examination in kindergartens using ball-ended community periodontal index probes and disposable dental mirrors with an intra-oral light-emitting diode light attached. Dental caries was assessed using diagnosis criteria recommended by World Health Organization. The decayed, missing, and filled primary teeth (dmft) were recorded. Zero-inflated negative binomial regression was applied to identify associations between risk factors and ECC. Results: Among 1462 participants (86% response rate), ECC prevalence was 58% (mean dmft: 2.5 ± 3.4), with untreated decay (dt) accounting for 92% of cases. Socioeconomic factors, including low family income (p < 0.001), non-local residency (p < 0.001), and low caregiver education level (p = 0.012), were significantly associated with higher dmft scores. Behavioral factors such as frequent sugary drink consumption (p = 0.005), lack of parental brushing assistance (p = 0.027), and non-fluoride toothpaste use (p = 0.008) also contributed to the risk of ECC. Conclusions: Over half of Shenzhen City’s 5-year-olds suffered from ECC, predominantly untreated, driven by socioeconomic disparities and modifiable behavioral factors. Public health strategies must prioritize parental education, fluoride use and early preventive practices to reduce the burden of ECC. Full article

Clarifying the influence of sensorimotor factors on feeding participation problems (FPPs) in children with autism may have implications for therapeutic interventions. Our objective was to assess the prevalence of FPPs in a population of children with autism and to study its association with sensorimotor factors (oral and tactile reactivity and oral praxis). Descriptive observational study including 26 autistic children aged 3 to 12 years. Behavioral Pediatrics Feeding Assessment Scale (BPFAS), Sensory Profile 2 (SP-2), and Oral Praxis (OPr) tests were used. Caregiver stress was evaluated by Parental Stress Index–Short Form (PSI-4-SF). Multivariate logistic analysis and Receiver Operating Characteristic curve was used to predict the risk of FPPs. 26 children (84.6% boys) were included, with a mean age of 6.92 years (95% CI 5.94–7.91). Feeding behavior difficulties were observed in 53.8% of participants, 80.7% exhibited oral praxis issues, and 65.4% of caregivers reported stress related to their child’s FPPs. Oral reactivity and sensory avoidance behaviors were significantly associated with FPPs. Among children with higher support needs, tactile reactivity was also significantly related to FPPs. FPPs in children with autism were associated with oral and tactile hyperreactivity, higher levels of sensory avoidance, dysfunctional parent–child interactions, and increased support needs. Full article

Background: Caring for dependent older relatives is thought to influence caregivers’ personal views of aging (VoA)—that is, perceptions regarding their own aging self. This study aimed to examine personal VoA, particularly felt age (FA) and awareness of age-related change (AARC), in caregivers of people with dementia (PwD) compared to non-caregivers, and to ascertain their relationship with caregiving-related burden and distress among dementia caregivers. Methods: Seventy dementia caregivers and 94 non-caregivers (age range: 45–85 years) reported their FA and completed a questionnaire assessing awareness of age-related gains (AARC-Gains) and losses (AARC-Losses) and a mood measure. Dementia caregivers’ burden and distress were also relieved. Results: No differences emerged between dementia caregivers and non-caregivers’ personal VoA. Different sociodemographic and health-related factors were related to AARC-Gains or AARC-Losses, but not felt age, in each group. AARC-Gains were associated with social status among non-caregivers, whereas AARC-Losses were related to chronological age and subclinical depression in non-caregivers, and to social status, self-rated health, and burden in dementia caregivers. A path model revealed a direct effect of burden, social status, and self-rated health, as well as an indirect one of subclinical depression through burden, on caregivers’ AARC-Losses. Conclusions: These findings confirm the interplay between VoA, sociodemographic, and health-related factors in adulthood and older age. They, then, suggest that the strains derived from caring for a PwD influence dementia caregivers’ personal VoA, particularly when their awareness of age-related losses is concerned. Full article

Background/Objectives: Pediatric asthma is the most prevalent chronic respiratory condition in children and adolescents worldwide and remains a major contributor to morbidity, school absenteeism, and the use of integrated healthcare services. The main goal of this systematic review is to synthesize the available evidence about the impact of biologic therapies on the quality of life in the pediatric population (children and adolescents) with asthma. Methods: This systematic review followed the PRISMA guidelines. A comprehensive search was performed across PubMed, Scopus, and Web of Science for articles published between 2015 and 2025 in English, Portuguese, or Spanish. Studies were eligible if they included pediatric patients (<18 years) with asthma receiving biologic therapies (e.g., omalizumab, mepolizumab, dupilumab) and reported health-related quality of life (HRQoL) outcomes using validated instruments. Article selection followed PICOS criteria and excluded reviews, case reports, and editorials. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Results: A total of 576 articles were found and screened, and 8 studies were selected. The characteristics of the studies highlighted the involved countries, study design, number of participants, conditions, type of biologic intervention, duration, and follow-up. In addition, the importance of biologic therapies in patients’ HRQoL was presented. All eight included studies reported statistically significant improvements in HRQoL using appropriate scales. Conclusions: The studies reinforced the importance of biologic therapies to improve HRQoL in both patients and families/caregivers. Implications for health promotion, in particular, greater involvement of integrated healthcare comprising health professionals, family, school contexts, and the community, are discussed. Full article

The number of caregivers is increasing globally making it imperative that we better understand the impact of caregiving and identify methods to address caregiver needs and health. These goals are best achieved with unified research approaches and measures that facilitate comparison across studies. Despite the need and policy support for unified research on caregiving, research often happens in silos that are diagnostic or age specific. To address this need we interviewed 33 researchers who (1) identified process, and outcome measures they commonly used in their research and (2) explained their selection. We found that researchers across the lifespan are using similar measures in their studies and are consistent in what they look for in a measure. Researchers also described barriers they face when selecting measures, including: inadequacy of current measures, familiarity, need for rigor, and measurement characteristics. These findings highlight the need for the creation and dissemination of a prioritized list of process and outcome measures being used by caregiving researchers. Full article

Background/Objectives: Engaging patients, caregivers, and community groups in health research priority-setting ensures that research agendas reflect genuine needs and enhance patient-centered care. Regions with cultural and linguistic diversity, such as South Tyrol in northern Italy, face challenges in achieving fair representation. This study aimed to identify health services research priorities in South Tyrol, a culturally and linguistically diverse region in Italy, through a bilingual participatory survey involving general practitioners (GPs) and patient and social interest organizations (PSIOs). Methods: A cross-sectional online survey (August–September 2025) was conducted among invited PSIOs (n = 64) and regional GPs (n = 290). A bilingual, self-developed questionnaire assessed organizational characteristics, priority ratings for predefined topics, experiences with research participation, and preferred participation modes. The data were analyzed descriptively. Group comparisons were performed using the Mann–Whitney U and chi-square tests with effect size calculation. Associations were examined using Spearman’s correlation. Free-text responses were thematically content-coded. Results: Ninety-five responses were analyzed, including nine general practitioners (9.5%) and 86 participants (90.5%) from patient and social interest organizations, of whom 27 (28.4%) held leadership or board positions. Across all groups, the highest-rated research priorities included children and adolescent mental health, palliative and end-of-life care, and continuity of primary care. Willingness to participate in future research was expressed by 38% of the respondents, with an additional 52% indicating conditional interest. Online surveys were the most preferred mode of participation, followed by workshops and board meetings. Conclusions: Participatory bilingual approaches are feasible in South Tyrol and highlight priorities that are highly relevant for patient-centered health services. Future initiatives should strengthen the structures for research participation, enhance GP engagement, and link identified priorities to research funding and policy action. Full article

Background/Objectives: Patients with multimorbidity frequently rely on emergency services when continuity of care is weak. Strengthening communication between emergency and primary care can prevent unnecessary hospitalizations, yet this relationship remains underexplored. The aim of this study was to analyze the relationship between primary health care utilization in patients with multimorbidity and their demand for prehospital emergency services. Methods: An observational, longitudinal, analytical, and retrospective study was conducted in Málaga (Spain) between 2013 and 2017. Adults (>18 years) with multimorbidity who requested prehospital emergency care services at home were included; those with cancer, rare diseases, severe mental disorders, or incomplete electronic records were excluded. Variables encompassed sociodemographic, clinical, and behavioral characteristics, comorbidities, functional status, polypharmacy, resource type, and outcomes (on-site resolution or hospital referral). Primary health care visits before and after prehospital emergency use were extracted from electronic records. Descriptive, bivariate, and multivariate analyses were performed. Results: Among 532 patients, prior primary health care attendance predicted subsequent utilization (β = 0.57; p < 0.001), along with caregiver availability (β = 0.12; p = 0.001) and prehospital emergency services hyper-demand (β = 0.08; p = 0.022). Super-utilizers were younger, had ≥4 comorbidities, polypharmacy, prior family medicine visits, home oxygen therapy, and lower substance or alcohol use. Conclusions: In multimorbid adults, prehospital emergencies demand is influenced by factors beyond severity, including comorbidities, polypharmacy, the use of home medical devices, caregiver availability, and primary health care utilization patterns. Strengthening coordination between prehospital emergencies and primary health care, promoting patient–caregiver education, and implementing early notification pathways may improve care continuity and reduce avoidable emergencies. Full article

Background/Objectives: Unintentional home injuries (UHIs) are a major yet preventable cause of morbidity and mortality among children. This study aimed to analyze the epidemiological characteristics, injury mechanisms, and clinical outcomes of pediatric UHIs over a nine-year period in Türkiye. Methods: This retrospective study included all children under 18 years who were diagnosed with UHIs in the Pediatric Emergency Department (PED) of a tertiary university hospital between January 2016 and November 2024. Demographic data, injury mechanisms, imaging findings, surgical interventions, hospitalizations, and Pediatric Intensive Care Unit (PICU) admissions were statistically analyzed. Results: Among 852,090 PED visits, 12,327 (1.4%) were diagnosed with UHIs. Most patients were younger than five years (72.1%) and male (56.8%). The leading causes were falls/collisions (60.6%), burns (12.1%), and foreign body aspirations (10.4%). Hospitalization and PICU admission rates were 11.7% and 1.2%, respectively, mainly involving children aged 2–4 years. Younger age and corrosive ingestion were independent predictors of hospitalization, while burns, falls/collisions, corrosive ingestion, poisoning, and foreign body aspiration significantly increased PICU admission risk. A marked rise in both hospital and PICU admissions was observed during the COVID-19 pandemic. Two fatalities occurred following falls. Conclusions: Falls, burns, and foreign body aspirations were the most common causes of pediatric UHIs, predominantly affecting children aged 2–4 years. Strengthening caregiver supervision, promoting safer home environments, and implementing targeted prevention programs are essential to reduce their impact on children and healthcare systems. Full article