Search Results (602)

Background: Maternal and newborn health disparities remain a challenge in Puerto Rico, especially in underserved communities. Comienzo Saludable Puerto Rico, sponsored by the U.S. Department of Health and Human Services’ Healthy Start Initiative (HRSA), addresses these gaps through an integrated Networks of Care model known as Cuidado Compartido. Comienzo Saludable Puerto Rico is a maternal, paternal, and child health program aimed at improving the health and well-being of pregnant women, mothers, fathers, newborns, and children in Puerto Rico, particularly those from disadvantaged communities. Methods: This paper presents the Comienzo Saludable Puerto Rico program’s Cuidado Compartido model to integrate a network of healthcare providers and services across hospitals, community organizations, and families. This model aims to improve maternal and newborn/child health outcomes by focusing on the importance of integrated, hospital-community-based care networks. Results: Participants experienced significant improvements in key birth outcomes: low birth weight prevalence declined by 27.2% compared to the community baseline, premature birth rates decreased by 30.9%, and infant mortality dropped by 75%, reaching 0% by 2021 and remaining there through 2023. These results were complemented by increases in maternal mental health screening, paternal involvement, and breastfeeding practices. Conclusions: The Cuidado Compartido model demonstrates a scalable, culturally responsive strategy to improve maternal, newborn, and child health outcomes. It offers critical insights for implementation in other high-need contexts. Full article

This study focuses on the current service/care difficulties and challenges that social institutions in Hungary are facing during their daily operations; how they can react to them utilizing their internal resources, mechanisms, and capacities; and what concrete, tangible needs and demands are emerging in terms of methodological professional support, potential forms, interventions, and direction for professional development. A total of 24 general and 55 specific service and operational problems were identified and assessed in eight different service areas (family and child welfare services, family and child welfare centers, respite care for children, care for the homeless, addiction intervention, care for people with disabilities, care for psychiatric patients, specialized care for the elderly, and basic services for the elderly). The empirical base of the study uses a database of 201 online questionnaires completed by a professional target group working for social service providers in two counties (Győr-Moson-Sopron and Veszprém), representing 166 social service providers. The questionnaires were completed between November and December of 2022. The findings will be used to develop a professional support and development problem map. Social institutions face complex and serious service/care difficulties and challenges in their daily operations. Three distinctive basic problems clearly stand out in both severity and significance from the complex set of factors assessed. The biggest problem in the social care system is clearly the complex challenge of low wages, followed by the administrative burdens in the ranking of operational difficulties, and the third key factor was the psycho-mental workload of staff. Full article

Background/Objectives: Laboratory tests conducted in community settings are occasionally repeated within hours of presentation to pediatric emergency departments (PEDs). Reducing unnecessary repetitions can ease child discomfort and alleviate the healthcare burden without compromising the diagnostic process or quality of care. The aim of this study was to develop a decision tree (DT) model to guide physicians in minimizing unnecessary repeat blood tests in PEDs. The minimal decision tree (MDT) algorithm was selected for its interpretability and capacity to generate optimally pruned classification trees. Methods: Children aged 3 months to 18 years with community-based complete blood count (CBC), electrolyte (ELE), and C-reactive protein (CRP) measurements obtained between 2016 and 2023 were included. Repeat tests performed in the pediatric emergency department within 12 h were evaluated by comparing paired measurements, with tests considered justified when values transitioned from normal to abnormal ranges or changed by ≥20%. Additionally, sensitivity analyses were conducted for absolute change thresholds of 10% and 30% and for repeat intervals of 6, 18, and 24 h. Results: Among 7813 children visits in this study, 6044, 1941, and 2771 underwent repeated CBC, ELE, and CRP tests, respectively. The mean ages of patients undergoing CRP, ELE, and CBC testing were 6.33 ± 5.38, 7.91 ± 5.71, and 5.08 ± 5.28 years, respectively. The majority were of middle socio-economic class, with 66.61–71.24% living in urban areas. Pain was the predominant presented complaint (83.69–85.99%), and in most cases (83.69–85.99%), the examination was conducted by a pediatrician. The DT model was developed and evaluated on training and validation cohorts, and it demonstrated high accuracy in predicting the need for repeat CBC and ELE tests but not CRP. Performance of the DT model significantly exceeded that of the logistic regression model. Conclusions: The data-driven guide derived from the DT model provides clinicians with a practical, interpretable tool to minimize unnecessary repeat laboratory testing, thereby enhancing patient care and optimizing healthcare resource utilization. Full article

Bring them home, keep them home is research based in New South Wales (NSW) Australia, that aims to understand successful and sustainable reunification for Aboriginal families who have children in out-of-home care (OOHC). This research is led by Aboriginal researchers, and partners with Aboriginal organisations. It is informed by the experiences of 20 Aboriginal parents and family members, and more than 200 practitioners and professionals working in child protection and reunification. This paper traces the evolution of Bring them home, keep them home which is now at the forefront of influence for NSW child protection reforms. Using specific examples, it highlights the role of research advocacy and resistance in challenging and disrupting systems in ways that amplify the voices of Aboriginal families and communities and embeds these voices as the foundation for radical innovation for child reunification approaches. The paper shares lessons being learned and insights for Aboriginal-led research with communities in the pursuit of restorative justice, system change, and self-determination. Providing a framework for liberating Aboriginal families from child abduction systems, this paper seeks to offer a truth-telling and practical contribution to the international efforts of Indigenous resistance to child abduction systems. Full article

Objective: To explore the experiences and self-efficacy of parent-caregivers providing care for a child with a tracheostomy tube. Study Design: Parent-caregivers completed surveys and participated in semi-structured interviews about their experiences learning to care for their child with a tracheostomy tube. Survey data were analyzed using descriptive statistics. Interviews were transcribed verbatim and analyzed thematically through coding. Results: Fifteen parent-caregivers participated in the survey, 13 of whom completed an interview. After receiving a tracheostomy, children were hospitalized a median of 6 months prior to discharge home. At the time of our study, children had been home for a median of 3.5 years. Parent-caregivers felt more prepared to perform routine daily care compared to triaging a change in medical status. Parent-caregiver self-efficacy in performing tracheostomy care skills improved with experience at home. Four themes were identified from interviews: new identity formation, enduring education, child and family biopsychosocial support, and establishing normalcy. Parent-caregivers shared that education was more than just acquiring skills; it also involved discovering diverse ways of learning and building confidence in one’s own abilities to fulfill the many types of roles they serve to successfully care for and keep their child safe while supporting their social and emotional needs as parent-caregivers. Conclusions: Parent-caregivers’ reflections on their experiences provide critical insight into their psychosocial needs and challenges in providing care to children with tracheostomies. Further investigation of lived experiences is vital to shaping a community that can support families of medically complex children. Full article

Background and Objectives: Estimating the need for palliative care for children is a crucial step in addressing the needs of children facing life-threatening conditions, while providing a powerful argument to combat unacceptably wide disparities in access to care. The need for palliative care for children in Romania remains insufficiently quantified. More accurate estimates are indispensable to assess the true extent of need and to support adequate policy responses. Materials and Methods: This retrospective cross-sectional study aimed to estimate the need for pediatric palliative care in Romania for 2022–2023. We analyzed secondary data obtained from the General Directorates of Social Assistance and Child Protection (DGASPC) in 41 counties and the six sectors of Bucharest. The analysis focused on life-limiting conditions as defined by the WHO Annex 3, Order no. 253/2018. Results: The study identified 14,499 pediatric cases with palliative care needs, showing a highly uneven national distribution, especially across diagnostic groups and age categories. We observed a higher number of cases in rural areas (7553) compared with urban areas (6946). Our own data do not include resource estimates; however, prior reports indicate only 50 palliative care beds for children in Romania. Conclusions: This study reveals a substantial and unevenly distributed need for pediatric palliative care in Romania, with notable disparities across age groups, diagnostic categories, and urban-rural areas. The identification of 14,499 eligible cases underscores the urgency of developing targeted policies and allocating adequate resources to ensure equitable access to specialized palliative services for all children in need. Full article

Background/Objectives: Dental anxiety in children is a common issue that can hinder the delivery of effective dental care. Traditional approaches to managing this are often insufficient or involve pharmacological interventions. This study shows the potential of virtual reality (VR) to aid in reducing anxiety in children undergoing simple dental procedures. By immersing children in relaxing VR environments (such as beaches, forests, mountains, or underwater scenes with calm music), the objective is to assess VR’s effectiveness in calming pediatrics patients during these procedures. Methods: Children scheduled for minor dental treatments wore a wearable device that monitored pulse, perspiration, and stress levels. Each child’s baseline data was collected without the VR headset, followed by data collection during VR exposure before and during dental procedures. VR scenarios ranged from soothing nature scenes to animated cartoons, designed to foster relaxation. Results: The data collected showed a reduction in physiological indicators of stress, such as lower heart rate and reduced perspiration, when the VR headset was used. Children appeared more relaxed, with a calmer response during the procedure itself, compared to baseline levels without VR. Conclusions: This study provides preliminary evidence supporting VR as an effective tool for reducing anxiety and stress in pediatric dental patients. By offering an engaging, immersive experience, VR can serve as an alternative or complementary approach to traditional anxiety management strategies in pediatric dentistry, potentially improving patient comfort and cooperation during dental procedures. Further research could determine if VR may serve as an alternative to local anesthesia for non-intrusive pediatric dental procedures. Full article

Background/Objectives: Intergenerational care plays a significant role in shaping household dietary quality and human capital development in China. Influenced by the legacy of the one-child policy, the care provided in these families often prioritizes child-focused practices. This study examines how intergenerational care influences schoolchildren’s sugar-sweetened beverage (SSB) consumption. Methods: This study utilizes data from the 2014–2015 China Education Panel Survey (CEPS) to investigate the impact of intergenerational care on schoolchildren’s dietary behaviors, with a focus on sugar-sweetened beverage (SSB) consumption. We apply both ordinary least squares (OLS) regression and the ordered logit model to estimate the impacts, and we use the instrumental variables approach to address potential endogeneity. Results: Schoolchildren from only-child families report greater SSB consumption, while those from multi-child families consume less. Intergenerational care is linked to more digital media exposure, more pocket money, and less parental supervision. These findings withstand rigorous validation through multiple robustness checks, including sample restriction strategies and propensity score matching (PSM) analysis. The effect is especially pronounced among boys, schoolchildren from families with higher parental education levels, and schoolchildren attending schools without formal nutrition education programs. Conclusions: The result indicates that intergenerational care significantly increases SSB consumption among schoolchildren from only-child families. Community nutrition and school health education programs can reduce schoolchildren’s SSB consumption, thereby lowering risks of obesity and other public health concerns. Full article

Background: Indigenous peoples in Canada endure lasting effects of colonialism including racism, marginalization, and social, political, and geographic inequities resulting in disproportionate rates of disease and inequitable healthcare. Indigenous infants and children in Canada experience a high incidence of birth complications and illnesses, and families are often left to navigate the care of their child with limited resources. Accordingly, improved, culturally responsive and safe healthcare is needed to enhance child outcomes and optimize family well-being. Purpose and Methods: A qualitative study was conducted by our research team including family members of Indigenous children with serious illnesses, a Cultural Advisor, researchers, and pediatric clinicians. In one component of the study, we explored pediatric healthcare providers’ (HCPs) experiences of caring for Indigenous families of children with serious illness. A purposive sample of 19 pediatric healthcare providers took part in semi-structured qualitative interviews or one focus group. The data were analyzed thematically to identify common experiences and priorities for improved supportive healthcare. Findings: Five themes were identified representing insights from pediatric HCPs, with a focus on barriers to effective healthcare at the interpersonal, institutional, and system levels for seriously ill Indigenous children and their families. Ideas for enhancing the social and cultural responsiveness and safety of supportive healthcare were identified. Implications and Conclusions: The findings offer valuable insights and strategies for HCPs to support holistic, comprehensive, and culturally safe and responsive healthcare. Full article

(1) Background: Intrapartum obstetric violence has become increasingly visible and is portrayed as a cross-cutting and complex phenomenon. Despite numerous international debates and extensive reports in the literature, there is limited consensus on its definition, emphasizing the need to clarify the concept. The aim of this article is to analyze the concept of obstetric violence in the care of women in labor in health institutions; (2) Methods: Search and selection of studies using the scoping review methodology, based on the Joanna Briggs Institute guidelines and Rodgers’ conceptual review method for data extraction and analysis; (3) Results: A sample of 49 studies provided a comprehensive understanding of the concept, revealing in its conceptualization attributes of physical, verbal, psychological, sexual, institutional and structural violence. Identification of antecedents of gender inequality and failure of relational, technical and structural standards at the level of health institutions and their professionals, as the main triggers of obstetric violence. Reporting of consequences with a negative impact on maternal and child health; (4) Conclusions: Conceptual analysis with important contributions to the paradigm shift in the work of health professionals. Multiple dimensions, cultural differences and variations in the concept should continue to be examined to improve its research and application. Full article

Background/Objectives: Visual impairment (VI) represents a significant health challenge among older adults, particularly due to their limited understanding of health information. This study aimed to investigate and compare the health information-seeking behavior (HISB) of older adults with VI across different stages of eye care. Methods: A cross-sectional comparative study was conducted in 248 older adults with VI in various stages of eye care, including the pre-visit stage (n = 84), treatment stage (n = 83), and follow-up stage (n = 81) at the Shenzhen Eye Hospital from July to October 2024. Participants completed an HISB questionnaire encompassing four dimensions: attitude, needs, sources, and barriers. Results: The overall mean score of HISB varied significantly among the different eye care stages. The treatment stage had the highest scores (3.70 ± 0.32), particularly in attitudes toward health information and information needs. Poor self-reported overall health facilitated HISB in each stage. In the pre-visit stage, higher income was associated with increased HISB, while a lack of internet access reduced it. In the treatment stage, higher education was associated with higher HISB, whereas moderate-to-severe VI and certain income levels were associated with negative effects. In the follow-up stage, rural residence and spousal or child caregiving emerged as key facilitators of HISB. Conclusions: The treatment stage is a critical period for HISB engagement in older adults with VI. Healthcare providers should consider stage-specific factors of HISB to optimize health information delivery. Full article

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition with a complex and multifactorial etiology, diagnosed on the basis of clinical criteria. Medical comorbidities are common and often lead to instrumental examinations; however, the clinical utility of routinely performing such tests remains uncertain. This study aimed to assess the practical value of instrumental assessments in ASD by examining both prescribing behaviors and the prevalence of abnormal findings in a sample of autistic children. Methods: A combined-method approach was adopted: (1) an online survey of child neuropsychiatrists across the Piedmont region (Italy) explored current attitudes and practices regarding instrumental testing in children with ASD; (2) a retrospective cross-sectional analysis examined the frequency and clinical relevance of abnormal findings in ASD patients who underwent comprehensive testing at a tertiary hospital in Turin. Results: The survey showed that 85.7% of centers follow specific protocols for instrumental examinations, though practices vary considerably. Genetic testing and blood analyses are routinely performed, while EEG, MRI, audiometry, and metabolic screenings are generally based on clinical indication. In the retrospective study, instrumental tests revealed a low rate of clinically significant findings. Clinically relevant genetic abnormalities were detected in 7.9% of CGH-array tests. EEG abnormalities were seen in 9% of cases, though 57% had nonspecific or unclear results. Among biochemical parameters, notable findings included altered lipid profiles (45%), ferritin deficiency (24%), and anemia (12.5%) and no metabolic disorders were identified. Discussion: These findings highlight substantial variability in clinical practice and suggest that while some instrumental tests may provide valuable insights, routine screening is often of limited benefit. The high prevalence of nonspecific findings reinforces the need for careful clinical correlation, emphasizing the importance of balancing comprehensive assessment against the risks of over-testing and challenges in interpreting results. Future research should focus on developing evidence-based guidelines for instrumental assessments in this population. Full article

Aboriginal communities in Australia have long advocated for self-determination in child protection. This includes appeals for greater structural authority in systems of care and protection, with Aboriginal children in the care of Aboriginal agencies. Advocacy from agencies, including the Victorian Aboriginal Child and Community Agency (VACCA), has resulted in legislative and funding reforms in Victoria that place Victorian Aboriginal community-controlled organisations (ACCOs) at the forefront of responses supporting Aboriginal children and families. This article provides an overview of that advocacy, the context in which the reform arose. Then, it details how VACCA has implemented the reforms by developing a model for Aboriginal child protection centred on culture, self-determination and human rights. Importantly, it discusses the process and negotiation of transferring authority exercised by the government to ACCOs and offers insights for the system and practice transformation. This article outlines how ACCOs like VACCA are shifting the language, culture and practice of child protection. Full article

The creation of child-friendly communities has become a key goal in sustainable global development. However, South Korea continues to experience a shortage of childcare facilities, resulting in gaps in the public care system and a growing reliance on private educational resources. Ensuring spatial spaces and implementing rational planning for children’s spaces have become critical tasks in building child-friendly cities. This study analyzed the accessibility of childcare facilities by housing type in Seongbuk-gu, Seoul, using the two-step floating catchment area (2SFCA) method, focusing on children residing in the district. It also evaluated whether these facilities were spatially and equally distributed. The findings are as follows. First, the overall accessibility to childcare facilities in Seongbuk-gu is limited, with significant disparities in accessibility depending on housing type. Second, the spatial equity assessment revealed high inequality indices for most facilities, particularly for those in apartment areas, which showed relatively higher levels of inequality. In conclusion, childcare facilities in Seongbuk-gu require substantial improvements in terms of both accessibility and equity. This study provides a policy framework for creating child-friendly communities and promoting equal access to care services for children by analyzing the spatial accessibility and equity of childcare facilities. Full article

Background/Objectives: The transition to motherhood can be particularly challenging for women with limited socioeconomic resources or mental health concerns. The FAmily Clinic And Municipality (FACAM) intervention was designed to provide additional support through health visitors or family therapists, starting in pregnancy and continuing until the child reached school age. This paper evaluates the effects of the FACAM intervention on the secondary outcomes, maternal mental health and parental functioning during the child’s first year of life. Methods: A total of 331 pregnant women were randomized to either the FACAM intervention (n = 163) or usual care (n = 168). Participants completed questionnaires at baseline and at 3 (N = 284) and 12 (N = 248) months postpartum. Outcomes included maternal mental well-being, satisfaction with motherhood, depressive symptoms, parental stress, parental reflective functioning, worries, and breastfeeding duration. Results: At 12 months postpartum, FACAM mothers reported greater concern about housing issues (b = 0.56, 95% CI [0.06, 1.06], p = 0.03). No other significant differences in the reported outcomes were observed between the groups. Conclusion: The FACAM intervention did not demonstrate superiority over usual care in improving maternal mental health and parental functioning during the first year postpartum. The high-quality and needs-based approach of standard care in Denmark may have limited the potential for additional interventions to yield measurable improvements in maternal outcomes. Full article