Search Results (161)

Child occupants are highly vulnerable to head and neck injuries in vehicle crashes; conventional child restraint systems primarily restrain the torso, with limited ability to directly reduce excessive head excursion and neck loads during frontal collisions. Therefore, effective cushioning and energy absorption are needed to improve head and neck protection in child restraint systems. This study proposed and evaluated a novel child restraint system integrated with an airbag to enhance head and neck protection. A finite element model of a five-point harness child safety seat with an airbag module mounted on the seatbelt buckle was developed. The predictive accuracy of the airbag model and child restraint system was validated through pendulum impact tests and frontal sled tests. Next, the PIPER 3 human model was applied to evaluate the effectiveness of the airbag. Compared with the five-point harness child restraint system without an airbag, the incorporation of the airbag significantly improved head and neck protection. Specifically, the maximum vertical head-T1 displacement decreased from 286 mm to 90 mm; additionally, HIC15, 3 ms resultant head acceleration, peak upper neck tension force, peak upper neck flexion moment, and 3 ms chest acceleration were reduced by 51.8%, 27.8%, 66.9%, 29.6%, and 16.0%, respectively. This study provided a technical basis for the development of passive safety technologies in child restraint systems with airbag applications. Full article

Background/Objectives: The Parenting Sense of Competence (PSOC) scale is one of the most widely used instruments to assess perceived parental competence, understood as the degree to which parents feel capable of adequately fulfilling their parental role. Despite its widespread use, studies seeking to determine PSOC normative scores are scarce, especially in specific populations such as mothers with infants younger than 9 months, which limits the interpretation of its scores in applied contexts. This study establishes PSOC normative scores in a nonclinical sample of 522 Spanish mothers with infants aged between 3 and 37 weeks who attended a public early intervention program. Methods: Regression and ANOVA analyses were performed to examine the effect of infant and maternal age, as well as educational level and occupation, on the dimensions of Efficacy, Satisfaction, and Total score of the PSOC. Results: The results show a significant decline in parental competence starting when their infants reach 9 months of age, and lower levels of self-efficacy in mothers over 35 years of age. No significant differences were found according to the educational level or occupation of the mothers. Normative scores are presented by percentiles, offering specific criteria for this stage of child development. Z- and T-scores are included, useful for standardized comparisons between subscale and studies. Conclusions: These findings provide useful information for early detection and psychoeducational interventions within the framework of early intervention. Full article

Background/Objectives: The main goal of this study is to identify predictors associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) seropositivity in children, including demographics, history of coronavirus disease 2019 (COVID-19) infection of the child and the household members, prevention practices, and maternal vaccination. Methods: This retrospective cross-sectional study within the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH)/MeKiTamara cohort included 300 mother-child dyads recruited in Paramaribo and Nickerie, Suriname (February–April 2023). The total immunoglobulin G (IgG) anti-spike domain 1 (S1) and anti-nucleoprotein (NP) were quantified in dried blood spot (DBS) eluates from children using indirect enzyme-linked immunosorbent assays (ELISAs). Demographic information, COVID-19 prevention measures, history of viral infection of the child and the household members, and COVID-19 vaccination questionnaire data were recorded. Predictors of SARS-CoV-2 seroprevalence were determined using binary logistic regression. Results: Among 278 seropositive children in 2023, 73.4% were in the 5–6-year-old age group, 54.7% were female, 36.3% were of Asian descent, and 69.8% were recruited in Paramaribo. Seroprevalence increased from 33.8% in 2021–2022 to 93.3% in 2023, with a mean follow-up of 21.5 months. Of the 100 children previously tested by Polymerase Chain Reaction (PCR) or antigen test, 25 had confirmed COVID-19, as reported by mothers. Children from unvaccinated mothers were 6.11 times more likely to be seropositive (p = 0.022). Conclusions: This study shows a significant increase in SARS-CoV-2 seropositivity in Surinamese children aged 3–6 years between collection periods, indicating multiple exposures. Future public health interventions and policies should account for maternal vaccination status to reduce children’s exposure to COVID-19 during future outbreaks. Full article

Background: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that severely affects cognitive, behavioral, and functional abilities, creating a substantial burden for family members who provide continuous care. Caregivers often experience role changes, occupational imbalance, emotional distress, and reduced quality of life, although some report personal growth. These experiences extend beyond active caregiving and include anticipatory grief during disease progression and grief after the relative’s death. Despite this continuum, few studies have examined caregiving, loss, and bereavement from an integrative perspective. This protocol describes a mixed-methods study aimed at exploring the lived experiences of family caregivers of individuals with AD, focusing on how evolving relational, occupational, and identity-related losses influence their well-being and adaptation. Methods: A parallel convergent mixed-methods design will be used. The quantitative component consists of a cross-sectional observational study including 66 caregivers recruited through purposive sampling across kinship categories (spouse/partner, adult child, grandchild) and care settings (home care with day-center attendance vs. institutionalized care). Data will be collected using the Zarit Burden Interview, Role Checklist, Short Form-36 Health Survey, and Occupational Balance Questionnaire. Descriptive and subgroup analyses will be conducted using SPSS (version 27). The qualitative component comprises a multiple-case study with approximately 36 participants across three groups: caregivers living with individuals with AD, caregivers of institutionalized relatives, and bereaved family members. Semi-structured interviews (45–80 min) will be conducted online or in person, transcribed verbatim, and analyzed thematically using MAXQDA (version 26). Integration will follow a concurrent approach, combining quantitative and qualitative results through joint narratives and displays to produce a comprehensive interpretation. Discussion: This study aims to deepen understanding of the caregiving–grief continuum in families affected by AD by integrating quantitative indicators of burden, health status, and occupational balance with qualitative accounts of adaptation and meaning-making. Findings are expected to support the development of holistic, evidence-based interventions that promote caregiver well-being throughout the care trajectory and during bereavement. Ethics and Dissemination: Ethical approval was granted by the Research Ethics Committee of Universidad Rey Juan Carlos (Code: 041220246522024; 15 October 2025). ClinicalTrials.gov Identifier: NCT07251738. Registered November 2025. Protocol version: Version 2. Full article

Background/Objectives: Early intervention is associated with improved outcomes for young children with developmental delays, yet many with mild delays are ineligible for services under the Individuals with Disabilities Education Act (IDEA). The Early Discovery (ED) Program addressed this gap by providing short-term, targeted intervention for children ages 0–5 who did not qualify for publicly funded services. This study evaluated program outcomes across intervention types. Methods: During 2024–2025, 342 families completed the ED Program, receiving one of the following: speech-language (68%), general developmental (12%), occupational (14%), or behavioral (6%) intervention across 8–20 sessions. Eligibility required Miami-Dade residency and ineligibility for IDEA-funded services. Standardized pre- and post-intervention assessments were analyzed using descriptive statistics, correlations, and group comparisons. Results: Most households reported incomes <$70,000 (71%), with many experiencing additional risk factors including prematurity (15%), public or no insurance (47%), limited English proficiency (21%), and single-caregiver households (30%). Overall, 85% of children met criteria for improvement. Improvement rates varied by child ethnicity. No statistically significant differences were observed by child age, race, gender, prematurity, insurance status, caregiver demographics, household characteristics, or intervention type. Sensitivity analyses largely confirmed the primary findings, with ethnicity no longer significant and younger age emerging as a significant predictor of improvement. Conclusions: Findings suggest short-term, targeted intervention may support developmental progress among young children with mild delays who would otherwise remain unserved. Community-based programs such as ED may play a critical role in advancing developmental equity by reaching children with developmental and socioeconomic risk factors prior to school entry. Full article

This study develops and validates a post-occupancy evaluation (POE) framework to assess the social support level of elderly–child composite spaces. Grounded in social support theory, POE theory, and Maslow’s hierarchy of needs, the framework comprises 2 core dimensions (instrumental support and emotional support), 6 first-level indicators, and 29 s-level indicators. The indicators were constructed through literature analysis, field research, and other methods, with weights determined via the Analytic Hierarchy Process (AHP) involving 10 interdisciplinary experts. Weighting results indicate that instrumental support (0.6208) carries greater importance than emotional support (0.3792); among first-level indicators, “accessibility and safety” (under instrumental support) and “degree of demand satisfaction” (under emotional support) rank highest. The framework was applied to 12 typical spaces across 4 categories in Hangzhou’s Minsheng Complexes (a community-integrated public service model). Empirical results show that infant–toddler growth stations achieved the highest scores (82.86–86.42), while community living rooms performed the weakest (78.96–81.21), with “function–need mismatch” identified as the core issue. This evaluation system provides a scientific basis for spatial diagnosis, optimization, and high-quality planning of elderly-child composite spaces in the future. Full article

Background: Mental health problems in childhood and adolescence constitute a major public health concern, influencing developmental trajectories, educational outcomes, and long-term well-being. This study aimed to assess developmental and socioeconomic gradients in perceived mental health and mood disorder risk among children and adolescents, integrating parental evaluations, symptom-related indicators, and sociodemographic correlates. Methods: A cross-sectional survey was conducted among 1177 parents or legal guardians of children aged 6–18 years in Poland. Data were collected via a structured questionnaire assessing perceived physical and mental health, socioeconomic characteristics, and seven symptom-based items aligned with the Children’s Depression Inventory 2 (CDI-2) diagnostic framework. Nonparametric tests (χ², Spearman’s ρ, Kruskal–Wallis H) were applied to examine age-related differences and socioeconomic gradients in perceived mental health and mood disorder risk. Results: Parental evaluations indicated a consistent discrepancy between physical and mental health, with psychological well-being rated less favorably and exhibiting greater variability. Both perceived mental health and mood disorder risk showed strong age-related differentiation, revealing declining scores with increasing age (ρ < 0, p < 0.001). Family financial situation demonstrated the strongest association with mental health outcomes (H = 71.39, p < 0.001), while parental occupational status exerted moderate effects and educational attainment showed no significant influence. Concentration difficulties, affective distress, and somatic symptoms such as fatigue and sleep disturbance were commonly reported. Conclusions: Findings indicate that child and adolescent mental health is shaped by interacting developmental and socioeconomic determinants. Adolescence and financial disadvantage represent key vulnerability factors associated with poorer psychological outcomes. The results highlight the need for developmentally targeted and socially equitable mental health strategies within pediatric and preventive healthcare systems. Full article

Background/Objectives: A plethora of articles report the effectiveness of many different interventions for managing cerebral palsy (CP), but there are few long-term follow-up studies of children after an intervention designed to improve function in children with CP. This observational mixed-methods study examined the functional gains observed more than one year after toddlers completed a 48-week investigation that included 5 days per week for 12 weeks of occupational and physical therapy using the Perception-Action Approach (P-AA). The aim was to observe whether the functional gains made by the children continued to improve, plateaued, or declined at long-term follow-up. Methods: The sample was 23 children with a mild-to-moderate level of CP (Gross Motor Function Classification System I, II, or III) who completed the original study at least one year prior. The follow-up assessment included quantitative data using the Gross Motor Function Measure-66 (GMFM) and the Pediatric Evaluation of Disability Inventory-Functional Skills (PEDI-FS). Seventeen of 23 children were evaluated with both instruments. Qualitative data were collected from 14 of the 23 families who completed the PEDI-FS. Those families completed a survey with an open-ended questionnaire that assessed the caregivers’ perspectives about their children’s functioning and the impact of the intervention. Results: Findings from the quantitative data based on prognostic GMFM-66 developmental curves by age for children with CP: seven of the 17 children who had GMFM evaluations showed greater than expected improvement (all 5 with GMFCS II), four met the expected improvement, and six did not. Children with GMFCS II or III maintained their positions relative to the mean on the PEDI-FS mobility subset. Findings from the qualitative data revealed that some parents believed the intervention contributed to the changes in their children’s physical, mental, and social functioning. Many parents indicated that the study helped them overcome financial barriers related to accessing intensive therapies. Most parents reported that their child’s functioning was better than they expected when given the diagnosis of CP. Conclusions: Many months following an intense physical and occupational therapeutic intervention, based on predicted age-appropriate percentiles for motor function, roughly one-third of the children exceeded expectations, and one-third did not meet expectations. Despite the time invested in the intense protocol, caregivers felt the intervention was largely responsible for improvements in their children’s functioning. Full article

This computational study examined how variations in the seatback angle of two generic child restraint systems (CRSs) affect spinal loading in young occupants (1.5 YO and 3 YO) during frontal impacts, performed according to the specifications included in UNECE R129. CRS seatback angle dictates torso recline, which in turn influences head, chest, and spine kinematics and loading. While manufacturers typically recommend 30–45° for rear-facing CRSs and an upright position for forward-facing CRSs, little is known about the biomechanical implications of deviating from these guidelines. Using PIPER human body models representing a 1.5-year-old in a rear-facing CRS and a 3-year-old in a forward-facing CRS, simulations were performed under UN-R129 frontal impact conditions. The seatbacks were rotated 5° and 10° more upright or reclined relative to the nominal angle, with occupants restrained by a five-point harness and CRSs secured with ISOFIX, top tether, or three-point belt. The results showed that reclined configurations generally increased the predictions of spinal loading (forces and/or moments) given by the PIPER model, while nominal or more upright angles reduced loads, particularly in the lumbar spine of the 3-year-old model. Overall, the study highlights how computational tools can guide CRS design improvements to optimize spinal protection and enhance child safety beyond current regulatory requirements. Full article

Background: Children with ADHD and children with intellectual disability (ID) often have problems with daily time management (DTM). It is, however, less well-known how the underlying time-processing ability (TPA) may impact children’s DTM and autonomy. The purpose of this study was to investigate DTM, TPA, and self-rated autonomy in the activities of everyday life among children aged 9–15 years with and without disabilities. Methods: The participants were matched samples of children with ADHD (n = 47), with ID (n = 47), and typically developing (TD) children (n = 47). A descriptive, comparative, and cross-sectional design was used. Group comparisons with one-way analysis of variance (ANOVA), Tukey post-hoc tests, bootstrapping, and a cluster analysis were used to analyze the data. Results: Children with ADHD and children with ID had significantly lower TPA and DTM than TD children. Children with ADHD had even lower DTM than those with ID. Children with ADHD and ID have the same overall pattern of TPA, but it may be delayed, affecting their DTM and autonomy. However, there was considerable heterogeneity among the children with ADHD and ID, ranging from skilled to having significant problems in TPA. For all children, the levels of self-rated autonomy seemed to follow the level of TPA. Conclusions: Children with ADHD and children with ID have an increased risk of delayed TPA, affecting their DTM and autonomy, which may also influence their participation in daily activities. The results indicate a need to measure TPA and DTM to tailor interventions for each child. Full article

Neurodevelopmental disorders (NDDs) are neurobiological conditions that arise in childhood and affect the personal, social, academic, and occupational development of those who exhibit them. The aim of this study is to analyze scientific research on neurodevelopmental disorders and their relationship to accessibility in cultural heritage, to identify the methodological approaches that currently predominate, and to examine which types of NDD are most studied and which ones are currently overlooked in scientific research. Existing adaptations for people with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) were used as a reference point for the analysis, given their high prevalence in the child population. This study was conducted following the DSM-5-TR criteria and the PRISMA 2020 protocol to select and analyze scientific articles published in the last decade, between 2015 and 2025, obtained from the Scopus database. The results show an increase in the dissemination of scientific literature on access to cultural heritage for people with NDDs, although in a very limited way. Furthermore, within the NDDs themselves, it is ASD that appears to be most represented, with an increase in applied techniques and inclusive experiences. Based on these findings, it is recommended that future research focus on finding educational tools and best practices that promote inclusion and accessibility to cultural heritage for people with other developmental disabilities, such as ADHD. Full article

Background/Objectives: Reports detailing rehabilitative interventions for infants with severe dermatologic disorders are scarce. Epidermolysis Bullosa (EB) is a genetic disorder characterized by skin fragility, which causes blistering after minor trauma. Since there is still no cure in general clinics, symptomatic treatment and developmental support are essential for managing the condition. While physiotherapy and occupational therapy guidelines for EB exist, descriptions of neonatal habilitation/rehabilitation are insufficient. Case: This case report describes the longitudinal habilitation/rehabilitation intervention process for a newborn with Dowling–Meara EB, the most severe form, from admission to the Neonatal Intensive Care Unit (NICU) until discharge. Since maneuvers requiring contact were strictly limited due to skin vulnerability, rehabilitation interventions were implemented utilizing the opportunity afforded by necessary care. Intervention strategies were modified according to developmental stages and skin stability, with a particular emphasis on sensory development, postural control training, and fostering the mother–child relationship. This report is the first to describe the applicability of sensory rehabilitation and the use of behavioral cues to facilitate voluntary movements. In addition, careful respiratory rehabilitation was implemented for comorbid tracheomalacia with specific attention to skin vulnerability. The child achieved stable head/neck control, symmetrical limb movements, reaching, guided rolling, and stable oxygenation by the time of discharge. Conclusions: Balancing skin disorder prevention and motor–neural development requires flexible approaches that minimize contact while utilizing routine care as a training opportunity. Our experience will contribute to the progress in the habilitation, wound rehabilitation and respiratory rehabilitation of infants with severe dermatologic disorders. Full article

Background: There is a growing gap between the increasing prevalence of children with neurodevelopmental disorders (NDDs) and the limited availability of developmental services. This raises an urgent need for effective and accessible intervention models. Hybrid intervention offers an innovative and practical solution, yet evidence regarding its feasibility and efficacy for children remains limited. This study aimed to adapt an evidence-based occupational therapy (OT) intervention model for remote delivery and to examine its feasibility and preliminary efficacy among children with NDDs. Methods: Using a quasi-experimental pre–post, mixed-methods design, children aged 5–8 years with NDDs were recruited from child development units in southern Israel. The intervention comprised 12–15 weekly video-conference sessions utilizing the Cognitive Orientation to (daily) Occupational Performance (CO-OP) approach. Standardized outcome measures assessed feasibility and preliminary efficacy. Focus groups with parents and therapists explored facilitators and barriers to implementation. Results: Of the 26 participants enrolled, 14 children (71% boys) completed the intervention and reported high satisfaction. Clinically significant improvements were observed in personal goal training, reported by both children (80%) and parents (73.68%). Content analysis identified three key themes: parents’ engagement, ecological intervention, and technological literacy. Conclusions: Tele-CO-OP intervention was found to be feasible for children with NDDs and showed potential to improve occupational performance in personal goals. Findings provide a practical foundation for developing hybrid OT services as a valuable complement to in-person care for this growing population. Full article

Purpose: To achieve a better understanding of the environmental factors that contribute to childhood cancers, so as to inform future prevention efforts. Methods: We conducted a comprehensive review of epidemiological studies on environmental risk factors and childhood cancer, which was published between January 2014 and March 2021. Potential exposure sources presented in this review include air pollution, radiation, and parental occupational exposures. We considered exposures during childhood and parental exposures occurring before the child’s conception and during pregnancy in relation to all types of childhood cancer. Results: Aggregated evidence is strong for associations between leukemia and parental/child exposure to traffic pollution, indoor paints, residential pesticides, and parental occupational/nonoccupational exposure to benzene. Evidence is also strong for associations between brain cancer and residential pesticides and parental occupational exposure to agricultural pesticides. Evidence of associations between leukemia and ionizing radiation from radon and nuclear power plants remains mixed, as does evidence of a link between electromagnetic fields (EMFs) and childhood leukemia. Conclusions: Clear associations have been demonstrated between childhood cancer and environmental factors, including parent/child exposure to traffic pollution, occupational/nonoccupational benzene, indoor paints, residential pesticides, and parental occupational exposure to agricultural pesticides. These associations can be used to inform further study of interventions and public health campaigns to reduce risk. Full article

Background: Children and youth often have challenges processing and integrating sensory information. These increasingly common challenges and can significantly impact development, learning, behavior, well-being, and participation in everyday activities. Since children with sensory integration challenges, with or without other concerns, are likely to present first to their primary care provider (PCP), it is important that they have resources about sensory integration challenges and their impact on the child or the need to refer these children for further assessment and intervention. Our aim is to assist PCPs in their clinical decision-making. Methods: We conducted a narrative review of CINAHL, PsychInfo, and Medline with no date restrictions, using the structure Population (children/youth with sensory integration/processing disorder/dysfunction/difference)/Concept (screening or referral)/Context (screening from PCP to occupational therapy) to identify the pertinent literature, providing (1) a description and synthesis of a circumscribed body of research on sensory integrative challenges; (2) findings related to screening and referral to occupational therapy by PCPs; and (3) the need for development of a Sensory Integration (SI) Decision Guide to support PCP clinical decision-making. Results: Findings from the narrative literature review search were integrated with information from the author panel of experts to provide a description of sensory integration challenges. Few screening tools were addressed in the literature, and no guidelines were identified to support PCP decision-making regarding referral. A Sensory Integration Decision Guide was developed to fill this gap. Conclusions: The Sensory Integration Decision Guide provides primary care providers with a systematic process for detecting sensory integration challenges and referring to specialized occupational therapy services. Future studies to examine the practical application of the tool for its accuracy and usefulness in clinical decision-making and effectiveness for referral decisions are needed. Full article