Search Results (1,733)

As population aging accelerates, the mounting burden on informal family caregivers in areas lacking formal care systems threatens the sustainability of elder care. This study aims at evaluating how the rural living environment and external connectivity jointly alleviate caregiver burden and exploring whether regional accessibility serves as a substitute for local infrastructure deficits. Guided by Ecological Systems Theory, we analyzed a cross-sectional dataset of 327 matched caregiver-recipient dyads from rural China using multivariate regression and mediation models. Results indicate that a favorable local environment reduces burden both directly and indirectly through improved recipient health. Crucially, county-level accessibility moderates this relationship via a substitution effect, where the marginal relief from local environmental improvements is most potent in isolated areas but diminishes where external access is convenient. Dimension-specific analyses show that developmental and physical strains are particularly sensitive to these factors. We conclude that sustaining informal care requires a dual-pathway strategy: prioritizing local “soft” assets like community safety and cultural activities while enhancing regional connectivity to service hubs. Ultimately, this research provides empirical evidence and a theoretical framework for enhancing rural informal care sustainability through environmental optimization, thereby advancing Sustainable Development Goals regarding health, reduced inequalities, and sustainable communities. Full article

Background and Objectives: Bladder cancer (BC) represents a significant global health burden, ranking as the tenth most commonly diagnosed malignancy worldwide, with an incidence rate of 5.6 per 100,000 person-years annually. The research team aimed to summarize evidence on specialized nursing-led interventions for bladder cancer management across the disease continuum. Materials and Methods: This scoping review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) methodology to search four databases from January 2018 to November 2025. Results: This concise but informative scoping review of 20 studies revealed substantial clinical and patient-reported benefits from specialized nursing interventions. Enhanced recovery after surgery (ERAS) protocols incorporating structured nursing care demonstrated a 35% reduction in postoperative complications. Integrated nursing interventions during postoperative intravesical therapy significantly improved patient satisfaction, treatment compliance, and self-efficacy while reducing anxiety and depression. Digital health platforms, including internet-based and mobile applications, proved effective in reducing caregiver burden, enhancing disease knowledge, and improving coping strategies. Preoperative stoma education and postoperative ostomy care management significantly improved self-efficacy, stoma care knowledge, and overall health-related quality of life. Psychosocial interventions, including cognitive behavioral therapy and mindfulness-based approaches, demonstrated significant improvements in quality of life and reductions in fear of recurrence, depression, and anxiety. However, a critical evidence gap exists regarding bladder cancer-specific mental health interventions. Conclusions: Specialized nursing-led care plays a critical role in strengthening clinical and assistive practice in bladder cancer. Evidence from this scoping review shows that nursing-led interventions significantly improve clinical outcomes, patient satisfaction, symptom management, and quality of life across all phases of bladder cancer care while reducing caregiver burden and enhancing psychological well-being for both patients and families, reinforcing the value of integrating specialized nursing roles into routine bladder cancer management. Full article

Intergenerational trauma significantly affects the health and mental health of African American families, particularly women whose lives are shaped by systemic inequities and historical oppression. This scoping review examines how trauma and resilience are transmitted across generations in African American communities, with a focus on dyads such as mother–child and mother–daughter relationships and a conceptual grandmother–mother–daughter triad. The review aims to identify mechanisms of trauma transmission and resilience and to inform culturally responsive, multigenerational interventions. Peer-reviewed studies published between 2012 and 2025 were identified that included African American caregivers and children and addressed biological, psychological, social, cultural, and resilience dimensions of intergenerational processes. Data were synthesized using a dimensional conceptual analysis approach. Findings indicate that intergenerational trauma is perpetuated through chronic stress and discrimination, maternal mental health challenges, family structure and caregiving strain, and cultural narratives about strength and self-reliance. At the same time, resilience is transmitted through sensitive caregiving, spirituality and faith, social and kin support, racial socialization, and economic survival strategies that draw on cultural and historical knowledge. These results underscore the importance of addressing intergenerational trauma holistically by integrating dyadic evidence within a broader conceptual triadic framework. Culturally responsive, multigenerational interventions that leverage family and community strengths and make space for emotional vulnerability are essential for interrupting cycles of trauma and fostering healing within African American families. Full article

Background/Objectives: In 2023, the United States Congress amended Section 13 of the National School Lunch Act to allow non-congregate meal service as an option within the Summer Food Service Program in rural areas, creating “SUN Meals To-Go.” The purpose of this qualitative study was to explore caregivers’ perceptions of USDA rural non-congregate summer meal programs in California during the summer of 2024. Methods: This was a cross-sectional, qualitative study using an electronic 20-item survey instrument that was available in English and Spanish. Five school foodservice directors in California shared and/or posted at meal pick-up sites a flyer with a QR code leading caregivers to the survey instrument. A conventional content analysis was conducted with the open-ended responses and descriptive statistics were calculated for close-ended items. Results: Caregivers (n = 827) were primarily married (70.5%) and Hispanic/Latino (54.3%) women (85.5%). They (55%) reported using the 2024 summer meal program “most times” or “every time” it was available. Three themes were constructed through qualitative content analysis: (1) Family support and resource relief, (2) Navigating program accessibility and logistics, and (3) Nourishment and practicality: Reflections on food quality, nutrition, and sustainability. Conclusions: Caregivers highlighted that the program supported their families and provided resource relief. They indicated that accessibility and logistics were effective, provided ideas for fine-tuning the delivery of the program, described this program as supporting their children’s nutrition. Full article

Background: Nirsevimab, a monoclonal antibody for respiratory syncytial virus (RSV), reduces medically attended RSV infections. It was introduced in the 2023–24 RSV season. This study examined the association between caregiver vaccination (seasonal influenza vaccine (SIV), COVID-19, and boosters) and intent to immunize infants against RSV. Methods: Data from 118 caregivers with infants ≤ 8 months were analyzed. Chi-squared tests and logistic regression assessed the relationship between caregiver vaccination and intent to immunize against RSV. Results: In total, 74.6% of caregivers intended to immunize their infants against RSV. Intent was positively associated with caregiver receipt of a seasonal influenza vaccine (p < 0.001), COVID-19 vaccine (p < 0.001), and COVID-19 booster (p < 0.001). Intent was also associated with older child seasonal vaccination. Caregiver receipt of both COVID-19 vaccinations and boosters had a strong relationship with RSV immunization intent (OR 7.91 (1.90–33.0, p = 0.004)). Conclusions: Caregiver vaccination behaviors are linked to RSV immunization intent, helping physicians identify hesitant families and prepare for immunization conversations. Full article

Background/Objectives: Neurodevelopmental disorders (NDDs) require contextual approaches emphasizing family roles. Parents of children with NDDs face a complex socio-emotional reality. They may experience high levels of stress, fatigue, depression, and feelings of guilt and uncertainty, and they are often left feeling isolated and unsupported. All of these factors increase their socio-emotional vulnerability and affect their children’s wellbeing. A significant part of the available evidence has focused on parents of typically developing children or on a single construct. For these reasons, and considering the impact of the COVID-19 pandemic, the aim of this study was to review interventions targeting the improvement of the socio-emotional wellbeing of parents of children with NDDs, in order to characterise recent research, the specific constructs addressed, and the effectiveness of interventions. Methods: No prior protocol/registration. ERIC and Web of Science databases (selected for their broad multidisciplinary coverage in psychology and social sciences) were searched from 2020–2025 (last search: 7 September 2025), limited to English/Spanish publications. Inclusion criteria encompassed parents/primary family caregivers of children with NDDs receiving socio-emotional programs. Two independent reviewers screened the titles/abstracts and full texts, resolving disagreements through discussion. Following PRISMA 2020 guidelines, this systematic review employed narrative synthesis without risk-of-bias assessment and included 16 studies (approximately, 1100 participants). Results: The analysis indicated a scarce but growing scientific output, with a complex methodological landscape showing promising preliminary convergence in intervention outcomes. Interventions effects appeared mediated by cultural suitability, accessibility, and contextual alignment. Conclusions: Future work should pursue multisystemic approaches engaging diverse societal contexts and agents to optimize child and family wellbeing. Full article

Background/Objectives: Current studies have shown that caregiving anxiety is associated with an individual’s dysfunctional thoughts. The aim of this study was to assess the mediating effect of caregivers’ forgiveness (benevolence, lack of avoidance and lack of revenge) on the relationship between dysfunctional thoughts and anxiety in the informal caregivers of dependent older adults. Methods: Participants were 222 family caregivers. We conducted path analysis to test the hypothesized model. Results: We found a model that showed a good fit (χ² = 3.410; χ²/gL = 5; p = 0.63; GFI = 0.994; CFI = 0.999; RMSEA = 0.001). It showed a direct and negative association between dysfunctional thoughts and lack of revenge, and this variable was related positively with both benevolence and lack of avoidance. In turn, benevolence was associated with lower levels of anxiety. The associations between dysfunctional thoughts and anxiety were mediated by caregiver forgiveness. Conclusions: Our research suggests the importance of health workers seeking to understand how individuals judge their avoidance, revenge and lack of benevolence, which affect individuals’ anxiety, for change. This study demonstrates the relevance of forgiving strategies in developing and testing informal caregiving assessments. It is necessary to detect and reduce avoidance and revenge related to caregivers. It is also necessary to detect and improve benevolence. Full article

Background/Objectives: Family members are the principal providers of home-based care for migrant older adults. Linguistic, cultural, and structural barriers within health systems exacerbate the caregiver burden across emotional, physical and financial domains. Although home healthcare services may alleviate this burden, variability in access, cultural safety, and care coordination can also intensify it. This scoping review maps the evidence on the burden experienced by family caregivers who deliver home-based healthcare to migrant older adults and examines how these arrangements affect caregivers’ health and well-being. It synthesizes the literature on facilitators and barriers—including access, cultural-linguistic fit, coordination with formal services, and legal/immigration constraints—and distills implications for policy and practice to strengthen equitable, culturally responsive home care. Method: The Joanna Briggs Institute (JBI) scoping review framework was used to conduct the review. A comprehensive search was performed across six databases (CINAHL, Scopus, Web of Science, PsycINFO, MEDLINE and Sociological Abstracts) for articles published between 2000 and 2025. Studies were selected based on predefined inclusion criteria focusing on the family caregiver burden in providing home healthcare for migrant older adults. Data extraction and thematic analysis were conducted to identify key themes. Results: The review identified 20 studies across various geographical regions, highlighting four key themes: (1) Multidimensional Caregiver Burden, (2) The Influence of Gender, Family Hierarchy, and Migratory Trajectories on Caregiving, (3) Limited Access to Formal and Culturally Appropriate Support, and (4) Health Outcomes, Coping, and the Need for Community-Based Solutions. Conclusions: System-level reforms are required to advance equity in home healthcare for aging migrants. Priorities include establishing accountable cultural-safety training for providers; expanding multilingual access across intake, assessment, and follow-up; and formally recognizing and resourcing family caregivers (e.g., navigation support, respite, training, and financial relief). Investment in community-driven programs, frameworks and targeted outreach—co-designed with migrant communities—can mitigate isolation and improve uptake. While home healthcare is pivotal, structural inequities and cultural barriers continue to constrain equitable access. Addressing these gaps demands coordinated policy action, enhanced provider preparation, and culturally responsive care models. Future research should evaluate innovative frameworks that integrate community partnerships and culturally responsive practices to reduce the caregiver burden and improve outcomes for migrant families. Full article

Background/Objectives: Pediatric asthma remains a pressing public health issue, especially among low-income, minority children living in subsidized housing. Methods: This study employed a community-based participatory research approach to explore barriers and potential solutions for improving asthma management in this vulnerable population. Semi-structured interviews were conducted with 22 caregivers of children with asthma and 8 community health workers in Washington, DC—a city marked by high childhood asthma rates and concentrated subsidized housing. Results: Thematic analysis identified six core findings: (1) families frequently encountered multiple home environmental asthma triggers, including pests, mold, secondhand smoke, leaks, poor ventilation, and aging infrastructure; (2) healthy housing services were under implemented, often due to unresponsive landlords, inadequate inspections, and poor maintenance; (3) existing services such as pest control, mold remediation, and smoke-free policies were ineffectively implemented; (4) challenges to service delivery included difficulties faced by landlords and structural barriers tied to geography, race, and socioeconomic status; (5) substandard housing conditions contributed to residents’ feelings of powerlessness, frustration, and distrust, with some taking legal action to address persistent hazards; and (6) participants recommended stronger housing code enforcement, sustained funding for home-based environmental interventions, housing-health liaisons, strengthened landlord accountability, support for landlords to facilitate repairs, centering families’ voices, and advocacy. Conclusions: This study underscores the persistent challenges caregivers face in managing asthma triggers in subsidized housing. The findings highlight the critical need for improved housing conditions, greater landlord and housing authority accountability, and policy reforms to ensure consistent, equitable, and sustainable healthy housing services that reduce pediatric asthma disparities. Full article

Sleep disturbances are prevalent among children receiving pediatric palliative care (PPC) and have a substantial negative impact on the quality of life of both patients and their families. This scoping review aims to examine further key factors contributing to sleep disturbances in PPC by analyzing available clinical studies, focusing on child-related aspects such as pain, repositioning, and epilepsy, as well as environmental factors such as light, noise, and the care setting. In addition, we discuss the critical role of interdisciplinary collaboration in improving sleep outcomes for this population and provide clinical implications. Future research should prioritize developing evidence-based interventions to optimize sleep and enhance the well-being of children with PPC needs and their caregivers. Full article

Background/Objectives: Home care plays a crucial role in contemporary healthcare systems, particularly in the long-term care of people with chronic and progressive illnesses. Family caregivers often experience substantial physical, emotional, and organizational burden. Telemedicine and digital health applications have the potential to support home care by improving health monitoring, communication, and care coordination. However, their use among family caregivers remains inconsistent, and little is known about how organizational support structures such as telemedicine centers influence acceptance and everyday use. This study aims to examine the benefits of telemedicine in home care and to evaluate the role of telemedicine centers as supportive infrastructures for family caregivers. Methods: A mixed-methods design was applied. Quantitative data were collected through an online survey of 58 family caregivers to assess the use of telemedicine and digital health applications, perceived benefits, barriers, and support needs. This was complemented by an in-depth qualitative case study exploring everyday caregiving experiences with telemedicine technologies and telemedicine center support. A systematic literature review informed the theoretical framework and the development of the empirical instruments. Results: Most respondents reported not using telemedicine or digital health applications in home care. Among users, telemedicine was associated with perceived improvements in quality of care, particularly through enhanced health monitoring, improved communication with healthcare professionals, and increased feelings of safety and control. Key barriers to adoption included technical complexity, data protection concerns, and limited digital literacy. Both quantitative findings and the qualitative case study highlighted the importance of structured support. Telemedicine centers were perceived as highly beneficial, providing technical assistance, training, coordination, and ongoing guidance that facilitated technology acceptance and sustained use. Conclusions: Telemedicine and digital health applications can meaningfully support home care and reduce caregiver burden when they are embedded in supportive socio-technical structures. Telemedicine centers can function as central points of contact that enhance usability, trust, and continuity of care. The findings suggest that successful implementation of telemedicine in home care requires not only technological solutions but also accessible organizational support and targeted training for family caregivers. Full article

The efforts to achieve early detection of autism spectrum disorders (ASD) are becoming increasingly important due to the high prevalence that continues to persist globally. The World Health Organization (WHO) and other official institutions agree that in marginalized regions, it is urgently necessary to develop effective alternatives and methods to improve the quality of life of children and their families. This study presents an integrated model for the early detection of ASD, based on the analysis of parental observations and supported by validated diagnostic tools. The proposed approach consists of four sequential modules, aiming to improve early detection through techniques such as natural language processing (NLP) and machine learning (ML) metrics. Records from two Latin American countries were standardized, thereby consolidating a single database comprising 153 records of children aged 2 to 6 years. The Parent Interview Instrument (PII) was administered by specialists to caregivers and subsequently compared with standardized tests. Encouraging results were obtained from the support vector machine (SVM) classification algorithm, yielding an accuracy range of 89.88–91.34%, a maximum precision of 90.02%, a recall of 89.02%, and a maximum F-measure of 91.12%. The results of the case study allow us to identify disorders related to autism, such as the repetition of behaviors, difficulties in social interaction, and issues with verbal expression. This contribution aligns with the United Nations Sustainable Development Goal 3, which promotes health and well-being. Full article

Background/Objectives: Fever and pain are among the most common symptoms in pediatric infections and chronic diseases, causing significant discomfort for children and concern for caregivers. Effective management is essential to relieve distress while avoiding overtreatment or undertreatment. Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), particularly ibuprofen, are the primary antipyretic and analgesic agents in pediatric care, but their use in children with chronic conditions might be challenging. Methods: A narrative review and clinical expert judgment were used to synthesize current evidence on the use of paracetamol and NSAIDs (especially ibuprofen) in children with some common chronic diseases. Results: Paracetamol is often considered a first-line option in several chronic conditions. Caution is warranted in children with pre-existing malnutrition, obesity, and neuromuscular disorders as these factors might increase the risk of hepatotoxicity. NSAIDs provide additional anti-inflammatory effects and comparable analgesic efficacy but should be used cautiously in some high-risk populations due to potential gastrointestinal, renal, and bleeding complications. Their use is contraindicated in children with dehydration, renal impairment, nephrotic syndrome relapses, while careful risk-benefit assessment is required in small and vulnerable neonates. Some data also suggests NSAIDs may worsen outcomes in certain acute bacterial and viral infections. Data on chronic infections such as tuberculosis, HIV, and viral hepatitis are limited, highlighting the need for further research. Combination therapy with paracetamol and ibuprofen may enhance analgesia in postoperative settings without significantly increasing adverse events. Overall, available evidence is limited and largely observational. Conclusions: This narrative review synthesizes current evidence and clinical expertise to provide practical guidance on the rational use of paracetamol and NSAIDs in children, emphasizing individualized therapy according to comorbidities, risk factors, and clinical context, particularly in vulnerable populations. A risk-adapted, evidence-based approach ensures optimal symptom control while minimizing harm, supporting safer, more effective, and family-centered care for children with fever and pain. Full article

The current study explores the social experiences of adolescent and transition-age youths with intellectual disabilities (IDs) and the support mechanisms available to these groups in Saudi Arabia. This study adopts a qualitative methodology with a semi-structured interview constituting the data collection method involving 13 parents with children aged between 11 and 19 years, a critical adolescent period and transition to early adulthood. The results suggest that family, caregivers, community, friendships, and healthcare providers play important roles that impact the quality of life for these groups. The main challenges identified include health-related issues, employment challenges, educational barriers, insufficient services, inadequate community participation, and limited social relationships, with special emphasis on obstacles linked to transition during the 18 to 19-year period when youths must navigate transfers from pediatric to adult services and changes associated with legal rights. This study highlights several reasons it is important to increase awareness and education, while also continuing to improve support systems aimed at dealing with both transition challenges and adolescent needs. The results further illustrate that although support from family provides the foundation for care, systemic changes are needed to promote social inclusion and reduce stigma during critical development periods. The current study contributes to the limited research related to IDs in the context of the Middle East, with special reference to Saudi Arabia. Finally, the discussion highlights several insights that are culturally specific for the development of policy and provision of services associated with the transition from adolescence to early adulthood. Full article

Heart failure (HF) and chronic kidney disease (CKD) are prevalent conditions in older adults, often coexisting and significantly increasing the risk of hospitalization, cardiovascular events, and mortality. Traditional hospital-based care, while essential for acute management, is often insufficient to ensure continuity of care and optimal long-term outcomes. Home-based care, although promising for improving quality of life and reducing hospital-acquired complications, faces challenges related to treatment adherence, monitoring, and caregiver support. Recent evidence highlights the potential of multidisciplinary, patient-centered care models integrating physicians, nurses, pharmacists, and family caregivers. Technological innovations, including telemedicine, remote monitoring, mobile health applications, and artificial intelligence, have shown efficacy in early detection of clinical deterioration, improving adherence, and reducing cardiovascular events in HF and CKD patients. Structured patient education, caregiver training, and proactive follow-up are key elements to optimize transitions from hospital to home and to improve long-term outcomes, including reduced rehospitalizations and better quality of life. Future care strategies should focus on personalized, integrated approaches that combine technology, education, and multidisciplinary collaboration to address the complex needs of HF and CKD patients, while mitigating healthcare costs and enhancing overall patient well-being. Full article