Search Results (173)

Informal waste picking and scrap collection constitute critical yet highly precarious livelihood strategies among economically marginalised women in rural South Africa. This article presents a cross-sectional mixed-methods study, guided by Sen’s Capability Approach as its analytical framework, examining the lived experiences, motivations, and livelihood outcomes of 126 Black African women engaged in scrap collection along the N2 Highway in the Eastern Cape, specifically in Mthatha, Xhora, and Qumbu. The study integrates quantitative descriptive statistics with qualitative thematic analysis derived from structured interviewer-administered questionnaires. The findings indicate that participation in scrap collection is overwhelmingly driven by structural economic constraints, including chronic unemployment, household poverty, and extensive caregiving responsibilities, rather than autonomous occupational choice. The sample is characterised by limited educational attainment, frequently disrupted by poverty, bereavement, early marriage, and early caregiving roles, which collectively constrain access to formal employment opportunities. Participants consistently described scrap collection as physically hazardous, economically insecure, and detrimental to both physical health and psychosocial wellbeing, while remaining indispensable for household survival. Through the lens of the Capability Approach, these conditions reflect severe restrictions in substantive freedoms, particularly in relation to economic security, bodily health and human dignity. Expressions of acceptance are interpreted as manifestations of adaptive preferences formed under conditions of prolonged structural deprivation rather than indicators of genuine agency. The study contributes to informal economy scholarship by demonstrating how intersecting structural inequalities constrain capability sets and limit livelihood trajectories and calls for targeted policy interventions to enhance occupational safety, income security and access to sustainable livelihood alternatives. Full article

Background: Antimicrobial resistance, driven by inappropriate use and overuse of antibiotics, is a major public health threat. Diarrhea and respiratory illness are the leading causes of pediatric healthcare visits in low- and middle-income countries like Bangladesh. Despite clear WHO guidelines recommending limited use of antibiotics for these conditions, potentially inappropriate or non-prescription antibiotic use remains a concern. Methods: We interviewed caregivers of 3025 under-5 children via cellphones to assess common illnesses, associated care-seeking practices, and antibiotic use for diarrhea and respiratory illnesses experienced by their children in the prior 14 days. Caregivers were identified through hospital outpatient screening and were contacted over the phone for the interview at least two months after that hospital visit. Results: Among the participants, 116 (3.8%) reported diarrheal disease and 570 (18.8%) experienced respiratory illness during the preceding 2-week recall period. Among the children with diarrhea, 52.6% received antibiotics, and 73.8% obtained them over the counter from pharmacies. Among those with respiratory illness, 26.3% received antibiotics, and 58% procured them from local drugstores without a prescription from a registered physician. For diarrhea, azithromycin and metronidazole were the commonly used antibiotics, while for respiratory illness, cefixime and azithromycin were frequently used. Notably, 68% of the diarrheal children either sought care from local drugstores, were self-medicated, or did not receive any formal treatment. Conventional practice, long wait times at healthcare facilities, distance, and poverty were the main reasons for not seeking care from a registered healthcare provider. Conclusions: Understanding community-level antibiotic use and care-seeking behavior is essential to strengthening antibiotic stewardship and child health programs. Our findings suggest the need for context-sensitive community education, improved access to appropriate care, and enforcement of regulations restricting the over-the-counter sale of antibiotics to curb irrational and excessive antibiotic use. Full article

Background and Objectives: Child dental neglect is a clinically significant form of maltreatment that frequently reflects broader challenges related to caregiving within the family environment. Although oral manifestations have been described in prior research, the socio-behavioral profile of responsible caregivers remains insufficiently characterized, particularly in Central and Eastern European contexts. This study aimed to identify caregiver-level socio-behavioral characteristics associated with child dental neglect and to examine their relationships with clinical outcomes. Materials and Methods: A retrospective cross-sectional analytical study was conducted on 333 children (aged 4–17 years) diagnosed with dental neglect, presenting at a municipal hospital and a private dental practice in Oradea, Romania (2020–2024). Caregiver-level variables included age, educational attainment, socioeconomic status, health condition, substance use, and family structure. Associations were analyzed using Fisher’s Exact Test, Pearson Chi-Square, and Mann–Whitney U test, with Bonferroni correction applied where appropriate. Results: Most caregivers were young adults (93.1%), with low educational attainment (40.2% had no formal schooling) and high rates of alcohol use (47.1%). Low family income was present in 89.2% of cases and was significantly associated with non-adherence to the dental treatment plan (p  =  0.039). Caregivers without formal education were associated with neglect in rural areas (43.4% vs. 26.2%; p  <  0.001). Children of drug-using caregivers were significantly older at presentation (median: 12 vs. 8 years; p  =  0.014), and caregiver drug use was more prevalent in urban settings (18.0% vs. 1.8%; p  <  0.001). Over half of the children (52.9%) came from disrupted family environments. Conclusions: Dental neglect was consistently associated with young, poorly educated, and financially disadvantaged caregivers exhibiting high rates of substance use and unstable family structures. These factors may interact in complex ways, highlighting the multifactorial nature of dental neglect. Dental professionals are well positioned for early identification and have a professional and ethical responsibility to integrate child safeguarding into routine clinical practice. Full article

Alzheimer’s disease (AD) results in progressive neural degeneration that causes cognitive and non-cognitive symptoms (NCSs). While cognitive symptoms commonly prompt a formal diagnosis, NCSs also contribute significantly to disability, caregiver burden, and overall disease progression. NCSs are rooted in both physiological and psychological consequences of AD, resulting in apathy/motivation loss, emotional dysregulation, anxiety, depression, agitation, and sleep disturbances. Despite progresses in pharmaceutical management of NCSs, variable efficacy, unwanted side effects, and lack of symptom-wide effectiveness often limit therapeutic practicality for people with AD, suggesting a need for the identification of practical adjunctive treatments. Mechanistic evidence of using music interventions as complementary treatment to manage cognitive symptoms in AD has been established, but the potential benefits for NCSs are less clear. Music interventions have the potential to adaptatively alter mechanisms underlying NCSs that span both physiological and psychological domains of symptomology. Physiologically, music has been shown to alter autonomic activity, neurotransmitter release in various brain regions, and mediate hormonal regulation. Psychologically, music interventions have been shown to enhance mechanisms related to motivation, emotional regulation, and resilience to mental stress. Behavioral and neuroimaging evidence further supports this and suggests that the mechanisms of music-induced benefits may aid in counteracting NCSs in people with AD. While the neuromechanistic rationale for music-induced benefits towards NCSs in AD is promising, findings are largely fragmented, leaving therapeutic application difficult. Accordingly, the purpose of this review is to integrate current mechanistic evidence and clinical findings for a rationale and framework for the therapeutic application of music interventions to combat NCSs in AD. Overall, evidence largely supports the use of music as an adjunctive, feasible, and non-invasive therapeutic tool to improve various aspects of NCSs in AD. The translation of mechanistic findings to therapeutic utility are further highlighted. Limitations, challenges, and future directions necessary to fully realize music benefits on NCSs in AD are also discussed with a goal of therapeutic translation. Full article

Introduction: Disability in South Africa remains a key driver of socioeconomic inequality, affecting labour market participation, income security, and access to social protection. Conventional fiscal instruments, including medical tax credits and deductions, favour formally employed, higher-income taxpayers, leaving many persons with disabilities fiscally excluded. This study used a mixed-methods secondary analysis of peer-reviewed literature, policy documents, labour force data, disability grant records, and household cost estimates to develop a conceptual framework for disability-responsive fiscal inclusion. Results: Labour force data indicate that 10.2% of individuals outside the labour force are due to illness or disability, while discouraged jobseekers rose from 15.2% (2016) to 20.6% (2025). Households with severe disabilities face opportunity costs estimated at R2441 per month from lost earnings, caregiving, transport, and medical expenses. Disability grant patterns show male dominance in permanent disability grants for ages 18–45, with females surpassing males at 50–60. Temporary disability grants follow similar trends, with male predominance in the 18–35 age range and female predominance in the 40–60 age range. These findings reveal systematic gender- and age-related inequities in access to fiscal relief. Conclusions: Existing tax measures insufficiently address the financial burden of disability, disproportionately favouring urban, formally employed households. Implementing refundable tax credits, simplifying administrative processes, and adopting gender- and age-sensitive policies can enhance fiscal inclusion, reduce inequities, and strengthen economic participation for persons with disabilities in South Africa. This study proposes a framework to guide policymakers in implementing refundable disability tax credits, simplifying administrative processes, and targeting vulnerable groups, including older women, rural households, and low-income earners, to enhance fiscal inclusion, equity, and access to essential services. Full article

Youth are increasingly struggling with mental health, yet many lack access to formal care. Evidence indicates that building coping skills can improve mental health and wellbeing. School personnel may be well-positioned to help youth build these coping skills by delivering discrete evidence-based ingredients in their everyday interactions and relationships with students. This scoping review synthesizes the literature on social-emotional evidence-based ingredients delivered by paraprofessionals and explores their potential application in school behavioral health. We searched PsycINFO and PubMed, screened 200 titles/abstracts and 46 full-texts, and yielded 19 studies from which we synthesized data using the RE-AIM framework. We identified 17 evidence-based ingredients, with the most common being mindfulness, relaxation, psychoeducation, exposure, and cognitive restructuring. These were delivered in various formats and settings by different paraprofessionals (e.g., graduate students, teachers, caregivers), with most paraprofessionals receiving some training and supervision. Thirteen studies showed significant improvements in at least one outcome (i.e., anxiety, depression, suicidality, wellbeing). Six studies examined long-term effects, with mixed findings. Despite variation in delivery and training, paraprofessionals appear to feasibly and effectively deliver evidence-based ingredients. These findings support task-shifting ingredients as a scalable approach for supporting youth mental health within school behavioral health systems. Full article

Background/Objectives: People aged 65 years and older who live alone and have limited functional abilities need support in many circumstances and for a variety of activities. This study was conducted to explore the available formal and informal help for seniors, using findings from the “Inclusive Ageing in Place” (IN-AGE) study. Methods: This descriptive study was carried out in 2019 in three Italian regions, i.e., Lombardy in the north, Marche in the centre, and Calabria in the south, and involved 120 older people who lived at home, either alone or with a personal/private care assistant (PCA). Using a mixed-methods approach revealed both qualitative (thematic/content analysis of narratives) and quantitative (quantifications of statements) results. Results: This study identified several needs of seniors in different circumstances concerning basic and instrumental activities of daily living (ADL and IADL), health, and mobility in/outside the home. The seniors reported that support was provided primarily by their families, followed by friends and neighbours. Public home services were considered insufficient. The participants also reported using mobility aids and instances of self-sufficiency. Conclusions: These results highlight the need to improve support services for frail seniors and to better integrate formal and informal caregiving to facilitate ageing in place and promote the well-being of older people. Adequate interventions should be implemented for both older people and their family caregivers, who play a central role in care. Full article

Background/Objectives: During the first COVID-19 lockdown, the sudden disruption of formal care services substantially increased reliance on informal caregiving. Emerging evidence suggests that increased caregiving demands may have contributed to a higher burden of mental-health-related temporary work disability; however, population-based data from occupational health systems remain limited. This study aimed to quantify and characterise, descriptively, the sociodemographic, clinical, and territorial characteristics of mental-health-related temporary work disability among workers with informal caregiving responsibilities in Spain during the first COVID-19 lockdown, and to descriptively examine differences between episodes occurring among workers with and without caregiving responsibilities. Methods: A retrospective descriptive study was conducted using anonymised nationwide occupational health records from Mutua Asepeyo. All episodes of temporary work disability certified for mental and behavioural disorders (ICD-10 F00–F99) between 14 March and 21 June 2020 were analysed. Caregiver status was determined based on documented informal caregiving responsibilities recorded within the occupational disability records. Sociodemographic, occupational, clinical, and territorial variables were examined using descriptive statistics and non-parametric tests. Results: A total of 2857 caregiver-associated episodes were identified, representing 55.6% (95% CI: 54.2–57.0) of all mental-health-related temporary work disability episodes during the study period. The majority involved women (68.1%) and caregivers of older dependent adults (59.3%). Generalised anxiety disorder was the most frequent diagnosis, followed by adjustment disorders and acute stress reactions, with significant differences by sex and employment regime. Marked territorial variability was observed, as well as longer durations of temporary work disability in specific regions and among women. Conclusions: A substantial proportion of mental-health-related temporary work disability episodes during the lockdown occurred among workers with informal caregiving responsibilities, particularly women and those caring for older dependents. These findings suggest that informal caregiving may be a determinant of occupational mental health during crises. However, given the descriptive and unadjusted nature of the study, no causal inferences can be drawn. Further research is needed to understand these associations better and inform future occupational health strategies. Full article

Background: Population ageing increases reliance on family caregivers (FCGs) for very old adults (80+). While caregiving is often studied as a source of burden, its impact on caregivers’ daily life and occupational balance remains underexplored. This study aimed to explore how caregiving responsibilities shape the daily lives, occupational balance, and support needs of FCGs, using the Stress Process Model (SPM) and the concept of Occupational Balance (OB). Methods: A qualitative study was conducted in the PACA region (France) within the SCOPE project. Seventeen semi-structured interviews were analysed using thematic content analysis, with independent double coding by two researchers. Results: Six themes were identified: caregiving role and identity, consequences, occupational patterns, needs, proposed actions, and barriers and facilitators. Caregiving generated both primary stressors (physical and emotional demands) and secondary stressors (role conflicts, financial strain, and social isolation). It also led to occupational imbalance, characterized by reduced leisure, diminished self-care, and reorganization of daily routines. Working FCGs reported greater role strain and time constraints, whereas retired FCGs emphasized informational needs and adaptation strategies. Across both groups, caregivers’ needs were rarely formally assessed. Conclusions: These findings highlight that caregiving for very old adults profoundly reshapes caregivers’ daily lives through both stress-related mechanisms and disruptions in occupational balance. They underscore the need for tailored, context-sensitive support strategies, including systematic needs assessment and more structured, individualized coordination approaches such as case management. Full article

Background/Objectives: Within a family-centered care framework, families of children with cerebral palsy (CP) rely on both informal and formal support systems to manage caregiving demands, yet the adequacy and perceived helpfulness of this support vary. This study aimed to examine the availability of different support sources for families of children with CP in Saudi Arabia, explore their perceived helpfulness, and evaluate the influence of child-, parent-, geographical-, and household-related characteristics on the level of family support helpfulness. Methods: A cross-sectional study was conducted among 223 caregivers of children diagnosed with CP across Saudi Arabia. The participants completed the Child and Family Questionnaire and the Family Support Scale (FSS), and the children were classified on the Gross Motor Function Classification System (GMFCS). Kruskal–Wallis H and Mann–Whitney U tests examined the differences in perceived support helpfulness across family, child, and household characteristics. Results: Spousal and kinship support were perceived as the most helpful sources, with families of children with bilateral spastic CP and more severe GMFCS perceiving less support. Overall, informal social support was significantly perceived as more helpful than formal support. Conclusions: Families of children with CP rely mainly on spouses and relatives for support, with lower perceived helpfulness among those facing greater caregiving demands, highlighting the need to improve the accessibility, coordination, and quality of support services. Full article

This study aimed to explore and describe the barriers to Antiretroviral Therapy (ART) adherence among children in Ekurhuleni, Gauteng. A quantitative, cross-sectional design using a survey method was employed. Convenience sampling was used to recruit 157 parents, guardians, and caregivers (PGCs) who consented to participate in the study. Data was collected using self-report questionnaires and analysed using descriptive statistics and frequency distributions. The study was not designed or statistically powered to formally test associations between variables; therefore, only descriptive statistical analyses were conducted. The reliability and validity of the instrument were ensured, and ethical clearance was obtained from the relevant authorities prior to data collection. The study was conducted in accordance with established ethical principles and in compliance with the Declaration of Helsinki. The findings revealed that there were multiple barriers to children’s adherence to ART. Approximately one-third of PGCs reported being fully informed about the importance of ART adherence, while the majority indicated being only partially informed. Missed doses emerged as a significant challenge, with a substantial proportion reporting missed medication on one or more days, and only 31.2% administering ART consistently on time. Difficulties in understanding blood test results were also reported. In addition, a notable proportion of PGCs admitted to missing clinic appointments. These findings emphasize the need for strengthened caregiver education, ongoing support, and tailored interventions directed at primary health care nurses to promote consistent ART adherence among children. Full article

Background: Hospice refers to specialised end-of-life care that supports patients and families, making it an important area for studying how language shapes experiences and expectations of care. This study compares hospice discourse on websites in Hong Kong and the United Kingdom, analysing how NLP-based sentiment and interpersonal features, such as personal pronouns and conjunctions, shape logical relations, structure information, and express emotion in patient narratives. Methods: Using a mixed approach that integrates sentiment analysis with Systemic Functional Linguistics (SFL), and taxonomy of conjunctions in particular, this study draws on a 52,086-word corpus from 40 hospice websites (20 from each region). The corpus analytical tool AntConc was used to identify co-occurrence, interpret log-likelihood, and perform concordance analysis. Results: The findings reveal significant differences in the digital delivery of hospice care across regions. According to our data, UK websites tend to express a wider range of personal emotions and frequently use concessive conjunctions when discussing sensitive palliative care topics. In contrast, Hong Kong websites tend to use more additive and causal conjunctions, projecting a stronger focus on institutional care. For example, Hong Kong texts tend to use formal, service-oriented connections such as “we + offer”, reflecting a more informational communicative style. However, both regions frequently use personal pronouns such as “you” and “we” to convey positive sentiment and demonstrate empathy towards patients and their caregivers. Conclusion: These patterns appear to be used strategically by hospice providers to build trust, signal alignment, and strengthen relationships tailored to each region. Lastly, this study makes an original contribution by combining computational and functional linguistic approaches to develop a systematic method for examining culturally shaped digital communication in end-of-life contexts, thereby enriching the field of healthcare discourse analysis. Full article

Neuropsychiatric symptoms in dementia impact diagnosis and caregiver burden. Informal caregivers effectively identify cognitive changes and confirm the care receiver’s symptoms. This study aims to examine the association between neuropsychiatric symptoms in primary care users with probable dementia and caregiver burden and depression, as reported by informal caregivers, and describe the most frequent neuropsychiatric symptoms in this population. This cross-sectional study included 101 primary care users aged 65+ with mental health concerns identified by their General Practitioner and informal caregivers, excluding those in institutional care, without memory concerns and an informal caregiver, or without Neuropsychiatric Inventory Questionnaire (NPI-Q) data. The sample (79.4 ± 7.7 years) was 53.5% female, 33.7% had no formal education, and 60.4% presented probable dementia per Global Deterioration Scale. The NPI-Q total score and the distress dimension score were 10.1 (sd = 5.6) and 11.9 (sd = 9.1), respectively. The most reported symptoms were agitation/aggression (69.3%) and apathy/indifference (65.3%). We found a significant positive association between NPI-Q total and Distress scores and Caregiver Burden Scale, 0.296 (p = 0.023) and 0.417 (p < 0.001), and between NPI-Q total and Distress scores and AB Clinician Depression Screen, 0.227 (p = 0.023) and 0.416 (p < 0.001). Probable dementia was linked to more neuropsychiatric symptoms and greater caregiver burden and depression. Training for caregivers can improve the quality of care and, as a result, may reduce burnout and depression. Full article

Singing-Oriented Language and Music Education (SOLME) is an accessible, low-resource pedagogical and cognitive framework in which singing serves as the primary interface through which musical activities support both first and foreign language acquisition processes. Early vocalizations in infancy make the overlap between singing and speech highly perceptible, forming a continuum rather than clearly separable domains. Child-directed speech similarly shares key features with singing—such as repetition, emotional engagement, exaggerated pitch variation and rhythm—and both input forms inherently combine musical and linguistic elements. Research has shown that the overlap between singing and language abilities persists throughout the lifespan, positioning singing as a valuable facilitator of language learning processes. Singing, integrated as a musical tool, has proven effective in enhancing key abilities for (foreign) language learning—including phonological awareness, pronunciation, and verbal memory, among others—and in supporting language functioning across diverse communication disorders, from developmental fluency challenges to acquired impairments. This entry outlines the benefits of singing as an integrated means to support musical development as well as first and second language acquisition processes. It outlines functional and structural similarities between singing and language development, from early caregiver–infant interaction to formal foreign-language instruction, and then discusses the many advantages of embedding singing as a musical tool in the (foreign) language learning process. Full article

Wheelchair provision remains an essential component of rehabilitation and participation support for children with disabilities, yet there is limited evidence on how wheelchairs are incorporated into daily activities and schooling decisions in rural low-resource contexts where environmental, social, and service constraints are substantial. This study employed a strictly exploratory multiple case study design involving two children with disabilities. Two home visits were conducted for each case, and a qualitative, descriptive cross-case analysis was conducted by integrating semi-structured interview data with WeeFIM scores and ICF Environmental Factors ratings. Wheelchair provision supported short-distance mobility and engagement in household and community activities and reduced some caregiving demands. Positive experiences during outdoor mobility and community interactions contributed to enjoyment and confidence. However, inaccessible housing, limited transportation, and family concerns about safety and readiness continued to inhibit broader independence and school enrollment. Both children remained outside formal schooling, while activities offered by Special Education Centers provided meaningful but limited opportunities for social interaction and development. The findings highlight not only practical implications but also the conceptual importance of environmental constraints and the ambivalent role of family support in shaping participation in rural settings. Full article