Search Results (988)

Background/objectives: Involving parents in the care of hospitalized children can improve outcomes for both patients and families. Our team previously developed a unit-level model of family integrated care that supports families as key members of the neonatal intensive care team. However, the model’s suitability for general inpatient pediatric settings has not yet been explored. To proactively plan for adapting and implementing a feasibility and pilot study of this model in these settings, we examined healthcare professionals’ perspectives on optimizing family integrated care by identifying potential barriers to implementation. Methods: We conducted one-on-one semi-structured interviews with ten healthcare professionals along with observational site visits in three general inpatient pediatric units at a large tertiary pediatric hospital in Western Canada. We analyzed data using thematic analysis. Results: On average, participants in our study were 35.9 years old, reported 12.2 years of experience in healthcare, were predominantly female, and came from diverse disciplines, and reported substantial healthcare and unit experience. Several themes emerged from the interviews and site observations: resource constraints, workforce challenges, siloed team members, challenges to integrating families in care teams, diverse populations of patients and families, communication barriers, and workflow constraints. Participants indicated these themes may influence integration of families in care in general inpatient pediatric units. Conclusions: Our identification of key barriers to integrating families in care offers practical guidance for adapting and implementing family-integrated care in general inpatient pediatric settings. Full article

The major subtypes of leukemia show sex differences. This review summarizes current knowledge and identifies gaps regarding sex differences across acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, and chronic lymphoblastic leukemia in epidemiology, mortality and survival rates, risk factors, and epigenetic, metabolomic, and sex-specific patterns. Males have higher incidence and mortality rates of leukemia compared to females, emphasizing the importance of biological sex. Underreporting of sex differences in leukemia is highlighted, suggesting that sex is often overlooked as a research variable. A significant clinical observation is that women demonstrate higher overall survival rates but experience more severe treatment-related toxicity. Clinically, women tend to survive longer but experience more severe side effects. In contrast, a significant clinical observation in pediatric leukemia contradicts this enigma, suggesting that sex differences may be less pronounced during childhood. These differences play a significant role in how the disease develops. This review presents a sex-based perspective for hematological and biochemical patterns, genetic risk factors, environmental, lifestyle, and parental risk factors, epigenetics and metabolites. Furthermore, males and females might have different responses to the same toxic, environmental, and hormonal exposures. Trying to understand these disparities better based on molecular mechanisms is considered an approach for precision medicine. Full article

Whilst there has been substantial attention to care-experienced parents’ needs and experiences in the academic literature internationally, understandings of nascent services, their characteristics and implementation processes are more limited. With an overarching socioecological resilience systems framing and drawing on an innovation perspective, we aim to develop understanding of how to design and develop innovations to enable care-experienced parents’ successing. We conducted a narrative literature review that included 33 sources published internationally between 2017 and 2025. We conducted thematic analysis to identify adversities experienced by and innovations developed for care-experienced parents. We authenticated the themes in a workshop with members of the practice community and developed frameworks to represent the themes. Findings are represented in three sections. First, we consider parental needs, with an overview of adversities experienced by care-experienced parents together with individual protective factors and required service responses, framed by psychological, social and structural domains. Second, drawing upon such understanding, we consider intervention design, with a focus on exemplar innovations and the characteristics that are represented by five service delivery models: therapeutic; social; partnership; advocacy; and co-production. Third, with a need to ensure that service intervention is effective, we examine the process of developing service innovations and consider five dynamic ingredients that enable implementation success: shared leadership; receptivity of context; co-production; learning and adaption; and outcome measurement. Our review contributes new understanding to inform processes of designing and implementing innovations to enable care-experienced parents’ successing. We offer a framework that represents a starting point towards enabling care-experienced parents’ successing that can be applied in policy and practice, although more research is needed. Full article

Introduction: Parents of children presenting global developmental delay (GDD) need to be involved in their therapy to intensify treatment. Vojta therapy (VT) is an intensive physiotherapeutic treatment that can be administered at home. Whilst parental experience of Home-Based Program (HBP) for preterm or cerebral palsy is well documented, there is a lack of understanding about parents of GDD children on HBP with VT. Objectives: The aim of this work was to describe parents’ perspectives concerning their participation in, concerns with, and perception of the results of an HBP with VT. Methods: A qualitative case design based on an interpretative approach was presented. A purposeful sampling was used. Data was collected in two stages: firstly, semi-structured interviews, and secondly, photo-elicitation. An inductive thematic analysis was used. Results: Seventeen parents were included. Three themes emerged from parents’ perspectives. Firstly, parents’ active participation in VT, which includes their desire to become an active agent to contribute to their child’s improvement, their implication of compromise, learning process, time required, effort, and factors that influence their adherence and continuity. Secondly, parents’ perception of the results achieved: motor improvement and better resting, feeding, and breathing; and time and commitment required to achieve them. Thirdly, parents’ initial concerns about suitability, daily implementation, therapy functioning, or evidence, as well as concerns about emotional bonds. Conclusions: Parents universally perceive that their commitment and efforts were rewarded. They recognized that the emotional bond with their child was strengthened by the therapy. The results regarding the beneficial effects perceived by the parents should be treated with caution, as no instruments for assessing the effect or efficacy were used in this study. 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

Background and Objectives: Paediatric palliative care in Romania is underdeveloped and unevenly distributed, which creates major difficulties in accessing services for children with life-limiting illnesses and their families. The lack of a dedicated national strategy, the shortage of specialised staff, and socio-economic barriers exacerbate the vulnerability of these groups. This study aimed to explore parents’ and caregivers’ experiences, to analyse the perspectives of public institutions and NGOs involved in supporting these children, and to identify the main barriers and facilitators in accessing paediatric palliative care. Materials and Methods: Given that all data were collected exclusively through focus group discussions, this study employed a qualitative design based on three focus groups guided by a semi-structured interview guide. The analysis was conducted using MAXQDA software, which enabled the coding and synthesis of emerging themes. Participants were parents/caregivers of children with life-limiting illnesses, representatives of public institutions, and members of relevant NGOs in Bacău County, Romania. Purposive sampling was used to capture diverse and experience-based perspectives, resulting in a total of 24 participants across three focus groups—parents and caregivers (n = 11), public institution representatives (n = 7), and NGO representatives (n = 6). No individual semi-structured interviews were conducted. Results: The analysis highlighted a complex typology of medical, emotional, social, educational, and spiritual needs of children and their families. Parents reported experiences of abandonment in the curative system, emphasising the importance of pain control, safety, and community support. Public institutions acknowledged the lack of skills and inter-sectoral coordination, while NGOs pointed to structural barriers and the low visibility of these children. Major needs include access to specialised care, psychological support, respite services for carers, financial and administrative assistance, education, and spiritual counselling. A significant obstacle is the lack of up-to-date statistical data needed to inform public policy. Conclusions: Paediatric palliative care should be considered a national priority through the development of a dedicated strategy, the expansion of specialised services, and the strengthening of partnerships between the public and non-governmental sectors. An integrated, child- and family-centred approach addressing the medical, social, emotional, and spiritual dimensions of care is essential. The results highlight the need for continuous staff training, information campaigns, and community support mechanisms to reduce inequalities and improve the quality of life of children with life-limiting illnesses. Full article

The cosmetics industry is experiencing dynamic growth, which poses significant environmental challenges, primarily due to the accumulation of cosmetic ingredients in aquatic and soil ecosystems. In response, sustainable solutions aligned with the principles of the circular economy and the concept of “clean beauty” are increasingly sought. One promising approach is the use of bioferments obtained through the fermentation of plant raw materials from the Asteraceae family as alternatives to conventional extracts in cosmetic formulations. This literature review provides up-to-date insights into the biotechnological transformation of Asteraceae plants into cosmetic bioferments, with particular emphasis on fermentation processes enabling enzymatic hydrolysis of glycosylated flavonoids into aglycones, followed by their conversion into low-molecular-weight phenolic acids. These compounds exhibit improved local skin penetration (i.e., higher local bioavailability within the epidermal barrier) compared to their parent glycosides, thereby enhancing antioxidant activity. The analysis includes evidence-based data on the enzymatic hydrolysis of glycosidic flavonoids into free aglycones and their subsequent conversion into low-molecular-weight phenolic acids, which exhibit improved antioxidant potential compared to unfermented extracts. Furthermore, this narrative review highlights the role of lactic acid bacteria and yeast in producing bioferments enriched with bioactive metabolites, including lactic acid (acting as a natural moisturizing factor and preservative), while emphasizing their biodegradability and contribution to minimizing the environmental impact of cosmetics. This review aims to provide a comprehensive perspective on the technological, dermatological, and environmental aspects of Asteraceae-based bioferments, outlining their potential as sustainable and functional ingredients in modern cosmetics. Full article

Background: Obesity is a chronic disease that has negative health consequences for children. Peer support models have been used to manage chronic diseases like diabetes; however, little is known about how a peer support intervention might promote healthy infant growth to prevent pediatric obesity. The aim of this project was to explore parental perspectives on how a peer support intervention might be developed to support healthy infant weight gain and nutrition. Methods: Data were collected from November 2022 to October 2023 at a single pediatric primary care clinic. Semi-structured interviews explored parents’ perspectives of how a peer parent coach could promote healthy infant nutrition and growth. Interviews focused on (1) common infant feeding and nutrition questions, (2) the role and importance of peer support during the newborn period, and (3) strategies for addressing and facilitating connections to food-related resources and addressing food insecurity. Results: A total of 18 interviews were conducted. Average parental age was 32.1 years (range 20–46 years). Thirty-three percent of the participants identified as Black, 28% identified as White, 11% identified as Asian, and the remaining identified as Other or preferred not to report. Half of the sample reported a household income of <$20,000, 67% reported having public insurance, and 11% reported household food insecurity. Themes that emerged included: peer parent coaches can (1) provide emotional support to families with young infants, (2) education focused on infant nutrition, and (3) facilitate connections with nutrition resources. Participants also noted the importance of understanding a family’s unique culture when counseling on infant growth and nutrition. Conclusions: Multiple themes were identified about how a peer support intervention could support healthy infant nutrition and growth. Future work should test the feasibility and acceptability of a peer support intervention to promote healthy infant weight gain. Full article

Karstic regions are globally distributed, and the soil-forming parent rocks and their weathering process primarily cause elevated geochemical heavy metal (HM) accumulation in karst soils. However, the patterns of HMs, the genes related to resistance, and their interactions in karstic soils developed from different parent materials remain unexplored. In this study, 36 field karst soil samples originating from two parent materials were collected, including 19 samples from the residues of the weathering and leaching of carbonate rocks (Car) and 17 samples from Quaternary sediments (Qua). In the Car soils, the levels of As, Cd, Cr, Zn, Cu, Ni, and Pb exceeded the risk screening values for soil contamination of agricultural land set by the Chinese standard GB15618-2018 by 100%, 100%, 94.11%, 64.71%, 64.71%, 47.06%, and 41.18%, respectively, while only 11.76% of As in Qua soils exceeded the risk screening values. The proportion of metal resistance genes (MRGs) and antibiotic resistance genes (ARGs) in Car soils was significantly higher than that in Qua soils. However, HM content had a significantly positive correlation with Nemerow integrated pollution index (NIPI), individual HM-related genes, MRGs, ARGs, and mobile genetic elements (MGEs) in Qua soils, respectively. Although the corresponding correlation was positive in the Car soils, it was not statistically significant. Results demonstrated that microbial activity was more crucial for the accumulation of HMs in Qua soils compared with Car soils. Meanwhile, our in-depth research also provides new perspectives to establish a more rational ecological assessment for the elevated HMs by identifying applicable and valid biomarkers from functional genes, which is vital in contamination monitoring, prevention, and standard establishment in agricultural soils of karst regions. Full article

People’s conceptions of the future influence their willingness to engage in sustainability-oriented actions today. A sense of moral responsibility toward both past and future generations may also be linked to greater interest in sustainability. This study explores how members of Generation Z (Gen Z) and their parents conceptualize the future, including their views on intergenerational justice and sustainability. Using semi-structured interviews with 11 Gen Z–parent pairs, we examined how ideas about the future are formed, transmitted, and expressed. Thematic analysis revealed that Gen Z participants most frequently framed the future in terms of economics, technology, and social dynamics, with environmental concerns mentioned occasionally but not as a dominant theme. Compared to their parents, Gen Z expressed distinct priorities—including creating opportunities for future generations—and used different language to describe future possibilities. We develop the concept of the lexicon of futures thinking—the specific terms, metaphors, and conceptual categories used to articulate visions of the future—as a tool for understanding and engaging youth perspectives. These findings offer insights into how educators and advocates can more effectively connect with Gen Z on sustainability issues by aligning with their values and linguistic framing. Full article

In the realm of children’s education, multimodal large language models (MLLMs) are already being utilized to create educational materials for young learners. But how significant are the differences between image-based fairy tales generated by MLLMs and those crafted by human authors? This paper addresses this question through the design of multi-dimensional human evaluation and actual questionnaire surveys. Specifically, we conducted studies on evaluating MLLM-generated stories and distinguishing them from human-written stories involving 50 undergraduate students in education-related majors, 30 first-grade students, 81 second-grade students, and 103 parents. The findings reveal that most undergraduate students with an educational background, elementary school students, and parents perceive stories generated by MLLMs as being highly similar to those written by humans. Through the evaluation of primary school students and vocabulary analysis, it is further shown that, unlike human-authored stories, which tend to exceed the vocabulary level of young students, MLLM-generated stories are able to control vocabulary complexity and are also very interesting for young readers. Based on the results of the above experiments, we further discuss the following question: Can MLLMs assist or even replace humans in writing Chinese children’s fairy tales based on pictures for young children? We approached this question from both a technical perspective and a user perspective. Full article

There have been many evaluations of specific parent programs, but there is minimal evidence of evaluation of the broader landscape of established advice or support services for parents of children under 18 years old. This paper investigates parent/carer perceptions of support services in their case study city. We explore and examine their perspectives on existing support services and how far they are meeting their needs. Through a thematic analysis of semi-structured interviews with parents and carers from across the city, a range of key themes emerged. These included the supportive environment and positive ethos of services accessed, lack of trust in some professionals, and perceived gaps in provision, highlighting the need for more activities, support, and accessible information, especially for families with special educational needs and disabilities (SEND). These findings underscore the complexity of navigating the landscape of support services and advocate for more coordinated, accessible, and trustworthy support systems for parents and carers. Full article

Aim: Assess transition readiness of adolescents with Type 1 Diabetes (T1D) from adolescent, parental, and clinician perspectives. Methods: Cross-sectional study (n = 36, 20 Male/16 Female, 16–18 years, June 2023–June 2024, metropolitan paediatric centre). Adolescents had diabetes knowledge, self-efficacy, and diabetes distress measured. Parents had an assessment of knowledge, diabetes-related distress, and estimated the adolescent’s self-efficacy. Clinicians estimated adolescent self-efficacy. Results: Median HbA1c was 7.4% (IQR 6.6–8.4). One adolescent met the guidelines for multidisciplinary team (MDT) appointments. Paired sample t-tests showed that adolescents’ knowledge was comparable to parent levels (t(24) = −1.69, p = 0.10). Adolescents’ knowledge was strongly associated with higher self-efficacy (r = 0.80 p < 0.001). Higher adolescent self-efficacy was associated with lower adolescent distress (r = −0.368, p = 0.03). Adolescent distress was lower than parent distress (t(24) = −3.13, p = 0.005). Although adolescent self-efficacy was strongly correlated with parent and clinician evaluation (r = 0.76, p < 0.001; r = 0.80, p < 0.001), adolescents reported higher self-efficacy than estimates by parents (t(24) = 4.76, p < 0.001) or clinicians (t(24) = 8.39, p < 0.001). Parent knowledge was moderately correlated with adolescent self-efficacy (r = 0.62, p = 0.001). Conclusions: Diabetes knowledge may confer greater self-efficacy and reduce diabetes distress in adolescents. Distress levels are higher in parents than in adolescents. Engagement with MDT is poor. Transition efforts should focus on parents and adolescents while increasing engagement with MDT. Full article

Use of assisted reproductive technology (ART) to bear children has in recent years become widespread in Japan. While midwives are required to understand the experiences of individual women and provide ongoing support for them, implementing respectful care that meets the needs of women using ART remains challenging. This study therefore aimed to explore the specific care components expected of midwives for women with twin pregnancies after ART. A cross-sectional questionnaire survey was conducted through Google Forms on 273 women with twin pregnancies, of whom 85 had conceived twins through ART. Women were recruited through national multiple birth support groups and midwifery centers providing postnatal care. Data were collected from July 2021 to December 2022, and care expectations were rated on a 5-point Likert scale. Factor analysis was performed to identify care components, and reliability was evaluated using Cronbach’s alpha. Among the participants, 41.2% were between 36 and 40 years of age. Seven primary care factors were identified: comprehensive parenting support for twins, addressing concerns regarding the sudden death of twins, interdisciplinary medical collaboration, connecting women with twin pregnancies, understanding post-delivery physical pain, providing continuity before and after delivery, and supporting the development and well-being of the twins. The findings emphasize the importance of understanding individual ART histories and providing tailored care to respond appropriately to women’s needs during pregnancy, childbirth, and the postpartum period. The identified components provide an empirical foundation for integrating these perspectives into routine midwifery care and educational programs for women with ART-conceived twin pregnancies. Full article

While many paediatric patients have a penicillin allergy label, most do not have a true allergy. The penicillin allergy label is associated with a lifetime risk of avoidable use of broad-spectrum antibiotics, higher healthcare costs, and poorer clinical outcomes. In this review, we present different types of penicillin allergies, de-labelling approaches, and significance on paediatric patients. We also discuss parental perspectives regarding penicillin de-labelling in the emergency setting. We highlight that despite the challenges posed by barriers such as overcrowding and the need for quick patient turnover in the PED, the availability of resources and expertise in managing potential allergic reactions makes the PED an ideal environment where PCN de-labelling can be both feasible and effective. We show that further education of both parents and healthcare professionals is essential to overcoming misconceptions, alleviating safety concerns, fostering trust in the de-labelling process, and normalising de-labelling in the PED. Full article