Search Results (295)

Background: Thailand is rapidly transitioning into an aging society, creating an intergenerational caregiving gap that strains existing support systems. Objective: This study evaluated the effectiveness of “Young Care,” a community-based intervention designed to enhance youth knowledge, attitudes, and caregiving practices (KAP) toward older adults. Methods: A two-day structured training was conducted in Maha Sarakham Province in 2023 using a pre-post mixed-methods design. Middle and high school students participated in lectures, multimedia sessions, and experiential learning activities related to caregiving. Quantitative data were collected using validated KAP questionnaires, while qualitative insights were obtained from focus group discussions involving students, older persons, caregivers, and local leaders. Results: Post-intervention analysis revealed significant improvements in knowledge and attitudes (p < 0.001), accompanied by increased empathy, caregiving initiative, and a sense of moral responsibility among participants. Conclusions: The initiative fostered formal partnerships among schools, local governments, healthcare providers, and universities through memoranda of understanding. These collaborations enabled budgetary support and outreach to out-of-school youth, positioning “Young Care” as a scalable, youth-centered strategy to address Thailand’s long-term care challenges. Full article

Background/Objectives: Pseudohypoparathyroidism (PHP) is a group of genetic disorders characterized by end-organ resistance to multiple hormones, short stature, brachydactyly, subcutaneous ossifications, obesity, and developmental delays. The tissue specific imprinting of GNAS in the hypothalamus may lead to different eating behavior phenotypes in maternally inherited (PHP1A, PHP1B) vs. paternally inherited (PPHP) variants. In this exploratory study, we aimed to evaluate differences in eating behaviors in a cohort of patients with PHP1A, PPHP and PHP1B. Methods: Assessments included caregiver-reported measures (hyperphagia questionnaire, children’s eating behavior questionnaire, child feeding questionnaire) and self-reported measures (three factor eating behavior questionnaire). Results: A total of 58 patients with PHP1A, 13 patients with PPHP and 10 patients with PHP1B contributed data, along with 124 obese pediatric controls. An increased risk of obesity was found in PHP1A vs. PPHP (adult body mass index (BMI) 39.8 ± 8.7 vs. 30.2 ± 7.4 kg/m², p = 0.03). Parents reported significantly earlier onset of interest in food in children with PHP1A (2.0 ± 2.3 years) and PHP1B (1.1 ± 1.3 years) compared with controls (5.2 ± 3.2 years, p < 0.001). Measures of hyperphagia, satiety and other feeding behaviors were all similar to controls. The highest hyperphagia questionnaire scores were seen prior to adolescence. In a multi-year, longitudinal assessment of 11 pediatric patients with PHP1A, hyperphagia scores were stable and 25% showed an improvement in symptoms. Conclusion: Patients with PHP1A/1B may have hyperphagia symptoms from a young age but they do not worsen over time. Patients may overeat when allowed access to food, but do not usually have disruptive food seeking behaviors. Early diagnosis can give clinicians the opportunity to provide anticipatory diagnosis on the increased risk of obesity in PHP1A/1B and need for scheduled meals and controlled portions. Further studies with larger cohorts are needed to confirm these findings. Full article

Background/Objective: A growing body of international research continues to show evidence of worsening youth mental health since the beginning of the COVID-19 global pandemic, yet very little research in this area has included young children under 6 years. Given the potential impact of early life stress during this critical period of development, it is crucial to better understand the effects on this age group. The objective of this study was to better understand the impact of the COVID-19 pandemic on the emotional health of very young children. Methods: This study utilized retrospective chart review of primary care records to compare the prevalence of markers of stress in two cohorts of children under the age of 6 years, comparing children presenting for care prior to the pandemic (1 April 2019–31 March 2020; control period) with those presenting for care during the first year of the pandemic (1 April 2020–31 March 2021; study period) in a large pediatric primary care clinic in Washington, DC, USA. Based on power calculations, charts of 200 patients from each cohort were reviewed and prevalence of stress markers were summarized using counts and percentages and compared between groups using chi-squared tests. Multivariable logistic regression models were also conducted for each domain adjusting for age, gender, and insurance type. Results: Overall, sleep difficulties were significantly more prevalent during the pandemic period compared to the control period (14% vs. 6.5%, p = 0.013). In addition, signs of stress presented differently across age groups. For example, during the pandemic period toddlers (13–35 months) were 13 times more likely (OR = 13, 95% CI [2.82, 60.4], p < 0.001) and preschool-aged children (36–71 months) were 18.5 times more likely (OR = 18.5, 95% CI [4.0, 86], p < 0.001) than infants to present with behavior problems, indicating substantially higher risk of externalizing symptoms in older children compared to infants. Toddlers were less likely than infants to present with mood changes (e.g., fussiness or crying) (OR = 0.15, 95% CI [0.03, 0.65], p = 0.011). In addition, toddlers (OR = 0.55, 95% CI [0.31, 0.97], p = 0.038) and preschool-aged children (OR = 0.15, 95% CI [0.06, 0.4], p < 0.001) were also less likely to present with feeding difficulties compared to infants. Conclusions: One of the very few studies of young children under 6 years (including infants) during the COVID-19 pandemic, this study found that even very young children experienced stress during the pandemic. Signs of emotional stress were identified in a primary care office during routine care, highlighting an important opportunity for early intervention and/or prevention, such as counseling and resources for caregivers, in settings where young children are already presenting for routine care. Full article

Despite high rates of emotional dysregulation among autistic children, few studies have explored interventions addressing dysregulation. Naturalistic developmental behavioral interventions (NDBIs) are a class of interventions focused on supporting social communication. As social communication and emotion regulation skills emerge from similar developmental processes, NDBIs may be one approach for addressing dysregulation among autistic children. The present study sought to characterize change in dysregulation among one-hundred and eleven caregiver–child dyads completing Project ImPACT, a caregiver-mediated NDBI. Caregivers reported on child communication and social engagement using the Social Communication Checklist and emotion regulation using the Emotional Dysregulation Inventory-Young Child at the beginning and end of services. Clinicians reported on caregiver fidelity at each intervention session. Children showed reductions in emotional dysregulation throughout Project ImPACT, though reductions were specific to children who began the program with elevated dysregulation. Child social engagement at baseline and caregivers’ fidelity to specific strategies within Project ImPACT were associated with reductions in emotional dysregulation. Very few studies have tested interventions aimed at supporting emotion regulation among young autistic children. These findings demonstrate that NDBIs may support emotion regulation as well as social communication skills. Further incorporating support for emotion regulation in NDBI may address this critical gap without increasing service coordination for families. Full article

Background/Objectives: Sexual health research involving young adolescents remains scarce despite rising rates of early sexual debut, pregnancies, and sexually transmitted infections (STIs) in this population. We explored community stakeholders’ perspectives on engaging young adolescents in sexual health research in Western New York to inform strategies for engaging young adolescents in sexual health research. Methods: This qualitative descriptive study was conducted from April 2022 to June 2023. Seventeen community stakeholders, including health education teachers, youth counselors, and adolescent health providers, participated in semi-structured in-depth interviews. Data were analyzed using conventional content analysis, managed by MAXQDA 2020. The rigor and trustworthiness of the data were ensured through triangulation with observations, peer debriefing, team analysis, and respondent validation. Results: Participants were predominantly female (94.1%), 52.9% Black/African American, 41.2% White, and 5.9% Caucasian–Indian American, and aged 23–59 years. Four themes emerged: perspectives on conducting sexual health research with young adolescents, recruitment strategies, sexual health questions appropriate for young adolescents, and building readiness for participation in sexual health research. Participants reported the need for sexual health research with young adolescents and recommended building a trusting relationship and involving schools, parents, and trusted community organizations in the research process. Suggested research questions included those related to awareness of sex, STIs, available resources, experiences with sexual education, and desired support. The findings also revealed the need to initiate sexual health conversations early when children start asking questions, as a foundation for meaningful participation in sexual health research. Conclusions: The findings suggest that sexual health research with young adolescents is feasible and necessary, with implications for the design of developmentally appropriate sexual health research and interventions grounded in trust and community collaboration. Future research should explore the perspectives of caregivers and young adolescents to inform studies and programs that are attuned to young adolescents’ developmental needs. Full article

Background/Objectives: Rates of receiving opioid use disorder (OUD) treatment among adolescents and young adults (AYA) aged 16–25 are low. The current study qualitatively analyzed informants’ perspectives regarding the availability of, developmental considerations relevant to, and barriers associated with OUD treatment for AYA. Methods: Thirty key informants involved with OUD treatment in the northeastern United States completed individual, semi-structured interviews, including treatment providers (N = 11) and clinic leaders in programs that provide medication and psychosocial treatments for AYA with OUD (N = 10), as well as opioid-related policymakers (N = 6) and patient advocates (N = 3). Interviews were transcribed and independently double coded. Template-style thematic analysis methods were used and revealed seven themes. Results: The first theme highlighted limited treatment program availability for adolescents (aged < 18 years) with OUD. Four themes related to developmentally optimizing OUD treatment for AYA, describing the importance of caregiver involvement, AYA peer connections, wraparound services, and early intervention. Two themes described barriers to AYA OUD treatment, including stigma and knowledge gaps about medications for OUD as well as deficits in AYA’s access to basic resources (e.g., housing, food security) that prohibit effective participation in treatment. Conclusions: Results highlight concerns from systems-level key informants regarding gaps in OUD treatment options for youth under the age of 18 and a high need for OUD treatment that is developmentally tailored to AYA. Findings point toward potential modifications and additions to existing adult treatment programs to make OUD treatment more accessible, relevant, and engaging for AYA. Full article

This article examines the intersecting forces of gender, class, and education in early twentieth-century Britain through a feminist reading of Pip Williams’ historical novel The Bookbinder of Jericho. Centering on the fictional character Peggy Jones—a working-class young woman employed in the Oxford University Press bindery—the study explores how women’s intellectual ambitions were constrained by economic hardship, institutional gatekeeping, and patriarchal social norms. By integrating close literary analysis with historical research on women bookbinders, educational reform, and the impact of World War I, the paper reveals how the novel functions as both a narrative of personal development and a broader critique of systemic exclusion. Drawing on the genre of the female Bildungsroman, the article argues that Peggy’s journey—from bindery worker to aspiring scholar—mirrors the real struggles of working-class women who sought education and recognition in a male-dominated society. It also highlights the significance of female solidarity, especially among those who served as volunteers, caregivers, and community organizers during wartime. Through the symbolic geography of Oxford and its working-class district of Jericho, the novel foregrounds the spatial and social divides that shaped women’s lives and labor. Ultimately, this study shows how The Bookbinder of Jericho offers not only a fictional portrait of one woman’s aspirations but also a feminist intervention that recovers and reinterprets the overlooked histories of British women workers. The novel becomes a literary space for reclaiming agency, articulating resistance, and criticizing the gendered boundaries of knowledge, work, and belonging. Full article

Context: Respiratory morbidity is a leading cause of children’s consultations with general practitioners. Auscultation, the act of listening to breath sounds, is a crucial diagnostic method for respiratory system diseases. Problem: Parents and caregivers often lack the necessary knowledge and experience to identify subtle differences in children’s breath sounds. Furthermore, obtaining reliable feedback from young children about their physical condition is challenging. Methods: The use of a human–artificial intelligence (AI) tool is an essential component for screening and monitoring young children’s respiratory diseases. Using clinical data to design and validate the proposed approaches, we propose novel methods for recognizing and classifying children’s breath sounds. Different breath sound signals were analyzed in the time domain, frequency domain, and using spectrogram representations. Breath sound detection and segmentation were performed using digital signal processing techniques. Multiple features—including Mel–Frequency Cepstral Coefficients (MFCCs), Linear Prediction Coefficients (LPCs), Linear Prediction Cepstral Coefficients (LPCCs), spectral entropy, and Dynamic Linear Prediction Coefficients (DLPCs)—were extracted to capture both time and frequency characteristics. These features were then fed into various classifiers, including K-Nearest Neighbor (KNN), artificial neural networks (ANNs), hidden Markov models (HMMs), logistic regression, and decision trees, for recognition and classification. Main Findings: Experimental results from across 120 infants and preschoolers (2 months to 6 years) with respiratory disease (30 asthma, 30 croup, 30 pneumonia, and 30 normal) verified the performance of the proposed approaches. Conclusions: The proposed AI system provides a real-time diagnostic platform to improve clinical respiratory management and outcomes in young children, thereby reducing healthcare costs. Future work exploring additional respiratory diseases is warranted. Full article

This study aims to analyze maladaptive schemas through the Young Schema Questionnaire—Short Form 3 among 895 high school students, with an average age of 18.15 years, in relation to the potentially traumatic experience of being the victim of violence inflicted by family members through hitting and beating and in connection with violent behavior (in and outside school). Almost half of the students reported that, in their families, there were prolonged problems in the couple relationship of their parents/caregivers, and almost 40% of these students were involved from time to time in at least one form of violence in or outside school, with the highest share of this violence resulting from physical aggression by hitting and pushing and verbal or emotional abuse. A factor analysis was performed using a unifactorial model and a mediation model, and it indicated that the presence of trauma increases the total violence score. A higher violence score was recorded in students who were subjected to family violence (t(890) = −6.267, p < 0.001). The schemas that proved to be the most relevant for the violence factor were those of Punitiveness (PU: 0.89) and Mistrust/Abuse (MA: 0.77), followed by the schemas of Emotional Inhibition (EI: 0.68), Unrelenting Standards/Hypercriticalness (US: 0.63), and Entitlement/Grandiosity (ET: 0.58). The mediation that the Punitiveness schema achieves between victimization in the family and subsequent aggressive behavior is based on the internalization of the punitive parental figure and the victim’s development of the belief that violence is the only answer when others do not meet their expectations. Full article

Background/Objectives: Previous literature shows that the demographic characteristics of caregivers, such as educational level, determine health processes in young children. However, the mechanisms through which educational level increases health in this population have scarcely been explored in low- and middle-income countries (LMICs). Evidence also suggests that caregivers who model healthy eating to their children, such as eating healthy foods in front of them or enjoying the consumption of healthy foods, increase the likelihood that their child will do the same. Methods: Eighty-two primary caregivers of children between 3 and 5 years of age in Costa Rica completed an electronic questionnaire with measures on the highest educational level attained, modeling the healthy eating and diet diversity of their children. Diet diversity indicates the intake of seven important groups of macronutrients that are needed for healthy development in Costa Rican children. Results: To investigate these relationships, a simple mediation analysis was carried out, with diet diversity as an outcome, caregiver educational level as a predictor, and modeling as a mediator. The indirect effect of educational level on diet diversity was found to be statistically significant [Effect size = 0.10, 95% C.I. (0.01–0.20)]; Conclusions: Results indicate that high educational level is associated with increased usage of healthy eating modeling with children, and this in turn is positively related to their diet being more diverse. Results suggest that the modeling of healthy eating could be the object of interventions aimed at preventing obesity in Costa Rican children. Full article

Background: Food neophobia, defined as reluctance to try new foods, may lead to nutritional deficiencies and complicate dietary management—especially in individuals with Down syndrome, who often present with oral-motor dysfunction. This condition may result in nutritional deficiencies and difficulties in adhering to dietary recommendations, particularly in individuals with comorbidities. In individuals with Down syndrome (DS), who frequently present with oral motor disorders and chronic diseases, the problem may be especially pronounced. Objectives: The aim of the study was to assess the risk of food neophobia and feeding difficulties in children, adolescents, and young adults with Down syndrome, as well as their associations with age, gender, and body weight. Methods: The research was conducted using the CAWI method among 310 caregivers of individuals with DS in Poland. Two validated tools were employed: the Montreal Children’s Hospital Feeding Scale (MCH-FS) and the Food Neophobia Scale for Children (FNSC). Body mass index (BMI), comorbidities, and demographic data were also analyzed. Results: Findings revealed that the majority of participants (55.2%) had normal body weight, while 19.4% were undernourished and 6.5% were classified as obese. Feeding difficulties of moderate to very high severity were reported in 26.5% of the participants. A high risk of food neophobia was identified in 41.3% of respondents, most frequently in the preschool age group. A statistically significant association was observed between age and the severity of both feeding difficulties and neophobia (p < 0.05). However, no significant relationships were found with gender or body weight. Conclusions: Feeding difficulties and food neophobia are prevalent among individuals with Down syndrome, particularly in preschool-aged children. The findings highlight the necessity of an interdisciplinary therapeutic approach and the individualization of dietary interventions, taking developmental age into account. Further studies are warranted, with consideration of environmental and psychosocial factors. Full article

Background/Objectives: Increased burdens on caregivers of infants and toddlers significantly affect caregivers’ quality of life and health. Although adequate care during infancy contributes to child development and special health care needs affect caregiver burden, the risk factors for and protective factors against increased caregiver burden remain unclear. We aimed to evaluate children’s health care needs and required caregiving time and identify factors associated with increased caregiver burden. Methods: We conducted an online survey of 287 Japanese caregivers who were randomly selected from a web panel and were raising children aged <4 years. The survey comprised a sociodemographic data form, Children with Special Health Care Needs (CSHCN) Screener, caregiving time survey form, and questions on increased burden. Needs and caregiving time were evaluated by dividing the participants into CSHCN and non-CSHCN groups. Related factors were analyzed using increased burden as the dependent variable. The chi-square test, Mann–Whitney U test, and modified Poisson regression were used for data analysis. Results: Among the children of the 287 participating caregivers, 16.4% were identified as CSHCN, while 96.9% had no specific diagnosis. Overall, 38.3% of the CSHCN group met only one of the five CSHCN Screener items. The CSHCN group spent significantly more time providing and arranging/coordinating health care. The non-CSHCN group spent significantly more time providing daily care. After adjusting for covariates, increased caregiver burden was significantly associated with a younger age of the child, more caregiving time required 6 months prior to the survey, and providing care for CSHCN. Conclusions: To help reduce the burden of childcare on caregivers of infants and young children, children’s needs should be identified and generous childcare provided from an early age. Early identification of CSHCN and appropriate support for families may help reduce caregiver burden during early childhood. Full article

Background/Objectives: Mental disorders that emerge during adolescence frequently extend into adulthood, predicting poor academic and employment outcomes and heavy societal burdens. Novel efforts to improve youth mental health have transitioned from clinical recovery, typically focused on a cure, to a strength-based approach to wellbeing in supporting youth within mental health services. Mental health scholars have appealed for interventions to adopt an ecological system of care approach that integrates the principal caregivers in a young person’s life. Despite preliminary literature indicating the importance of caregivers, little research has focused on the caregiver’s role in supporting personal recovery in youth. Methods: This study sought to understand the role of caregivers in youth recovery by employing a qualitative design to inductively analyze the narratives from nine semi-structured interviews with caregivers. Additionally, deductive analysis explored the core five underpinnings of personal recovery connectedness, hope, identity, meaning, and empowerment (CHIME). Results: A thematic analysis of the literature identified five themes: providing unconditional love and positive regard; encouraging connection with peers; co-creating a sense of purpose, meaning, and hope; supporting assertiveness and advocacy; and promoting strength and opportunity for mastery aligning with the CHIME framework. The findings will allow health services to understand caregivers’ roles better, thus providing information to guide recovery-oriented and family-centered care. Full article

Although the relationship between grandparent and grandchild is often unique due to the supportive and foundational roles grandparents can have in the lives of young or youthful grandchildren, the extent of grandparent–grandchild coresidence globally is under-researched. We harmonized household roster survey data on grandchild coresidence using population-based data on adults 55+ years across 24 countries. Grandchild coresidence rates ranged from 41.1% in Mexico to 0.1% in Sweden. Across contexts, grandchild coresidence was more common among women (compared to men), non-partnered individuals (compared to partnered individuals), those who reported difficulty with activities of daily living (compared to those without such difficulties), and those with education levels below the median (compared to those above the median). Logit regressions indicated gaps in rates of grandchild coresidence by partner status, ADL status, and education were generally not driven by income or other socio-demographic variables. Coresidence with adult grandchildren was not uncommon in most countries with non-negligible rates of grandchild coresidence. In about 25% of households of middle-aged and older adults coresiding with grandchildren, grandchildren ages 0–5 years were present. Future research should consider the meaning of grandparent–grandchild coresidence for the health outcomes of middle-aged and older adults globally, particularly when grandparents are not caregivers of grandchildren. Full article

Parent Peer Support (PPS) provided by other caregivers who have lived experience raising a child with mental health conditions (e.g., such as anxiety, depression, attention, and/or behavior disorders) holds promise as a service that can improve outcomes by helping young people and their families overcome system- and individual-level barriers to receiving care. Here, we describe the development of a collaboration of researchers and Family-Run Organizations (FROs) to provide research support for PPS through three phases (1) developing a research agenda and study aims through a Patient-Centered Outcomes Research Institute (PCORI) “Pipeline to Proposal” grant; (2) designing a pilot study, including refining the measurement framework for a successful grant application to the National Institute of Mental Health (NIMH); and (3) implementing the study through the incorporation of research methodology into FRO operations without disrupting the organizations’ missions. This paper summarizes the participatory action research (PAR) strategies employed by this interdisciplinary research team throughout the three phases, covering the benefits and challenges of these unique partnership activities. We focus on how this project was able to increase the relevance of the research to the FROs and the communities they serve and improve dissemination and utilization of the results to support other PPS projects. Full article