Child Care Health and Development最新文献

Background

Clinicians can help address the discrimination that children and youth with disabilities often encounter. However, they commonly report lacking training and experience in addressing multiple forms of discrimination, such as ableism and racism. A lack of knowledge could lead to stigma and inequities within healthcare. This study explores clinicians' suggestions for addressing multiple forms of discrimination among children and youth with disabilities.

Methods

This qualitative study involved in-depth interviews with a purposive sample of 15 paediatric rehabilitation clinicians and community service providers working with disabled youth who have multiple minoritized identities. We applied an inductive thematic analysis to the interview transcripts.

Results

Our findings highlighted the following four themes: (1) disability awareness and anti-ableism training and education; (2) enhancing inclusive programming, services and policies; (3) building connections to supports and resources; and (4) advocacy and incorporating lived experience perspectives.

Conclusion

The results underscore the need for clinicians to engage in more training and to facilitate access to resources for multiply minoritized youth with disabilities. Dedicated funding, resources and commitment at organizational, systems and policy levels are needed to address discrimination.

Background

Time alone between adolescents with chronic illnesses and their clinicians may contribute to patient-centred care and transition readiness within this population. Shifts in the adolescent–parent–clinician relationship underpin this contribution; as such, this qualitative study explored adolescent, parent and clinician perspectives on time alone in routine visits for paediatric chronic illness.

Methods

Semi-structured interviews with English-speaking adolescents (ages 12–17, n = 65) and their parents (n = 63) were conducted after follow-up visits for inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), sickle cell disease (SCD) or type 1 diabetes (TID) at specialty clinics affiliated with the Children's Hospital of Philadelphia. Clinicians (n = 16) at the same clinics were also interviewed for this cross-sectional qualitative study. Interviews were transcribed, and thematic analysis was performed using an inductive approach.

Results

Qualitative analysis yielded six themes: (1) Clinician, parent and adolescent factors influence provision of time alone; (2) some adolescents communicate more openly with their clinician during time alone; (3) some adolescents do not share new information during time alone; (4) time alone facilitates the development of the clinician-adolescent relationship and helps prepare the adolescent for the transition to adult care; (5) clinicians continuously re-negotiate the parent–adolescent–clinician relationship to meet adolescents' needs; and (6) time alone can raise challenges for clinicians.

Conclusion

Time alone can affect information sharing and relationship building between adolescents with chronic illnesses and their clinicians. By fostering open communication and trust in the adolescent–clinician relationship, time alone may help prepare adolescents with chronic illnesses for the transition to adult care.

Background

In the Chinese context, a greater emphasis is placed on academic skills rather than healthy lifestyles among pre-school children. To promote well-being as a whole, a comprehensive interpretation of multivariant relationships between health, functioning and well-being is necessary for children in this age group.

Methods

The current study adopted a network analysis among 422 urban Chinese pre-school children (57.8 ± 9.7 months, 54.2% boys) to detect the inter-relationships between the variables from nine domains, including demographics, adiposity, physical activity levels, executive function, motor coordination, sleep disturbance, diet health and mental strengths and difficulties. Data was obtained through both questionnaires completed by parents and direct assessment among children.

Results

Findings indicated that poor well-being outcomes were prevalent among the participating children, including risk of central obesity (18.9%), global sleep disturbance (38.4%) and moderate-to-severe mental difficulties (42.6%). The network analysis demonstrated that age fully/partially mediated the associations among child functioning such as executive function and motor coordination. Mental strength, mental difficulties and sleep health had mutual correlations, however, none of them had a significant relationship with age. Furthermore, sex played little role in the network.

Conclusion

This study supports that healthy lifestyle is crucial for Chinese pre-school children to learn and practice. Results of network analysis implies that education on child's mental health are warranted for children, parents and teachers. A balance between academic achievement and child's health well-being should be prioritized in child care and early childhood education.

Background

Completion of the newborn and infant healthcare practices across the continuum of care, including essential newborn care, exclusive breastfeeding from birth to 6 months of age and immunisation, remains low in Ethiopia. Therefore, this study aimed to determine the impact of maternal pregnancy intention on the newborn and infant continuum of care in Ethiopia.

Methods

The analysis used data from the Performance Monitoring for Action Ethiopia longitudinal survey. This nationally representative survey was conducted from 2019 to 2021. The impact of maternal pregnancy intention on the newborn and infant continuum of care was assessed using propensity score methods. Essential newborn and infant care practices were examined as outcome variables, with pregnancy intention as the exposure variable. Adjusting for potential covariates, the impact of exposure on outcomes was determined using a logistic regression model with an odds ratio at 95% CI based on the inverse probability of treatment weights.

Results

Women with intended pregnancies had 28% higher odds of early initiation of breastfeeding (AOR = 1.28, 95% CI: 1.03–1.59) and 34% higher odds of exclusive breastfeeding from birth to 6 months of age (AOR = 1.34, 95% CI: 1.08–1.66) compared with women with unintended pregnancies. Similarly, the odds of full infant immunisation were 39% higher among women with intended pregnancies compared with women with unintended pregnancies (AOR = 1.39, 95% CI: 1.03–1.87). However, there was no statistically significant difference in the odds of essential newborn care practices between women with intended and unintended pregnancies (AOR = 0.83, 95% CI: 0.53–1.31).

Conclusion

Pregnancy intention significantly impacts the newborn and infant healthcare practices across the continuum of care. Therefore, prioritising interventions for preventing unintended pregnancies by providing family planning services, early identification of women with unintended pregnancies and ensuring they receive appropriate healthcare services is essential.

Background

The study aimed to determine whether the type of disability (intellectual, motor, hearing, or autism spectrum) differentiates mental health, parental stress, self-compassion and perceived support among parents of children aged 0–7 years.

Methods

The study took place anonymously from February to May 2023 using online questionnaires. Instruments such as GHQ-12, PSS-10, PSI-4-SF, Self-Compassion Scale (SCS) and MSPSS were used to assess mental health, parental stress, self-compassion and social support. Tools were translated, adapted and reliability tested for Polish conditions.

Results

While no significant differences in mental health symptoms were observed across disability types, parents of children with autism and intellectual disabilities reported higher stress related to daily life and personal problems. They also faced more conflicts, lower parental competence and less support from friends, particularly those with children on the autism spectrum.

Conclusion

Parents of children with autism spectrum disorders experience the highest stress levels and lowest parental competence. Specialists should prioritize teaching self-compassion and social support utilization while continuously monitoring the mental health of these parents to improve their well-being and caregiving.

Background

Wait time at vaccine clinics is a barrier to routine childhood vaccinations in low- and middle-income countries (LMICs). Waiting for a critical mass of clients to accrue before conducting the vaccine health education talk prolongs clinic time.

Methods

We implemented a workflow change, including a looped audiovisual vaccine education talk on a solar-powered television. We compared clients' average clinic time using a before-and-after study, time-motion design, and surveyed providers and clients on their perspectives on the workflow change.

Results

In the post-implementation phase, compared to the pre-implementation phase, the average clinic time for all clients and the subgroup who presented before 9:00 AM was significantly reduced by 13 and 31 min, respectively (p = 0.006 and < 0.000). Providers and clients were positive about the workflow change.

Conclusion

A looped audiovisual vaccine education talk significantly reduces client vaccine clinic wait time and is acceptable to providers. Research on the impact of workflow change with alternate vaccine health talk delivery mode on vaccine uptake and completion is required.

Background

Parents of children with autism often face significant stress, low self-efficacy, and caregiver burden in meeting their children's complex needs. This study evaluated the effectiveness of a parent empowerment program combining parental training and motivational interviewing to support caregivers of children with autism in Türkiye.

Methods

A total of 69 parents (intervention = 34, control = 35) participated in this unblinded, two-group randomized controlled study, which was conducted between September 2020 and May 2022. A parent empowerment program, including four parental training sessions and two motivational interview sessions, was applied to the parents in the intervention group. The Parental Self-Efficacy Scale, Zarit Care Burden Scale, Perceived Stress Scale and Family Empowerment Scale were used to evaluate the effectiveness of the empowerment program. Standard practice was performed for the control group.

Results

Parents in the intervention group showed significantly greater improvements than those in the control group in self-efficacy (t = 5.340, p < 0.001), perceived stress (t = −4.636, p < 0.001) and family empowerment (t = 2.745, p = 0.008). No significant difference was observed between the groups in caregiver burden (p = 0.086).

Conclusion

This study reveals that using a parent empowerment program that includes motivational interviews along with training interventions is effective in empowering parents to manage their children's care, reducing stress, and supporting them to acquire effective parenting skills by increasing self-efficacy. Future research should explore designs that assess the independent and combined effects of motivational interviews and parent training programmes in randomised controlled trials.

The study was registered at ClinicalTrials.gov (https://clinicaltrials.gov/) under the registration number NCT06629974 on October 8, 2024.

Background

Neuroblastoma (NB) is a prevalent malignant tumour affecting children. Due to its insidious onset, malignant nature and poor prognosis, the absence of effective treatments presents a significant challenge, profoundly impacting children and their families. Children embody the core and hope of a family, and when faced with sudden adversity, parents often undergo psychological crises marked by anxiety, depression and severe emotional distress. Fortunately, XXX Hospital serves as a testing ground for novel domestic medications, offering not only therapy but also instilling hope in children with NB and their families. Among these medications, naxitamab (hu3F8) has shown promising efficacy in treating NB. This qualitative study aims to investigate the psychological experiences of caregivers of children with NB undergoing naxitamab treatment at a hospital in China, a specialized institution. Subsequently, tailored psychological support for caregivers will be considered based on the findings.

Method

Employing phenomenological research techniques, we conducted face-to-face semistructured interviews with 14 caregivers of children diagnosed with NB. Colaizzi's seven-step analysis method was employed to analyse the interview data.

Results

The psychological experiences of caregivers of children with NB were categorized into three main themes and 11 subthemes: the pretreatment stage (challenges during diagnosis, shock and collapse upon diagnosis and persistent pursuit of hope); the in-treatment stage (treatment-related worries and fears, significant financial strain, renewed hope and expectations during treatment and reliance on medical staff for trust and hope); and the posttreatment stage (changes in perspectives following treatment, rethinking expectations for children, anticipating the development of novel therapeutic agents and expectations regarding financial support).

Conclusion

Caregivers of children undergoing naxitamab treatment for NB encounter diverse psychological challenges throughout different stages. It is crucial for clinical medical professionals to provide tailored psychological support to both children and their families during various stages of treatment.

Aim

To investigate Conductive Education (CE) interventions in children with cerebral palsy (CP), examining how practice time, assessment methods, and CP characteristics influence treatment outcomes.

Method

A systematic review (PROSPERO-CRD42024578760) searched seven databases using ‘Conductive Education’. Inclusion criteria: interventional studies in young people with CP receiving CE treatment. The PRISMA strategy guided study selection, aided by Rayyan software. Study quality was assessed using ROBINS-I.

Results

Eighteen studies were included. Seven studies showed low risk of bias; considering low and moderate risk studies, 67% demonstrated positive CE effects. Practice duration appeared crucial: Studies reporting positive outcomes averaged 25.2 h/week compared to 17.7 h/week in studies showing no effect. The Gross Motor Function Measure was the most used assessment tool, followed by the Paediatric Evaluation of Disability Inventory. CE showed better outcomes in spastic CP, particularly in cases with diplegic presentation, compared to athetoid or ataxic types.

Interpretation

CE demonstrates promise for improving motor performance in children with CP, particularly with adequate practice time (≈25 h/week). Treatment success appears influenced by CP type and assessment methods. Future research should prioritize standardized protocols and consistent outcome measures to strengthen evidence quality.