Child Care Health and Development最新文献

Background

Caregivers of children and youth with special healthcare needs (CYSHCN) often experience significant challenges accessing home and community-based services (HCBS), resulting in psychological distress, increased burden and decreased caregiver wellbeing. However, little is known about the associations between HCBS access and caregiver wellbeing in rural areas. Therefore, the purpose of this study was to (1) explore the associations between caregiver and child sociodemographic characteristics and HCBS access on caregiver wellbeing in a rural context and (2) add additional empirical support to an emerging theoretical framework.

Methods

This exploratory cross-sectional study used convenience sampling to recruit caregivers of CYSHCN (N = 162) from the north central Appalachian region of the United States. Electronic surveys included items related to sociodemographics and HCBS, along with the Depression, Anxiety, and Stress Scale, Post-Traumatic Growth Inventory, and Meaning in Life Questionnaire, which were guided by an emerging theoretical framework.

Results

Most caregivers reported caring for CYSHCN ages 2–17 (72.8%) with moderate-to-severe functional limitations (73.3%). Overall, caregivers reported mild-to-moderate depression, anxiety and stress; a medium-to-high degree of posttraumatic growth (PTG); and a greater presence of meaning in life. Caregiver wellbeing was associated with various sociodemographic characteristics and access to HCBS. Although challenges with HCBS access were related to psychological distress, they were also associated with PTG and meaning in life.

Conclusions

Caregivers who experienced psychological distress and challenges accessing HCBS also experienced PTG and meaning in life. Findings warrant therapeutic interventions designed to leverage caregiver empowerment and resilience, while exploring innovative care delivery methods in rural communities to improve health equity.

Background

It is unclear whether the underutilisation of the UK Children's Epilepsy Surgery Service (CESS) can be attributed to regional referral differences. This study develops a mapping tool to visualise CESS referrals, identifying any regional disparities and exploring the relationship between referrals and deprivation. Mapping posterior urethral valve (PUV) surgery referrals demonstrates the utility of this model for other health conditions.

Methods

Accepted CESS referrals within the catchment area of one centre between April 2017 and March 2022 were recorded in the Orion registry (n = 291). PUV referrals to one tertiary centre in the same region, between January 2013 and June 2023, were mapped using the same model (n = 212).

Results

Referral incidences per integrated care board (ICB) were calculated and visualised with choropleth maps. Pearson's correlation coefficient identified any relationship between referral incidence and population-weighted ICB deprivation scores.

CESS referral incidence ranged from 30.06 to 39.9 per million under-18s. PUV referral incidence ranged from 12.0 to 46.9 per million under-18 males, yielding a statistically significant difference in variability between the two groups (p = 0.04). Referral incidence was independent of deprivation (p = 0.29 and p = 0.13, respectively).

Conclusion

There is equity in CESS referrals within the region. The mapping tool is widely applicable, providing visually representable referral data without being patient-identifiable.

Background

In the United States, most school-aged children do not meet recommended physical activity (PA) guidelines that promote health. Prior to the COVID-19 pandemic, schools were well-situated to provide children with structured PA opportunities through physical education, organized sports, recess and active transportation to school. However, the COVID-19 pandemic limited schools' abilities to provide these opportunities, likely due to the global adoption of recommended COVID-19 guidelines (e.g., social distancing guidelines, remote and hybrid learning, shared equipment limitations). Preliminary evidence suggests that children's PA levels decreased during the COVID-19 pandemic, but few studies have explored how schools responded to these challenges in real time.

Methods

This study explored how schools provided students with PA opportunities amid COVID-19 pandemic restrictions during the 2020–2021 school year. We conducted a secondary data analysis using an interpretive qualitative approach through a partnership with a childhood obesity prevention initiative providing infrastructure to schools to promote healthy behaviours. Participants representing 247 schools in Maine and Carroll County, New Hampshire, USA responded to a 34-question digital survey, including a subset of three open-ended questions, which were analysed through inductive thematic analysis.

Results

The 247 participants were predominantly nurses and teachers. Most schools were public schools with fewer than 400 students enrolled, nearly half of the participants represented elementary schools and more than half of the student body was eligible for free/reduced lunch in 35% of schools. Themes included: (1) PA strategies in disruptive learning environments; (2) barriers to PA participation; and (3) silver linings: physical activity and crisis resilience.

Conclusion

These findings provide insight into how schools created PA opportunities for students amid COVID-19 pandemic restrictions. Emergency preparedness plans may incorporate flexible PA programming and further develop infrastructure that supports opportunities for PA.

Background

Children with Special Health Care Needs (CSHCN) face significant challenges in maintaining oral hygiene and accessing dental services due to disabilities. It has been reported that, because of these disadvantages, individuals with special needs experience oral health problems at a higher rate compared to the general population.

This study aimed to assess factors influencing oral health in CSHCN within the dental home framework and propose preventive strategies.

Methods

A total of 1229 children aged 0–8 years with disability health reports in Istanbul were examined through home visits by mobile dental teams. Caries experience was evaluated using combined indices (dfs + DMFS and dft + DMFT). Data on oral hygiene habits, dietary patterns, parental education level and dental visit history were collected through structured questionnaires. Statistical analyses included Mann–Whitney U, Kruskal–Wallis, chi-square and Spearman's correlation tests (significance set at p < 0.05).

Results

A statistically significant positive correlation was found between age and all caries indices (p < 0.01) 0.57. 1% of children reported brushing their teeth, with irregular brushers showing significantly higher caries indices than regular brushers (p < 0.05). Children requiring > 45 min to eat had significantly higher dfs + DMFS (1 surface) (p = 0.036) and dft + DMFT values (p = 0.019). Those consuming snacks > 3 times daily showed significantly higher caries indices across all measures (p < 0.01). Moderate/severe plaque accumulation was detected in 50.5% of participants. Lower parental education levels were significantly associated with higher caries indices (p < 0.01).

Conclusions

This study highlights the necessity of an interdisciplinary approach to protect the oral health of CSHCN. The widespread implementation of the dental home model and regular dental check-ups will be a significant step in addressing oral health needs.

Background

Upper extremity impairments in children with cerebral palsy (CP) often lead to activity limitation and participation restrictions. Recent advances in exoskeleton technology offer promising potential for enhancing rehabilitation outcomes. This systematic review investigates the impact of upper extremity exoskeletons on children with CP using the International Classification of Functioning, Disability and Health (ICF) framework.

Methods

Following PRISMA guidelines, five electronic databases were searched without time limitations (PROSPERO ID: CRD42021282377). Studies included randomized and non-randomized trials, focusing on upper extremity exoskeleton interventions for children with CP and published in English. Data were screened and extracted by two independent reviewers. The risk of bias was evaluated using the Revised Cochrane Risk of Bias Tool and the Risk of Bias in Non-Randomized Studies of Interventions for randomized and non-randomized studies, respectively.

Results

A review of 22 studies involving 274 participants assessed the effectiveness of upper extremity exoskeletons on children with CP across different ICF domains. The studies employed various designs, including randomized controlled trials, cohort studies and case series, with a primary emphasis on body functions and structures.

Conclusion

While advancements in body function and structure are noteworthy, they do not inherently lead to improved activity and participation, highlighting the importance of conducting further research to evaluate the effectiveness of exoskeletons, particularly in enhancing participation outcomes among children with CP.

Background

The Global Matrix initiative aims to create a world map of indicators related to physical activity to provide the most up-to-date information for decision-making. In the latest edition, three regions from Spain joined the initiative, based on a ‘glocal’ approach. The objectives of this study were (i) to compare the grades of the Report Card and the public policies between and within the Spanish regions and with the national Report Card; (ii) to evaluate sex differences; and (iii) to identify differences in the policy priorities between regions and the national policy.

Methods

The three regions studied and the country followed a harmonized process to develop a Report Card. The common physical activity indicators included in the Global Matrix 4.0 were analysed. The Government indicator was analysed using an approved methodology. Additionally, sex-specific information was provided. Report Card leaders provided the main priorities to improve the indicators included in the analysis, and a comparison by indicator was performed.

Results

Regional differences were observed in the grades assigned to the behavioural indicators included; however, the average grades were similar, with Extremadura showing the lowest average. Grades for the sources of influence indicators differed in the analysed Report Cards.

Conclusion

Regional Report Cards analysed in Spain differ among themselves, with similar average grades in the behavioural indicators. These identified regional differences could lead to a more ‘glocal’ approach that will allow for more efficient action at the local level.

Background

Children who have chronic illnesses (CIs) and their siblings often miss school when the child with a CI is hospitalized. Understanding the perspectives of the child with an illness, siblings and parents will provide information about how they keep up with schoolwork, their perceptions of not being in school, or of homeschooling that will inform educators, families and medical professionals.

Methods

English-speaking children diagnosed with CI, siblings and parents participated. They were residing at a Ronald McDonald House. A qualitative study using interviews with children with CIs, siblings and parents was completed.

Results

All three informant groups reported positive experiences with completing schoolwork, and teacher flexibility and availability were key to child success. Ensuring that schoolwork covered the basic academic subjects and materials was important, as children were tired and could lack time to complete work. Missing friends and school, and after-school activities were negative effects of missing school. Several parents homeschooled their children and felt positively about this experience, as they were then able to care for their child's medical needs, match educational lessons to their child's abilities and ensure they had time to make the child's medical appointments.

Conclusions

Children with illnesses, siblings and parents reported that their school experiences during the hospitalization of the child with an illness were usually positive. Importantly, children were able to keep up with their work. Children did miss interacting with teachers, peers and engaging in school and after-school activities. In the future, more information about the quality and impact of homeschooling will provide information to advance knowledge on ways to support the academic needs of children who are educated at home.

Background

Executive function (EF), a multimodal construct that captures one's control over cognition and behaviour, is associated with academic achievement and social–emotional competence. Prior research suggests that early childhood experiences and the family context shape EF development. Harsh parenting practices—defined through verbal and psychological aggression—and maternal depression are identified as factors that may inhibit early EF development. We examined the relation between these two parenting factors at child age 30 months and two fundamental EF skills, attention and inhibitory control (IC), measured at 42 months.

Methods

We used a combination of parent self-report (Center for Epidemiological Studies Depression, Childhood Behaviour Questionnaire) and independent observational data (Home Observational Measurement of the Environment) from a random, representative sample of 549 births in Durham County, North Carolina. Linear regression models estimated the effects of harsh parenting and maternal depression on later child EF outcomes, while accounting for child and family characteristics.

Results

Harsh parenting behaviours at 30 months predicted lower child IC skills (b = −0.46, p = 0.041) and lower attention skills (b = −0.64, p = 0.007) at 42 months. Greater maternal depression symptoms at 30 months predicted lower IC skills (b = −0.14, p = 0.017) and lower attention skills (b = −0.21, p = 0.001) at 42 months.

Conclusions

Results highlight the importance of parenting behaviours and parental mental health in shaping early EF. Although correlational in design, this work may inform future early childhood interventions aimed at altering parental behaviour and mental health to promote childhood EF.

Background

The ‘Right to Play’ is included in the United Nations Convention on the Rights of the Child. Outdoor play contributes to children's overall development, physical and mental health and quality of life. Unfortunately, children with disabilities often experience restrictions while playing outdoors. Understanding children's perspectives is crucial to effectively support them in participating. Our aim was to explore facilitators and barriers perceived by Dutch children with and without disabilities (6–12 years), in regular and special primary education, for participating in inclusive outdoor play.

Methods

We conducted 40 semi-structured interviews in school-aged children (mean age years 8.7, SD 1.9): 22 without disabilities, 10 with disabilities attending regular education and 8 with disabilities attending special education. We transcribed all interviews verbatim, and two independent researchers analysed the data using an inductive thematic approach.

Results

We identified three main themes: personal factors of children with and without disabilities, interacting factors and environmental factors. Each theme has sub-themes acting as either facilitators or barriers to inclusive outdoor play. Personal factors include being open to playing with each other, coping with disabilities, experiencing autonomy, insufficient knowledge about disabilities and feelings about physical and social limitations. Interacting factors include growing up together, making contact and adapting ways of playing. Environmental factors include parents, play environments, communities and time constraints.

Conclusions

Children with and without disabilities in regular and special primary education identify facilitators and barriers in personal, interacting and environmental factors for inclusive outdoor play. Children with disabilities encounter more barriers than those without disabilities. All children are open to playing together, and paediatric rehabilitation professionals and parents play a crucial role in facilitating positive play experiences early on, providing knowledge about the consequences of disabilities, showcasing the capabilities of children with disabilities and collaborating to adapt playgrounds.