COVID-19 Pandemic Experiences of Families in Which a Child/Youth Has Autism and Their Service Providers: Perspectives and Lessons Learned

PURPOSE

The impacts of the COVID-19 pandemic on autistic children/youth and their families and on service providers are not yet well-understood. This study explored the lived experiences of families with an autistic child and service providers who support them regarding the impacts of the pandemic on service delivery and well-being.

METHODS

In this qualitative study, families and service providers (e.g., early intervention staff, service providers, school personnel) supporting autistic children/youth were interviewed. Participants were recruited from a diagnostic site and two service organizations that support autistic children/youth.

RESULTS

Thirteen parents and 18 service providers participated in either an individual or group interview. Findings indicate challenges associated with pandemic restrictions and resulting service shifts. These challenges generally imposed negative experiences on the daily lives of autistic children/youth and their families, as well as on service providers. While many were adversely affected by service delivery changes, families and service agencies/providers pivoted and managed challenges. Shifts have had varied impacts, with implications to consider in pandemic planning and post-pandemic recovery.

CONCLUSION

Results highlight the need for autism-focused supports, as well as technology and pandemic preparedness capacity building within health, therapeutic and educational sectors in order to better manage shifts in daily routines during emergencies such as a pandemic. Findings also offer instructive consideration in service delivery post-pandemic.

Can the concentration of elements in wild-growing mushrooms be deduced from the taxonomic rank?

The mineral composition of wild-growing mushroom species is influenced by various environmental factors, particularly the chemical properties of the soil/substrate. We hypothesised that element uptake might also correlate with taxonomic classification, potentially allowing us to predict contamination levels based on mushrooms within the same taxonomic rank. This study compared the mineral composition (Ag, As, Ba, Ca, Cd, Co, Cu, Fe, Hg, K, Mg, Mn, Mo, Na, Ni, Pb, Se, and Zn) of 16 saprotrophic mushroom species from 11 genera across 4 families and 2 orders. Among these were 13 edible and 3 inedible mushrooms, all collected from natural, wild stands in a forest in central-western Poland between 2017 and 2020. Phallus impudicus exhibited the highest mean content of Ba (together with Phallus hadriani) (6.63 and 8.61 mg kg-1, respectively), Ca (with Paralepista gilva and Stropharia rugosoannulata) (803, 735 and 768 mg kg-1, respectively), Cd (with Lycoperdon perlatum) (3.59 and 3.12 mg kg-1, respectively), Co (0.635 mg kg-1), and Fe (with P. hadriani and S. rugosoannulata) (476, 427 and 477 mg kg-1, respectively), while Macrolepiota mastoidea showed the highest content of Ag (1.96 mg kg-1), As (with Coprinus comatus) (1.56 and 1.62 mg kg-1, respectively) and Cu (with Macrolepiota procera and Chlorophyllum rhacodes) (192, 175 and 180 mg kg-1, respectively). Comparing the content of the analysed elements in the genera represented by at least two species, a similarity was observed, the same as the mean concentration in soil under these species. Soil characteristics could be a superior factor that overshadows the impact of the mushroom genus on the elements accumulation, obscuring its role as a determinant in this process. The results are not definitive evidence that belonging to a particular taxonomic rank is a prerequisite condition affecting the accumulation of all elements. A closer focus on this issue is needed.

Stressors and Silver Linings during COVID-19: Implications for Supporting Families with Young Children in a Post-Pandemic World

OBJECTIVES

To better understand impacts of the COVID-19 pandemic and resulting economic and social disruptions on families, we analyzed qualitative data capturing perspectives from parents of young children.

METHODS

This study analyzes interviews of parents of children aged 1-3.5 years at enrollment, recruited from four primary care systems serving mainly lower-income Hispanic families in Los Angeles, California. Interviews were conducted over 15 months beginning September 2020. Analyses focused on the open-ended question: Please describe in your own words how the COVID-19 pandemic has affected you and your family. We used iterative, multi-step processes to identify emergent qualitative themes.

RESULTS

A total of 460 parent responses were collected and coded. Key themes and subthemes were tested for interrater reliability, with Kappa ranging from 0.74 to 0.91. Thematic analysis revealed two groups of responses, one emphasizing stress and one emphasizing "silver linings." Parents cited a range of stressors, from fear of COVID-19 to social isolation. Those emphasizing "silver linings" also referenced formal or informal supports - especially government/community assistance programs and childcare access - that enabled stronger family ties and positive lifestyle modifications.

CONCLUSIONS FOR PRACTICE

Experiences of families with young children during COVID-19 were not uniform. Economic stability and reliable childcare may be critical mediators of family stress. Results affirm that the pandemic's impacts were distributed through channels largely built on, and possibly exacerbating, existing disparities. For lower-income families with young children, funding for public and private programs that target economic stability and childcare assistance may merit prioritization in future socio-economic disruptions.

The experiences of cardiac arrest survivors and their key supporters following cardiac arrest: A systematic review and meta-ethnography

AIM

To review qualitative studies on the experience of sudden cardiac arrest survival from the perspective of both survivors and their key supporters, including family/close friends.

METHODS

A seven-step meta-ethnography and synthesis of qualitative evidence was undertaken, informed by the Meta-Ethnography Reporting Guidelines (eMERGe). Four major databases were searched (Medline, EMBASE, CINAHL, PsycINFO; January 1995-January 2022, updated July 2023) for qualitative studies exploring survivors' and/or key supporters' experiences of cardiac arrest survival. The Critical Appraisal Skills Programme checklist and Grading of Recommendations Assessment, Development and Evaluation - Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) were applied to evaluate the overall confidence in research findings. Constructs were identified from each paper, informing theme and sub-theme development.

RESULTS

From 15,917 unique titles/abstracts and 196 full-text articles, 32 met the inclusion criteria. Three themes captured the survivors' experiences: 1) Making sense of my cardiac arrest; 2) Learning to trust my body and mind; and 3) Re-evaluating my life. A further three themes reflected key supporters' experiences: 1) Emotional turmoil; 2) Becoming a carer: same person but different me; and 3) Engaging with a new and unknown world. However, limited data and some methodological weaknesses in included studies reduced confidence in several themes. The findings were conceived within the overarching concept of 'negotiating a new normal'.

CONCLUSIONS

The enduring psychosocial and physical sequelae of cardiac arrest survival substantially impacts the lives of survivors and their key supporters, requiring negotiation of their 'new normality'. The need for sense-making, physical and psychological recovery, and the new roles for key supporters should be strong considerations in the development of future interventions.

Delving the vitamin D receptor variation and expression profiles in the context of type 2 diabetes among families

BACKGROUND

Vitamin D is essential for insulin secretion and sensitivity. Consequently, its inadequacy is linked to higher insulin resistance and Type 2 Diabetes (T2D). The Vitamin D receptor (VDR) gene is one potential candidate for T2D, and multiple polymorphisms in VDR have been examined in various populations, but no conclusive answers have been provided.

OBJECTIVES

This study was designed to evaluate the susceptibility of VDR gene polymorphism and its expression in diabetic families in Pakistan.

METHODOLOGY

In this family-based study, twenty diabetic families with a positive family history of T2D and at least three T2D patients were recruited from outpatient clinics and public hospitals. The current study comprised 143 individuals with 55 affected and 88 unaffected individuals. Blood samples of the selected families were collected. DNA was extracted from the collected samples and the PCR-RFLP method was followed to identify the genotyping and RT-qPCR for expression. Phenotypic and genotypic pedigrees of the families were developed by the progeny online tool. The association values of SNPs were determined by TDT and DFAM analysis implemented on Plink software.

RESULTS

The results explained a significant familial aggregation among phenotypic characters including Age, Gender, BMI (body mass index), age of disease diagnosis, disease duration, and blood pressure in the probands, affected FDRs (First Degree Relatives) and affected SDRs (Second Degree Relatives). A significant association of rs731236 C/T (OR = 1.522), rs2228570 C/T (OR = 1.327) with p < 0.05. Whereas, for rs1544410 G/A (OR = 0.9706) and rs7975232 T/G (OR = 0.7368) no considerable association evidence was seen (p > 0.05) in families. The mRNA expression of VDR increased threefold (p = 0.0204) in patients compared to controls. Variation-based expression analysis exhibited that the rs2228570 genotype influences the expression.

CONCLUSION

A linkage was found among the FDRs with probands. Variation in the gene VDR at loci rs731236 and rs2228570 was associated with familial T2D. However further research is required to explore more genetic factors that could influence T2D risks in families.

Building a better society: The Vital role of Family's social values in creating a culture of giving in young Children's minds

This study aimed to investigate the role of families in instilling social values that enhance children's awareness of the culture of giving. A descriptive research design was used, and a sample survey method was employed, with 174 children participating. Results showed that the family's role in instilling social values was rated as moderate (weighted relative weight of 61.97%), with a total weight of 9705. The study also found that children face difficulties in adhering to the encouraging social values of volunteering. Specifically, the difficulties that children face were rated as moderate (weighted relative weight of 61.58%), with a total weight of 4822. One of the most important of these difficulties was the frequent family disputes between a child's parents that do not give them a way to practice volunteering. Besides, the families of some children are not interested in explaining the nature and mechanism of applying the encouraging social values of giving. Furthermore, the study revealed statistically significant differences in children's awareness of social values based on gender, age, educational stage, parents' educational level, and family cultural level. One of the study's key recommendations is to activate the role of families and educational institutions in organizing field visits for children to participate in voluntary and humanitarian programs. This would create constructive communication between children and vulnerable groups in society, such as orphans and the elderly, and deepen children's sense of the existence of these categories within society and the importance of providing support and assistance to them. Overall, this study highlighted the crucial role of families in instilling positive social values in children, which is essential for building a compassionate and committed future generation capable of giving back to society in various fields, particularly in human services.

The performance of the EQ-HWB-S as a measure of quality-of-life of caregivers in families that have experienced adverse events

PURPOSE

The recently developed EQ Health and Wellbeing Instrument (EQ-HWB) is a broad, generic measure of quality-of-life designed to be suitable for caregivers. The aim of this study was to investigate performance and validity of the 9-item version (EQ-HWB-S) for caregivers where families had experienced adverse-life-events.

METHODS

Using survey data from caregivers of children aged 0-8 years attending a community-health centre in 2021-2022, the general performance, feasibility, convergent and known-group validity, responsiveness-to-change, and test-retest reliability of the EQ-HWB-S was assessed. Twelve semi-structured interviews were conducted with survey respondents to assess acceptability and content validity.

RESULTS

The sample included  234 caregivers at baseline (81% female, mean age 36-years, 38% Australian-born) and 190 at 6-months follow-up. Most EQ-HWB-S item responses were evenly spread, except for 'Mobility'. The instrument showed good convergent validity with psychological distress (Kessler 6 (K6)) and personal-wellbeing (PWI-A) scales. EQ-HWB-S level sum-scores and preference-weighted scores were significantly different in all known-group analyses, in expected directions, and the instrument was responsive to change. For test-retest reliability, Intraclass Correlation Coefficients were excellent and individual item Kappa scores were moderate. The instrument was well received by interviewees who found the questions clear and relevant. The items were appropriate for parents experiencing adversity and carers of children with additional needs.

CONCLUSION

The EQ-HWB-S appeared valid, responsive to change, feasible, and well accepted by caregivers. By demonstrating the validity of the EQ-HWB-S in this hard-to-reach population of caregivers in families experiencing adverse events, this study adds to existing international evidence supporting its use.

Upholding the Human Rights and Well-Being of Refugee Children Through Effective Clinical Care

Refugee children are often exposed to adversities and traumatic experiences that can harm the mental health and well-being of refugee children. These include human trafficking and exploitation and dangers in detention centers and refugee camps. All these adverse events can be traumatic and contribute to poor mental health, including posttraumatic stress, anxiety, depression, and substance use disorders. Therefore, the assessment of refugee children and adolescents should include screening and identification for these experiences, provision of evidence-based trauma treatment, and social supports to promote their well-being and thriving.

Connecting families: a qualitative study examining the experiences of parenting young children under financial strain in Ontario, Canada

BACKGROUND

There is little research investigating the subjective experiences of parenting young children while living in poverty and experiencing financial strain using qualitative methodologies. Therefore, the objective of this study was to employ a qualitative approach to provide a nuanced and balanced view on the topic of parenting young children under financial strain in the Canadian context.

METHODS

We conducted a qualitative study using semi-structured interviews between July and August 2021 in Kingston, Ontario, Canada. Sixteen participants aged 20-39 self-identified as living under financial strain while parenting a child aged 2-5 years. A qualitative inductive thematic analysis was undertaken with a focus on describing the contents of the data.

RESULTS

Four major themes emerged from the data: experience of being a parent, impact of financial strain on the family unit, impact of financial strain on the children, and impact of financial strain on the parent. Numerous deleterious physical, mental, and material impacts on the family unit and parent were identified, however parent-perceived impacts of financial strain on their children were minimal. Parents described striking levels of resourcefulness and resiliency in providing the necessities for their families, absorbing the most significant impacts of financial strain through the phenomenon of self-sacrifice.

CONCLUSION

The impacts of financial strain on families with young children are far reaching. Further research into the impacts of self-sacrifice on parents experiencing financial strain are needed to better understand this issue, and to inform social programming and resources that could help alleviate the deleterious impacts of poverty on parent mental, social, and physical health.

Influence of families and other adult support on HIV prevention outcomes among black men who have sex with men

BACKGROUND

Prior research has consistently shown that the involvement of families plays a vital role in reducing risk behaviors, such as engaging in condomless sex, and promoting HIV prevention behaviors among young Black men who have sex with men (YBMSM). With the aim of expanding the existing knowledge, this study aimed to examine the specific influence of families and other supportive adults in facilitating casual condom use, partner condom use, HIV testing, and preexposure prophylaxis (PrEP) utilization among young Black MSM.

METHODS

A sample of YBMSM aged 18-29 years (N = 400) was collected online. We used a path analysis to examine the influence of family factors on PrEP stigma and PrEP use. Respondents were recruited from December 1, 2021, to January 31, 2022. We used a path analysis to examine the direct and indirect effects of family factors on PrEP use through HIV testing and encouraging condom use.

RESULTS

Among BMSM, other adult support was positive and directly associated with condom use by both casual partners (β = 0.04, p < .05) and partners (β = 0.17, p < .01). Condom use by casual partners was negative and was directly associated with HIV testing (β = - 0.15, p < .01).

CONCLUSION

The primary aim of this research was to examine the influence of family and adult support on HIV prevention behaviors among young Black MSM, including condom use, HIV testing, and PrEP use. Our findings highlight the significance of implementing interventions that incorporate families and other supportive adults to enhance the engagement of young Black MSM in HIV prevention behaviors.

Experiences and concerns of parents of children with a 16p11.2 deletion or duplication diagnosis: a reflexive thematic analysis

BACKGROUND

16p11.2 proximal deletion and duplication syndromes (Break points 4-5) (593KB, Chr16; 29.6-30.2mb - HG38) are observed to have highly varied phenotypes, with a known propensity for lifelong psychiatric problems. This study aimed to contribute to a research gap by qualitatively exploring the challenges families with 16p11.2 deletion and duplication face by answering three research questions: (1) What are parents' perceptions of the ongoing support needs of families with children who have 16p11.2 living in the UK?; (2) What are their experiences in trying to access support?; (3) In these regards, do the experiences of parents of children with duplication converge or vary from those of parents of children with 16p11.2 deletion?

METHODS

33 parents with children (aged 7-17 years) with 16p11.2 deletion or duplication participated in structured interviews, including the Autism Diagnostic Interview- Revised (ADI-R). Their answers to the ADI-R question 'what are your current concerns' were transcribed and subsequently analysed using Braun and Clarke's six step reflexive thematic analysis framework.

RESULTS

Three themes were identified: (1) Child is Behind Peers (subthemes: developmentally; academically; socially; emotionally); (2) Metabolism and Eating Patterns and; (3) Support (subthemes: insufficient support available; parent has to fight to access support; COVID-19 was a barrier to accessing support; 16p11.2 diagnosis can be a barrier to support, child is well-supported).

CONCLUSIONS

Parents of children with either 16p11.2 deletion or duplication shared similar experiences. However, metabolism concerns were specific to parents of children with 16p11.2 deletion. The theme Child is Behind Peers echoed concerns raised in previous Neurodevelopmental Copy Number Variant research. However, there were some key subthemes relating to research question (2) which were specific to this study. This included parents' descriptions of diagnostic overshadowing and the impact of a lack of eponymous name and scant awareness of 16p11.2.

A Cross-Sectional Comparative Study of Nurses' and Family Members' Perceptions on Priority and Satisfaction in Meeting the Needs of Family Members at the Emergency Department

INTRODUCTION

Family members experience considerable physiological, psychological, and emotional pressure when accompanying a critically ill relative in the emergency department. The culture and context of care influence the needs of the family, and a thorough understanding of these needs by health care professionals is essential to providing patient- and family-centered care. This study aimed to compare nurses' and family members' perceptions of the priorities of family member needs and their satisfaction with meeting those needs in the emergency department.

METHODS

A comparative, cross-sectional descriptive study was conducted. Participants were 140 family members of patients receiving care and 122 nurses working in the emergency department in hospitals of Tabriz University of Medical Science, in Iran. The data were collected through Critical Care Family Needs Inventory-ED and analyzed with SPSS Statistics software.

RESULTS

Family members rated their care needs as significantly greater than did nurses (129.45 [31.5] vs 124.45 [24.8], P = .003). Families rated their needs as having been met significantly less than the nurses estimated (103.6 [17.6] vs 110.8 [19.61], P < .05).

DISCUSSION

The perceived importance of the patient's family's needs differed from the viewpoints of the patient's family members and the nurses. In addition, emergency nurses overestimated the extent to which family members' needs were met compared with family members. To more adequately gauge and meet the needs of family members, nurses need to acquire more knowledge about patient family needs in the emergency department.

A Qualitative Study of Adults' and Support Persons' Experiences of Support After Autism Diagnosis

Adulthood autism diagnosis has become increasingly common, but little is known about post-diagnosis support experiences and needs. We interviewed 19 autistic adults and 4 support persons on experiences of formal and informal post-diagnosis support. Reflexive thematic analysis was used to identify themes. Participants reported difficulties accessing suitable formal support, especially regarding education and employment. Informal support was helpful but created challenges in the relationships between autistic adults and support persons. For autistic adults, support from autistic peers fostered belonging and self-acceptance. We also identified complex interactions between adults' post-diagnosis identity development and support experiences as they resolved the dilemma between self-acceptance and a desire to change. Findings have important implications for services working with autistic adults and their families.

Translation and validation of a simplified Chinese version of the psychosocial assessment tool

BACKGROUND

The Psychosocial Assessment Tool (PAT2.0) is widely used to assess psychosocial risk in families of children with cancer. Our study aims to apply PAT2.0 to Chinese patients and assess the reliability, content validity, and construct validity of the Chinese version.

METHODS

A total of 161 participants completed the study, each with only one child diagnosed with cancer. Psychometric evaluations, including internal consistency, score distribution, test-retest reliability, and construct validity, were conducted.

RESULTS

Cronbach's alpha values ranged from 0.732 to 0.843, indicating good internal consistency. Additionally, intraclass correlation coefficient values ranged from 0.869 to 0.984, indicating excellent test-retest reliability. The Simplified Chinese version of PAT2.0 demonstrated high construct validity in factor analyses and correlations with the General Functioning Subscale of the Family Assessment Device.

CONCLUSION

The translation process of the Chinese version of PAT2.0 was successful, proving its applicability for psychosocial evaluation and interventions in families of children with cancer in China.

The impact of austerity on children: Uncovering effect heterogeneity by political, economic, and family factors in low- and middle-income countries

Which children are most vulnerable when their government imposes austerity? Research tends to focus on either the political-economic level or the family level. Using a sample of nearly two million children in 67 countries, this study synthesizes theories from family sociology and political science to examine the heterogeneous effects on child poverty of economic shocks following the implementation of an International Monetary Fund (IMF) program. To discover effect heterogeneity, we apply machine learning to policy evaluation. We find that children's average probability of falling into poverty increases by 14 percentage points. We find substantial effect heterogeneity, with family wealth and governments' education spending as the two most important moderators. In contrast to studies that emphasize the vulnerability of low-income families, we find that middle-class children face an equally high risk of poverty. Our results show that synthesizing family and political factors yield deeper knowledge of how economic shocks affect children.

Defining and Identifying Only Children: A Research Note on the Concept and Measurement Illustrated With UK Survey Data

Despite increasing interest in the circumstances and outcomes of only children in the demographic literature, the conceptualization of this group has received limited scholarly attention. This research note argues for greater engagement by demographers and social scientists in the conceptualization and identification of only children by addressing three aims. First, we outline potential definitions of only children, present a framework to guide researchers' decisions, and evaluate whether only children can be reliably identified using the British birth cohort studies. Second, we show that the prevalence estimates are contingent on the timing of measurement in childhood, indicating the need for caution when deriving only-child status from cross-sectional household grid data. Third, we demonstrate that both the size and the characteristics of the only-child group may differ across definitions, highlighting that the accurate operationalization of some definitions is particularly restricted by survey designs that prioritize mothers for data collection on children and families. We argue that researchers interested in sole children's outcomes must choose the most appropriate measure for a given research question and, given that many datasets limit how accurately any indicator of only children can capture the chosen definition, reflect on how the operationalization of their measure might affect the results.

Exploring the world of food with families: perspectives of low-income families on factors influencing their food choices

OBJECTIVE

The aim of this study was to investigate the social and environmental factors involved in the food decision-making processes of families living on lower incomes on the Island of Ireland.

DESIGN

A qualitative design was employed for this study, using photovoice and creative mapping methods. Parents were requested to take photos and draw maps of their food environments. Interviews were then conducted with parents, using the materials produced by parents as a cue to discuss their food environments, influences and decision-making processes around food choices.

SETTING

The participants were interviewed online via Microsoft Teams.

PARTICIPANTS

The participants were parents or guardians of children between the ages of 2 and 18 who self-defined as 'living on a tight budget'.

RESULTS

Twenty-eight participants were recruited and interviewed for this study, including twelve parents in Northern Ireland and sixteen in the Republic of Ireland. The findings were mapped on to Bronfenbrenner's Ecological Systems Theory and showed that multiple, overlapping and intersecting factors at the individual, micro-, meso-, exo-, macro- and chrono-system were implicated in family food choices. Upstream factors in particular, including structural, policy and commercial determinants, appear to be significant drivers of behaviour.

CONCLUSIONS

While the findings suggest that a complex range of factors are involved in family food choices, it is clear that policy measures and regulations are needed to stave off the impacts of rising social inequality and food poverty. Health promoters should strive to find non-stigmatising interventions to bridge the nutritional divide experienced by lower-income families.

What determinants impact deceased organ donation consent in the adult intensive care unit? An integrative review exploring the perspectives of staff and families

BACKGROUND

Deceased organ donation saves lives. Donation processes in New Zealand operate under an opt-in system, which requires consent from families of patients diagnosed with brain death or circulatory death while in the intensivecare unit. The donation demand and supply mismatch is a global phenomenon.

OBJECTIVES

The objective of this study was to understand the determinants of deceased organ donation decisions in the adult intensive care setting from the perspectives of staff and families.

METHODS

An integrative review based on Whittemore and Knafl's approach searched literature through databases CINAHL Plus, SCOPUS, Proquest Medline Ovid, and manual ancestry searches. Inclusion/exclusion criteria screened for pertinent literature, which were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Selected studies were appraised using a generic scoring tool, and data were systematically extracted and coded onto spreadsheets using inductive, thematic analysis.

RESULTS

A total of 21 studies (12 qualitative, seven quantitative, two mixed methods) were included. Publication dates ranged from 1993 to 2021 from multiple countries (18 opt-in, three opt-out systems). Four overarching themes pertaining to families and staff were generated. Important knowledge related to families' knowledge deficits around brain death, the purpose of ventilation, donation procedures, patients' wishes, and staffs' lack of training. Challenging communication highlighted miscommunications due to language choices and interrupted continuity of care during staff-family interactions. Internal determinants explored the cultural, spiritual, and emotional perspectives of families, while staff faced a sense of burden and conflicting values in delivering care between donors and recipients. External determinants related to the clinical environment impacting on grieving families, while for the staff, it explained concerns around resources and organisational processes.

CONCLUSIONS

Factors underpinning deceased organ donation are multifaceted and complex. Staff actions and families' decisions are inextricably intertwined. Modifiable factors include a lack of formal training and communicational skills and environmental limitations of an intensive care setting.

To capture the child's interest - nurses experiences of 'Saga stories in health talks'

BACKGROUND

As unhealthy lifestyle habits have been found to be established early in life and often track into adulthood, early preventive initiatives are important. 'Saga Stories in health talks' is a newly developed material that is intended to be used as a support for nurses at child health care (CHC) centers in their health talks with children and parents in Sweden. The aim of this study is to explore how CHC nurses experience the usability of the 'Saga Stories in health talks' material.

METHODS

This study used a qualitative design. The material 'Saga Stories in health talks' was tested by 33 CHC nurses working in 11 CHC centers in three regions in Sweden. All CHC nurses were invited to participate in the interviews and 17 agreed. The interviews were transcribed and analysed using content analysis.

RESULTS

Three categories and eight sub-categories emerged. The categories were: (1) An appreciated tool suitable for health talks, (2) Illustrations to capture children's interest in the conversation with families, and (3) Barriers and facilitators. Saga Stories in health talks' was experienced by the CHC nurses as an appreciated tool with content highly relevant to what should be discussed during the health talks. The CHC nurses described the material as well-designed with illustrations that helped them capture the child's interest and increase their participation, while still involving the parents. Support from colleagues, the researchers, and managers were seen as important facilitators. Challenges included structural factors such as how and when to best use the material, especially concerning that the 4-year visit contained many other mandatory parts.

CONCLUSIONS

This pilot study show that the material 'Saga Stories in health talks' was highly appreciated by CHC nurses and facilitated their health talks with families in CHC. Important aspects with the material were the relevant content and the focus on healthy living habits, as well as the child friendly illustrations. These findings can be used when similar material is developed to facilitate health talks with families in other contexts. Our results also highlight the importance to adjust the implementation of a new material with already established practice and routines.

Exploring the varied manifestations of structural violence in the lives of children on the autism spectrum and their families: a qualitative longitudinal study in Kurdistan, Iran

BACKGROUND

There are many dimensions regarding autism that are closely connected to social structures, policies, and power dynamics, silently impacting the well-being of individuals within the autism spectrum. This research aims to explore these overlooked aspects using a theoretical framework called "structural violence."

METHODS

The study was conducted in Kurdistan, Iran, and a qualitative longitudinal approach was chosen. A purposive sampling method was employed to select the participants, with 11 parents taking part. The study data comprised 29 interviews using a topic guide conducted over a span of 2 years. Thematic analysis and a matrix-based approach were utilized for data analysis. To enhance the scientific rigor of this research, four criteria, including Guba and Lincoln's principles, were implemented to ensure methodological accuracy.

RESULTS

The research findings highlight four primary forms through which structural violence impacts children on the autism spectrum and their families: access to healthcare, geographic disparities, awareness and stigma, and poverty and financial burden. Additionally, the study identified 11 subthemes related to structural violence in the context of autism and families.

CONCLUSIONS

We illustrated how structural forces create barriers to accessing adequate healthcare services, exacerbate discrimination based on ethnicity and geography, perpetuate stigma, and contribute to poverty and the inability to meet basic needs. These factors not only worsen health issues but also deepen existing disparities in healthcare access and outcomes for children on the autism spectrum and families. We emphasize the urgent need for systemic changes to address these issues. It is essential to promote public awareness, provide better access to health and support services, and address economic and political factors that contribute to these inequalities.

Characteristics and impacts of live music interventions on health and wellbeing for children, families, and health care professionals in paediatric hospitals: a scoping review

PURPOSE

The objective of this scoping review is to compile and examine characteristics and impacts of live music interventions on the health and wellbeing of children, families, and health care professionals in paediatric hospital care.

METHODS

We searched four scientific databases for peer-reviewed publications of empirical studies of all study designs. The first author screened the publications, with spot-checks for eligibility by the second and third authors. Data extraction and quality assessment were made by the first author with support from the second and third. Additionally, the included studies were screened for quality appraisal. The analysis followed an inductive, interpretive approach for synthesis.

RESULTS

Quantitative features were screened and compiled, and qualitative inductive analyses of findings were elaborated into categories connected to research questions. The reported impacts were thematized through emergent features of importance and prerequisites beneficial for successful interventions. Recurrent outcomes present themes of positive affect, copingand reduced hospitalization. Emotional regulation, play and participation, age, session design, adaptivity, and familiarity present benefits, barriers, and facilitators for outcomes.

CONCLUSIONS

Findings from collected empirical research display philosophy, practice, and relations as keys for characteristics, impacts, and implications of live music interventions in paediatric hospital care. The communicative aspects of music appear at the core of importance.

The prolactin receptor gene (PRLR) is linked and associated with the risk of polycystic ovarian syndrome

The prolactin receptor gene (PRLR) may contribute to polycystic ovarian syndrome (PCOS) since it plays important roles in physiological ovarian functions. PRLR-knockout mice have irregular cycles and subfertility and variants in or around the PRLR gene were associated in humans with female testosterone levels and recurrent miscarriage. We tested 40 variants in the PRLR gene in 212 Italian families phenotyped by type 2 diabetes (T2D) and PCOS and found two intronic PRLR-variants (rs13436213 and rs1604428) significantly linked to and/or associated with the risk of PCOS. This is the first study to report PRLR as a novel risk gene in PCOS. Functional studies are needed to confirm these results.

Affectivity, sexuality, and autism spectrum disorder: qualitative analysis of the experiences of autistic young adults and their families

BACKGROUND

Autistic people have communication, sensorial, and social difficulties, which on many occasions, make their adaptation on the sexual and affective levels difficult. For this reason, it is important to know the opinion of individuals with autism spectrum disorders (ASD) and their families, to offer this perspective to professionals to facilitate adapted health education programs in mental health units.

METHODS

This qualitative descriptive design presents the experiences of autistic individuals and their families in relation to the affective-sexual experiences from individual, family, and social perspectives. Two focus group sessions were held with eight family members and seven individual semi-structured interviews with autistic young adults. The transcripts were qualitatively analysed using content analysis.

RESULTS

Four themes (Family and social dynamic; Social behaviour of the autistic individual; Affective-sexual relationships; Addressing affective and sex education) and 13 related categories emerged from these results. Communication and social interaction problems act as barriers for young adults when developing affective-sexual relationships, leading to the emergence of negative feelings and experiences that reinforce avoidance behaviours, further intensifying their difficulties in interacting with others. Families, especially mothers, exhibit a poor perception of their ability to provide affective-sexual guidance, leading to anxiety and frustration. There are also reports of poor sex education and lack of support systems.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The experiences of young people and their families are sometimes conflicting when it comes to affectivity and sexuality, but the parental role emerges as relevant in the sex education process. Families play a pivotal role in sex education, which is why professionals should provide them with support and information through health education programmes, foster empathetic communication and promote sexual and emotional development that is adapted to the characteristics and interests of autistic people.

Siblings' experiences of sleep disruption in families with a child with Down syndrome

OBJECTIVE

Adverse effects of sleep disruption are identified in parents who live with a child with Down Syndrome (DS), yet there is no research on siblings' experiences. This study addresses this knowledge gap.

DESIGN

A qualitative research study using semi-structured interviews to understand the experiences of siblings of a child with DS and sleep difficulties from the perspectives of parents and siblings.

PARTICIPANTS

Eleven siblings aged 5-15 years old, and 11 parents, from 8 families with a child with DS in Australia.

METHODS

Semi-structured sibling interviews explored what it was like to have a sibling with DS and sleep difficulties; the participant's own sleep; how their sleep affected how they felt during the day; how sleep impacted their family; and advice that they would give to other siblings. Parent interviews included similar topics; here we report on excerpts in which parents reference siblings. Interviews were audio recorded, transcribed verbatim, and analyzed using a reflexive thematic analysis.

RESULTS

Siblings and parents acknowledge sleep disruption for siblings; yet sleep disruption is normalized, viewed with acceptance and inevitability. Siblings report adverse effects from sleep disruption, view sleep in a relational way, and cope with sleep disruption. Parents can underestimate siblings' sleep disruption and are uncertain whether siblings' symptoms result from sleep disruption or other causes.

CONCLUSIONS

Siblings of a child with DS experience sleep disruption and may be at risk of developing long-term health problems without focused support.

Effects of an online information tool on post-traumatic stress disorder in relatives of intensive care unit patients: a multicenter double-blind, randomized, placebo-controlled trial (ICU-Families-Study)

PURPOSE

Intensive care unit (ICU) hospitalization is challenging for the family members of the patients. Most family members report some level of anxiety and depression, sometimes even resulting in post-traumatic stress disorder (PTSD). An association has been reported between lack of information and PTSD. This study had three aims: to quantify the psychological burden of family members of critically ill patients, to explore whether a website with specific information could reduce PTSD symptoms, and to ascertain whether a website with information about intensive care would be used.

METHOD

A multicenter double-blind, randomized, placebo-controlled trial was carried out in Austria and Switzerland.

RESULTS

In total, 89 members of families of critically ill patients (mean age 47.3 ± 12.9 years, female n = 59, 66.3%) were included in the study. 46 relatives were allocated to the intervention website and 43 to the control website. Baseline Impact of Event Scale (IES) score was 27.5 ± 12.7. Overall, 50% showed clinically relevant PTSD symptoms at baseline. Mean IES score for the primary endpoint (~ 30 days after inclusion, T1) was 24 ± 15.8 (intervention 23.9 ± 17.9 vs. control 24.1 ± 13.5, p = 0.892). Hospital Anxiety and Depression Scale (HADS - Deutsch (D)) score at T1 was 12.2 ± 6.1 (min. 3, max. 31) and did not differ between groups. Use of the website differed between the groups (intervention min. 1, max. 14 vs. min. 1, max. 3; total 1386 "clicks" on the website, intervention 1021 vs. control 365). Recruitment was prematurely stopped in February 2020 due to coronavirus disease 2019 (COVID-19).

CONCLUSION

Family members of critically ill patients often have significant PTSD symptoms and online information on critical illness did not result in reduced PTSD symptoms.

Validation of the Psychosocial Assessment Tool 2.0 for paediatric burn patients

OBJECTIVE

The Psychosocial Assessment Tool 2.0 (PAT-B) is an adaptation of an existing screening tool with the aim of the present study to examine its effectiveness and suitability to identify children and families at risk of emotional, behavioral, and social maladjustment following paediatric burns.

METHODS

Sixty-eight children aged between 6 months - 16 years (M = 4.40) admitted into hospital following paediatric burns, and their primary caregivers, were recruited. The PAT-B comprises several dimensions including family structure and resources, social support, as well as caregiver and child psychological difficulties. Caregivers completed the PAT-B and several standardized measures for validation purposes (e.g., caregiver reports of family functioning, child emotional and behavioural problems, caregiver distress). Children old enough to complete measures reported on their psychological functioning (e.g., posttraumatic stress and depression). Measures were completed within 3 weeks of child admission and then again at 3 months after burn.

RESULTS

The PAT-B demonstrated good construct validity, evidenced by moderate to strong correlations between the PAT-B Total and subscale scores and several criteria measures (family functioning, child behaviour and caregiver distress, child depressive symptoms, rs ranging from 0.33 -0.74). Preliminary support for criterion validity of the measure was observed when examined against the three tiers of the Paediatric Psychosocial Preventative Health Model. The proportion of families falling within these tiers of risk (Universal [low risk], 58.2%; Targeted, 31.3%; or Clinical range, 10.4%) was consistent with prior research. Sensitivity of the PAT-B to identify children and caregivers at high risk of psychological distress was 71% and 83%, respectively.

CONCLUSION

The PAT-B appears to be a reliable and valid instrument for indexing psychosocial risk across families who have sustained a paediatric burn. However, further testing and replication using a larger sample size is recommended before the tool is integrated into routine clinical care.

Accompaniment of minors during health care procedures

In clinical practice, it is not rare to encounter situations in which parents and families are asked to leave the child alone with the health care team in rooms full of devices throughout the performance of procedures, which at times may give rise not only to conflicts but, more importantly, emotional sequelae in children or adolescents. We conducted a narrative review of the literature by searching the digital library of the public health care system of Andalusia for articles concerning the experiences of health care professionals and families with the accompaniment of paediatric patients during health care procedures. We restricted the search to studies published in Spanish or English and conducted in humans. The review evinced the need to humanise care in order to improve care quality. The need to accompany minors is supported by the evidence from works that have analysed the factors involved in the persistence of these behaviours and attitudes in both professionals and parents. We consider it necessary to develop institutional policies and appoint mediators to compile the statements of different national and international societies, taking into account legal aspects but, above all, the pertinent values from a health care ethics perspective, and in pursuit of the best interests of the child.

Families' experiences of supporting Australian veterans to seek help for a mental health problem: a linked data analysis of national surveys with families and veterans

BACKGROUND

Families play a critical role in supporting currently serving and transitioned veterans' wellbeing and help-seeking for mental health concerns; however, little is known about families' experiences.

AIMS

This study used Australian national survey linked-data (n = 1217) from families (Family Wellbeing Study-FWS) and veterans (Mental Health Wellbeing Transition Study-MHWTS) to understand veteran-family help-seeking relationships.

METHODS

Veterans' and family members' responses to mental health and help-seeking questions in FWS and MHWTS datasets from perspective of family members were cross-tabulated. Help-seeking support provided by family members was compared by veterans' probable disorder.

RESULTS

Results highlighted high levels of involvement and continuous assistance provided by families. Two in three family members thought the veteran had probable mental health concerns although they have never been diagnosed or treated. Clear disparities between family and veteran perspectives regarding mental health concerns indicates the extent of non-treatment seeking in this population, missed opportunities for early intervention, and need for greater support to families to promote help-seeking.

CONCLUSIONS

Encouraging help-seeking is complex for veteran families particularly where veterans' reluctance to seek help may lead to family relationship strain and conflict. Families need early information, support, and recognition by service agencies of the role of the family in encouraging help-seeking.

Considering the experiences and adjustment of sexual and gender minority youths during the COVID-19 pandemic

Sexual and gender minority (SGM) adolescents and emerging adults experienced social and structural inequities and evinced more psychosocial adjustment difficulties than cisgender, heterosexual youths before the onset of the COVID-19 pandemic. The unique array of stressors confronting SGM youths during the pandemic - including separation from affirming and supportive peers, teachers and communities, and mandated co-residence with potentially rejecting family members - may have exacerbated these discrepancies. Conversely, social distancing and remote learning may have reduced direct exposure to discrimination outside the home, and many SGM youths leveraged their personal and social resources to cope with pandemic-related stressors. This review considers the empirical literature on the academic, psychological, and social consequences of the COVID-19 pandemic for SGM youths.

How do Latina/o Parents Interpret and Respond to the US Household Food Security Survey Module? A Qualitative Cognitive Interviewing Study

BACKGROUND

The US Latino/a population disproportionately lives in poverty and experiences household food insecurity, especially households with children. The Household Food Security Survey Module (FSSM) was originally developed among rural White women. Despite wide use in English and Spanish, how well the FSSM captures the food insecurity experiences of Latino/a households is not well known.

OBJECTIVE

This study explored how Latino/a caregivers understood, interpreted, and perceived FSSM items and responses, and how well quantitative FSSM responses captured their reported food insecurity experiences.

DESIGN

Trained researchers conducted in-depth cognitive interviews in a qualitative study.

PARTICIPANTS AND SETTING

Interviews were conducted between October 2021 and August 2022 with Latino/a adults (N = 62) experiencing food insecurity while caring for a child (aged 18 years or younger) in the same household, and living in California, New York, or Texas.

STATISTICAL ANALYSIS PERFORMED

Qualitative analysis using iterative summaries for data reduction focused on item interpretation, response patterns, and cross-cutting themes.

RESULTS

Participants generally understood FSSM items as intended. The most salient findings were themes that applied across multiple FSSM items rather than wording issues with specific items. Underreporting of food insecurity was linked to nonaffirmative ("never") responses to items referencing not having enough money for food while describing reliance on nonmonetary resources (eg, food assistance or food pantries); emotional sensitivity to discussing food insecurity, particularly as it related to children; stigma and emotions related to skipping meals; and limited response options that participants believed did not reflect their experiences. These issues influenced multiple items, impeding ease of responding and leading to inaccurate responses in English- and Spanish-language versions.

CONCLUSIONS

Assessing coping strategies and providing more acceptable response options could enhance FSSM validity. Considering emic perspectives of Latino/a caregivers and how food access experiences differ from quantitative survey measures of food security could strengthen policy and programs.

Shifting focus: A grounded theory of how family members to critically ill patients manage their situation

OBJECTIVES

Critical illness is a life-threatening condition for the patient, which affects their family members as a traumatic experience. Well-known long-term consequences include impact on mental health and health-related quality of life. This study aims to develop a grounded theory to explain pattern of behaviours in family members of critically ill patients cared for in an intensive care unit, addressing the period from when the patient becomes critically ill until recovery at home.

RESEARCH METHODOLOGY/DESIGN

We used a classic grounded theory to explore the main concern for family members of intensive care patients. Fourteen interviews and seven observations with a total of 21 participants were analysed. Data were collected from February 2019 to June 2021.

SETTING

Three general intensive care units in Sweden, consisting of a university hospital and two county hospitals.

FINDINGS

The theory Shifting focus explains how family members' main concern, living on hold, is managed. This theory involves different strategies: decoding, sheltering and emotional processing. The theory has three different outcomes: adjusting focus, emotional resigning or remaining in focus.

CONCLUSION

Family members could stand in the shadow of the patients' critical illness and needs. This emotional adversity is processed through shifting focus from one's own needs and well-being to the patient's survival, needs and well-being. This theory can raise awareness of how family members of critically ill patients manage the process from critical illness until return to everyday life at home. Future research focusing on family members' need for support and information, to reduce stress in everyday life, is needed.

IMPLICATIONS FOR CLINICAL PRACTICE

Healthcare professionals should support family members in shifting focus by interaction, clear and honest communication, and through mediating hope.

I AM FAMILY: Understanding the adapted sport experiences of family members of military personnel with physical and psychological illnesses and injuries through the lens of the Invictus Games

Family are influential actors in adapted sport participation. However, little is known about their experiences with adapted sport. The current study sought to explore the experiences of families in adapted sport through the context of the Invictus Games, an international adapted sport competition for military personnel with physical and psychological illnesses and injuries that is unique in its inclusion of family programming. Family members (n = 21; partners, parents, siblings, and children) of Invictus Games Toronto 2017 competitors participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis. Three themes were identified: recognition of family experiences during service and after onset of disability; creating a sense of belonging; and improving family knowledge and perceptions. This study provides insight regarding how adapted sport events can support the well-being of both individuals with illnesses and injuries and their families.

General practitioners' perspectives regarding early developmental surveillance for autism within the australian primary healthcare setting: a qualitative study

BACKGROUND

Significant challenges remain in the early identification of child developmental disabilities in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental disabilities, including autism. As part of a cluster randomised controlled trial, this study seeks to examine and compare the perspectives and experiences of Australian general practitioners (GPs) in relation to a digital developmental surveillance program for autism and usual care pathway, in general practice clinics.

METHODS

A qualitative research methodology with semi-structured interviews and thematic inductive analysis underpinned by grounded theory was utilised. All GPs from South Western Sydney (NSW) and Melbourne (Victoria) who participated in the main program ("GP Surveillance for Autism") were invited to the interview. GPs who provided consent were interviewed either over online or in-person meeting. Interviews were audio-recorded, transcribed, and coded using NVivo12 software. Inductive interpretive approach was adopted and data were analysed thematically.

RESULTS

Twenty-three GPs across the two sites (NSW: n = 11; Victoria: n = 12) agreed to be interviewed; data saturation had reached following this number of participants. Inductive thematic coding and analysis yielded eight major themes and highlighted common enablers such as the role of GPs in early identification and subsequent supports, enhanced communication between clinicians/professionals, relationship-building with patients, and having standardised screening tools. Specific facilitators to the feasibility and acceptability of a digital screening program for the early identification of developmental disabilities, including the early signs of autism, and encouraging research and education for GPs. However, several practical and socioeconomic barriers were identified, in addition to limited knowledge and uptake of child developmental screening tools as well as COVID-19 lockdown impacts. Common and specific recommendations involve supporting GPs in developmental/paediatrics training, streamlined screening process, and funding and resources in the primary healthcare services.

CONCLUSIONS

The study highlighted the need for practice and policy changes, including further training of GPs alongside sufficient time to complete developmental checks and appropriate financial remuneration through a Medicare billing item. Further research is needed on implementation and scale up of a national surveillance program for early identification of developmental disabilities, including autism.

[Families with infants and toddlers in the COVID-19 pandemic: parental stress and child development considering social class]

INTRODUCTION

It is now well established empirically that families and children who could not attend educational and childcare institutions during the COVID-19 pandemic experienced disadvantages. This is particularly true for families in poverty. However, little is known about the situation of families with young children. The aim of the paper is to investigate (1) to what extent families with infants and toddlers also experienced their situation during the pandemic as stressful, (2) whether there were differences depending on social class, (3) how the pandemic affected the healthy development of infants and toddlers, and (4) to what extent class-related differences can also be identified in this.

METHODS

The German National Centre for Early Prevention conducted a nationally representative survey of families with children of age 0 to 3 years in April to December 2022, "Kinder in Deutschland 0‑3 2022" (N = 7821). The KiD 0‑3 study combines a parent survey on family psychosocial burden and resources with pediatric documentation of child development.

RESULTS

Parents with very young children experienced their situation in the COVID-19 pandemic as stressful. A clear difference depending on social class emerged. Both from the parents' perspective and in pediatric judgment, the pandemic had a negative impact on social and affective development even in young children. These effects were more pronounced in children from families experiencing poverty than in children from families not receiving basic government benefits.

DISCUSSION

In order to mitigate the psychosocial consequences of the COVID-19 pandemic for families and to improve children's chances of growing up in a healthy way that promotes their development, it is necessary to support families in need without stigmatization.

Palliative care interventions and end-of-life care as reported by patients' post-stroke and their families: a systematic review

AIMS

Internationally, there is an urgent need to implement guidelines supporting integration of palliative care into stroke clinical practice. Despite considerable advances in acute stroke management, ∼20% of all acute stroke patients die within the first 30 days. Palliative care is well established in diseases such as cancer or advanced heart failure, but evidence-based interventions of high quality are limited in stroke populations. This systematic review aims to identify and evaluate quantitative studies that describe palliative care interventions and end-of-life care as reported by patient's post-stroke and their families.

METHODS AND RESULTS

A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted in Cumulative Index to Nursing and Allied Health Literature, PubMed, Cochrane, Embase, Ovid, Proquest, and Scopus from 1990 to April 2021. The National Heart, Lung and Blood Institute standardized quality rating tools for quality assessment were used. Seven studies were identified, and all used descriptive quantitative designs. There were no interventional studies. The results were synthesized narratively according to the elements of palliative care interventions and end-of-life care: symptom burden and satisfaction, loss of autonomy at the end of life, and acknowledging uncertainty.

CONCLUSION

This review highlights the limited empirical evidence that describes palliative care interventions and end-of-life care as reported by patient's post-stroke and their families. Most of the current evidence focuses on the provision of care during the final days and hours of life, or end-of-life care, with little evidence to guide the integration of palliative care into post-stroke clinical care, especially for patients with an uncertain prognosis. Acute stroke is sudden, unexpected, and life-changing, and patients and families would benefit from well-designed targeted interventions to determine strategies that address the diverse palliative needs of this patient population.

REGISTRATION

PROSPERO CRD42021254536.

Barriers and facilitators to accessibility, continuity, validity, flexibility, and provider-family relationship along the diagnostic pathway in developmental disabilities

BACKGROUND

Parents of children with developmental disabilities must navigate a complex network to obtain a diagnosis and interventions for their child. However, their subjective experience of this journey has yet to be analyzed through the lens of a theorical framework that could support research, organizational program evaluation, and facilitate providers' reflection on how to enhance families' diagnostic services trajectory.

AIMS

This study sought to examine the diagnostic journey as experienced by 77 parents whose children were recently diagnosed with developmental disabilities (e.g., autism, intellectual disability) in the metropolitan area of Montréal, Québec (Canada).

METHODS AND PROCEDURES

A mixed qualitative content analysis approach was used to describe their perspective on barriers and facilitators in reference to the five dimensions of the Evaluation of the Trajectory Autism for Parents (ETAP) model (Rivard et al., 2020): accessibility, continuity, validity, flexibility, and provider-family relationship.

OUTCOMES AND RESULTS

The barriers and facilitators related to systemic factors identified by parents were consistent with the five dimensions outlined by the ETAP model. However, beyond these characteristics of the service delivery system, parents additionally identified their own, personal facilitators CONCLUSIONS AND IMPLICATIONS: This study supports the relevance of the ETAP framework to understanding the experience of families seeking a diagnosis. It also reinforces the potential contributions of this model to organize extant and future research as well as structure program evaluation and improvements.

Mechanism mapping: A qualitative study of how different forms of instability mediate the relationship between legal status and immigrant mental well-being

Scholarship on undocumented immigrants has linked irregular forms of legal status to depressed mental health experiences and outcomes. The children of undocumented immigrants have also been shown to report mental health issues. More regular forms of legal status, like Deferred Action for Childhood Arrivals (DACA), have been shown to improve psychological outcomes for migrants and their children. Though the relationship between legal status and mental well-being has appeared again and again in the literature, less work has explored the mechanisms through which legal status impacts mental well-being. This paper aims to help detail this link by drawing on 50 in-depth interviews with DACA-recipient and undocumented (DACA-ineligible) immigrants conducted from 2017 to 2018 (pre- and post-DACA rescindment). Thematic analysis identified three forms of instability (nation-state, residential and household) that mediate the influence of legal status on the mental well-being of immigrants and their families. Coping with nation-state, residential and household changes depleted immigrant's mental and emotional resources, hurting their mental well-being. More regular forms of legal status (like DACA) suppressed the occurrence of instability, bolstering the mental well-being reports of DACA-recipients compared to their undocumented counterparts. Yet the program's rescission in September 2017, spiked the threat of future instability for DACA-respondents leading their negative mental well-being reports to echo those of undocumented respondents. We propose that experiencing or even expecting these forms of instability to occur mediates the influence of legal status on mental well-being. Findings shed light on how legal status influences mental well-being and contribute to the immigrant mental health literature.

A scoping review of military and Veteran families within international suicidality and suicide prevention research

The impacts of suicidality on families are well known, which is particularly relevant in at-risk populations, such as active duty military personnel and Veteran communities. This scoping review describes how military and Veteran families have been conceptualized within suicide prevention research. A systematic, multi-database search was conducted, and 4,835 studies were screened. All included studies underwent quality assessment. Bibliographic, participant, methodological, and family-relevant data was extracted and descriptively analyzed into Factors, Actors, and Impacts. In total, 51 studies (2007 - 2021) were included. Most studies focused on suicidality rather than suicide prevention. Factor studies described family constructs as a suicidality risk or protective factor for military personnel or Veterans. Actor studies described families' roles or responsibilities to act in relation to the suicidality of military personnel or Veterans. Impacts studies described the impacts of suicidality on military and Veteran family members. The search was limited to English language studies. There were few studies on suicide prevention interventions for or including military and Veteran family members. Family was typically considered peripheral to the military personnel or Veteran experiencing suicidality. However, there was also emerging evidence of suicidality and its consequences in military-connected family members.

Civil commitment perspectives and experiences among friends and family of people who use illicit opioids in Massachusetts, USA

BACKGROUND

Civil commitment statutes allow qualified individuals to petition for court-mandated commitment for someone with a substance use disorder (SUD). Despite a lack of empirical evidence showing efficacy of involuntary commitment, these statutes are prevalent worldwide. We examined perspectives on civil commitment among family members and close friends of people who use illicit opioids in Massachusetts, U.S.A.

METHODS

Eligible individuals were Massachusetts residents, ≥18 years of age, did not use illicit opioids but had a close relationship with someone who did. We used a sequential mixed methods approach in which semi-structured interviews (N=22) were followed by a quantitative survey (N=260). Thematic analysis was used to analyze qualitative data and survey data were analyzed using descriptive statistics.

RESULTS

While some family members were influenced by SUD professionals to petition for civil commitment, influence from social networks based on personal experience was more common. Motivations for civil commitment included initiating recovery and believing that commitment would reduce overdose risk. Some reported that it afforded them respite from caring for, and worrying about, their loved one. A minority discussed increases in overdose risk following a period of forced abstinence. Participants expressed concerns about the variable quality of care during commitment, largely based on the use of corrections facilities for civil commitment in Massachusetts. A minority endorsed the use of these facilities for civil commitment.

CONCLUSIONS

Despite participants' uncertainty and the harms stemming from civil commitment, including increased risk of overdose after forced abstinence and the use of corrections facilities, family members resorted to this mechanism to reduce immediate overdose risk. Our findings indicate that peer support groups are an appropriate forum to disseminate information about evidenced-based treatment and that family members and others close to those with SUD often lack adequate support for, and respite from, the stress of caring for them.

Transitions in mental health and addiction care for youth and their families: a scoping review of needs, barriers, and facilitators

INTRODUCTION

Transitional-aged youth (TAY) with mental health and/or addictions (MHA) concerns and their families experience significant challenges finding, accessing, and transitioning through needed MHA care. To develop appropriate supports that assist TAY and their families in navigating MHA care, their experiences of transitions in the MHA care system must be better understood. This scoping review identifies and explores the needs, barriers, and facilitators for TAY and their families when transitioning through MHA care.

METHODS

This scoping review commenced with a search of five relevant databases. Three research team members were involved in title, abstract, and full-text scanning and data extraction. Sources focusing on TAY anywhere between the ages of 12-29 years and meeting the study objectives were included. Extractions compiled background and narrative information about the nature and extent of the data. Analysis and synthesis of findings involved numerical description of the general information extracted (e.g., numbers of sources by country) and thematic analysis of narrative information extracted (e.g., family involvement in TAY help-seeking).

RESULTS

A total of 5894 sources were identified. Following title and abstract scanning, 1037 sources remained for full-text review. A total of 66 sources were extracted. Findings include background information about extracted sources, in addition to five themes that emerged pertaining to barriers and facilitators to access and transitions through care and the needs and roles of TAY and families in supporting help-seeking and care transitions: holistic supports, proactive preparation, empowering TAY and families, collaborative relationships, and systemic considerations. These five themes demonstrate approaches to care that can ensure TAY and families' needs are met, barriers are mitigated, and facilitators are enhanced.

CONCLUSION

This review provides essential contextual information regarding TAY with MHA concerns and their families' needs when seeking care. Such findings lend to an enhanced understanding of how MHA programs can support this population's needs, involve family members as appropriate, reduce the barriers experienced, and work to build upon existing facilitators.

Evaluating an emotion coaching programme for parents of young adolescents attending Child Adolescent Mental Health Services (CAMHS) in New Zealand: protocol for a multi-site feasibility trial including co-design with service users

BACKGROUND

Early adolescence is a time of increased vulnerability for the development of common mental health conditions such as anxiety and depression (internalising outcomes). Current treatments such as cognitive-behavioural therapy and antidepressant medication are focused on the individual and have small effect sizes, particularly in real-world clinical settings such as the public Child Adolescent Mental Health Services (CAMHS). Parents are an important and under-utilised resource in treating these conditions in young adolescents. Teaching parents how to respond to their young person's emotions can improve emotion regulation and reduce internalising outcomes. One emotion-focused programme for parents of this age group is Tuning in to Teens (TINT). This is a structured, manualised skills group for parents only focused on teaching skills to coach young people through their emotional experiences. This study aims to investigate the impact of TINT in the clinical setting of publicly funded CAMHS in New Zealand.

METHODS

The trial will evaluate the feasibility of a two-arm multi-site randomised control trial (RCT). Participants will be 10-14-year-olds referred to CAMHS in Wellington, New Zealand, with anxiety or depression, and their parents or guardians. Arm 1 will be parents attending and implementing TINT (in addition to the usual care received at CAMHS). Arm 2 will be usual care only. TINT groups will be facilitated by CAMHS clinicians who have been trained in the programme and will be delivered over 8 weekly sessions. Prior to the RCT, a co-design methodology will be used with service users to inform outcome measures used in the trial. A group of service users meeting the RCT criteria will be recruited to take part in workshops to help determine their priority outcomes. Measures based on the results of workshops will be included in the outcome measures. The primary feasibility outcomes will be the recruitment and retention of participants, acceptability of the intervention for service users and clinicians and acceptability of outcome measures.

DISCUSSION

There is a need to improve outcomes for the treatment of adolescent anxiety and depression. TINT is a programme with the potential to enhance outcomes for those accessing mental health services by providing targeted support to parents of adolescents. This trial will inform whether a full RCT is feasible to evaluate TINT. Including service users in the design will increase its relevance of an evaluation in this setting.

TRIAL REGISTRATION

The Australian New Zealand Clinical Trials Registry (ACTRN): ACTRN12622000483752. Registered on 28 March 2022.

Child and Adolescent Anxiety and Depression Prior to and During the COVID-19 Pandemic in the United States

Childhood anxiety and depression have been increasing for years, and evidence suggests the COVID-19 pandemic has exacerbated this trend. However, research has examined anxiety and depression primarily as exclusive conditions, overlooking comorbidity. This study examined relationships between the COVID-19 pandemic and anxiety and depression to clarify risk factors for singular and comorbid anxiety and depression in children. Using 2018-2019 and 2020-2021 samples from the National Survey of Children's Health, a nationally representative survey of children aged 0-17 in the United States, associations between the COVID-19 pandemic and child anxiety and depression were examined via survey-weights' adjusted bivariate and multiple regression analyses, controlling for demographic characteristics. The COVID-19 pandemic was associated with higher odds of having comorbid anxiety and depression but not singular anxiety or depression. Female sex, older age, having special healthcare needs, more frequent inability to cover basic needs on family income, and poorer caregiver mental health were associated with having been diagnosed with singular and comorbid anxiety and depression. Children that witnessed or were victims of violence in the neighborhood were also more likely to have comorbid anxiety and depression. Implications for prevention, intervention, and policy are discussed.

Vertical distribution and acoustic characteristics of deep water micronektonic crustacean in the Bay of Biscay

Vertical distribution of meso- and bathypelagic crustacean are scarcely known. The logistics involved in their studies hinder an adequate assessment of their role in the deep ecosystems. As a result, the literature on zooplankton scattering models is mainly focused on epipelagic organisms, particularly krill species. This study analyses data of the plankton community classified by family from the surface down to 2000 m taken in the Bay of Biscay, but focusses on the meso- and bathypelagic zone. Photographic data was employed to obtain a micronektonic crustacean shape catalogue. The Distorted Wave Born Approximation (DWBA) model was employed to estimate target strength. Pasiphaeidae, Euphausiidae and Acanthephyridae were mainly distributed above 500 m depth, while Benthesicymidae, Sergestidae and Mysidae were concentrated in the lower mesopelagic to upper bathypelagic area. The most abundant species were Euphausiidae and Benthesicymidae with up to 30 and 40 individuals per cubic meter respectively. Standard length ranged from 8 to 85 mm and was significantly related with height but not with depth. The Pasiphaeidae family presented the largest individuals followed by Acanthephyridae and Sergestidae while Euphausiidae, Benthesicymidae, and Mysidae were shorter. An smooth fluid-like response was estimated for shorter organisms, while individuals of 60 mm or higher present TS oscillations from around 60 kHz. Pasiphaeidae present an almost 10 dB higher TS than Sergestidae, Acanthephyridae and Benthesicymidae while Mysidae followed by Euphausiidae produce the lower TS. Simple models of TS values at broadside versus the logarithm of standard length (SL) that can be employed as an approximation of their scattering are provided for four common frequencies (TS = 58.5*log₁₀(SL)-188.7, TS = 57.03*log₁₀(SL)-174.1, TS = 22.48*log₁₀(SL)-157.14, TS = 17.55*log₁₀(SL)-135 and TS = 10.53*log₁₀(SL)-109 at 18, 38, 70, 120 and 200 kHz respectively). Changes in body density and sound speed contrast may increase by 10 or 2 dB the resulting TS respectively but are constant in phase, while orientation can decrease the TS by up to 20 dB at the higher frequencies and alter the spectra to an almost flat trend. This study provides further insight into the vertical distribution and physical characteristics of the micronektonic crustacean families inhabiting the Bay of Biscay down to 2000 m depth. It also estimates their echo from a real-shape catalogue that can be employed to infer knowledge from acoustic recordings, particularly of the lower mesopelagic and the bathypelagic zones.

Navigating the quality-of-life impacts of a chronic inflammatory disease (CID) among South Asian children and parents

This study investigates quality-of-life impacts (QOL) associated with managing a chronic inflammatory disease (CID) among first and second generation South Asian children and parents in the Greater Toronto Area, Ontario. While empirical evidence on both the rise of CIDs among immigrants and the QOL impacts of managing a CID is increasing, little attention has been given to the QOL impacts of managing a CID among immigrant adult children and their families. Drawing on analysis of 24 in-depth interviews with adult children and parents (14 adult children, 10 parents) the results indicate that first and second generation South Asian adult children and parents experience challenges acquiring a CID diagnosis (e.g., bureaucratic issues, transportation, inconsistent and unavailable physician care), and encounter multidimensional short- and long-term QOL implications associated with CID management. These challenges are compounded further by culturally insensitive care and language barriers in the health system. QOL impacts associated with CID management among adult children ranged from comfort and peace of mind due to increased ability to participate in daily life, while others reported intensified anxiety, stress and depression due to their inability to fully engage in daily life. Although all parents reported heightened stress due to their child's CID diagnosis and new management regimens, parents employed different coping mechanisms that created new short term QOL challenges for their families. The findings suggest that a patient centered approach to CID diagnosis and management, informed by personal experiences, cultural sensitivities and lived experiences of QOL representations are needed to mitigate negative QOL outcomes across a patient's life and deliver appropriate evidence informed care for those in need.

A randomized controlled trial of moderated online social therapy for family carers of first-episode psychosis patients in a specialist treatment setting

BACKGROUND

Family members, who provide the majority of informal care during the recovery period from first-episode psychosis (FEP), experience high levels of psychological distress. However, there is a lack of effective and accessible interventions for FEP carers.

OBJECTIVE

To determine the effectiveness of an online intervention ("Altitudes") in relation to the primary outcome of FEP-carer stress at 6 months follow-up.

METHODS

We conducted a cluster randomized controlled trial in which FEP carers were randomized to Altitudes combined with specialized treatment as usual (STAU) or STAU alone. In addition to questionnaires, we included multiple waves of intensive ecological momentary assessment (EMA) to measure carer stress and family outcomes in 164 carers of young (15-27 years) FEP patients.

RESULTS

Both groups improved over time on stress and a range of secondary outcomes, including mental health symptoms, self-efficacy, and expressed emotion with no group by time interactions. At 12 months there were significantly fewer visits to emergency departments by FEP patients in the Altitudes group (p = 0.022). Modelling of multiple EMA waves revealed that more time spent by carers with FEP patients predicted greater worry, expressed emotion, and adaptive coping.

CONCLUSIONS

Engagement and usability findings for Altitudes were positive. Further refinements to our online carer interventions may be needed to engage carers in purposeful skill development for improved management of stress and communication with the young person compared with existing specialist family interventions.

TRIAL REGISTRATION

ACTRN12616000968471.

Supporting Families from a Distance: Implementing Routines-Based Home Visits via Telepractice

Early intervention is a system of services designed to strengthen child outcomes and build family capacity. One approach of service provision is the Routines-Based Model which implements adult-learning practices wherein service providers and caregivers partner to build family-mediated interventions for children. Owing to COVID-19 and the benefits of telepractice, more and more service providers are likely to incorporate a telepractice modality into service provision. Because the Routines-Based Model uses family consultation, these home-visiting practices translate well to telepractice. In addition to consultation techniques, however, service providers must use technology advantageously to ensure effective communication practices. This article discusses technology uses in telepractice that can be incorporated in the Routines-Based Model, Tele-Routines-Based Home Visits, and examples of Tele-Routines-Based Home Visits.

Cancer trends and burden among Armed Forces personnel, veterans and their families: Cancer registry data analysis from tertiary care hospital

Background

Cancer incidence is rising across the globe. The incidence and patterns of various cancers among Armed Forces Personnel and Veterans is not known. We did the analysis of registry data maintained at our hospital.

Methods

A retrospective analysis was performed of all patients registered at our hospital cancer registry between 01st January 2017 and 31st December 2019. Patients were registered with unique identification number. Baseline demographics and cancer subtype data were retrieved. Patients with histopathologically proven diagnosis and age ≥18 years were studied. Armed Forces Personnel (AFP) were defined as those who are in active service, and Veterans as those who had retired from service at the time of registration. Patients with Acute and Chronic Leukemias were excluded.

Results

New cases registered were 2023, 2856 and 3057 in year 2017, 2018, 2019 respectively. AFP, Veterans and dependents among them were 9.6%, 17.8%, and 72.6% respectively. Haryana, Uttar Pradesh and Rajasthan represented 55% of all cases with male to female ratio 1.14:1 and median age was 59 years. The median age among AFP was 39 years. Among AFP as well as veterans, Head and Neck cancer was the most common malignancy. Cancer incidence was significantly higher in adults >40 years as compared to <40 years.

Conclusion

Seven percent rise per year of new cases in this cohort is alarming. Tobacco-related cancers were the most common. There is an unmet need to establish a prospective centralized Cancer Registry to better understand the risk factors, outcomes of treatment and strengthen the policy matters.

The development of a family-based wearable intervention using behaviour change and co-design approaches: move and connect

BACKGROUND

Previous research has explored the effectiveness of wearable activity trackers (wearables) for increasing child physical activity (PA) levels, but there have been mixed results. The use of theoretical frameworks and co-design techniques are recognised ways of increasing an intervention's acceptability and effectiveness.

AIMS

This study aims to use co-design workshops and an evidence-based theoretical framework (the Behaviour Change Wheel) to develop a family-based PA intervention using wearables.

METHODS

Three stages of intervention development outlined by the Behaviour Change Wheel were used. Co-design workshops with seven families (11 parents and 12 children) and seven PA experts were conducted where stakeholders discussed how to overcome previously identified barriers to families being active and using wearables. This resulted in the intervention's components being developed, with each component's mechanisms of action (e.g. intervention functions and behaviour change techniques) being retrospectively identified.

RESULTS

The 'Move & Connect' intervention was developed, which targets family PA and wearable use. The intervention takes a flexible approach and includes eight components, including wearable devices (Fitbit Alta HR), support resources, an introductory workshop, collective challenges, goal setting and reviewing, engagement prompts, social support and health-related resources (e.g. educational videos). The intervention incorporates six intervention functions targeting PA and wearable use: education, training, modelling, persuasion, incentivisation and environmental restructuring and 24 behaviour change techniques, including goal setting, social comparison, feedback on behaviour and graded task.

CONCLUSIONS

This is the first known study to use an evidence-based framework and co-design to develop a family-based wearable intervention. The identification of the intervention's mechanisms of action will prove useful when implementing and evaluating the 'Move & Connect' intervention and allow researchers to replicate its components.

Effects of a family-based lifestyle intervention on co-physical activity and other health-related outcomes of fathers and their children: the 'Run Daddy Run' intervention

BACKGROUND

Fathers are important in establishing healthy behaviors in their children, but are rarely engaged in lifestyle programs. Focusing on physical activity (PA) of both fathers and their children by engaging them together in PA (i.e. "co-PA") is therefore a promising novel strategy for interventions. The study aim was to investigate the effect of the 'Run Daddy Run' on co-PA and PA of fathers and their children, and secondary outcomes such as weight status and sedentary behaviour (SB).

METHODS

This study is a non-randomized controlled trial (nRCT), including 98 fathers and one of their 6 to 8 years old children (intervention = 35, control = 63). The intervention was implemented over a 14-week period, and consisted of six (inter)active father-child sessions and an online component. Due to COVID-19, only 2/6 sessions could be implemented as planned, the remaining sessions were delivered online. In November 2019-January 2020 pre-test measurements took place, and post-test measurements in June 2020. Additional follow-up test was conducted in November 2020. PA (i.e. LPA, MPA, VPA and volume) of fathers and children were objectively measured using accelerometry, co-PA and the secondary outcomes were questioned using an online questionnaire.

RESULTS

Significant intervention effects were found for co-PA (+ 24 min./day in the intervention compared to the control group, p = 0.002), and MPA of the father (+ 17 min./day, p = 0.035). For children, a significant increase in LPA (+ 35 min./day, p < 0.001) was found. However, an inverse intervention effect was found for their MPA and VPA (-15 min./day, p = 0.005 and - 4 min./day, p = 0.002, respectively). Also decreases in fathers' and children's SB were found (-39 min./day, p = 0.022 and - 40 min./day, p = 0.003, respectively), but no changes in weight status, the father-child relationship, and the PA-family health climate (all p > 0.05).

CONCLUSION

The Run Daddy Run intervention was able to improve co-PA, MPA of fathers and LPA of children, and decreasing their SB. Inverse intervention effects were however found for MPA and VPA of children. These results are unique given their magnitude and clinical relevance. Targeting fathers together with their children might be a novel and potential intervention strategy to improve overall physical activity levels, however, further efforts should however be made to target children's MPA and VPA. Last, replicating these findings in a randomized controlled trial (RCT) is recommended for future research.

TRIAL REGISTRATION NUMBER

This study is registered as a clinical trial (clinicaltrials.gov, ID number: NCT04590755, date: 19/10/2020).

From childhood obesity risk to healthy growth in the U.S.: A 10-year social work research & policy update

Childhood obesity is a major health issue and a prominent chronic health condition for children in the United States (U.S.), caused by a multitude of factors. Most existing models of childhood obesity prevention have not worked, yielding little to no effect on improving weight status or the proximal health behaviors most attributed to obesity risk: nutritional intake, physical activity, sedentary behaviors, and sleep. There is an urgent need for new approaches to prevent health disparities that are responsive to impacts of economic inequality on healthy child growth in marginalized populations. In this Short Commentary, a social justice update is provided to motivate a new generation of research that promotes equitable and healthy child growth under present-day social, economic, and political circumstances. Social work-specific research and policy recommendations are provided to guide future research that targets underlying social and economic determinants of weight-related health disparities in childhood. Recommendations include research on cross-disciplinary metrics to better capture reductions in health disparities and the development and testing of policy and system interventions that address structural issues and strengthen health resources in marginalized communities. Progress in reducing disparities in childhood obesity will likely remain inhibited until recommendations from social work research are incorporated to strengthen existing medical and public health models and redirect the childhood obesity epidemic toward equitable, healthy child growth.