Fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática / Intervening factors in the management of nursing care for children hospitalized with rheumatic heart disease / Factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática

Objetivo: analisar os fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo descritivo-exploratório com abordagem qualitativa, que utilizou a Teoria Fundamentada em Dados e o Interacionismo Simbólico, respectivamente, como referencial metodológico e teórico. A coleta de dados foi realizada em uma instituição especializada em atendimento cardiológico, no munícipio do Rio de Janeiro. Foram entrevistados 19 profissionais de enfermagem através de um roteiro semiestruturado. Resultado: emergiram os seguintes fatores intervenientes na prática da gerência do cuidado: condição socioeconômica da família, comportamento da criança, condições de trabalho, comunicação ineficaz, educação permanente, trabalho em equipe e experiência profissional. Conclusão: os resultados apontam para a necessidade de proposição de estratégias de ação e interação que facilitem a prática gerencial de cuidado à criança com cardiopatia reumática e sua família face aos fatores intervenientes identificados.

Objective: to analyze the factors involved in the management of nursing care for children hospitalized with rheumatic heart disease. Method: this is a descriptive-exploratory study with a qualitative approach, which used Data-Based Theory and Symbolic Interactionism, respectively, as methodological, and theoretical references. Data was collected in an institution specializing in cardiac care in the city of Rio de Janeiro. Nineteen nursing professionals were interviewed using a semi-structured script. Result: the following intervening factors in the practice of care management emerged: the family's socioeconomic status, the child's behavior, working conditions, ineffective communication, continuing education, teamwork, and professional experience. Conclusion: the results point to the need to propose strategies for action and interaction that facilitate management practice in caring for children with rheumatic heart disease and their families, given the intervening factors identified.

Objetivo: analizar los factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio descriptivo-exploratorio con enfoque cualitativo, cuyos marcos metodológico y teórico fueron la Teoría Fundamentada y el Interaccionismo Simbólico, respectivamente. La recolección de datos se realizó en una institución especializada en atención cardiológica, en la ciudad de Río de Janeiro. Fueron entrevistados 19 profesionales de enfermería mediante un cuestionario semiestructurado. Resultado: surgieron los siguientes factores intervinientes en la práctica de la gestión del cuidado: condición socioeconómica de la familia, comportamiento del niño, condiciones de trabajo, comunicación ineficaz, educación continua, trabajo en equipo y experiencia profesional. Conclusión: los resultados indican que es necesario proponer estrategias de acción e interacción que faciliten la práctica de la gestión del cuidado al niño con cardiopatía reumática y a sus familiares, con respecto a los factores intervinientes identificados.

Mother-child memory conversation and children's independent memory: the roles of maternal characteristics.

Mother-child memory conversations are a nuanced and important factor in children's memory development. The current study focuses on maternal characteristics that are related to individual differences in maternal elaborative style. It also examines the role of maternal elaborative style in children's elaborativeness in the context of reminiscing and recounting. Two hundred and nine Turkish mothers (Mage = 36.32, SD = 4.99) and their 5- to 6-year-olds (Mage in months = 66.88, SD = 4.04) (110 girls, 99 boys) participated in the current study. Results revealed that maternal individuation and balanced self-construal type predicted maternal elaborativeness, which in turn predicted child elaborativeness in reminiscing and recounting. Yet, such a relation was not observed for maternal attachment styles or sensitivity. Findings suggested the importance of maternal individuation and balanced self-construal for mothers' and children's elaborativeness in memory conversations.

Quantitative assessment of colour fundus photography in hyperopia children based on artificial intelligence.

OBJECTIVES: This study aimed to quantitatively evaluate optic nerve head and retinal vascular parameters in children with hyperopia in relation to age and spherical equivalent refraction (SER) using artificial intelligence (AI)-based analysis of colour fundus photographs (CFP). METHODS AND ANALYSIS: This cross-sectional study included 324 children with hyperopia aged 3-12 years. Participants were divided into low hyperopia (SER+0.5 D to+2.0 D) and moderate-to-high hyperopia (SER≥+2.0 D) groups. Fundus parameters, such as optic disc area and mean vessel diameter, were automatically and quantitatively detected using AI. Significant variables (p<0.05) in the univariate analysis were included in a stepwise multiple linear regression. RESULTS: Overall, 324 children were included, 172 with low and 152 with moderate-to-high hyperopia. The median optic disc area and vessel diameter were 1.42 mm2 and 65.09 µm, respectively. Children with high hyperopia had larger superior neuroretinal rim (NRR) width and larger vessel diameter than those with low and moderate hyperopia. In the univariate analysis, axial length was significantly associated with smaller superior NRR width (ß=-3.030, p<0.001), smaller temporal NRR width (ß=-1.469, p=0.020) and smaller vessel diameter (ß=-0.076, p<0.001). A mild inverse correlation was observed between the optic disc area and vertical disc diameter with age. CONCLUSION: AI-based CFP analysis showed that children with high hyperopia had larger mean vessel diameter but smaller vertical cup-to-disc ratio than those with low hyperopia. This suggests that AI can provide quantitative data on fundus parameters in children with hyperopia.

Association between ultra-processed food consumption, sociodemographic characteristics, malnutrition and obesity among urban school-aged children in Lilongwe, Malawi: a cross-sectional study.

INTRODUCTION: The escalating consumption of ultra-processed foods (UPFs) among school-aged children in developing countries poses a significant threat to public health, contributing to the dual burden of malnutrition. In Malawi, where undernutrition coexists with a burgeoning obesity epidemic, understanding the determinants of UPF consumption and its impact on children's nutritional status is imperative. This study, conducted in Lilongwe, Malawi, aimed to investigate the association between UPF consumption, sociodemographic factors and the nutritional status of school-aged children. MATERIALS AND METHODS: 511 children aged 7-14 were recruited from 2 densely populated townships using systematic random sampling. Data on sociodemographic factors, UPF consumption and nutritional status were collected through face-to-face interviews and anthropometric measurements. UPF consumption was assessed using a validated Food Frequency Questionnaire while multinomial logistic regression was employed to analyse associations. RESULTS: Results revealed alarmingly high UPF consumption among children, particularly those high in sugar. Multinomial logistic regression identified significant predictors of malnutrition outcomes. Notably, children consuming UPFs more than three times a week were more likely to be malnourished. Overweight status was positively associated with sausage intake (ß=0.226, adjusted OR 1.254, 95% CI 1.004 to 1.566, p=0.046) and age (ß=0.020, adjusted OR=0.257, 95% CI 0.156 to 0.28, p=0.003). Conversely, underweight status was linked with residential location (ß=4.507, adjusted OR 0.01, 95% CI 0.000 to 0.281, p=0.006) and fizzy drinks (ß=1.071, adjusted OR 2.919, 95% CI 1.413 to 6.028, p=0.004). CONCLUSION: The high prevalence of UPF consumption among school-aged children is significantly associated with malnutrition. Moreover, sociodemographic factors influence UPF consumption, highlighting the need for targeted interventions to reduce malnutrition. These findings may inform public health policies to mitigate malnutrition among children in Malawi's urban communities.

Mentalisation-based online intervention for psychologically distressed parents: protocol of a non-randomised feasibility trial of the Lighthouse Parenting Programme-Online (LPP-Online).

INTRODUCTION: Online-based interventions provide a low-threshold way to reach and support families. The mentalisation-based Lighthouse Parenting Programme is an established intervention aimed at preventing psychopathological development in children. The objective of this study is to examine the feasibility of an online adaptation of the Lighthouse Parenting Programme (LPP-Online), evaluating (a) recruitment capability, compliance, acceptability and satisfaction with the intervention; (b) the psychometric properties of and the acceptability regarding the adjunct psychological evaluation; and (c) the employed materials and resources. The study will also obtain a preliminary evaluation of participants' responses to the intervention. METHOD AND ANALYSIS: In this monocentric, one-arm, non-randomised feasibility trial, n=30 psychologically distressed parents with children aged 0 to 14 years will participate in the LPP-Online for a duration of 8 weeks. The intervention consists of online group sessions and individual sessions, 38 smartphone-based ecological momentary interventions (EMI), and psychoeducational materials (website, booklet). At baseline (T0) and the end of the intervention (T1), parents complete self-report questionnaires as well as 7-day ecological momentary assessments (EMA) via smartphone. During the intervention, additional EMA are completed before and after the daily EMI. An interview regarding parents' subjective experience with the intervention will be conducted at T1. The feasibility of the intervention, the psychological evaluation and the resources will be examined using descriptive and qualitative analyses. The preliminary evaluation of the parents' response to the intervention will be conducted by analysing pre-post changes in questionnaire measures and the 7-day EMA as well as data of additional EMA completed before and after the daily EMI. ETHICS AND DISSEMINATION: Ethical approval of the study has been obtained from the local ethics board (Faculty of Behavioural and Cultural Studies, University of Heidelberg). Consent to participate will be obtained before starting the assessments. Results will be disseminated as publications in peer-reviewed scientific journals and at international conferences. REGISTRATION DETAILS: German Clinical Trials Register (DRKS00027423), OSF (https://doi.org/10.17605/OSF.IO/942YW).

Assessment of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS™) with modification of the management recommendations for pediatric thyroid nodules.

BACKGROUND: Thyroid nodules are unusual in children, but when present, they carry a higher risk for malignancy, as compared to adults. Several guidelines have been created to address the risk stratification for malignancy of thyroid nodules in adults, but none has been completely validated in children. A few authors have proposed lowering the size threshold to the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS™) management guidelines to decrease missed carcinomas at presentation in children; however, little information is known regarding their accuracy. OBJECTIVE: To assess the performance of proposed modifications of the ACR TI-RADS™ size criteria to guide management decisions in pediatric thyroid nodules and to assess the associated increase in number of fine needle aspiration (FNA) and follow-up exams. MATERIALS AND METHODS: This is a retrospective study of children under 18 years old who underwent ultrasound assessment of a thyroid nodule at a tertiary care pediatric institution between January 2006 and August 2021. The largest dimension, maximum ACR TI-RADS™ score, and final thyroid nodules' diagnoses were documented. The course of action based on the adult ACR TI-RADS™ and after modifying the size threshold for management recommendations was documented and compared. Statistics included descriptive analysis, weighted Kappa statistics, sensitivity, specificity, accuracy, and positive/negative predictive values of the ACR TI-RADS™ presented with 95% confidence intervals (CI) using either Clopper-Pearson or standard logit methods. RESULTS: Of 116 nodules, 18 (15.5%) were malignant. Most malignant nodules (94.4%, n = 17) were ACR TI-RADS™ 4 and ACR TI-RADS™ 5 categories. Based on the adult ACR TI-RADS™ criteria, 24 (24.5%) benign and 15 (83.3%) malignant nodules would have undergone FNA; 14 (14.3%) benign and 3 (16.7%) malignant nodules would have been followed up; and 60 (61.2%) benign and none of malignant nodules would have been dismissed. Three (16.7%) malignant nodules would not have been recommended FNA at presentation, delaying their diagnoses. By lowering the size-threshold criteria of the ACR TI-RADS™ guidelines, no malignancy would have been missed at presentation, but this also resulted in a higher number of FNA from 24 (24.5%) to 36 (36.7%) and follow-up ultrasound exams from 14 (14.3%) to 62 (63.3%). CONCLUSION: Applying potential modifications to the ACR TI-RADS™ guideline lowering the size threshold criteria of the thyroid nodule to guide management decisions for pediatric thyroid nodules can lead to early detection of malignant nodules in children, but at the cost of a significantly increased number of biopsies or ultrasound exams. Further tailoring of the guideline with larger multicentric studies is needed, before warranting its acceptance and general use in the pediatric population.

Assessing the Factors Affecting Recruitment to Child and Adolescent Psychiatry Fellowship Programs.

OBJECTIVE: The objective of this pilot study was to sample early career child and adolescent psychiatrists (EC CAP), Child and Adolescent Psychiatry (CAP) fellows, adult residents, and medical students to identify factors affecting recruitment to CAP fellowship. METHOD: A 25-item questionnaire was sent to all adult psychiatry, CAP fellowship, triple-board residency program directors, and coordinators in the US to disseminate to their trainees. Questionnaires also were disseminated via professional groups on social media, and through psychiatry student interest groups to medical students. RESULTS: A total of 369 people responded, of which 315 questionnaires were evaluable. Approximately half of the respondents were CAP fellows or EC CAP. Most decided to pursue a career in child psychiatry during medical school. Forty-three percent owed more than $200,000 in educational debt. The top reasons for pursuing a career in child and adolescent psychiatry included working with children, finding it to be a rewarding career, and finding it intellectually stimulating. A switch to a 1-year fellowship and higher income potential were noted to be factors that may increase consideration for CAP fellowship among those who chose not to pursue it. CONCLUSIONS: The majority of early career child and adolescent psychiatrists were recruited during medical school, motivated by altruistic reasons. Early child psychiatry exposure, a means of addressing physician debt, providing additional incentives in geographically undesirable locations, and improving compensation, is needed to improve recruitment to this specialty.

"If you're struggling, you don't really care" - what affects the physical health of young people on child and adolescent mental health inpatient units? A qualitative study with service users and staff.

BACKGROUND: Physical health inequalities of people with serious mental illness (SMI) have been labelled an international scandal; due to the 15-20-year reduction in life expectancy associated with poor physical health. This occurs at an early stage and evidence shows young people with and at risk for SMI are a particularly vulnerable group requiring intervention and support. However, most work has been conducted with adults and little is known about what affects physical health for young people, specifically those receiving inpatient care. METHODS: We conducted semi-structured qualitative interviews with 7 service users and 6 staff members (85% female, age 14-42) on a generic mental health inpatient unit for children and adolescents. Interviews aimed to identify how young people viewed theirphysical health and factors affecting physical health and lifestyle and identify any support needed to improve physical health. Thematic analysis was conducted. . RESULTS: Thematic analysis revealed the main factors affecting physical health and lifestyle for young people. Three main themes were individual factors (subthemes were mental health symptoms, knowledge, attitudes and beliefs), environmental factors (subthemes were opportunities in a restricted environment and food provision), and the influence of others (subthemes were peers, staff, family members). These factors often overlapped and could promote a healthy lifestyle or combine to increase the risk of poor physical health. Young people discussed their preferences for physical health initiatives and what would help them to live a healthier lifestyle. CONCLUSIONS: Promoting physical health on inpatient units for young people is an important, yet neglected area of mental health research. We have identified a range of complex factors which have an impact on their physical health, and there is a pervasive need to address the barriers that young people experience to living a healthy lifestyle. There is an increasingly strong evidence base suggesting the benefits of physical health interventions to improve outcomes, and future work should identify ways to implement such interventions considering the barriers discussed in this article. Further collaborative research is needed with young people, clinical teams, caregivers, and commissioners to ensure improvements are made to clinical care provision and optimisation of the inpatient environment.

Maternal insecure attachment representation as a long-term risk factor for disrupted mother-child-interaction and child mental health.

Maternal childhood maltreatment (CM) represents an important factor in the transmission of trauma that may lead to impaired child mental health. Apart from childhood maltreatment insecure attachment has been identified as a risk factor for insensitive caregiving behavior, which may affect child's mental health. The aim of this study is to identify the working mechanisms in the relationship between maternal CM and child mental health, considering maternal attachment representation, mother-child-interaction und maternal helplessness and fear. N = 103 mother-child-dyads from a longitudinal cohort study were examined at four different measuring points. Data was assessed using self and external report questionnaires as well as the AMBIANCE scales during the Strange Situation Procedure and the Adult Attachment Projective Picture System (AAP). Maternal CM experience did not predict an insecure attachment representation (OR = 2.46 [0.98, 6.53], p = .060). Maternal insecure attachment was associated with higher AMBIANCE scores (F(8, 94) = 11.46, p < .001), which indicates more disrupted communication between mother and child. AMBIANCE scores in turn predicted higher self-perceived helplessness (F(9, 93) = 8.62, p < .001) and fear (F(9, 93) = 7.40, p < .001) in mothers. Helplessness and fear both were associated with higher SDQ-scores, indicating more mental health problems in children (F(10, 92) = 3.98, p < .001; F(10, 92) = 3.87, p < .001). The results of this study highlight how even insecure attachment in a low-risk sample has a long-term impact on parenting behavior and child mental health, therefore underlining the need of early intervention programs in affected and at-risk families.

Litigation in access to universal health coverage for children and adolescents in Brazil.

Background: Brazil's Unified Health System (SUS) ensures universal, equitable, and excellent quality health coverage for all. The broad right to health, supported by the Constitution, has led to excessive litigation in the public sector. This has negatively impacted the financial stability of SUS, created inequality in children and adolescents' access to healthcare, and affected communication between the healthcare system and the judiciary. The enactment of Law Number 13.655 on 25 April 2018, proposed significant changes in judicial decisions. This study aimed to investigate decision-making changes in health litigation involving children and adolescents following the implementation of the new normative model. Methods: The study is cross-sectional, analyzing 3753 national judgment documents from all State Courts of Brazil, available on their respective websites from 2014 to 2020. It compares regional legal decisions before and after the promulgation of Law Number 13.655/2018. Data tabulation, statistical analysis, textual analysis, coding, and counting of significant units in the collected documents were performed. The results of data cross-referencing are presented in tables and diagrams. Results: The majority (96.86%) of legal claims (3635 cases) received partial or total provision of what was prescribed by the physician. The Judiciary predominantly handled these cases individually. The analysis indicates that the decisions made did not adhere to the norms established in 2018. Conclusion: Regional heterogeneity in health litigation was observed, and there was no significant variability in decisions during the studied period, even after the implementation of the new normative paradigm in 2018. Technical-scientific support was undervalued by the magistrates. Prioritizing litigants undermines equity in access to Universal Health Coverage for children and adolescents.

Correlations between the screen time of children with special needs and their parent-child relationships, home participation, and occupational performance.

This study aimed to examine the relationships between the screen time of children with special needs and of their parents with their home participation, occupational performance, and parent-child relationships according to sex and diagnosis. Parents of 150 children with special needs (age range, 4 to 6 years) such as autism spectrum disorder, cerebral palsy, and attention deficit hyperactivity disorder, as well as undiagnosed and developmentally risky children, were included. The Demographic Information Form, Screen Time Usage Form, Parent-Child Relationship Scale, Participation and Environment Measure for Children and Youth, and Short Child Occupational Profile were used for the data collection. There was a significant relationship between the screen time of girls and their parent-child relationships, home participation, and occupational performance. Moreover, we detected a relationship between the screen time of children with autism spectrum disorder and positive parent-child relationships, home participation, and occupational performance. Therapists should account for screen time in their interventions associated with parent-child relationships, home participation, and occupational performance.

Parents/primary caregivers' perspectives on the well-being, and home-based learning of children with neurodevelopmental disorders during COVID-19 in Bangladesh.

Background and Aims: The coronavirus pandemic (CP) leading to prolonged lockdown, and restriction of movement for almost two years in Bangladesh severely affected not only the well-being (physical and mental health) of both children and adults but also their access to home-based learning. The present study aimed to explore the mental, and physical health problems of children with neurodevelopmental disorders (NDDs), their use of telehealth services, and the status of their home-based learning by asking questions to their parents/primary caregivers (N = 149) during the second year of lockdown (November and December 2021). Methodology: The present study was a cross-sectional self-reported survey covering as many parents/primary caregivers as possible within Bangladesh. The survey questions were selected from a larger study by Masi et al. named 'COVID-19 impact survey' with permission. A total of 149 parents/primary caregivers with one or more children (mean age = 5.54) having any of the NDDs took part in the survey. Data were collected via physical sitting, telephone interview, and anonymous Google form. Results: Almost one-third of parents/caregivers felt that the NDD symptoms of their children were worsening with time, and half of them reported that their children's health and well-being were negatively impacted. More than 90% of the caregivers felt that their children are facing challenges following the rules of social distancing. Whereas more than 80% of parents agreed that their children's learning was disrupted during covid-19, and they were not getting enough online/offline support from the authorities. Conclusions: The outcome of this study suggested that CP had a significant impact on the wellbeing and home-based learning of children with NDDs and their families in Bangladesh. Most of the caregivers reported that the NDDs symptoms of their children are worsening with disrupted routine, facing problems following social distancing and maintaining fruitful relationships. In terms of home-based learning, most caregivers reported insufficient support from school authorities. The parents recommended the development of an adequate system for telehealth services and policies to help the vulnerable individuals in the future.

Exploring the Link Between Profuse Warts and Hyper-Immunoglobulin E (IgE) Syndrome: A Pediatric Case Report.

The relationship between warts and hyper-immunoglobulin E (IgE) syndrome lies in the fact that patients with this syndrome may have recurrent or persistent skin warts because of their immune dysfunction. Therefore, it is important to consider this possibility when evaluating a patient with skin warts, especially if they are associated with other symptoms such as recurrent infections or pulmonary issues. Warts can thus be an important clinical sign indicating the presence of this syndrome. We report the case of a young girl presenting with numerous warts accompanied by pulmonary involvement and weight delay, in whom the diagnosis of hyper IgE syndrome was established.

Acral persistent papular mucinosis: a rare child case report and literature review.

Background: Acral persistent papular mucinosis (APPM) is a rare idiopathic subtype of localized lichen myxedematosus. To date, there have been less than 41 APPM cases reported worldwide, however, almost all patients were older than 18 years of age. A 7-year-old child was first reported in this paper. Case Description: A 7-year-old boy was admitted to our hospital with a solitary skin-colored papule on the radial side of the middle segment of his right index finger. The patient wanted to know the exact diagnosis and remove it because the flexion movement of the middle segment had been affected. Thus, a surgery was performed. Histopathological examination of a biopsy specimen obtained from the papule on the radial side of the middle segment of his right index finger showed a focal and well-circumscribed deposit of mucin in the papillary and middermis. The deposit never extended deeply into the reticular dermis. Mucin spared a subepidermal area in the papillary dermis. Alcian blue stains can highlight the mucin. The papule was histologically diagnosed as an APPM and excised surgically. The wound gradually healed after the operation, and no obvious recurrence, scar or other discomfort was observed during follow-up so far. Conclusions: To the best of our knowledge, this is the rare case of a child APPM presenting as a solitary papule affecting the flexion movement of the middle segment. Since it is a rare disease, we report this case to contribute to future research on the diagnosis and pathogenesis of APPM.

Parents's knowledge and awareness about hepatitis B can influence the vaccination of their children.

BACKGROUND: Birth-dose (Hep-BD) followed by three additional doses (Hep-B3) of hepatitis B virus (HBV) vaccine are key to eliminating HBV by 2030. Unfortunately, Hep-BD and Hep-B3 coverage in our country is poor. AIM: To studied the parent's knowledge and awareness about HBV infection, its prevention, consequences and vaccination. METHODS: Parents of 6 months to 8 years old children were interviewed to assess their knowledge & awareness about hepatitis B, its transmission, prevention, illness caused by this, and vaccination. Eighteen close-ended questions were administered, and responses were recorded as 'yes', 'no', or 'not sure'. HBV knowledge score was calculated based on the sum of correct answers. Each correct response scored one point and incorrect, missing or 'not sure' responses received no points. Categorical data are presented as number (%) and numerical data are expressed as median. Data were compared using Chi2 tests and level of significance was kept as P < 0.05. RESULTS: Parents (58.3% mothers) of 384 children (89.9% age < 5 years; 82% age-appropriately vaccinated) were included. Three hundred and twenty-two (83.9%) children were Hep-B3 vaccinated. 94.3%, 87.5%, and 29.2% parents knew about polio, tetanus, and hepatitis B vaccine. Overall, 41.2%, 15.8%, and 23% parents knew about hepatitis B transmission, consequences of infection, and prevention respectively. Only 7.6% parents knew about three-dose schedule of hepatitis B vaccination. Only 23% parents believed that vaccine could prevent HBV, 15.7% knew that HBV affects liver. Parents of Hep-B3 vaccinated children were significantly more aware about HBV than the parents of unvaccinated children (P < 0.05 for 17/18 questions). CONCLUSION: The knowledge and awareness among the parents about hepatitis B is poor. The Increasing knowledge/awareness about HBV among parents may improve Hep-B3 vaccination coverage.

Affiliate Stigma, Resilience and Quality of Life among Parents of Children with Autism Spectrum Disorder in Two Public Hospitals in Kelantan, Malaysia.

Background: Often, the indirect impact of autism spectrum disorder (ASD) presents the family with significant challenges. One of these challenges is affiliate stigma due to parental affiliation with their child. This study aimed to explore affiliate stigma, resilience and quality of life (QoL) among parents of children with ASD. Methods: Cross-sectional study of 144 parents of children with ASD were recruited from two main tertiary hospitals in Kelantan, Malaysia, a developing country in Southeast Asia. Pearson correlation was used to examine the relationship between parental affiliate stigma, resilience and QoL. Simple and multiple linear regression analyses were used to identify the significant associated factors of affiliate stigma, resilience and QoL. Results: Correlational analyses revealed that perceived affiliate stigma demonstrated an inverse relationship with resilience and QoL. Additionally, resilience had a positive relationship with QoL. Regression analyses revealed that the father's employment status, the mother's level of education, having a disability card, the child's age at ASD diagnosis, comorbidities of the child and ASD severity perceived by parents were associated with parental affiliate stigma, resilience and QoL. Conclusion: Study findings highlight the contribution of socio-demographic characteristics of children with ASD and their families in the determination of affiliate stigma, resilience and QoL.

Fathers' experiences with supportive parenting interventions: A qualitative systematic review.

Despite proven efficacy, fatherhood interventions face challenges in attracting and retaining participants. This qualitative systematic review aims to inform the future design of fatherhood interventions by consolidating and synthesizing the evidence around fathers' experiences with interventions aimed at enhancing their involvement and relationships with their children. Following PRISMA guidelines, we analyzed 10 studies from a search of six electronic databases. Our analysis coalesced into three pivotal themes: (a) creating a sense of belonging: facilitating participation; (b) transformative takeaways; and (c) challenges of negotiating expectations of masculinity. Our findings indicate that group-based, culturally sensitive programs are advantageous but also reveal that fathers grapple with reconciling evolving fatherhood roles with societally entrenched expectations of masculinity. This review offers actionable insights for the future development, evaluation, and implementation of fatherhood interventions, particularly those utilizing qualitative research methodologies.

Late Adverse Effects after Treatment for Childhood Acute Leukemia.

The aim of this review is to raise awareness and knowledge among healthcare professionals and policymakers about late adverse effects in survivors of childhood leukemia. With contemporary treatment, over 90% of children with acute lymphoblastic leukemia (ALL) and over 60% with acute myeloid leukemia (AML) are cured. Large cohort studies demonstrate that 20% of ALL and most AML survivors have at least one chronic health condition by 20-25 years after diagnosis. These are life-changing or threatening in some survivors and contribute to increased premature mortality. We describe the frequency, causes, clinical features, and natural history of the most frequent and severe late adverse effects in childhood leukemia survivors, including subsequent malignant neoplasms, metabolic toxicity, gonadotoxicity and impaired fertility, endocrinopathy and growth disturbances, bone toxicity, central and peripheral neurotoxicity, cardiotoxicity, psychosocial late effects, accelerated ageing and late mortality. The wide range of late effects in survivors of haemopoietic stem cell transplant is highlighted. Recent developments informing the approach to long-term survivorship care are discussed, including electronic personalized patient-specific treatment summaries and care plans such as the Survivor Passport (SurPass), surveillance guidelines and models of care. The importance of ongoing vigilance is stressed given the increasing use of novel targeted drugs with limited experience of long-term outcomes. CONCLUSION: It is vital to raise awareness of the existence and severity of late effects of childhood leukemia therapy among parents, patients, health professionals, and policymakers. Structured long-term surveillance recommendations are necessary to standardize follow-up care.

Parental prenatal representations of the child are related to 18-month-old children's social-emotional competence.

Parental representations of the child are linked to positive developmental outcomes in children, but the impact of prenatal representations on early social-emotional development, particularly from fathers, is less understood. This study explores how fathers' and mothers' prenatal representations within two-parent families are associated with early social-emotional development. Prenatal representations of fathers (n = 88) and mothers (n = 92) were assessed between 28 and 32 weeks of gestation using the Working Model of the Child Interview, categorizing them as balanced or nonbalanced. The children's (n = 97; 49.5% girls) social-emotional and behavioral problems and competencies were measured at 18 months using the Brief Infant-Toddler Social and Emotional Assessment. Balanced prenatal representations of both parents were related to higher social-emotional competence in toddlers. However, prenatal representations were not related to social-emotional and behavioral problems. The results highlight the benefits of balanced prenatal representations in promoting early social-emotional competence in children.

Association of uric acid with length of stay and mortality in pediatric hospitalized population.

PURPOSE: Elevated uric acid (UA) levels have been associated with acute and chronic diseases, which could affect the prognosis of pediatric hospitalized patients. However, the association of UA levels with length of hospital stay (LOS) and mortality in hospitalized children and adolescents remains unknown. Therefore, the aim of this study was to evaluate the association of serum UA levels with in-hospital mortality and prolonged LOS in hospitalized children and adolescents. METHODS: A retrospective cohort study was conducted, involving 128 patients under 18 years of age, admitted to a tertiary-care hospital between January 2014 and December 2018. UA levels were assessed with an average of 3 days before the in-hospital outcome (discharge or death). Logistic regression was used to determine the association of UA with prolonged LOS (defined as over 30 days of hospitalization), while Cox regression multivariate analysis was employed to assess UA as a predictor of in-hospital mortality. RESULTS: UA levels showed an inverse association with prolonged LOS. Specifically, for every 1 mg/dL increase in UA level, the odds of experiencing prolonged LOS decreased by 31% (OR = 0.69; 95% CI: 0.50-0.95). Additionally, individuals with elevated UA levels had lower odds of prolonged LOS (OR = 0.23; 95% CI: 0.08-0.66). However, UA levels were not associated with in-hospital mortality (HR = 1.63; 95% CI: 0.94-2.82). CONCLUSION: Serum UA was inversely associated with LOS among children and adolescents, but no association was observed with in-hospital mortality.