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BMJ Open May 2024Although adolescents make treatment gains in psychiatric residential treatment (RT), they experience significant difficulty adapting to the community and often do not...
Families in transition (FIT) study protocol: feasibility, acceptability and preliminary effects of a group-based parent training in parents of youth in psychiatric residential treatment.
INTRODUCTION
Although adolescents make treatment gains in psychiatric residential treatment (RT), they experience significant difficulty adapting to the community and often do not sustain treatment gains long term. Their parents are often not provided with the necessary support or behaviour management skillset to bridge the gap between RT and home. Parent training, a gold standard behaviour management strategy, may be beneficial for parents of these youth and web-based parent training programmes may engage this difficult-to-reach population. This study focuses on a hybrid parent training programme that combines Parenting Wisely (PW), a web-based parent training with facilitated discussion groups (Parenting Wisely for Residential Treatment (PW)). This study aims to: (1) establish the feasibility and acceptability of PW, (2) evaluate whether PW engages target mechanisms (parental self-efficacy, parenting behaviours, social support, family function) and (3) determine the effects of PW on adolescent outcomes (internalising and externalising behaviours, placement restrictiveness).
METHODS AND ANALYSIS
In this randomised control trial, parents (n=60) will be randomly assigned to PW or treatment as usual. Each week for 6 weeks, parents in the PW condition will complete two PW modules (20 min each) and attend one discussion group via Zoom (90 min). Adolescents (n=60) will not receive intervention; however, we will evaluate the feasibility of adolescent data collection for future studies. Data from parents and adolescents will be collected at baseline, post intervention (6 weeks post baseline) and 6 months post baseline to allow for a robust understanding of the longer-term effects of PW on treatment gain maintenance.
ETHICS AND DISSEMINATION
The study has been approved by The Ohio State University Institutional Review Board (protocol number 2022B0315). The outcomes of the study will be shared through presentations at both local and national conferences, publications in peer-reviewed journals and disseminated to the families and organisations that helped to facilitate the project.
TRIAL REGISTRATION NUMBER
NCT05764369 (V.1, December 2022).
Topics: Humans; Adolescent; Parents; Feasibility Studies; Residential Treatment; Parenting; Female; Male; Mental Disorders; Randomized Controlled Trials as Topic; Social Support
PubMed: 38816058
DOI: 10.1136/bmjopen-2023-080603 -
BMJ Open May 2024To examine children and young people's (CYP), caregivers' and healthcare professionals' (HCPs) views or experiences of facilitators and barriers to CYP access to UK... (Review)
Review
Access to primary care for children and young people (CYP) in the UK: a scoping review of CYP's, caregivers' and healthcare professionals' views and experiences of facilitators and barriers.
OBJECTIVES
To examine children and young people's (CYP), caregivers' and healthcare professionals' (HCPs) views or experiences of facilitators and barriers to CYP access to UK primary care services to better understand healthcare inequity. To explore differences across CYP subpopulations with greater health needs from deprived areas, identifying as ethnic minorities, with experiences of state care, special educational needs or disabilities, chronic conditions or mental health problems.
DESIGN
Scoping review.
ELIGIBILITY CRITERIA
Included studies were in English, published 2012-2022 and reported: the views/experiences of CYP (0-25 years), caregivers or HCPs about accessing UK primary care; using quantitative or qualitative empirical methods.
DATA SOURCES
PubMed, CINAHL, Web of Science, PsycINFO and Scopus.
RESULTS
We included 47 reports (46 studies). CYP/caregivers' decision to access care was facilitated by CYP/caregivers' or their family/friends' ability to identify a health issue as warranting healthcare attention. Barriers to accessing care included perceived stigma (eg, being seen as a bad parent), embarrassment and discrimination experiences. CYP and caregivers believed longer opening hours could facilitate more timely access to care. Caregivers and HCPs reported that delayed or rejected referrals to secondary or adult care were a barrier to having needs met, especially for CYP with poor mental health. CYP and caregivers in numerous studies emphasised the importance of communication and trust with HCPs, including taking their concerns seriously, being knowledgeable and providing continuity of care for CYP. Common barriers reported across high-need subpopulations were caregivers needing knowledge and confidence to advocate for their child, gaps in HCP's knowledge and a lack of connectedness between primary and secondary care.
CONCLUSIONS
Connecting general practices and community health workers/services, improving CYP/caregivers' understanding of common childhood conditions, addressing HCP's knowledge gaps in paediatric care and integrated approaches between primary and secondary care may reduce inequity in access.
Topics: Humans; Health Services Accessibility; Child; Primary Health Care; Adolescent; United Kingdom; Caregivers; Health Personnel; Attitude of Health Personnel; Child, Preschool; Young Adult; Infant; Access to Primary Care
PubMed: 38816045
DOI: 10.1136/bmjopen-2023-081620 -
BMJ Open May 2024Prevention of necrotising enterocolitis (NEC) is vital for improving neonatal outcomes. Feeding own mother's milk helps prevent NEC. Rates of own mother's milk feeding...
Effects of implementation of a care bundle on rates of necrotising enterocolitis and own mother's milk feeding in the East Midlands: protocol for a mixed methods impact and process evaluation study.
INTRODUCTION
Prevention of necrotising enterocolitis (NEC) is vital for improving neonatal outcomes. Feeding own mother's milk helps prevent NEC. Rates of own mother's milk feeding in the East Midlands are lower than the national average and the incidence of NEC is higher. The East Midlands Neonatal Operational Delivery Network (EMNODN) has created a care bundle to improve these in babies born at <32 weeks' gestation, the group at the highest risk of NEC. The bundle was introduced in September 2022 and embedded by December 2022. We will evaluate its effectiveness and conduct a process evaluation to understand barriers and facilitators to implementation.
METHODS AND ANALYSIS
We will conduct a retrospective cohort study (workstream 1) using data from the National Neonatal Research Database (NNRD). We will identify infants receiving any own mother's milk on day 14 and at discharge, and cases of severe NEC. We will aggregate outcomes by birth month and use interrupted time series analysis to estimate an incidence rate ratio for changes after the care bundle was embedded, relative to pre-implementation. We will model data from all other NNRD units and assess whether there are any concurrent changes to exclude confounding due to other events.We will apply the RE-AIM framework (workstream 2), supplemented by the Consolidated Framework for Implementation Research and Framework for Implementation Fidelity, to conduct a mixed methods evaluation in EMNODN units. We will triangulate data from several sources, including questionnaires and semistructured interviews with parents and healthcare professionals, and data from patient records.
ETHICS AND DISSEMINATION
The study has approval from the South East Scotland Research Ethics Committee 01 and the Health Research Authority and Health and Care Research Wales (IRAS 323099). Results will be disseminated via scientific journals and conferences, to neonatal service commissioners and through public-facing infographics.
TRIAL REGISTRATION NUMBER
NCT05934123.
Topics: Enterocolitis, Necrotizing; Humans; Infant, Newborn; Retrospective Studies; Patient Care Bundles; Female; Milk, Human; Breast Feeding; Infant, Premature; Research Design; Incidence
PubMed: 38816042
DOI: 10.1136/bmjopen-2023-078633 -
JMIR Pediatrics and Parenting May 2024Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged...
BACKGROUND
Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged populations. A better understanding of fathers' experiences and needs regarding support access and child nutrition information in the context of disadvantage can inform future interventions engaging fathers.
OBJECTIVE
This study aims to explore fathers' experiences; perceived enablers; and barriers to accessing support and information related to parenting, child feeding, and nutrition and to co-design principles for tailoring child nutrition interventions to engage fathers.
METHODS
Australian fathers of children aged 6 months to 5 years with lived experience of disadvantage participated in semistructured interviews and co-design workshops, primarily conducted via videoconference. Creative analogies were used to guide the ideation process in the workshops.
RESULTS
A total of 25 interviews and 3 workshops (n=10 participants) were conducted, with data analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation-Behavior model. The interview data illuminated factors influencing fathers' initiation in seeking support for parenting, child feeding, and nutrition, including their experiences. It highlighted fathers' diverse information needs and the importance of an inclusive environment and encouragement. Enablers and barriers in accessing support related to parenting and child nutrition were identified at the individual (eg, personal goals and resource constraints), interpersonal (family support and false beliefs about men's caregiving role), organizational (inadequate fathering support), and systemic levels (father-inclusive practice and policy). Digital data collection methods enabled Australia-wide participation, overcoming work and capacity barriers. Videoconferencing technology was effectively used to engage fathers creatively. Key principles for engaging fathers were co-designed from the workshop data. Interventions and resources need to be father specific, child centered, and culturally appropriate; promote empowerment and collaboration; and provide actionable and accessible strategies on the what and how of child feeding. Fathers preferred multiformat implementation, which harnesses technology-based design (eg, websites and mobile apps) and gamification. It should be tailored to the child's age and targeted at fathers using comprehensive promotion strategies.
CONCLUSIONS
Fathers faced barriers to accessing support and information related to parenting and feeding that may not adequately address their needs. Future interventions could integrate the co-designed principles to engage fathers effectively. These findings have implications for health service delivery and policy development, promoting father-inclusive practice.
PubMed: 38815260
DOI: 10.2196/57849 -
Acta Pharmaceutica (Zagreb, Croatia) Jun 2024In patients with chronic heart failure (CHF), the use of angiotensin-converting enzyme inhibitors, including ramipril, is recommended to reduce the risk of heart failure...
In patients with chronic heart failure (CHF), the use of angiotensin-converting enzyme inhibitors, including ramipril, is recommended to reduce the risk of heart failure worsening, hospitalisation, and death. Our aim was to investigate the influence of body composition on the pharmacokinetics of ramipril and its active metabolite ramiprilat and to evaluate the changes in pharmacokinetics after prolonged therapy. Twenty-three patients with CHF who were on regular therapy with ramipril participated at the first study visit ( median age 77 years, 65 % male, and 70 % New York Heart Association Class II); 19 patients attended the second study visit and the median time between the two visits was 8 months. Pharmacokinetics were assessed using a nonlinear mixed-effects parent-metabolite model comprising two compartments for ramipril and one compartment for ramiprilat. The influence of body size and composition was best described by an allometric relationship with fat-free mass. In addition, ramipril clearance was related to patient age and daily ramipril dose, while clearance of ramiprilat was influenced by glome rular filtration rate and daily ramipril dose. There were no clinically relevant changes in the pharmacokinetics of ramipril and ramiprilat between the study visits. Due to the relatively stable pharmacokinetics of ramipril, regular outpatient visits at 6-month intervals seem appropriate to evaluate ramipril therapy.
Topics: Humans; Ramipril; Heart Failure; Male; Angiotensin-Converting Enzyme Inhibitors; Aged; Female; Longitudinal Studies; Chronic Disease; Aged, 80 and over; Middle Aged; Body Composition
PubMed: 38815200
DOI: 10.2478/acph-2024-0018 -
JAMA Network Open May 2024Although new parents' mental health is known to decline, less is known about changes in therapy attendance, especially among military service members.
IMPORTANCE
Although new parents' mental health is known to decline, less is known about changes in therapy attendance, especially among military service members.
OBJECTIVE
To investigate changes in therapy attendance among new parents and by parental leave length.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study of US Army and Navy service members from January 1, 2013, to December 31, 2019, compared parents' monthly therapy attendance with matched nonparents' across childbirth and compared mothers' weekly therapy attendance before vs after returning to work. Eligible monthly sample members included service members with first births from January 1, 2014, to December 31, 2017, and 12 months of data before to 24 months after birth and nonparents with 36 months of data. Eligible weekly sample members included mothers with first births from January 1, 2013, to June 30, 2019, and data from 12 months before to 6 months after birth and nonparents with 18 months of data. Data analysis was performed from July 1, 2023, to January 15, 2024.
EXPOSURE
Those exposed to parenthood had no prior children, acquired a dependent younger than 1 year, and, for mothers, had an inpatient birth. Unexposed matches did not add a dependent younger than 1 year.
MAIN OUTCOMES AND MEASURES
Monthly counts of mental health therapy sessions and any therapy sessions (weekly).
RESULTS
The monthly sample included 15 554 193 person-month observations, representing 321 200 parents and matches, including 10 193 mothers (3.2%; mean [SD] age, 25.0 [4.9] years), 50 865 nonmother matches (15.8%; mean [SD] age, 25.0 [5.0] years), 43 365 fathers (13.5%; mean [SD] age, 26.4 [4.8] years), and 216 777 nonfather matches (67.5%; mean [SD] age, 26.4 [4.8] years). The weekly sample included 17 464 mothers. Mothers went to 0.0712 fewer sessions at 1 month post partum (95% CI, -0.0846 to -0.0579) compared with 10 months before birth. Fathers went to 0.0154 fewer sessions in the month of birth (95% CI, -0.0194 to -0.0114) compared with 10 months before. Parents with preexisting treatment needs had larger decreases in treatment. Weekly therapy attendance increased by 0.555 percentage points (95% CI, 0.257-0.852) when mothers returned to work from 6 weeks of leave and 0.953 percentage points (95% CI, 0.610-1.297) after 12 weeks of leave.
CONCLUSIONS AND RELEVANCE
In this cohort study of new parents, therapy attendance decreased around childbirth, especially among parents with prior mental health needs and mothers with longer maternity leaves. These findings suggest that more accessible treatment, including home visits or telehealth appointments, is needed.
Topics: Humans; Female; Pregnancy; Military Personnel; Adult; United States; Cohort Studies; Postpartum Period; Mental Health Services; Mental Disorders; Male; Parental Leave; Young Adult; Mothers
PubMed: 38814641
DOI: 10.1001/jamanetworkopen.2024.13884 -
The Turkish Journal of Pediatrics May 2024Understanding the severity of the disease from the parents' perspective can lead to better patient outcomes, improving both the child's health-related quality of life...
The effect of 3D modeling on family quality of life, surgical success, and patient outcomes in congenital heart diseases: objectives and design of a randomized controlled trial.
BACKGROUND
Understanding the severity of the disease from the parents' perspective can lead to better patient outcomes, improving both the child's health-related quality of life and the family's quality of life. The implementation of 3-dimensional (3D) modeling technology in care is critical from a translational science perspective.
AIM
The purpose of this study is to determine the effect of 3D modeling on family quality of life, surgical success, and patient outcomes in congenital heart diseases. Additionally, we aim to identify challenges and potential solutions related to this innovative technology.
METHODS
The study is a two-group pretest-posttest randomized controlled trial protocol. The sample size is 15 in the experimental group and 15 in the control group. The experimental group's heart models will be made from their own computed tomography (CT) images and printed using a 3D printer. The experimental group will receive surgical simulation and preoperative parent education with their 3D heart model. The control group will receive the same parent education using the standard anatomical model. Both groups will complete the Sociodemographic Information Form, the Surgical Simulation Evaluation Form - Part I-II, and the Pediatric Quality of Life Inventory (PedsQL) Family Impacts Module. The primary outcome of the research is the average PedsQL Family Impacts Module score. Secondary outcome measurement includes surgical success and patient outcomes. Separate analyses will be conducted for each outcome and compared between the intervention and control groups.
CONCLUSIONS
Anomalies that can be clearly understood by parents according to the actual size and dimensions of the child's heart will affect the preoperative preparation of the surgical procedure and the recovery rate in the postoperative period.
Topics: Humans; Quality of Life; Heart Defects, Congenital; Printing, Three-Dimensional; Child; Parents; Models, Anatomic; Treatment Outcome; Female; Cardiac Surgical Procedures; Male
PubMed: 38814302
DOI: 10.24953/turkjpediatr.2024.4574 -
The Turkish Journal of Pediatrics May 2024Given the strong genetic background of familial Mediterranean fever (FMF), the frequently reported co-existing diseases in children with FMF should also be investigated...
BACKGROUND
Given the strong genetic background of familial Mediterranean fever (FMF), the frequently reported co-existing diseases in children with FMF should also be investigated in other family members. Therefore, we aimed to examine the medical conditions of first-degree relatives (FDRs) of our pediatric patients with FMF in the present study.
METHODS
Chronic diseases of FDRs of pediatric 449 FMF, 147 juvenile idiopathic arthritis (JIA) patients and 93 healthy controls (HC) were questioned during their routine clinical visits for 9 consecutive months.
RESULTS
A total of 1975 FDRs of 449 FMF, 690 FDRs of 147 JIA patients, and 406 FDRs of 93 HC were included into the study. The most common medical conditions were non-atopic asthma (n=71, 3.6%), type 2 DM (n=14, 2%), and tonsillectomy history (n=12, 2.95%) in the FMF, JIA, and HC groups, respectively. Atopic diseases (FMF vs. JIA: p=0.013; FMF vs. HC: p=0.014), rheumatic diseases (FMF vs. JIA: p=0.030; FMF vs. HC: p=0.017), and surgical histories (FMF vs. JIA: p<0.01; FMF vs. HC: p=0.026), including adenoidectomy, tonsillectomy, and appendectomy, were significantly more common in the FMF group than in other groups.
CONCLUSIONS
Our novel findings may contribute to understanding the hereditary burden of co-existing diseases in children with FMF and encourage further studies involving genetic screenings.
Topics: Humans; Familial Mediterranean Fever; Female; Male; Child; Child, Preschool; Arthritis, Juvenile; Adolescent; Turkey; Case-Control Studies; Family; Adult; Asthma
PubMed: 38814299
DOI: 10.24953/turkjpediatr.2024.4589 -
Journal of Migration and Health 2024To explore the impacts of parental deportation on the health and well-being of U.S. citizen children of Mexican immigrants.
OBJECTIVE
To explore the impacts of parental deportation on the health and well-being of U.S. citizen children of Mexican immigrants.
METHODS
From 2019-2020, this ambi-directional cohort study recruited U.S.-based families with an undocumented Mexican immigrant parent and U.S.-citizen childrens (ages 13-17) recently exposed to parental deportation ( = 61), and similar families without a history of parental deportation ( = 51). Children health, behavioral, economic, and academic outcomes were measured via phone surveys upon enrollment and six months later. A subsample of "exposed" caregivers ( = 14) also completed in-depth semi-structured interviews. Data were analyzed using fixed-effects regression models and thematic analyses.
RESULTS
Childrens exposed to parental deportation had significantly worse health status, behavioral problems, material hardship, and academic outcomes than children in the control arm (<.05). Caregivers' interviews illustrated these health, behavioral, academic and family impacts.
CONCLUSIONS
Parental deportations have wide and potentially long-lasting health, behavioral, economic, and academic consequences for U.S. citizen youth. Changes in immigration policies and enforcement practices are urgently needed to protect the unity of mixed-legal status families in the U.S. and prevent the suffering of U.S. children in these families.
PubMed: 38813455
DOI: 10.1016/j.jmh.2024.100233 -
Frontiers in Public Health 2024Breast milk is the ideal food for the infant and is associated with various public health benefits for both the infant and the mother. The recommended time for early...
INTRODUCTION
Breast milk is the ideal food for the infant and is associated with various public health benefits for both the infant and the mother. The recommended time for early initiation of breastfeeding is within one hour after birth. The prevalence of early initiation of breastfeeding was lower than the plan of the Ethiopian Ministry of Health Sector Development program. Thus, the main objective of this study was to identify individual and group-level factors associated with the early initiation of breastfeeding in Ethiopia.
METHODS
Secondary data on children was obtained from the 2019 Ethiopia mini-demographic and health survey. The survey was a population-based cross-sectional study and was downloaded from the Measure Demographic and Health Survey website (http://www.measuredhs.com). The study included a random sample of 2,125 last-born infants who were born within 24 months before the survey. A multilevel binary logistic regression analysis was employed to identify the factors associated with the early initiation of breastfeeding in Ethiopia. Statistical data was analyzed using the Statistical Analysis System (SAS 9.4).
RESULTS
The prevalence of early breastfeeding initiation was 72%. The higher preceding birth interval (AOR = 1.18, 95% CI: 1.1076, 1.5451), the higher gestational age of infants (AOR = 1.38, 95% CI: 1.2796, 1.4782), the higher number of antenatal care visits (AOR = 1.26, 95% CI: 1.2340, 1.2934), delivery at a health facility (AOR = 1.60, 95% CI: 1.4585, 1.7515), vaginal delivery (AOR = 1.11, 95% CI: 1.1019, 1.1123), mothers with primary education (AOR = 1.14, 95% CI: 1.0204, 1.2738), mothers with secondary education (AOR = 1.54, 95% CI: 1.4678, 1.6190), and mothers with higher education (AOR = 2.62, 95% CI: 2.2574, 3.0526) were associated with higher odds of early initiation of breastfeeding. Being a rural dweller (AOR = 0.63, 95% CI: 0.5684, 0.7038) and the age of mothers (AOR = 0.44, 95% CI: 0.3921, 0.4894) were associated with lower odds of early initiation of breastfeeding.
CONCLUSION
Since the prevalence of early initiation of breastfeeding was minimal among rural mothers who delivered their child by caesarean section, this study strongly suggests special supportive care for these mothers.
Topics: Humans; Breast Feeding; Ethiopia; Female; Cross-Sectional Studies; Adult; Multilevel Analysis; Infant; Male; Infant, Newborn; Adolescent; Young Adult; Mothers; Prevalence; Time Factors; Health Surveys; Socioeconomic Factors
PubMed: 38813432
DOI: 10.3389/fpubh.2024.1393496