Brief parenting intervention (Triple P) for families of children with eczema: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy and costs of a brief, group-delivered parenting intervention for families of children with eczema. METHODS: A randomized controlled trial design was used. Families attending the Queensland Children's Hospital and from the community (n = 257) were assessed for eligibility (child 2-10 years, diagnosed with eczema, prescribed topical corticosteroids). Families who consented to participate (N = 59) were assessed at baseline for clinician-rated eczema severity, parent-reported eczema symptom severity, and electronically-monitored topical corticosteroid adherence (primary outcomes); and parenting behavior, parents' self-efficacy and task performance when managing eczema, eczema-related child behavior problems, and child and parent quality of life (secondary outcomes). Families were randomized (1:1, unblinded) to intervention (n = 31) or care-as-usual (n = 28). The intervention comprised two, 2-hr Healthy Living Triple P group sessions (face-to-face/online) and 28 intervention families attended one/both sessions. All families were offered standardized eczema education. Families were reassessed at 4-weeks post-intervention and 6-month follow-up, with clinician-raters blinded to condition. Costs of intervention delivery were estimated. RESULTS: Multilevel modeling across assessment timepoints showed significant intervention effects for ineffective parenting (d = .60), self-efficacy (d = .74), task performance (d = .81), and confidence with managing eczema-related child behavior (d = .63), but not disease/symptom severity, treatment adherence or quality of life. Mean cost per participating family with parenting behavior (clinically) improved was $159. CONCLUSIONS: Healthy Living Triple P is effective in reducing ineffective parenting practices and improving parents' self-efficacy and task performance when managing children's eczema and eczema-related behavior difficulties. There was no effect on disease/symptom severity, treatment adherence, or quality of life. CLINICAL TRIAL REGISTRATION: ACTRN12618001332213.

Moral distress among acute mental health nurses: A systematic review.

Moral distress has been identified as an occupational hazard for clinicians caring for vulnerable populations. The aim of this systematic review was (i) to summarize the literature reporting on prevalence of, and factors related to, moral distress among nurses within acute mental health settings, and (ii) to examine the efficacy of interventions designed to address moral distress among nurses within this clinical setting. A comprehensive literature search was conducted in October 2022 utilizing Nursing & Allied Health, Embase, CINAHL, PsychInfo, and PubMed databases to identify eligible studies published in English from January 2000 to October 2022. Ten studies met inclusion criteria. Four quantitative studies assessed moral distress among nurses in acute mental health settings and examined relationships between moral distress and other psychological and work-related variables. Six qualitative studies explored the phenomenon of moral distress as experienced by nurses working in acute mental health settings. The quantitative studies assessed moral distress using the Moral Distress Scale for Psychiatric Nurses (MDS-P) or the Work-Related Moral Stress Questionnaire. These studies identified relationships between moral distress and emotional exhaustion, depersonalization, cynicism, poorer job satisfaction, less sense of coherence, poorer moral climate, and less experience of moral support. Qualitative studies revealed factors associated with moral distress, including lack of action, poor conduct by colleagues, time pressures, professional, policy and legal implications, aggression, and patient safety. No interventions targeting moral distress among nurses in acute mental health settings were identified. Overall, this review identified that moral distress is prevalent among nurses working in acute mental health settings and is associated with poorer outcomes for nurses, patients, and organizations. Research is urgently needed to develop and test evidence-based interventions to address moral distress among mental health nurses and to evaluate individual and system-level intervention effects on nurses, clinical care, and patient outcomes.

Digital health interventions for postoperative recovery in children: a systematic review.

BACKGROUND: Digital health interventions offer a promising approach for monitoring during postoperative recovery. However, the effectiveness of these interventions remains poorly understood, particularly in children. The objective of this study was to assess the efficacy of digital health interventions for postoperative recovery in children. METHODS: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the use of automation tools for searching and screening. We searched five electronic databases for randomised controlled trials or non-randomised studies of interventions that utilised digital health interventions to monitor postoperative recovery in children. The study quality was assessed using Cochrane Collaboration's Risk of Bias tools. The systematic review protocol was prospectively registered with PROSPERO (CRD42022351492). RESULTS: The review included 16 studies involving 2728 participants from six countries. Tonsillectomy was the most common surgery and smartphone apps (WeChat) were the most commonly used digital health interventions. Digital health interventions resulted in significant improvements in parental knowledge about the child's condition and satisfaction regarding perioperative instructions (standard mean difference=2.16, 95% confidence interval 1.45-2.87; z=5.98, P<0.001; I2=88%). However, there was no significant effect on children's pain intensity (standard mean difference=0.09, 95% confidence interval -0.95 to 1.12; z=0.16, P=0.87; I2=98%). CONCLUSIONS: Digital health interventions hold promise for improving parental postoperative knowledge and satisfaction. However, more research is needed for child-centric interventions with validated outcome measures. Future work should focus development and testing of user-friendly digital apps and wearables to ease the healthcare burden and improve outcomes for children. SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42022351492).

"Their Happiness, Not Neurotypical Success": Autistic Adults Reflect on the Parenting of Autistic Children.

PURPOSE: Parenting has implications for psychosocial adjustment well into adulthood. While much is known about the parenting behaviors that influence adjustment in autistic children, little is known about how the effects of parenting persist in autistic adults. Further, autistic adults' perspectives on how they were parented have not been investigated to date. This study aimed to examine autistic adults' perspectives on their experiences of being parented in childhood and the advice they would like to offer to parents of autistic children in the context of their lived experience. METHODS: Ninety-six Australian autistic adults responded to open-ended questions in a larger survey assessing childhood experiences of being parented, adult attachment, psychological flexibility, and adult adjustment. RESULTS: A total of 10 themes were identified. Autistic adults emphasized the importance of embracing early diagnosis and that the goal of parents should be their child's happiness rather than "neurotypical" success. They highlighted the importance of unconditional love and understanding of their autistic child, recognizing that autistic children have similar fundamental needs as other children. Participants discussed the importance of structure and predictability in the home to feelings of safety. Parents were encouraged to meet them halfway. Finally, autistic adults reflected on the role of parents in advocacy and parental well-being. Parental neurodivergence was discussed as a possible bane or boon. CONCLUSIONS: Autistic adults emphasized the importance of unconditional acceptance from their parents, with the goal being their child's happiness. Findings from this study will inform future programs for families of autistic children.

Predictors of compassion satisfaction among healthcare professionals working in intensive care units: A cross-sectional study.

OBJECTIVE: To determine the prevalence of compassion satisfaction, related factors, and predictors among healthcare professionals in Thai intensive care units. METHODS: A cross-sectional study was conducted in 12 intensive care units at a university hospital in Thailand from August to November 2022. All nurses and doctors were invited to complete an anonymous online survey which included: the Professional Quality of Life Scale version 5, Connor-Davidson Resilience Scale, Passion Scale, Flourishing Scale, and Acceptance and Action Questionnaire. Descriptive statistics, Pearson's correlation coefficients, and hierarchical multiple regressions were used for data analysis in SPSS 28.0. RESULTS: A total of 178 nurses and doctors participated (92.13% nurses, 89.89% female, mean 32.10 years). Average compassion satisfaction (assessed using the Professional Quality of Life Scale) was moderate, with a mean score of 37.94 (SD = 5.58). The final regression model predicting compassion satisfaction was significant and explained 65% of the variance in compassion satisfaction, F (11, 154) = 26.00, p < 0.001. Four out of 11 predictor variables made unique statistically significant contributions to the final model: resilience (ß = 0.48, p < 0.001), harmonious passion (ß = 0.24, p < 0.001), being a nurse (not a doctor; ß = 0.17, p < 0.05), and holding a postgraduate qualification (ß = 0.10, p < 0.05). CONCLUSION: Most healthcare professionals in critical care units have a moderate level of compassion satisfaction, which is correlated with resilience, flourishing, and harmonious passion. Resilience and harmonious passion predict compassion satisfaction. These factors are modifiable through intervention. IMPLICATION FOR CLINICAL PRACTICE: Assessment of staff psychological well-being can identify those at risk for stress and impaired professional quality of life. Resilience and harmonious passion predict compassion satisfaction and can be modified through psychological interventions to promote psychological well-being and professional quality of life in healthcare workers in intensive care units.

Managing Screen Use in the Under-Fives: Recommendations for Parenting Intervention Development.

The impact of excessive screen use on children's health and development is a public health concern and many countries have published recommendations to limit and guide the use of screen media in childhood. Despite this, international studies report that the majority of parents and children do not adhere to screen use recommendations. Existing research aiming to understand children' screen use has largely focused on older children, and on demographic and structural aspects of the child's environment. Parents play a central role in determining young children's screen use and identify numerous barriers to developing healthy screen use practices with their children. However, no clear models exist that incorporate key parenting factors in understanding children's screen use, which presents an impediment to intervention development. Likewise, while some evidence exists for interventions to improve children's screen use behaviours, most are focused on older children and parental involvement has generally been limited. In this paper, we overview key factors associated with screen use in young children (< 5 years) and summarise the existing evidence base for interventions designed to support healthy screen use. This paper proposes a conceptual model linking aspects of parenting and the socio-ecological environment to young children's screen use. Our proposed model could be used to design longitudinal studies of screen use predictors and outcomes, and inform intervention development. Finally, the paper provides key recommendations for future research, intervention development and testing.

Relationships between parenting and illness factors and child behaviour difficulties in children with asthma and/or eczema.

Chronic health conditions such as asthma and eczema are common and are associated with significant psychosocial sequelae for children and their families. A number of parenting variables have been implicated in child health outcomes; however, there are gaps in understanding of the relationships between parenting and child adjustment in the context of chronic illness. This study examined the role that modifiable parenting factors including parenting style, self-efficacy, and adjustment play in explaining general and illness-related child behaviour and emotional problems. Parents (N = 107) of children diagnosed with asthma only (n = 22), eczema only (n = 59), or both conditions (n = 26) completed a range of parenting and child adjustment measures. The majority of the modifiable parenting factors (parents' self-efficacy with managing their child's internalising, asthma-related, and eczema-related behaviours; parent adjustment; and use of ineffective parenting strategies) made significant contributions to explaining variance child behaviour. Parenting variables consistently explained greater proportions of variance in general and illness-related child behaviour difficulties compared to demographic and illness factors and represent important intervention targets.

Psychological interventions targeting mental health and the mother-child relationship in autism: Systematic review and meta-analysis.

AIM: To investigate the efficacy of psychological interventions delivered to mothers of young children with autism spectrum disorder (ASD) in improving maternal mental health and the parent-child relationship. METHOD: Electronic databases were searched from inception to December 2021. Studies were included if they were randomized controlled trials (RCTs) of psychological interventions that targeted maternal mental health (primary outcome) and/or the parent-child relationship (secondary outcome), delivered to mothers of children (mean age < 60 months) with ASD. Meta-analyses of three parent mental health outcomes (stress, depressive symptomatology, and general mental health) and seven parent-child relationship outcomes (parent responsiveness, affect, directiveness, non-directiveness, child initiation, infant positive affect, and infant attentiveness) were conducted using both mean and standardized mean differences. RESULTS: Thirty-two RCTs met the inclusion criteria (2336 participants). Six RCTs showed improved maternal mental health (Cohen's d = 0.41-1.15), with moderate certainty of evidence for improvement in parental stress. There was low and high certainty of evidence of treatment effect on parental depressive symptoms and general mental health respectively, which did not show significant treatment effects post-intervention. Seventeen RCTs showed improved parent-child relationship (d = 0.33-2.28; low certainty of evidence). INTERPRETATION: Results demonstrated that parenting interventions promoting responsiveness had the largest positive effect on the parent-child relationship and a moderate effect on overall parenting stress; however, the studies were heterogeneous, making it difficult to identify the intervention components that were responsible for the positive treatment effects. There was no significant treatment effect for studies targeting depression or general mental health, likely due to the lack of an interventional component directly targeting mental health.

Parent-reported barriers to establishing a healthy diet with young children in Australia.

BACKGROUND: Parents' beliefs and behaviours affect children's nutrition, eating behaviours, and health outcomes; however, little is known about parents' experiences and perspectives on establishing a healthy diet with young children. METHODS: A community-recruited sample of 391 parents of young children (under age 5) completed an anonymous cross-sectional online survey assessing the degree to which their children met recommendations outlined in Australian nutrition guidelines, perceived barriers to establishing a healthy diet with their child, and interest in receiving tips/information about establishing healthy eating habits with their children. Descriptive statistics illustrated proportions of children adhering to recommendations. Thematic analysis was used to analyse qualitative data. RESULTS: Adherence to recommended nutrition guidelines varied across age groups. Most children across all age groups had water as their main drink, routinely consumed a variety of fruit, and consumed sweet drinks or fast foods only rarely. In contrast, less than half of 2- and 3-year-olds regularly consumed a variety of vegetables. The proportion of children consuming discretionary "treat" foods increased sharply over the first 2 years of life, and two thirds of 2-, 3-, and 4-year-olds consumed treat foods a few days per week or more. Parent-reported barriers to establishing a healthy diet with young children included child behavioural factors (e.g., dislike of vegetables), parental influences (e.g., lack of time), family dynamics (e.g., influence of extended family) and external influences (e.g., external environment). Parents were most often interested in ways to modify child behaviour and information about child nutrition. CONCLUSIONS: Parents cite child behavioural issues as a major barrier to establishing a healthy diet with young children. Behavioural interventions that provide parents with information and support on how to establish a healthy diet with young children, as opposed to educational interventions focusing mainly on what children should be eating, may better meet families' needs.

Emotional availability in the mother-child relationship for families of young children with autism spectrum disorder in Australia: A cross-sectional survey.

BACKGROUND: In families of children with autism spectrum disorder (ASD) the mother-child relationship can be affected by many factors; however, the impacts of maternal broad autism phenotype (BAP) and attachment styles are unknown. This study investigated predictors of emotional availability in the mother-child relationship in families of children with ASD. METHODS: Mothers (N = 231) of children with ASD living in Australia completed questionnaires assessing emotional availability in the parent-child relationship (mutual attunement, child involvement, affect quality) and mothers' BAP, mental health, adult attachment style and parenting experiences. Hierarchical multiple regressions and a mediation analysis were conducted. RESULTS: Parent-reported positive parenting experiences was the greatest predictor of mutual attunement, child involvement and affect quality in the parent-child relationship. Maternal stress and anxiety predicted poorer mutual attunement, stress and depressive symptoms predicted less child involvement and anxiety predicted worse affect quality. Negative parenting experiences, maternal anxiety and stress mediated the relationship between BAP and mutual attunement. CONCLUSION: Interventions combining mental health and parenting support for mothers of children with ASD to bolster emotional availability within the mother-child relationship may be warranted.

Parent-Reported Barriers and Enablers to Establishing Sun Safety Practices with Young Children in Australia.

This study investigated parent-reported barriers and enablers to establishing sun safety practices with young children (0-4 years; N = 423) living in Australia. An online survey examined parent/child adherence to recommended sun safety practices and barriers and enablers to establishing sun safety practices. Adherence to different sun safety practices varied across age groups. Lack of child cooperation was the most commonly-endorsed barrier while child compliance was the most commonly-endorsed facilitator. Young children's lack of cooperation with sun safety practices represents a major obstacle for parents. In conclusion, the development and testing of family-based intervention approaches to reduce child resistance and promote cooperation is warranted.

Protocol of a cluster randomised controlled trial evaluating the effectiveness of an online parenting intervention for promoting oral health of 2-6 years old Australian children.

INTRODUCTION: Dental decay is a major problem among Australian children. It can be prevented through good self-care and limiting sugar intake, but many parents/caregivers lack the skills and confidence to help their children adopt these practices. This trial will evaluate the efficacy of Healthy Habits Triple P - Oral health, a web-based online programme, in improving children's oral health-related behaviours (toothbrushing, snacking practices and dental visits) and related parenting practices, thereby preventing dental caries. METHODS AND ANALYSIS: This is a cluster, parallel-group, single-blinded, randomised controlled trial of an online intervention for parents/caregivers of children aged 2-6 years. From the City of Gold Coast (Australia), 18 childcare centres will be randomly selected, with equal numbers randomised into intervention and control arms. Intervention arm parents/caregivers will receive access to a web-based parenting intervention while those in the control arm will be directed to oral health-related information published by Australian oral health agencies. After the completion of the study, the Healthy Habits Triple P - Oral health intervention will be offered to parents/caregivers in the control arm. The primary outcome of this trial is toothbrushing frequency, which will be assessed via Bluetooth supported smart toothbrushes and parent/caregiver report. Data on other outcomes: parenting practices and child behaviour during toothbrushing, consumption of sugar rich foods and parents' confidence in dealing with children's demands for sugar rich food, and dental visiting practices, will be collected through a self-administered questionnaire at baseline (before randomisation), and 6 weeks (primary endpoint), 6 months and 12 months after randomisation. Data on dental caries will be collected at baseline, 12 and 18 months post-randomisation. ETHICS AND DISSEMINATION: Ethical approval has been obtained from Human Research Ethics Committees of Griffith University (2020/700) and the University of Queensland (2020002839). Findings will be submitted for publication in leading international peer-reviewed journals. TRIAL REGISTRATION NUMBER: ACTRN12621000566831.

Childhood experiences of being parented, adult attachment, psychological inflexibility, social engagement, and mental health of autistic adults.

BACKGROUND: Autistic adults have an increased risk of poor mental health. Although parental care and overprotection in childhood influence later attachment and mental health in the general adult population, this has not been investigated in the autistic population. Likewise, the roles of psychological inflexibility and social engagement in influencing mental health outcomes for autistic adults have yet to be examined. AIMS: To examine if retrospectively recalled childhood experiences of parental care and overprotection, as well as current adult attachment, psychological inflexibility and social engagement are associated with mental health in autistic adulthood. Further, to examine mediators of the association between parental care and overprotection and mental health in autistic adults. METHODS AND PROCEDURES: A community-recruited convenience sample of 126 Australian autistic adults completed an online survey assessing childhood experiences of parental care and overprotection and current adult attachment, psychological inflexibility, social engagement, and mental health. OUTCOMES AND RESULTS: Linear regressions showed that psychological inflexibility was the strongest predictor of depression, anxiety, and stress, followed by attachment anxiety (depression, anxiety) and attachment avoidance (anxiety, stress). Mediation analyses revealed that psychological inflexibility and attachment anxiety mediated the associations between parental care and overprotection and mental health outcomes in autistic adulthood. CONCLUSIONS AND IMPLICATIONS: Psychological inflexibility and adult attachment (anxious and avoidant attachment) are important to understanding mental health of autistic adults. Psychological inflexibility and attachment anxiety mediate associations between recalled childhood experiences of parental care and overprotection and mental health in autistic adulthood.

Randomised controlled trial of the Healthy Living Triple P-Positive Parenting Program for families of children with type 1 diabetes.

This randomised controlled trial examined the efficacy of a brief, group-based parenting program in improving child and family outcomes for families of children with type 1 diabetes. Families (N = 50) of children (2-10 years) with type 1 diabetes were randomly allocated to intervention (n = 22) or care-as-usual (n = 28). Assessments (pre-intervention, post-intervention and 6-month follow-up) evaluated parent- and child-reported parenting behaviour, child behaviour/adjustment and child quality of life (primary outcomes); and metabolic control (routinely-collected blood glucose data), parents' self-efficacy with diabetes management, diabetes-specific child behaviour difficulties, family quality of life, parents' diabetes-related and general parenting stress and observed parent and child behaviour (secondary outcomes). Intent-to-treat analyses indicated greater rate of improvement over time for families allocated to intervention compared to care-as-usual for use of corporal punishment (primary caregivers only), and confidence with managing children's emotions/behaviours, parent-rated child quality of life and adjustment to the child's illness (secondary caregivers only). There were no other intervention effects. Although families found the intervention useful, low levels of psychosocial problems at baseline limited the scope for group-level improvement and there was limited evidence for intervention efficacy. Individually-tailored measures of goal-specific behaviour change may be considered in future research.

Effects of comorbid asthma and eczema on child and family quality of life.

Paediatric chronic health conditions are associated with poorer psychological wellbeing and quality of life for children and families. This study investigated differences in child and parent/family quality of life between families of children with asthma only, eczema only, or both asthma and eczema, and tested predictors of child and parent/family quality of life. A convenience sample of 106 families completed parent-report measures of child and parent/family quality of life, child emotional and behavioural difficulties, parent adjustment and parenting practices. Between-groups ANOVAs indicated no differences for child quality of life, whereas parent/family quality of life was worse for those with eczema only compared to asthma only. Multiple linear regression revealed that child emotional difficulties predicted worse child quality of life, whereas worse parent adjustment, child emotional difficulties and eczema only (compared to both asthma and eczema) predicted worse parent quality of life. Results suggest that families of children with eczema may be at particular risk for impaired parent/family quality of life. Interventions that take a family-centred approach to improving child and parent adjustment should be investigated as an adjunct to medical treatment to reduce the impact of chronic health conditions on quality of life for children and families.

Online Parenting Intervention for Children's Eating and Mealtime Behaviors: Protocol of a Randomized Controlled Trial.

INTRODUCTION: Obesity and overweight are significant health problems among Australian children. Parents play a vital role in establishing healthy eating behaviors in their children. However, parents often experience difficulties in implementing effective parenting practices and lack confidence in their ability to help children adopt these behaviors. This trial will evaluate the efficacy of an online program, Healthy Habits Triple P, in improving children's snacking and mealtime behaviors and related parenting practices. METHODS AND ANALYSIS: This is a single-blinded, randomized controlled trial for parents of young Australian children aged 2-6 years. Participants will be recruited through childcare centers, social media, online parent forums and existing networks. The participants in the intervention arm will receive access to a web-based parenting intervention in addition to nutrition-related information for parents published by the National Health and Medical Research Council of Australia; those in the control arm will receive nutrition-related information only. After the completion of the study, the parenting intervention will be offered to the control arm. The primary outcome will be improvement in children's eating habits. The secondary outcomes include parents' self-efficacy, confidence, children's mealtime behaviors and mealtime parenting strategies. Both primary and secondary outcomes will be evaluated through online-administered, validated parent-reported questionnaires. We will also undertake a quantitative and qualitative evaluation of the practicality and acceptability of the intervention.

Compassion satisfaction, resilience and passion for work among nurses and physicians working in intensive care units: A mixed method systematic review.

OBJECTIVE: To identify, appraise, and synthesise current evidence on prevalence, correlates, and interventions to enhance compassion satisfaction, resilience, and passion for work among nurses and physicians working in intensive care units. METHODS: A mixed methods systematic review was conducted. The comprehensive search used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seven databases (MEDLINE, EMBASE, CINAHL, JBI, ProQuest, PsycINFO, and Cochrane Library) were searched for literature published between January 2011 and June 2021. The Mixed Methods Appraisal Tool was used to assess methodological quality. Data from included studies were analysed using a convergent mixed methods design. The protocol was prospectively registered (PROSPERO 2021 CRD42021252051). RESULTS: A total of 37 studies met the inclusion criteria. Most studies reported moderate levels of compassion satisfaction among intensive care health professionals, whereas levels of resilience varied. Compassion satisfaction and resilience were positively correlated, but relationships between compassion satisfaction and resilience and other correlates (personal factors, psychological factors, and work-related factors) were inconsistently reported. Only four interventions aimed to improve compassion satisfaction or resilience among intensive care health professionals. None of the included studies investigated passion for work. CONCLUSION: Compassion satisfaction, resilience, and passion for work among staff in the intensive care unit are important in the current global COVID-19 pandemic. Health professionals report a moderate level of compassion satisfaction but findings in relation to resilience are mixed. No studies examined passion for work. Further research to determine ongoing psychological wellbeing and professional quality of life and evaluate tailored interventions to support intensive care staff well-being is recommended.

Development and validation of the parenting and child tooth brushing assessment questionnaire.

OBJECTIVE: We report the development and validation of a comprehensive Parenting and Child Tooth brushing Assessment (PACTA) questionnaire. METHODS: This cross-sectional study was conducted with community-recruited Australian parents (N = 450) of children aged 2-8 years. Parents completed an online survey including the newly developed PACTA (comprising four scales assessing children's tooth brushing behaviours, parenting strategies, attitudes and knowledge) and established scales assessing parenting behaviours, attitudes and self-efficacy. RESULTS: Exploratory factor analyses revealed two-factor structures for scales assessing child behaviour ('noncompliance' and 'avoidance behaviour'), parenting strategies ('effective strategies' and 'ineffective strategies') and attitudes ('emotional reactions' and 'lack of concern'), whereas the knowledge scale was unidimensional. Internal consistencies were satisfactory (>0.7) for all except the knowledge scale. There was good evidence of convergent and predictive validity. All subscales predicted children's parent-reported tooth brushing frequency; children were more likely to brush at least twice per day when parents reported fewer tooth brushing behavioural problems, using effective parenting strategies, and having better attitudes and knowledge. Poorer scores on the 'lack of concern' subscale of the attitudes scale were the strongest unique predictor of twice-daily brushing (OR, 95% CI: 1.51, 1.36-1.67). CONCLUSIONS: PACTA demonstrates satisfactory validity and reliability. Further research assessing sensitivity to change following intervention is warranted.

Effect of Parenting Interventions on Perinatal Depression and Implications for Infant Developmental Outcomes: A Systematic Review and Meta-Analysis.

Considering the significant impact of perinatal depression on both maternal wellbeing and infant development, it is important to examine the effectiveness of interventions designed to prevent or reduce these risks. This systematic review and meta-analysis synthesised evidence on parenting intervention in relation to how such programs affect symptoms of perinatal depression and infant outcomes within 12 months of postpartum. We followed the Cochrane Collaboration guidelines on conducting systematic reviews and meta-analyses. A total of five electronic databases were searched for controlled trials that met pre-determined eligibility criteria. Outcomes of interest were maternal depressive symptoms and infants' language, motor and socioemotional development. Seventeen studies involving 1665 participants were included in the systematic review. Estimates from a random effects model of 15 studies in the final meta-analysis revealed statistically significant reductions in maternal depressive symptoms at post-intervention for mothers allocated to receive parenting interventions (SMD = - 0.34, 95%CI - 0.44, - 0.24; z = 5.97, p < 0.001; I2 = 0%). Data on infant development outcomes from the included studies were scarce, and therefore, infant outcomes were not analysed in this review. For individual study outcomes, the majority of studies reported a general trend for reductions in maternal depressive symptoms from pre- to post-intervention. Although parenting interventions are frequently considered preventive strategies that are designed to offer support to parents and impart skills that promote their physical and psychological wellbeing, our findings suggest that these interventions have a positive effect on perinatal depressive symptoms. Implications and recommendations for future research are addressed. The systematic review protocol was registered with PROSPERO 2020 CRD42020184491.

Child- and family-level factors associated with toothbrushing frequency in a sample of Australian children.

BACKGROUND: Identifying the factors that are conducive to good toothbrushing practices is fundamental for planning oral health promotion interventions. AIM: This study evaluated the relationships between child and family socio-demographic characteristics; children's behaviour during toothbrushing; family support for toothbrushing; parents' practices, attitudes and knowledge related to toothbrushing; general parenting practices; and children's behavioural problems, and children's toothbrushing frequency. DESIGN: A cross-sectional survey was conducted between February and May 2020 with parents of children aged 2-8 years, recruited through childcare centres throughout Australia. Parents completed self-administered surveys on child and family characteristics. RESULTS: A total of 606 parents completed the survey. Only half (52.5%) of the children of surveyed parents brushed their teeth twice or more/day. Children of university-educated parents [odds ratio (OR): 6.48; 95% confidence intervals (CIs): 1.21-34.71] and those concerned about their child's toothbrushing (OR: 1.44; 95% CI: 1.21-1.72) were more likely to brush twice or more/day. Where children were non-compliant during toothbrushing or parents reported using ineffective parenting strategies during toothbrushing, children were less likely to brush their teeth twice or more/day. Lack of concern of parent about toothbrushing was associated with brushing less than twice/day in children CONCLUSIONS: Measures of parenting and child behaviour that were specific to the toothbrushing context were associated with twice daily brushing while general measures of parenting and child behaviour were not correlated with twice daily brushing.