Does autonomous motivation and self-efficacy mediate associations between environmental factors and physical activity in adolescents?

BACKGROUND: To analyze the associations among autonomous motivation, self-efficacy, satisfaction of basic psychological needs, social support and perceived environment with physical activity practice of adolescents aged between 12 and 15 years; and to test autonomous motivations and self-efficacy as potential mediators of the associations between these environmental factors and physical activity practice. METHODS: We evaluated 553 adolescents, that participated in the ActTeens Program. Physical activity was assessed using the Physical Activity Questionnaire for Adolescents. Autonomous motivation, self-efficacy, satisfaction of basic psychological needs, parents' social support and perceived environment were assessed using specifics questionnaires. Linear regression models were used to test the associations. RESULTS: Parents' support (ß = 0.32), satisfaction of basic psychological needs of colleagues (ß = 0.21) and teachers (ß = 0.12), and perceived environment (ß = 0.10) had significant associations with physical activity (p < 0.05). The direct effect value was reduced when autonomous motivation was added as a mediator of the association between parents' support and physical activity (ß = 0.24), with a 25% mediated effect. Autonomous motivation was mediator of the relationship between basic psychological needs of colleagues (ß = 0.13; EM = 38%), teachers (ß = 0.02; EM = 83%), and perceived environment (ß = 0.03; EM = 70%) with physical activity. CONCLUSION: Self-efficacy was not associated with physical activity and autonomous motivation was an important mediator of adolescents' physical activity.

Parents' or legal guardians' beliefs and attitudes about childhood vaccination: a scoping review.

OBJECTIVE: to map scientific evidence about perceptions, beliefs, knowledge and attitudes of parents or legal guardians of children under 5 years of age regarding routine childhood vaccination. METHODS: a scoping review, conducted in accordance with the JBI framework. The searches were carried out in the PubMed/MEDLINE, Web of Science, Scopus and LILACS databases. A total of 5,535 studies were returned and 77 were selected, which met the inclusion criteria. RESULTS: perceptions related to interaction with healthcare professionals and services, with family organization and structure, with social interaction and public policies, cultural, religious and personal beliefs, knowledge about vaccination schedule, vaccination and immunization process and sources of information are the main factors mapped and which can positively or negatively influence parents' or legal guardians' attitudes towards vaccinating children. CONCLUSIONS: the findings allow us to identify factors related to parents' perception and beliefs about childhood vaccination.

"Times of war and time of uncertain peace": Narratives of parents of childhood cancer survivors.

OBJECTIVE: to analyze the meaning attributed by parents to the extended and permanent survival of childhood cancer. METHOD: qualitative narrative inquiry, developed with parents of adolescents and young adults who survived childhood cancer. Recruitment and data collection involved virtual and in-person approaches. The data were collected through semi-structured interviews. Data were analyzed according to reflective thematic analysis. RESULTS: a total of ten parents were included in the study. Two thematic narrative syntheses were constructed: "Times of war"; and "Time of uncertain peace", with their respective sub-themes. The cancer diagnosis marks the beginning of times of war in the parents' lives. They experience cancer treatment as "highs and lows" with potential threats to their children's lives. After that, "Time of uncertain peace" are reached, and the balance of the family unit is reestablished. However, the fear of recurrence makes the family peace uncertain, and its maintenance requires constant vigilance and attention to the signs and symptoms of a possible new battle. CONCLUSION: the results highlight the experience of being a parent of a childhood cancer survivor and can be applied to develop models of care centered on the survivors' family.

Stress in parents of preschoolers with Autism Spectrum Disorders: an update review.

BACKGROUND: Parental stress experienced in the context of caring for children with autism spectrum disorder (ASD) in preschool is significant and has been poorly studied; studies tend to focus on more advanced ages of children where parental symptomatology has become chronic. The current study sought to provide new empirical evidence on factors associated with parental stress. METHODS: An exhaustive search was conducted in four academic databases: CINAHL Complete, Medline Complete, Web of Science (WoS), and Scopus, limiting the articles to those published between 2017 and 2023. RESULTS: The sample obtained consisted of 24 selected articles, which were produced in 11 countries, and all were in English. In terms of content, the topics addressed were the manifestation of parental stress, factors of the child with ASD and their relationship with parental stress, factors of parents of children with ASD, family factors of parents of children with ASD, social factors of parents of children with ASD, parental stress and access to formal care services, and parental stress and specialized interventions. CONCLUSIONS: It is possible to affirm that research reports indicate that the general level of stress among parents of children with ASD is compared to their reference groups, both in relation to child-related stress and other stressors. The variables that affect parental stress exhibit a reciprocal influence among them, so interventions aimed at early childhood should incorporate both the children and their parental figures. This is in consideration of the impact that stress has on the mental health of parents, establishing that parents with better health have early access to support services during the early years of parenting, as well as in later years.

INTRODUCCIÓN: El estrés parental vivenciado en el contexto de cuidado de los niños con trastorno del espectro autistas en etapa preescolar es significativo y ha sido muy poco estudiado, las investigaciones tienden a focalizarse en edades de los niños más avanzada donde la sintomatología de los padres se ha cronificado. El objetivo de la presente investigación fue actualizar el corpus de evidencia empírica referida a los factores relacionados con el Estrés parental. MÉTODOS: Se realizó una búsqueda exhaustiva en cuatro bases de datos académicas: CINAHL Complete, Medline Complete, Web of Science (WoS) y Scopus, limitando los artículos publicados entre los años 2017 y 2023. RESULTADOS: La muestra obtenida fue de 24 artículos seleccionados, los cuales fueron producidos por 11 países todos de habla inglesa. En cuanto al contenido, los temas abordados son: La manifestación del estrés parental, factores del niño con TEA y su relación con el estrés parental, factores de los padres de los niños con TEA, factores familiares de los padres de los niños con TEA, factores sociales de los padres de los niños con TEA, estrés parental y acceso a los servicios formales de atención, y estrés parental e intervenciones especializadas. CONCLUSIONES: Es posible afirmar que las investigaciones reportan que el nivel general de estrés de los padres de niños con TEA es superior al de sus grupos de referencia, tanto en relación al estrés relacionado con el niño, como el que no. Las variables que afectan el estrés parental presentan una influencia recíproca entre éstas, por lo que las intervenciones dirigidas a la primera infancia deberían incorporar a los niños y a sus figuras parentales. Esto, en atención al impacto que el estrés presenta en la salud mental de los padres, estableciendo que los padres con mejor salud mental presentan mayor acceso temprano a los servicios de apoyo durante los primeros años de crianza, y en los años posteriores.

Mental Health and Other Factors Associated with COVID-19 Vaccination Intention toward Children of Military Parents in Lambayeque, Peru.

There is evidence that vaccine acceptability is strongly associated with mental health. However, no studies assessing intention to vaccinate (ITV) intention toward children of military parents have been documented. The current research aimed to establish the prevalence and factors of ITV children against COVID-19 in military parents in Lambayeque-Peru, 2021. Analysis was conducted with the dependent variable ITV children reported by military parents. The independent variables were history of mental health, searching for mental health support, food insecurity, resilience, anxiety, depression, burnout, posttraumatic stress, and suicidal risk. Prevalence ratios and 95% confidence intervals were estimated. Of 201 military personnel evaluated, 92.5% were male, 82.5% were of the Catholic faith, and the median age was 40.9% of respondents reported seeking mental health help during the COVID-19 pandemic. It was reported anxiety (20.3%), depression (6.5%), and posttraumatic stress disorder (6.5%). Most reported ITV in children against COVID-19 (93%). In the multiple models, we found that Catholics had a 23% higher prevalence of ITV in the children where PR = prevalence ratios and CI = confidence intervals (PR = 1.23; 95% CI: 1.01-1.50). Likewise, seeking mental health support increased the prevalence of ITV by 8% (PR = 1.08; 95% CI: 1.00-1.15). Seeking mental health support and belonging to the Catholic faith had a higher ITV of children of Peruvian military personnel. Finding mental health support, experiencing burnout syndrome, having a relative who suffers from mental health problems, and being part of the Catholic religion were associated with a higher willingness to immunize the children of Peruvian military members.

Parental stress, depression, anxiety and participation to care in neonatal intensive care units: results of a prospective study in Italy, Brazil and Tanzania.

BACKGROUND: Studies comparing the frequency of different mental health conditions across different settings and evaluating their association with parental participation in newborn care are lacking. We aimed at evaluating the frequency of parental stress, anxiety and depression, along with the level of participation in newborn care, among parents of newborns in Italy, Brazil and Tanzania. METHODS: Parental stress, anxiety, depression and participation in care were assessed prospectively in parents of newborns in eight neonatal intensive care units (NICUs) utilising: the Parental Stressor Scale in NICU (PSS:NICU); the Edinburgh Postnatal Depression Scale (EPDS) and EPDS-Anxiety subscale (EPDS-A); the Index of Parental Participation in NICU (IPP-NICU). Univariate and multivariate analyses were conducted. RESULTS: Study outcomes were assessed on 742 parents (Brazil=327, Italy=191, Tanzania=224). Observed scores suggested a very high frequency of stress, anxiety and depression, with an overall estimated frequency of any of the mental health condition of 65.1%, 52.9% and 58.0% in Brazil, Italy, Tanzania, respectively (p<0.001). EPDS scores indicating depression (cut-off: ≥13 for Brazil and Tanzania, ≥12 for Italy) were significantly more frequent in Tanzania (52.3%) when compared with either Brazil (35.8%) and Italy (33.3%) (p<0.001). Parental participation in care was also significantly higher in Tanzania (median IPP-NICU=24) than in the other two countries (median=21 for Brazil, 18 for Italy, p<0.001). Severe stress (PSS:NICU ≥4) was significantly more frequently reported in Brazil (22.6%), compared with Italy (4.7%) and Tanzania (0%, p<0.001). Factors independently associated with either parental stress, anxiety or depression varied by country, and a significant association with parental participation in care was lacking. CONCLUSIONS: Study findings suggest that parental stress, anxiety and depression are extremely frequent in NICUs in all countries despite diversity in the setting, and requiring immediate action. Further studies should explore the appropriate level of parental participation in care in different settings.

Validity and reliability of the Brazilian version of the Illness Perception Questionnaire-Revised for Dental.

This study aimed to test the validity and reliability of the Brazilian version of the "Illness Perception Questionnaire-Revised for Dental" (IPQ-RD) in parents/guardians of children aged six to 14 years. The sample consisted of 63 parents/guardians of schoolchildren from the municipal school system of Teófilo Otoni, MG. Remote and virtual data collection consisted of self-completion of personal data, socioeconomic questionnaire and the Brazilian short versions of the "Parental-Caregiver Perceptions Questionnaire" (16-P-CPQ) and the "Family Impact Scale" (4-FIS). The IPQ-RD was applied by telephone interview. Almost half of the sample belonged to socioeconomic classes C1 and C2. Approximately 1/3 classified their child's oral health as "regular" or "poor", while 11.1% reported "strong" or "very strong" impact on their child's well-being. The items most frequently cited as having an impact on the four domains of the 16-P-CPQ were: "bad breath" (23.8%), "mouth breathing" (20.7%), "feeling anxious or afraid" (20.7%), and "paying attention at school" (10%). In the 4-FIS, 11.1% "had little time for themselves or the family". There were higher IPQ-RD scores in the "disease coherence" domain for women and lower values of "emotional dimensions" for parents/guardians with incomplete education. The mean IPQ-RD score was 126.4 (±15.1), and domain scores were positively correlated. The internal consistency was "almost perfect" for the IPQ-RD total score, ranging from "moderate" to "almost perfect" for the "child-control" and "child-consequences" domains. The intraclass correlation coefficient ranged from 0.04 (poor) to 0.68 (substantial). The Brazilian Portuguese version of the IPQ-RD proved to be valid and reliable for assessing the cognitive and emotional perception of parents/guardians about childhood dental caries.

Determinants of undervaccination of routine childhood immunization in Argentina: A cross-sectional study.

Routine childhood immunization is one of the most effective methods of preventing infectious diseases in children. In Argentina, there has been a decline in routine immunization coverage since 2015, with very little evidence to date on underlying drivers of this steady decline. We administered an online nationwide behavioral insights survey in Argentina between July 1-25, 2022, targeting parents with at least one child under the age of 12 years. Our survey included 1504 parents, 7% (n = 111) of whom did not or only partially vaccinated their children. We found that, compared to the youngest parents (aged 18-24), older parents were less likely to under-vaccinate their children (e.g., 30-34 year-old parents: adjusted Odds Ratio (aOR): 0.31, 95% Confidence Interval (CI) 0.16-0.57). Parents who undervaccinated their children were more likely to take vaccination advice from parent and wellness social media influencers (parent influencers: aOR 2.51, 95% CI 1.46-4.31), and were less likely to trust the social media accounts of official health organizations (aOR 0.82, 95% CI 0.70-0.96). Furthermore, these parents had heightened concerns about routine immunizations, including the number of vaccines given to children and potential for adverse side effects. When asked whether they knew enough to make a vaccine decision for their children, parents who undervaccinated their children were more likely to report that they did not know enough about vaccines or the vaccination schedule to make a decision. These results offer important insights into parental concerns surrounding routine childhood immunization and suggest potential drivers of - and solutions to - the decline in routine immunization seen in Argentina since 2015.

Acceptance of Behavior Guidance Techniques in Pediatric Dentistry Between American and Colombian Parents.

Purpose: To compare the degree of acceptance of behavior guidance techniques (BGT) in pediatric dentistry between American and Colombian parents. Methods: American parents (n=150) and Colombian parents (n=150) of children between three and 12 years of age undergoing pediatric dental treatment participated in this multicenter cross-sectional study. Parents viewed a video depicting 10 BGTs approved by the American Academy of Pediatric Dentistry and rated their acceptance on a visual analog scale. Differences in the degree of acceptance were analyzed using quantile regression analysis. The level of significance was set at five percent. Results: American parents generally demonstrated higher median acceptance scores across various BGTs compared to Colombian parents (P<0.05). American parents exhibited higher acceptance levels of tell-show-do, voice control, non-verbal communication, positive reinforcement, distraction, presence/absence of parents and nitrous oxide, with statistically significant differences noted. American parents also displayed higher acceptance scores for advanced techniques such as protective stabilization, conscious sedation and general anesthesia. Conclusion: American parents consistently exhibited higher acceptance BGTs, suggesting variations in cultural attitudes toward pediatric dental care between the two groups.

Development of coparenting during the transition to parenthood: Integrating parents' representations with observed interactions.

The transition to parenthood is a significant period of transformation and adjustment for all members of a new family, reshaping relational dynamics that often endure throughout the initial years of a child's life. This qualitative and longitudinal study aimed to explore coparenting representations held by both partners in a parental couple, along with observations of their family interactions, at three distinct points in time, with the aim to better understand the interaction between these representational and behavioral observations. In-depth interviews were conducted with 17 heterosexual, first-time parents in Santiago de Chile, during pregnancy and at two different times during the first year of their child's life. Family interactions were assessed using the Lausanne Trilogue Play task (LTP) on all occasions. Three main coparenting representation categories emerged: traditional, ambiguous, and co-responsible. On observation, approximately half of the couples showed cooperative coparenting interactions, while the other half had conflictual interactions. Couples generally followed stable trajectories over time. Cooperative couples demonstrated co-responsibility and open dialogue, while conflictual couples tended to follow traditional gender roles with tacit communication styles. This study highlights the importance of promoting co-responsibility and dialogue for fostering cooperative relational dynamics during the critical transition to parenthood.

La transición a la paternidad/maternidad es un período significativo de transformación y ajuste para todos los miembros de una nueva familia, dándole nueva forma a las dinámicas de relación que a menudo se sobrellevan a lo largo de los años iniciales de la vida del niño. Este estudio cualitativo y longitudinal se propuso explorar las representaciones en la crianza compartida que tienen ambos miembros de una pareja de padres, junto con observaciones de sus interacciones familiares, en tres puntos distintivos en el tiempo, con el propósito de comprender mejor la interacción entre estas observaciones representacionales y de comportamiento. Se llevaron a cabo entrevistas profundas con 17 padres primerizos, heterosexuales, en Santiago de Chile, durante el embarazo y en dos momentos diferentes durante el primer año de vida de sus niños. Se evaluaron las interacciones de familia usando la tarea del Juego Tripartito de Lausanne (LTP) en todas las ocasiones. Tres principales categorías representacionales de crianza compartida surgieron: tradicional, ambigua y de responsabilidad compartida. Bajo observación, aproximadamente la mitad de las parejas mostró interacciones cooperadoras de crianza compartida, mientras que la otra mitad tuvo interacciones conflictivas. Las parejas generalmente siguieron trayectorias estables a lo largo del tiempo. Las parejas cooperadoras demostraron responsabilidad compartida y diálogo abierto, mientras que las parejas conflictivas tendieron a seguir papeles tradicionales de género con estilo de comunicación tácitos. Este estudio subraya la importancia de promover la responsabilidad compartida y el diálogo para cultivar relaciones dinámicas de cooperación durante la crucial transición a la paternidad/maternidad.

Revisiting the Link between Workplace Support for Families, Family Support, Diet Quality, and Satisfaction with Food-Related Life in the Second Year of the Pandemic.

The main objective of this study was to examine the actor and partner effects between Perceived Workplace Support for Families (PWSFs) and family support (PFS), diet quality, and satisfaction with food-related life (SWFoL) in households with both parents working and adolescents, along with the role of the three family members' diet quality as a mediator. During the second year of the pandemic in Chile, 860 dual-earner parents of different sexes and their adolescent child (average age 13 years, with 50.7% being male) were recruited from two cities. Parents responded to a measure of PWSFs and the Perceived Family Support Scale. Mothers, fathers, and adolescents answered the Adapted Healthy Eating Index (AHEI) and the satisfaction with food-related life Scale. The examination employed the mediation Actor-Partner Interdependence Model and structural equation modeling for the analyses. Results showed that mothers' PWSFs improved their and their teenage children's SWFoL, while fathers' PWSFs only improved their SWFoL. The mothers' PFS improved their and the fathers' diet quality while enhancing their SWFoL and the adolescents' SWFoL. The fathers' PFS enhanced their and the adolescents' SWFoL. The mothers' PFS also indirectly enhanced their and the fathers' SWFoL via each parent's diet quality. Each family member's diet quality was positively related to their SWFoL, while mothers' diet quality was positively related to the fathers' SWFoL. These results imply that resources obtained by parents from PFS positively impact the SWFoL of the three family members through different mechanisms. They also highlight the importance of maternal family support for SWFoL during the pandemic.

Acceptance of a third COVID-19 vaccine dose, vaccine interchangeability, and clinical trial enrolment among parents of children 12-17 years in Lima, Perú.

Objectives: To characterize factors associated with parental willingness for their children participation in a COVID-19 vaccine trial, use of different COVID-19 vaccines and acceptance of a third vaccine dose. Methods: Parents of children aged 12-17 years in Lima, Perú were asked to complete an online questionnaire via social networks, from November 9, 2021, to April 23, 2022. We calculated crude and adjusted prevalence ratios with 95% confidence intervals to compare factors with the mentioned outcomes. Results: From 523 parents responding, 374 completed the survey. 90.4% would give their children a third vaccine dose, 36.6% would allow their children participation in a COVID-19 vaccine clinical trial, and 33.2% would accept different vaccine brands between doses. Parental belief that COVID-19 vaccine studies met quality standards was associated with acceptance of a third booster dose (adjusted PR 3.25; 95% CI1.57-6.74; p = 0.002), enrolment in a COVID-19 clinical trial (adjusted PR 4.49; 95% CI1.25-16.06; p = 0.02), and acceptance of different COVID-19 vaccine brands between doses (adjusted PR 10.02; 95% CI1.40-71.95; p = 0.02). Conclusion: Most parents would accept a third vaccine booster dose, approximately a third would participate in COVID-19 vaccine trials. Believing COVID-19 vaccines studies fulfilled quality standards was associated with the study outcomes. It is necessary to inform about the rigorous processes for the development of COVID-19 vaccines to generate confidence in parents to accept these vaccine-related outcomes.

Prevention of Violence Against Children: A Qualitative Exploration of Colombian Policymakers', Programme Facilitators' and Caregivers' Perceptions.

OBJECTIVE: Violence against children (VAC) is a global public health and human rights issue that can lead to long-lasting negative consequences for individual and societal outcomes. While extensive evidence indicates that parenting programmes might be effective in preventing VAC, there are several unsolved questions on how to ensure interventions are acceptable, feasible, effective and sustainable, particularly in low- and- middle-income countries (LMICs). METHOD: In this study, we report findings from a qualitative examination of policymakers' (N = 10), early childhood and parenting programme facilitators' (N = 20) and parents' and other caregivers' (N = 38) perspectives on VAC prevention to examine the implementation ecosystem of parenting programmes in Colombia, including contextual risk and protection factors, features of existing programmes, and stakeholders' needs. We conducted interviews and focus groups using a semistructured format, along with a thematic approach, to analyse the data from each group of participants (i.e., policymakers, facilitators and caregivers) independently. RESULTS: Overall, the data revealed the critical role of intersecting and interacting factors at the micro (e.g., caregivers' capabilities and beliefs), meso (e.g., programme content and delivery approaches) and macro (e.g., policymakers' vision and existing infrastructure) levels in exacerbating risks/imposing barriers versus protecting/promoting VAC prevention. CONCLUSIONS: These findings provide evidence on the implementation ecosystem of prevention programmes to inform the design of novel strategies and programmes aimed at preventing violence and promoting families' well-being and young children's development.

Impact of immigrant-related stress on mental health among Mexican-origin families: Implications for a shifting and complex immigration climate.

OBJECTIVES: Latinx immigrant families may face stressful experiences premigration, en route to the host country, and once they arrive in the host country (postmigration). The present study examines the impact of premigration stress and postmigration stress (together defined as immigrant-related stress) on the mental health of Mexican-origin parents and their children using both cross-sectional and longitudinal methodology. METHOD: Data collection across four timepoints occurred from 2013 to 2018. At Time 1, 104 families were enrolled in the study and met the following criteria: (1) At least one Mexican-origin immigrant parent; (2) One child between the ages of 6-10 years; and (3) Family income at or below 150% of the federal poverty line. RESULTS: Hierarchical multiple regression and hierarchical linear modeling (HLM) were used to analyze the cross-sectional and longitudinal data, respectively. HLM models revealed that higher postmigration stress over time (2013-2018) was related to higher mental health problems among parents and children. Higher premigration stress was associated with higher parent-reported child mental health problems, while postmigration stress was associated with higher parent mental health problems. Specifically, discrimination emerged as a salient factor of poor parent mental health. Immigrant-related stress was related to higher total parent and child mental health problems. CONCLUSION: This study demonstrates the strong impact of postmigration stress on mental health over the span of several years and during a time of heightened stress for many Mexican immigrant communities. The results inform the need for family-wide interventions that address the complexities of immigrant-related stress as well as comprehensive policy changes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

'Humility, Concern, Respect': A Qualitative Study Exploring Parent Perspectives on a Pediatrician's Role in Addressing Racism.

OBJECTIVE: To explore racially minoritized families' perceptions on how, and if, physicians should address children's racial identity and concepts of racism within clinical settings. STUDY DESIGN: Parents of racially minoritized children, ages 5 through 18, were interviewed to explore experiences with racial identity formation, discrimination, and the extent to which they wanted pediatricians to address these topics. Children were included at the discretion of their parents. Interviews were transcribed, coded, and analyzed through a critical race theory lens based in constructivist grounded theory. RESULTS: Parents encouraged their children to embrace their racial identities but also wanted to shield them from negative experiences of racism to preserve identity safety. Parents felt pediatricians should address racial issues in a manner specific to their child's situation. Thoughtful inclusion of race-related questions, whether in discussion or on questionnaires, is essential to prevent tension in a therapeutic relationship. There was no consensus on the use of preclinical screening. Instead, families highlighted the importance of embracing humility, trust, and respect. CONCLUSIONS: Participant families have preferences for approaches to address the effects of racism on their children's health. Pediatricians should understand the importance of identity safety and approach their discussions with cultural humility, which includes self-reflection, empathy, active listening, and flexible negotiation. Above all, pediatricians need to create a safe environment for appropriate discussion of these issues.

Mental health of parents of children and adolescents who require special health care.

OBJECTIVE: To identify the manifestations presented by parents of children and adolescents who require special health attention that can impact their mental health. METHODS: exploratory, qualitative research, based on the concept of vulnerability, with data collection carried out through interviews with 18 parents of children and adolescents with special health care needs, hospitalized in the pediatric ward of a hospital in Paraná, between May/2017 and May/ 2018. Data analyzed by inductive thematic analysis. RESULTS: parents experienced situations of vulnerability when providing care at home, with repercussions on their mental health, expressed by manifestations of lack of protection, anxiety and depression. FINAL CONSIDERATIONS: It is important that health professionals seek to expand actions to promote care and reduce situations that generate threats, insecurities, concerns and damage to the health of parents, which can impact and further weaken care for children and adolescents who need attention especially health.

Cross-cultural adaptation and validation of Work Productivity and Activity Impairment questionnaires for caregivers of patients with pediatric inflammatory bowel disease in Spain. A multicenter study. / Adaptación transcultural y validación de cuestionarios WPAI (Work Productivity and Activity Impairment) para cuidadores de pacientes con enfermedad inflamatoria intestinal pediátrica en España. Estudio multicéntrico.

Introduction. The WPAI-UC/CD-Caregiver questionnaires assess the impact of ulcerative colitis (UC) or Crohn's disease (CD) on parents'/caregivers' work life and daily activities. Our objective was to adapt and validate these questionnaires in the Spanish population. Methods. A translation and back-translation were done. The document was assessed by an expert committee and a pilot group of families of patients with pediatric inflammatory bowel disease (p-IBD). For validation, the parents/caregivers of patients with p-IBD (10-18 years old) were recruited. The expert committee and the pilot group conducted a subjective assessment of the format and time necessary to complete the questionnaires. Cronbach's alpha coefficient was estimated and a factor analysis with varimax rotation was done. Kaiser- Meyer-Olkin (KMO) coefficients and Bartlett's sphericity test were estimated to test the adequacy of the factor analysis. Results. A total of 370 patients (median age: 14.1 years) and 263 parents/caregivers of patients with UC or unclassified IBD and 261 parents/caregivers of patients with CD were included. The KMO coefficients (0.6947 and 0.7179) and Bartlett's sphericity test (p < 0.001) confirmed the adequacy of the factor analysis. The 6 items targeted the same domain. The factor model accounted for 99.99% and 94.68% of variance, and Cronbach's alpha coefficients (0.6581 and 0.6968) showed an adequate consistency. The format and the median time of 2 minutes to complete the questionnaires were considered optimal. Conclusions. The versions of the WPAI-Caregiver questionnaires validated in the Spanish population may be used in families whose children have IBD.

Introducción. Los cuestionarios WPAI-UC/CD-Caregiver evalúan la repercusión laboral y en actividades cotidianas de los padres/cuidadores de pacientes con colitis ulcerosa (CU) o enfermedad de Crohn (EC). El objetivo fue adaptar y validar estos cuestionarios en la población española. Métodos. Se realizó la traducción y la retrotraducción. El documento fue evaluado por un comité de expertos y por un grupo piloto de familias de pacientes con enfermedad inflamatoria intestinal pediátrica (EII-p). Para la validación, se reclutaron padres/cuidadores de pacientes con EII-p (10-18 años). El comité de expertos y el grupo piloto evaluaron subjetivamente el formato y el tiempo necesario para completar los cuestionarios. Se calculó el coeficiente alfa de Cronbach y se realizó el análisis factorial con rotación Varimax. Se calcularon los coeficientes de Kaiser-Meyer-Olkin (KMO) y la prueba de esfericidad de Bartlett para comprobar la adecuación del análisis factorial. Resultados. Se incluyeron 370 pacientes (mediana 14,1 años), y 263 padres/cuidadores de pacientes con colitis ulcerosa o EII no clasificada y 261 padres/cuidadores de pacientes con enfermedad de Crohn. Los coeficientes KMO (0,6947 y 0,7179) y la prueba de esfericidad de Barttlet (p <0,001) confirmaron la adecuación del análisis factorial. Los 6 ítems se dirigieron a la misma dimensión. El modelo factorial explicó el 99,99 % y el 94,68 % de la varianza, y los alfa de Cronbach (0,6581 y 0,6968) indicaron buena consistencia. El formato y la mediana de 2 minutos para completarlos se consideraron óptimos. Conclusiones. Las versiones validadas en la población española de los cuestionarios WPAI-Caregiver pueden considerarse para su uso en familias con hijos con EII.

Is religious affiliation associated with parent disciplinary behavior in Suriname and Guyana.

BACKGROUND: Although limited, there is some evidence that certain physical punishments may vary by household religion. OBJECTIVE: This study aimed to determine whether parent disciplinary behavior varies by religious affiliation in two countries which have large, diverse religious groups. PARTICIPANTS AND SETTING: Data from Multiple Indicator Cluster Surveys for Suriname (2018) and Guyana (2019-20), which contain nationally representative household samples, were used. The study was restricted to the three most prevalent religious groups: Christians, Hindus, and Muslims. METHODS: Adult responses to a standardized survey that included questions about use of disciplinary behaviors in the household towards children (aged 1-14 years) were examined in relation to religious affiliation of the head-of-household and multiple covariates. RESULTS: Of the 3518 Suriname households, 62.4 %, 23.3 % and 14.3 % were Christians, Hindus, and Muslims, respectively. Compared to Christians, children in both Hindu and Muslim households had significantly lower odds of being hit with an object in adjusted logistic regression models. However, only Hindus had lower odds of being spanked and Muslims lower odds of exposure to a combined physical and non-physical practice, compared to Christians. Of the 2535 Guyana households, 69.5 %, 23.5 % and 7.0 % were Christians, Hindus, and Muslims, respectively. Children in Hindu, but not Muslim households, had significantly lower odds of being spanked, hit with an object, and exposed to a combine practice in adjusted models compared to Christians. CONCLUSIONS: Partial support was found for a potential influence of religion on some disciplinary behaviors. Further investigation is warranted to identify possible conditions and mechanisms.

Parent-Guided Developmental Intervention for Infants With Very Low Birth Weight: A Randomized Clinical Trial.

Importance: Early interventions improve neurodevelopmental outcomes after preterm birth, but few studies of early intervention have focused on preterm infants whose families reside in low- or middle-income countries (LMICs). Objective: To evaluate whether parent-guided early intervention improves the neurodevelopmental outcomes of preterm infants in an LMIC. Design, Setting, and Participants: This randomized clinical trial was performed at a high-risk obstetric referral hospital in Brazil, with outcome evaluations by examiners masked to randomization group. Eligibility criteria were (1) birth at the study hospital, (2) residence within 40 km of the birth hospital, and (3) gestational age of less than 32 weeks or birth weight of less than 1500 g. Of 138 enrolled infants, 19 died after randomization and 19 withdrew from the study; all other enrollees (50 per randomization group) were evaluated for the primary outcome. Data were collected from January 1, 2016, to May 31, 2022, and analyzed from June 10 to July 31, 2022. Interventions: On postnatal day 7, infants were randomized to usual care, consisting of support for lactation, kangaroo care, and routine developmental therapies, or to a parent-guided enhanced developmental intervention, consisting of usual care plus infant massage and enhanced visual stimulation, auditory stimulation, social interactions, and support for motor development, instructed by developmental therapists. Main Outcomes and Measures: The primary outcome was the Bayley Scales of Infant and Toddler Development-Third Edition score at 18 months of age adjusted for prematurity. Results: Among the 100 infants included in the analysis, mean (SD) gestational age was 28.4 (2.2) weeks, and 57 (57%) were male. The mean (SD) gestational age for the intervention group was 28.3 (2.3) weeks; for the usual care group, 28.5 (2.2) weeks. Female infants accounted for 21 infants (42%) of the intervention group and 22 (44%) of the usual care group; male infants, 29 (58%) and 28 (56%), respectively. The enhanced developmental intervention group had higher cognitive scores at 18 months of corrected age (mean [SD], 101.8 [11.9] vs 97.3 [13.5]; mean difference, 4.5 [95% CI, 0.1-8.9]). Conclusions and Relevance: In this randomized clinical trial of a parent-guided developmental intervention for early cognitive function of very preterm or very low birth weight infants implemented in an LMIC, the intervention improved very preterm infants' neurodevelopmental outcomes at 18 months of adjusted age. Parent-guided early intervention can improve neurodevelopmental outcome of very preterm infants born in LMICs. Trial Registration: ClinicalTrials.gov Identifier: NCT02835612.

Parent-provider communication dynamics during the pediatric oncology diagnostic process in Guatemala: A qualitative study.

BACKGROUND: Effective communication is founded on bidirectional participation from families and healthcare providers. In adult medicine, bidirectional communication promotes treatment adherence and builds the family-provider relationship. However, the relationship between communication styles in pediatrics remains poorly understood, particularly in culturally diverse settings. This study aims to investigate parent-provider communication dynamics and parental involvement during diagnostic cancer communication in Guatemala. PROCEDURE: This qualitative study included 20 families of children with cancer and 10 providers at Unidad Nacional de Oncología Pediátrica in Guatemala. Psychoeducation and diagnostic conversations between parents, psychologists, and oncologists were recorded and thematically analyzed using a priori and novel codes exploring communication behaviors, parental engagement, and interpersonal dynamics. RESULTS: Participating parents had children with various diagnoses. Only 15% of fathers and 5% of mothers reported education beyond primary school. Providers spoke 68% of words during psychoeducation and 85% of words during diagnosis conversations. Providers used supportive communication behaviors providing explanations, demonstrating verbal attentiveness, and soliciting questions and non-supportive behaviors including paternalistic talk. Parental participation was considered active when they asked questions, expressed hopes or concerns, or asserted their opinions, and non-active when participation was limited to brief responses to closed-ended questions. Supportive provider communication often encouraged active participation; non-supportive communication did not. Furthermore, active parental participation prompted supportive communication from providers, while non-active participation did not. CONCLUSIONS: Our findings highlight the bidirectional nature of effective communication, establishing that provider communication styles both influence and are influenced by parental participation, and emphasizing the importance of supportive provider communication for patient-centered care.