Caregivers Research Articles

Effects of a nurse-led motor function rehabilitation training program for patients with ischemic stroke and family caregivers: study protocol for a randomized controlled trial

BackgroundBoth individuals and society bear a considerable burden from ischemic stroke (IS), not only do patients continue suffering from motor dysfunction after discharge from hospital, but their caregivers also undertake the principal responsibility of assisting them in reintegrating into the family and society. To better improve the IS patients’ limb function and daily life activities, their caregivers should also be involved in the training of the motor function rehabilitation during the period transitioning from hospital back home. This study mainly aims to investigate the effects of a nurse-led training for IS patients and their family caregivers on the improvement of the patients’ physical function and the burden of caregivers.Methods/designA randomized controlled trial with blind assessment will be conducted in hospitals and during the follow-ups at home. Fifty-eight pairs of adults diagnosed with ischemic stroke and their primary caregivers will be included. Participants will be randomly given with (1) a nurse-led, home-based motor rehabilitation training participated by caregivers (intervention group) or (2) routine self-care (control group). Both groups will receive assessment and health guidance on the day of discharge, and the intervention group will receive an additional home-based training program and supervision. These two groups will be followed up every week after discharge. The primary results are drawn from the evaluation of physical function and caregiver-related burden, and the secondary results derived from statistics of the modified Barthel index, stroke-specific quality of life, and National Institutes of Health Stroke Scale. Differences between the two groups will be measured by two-way repeated measures ANOVA, considering the data at baseline and at 1-week and 4-week follow-up after training.DiscussionResults may provide novel and valuable information on the effects of this culturally appropriate, caregiver-involved, and home-based rehabilitation training on the physical function of IS patients and caregiver-related burden.Trial registrationChinese Clinical Trial Registry (chictr.org.cn) ChiCTR2300078798. Registered on December 19, 2023.

Digital Parenting Program: Enhancing Parenting and Reducing Child Behavior Problems.

Digital parenting programs using smartphone apps can support families in positive parenting and require evaluations of their effects, mainly in low- and middle-income countries with caregivers experiencing psychosocial vulnerabilities. The study evaluated the "Born Learning" digital parenting program on improving parenting practices, child prosocial behavior, and reducing the children's externalizing behavior problems. Additionally, participants' satisfaction and engagement with the program were evaluated. Brazilian primary caregivers of 3- to 6-year-old children totaling 91, participated in the "Born Learning" program and pre-, post-intervention, and five-month follow-up evaluations. Most participants received cash transfers (64%) and reported some level of food insecurity (78%). The parenting coercive practices decreased from pre- to post-intervention, with maintenance in follow-up. Satisfaction with the role of parenting increased, and child conduct behavior problems decreased from pre-intervention to follow-up. Most participants found the program content very interesting and engaged adequately with the program strategies, such as messages and videos. The digital parenting program can support caregivers by enhancing parenting and decreasing child behavior problems, highlighting the potential for broader implementation in similar contexts.

Physical, emotional, and financial burdens of toileting assistance for family caregivers in home care settings and factors associated with each burden: A cross-sectional study.

Caregivers in home care settings may experience significant physical, emotional, and financial burdens in providing toileting assistance. However, few studies have evaluated these three aspects of caregiver burden. Therefore, this study aimed to clarify the physical, emotional, and financial burdens of toileting assistance and examine the factors associated with each burden. A self-administered postal questionnaire was distributed to 405 family caregivers of older adults receiving home care and subsidies for incontinence products in Japan in 2019. Family caregivers answered questions about toileting assistance, the perceived physical, emotional, and financial burdens of providing toileting assistance at home, and the urinary/fecal symptoms of older adults. Of the 242 family caregivers who reported each burden, 213 (88%) had experienced at least one physical, emotional, or financial burden. The prevalence of physical, emotional, and financial burdens was 77.3%, 78.1%, and 70.7%, respectively. Approximately 60% of respondents reported experiencing all three burdens. Physical burden was associated with spouses acting as primary caregivers, nocturia, fecal incontinence, and the odor of urine/feces from toileting assistance. Emotional burden was associated with nighttime assistance, urinary/fecal leakage from absorbent incontinence products, and the odor of urine/feces. Financial burden was associated with frequent assistance, disposal costs of absorbent incontinence products, and the degree of toileting assistance. The results revealed a high prevalence of the three burdens of toileting assistance among family caregivers, suggesting the need to assess these burdens. Furthermore, they suggested the importance of providing guidance to family members, which may help reduce these burdens.

Patterns of adverse childhood experiences and community environments

This study examined patterns of adverse childhood experience and its association with community environments. Using the 2020 National Survey of Children’s Health (NSCH) data, 30,056 children who are 6–17 years of age were our samples for the investigation. Among them, 14,026 children with at least one Adverse Childhood Experience (ACE) were profiled through latent cluster analysis. We found four classes of ACEs: separation/divorce, multiple low-risk, multiple high-risk, and alcohol/drug problem. Moreover, controlling for socio-demographic variables (i.e., race/ethnicity, the highest education level of primary caregiver in a household), we found significant differences in the quality of supportive neighborhoods and the number of positive and adverse community amenities across children categorized into four classes of ACEs and no ACE class (i.e., children without ACEs, n = 16,030). Implications for research on ACEs and their association with the community environment are discussed.

Sensory symptoms associated with autistic traits and anxiety levels in children aged 6–11 years

BackgroundAutism spectrum conditions (ASC) and quantitative autistic traits (QATs) are associated with sensory symptoms, which may contribute to anxiety and adversely affect social and cognitive development. Although sensory symptoms can occur across all senses, the relative roles of specific sensory modalities as contributors to the autistic phenotype and to anxiety are not well understood. The objective of this study was to examine which sensory symptoms were most predictive of high anxiety.MethodsWe recruited 257 female primary caregivers of children aged 6 to 11 years (49% girls) to a questionnaire study comprising parent-report measures for classical QATs (social, communicative, and rigid), autism-related sensorimotor symptoms (visual, auditory, tactile, olfactory, gustatory, vestibular, proprioceptive, and motor), and anxiety symptoms. First, Bayesian stochastic search variable selection (SSVS) was used to identify the most probable sensorimotor predictors of specific QATs as well as diagnosed ASC. Then, the selected predictors were used in another SSVS, using anxiety symptoms as a dependent variable, to identify which of the autism-relevant sensorimotor symptoms were most robustly predictive of anxiety. Finally, the effect sizes of anxiety-related sensory symptoms were estimated with linear regressions.ResultsWe found that auditory symptoms and motor difficulties were most predictive of ASC diagnosis. Developmental motor difficulties were also strongly related to all individual QATs, whereas auditory symptoms were more selectively predictive of rigid traits. Tactile symptoms robustly predicted social interaction QATs, and proprioceptive symptoms predicted communicative QATs. Anxiety outcomes were most strongly predicted by difficulties with auditory and olfactory processing.ConclusionsThe results support the clinical importance of being alert to complaints about sounds and hearing in neurodevelopmental populations, and that auditory processing difficulties may be evaluated as an early marker of poor mental health in children with and without diagnosed autism. Olfactory processing differences appeared to be an anxiety marker less strongly associated with ASC or QATs, while motor difficulties were highly autism-relevant but not equally strongly associated with anxiety outcomes. We suggest that future studies may focus on the mechanisms and consequences of neurodevelopmental central auditory processing dysfunction and its potential relationship to anxiety disorders.

Understanding Parental Adherence to Early Childhood Domestic Injury Prevention: A Cross-Cultural Test of the Integrated Behavior-Change Model.

Unintentional injuries pose a significant risk to children in early years globally. In particular, toddlers and preschoolers are vulnerable to injuries that occur at home. Despite the availability of preventive measures that can greatly reduce the risks of domestic injuries, some caregivers (e.g., parents) of children in early childhood may not fully implement these safety measures due to poor behavioral adherence or low awareness of the risk of domestic injury. Therefore, it is crucial to understand how caregivers in different cultural contexts approach injury prevention in the home environment. In this multi-cultural study, we investigated the motivational and belief processes underlying childhood domestic injury prevention among a total of 2059 primary caregivers (parents/guardians) of infant and toddlers (aged 2 to 6 years) across four societies, Australia (AU; N = 500), the United States (US; N = 500), Singapore (SG; N = 507), and Hong Kong (HK; N = 552), by applying the integrated model of self-determination theory (SDT) and theory of planned behavior (TPB). Our results support the key tenets of the integrated model and demonstrated cultural invariance model pathways across the four societies studied. In particular, the positive relationships among psychological need support, autonomous motivation, socio-cognitive beliefs, intention, and behavior adherence remained constant across societies. With a multi-cultural sample, this study provides valuable insights into the similarities and differences in motivation and beliefs surrounding childhood domestic injury prevention across these four societies.

Predictors of health-related quality of life (HRQoL) for caregivers of children with developmental disabilities in Saudi Arabia: An observational study.

To examine predictors of health-related quality of life (HRQoL) for caregivers of children with developmental disabilities, a cross-sectional design was used. Participants were primary caregivers of children with developmental disabilities. Caregivers completed a demographic form about the child and the family, and the Arabic version of Patient-Reported Outcomes Measurement Information System-Profile 29 (PROMIS-29 v2.0). Descriptive statistics were used to report on demographic data, 1-sample Z tests to compare PROMIS domain scores with the general population, and multiple linear regression analyses to identify predictors of each domain. Participants were 111 primary caregivers, mostly mothers (65.8%). Caregivers reported higher levels of anxiety, depression, fatigue, sleep disturbance, and pain interference, and lower levels of physical function and social participation compared to the general population, P < .05. The regression models for predicting the HRQoL accounted for 12.3% of the variance in the physical function domain (P = .016), 13.9% in the anxiety domain (P = .009), 24.7% in the ability to engage in social activities and roles (P < .001), and 11.4% in the pain interference domain (P = .02). In these models, the severity of the child's disability and/or the child's age were common significant predictors. Specifically, child's age was the only significant predictor in 2 domains, the anxiety domain (β = -.29, P < .01) and ability to participate in social activities and roles domain (β = .42, P < .05). The severity of the child's disability was the only significant predictor in the physical function domain (β = -.52, P < .01). Both the severity of the child's disability and the child's age were significant predictors in the pain interference model (β = .40, P < .05), and (β = -.23, P < .05), respectively. However, the models did not significantly predict depression, fatigue, or sleep disturbance, P > .05. HRQoL is a complex construct and is influenced by multiple child and family factors. Implications of the study emphasize the importance of regular HRQoL screening for caregivers, the development of efficient referral systems for support services, and the exploration of respite care options.

Strong cultural connectedness buffers urban American Indian children from the negative effects of stress on mental health.

We explored whether urban American Indian (AI) caregivers who maintained a strong sense of cultural connectedness buffered their children from the negative effects of stress on mental health. A community sample of 161 urban AI children (91 girls) ages 8-15 years (M = 11.20 years) and their primary caregivers participated between 2016 and 2017. Caregiver cultural connectedness moderated associations among child stressful life events and increased anger (R2 = .13) and post-traumatic stress disorder (PTSD) symptoms (R2 = .15). For caregivers with greater cultural connectedness, associations were attenuated and not significant. Higher hair cortisol was related to increased depressive (R2 = .11), anxiety (R2 = .10), and PTSD (R2 = .15) symptoms and was not moderated by cultural connectedness.

Laboratory-based measures of executive function and daily living skills in young children with Down syndrome: informing future interventions.

Adaptive behaviour refers to the practical skills necessary for independence and is considered a high-priority intervention target for children with neurogenetic conditions associated with intellectual disability, like Down syndrome (DS). Daily living skills (DLS) are a critical aspect of adaptive behaviour, but they have received little intervention attention, possibly because they involve a wide variety of skills across many settings. The present study aimed to advance DLS intervention science by examining the concurrent and longitudinal association between DLS performances and a cognitive skillset hypothesised to support DLS skill acquisition, executive function (EF). Participants were 71 children with DS between the ages of 2.5 and 8.7years (M=5.23years; standard deviation=1.65) who completed a battery of adapted EF tasks and a primary caregiver who completed the Vineland Adaptive Behavior Scales 3rd Edition Parent/Caregiver Comprehensive Report Form. A subset of caregivers also provided 6- and 12-month follow-up adaptive behaviour information. Results demonstrated a positive association between EF task performance and DLS standard scores and v-scores both concurrently and longitudinally. The findings have implications for potential future intervention approaches that aim to strengthen DLS performances by advancing EF skills in this population.

Living With Cancer: Child-Parent Dyads' Perspectives and Experiences From a Private Tertiary Care Hospital in Pakistan.

The life experiences of children with cancer and their parents as individuals have been well documented in literature. However, little is known about their experiences as child-parent dyads in Pakistan regarding these children's quality of life. Thus, the study was conducted in the context of the family-centric society of Pakistan. In-depth interviews were conducted with 28 participants (14 child-parent dyads), comprising 9 female and 5 male children receiving cancer treatment and 8 mothers and 6 fathers (primary caregivers). All the participants were Muslims and hailed from diverse ethnic backgrounds, and most belonged to middle socioeconomic backgrounds. Thematic analysis was performed using Braun and Clarke's (2006) framework, which revealed four themes: (1) Stress, Fears, and Optimism; (2) Reactions to Restrictions; (3) Adaptation and Coping; and (4) Support Structure and Mechanisms. The findings indicated that children's and parents' daily lives were affected in various ways during the children's cancer journey. They faced several challenges which impacted their well-being. Particularly, the children considered their symptoms as restrictions in the way of carrying out their routine lives. However, children and parents also elaborated on using different coping strategies, such as play, reminiscing the past, incorporating religious practices into their daily routines, and keeping a family-centred approach towards the child's care. The parents also recommended that cancer-specialised services and support groups should be accessible. Conclusively, these findings are useful for healthcare providers in giving family-centred care to afflicted families and devising innovative interventions that address the needs of children with cancer and improve their quality of life.

Impact of co-resident health and living alone on risk of hospital admission for people with Parkinson’s disease

BackgroundPeople with Parkinson's Disease (PwP) have a higher rate of hospitalisation compared to the general population. Little is known about the impact of having a co-resident and their health on hospitalisation rates of PwP. MethodsWe utilised Clinical Practice Research Datalink (CPRD) GOLD data (2010–2015) to identify PwP and co-residents. We classed either the fittest or youngest adult as the primary caregiver in each household. Caregiver health was classified by the Cambridge Multimorbidity Score (CMS), primary care utilisation and prescriptions. We calculated the hospitalisation (elective, emergency) incidence rate ratios (IRRs) for PwP who lived alone compared to those with a caregiver using negative binomial regression, and whether worse caregiver health predicted higher risk of admissions. ResultsWe identified 3254 PwP and 4007 family members. PwP who lived alone were less likely to have an elective admission (0.79; 95 % CI 0.69–0.91) and more likely to have an emergency admission (1.40; 95 % CI 1.70-1.54). Worse caregiver health, as measured by the CMS, was associated with an increased risk of emergency admission (IRR 1.35; 95 % CI 1.17–1.57), but this attenuated and was consistent with chance in the fully adjusted model (1.04; 95 % CI 0.95–1.13). No strong associations were seen between caregiver health and elective admissions. ConclusionPwP who live alone are at increased risk of emergency and less likely to have elective hospital admissions. It is important that health care providers support such people and ensure they receive equitable access to the potential benefits of elective procedures.

A Survey on End-of-Life Contemplation Among Patients on Dialysis

Considering that mortality among patients on dialysis is high, it would be advisable for patients, relatives, and care givers to acknowledge that after dialysis initiation for many patients, the last phase in life has begun. We sought to investigate the frequency of precautionary planning directives, contemplation about the end-of-life (EOL) and embedding of patients' wishes in the interaction with relatives and the treating nephrologists. In a questionnaire-based interview survey, we investigated the frequency of precautionary planning, EOL wishes, and frequency of relatives' or medical professionals' conversations with patients about those wishes as well as possibly associated demographic, socioeconomic and medical factors. The interviews were conducted by a single investigator in 7 dialysis centers in Germany. From 349 identified patients, 268 (77%) participated. The participants (36% female) had a median age of 70 (interquartile range [IQR]: 58-80) years and had spent a median of 3 (IQR: 1-7.5) years on dialysis. Overall, 46% of patients on dialysis contemplated their EOL wishes at least occasionally. Of those, 85% talked about EOL wishes with their relatives, whereas 19% discussed them with their nephrologists, yet another 28% would like to have such a discussion with their nephrologist. Almost half of patients on dialysis contemplate their EOL and the vast majority engage in discussions about that with their relatives. Despite patients being interested, the frequency of consultation of nephrologists on EOL care is low. This study suggests that there is a substantial but unmet need for EOL care consultation for patients on dialysis.

Health and oral health literacy: A comprehensive literature review from theory to practice.

Health literacy (HL) refers to an individual's ability to access, understand, and apply health information to make informed decisions about their health. On the contrary, oral health literacy (OHL) focuses on an individual's ability to understand and utilize oral health information to maintain good oral health. This study presents a comprehensive literature review that explores the theoretical foundations and practical applications of HL and OHL. A comprehensive search was conducted using keywords on the following databases: PubMed, Google Scholar, and Cochrane Database of Systematic Reviews. The existing literature on various aspects of HL, including the most common used definitions of HL, conceptual frameworks, and consequences of limited health and OHL, was summarized. Additionally, the review discussed the significance of HL and OHL. Also, the relation between parent level of OHL and children's oral health was described. It further highlights modern approaches that have been shown in previous studies to improve the OHL of primary caregivers. Understanding the significance of HL and OHL is crucial in developing effective interventions that can address disparities and improve oral health outcomes for individuals of all backgrounds.

Characteristics of Informal Caregivers and Social Participation of People With Dementia.

Social participation is associated with increased quality of life and well-being but declines following the onset of dementia. Informal caregivers may facilitate social participation among people with dementia. This study aims to identify characteristics of informal caregivers associated with social participation of people with dementia in valued activities. This cross-sectional study used data from the 2011, 2015, and 2017 National Health and Aging Trends Study (NHATS) and the National Study of Caregiving. NHATS respondents with possible or probable dementia and an informalcaregiver were included (N = 1,060). Respondents were asked whether they participated in each of 5 social activities during the past month. Valued activities were considered somewhat or very important. Survey-weighted logistic regression models were computed to identify characteristics of primary informal caregivers associated with participation of people with dementia in social activities. Social participation of people with dementia was not independently associated with sociodemographic variables or relationship to the primary caregiver (spouse/partner, adult child, or other relative/nonrelative). Social participation of primary caregivers was associated with increased participation of people with dementia in the same activity for visiting friends/family (odds ratio [OR] = 1.88, p = .016), attending religious services (OR = 4.82, p < .001), and volunteering (OR = 3.25, p = .015), whereas greater caregiver external support was associated with increased participation of people with dementia in organized activities (OR = 1.37, p = .022). Assets of informal primary caregivers found to promote social participation of people with dementia include traveling to the person with dementia's home, being socially active themselves, and utilizing support services.

Demographic characteristics, diagnostic challenges, treatment patterns, and caregiver burden of mitochondrial diseases: a retrospective cross-sectional study

BackgroundThis study aimed to explore the demographic characteristics, diagnostic challenges, treatment patterns, and caregiver burden of mitochondrial diseases.MethodsThis retrospective cross-sectional study enrolled patients diagnosed with mitochondrial diseases from the Department of Neurology at Peking University First Hospital between January 2010 and December 2021. A questionnaire covering demographic characteristics, diagnostic dilemma, treatment, economic aspects, and caregiver stress was administered, and disability was assessed using the modified Rankin Scale (mRS).ResultsA total of 183 patients (mean age: 16 (IQR: 12–25), 49.72% males) were enrolled, including 124 pediatric patients and 59 adult patients. MELAS (106. 57.92%) and Leigh syndrome (37, 20.22%) were predominant among the mitochondrial disease subtypes. Among them, 132 (72.13%) patients were initially misdiagnosed with other diseases, 58 (31.69%) patients visited 2 hospitals before confirmed as mitochondrial disease, and 39 (21.31%) patients visited 3 hospitals before confirmed as mitochondrial disease. Metabolic modifiers were the most common type of drugs used, including several dietary supplements such as L-carnitine (117, 63.93%), Coenzyme Q10 (102, 55.74%), idebenone (82, 44.81%), and vitamins (99, 54.10%) for proper mitochondrial function. Mothers are the primary caregivers for both children (36.29%) and adults (38.98%). The mRS score ranged from 0 to 5, 92.35% of the patients had different degrees of disability due to mitochondrial disease. The average monthly treatment cost was 3000 RMB for children and 3100 RMB for adults.ConclusionsThis study provided valuable insights into the characteristics and challenges of mitochondrial diseases, which underscores the need for improved awareness, diagnostic efficiency, and comprehensive support for patients and caregivers.

Over Three Decades of Growth Hormone Treatment in Children With Chronic Kidney Disease-Associated Growth Failure Before and After Kidney Transplantation.

Growth retardation and short final height is a common complication of chronic kidney disease (CKD) beginning in childhood, with profound deleterious effects on quality of life, mental health, and social achievement. Despite optimal treatments of causative factors for growth retardation in children with CKD, more than 50% of patients reach end-stage renal failure with a height >2 SD below the mean, and most do not demonstrate "catch-up" growth after receiving a kidney transplant. Four decades ago, recombinant human growth hormone (rhGH) treatment was introduced after studies showed increased growth velocity and improved height SDS in uremic subjects. Since then, an abundance of published data showed significant improvements in health-related quality of life, and most studies revealed no significant adverse effects. Clinical practice guidelines recommended rhGH treatment in CKD Stages 3-5D and after transplantation. Despite these guidelines, this therapy remained underutilized. Most commonly cited barriers to the implementation of rhGH treatment were the need for daily injections, financial challenges, physicians' unfamiliarity with guidelines, and fear of adverse events. rhGH has been shown to improve growth and final height in short children with CKD, with minimal adverse effects. Despite data of its successful use generated over 3 decades, this treatment is underutilized. More judicious utilization of the treatment should emphasize educating patients, their care givers, and members of the multidisciplinary treating team. Additional studies are needed to assess the longer-term rhGH treatment in larger cohorts of patients, leading to additional supportive data and clearer recommendations.

Cardiovascular effects of dog appeasing pheromone in the hospital environment

Recent research has emphasized the health implications of acute or chronic stress in animals. Hospitalized dogs are susceptible to stress due to various factors, including exposure to a novel environment, invasive procedures, and separation from their primary caregiver. The clinical significance of stress in these animals underscores the importance of stress management from the moment of admission. However, there remains a lack of universal qualitative and quantitative indicators of stress in small animals, necessitating reliance on behavioral analysis and stress marker assessment for accurate diagnosis. Among these markers, cardiovascular parameters such as heart rate and systolic blood pressure are commonly used, although their interpretation can be influenced by various factors. The aim of the study was to assess the impact of appeasing pheromone on cardiovascular parameters in hospitalized dogs. Ten healthy dogs were selected for a prospective, paired, randomized, and double-blinded. The dogs were submitted to two experimental protocols: pheromone administration and placebo. The cardiovascular parameters were evaluated at baseline until the end of a 24-hour hospitalization period. The study evaluated ambulatory electrocardiography and systolic non-invasive blood pressure using a doppler. Analysis of cardiovascular parameters revealed no significant difference in systolic blood pressure between groups, despite its elevation in both treatment conditions. In the placebo group, the maximum heart rate of the placebo group at time baseline (T0) was lower compared to subsequent time points (T6, T12, T20), indicative of stress upon arrival in the hospital environment. Conversely, the pheromone group showed a higher mean heart rate at T20 compared to the placebo group. Additionally, the placebo group displayed a higher minimum heart rate at time baseline (T0) compared to later time points (T6, T12, T20, T24). At time T6, a higher minimum heart rate was observed in the pheromone group. Even though fluctuations were observed in mean and minimum heart rates during monitoring, they indicated no clinically relevant deviations. There was no difference in heart rate variability over time between the analyzed substances. Exposure to dog appeasing pheromone through a diffuser presentation, therefore, did not lead to significant changes in cardiovascular parameters related to stress reduction in hospitalized dogs.

Experiences of Exercise-Related Worry Among Chinese Childhood Cancer Survivors and Their Carers: A Qualitative Study.

The low levels of physical activity in childhood cancer survivors have increasingly garnered attention from nursing scholars. Exercise-related worry is a prominent barrier, yet the understanding of such experiences among childhood cancer survivors and their primary caregivers remains scarce. The aim of this study was to further understand the factors contributing to exercise-related worry from the perspective of childhood cancer survivors and their primary caregivers. In this qualitative study, we conducted face-to-face semistructured interviews with childhood cancer survivors (n = 20) and carers (n = 20) in 2 hospitals in China. The interviews were analyzed according to thematic analysis. Two main themes and 8 subthemes emerged: (1) internal factors: changes in the perception of physical activity (threat perception from the disease, active avoidance of stressful events, lack of safety due to past experiences), and (2) external factors: weak support system (limited peer support, family strength, feeling abandoned by the tumor team, reintegration into school, external environmental constraints). In summary, exercise-related worry is from internal factors and can be influenced by external factors. There are various factors contributing to the concerns of exercise in childhood cancer survivors, which may be a key factor for their significantly lower levels of physical activity compared to guideline recommendations. The findings of this study call for healthcare professionals to provide additional assistance for childhood cancer survivors with exercise-related worry and establish personalized mechanisms for supporting physical activity in pediatric cancer survivors within the Chinese healthcare system.

Impact of a Brief Parenting Intervention on Parent and Infant Imitation

Research examining the effect of behavioral parenting interventions, such as parent–child interaction therapy (PCIT), on parent and child imitation is limited despite known benefits to early child development. We examined the effect of a brief, home-based adaptation of PCIT, the Infant Behavior Program (IBP), on changes in observed frequency of parent and infant imitation, moderating effects of parent language (English, Spanish), and mediational effects of parent and infant imitation on the effect of intervention on infant behavior problems. Participants were 60 12- to 15-month-olds with elevated behavior problems and their primary caregiver, all of which were mothers. Parent–infant dyads were randomly assigned to receive either the IBP or standard pediatric primary care. Parents receiving the IBP demonstrated significantly higher rates of observed imitation at postintervention and at the 3-month follow-up compared to those receiving standard care, and the effect at postintervention was stronger for English-speaking than for Spanish-speaking families. Although the IBP did not directly affect changes in infant imitation at postintervention or the 3-month follow-up, rates of infant imitation increased significantly for those who received the IBP at the 6-month follow-up. Additionally, moderation results suggested that the IBP led to improvements in infant imitation at post for Spanish-speaking families but not for English-speaking families. There were no significant mediational effects of parent or infant imitation. Future research is needed to examine the impact of increases in imitation on other aspects of child development, such as social–cognitive and language abilities, and to examine how cultural factors may play a role in individual differences in imitation.

Depressive Symptoms Among Caregivers of Older Adults With Both Diabetes and Functional Limitations and Moderation by Caregiver Expressive Social Support.

The purpose of the study was to explore how caring for older adults with both diabetes and functional limitations impacts caregiver depressive symptoms and whether this impact is moderated by caregivers' expressive social support and psychological resilience. Cross-sectional data of 278 dyads, each comprising an older adult with functional limitations and his/her primary family caregiver were analyzed. Older adult diabetes status (yes/no) was based on ever-diagnosis of diabetes. Caregiver depressive symptoms, expressive social support, and psychological resilience were measured using standard scales. Multivariable linear regression was used to assess the association of interest and its moderation by caregiver expressive social support and psychological resilience. Caregivers of older adults with both diabetes and functional limitations had a higher depressive symptoms score compared to caregivers of older adults with only functional limitations. This association was inversely moderated by caregiver expressive social support. As caregiver expressive social support increased, the difference in depressive symptoms between caregivers of older adults with diabetes and functional limitations and caregivers of older adults with only functional limitations reduced. Family caregivers of older adults with functional limitations and diabetes have a higher depressive symptoms score. However, enhancing caregiver expressive social support could mitigate this risk. Service providers should prioritize support for caregivers in such vulnerable situations and strive to enhance their expressive social support.