Caregiver Supervision Research Articles

Slovenian policies and initiatives addressing noise and acoustics issues in kindergartens and schools

The focus of this paper is on Slovenian policies and initiatives addressing acoustics and noise issues in kindergartens and schools. Despite crucial legislation for noise protection in buildings, technical guidelines are inconsistently followed, resulting in reverberation issues in various educational premises. Surveys gathered teachers' opinions on noise disturbance in three categories: kindergartens, primary schools, and a broader survey on dietary guidelines, which included questions on noise in dining areas. Preliminary findings reveal that primary schools, more than kindergartens, view noise as a significant concern, particularly acoustics over external sources. A National Institute of Public Health study, covering 653 education institutions, found that 107 primary schools considered noise disturbing. Poor acoustics was identified as the primary cause of disturbance in 171 of all institutions. Additional reasons included loud children, overcrowded places, and insufficient caregiver supervision. Information from a specialized noise and acoustics company highlighted nearly 180 interventions in Slovenian educational institutions over 15 years, primarily in primary schools (104), followed by kindergartens (11), and music schools (26). The widespread need for improvements underscores the importance of awareness and recommendations for schools, kindergartens, and municipalities to enhance the educational sound environment. This work was partly supported by the EU H2020 Equal-Life project.

Factors Related to Rehabilitation Adherence in Pediatric Cancer: A Systematic Review

Background: Rehabilitation is crucial for improving the functional outcomes of children and adolescents with cancer. An understanding of factors related to rehabilitation adherence is needed to improve intervention design and effectiveness, and decrease healthcare costs. Therefore, this systematic review aims to identify factors related to pediatric cancer rehabilitation adherence. Methods: Based upon the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a search of MEDLINE and CINAHL was completed in January 2023, including terms of pediatrics, cancer, rehabilitation, and adherence. Study eligibility included: (1) published after 2011, (2) English language, (3) a physical therapy, occupational therapy, speech-language pathology, cognitive or exercise intervention or service, (4) mean age ≤18 years old, within 5 years of a cancer diagnosis, and (5) measurement and reporting of adherence factors. Study quality was evaluated using the Joanna Briggs Critical Appraisal Tools. Results: The review included 13 studies providing interventions to 318 children. Most of the interventions were related to exercise. Adherence levels of supervised sessions ranged from 61% to 91%. Unsupervised intervention adherence was not a common outcome, but the reported measurements ranged widely (<1-72%). The classification of factors associated with adherence included organizational, treatment, and personal factors. Common barriers to adherence were fatigue, illness, time and motivation. Facilitators of adherence included peer or caregiver support and supervision. Conclusion: Additional research is needed to investigate the factors related to rehabilitation intervention adherence, especially factors beyond exercise and those associated with unsupervised interventions. Standardized measures are crucial to ensure the reliability and comparability of findings.

Dimensions of Early-Life Adversity Are Differentially Associated With Patterns of Delayed and Accelerated Brain Maturation

BackgroundDifferent types of early-life adversity (ELA) have been associated with children’s brain structure and function. However, understanding the disparate influence of distinct adversity exposures on the developing brain remains a major challenge. MethodsThis study investigates the neural correlates of 10 robust dimensions of ELA identified through exploratory factor analysis in a large community sample of youth from the Adolescent Brain Cognitive Development Study. Brain age models were trained, validated, and tested separately on T1-weighted (n = 9524), diffusion tensor (n = 8834), and resting-state functional (n = 8233) magnetic resonance imaging data from two time points (mean age = 10.7 years, SD = 1.2, age range = 8.9–13.8 years). ResultsBayesian multilevel modeling supported distinct associations between different types of ELA exposures and younger- and older-looking brains. Dimensions generally related to emotional neglect, such as lack of primary and secondary caregiver support and lack of caregiver supervision, were associated with lower brain age gaps, i.e., younger-looking brains. In contrast, dimensions generally related to caregiver psychopathology, trauma exposure, family aggression, substance use and separation from biological parent, and socioeconomic disadvantage and neighborhood safety were associated with higher brain age gaps, i.e., older-looking brains. ConclusionsThe findings suggest that dimensions of ELA are differentially associated with distinct neurodevelopmental patterns, indicative of dimension-specific delayed and accelerated brain maturation.

Risk rates and profiles at intake in child and adolescent mental health services: A cohort and latent class analyses of 21,688 young people in South London.

Children and young people (CYP) seen by child and adolescent mental health services (CAMHS) often experience safeguarding issues. Yet little is known about the volume and nature of these risks, including how different adversities or risks relate to one another. This exploratory study aims to bridge this gap, examining rates at entry to services and profiles of risk using a latent class analysis. Data were extracted for CYP who received at least one risk assessment at CAMHs in South London between January 2007 and December 2017. In total, there were 21,688 risk assessments. Latent class analysis was used to identify profiles of risk from the risk assessments. Concerns about parent mental health (n=5274; 24%), emotional abuse (n=4487; 21%), violence towards others (n=4210; 19%), destructive behaviour (n=4005; 18%), and not attending school (n=3762; 17%) were the most commonly identified risks. Six distinct profiles of risk were identified from the latent class analyses: (1) maltreatment and externalising behaviours, (2) maltreatment but low risk to self and others, (3) antisocial behaviour, (4) inadequate caregiver supervision and risk to self and others, (5) risk to self but not others, and (6) mental health needs but low risk. These findings provide fresh insights into adverse experiences and risks identified by CAMHS. For professionals, the profiles identified in this study might provide insights into profiles of identified risks, in contrast to traditional cumulative approaches to risk. For researchers, these profiles may be fertile ground for hypothesis-driven work on the association between adversity and later outcomes.

Protective factors for adolescent sexual risk behaviours and experiences linked to HIV infection in South Africa: a three-wave longitudinal analysis of caregiving, education, food security, and social protection

BackgroundStructural interventions are endorsed to enhance biomedical and behavioural HIV prevention programmes for adolescents. Aiming to inform future interventions, we evaluated longitudinal associations between six protective factors that link closely to existing structural HIV prevention interventions, and five sexual risk behaviours for HIV transmission in a cohort of adolescents in South Africa.MethodsWe used three rounds of data between 2014–2018 on 1046 adolescents living with HIV and 473 age-matched community peers in South Africa’s Eastern Cape (Observations = 4402). We estimated sex-specific associations between six time-varying protective factors − number of social grants, education enrolment, days with enough food, caregiver supervision, positive caregiving, and adolescent-caregiver communication; and five HIV risk behaviours − multiple sexual partners, transactional sex, age-disparate sex, condomless sex, and sex on substances. HIV risk behaviours were analysed separately in multivariable random effects within-between logistic regression models that accounted for correlation of repeated observations on the same individual. We calculated prevalence ratios (PR), contrasting adjusted probabilities of HIV risk behaviours at ‘No’ and ‘Yes’ for education enrolment, and average and maximum values for the other five protective factors.ResultsThe sample mean age was 15.29 (SD: 3.23) years and 58% were girls. Among girls, within-individuals, increases from mean to maximum scores in positive caregiving were associated with lower probability of transactional sex (PR = 0.79; 95%CI = 0.67–0.91); in caregiver supervision were associated with lower probability of transactional sex (PR = 0.75; 95%CI = 0.66–0.84), and age-disparate sex (PR = 0.84; 95%CI = 0.73–0.95); in adolescent-caregiver communication were associated with higher probability of transactional sex (PR = 1.70; 95%CI = 1.08–2.32); and in days with enough food at home were associated with lower probability of multiple sexual partners (PR = 0.89; 95%CI = 0.81–0.97), and transactional sex (PR = 0.82; 95%CI = 0.72–0.92). Change from non-enrolment in education to enrolment was associated with lower probability of age-disparate sex (PR = 0.49; 95%CI = 0.26–0.73). Between-individuals, relative to mean caregiver supervision scores, maximum scores were associated with lower probability of multiple sexual partners (PR = 0.59; 95%CI = 0.46–0.72), condomless sex (PR = 0.80; 95%CI = 0.69–0.91), and sex on substances (PR = 0.42; 95%CI = 0.26–0.59); and relative to non-enrolment, education enrolment was associated with lower probability of condomless sex (PR = 0.59; 95%CI = 0.39–0.78). Among boys, within-individuals, increases from mean to maximum scores in positive caregiving were associated with lower probability of transactional sex (PR = 0.77; 95%CI = 0.59–0.96), and higher probability of condomless sex (PR = 1.26; 95%CI = 1.08–1.43); in caregiver supervision were associated with lower probability of multiple sexual partners (PR = 0.73; 95%CI = 0.64–0.82), transactional sex (PR = 0.63; 95%CI = 0.50–0.76), age-disparate sex (PR = 0.67; 95%CI = 0.49–0.85), and sex on substances (PR = 0.61; 95%CI = 0.45–0.78), and in days with enough food at home were associated with lower probability of transactional sex (PR = 0.91; 95%CI = 0.84–0.98).ConclusionEffective structural interventions to improve food security and education enrolment among adolescent girls, and positive and supervisory caregiving among adolescent girls and boys are likely to translate into crucial reductions in sexual risk behaviours linked to HIV transmission in this population.

Financial Behaviors and Experiences of Financial Loss in those with Alzheimer’s disease and Frontotemporal Dementia: Preliminary findings from a survey

AbstractBackgroundOlder adults are increasingly experiencing financial loss, with annual costs estimated to be about $2.9 billion. The risk of experiencing financial loss is magnified in those with neurodegenerative conditions, including Alzheimer’s disease (AD) and Frontotemporal Dementia (FTD). However, limited information exists on the frequency and amount of money lost, and the behaviors that contribute to such loss in these conditions. The current study sought to characterize the nature of financial losses in AD and FTD, and to identify risk factors in an effort to prevent or mitigate financial loss.MethodSurvey data were collected from ten caregivers of individuals clinically diagnosed with AD or FTD recruited via the Neurodegeneration‐Associated Psychiatric Syndromes study and caregiver support groups at Columbia University Medical Center. Survey items queried demographic information, details of financial loss, level of concerns experienced by care partners and patients, and financial behaviors resulting in financial losses (Table 1).ResultCaregivers had known the patients on average for 46 years. Out of 10 patients, 6 experienced financial loss. See Table 2 for detailed results. While the same number of patients with AD and FTD lost money, those with FTD lost money more frequently and to a larger amount than those with AD. Caregivers of FTD patients expressed a higher degree of concern relative to those with AD. Moreover, most AD patients were described as being concerned about their financial ability, as compared to none of the FTD patients having concern for their financial ability. Additionally, 3 of 5 FTD patients were reported to have engaged in repetitive spending as compared to none of the AD patients.ConclusionPreliminary data indicate a high prevalence of financial loss (60%) in AD and FTD. The intensity of financial loss and related caregiver burden appears higher in FTD, with caregivers describing repetitive spending and less concern about difficulties, likely tied to the lack of insight which is a core feature of this disease. These findings can guide caregiver supervision and interventions to preserve family funds.

Expanding the Concept of Caregiver Supervision to Prevent Child Drowning.

Expanding the Concept of Caregiver Supervision to Prevent Child Drowning.

Tailoring a Child Injury Prevention Program for Low-Income U.S. Families.

Unintentional injuries are the leading cause of death for children in the United States (U.S.), and young children ages (1-4) are particularly at risk. Supervising for Home Safety (SHS) is a Canadian intervention that has been shown to reduce children's injury risk by increasing caregiver supervision. Given that low-income children are at greatest risk for injury, this study describes a process of modifying the SHS program to be culturally appropriate for low-income families of U.S. preschool children. Two rounds of focus groups were completed; feedback from the first round of focus groups was used to modify program materials prior to the second round. Caregivers gleaned important take-away messages from both the original and modified materials, including the idea that injuries can happen quickly and that caregivers can prevent injuries. Modifications to the intervention included increased diversity in the families represented in the videos as well as inclusion of U.S. injury statistics. Caregivers in both rounds of focus groups noted that the program messages were relatable and realistic and that the materials were impactful in increasing their awareness of children's injury risk. We were able to successfully modify the SHS program to be appropriate for low-income U.S. families while preserving the core program messages.

Adolescent Mental Health Resilience and Combinations of Caregiver Monitoring and Warmth: A Person-centred Perspective

Caregiver monitoring and warmth have protective mental health effects for adolescents, including vulnerable adolescents. However, combinations of the aforesaid parenting behaviours and their relationship with adolescent mental health are underexplored, especially among younger and older South African (SA) adolescents challenged by structural disadvantage. Hence, the purpose of this study was to investigate unique profiles of caregiver monitoring and warmth and their associations with depression and conduct problems as reported by younger and older adolescents from disadvantaged SA communities. Latent profile and linear regression analyses were used to examine cross-sectional survey data generated by 891 adolescents from two disadvantaged SA communities (62.2% aged 13–17 [average age: 16.13]; 37.5% aged 18–24 [average age: 20.62]). Two profiles emerged. The first, i.e. substantial caregiver warmth and some monitoring, was associated with younger and older adolescent reports of statistically significantly fewer symptoms of depression and conduct problems. The second, i.e. caregiver monitoring without much warmth, was associated with significantly more symptoms of depression or conduct problems among younger and older adolescents. Traditional gender effects (i.e. higher depression symptoms among girls; higher conduct problem symptoms among boys) were amplified when caregiver monitoring was combined with low warmth. In short, protecting the mental health of younger and older adolescents from disadvantaged communities requires higher levels of caregiver warmth combined with moderate levels of caregiver supervision. Because stressors associated with disadvantaged communities jeopardise warm parenting, supporting caregiver resilience to those stressors is integral to supporting adolescent mental health.

Caregivers’ Perceptions of a High Repetition Sit-To-Stand Exercise Program for Children with Cerebral Palsy Who Have Mobility Limitations

Aims To explore caregiver perceptions about the outcomes and feasibility of a high repetition sit-to-stand home-based exercise program on themselves and their children with cerebral palsy who have mobility limitations. Methods Face-to-face semi-structured interviews were conducted with 19 caregivers (17 women, mean age 39 y 6 mo (SD 8 y 4 mo) of 19 children with cerebral palsy (10 males, mean age 7 y 2 mo (SD 2 y 1 mo) classified as level III (n = 8) or IV (n = 11) on the Gross Motor Function Classification System. The children had completed a 6-week task-specific sit-to-stand exercise program. Each week a physical therapist and caregivers supervised the program: twice by the physical therapist and three times by the caregivers. Interviews were completed immediately after program completion, and transcripts were analyzed using a process of inductive thematic analysis within an interpretive description framework. Results Themes were: (1) caregivers saw positive changes in their children from completing the program, (2) seeing positive changes gave caregivers hope that their child could develop with further training, and (3) the program was feasible to complete. Conclusions Caregivers perceived positive changes in their children and expressed increased hope for their child’s future after a high repetition sit-to-stand exercise program, suggesting the program is feasible with caregiver supervision.

Caregivers\u2019 experience of sleep management in Smith\u2013Magenis syndrome: a mixed-methods study

BackgroundSmith–Magenis syndrome (SMS) is a rare genetic syndrome associated with a unique profile of early morning waking and daytime sleepiness. Children with SMS evidence high rates of self-injury and aggression and have a preference for adult over peer attention, with strong motivation to interact with a particular caregiver. In addition, people with SMS have lower adaptive functioning skills relative to cognitive abilities and demonstrate high levels of impulsivity. Taken together, these factors may result in individuals being awake overnight requiring vigilant caregiver supervision. Despite these complexities, no study has described the strategies caregivers take to keep their children with SMS safe overnight or considered the impact of these experiences on caregivers or the wider family.MethodsThe current study used a mixed-methods approach to consider sleep management strategies and challenges for caregivers of people with SMS at different ages. Caregivers completed an international online survey about sleep management and related difficulties, use of interventions and access to services and support. Semi-structured interviews were conducted with 14 caregivers in the UK to increase understanding of caregiver experiences and priorities for change in the UK context. Interviews were transcribed verbatim and coded using thematic analysis.ResultsEvidence from the online survey (n = 40) revealed wide-ranging impacts of poor sleep on the person with SMS and the wider family. Only 5% of caregivers reported that the sleep problems had no impact on their child, and 76% reported a moderately or extremely significant impact on themselves. For some individual caregivers, sleep management difficulties improved over time whereas for others no change was reported. Weekly respite emerged as the ideal provision for 49% of caregivers, although only 14% had access to this. The majority of caregivers (54%) received no respite. Thematic analysis of qualitative interviews revealed interactions between aspects of the behavioural phenotype of SMS which may contribute to complex and unusual presentations in relation to sleep management and safety.ConclusionsCaregivers’ priorities for sleep management and support were delineated, with key implications for services in terms of the use of SMS-sensitive strategies and respite provision.

Spatial Neglect and Anosognosia After Right Brain Stroke.

Up to 80% of survivors of right brain stroke leave acute care without being diagnosed with a major invisible disability. Studies indicate that a generic cognitive neurologic evaluation does not reliably detect spatial neglect, nor does it identify unawareness of deficit after right brain stroke; this article reviews the symptoms, clinical presentation, and management of these two cognitive disorders occurring after right brain stroke. Stroke and occupational therapy practice guidelines stress a quality standard for spatial neglect assessment and treatment to reduce adverse outcomes for patients, their families, and society. Neurologists may attribute poor outcomes associated with spatial neglect to stroke severity. However, people with spatial neglect are half as likely to return to home and community, have one-third the community mobility, and require 3 times as much caregiver supervision compared with similar stroke survivors. Multiple randomized trials support a feasible first-line rehabilitation approach for spatial neglect: prism adaptation therapy; more than 20 studies reported that this treatment improves daily life independence. Evidence-based treatment of anosognosia is not as developed; however, treatment for this problem is also available. This article guides neurologists' assessment of right brain cognitive disorders and describes how to efficiently assemble and direct a treatment team to address spatial neglect and unawareness of deficit.

Epidemiology of paediatric orthopaedic-related trauma injuries sustained across a lockdown period during the COVID-19 pandemic.

Lockdowns have been implemented by countries to slow down SARS-CoV-2 transmission. Singapore's lockdown was enforced between 7 April 2020 and 1 June 2020. The objective of this study was to compare the epidemiology of paediatric orthopaedic trauma injuries during and immediately after the lockdown, with a non-pandemic period in 2019. All paediatric outpatients and inpatients seen in our hospital following an orthopaedic-related traumatic injury from the 8-week lockdown and 8 weeks post-lockdown were evaluated. Cases for matched periods in 2019 were identified retrospectively for baseline comparison. Patient demographics, venue of injury, anatomic location of injury, caregiver supervision and location of procedures performed in the hospital were assessed. 968 and 2810 injuries were observed in 2020 and 2019, respectively. While the proportion of injuries sustained by pre-schoolers and toddlers increased, those sustained by primary and secondary school children decreased in 2020 (p < 0.001). Majority of the injuries during the lockdown were sustained at home compared to schools or public recreational facilities (p < 0.001). Hand (26.2%) and elbow (20.8%) injuries were the most common during the lockdown. The proportion of procedures performed in the Children's Emergency during the lockdown was more than twice that of the same period in 2019 (p < 0.001). Our study showed a 2.9-fold decrease in orthopaedic-related injuries seen during the peri-lockdown period compared to a non-pandemic period. Pre-schoolers seem to be most vulnerable to injuries during the lockdown. Hand and elbow injuries were most common.

Effects of Cell Phone Use on Caregiver Supervision and Child Injury Risk.

Unintentional injuries are the leading killer of children in the United States. Caregiver supervision decreases child injury risk; however, little research has examined the effects of distractions (e.g., cell phone use) on caregiver supervision and subsequent ability to protect children from injury. In particular, despite the prevalence of cell phone use, no research has examined the degree to which caregiver cell phone use may impair caregivers' ability to supervise their children effectively. The present study used a within-subjects design to examine whether caregiver cell phone use impacted caregiver vigilance and child engagement with potential hazards. A total of 51 caregiver-child dyads were observed in a pseudo hazards room across three conditions (cell phone distraction, pen-and-paper distraction, no distraction) to examine the effects of cell phone use on caregiver vigilance and child behavior (i.e., engagement with hazards) related to injury risk. Caregiver vigilance was higher in the no distraction condition compared to the two distraction conditions (cell phone and pen-and-paper). Moreover, child engagement with hazards was lower in the no distraction condition than in the two distraction conditions. Although both distraction conditions impaired caregiver vigilance, caregivers were more impaired in the pen-and-paper condition compared to the cell phone condition. Regardless the form, distracting tasks (both cell phone use and pen-and-paper task) impacted both caregiver and child behavior associated with injury risk. It is important that professionals working with parents educate them about the risks of supervising children while distracted and encourage mindful supervision to ensure safety.

Predictors of swimming pool supervision for caregivers of toddlers.

In the U.S., drowning is a leading cause of death for toddlers. One important layer of protection against submersion injuries and fatalities is parent or caregiver supervision. The aims of this study are to explore current supervisory behavior of caregivers, determine how caregivers view com-mon supervision distractions, like cell phones and grilling, and identify what factors shape the quality of supervision that is given when swimming with their toddler at a swimming pool. This cross-sectional study used the MTurk online platform to survey 650 caregivers of toddlers (1-4 yrs old) about their supervision behavior, their drowning knowledge, their perceptions of arm's reach supervision, the water competency of their toddler, and other background information. Regression analysis was used to identify factors that predicted report-ed supervision behavior. The average supervision behavior score for caregivers indicated an attitude between neutral and disagreement with allowing distractions for themselves while supervising their toddler in a swimming pool. High water safety knowledge and positive perceptions of arm's reach supervision were the biggest predictors of attentive supervision behavior. Having a home pool, higher education level, and believing their toddler had greater water competency were predictive of less attentive supervision behavior. Results suggest that supervision behavior while toddlers are in a swimming pool may be inade-quate. Low water safety knowledge and attitudes about what constitutes quality supervision are related to pool supervision behavior and changing these may reduce drowning risk. Caregivers should be encouraged to not reduce supervision as their toddlers gain water competency and if they have a home pool.

Sit-to-stand training for self-care and mobility in children with cerebral palsy: a randomized controlled trial.

To investigate if a sit-to-stand exercise programme for children with cerebral palsy (CP) would improve self-care and mobility. Thirty-eight children with CP (19 males, 19 females; mean age 8y 0mo, SD 2y 4mo, age range 4y 0mo-12y 4mo) classified in Gross Motor Function Classification System (GMFCS) levels III and IV and their caregivers were randomly allocated to sit-to-stand training plus routine physiotherapy (balance and gait training) or routine physiotherapy only (controls). Task-specific sit-to-stand training was completed five times a week for 6 weeks under physiotherapist (twice weekly) and caregiver (three times weekly) supervision. Blinded outcome assessments at week 7 were the self-care and mobility domains of the Functional Independence Measure for Children, Five Times Sit-to-Stand Test (FTSST), and Modified Caregiver Strain Index (MCSI). The sit-to-stand group self-care increased by 2.2 units (95% confidence interval [CI] 1.3-3.1) and mobility increased by 2.2 units (95% CI 1.4-3.0) compared to the control group. In the sit-to-stand group, the FTSST was reduced by 4.0 seconds (95% CI -4.7 to -3.2) and the MCSI was reduced by 0.8 units (95% CI -1.2 to -0.4) compared to the control group. A sit-to-stand exercise programme for children with CP classified in GMFCS levels III and IV improved sit-to-stand performance and resulted in small improvements in self-care and mobility, while reducing caregiver strain. What this paper adds Sit-to-stand training improved independence in self-care and mobility for children with cerebral palsy (CP). Home-based sit-to-stand training programmes for children with CP can reduce the burden on supervising caregivers.

Predictors of swimming pool supervision for caregivers of toddlers

:Background:In the U.S., drowning is a leading cause of death for toddlers. One important layer of protection against submersion injuries and fatalities is parent or caregiver supervision. The aims of this study are to explore current supervisory behavior of caregivers, determine how caregivers view com-mon supervision distractions, like cell phones and grilling, and identify what factors shape the quality of supervision that is given when swimming with their toddler at a swimming pool. Methods:This cross-sectional study used the MTurk online platform to survey 650 caregivers of toddlers (1-4 yrs old) about their supervision behavior, their drowning knowledge, their perceptions of arm’s reach supervision, the water competency of their toddler, and other background information. Regression analysis was used to identify factors that predicted report-ed supervision behavior.Results:The average supervision behavior score for caregivers indicated an attitude between neutral and disagreement with allowing distractions for themselves while supervising their toddler in a swimming pool. High water safety knowledge and positive perceptions of arm’s reach supervision were the biggest predictors of attentive supervision behavior. Having a home pool, higher education level, and believing their toddler had greater water competency were predictive of less attentive supervision behavior. Conclusions:Results suggest that supervision behavior while toddlers are in a swimming pool may be inade-quate. Low water safety knowledge and attitudes about what constitutes quality supervision are related to pool supervision behavior and changing these may reduce drowning risk. Caregivers should be encouraged to not reduce supervision as their toddlers gain water competency and if they have a home pool.

Mother’s hair cortisol and symptoms of attention deficit hyperactivity disorder in her preschool child

Children with attention deficit hyperactivity disorder (ADHD) require increased caregiver assistance and supervision, and their parents have shown high perceived parenting stress. Hence, physiological adjustment processes in the caregivers, involving the hypothalamic-pituitary-adrenal axis, seem plausible. We analyzed the association between maternal hair cortisol concentration (HCC) and symptoms of ADHD in preschool-aged children. 150 mothers of 4–5-year-old children participated in the study. To determine the HCC, the first scalp-near 3 cm hair segment was used. ADHD symptoms of the child were measured using teacher- and parent-report questionnaires and a clinical interview with the mother. When controlling for several putative confounders, teacher-reported ADHD symptoms were significantly positively associated with mothers’ HCC. No associations of HCC with the mother-reported ADHD symptoms of the child emerged. It is possible that teacher-reported ADHD symptoms of the child reflect relevant ADHD symptoms more validly. As our study is the first on this issue, cross-validation is needed.

Emergency department visits for pediatric traumatic injuries during general confinement: A single-center study in an urban setting

BackgroundThe first case of SARS-CoV-2 was detected in France in January 2020 and the government decided on national confinement from March 17 to May 11, 2020. Our aim was to analyze the incidence of pediatric emergency department (ED) visits and hospitalizations for traumatic injuries during this period. MethodsAny visit with an ICD-10 discharge diagnosis code of burn, fracture, traumatic wound, or sprain/bruise contusion was recorded within the 2 weeks before (weeks 10 and 11) and during the confinement (weeks 12 and 19). The visits with the same ICD-10 discharge diagnosis code during similar weeks of the previous 2 years were also included. For each of those visits, the number of hospitalizations was counted. ResultsThe number of recorded visits between week 10 and 19 in 2018, 2019, and 2020 was, respectively, 2657, 2625, and 1106 children. The average number of visits per day during the confinement (13±5) was significantly different from the average number of visits per day during the same weeks in 2018 and 2019 (38±8 vs. 39±9, P<0.0001). The average number of visits per day was significantly lower during confinement compared with 2018/2019 for three categories of diagnoses (P<0.0001) but not for burns (1.7 vs. 1.8, P=0.23). The average number of hospitalizations per day was significantly lower during the confinement than during 2018/2019 (1.6±1.3 vs. 2.6±1.8, P<0.0001). ConclusionConfining children in an urban setting appears to decrease the incidence of injuries, except for burns. These data may be useful in reorganizing caregiver supervision and hospital units. These results will need to be consolidated in a multicenter study.

Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa

BackgroundMental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question.MethodsThe study traced adolescents aged 10–19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents.ResultsImprovements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97–0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98–1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92–0.97, p<.0001) and anxiety (0.91, 95% CI 0.89–0.94, p<.0001) symptoms reported by adolescents.ConclusionsFindings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.