Challenges In Care Of Children Research Articles

Impact of the COVID-19 Pandemic Onset on the Early Careers of Pediatric Oncology Health Professionals and Researchers: A Report From the Children's Oncology Group Young Investigators Committee, Young SIOP Network, and Young SIOPE.

The COVID-19 pandemic onset had a global debilitating impact on individuals and on burgeoning careers. In 2021, the Children's Oncology Group Young Investigators Committee, Young SIOP (International Society of Paediatric Oncology) Network, and Young SIOPE (European Society for Paediatric Oncology) co-sponsored a survey to explore the impacts of the first year of the pandemic on early-career pediatric oncology professionals with respect to working practices, productivity, professional and career development, personal wellbeing, and changing childcare needs. The survey comprised demographic, multiple-choice, and free-text questions, and was distributed via email and social media with English, French, and Spanish versions available. Descriptive statistics and chi-square tests were used to compare quantitative data by self-designated gender and country of origin. Qualitative data were described using content analysis. Professionals (N = 499, 26.3% male, 77.2% MDs) in 48 countries (77.6% high income) responded in English (79.4%), Spanish (12.4%), and French (8.2%). Respondents had difficulty obtaining and keeping jobs (26.9%), worsened overall academic productivity (50.7%, with higher rates among bench scientists, p<0.01), and decreased career opportunities (40.9%). Childcare challenges impacted 56.7% of respondents and was felt more negatively among women (p = 0.008) and in high-income settings (p<0.0001). Qualitative data (n = 300) highlighted these differences were often attributable to diminished professional/personal boundaries and impacted their personal wellbeing. The COVID-19 pandemic significantly impacted early-career academic and clinical professionals working in pediatric oncology, with unique challenges noted among those with childcare responsibilities. Career disruptions that resulted from the pandemic should be considered and mitigated by governing bodies and hiring institutions.

Virtual connection and real community: the qualitative experience of participating in a videoconferencing-based psychotherapy group for postpartum depression and anxiety

BackgroundGroup psychotherapy, an effective treatment for common postpartum mental disorders (e.g. depression, anxiety), has increasingly been delivered virtually since the pandemic. This study aims to understand experiential aspects of participating in videoconferencing-based group psychotherapy in the postpartum period.MethodsOur urban academic ambulatory hospital has delivered group psychotherapy for women (cis and trans) and non-binary individuals of female sex with postpartum depressive and anxiety symptomatology via videoconferencing since 2020. One therapist-facilitator conducts weekly 60-min group therapy sessions with 5-6 participants for eight weeks. Group participants were invited to complete a semi-structured qualitative interview on their experience. Using an interpretive description approach, we conducted reflexive thematic analysis to code anonymized transcripts and construct themes. Facilitator interviews were used for triangulation and additional context.ResultsOf 134 patients in video psychotherapy groups over 11 months, 14 completed an interview, as did all group facilitators (n = 3). Overall, participants felt the experience with videoconferencing group therapy was beneficial for their mental health. Three themes were constructed: (1) “Moving Towards a New Normal”: The group helped participants normalize feelings and experiences around transition to parenthood, and accessing health care virtually was now considered to be normal practice, although some wanted an element of choice. (2) “Virtual Connection, Real Community”: Connections were made virtually, yet participants felt a real sense of community. Facilitators played an important role fostering an environment in which participants could create lasting bonds. Participants noted challenges with feeling comfortable virtually and provided pragmatic and structural suggestions for enhancing the creation of community. (3) “Trade-offs to Virtual Engagement”: Participants made positive and negative trade-offs (e.g. no informal interactions, travel, isolation at home, childcare challenges) to maximize their experience and were able to be more authentic in their self-presentation to the group.ConclusionsPeople with postpartum depression and anxiety who participated in videoconferencing-based group psychotherapy appreciated the sense of community within their groups to normalize their experience transitioning to parenthood. Participants had to make trade-offs to access virtual groups, but felt the experience was worthwhile and helped improve their mental health. Findings will help inform continued delivery of virtual group mental health services.

Further assessment of structural and social determinant of health effects on breast cancer care timelines: A qualitative study.

121 Background: Time to treatment (TTI) delays result in increased morbidity and mortality for cancer patients. These treatment delays disproportionately occur within marginalized communities due to structural challenges with social determinants of health (SDoH), disengagement with the healthcare system and limited or low health literacy that impacts their ability to obtain timely, appropriate care. We conducted semi-structured interviews with patients treated for breast cancer about their care treatment trajectories to further understand barriers and facilitators for timely treatment from the patient perspective. Methods: We conducted semi-structured interviews with 30 patients in 2023 who received curative intent breast cancer treatment at Montefiore Medical Center from 2019 to 2023. Interviews addressed barriers and facilitators of timely TTI, perceived timeliness and salience of timeliness, emotional well-being, and perceptions of the healthcare team and communication. We analyzed interviews using framework analysis. Results: A total of 30 patients were interviewed (mean age 58.9 year ± 10.6, 75% Non-Hispanic Black, 25% Non-Hispanic White). The median TTI was 52.5 days (49, 62 IQR). First treatment modality included surgery (75%) and chemotherapy (25%). Many participants found significant emotional and logistical support through family, social networks, religion, and connecting with survivors. Several patients faced transportation issues hindered their ability to adhere to schedules, childcare challenges, and difficulty managing numerous appointments, with some wishing transportation services had been offered at diagnosis. Some participants experienced unique cancer presentation, required clearances, involvement of non-oncologic providers and consultants, and time for decision-making about treatment options that may have contributed to delays. Some patients faced financial burdens including personal expenses, family support needs, and difficulties accessing third-party assistance (i.e., short-term disability, Supplemental Security Income). Some patients valued mental health counseling and other resources like group therapy and social workers, though some wished for earlier, more specialized support, indicating gaps in the support timeline. A few patients expressed preference for longer TTI that afforded them time to make important decisions and seek opinions. Conclusions: The study revealed that many patients faced logistical, emotional, and informational challenges while awaiting treatment and highlighted a need for more tailored assistance and timely interventions. Findings from our work highlight the need for further study on how healthcare systems can better equip and engage patients early in the care timeline to avoid delayed TTI.

Exploring patterns in online discussions into the lingering impact of COVID-19, two years on

PurposeThe purpose of this study was to explore underlying patterns in the users’ discussions in an online community on the darker effects of COVID-19. Understanding these patterns is critical as they can provide new information in tailoring support to individuals facing specific post-pandemic issues.MethodsTwo methods were used to identify patterns in large volumes of publicly available responses (n = 23,957 posts; ~ 1,061,825 words) from an online community. Qualitatively (using Gioia methodology), 1000 random responses were manually coded by two coders and vetted by an investigator. As it was difficult to manually code such a big dataset, a quantitative approach building a topic model was employed with a language model.ResultsQualitative analyses revealed 20 themes, including mental health (13%), impacts of direct and indirect deaths on socio-economically vulnerable groups (e.g. children and elderly, 10.4%), increasing sociopolitical divide and vaccination debate (6.8%), and work-related issues (e.g. burnout and layoffs, 6%). Topic analyses resulted in similar categories (n = 30), including physical health, loss experiences during COVID-19 and suicide; sociopolitical impact and adaptations in pandemic lifestyle; mental health and vaccination; pandemic restrictions, youth and behavioral expectations; distrust for institutions and resource scarcity; staffing issues and personal crisis; disrupted careers; and childcare challenges and economic shifts.ConclusionAs researchers are harnessing vast amounts of real-time human interaction data to study a variety of public health issues, our study provides insights into the specific challenges that people experienced when it became convenient to share concerns online amid an overloaded healthcare system during the pandemic.

Enhancing Work-Life Balance of Teachers in Self-Financing Schools

Introduction: Teachers contribute significantly to the growth of schools and students by determining each child's future. Teachers support young minds and help them do great things. So, a teacher's work-life balance needs to be taken care of and is a must for every teacher. The school teachers can better balance their family and work life by adopting a work-life balance strategy. In order to maintain work life balance, teachers should prioritise their time and balance their work with their family, health, holidays, and other commitments. Objectives: To study the demographic factors on stress level among teachers, to assess the variables that affect work-life balance and to determine the consequences of not maintaining the work-life balance of teachers at self-financing schools.Method: The primary data were gathered using questionnaires, and a total of 200 samples were chosen. The methodology includes specific statistical tools such as percentage analysis, chi-Square, correlation, and one-way ANOVA for analysis and interpretation. Results: The analysis suggests that the factors affecting work-life balance, including heavy household work, financial commitments, childcare challenges, lack of recognition, job dissatisfaction, and family time constraints, are significantly correlated with higher stress levels among the teachers of self-financing schools. The findings suggest that achieving work-life balance is possible with the help of school support through counseling programmes, transparent flexible working hours, and accommodating leave for family emergencies. Conclusion: Neglecting work-life balance can have a negative impact on teachers in self-financing schools, limiting their ability to manage domestic tasks, causing physical health concerns, and leading to professional and personal errors. However, teachers can truly enjoy the blessings of life by developing the necessary life coping skills to effectively manage work-life balance

“Mom's a bit different”: The challenges of first-time mothers with cerebral palsy in caring for their children from birth until age three

This qualitative study examines childcare challenges and adaptive strategies among first-time Czech mothers with cerebral palsy (CP) in caring for children aged 0–3. Data obtained from ten semi-structured interviews were analyzed using selected procedures of situational analysis. The results were structured around three major themes: (1) The decision to become a mother and preparation for childcare tasks; (2) Challenges in childcare and adopted childcare strategies; (3) Social support received to manage childcare challenges. Along with findings related to the women with CP preparing themselves for the maternal role and childcare tasks, i.e. by attending a prenatal course to learn a suitable hand grip to safety hold their baby or to choose a suitable pram, the participants identified a number of practical childcare challenges they encountered postpartum. The first-time mothers initially tended to delegate challenging childcare tasks, such as lifting and carrying the newborn child, bathing and dressing or changing nappies, to family members or friends, with this support contributing to gradual development of the women's childcare methods to become an independent caregiver. Our findings underline the importance of sharing the lived experiences of mothers with CP with professional communities as well as the general public through formal education programs and informal community outreach.

“I'm completely off base here on what this child is capable of”: A qualitative analysis of how medical ableism manifests in PICU clinicians' care of children with severe neurological impairment

BackgroundChildren with severe neurological impairment (SNI) are at heightened risk of experiencing medical ableism from clinicians in the pediatric intensive care unit (PICU), where barriers such as time scarcity and heavy workloads limit clinicians’ ability to provide personalized care. ObjectiveTo examine medical ableism and strategies to support PICU clinicians in understanding the lives of children with SNI and their families. MethodsThis US-based, single-center, qualitative study included PICU clinicians identified by the parents/caregivers of a child with SNI. Semi-structured 1:1 60-min interviews about the challenges of caring for children with SNI were conducted virtually. Coded data were extracted, thematically analyzed, and further conceptualized using the Dual Process Theory (DPT) bias reduction framework. ResultsNineteen PICU clinicians participated. Three major themes emerged: 1) assumptions and misconceptions about children with SNI and their families, 2) barriers to providing personalized care, and 3) clinician-suggested strategies to honor the lives of children with SNI. These themes aligned with the DPT framework. As outlined in the DPT, system 1 “fast thinking” errors occur when quick observations inform decisions (e.g., snap judgments about a child's capabilities). Second, barriers (e.g., insufficient time for meaningful interactions) may prevent clinicians from providing unbiased care. Third, system 2 “slow thinking,” where complex decision-making occurs, and can be enhanced through personalization strategies (e.g., viewing visuals of the child at baseline health). ConclusionsIncreasing clinician awareness of their potential implicit biases and utilizing bias reduction strategies to mitigate medical ableism in care are critical areas for future research.

Disparities in Unmet Health Care Needs Among US Children During the COVID-19 Pandemic.

The COVID-19 pandemic disrupted pediatric health care in the United States, and this disruption layered on existing barriers to health care. We sought to characterize disparities in unmet pediatric health care needs during this period. We analyzed data from Wave 1 (October through November 2020) and Wave 2 (March through May 2021) of the COVID Experiences Survey, a national longitudinal survey delivered online or via telephone to parents of children aged 5 through 12 years using a probability-based sample representative of the US household population. We examined 3 indicators of unmet pediatric health care needs as outcomes: forgone care and forgone well-child visits during fall 2020 through spring 2021, and no well-child visit in the past year as of spring 2021. Multivariate models examined relationships of child-, parent-, household-, and county-level characteristics with these indicators, adjusting for child's age, sex, and race/ethnicity. On the basis of parent report, 16.3% of children aged 5 through 12 years had forgone care, 10.9% had forgone well-child visits, and 30.1% had no well-child visit in the past year. Adjusted analyses identified disparities in indicators of pediatric health care access by characteristics at the level of the child (eg, race/ethnicity, existing health conditions, mode of school instruction), parent (eg, childcare challenges), household (eg, income), and county (eg, urban-rural classification, availability of primary care physicians). Both child and parent experiences of racism were also associated with specific indicators of unmet health care needs. Our findings highlight the need for continued research examining unmet health care needs and for continued efforts to optimize the clinical experience to be culturally inclusive.

Perceptions of Mental Health in the LGBTQ+ Student Community: Needs, Barriers, and Access

In 2020, the COVID-19 pandemic devasted health outcomes and economies globally. As a result, many suffered financial hardships, childcare challenges, and poor mental health due to the pandemic’s negative effects. Young people were particularly affected by the pandemic as it pertained to education, social isolation, and access to essential resources and services. Additionally, the U.S. experienced a rise in anti-LGBTQ+ proposals and laws were introduced or passed in various states across the country, particularly in the South. LGBTQ+ youth and young adults are more likely to experience and report poor mental health compared to their straight counterparts. As a result, my two research collaborators (Dr. Gayle Beck and Phillis Lewis) and I proposed to examine the perceptions of mental health services, access, and availability among the LGBTQ+ student community and LGBTQ+ identifying faculty and staff on the University of Memphis campus. As a result of the pending or enacted anti-LGBTQ+ legislation and the effects of the pandemic, a needs assessment was conducted. Three methodological approaches were used to capture student, faculty, and staff insights; an online survey, focus groups, and interviews. The results of the needs assessment suggest that efforts could be used to improve access and reduce barriers for LGBTQ+ students on campus to improve overall mental health by facilitating the provision of counseling services, improving the campus atmosphere for students via training, and supporting LGBTQ mental health on campus.

Problem behaviours and caregiver burden among children with Autism Spectrum Disorder in Kuching, Sarawak.

Caregivers of children with Autism Spectrum Disorder (ASD) often experience emotional and psychological distress, as well as disruptions to family life and employment due to the challenges of caring for children with ASD. This study examines the relationship between problem behaviours and caregiver burden among children with ASD. A cross-sectional study using convenience sampling recruited 230 caregivers of children with ASD aged 4 to 18 years from selected autism centres in Kuching, Sarawak. The caregivers completed the Aberrant Behaviour Checklist-2 and the Zarit Burden Interview. Univariate analysis revealed a significant difference in caregiver burden for children with ASD receiving medications (p = 0.013), registered with the Social Welfare Department (p = 0.036), and having siblings with ASD (p = 0.046). About 40% of the children exhibited at least one domain of problem behaviour. More than half of the caregivers (53.9%) experienced burden, with the majority experiencing mild burden. Positive associations were seen between irritability (r = 0.458, p < 0.01), social withdrawal (r = 0.439, p < 0.01), stereotypic behaviour (r = 0.392, p < 0.01), hyperactivity/non-compliance (r = 0.467, p < 0.01), and caregiver burden. Child factors, including the duration of problem behaviour (r = 0.182, p = 0.007), medication use (eta = 0.187, p = 0.005), Social Welfare Department registration (eta = 0.138, p = 0.036), and the presence of siblings with ASD (eta = 0.130, p = 0.046) were associated with caregiver burden. Multiple linear regression showed that hyperactivity/noncompliance significantly predicted caregiver burden. Specific problem behaviours in children with ASD were associated with caregiver burden. These results highlight the need for interventions for the child with ASD and their caregivers.

Veteran Caretaker Perspectives of the Need for Childcare Assistance During Health Care Appointments

PurposeIn 2020, Congress passed legislation to establish the national Veterans Child Care Assistance Program (VCAP) targeting eligible veterans receiving care through the Veterans Health Administration (VA). This needs assessment describes the childcare needs of veteran caretakers of young children and explores the implications of inadequate childcare on health care engagement. MethodsSurvey data were collected from 2,000 VA users with dependent children; data were analyzed using standard descriptive statistics. Qualitative data were collected from 19 veterans through focus groups and analyzed using rapid thematic analysis. FindingsMore than 75% of veterans surveyed indicated that they required childcare assistance during health care appointments and 73% reported barriers to finding childcare. Prominent barriers included the high cost of childcare and not having a trusted source of childcare. Nearly 58% of survey respondents reported missed or canceled VA health care appointments due to childcare challenges. Furthermore, 35% of surveyed veterans reported that their children had accompanied them to an appointment in the past year. Among these veterans, 59% brought their children into the exam room. Focus group participants discussed how having children present during their health care appointments hampered communication with health care providers. ConclusionsVeterans report that lack of childcare keeps them from attending and remaining focused on the provider during their health care visits, which could compromise quality of care. As one of the only health systems in the United States that will offer childcare assistance, VCAP presents an opportunity to improve health care access and quality by reducing missed appointments and suboptimal care.

Exploring spiritual/religious coping strategies among mothers of children with severe or profound intellectual disability during genetic counseling in Brazil.

Parents use several coping strategies to deal with the challenges of caring for children with disabilities. This qualitative study explored the spiritual/religious coping strategies adopted by Brazilian mothers of children with severe or profound intellectual disabilities who were attending the medical genetics clinic for genetic counseling. Individual semi-structured interviews were conducted with 15 participants, selected by convenience. Thematic content analysis was used to investigate the data. Five major themes were recognized: (1) spirituality/religion as a source of resilience; (2) surrender to God's plan; (3) a feeling of predestination; (4) children with a disability perceived/conceived as a blessing; and (5) pleading for divine intervention. Participants highlighted the ability to recover and adapt to bad circumstances and stressful events with God's support using spiritual/religious resources and practices. They attributed the cause and control of events in their lives to an external and transcendental source, showing themselves to be resigned to the condition of their child with a disability and his/her demands. The feeling of predestination appeared as a form of divine intervention as well as a way of attributing meaning to the situation. Their child with a disability was compared constantly to an "angel," a celestial being created by God to be a messenger and fulfill divine purposes. From the participants' perspective, these coping mechanisms appeared to have helped them adjust to the situation. Spirituality and religiousness have become crucial in cultures such as Brazil, where religious practices, often highly syncretic, are common. A more detailed and comprehensive understanding of how spiritual/religious coping strategies are mobilized during the genetic counseling process can improve the cultural competence of genetic counselors and help guide proposals for more effective clinical interventions.

Extended family collaboration in childcare during the coronavirus disease-19 pandemic

The coronavirus disease-19 pandemic and the accompanying public health restrictions have posed significant challenges to parents with dependent children. A rich body of literature has examined the problems encountered by parents and their gendered division of labour in childcare during the pandemic. However, little attention has been paid to their interactions and collaborations with extended family for childcare. Drawing on qualitative interviews with 43 urban parents in Shenzhen, China, I examine how parents mobilised childcare support from extended family during the pandemic, focusing on their collaboration with grandparents. Viewing parenting as a series of interactive and relational practices, I analyse how parents made new childcare arrangements and sought support from extended family to cope with work–childcare conflict and their ambivalence towards family collaboration in childcare during the pandemic. My findings highlight the significance of extended family collaboration for parents to overcome childcare challenges and reveal the embeddedness and relationality of parenting during the coronavirus disease-19 pandemic within extended family.

Exploring the Lived Experiences of Compassion Fatigue in Parents who Adopt Children with Trauma Histories

Abstract The challenges of caring for children with early life adversity have been identified as contributing to feelings of compassion fatigue (CF)—an emotional disconnection resulting from repeated exposure to another’s trauma. Although extensive studies have focused on contributors to trauma-inducing workplace stress and well-being, research on trauma-related stress in the home, especially in adoptive parent populations, is relatively underexplored. This study aimed to understand how adoptive parents make sense of their experiences of parenting adopted children, identify core components of CF, understand parents’ perceptions of contributing factors and explore wider relational impacts. Parents were recruited from Adoption UK via email invite. Semi-structured interviews were conducted with twelve parents to form a holistic picture of adoptive parents’ experiences. Data were analysed using Reflexive Thematic Analysis. Findings yielded three overarching and interrelated themes: (i) a parent not a therapist; (ii) strained connections; and (iii) support is a mirage. Findings support recent literature highlighting the reality of CF in adoptive parents and the need to develop more preventative structures and responsive systems of support adapted to the needs of adopted children but also the unique needs of their families to help prevent mental health crises across the family and adoption breakdowns.

Longitudinal Outcomes of Chronically Transfused Adults with Sickle Cell Anemia and a History of Childhood Stroke

Background: Rigorous studies define the use of chronic transfusion therapy (CTT) for secondary stroke prevention in children with sickle cell anemia (SCA). Limited evidence informs the use of indefinite CTT for children with SCA and a history of stroke when they enter adult care. Often, adults with a history of childhood stroke are treated by extrapolation of pediatric practice and continue CTT. However, the risk of recurrent stroke in these adults is unknown. In this retrospective study, we describe outcomes of adults with a history of SCA and childhood stroke and compare them to adults without a history of childhood stroke. Methods: The Johns Hopkins University Institutional Review Board approved this study. The inclusion criteria were: SCA diagnosis, ≥ 18 years old, received adult care at Johns Hopkins Hospital (JHH), and documentation of a stroke via diagnosis code or mention in hematology clinic notes prior to the age of 18 or no stroke in childhood. Subjects without a history of stroke in childhood were matched based on age, gender, and genotype. For each subject, we performed a systematic chart review extending from their initial encounter with hematology care at JHH (pediatric or adult, whichever was available) to the final visit in the electronic medical record. Data collection spanned from January 1990 to February 2022. Variables collected include demographic data, SCA morbidities, and CTT treatments. We reported descriptive statistics for the subjects with a history of childhood stroke. Then we compared subjects with and without childhood stroke using the Mann Whitney U test for continuous outcomes and Fischer's exact test for categorical outcomes. We performed data analysis with Stata/SE Version 16.1. Results: There were 42 subjects with SCA and a history of childhood stroke (Table 1). In this group, the median age at the time of the study was 30 years (IQR 24 to 35 years). The median age at the time of childhood stroke was 7 years (IQR 5 to 11 years), and all subjects received CTT for secondary stroke prevention. Subjects received a median of 17.7 years of CTT (IQR 12.2 to 23.3 years). The median annual pretransfusion hemoglobin S for this group was 31% (IQR 24 to 39%), which suggests adherence to CTT. The median ferritin was 3842 ng/dL (SD 3842); 45% were alloimmunized. Five subjects with a history of childhood stroke had a stroke in adulthood: one subject (age 24) had discontinued CTT, two subjects (age 21, 23) were intermittently adherent to CTT and stroke occurred at a hemoglobin S of 49% in one subject (other unrecorded), and two subjects (ages 21, 22) received regular CTT and presented with a hemoglobin S of 14% and 24% respectively. Comparison of subjects with and without a history of childhood stroke are shown (Table 2). More subjects with a history of childhood stroke received CTT than those without (33 (100%) vs 21 (63%), p = 0.0001). We observed 0.7 strokes per 100 person·years in subjects with a history of childhood stroke and 1.1 strokes per 100 person·years in subjects without a history of childhood stroke. These were not different (p = 0.63). A comparison of SCD complications between those with and without a history of childhood stroke identified that adults on CTT because of childhood stroke had less avascular necrosis (AVN) (4 (12%) vs 12 (42%), p = 0.01) and leg ulcers (0 vs. 6 (18%), p = 0.02) than those without a history of childhood stroke. Conclusions: Among 42 adults with a history of childhood stroke, recurrent strokes occurred in 12% and in a comparable number of adults without a history of childhood stroke. This finding suggests that continuing CTT in adult care may reduce the risk of recurrent stroke to that of a population without a history of childhood stroke. Here, we find that adults with a history of childhood stroke on CTT have lower rates of AVN and leg ulcers, which suggests that CTT may reduce the risk of developing these complications. Larger, prospective studies are needed to define the extent to which CTT reduces recurrent stroke in adults with a history of childhood stroke. This evidence is necessary to inform decisions to continue CTT in adulthood because iron overload associated with CTT can be morbid and the burden of CTT visits may lead to missed work, lost wages, and childcare challenges. Further studies may also enhance decisions during pediatric care to direct children with history of stroke towards curative therapy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Kōrero Mai: A Kaupapa Māori study exploring the experiences of whānau Māori caring for tamariki with atopic dermatitis

Racism and colonisation have caused the systemic exclusion of Indigenous Māori populations in Aotearoa (New Zealand) and the perpetuation of health inequities. Atopic dermatitis, a chronic skin condition, is one such example where Māori tamariki (children) are disproportionately affected. International research highlights the challenges of caring for children with atopic dermatitis; however, there has been no such research in Aotearoa. This small qualitative study, using Kaupapa Māori (Indigenous Māori) methodology, aimed to explore the experiences of Māori parents caring for their tamariki with atopic dermatitis. Cultural engagement was paramount to the research using kaupapa kōrero (cultural narrative) through kanohi-ki-te-kanohi (face-to-face) interviews to explore the lived experiences of six whānau Māori (Māori families). Data were analysed thematically using a kaupapa Māori lens with five overarching themes: 1) the constant hard work of maintaining good skin health for tamariki; 2) the embarrassment is punishing for whānau; 3) courage is required to maintain vigilance; 4) constantly seeking solutions; and 5) whānau/people-focused solutions. Kōrero (conversations) illustrated that whānau Māori experience systemic racism across health, education, and social systems; implicit bias; and differential treatment within health services that impact caring for their tamariki. These findings reiterate the failure of mainstream primary healthcare institutions to enact Te Tiriti o Waitangi obligations and ensure health equity for whānau Māori. To survive and thrive within their contexts, Māori whānau drew on mātauranga Māori (Māori knowledge systems) in their everyday practices. Therefore, strategies to support whānau to reclaim and maintain Indigenous practices, alongside the responsibility of healthcare providers to improve health outcomes, are imperative to achieve health equity for Māori.

When the Challenges of Widowhood Extend to Childcare: Essential Considerations for Social Work Practice

Unless widows recount their painful experiences of caring for their children, their day-to day lived challenges of childcare may be misunderstood if not totally missed by social workers in practice. This article discusses the widow’s painful experiences of caring for their children in Binga District in Zimbabwe and the critical aspects needed for consideration by social workers in practice. A qualitative research approach using a phenomenological research design was adopted to capture the lived struggles of the widows in caring for their children. Using purposive sampling, twenty-four widows participated in the in-depth interviews, with ten widows participating in individual interviews whilst fourteen widows participated in two separate focus group interviews with seven widows in each group. Data were analysed thematically with predetermined and emerging themes critically discussed and compared with existing literature. The findings showed that due to dwindling resource bases, widows are bound to fail to meet the physiological, psychosocial, economic and educational needs of their children. The article recommends deliberate and systematic social work considerations in efforts to intervene and avert the circumstances of the widows that have a negative impact on childcare.

Adolescent marriage and motherhood in Turkey: A qualitative study exploring determinants, impacts and opinions about preventive strategies.

This study aimed to understand the determinants of child marriages, becoming a child mother, their impacts and opinions about preventive strategies. The phenomenological research approach was adopted with one-to-one semi-structured interviews between December 2017 and May 2018. The population of the study consisted of 36 adolescent married mothers registered in the Family Health Centres. Interviews were recorded, transcribed and evaluated based on a thematic analysis was conducted. In the study, four main themes and 12 subthemes were determined. Adolescent marriages determinants occurred as patriarchal cultural norms, the perception that girls would be safe under the protection of another man, and poverty. Adolescent brides experienced partner violence and were subjected to physical, psychological and sexual violence in their marriage. Adolescent mothers had low maternal self-confidence, childcare challenges and were late to take on childcare responsibilities, and their children were neglected. As a result of early marriage, the participants experienced psychological problems and burnout later in their lives. Improving family-child communication, and eliminating financial inadequacies were among the opinions on prevention strategies of child marriages. The findings of this study identified the determinants and impact of adolescent marriages and revealed the problems experienced by adolescent brides and mothers. The most important contribution of this study is that it deals with the motherhood experiences. In addition, it is one of the important findings of this study that it draws attention to their neglected children's due to lack of knowledge and experience of their mothers about childcare.

Operational Constraints and Gender Biases: A Qualitative Analysis of Physician Parenting Experiences.

Objective:Although parenting responsibilities are correlated with gender disparities in professional development and salary, the nature of parental challenges is not well characterized. The aims of this study were to (1) illuminate faculty physicians' experiences with parenting and (2) identify system challenges and opportunities for improvement.Materials and Methods:In October 2019, a survey about parenting was sent to all physician faculty at a large Midwest academic medical center. Qualitative analysis of free-text response to the survey item “is there anything you wish to share about your experience of pregnancy or parenting as a physician” was performed. Themes were inductively identified and developed from the responses in a team-based iterative approach.Results:Of 2069 total physician faculty, 1085 (52.4%) responded to the survey and 253 (23%) of the respondents provided free-text comments. From these comments, the authors identified three themes as sources of challenges for physician parents: operational constraints, gender biases, and nontraditional or nonheteronormative family structures. Operational factors pertained to lack of scheduling flexibility, childcare challenges, lactation, colleague coverage, and transparency of policies. Responses indicated that gender biases are encountered by all genders, and expectations built on assumptions of “traditional” gender roles and family structure are problematic for many physician parents.Conclusion:Addressing the challenges and opportunities identified in the study is critical to building a more supportive institutional culture around parenting and to increase gender parity in academic medicine.

Tips for Coping with a New Baby During COVID-19

All babies cry. Most babies cry a lot from two weeks to two months of age. Some cry more than others, and some cry longer than others. For many new parents, crying is one of the most stressful parts of coping with a newborn.In some cases, extreme stress and a temporary lapse of emotional control in a caregiver can lead to actions that result in abusive head trauma. In fact, the most common trigger for abusive head trauma is simply a crying baby. As an American Academy of Pediatrics policy statement points out, actions that lead to abusive head trauma often happen when caretakers experience stress and get to the end of their rope.However, there is a bright side: The key to preventing abusive head trauma is to understand how common feelings of frustration, isolation, and exhaustion are during the first few months of an infant’s life.Usually, new parents can seek out social supports and external help—but what when we are all restricted in our movements and our contacts? What happens when families face child care challenges and more ongoing fallout from the COVID-19 pandemic? Here are a few suggestions:American Academy of Pediatricswww.aap.org and www.HealthyChildren.orgAdapted from the HealthyChildren.org article Tips for Coping with a New Baby During COVID-19 by Robert Sege, MD, PhD, FAAP (1/13/2022).The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.