Child Health Research Articles

Children and Youth with Special Health Care Needs: Progress Towards More Family-Centered Systems of Care.

Children and youth with special health care needs have increasingly been included in community and society over the past 50 years. Changing definitions and programs in the education, health, and public health/Title V sectors document this greater inclusion. The most profound change was in the education system, with the passage of legislative mandates for inclusion and parental rights. Although the health system has no similar universal mandate, the sequential passage of Medicaid, Children's Health Insurance Plan, and the Patient Protection and Affordable Care Act led to expanded health care coverage with no pre-existing conditions and lifetime caps. Title V of the Social Security Act, originally passed in 1935, evolved from a focus on individual medical services to a public health systems approach focusing on building family-centered, coordinated, comprehensive care in community settings. Most of the changes in all the sectors are the result of the advocacy and engagement of parents and families; the Maternal and Child Health Bureau was a supportive and innovative leader for family-professional partnerships. Much work on understanding disparities across the sectors has led to more recent focus on equity.

Gender messages in girls' puberty books: A focus on parent representation.

This study provides an ethnographic lens to understand gender messages in girls' puberty books, focusing on the representation of parents in both text and images. A content and thematic analysis was performed on 22 children's books on girls' pubertal development drawn from Amazon bestselling books on Children's Health & Maturing. Content analysis results demonstrated an imbalance in the representation of parents in books about girls' pubertal development. Mothers appeared and were mentioned in the text significantly more than fathers. Mothers relative to fathers also were depicted significantly more in illustrations with positive expressions (e.g., smiling) while talking or interacting with their daughters. Fathers were under-represented and portrayed as relatively stoic actors with no clear role in preparing their daughters for puberty. Thematic analysis of the books reinforced and challenged gender norms and expectations. While mothers were observed as the primary source of support during this transition, some books emphasized fathers' valuable role in advocating for their daughters' well-being and fostering open communication. Implications for girls' gender role development are discussed.

Quality of Life in Children With Chronic Health Conditions and Its Contribution to Unmet Supportive Care Needs of Families.

While theoretical models have established the bidirectional relationship between health and wellbeing of parents and children with chronic health conditions (CHCs), previous work has predominantly emphasised the impact of parent functioning on child outcomes. This study examines how quality of life (QoL) domains in children with CHCs are associated with unmet supportive care needs (SCN) of their parents and explores whether these associations vary by health condition. Parents of children with congenital heart disease (CHD), type 1 diabetes (T1D) and cancer diagnosed before the age of 12 years and receiving treatment within the last 5 years were eligible. Parents recruited through charity organisations and social media platforms completed a secure, online survey via Qualtrics. The PedsQL examined child QoL across four dimensions: physical, emotional, social and school functioning. A 34-item survey assessed parents' unmet SCN in the previous month across six need domains (e.g., care and informational). Linear regressions examined associations between child QoL and unmet SCN domains and moderation analyses determined whether associations varied as a function of CHC. The study included 186 parents (age range 25-56 years) of children diagnosed with various CHCs (52% CHD; 27% T1D, 21% cancer). The child's emotional functioning was inversely related to all unmet SCN domains, social functioning was inversely related to three domains (physical and social; support; financial), school functioning was inversely related to two domains (physical and social; care), and child's physical functioning was not associated with any SCN domains. Only the association between child school functioning and unmet care needs was significantly moderated by CHC type (p < 0.05). Poorer emotional functioning in children with a CHC is a key factor in determining parents unmet SCN. Larger studies are required to replicate these findings and inform design of interventions addressing QoL and unmet SCN in families of children with common CHCs.

The Relationships Between Trust Beliefs in Physicians by Children With Asthma, Those by Their Mothers and the Children's Medical Health.

The study examined whether there were linear and curvilinear relationships between the trust beliefs in physicians by the children, those by their mothers and the children's medical health. The study examined whether there were changes in those relationships across time. The data gathered in a previous study were subjected to further analyses. One hundred and forty-three children with asthma (116 males, Mage = 12 years and 7 months) and their mothers were administered standardized scales twice across 1 year. The scales assessed the children's trust beliefs in physicians, the mothers' trust beliefs in physicians, the children's quality of life and the children's adherence to prescribed medical regimes. Quadratic relationships were found between the children's quality of life and both their and their mothers' trust beliefs in physicians. The quadratic relationship increased over time. Linear relationships were found between trust beliefs in physicians and children's adherence to prescribed medical regimes. Children with asthma are prone to a lower quality of life when they and their mothers hold very high, as well as hold very low, trust beliefs in physicians. Children's trust beliefs in physicians increase the probability of adherence to prescribed medical regimes.

A Systematic Review of the Influence of Aquatic Exercises on the Physical and Psychological Health of Children with Autism Spectrum Disorder

Background: Children with Autism Spectrum Disorder (ASD) show significant motor deficits and behavioral dysfunctions, as part of their clinical manifestations. Also, these children are facing important difficulties in social learning, which negatively impacts their adjustment to society’s requirements. Apart from other modes of exercise, aquatic exercises may be more attractive to children. Aquatic exercises have been shown to have a beneficial effect on gross motor skills and executive functions in children with ASD. Aim: To study the influence of aquatic exercises on the physical and psychological health of children with ASD. Methods: Researchers used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews and meta-analyses. Researchers looked for articles on PubMed, Google Scholar, and by manual search. Searched articles were screened for relevancy. Potential articles were selected using inclusion and exclusion criteria. Results: Out of the 231 articles, four studies were included in the current systematic review. The age of participants ranged from 3−15 years. Overall, included studies found improvements in various aspects of gross motor and executive functions by aquatic exercise in children with ASD. Conclusion: Aquatic exercises can provide health benefits to children with ASD. Aquatic exercises can be useful as a part of therapy in children with ASD. There is wide scope for further studies to evaluate the beneficial effects of aquatic exercises.

Cardiovascular Risk in Pediatric Renal Transplant Recipients.

The survival of pediatric chronic kidney disease (CKD) patients has improved in recent decades due to advances in dialysis and transplantation. However, cardiovascular disease (CVD) emerges as the main cause of mortality in patients with CKD. To estimate cardiovascular risk in children with CKD at least 1 year after kidney transplantation. In addition, the possible association of cardiovascular risk with classic biochemical markers and potential new markers of this outcome was investigated. An observational ambidirectional (retrospective capture of risk factors and prospective study of outcomes) research including 75 patients who underwent renal transplant between 2003 and 2013 with postoperative follow-up of at least 1 year was conducted. The outcome variables adopted were the LV mass Z-score and the presence of coronary calcification on computed tomography using calcium Agatston score. Only one patient had an elevated calcium score, and three children (4%) had an LV mass Z-score ≥ 2.0. After multivariable analysis, only gender, serum triglyceride, and serum renalase concentration remained significantly associated with LV mass. The low incidence of cardiovascular changes in the population studied confirms the benefit of transplantation for the cardiovascular health of children. Nevertheless, long-term follow-up of these patients is recommended, given the limited duration of kidney function provided by transplantation and the high likelihood of further dialysis and kidney transplants being required in these children.

Congenital Anomalies of the Kidney and Urinary Tract in Patients with Hirschsprung Disease.

To determine the frequency and types of congenital anomalies of the kidney and urinary tract (CAKUT) in patients with Hirschsprung disease. An observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan, from June to December 2022. All patients with biopsy-proven Hirschsprung disease were included. Ultrasound was done to find out the anatomical and structural anomalies of the kidney and urinary tract. Functional assessment was done by renal function tests and MAG3 radioisotope scan where indicated. Fisher's exact test was applied to find out the association. A p ≤0.05 was taken as significant. Out of a total of 83, 15 (18.0%) patients had CAKUT. The mean age of the study population was 5.5 ± 2.3 years. It included 61 (73.5%) males and 22 (26.5%) females. No significant association was found between the type of Hirschsprung disease and CAKUT (p = 0.7). The gender distribution between CAKUT patients was also insignificant (p = 0.7). Renal hypoplasia was the most common anomaly found in six patients followed by hydronephrosis due to pelvi-ureteric junction obstruction in four children. All of these children were asymptomatic. Five male patients had undescended testis. Nearly a fifth of the children with Hirschsprung disease had CAKUT of whom renal dysplasia was the most common anomaly. There was no gender predilection and patients were asymptomatic regarding the urinary system. A routine ultrasound abdomen is a good screening investigation for identifying CAKUT. Hirschsprung disease, Kidney and urinary tract, Congenital diseases of the urinary tract, Congenital anomalies.

EDCs: a threat to child health

EDCs: a threat to child health

The long-term effects of cash transfer programmes on young adults' mental health: A quasi-experimental study of Colombia, Mexico and South Africa.

Poverty is associated with poorer mental health in early adulthood. Cash transfers (CTs) have been shown to improve child health and education outcomes, but it is unclear whether these effects may translate into better mental health outcomes as children reach young adulthood. Using a quasi-experimental approach that exploits variation across countries in the timing of national CT programme introduction, we examine whether longer exposure to CTs during childhood (0-17 years) reduces depressive symptoms in early adulthood (18-30 years). Based on harmonized data from Colombia, Mexico and South Africa (N= 14 431) we applied logistic regression models with country- and birth-cohort fixed effects to estimate the impact of cumulative years of CT exposure on mental health, educational attainment and employment outcomes. Our findings indicate that each additional year of CT exposure during childhood is associated with a 4% reduction in the odds of serious depressive symptoms in early adulthood (OR = 0.96, 95% CIs: 0.93 to 0.98). We find no consistent effect of years of exposure on completion of secondary school (OR = 1.01, 95% CIs: 0.99, 1.03), and a negative effect on the probability of employment in early adulthood (OR = 0.90, 95% CIs: 0.88, 0.91). These results suggest that longer exposure to CTs may contribute to modest but meaningful reductions in population level depressive symptoms during early adulthood.

Collaboration to Reduce Sudden Unexpected Infant Death With Child Fatality Review and Outreach.

Sudden unexpected infant death (SUID) is the leading cause of postneonatal infant mortality in the United States, with disproportionately high rates in Baltimore City and Baltimore County in Maryland. This Advocacy Case Study describes the collaboration between the City and County Child Fatality Review teams to decrease infant mortality. B'more for Healthy Babies, formed in 2009 by the Bureau of Maternal Child Health in Baltimore City with the goal of reducing infant mortality through policy change, service improvements, community mobilization, and behavior change has had a sustained effort to respond to SUID. Recognizing that infants born in Baltimore City often reside in Baltimore County (and vice versa), collaboration with Baltimore County has been essential to increasing B'more for Healthy Babies' scope, reach, and effectiveness. Public health messaging campaigns, creation, and dissemination of a "SLEEP SAFE" testimonial video, and Safe Sleep Summits have involved caregivers, healthcare providers, and community partners. Outcomes of this ongoing collaboration demonstrate a decrease in sleep-related infant mortality rates. Our findings also highlight the need for continued, real time monitoring of sleep-related infant mortality trends with a coordinated, multidisciplinary, and crossjurisdictional response. This initiative can serve as a model of cross-sector communication that can be replicated in other similar geographic locations to further reduce SUID.

Web-Based Intervention (SunnysideFlex) to Promote Resilience to Posttraumatic Stress Disorder Symptoms During Pregnancy: Development and Pilot Study.

Approximately 4% to 8% of pregnant individuals meet the criteria for current posttraumatic stress disorder (PTSD), a known risk factor for a multitude of adverse maternal and child health outcomes. However, PTSD is rarely detected or treated in obstetric settings. Moreover, available prenatal PTSD treatments require in-person services that are often inaccessible due to barriers to care. Thus, web-based interventions offer great potential in extending PTSD treatment to high-risk pregnant individuals by providing affordable, accessible care. However, there are currently no web-based interventions designed specifically for the treatment of PTSD symptoms during pregnancy. This study aims to develop and pilot a 6-week, web-based, cognitive behavioral therapy intervention for PTSD, SunnysideFlex, in a sample of 10 pregnant women with current probable PTSD. Consistent with established guidelines for developing and testing novel interventions, the focus of this pilot study was to evaluate the initial feasibility and acceptability of the SunnysideFlex intervention and preintervention to postintervention changes in PTSD and depression symptoms. This approach will allow for early refinement and optimization of the SunnysideFlex intervention to increase the odds of success in a larger-scale clinical trial. The SunnysideFlex intervention adapted an existing web-based platform for postpartum depression, Sunnyside for Moms, to include revised, trauma-focused content. A total of 10 pregnant women in weeks 16 to 28 of their pregnancy who reported lifetime interpersonal trauma exposure (ie, sexual or physical assault) and with current probable PTSD (scores ≥33 per the PTSD checklist for DSM-5) were enrolled in the SunnysideFlex intervention. Assessments took place at baseline and 6 weeks (postintervention). All participants were retained through the postintervention assessment period. Engagement was high; participants on average accessed 90% of their lessons, logged on to the platform at least weekly, and reported a generally positive user experience. Moreover, 80% (8/10) of participants demonstrated clinically meaningful reductions in PTSD symptoms from baseline to postintervention, and 50% (5/10) of participants no longer screened positive for probable PTSD at postintervention. Most (6/10, 60%) of the participants maintained subclinical depression symptoms from baseline to postintervention. Findings from this small pilot study indicate that SunnysideFlex may be a feasible and acceptable mechanism for delivering PTSD intervention to high-risk, trauma-exposed pregnant women who might otherwise not have opportunities for services. Larger-scale trials of the intervention are necessary to better understand the impact of SunnysideFlex on PTSD symptoms during pregnancy and the postpartum period.

Intermittent preventive treatment for malaria in pregnancy and infant growth: a mediation analysis of a randomised trial

Intermittent preventive treatment for malaria in pregnancy (IPTp) can improve birth outcomes, but whether it confers benefits to postnatal growth is unclear. We investigated the effect of IPTp on infant growth in Uganda and its pathways of effects using causal mediation analyses. We analysed data from 633 infants born to mothers enrolled in a randomised trial of monthly IPTp with dihydroartemisinin-piperaquine (DP) vs. sulfadoxine-pyrimethamine (SP) (NCT02793622). Weight and length were measured from 0 to 12 months of age. Using generalised linear models, we estimated effects of DP vs. SP on gravidity-stratified mean length-for-age (LAZ) and weight-for-length Z-scores (WLZ). We investigated mediation by placental malaria, gestational weight change, maternal anaemia, maternal inflammation-related proteins, preterm birth, birth length, and birth weight. Mediation models adjusted for infant sex, gravidity, gestational age at enrolment, maternal age, maternal parasitaemia at enrolment, education, and wealth. SP increased mean LAZ by 0.18-0.28 Z from birth through age 4 months compared to DP, while DP increased mean WLZ by 0.11-0.28 Z from 2 to 8 months compared to SP among infants of multigravidae; at these ages, confidence intervals for mean differences excluded 0. We did not observe differences among primigravida. Mediators of SP included birth weight, birth length, maternal stem cell factor, and DNER. Mediators of DP included placental malaria and birth length, maternal IL-18, CDCP1, and CD6 at delivery. In high malaria transmission settings, this exploratory study suggests different IPTp regimens may influence infant growth among multigravidae, potentially through distinct pathways, in the exclusive breastfeeding period, when few other interventions are available. Stanford Center for Innovation in Global Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bill & Melinda Gates Foundation.

Breastfeeding practices amongst immigrants living in Finland: results from the FinChildren survey

BackgroundBreastfeeding is a corner of child health and survival as it provides crucial, non-replaceable nourishment necessary for infant's growth and development . Immigration has been shown to influence breastfeeding particularly among immigrants from low-and-middle-income countries. Our aim was to examine breastfeeding practices and sociodemographic characteristics of Somali/Arabic and Russian speaking in comparison with Finnish speaking mothers. MethodsWe analyzed data from 5348 mothers with infants who participated in FinChildren survey conducted in 2020. Univariate and multivariate analysis was used to estimate the association between maternal origin and breastfeeding practices by comparing immigrant mothers and native-born mothers. ResultsSomali/Arabic-speaking mothers were younger, less educated and had higher BMI than Russian and native Finnish speaking mothers. Proportions of exclusive breastfeeding at 4-5 months of age were lowest among Somali/Arabic speaking mothers (21 %) compared to native-born (49 %) and to Russian-speaking mothers (52%) Again, Somali/Arabic-speaking mothers had the highest proportions of mixed feeding (66%) compared to native Finnish-speaking (38 %) and Russian-speaking mothers (32%) Being a Somali/Arabic-speaking mother decreased the odds of exclusive breastfeeding (OR 0.20, 95% CI 0.10-0.45) and quadrupled (OR 4.0, 95% CI 2.18-7.37) the odds of mixed feeding at 4-5 months of age. ConclusionEven though the number of immigrant mothers was low, this study suggests that maternal origin is a significant predictor of suboptimal breastfeeding independent of sociodemographic and antenatal characteristics. There is a need for culturally sensitive interventions to promote breastfeeding among these groups.

Family-based mobile application needs in childhood obesity management in South Korea: a qualitative study.

It is essential to investigate the users' needs in developing user-centered, family-based applications (apps) for managing childhood obesity. This study conducted focus group interviews with ten parents, ten children, and four app developers to investigate the need to develop a family-based mobile app for childhood obesity. The interview period was from July 17 to August 30, 2023. The data were analyzed using thematic analysis. The results highlighted 31 key themes critical to family-based app development, including the need for comprehensive content promoting healthy lifestyle habits, tailored expert support, and motivational factors for app engagement, which were categorized as intrinsic, extrinsic, and social motivations and technological features. Participants also highlighted potential challenges, such as app usability issues and the need for a user-friendly interface. The pivotal role of parents in guiding and supporting their children's health behaviors was emphasized, particularly in creating a supportive environment that encourages sustained engagement with the app. These findings provide a comprehensive understanding of the needs and preferences of parents, children, and app developers in managing childhood obesity. Emphasis on integrating healthy lifestyle content, providing expert support, and incorporating motivational strategies is crucial for the app's success. Additionally, addressing potential difficulties and recognizing the pivotal role of parents are essential considerations. These insights will inform the design and development of a user-centered mobile app that supports families in managing childhood obesity.

Parental Awareness, Understanding, and Factors of Stunting among Preschool Children

Undernutrition, including stunting, is a global issue, with significant prevalence in Asia, including Malaysia. Stunting, characterized by low height-for-age in children under five, is a critical health concern. This study focused on parents in Puncak Alam, Selangor, to assess their awareness and understanding of stunting factors. Using a cross-sectional quantitative approach with 137 participants, the study found that most parents had a good awareness and understanding of stunting. Parental education emerged as a key factor influencing understanding. These findings can guide policymakers and health professionals in reducing stunting and improving children's health in Malaysia.

Machine Learning Analysis of Factors Influencing Pediatric Telehealth Visits During COVID-19: A State-Level Comparison Using 2021–22 National Survey of Children’s Health Data

Background/Objectives: The COVID-19 pandemic reduced in-person pediatric visits in the United States by over 50%, while telehealth visits increased significantly. The national use of telehealth for children and the factors influencing their use have been rarely studied. This study aimed to investigate the prevalence of telehealth use during the COVID-19 pandemic and explore the potential factors linked to its use at the state level. Methods: A cross-sectional study of the National Survey of Children’s Health (2021–22) sponsored by the federal Maternal and Child Health Bureau was performed. We used the least absolute shrinkage and selection operator (LASSO) regression to predict telehealth use during the pandemic. A bar map showing the significant factors from the multivariable regression was created. Results: Of the 101,136 children, 15.25% reported using telehealth visits due to COVID-19, and 3.67% reported using telehealth visits due to other health reasons. The Northeast states showed the highest telehealth use due to COVID-19. In the Midwest and Southern states, children had a lower prevalence of telehealth visits due to other health reasons. The LASSO regressions demonstrated that telehealth visits were associated with age, insurance type, household income, usual source of pediatric preventive care, perceived child health, blood disorders, allergy, brain injury, seizure, ADHD, anxiety, depression, and special needs. Conclusions: This study demonstrated significant variability in the use of telehealth among states during the COVID-19 pandemic. Understanding who uses telehealth and why, as well as identifying access barriers, helps maximize telehealth potential and improve healthcare outcomes for all.

Health promotion intervention in at-risk South African primary schools

Background: Interventions to promote health have been implemented in some urban settings. However, school-based health promotion interventions in at-risk urban schools have not been thoroughly investigated. Objective: This article investigates teachers’ perceptions regarding health promotion interventions with the main goal of establishing social change in at-risk school communities. Design: The study used phenomenology as a theoretical lens supported by the use of a qualitative research approach. As a theoretical framework, the researchers utilised Vygotsky’s sociocultural theory. Setting: The investigation used a descriptive case study design to select 17 teachers from 2 at-risk urban primary schools in Pretoria. Methods: Visual data including participatory reflection action posters and photographs, and field notes were part of the data collection techniques. Findings: Teachers’ responses informed how school-based health promotion interventions can be developed in the foundation phase of education. Themes relevant to this included recognition of the importance of education in bringing about social change; involving the whole community in developing health promotion projects; working closely with parents; promoting physical activity; and advocating for nutritional literacy. Goals can best be achieved through a focus on nutritional needs, physical health and social needs of at-risk communities. Conclusion: Findings from this study can be used to inform at-risk communities about food consumption, optimum physical activities and positive socio-emotional actions. Beyond this, young professionals entering the field of education should be encouraged to develop awareness of how school-based health promotion programmes can benefit the health and well-being of children.

The Cross-Sectional and Longitudinal Associations Between Adherence to 24-Hour Movement Behavior Guidelines and Bone Health in Young Children

Background: Adherence to the World Health Organization’s 24-hour movement behavior (24-HMB) guidelines is associated with various health outcomes. However, its relationship with bone mineral density (BMD) in young children has not been investigated. This study aimed to examine the cross-sectional and longitudinal associations between adherence to the 24-HMB guidelines and BMD in young children. Methods: A total of 120 children aged 3–5 years were recruited from three kindergartens in Changsha, Hunan, China. Physical activity (PA) was objectively measured using ActiGraph wGT3X-BT accelerometers, and BMD was assessed using the Sunlight Omnisense 7000P ultrasound device. Screen time (ST) and sleep duration (SD) were reported by parents. Logistic regression was used to analyze the associations between guideline adherence and BMD. Results: Only 5.5% of the participants met all three guidelines for PA, ST, and SD, while 16.5% did not meet any. In the cross-sectional analysis, young children who met both ST and SD guidelines (OR = 0.29, 95% CI: 0.09, 0.95) had a lower risk of insufficient BMD compared to those who met none. In the one-year cohort follow-up, young children who met the PA guideline at baseline (OR = 0.22, 95% CI: 0.07, 0.71), as well as those who met both the PA and ST guidelines (OR = 0.18, 95% CI: 0.04, 0.83) or all three (OR = 0.13, 95% CI: 0.03, 0.69), had a lower risk of insufficient BMD at one year. Conclusions: Adherence to the 24-HMB guidelines may promote bone health in young children. Future research should prioritize achievable goals, such as limiting ST and ensuring adequate SD, while gradually increasing MVPA to optimize bone development.

Nurse leaders’ recommendations for implementing LGBTQ+ inclusive practices in health systems: A qualitative descriptive study

BackgroundDiscrimination against lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) individuals in healthcare settings remains a priority issue. Nurse leaders, who oversee the largest healthcare workforce, are critical in implementing inclusive practices to address LGBTQ+ discrimination, yet implementing LGBTQ+ inclusive practices and effective strategies is inconsistent. This qualitative descriptive study explored nurse leaders’ perceptions of LGBTQ+ inclusive practices across the United States to inform recommended strategies within health systems. MethodsTwenty-one nurse leaders (e.g., chief nurse executives) from diverse healthcare settings (e.g., children's hospitals and public health centers) in 12 states across the United States participated in semi-structured interviews from October to December 2023. Interview transcripts were analyzed using content analysis to (1) describe nurse leaders’ definitions of LGBTQ+ inclusive practices and (2) identify effective strategies for their implementation. ResultsNurse leaders defined LGBTQ+ inclusive practices to include delivering culturally responsive and competent care, fostering safe and affirming environments, integrating inclusivity into daily interactions and organizational culture, and supporting the needs of both LGBTQ+ staff and patients. Key implementation strategies included fostering a flexible organizational culture through open communication; a diverse workforce; and inclusive mission statements, policies, and strategic plans. Supportive infrastructure involved effective LGBTQ+ training and adapting electronic health record systems to include information on sexual orientation and gender identity. Active and interdisciplinary engagement from staff and leadership, as well as systematic data collection on patient and staff experiences, were essential for driving inclusivity. The advocacy highlighted included legislative support, discourse within the nursing profession, and the incorporation of LGBTQ+ inclusion into healthcare regulations and accreditation standards. Additionally, multisectoral partnerships with LGBTQ+ health experts and external organizations, along with multilevel evaluations, were recommended to develop tailored interventions and promote LGBTQ+ inclusive practices. ConclusionImplementing LGBTQ+ inclusive practices in healthcare is a multifaceted effort influenced by strategies at various levels. Promoting a supportive organizational culture, establishing comprehensive support structures, encouraging active engagement, and fostering community partnerships can address the needs of LGBTQ+ individuals more effectively. Future implementation efforts should tailor strategies to accommodate variability across healthcare settings and regions, ensuring that practices are both adaptable and sustainable.

Remember Darwin: Individualism, Neuroscience and Language

Individualism has been a constant theme of the development of child and adolescent mental health since at least 1870. Freud’s Scientific Project is an exercise in neurological individualism as have many subsequent neuroscience projects. Just because bodies contain neurological and chemical circuits, it does not mean that mammalian animals are discrete. Mammals live in communication networks and humans have evolved to make those networks linguistic. It is species adaptations that are manifest in the lives of single members of a species and provide for fitness to environment. The many biological scientists that call themselves neurologists have been prone to misunderstand this Darwinian premise.