Abstract Background Internalising and externalising behaviours—significant markers for lifetime psychiatric vulnerability—are elevated in children with neurodevelopmental diagnoses, including autism. Although neurodevelopmental features of autism are dimensions that span the population, limited research has examined their differential patterns of association with internalising and externalising behaviours in children without specific, categorically‐defined diagnoses. Evidence of such associations outside of a traditional diagnostic context may enable more targeted support for children's individual needs, irrespective of diagnoses. The current study aimed to characterise the relationship between neurodevelopmental features found in autism—restricted and repetitive behaviours (RRB) and social communication difficulties—and internalising and externalising behaviours in children from mainstream school who experience emotional, behavioural, or cognitive challenges. Methods We recruited 136 6–7‐year‐olds without known clinical conditions but with school‐identified emotional, behavioural or cognitive difficulties. The Repetitive Behaviour Questionnaire‐2 assessed RRBs, the pragmatics scale from the Revised Children's Communication Checklist‐2 assessed social communication, and the Strengths and Difficulties Questionnaire examined internalising and externalising behaviours. Results Simultaneous hierarchical linear regression analysis identified differential associations when adjusting for covariance between internalising and externalising. Social communication made a stronger contribution than RRBs to variance in externalising behaviours ( F change (1, 131) = 11.84, p < 0.001). However, for internalising behaviours, RRBs made the strongest contribution ( F change (2, 131) = 8.19, p < 0.001). The insistence on sameness subdomain of RRB predicted variance in internalising but not externalising behaviours independently of social communication while the repetitive sensory and motor behaviour subdomain predicted variance in externalising but not internalising behaviours, but only when social communication was not included. Conclusion These findings will inform future research aimed at understanding the co‐occurrence of traits across diagnostic boundaries. Evidence that RRBs and social communication are differentially associated with internalising and externalising behaviours may identify target areas for the support of children with emotional and behavioural difficulties, a group whose co‐occurring neurodevelopmental features are often under‐recognised.

ABSTRACT Many models describing the choice and engagement with Pro-Environmental Behaviour (PEB) lean heavily on Local Ecological Knowledge (LEK) and Place Attachment (PA) as essential components and are designed for adults. The few child-based models often overlook other key components. This study learns from 9 to 10 year-old children living in the Galápagos Islands, Ecuador, that there is place- and age-based uniqueness of LEK, PA, and PEB, and also that environmental emotions and agency to engage in experiential learning are mediators of LEK, PA, and PEB. Galápagos, an Ecuadorian National Park and UNESCO Natural World Heritage Site, is a small equatorial archipelago, where the human population is recently established and thus not Indigenous to the islands, and whose ecosystems are facing increasing climate impacts. We adopt the framework of childism to centre children’s experiences and thoughts. Children exemplified robust and locationally unique LEK, PA, and PEB, but additionally shared environmental emotions and agency to engage in abundant environmental experiences which connected and mediated LEK, PA, and PEB. This case study provides support for children’s role in local conservation to support climate action in other young global communities.

As housing markets become increasingly unaffordable, there has been growing interest in the role of intergenerational transfers for enabling first homeownership. However, there is little understanding of parents’ motivations to assist their children and how these motivations are formed. Drawing on semi-structured interviews and focus groups with Australian parents, we find that while parents appear largely motivated by altruistic intents, with little expectation of direct reciprocity, the divide between altruism and reciprocity is often blurred by evidence of indirect, hidden or heritage driven reciprocities. In terms of fairness concerns, parents with multiple children are keen to ensure fair treatment across siblings, but we find that parental concerns for fairness extend beyond the family to addressing intergenerational unfairness. Important, some forms of parental assistance are fraught with financial risks, and some parents also exhibit an aversion to loss of family wealth to children’s future partners and apply intentional strategies to mitigate this risk when their children form new relationships. Thus, in practice, parental support for children’s home purchase is a highly complex endeavour that challenges traditional economic assumptions of rational choice.

Background: Non-suicidal self-injury (NSSI) in adolescents is a significant clinical and social concern, particularly among girls. It is associated with anxiety, maladaptation, and lack of social support. Despite increasing research attention, the interplay of these factors in clinical samples in Russia remains insufficiently explored. Objective. To analyze the relationships between anxiety levels, socio-psychological adaptation, perceived social support, and clinical characteristics in adolescent girls with NSSI in order to identify key psychological and social factors associated with this behavior. Patients and Methods: A crosssectional study with prospective data collection was conducted. The sample included 186 girls aged 12–17 years with confirmed NSSI episodes, undergoing inpatient treatment. Psychometric tools: Multidimensional Assessment of Child Anxiety (MODT), Socio-Psychological Adaptation Scale (SPA), Child and Adolescent Social Support Scale (CASSS). Statistical analysis included descriptive methods, Mann-Whitney U-test, and Spearman’s correlation. Results: Participants demonstrated high anxiety levels (M = 5.12 on MODT), particularly in situations of social evaluation (M = 5.41) and self-expression (M = 5.5). Adaptation deficits (SPA integral score: M = 59.28) correlated with anxiety (r = –0.74). Low parental (M = 50.02) and teacher support (M = 47.01) were more pronounced in affective disorders (p < 0.001). Conclusion: The results confirm the association between anxiety and a lack of social support with NSSI in adolescent girls. A comprehensive approach is recommended, including psychotherapy, family counseling, and school-based prevention programs.

Zika virus (ZIKV) infections have impacted public health in Brazil since 2015, primally due to Congenital Zika Virus Syndrome (CZVS) cases, which may lead to microcephaly and other clinical manifestations, such as hearing and visual impairments. More than ten years after the first diagnosis of Zika in Brazil, some progress has been made and the epidemiological scenario has improved considerably. However, despite these advances, more than a thousand ZIKV infections are reported annually in Brazil and new CZVS cases continue to be observed. Herein, we performed a retrospective and prospective analysis to assess the progress made and identify gaps and challenges that still need to be addressed. Overall, we believe that future ZIKV control efforts in Brazil must include: enhanced vector control measures; surveillance for potential vertebrate reservoirs; medical care for pregnant women, including prevention of infection and vertical transmission; sensitive and specific intrauterine CZVS diagnosis; ongoing support for children and families with CZVS cases; expansion of the national diagnostic network for arboviruses, including encouraging healthcare professionals to perform laboratory tests; assessment of the impactof the dengue vaccine, recently implemented in Brazil, on ZIKV infections; and affordable, sensitive and specific multiplex diagnostic strategies adequately validated for cross-reactivity with other arboviruses circulating in Brazil.

It is a well-established fact that adequate social security measures are used as a tool to allow persons a measure of financial security and support in the event of certain contingencies. In South Africa, the disability grant is intended to be income replacement for persons with disabilities who are unable to work as a result of their disability. Persons with disabilities represent approximately 6% of the population of South Africa. However, they only represent an average of 1% of the workforce in South Africa. This means that persons with disabilities are proportionally underrepresented in the workforce. As of 31 March 2024, there were 19.1 million social grants paid monthly in South Africa. Of these, 13.2 million are the child support grant (paid to the caregivers of children under 18 years of age), 4 million are the older persons grant (paid to persons over 60 years of age) and 1.06 million are the disability grant. The disability grant is thus the third largest group of social grant recipients and is the only one of the top three groups of persons who are of working age (ie aged 18 – 59). The aim of the paper is to consider measures to reduce growth in the number of disability grants paid in South Africa and simultaneously increase the number of persons with disabilities in employment.

A qualitative study of age-specific care needs in patients with early-onset advanced colorectal cancer.

The US Department of Veterans Affairs (VA) healthcare system is dedicated to preventing veteran homelessness, but there is limited research on the specific sources of financial debt among homeless veterans. We investigated the proportion of veterans seeking VA homeless services reporting any debt and specific types of outstanding debt, associations between homelessness experiences and debt, and whether these associations vary by sex. Using VA administrative data, we cross-sectionally evaluated various types of outstanding debt among 118 594 homeless and at-risk veterans in the VA healthcare system from fiscal years 2023-2024. Multivariable logistic regression models were constructed for history of homelessness experiences in relation to any and different types of financial debt, overall, and by sex. About 48% of veterans in VA homeless programs had outstanding debt, with credit cards being the most prevalent contributors to debt. Outstanding debt related to student loans, child support, medical expenses, and tax bills were significantly associated with greater episodes of recent homelessness. Medical expenses, fines, or other legal obligations were significantly associated with lifetime homelessness duration. Housing loans were associated with shorter duration and fewer episodes of homelessness (over the past 3 years). Similar patterns were observed among male and female veterans. Financial debt is linked to prolonged homelessness among veterans, necessitating increased social services for financial literacy, debt consolidation, and other interventions to mitigate risks.

We documented how many adolescents contribute to their families through chores, emotional support, earning wages, and caregiving for children and family members with chronic illness. Further, we examined whether adolescents who contribute to their families in more ways differ in mental health from peers, controlling for social and economic resources, and with attention to potential demographic moderators. We drew from a diverse survey of 1854 adolescents ages 14-17 in Massachusetts (60% girls, 52% White non-Hispanic, 19% Hispanic, 9% Black, 6% Asian). Adolescents who contributed to their families in relatively more ways were disproportionately older, girls, and Hispanic, and from families with relatively lower levels of social and economic resources. Contributing to the family in more ways was associated with significantly higher levels of distress (i.e., anxiety and depression symptoms), controlling for background demographics. This association was consistent across age, gender, and racial/ethnic groups. It was also significant for youth from homes within all levels of social and economic resources, although it was stronger among youth from homes with relatively higher (compared to lower) levels of social and economic resources. These findings suggest that contributing to the family in many ways could be emotionally taxing over time, even though prior daily diary studies show it can also be rewarding day to day. Perhaps surprisingly, it may be especially taxing for adolescents from more advantaged homes who are less likely to help the family overall. More long-term, within-subject studies are needed to adjust for numerous co-occurring family circumstances and resources that may confound our findings.

Introduction: Rates of extracorporeal life support (ECLS) for children with critical illness have doubled in the last decade. This increase has been associated with a significant burden of morbidity amongst ECLS survivors. Our objective was to identify demographic, clinical, and ECLS-related variables associated with favorable neurologic and functional outcomes in pediatric survivors of ECLS. Methods: Multicenter retrospective cohort study utilizing the Pediatric ECMO Outcomes Registry (PEDECOR). Survivors of ECLS aged 30 days to 18 years across 10 years (2015-2024) were included. Neonates and those who received cardiopulmonary bypass were excluded. Favorable neurologic and functional outcomes were defined as a change in Pediatric Cerebral Performance Category (PCPC) score or Functional Status Score (FSS) of ≤2 or unchanged from baseline, respectively. Logistic regression models were used to assess the association between study variables and outcomes. Results: Of 139 included patients, 94% had a favorable neurologic outcome and 66% had a favorable functional outcome. ECLS type was a nearly even distribution between Veno-arterial and Veno-venous (48% vs. 52%). Patients with longer median time to cannulation from intubation, primary diagnosis of infection, autoimmune, or multisystem disorder, age ≤ 2 years, and longer median time in the PICU after decannulation had significantly lower odds of favorable functional outcome in the unadjusted analysis (p< 0.05 for all). In the adjusted models, each additional day of ECLS was associated with 30% lower odds of a favorable functional outcome (p< 0.001). Patients who received ECLS for an infectious or autoimmune indication had 96% lower odds of a favorable functional outcome compared to those who received ECLS for a cardiovascular indication (p=0.012). The effect of ECLS duration on functional outcome was modified by age and history of a neurologic disorder. ECLS type was not significantly associated with functional outcome. No study variables were associated with a favorable neurologic outcome. Conclusions: Among pediatric survivors of ECLS, we observed high rates of favorable neurologic and functional outcomes. Factors independently associated with a worse functional outcome were younger age and indications for ECLS due to infectious or autoimmune conditions.

Losing a parent in childhood can significantly impact the child, yet little research examines how cause of parental death may affect children differently. This study aims to investigate risks of deliberate self-harm (DSH) and suicide in bereaved children by parental cause of death. Data from Norwegian population registers were interlinked to investigate exposure to parental death from specific causes and risks of DSH and suicide via a nested case-control design. Children under the age of 35 who were treated for DSH (n=20,180) or died by suicide (n=5039) constituted the cases and were compared with population controls of 20 per case matched by gender and age. Conditional logistic regression models were used to assess the risk. In the study population, 9.7% of the DSH cases and 13.1% of the suicide cases lost a parent. The risk of DSH was increased for bereaved children [OR=1.54, 95%CI 1.46-1.62], with the highest risk associated with parental death caused by mental diseases [2.84, 2.34-3.44], followed by accidental poisoning and suicide. The risk of suicide was significantly increased for bereaved children after parental death [1.28, 1.17-1.40], with the highest risk associated with parental death caused by homicide [4.68, 2.18-10.02], followed by suicide and accidental poisoning. No gender interactions or gender-of-deceased interactions was detected. Parental-bereaved children are at significantly increased risk of DSH and suicide in early life, but the risk differ by parental cause of death. This underscores the importance of psychosocial and familial support for children following a parental loss.

Children in contact with children's social care (CSC) services have high levels of hospital utilisation, but patterns before and after referral remain insufficiently understood. To evaluate healthcare utilisation two years before and after CSC referral. Retrospective cohort using ECHILD linked health and social care data, including children with a first CSC referral between 2009 and 2018 in England. We compared monthly planned and unplanned hospital contact rates for Children in Need, Children under Protection Plans, and Children Looked After with age-sex-matched cohorts. We used interrupted time series analysis to examine how healthcare utilisation changed following referral. We also explored reasons for hospital contacts. We analysed >12 million hospital contacts for 1,014,330 Children in Need, 204,240 Children under Protection Plan and 177,640 Children Looked After. Children Looked After had the highest average number of total contacts (11.8 per child over a 4year period), followed by Children in Need (8.8) and Children under Protection Plans (8.4). All CSC groups had about twice the contacts of matched peers. Healthcare utilisation increased sharply prior to referral, with a peak around referral. After referral, planned care increased and unplanned care decreased, with pre referral upward trends slowing or reversing. The most common reason for healthcare utilisation was mental health-related. At a population level, CSC referral marks a pivotal point in healthcare utilisation, with a shift from unplanned to planned care. This may reflect more structured engagement with health services and coordinated support for children and families.

Long-term outcomes of preterm children

A study on user satisfaction with medical devices for the elderly: The case of blood pressure monitors.

License suspension and civil contempt have long served as mainstays for enforcing child support orders when obligors do not pay the support they owe. Yet, among growing concerns about their consequences, much remains unknown about when and how they are used. In this study, we aim to: (1) examine how and when license suspension and civil contempt are used in one state; and (2) identify potential disparities in use by obligor characteristics. We use an explanatory mixed methods approach, drawing on both state administrative records and interviews with child support agency staff, to investigate how often and under what conditions these tools are used. Obligors experienced contempt-related enforcement actions more frequently than license suspension-related actions and threats occurred more frequently than imposition. This aligns with interviews which suggested that staff take a range of other actions before warnings and sanctions. We also identified changes in frequency of use of these tools pre- and post-issuance of the 2016 Final Rule and find differences in use and staff approaches by obligor characteristics. Findings highlight the role of proactive outreach strategies in building trust and affecting child support compliance. Additionally, we find a decrease in contempt actions over time, following policy guidance, suggesting that official guidance may be effective in steering practice and possibly increasing consistency in use of tools. Finally, because different approaches may work for different obligors, a multipronged approach may be needed.

Background: Pediatric visual impairment is an underrecognized health disparity affecting developmental, educational, and social outcomes. Medical education offers limited exposure to visual impairment in the pediatric population. OptiKids Outreach was initiated by medical students at the University of Louisville School of Medicine to help educate students about children with visual impairment and their resilience. Objective: To evaluate medical students’ early awareness, engagement, and support for children with visual impairment through “Resilience and Living with Vision Loss,” a patient-centered panel conducted by OptiKids Outreach and Visually Impaired Preschool Services. Methodology: A novel pre- and post-panel survey tool evaluated 60 medical students in three key areas: (1) awareness, (2) engagement, and (3) support for visually impaired children. Students were evaluated before and after an in-person panel of families from Visually Impaired Preschool Services. Discussions included the lived experiences of childhood vision loss and barriers to access and education among healthcare providers. Data was analyzed using two-tailed paired t-tests, with statistical significance set at p &lt; 0.05. Results: Post-panel survey results demonstrated statistically significant improvements across all measured domains. Average awareness scores increased from 4.17 (standard deviation (SD) = 1.05) to 5.20 (SD = 0.82) (p &lt; 0.001), engagement scores rose from 13.02 (SD = 3.03) to 16.58 (SD = 1.87) (p &lt; 0.001), and support scores improved from 12.42 (SD = 3.25) to 16.51 (SD = 2.14) (p &lt; 0.001). Conclusion: Patient-centered panels like the OptiKids Outreach panel may serve as educational tools to enhance early medical student awareness, engagement, and support for visually impaired children.

Children living in custodial-mother families are disproportionately poor as compared to children living with both parents. Child support from the noncustodial father is associated with lower poverty rates among custodial-mother families, suggesting that policies to promote child support payments improve the economic well-being of these families. Yet, we do not know whether child support remains a protective factor against child poverty when other anti-poverty strategies are considered, and whether this association remains significant throughout childhood, especially in middle- and low-income countries. We contribute to addressing these research gaps by investigating the following questions in Chile and Colombia: (1) How do child poverty and child support receipt change over time among children in custodial-mother families? (2) To what extent does child support protect these children against concurrent poverty? And (3) To what extent does child support protect these children against future childhood poverty? We find that chronic poverty is common among children in custodial-mother families in both countries, but a higher proportion of Colombian children remain poor throughout their childhood. In both countries child support is inconsistently received, but a higher proportion of Chilean children receive child support throughout their childhood. Child support is associated with a 6-8 percentage point decline in concurrent poverty in both countries. However, child support is associated with a decline in future childhood poverty only in Chile. Our findings highlight the importance of cross-national research to better understand the strengths and limitations of child support policy as a strategy to address child poverty.

When the court explicitly acknowledges a father's economic incapacity, child support obligations after divorce create acute legal tension. This article looks at a confusing situation in child support decisions after divorce, based on Decision Number 4501/Pdt.G/2024/PA.Jr. from the Jember Religious Court, Indonesia, where the court required a fixed child support payment even though the father had proven he couldn't afford it. The case highlights a bigger problem that courts face in areas with different laws and economic challenges: how to balance the need to protect children with the reality that some financial obligations may not be possible to enforce. This study uses a legal approach to analyse laws, court decisions, and important Islamic legal sources to assess whether the court's reasoning is fair. The findings reveal a structural inconsistency. Even though the court referenced child protection rules and traditional legal views that support parental responsibility, the maintenance order was too high for the father to afford, making it very difficult for him to follow. Through the evaluative lens of Maqāṣid al-Sharīʿah, the decision demonstrates a failure of proportional balancing: the protection of offspring (ḥifẓ al-nasl) was prioritised without adequate consideration of economic preservation and basic welfare (ḥifẓ al-māl and ḥifẓ al-nafs), both foundational objectives within Islamic legal thought. The article argues that this pattern in court decisions shows a common problem in family courts with limited resources, where the legal responsibilities are recognised more than they can actually be enforced. By placing a local decision within this ongoing issue, the study adds to worldwide discussions about fairness, the ability to enforce choices, and the power of judges in child support cases after divorce.

ABSTRACT Access to standardized cognitive assessment remains limited in low- and middle- income countries (LMICs), with direct implications for the identification and support of children with neurodevelopmental disorders. Among these, Autism Spectrum Conditions (ASC) and Attention-deficit/hyperactivity disorder ADHD are highly prevalent and frequently co-occurring yet characterized by distinct cognitive profiles. Online assessment methods represent a promising avenue for scalable, cost-effective screening and research. The present study investigated whether a brief online cognitive task could reliably distinguish performance patterns among children and adolescents with ADHD, ASC, both (ASC + ADHD) and a group of typically developing (TD) peers. Children between the ages of 8 and 14 from diverse regions of Mexico completed a brief online working memory task, where they were required to remember either the identity(N = 61) or the emotional expression (N = 99) of a face. Task completion rates were high, demonstrating the feasibility of remote administration (84.6%). Clinical groups showed expected differences relative to TD peers: the ADHD group was distinguished by poorer overall working memory performance and increased intra-subject variability. The ASC group was selectively impaired in the emotion task. This study demonstrates the feasibility of deploying online cognitive tasks in LMIC contexts, providing a scalable approach to developmental research and early identification and referral. Intra-subject variability is a robust marker for ADHD, while careful future work should continue to disentangle overlapping disorders.

Family-centred, culturally sensitive care is needed as parents navigate uncertain feeding, conflicting beliefs and inadequate support for children with developmental disabilities.