Children's Quality Research Articles

Who Benefits Most from the Family Education and Support Program in Cape Verde? A Cluster Analysis.

Child parenting programs can enhance parental skills, prevent future issues in child development, and improve children's quality of life. The present research aimed to study the changes promoted by the Family Education and Support Program (FAF) implemented in Cape Verde, regarding parental educational practices, perceived parental efficacy, and attitudes and beliefs of Cape Verdean parents. To this end, 37 participants were evaluated through a pretest-postest design. The evaluated dimensions were perceived parental competence, parenting practices, Parental attitudes and beliefs, mental health and perceived child quality of life. A cluster analysis was conducted, distinguishing two groups. Both groups benefited from the program. Cluster 1 reported more significant gains in dimensions of parental efficacy and satisfaction, inadequate expectations, affection and support, and reactivity, while cluster 2 showed a greater difference in regulation and reactivity. Overall, the FAF intervention contributed to an increase in positive parenting practices. By analyzing potential underlying profiles in the change process, this study suggests that there are participants who benefit more than others from the intervention, and this information may be relevant for professionals and researchers in the field.

Investigating the Effectiveness of Equine-assisted Therapy on Children Regardless of Their Mental Disorder

Equine-assisted therapy (EAT) is a common and popular complementary and alternative therapy among children with different mental disorders. In this study, the effectiveness of EAT was investigated on children with diverse mental disorders by analyzing their gait. Fifty-six children (age: 8.30 ± 3.77 years) were involved in the research who participated weekly in equine-assisted therapy during a school year. The gait of the children was measured twice with the GAITRite® pressure-sensing mat, before and after the therapy period. The participants did ten sections of walking on the pressure-sensing mat. Twenty-one spatial and temporal gait parameters were chosen and evaluated for further statistical analysis. To determine the normal distribution of the parameters, the Lilliefors normality test was carried out. Depending on the result, the paired t test or the Wilcoxon signed-rank test was used to compare the means of the results of the two measurements (p < 0.05). Significant differences were observed for eight out of the twenty-one parameters which investigation provides some promising results regarding the benefits of equine-assisted therapy for children's quality of life.

Adaptation and validation of Arabic version of the screening tool of feeding problems applied to children (STEP-CHILD)

Objectives Early identification of pediatric feeding problems is crucial to preventing their subsequent negative impact on children's quality of life. This study aimed to create and validate an Arabic-modified version of the Screening Tool of Feeding Problems Applied to Children (STEP-CHILD) to identify feeding problems in Arabic-speaking children. Methods The STEP-CHILD Arabic was created and administered to the parents/caregivers of 390 Arabic-speaking children aged 2-18 years. 89 typically developing children without feeding/swallowing problems and 301 children with developmental disabilities were included in the study. The data was statistically analyzed to examine the validity and reliability of the questionnaire. Results The STEP-CHILD Arabic demonstrated excellent content validity, face validity, discriminant validity, and convergent validity. Predictive validity showed that the questionnaire has moderate to high accuracy in identifying pediatric feeding problems. It also showed excellent reliability and allowed for determining the specific feeding problems that would be targeted in the intervention. Conclusions The STEP-CHILD Arabic is a valid, reliable, and easily applicable tool that can be used as a routine evaluation for Arabic-speaking children at high risk of feeding problems.

The Influence of Maternal Factors on the Incidence of Stunting in Toddlers: A Narrative Review

Stunting, a severe challenge in the global public health domain, significantly impacts efforts to improve children's quality of life worldwide. The World Health Organization (WHO) defines stunting as a growth disorder in children's height, based on the height-for-age index with a Z-score of less than -2 standard deviation. This study aims to determine the influence of maternal factors on the incidence of stunting in toddlers. It is a narrative literature review. We studied national and international articles published in ScienceDirect, Google Scholar, and PubMed databases within the past ten years (2014 -2024). The keywords used to search for these articles were stunting and maternal factors. Based on the literature review, eight maternal factors contributed to the incidence of stunting in toddlers: maternal education, maternal knowledge, parenting style, maternal nutritional status, anemia during pregnancy, maternal height, maternal age, and birth spacing. There is evidence that improving these factors is essential for preventing stunting. Keywords: Stunting; Maternal Factors; Toddlers

Representações discursivas e relações de poder de profissionais de saúde na prática de cuidado paliativo neonatal

This work aims to investigate how healthcare workers discursively represent the practices involved in neonatal palliative care, in a Neonatal Intensive Care Unit of a public hospital in the Federal District, Brazil. This study is theoretically and methodologically based in Critical Discourse Analysis, using the discursive-ethnography approach, which allowed us to reflect on the interactions and representations of 14 interviews with healthcare workers, from different professions, considering the ideologies involved in the context of their relationships. The results reveal a dependence on high technology to maintain life, leading to reflections on the limits of postponing neonatal death, considering the child's dignity and quality of life. Representations related to problems such as social inequality suggest that professionals need knowledge and understanding about how to relate to these families and how to deal with the issue of palliative care.

Family functioning, parental cancer-related emotions, and quality of life in childhood cancer patients

Background Childhood cancer and its treatment affects not only children’s health, but also children’s and families’ psychosocial function, relationship, emotion, and quality of life. Several studies in developed countries have been conducted to address this issue using the Family Adaptation and Cohesion Scales (FACES) III and the Situation-Specific Emotional Reaction Questionnaire (SSERQ). Screening psychosocial problems is crucial as part of cancer comprehensive care. Objective To investigate the dynamics of family functioning, parental cancer-related emotions, and to evaluate possible associations with the child's quality of life. Methods This cross-sectional study was done in child with cancer aged 0-18 years. Parents completed the validated Indonesian versions of three sets of questionnaires regarding subjects’ quality of life (PedsQL), family function (FACES III), and family cancer-related emotions (SSERQ). Validity and reliability tests were done to assess the Indonesian versions of the questionnaires. Results A total of 269 subjects were recruited. Parental proxy of PedsQL evaluations revealed that the 8-12-year-old age group had significantly lower score than the other groups (P=0.014). Solid tumor subjects had significantly lower PedsQL score compared to subjects with hematological malignancy (P=0.001). The FACES III questionnaire results showed that connected families tended to have better PedsQL score based on children’s evaluation compared to disengaged families (P=0.049). No significant difference was found between adaptability of family function and PedsQL score. The SSERQ revealed significant associations between negative emotions and lower PedsQL scores in the children (all P=0.000). Conclusions Parental proxy of PedsQL scores were significantly lower in older children (8 to 12 years). Children with connected families have significantly higher PedsQL scores than disengaged families, for the PedsQL children’s evaluation. Parents’ emotions (loneliness, helplessness, and uncertainty) experienced by a family member of a child with cancer are also correlated with lower PedsQL scores by both evaluations.

Predictors of children's headaches during the second COVID-19 pandemic wave in the country with long-lasting lockdown.

The current study examined the links and interactions among headaches, screen-based media use, physical activity, sleep, and the family environment in Lithuanian school-aged children during the second COVID-19 lockdown. The study comprised data of 541 children aged 7-14 years from different Lithuania regions, and without chronic health conditions or developmental disorders. Information about the child was provided by their parents or caregivers who filled questionnaire on child's screen time, sleep duration and quality, physical activity, parental distress, parent-child relationship, history of child's headaches and infectious diseases. During the study period, 54% of the children had headaches, and the frequency was positively associated with child's age, screen time and parental distress, as well as negatively related to physical activity (PA), sleep quality, and the parent-child relationship. Parental education was related to child's PA, screen time and sleep quality. The results of binary logistic regression analysis and path analysis revealed that sleep quality and parental distress were significant predictors of headaches in children. Family and child or adolescent education and lifestyle modification aiming to improve sleep hygiene and PA, and to reduce screen-based sedentary behaviour should be provided. Family centred approach for more effective coping with distress and improvement of parent-child relationship is also important in treating child and adolescent headache.

Parent's perception of respiratory syncytial virus and subsequent wheezing burden: A multi-country cross-sectional survey.

Respiratory Syncytial Virus (RSV) is the leading cause of hospitalization in infants. RSV bronchiolitis is associated with an increased risk of subsequent wheezing. We aimed to document the parents' perception of the link between RSV infection and subsequent wheezing, wheezing-related healthcare and family resources use, and its impact on family daily life. This cross-sectional online survey enrolled 1200 parents with at least one child ≤6y living in the United States, United Kingdom, Spain, and Italy. Children diagnosed with RSV bronchiolitis before age of 2 years were included in the RSV group, and those never diagnosed with RSV bronchiolitis in the Reference group. The odds of wheezing were 4.5-fold (95%CI 3.5-5.9) higher in the RSV than in the Reference group. The odds increased to 7.7-fold (95%CI 5.4-11.1) among children who were hospitalized, and 9-fold (95%CI 5.1-16.6) among those admitted to pediatric intensive care with RSV bronchiolitis. Similar trends were observed across all countries. In total, 57% of parents reported their child's wheezing to have moderate to severe impact on their emotional well-being, and 53% on their daily life activities and/or social life. 64% of parents reported moderate-severe impact of wheezing on child's quality of sleep and 49% and 46% reported a moderate-severe impact on their children's emotional well-being and physical activities. This survey suggests an association between RSV infection and subsequent wheezing in children across different countries. Wheezing, especially in association with RSV infection, was associated with increased healthcare utilization and costs, and significantly impacted parents' and children daily life.

Deep learning-based differentiation of ventricular septal defect from tetralogy of Fallot in fetal echocardiography images.

Congenital heart disease (CHD) seriously affects children's health and quality of life, and early detection of CHD can reduce its impact on children's health. Tetralogy of Fallot (TOF) and ventricular septal defect (VSD) are two types of CHD that have similarities in echocardiography. However, TOF has worse diagnosis and higher morality than VSD. Accurate differentiation between VSD and TOF is highly important for administrative property treatment and improving affected factors' diagnoses. TOF and VSD were differentiated using convolutional neural network (CNN) models that classified fetal echocardiography images. We collected 105 fetal echocardiography images of TOF and 96 images of VSD. Four CNN models, namely, VGG19, ResNet50, NTS-Net, and the weakly supervised data augmentation network (WSDAN), were used to differentiate the two congenital heart diseases. The performance of these four models was compared based on sensitivity, accuracy, specificity, and AUC. VGG19 and ResNet50 performed similarly, with AUCs of 0.799 and 0.802, respectively. A superior performance was observed with NTS-Net and WSDAN specific for fine-grained image categorization tasks, with AUCs of 0.823 and 0.873, respectively. WSDAN had the best performance among all models tested. WSDAN exhibited the best performance in differentiating between TOF and VSD and is worthy of further clinical popularization.

Microenvironment-Responsive Hydrogel Reduces Seizures After Traumatic Brain Injury in Juvenile Rats by Reducing Oxidative Stress and Hippocampal Inflammation.

Traumatic brain injury (TBI) is the primary cause of child mortality and disability worldwide. It can result in severe complications that significantly impact children's quality of life, including post-traumatic epilepsy (PTE). An increasing number of studies suggest that TBI-induced oxidative stress and neuroinflammatory sequelae (especially, inflammation in the hippocampus region) may lead to the development of PTE. Due to the blood-brain barrier (BBB), typical systemic pharmacological therapy for TBI cannot deliver berberine (BBR) to the targeted location in the early stages of the injury, although BBR has strong anti-inflammatory properties. To break through this limitation, a microenvironment-responsive gelatin methacrylate (GM) hydrogel to deliver poly(propylene sulfide)60 (PPS60) and BBR (GM/PB) is developed for regulating neuroinflammatory reactions and removing reactive oxygen species (ROS) in the brain trauma microenvironment through PPS60. In situ injection of the GM/PB hydrogel efficiently bypasses the BBB and is administered directly to the surface of brain tissue. In post-traumatic brain injury models, GM/PB has the potential to mitigate oxidative stress and neuroinflammatory responses, facilitate functional recovery, and lessen seizing. These findings can lead to a new treatment for brain injuries, which minimizes complications and improves the quality of life.

The effect of 3D modeling on family quality of life, surgical success, and patient outcomes in congenital heart diseases: objectives and design of a randomized controlled trial.

Understanding the severity of the disease from the parents' perspective can lead to better patient outcomes, improving both the child's health-related quality of life and the family's quality of life. The implementation of 3-dimensional (3D) modeling technology in care is critical from a translational science perspective. The purpose of this study is to determine the effect of 3D modeling on family quality of life, surgical success, and patient outcomes in congenital heart diseases. Additionally, we aim to identify challenges and potential solutions related to this innovative technology. The study is a two-group pretest-posttest randomized controlled trial protocol. The sample size is 15 in the experimental group and 15 in the control group. The experimental group's heart models will be made from their own computed tomography (CT) images and printed using a 3D printer. The experimental group will receive surgical simulation and preoperative parent education with their 3D heart model. The control group will receive the same parent education using the standard anatomical model. Both groups will complete the Sociodemographic Information Form, the Surgical Simulation Evaluation Form - Part I-II, and the Pediatric Quality of Life Inventory (PedsQL) Family Impacts Module. The primary outcome of the research is the average PedsQL Family Impacts Module score. Secondary outcome measurement includes surgical success and patient outcomes. Separate analyses will be conducted for each outcome and compared between the intervention and control groups. Anomalies that can be clearly understood by parents according to the actual size and dimensions of the child's heart will affect the preoperative preparation of the surgical procedure and the recovery rate in the postoperative period.

Associations between sleep problems in children with ADHD and parental insomnia and ADHD symptoms.

Sleep problems are common in children with attention deficit hyperactivity disorder (ADHD). Children's sleep problem may influence, and be influenced by, parents' sleep problems as well as parents' ADHD symptoms. In the current study we examined the associations of parent-rated sleep quality and sleep timing of pre-adolescent children with parental insomnia symptoms, parental ADHD symptoms and dysfunctional attitudes and beliefs about sleep in a convenience sample recruited by advertisement (N = 120). Childhood sleep problems were common in the sample, with 82% of children exceeding the threshold for the presence of a paediatric sleep disorder. Children's sleep quality showed minimal association with their sleep timing and chronotype. Parental insomnia symptoms, ADHD symptoms and dysfunctional beliefs and attitudes about sleep all associated with their children's sleep quality, and with the sleep subdomains of sleep anxiety and parasomnias. In multiple regression analysis only parental insomnia score was a significant predictor of children's sleep quality. Children's bedtimes, wake times, sleep duration, chronotype or social jetlag did not associate with parents' ADHD or insomnia symptoms. Sleep quality was significantly poorer in children whose parents scored as both consistent for adult ADHD and probable for insomnia disorder compared to parents who scored as either ADHD consistent or insomnia probable, or those who parents scored as neither. We discuss the putative nature of the relationships between sleep quality of children with ADHD and parental ADHD and insomnia symptoms, and suggest that clinicians consider parental sleep when attending to children with ADHD.

Quality of Life of Children Treated for Split Cord Malformation

PurposeSplit cord malformation (SCM), associated with neurological deficits, necessitates surgical intervention for spinal cord de-tethering. Limited evidence exists regarding its impact on children's quality of life. Our study aims to evaluate the postoperative quality of life in children treated for split cord malformation. MethodsThis retrospective cohort study examined records of patients with split cord malformation operated on between July 1, 2012, and July 31, 2022, at a single center. Data, including Health Utility Index-3 (HUI-3) scores provided by guardians, was collected to assess quality of life. Clinical and neurological outcomes were also analyzed. ResultsTwenty-five patients, predominantly females (68%), with a median age of 7 years, were included. Most presented with normal motor function (76%). The most common anatomic level of split cord malformation was lumbar (12 48%) followed by lumbosacral (5, 20%). A bony spur from the lamina was the most common cause of splitting the cord (64%). Over a median follow-up of 3.3 years, 64% showed neurological stability, 16% showed neurological improvement, and 4% experienced deterioration. The mean HUI-3 score for 21 children was 0.93 ± 0.24. ConclusionSurgical management of split cord malformation demonstrated favorable neurological outcomes and a positive long-term quality of life, as evidenced by HUI-3 scores. Our findings emphasize the efficacy of surgical intervention in improving the lives of children with this condition.

Participation as a Predictor of Quality of Life among Japanese Children with Neurodevelopmental Disorders Analyzed Using a Machine Learning Algorithm.

Participation is important for children's quality of life (QOL). This study aimed to identify participation factors that influence QOL among Japanese children with neurodevelopmental disorders. Ninety-two Japanese parents of children with neurodevelopmental disorders participated in this study. The parents completed the parent version of the Kid- and Kiddo-KINDL health-related QOL questionnaire and the Participation and Environment Measure for Children and Youth. The data were examined using the random forest algorithm to analyze the participation factors that affected the children's QOL. The analyses revealed that school and community environmental factors that affected participation were the most important predictors of QOL among children. As school and community environments can significantly impact the QOL of children with neurodevelopmental disorders, greater focus should be placed on participation in environmental contexts.

Preservation of Pancreatic Function Should Not Be Disregarded When Performing Pancreatectomies for Pancreatoblastoma in Children.

Complete surgical resection in the context of a multimodal approach has been associated with excellent long-term survival in children diagnosed with pancreatoblastoma (PB). Traditionally, curative intent surgery for PB implies standard pancreatic resections such as pancreaticoduodenectomies and distal pancreatectomies with splenectomies, surgical procedures that may lead to significant long-term pancreatic functional deficiencies. Postoperative pancreatic functional deficiencies are particularly interesting to children because they may interfere with their development, considering their long life expectancy and the significant role of pancreatic functions in their nutritional status and growth. Thus, organ-sparing pancreatectomies, such as spleen-preserving distal pancreatectomies and central pancreatectomies, are emerging in specific tumoral pathologies in children. However, data about organ-sparing pancreatectomies' potential role in curative-intent PB surgery in children are scarce. Based on the literature data, the current review aims to present the early and late outcomes of pancreatectomies in children (including long-term deficiencies and their potential impact on the development and quality of life), particularly for PB, and further explore the potential role of organ-sparing pancreatectomies for PB. Organ-sparing pancreatectomies are associated with better long-term pancreatic functional outcomes, particularly central pancreatectomies, and have a reduced impact on children's development and quality of life without jeopardizing their oncological safety. The long-term preservation of pancreatic functions should not be disregarded when performing pancreatectomies for PB in children. A subset of patients with PB might benefit from organ-sparing pancreatectomies, particularly from central pancreatectomies, with the same oncological results as standard pancreatectomies but with significantly less impact on long-term functional outcomes.

Pediatric Lower Urinary Tract Dysfunction: A Comprehensive Exploration of Clinical Implications and Diagnostic Strategies.

Lower urinary tract dysfunction is clinically important because it may cause urinary tract infections, mainly due to accumulation of residual urine, and adversely affect renal function. In addition, it may cause urinary incontinence, strongly affecting the child's quality of life. The function of the lower urinary tract is closely associated with function of the bowel because constipation is commonly present with bladder dysfunction. The interplay between the lower urinary tract and bowel function, coupled with common conditions such as detrusor overactivity and voiding dysfunction, requires a nuanced diagnostic approach. Detrusor overactivity, a benign but socially harmful condition, is the principal cause of daytime urinary incontinence in childhood. It needs to be differentiated from more serious conditions such as neurogenic bladder dysfunction or urethral obstruction. Voiding dysfunction, a habitual sphincter contraction during voiding, is common in children with detrusor overactivity and may be self limiting but may also result in residual urine and urinary tract infections. It may resemble, in severe cases, neurogenic bladder dysfunction, most often caused by spinal dysraphism, which very often leads to recurrent urinary tract infections and high intravesical pressures, jeopardizing renal function. A voiding diary is crucial in the initial evaluation of lower urinary tract function in children.

Smartphone App-Delivered Mindfulness-Based Intervention for Mild Traumatic Brain Injury in Adolescents: Protocol for a Feasibility Randomized Controlled Trial.

Concussion in children and adolescents is a significant public health concern, with 30% to 35% of patients at risk for prolonged emotional, cognitive, sleep, or physical symptoms. These symptoms negatively impact a child's quality of life while interfering with their participation in important neurodevelopmental activities such as schoolwork, socializing, and sports. Early psychological intervention following a concussion may improve the ability to regulate emotions and adapt to postinjury symptoms, resulting in the greater acceptance of change; reduced stress; and recovery of somatic, emotional, and cognitive symptoms. The primary objective of this study is to assess the feasibility of conducting a parallel-group (1:1) randomized controlled trial (RCT) to evaluate a digital therapeutics (DTx) mindfulness-based intervention (MBI) in adolescents aged 12 to <18 years. The attention-matched comparator intervention (a math game also used in previous RCTs) will be delivered on the same DTx platform. Both groups will be provided with the standard of care guidelines. The secondary objective is to examine intervention trends for quality of life; resilience; self-efficacy; cognition such as attention, working memory, and executive functioning; symptom burden; and anxiety and depression scores at 4 weeks after concussion, which will inform a more definitive RCT. A subsample will be used to examine whether those randomized to the experimental intervention group have different brain-based imaging patterns compared with those randomized to the control group. This study is a double-blind Health Canada-regulated trial. A total of 70 participants will be enrolled within 7 days of concussion and randomly assigned to receive the 4-week DTx MBI (experimental group) or comparator intervention. Feasibility will be assessed based on the recruitment rate, treatment adherence to both interventions, and retention. All outcome measures will be evaluated before the intervention (within 7 days after injury) and at 1, 2, and 4 weeks after the injury. A subset of 60 participants will undergo magnetic resonance imaging within 72 hours and at 4 weeks after recruitment to identify the neurophysiological mechanisms underlying the potential benefits from MBI training in adolescents following a concussion. The recruitment began in October 2022, and the data collection is expected to be completed by September 2024. Data collection and management is still in progress; therefore, data analysis is yet to be conducted. This trial will confirm the feasibility and resolve uncertainties to inform a future definitive multicenter efficacy RCT. If proven effective, a smartphone-based MBI has the potential to be an accessible and low-risk preventive treatment for youth at risk of experiencing prolonged postconcussion symptoms and complications. ClinicalTrials.gov NCT05105802; https://classic.clinicaltrials.gov/ct2/show/NCT05105802. DERR1-10.2196/57226.

Euterpe music therapy method for children with cerebral palsy.

The main purpose of our study was to evaluate whether involvement in a personalized music therapy program (Euterpe method), could improve the condition of children with cerebral palsy and their parents, compared to a control group. It investigated whether it could positively affect children's sleep quality, temperament and quality of life, quality of family life, and parental stress. A prospective single-center experimental study was conducted at "Bambino Gesù" Children's Hospital (Rome, Italy). All subjects involved attended an intensive rehabilitation program in the Neurorehabilitation Unit. In a group of patients (n = 25), a music therapy treatment was applied to evaluate the effect before and after the intervention. This group was also compared with a control group (n = 10) undergoing a standard protocol without music therapy. In the experimental group, the analysis shows statistically significant effects in the Disorders of initiating and maintaining sleep (p = 0.050) and the Sleep wake transition disorders (p = 0.026) factors, and the total score (p = 0.031) of Sleep Disturbances Scale for Children; the Positive emotionality scale (p = 0.013) of Italian Questionnaires of Temperament (QUIT); the Emotional Functioning (p = 0.029), Social Functioning (p = 0.012), Worry (p = 0.032), Daily Activities (p = 0.032), Total Score (p = 0.039) and Parent HRQL Summary Score (p = 0.035) dimensions of Pediatric Quality of Life for family. While in the control group, only the Attention scale of QUIT (p = 0.003) reaches statistical significance. Our study suggests that music therapy with the Euterpe Method has beneficial effects on fundamental aspects of the child's and his parents' lives, such as sleep, emotion control, and quality of family life.

Exposure to Smartphones and Tablets, Physical Activity and Sleep in Children From 5 to 10 Years Old: A Systematic Review and Meta-Analysis.

To conduct a systematic review and meta-analysis to verify the association between smartphone/tablet exposure and physical activity and sleep in children from 5 to 10years old. Data Source: This study followed the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and included studies that met eligibility criteria based on the "PECO" strategy: participants (children from 5 to 10years old), exposure (smartphone and tablet use), and outcome (physical activity and sleep). The inclusion criteria were observational studies published in indexed scientific journals and written in Portuguese, English, and Spanish that verified the association of exposure to smartphones/tablets with physical activity and sleep in children aged 5 to 10years of both sexes. Studies were considered eligible only if they met the previous criteria. Data Extraction: The search was conducted in January 2023 on databases from electronic journals without the restriction of the period. To meta-analyze were extracted and grouped using models of fixed and random effects, the coefficients Odds Ratio (OR), Beta (β), Standard Error (SE), and Confidence Intervals of 95% (95%CI). Data Synthesis: 2396 potentially relevant papers were identified, and 17 met the inclusion criteria. It can be verified that there was an inverse association between smartphones with physical activity and sleep. Studies indicate that for every additional hour of smartphone and tablet use, sleep can be expected to decrease by an average of 11 minutes (β = - 0.11; 95%CI = -0.13; -0.09). Children using smartphones and tablets were 1.79 times (OR = 1.79; 95%CI = 1.72-1.86) more likely to have shorter sleep duration and 1.53 times (OR = 1.53; 95%CI = 1.41-1.65) more likely to have worse sleep quality. Children with shorter smartphone and tablet usage were 1.19 times more likely to be active (OR = 1.19; 95% CI = 1.03-1.37). Children of 5 to 10years who are more often exposed to smartphones and tablets are prone to have worse quality and quantity of sleep, as well as less practice of physical activity. Health promotion actions can be encouraged based on the results, aiming to reduce the use time of these devices and improve children's health and quality of life.

Parental Involvement and Stress in Children's Quality of Life: A Longitudinal Study with Portuguese Parents during the COVID-19 Pandemic Period.

Parental involvement (PI) has particular relevance on children's academic adjustment and on children's general quality of life (QoL). QoL can be influenced by parental stress, specifically the stress suffered during the COVID-19 pandemic. Thus, this study aimed to analyze the differences during the pandemic period (before, after and with no lockdown), comparing these constructs with parental educational level to provide predictors of their children's quality of life. Data collection was performed with a non-probability convenience sampling procedure. It was composed of 129 parents, mainly women (71.8%), with children aged between 6 and 12 years. The family's sociodemographic characteristics were assessed, as well as the PI, parental stress, and children's QoL. The comparison between the three times revealed an increase in the children's QoL, but no differences were found in PI. Based on the parental educational level, as defined by academic qualifications and split into superior and non-superior levels, it is possible conclude that engagement in school activities and parents' meetings increased in the parents with superior education levels and decreased in the parents with lower education levels. This study concluded that despite this difficult and uncertain pandemic period, these parents were able to maintain important aspects of their children's lives.