Information To Parents Research Articles

Sociodemographic and regional differences in neonatal and infant mortality in Switzerland in 2011–2018: the Swiss National Cohort

BACKGROUND AND AIMS: Despite a well-funded healthcare system with universal insurance coverage, Switzerland has one of the highest neonatal and infant mortality rates among high-income countries. Identifying avoidable risk factors targeted by evidence-based policies is a public health priority. We describe neonatal and infant mortality in Switzerland from 2011 to 2018 and explore associations with neonatal- and pregnancy-related variables, parental sociodemographic information, regional factors and socioeconomic position (SEP) using data from a long-term nationwide cohort study. METHODS: We included 680,077 live births, representing 99.3% of all infants born in Switzerland between January 2011 and December 2018. We deterministically linked the national live birth register with the mortality register and with census and survey data to create a longitudinal dataset of neonatal- and pregnancy-related variables; parental sociodemographic information, such as civil status, age, religion, education, nationality; regional factors, such as urbanity, language region; and the Swiss neighbourhood index of socioeconomic position (Swiss-SEP index). Information on maternal education was available for a random subset of 242,949 infants. We investigated associations with neonatal and infant mortality by fitting multivariable Poisson regression models with robust standard errors. Several sensitivity analyses assessed the robustness of our findings. RESULTS: Overall, neonatal mortality rates between 2011 and 2018 were 3.0 per 1000 live births, with regional variations: 3.2 in German-speaking, 2.4 in French-speaking and 2.1 in Italian-speaking Switzerland. For infant mortality, the rates were 3.7 per 1000 live births overall, and 3.9 in the German-speaking, 3.3 in the French-speaking and 2.9 in the Italian-speaking region. After adjusting for sex, maternal age, multiple birth and birth rank, neonatal mortality remained significantly associated with language region (adjusted rate ratio [aRR] 0.72, 95% confidence interval [CI]: 0.64–0.80 for the French-speaking region and aRR 0.66, 95% CI: 0.51–0.87 for the Italian-speaking region vs German-speaking region), with marital status (aRR 1.55, 95% CI: 1.40–1.71 for unmarried vs married), nationality (aRR 1.40, 95% CI: 1.21–1.62 for non-European Economic Area vs Swiss) and the Swiss-SEP index (aRR 1.17, 95% CI: 1.00–1.36 for lowest vs highest SEP quintile). In the subset, we showed a possible association of neonatal mortality with maternal education (aRR 1.24, 95% CI: 0.95–1.61 for compulsory vs tertiary education). CONCLUSION: We provide detailed evidence about the social patterning of neonatal and infant mortality in Switzerland and reveal important regional differences with about 30% lower risks in French- and Italian-speaking compared with German-speaking regions. Underlying causes for such regional differences, such as cultural, lifestyle or healthcare-related factors, warrant further exploration to inform and provide an evidence base for public health policies.

'They got my back': Thematic analysis of relationship building in nurse home visiting in Aboriginal communities.

The client-practitioner relationship is the cornerstone of nurse home-visiting programs. Little is understood about how relationship-based maternal and early childhood health care is perceived by women in remote Aboriginal communities. As part of an evaluation of nurse home-visiting in the Northern Territory, this research examines how relationships are established with clients, and what elements are valued most by women. Maternal Early Childhood Sustained Home-visiting (MECSH) is an Australian model of nurse-led home-visiting targeted at women facing adversity who need extra support. The model provides parenting information, health education and psychosocial support during pregnancy and the first 3 years of children's development. Interviews were conducted with 92 Aboriginal women and 11 practitioners including nurses, social workers and community workers. Qualitative semi-structured interviews were conducted with convenience samples of MECSH clients and practitioners. Data were analysed using a two-step process of structural coding and thematic analysis. Trust was the foundation of clients' positive perception of the relationship with their MECSH provider. Relationships took time to develop, often beginning with practical support to meet clients' basic needs. Practitioner dependability and flexibility to client priorities, communication, confidentiality and being helpful to the woman and her family was important. Clients emphasised emotional support and friendship. The relationship-based approach was valued and consistent with culturally safe and trauma informed ways of working with Aboriginal families. Effort is required to commit to the model to address ongoing healthcare engagement and health outcomes in remote Northern Territory communities.

Parental stress and nurse-parent support in the neonatal intensive care unit: a cross-sectional study

BackgroundAdmission of a preterm infant to the Neonatal Intensive Care Unit (NICU) is highly stressful for parents. NICU nurses play a crucial role in providing support, positively impacting health and aiding effective stress management during this challenging period. This study assesses stress and nurse-parent support for parents with preterm infants in the NICU, exploring connections between stress, support, and various parental and infant variables.MethodsThis descriptive cross-sectional study was conducted between January and July 2019 on a total of 150 parents (75 mothers and 75 fathers) with preterm infants in a private hospital’s NICU in Ankara, Turkey. Data were collected using the Parent and Infant Information Form, Parental Stressor Scale: NICU (PSS: NICU), and Nurse-Parent Support Tool (NPST).ResultsThere was no significant correlation between PSS: NICU and NPST scores (p > 0.05). However, a significant difference was observed in the overall NPST score (p = 0.036) and its emotional support subscale (p = 0.013). Mothers’ PSS: NICU was influenced by infant information (p = 0.027) and marital duration ((p = 0.002), while fathers’ was influenced by number of children (p = 0.040) and infant care participation (p = 0.001). NPST was affected by number of children (p = 0.004) and infant respiratory status (p = 0.011) for mothers and number of children for fathers (p = 0.038). Since parents require informational, emotional, and care-related support, nurses should continuously enhance their professional and communication skills to establish effective communication with parents and provide targeted support.ConclusionThis study found mothers received greater nurse support than fathers. Mothers with one child had higher nurse support, while mechanical ventilation for mothers and having more than one child for fathers were linked to reduced support. Lower stress levels were noted in mothers married for 6–10 years, those informed about the infant, and fathers actively participating in infant care with more than one child.

YouTube as a source of information for parents about silver diamine fluoride.

To depict and evaluate the characteristics, engagement, content, and quality of YouTube videos containing information about silver diamine fluoride (SDF). A total of 200 YouTube™ videos were selected and screened, and the video characteristics and engagement indicators were recorded. They were then reviewed for consistency with current professional guidelines on this topic. Two independent reviewers scored the videos using a customized 8-point scoring and 5-point Global Quality Scale (GQS) to assess the content information and the overall quality of each video. These videos were further classified into good, moderate, and poor videos. Kruskal-Wallis, Chi-squared, and Spearman's correlation tests were used for the statistical analysis. 110 videos met the inclusion criteria. The median total content score was 3 (IQR = 4) and the median GQS score was 2 (IQR = 2). Less than half (n = 49; 45.5%) of the videos were uploaded by healthcare professionals. The video content was classified as good (n = 26; 23.64%), moderate (n = 43; 39.09%), and poor (n = 41; 37.27%). Good-quality videos have a significantly higher information content score than the other groups (P = 0.001). A strong correlation was found between the total content score and GQS score (rho = 0.970, P = 0.001). Longer duration, higher interaction index, and recent upload are associated with higher content and quality scores. A considerable number of videos are available on YouTube about SDF treatment and are attracting public interest. The content and quality of these videos vary widely and are related to several factors.

Educational outcomes of children with major congenital anomalies: Study protocol for a population-based cohort study using linked hospital and education data from England

Background Major congenital anomalies (CAs) affect around 2% of live births and are a primary cause of infant mortality, childhood morbidity and long-term disability, often requiring hospitalisation and/or surgery. Children with CAs are at greater risk of lower educational attainment compared with their peers, which could be due to learning disabilities, higher rates of ill-health and school absences, or lack of adequate educational support. Our study will compare the educational attainment of children with CAs to those of their peers up to age 11 in England, using linked administrative health and education data. Methods We will analyse data from the ECHILD (Education and Child Health Insights from Linked Data) database. Children born in NHS-funded hospitals from 1st September 2003 to 31st August 2008 whose hospital records were linked to their educational records at three Key Stages (ages 4/5, 6/7 and 10/11 years) will be included. Children with different CAs, indicated by recorded hospital diagnosis codes, will be compared to children without CAs. We will compare the proportions of enrolled children who take the assessment, the proportions who reached national expected levels of attainment, and the mean standardised attainment scores for Maths and English at each Key Stage. We will describe variations in outcome by sex, ethnic minority background, region, and neighbourhood deprivation, and perform regression modelling to compare the attainment trajectories of children with and without CAs, controlling for sociodemographic factors. Ethics and dissemination Ethics approval has been obtained for the analyses of the ECHILD database. Our findings will provide information for parents regarding their children’s expected academic potential, and also enable the development of interventions to support those at risk of not doing well. We will disseminate our findings to academics, policy makers, service users and providers through seminars, peer-reviewed publications, conference abstracts and other media (lay summaries and infographics).

Familial coaggregation and shared genetic influence between major depressive disorder and gynecological diseases.

The mechanism underlying the co-occurrence of major depressive disorder (MDD) and gynecological diseases remains unclear. This study aimed to investigate the familial co-aggregation and shared genetic loading between MDD and gynecological diseases, namely dysmenorrhea, endometriosis, uterine leiomyomas (UL), and polycystic ovary syndrome (PCOS). Overall, 2,121,632 females born 1970-1999 with parental information were enrolled from the Taiwan National Health Insurance Research Database (NHIRD); 25,142 same-sex twins and 951,779 persons with full-sibling(s) were selected. Genome-wide genotyping data were available for 67,882 unrelated female participants from the Taiwan Biobank linked to the NHIRD. A generalized linear model with a logistic link function was used to examine the associations of individual history, family history in parents/full-siblings/same-sex twins, and polygenic risk scores (PRS) for MDD with the risk of gynecological diseases; generalized estimating equations were used to consider the non-independence of data. Both parents affected with MDD was associated with four gynecological diseases, and its magnitude of association was higher than either affected parent; maternal MDD showed a higher magnitude of association than paternal MDD. Full-siblings of patients with MDD had a higher risk of four gynecological diseases; same-sex twins of patients with MDD had a greater association with dysmenorrhea and PCOS. PRS for MDD was associated with dysmenorrhea and endometriosis. Familial co-aggregation was observed in the co-occurrence of MDD and four gynecological diseases. There exists a shared polygenic liability between MDD and dysmenorrhea and endometriosis. Individuals with MDD-affected relatives or a higher PRS for MDD should be monitored for gynecological diseases.

Features of developing toilet skills in young children: Information for clinicians and parents. A review

The upbringing and teaching of toilet skills to young children is an important stage in the physiological development of the child. Control over urination and defecation in infants develops gradually, starting with a completely reflexive process and moving on to conscious control. This process is of great importance in the formation of a healthy and independent personality, preparing the child for the next stages of growing up and acquiring new skills. The article presents historical aspects of the formation of toilet skills among different peoples and at different stages of society development. Interesting facts about potty training in different countries of the world, anatomical features of urination and defecation, signs of readiness for potty training and toilet training, the age recommended for potty training, and what a potty should be like are shown. Approaches to teaching this level of independence are important not only for the child’s physical health, but also for understanding his psychological readiness, social development, and adaptation in children’s groups.

Acceptability of Adolescent Portal Access Policies to Parents and Adolescents: A Delphi Study

PurposeUnited States healthcare systems have enacted varied adolescent online patient portal policies. No prior work has established whether these policies are acceptable to adolescents and parents. MethodsMixed-method Delphi approach with 18 parents and 18 adolescents with and without chronic illness. We presented 19 policies related to (1) who can access different types of information through the portal; (2) timing of results release; and (3) portal messaging policies, such as whether individuals are charged for portal messages. Panelists voted on whether they “supported,” “could live with,” or “opposed” each policy. ResultsThirty-six panelists completed surveys with no attrition. For access-related policies, panelists opposed prohibiting parent or adolescent access, and they accepted policies that provided transparent access to sensitive and nonsensitive information for parents and adolescents. Panelists failed to reach consensus about whether adolescents should have the granular ability to determine which parts of the medical record their parents can see. For policies related to timing of release, panelists found either immediate or delayed access to results to be acceptable, although more panelists supported immediate access. For portal messaging policies, panelists supported the ability of parents and adolescents to send messages and opposed being charged for portal messages. Panelists found it acceptable for adolescents to see messages written by their parents, but failed to reach consensus on whether parents should see messages written by adolescents. DiscussionSome healthcare systems have implemented adolescent portal policies that panelists opposed or found concerning. Hospital leaders should consider these data as they re-evaluate institutional policies.

Exploring Communication Barriers and Facilitators in School Vaccination: A Case Study in South Eastern Sydney, Australia.

Background/Objectives: Given the discrepancies in immunisation coverage, the goal of this study was to explore the barriers and facilitators to effective communication across the school-based vaccination program in South Eastern Sydney schools. Methods: A qualitative study was undertaken with purposively selected immunisation staff, school coordinators, and parents of Year 7 students who had not received two vaccinations (dTpa and HPV) at school. A focus group with immunisation staff and interviews with school coordinators explored the barriers and facilitators to vaccination uptake, including communication across stakeholders. The parent interviews explored attitudes to vaccination and the school program and investigated the program communication methods. Results: Five immunisation staff, eleven school coordinators, and eleven parents participated in the study. The barriers to participation in the school vaccination program included low parent recall of vaccination information, challenges encountered by school staff in consent tracking, no communication channel between health staff and parents, a greater school focus on vaccination facilitation than student education, and limited communication between stakeholders about catch-up vaccinations. The facilitators included established school/parent relationships for vaccine communication, effective communication between health and school staff, and using multiple methods to promote clinic and consent requirements. Conclusions: Opportunities exist to increase program participation by enhancing vaccination information and education for students and parents, with better communication about vaccination catch-ups and consent.

영유아기 자녀를 둔 아버지의 온라인(on-line) 양육참여 경험의 의미와 개선요구

Objectives This study aimed to explore the meaning and the demand of online involvement in parenting for fathers raising young children. Methods To this end, a qualitative study centered on depth-interview with 8 fathers raising young children was conducted to specifically analyze the actual experiences of fathers in online involvement in parenting. Results First, it was analyzed that fathers' on-line involvement in parenting is meaningful as an effective channel for getting closer to their children through online and offline mixed play, personalized education through online-based customized information acquisition, further activating child-rearing-related communication, and achieving child-rearing goals and solving problems. Second, it was found that fathers required reliable standards for online parenting and educational information, family-friendly online content and platform development and dissemination, parental education support for content selection, and hardware support at the national and regional level to improve on-line involvement in parenting. Conclusions The main context of online involvement in parenting for fathers raising young children was the expansion of play between fathers and children through online and offline connection, and in this process, it was found that social and emotional meaning was formed to form a closer relationship with each other. In addition, it was found that fathers' online-based involvement in parenting enabled information tailored to their children's personal characteristics, enabling individualized education for children, and further activating communication with spouses and families and children.

Behavioural impact of antibiotic stewardship in children in primary care: interviews with GPs and parents.

The ARON study, a randomized controlled trial, assesses a behavioural intervention incorporating clinically guided C-reactive protein (CRP) point-of-care testing and a parental information booklet to reduce inappropriate antibiotic prescriptions for acutely ill children in Belgian primary care. To explore GP and parent views and experiences regarding the ARON trial intervention. We conducted a qualitative embedded process evaluation in Belgian general practice. Semi-structured interviews were held with purposively sampled GPs and a convenience sample of mothers of acutely ill children presenting to primary care. Data were analysed using inductive thematic analysis. Thirty-four interviews were conducted with 17 GPs and 17 parents from the intervention arm, and four themes were identified. The first theme centres on the supportive role of CRP point-of-care testing in reducing diagnostic uncertainty and decreasing inappropriate prescriptions. The second theme explores the use of CRP in managing perceived parental expectations of antibiotics. The third theme discusses the use of intermediate CRP levels (above the trial's 5 mg/L cut-off) as an indicator of serious infection, as opposed to its intended role in the trial as a rule-out factor. The final theme delves into the dual functionality of the booklet, enhancing self-management and offering reassurance through safety-netting advice. A logic model depicts the assumptions and (un)anticipated dynamics underlying the relationships between these themes and their subthemes. Both GPs and parents consider the intervention to be a helpful complementary tool during consultations for acutely ill children.

Adoptive Parent Advice: Challenges, Strategies, and Insights for Future Adoptive Parents

This qualitative study examines the advice from 2,131 adoptive parent responses, answering: “What do you believe is important for future adoptive parents to know?” An inductive thematic analysis yielded the following major findings: Various reasons adoption is challenging, strategies to confront challenges, and how adoption is worth the challenges. Parents describe adoption as difficult because (a) parents have unmet expectations, (b) it is time-consuming, (c) emotionally taxing, (d) there are limited resources, and (e) adopted children have behavioral challenges. Strategies for responding to challenges include (a) educating oneself, (b) establishing support, and (c) being patient. These findings suggest there are many absences in information for prospective adoptive parents, indicating the need for increased training, education, and knowledge dissemination. Implications for adoptive parents are delineated.

Just Google it: Evaluating Online Mental Health Information for Parents of Children with Cystic Fibrosis

Just Google it: Evaluating Online Mental Health Information for Parents of Children with Cystic Fibrosis

Knowledge & Attitude among Parents of Children with Bronchial Asthma whom Attending Iraq Pediatric Hospital

Background: Asthma is a prevalent chronic condition in pediatric populations. The rising incidence, morbidity, and mortality rates associated with asthma have heightened public health concerns. Pediatric asthma imposes a substantial burden on affected children, their families, and the broader community. Effective asthma management encompasses regular monitoring, symptom control, and the prevention of exacerbations. Objectives: The study aimed to document the knowledge, attitudes of parents of children with asthma and to identify the factors associated with parent knowledge and attitude. Method: A study was conducted involving 205 parents of children under five years old with asthma, who attended the Karbala Pediatric Hospital between February 15 and May 15, 2023. A specially designed questionnaire was utilized, comprising three sections: the first section addressed socio demographic information of both children and parents, the second section evaluated the parents' knowledge, and the third section assessed the parents' attitudes. Responses were scored with one point for correct answers and zero points for incorrect or "I don't know" answers. Statistical analyses, including the Student's T-test, ANOVA, and linear regression, were employed to identify factors associated with parental knowledge. Results: The results indicated that the majority of participants were mothers, with a mean age of 29 years, and the majority of asthmatic children were male (69.3%), with a mean age of 34.4 months. It was found that 48.8% of participants had a poor knowledge score, while 61% had a poor attitude score. Key factors influencing knowledge scores included the family’s place of residence, the child’s birth order, the duration of the disease, the age at disease onset, the participant’s age, and the mother's educational level. Conclusion: Overall, the parents demonstrated limited knowledge and unfavorable attitudes regarding childhood asthma. Enhancing their understanding and attitudes could potentially lead to improved management practices among parents of children with asthma.

Two-layer surrogate-assisted collaborative framework for expensive constrained optimization problems involving mixed integer variables

Many surrogate-assisted evolutionary algorithms (SAEAs) have been shown exceptional abilities in solving expensive constrained optimization problems (ECOPs). However, few of them are designed for ECOPs involving mixed integer variables (ECOPs-MI). Therefore, a two-layer surrogate-assisted collaborative framework called TLSACF is designed, in which the radial basis function (RBF) and Gaussian Process (GP)-based mixed-integer collaborative frameworks are combined effectively. In the RBF-based collaborative framework, the combination between RBF-assisted prescreening and RBF-based local search achieves effective population update by balancing the exploration and exploitation on high potential parental information. For the GP-based collaborative framework, a variable type-based cooperative mutation is utilized to obtain potential candidate individuals by assigning targeted mutation for different variables, and a hypervolume-based complete expected improvement matrix function is derived to prescreen these candidate solutions from the perspective of balancing the optimization on constraints and the objective for the effective search on disconnected sub-feasible regions caused by integer variables. Experimental results on ten classical problems show that TLSACF performs excellent in solving ECOPs-MI.

Usefulness and accessibility of information on the treatment of children with congenital clubfoot: results of a survey of parents

BACKGROUND: Treatment of congenital clubfoot remains controversial from both specialists and parents regarding the details of its practical application, individual effectiveness, and follow-up, rehabilitation treatment, prevention, and treatment of relapses. The assessment of parental attitudes using an online survey optimizes doctor–patient interaction. Information available to parents regarding the diagnosis and treatment of children with congenital clubfoot is lacking. AIM: This study aimed to assess the usefulness and accessibility of information for parents about the treatment of children with congenital clubfoot. MATERIALS AND METHODS: To assess the usefulness and accessibility of information about the treatment of congenital clubfoot, a survey of the patients’ parents was conducted using an electronic fillable form proposed for anonymous completion in a thematic group dedicated to the treatment of congenital clubfoot on the social network “VKontakte”; the study included 5500 participants at the time of the survey (2 weeks), with 328 responses received. RESULTS: Most parents noted a lack of information regarding clubfoot treatment before it actually began. The preferred source of information was Internet resources (i.e., websites of medical institutions and social networks). Achilles tenotomy and wearing braces raised the most questions, requiring additional information from both doctors and alternative sources. The possibility of errors and complications in wearing braces caused the greatest concern among parents, as well as possible relapses and the correctness of prescriptions during the rehabilitation treatment. Online parent communities and physician blogs are considered significant information sources. Most parents prefer to expand information about congenital clubfoot on the Internet, including social networks and popular resources. CONCLUSIONS: Analysis of the results of an anonymous survey of parents of children with congenital clubfoot showed a significant demand for high-quality, accessible information regarding the diagnosis, treatment, and rehabilitation of children with congenital clubfoot. Significant interest in the information provided by social media and other Internet resources determines the need for competent representatives of the professional community to participate in this process.

Parenting and production of anxiety on social media: Analysis of parenting on Instagram @parentalk.id

This article discusses the phenomena parenting of the anxiety production constructed by @parentalk.id as a result of interacting with parenting social media accounts. In the digital era, social media has become a primary source of information for many parents seeking guidance and support in raising their children. However, the content often emphasizes ideal standards of parenting that can trigger feelings of anxiety among parents. This study uses a qualitative approach with critical multimodal discourse analysis of the Instagram social media account @parentalk.id. The research findings show that the Instagram account @parentalk.id generates anxiety among parents through its content, which portrays ideal parenting standards. The account acts as a "regime" that limits parents' freedom, guiding them towards the account's constructed ideas of ideal parenting. The account also shapes the parenting narrative by disciplining the parents themselves. Uncertainty in modernity is also used as a tool to produce anxiety in parenting. Additionally, the study found that child health is a key content theme that can trigger anxiety among parents.

A population-based study of familial coaggregation and shared genetic etiology of psychiatric and gastrointestinal disorders

BackgroundIt has been proposed that having a psychiatric disorder could increase the risk of developing a gastrointestinal disorder, and vice versa. The role of familial coaggregation and shared genetic loading between psychiatric and gastrointestinal disorders remains unclear.MethodsThis study used the Taiwan National Health Insurance Research Database; 4,504,612 individuals born 1970–1999 with parental information, 51,664 same-sex twins, and 3,322,959 persons with full-sibling(s) were enrolled. Genotyping was available for 106,796 unrelated participants from the Taiwan Biobank. A logistic regression model was used to examine the associations of individual history, affected relatives, and polygenic risk scores (PRS) for schizophrenia (SCZ), bipolar disorder (BPD), major depressive disorder (MDD), and obsessive-compulsive disorder (OCD), with the risk of peptic ulcer disease (PUD), gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD), and vice versa.ResultsHere we show that parental psychiatric disorders are associated with gastrointestinal disorders. Full-siblings of psychiatric cases have an increased risk of gastrointestinal disorders except for SCZ/BPD and IBD; the magnitude of coaggregation is higher in same-sex twins than in full-siblings. The results of bidirectional analyses mostly remain unchanged. PRS for SCZ, MDD, and OCD are associated with IBS, PUD/GERD/IBS/IBD, and PUD/GERD/IBS, respectively. PRS for PUD, GERD, IBS, and IBD are associated with MDD, BPD/MDD, SCZ/BPD/MDD, and BPD, respectively.ConclusionsThere is familial coaggregation and shared genetic etiology between psychiatric and gastrointestinal comorbidity. Individuals with psychiatric disorder-affected relatives or with higher genetic risk for psychiatric disorders should be monitored for gastrointestinal disorders, and vice versa.

Pathways from education to mortality, mediated through income.

Lower levels of education are associated with higher mortality. Lower levels of education are also associated with lower income, which is also associated with higher mortality. We investigate the impact of education on mortality and the extent to which this is mediated through income over the life course. We account for both selective educational attainment and selective income over the life course, through inverse propensity weighting (IPW) of the mortality hazard. We decompose the educational gain, that is, the decrease in mortality from more education, in the hazard into an indirect effect of education, running through changes in income and a direct effect of education, running through other factors. We use Swedish conscription data (men only), linked to parental information and individual annual income for the period 1968 till 2012. Our empirical results indicate large educational gains in mortality. We also find that this educational gradient runs through changes in income, especially for the more educated, and does not run through other factors related to education. We conduct several robustness and sensitivity checks that indicate that the results are robust.

Effect of the Partners in Play Intervention on Parents' Autonomy-Supportive Guiding Behaviour and Children's Self-Regulation.

Compelling evidence supports the foundational importance of early self-regulation (SR). It also supports parents in the home environment as having the foremost influence on early development. Yet, prevailing approaches to support early SR growth have tended to leverage early education and clinical settings. Partners in Play (PiP) was developed as a sustainable approach for parents to learn how and when to support children through experiences of self-regulation challenges in the home learning environment. This study reports the first randomised control trial evaluation of the PiP program, with 21 parent-child dyads (consisting of twelve girl-mother dyads, eight boy-mother dyads, and one boy-father dyad; mean child age = 4.12 years, SD = 0.65). Dyads were randomised to a PiP intervention group (n = 10), which entailed four online parent information sessions and four out-of-home guided practice dyadic play sessions across 8 weeks, or an active control group (n = 11). The primary outcome was parent autonomy support, and the secondary outcome was child SR. Results indicated a significant increase in parents' use of autonomy support and a non-significant but moderate-sized effect on child SR. This innovative proof-of-concept program and evaluation provides a roadmap for effecting change in parental support during children's play, to the prospective benefit of important abilities such as child SR. Analyses show promise for a parent-based model toward parent behaviour change and child SR improvement.