Abstract Issue/problem Vaccination at the time of the Covid-19 pandemic is a challenge for vaccinators. The consequences of not vaccinating against human papilloma virus (HPV) of youngs for their future reproductive health are far-reaching. In Croatia, HPV vaccination is voluntary and free for all school children and students. Description of the problem Rate of HPV vaccination in eighth grade students before the epidemic school year 2018/19, at the onset of the epidemic 2019/20 and 2020/21 in the midst of the epidemic, Croatia in the city of Koprivnica and 11 municipalities in the Koprivničko-križevačka County. The research included 1530 children of eighth grade during three school years in the city of Koprivnica and 11municipalities. Data were collected by the School Health Service. Before the panidemic, vaccinations took place at school, and during the epidemic exclusively in school medicine practices. Completely vaccinated are considered those vaccinated with two or three doses depending the student age. Results Fully vaccinated students 2018/2019 is 54.2% (277/511), urban area 48.0% (133/277) and rural area 61.5% (144/234). 2019/2020 62.0% (330/532) of students were vaccinated, urban area 56.3% (160/284) and rural area 68.6% (170/248). Coverage of girls with full vaccination 2018/2019 is 63.4% and boys 46.6%. In 2019/2020 71.8% girls and 52.3% boys were fully vaccinated. In 2020/2021 the first dose received 53.4% (260/487), girls 65.3% and boys 43.4%. The second dose did not received in 2018/2019 5.2% students and 2019/2020 8.8%. The main reason in the rural area is the distance from school clinics and the inability to vaccinate children at school. Lessons In the school year 2019/2020 there was an increase in vaccination compared to 2018/2019 of 7.8%, despite difficult conditions. Key messages Unexpectedly during the epidemic the response to vaccination increased. HPV vaccination should remain a priority in adolescent health protection.
Introduction Covid-19 intensified public demand for telehealth services in child psychiatry. The shift towards online services raised concerns related to safety and quality of services. Objectives The objective of the study was to explore outcomes and perceptions regarding psychiatric telehealth services from the patients’ and professionals’ perspectives. Methods Survey and questionnaires were the main methods to collect feedback after 1129 sessions conducted by psychiatrists and psychotherapists for 559 young patients in 2020. Results Overall, patients/caregivers were generally satisfied with the quality of services, despite some technical issues and limitations of the platform. The most common outcomes of the sessions were: psychotherapy, in-depth assessment, pharmacotherapy, in-patient treatment, referrals for in-person appointments with other specialists, parenting strategies. Professionals gave more positive feedback on telehealth services after a few months of practice and training. Psychiatrists preferred conducting telehealth appointments for the patients they have previously seen in-person. The most common diagnosis were various neurodevelopmental disorders (48,9%), as well as patients within F84.0-F84.5 27,9%, and F84.8 (19,8%). Identification challenges, confidentiality and safety maintenance were among the top concerns for mental health workers. Specific guidelines for caregivers helped to use the appointment time effectively, prevent some technical and organizational issues and decrease negative effects of limited communication capabilities during a telehealth appointment. Conclusions Telehealth services in psychiatry are meeting real needs of patients, caregivers and professionals, and require further development. Proper training for professionals and clear guidelines for caregivers are among the key factors that enhance the quality of services.
Children's exposure to sexually explicit online material has been associated with early sexualisation, distorted gender norms, risky sexual behaviours, and adverse mental health outcomes, with first exposure often occurring before the age of 12 and increasingly through mainstream digital platforms. Age assurance has therefore emerged as a regulatory approach that shifts the responsibility of restricting underage access from parents to digital services. The United Kingdom Online Safety Act 2023 establishes one of the first comprehensive statutory age assurance frameworks, combining risk-based duties, regulatory guidance, multiple verification pathways, privacy protections, and staged enforcement. This study applies a desk-based policy analysis, guided by the Health Policy Triangle, to examine the regulatory architecture of the United Kingdom age assurance framework and assess the conditional transferability of its safeguards to sub-Saharan Africa. The sources included legislation, regulatory guidance, official policy documents, civil society analyses, peer-reviewed literature, and early implementation reports published between 2020 and 2025. Early implementation signals indicate platform compliance actions, reported traffic reductions to certain adult sites, increased circumvention behaviour, including the use of virtual private networks, and mixed public responses characterised by broad support for child protection alongside concerns about the effectiveness of the measures and the sharing of identity credentials. These indicators are interpreted as preliminary governance and implementation signals rather than the evidence of policy effectiveness. Five policy design elements appear potentially adaptable under equity and capacity constraints: risk-based proportionality, multiple and document-free verification pathways, transparency and vendor accountability, staged supervision and enforcement, and cross-regulator coordination. The study provides a policy analytic framework for country-level adaptation in sub-Saharan Africa and highlights priorities for context-sensitive implementation and future evaluation.
Abstract Introduction The promotion of rights and the protection of children implies involvement between state agencies and families in the evaluation processes, having developed in the child Welfare systems Internationally [1–3]. Although effective involvement is an essential component of the Help process [4], it presents continuous challenges for Professionals [5]. There is also an underlying tension between the regulatory role inherent in the protection system and the importance of involvement and contribution to develop the capacities of families producing better outcomes for children [6]. It is a challenge for families and professionals to deal with the duality of the relationship, given the expectations that workers engage in conflicting roles of supporting families, on the one hand, and ensuring the safety of children, on the other, having the authority and The mandate to remove children when necessary causes a level of mistrust that interposes in interactions [7]. We define as objectives to carry out a comprehensive research in order to identify how the families of children and young people in danger are evaluated and which indicators are used in the literature and in the organisations of the various countries. This scoping review presents as a premise the question of research: what are the family hazard indicators that jeopardise the harmonious development of children and young people? Scope studies present an increasingly frequent option to synthesise health evidences [8]. Materials and methods This scoping review was performed by both authors and a protocol was defined using the items for scoping review (PRISMA-SCR) Checklist, supported in two research strategies. A first through electronic databases EBSCOhost (CINAHL, Nursing & Allied Health Collection: Comprehensive, MEDLINE Complete, MedicLatina), BVS (MEDLINE, LILACS, Index psychology-technical-scientific journals, BDENF-nursing) and in a Second phase on the sites of State institutions and non-governmental organisations, which promote rights and protect children, with relevant research data (web of Science). The research was carried out between 2017 and 2018. All researches that could answer the research question were included, the limitation of this study was the difficulty in finding authors whose research is centre in the indicators of family hazard for children and young people, with a The vast literature where risk and danger coexist. The first author performed the research in the databases and on the websites of the organisations and the two authors examined the same (no 225) publications, discussed the results and defined the data to be harvested. The disagreements in the selection of studies and data extraction were resolved by consensus and discussion. The descriptors (keywords) and their combinations were: indicators, social service/social work/protection service, family/caregiver, negligence/abuse/maltreatment, child/Young, assessment/evalution tools. The data protocol to be extracted was jointly developed by the two reviewers who mapped the data independently, discussed the results and continuously updated the data collection protocol in an interactive process [9]. Results: Throughout the research process, we were confronted with the meaning of the concepts of risk and danger. For some realities it is understood as a risk the probability of an event happening, while danger is the condition for the risk to occur, however, most countries consider the danger as being a situation where the medium risk and high Risk. In this sense, the existence of a situation affecting the fundamental rights of the child is not sufficient; It is necessary for it to be unprotected in the face of this danger. What guided the identification of the indicators of family hazard, focussed on the absence of protective factors, which expose the child to the circumstances before which it is unprotected. After analysing the integral texts, seventeen articles fulfilled the criteria for inclusion in this study, immersed 35 family hazard indicators, as well as the danger problems for children associated with each of these, the findings were in a framework in order to mirror its representation. The sites included in this research also fulfilled these inclusion criteria, referring to hazard indicators, resulting from structured investigations and manuals, which serve as a reference for professionals, from a given Region or country. The results inherent to them were also structured in a framework that would render the collection objective and easily identifiable, We idenfied twenty-five indicators of family hazard. The risk indicators as a whole resulted, either from the research carried out in the databases or from the websites consulted. In the table below are listed all the indicators of family hazard that emerged from the literature (Table 1). Discussion and Conclusions: The studies included in a meta-analysis on the impact of family intervention programs at home in reducing neglect and ill-treatment for children considered that alcohol and/or drug abuse is an indicator of high risk in the perpetuation of Negligence in particular with children between 0 and 5 years, because it is considered a greater vulnerability in this age group [10]. One of the questions that is observed in the assessments performed are the attitudes of caregivers in relation to the child, and the negative attitudes towards the child are considered as a predictor of danger [11]. In order to identify the detailed risk profile of the families referred to the CPS, it was included as an indicator for a high risk of negligence, mothers living in poverty, having been enrolled to receive home visits until the child completes Five years [12]. Loman and Siegel found significant differences between parental competence impairment, when physical abuse is in question (the child suffered severe harm that was inflicted on him) and when the problem signalled is neglect Children (lack of supervision, unmet basic needs, unsafe domestic environment and absence of health care) [4]. There is no evidence that safety risks and domestic appearance are associated with the severity of child abuse potential, however, domestic safety and appearance factors are relevant in caregivers referenced as negligent for With their children and who have a substance abuse behaviour [13]. The father's criminal history was also identified as a significant risk factor regardless of the level of parental involvement in these high-risk families [12]. The recurrence of maltreatment (represented by the presence of multiple reports to the CPS) may be a more appropriate way to stratify the families involved with the child protection agencies. The recurrence of mistreatment was consistent with the number of times the family was signalled. Previous studies suggest that the number of reports and evidence of the reports should be considered as indicators of the severity of the abuse [12]. The home intervention programs reported by Cassillas et al. concentrate their attention mainly on mistreatment, having as target population parents with a history of maltreatment [10]. The verification of the full reports of the CPS, carried out by Duffy, Hughes, Asnes and Leventhal (2015), provided systematic information on the factors considered to increase the risk of child abuse the existence of a history of signalisation to Parent CPS as children. In the investigation carried out by the aforementioned authors, almost half of the mothers had a history of previous involvement with the CPS, considering this situation as one of the highest risk levels for the mothers [12]. The age of caregivers (adolescents/older age) is one of the reasons, either for their signalling to services (CPS) or for intervention programs with home follow-up conducted by Community agencies [10]. As a risk factor in relation to social characteristics, social deprivation is mirrored, as well as a social network Parca [12]. For Cassillas, Fauchier, Derkash and Garrido (2016) being a single parent was considered a risk factor for the existence of maltreatment and neglect [10]. The only risk factor that was of borderline significance for the outcome of recurrence was the presence of many caregivers. In this study, this finding was potentially important about the care environment in these high-risk families and need more studies where this variable is included [12]. There is a comprehensive literature on risk factors for abuse and neglect, in the four major risk domains, one of the identified are the social characteristics, in which the violent neighbourhood encompasses, as well as police involvement and Feeling of insecurity [12]. The caregiver's physical health is considered as a safety item, hence its absence increases the danger situation for the child. The history of psychiatric illness is one of the risk factors referenced, and maternal sociopathy is one of the mental problems encountered where the dangerousness increases [4]. Based on the several studies conducted over decades, they were focussed as one of the six risk factors for the absence of mental health of caregivers. It is verified in the reports of the families referred to the CPS, the highest levels of danger for the mothers, essentially centred on mental health problems [12]. Domestic violence is present in almost all families referred to the services, being considered one of the factors for the existence of danger for children. According to Loman and Siegel, there were no differences in the case of domestic violence (measured by acts of family violence, violence around the child and threats of care) The families referred to the services (CPS) have a high percentage of Episodes of violence. The authors found that violent behaviour around the child and acts of family violence jeoparthe their safety in the immediate [4]. Investment in children involves a whole range of services, but also regulates the behaviour and responsibilities of professionals and parents. This is a future-oriented approach, investing in children is designing the assurance that later develop productive and law-abiding adults. States will have to assume a new proactive and preventive role mainly because the current challenges are great, "the family" is not considered the most appropriate, by itself, to accomplish the expected tasks. This may have also been one of the historical motivations for the challenges in changing child protection systems [14]. We found that the indicators of family hazard are centred on several factors that contribute to the severity of the maltreatment inflicted on children and young people, it is unanimous for several authors the existence of alcohol and drug consumption; Mental illness; Domestic violence; Adverse socio-economic conditions; Parental competence. Most countries lack an adequate response, which respects the child's time, being the whole context of ambiguous evaluation and intervention, poorly structured and with scarce longitudinal studies that allow us to verify which strategy is most appropriate for Each of the situations referenced. We still have a long way to go in order to fulfil the entire convention of the rights of our children and young people.Table 1. Family hazard indicators that emerged from scoping review.1Alcohol and/or drug abuse2Negative attitudes towards the child3Lack of social support4Absence of transport5Low schooling of caregivers6Low economic resources/long-term unemployment/no financial autonomy7Commitment of parental competencies/discipline rigid, inflexible or inconsistent/recourse to physical punishment8Inappropriate communication between separate parents/separations and conflictual divorces9Conditions/security/instability/housing precharity10Caregiver with criminal record/history of crime11Multiple journeys to emergency services with the child12Divergences/conflicts/dysfunctional/family isolation13Existence of Stepmothers and stepfathers14Unrealistic expectations of the caregiver for the child15Lack of co-operation of the caregiver with the services16Families already referenced to protection services17Single-parent families/unmarried mothers18Perpetuating history of inflicting ill-treatment19Personal history of having been the victim of maltreatment/abandonment in childhood20Parental signalling history as a child21Age of caregivers (adolescents/advanced age)22Multiple Caregivers23Child's special Needs24High number of children in family25Unwanted child26Physical health problems27Mental Health problems28Parents absent in children's education29Being the first child30Domestic violence31Violence in the community and in the neighbourhood/social neighbourhoods overcrowded/environmental negligence/neighbourhoods with crime/victims of discrimination
Background Approximately 40%-60% of children diagnosed with autism spectrum disorder (ASD) exhibit challenging behaviors such as aggression, elopement, self-injury, and property destruction that can endanger the health and safety of the child or others, often cause significant distress for families, and hinder the child's developmental progress. Although behavioral treatments grounded in the principles of applied behavior analysis have been shown to effectively reduce or eliminate these behaviors, significant gaps remain in how to deliver these interventions equitably. Objective This study aims to compare the efficacy of delivering in-person versus telehealth caregiver-mediated behavioral treatment for challenging behaviors in children with ASD. Methods The Caregiver Outreach for Autism Coaching at Home trial is a single-site, multiarm, parallel-group randomized controlled trial to evaluate the efficacy of delivering caregiver-mediated behavioral treatment for children with ASD who exhibit challenging behaviors. We aim to recruit 90 caregiver-child dyads with children with ASD aged 2 years, 0 months to 7 years, 11 months from metropolitan, suburban, and rural areas across New Mexico and the neighboring El Paso, Texas region. Following a practical functional assessment to identify the potential social-environmental variables maintaining the child's challenging behavior, caregiver-child dyads will be randomized into one of three parallel treatment arms: (1) caregiver-mediated behavioral treatment delivered via telehealth, (2) caregiver-mediated behavioral treatment delivered in person, or (3) caregiver online psychoeducation. Interventions will be delivered by clinicians in weekly 1-hour sessions in the home setting over 12 weeks. Results The study was funded in May 2022, and recruitment began in January 2024. As of March 2026, 81 caregiver-child dyads have been enrolled, with equal allocation across the 3 study groups (27 per group). Recruitment is expected to conclude in October 2026, with data analysis planned for Winter 2026 through Spring 2027. Conclusions This study will address a critical gap in the scientific literature on scalable, family-centered approaches to safely and effectively reduce challenging behavior in children with ASD and decrease caregiver stress. Findings may inform best practices and payer policy for telehealth-delivered behavioral interventions targeting child safety and caregiver well-being.
Background Preterm-born children are vulnerable to respiratory tract infections (RTIs), but we know little about how these were affected by COVID-19 pandemic control measures. Methods We studied Norwegian population-wide registry data on 1-5-year olds born 2012-2021. RTI hospitalisations were identified from primary hospitalisation diagnosis codes. We modelled prepandemic hospitalisation rates, January 2017 to March 2020, using quasi-Poisson regression with harmonic seasonal terms. These were compared with monthly hospitalisation rates, March 2020 to December 2022. The calculations were performed separately for gestational age groups: 23-33, 34-36, 37-41 completed weeks. Results We identified 9734 RTI hospitalisations among 449 105 children aged 1-5 years, with higher rates in the most preterm groups. Across gestational ages, we observed lower hospitalisation rates during control measures in 2020, followed by a surge after measures were lifted in 2021. For children born in weeks 23-33, the rate reduction with 95% CI during the first year of the pandemic compared with the prepandemic years was -21 per 1000 person-years (95% CI -30 to -13), whereas in April-December 2022, there was an increase of 22 (95% CI 12 to 31). For term born (week 37-41), the corresponding changes were -4.9 (95% CI -5.5 to -4.3) and 3.6 (95% CI 2.9 to 4.2). Conclusions Compared with term born, preterm-born children of all gestational age groups were more distinctly protected by pandemic control measures. They were also more affected by the resurgence of infections when measures were lifted. These findings call for policies to protect preterm-born children better from RTIs, especially when viral spread is high.
Background Parents and caregivers are responsible for safely administering prescribed medicines to their children at home. This complex process relies on caregivers to be adaptive to any disruptions to this process that may diminish their ability to provide safe care to their children. Learning about the disruptions caregivers experience, alongside any adaptations to these disruptions, will inform improvements to healthcare systems. The aim of this review is to explore the experiences of disruptions to safety and any subsequent adaptations reported in research by parents and caregivers who administer prescribed medicines to children at home. Methods This review followed the Cochrane-Campbell methodology for framework synthesis. Major healthcare databases (Embase, PyscINFO, CINAHL, Cochrane, PubMed) were searched to identify qualitative studies which reported the experiences of parents and caregivers who administered medicines to children at home. Quantitative studies were not included. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the quality of included studies. Extracted data from studies was organised and interpreted using the Moments of Resilience framework. Results 27,940 studies were identified and screened. Fifty-one studies were included in the review. The synthesis identified that caregivers experienced frequent disruptions from medicines, healthcare systems and family life that required adaptations to avoid causing harm to their children. Caregivers used a variety of short-term situated adaptations, that were supported by medium-term structural adaptations. However, these were not equally distributed across individuals and resources involved. There was a limited description of long-term systemic adaptations experienced by caregivers. Discussion The use of adaptations by caregivers was well described and often involved significant effort from caregivers. The adaptive capability and capacity of caregivers was influenced by several factors such as family characteristics, access to resources and healthcare systems design. Future improvements to healthcare systems should reduce disruptions to avoid the need for adaptations entirely, alongside strengthening the ability of caregivers, professionals and healthcare systems to be adaptive to novel and unpredictable disruptions. Limitations include the variable quality of included studies, the lack of reporting of theoretical or cultural perspectives, and the influence of researchers on data and findings. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024487154, PROSPERO #487154.
Road traffic injuries remain a leading cause of death and serious harm among children, and a substantial proportion of this burden occurs among child passengers. Despite clear safety recommendations, incorrect installation and suboptimal child restraint system (CRS) selection remain widespread, representing a persistent public health implementation gap. Against this backdrop, the present study examined determinants of CRS selection decisions and self-reported installation and use practices, with a particular focus on how selection and retail-support experiences relate to intention to choose the same CRS again. A cross-sectional online survey (Google Forms) was conducted from February to December 2024, yielding 3,750 questionnaires, of which 1,150 complete cases were included in analysis. Descriptive statistics were supplemented with chi-square tests (Cramér's V) and multivariable logistic regression (odds ratios, 95% CI) for top-box intention to choose the same CRS again ("yes/probably yes"). Price (58.1%), seat weight (48.2%), and installation method (46.1%) were the most frequently reported selection determinants, while safety tests (28.3%) and comfort (26.4%) were less commonly cited. ISOFIX solutions predominated (74.6%), with installation most often behind the driver (45.0%) and a notable share on the front seat (25.4%). Intention to choose the same CRS again was low (27.4% top-box; 62.3% negative). Seller installation demonstration was associated with intention to choose the same CRS again (χ2 = 22.82, p = 0.0036; V = 0.100), whereas reported child discomfort was not (p = 0.9378). In logistic regression, only age 26-35 years (vs. 18-25) predicted top-box intention to choose the same CRS again (OR = 1.42, 95% CI 1.05-1.91), with overall low explanatory power (McFadden pseudo-R2 = 0.0167). The findings suggest that economic and usability considerations outweigh explicitly stated safety criteria, and that closing the implementation gap requires stronger, scalable support for correct CRS selection and installation.
Introduction Mental health crises among children and young people are increasing in frequency and complexity, yet emergency responses often lack appropriate tailoring for young people and responders cite a need for further workforce training and support. This study will integrate immersive theatre, co-production methods, health economic analysis, research data, and a realist synthesis to develop a holistic programme theory informing joint responses to crisis care for children and young people. It will incorporate novel triangulation across these methods and, where appropriate, draw on the recently published Realist Economic Evaluation Methods(REEMS) guidance. Methods This study aims to evaluate a novel intervention involving a joint response by police officers and mental health practitioners. A realist and health economic evaluation design will be employed, incorporating multiple data collection methods. Participants will include children and young people aged 5-18, their families, carers, and practitioners. Data will be collected through surveys, interviews, and routine service records, with recruitment via five distinct pathways including direct response and online participation. Results The evaluation will explore how, why, and for whom the joint response car works, identifying mechanisms and contextual factors that influence outcomes. A cost-consequence analysis will assess the financial implications of the intervention compared to usual care. Discussion Findings will inform best practice guidance for emergency mental health care and support national implementation of joint response models. The study will also contribute to understanding service integration and stakeholder engagement in crisis care.
Background The management of house dust mite (HDM) allergies in children is evolving with new evidence for precision diagnosis and therapies. However, global disparities in resource availability and regional variations in sensitization profiles challenge the implementation of optimal care. Objective To synthesize the latest evidence (2014-2025) and propose a component-resolved diagnosis (CRD)-guided stepped-care framework for pediatric HDM allergies, addressing evidence gaps and global health disparities. Methods We conducted a systematic review following PRISMA guidelines and searched the PubMed, EMBASE, Cochrane Library, and Web of Science databases for randomized controlled trials, meta-analyses, cohort studies, and clinical guidelines. Two reviewers independently screened records, assessed eligibility, and extracted data. Of 3371 records identified, 92 studies met the inclusion criteria and were included in the qualitative synthesis. The outcomes included the efficacy and safety of environmental controls, immunotherapy (sublingual [SLIT] vs subcutaneous [SCIT]), biologics, and the role of CRD. A narrative synthesis was performed because of substantial clinical heterogeneity across studies, supplemented by recent meta-analyses in a quantitative context. Results Individual studies reported short-term Der p 1 reductions of 45-60% with physical interventions; however, a meta-analysis of 17 Randomized Clinical Trials (RCTs) revealed that these reductions were insufficient to improve clinical outcomes, and long-term adherence remained poor (<42%). Compared with SCIT, SLIT demonstrated a superior safety profile (local reactions <10%) and lower systemic reaction risk (OR 2.6, 95% CI 1.8-3.8), whereas SCIT was more effective in polysensitized children (symptom remission: 40% vs. 25%; RR 1.60, 95% CI 1.12-2.28). Omalizumab improved lung function (FEV1: +12.5%, p < 0.01) in patients with severe asthma, but its high cost (∼$30,000/year) limited patient access. CRD identified Der p 23 as a key biomarker for asthma severity (OR 2.5, 95% CI 1.3-4.8) and revealed distinct geographic sensitization patterns-such as Der p 1 predominance in Asia versus Der p 23 in Europe. These observations raise the hypothesis that regionally tailored immunotherapy formulations could improve outcomes, although this hypothesis requires prospective validation through multinational clinical trials. Conclusion Based on the synthesized evidence, this review outlines a preliminary CRD-guided, stepped-care framework that integrates molecular sensitization profiles with clinical phenotype and resource availability. This conceptual model seeks to move beyond conventional one-size-fits-all approaches by proposing resource-stratified pathways that prioritize cost-effective strategies in resource-limited settings while reserving intensive therapies for high-risk subgroups. However, the framework remains conceptual and requires prospective validation in diverse clinical and socioeconomic settings before its utility for addressing global health disparities can be assessed. Future priorities include gathering long-term biologic safety data, conducting real-world cost-effectiveness analyses, and developing globally harmonized, resource-sensitive guidelines.
