We examine the relationship between gender equality and fertility ideals, focusing on the role of societal norms about men's participation in care and household work, known as the second half of the gender revolution. We set out to capture how the prevalence of this revolution translates into fertility ideals on the societal level and among different social groups. Data come from the ISSP module 2012, covering 26 societies. The first objective is to examine the relationship between gender equality norms and fertility ideals across national contexts. The second objective is to compare how measures of gender equality focusing on the first half of the gender revolution, and the second half, respectively, are associated with fertility ideals. As previous research focusing on the first half of the gender revolution noted and/or predicted that actual or intended fertility tends to be comparatively lower among women, the highly educated, younger generations, and the non-religious, our third objective is to analyse the extent to which norms embracing the second half have the capacity to modify these relationships. The results show that norms about gender equality are positively related to fertility ideals and seem to influence patterns of fertility ideals among social groups. In societies with strong gender equality norms, women, the highly educated, and the young display comparatively higher fertility ideals. In societies with weak gender equality norms, these patterns are reversed. Differences depending on gender equality norm measures were small but systematically in favour of those capturing the second half of the gender revolution.
Ethiopia has prioritised high-impact interventions to reduce neonatal deaths, including antenatal corticosteroids (ACS) utilisation. However, effective ACS use has faced various challenges. We used multiple data sources to examine the current landscape of ACS use in Ethiopia and to elucidate barriers to effective ACS utilisation, including a review of national obstetric guidelines over the past decade, a review of literature, and a descriptive analysis of health facility data.National obstetric protocols recommend administering ACS in both hospitals and health centres. However, ACS remains substantially underused. The 2016 Ethiopian Emergency Obstetric and Newborn Care Assessment reported that only 5% of preterm infants were born to women who had received corticosteroids before delivery. At the health facility level, the 2021 Ethiopian Service Provision Assessment survey showed that only 22.1% of facilities providing antenatal care and delivery services had administered ACS in the past 3 months, and 44.7% of facilities had injectable corticosteroids in stock at the time of the survey. Notably, private clinics had both the lowest corticosteroid availability (16.9%) and utilisation rate (2.8%).We identified several barriers to effective ACS use, including healthcare service delivery organisation, gaps in healthcare providers' knowledge and skills (particularly at the primary healthcare level and in private facilities), challenges in accurate gestational age assessment resulting from limited access to early ultrasound and late initiation of antenatal care, and insufficient corticosteroid availability. Increasing ACS uptake alone is unlikely to have the desired population benefits without considering health service delivery redesign and integration with other life-saving maternal and newborn health interventions.
Background This study investigates the characteristics of children with refractory status epilepticus (RSE) who experienced withdrawal seizures and responded favorably to continuous midazolam (cMDL) therapy. Methods Patients who experienced RSE and achieved seizure cessation with cMDL were included in the study. Withdrawal seizure was defined as a seizure occurring from the initiation of cMDL tapering until 48 h after the discontinuation of cMDL. The patients were categorized into two groups: seizure cessation and withdrawal seizure groups. Results Nineteen patients with RSE achieved seizure cessation with cMDL. The seizure cessation group comprised 11 patients, while eight patients (42.1 %) were classified into the withdrawal seizure group. The median maintenance dose of cMDL were 0.1 mg/kg/h (interquartile range [IQR]: 0.1-0.2) for the seizure cessation group, and 0.25 mg/kg/h (IQR: 0.15-0.3) for the withdrawal seizure group. The median maintenance periods were 27 h (IQR: 12-32.5) for the seizure cessation group, and 52.5 h (IQR: 23-65.5) for the withdrawal seizure group. The seizure cessation group had a median cumulative MDL of 2.7 mg/kg (IQR: 1.6-4.9), while the withdrawal seizure group had 11.6 mg/kg (IQR: 4.5-24.5). Conclusion Although statistical analysis was not conducted due to the small sample size, maintenance dose of cMDL is potentially correlated with withdrawal seizure. A multi-center study with large sample size and statistical analysis of this relationship may contribute to the establishment of an optimized cMDL tapering protocol.
Urea cycle disorders (UCDs) are rare inherited metabolic diseases characterized by defective detoxification of nitrogen, leading to hyperammonemia and neurological complications. While pediatric UCDs have been extensively studied in Japan, data on adult patients remain limited. This study aims to evaluate the current status of Japanese adult UCD patients, hereby comparing long-term outcomes after neonatal/infantile or late onset in a new nationwide study investigating clinical manifestations and management. In total, we collected data of 116 adult UCD patients diagnosed and/or treated at various institutions, combining this new cohort (34 UCD patients between January 2010 and December 2022) with data from a previous nationwide study (82 UCD patients between January 2000 and March 2018). Among 116 adult UCD patients, ornithine transcarbamylase deficiency was the most common subtype (N = 69). Hyperammonemia occurred in 91.4% of patients, and intellectual disability was present in 50.0%. Patients generally showed reduced final height and BMI compared to Japanese controls, particularly among females and those with infantile-onset UCDs. Peak ammonia levels ≥ 360 μmol/L were significantly associated with intellectual disability. Liver transplantation (LT) was performed in 20 patients, and although it helped to avoid hyperammonemia, it did not statistically improve neurocognitive outcomes in patients with peak ammonia < 360 μmol/L. This study provides the first comprehensive overview of adult UCD patients in Japan, highlighting frequent growth impairment and variable cognitive outcomes. LT improves metabolic control but cannot prevent intellectual disability in all patients. These findings underscore the need for early diagnosis, individualized treatment strategies, and long-term follow-up into adulthood.
Aim To describe the epidemiology of cerebral palsy (CP) among children in rural areas of Malawi. Method This was a cross-sectional study on children with CP younger than 18 years from a rural district registered in the Malawi Cerebral Palsy Register. Community child protection workers, trained as CP key informants, identified children with CP using a population-based approach. A multidisciplinary medical team ascertained the CP diagnosis before registration. The children's baseline characteristics, CP risk factors, and comorbidities were documented. Descriptive and inferential analyses were completed. Results A total of 911 children were screened (December 2023-June 2024), and 538 were registered (median [interquartile range] age = 5 years 11 months [range: 2 years 7 months-11 years 10 months], 59.3% male). Bilateral spastic CP was the most common type (46.3%), with most children (90.5%) classified in Gross Motor Function Classification System levels III to V. The observed CP prevalence was 1.7 per 1000 children. Perinatal asphyxia (40.5%) and cerebral malaria (12.3%) were the most common 'probable causes'. Institutional deliveries were reported in 95.1% and prolonged or obstructed labour was the most reported labour complication (42.7%). Interpretation Our findings suggest that preventable causes are the main drivers of CP in Malawi. As such, factors in the health care system that contribute to these causes need to be evaluated.
Aims To assess the reliability and validity of a negative emotion scale for public health nurses conducting child abuse prevention activities. Design A four-phase mixed method design. Methods Participants were public health nurses with experience in child abuse prevention across Japan. The initial scale was developed and refined based on previous studies, expert panel reviews, interviews with public health nurses, and a questionnaire-based pilot study. In 2024, 549 public health nurses completed a questionnaire on scale items. Item analysis, exploratory factor analysis, confirmatory factor analysis, comparisons with a preexisting scale, the number of times negative attitudes and the types of behaviours exhibited by parents were used to narrow the scale and assess its psychometric properties. Results Item analysis and exploratory factor analysis reduced the scale to 15 items on two factors: 'negative emotions toward aggressive and emotional attitudes' and 'negative emotions toward rejecting and uncooperative attitudes.' Confirmatory factor analysis indicated a good model fit. The Cronbach's alpha was high, and the negative emotions scale score positively correlated with the pre-existing scale, negative attitudes and parental behaviours. Conclusions The Cronbach's alpha coefficient and other factors confirmed the scale's reliability, and correlations with other scales confirmed its validity. Implications for the profession Evaluating negative emotions provides critical insights into the quality of support and its influence on psychological well-being. Impact By assessing negative emotions that public health nurses find difficult using this scale, the support system for them can be examined. Reporting methods STROBE checklist for cross-sectional studies was followed. Patient or public contribution Public health nurses were involved in the generation of items for the scale. Their perspective was sought in determining the items for the scale. Trial and protocol registration Registered in the UMIIN Clinical Trial Registry (UMIN-CTR ID UMIN000054650).
Parental labour migration is a widespread phenomenon in developing countries across Central and Eastern Europe and may impact the emotional security of Left-Behind Children (LBC) due to prolonged separation from primary attachment figures. In Romania, official data estimate that nearly 58,000 children have parents working abroad. Parental migration has both positive and negative effects on children's development. This review examines the scope of the phenomenon and its psychological impact on Romanian children. A literature search was conducted across Web of Science, PubMed, SAGE, ScienceDirect, ProQuest, and Google Scholar for studies published between 2007 and 2024. Fourteen studies were included, highlighting psychological effects of parental migration on children's mental health and parent-child relationships. The findings are discussed through the lens of attachment theory. Further research is needed to understand the long-term consequences of such separations. The findings are relevant not only to researchers but also to institutions seeking to develop policies aimed at reducing parental labour migration or mitigating its negative impact on LBC.
Objectives Daytime sleepiness in children is a significant public health concern. This study aimed to examine the association between subjective sleepiness and vigilant attention in elementary school students, as well as the interaction effects of grade and sleepiness on this association. Methods We enrolled 2789 students from six elementary schools in Tokyo, Japan. Sleepiness was assessed using the self-reported Karolinska Sleepiness Scale (KSS) and a parent-reported questionnaire. Vigilant attention was measured with the 3-minute brief Psychomotor Vigilance Test (PVT-B). Generalized linear models were used to examine the associations between sleepiness and PVT-B performance metrics, including response speed (mean reciprocal reaction time, 1/s) and lapse500 (number of reaction time ≥500 ms), as well as the interaction effects between sleepiness and grade. Results This cross-sectional study included 1955 elementary school students (aged 6-12 years; 52% boys). Significant interactions between KSS and grade were observed for response speed (B = -0.0032, FDR-adjusted q < 0.05) and lapse500 (B = 0.0096, FDR-adjusted q < 0.01). Similarly, significant interactions between parent-reported sleepiness ("falling asleep during an activity") and grade were found for lapse500 (B = 0.0347, FDR-adjusted q < 0.05). Conclusions Our findings indicate that the association between sleepiness and vigilant attention among children varies by age, emphasizing the importance of considering developmental differences when evaluating sleep health in pediatric populations.
Objectives To collate and appraise evidence from existing systematic reviews and meta-analyses on interventions to prevent stillbirth and reduce perinatal mortality across the reproductive continuum, including preconception, antenatal, intrapartum and immediate newborn periods. Design Umbrella review synthesising evidence from systematic reviews, including meta-analyses where available. Data sources A comprehensive search was conducted in CENTRAL (via Cochrane Register of Studies Online), PubMed, Embase and Web of Science, along with trial registries (WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and ISRCTN Registry), from inception to 12 January 2026. Eligibility criteria Systematic reviews and meta-analyses synthesising randomised controlled trials or quasi-experimental studies that reported stillbirth, perinatal mortality, fetal loss or fetal death were included. Reviews focused exclusively on predefined high-risk populations were excluded. Data extraction and synthesis Two reviewers independently extracted data and assessed methodological quality using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty ratings were extracted as reported by the original review authors. Evidence synthesis followed a structured framework adapted from Ota et al, integrating direction of effect and certainty of evidence based on pooled estimates and GRADE assessments. Publication overlap was assessed using the Corrected Covered Area index where relevant. Results A total of 116 systematic reviews were included, synthesising evidence from randomised controlled and quasi-experimental studies across preconception, antenatal, intrapartum and immediate newborn periods. Evidence from individual reviews showed clear benefit for several interventions, including balanced energy-protein supplementation, home visits by community health workers, birth preparedness interventions, labour induction at or beyond 37 weeks of gestation and skilled or community-based intrapartum care, primarily for reducing perinatal mortality. Reduced antenatal visit schedules compared with standard care were associated with a possible increase in stillbirth or perinatal mortality, indicating potential harm. Many interventions-such as group antenatal care (ANC), nutritional education, case-note provision, routine ultrasound or Doppler monitoring, antibiotic treatment for bacterial vaginosis, antiretroviral therapy in pregnancy and several pharmacological or hormonal interventions-demonstrated unknown or inconclusive effects on stillbirth or perinatal mortality, largely due to imprecision and heterogeneity. Conclusions This umbrella review identifies a range of interventions with evidence of effectiveness across the reproductive continuum, particularly those addressing maternal nutrition, continuity of ANC and quality intrapartum and newborn care. However, substantial evidence gaps remain, especially for interventions widely implemented without strong supporting evidence. These findings highlight the need for context-specific implementation research and prioritisation of proven strategies in low- and middle-income countries, where the burden of stillbirth remains highest. Prospero registration number CRD42024531100.
Purpose To evaluate the self-perceived enablers and barriers among female ophthalmologists practising in health centres nationwide across Saudi Arabia. It also reviews their work-life balance, psychological wellbeing, experience of workplace discrimination, maternity-related challenges, and the personal and institutional factors that facilitate or hinder their professional and maternal roles. Patients and methods A cross-sectional, face-to-face survey was conducted among female ophthalmologists practising in health centres nationwide across Saudi Arabia over an eight-month period (October 2023 - June 2024). Participants were interviewed using a structured, piloted, and back-translated questionnaire. Self-perceived work-life balance (WLB), psychological wellbeing, happiness at home and at the workplace, experience of workplace discrimination, maternity-related challenges, and personal and institutional facilitating and impeding factors were assessed. Associations between WLB and demographic, family-related, and workplace variables were explored using non-parametric statistical tests. Results Fifty-five female ophthalmologists were enrolled in the study. Key enablers included strong family support (94.5%), spousal understanding (78.2%), and satisfactory WLB in 40 participants (72.7%). The predominant barriers were psychological unrest in 32 participants (58.2%), workplace discrimination in 27 (49.1%), and disproportionate childcare responsibility in 46 (83.6%). Median happiness scores were higher at home (9.0; IQR 8-9) than at the workplace (8.0; IQR 7-8). Most participants (61.8%) experienced their first birth during ophthalmology residency. The principal institutional barriers were workplace inflexibility (38.2%) and children's demands on maternal time (83.6%). No statistically significant associations were identified between WLB and age, number of children, or spouse's occupation (all P>0.05). Conclusion Female ophthalmologists in health centres nationwide across Saudi Arabia navigate a dual reality of meaningful enablers - including strong family networks, high WLB satisfaction, and effective personal coping strategies - alongside significant barriers, most notably psychological unrest, workplace discrimination, and institutional inflexibility. Targeted institutional and policy-level interventions are urgently needed to strengthen the enablers while systematically reducing the barriers faced by this workforce.
