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How to deal with COVID-19 vaccine hesitancy in pregnant and breastfeeding women? A meta-analysis : Francesco Paolo Bianchi

Abstract Background Pregnant and breastfeeding women are at an increased risk of severe illness from COVID-19 compared to people who are not pregnant. Therefore, the CDC recommends COVID-19 vaccination for women who are pregnant, breastfeeding, and trying to become pregnant or who may become pregnant in the future. Despite this, low vaccination coverages are reported in this population sub-group. The purpose of this study is to estimate the proportion of pregnant and breastfeeding women expressing hesitation to the COVID-19 vaccine worldwide. Determinants of vaccine compliance and options suggestedto address vaccine hesitancy were also analyzed. Methods Forty-six studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar, and Scopus databases between January 1, 2020 and February 6, 2022. The following terms were used for the search strategy: (adherence OR hesitancy OR compliance OR attitude) AND (covid* OR SARS*) AND (vaccin* OR immun*) AND (pregnan* OR post-partum OR breastfeeding OR lactating). Results The vaccine hesitation rate was 48.4% (95%CI=43.4-53.4%). In a sub analysis by study period, the pooled prevalence of vaccine hesitation was 40.0% (95%CI=31.6-46.6%) considering surveys administered in 2020, 58.0% (95%CI=48.9-66.9%) considering surveys administered in the first semester of 2021, and 38.1% (95%CI=25.9-51.2%) considering surveys administered in the second semester of 2021. The main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events for both mother and fetus/child. Conclusions In order to achieve high vaccination coverage, a multifactorial approach is needed, requiring major social, scientific, and health efforts. The success of the vaccination campaign in this population depends on the capillarity and consistency of the interventions implemented. Key messages • Vaccine hesitancy can be a determining factor in the success (or otherwise) of the anti-COVID-19 immunization campaign. • Vaccine hesitancy in pregnant and breastfeeding women is a genuine public health concern worldwide.

Bianchi F, Stefanizzi P, Di Gioia M et al.

A taxonomy of states' approaches to plans of safe care.

Background The 2016 Comprehensive Addiction and Recovery Act amended the Child Abuse Prevention and Treatment Act (CAPTA), expanding requirements for the development of state-specific Plans of Safe Care (POSC) for prenatal substance exposure. POSCs were intended to amplify existing efforts to include maternal referral to treatment and services in addition to infant safety planning. States were left to re-operationalize their own POSC procedures, including the extent to which the POSC process involved the child welfare system. We reviewed state statutes, regulations, and reports to create a taxonomy of state POSC approaches based on their relationship with child protective services (CPS) and healthcare systems. Methods We evaluated state POSC-related statutes, regulations, and federally mandated child welfare state reports (Annual Progress & Services Reports, Child & Family Services Plans, & CAPTA plans) for all 50 states and Washington, D.C. from 2012 to 2024. Using artificial intelligence-assisted text extraction and subject matter expert textual interpretation, we reviewed 634 documents and more than 123,000 pages of text. Through iterative categorization, we developed a five-domain POSC taxonomy, organizing POSC policies by their proximity to and engagement with CPS and healthcare systems. We then identified the number of states with POSC policies in each domain and the timing of implementation. Results Nearly all states had implemented their POSC by 2024. Our final taxonomy consisted of the following domains: (a) All CPS Referrals (26%), (b) Open Case Only (28%), (c) Alternative Response (26%), (d) Hospital-initiated (16%), and (e) Dual Pathways, that uses type of substance exposure to determine receipt of a Hospital-initiated POSC or traditional CPS response (14%). Eighty percent (80%) of states restrict POSC access to families already subject to CPS reporting or investigation. Conclusions Despite federal intent to broaden public health supports, state POSC policies largely reinforce existing CPS practices rather than offering proactive, non-punitive interventions. The proposed taxonomy offers a framework for future comparative research, policy evaluation, and reform efforts.

Sieger ML, Loch SF, Andraka-Christou B et al.

Medical Assessment and Management of Self-Inflicted Head Injury in an Inpatient Child and Adolescent Mental Health Services (CAMHS) Setting

Aims To ascertain whether current medical assessment and management of self-inflicted head injuries in an inpatient CAMHS setting conforms with current NICE guidance. Methods Incidents of self-inflicted head injury were identified on the incident logging system Ulysses. Incidents were matched to entries on Paris, the online clinical notes system. Data were collected from Paris on whether the incident was reviewed by a doctor, time until doctor review and which components of the NICE guidance were completed during the review. The data were collated into an Excel spreadsheet and analysed. Inclusion criteria were CAMHS inpatients at 1 Greater Manchester hospital during November 2021 who had an incident of ‘head banging’ recorded on Ulysses. Exclusion criteria were patients on ward A as the ward was found to have its own care plans for managing head banging rather than escalating to doctors. Results There were 52 incidents of head banging logged. 56% (n = 29) of incidents received a doctor review and 32% (n = 17) did not. For 10% (n = 5) of incidents a doctor review was declined and for 2% (n = 1) a review was conducted for another indication. The mean time taken until review was 4.3 hours with a range of 1 to 16 hours. NICE guidance lists 9 components of the history that should be covered. 1 component met the 100% target and 1 component was documented in > 50% of incidents. The remaining 7 components were documented in < 50% of incidents. NICE guidance lists 16 components of physical examination that should be completed. No components of the physical examination met the 100% target. 5 components were documented in > 50% of incidents. The remaining 11 components were documented in <50% of incidents. NICE guidance recommends verbal and written safety netting advice is given. Advice was given in 16% (n = 5) of incidents. NICE recommends a responsible adult remains with the patient for 24 hours, this was documented in 77% (n = 22) of incidents. NICE recommends ongoing doctor concerns necessitate patient transfer to A&E. Concerns/lack of concerns were documented in 6.6% (n = 2) of incidents. Conclusion This audit has demonstrated inconsistencies between doctor's documentation of self-inflicted head injuries in an inpatient CAMHS setting. The reviews do not meet the standards outlined by NICE. There is a good emphasis on gross neurology but less awareness of the need to document more subtle pathology and ongoing monitoring requirements.

Patrick G, Smallwood J, Webb C

mHealth-Supported Perioperative Care for Family Caregivers of Children Undergoing Tonsillectomy and/or Adenoidectomy (TONAPP): Randomized Controlled Trial.

Background Pediatric ear, nose, and throat (ENT) surgery is common, but generates perioperative anxiety for caregivers and distress in children. Limited time for perioperative education and reliance on unverified online information can reduce family preparedness and increase stress. Few studies have evaluated co-designed mobile health (mHealth) apps to support and engage families in the perioperative ENT journey. Objective This study aimed to compare caregiver anxiety between an mHealth app-supported care pathway and standard supportive and educational care alone in the perioperative ENT context. Secondary objectives explored between-group differences in caregiver anxiety at follow-up, family preparation, child distress, and social-impact indicators. Methods A 2-arm, parallel-group, open-label randomized controlled trial (RCT) enrolled caregivers of children undergoing ENT surgery (tonsillectomy, adenoidectomy, tympanostomy tube insertion). The intervention was an mHealth app co-designed through a user-centered participatory approach and developed following Schnall and colleagues' Information Systems Research Framework, with content based on caregivers' informational needs. RCT participants were recruited at the hospital during their presurgery visit, when a health care provider introduced the study and provided instructions on how to use the app. No additional human support was scheduled thereafter. A sample size of 180 participants (90 per group) was estimated to detect the expected between-group difference in caregiver anxiety. Participants were randomly assigned in a 1:1 ratio to app use or standard care alone. The primary outcome was the between-group difference in caregiver state anxiety (State-Trait Anxiety Inventory [STAI-Y]). Secondary outcomes included between-group differences in child distress (modified version of the Yale Preoperative Anxiety Scale [mYPAS]), child preparation for surgery, family preparation for hospital admission and surgery, and social impact indicators. Outcomes were assessed online through questionnaires, which included both self-reported measures and evaluations completed by a nurse on the day of surgery. App engagement metrics were also collected. Reporting followed the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines. Results The study enrolled 227 caregivers, with 111 allocated to the control group (CG) and 116 to the experimental group (EG), achieving the target sample size. No statistically significant differences were observed between the groups for the primary or secondary outcomes (all P>.05). In the EG, 75% (n=87) of the participants accessed at least 1 item of in-app content. Higher baseline anxiety was linked to lower app use (ρ=-0.22, 95% CI -0.39 to -0.04; P=.02), while greater use was linked to lower child distress (ρ=-0.23, 95% CI -0.40 to -0.04; P=.02). Conclusions Although the hypotheses were not confirmed, these findings provide valuable insights for future perioperative mHealth research. The lack of effectiveness may reflect limited exposure to the intervention, outcome selection and timing, and contextual factors such as caregivers' independent information-seeking. These findings support a greater focus on implementation processes and on identifying the caregivers most likely to benefit from mHealth-supported education.

Dobrina R, De Vita C, Brunelli L et al.

Dupilumab for the treatment of eczema molluscatum: A pediatric case report and systematic literature review.

Atopic dermatitis (AD) may be complicated by disseminated molluscum contagiosum virus (MOCV) infection, known as eczema molluscatum (EM), particularly in children. Topical treatments are not always effective, and although modern systemic immunomodulatory therapies for AD, including use in early childhood, are available, their impact on co-occurring MCV infection is not well documented. We present a 4-year-old child with severe EM that was refractory to conventional topical therapy. She was treated with dupilumab (300 mg subcutaneously every four weeks), which led to a rapid resolution of symptoms and clinical clearance of MOCV-1 infection without adverse events. To contextualize our findings, we performed a systematic literature review, including PubMed, ScienceDirect, Scopus, and Google Scholar, to identify published case descriptions of dupilumab use with co-occurring MOCV infection (PROSPERO ID CRD420251106639). We identified a total of six publications reporting on nine adult patients (mean age: 40 years, range: 21-58 years, 8/9 male). In five of these patients, EM temporarily flared up before resolution. The present report is the first of a child. Our findings, along with existing reports, suggest that dupilumab may be a safe and effective treatment option for AD patients with MOCV infection. Prospective evaluation using standardized outcome measures is warranted.

Obermeier PE, Puzich U, Brinkmann A et al.

Prospective prediction of substances use among a cohort of Tunisian adolescents

Abstract Background The risk of substances use increases during adolescence. In Sousse (Tunisia), an upward trend of these risk behaviors has been observed during the last years among young adolescents. Among older adolescents, the trend of their use is unknown. Objectives To determine the incidences and the most influencing factors on substances use among high school students in Sousse between 2018 and 2019. Methods A prospective longitudinal study was conducted among a cohort of high school students from Sousse. The same pre-tested questionnaire served to collect data in 2018 and 2019 from the same participants in their classes and in the presence of pre-trained investigators. Results A total of 404 high school students have participated in the study. Their median age was of 17 (IIQ: 15.8-17.6) years. Girls represented 66.8% of participants. The incidence rates of lifetime tobacco use, alcohol consumption, lifetime inhalants use and lifetime illicit substances use between 2018 and 2019 were 13%, 3.5%, 1.8% and 2 .9% respectively. Lifetime tobacco use was the main predictor of inhalants experimentation. This latter was the main predictor of becoming a user of e-cigarettes while alcohol consumption was the most influencing factor on cannabis experimentation among high school students. On the other hand, illicit substances use among friends predicted e-cigarette use, alcohol consumption, and cannabis experimentation among participants. Conclusions The existing prevention programs aiming at reducing tobacco use and substances use in the schools of Tunisia should be reinforced and integrate a comprehensive and multi-sectoral prevention program. The implementation of a national observatory of substances use would ensure the continuous improvement of this program. Key messages • There is an upward trend on using substances among the adolescents of Sousse, Tunisia. • Tobacco experimentation and alcohol consumption are the gateway to later substances experimentation among the adolescents of Sousse, Tunisia.

Zammit N, Amara A, Ghammam R et al.

77 Case series of juvenile scleroderma from Nigeria

Abstract Background The word scleroderma means ‘hard skin’ that develops due to excessive accumulation of collagen. It is the third most frequent rheumatic disease in paediatric rheumatology after juvenile idiopathic arthritis and systemic lupus erythematosus. When it occurs in individual <16 years, it is called juvenile scleroderma. It is a rare disease that occurs in one per million children, documented to be more common in African adults with poorer survival states compared with Caucasians. Objectives To describe the clinical and laboratory characteristics of children with juvenile scleroderma seen in our clinic, thus, increasing its awareness. Methods Retrospective review of records of three children diagnosed with juvenile scleroderma at the paediatric Rheumatology Clinic of Lagos State University Teaching Hospital(LASUTH) between May 2018 to April 2022. Results Case 1 A 12-year-old girl presented with skin tightness of the left hand and thigh of one year, contracture of the 3rd, 4th and 5th proximal interphalangeal joints, arthritis of the left wrist, skin induration of the dorsum of the left hand involving the 4th and 5th finger and extending to the wrist and skin and induration of the anterolateral aspect of the left thigh. Her blood tests showed an erythrocyte sedimentation rate (ESR) at 20 mm/h, an ANA titre of 1:2560, a negative anti-Scl 70/anti-centromere antibodies, a normal complete blood count and serum electrolytes/urea/creatinine. A diagnosis of linear scleroderma was made, the patient had prednisolone, methotrexate and folic acid, in addition to topical emollients. She improved clinically as observed during follow up visits six weeks after initiation of treatment but later defaulted from the clinic due to unknown reason. Case 2 A 4-year-old girl presented with constitutional symptoms, swollen hands and feet, sclerodactyly, narrowing of oral aperture, ulcers at tips of the fingers, inflammatory pain of the large joints, hypopigmented macules on the face, trunk, abdomen and back and also abnormal capillaroscopy. Erythrocyte sedimentation rate was 22 mm/h with normal levels of electrolytes/urea/creatinine, thrombocytosis, ANA titre of 1:640 and negative anti-centromere and anti-U1RNP antibodies. A diagnosis of diffuse systemic sclerosis was made. She started prednisolone, methotrexate, nifedipine and omeprazole and was asked to do an ECG, an Echocardiogram, a spirometry and a chest HRCT but she couldn’t afford to do these investigations due to severe financial constraints. She was clinically stable for four months until she presented at the emergency room with sudden loss of consciousness and congestive cardiac failure. She died during resuscitation attempt. Case 3 An 11-year-old girl known patient of haematology unit with sickle cell anaemia, presented with inflammatory arthritis of the small joints of the hands, elbows and knees of nine-month duration, sclerodactyly, contractures of the PIP of the fingers, narrowing of oral aperture, generalized hypopigmented macules and abnormal nailfold capillaroscopy. Investigation showed an ANA titre of 1:640, positive anti-Scl 70 antibodies, negative anti-centromere antibodies, ESR of 130 mm/h and thrombocytosis. The echocardiogram showed a normally structured heart with severe restriction on spirometry and features of interstitial lung disease on HRCT of the chest. She started mycophenolate mofetil, prednisolone and nifedipine. She later received 2 doses of rituximab due to slow clinical improvement. She is being followed up. Conclusion Most data on scleroderma are from adult studies, we reported these three cases due to the rare occurrence of scleroderma in children, thus increasing its awareness.

Faleye A, Akinwumi I, Akinola I et al.

Tracking mental health and cognitive changes following the Australian social media minimum age legislation: a 4-wave longitudinal study protocol.

Introduction Over the last two decades, increases in adolescent mental health difficulties have been recorded alongside a rapid expansion in social media use. In response to these trends, on 10 December 2025, the Australian government implemented Social Media Minimum Age legislation prohibiting Australians under the age of 16 years from having social media accounts. The introduction of this legislation allows for a unique quasi-experimental investigation of the impact of social media use on adolescent mental health and the mechanisms through which social media may impact young Australian adolescents' mental health, well-being and cognition. Methods and analysis To assess the relationship between social media use and young adolescents' mental health, well-being and cognition, a longitudinal mixed-methods approach will be taken. 422 young people (aged 10-15 years) and parent/carer dyads were recruited and invited to complete a baseline assessment before the implementation of the Social Media Minimum Age legislation (October-December 2025). Three follow-up assessments will then be completed after 6 (April-May 2026), 12 (October-November 2026) and 18 months (April-May 2027). Data from parent/carer and adolescent surveys, ecological momentary assessments (EMAs), cognitive tasks and smartphone-recorded screenshots of social media and messaging app use across each of these timepoints will be analysed. Linear regression analyses will be used to assess correlational relationships between social media experiences and responses and mental health outcomes as well as how individual factors moderate these relationships. To assess these relationships over time and between momentary experiences and responses (EMA data) and more stable trait-based (individual) and environmental (parenting and government restrictions) factors, we will use linear mixed-effects models and mixed-effects segmented regression. Ethics and dissemination This study has been approved by the UNSW Human Research Ethics Committee (iRECS 9197). Findings from this study will help identify potential opportunities for interventions at individual, micro (parental) and macro (governmental) levels to mitigate any negative impacts of social media for younger adolescents. Results will be disseminated through peer-reviewed publications, conference presentations, public engagement opportunities and researcher-associated websites. After each assessment timepoint, core findings will also be distilled into engaging formats such as infographics and videos, which will be shared with young people and their parent/carer.

Bilston A, Brown L, Qi X et al.

SWK-07. Family mental health screening early after a diagnosis of pediatric brain tumor

Abstract INTRODUCTION: A new diagnosis of a brain tumor in a child has significant emotional consequences for every member of the family. Nevertheless, early phases of oncologic care rarely provide formal mental health screening. METHODS: We implemented a mental health screening protocol for families and patients with a newly diagnosed brain tumor admitted to our pediatric intensive care unit (PICU) at the time of diagnosis. Screening instruments were selected based on their previous validation and relevance to both a brain tumor diagnosis and PICU admission. Parents were contacted by a member of our team within 2 weeks of their child’s diagnosis, and completed the screening independently within the next 2 weeks via an online interface. Parent proxy reports for the children were used when necessary. Scores were shared with the family and neuro-oncology team. When indicated, supportive counseling was offered. RESULTS: Eighteen patients have met criteria for mental health screening. Of these, 8 patient and parent dyads have completed the screening (mean patient age 8.6 years; 75% white; 50% female). Of the families that completed the evaluation, most parents (62.5%) reported that their child’s diagnosis negatively impacted their health-related quality of life (HRQL), while 87.5% of children themselves reported a lower HRQL. Most children (66.7%) self-reported having symptoms outside of normal range for anger, anxiety and depression and 100% had scores outside of normal range for pain interference with their daily lives. Only half of eligible families accepted referrals for new mental health support. CONCLUSION: Both children with a new diagnosis of brain tumor and their parents are at risk for impaired mental health and quality of life early after diagnosis. A systematic approach to these concerns at the time of diagnosis may be helpful.