Background Global immunization efforts still face major inequities and declining vaccine confidence, leaving millions of children in low- and middle-income countries unvaccinated or under-vaccinated. Objectives This article aims to discuss "digital vaccines," including SMS reminders, mobile apps, electronic immunization registries, gamification, and virtual reality education, as practical complements to routine immunization services. Results Using an organizing framework focused on access, equity, and trust, we highlight how digital tools can reduce missed appointments, strengthen follow-up for zero-dose children, improve data quality for planning, and support transparent and culturally responsive communication to counter misinformation. We also outline the barriers that limit equitable impact, including digital divides, gender gaps in phone access, fragmented information systems, limited financing, and concerns about data governance. Many children in poorer countries still do not get the vaccines they need. Some families live too far from clinics. Others do not trust vaccines or the health system. This article looks at how digital tools can help more children get vaccinated. These tools include text message reminders, phone apps, online health records, digital games, and virtual reality lessons. Text reminders help parents remember vaccine dates. Online records help health workers find children who missed their vaccines. Digital games teach people why vaccines are safe. These tools can also help planners know how many vaccines are needed and where to send them. They can share clear, respectful health messages and fight false claims about vaccines. But not everyone can use these tools. Some people do not have smartphones or internet access. Women, who often care for children, may not have their own phones. There are also worries about keeping personal data safe and paying for these systems. Conclusions We propose implementation principles that emphasize inclusive design, interoperability, privacy safeguards, and hybrid online and offline delivery models. We suggest that digital tools should be easy to use for all, keep private data safe, and work well with other health systems. Where there is no internet, non-digital options should also be offered. With the right support, these tools can help make sure all children get their vaccines.
Background Kangaroo Mother Care (KMC) reduces morbidity and mortality among preterm and low birth weight infants, yet continuity between facility initiation and home practice remains weak in rural settings. This study examined a facility-community circle of care model in a primary care setting in southern Rajasthan, India. Methods In a primary health centre (PHC) managed as a public-private partnership in rural south Rajasthan, India, we trained and supported the PHC facility-based team to initiate KMC for all low birth weight babies at birth, and the outreach team to continue KMC at household levels. Both teams educated and supported mothers and family members to provide and sustain KMC for the babies.We reviewed the programme and supervisory data of a 3-year period (2021-2024) following the KMC introduction to estimate key indicators of its coverage and effectiveness. We also conducted semi-structured interviews with the team members to understand and document the process of introduction. Results Among 1188 live births, 34% were low birth weight. Facility KMC coverage rose from 60% to 88%, and 52% of dyads continued KMC at home. Exclusive breastfeeding reached 98%, mean skin-to-skin contact averaged 9 hours daily and infant survival was 99%. The circle of care strengthened continuity, trust and workforce capability. Conclusion Embedding KMC within a coordinated, mentorship-supported circle of care provides a scalable systems approach to enhancing newborn outcomes and primary care in rural and tribal settings.
Background Adolescent and young adult (AYA) mothers often experience unmet psychosocial needs, and those under 25 years of age are at increased risk of perinatal depression. Although home visiting programmes may be beneficial, no controlled trial has evaluated a programme co-designed with first-time AYA mothers and grounded in their lived experiences. Objective We evaluated the effect of the co-designed Early Partnership programme on perceived fulfilment of psychosocial needs and postnatal depressive symptoms among first-time AYA mothers. Methods We emulated a target trial using data from a pragmatic historically controlled study in four Tokyo municipalities. Participants were primiparous women aged 16-25 years. The intervention group included 151 participants and the control group included 158 participants. The intervention group received intensive tailored home visits by multi-professional family support workers from pregnancy to 12 months postnatally, and the historical control group received publicly funded health and social services. Findings Retention at 12 months was high in both groups (intervention group, 82.1%; control group, 82.9%). For the primary outcome analysis, the intervention group had greater improvement in perceived fulfilment of psychosocial needs at 6 months postnatally (difference in mean changes 4.16, 95% CI 1.35 to 6.97, Cohen's d 0.40, 95% CI 0.13 to 0.67) and 12 months postnatally (difference in mean changes 3.93, 95% CI 0.63 to 7.23, Cohen's d 0.39, 95% CI 0.06 to 0.72) than the control group. Postnatal depressive symptoms were lower in the intervention group at 6 months postnatally (mean difference -1.54, 95% CI -2.70 to -0.38, Cohen's d -0.34, 95% CI -0.59 to -0.08) and 12 months postnatally (mean difference -1.55, 95% CI -2.74 to -0.36, Cohen's d -0.34, 95% CI -0.61 to -0.07). Well-being also improved at each time point, but estimates were imprecise. Conclusions The Early Partnership programme, co-designed with young mothers and delivered by multi-professional teams, was acceptable and effective in improving perceived fulfilment of psychosocial needs and postnatal depressive symptoms. Clinical implications These findings suggest that a person-centred and relationship-based home visiting model, delivered through a non-stigmatising design, may represent a plausible model of maternal care.
BACKGROUND: The Pediatric Symptom Checklist (PSC) is a brief questionnaire aimed at detecting psychosocial problems of children and adolescents for intervention in the early stage. Though we have devised a 17-item version of the PSC-Youth Self-Report (PSC-17-Y) Japanese version, our subsequent goal was to evaluate its adequacy by comparing the scores of patients and of schoolchildren for the prevention and early intervention of schoolchildren’s psychosocial problems. METHODS: This study was conducted in Osaka, Japan’s second-largest city, between July 2020 and September 2022, during which participants completed the Japanese version of the PSC-17-Y (JPSC-17-Y). The participants were 52 patients with psychosocial problems (23 boys and 29 girls; mean age, 13.6 years) and 64 age-matched schoolchildren (24 boys and 40 girls; mean age, 13.4 years). The total score and each factor score of the JPSC-17-Y were compared, with the Mann-Whitney U test used to examine the differences between the groups. RESULTS: The results showed that the patient group’s scores were significantly higher than the control group’s for all factors and the total score. To estimate the cutoff value for differentiating between the control group and the patient group using the total score of the JPSC-17-Y, the Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) curve was calculated. The AUC was 0.755, indicating a moderate level of predictive performance for the JPSC-17-Y. The cutoff value of the total score between 12 and 13 was considered clinically appropriate. CONCLUSIONS: These findings suggest that the JPSC-17-Y can lead to prevention of and early intervention for psychosocial problems of schoolchildren.
Background Antenatal colostrum expression is a practice involving self-massage of the breasts starting in late pregnancy (typically 35-36-weeks of gestation), which is thought to stimulate lactation and allow individuals to secrete and store colostrum prior to delivery. To support successful breastfeeding initiation and continuation among patients, some clinicians provide antenatal colostrum expression teaching as part of standard prenatal care. However, the impact of antenatal colostrum expression teaching is unclear due to limited evidence which is largely anecdotal. The primary aim of this case-control chart review was to evaluate the effect of antenatal colostrum expression teaching as part of standard obstetrical care on breastfeeding practices at first postpartum checkups, gaining pilot data to inform future research. Secondary outcomes included the evaluation of preterm delivery, mode of delivery, and repeat hyperbilirubinemia screening between groups. Methods A retrospective case-control chart review before (n = 79) and after (n = 96) antenatal colostrum expression teaching was incorporated into standard care at 36-gestational week visits in an obstetrical practice in North Battleford, SK, Canada (2016-2020). Odds of fully breastfeeding at first postpartum check-ups in cases vs. controls was evaluated with logistic regression, adjusted for parity, mode of delivery, and infant age at postpartum check-ups. Odds of repeat hyperbilirubinemia screening in cases vs. controls was evaluated with logistic regression, adjusted for parity, mode of delivery, and infant sex. Results Antenatal colostrum expression teaching increased the odds of fully breastfeeding at postpartum check-ups by > 3-fold as compared to controls (aOR = 3.09; 95% CI = 1.35-7.09). Odds of repeat hyperbilirubinemia screening was 59% lower in cases vs. controls (aOR = 0.41; 95% CI = 0.18-0.92). No significant differences in gestational age at delivery or mode of delivery were found between groups. Conclusion Antenatal colostrum expression presents a promising intervention to help prepare patients mentally and physiologically for breastfeeding and labour. While these findings suggest that advocacy efforts are warranted to increase standard provision of antenatal colostrum expression teaching in late gestation, results should be confirmed in a randomized intervention trial, which further aims to understand the effect on longer-term breastfeeding rates and infant health.
Rationale Clinical trials have demonstrated the efficacy, rapid action, and safety of calcitonin gene related peptide-related antibody drugs for migraine prevention, and subcutaneous galcanezumab was launched in Japan in April 2021. However, the safety of this drug in pregnant migraine patients has not been demonstrated in humans, with evidence of safety available only from animal studies. We report 2 cases in which subcutaneous galcanezumab was administered continuously until the first and second trimesters of pregnancy, resulting in normal births without any complications for either the mother or child. Patient concerns The cases involved pregnant patients, aged 34 and 43, with long-standing migraines without aura. Diagnoses Migraines without aura. Interventions They were administered galcanezumab until the fifth week and fifth month of pregnancy, respectively. After discontinuation of treatment, the increase in the frequency of the mothers' migraines remained mild. Outcomes Each mother safely gave birth to a baby boy, with acetaminophen administered as needed for the management of headaches. Subsequent checkups showed that both mothers and their children were healthy. Lessons The safety of galcanezumab administration in pregnant women has only been reported in scattered case reports, and further case studies are needed. It is considered necessary to continue to monitor newborns for the development of neurological abnormalities, including higher brain functions.
Rationale Induction of labour (IoL) aims to initiate labour when the risks of continuing pregnancy outweigh the benefits. Over 10 methods are currently available, yet the most effective and safest method remains unclear. Objectives To compare the benefits and harms of various cervical ripening and IoL methods at or beyond term labour and to rank the methods. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the WHO ICTRP until 1 February 2023. Eligibility criteria We included randomised controlled trials (RCTs) evaluating IoL methods among women with a live fetus at or beyond term labour (gestational age ≥ 37 weeks). We focused on the methods currently recommended by international guidelines and those proposed by previous Cochrane reviews. Outcomes Our critical outcomes included failure to achieve vaginal delivery within 24 hours, caesarean section due to any causes, caesarean section due to non-reassuring fetal status, uterine hyperstimulation with changes in the heartbeat of the baby before birth, perinatal death, and severe neonatal morbidity. Risk of bias We assessed bias and trustworthiness using the Cochrane RoB 1 tool and the Cochrane Pregnancy and Childbirth Trustworthiness Tool (CPS-TST), respectively. The final analyses only included trials that met the CPS-TST. Synthesis methods We performed pair-wise meta-analyses using a random-effects model and network meta-analyses (NMA) with a frequentist approach. We reported analyses and results separately for two populations: 1) women without a previous caesarean section and a mix of women with or without a previous caesarean section (where more than 50% of participants had no previous caesarean section), and 2) women with a previous caesarean section. We used risk ratio (RR) and mean difference (MD) to present treatment effects with 95% confidence intervals (CIs). We assessed the certainty of evidence for critical outcomes using the GRADE approach for NMA. We used the surface under the cumulative ranking curve (SUCRA) to estimate treatment ranking. Included studies The analysis included 106 RCTs assessing 13 IoL methods among 30,348 women. Most trials (84.9%) were conducted in inpatient settings. Only two RCTs recruited women with previous caesarean section, and seven RCTs recruited a mix of women with or without a previous caesarean section. Synthesis of results We evaluated the effects of the following IoL methods: vaginal misoprostol (≤ 50 μg), oral misoprostol (≤ 50 μg), sublingual or buccal misoprostol (≤ 50 μg), controlled-release misoprostol vaginal pessary, vaginal dinoprostone (tablet or gel), controlled-release dinoprostone vaginal pessary, oxytocin (alone), nitric oxide donors, balloon catheters, osmotic cervical dilators, oxytocin plus amniotomy (Oxytocin+Amniotomy), balloon catheters plus oxytocin (Balloon+Oxytocin), balloon catheters plus vaginal/oral misoprostol (≤ 50 μg) (Balloon+Misoprostol ≤ 50 μg), and inactive methods (placebo, no intervention, and expectant management). The following results show the relative effects of NMA for four of the six critical outcomes among women without previous caesarean section and a mix of women with or without previous caesarean section. The findings of women with previous caesarean section are not presented here due to limited evidence. We used vaginal misoprostol (≤ 50 μg) as the reference method for presenting results, where data for this method were available in the network. 1) Failure to achieve vaginal delivery within 24 hours There was no clear evidence that any of the methods were more effective than vaginal misoprostol (≤ 50 μg) in reducing the risk of this outcome. Oxytocin+Amniotomy (RR 0.41, 95% CI 0.14 to 1.24, 22.4% fewer, moderate-certainty evidence), Balloon+Misoprostol ≤ 50 μg (RR 0.85, 95% CI 0.60 to 1.19, 5.7% fewer, high-certainty evidence), and Balloon+Oxytocin (RR 0.94, 95% CI 0.71 to 1.26, 2.3% fewer, low-certainty evidence) likely resulted in little to no difference in this outcome compared with vaginal misoprostol (≤ 50 μg). Despite the comparable relative treatment effects between some methods and vaginal misoprostol (≤ 50 μg), these three methods ranked highest. 2) Caesarean section due to non-reassuring fetal status There was no clear evidence that any of the methods were more effective than vaginal misoprostol (≤ 50 μg) in reducing the risk of this outcome. Balloon+Oxytocin (RR 0.77, 95% CI 0.47 to 1.25, 2.0% fewer, moderate-certainty evidence), controlled-release dinoprostone vaginal pessary (RR 0.86, 0.62 to 1.18, 1.2% fewer, low-certainty evidence), and balloon catheters (RR 0.88, 95% CI 0.70 to 1.11, 1.0% fewer, low-certainty evidence) may result in little to no difference in this outcome when compared with vaginal misoprostol (≤ 50 μg). Despite the comparable relative treatment effects between all methods and vaginal misoprostol (≤ 50 μg), these three methods ranked highest. 3) Uterine hyperstimulation with changes in the heartbeat of the baby before birth Nitric oxide donors (RR 0.05, 95% CI 0.01 to 0.47, 3.9% fewer, moderate-certainty evidence), osmotic cervical dilators (RR 0.07, 95% CI 0.01 to 0.42, 3.8% fewer, moderate-certainty evidence), balloon catheters (RR 0.38, 95% CI 0.21 to 0.69, 2.5% fewer, moderate-certainty evidence), and oral misoprostol (≤ 50 μg) (RR 0.62, 95% CI 0.39 to 0.99, 1.6% fewer, moderate-certainty evidence) probably reduce this outcome compared with vaginal misoprostol (≤ 50 μg). When compared with inactive interventions (placebo, no intervention, or expectant management), vaginal misoprostol (≤ 50 μg) (RR 3.47, 95% CI 1.16 to 10.35) probably increases the risk of this outcome. The three highest-ranked methods were nitric oxide donors, osmotic cervical dilators, and inactive methods (placebo, no intervention, and expectant management). 4) Perinatal death There was no clear evidence for this outcome, as it was rare (10 cases reported across trials). Authors' conclusions For women without previous caesarean section and a mix of women with or without previous caesarean section, there was no clear evidence that any of the IoL methods were more effective than vaginal misoprostol (≤ 50 μg) for the outcomes of failure to achieve vaginal delivery within 24 hours, caesarean section due to non-reassuring fetal status, and perinatal death. Nitric oxide donors, osmotic cervical dilators, balloon catheters, and oral misoprostol (≤ 50 μg) probably reduce the risk of uterine hyperstimulation with changes in the heartbeat of the baby before birth. Funding This review had no dedicated funding. Registration Protocol (2023): https://doi.org/10.1002/14651858.CD015234.
Rattanakanokchai S, Gallos ID, Kietpeerakool C et al.
Background Adolescent substance use in India has become a significant public health challenge. It is increasingly characterized by a shift toward easily concealed smokeless tobacco pouches ("Cool Lip") and inhalants, which fall outside awareness-based school prevention frameworks. School absenteeism has been identified in the global literature as the key behavioral indicator of adolescent substance use, based on the assumption of a relatively stable home environment. This assumption may not hold in low-income urban government schools in India, where the Right of Children to Free and Compulsory Education (RTE) Act, 2009, legally requires that every child enrolled be retained. This study investigates this question from the perspective of government school teachers. Methodology Semi-structured in-depth interviews were conducted with twenty-one government school teachers, headmasters, and physical education instructors across 16 schools in Chennai district, Tamil Nadu, India. Data were analyzed using reflexive thematic analysis in combination with a six-step conceptual model development process, with theoretical frameworks introduced only after the inductive generation of themes. Results Five themes were identified. In contrast to the global pattern, substance-using students were consistently described as regular attendees-the Attendance Paradox. The substance landscape has shifted toward easy-to-hide substances, reshaped by post-pandemic mask use and digital peer coordination through mobile phones acquired for online learning. Teachers described a porous school perimeter where making complaints was perceived as personally risky, thereby sustaining institutional silence. Family conditions were an expression of economic precarity, not parental neglect. Teachers prioritized relational inclusion over exclusionary discipline because they perceived that excluding students could increase their vulnerability to becoming "social elements" who might subsequently influence younger peers. Discussion The findings are synthesized into the Institutional Ambivalence Model (IAM), an empirically grounded conceptual model that explains the Attendance Paradox by showing how urban government schools simultaneously function as spaces of care and exposure. The model thereby extends sociological ambivalence from individual social roles to institutions. Policy implications support reintegration-first approaches, attention to post-pandemic digital coordination, and safer perimeter-reporting channels over attendance monitoring or exclusionary discipline.
Understanding families' food purchase decision-making is essential to developing successful interventions to promote healthier behaviours. Several factors can influence the foods people purchase. However, knowledge about how parents handle dilemmas in food purchase decisions and how these decisions affect families' food purchases is scarce. This study explores families' food purchase decisions in supermarkets and illustrates how parents navigate the tension between their values and contextual and situational circumstances (e.g. family situation). We conducted 37 semi-structured, shop-along, and photo-elicited interviews with parents from fifteen families with children ranging from 0 to 19 years of age (September 2022–January 2023). We used an abductive analytical approach to investigate the role of conscience and morality in our empirical findings. We applied the theoretical concept of moral labour to examine how individuals navigate the discomfort associated with guilt or a guilty conscience, which arises from conflicts or dissonance of their values when making food purchases in supermarkets. Food purchase decisions were influenced by moral considerations related to animal welfare, climate, parental responsibility, and good and healthy food. However, product availability and presentation, price, and the parent-child interaction, as well as contextual and situational circumstances, could challenge parents’ values, triggering moral labour. The study illustrates how parents performed moral labour, e.g., minimising the health impact, to reconcile with negative feelings of conflicting values. Future intervention studies should consider focusing on supportive food environments over individual behaviour changes to minimise the potential moral labour among parents from such initiatives.
This study explores the relationship between adult children's unemployment and parental mental health. Given India's large inequalities in social capital and income, we examine the heterogeneous effects of these factors on the relationship. We utilise data from the Longitudinal Ageing Survey of India, which includes 73,396 individuals aged 45 and above. We analyse the relationship between the exposure to the unemployment of adult children and the parental risk of depression using the CES-D score, with respondents reporting four or more symptoms out of 10 considered at risk of being "depressed". We employ inverse probability weighting based on a logistic regression model to form a pseudo-control group, accounting for confounding demographic and socioeconomic characteristics. Our findings show a 3.14 percentage points (ppts) increase in absolute terms (and a 12.48% relative increase) in the probability of parental depression risk associated with adult children's unemployment. There are no significant differences between fathers and mothers in the increased risk of depression, but for the unemployment of the firstborn son, there is a significantly higher association of increased risk of depression than for the unemployment of the firstborn daughter. Heterogeneity analyses reveal that among older adults with high social participation, there is no significant increase in their risk of depression associated with their children's unemployment. Similarly, among older adults residing in low and medium-income inequality states, the negative consequences of their children's unemployment are weaker. Overall, we conclude that while adult children's unemployment is associated with an increased risk of parental depression, higher social participation and residing in low or medium-income inequality states might have protective effects on older adults' mental health following their children's unemployment. Governments may consider expanding labour market policies that support youth labour market entry as a means to improve not only the employability of younger individuals, but also the well-being of older generations.
