Background: Sibling sexual abuse (SSA) creates particular challenges for practitioners working with affected families, as it damages multiple family relationships, generates loyalty conflicts among parents and children, and produces ambiguity around responsibility. These challenges may necessitate a specific treatment for the impact of SSA. However, information on how to approach the challenges during treatment is scarce.Objective: This study qualitatively investigated, from a practitioner's perspective, helpful elements for tailoring the treatment of families that had been exposed to SSA.Participants and setting: Twelve practitioners from different treatment centres in the Netherlands with experience in the treatment of families exposed to SSA.Methods: Online one-on-one interviews were conducted and thematic analysis was used to identify central themes.Results: Four themes were generated: (1) family crisis; (2) guilt, shame, and secrecy; (3) balancing act; and (4) restoration of family relationships. Practitioners highlighted the importance of tailoring treatment to the specific dynamics related to the SSA. Families starting treatment after the disclosure of SSA are often in 'shambles', as the situation affects the relationships between all family members. Restoration of family relationships was described as both the most challenging and the most essential aspect of treatment, with parents having a central role in this recovery process. Professionals needed to assist them with offering appropriate support for all their children and re-establishing trust and safety within the family.Conclusions: The findings offer initial practical considerations and recommendations for the treatment of families that have experienced SSA, thereby providing a first step towards developing a practical framework for applying systemic therapy to families that have experienced SSA.
Study question How are educational level, labour market attachment, and income associated with achieving a live birth following ART treatment initiation among women in Denmark? Summary answer Higher educational level, labour market attachment, and higher income were strongly associated with achieving a live birth after initiating ART treatment among women in Denmark. What is known already During the study period 1994-2017, three 'fresh' IVF or ICSI treatments with hormonal stimulation were offered free of charge in public healthcare in Denmark, while additional ART treatments were self-financed in the private healthcare sector. Earlier research indicates that higher socioeconomic position (SEP) increases the probability of initiating ART treatment; however, knowledge about SEP and its relation to outcomes after ART treatment is limited. Study design size duration This is a national, register-based cohort study based on the Danish National ART-Couple (DANAC II) Cohort. Women initiating ART treatment during 1994-2017 were identified in the Danish IVF register and individually linked with data from sociodemographic registries and the Medical Birth Registry using the Danish Personal Identification number. The study population comprised 68 738 women who initiated ART. The women were followed until achieving a live birth, death, migration, or end of study (31/12/2017). The median follow-up time was between 1.3 and 1.9 years. Participants/materials settings methods Women included in the analyses were aged 18-45 years. Overall associations between achieving a live birth after initiating ART treatment and educational level, labour market attachment, and income were examined and further stratified by nulliparity at baseline and age group. Hazard ratios (HRs) with confidence intervals (CIs) were estimated by Cox proportional hazards regression, and with adjustment for potential confounders including age and ethnicity. Live births refer to both treatment and non-treatment-related births. Main results and the role of chance Adjusted results showed that educational level, labour market attachment, and income significantly determined the probability of achieving a live birth after initiating ART treatment. HRs of achieving a live birth after initiating ART treatment increased stepwise with higher education and income level, respectively. Compared with primary school education, the highest HR was found among women with a research education (adjusted HR (aHR) = 3.02 [95% CI, 2.71; 3.35]). Unemployed women had the lowest HR of achieving a live birth after initiating ART treatment (aHR = 0.67 [95% CI, 0.64; 0.69]) compared to employed women. Women at the highest income level had two times higher HR (aHR = 2.00 [1.94; 2.06] of achieving a live birth after initiating ART compared to women at the lowest income level. Analyses of different age groups showed that higher SEP was associated with a live birth after ART treatment in all ages. The same consistency was found for both childless women and women who had a child or children prior to ART treatment. Analyses showed that women with higher SEP were more likely to continue ART treatment after unsuccessful attempts, which could explain the observed social inequality in achieving a live birth after ART treatment. Limitations reasons for caution The Danish IVF register did not register non-ART treatments (intrauterine inseminations) before 2007; thus, these treatments were not included. Whether the severity of infertility differs among SEP groups is unclear. Also, geographical distance to fertility clinics could have provided additional perspectives. Wider implications of the findings Free access to fertility treatment in public healthcare should ideally provide equal access. Patients encounter barriers during treatment, and as shown, treatment success differs based on socioeconomic background. Difficulties encountered during treatment that challenge certain patients more than others based on their socioeconomic background need to be considered further. Study funding/competing interests No specific funding was achieved for this project. The authors have no conflicts of interest to declare. Trial registration number N/A.
Objective To evaluate the 10-year economic burden experienced by mothers of children with major congenital anomalies in Denmark. Design Population-based matched retrospective cohort study. Setting Denmark, 1 January 2007 to 31 December 2017. Participants All women who gave birth to a singleton child with a major congenital anomaly during the study period (n=12 513). A comparison cohort of mothers with singleton births of children without major congenital anomalies was included, matched 1:10 by maternal age, parity and delivery year (n=125 008). Main outcome measures Societal costs associated with mothers of children with major congenital anomalies. Costs were quantified as direct healthcare costs (primary care, outpatient, inpatient, psychiatric services and prescriptions) and indirect costs (productivity losses estimated using the human capital approach, including income, labour market contributions, supplementary pensions and fringe benefits). Results Direct costs peaked in the delivery year with a mean attributable cost of more than €1731 (95% CI €1634 to €1824). Indirect costs increased over time, reaching a peak of €2251 (95% CI €978 to €3442) at 9 years after delivery. Over a median follow-up of 6.3 years, attributable indirect costs were two and a half times higher than direct costs. Total societal costs associated with the 12 513 mothers of children with major congenital anomalies in our cohort were estimated at €152 million (95% CI €92 million to €219 million). Conclusions Mothers of children with major congenital anomalies experienced substantial and persistent economic burdens, with indirect costs increasing over time and exceeding direct healthcare costs. These findings highlight the need for targeted public health and policy initiatives to support affected families and address long-term societal costs.
Purpose A sudden illness in family, such as cancer, is known to have significant economic effects, but the consequences of a child's genetic disease on parental income and employment have gained much less attention. This study examines the association of having a child with neurofibromatosis 1 (NF1) and parental income and employment. Methods The Finnish cohort of 1,811 individuals with verified NF1 was cross-linked with income and employment data from Statistics Finland. The 772 parents of 390 children with sporadic NF1 and 446 parents of 229 children with familial NF1 born in 1988-2019 were compared with 7,635 and 4,465 parents of 3,862 and 2,252 matched non-NF1 individuals, respectively. Results Parents of children with NF1 experienced slower income growth and lower employment rate increases following the birth of a child compared to the parents in the comparison group. Specifically, the parents of children with NF1 had a 14-23% lower income increase and 1-3 percentage points lower rise in employment rates compared to the comparators' parents after the child's birth. Conclusions The effects of a child's NF1 are gradual rather than immediate, reflecting both pre-existing labour market disparities and age-related income trends.
Background: Children in multilingual families may translate school communications for their parents. Although this work can express competence, reciprocity and family solidarity, it can also shift institutional communication duties to minors when messages concern assessment, conflict or confidential support. Switzerland offers a salient context because of its multilingual population, locally governed schools and growing use of digital parent–school communication. Objective. To integrate psychological research on child language brokering with scholarship on intercultural school–family cooperation, Swiss educational governance and digital communication, and to identify a testable institutional rather than child-deficit research agenda. Approach. A critical, purposive integrative synthesis drew on identified peer-reviewed studies, a 2026 Swiss university research chapter, Swiss public statistics, education governance sources and relevant conceptual work. Sources were located through targeted bibliographic and institutional web searches completed on 10 October 2026. This is not a systematic review, meta-analysis or study involving new participants. Synthesis. Evidence suggests that brokering frequency alone poorly captures its meaning: perceived obligation, affect, power asymmetries, message sensitivity and adult support matter. A provisional SCOPE framework is proposed to assess Stakes, Child agency, Organisational ownership, Provision of adult language support and Evaluation of communication outcomes. It distinguishes voluntary family assistance from situations in which schools should provide an accessible adult-to-adult route. Digital translation may ease routine messages but cannot reliably substitute for relational trust or skilled interpretation in high-stakes encounters. Conclusion. A Swiss research agenda should evaluate responsibility allocation and communication accessibility alongside children’s wellbeing and parents’ participation. The framework is an analytical proposal, not a validated instrument or proof of a causal effect.
Objectives Reducing inequalities in early childhood support is a central public health and prevention challenge because services are most effective when families with high psychosocial burden can access them. This study examined a potential need-access gap in Early Support Services (Frühe Hilfen) in Southern Germany by analysing overall service use and use within a subgroup of highly burdened parents. Materials and methods Cross-sectional data from the Junge Familien in Bayern (JuFaBY) cohort of families with young children were used. High need was defined as membership in the highest cut-off category of the Eltern-Belastungs-Inventar (EBI), indicating clinically significant parenting stress. Multivariable logistic regression models with robust standard errors were estimated, adjusting for socio-economic position, family structure, parental mental health, parenting behaviour difficulties, child health, childcare hours, labour status, survey year and non-linear child age effects. Results In the full sample (N = 20 216), Early Support use was positively associated with several need indicators, including parenting stress, parenting behaviour difficulties, single parenthood and chronic child illness. A socio-economic gradient was also observed: Lower household income was associated with higher uptake, while higher parental education was associated with higher use. In the high-need subgroup (N = 3232), income differences attenuated, but disparities by parental education and migration proxy persisted. Conclusion Early Support Services appear broadly need-responsive, while selective access barriers may remain among families with high support needs. In particular, educational and migration-related differences in uptake within highly burdened families indicate potential inequalities in access despite comparable levels of need.
This study presents a revised estimation of the prevalence of female genital mutilation/cutting (FGM/C) among migrant women and second-generation girls in Italy as of 1 January 2023. The study is based on an enhanced indirect estimation of the prevalence among migrants and data on first- and second-generation women legally residing in Italy as of 1 January 2023. The study estimates that approximately 88,600 women aged 15 and over have undergone FGM/C in Italy, representing 46% of migrant women from practising countries. Notably, around one-third of these women are over 50 years old, indicating that FGM/C remains a significant health concern beyond childbearing age. Among foreign-born women, 46.5% are estimated to be affected, compared to 22.5% of Italian-born women. The research also identifies approximately 16,000 girls under 15 at potential risk, with the highest numbers among those of Egyptian, Nigerian, and Senegalese descent. Methodologically, the study underscores the importance of refining indirect estimation techniques to account for the socio-demographic selectivity of migration. While the overall prevalence of FGM/C is decreasing, the persistence of the practice among specific communities calls for targeted interventions. The findings emphasise the need for culturally sensitive awareness campaigns, strengthened legal frameworks, and accessible healthcare services. Furthermore, this research contributes to the European discourse on FGM/C by providing a replicable estimation model adaptable to other non-practising countries receiving migrants from FGM/C-prevalent regions. Periodic replication of such estimates can provide valuable insights into evolving FGM/C trends, aiding policymakers in resource allocation and intervention strategies to eradicate the practice.
Background Due to increasing global migration female genital mutilation/cutting (FGM/C) also affects women and girls who live outside countries with high prevalence of FGM/C. Therefore, prevention strategies are essential FGM/C affects populations living immigration countries, including Germany. The aim of this study was to explore the perspective of experts on enablers and barriers of FGM/C prevention and to examine the impact of preventative measures on the health of women with FGM/C. Methods This qualitative study consisted of a purposive sample of experts involved in prevention of FGM/C. A semi-structured interview guideline was used for the interviews which were conducted between June and July 2024. The data were evaluated using qualitative content analysis by using a deductive-inductive approach. Results In total, 12 experts were interviewed. The sample comprised gynaecologists, consultants (social and welfare workers) and one plastic surgeon. Educational work, mental health support, and connectivity were considered important enablers of prevention. Barriers were identified on intra- and interpersonal levels as well as on the structural level, such as trauma-related barriers, language barriers, lack of cultural sensitivity and problems caused by asylum regulations. Conclusions The results demonstrate important insights into the experiences of experts working in the field of prevention of FGM/C in Germany. A migrant-sensitive health care should be an important goal for each host country to ensure health equity. Based on the experts' views, it is crucial to train professionals working in the field of FGM/C with special consideration of culturally sensitive approaches.
Objective To enhance paediatric gynaecological knowledge of female genital mutilation (FGM) within European hospital settings. Design and setting A retrospective study was conducted of girls aged 0-18 years who were referred to the Children and Victim Protection Center (CAVPC) of the Medical University of Vienna-a tertiary care hospital-on suspicion of FGM between 2014 and 2024. Main outcome measures Registry data from the CAVPC were analysed, and baseline characteristics were described. The primary outcome was the annual prevalence of FGM cases. Secondary outcomes included the type and setting of the procedure, age at FGM, country of performance, presenting symptoms and management strategies. Results Over 10 years, the centre recorded a median of 3.2 suspected cases annually (range 0-7), with peaks in 2017-2018, a decline during 2019-2020-likely due to COVID-19 restrictions-and a rise again in 2023-2024 (p=0.03). FGM was confirmed in 77.1% of referrals, most commonly among Somali girls (80%) with a median age at examination of 11 years (range: 3-15 years). Procedures had exclusively occurred in the country of origin, typically in non-medical settings at a median age of 7 years (range: 4-9 years). WHO Types I and III predominated; 75% of Type III cases required defibulation for chronic complications. Conclusions These findings emphasise the urgent need for centres with specialisation in paediatric gynaecology with surgical expertise in FGM. Broader European data are required to strengthen healthcare responses and to improve outcomes for affected girls and young women.
Female genital mutilation/cutting (FGM/C) is a significant global public health and human rights concern that has become increasingly relevant in Europe due to sustained migration from practicing countries. However, the absence of harmonized, age-specific data has limited up-to-date comparative estimates of FGM/C prevalence among migrant populations. We present updated estimates of the number of foreign-born women and girls aged 10 years and above residing in the European Union, Switzerland, Norway, and Iceland (EU+) as of January 1st, 2021, who are expected to have undergone FGM/C. Using population and census data combined with age-specific prevalence rates from national household surveys and an enhanced indirect estimation approach that accounts for cohort effects and migrant selectivity, we estimate that approximately 610,000 (40.6 percent) of the 1.5 million women and girls aged 10 years and above born in FGM/C-practicing countries and residing in the EU+ area have experienced FGM/C. Prevalence increases markedly with age, reflecting declining practice among younger cohorts, and varies substantially across destination countries depending on migrant composition. These findings provide a comprehensive benchmark for monitoring FGM/C in migration contexts and for informing evidence-based policies, prevention strategies, and service provision for affected women, while supporting efforts to prevent intergenerational transmission of the practice.
