Purpose To explore the therapeutic potential of hospital play for children, their caregivers, and health professionals. Design and method This exploratory qualitative study recruited 34 healthcare professionals from four hospitals in different regions of Chile through purposive sampling. Data were collected through semi-structured interviews and analysed using reflective thematic analysis. Results Play helps children adapt to the hospital environment, reducing their stress and mitigating the risk of medical trauma. It also offers relief to families in distress and assists them in coping with the pain they may be experiencing in response to a child's illness or death. Furthermore, play is a vital resilience-building factor for health professionals, helping them manage the emotional challenges of paediatric care. Finally, play acts as a catalyst for organisational change by fostering a more inclusive, less hierarchical, and more child-friendly healthcare environment. Conclusion This study reveals a win-win dynamic of play, wherein supporting children's well-being through play during hospitalisation yields significant therapeutic benefits for the adults involved. Practice implication In a hospital, children's play should be recognised as an integral component of child-friendly nursing care. Many play activities would benefit from intergenerational participation, as these can strengthen bonds between children, families, and health professionals. Through intergenerational, family-based play interventions, nurses can promote trust and create a sense of community in challenging hospital settings.
Objective To analyze the multidimensional factors associated with postpartum post-traumatic stress disorder (PP-PTSD) in primiparas based on the Integrated Framework for Population Health Risk Management (IFPHRM), multiple machine learning-based predictive models were constructed and externally validated to identify high-risk individuals and to provide a robust evidence base for targeted preventive interventions. Methods This cross-sectional study consecutively enrolled 1, 135 primiparous women from the Department of Obstetrics at Hefei Maternal and Child Health Hospital between June 2024 and May 2025. Participants were divided chronologically into a training cohort and an independent temporal validation cohort. Women recruited from June 2024 to January 2025 were included in the training cohort (n = 794), whereas those recruited from February 2025 to May 2025 were included in the temporal validation cohort (n = 341). At six weeks postpartum, PP-PTSD symptoms were assessed using the Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), with a score ≥38 indicating probable PP-PTSD. Multidimensional variables, including physiological and psychological factors, environmental and family-related factors, and social-behavioral factors, were collected. Candidate predictors were first screened using univariate analysis and then selected using least absolute shrinkage and selection operator (LASSO) regression. Multivariable logistic regression was used to identify independent associated factors. Seven machine learning models, including Logistic Regression, Naive Bayes, Support Vector Machine, Decision Tree, Gradient Boosting, AdaBoost, and Linear Discriminant Analysis, were constructed. Model performance was evaluated in the independent temporal validation cohort using receiver operating characteristic curves, calibration curves, decision curve analysis, and the DeLong test. SHAP analysis was used to interpret the optimal model. Results Among the 794 participants in the training cohort, the incidence of PP-PTSD was 25.18%. Five key predictors were selected by LASSO regression: social support, depression, neonatal caregiving style, husband's participation, and sleep quality. Multivariable logistic regression showed that depression and poor sleep quality were associated with an increased risk of PP-PTSD, whereas higher social support, greater husband's participation, and parental assistance in neonatal care were associated with a reduced risk. Among the seven models, the Gradient Boosting model achieved the best overall performance in the temporal validation cohort, with an AUC of 0.939, F1 score of 0.700, specificity of 0.943, sensitivity of 0.651, and Youden index of 0.595. The DeLong test showed that Gradient Boosting performed significantly better than Logistic Regression. SHAP analysis further indicated that social support, husband's participation, sleep quality, and depression were the major contributors to model prediction. Conclusion Postpartum PTSD (PP-PTSD) exhibits a higher incidence among primiparous women and exerts substantial adverse effects on maternal mental health, the mother-infant relationship, and overall family functioning. Guided by the Integrated Framework of Perinatal Health Risk Management (IFPHRM), this study elucidated the multidimensional mechanisms underlying PP-PTSD, encompassing physiological and psychological factors (e.g., sleep quality and depression), environmental and occupational factors (e.g., social support, paternal involvement, and infant caregiving practices), and social behavioral factors. The Gradient Boosting prediction model demonstrated robust performance and high predictive accuracy upon independent external validation, highlighting its potential utility for risk stratification and future clinical translation. Nevertheless, multicentre validation and the development of clinically implementable tools are warranted. Collectively, this study offers a theoretical foundation and methodological framework for the early identification, targeted intervention, and long-term health management of PP-PTSD in primiparous women.
Purpose Medical students experience significant academic and psychosocial stressors. Resilience may help mitigate negative psychological outcomes. This study assessed the level of resilience among MBBS undergraduate students and examined its associations with selected socio-demographic and academic variables. Methods A cross-sectional online survey was conducted among MBBS students at AIIMS Rishikesh using the validated 16-item Child and Youth Resilience Measure (CYRM-16). Responses were scored on a five-point Likert scale ranging from 1 ("Not at all") to 5 ("A lot"). Data were analyzed using descriptive statistics and appropriate inferential tests. Results Of 500 invited students, 324 valid responses were analyzed. The mean age was 20.31 ± 1.9 years and 59% were male. Based on CYRM-16 scores, 16% demonstrated low resilience, 68.8% moderate resilience, and 15.1% high resilience. Higher resilience was significantly associated with academic year, number of siblings, and participation in extracurricular activities (p < 0.05). Conclusions Most MBBS students reported moderate resilience. Students further along in training, those with more siblings, and those participating in extracurricular activities demonstrated higher resilience. Institutions should consider structured resilience-building interventions.
Background and objectives The National School Lunch and Breakfast Program, a US program that addresses food insecurity, requires children with higher household incomes to pay for meals. It is unclear whether universal school meals (USM) policies, which make all meals free, further alleviate food insecurity, particularly for students who would otherwise pay. This study estimates the association between statewide USM policies and food insecurity. Methods A difference-in-differences study using a nationally representative sample of US households with 6- to 17-year-old children from 2012 to 2021 and 2023 to 2024. The exposure was maintaining statewide USM policy after 2022, determined based on state of residence. The primary outcome was household food insecurity; the secondary outcome was child food insecurity. Analyses were stratified by household income. Results The sample included 75 122 households. Households with the highest incomes in USM-maintaining states experienced a 1.3-percentage-point (95% CI: -2.1, -0.5) differential decrease in household food insecurity and a 0.9-percentage-point (95% CI: -1.4, -0.5) differential decrease in child food insecurity. Households with low-middle income in USM-maintaining states experienced a 3.2-percentage-point (95% CI: -6.1, -0.3) differential decrease in household food insecurity but no differential change in child food insecurity. Households with lowest income in USM-maintaining states experienced no differential change in household food insecurity and a 3.8-percentage-point (95% CI: -6.2, -1.5) decrease in child food insecurity, although caution is required because the parallel trends assumption was violated. Conclusions and policy implications Implementing statewide USM policies could contribute to decreased food insecurity among households with school-aged children.
Background Fire-related injuries and deaths are significant public health concerns, with high-risk groups including children under 5 years. Although the use of functioning smoke alarms is an effective prevention strategy, many are not regularly tested. This study aims to establish the feasibility of surveying home fire safety practices and awareness of community resources among caregivers visiting a paediatric emergency department (ED). Methods This feasibility study surveyed a convenience sample of caregivers accompanying children to an urban mid-Atlantic academic paediatric ED. Caregivers reported on the number, location and status of home smoke alarms, fire safety practices, knowledge of community resources, and interest in using a free smoke alarm programme. Enrolment information for programmes was provided. Telephone and email follow-up was conducted at 1 month to determine programme participation and gather feedback about programme enrolment. Results Of 166 patients approached, 103 (62%) participated; of these, 40% had children under 5 years residing in the home. Although most participants reported having multiple smoke alarms, only 25% reported testing alarms monthly, and 32% lacked a fire safety plan. About two-thirds (65%) were unaware of community-based smoke alarm programmes, 38% expressed interest in participating, and, of these, 9% reported contact with the programme at follow-up. Discussion and conclusions There are opportunities to improve home fire safety practices, awareness of smoke alarm programmes and programme participation in this at-risk population. The paediatric ED may be an important setting to provide fire safety education and directly link caregivers to community resources to reduce fire-related risks.
Background/objectives Early childhood is an important period when growth and adiposity patterns emerge and may persist into later childhood. Children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) face elevated obesity risk. We characterized BMI-for-age z-score (BMIz) trajectories from 24 to 60 months and their child-, caregiver-, and household-level correlates. Methods This was a secondary analysis of the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2) public-use dataset. We analyzed 5,583 BMIz observations from 2,247 dyads; adjusted models used 4,314 observations from 1,738 children. Linear mixed-effects models tested individual, interpersonal, and household predictors. Restriction and pressure-to-eat were lagged, time-varying exposures. Results Mean BMIz was elevated at all waves (0.46 to 0.56). Obesity prevalence rose from 15.4% to 18.5%. Unconditionally, BMIz was stable from 24 to 48 months and rose by 60 months. Adjusted models linked higher BMIz to higher birth weight, Hispanic or Latino ethnicity, birth complications, maternal overweight or obesity, paternal overweight, prenatal smoking, adolescent maternal age, and lower maternal education. Male sex was associated with lower BMIz. Prior-wave restriction was associated with higher, and pressure to eat with modestly lower, subsequent BMIz. Household indicators showed no independent association. Conclusions Caregiver and perinatal characteristics and feeding practices were the most consistent modifiable correlates of late-preschool BMIz. These observational, complete-case findings warrant caution. The 48-60-month window may be a promising period to target for WIC-based obesity prevention.
Abstract Background Feeding selectivity is one of the most prevalent and persistent challenges experienced by children with Autism Spectrum Disorder (ASD). Although intervention outcomes are traditionally evaluated by the number of accepted foods or nutritional indicators, these measures may underestimate broader developmental changes that occur throughout feeding intervention. This case report proposes a multidimensional perspective of feeding outcomes by introducing the concept of Feeding Development as a functional framework for understanding therapeutic change. Case Presentation: A preschool-aged child with ASD presenting with severe feeding selectivity, sensory processing differences, oral-motor difficulties, and significant functional limitations during mealtimes underwent a comprehensive interdisciplinary assessment followed by a longitudinal, family-centered intervention. Clinical reasoning integrated occupational therapy, Ayres Sensory Integration® principles, behavioral learning strategies, caregiver coaching, and environmental modifications. Standardized assessments, developmental history, sensory processing evaluation, and longitudinal clinical observations guided individualized intervention planning. Intervention: Treatment prioritized the progressive development of sensory regulation, food exploration, behavioral flexibility, occupational participation, and caregiver competence before targeting food acceptance. Intervention was organized into sequential therapeutic phases emphasizing graded sensory experiences, play-based food interaction, family participation, and generalization across natural environments. Outcomes: Longitudinal follow-up demonstrated clinically meaningful improvements across multiple domains, including sensory tolerance, food exploration, behavioral flexibility, mealtime participation, caregiver confidence, and occupational feeding performance. Expansion of the child's food repertoire occurred progressively as a consequence of these broader developmental changes rather than as an isolated therapeutic objective. Conclusions This report suggests that feeding intervention in ASD should be conceptualized as a developmental process rather than solely as an increase in accepted foods. We propose Feeding Development as a multidimensional functional construct integrating sensory, motor, behavioral, environmental, family, and occupational dimensions of pediatric feeding. This framework may contribute to more comprehensive outcome measurement, improved clinical reasoning, and future longitudinal research investigating functional trajectories of feeding intervention in children with ASD.
Objective To evaluate within-participant changes in knowledge, attitude, and practice (KAP) among school teachers following a structured educational intervention on children's eye health in Skardu District, Gilgit-Baltistan (GB), Pakistan. Methods This single-group pre-post quasi-experimental study was conducted across 132 government schools in Skardu District, GB, Pakistan. A total of 264 full-time school teachers were purposively selected in consultation with district education authorities. A structured two-day paediatric eye health and vision screening training programme combined theory-based instruction with supervised hands-on practice and was delivered by ophthalmologists and optometrists. The primary outcomes were within-participant changes in knowledge (0-10), attitude (5-25) and self-reported practice (5-25) scores. Knowledge was reassessed immediately after training, while attitude and practice were reassessed 2-3 weeks later, after school-based screening activities had begun. Results Knowledge showed the largest within-participant change, increasing from a median of 6 to 9, with an estimated paired location shift of 2.5 points (95% CI 2.0-3.0; p < 0.001; standardised Wilcoxon effect size r = 0.66, large). Self-reported practice increased from a median of 22 to 23, with an estimated paired location shift of 2.0 points (95% CI 1.5-2.5; p < 0.001; r = 0.39, moderate), although the absolute change in the median was modest. Attitude scores were high at baseline and showed a statistically significant but small-magnitude change; the median remained 23 (IQR 21-24 to 22-25), with an estimated paired location shift of 1.0 point (95% CI 0.5-1.5; p < 0.001; r = 0.27, small). Item-level knowledge gains were greatest for childhood cataract and glaucoma (+ 50.4% points) and recommended eye examination (+ 33.3% points). No evidence of differential change was detected across the examined teacher subgroups (all p > 0.05). Conclusion Following the structured two-day teacher-training programme, teachers demonstrated substantial within-participant gains in knowledge, a moderate improvement in self-reported practice, and a small change in attitude from an already high baseline. Because the study had no control group, used short-term follow-up, and relied on self-reported attitude and practice measures, the findings should not be interpreted as proof of causal effectiveness or sustained behavioural change. The results support further controlled and longer-term evaluation of teacher training as one component of school eye-health programmes in remote settings.
Abstract Background Depression during pregnancy is common, but long-term outcomes in the offspring of antenatally depressed mothers are unknown. Among severe mental disorders at least schizophrenia is considered to be a neurodevelopmental disorder acting already in utero with high genetic vulnerability. The aim was to study whether offspring of antenatally depressed mothers have an elevated risk for severe mood disorders till middle adulthood, taking account parental severe mental disorder. Methods The general population-based Northern Finland 1966 Birth Cohort includes 12,058 children, whose mothers were asked at mid-gestation if they felt depressed. The offspring were followed for over 40 years, and hospitalised severe mental disorders were detected using the Finnish Hospital Discharge Register. It was also used for identifying severe mental disorders in the parents till 1984, when the offspring were of age. Results Of the mothers, 14% self-reported depression during pregnancy. Of the parents, 10% had suffered from a hospitalised severe mental disorder. Adult offspring of antenatally depressed mothers had modestly increased risk for mood disorders both non-psychotic (crude OR 1.6; 95%CI 1.1–2.2) and psychotic (2.0; 1.0–4.1) but not for schizophrenia nor substance use disorder, when compared with the children of mothers without antenatal depression. Maternal depression during pregnancy combined with parental severe mental disorder increased the risks for severe mental disorders in the offspring widely. The risks for both non-psychotic (crude OR 3.8; 95%CI 2.1–6.6) and psychotic mood disorder (5.4; 1.6–18.1) and also for schizophrenia (4.3; 2.3–8.2) and substance use disorder (2.8; 1.7–4.7) were higher in the offspring with both maternal antenatal depression and parental severe mental disorder than in those without maternal depression and with severe mental disorder in the parent (for non-psychotic 1.5; 1.0–2.4 and psychotic mood disorder 4.2; 1.9–9.2, for schizophrenia 1.3; 0.8–2.4 and for substance disorder 1.5; 1.1–2.2) or in those with a depressed mother but without parental severe mental disorder (for non-psychotic 1.3; 0.9–1.9, and for psychotic mood disorder 2.1; 0.9–5.0, for schizophrenia 0.9; 0.5–1.6 and substance disorder 1.4; 1.1–2.0). The reference group was birth cohort members without maternal antenatal depression and without paren¬tal hospital-treated mental disorder. The risks remained statistically significant even after adjustment for maternal smoking during pregnancy, perinatal complications, father’s social class and family type at birth. In the offspring of antenatally depressed mother and a father with severe mental disorder the risk was elevated only for schizophrenia (7.5; 2.2–26.2). Discussion Maternal depression during pregnancy increased the risk for mood disorders in the offspring slightly but not for schizophrenia nor substance use disorder when compared with the children of mothers without antenatal depression. Maternal antenatal depression combined with parental severe mental disorder increased the risks for all of these severe mental disorders in the adult offspring. The risk was highest for schizophrenia in the offspring of antenatally depressed mother and a father with severe mental disorder. To our knowledge, this is the first study of mood disorders, schizophrenia and substance use disorder in the offspring of antenatally depressed mothers with long follow-up till middle age where familial vulnerability for severe mental disorders was taken into account in a general population-based sample. References 1. Mäki P, et al. Am J Psychiatry 2010;167(1):70–7, 2. Taka-EilolaT et al. Eur Psychiatry 2017; 42:36–43
Cultural beliefs that success in certain fields depends on brilliance undermine women's participation in those fields, as demonstrated in adults. Understanding the development and consequences of these field-specific brilliance beliefs in early childhood is crucial for addressing gender gaps at their roots. The present research (N = 352; 5- to 10-year olds; 50% girls; 45.4% White) showed that children around age six began to attribute brilliance to computer science but not biology, suggesting that distinct associations between brilliance and fields emerge early. Brilliance beliefs shaped children's academic interests: girls were less interested than boys in pursuing a science field requiring brilliance. These findings highlight that gender disparities take hold early, and disrupting brilliance-field associations may promote greater gender equity.
