Objective Assess impacts of the Child and Adult Care Food Program (CACFP) reinstatement of tiered reimbursements among family child care home (FCCH) providers, sponsors, and families. Design Mixed methods (survey and interviews). Setting California. Participants Randomly selected FCCH providers surveyed (n = 277); purposively selected FCCH providers (n = 10) and sponsors (n = 5), and conveniently selected families (n=5) interviewed. Phenomenon of interest and variables Perceptions of adequacy and impacts of tier reinstatement, and optimal amount and number of meals/snacks covered by CACFP. Analysis Linear and logistic regression for survey responses by tier; qualitative analysis using the framework method. Results Irrespective of tier, surveyed providers reported that the reinstated, tiered reimbursements were insufficient (92.4%), resulting in reduced food variety (39.1%) and quality (14.8%), and increased financial burden on providers (96.9%) and parents (24.0%). The ideal number of meals/snacks reimbursed was 4, and the ideal reimbursement amount for 2 meals/1 snack daily per child was $7.58 (currently $5.70 tier 1, $2.72 tier 2). Qualitative analysis identified 4 themes providing context on the challenges resulting from tier reinstatement: economic landscape, CACFP participation, food and care provided, and policy solutions. Conclusions and implications Increases to CACFP reimbursements and meals/snacks covered is recommended to support healthy eating by FCCH children.
Objectives The Interim Canada Dental Benefit (CDB) provided financial support for the dental needs of children < 12 years old, from low-income families in Canada. Funds were distributed during two periods, Regular Period 1 (October 2022 through June 2023) and the Regular Period 2 (July 2023 through June 2024). This study evaluated the adjusted rate of child participation across provinces and territories, proportionally for children aged 0-11 who lack dental insurance, from households with a net annual income < $90,000 (Canadian). Methods Publicly available data were sourced from the Government of Canada Open Data Portal. Variables of interest were presented as distributions by provinces and territories, age grouping of children, and family net income. Child participation rates were calculated based on Statistics Canada data (2025). Results A total of 452,460 applications were accepted, with $440.7 million distributed. The adjusted national rate of participation for children without private and public dental insurance from low-income households was 267.3/1000 children in Regular Period 1 and 273.2/1000 in Regular Period 2. The provinces and territories with the highest adjusted rates were Nova Scotia, Saskatchewan, Newfoundland and Labrador, and the Northwest Territories. Families earning less than $30,000 annually made up the largest share of applicants. Conclusions Government-funded programs, like the Interim CDB, have the capacity to improve access to dental care for Canadians. The results show clear regional differences, with higher participation often found in regions where public dental programs for children are limited or absent.
Background Childhood cancer survivors (CCS) are at increased risk of long-term cardiopulmonary and functional complications, but physical activity participation remains low. Scalable, evidence-based interventions integrated into routine survivorship care are limited, especially in low- and middle-income settings. This study evaluated the effectiveness of a brief, family-centered educational intervention in improving physical activity behaviors and exercise-related cognition among CCS in China. Procedure We conducted a mixed-methods, single-arm educational intervention involving CCS and their caregivers. Baseline assessments (T0) and follow-up assessments conducted 1-3 months after the intervention (T1) evaluated three major outcome domains: (i) physical activity behaviors, assessed using the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and selected Physical Activity Questionnaire for Children/Adolescents (PAQ-C/A) items, including moderate-to-vigorous physical activity (MVPA) and total physical activity; (ii) exercise-related cognitive constructs, assessed using Health Belief Model (HBM)-based measures and selected Exercise Benefits/Barriers Scale (EBBS) items; and (iii) family support and parental awareness regarding exercise and treatment-related health risks. Semi-structured interviews were conducted to further explore perceptions and experiences related to physical activity participation. Results A total of 106 CCS completed T0 and 78 (73.6%) completed T1; 18 participated in interviews. At baseline, most survivors reported low physical activity levels and exercise-related fatigue during vigorous activity. Following the intervention, physical activity behaviors improved significantly, with increases in weekly MVPA (from 98.5 to 172.3 min/week; p = 0.004), total physical activity (from 166.6 to 318.0 min/week; p < 0.001), and GLTEQ scores (from 40.4 to 56.0; p = 0.005). Exercise-related cognition also improved, including greater perceived severity of insufficient physical activity, and increased perceived energy and vitality benefits of exercise. Parental awareness of cardiopulmonary risk increased from 50.0% to 71.8% (p = 0.003). Family support behaviors improved, including parental encouragement (p = 0.016), family co-exercise (p = 0.006), and caregivers' own exercise habits (p = 0.008). Qualitative interviews highlighted the importance of medical guidance, family involvement, individualized exercise recommendations, and concerns regarding fatigue and safety. Conclusions A brief, family-centered educational intervention was associated with improved physical activity behaviors, enhanced exercise-related cognition, increased parental awareness, and stronger family support among childhood cancer survivors. These findings support the feasibility and potential value of integrating scalable exercise education into routine survivorship care.
Having special needs is considered a difficult situation in society, but perhaps only families experiencing this situation know how challenging it is to be the parent of a child with special needs. Since families plan their entire lives around their children's needs, they often neglect their own social lives and free time. The aim of this study is to investigate whether having a child with special needs constitutes a barrier to physical activity for parents, using a mixed methods approach. A total of 212 parents caring for individuals with special needs volunteered to participate in the study. The quantitative part of the study used a questionnaire to collect demographic information, as well as scales to measure perceived barriers to physical activity and care burden, and a shortened version of the international physical activity questionnaire. For the qualitative part of the study, a four-question interview form was used. It was observed that, as participants' scores for physical activity barriers increased, so did their body mass index and care burden scores (p < 0.05). According to the results of the regression analysis, the model of physical activity barriers and care burden status of parents of children with special needs according to the participants' metabolic equivalent classification was not significant (p > 0.05). However, the results of the qualitative data analysis revealed four barriers that parents indirectly associated with having a child with special needs hindering physical activity: responsibilities, having a child with special needs, psychological state and problems related to sports facilities. These results suggest that quantitative research methods alone may be insufficient for identifying factors hindering physical activity among individuals with special needs. Future studies may wish to conduct applied research projects on physical activity barriers among parents of children with special needs.
Background Optimal infant and young child feeding (IYCF) practices are important determinants of early childhood growth and development. Although breastfeeding and complementary feeding recommendations are well established, gaps often remain between maternal knowledge and actual feeding practices. Local evidence from the Northern Emirates of the United Arab Emirates (UAE) is limited, particularly regarding differences between local and expatriate mothers and the relationship between IYCF practices and child anthropometric outcomes. This study assessed maternal knowledge and practices related to IYCF and examined their association with weight-for-age (WAZ) and length-for-age z-scores (LAZ) among children under 2 years in Ras Al Khaimah and Fujairah, UAE. Methods An analytical cross-sectional study was conducted among 381 mother-child pairs with children aged up to 24 months. Participants were recruited from community settings and pediatric outpatient areas. Data were collected using a structured English and Arabic questionnaire, and child anthropometric measurements were recorded. Descriptive statistics, chi-square tests, independent-samples t-tests, and regression analysis were used. Results The mean maternal age was 29.14 ± 6.53 years, and the mean child age was 15.04 ± 7.22 months. Knowledge was generally high for early initiation of breastfeeding, colostrum feeding, and exclusive breastfeeding, but significant differences between local and expatriate mothers were observed for selected knowledge indicators. Correct early initiation of breastfeeding was reported by 284 mothers (74.5%), while exclusive breastfeeding for 6 months was reported by 189 of 345 eligible mothers (54.8%). Among eligible children aged 6-23 months, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet were achieved by 163 (47.2%), 185 (53.6%), and 134 (38.8%) children, respectively. In adjusted linear regression, early initiation of breastfeeding, exclusive breastfeeding, and higher maternal knowledge score were positively associated with WAZ, while number of children was negatively associated with WAZ. Exclusive breastfeeding was positively associated with LAZ, whereas male sex was negatively associated with LAZ. Conclusion Maternal knowledge of recommended IYCF practices was generally favorable, but important gaps remained in actual feeding practices, particularly exclusive breastfeeding, avoidance of pre-lacteal feeding, continued breastfeeding, and minimum acceptable diet. As this was a cross-sectional study, the observed relationships between IYCF practices and anthropometric outcomes should be interpreted as associations rather than causal effects. Strengthening culturally appropriate breastfeeding and complementary feeding counseling may help improve recommended IYCF practices in the Northern Emirates of the UAE.
Background/Objectives: Young people's mental health is increasingly discussed using diagnostic terms. However, limited knowledge exists about how young people describe distress and support needs. This study explored how young people with self-reported functional difficulties described challenges affecting their mental health and everyday lives. Methods: A qualitative study was conducted using 137 anonymized chat and text message contacts from BRIS (Children's Rights in Society), a Swedish youth helpline. Contacts registered within the category "Functional Impairments" were selected through predefined inclusion criteria. The material was analysed in Swedish using Framework Analysis. Results: One overarching theme, Trying to Survive in an Emotional Storm, was identified, comprising three subthemes: Social Environment-Between Norm Pressure and the Need for Support, A Constant Struggle in the Educational System and Insufficient Parental Support-Between Desire for Help and Barriers to Understanding. Young people described challenges related to social relationships, school demands, and limited support from adults. Self-reported diagnostic labels, particularly ADHD, were used to explain and communicate distress. Conclusions: The findings suggest that distress was closely linked to social and contextual circumstances. For nurses and other mental health professionals, the findings highlight the importance of listening to young people's narratives and supporting participation, autonomy, and meaning-making.
Myocyte enhancer factor 2 C (MEF2C) is a transcription factor that plays a central role regulating cell differentiation, proliferation, survival and apoptosis. MEF2C has been implicated in each of the most recent GWAS of cognitive ability (CA) and educational attainment (EA). Animal studies have indicated that knockout of Mef2c interferes with healthy development of brain regions associated with cognitive function, e.g. hippocampal dentate gyrus, neocortex. Furthermore, mutation/deletion of MEF2C can cause severe intellectual and developmental disability. We therefore hypothesised that genes regulated by MEF2C would be associated with cognitive function. We created a set of differentially expressed genes (DEGs) based on an RNA-seq study that captured the transcriptional changes in mouse adult brain that result from early embryonic deletion of Mef2c in cortical and hippocampal excitatory neurons. This mouse DEG list was converted to human orthologues (n=1052) and tested for enrichment of genes associated with 1) CA, and 2) EA, using MAGMA and recent GWAS summary statistics for each phenotype. We also performed hypergeometric tests to investigate if the DEGs were enriched for current primary intellectual disability (ID), autism, and loss-of-function (LoF) intolerant (i.e. highly constrained) genes. We then used Ingenuity Pathway Analysis (IPA) to explore functional pathways implicated by the MEF2C DEGs. The DEGs were significantly enriched for CA (p=1.08e-07) and EA (p=9.88e-09) genes; along with ID (p=0.008), autism (p=0.001) and LoF intolerant (p=5.55e-21) genes. The top functions IPA predicted to be decreased from these DEGs are ‘development of neurons’ (p=5.41e-38, z-score=-2.0) and ‘formation of cellular protrusions’ (p=1.02e-28, z-score=-2.1). These findings indicate that genes influenced by MEF2C are highly constrained and contribute to cognitive function and neurodevelopmental disorders with severe cognitive deficits. Background & Aims: Newborn screening for Cystic Fibrosis (CF) commenced in the Republic of Ireland in July 2011. The aim of this study was to do a comprehensive review of the first five years, focusing on those who had CFTR genetic testing following an elevated IRT. Methods: This study included all neonates screened from July 2011 to June 2016. Data was expanded by cross-referencing patient charts, clinical and lab databases with the Non-NBS database to track down cascade tested relatives. Results: In this period a total of 342,424 infants were screened. 141 CF and 19 CF-SPID cases were identified in addition to 238 healthy carriers. 2 babies died from unrelated illnesses, before their Sweat Test. A total of 300/400 (75%) couples with a CF/CF-SPID/Carrier child were seen by a Genetic Counsellor. Phe508del was the most common mutation (79.9%) followed by Gly551Asp (8.7%). Consequently, 185/238 Carrier parents (78%) underwent genetic testing, identifying 1 carrier couple. 101/160 (63%) CF/CF-SPID parents were tested. 255 additional relatives came forward for cascade testing - 184 from 68/162 CF affected/CF-SPID/RIP families (42%), resulting in 3 new CF cases, 3 new CF-SPID cases and 64 additional carriers. Two cases were siblings born prior to NBS. One case was missed though NBS. 71 relatives from 33/238 Carrier families (14%) came forward for cascade testing, identifying a further 18 carriers. Conclusion: Through early detection of CFTR mutations, NBS provides the opportunity of early intervention and complication prevention as well as improvements in prenatal diagnoses and availability of cascade testing. Introduction: Interstitial deletions of 12q are rare with around 6 cases including 12q21 deletions described in the literature. We identified a male infant with 12q21.1-q21.33 deletion with phenotypic features including wide sandal gap and longitudinal plantar creases, short upturned nose, low set ears, feeding difficulties and delayed development. Methods: Array-CGH using the Agilent (ISCA*v2) 8x60K oligo array (genome assembly Build GRCh37) was undertaken on a chorionic villus sample at 13 weeks gestation due to raised nuchal translucency, and confirmed on venous blood after birth. A comparison of a-CGH microarray profiles was undertaken on the existing described cases. Results: Array-CGH confirmed a ~16Mb deletion containing nine OMIMMorbid genes ALX1 (OMIM *601527), BBS10 (OMIM *610148), CEP290 (OMIM *610142), DUSP6 (OMIM *602748), KITLG (OMIM *184745), MYF6 (OMIM *159991), OTOGL (OMIM *614925), PTPRQ (OMIM *603317) and TMTC3 (OMIM *617218). Using overlapping features of different 12q21 cases allowed microarray profiles to confirm a common deletion region including a non-morbid gene LIN7A. Its role encodes a scaffold protein within the CASK pathway which is important in synaptic function and is a possible responsible gene for the intellectual disability and cortical development present in all described cases. Parental a-CGH was normal confirming our case is de-novo. Conclusion: We delineate a 12q21 deletion syndrome with characteristic phenotypic features. LIN7A is a consistent deleted gene in this region and may be responsible for the intellectual disability due to cortical maldevelopment in this syndrome.
Background Children undergoing cancer treatment are at high risk for malnutrition, poor diet quality, and early cardiometabolic risk due to treatment-related side effects, disrupted appetite, and household-level barriers to healthy eating. Caregivers play a central role in nutritional support during treatment but often experience substantial burden, time constraints, and nutrition insecurity. Food-as-medicine strategies, including medically tailored meals (MTMs), have shown promise in adult populations but remain underexplored in pediatric oncology, particularly during active treatment and within family-centered models. Objective The primary objective of this study is to evaluate the feasibility, acceptability, and adherence of From Kitchen to Clinic, a 12-week, family-centered food-as-medicine intervention that integrates MTM delivery with caregiver coaching for caregivers of children undergoing cancer treatment. Secondary objectives include collecting exploratory data on patient dietary intake, weight and lean body mass trajectories, treatment tolerance, household food and nutrition security, and caregiver burden and distress to inform a future definitive trial. Methods This prospective, single-arm feasibility study will enroll 60 caregiver-child dyads (N = 120) recruited from three outpatient pediatric oncology clinics at a large children's hospital. The 12-week intervention includes an intensive phase (weeks 1-8) with weekly MTM delivery and caregiver coaching, followed by a tapered phase (weeks 9-12) with reduced meal frequency and bi-weekly coaching. Feasibility outcomes include recruitment, retention, assessment completion, intervention adherence, and acceptability, evaluated against predefined progression criteria. Exploratory outcomes will be assessed at baseline and at 3, 6, and 12 months post-intervention using validated dietary, anthropometric, clinical, and caregiver-reported measures. Trial registration NCT07454902.
Background Families frequently recognise early signs of deterioration in their children. In English-centric environments, families from culturally and linguistically diverse (CALD) backgrounds face challenges in escalating concerns in hospital because of language barriers, limited health literacy, uncertainty about escalation pathways, and variable staff responsiveness. Although digital approaches may support communication, it remains unclear whether they address the wider organisational conditions required for equitable escalation of care. Objective This study explored hospital experiences of CALD families and investigated their views on a potential digital tool to escalate acute clinical concerns during their child's hospitalisation. Material and methods This qualitative study was guided by a multicultural consumer advisory group. Families from CALD backgrounds participated in semi-structured focus groups and one-to-one interviews, conducted in English or with interpreters. Audio-recordings were transcribed, de-identified and analysed using reflexive thematic analysis. Results Thirty-four parents/carers representing 34 distinct families and 15 CALD backgrounds participated in 11 focus groups and two individual interviews. Three themes were identified: (i) communicating is not easy; (ii) shaping health system satisfaction; (iii) communicating using digital tools. Families described both supportive and challenging interactions with health staff and the system. Positive experiences were associated with plain language, clear explanations, and inclusive communication. Negative experiences included not feeling heard when raising concerns, inconsistent access to interpreters, unclear information about how to escalate concerns, and distress associated with waiting and uncertainty in emergency care. Although some families saw the value in digital tools, particularly for translation, rapid communication, and access to information, they consistently prioritised broader service changes. These included routine offers of interpreter support, clearer explanations of hospital processes, more detailed information about their child's condition and treatment, and a more welcoming environment for asking questions and raising concerns. Conclusions Families viewed digital tools as potentially useful, but not sufficient on their own. Inequities in escalation of care were shaped not only by language discordance, but also by wider organisational conditions, including inconsistent interpreter access, unclear escalation pathways, variable staff responsiveness, and limited opportunities for families to feel heard. System change is therefore essential if digital approaches are to support equitable escalation of care in hospital settings for these families. Lived experience or public contribution A consumer and community involvement was integral to the study. A Multi-Cultural Consumer Advisory Group (MCAG), comprising six members from CALD backgrounds (China, Egypt, India, Russia, Sierra Leone, and Vietnam), contributed to study design, recruitment planning, interpretation of findings, and refinement of the developing intervention. MCAG members also supported recruitment by sharing study information with their communities.
OBJECTIVES/SPECIFIC AIMS: This case-control study aims to determine the relationships among childhood adversity, attachment style, and the likelihood of accepting or declining a referral for HV. The study will serve as a pilot to inform the power analysis of a subsequently proposed full-scale study. METHODS/STUDY POPULATION: Using a case-control study design, 25 women who decline HV referral (cases) will be compared with 25 women who accept HV referral (controls) on their exposure to childhood adversity and attachment style. Women who are eligible for the study are English-speaking mothers who have been offered HV services by Health Care Access Maryland. Surveys are administered in-person, either in the participant’s home or at another location (e.g., public library), based on participant preference. The dependent variable is participant’s verbal response to the HV referral (accept/decline). The independent variable, childhood adversity, will be measured using the Philadelphia Urban Adverse Childhood Experiences (ACEs) Survey and the Attachment Style Questionnaire (ASQ). Control variables include demographics (i.e., age, race, education, employment, housing, marital status), obstetric history (i.e., previous preterm birth, miscarriage, fetal death, infant death, abortion), and current psychosocial risk factors (i.e., history of substance use, intimate partner violence, depression). Descriptive comparisons will be done for the independent and control variables in controls versus cases. Bivariate analysis will examine associations between the odds of being a case and ACE score and ASQ score. Multivariate logistic regression models will be used to examine the relationship between ACE total and ASQ score; exposure to ACE in cases versus controls; and the odds of an avoidant and anxious attachment styles in cases versus controls. RESULTS/ANTICIPATED RESULTS: We hypothesize that (a) higher ACE scores will be positively associated with a higher level of avoidant attachment; (b) higher ACE scores will be positively associated with declining a HV referral; and (c) higher levels of avoidant attachment will be associated with declining a HV referral. DISCUSSION/SIGNIFICANCE OF IMPACT: Racial inequities in birth outcomes are pervasive and unjust. Non-Hispanic Black women experience births that result in infant mortality, fetal mortality, preterm birth, and low birth weight babies at more than double the rate of non-Hispanic White women in Baltimore and nationally. Prenatal and early childhood home visiting programs have been found to decrease maternal smoking and hypertensive disorder which are associated with PTB, reduce closely spaced births which is associated with fetal and infant death, and improve women’s long-term economic self-sufficiency, child health and social outcomes. However, as community-based programs, these services are not reaching the majority of eligible women in low-income urban settings—women who are also disproportionately burdened with poor pregnancy-related health outcomes. Considering the potential to improve outcomes, the importance of eliminating health disparities, and the national and local investment in HV services, it is vital to understand why some women are not enrolling in prenatal HV programs. The findings from this and subsequent studies will inform the translation of evidence-based HV program outreach efforts for women with complex social history. It will inform the design of enhanced outreach and engagement efforts of HV programs to more reliably engage women.
