Armed conflict not only disrupts health systems but reconfigures trust in vaccination and interactions with information. This study explored how the war in Ukraine has reshaped vaccine attitudes among parents living in Lviv, Ukraine and those displaced to Warsaw, Poland. Using a qualitative design, we conducted semi-structured interviews with 30 Ukrainian parents and 21 key informants, including healthcare workers, journalists, humanitarian actors and policy makers. Data were collected between November 2024 and March 2025 and analysed thematically to identify key patterns in how conflict and displacement influence trust and decision-making around childhood vaccination. Findings show that war and displacement disrupted continuity of care, with vaccination often deprioritised as families navigate documentation, housing and safety. Structural and language barriers further limited access, especially for displaced families. Yet, some parents described vaccination as a means to protect their children and reclaim their agency amid uncertainty, demonstrating active engagement with healthcare despite instability. Information practices were also reconfigured: digital platforms, particularly Telegram, became key spaces for seeking, sharing and interpreting information. Trust was shaped by perceived authenticity, responsiveness and emotional connection to information sources. This study highlights that access and vaccine confidence are mutually reinforcing. At the same time, efforts to sustain trust in vaccination must therefore go beyond focusing on information (and mis/disinformation) and draw on empathetic, transparent and participatory communication means. Strengthening continuity of care, empowering health workers and embedding community feedback mechanisms within humanitarian health responses are critical for sustaining confidence in vaccines in conflict settings.
Abstract The COVID-19 pandemic created substantial disruptions in the delivery of health services around the world. Reductions in hospital admissions have been reported for several conditions in the adult population; less evidence currently exists for children. To what extent such changes reflect a risk for patients due to unmet care needs, or a “correction” of previous overprovision of care has not been thoroughly examined yet. Based on complete national hospital discharge data, we compare the top 30 diagnoses for which children were hospitalised in 2019, 2020 and 2021 in Germany. We also analyse the development of monthly admissions between January 2019 and December 2021 for three tracers of variable urgency and severity. Total admissions were approximately 20% lower in 2020 and 2021 compared to 2019. The composition of the most frequent diagnoses did not change dramatically across years, although changes in rank were observed. The number of admissions for acute lymphoblastic leukaemia (tracer 1) showed a slight increasing trend and a periodicity prima vista unrelated to pandemic factors. Appendicitis admissions (tracer 2) decreased by about 9% in 2020 and a further 8% in 2021, while tonsillectomies/adenoidectomies (tracer 3) decreased by more than 40% in 2020 and a further 30% in 2021; for these tracers, monthly changes are in line with pandemic waves. Observed variations in child hospitalisations reflect the effects of pandemic mitigation measures and/or changes in demand. In Germany, inpatient care for critical conditions appears to have been largely upheld, potentially at the expense of elective treatments. Complementary data on ambulatory care and health outcomes would enable a better understanding of change in healthcare patterns and effects on children's health.
Background Gaps often exist between a therapy's performance in a controlled research setting and outcomes in routine clinical practice. A prescription binocular treatment delivered via head-mounted display has demonstrated efficacy for improving visual acuity in children with amblyopia in a pivotal randomized controlled trial (RCT). A retrospective patient registry has been established to collect real-world data on the treatment. Objective To evaluate the real-world effectiveness of this treatment by benchmarking outcomes from a patient registry against those from the RCT. Methods A retrospective analysis of a multicenter US patient registry was completed. The Registry was queried for patients who matched key eligibility criteria of the RCT with respect to age, amblyopia type and severity, and prior treatment exposure. The primary outcome was the change in amblyopic eye best-corrected visual acuity from baseline to the 12-week follow-up visit. These outcomes were compared with the historical intent-to-treat cohort (n = 45) from the RCT using a two one-sided tests procedure for equivalence with an equivalence margin of ±0.75 lines. Results Among the 40 registry patients meeting query criteria, mean age was 5.7 ± 1.0 years, and 21/40 (53%) had a history of prior treatment. Amblyopic eye best-corrected visual acuity improved a mean 1.7 lines (95% CI = 1.2-2.2), consistent with statistical equivalence within the prespecified ±0.75-line margin compared with RCT participants (1.8 lines; 95% CI = 1.4-2.3; two one-sided tests P = 0.038). No adverse safety events were reported. Conclusions Patients prescribed this treatment for amblyopia in clinical practice achieved visual acuity improvements consistent with those observed in the RCT, indicating that effectiveness generalizes to real-world settings.
OBJECTIVES/GOALS: Inflammatory bowel diseases (IBD) are most often diagnosed in adolescence and young adulthood, affecting 10 in 100,000 pediatric patients in the US and Canada. Adolescents with IBD are vulnerable to poorer outcomes and higher health costs, partially attributable to disruptions in the continuity of care in the transition from pediatric to adult care settings. There is currently no consensus among providers about the timing of initiation and completion of the transition process for adolescents and young adults with IBD, and access to structured pediatric transition readiness programs are lacking, with a paucity of research to evaluate relevant clinical outcomes in such existing programs. While prior studies have primarily examined barriers and facilitators of successful transitions from the provider perspective, only few studies have systematically examined such factors from the patient and caregiver perspective. We wish to better understand the experience of living with IBD for adolescents and young adults, as well as their parents, to understand barriers and facilitators of successful transitions in care. Ultimately, we wish to articulate best practices in this domain in order to create and evaluate a transitions program for patients and parents at the Mount Sinai IBD Center. METHODS/STUDY POPULATION: We are recruiting 15-25 patient-parent dyads to complete our study. At recruitment, we collect baseline quantitative metrics from patients pertaining to demographics, disease characteristics, transition-readiness, self-efficacy, resilience, disease-specific health knowledge, and health literacy. From parents, we collect demographic information, concordance metrics (e.g. how parents perceive their children’s resilience, self-efficacy), parenting style questionnaires, and others. These data are used to understand the characteristics of the young adults and parents within our sample to ensure that the results of our study will be generalizable to a diverse range of patients and families. We then train our patient-parent dyads in Photovoice, the primary method of our study. Photovoice is a community based participatory research (CBPR) methodology used in health education and other fields. The method employs photography for participants to capture their experiences living with IBD, or being a parent to a child with IBD. We then interview all participants about the photos using a standard script employed in Photovoice. All surveys are transcribed and coded for thematic analysis. Based on our findings, we hope to determine phenotypes of patient-parent dyads who are likely undergo successful transitions as well as those at higher risk, understand competencies necessary for successful transitions, and create a comprehensive transitions program for the IBD Center that can be applied with all patients undergoing transitions from pediatric to adult GI care. RESULTS/ANTICIPATED RESULTS: We currently have 26 patients and 25 parents (1 pair of siblings) aged 14-25 enrolled in the study. We hypothesize that adolescents with higher baseline resilience, efficacy, disease-specific health knowledge, and less active disease will have more successful transitions than adolescents with lower scores on these metrics. Similarly, we predict that adolescents with lower baseline resilience, self-efficacy, disease-specific health knowledge and more active disease will be ideal candidates for a more robust transition-readiness program. Further, we hypothesize that children of more authoritarian parents will be less prepared for transition than those with assertive parents. We are currently in the process of conducting patient/parent interviews, and have collected 6 interviews thus far. We will begin the qualitative coding process once we have four interviews from each cohort. Themes emerging thus far involve: medication management, psychiatric co-morbidity, social support, direct communication with doctors, the role of surgery, school absences, travel, and others. DISCUSSION/SIGNIFICANCE OF IMPACT: Transition-readiness is defined as a series of skills in the realms of knowledge, information gathering, self-management, and decision-making that must be mastered by a patient in preparation for a healthcare transition, such as that from pediatric to adult IBD care. It has been shown that many clinicians who rely on subjective measures such as perceived health literacy overestimate transition readiness in their IBD patients. Many pediatric gastroenterologists who use more objective measures rely on a validated self-report questionnaire, the Transition Readiness Assessment Questionnaire (TRAQ) to assess readiness for transition and to facilitate discussions around the skills necessary to transition, including appointment keeping, tracking health issues, managing medications, talking with providers, and managing daily activities. However, the TRAQ has been shown to be limited in its ability to predict transition readiness independently of age, and ignores both provider and family perspectives. Given the critical role of parents in medical decision making, and the differential emphasis of the caregiver role in pediatric versus adult IBD care paradigms, it is vitally important to identify barriers to transition as well as differences in perspectives between adolescents living with IBD and their parents. Our study is the first to employ Photovoice, a method that ‘gives a voice to the voiceless’ in the gastroenterology space, in order to understand the needs that adolescents and young adults themselves perceive as critical in promoting transition-readiness. We include parents in this inquiry in order to understand how parental perceptions of their children’s transition-readiness promote or stifle successful transitions and independent disease self-management. We will ultimately use this data to create a Transitions program to evaluate in our center for adolescents with IBD and their parents.
Background As the global population ages as a whole, interest in the "place" dimension of aging is growing. Previous studies on relocation in older age were often qualitative in nature and based on small samples. Large-scale epidemiological studies that specifically account for nonmovers are scarce but may contribute to a better understanding of older people's reasoning about relocation. Methods Data from the Second Longitudinal Study of Aging-Wave II, a U.S. population-based survey from 1997 to 1998, was analyzed to explore the most common reasons for moving in adults aged ≥ 70 years. The data were analyzed with a cross-sectional analytical approach. The predicted probability of moving depending on age and sociodemographic factors was estimated based on survey-weighted multivariable logistic regression. Moving/relocation was self-reported and covered a preceding 2-year period; reasons for moving implied a permanent relocation. Results The weighted percentage of participants reporting relocation within the last 2 years was 10.83% (9.81-11.95). The predicted probability of moving increased with higher age and doubled from 10% to 20% when comparing those aged 70 years and 90 years. Participants reporting fair/poor overall health were significantly more likely to have moved than those participants with excellent health (contrast: +7% (95% CI: 4.1%-9%), p < 0.001). A similar contrast was found when comparing married participants with widowed/divorced participants (+6.8% (95% CI: 3%-10%), p = 0.001). Deteriorating health and the desire to go to a smaller place were the most frequently reported reasons for moving with 35.67% (31.98-39.53) and 18.71% (15.29-22.70), respectively. More than 10% of participants who relocated indicated a desire to live closer to their child/children. Conclusions Results from this epidemiological analysis corroborate motivations for relocation identified in previous interview-based qualitative studies. The estimated marginal predicted probabilities provide new insights into the complex dynamics of relocation in older age.
High-quality data on anticoagulant prophylaxis for pediatric VTE prevention are scarce. Key research priorities include the development and validation of subgroups-specific VTE risk assessment models, and evaluation of the safety and efficacy of risk-stratified anticoagulant prophylaxis strategies across different pediatric subgroups. Background Venous thromboembolism (VTE) is a significant cause of morbidity in children, particularly among hospitalized patients and those with chronic medical conditions. There is a lack of consensus on anticoagulant prophylaxis strategies. Objective These evidence-based guidelines from the American Society of Hematology (ASH) and the International Society on Thrombosis and Haemostasis (ISTH) are intended to support patients and health care professionals in decisions about anticoagulant prophylaxis for pediatric VTE prevention. Methods ASH formed a multidisciplinary guideline panel that included 1 patient representative. The University of Kansas Health System supported the guideline development process, including systematic evidence reviews up to April 2025. Clinical questions and outcomes were prioritized according to their importance for clinicians and patients. The panel used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to assess certainty in the evidence and make recommendations. Results The panel agreed on 12 recommendations. For pediatric patients with solid cancer, who have experienced trauma, or who are critically ill, the panel issued conditional recommendations suggesting no anticoagulant prophylaxis. For pediatric patients with antiphospholipid antibody syndrome, or those on long-term total parenteral nutrition, the panel issued conditional recommendations suggesting the use of anticoagulant prophylaxis. Other pediatric subgroups addressed included patients with acute lymphoblastic leukemia or lymphoma, surgical and hospitalized patients, and those with a central venous access device. Conclusions High-quality data on anticoagulant prophylaxis for pediatric VTE prevention are scarce. Key research priorities include the development and validation of subgroups-specific VTE risk assessment models, and evaluation of the safety and efficacy of risk-stratified anticoagulant prophylaxis strategies across different pediatric subgroups.
With societal advancement, the increasing burden of childcare and parenting has significantly impacted the quality of life and mental wellbeing of both children and parents, posing serious challenges to family stability and sustainable social development. As the primary living environment for children and parents, communities play a crucial role in meeting their daily needs. However, existing research largely proposes generalized child- and parent-friendly strategies at the urban scale, with limited attention paid to the development of targeted community-level childcare and parenting support environments. Grounded in Person-Environment (P-E) Fit Theory, this research develops an applied analytical framework for a Community Childcare and Parenting Support System (CCPSS). It aims to examine the associations between community environmental subsystems and the satisfaction of multi-level needs among children and parents, in order to enhance their wellbeing. A questionnaire survey was conducted in the communities within Heping District, Tianjin, China, collecting data from both children and parents. Pearson correlation analysis and random forest-based importance ranking were used to examine the associations and relative contributions of different community environmental subsystems to the need satisfaction levels of children and parents. The results indicate a significant positive correlation between the fulfillment of childcare and parenting needs and community environmental systems, with different environmental dimensions contributing to varying degrees. This research extends the application of P-E Fit Theory to the parenting context and provides theoretical and empirical evidence to inform the development of more targeted CCPSS at the community level.
Abstract Background Behçet disease is a rare vasculitis that involves medium and small calibre arteries. Multisystem involvement is possible. Few are the papers that provide information about its clinical course, and outcome in the pediatric population. Also, the management is mainly based on adult guidelines. Objectives To shed light on the clinical course and outcome of juvenile Behçet disease. Methods A single center retrospective descriptive study of 13 children with Bechet disease. The mean follow-up period was for 3 years. Results We had 8 boys and 5 girls. Four of our patients were consanguineous. The mean age was 9 years. The mean interval between onset and diagnosis was 3 months. All of our patients had recurrent aphthous stomatitis with a median of 6 episodes per year. The other symptoms at diagnosis were concomitant genital ulcers in 4 cases, pseudo-folliculitis in 7 cases, urticarial rush in 4 cases, severe headache in 2 patients, stroke in one patient, prolonged and/or recurrent fever in 9 patients, uveitis in 4 cases, episcleritis in one case, arthritis in 5 cases, pulmonary hemorrhage in one case, and pyoderma gangrenosum in one case. The pathergy test was performed in all the patients, and was positive in 3 of them. Diagnosis was based on the International Criteria for Behcet's Disease. Acute phase reactants (ESR and CRP) were high in all patients. Meanwhile, granulocytosis was found in 10 patients. HLA 51 was positive in 8 patients, from whom three were siblings. All our patients were on steroids, five had colchicine, seven had azathioprine, two had methotrexate, two had cyclophosphamide, three had etanercept and one had tocilizumab. Complete remission was obtained in 8 cases in a mean time of 15 months, while five children had partial remission, and one boy lost sight of his left eye after a severe retinitis. Conclusion Behcet’s disease can cause severe sequalae if not diagnosed and treated on time. More studies are needed to establish management guidelines for pediatric population.
Background Limited studies in Iran have assessed child health-friendly neighbourhood domains or examined the extent to which neighbourhoods support the health of children under 6 years of age. This study aimed to assess the status of child health-friendly neighbourhood domains in selected districts of Tehran using a previously designed and locally validated tool, with a focus on identifying neighbourhood strengths and weaknesses. Methods This pilot study was conducted between April and July 2023 in Tehran. 10 neighbourhoods from five districts were selected using convenience random sampling. Neighbourhoods were assessed using the Iranian Child Health-Friendly Neighbourhood checklist. Six dimensions-green spaces and parks, recreational centres, cultural centres, passages and streets, healthcare centres and kindergartens-were evaluated across five domains: facilities and services, accessibility, security, safety and aesthetics and view. Descriptive statistics, including means and frequencies, were used for data analysis. Results Accessibility achieved the highest overall score (94%), particularly for kindergartens and cultural centres. The lowest scores were observed in green spaces and parks and in the domain of aesthetics and view (both 57.2%). Neighbourhood safety and security were scored 73.5% and 66.8%, respectively. The aesthetics and view of green spaces and parks (32.2%) and facilities and services in kindergartens (38%) were identified as the lowest-scoring components. Based on the design of the tool, the aim was to identify neighbourhood strengths and weaknesses; therefore, no predefined criteria were applied to classify neighbourhoods as child-friendly or not. Conclusions Despite some strengths, the overall status of the assessed neighbourhoods indicates a need for targeted improvements to better support and promote children's health. The integration of field observation, a locally validated assessment tool and a focus on children under 6 years of age provides practical evidence to inform urban planning and health promotion policies aimed at creating safer and more child-friendly neighbourhoods.
Aims Chlamydia, a sexually transmitted bacterial infection caused by Chlamydia Trachomatis can result in long-term complications for affected individuals. The National chlamydia screening programme recommends screening at-risk young persons, however for the vulnerable patients at the Forensic Child and Adolescent Mental Health Service (FCAMHS), there has been no audit to determine the completion rate. This audit aim to (1) Determine the demographics of young persons on admission (2) To determine the rate of chlamydia screening as well as the percentage of patients who qualified for a Chlamydia screening(3) To determine the rate of documentation for completed tests. Methods This was a retrospective study. The medical electronic records of patients who met the inclusion criteria was searched. All the three mixed-sex adolescent forensic wards (2 medium secure units and one low secure unit) at FCAMHS Ardenleigh, Birmingham were sampled. All patients that were on admission aged above 15 years of age were recruited. A total sample size of 19 was obtained for the initial audit and 12 for the re-audit. Data collection Data were collected by the author for the initial-audit and re-audit by searching the clinical progress notes, the investigation results and the physical health rethink forms. An excel software was used for analysis. Results Demographics There were 11 males (57.9%) and 8 females (42.1%) in the initial audit In the re-audit, there were 7 males (58.3) and 5 females (41.7). Some of the patients were still on admission at the time of the re-audit, hence the percentages were calculated differently. The mean age and average length of admission was also calculated. Chlamydia screening In the initial audit, the percentage of patients tested for Chlamydia was 11.5%, even though 36.8% of patients met the criteria for Chlamydia screening. In the re-audit, 25.0% were tested, and 41.7% met the criteria for Chlamydia screening. Physical health (Rethink) forms The physical health form was completed for majority of patients 73.7% in the initial audit although, this was not compatible with screening rates. Before the re-audit was concluded, the physical health forms were no longer in use. Conclusion The audit highlighted an overall improvement in the rate of screening following recommendations from initial audit. The inclusion of Chlamydia screening in admission processes could be useful in improving sexual health.
