BACKGROUND: The Pediatric Symptom Checklist (PSC) is a brief questionnaire aimed at detecting psychosocial problems of children and adolescents for intervention in the early stage. Though we have devised a 17-item version of the PSC-Youth Self-Report (PSC-17-Y) Japanese version, our subsequent goal was to evaluate its adequacy by comparing the scores of patients and of schoolchildren for the prevention and early intervention of schoolchildren’s psychosocial problems. METHODS: This study was conducted in Osaka, Japan’s second-largest city, between July 2020 and September 2022, during which participants completed the Japanese version of the PSC-17-Y (JPSC-17-Y). The participants were 52 patients with psychosocial problems (23 boys and 29 girls; mean age, 13.6 years) and 64 age-matched schoolchildren (24 boys and 40 girls; mean age, 13.4 years). The total score and each factor score of the JPSC-17-Y were compared, with the Mann-Whitney U test used to examine the differences between the groups. RESULTS: The results showed that the patient group’s scores were significantly higher than the control group’s for all factors and the total score. To estimate the cutoff value for differentiating between the control group and the patient group using the total score of the JPSC-17-Y, the Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) curve was calculated. The AUC was 0.755, indicating a moderate level of predictive performance for the JPSC-17-Y. The cutoff value of the total score between 12 and 13 was considered clinically appropriate. CONCLUSIONS: These findings suggest that the JPSC-17-Y can lead to prevention of and early intervention for psychosocial problems of schoolchildren.
Background Antenatal colostrum expression is a practice involving self-massage of the breasts starting in late pregnancy (typically 35-36-weeks of gestation), which is thought to stimulate lactation and allow individuals to secrete and store colostrum prior to delivery. To support successful breastfeeding initiation and continuation among patients, some clinicians provide antenatal colostrum expression teaching as part of standard prenatal care. However, the impact of antenatal colostrum expression teaching is unclear due to limited evidence which is largely anecdotal. The primary aim of this case-control chart review was to evaluate the effect of antenatal colostrum expression teaching as part of standard obstetrical care on breastfeeding practices at first postpartum checkups, gaining pilot data to inform future research. Secondary outcomes included the evaluation of preterm delivery, mode of delivery, and repeat hyperbilirubinemia screening between groups. Methods A retrospective case-control chart review before (n = 79) and after (n = 96) antenatal colostrum expression teaching was incorporated into standard care at 36-gestational week visits in an obstetrical practice in North Battleford, SK, Canada (2016-2020). Odds of fully breastfeeding at first postpartum check-ups in cases vs. controls was evaluated with logistic regression, adjusted for parity, mode of delivery, and infant age at postpartum check-ups. Odds of repeat hyperbilirubinemia screening in cases vs. controls was evaluated with logistic regression, adjusted for parity, mode of delivery, and infant sex. Results Antenatal colostrum expression teaching increased the odds of fully breastfeeding at postpartum check-ups by > 3-fold as compared to controls (aOR = 3.09; 95% CI = 1.35-7.09). Odds of repeat hyperbilirubinemia screening was 59% lower in cases vs. controls (aOR = 0.41; 95% CI = 0.18-0.92). No significant differences in gestational age at delivery or mode of delivery were found between groups. Conclusion Antenatal colostrum expression presents a promising intervention to help prepare patients mentally and physiologically for breastfeeding and labour. While these findings suggest that advocacy efforts are warranted to increase standard provision of antenatal colostrum expression teaching in late gestation, results should be confirmed in a randomized intervention trial, which further aims to understand the effect on longer-term breastfeeding rates and infant health.
Rationale Clinical trials have demonstrated the efficacy, rapid action, and safety of calcitonin gene related peptide-related antibody drugs for migraine prevention, and subcutaneous galcanezumab was launched in Japan in April 2021. However, the safety of this drug in pregnant migraine patients has not been demonstrated in humans, with evidence of safety available only from animal studies. We report 2 cases in which subcutaneous galcanezumab was administered continuously until the first and second trimesters of pregnancy, resulting in normal births without any complications for either the mother or child. Patient concerns The cases involved pregnant patients, aged 34 and 43, with long-standing migraines without aura. Diagnoses Migraines without aura. Interventions They were administered galcanezumab until the fifth week and fifth month of pregnancy, respectively. After discontinuation of treatment, the increase in the frequency of the mothers' migraines remained mild. Outcomes Each mother safely gave birth to a baby boy, with acetaminophen administered as needed for the management of headaches. Subsequent checkups showed that both mothers and their children were healthy. Lessons The safety of galcanezumab administration in pregnant women has only been reported in scattered case reports, and further case studies are needed. It is considered necessary to continue to monitor newborns for the development of neurological abnormalities, including higher brain functions.
Rationale Induction of labour (IoL) aims to initiate labour when the risks of continuing pregnancy outweigh the benefits. Over 10 methods are currently available, yet the most effective and safest method remains unclear. Objectives To compare the benefits and harms of various cervical ripening and IoL methods at or beyond term labour and to rank the methods. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the WHO ICTRP until 1 February 2023. Eligibility criteria We included randomised controlled trials (RCTs) evaluating IoL methods among women with a live fetus at or beyond term labour (gestational age ≥ 37 weeks). We focused on the methods currently recommended by international guidelines and those proposed by previous Cochrane reviews. Outcomes Our critical outcomes included failure to achieve vaginal delivery within 24 hours, caesarean section due to any causes, caesarean section due to non-reassuring fetal status, uterine hyperstimulation with changes in the heartbeat of the baby before birth, perinatal death, and severe neonatal morbidity. Risk of bias We assessed bias and trustworthiness using the Cochrane RoB 1 tool and the Cochrane Pregnancy and Childbirth Trustworthiness Tool (CPS-TST), respectively. The final analyses only included trials that met the CPS-TST. Synthesis methods We performed pair-wise meta-analyses using a random-effects model and network meta-analyses (NMA) with a frequentist approach. We reported analyses and results separately for two populations: 1) women without a previous caesarean section and a mix of women with or without a previous caesarean section (where more than 50% of participants had no previous caesarean section), and 2) women with a previous caesarean section. We used risk ratio (RR) and mean difference (MD) to present treatment effects with 95% confidence intervals (CIs). We assessed the certainty of evidence for critical outcomes using the GRADE approach for NMA. We used the surface under the cumulative ranking curve (SUCRA) to estimate treatment ranking. Included studies The analysis included 106 RCTs assessing 13 IoL methods among 30,348 women. Most trials (84.9%) were conducted in inpatient settings. Only two RCTs recruited women with previous caesarean section, and seven RCTs recruited a mix of women with or without a previous caesarean section. Synthesis of results We evaluated the effects of the following IoL methods: vaginal misoprostol (≤ 50 μg), oral misoprostol (≤ 50 μg), sublingual or buccal misoprostol (≤ 50 μg), controlled-release misoprostol vaginal pessary, vaginal dinoprostone (tablet or gel), controlled-release dinoprostone vaginal pessary, oxytocin (alone), nitric oxide donors, balloon catheters, osmotic cervical dilators, oxytocin plus amniotomy (Oxytocin+Amniotomy), balloon catheters plus oxytocin (Balloon+Oxytocin), balloon catheters plus vaginal/oral misoprostol (≤ 50 μg) (Balloon+Misoprostol ≤ 50 μg), and inactive methods (placebo, no intervention, and expectant management). The following results show the relative effects of NMA for four of the six critical outcomes among women without previous caesarean section and a mix of women with or without previous caesarean section. The findings of women with previous caesarean section are not presented here due to limited evidence. We used vaginal misoprostol (≤ 50 μg) as the reference method for presenting results, where data for this method were available in the network. 1) Failure to achieve vaginal delivery within 24 hours There was no clear evidence that any of the methods were more effective than vaginal misoprostol (≤ 50 μg) in reducing the risk of this outcome. Oxytocin+Amniotomy (RR 0.41, 95% CI 0.14 to 1.24, 22.4% fewer, moderate-certainty evidence), Balloon+Misoprostol ≤ 50 μg (RR 0.85, 95% CI 0.60 to 1.19, 5.7% fewer, high-certainty evidence), and Balloon+Oxytocin (RR 0.94, 95% CI 0.71 to 1.26, 2.3% fewer, low-certainty evidence) likely resulted in little to no difference in this outcome compared with vaginal misoprostol (≤ 50 μg). Despite the comparable relative treatment effects between some methods and vaginal misoprostol (≤ 50 μg), these three methods ranked highest. 2) Caesarean section due to non-reassuring fetal status There was no clear evidence that any of the methods were more effective than vaginal misoprostol (≤ 50 μg) in reducing the risk of this outcome. Balloon+Oxytocin (RR 0.77, 95% CI 0.47 to 1.25, 2.0% fewer, moderate-certainty evidence), controlled-release dinoprostone vaginal pessary (RR 0.86, 0.62 to 1.18, 1.2% fewer, low-certainty evidence), and balloon catheters (RR 0.88, 95% CI 0.70 to 1.11, 1.0% fewer, low-certainty evidence) may result in little to no difference in this outcome when compared with vaginal misoprostol (≤ 50 μg). Despite the comparable relative treatment effects between all methods and vaginal misoprostol (≤ 50 μg), these three methods ranked highest. 3) Uterine hyperstimulation with changes in the heartbeat of the baby before birth Nitric oxide donors (RR 0.05, 95% CI 0.01 to 0.47, 3.9% fewer, moderate-certainty evidence), osmotic cervical dilators (RR 0.07, 95% CI 0.01 to 0.42, 3.8% fewer, moderate-certainty evidence), balloon catheters (RR 0.38, 95% CI 0.21 to 0.69, 2.5% fewer, moderate-certainty evidence), and oral misoprostol (≤ 50 μg) (RR 0.62, 95% CI 0.39 to 0.99, 1.6% fewer, moderate-certainty evidence) probably reduce this outcome compared with vaginal misoprostol (≤ 50 μg). When compared with inactive interventions (placebo, no intervention, or expectant management), vaginal misoprostol (≤ 50 μg) (RR 3.47, 95% CI 1.16 to 10.35) probably increases the risk of this outcome. The three highest-ranked methods were nitric oxide donors, osmotic cervical dilators, and inactive methods (placebo, no intervention, and expectant management). 4) Perinatal death There was no clear evidence for this outcome, as it was rare (10 cases reported across trials). Authors' conclusions For women without previous caesarean section and a mix of women with or without previous caesarean section, there was no clear evidence that any of the IoL methods were more effective than vaginal misoprostol (≤ 50 μg) for the outcomes of failure to achieve vaginal delivery within 24 hours, caesarean section due to non-reassuring fetal status, and perinatal death. Nitric oxide donors, osmotic cervical dilators, balloon catheters, and oral misoprostol (≤ 50 μg) probably reduce the risk of uterine hyperstimulation with changes in the heartbeat of the baby before birth. Funding This review had no dedicated funding. Registration Protocol (2023): https://doi.org/10.1002/14651858.CD015234.
Rattanakanokchai S, Gallos ID, Kietpeerakool C et al.
Background Adolescent substance use in India has become a significant public health challenge. It is increasingly characterized by a shift toward easily concealed smokeless tobacco pouches ("Cool Lip") and inhalants, which fall outside awareness-based school prevention frameworks. School absenteeism has been identified in the global literature as the key behavioral indicator of adolescent substance use, based on the assumption of a relatively stable home environment. This assumption may not hold in low-income urban government schools in India, where the Right of Children to Free and Compulsory Education (RTE) Act, 2009, legally requires that every child enrolled be retained. This study investigates this question from the perspective of government school teachers. Methodology Semi-structured in-depth interviews were conducted with twenty-one government school teachers, headmasters, and physical education instructors across 16 schools in Chennai district, Tamil Nadu, India. Data were analyzed using reflexive thematic analysis in combination with a six-step conceptual model development process, with theoretical frameworks introduced only after the inductive generation of themes. Results Five themes were identified. In contrast to the global pattern, substance-using students were consistently described as regular attendees-the Attendance Paradox. The substance landscape has shifted toward easy-to-hide substances, reshaped by post-pandemic mask use and digital peer coordination through mobile phones acquired for online learning. Teachers described a porous school perimeter where making complaints was perceived as personally risky, thereby sustaining institutional silence. Family conditions were an expression of economic precarity, not parental neglect. Teachers prioritized relational inclusion over exclusionary discipline because they perceived that excluding students could increase their vulnerability to becoming "social elements" who might subsequently influence younger peers. Discussion The findings are synthesized into the Institutional Ambivalence Model (IAM), an empirically grounded conceptual model that explains the Attendance Paradox by showing how urban government schools simultaneously function as spaces of care and exposure. The model thereby extends sociological ambivalence from individual social roles to institutions. Policy implications support reintegration-first approaches, attention to post-pandemic digital coordination, and safer perimeter-reporting channels over attendance monitoring or exclusionary discipline.
Understanding families' food purchase decision-making is essential to developing successful interventions to promote healthier behaviours. Several factors can influence the foods people purchase. However, knowledge about how parents handle dilemmas in food purchase decisions and how these decisions affect families' food purchases is scarce. This study explores families' food purchase decisions in supermarkets and illustrates how parents navigate the tension between their values and contextual and situational circumstances (e.g. family situation). We conducted 37 semi-structured, shop-along, and photo-elicited interviews with parents from fifteen families with children ranging from 0 to 19 years of age (September 2022–January 2023). We used an abductive analytical approach to investigate the role of conscience and morality in our empirical findings. We applied the theoretical concept of moral labour to examine how individuals navigate the discomfort associated with guilt or a guilty conscience, which arises from conflicts or dissonance of their values when making food purchases in supermarkets. Food purchase decisions were influenced by moral considerations related to animal welfare, climate, parental responsibility, and good and healthy food. However, product availability and presentation, price, and the parent-child interaction, as well as contextual and situational circumstances, could challenge parents’ values, triggering moral labour. The study illustrates how parents performed moral labour, e.g., minimising the health impact, to reconcile with negative feelings of conflicting values. Future intervention studies should consider focusing on supportive food environments over individual behaviour changes to minimise the potential moral labour among parents from such initiatives.
This study explores the relationship between adult children's unemployment and parental mental health. Given India's large inequalities in social capital and income, we examine the heterogeneous effects of these factors on the relationship. We utilise data from the Longitudinal Ageing Survey of India, which includes 73,396 individuals aged 45 and above. We analyse the relationship between the exposure to the unemployment of adult children and the parental risk of depression using the CES-D score, with respondents reporting four or more symptoms out of 10 considered at risk of being "depressed". We employ inverse probability weighting based on a logistic regression model to form a pseudo-control group, accounting for confounding demographic and socioeconomic characteristics. Our findings show a 3.14 percentage points (ppts) increase in absolute terms (and a 12.48% relative increase) in the probability of parental depression risk associated with adult children's unemployment. There are no significant differences between fathers and mothers in the increased risk of depression, but for the unemployment of the firstborn son, there is a significantly higher association of increased risk of depression than for the unemployment of the firstborn daughter. Heterogeneity analyses reveal that among older adults with high social participation, there is no significant increase in their risk of depression associated with their children's unemployment. Similarly, among older adults residing in low and medium-income inequality states, the negative consequences of their children's unemployment are weaker. Overall, we conclude that while adult children's unemployment is associated with an increased risk of parental depression, higher social participation and residing in low or medium-income inequality states might have protective effects on older adults' mental health following their children's unemployment. Governments may consider expanding labour market policies that support youth labour market entry as a means to improve not only the employability of younger individuals, but also the well-being of older generations.
Early childhood caries (ECC) is a multifactorial chronic disease strongly influenced by feeding behaviors and oral hygiene practices. Co-sleeping is a common caregiving practice that may increase ECC risk by facilitating nocturnal feeding and limiting adequate nighttime oral care. This study aimed to evaluate the association between co-sleeping, related behavioral factors, and the presence and severity of ECC in children aged 1 to 6 years. A retrospective observational study was conducted using clinical and radiographic records from a pediatric dentistry clinic. The sample included 150 children aged 12 to 72 months. Parents completed a validated questionnaire on feeding practices, dietary habits, oral hygiene routines, sugar intake, and co-sleeping behaviors. ECC was assessed using the decayed, missing, and filled teeth index according to World Health Organization criteria. Logistic regression analyses were performed to identify associations between co-sleeping, behavioral variables, and ECC outcomes. Co-sleeping was reported in 18.7% of children. Co-sleeping children showed significantly higher mean decayed, missing, and filled teeth index scores than non-co-sleepers (7.14 vs 3.49). Co-sleeping was significantly associated with nighttime breastfeeding on demand, higher carbohydrate consumption, and inadequate oral hygiene practices (P < .05). In most co-sleeping cases (89.3%), children fell asleep with milk remaining in the oral cavity. Co-sleeping was associated with an approximately 2-fold increase in ECC risk, and behaviors that may increase the risk and severity of ECC, particularly nocturnal feeding and insufficient oral hygiene. Targeted parental education on nighttime feeding and oral care practices may help reduce ECC risk. Prospective studies are warranted to confirm these findings.
Bayón-Hernández G, Solano-Mendoza P, Solano-Mendoza B et al.
Community has long been key to the well-being of gay men, yet little research examines how gay fathers, specifically, relate to the broader LGBTQ+ community. Drawing on interviews with 18 mostly White, (upper-) middle-class Canadian gay fathers, I investigate their expectations and experiences of family and community, showing they describe 'gay community' in terms of gay ancestors, friends, and shared gay activities. Fathers express deep gratitude for past LGBTQ+ people whose interdependent collective struggle secured their rights to marry and parent. They hope for support from family and gay friends and strive to maintain community ties, but find their efforts complicated by the demands of intensive parenting, geographic distance, and limited childcare support. As children grow, fathers build community with the straight parents of their children's friends, demonstrating how social class, whiteness, and homonormativity shape the reorganisation of these Canadian gay fathers' lives-a process I call the gay parental turn.
Background Infant and young child feeding (IYCF) practices are critical for child growth and survival, yet they are strongly shaped by sociocultural and livelihood contexts. In pastoralist settings, feeding practices are influenced by traditional beliefs, mobility, environmental constraints and access to health services. However, limited evidence exists on how community norms and social structures influence IYCF in remote pastoralist communities of Ethiopia. Objective This study aimed to explore maternal and community perspectives on IYCF practices in the pastoralist communities of Afar Region, Ethiopia. Design Qualitative observational study using a phenomenological approach. Setting Pastoralist communities in the Afar Region, Ethiopia. Participants 16 mothers of children aged 6-23 months participated in in-depth interviews, and 20 community members (religious leaders, elders and clan leaders) participated in three focus group discussions. Methods Participants were purposively selected. Data were collected using semi-structured interviews and focus group guides, audio-recorded, transcribed verbatim and translated into English. Data were analysed using an inductive thematic analysis approach. Results Four interrelated themes shaped IYCF practices. Cultural rituals and elder authority influenced breastfeeding initiation, particularly following home births, where pre-lacteal feeding linked to the Onor/Onqor ritual was described as delaying initiation. Although awareness of exclusive breastfeeding was commonly reported among participants, seasonal water supplementation and maternal workload limited consistent adherence. Complementary feeding was generally introduced at 6 months; however, dietary diversity was constrained by pastoral livelihood instability, drought, market inaccessibility and rising food prices. Gendered household dynamics shaped resource control and caregiving responsibilities, with women bearing primary responsibility for childcare, feeding and hygiene. Clan-based social networks provided support during hardship but also reinforced some traditional feeding practices. Conclusions IYCF practices in pastoralist Afar are shaped by cultural norms, gender relations and structural constraints, including livelihood insecurity and limited service access. Interventions should integrate culturally responsive community engagement with gender-sensitive and livelihood-informed nutrition strategies.
