Background Childhood obesity is a prevalent public health concern, particularly among children from marginalized backgrounds. Epigenomic mechanisms, including DNA methylation (DNAm), offer insight into the biological embedding of metabolic risk, yet protective family-level factors remain understudied. This study examined whether participation in a positive parenting intervention was associated with reduced epigenetic cardiometabolic risk among preschool-aged children. Methods Participants were 74 children ( n = 35 intervention; n = 39 services-as-usual; mean age = 36 months). Using a secondary analysis of a randomized controlled trial, DNAm-derived body mass index (BMI) and anthropometric BMI were assessed at baseline and 12-month follow-up, and parenting practices were observed post-treatment. Results Children in the intervention group demonstrated significantly lower DNAm BMI at 12 months relative to controls, adjusting for child sex, race and/or ethnicity, and anthropometric BMI. No treatment effect was observed for anthropometric BMI, and DNAm BMI was not associated with anthropometric BMI at 12 months. Although parenting practices improved, they did not mediate intervention effects on DNAm-derived BMI. Conclusions Parenting interventions may influence biological pathways related to cardiometabolic risk, even before changes in anthropometric outcomes, underscoring the potential of family-centered approaches to promote early metabolic health. Impact Participation in a positive parenting intervention was associated with a lower epigenetic biomarker of BMI in preschool-aged children. Findings: highlight a disconnect between biological markers and traditional anthropometric measures. Results: underscore potential for early family-centered interventions to shape biological pathways associated with long-term health, ultimately supporting prevention strategies before clinical risk is observable.
Abstract BACKGROUND/PURPOSE: Stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) deliver highly conformal, ablative doses of radiation over 1–5 treatments, while minimizing dose to surrounding normal tissues. To document toxicities and outcomes of these treatments in children, our updated institutional experience with SRS or SRT for intracranial targets in pediatric patients was reviewed. METHODS: On an IRB approved study, institutional databases were reviewed to identify pediatric patients with intracranial lesions treated with SRS or SRT from October 2009 to July 2021. Medical records were retrospectively reviewed for patient and treatment characteristics. Outcomes were analyzed for symptomatic radionecrosis and CNS progression. RESULTS: Thirty SRS or SRT treatment courses in 26 patients age 3.2 to 17.8y (median, 15.6y) at the time of SRS or SRT were identified. Twenty-two patients had one treatment and four had two treatments. Sixteen patients had brain metastases from extracranial primary disease; 10 had recurrence of a primary CNS tumor. Fifteen patients had prior fractionated radiation to the brain. Nineteen treatments used Gamma Knife (GK) with Leksell frame, three used GK ICON with mask, and eight used linear accelerator with volumetric modulated arc therapy with thermoplastic mask. All patients (10 treatments in nine patients) treated since July 2016 received mask-based radiation. Twelve of 26 (46%) patients were treated with anesthesia. With 9.6-month median follow up (range, 0.1-96.2m), five patients had progression of treated lesions, eight had distant CNS failure, and one had both local and distant failure, for a crude local failure rate of 6/26 (23%) and a crude distant failure rate of 9/26 (35%). There were no skull fractures or other complications from Leksell frame placement. One patient developed symptomatic radionecrosis requiring surgery. CONCLUSION: SRS and SRT can be safely performed in pediatric patients with intracranial lesions. Mask-based immobilization provides an alternative to frame-based treatments.
Background Family-based interventions offer a promising solution to the pressing global health concern of childhood obesity by addressing the interconnected behaviours of parents and children. Nevertheless, limited evidence identifies which families benefit most when outcomes are evaluated at the parent-child dyad level. Aim To identify which parent-child dyads experienced clinically meaningful improvements in weight status over 1- and 2-year periods within the Feel4Diabetes study, a school- and community-based intervention targeting European families at risk for Type 2 diabetes. Methods Data were drawn from 2402 high-risk families across six European countries. For participants with overweight/obesity, improvement meant ≥ 5% parental weight loss and a ≥ 0.15-unit child BMI-z reduction. Multiple logistic regression models identified socio-demographic and contextual predictors of dyadic improvement. Results After 2 years, 5.3% of families achieved improvements in both parent and child. Significant predictors of dyadic success included intervention group participation [OR = 2.56 (95% CI: 1.31-5.03)] and residing in high-income countries under austerity measures [OR = 2.44 (1.00-6.02)]. Girls were more likely to improve than boys, while full-time maternal employment was associated with lower odds of dyadic improvement. Conclusions Sustained benefits were observed in a subset of families, highlighting the need for tailored, context-sensitive family-centred obesity prevention strategies.
Abstract BACKGROUND/OBJECTIVES We examined longitudinal verbal and visual memory functioning in children treated for medulloblastoma on COG protocol ACNS0331. METHODS Children with medulloblastoma participated in neuropsychological testing at three timepoints over a 6-year period. Children aged 3–7 years were randomized to receive craniospinal irradiation (CSI) of either 23.4Gy (standard dose; SDCSI) or 18Gy (lower dose; LDCSI). Children aged 8+ received SDCSI. All children were also randomized to receive either a reduced radiation boost to the involved field (IFRT) or a standard boost to the whole posterior fossa (PFRT). Memory functioning was evaluated an average of 0.67(T1), 2.95(T2), and 4.90(T3) years post-diagnosis. RESULTS Of 464 eligible patients enrolled on ACNS0331, 354 (76%; 65.3% male, 83.1% white) completed some neuropsychological testing. Mean age at diagnosis was 9.1 years (range=3–19). Verbal and visual short-term memory and learning were broadly within the average range for the overall sample at all three timepoints. However, a large percentage of children exhibited scores ≥1SD below the mean on tasks of verbal learning both immediately (43.4%) and after a delay (40.7%) at T3. In addition, 58.6% of children randomized to SDCSI exhibited impairment in verbal learning after a delay compared to 34.8% of children randomized to LDSCI, and 35.0% of those aged ≥8 at diagnosis receiving SDCSI. CONCLUSIONS Younger children receiving SDCSI have particularly high rates of memory impairment five years after diagnosis of medulloblastoma. Limiting CSI dose and/or volume in young children treated for this diagnosis may improve outcomes for memory functioning.
Aim Chronic paediatric conditions often significantly impact the patients' and their families' quality of life (QoL). There is a paucity in the medical literature around the QoL impact of paediatric vascular anomalies on patients and their families in the Australian context. This study aims to address this gap. Methods We conducted a three-month prospective questionnaire study using the children's dermatology life quality index (CDLQI), the outcome measures for vascular malformations (OVAMA), and the family dermatology life quality index (FDLQI). Results Twenty-five paediatric patients and 27 family members were recruited for the study. The mean scores for CDLQI, FDLQI, and OVAMA were 5, 6, and 33 respectively. The most reported QoL impact reported by paediatric patients was change of clothing and participation in sports whilst the most reported QoL impact reported by family is emotional stress and other people's reactions. The OVAMA questionnaire results highlight the significant impact caused by the change of colour of the skin due to vascular anomaly, which corresponds to the QoL impact reflected by the CDLQI and FDLQI surveys. Conclusions This study highlights the appearance-related quality-of-life impact of vascular anomaly experienced by both patients and their families within the Australian context. The findings underscore the potential benefit of cosmetic interventions in improving the overall well-being of this patient population.
Background Requiring active parental consent in school-based adolescent surveys may reduce participation rates and introduce response bias, particularly in studies assessing sensitive outcomes such as mental health. However, experimental evidence on its impact remains limited. Methods A cluster randomized controlled trial within 20 Norwegian lower secondary schools: 259 classes were randomized to either (1) active parental consent, or (2) adolescent self-consent. Data were collected with online questionnaires administered during school hours in the autumn of 2025. Differences in class-level participation rates were examined, as well as sample composition (sex, age, immigrant background, subjective socioeconomic status) and a broad range of mental health-related measures. The data were analyzed using fixed-effects regression models. Results Requiring active parental consent substantially reduced participation (average marginal effect: -32.2 percentage points, 95% CI -35.5, -28.8). Despite this large difference, sample composition was highly similar across conditions with respect to sex, age, and socioeconomic status. However, a lower proportion of students with two parents born abroad participated in the active parental consent condition (average marginal effect: -7.1 percentage points, 95% CI -9.4, -4.7). For mental health outcomes, no statistically significant differences were observed. Conclusions Requiring active parental consent can markedly reduce participation in school-based adolescent surveys, but it does not appear to meaningfully bias sample composition or estimates of mental health outcomes, although students with immigrant backgrounds may be underrepresented. These findings can inform ethical and methodological debates regarding adolescent autonomy, survey validity, and consent procedures in public health research.
Children and adolescents undergoing cancer treatment, along with their families, experience psychological and emotional distress. Music therapy is increasingly acknowledged as an intervention that may foster emotion regulation, coping, and communication; however, family involvement remains insufficiently delineated. This scoping review maps evidence on family involvement in music therapy for paediatric oncology, characterises the forms and intensity of participation, summarises intervention features and reported outcomes, and identifies limitations and research gaps. Following PRISMA-ScR guidelines, a systematic search was conducted in PSYNDEX, PubMed, The Cochrane Library, and Embase (2010-2025). Studies were eligible if they examined music therapy interventions or structured music-therapy-based interventions in paediatric oncology and involved family members at any level of participation. Eighteen studies met the inclusion criteria and were synthesised descriptively. Across the studies, reported outcomes included reductions in anxiety, stress, and pain, as well as improvements in mood, quality of life, and family interaction. Family involvement ranged from primarily observational and reflective roles to direct participation in shared music-making and, in some cases, therapist-guided parent-led facilitation. Interaction-focused and parent-directed approaches were most often described as supporting emotional connectedness, shared coping, and family resilience. Methodological heterogeneity, small sample sizes, and inconsistent conceptualisations of family involvement limited comparability. The reviewed literature suggests that family involvement in music therapy may support psychosocial well-being and relational functioning within paediatric oncology. However, the available evidence is heterogeneous and primarily descriptive. Future research would benefit from clearer conceptualisations of family involvement and more methodologically comparable studies to clarify mechanisms of change and long-term effects.
Abstract Study question Is an online consultation for fertility work-up as effective as regular consultation in terms of patient centeredness and shared decision making? Summary answer This study shows no significant differences in level of patient-centeredness and shared decision making for an online fertility work-up compared to a regular appointment. What is known already Couples who suffer from involuntarily childlessness can experience a high psychological burden and treatment for their infertility has a high impact on their daily life. Most optimally, patients receive personalized information and undergo diagnostic testing for fertility work-up, with as little as possible interference in their personal life. Two recent studies already evaluated the use of video-consulting to further modernize current fertility care, with positive results. However, more well-designed research is needed to expand and carefully evaluate the idea of an online fertility work-up for patients with an unfulfilled child wish. Study design, size, duration This is a single-center non-blinded randomized controlled trial of 84 heterosexual patient couples. Patients were followed up from the start of the fertility work-up until three months after completion of the work-up. After the work-up, a questionnaire was send through an online research program consisting of a modified version of the Patient-Centered Questionnaire-Infertility (PCQ-I) to measure patient-centeredness and the CollaboRATE questionnaire to evaluate the level of shared decision making. Participants/materials, setting, methods The study population consisted of infertile couples, who were referred to a fertility clinic for the first time. Couples were randomized between a regular fertility work-up, consisting of two face-to-face appointments of in total 45 minutes, and an online fertility work-up. The latter consisted of online recommendations and diagnostic tests, based on patient specific characteristics from an anamnesis questionnaire, followed by a 30 minute video consultation with a fertilitydoctor to discuss results and treatment advice. Main results and the role of chance Of the 84 included patients, 75 questionnaires were returned for this abstract (89%). The mean score on the total PCQ-I was 2.66 (SD 0.20), on a scale of 0-3, for the online fertility work-up versus 2.57 (SD 0.29) for the control group. This was not statistically significant (p = 0.147). Also the different subscales of the PCQ-I did not show statistically differences between the two groups, but there was a positive trend for the online fertility work-up on the subscale ‘Information and Communication’ (2.85 (SD 0.21) vs 2.72 (SD 0.31); p = 0.055). On the CollaboRATE questionnaire, no significant differences in experienced level of shared decision making were found between the two groups (means between 7.52 – 7.91 on a ten point Likert scale). During seven video consultations (17%) some technical difficulties were experienced, for example the video worked but there was no sound. For 62% of the couples in the intervention group the time for preparation for the online fertility workup was less than five minutes, while the majority of the patients in the control group (52%) spend at least 60-90 minutes on their appointment in the fertility clinic. Limitations, reasons for caution This study was performed during the COVID-19 pandemic, when patients were more used to online meetings. The preferences of patient post pandemic might be different. At this point we have not yet evaluated whether online fertility consultation leads to different conclusions and treatment advices than regular fertility care. Wider implications of the findings In our study online fertility work-up with video consultation is perceived as good as a regular work-up, therefore future patients should be offered a choice between the two methods. Considering the rapid development of online technology, online fertilitycare may develop further. It is important that developments undergo thorough scientific evaluation. Trial registration number NL8554
Background Because instruments are routinely employed by health professionals, it is essential to establish their psychometric quality, particularly regarding validity evidence. Objective The study aimed to analyse the psychometric measures used in studies of validity evidence of instruments for assessing the occupational performance of children with developmental coordination disorder. Methods A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines using five electronic databases. Results Twenty-four articles were included, with 17 different scales. Discriminant validation was the most reported psychometric measure, with half of the studies reporting using parametric and nonparametric analyses. Among the psychometric methods verified in the studies, reliability analysis was the most prevalent, using Cronbach's alpha and test-retest; one study used ordinal alpha. One third of the studies used exploratory or confirmatory factor analysis for internal structure. Conclusion The validation techniques used varied among the studies found, and these were sometimes incomplete and confusing, as well as an insignificant result in relation to the use of more contemporary concepts for the types of validity evidence. Factor analysis for internal structure was rarely reported in the studies; however, it stands out for being a more robust technique for this type of validation.
This cross-sectional study examined the association of maternal educational involvement with early adolescent academic adjustment and tested maternal authoritativeness as a moderator. Participants were 665 senior elementary school students (52% were boys; mean age = 10.54 years; age range = 9.08-14.83) from Hong Kong, China. Using paper-and-pencil questionnaires, students rated their mothers' home-based involvement (i.e., support and encouragement, expectations and attitudes, and rules and monitoring) and school-based involvement (i.e., communication with teachers and participation in school events) as well as their mothers' overall authoritativeness. Students also rated their own academic adjustment (i.e., motivation, skills, and competence). Hierarchical regressions indicated that maternal support and encouragement were uniquely linked to early adolescent academic skills, whereas maternal rules and monitoring were uniquely linked to early adolescent academic motivation and competence. Moreover, especially for students with authoritative mothers, maternal expectations and attitudes were uniquely linked to academic motivation, skills, and competence, and maternal communication with teachers was uniquely linked to early adolescent academic skills and competence. Findings highlighted the importance of conceptualizing parental educational involvement and adolescent academic adjustment as multidimensional constructs and differentiating between parenting practices versus parenting styles. Practically, interventionists and policy makers may consider targeting both maternal educational involvement and maternal authoritativeness as possible ways to promote early adolescent academic adjustment.
