This article examines the acute ambiguity in the law governing the deprivation of liberty of children in England and Wales, where protective interventions often rely on judicial direction and on unclear statutory safeguards. It is argued that the current framework is reactive, welfare-driven, and lacking in procedural coherence. Drawing upon Fineman's theory of vulnerability, Fraser's parity of participation, and Lundy's analysis of children's agency in relation to the participatory guarantees of Article 12 of the United Nations Convention on the Rights of the Child, the article reconceptualizes vulnerability and rejects the paternalistic protection ethos of the status quo. The article exposes structural gaps in the light of a shifting legal landscape. This backdrop includes the Supreme Court's recent 2026 move away from the rigid, single-determinant tests for confinement towards contextual, multifactorial assessments. It proposes an original statutory architecture: the Children's Liberty Protection Framework (CLPF) that establishes statutory mechanisms of advocacy, review, and oversight at Tribunal level. The CLPF transforms vulnerability from being a control-based condition into a procedural right to participate. As such, it offers a coherent legal pathway for reconciling the challenges posed by the right to liberty and the need to protect children within a supportive and responsive state.
Background Child maltreatment, a major public health concern, has long-term neurobiological, psychological, and social consequences. Recognizing, documenting, and reporting suspected cases should be systematic across hospital and community services, but these processes are hindered by inconsistent surveillance systems, uneven professional training, and the lack of standardized data collection tools. Timely follow-up, updated clinical criteria, and structured multidisciplinary training can improve case assessment, traceability, and professionals' ability to report suspected maltreatment. The Sentinel project was developed to address these clinical, organizational, and public health gaps through a combined REDCap-based digital registry and structured training program for pediatric health care professionals. Objective This study aims to evaluate the usability, feasibility, and preliminary impact of an integrated surveillance and training system designed to improve the early detection, documentation, and reporting of suspected child maltreatment by pediatricians and health care professionals. Methods This is an observational, exploratory, monocentric pilot implementation study with a pretest-posttest evaluation design. The study will be conducted over 24 months in a hospital-community pediatric network. Voluntary participants will be hospital and community pediatricians and other pediatric health care professionals who provide written informed consent. The project includes two interconnected components: (1) implementation of a secure, anonymized REDCap registry for standardized documentation of suspected maltreatment, follow-up, reporting pathways, and case management outcomes and (2) a theoretical-practical training program delivered through lectures, e-learning modules, webinars, supervised exercises, and hands-on registry sessions. Primary and secondary outcomes will be assessed at prespecified time points, including baseline, immediately after training, during registry use, and at the end of follow-up. Registry usability will be measured using the System Usability Scale; training effectiveness will be measured through pretest-posttest knowledge, competency tests, and satisfaction questionnaires; and reporting outcomes will be measured through comparison of pre- and postimplementation reporting rates. Results The study will report the usability, feasibility, and preliminary implementation outcomes of the integrated registry training system. Main results will include System Usability Scale scores, registry completion indicators, reporting timeliness, the number and rate of suspected maltreatment reports before and after implementation, changes in knowledge and competency scores, participant satisfaction, and qualitative feedback on barriers to and facilitators of implementation. Participant recruitment and data collection began in April 2026 and are currently ongoing. Completion of data collection and publication of the results are expected between December 2027 and January 2028. Conclusions The Sentinel project will test an innovative and scalable pilot model that integrates digital surveillance with structured professional training to enhance the early detection, documentation, and management of suspected child maltreatment. By standardizing data collection, strengthening professional competencies, and fostering collaboration across hospital and community settings, the study will inform the development of a regional or national observatory and support an evidence-based, system-wide approach to child protection. Trial registration ClinicalTrials.gov NCT07250074; https://clinicaltrials.gov/study/NCT07250074. International registered report identifier (irrid) PRR1-10.2196/89128.
Abstract BACKGROUND: Neuropsychological comparison of medulloblastoma (MB) and cerebellar low-grade astrocytoma (LGA) survivors to controls can clarify treatment-related neurocognitive late effects. While both brain tumor groups undergo surgery to the posterior fossa, children with MB additionally receive craniospinal irradiation with boost and chemotherapy. This study provides an updated comparison of neuropsychological functioning in these two groups and examines effects of demographic risk factors upon outcomes. PROCEDURE: Forty-two children (16 MB, 9 LGA, 17 controls) completed measures of intellectual functioning, verbal learning/memory, visual-motor integration, and fine motor functioning. The effects of age at diagnosis, time since diagnosis, gender, fatigue, and social status on neuropsychological functioning were examined. RESULTS: MB survivors demonstrated the worst neurocognitive late effects, but they were less severe and extensive than in prior studies. LGA survivors’ mean scores were below normative expectations in working memory, processing speed, and fine motor functioning. Additionally, parents of LGA survivors reported the most difficulty with behavior and cognitive regulation compared to healthy controls and medulloblastoma survivors. In this overall sample, processing speed difficulties were independent of fine motor functioning and fatigue. Higher parental education was associated with better intellectual functioning, working memory, delayed recall, and visual-motor integration. Neuropsychological function was not associated with gender, age at diagnosis, or time since diagnosis. CONCLUSION: The results support that contemporary treatment approaches with craniospinal irradiation plus boost and chemotherapy confer the greatest risk for late effects, while surgical resection is associated with subtle but important neurocognitive difficulties. Ultimately, this study furthers our understanding of factors impacting neuropsychological function in pediatric MB and LGA survivors and contributes to empirical support for close monitoring and targeted interventions into survivorship.
Background Priority-setting partnerships (PSPs) are used to identify research questions that matter most to patients, caregivers, and clinicians. However, submissions that fall outside the scope of research prioritisation are rarely examined despite their potential to reveal important unmet needs. This study explored concerns relevant to practice and policy using the out-of-scope questions submitted during the Australian Child and Adolescent Cancer PSP. Methods We conducted the Australian Child and Adolescent Cancer PSP with the James Lind Alliance to identify research priorities for childhood cancer. An online national survey collected submissions from children and adolescents diagnosed with cancer, their caregivers, and healthcare professionals. We identified submissions that fell outside the PSP scope. These were collated and analysed using qualitative content analysis, followed by framework analysis to deductively map themes to the World Health Organisation Health System Building Blocks, enabling system-level interpretation of community-identified concerns. Results Of the 701 submissions, 99 (14%) were classified as out-of-scope and included in this analysis. Seventy-two respondents contributed to these submissions, most of whom were caregivers (n = 58, 81%). Themes mapped across the WHO building blocks, including treatment access, research innovation and translation, health financing, service delivery and environment of care, leadership and governance, health information and communication, and health workforce. Additional concerns were classified as dimensions of care. Conclusions Out-of-scope PSP submissions provide valuable insights into patient, caregiver, and clinician concerns that complement research priorities. They highlight persistent challenges in access to care, supportive services, workforce capacity, information provision, and financial burden, underscoring that many family concerns stem from gaps in implementation, service delivery, and policy, rather than evidence alone. These system-level challenges must be communicated to funders, policymakers, charities, and consumers to translate these insights into meaningful improvements in care.
Abstract Background/Objectives About 1,000,000 new cases of cancer in Adolescent and Young Adults (AYAs) are diagnosed annually worldwide. . While their long term survival is about 80%, they are six times more likely to develop a second primary cancer (SPC) compared to their peers. This risk is multifactorial and depends on the type of first cancer, treatment received and prevalence of risk factors. PREVAPAJA aimed to implement a clinical program based on physical activity (PA) and cancer prevention recommendations for AYAs with cancer at Centre Léon Bérard-AYAs Department. Methods The study was conducted at Leon Berard Comprehensive Cancer Centre among patients aged 15-25 years. AYAs attended PA sessions during the active treatment period and were individually informed on SPC risk prevention. PA, sedentary, anthropometrics, quality of life and fatigue were assessed at baseline (T1) and at the end of treatment (T2). PA level and intention of changes in health behaviors were assessed by phone 1 year after T1. Results 68 AYAs (median age=19 years) were enrolled in 2016-2017). The results showed an improvement in PA level during and at distance of the intervention, with also a reduction of sitting time. Fatigue decreased between T1 and T2 (p>0.003) and overall quality of life improved significantly between T1 and T2 (p>0.001). Conclusions This study showed the feasibility of implementing a clinical program based on PA intervention and cancer prevention recommendations for AYAs with cancer. It responded to AYAs' needs for support and discussions regarding PA recommendations and ways to prevent SPC. Beneficial outcomes of this program should encourage to systematically proposing PA intervention in combination with information exchanges with AYAs with cancer.
While caregiver-mediated programs have been studied in research settings, little is known about their delivery and accessibility in real-world practice, including which populations they reach and their levels of engagement. This project evaluated the reach and implementation of one such program, More Than Words® (MTW), delivered virtually, as part of a large-scale government initiative for families in Ontario, Canada during the COVID-19 pandemic. Data from 2284 families with a young autistic child who registered for MTW were analyzed using the RE-AIM Framework to assess two domains: (a) reach, by examining demographic characteristics such as child age, social communication stage, and geographic location; and (b) implementation, by analyzing completion rates and attendance patterns. While the MTW program reached many families with autistic children of varying ages and social communication skills, participation from families living outside large population centres was lower than expected based on census data. Most families (71%) completed the program, but only 39% attended all of the program sessions, suggesting challenges to sustained participation. Further research is needed to understand barriers to engagement and how service delivery models can be adapted to better meet the diverse needs of families participating in the real world.
Abstract Background Studies found that maternal education is the most frequently assessed predictor of child’s birth weight. Lower level of education was consistently found as indicator of lower child’s birthweight. In turn, inequalities in child’s birthweight have been repeatedly shown to be closely related to inequalities in later adult health. The aim of this project is to evaluate the association between the highest achieved level of maternal education and birthweight of single born babies in large English and Welsh population sample, taking into account factors such as child’s gender, parity, maternal age, partnership status, ethnicity, and household socioeconomic characteristics. Methods Using Office for National Statistics Longitudinal Study (ONS LS) based on English and Welsh Census data, information from almost quarter of a million children born since 1981 to ONS LS sample mothers were used. Maternal education was categorised in 3 categories (below secondary, completed secondary education, degree and higher), and its association with child’s birth weight was analysed by logistic regression accounting for range of available covariates. Results Significant association between the level of education and birth weight was found in crude analysis (p < 0.001). When adjusted, the magnitude of the association with education gradient declined but remained highly significant and was found to considerably increase over the years. The birth weight difference between those born to mothers with below secondary education and those born to mothers with degree increased by more than 60 grams (p for change <0.001) between 1981 and 2016. Conclusions These findings support previous evidence based on different population samples. According to our results, children of mothers with below secondary education tend to have lower birth weight. Our results suggest that the inequalities in birth weight by the highest education level achieved by mother significantly increased since 1981. Key messages • Lower levels of maternal education predict low birth weight in children. • The differences in birth weight by maternal educational demonstrate increase in inequalities over the years.
Aim To systematically evaluate evidence on the effects of post-discharge early developmental intervention programs (EI) on behavioral development, quality of life, participation, executive functioning, parent-child interaction, and use of medical services from infancy through adolescence in children born preterm. Method Four bibliographic databases and one trial registry were systematically searched for randomized controlled trials up to April 23, 2024. Two reviewers independently screened studies and extracted data. In clinically and methodologically comparable studies, random-effects meta-analysis was performed. Risk of bias was assessed with the Cochrane RoB 2 tool, and certainty of evidence with the GRADE approach. Results Twenty-six studies met inclusion criteria, eleven studies including 2315 preterm born infants reported relevant outcomes, and seven contributed to meta-analyses. Most reported results showed some concerns or high risk of bias; certainty of evidence ranged from very low to moderate across outcomes. EI probably has little to no effect on special educational needs (moderate-certainty). EI may slightly increase maternal sensitivity and may slightly reduce behavioral problems in infancy (low-certainty). There is very low-certainty evidence on attention, language skills, executive functioning, and use of medical services. No studies evaluated the effect on ADHD, quality of life, or participation related to mobility or leisure activities. Interpretation EI may improve some outcomes in preterm children, but evidence for most outcomes remains uncertain. High-quality, contemporary trials are needed to establish reliable clinical recommendations regarding EI strategies and complementary interventions throughout childhood.
Abstract Background For the past decade, community-based programmes have been a popular strategy for physical activity promotion. The implementation of these programmes is a complex process, characterized by (a) objectives that vary locally, (b) adaptions to the programme over time in response to a community's shifting needs, challenges and opportunities, (c) emergent outcomes, and (d) non-linear causality. This poses several challenges for evaluation, as commonly used evaluation designs mainly focus on predetermined programme components and outcomes. Such a traditional evaluation approach may overlook necessary but unanticipated programme developments or outcomes and provide limited opportunity to learn from these. The aim of this study was to develop a novel evaluation approach that considers the complexity perspective, in order to evaluate a large community-based programme for children's physical activity and health promotion in the Netherlands. Methods An exploratory review of theoretical and methodological literature regarding community-based health promotion, complexity theory, developmental evaluation and theory based evaluation was conducted. Based on this review a novel evaluation approach was developed. Results The developed evaluation framework focusses on elements of the complex and adaptive implementation process of community-based health promotion. These include the local programme theory, implementation, adaption, the influence of context and feedback loops, and intended as well as emergent and unintended outcomes. By studying each of these elements in practice using innovative qualitative methods, including Ripple Effects Mapping and the Critical Event Card tool, principles that guide effective health promotion across community contexts can be extracted. Practice-based knowledge can subsequently be validated in other contexts. Conclusions The proposed evaluation approach aims to inform both research and practice (local and national programme planners and policy makers), by considering the implementation of community-based programmes as a complex process in evaluation. Using this evaluation approach will provide insight in how community-based health promotion programmes impact communities, and which mechanisms underly success or failure. The proposed evaluation approach may be relevant for other physical activity promotion programmes or policies. Since considering complexity in evaluation is a relatively new challenge in public health, we believe it is essential to share and deliberate on innovative evaluation approaches and methods.
Abstract Ethiopia is highly vulnerable to droughts due to its geographic features and the effects of climate change. Droughts contribute to child undernutrition by disrupting food security, yet little is known about the extent to which social protection systems can buffer these impacts. Using panel data from the Young Lives cohort study (2009–2017), we examined how drought exposure during early childhood influences adolescent nutritional outcomes and whether Ethiopia’s Productive Safety Net Program (PSNP) mitigates these effects. The dataset includes information on children’s anthropometric status, food aid participation, and historical community-level weather records. Droughts were defined using the Standardized Precipitation Index (SPI), with values below − 1 indicating drought conditions. Associations were assessed using Generalized Linear Mixed-Effects Models (GLMMs), with bootstrapping to obtain robust standard errors. Results indicate that exposure to a 24-month drought is associated with both chronic and acute undernutrition, while 12-month droughts were associated only with acute undernutrition. Six-month drought was not associated with either outcome. Participation in PSNP significantly reduced the likelihood of undernutrition among children affected by prolonged (12- and 24-month) droughts, suggesting a protective effect of sustained food assistance. These findings highlight the critical role of long-term social protection and food aid programs in buffering children from the nutritional impacts of climate shocks. Strengthening and expanding such programs will be essential for safeguarding child health and resilience in drought-prone settings amid a changing climate.
