Peer-reviewed articlePubMed (US National Library of Medicine)
The Safe Social Media Act: lessons from international online safety policies for protecting child health in Canada.
Christo Hall, Reshma Patel, Charlotte Moore Hepburn
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Christo Hall, Reshma Patel, Charlotte Moore Hepburn
PROBLEM: Improving maternity care quality is key to reducing adverse outcomes and ensuring maternal and newborn safety in China. BACKGROUND: Evaluating service quality is an important step in promoting quality improvement. The Chinese version of the Quality Maternal and Newborn Care Framework index (C-QMNCFi) is a comprehensive and reliable tool to assess maternity care quality based on women's perceptions. AIM: To conduct a large-scale assessment of maternity care quality in China using the C-QMNCFi and to examine factors associated with women's perceived care quality. METHODS: An online survey using the C-QMNCFi was conducted between March and November 2025 among women between 42 days to 12 months postpartum recruited from nine hospitals across eastern, central, and western China. Descriptive statistics summarized scores, and quantile regression was used to identify factors associated with the global index score. FINDINGS: A total of 1453 women participated. The mean C-QMNCFi global index score was 91.4% (IQR 84.3%-95.2%). Lower scores were observed in the Care providers (continuity of carer) and Information-giving and advice. Quantile regression showed that higher scores were associated with residence in central or eastern China, higher household income, receiving midwife-led care, and receiving pregnancy care or giving birth in public tertiary or private hospitals (all p < 0.05). Lower scores were associated with urban residence, longer travel time to hospitals, and maternal complications (p < 0.05). CONCLUSION: Women generally reported positive maternity care experiences. It is recommended to optimize maternity care provision according to the characteristics of women.
Yan Li, Jie Tao, Xinqian Geng et al.
Sudden unexpected infant death remains a significant public health concern, with South Africa reporting among the highest incidence globally. However, little is known about infant sleep practices, motivations for sleep arrangements, or adherence to safe sleep recommendations within this context. This study explored caregiver and child characteristics associated with potential sleep-related risk, and caregiver motivations underlying infant sleep arrangements, among South African caregivers. A cross-sectional online survey was completed by 201 caregivers of infants. Prevalence of adherence to American Academy of Pediatrics guidelines was determined. A safe sleep composite score, derived from items of the Brief Infant Sleep Questionnaire-Revised, classified caregivers into low-, moderate-, and high-adherence groups. Bivariate associations between demographic characteristics and low-adherence group membership were examined using chi-square tests, with hierarchical multiple regression to identify predictors of adherence to guidelines. Prevalence of motivations for sleep arrangements were determined and compared across demographic characteristics. Bed-sharing and non-supine sleeping was common. Unemployed caregivers were more than twice as likely to fall into the low-adherence group (45.9% vs. 20.5%), and caregiver characteristics explained significant variance beyond child characteristics (ΔR2 = 0.20, p = .022), with unemployment the only significant independent predictor. No child characteristics were associated with adherence. Feeding, bonding, and safety were the primary motivations for bed and room-sharing, while separate-room sleeping motivations centered on caregiver sleep quality. Adherence to guidelines is complex. Caregiver characteristics were associated with potential sleep-related risk. Findings support safe sleep interventions tailored to caregivers' practical and socioeconomic circumstances, particularly for unemployed and single caregivers.
Jacomien Muller
CONTEXT: Child nutrition (CN) professionals must meet ongoing United States Department of Agriculture (USDA) nutrition standards and professional training requirements, yet national evidence on priority training topics and preferred delivery formats across roles is limited. OBJECTIVE: To identify high priority training needs and preferred delivery modes among School Nutrition (SN) and Child and Adult Care Food Program (CACFP) professionals nationwide. DESIGN: Cross sectional, web-based survey. SETTING: United States; survey distributed through the Institute of Child Nutrition national contact database (emails sent November 7 to December 5, 2023). PARTICIPANTS: A total of 777 CN professionals including SN management/other staff, SN frontline staff/workers, and CACFP professionals. INTERVENTION IF APPLICABLE: Not applicable. MAIN OUTCOME MEASURES: Respondents selected high-need training topics to complete within the next 2 years and indicated preferred delivery mode (in-person live, live virtual, or self-paced online) for each selected topic. RESULTS: Training priorities and delivery preferences differed by role and topic. SN management/other respondents most often preferred in-person live training for operational and complex topics such as food production (17.8%) and program management (17.6%), while live virtual training was most frequently preferred for special diets (19.0%). Self-paced online formats were most frequently preferred for compliance-oriented topics including civil rights (23.1%) and food safety/Hazard Analysis and Critical Control Point (22.2%). SN frontline staff/workers most often preferred self-paced online training for USDA meal pattern requirements (26.6%) and civil rights (22.9%), and live virtual training for special diets (17.4%). CACFP professionals most often preferred self-paced online training for USDA meal pattern requirements (30.7%) and health and safety (29.1%), with live virtual training commonly preferred for administration/paperwork (24.4%) and special diets (24.4%). CONCLUSIONS: CN professionals report role and topic-specific training needs and distinct delivery preferences, supporting flexible, differentiated training pathways (eg, in-person for hands on operations; self-paced online for standardized compliance content) to strengthen implementation of USDA standards.
Ruaa Al Juboori, Mackinsey K Shahan, Keith Rushing
INTRODUCTION: Hand injuries are a frequent cause of morbidity, with patterns influenced heavily by societal behaviour. This audit investigated hand injuries in the UK occurring after COVID-19 restrictions were lifted (early 2022) and compared them with data from the COVID-19 lockdown period (early 2021). METHODS: A multicentre cross-sectional study was conducted across 23 hospitals, with clinicians prospectively recording consecutive hand injuries over a 2-week period (February-March 2022). Eligible cases included referrals to Orthopaedic, Plastic, or Hand surgery services. Data were submitted using a standardised online proforma, and preventability was classified using predefined criteria. RESULTS: 2,309 injuries were recorded from 23 hospitals - a 21% rise. Males made up 60% of cases. Median age was 34, similar to the lockdown period of 40. Sports-related injuries increased (10.2% to 22.7%), while DIY-related injuries declined (8% to 4%). Phalangeal and metacarpal fractures were the most common injuries. Alcohol and drug-related injuries rose from 2.4% to 4.5%. Overall, preventable injuries decreased from 50% to 35%, with only 19% of injuries in children under 16 deemed preventable. Most cases (63%) were managed non-operatively, and 43% required follow-up. CONCLUSION: Following the lifting of COVID-19 restrictions, hand injuries increased, with a shift toward sports-related mechanisms and fewer preventable injuries. Despite this reduction, preventable injuries remain a substantial public health concern, highlighting opportunities for targeted safety interventions.
Konstantinos Devetzis, Jennifer C E Lane, Ella Darveniza et al.
Two new RSV immunization products exist for infants: a prenatal vaccine (RSVpreF) and a long-acting monoclonal antibody for infants (nirsevimab). While both showed promise in clinical trials, implementation has varied across jurisdictions. Before rollout in Canada, we conducted an anonymized, online survey with a nationally representative sample of 1,015 expectant and recent birth parents. The primary outcome was product acceptability (disagree, undecided, agree). Odds ratios (ORs) and 95% confidence intervals (CIs) identified factors associated with agreement or indecision versus disagreement. Approximately 49% (n = 499) were expecting; 51% (n = 516) had a baby in the past year. Overall, 72% (n = 727) agreed to receive a product: 61% (n = 624) for RSVpreF and 60% (n = 608) for nirsevimab. RSVpreF agreement was higher among older parents (e.g., OR = 3.64; 95% CI, 1.99-6.67 for age 25-34 versus 18-24 years), those with a university degree (OR = 3.65; 95% CI, 2.01-6.64 versus high school), higher income (OR = 2.31; 95% CI, 1.01-5.28 for ≥$150k versus <$40k), or receipt/intention for Tdap (OR = 3.76; 95% CI, 2.37-5.96 versus no receipt/intention) or influenza (OR = 2.04; 95% CI, 1.29-3.21) vaccines. Agreement was higher among parents of children without a high-risk medical condition compared to those with (OR = 2.32; 95% CI, 1.44-3.72). Similar trends were observed for nirsevimab, with lower agreement also noted among those who self-researched antibodies (OR = 0.51; 95% CI, 0.30-0.88 versus not). As most respondents rated product safety (76%), effectiveness (71%), and disease severity risk (70%) as important in decision-making, providing clear information on these, alongside communications targeted to subgroups with lower agreement, may optimize uptake as programs rollout.
Tiffany Fitzpatrick, Jeanna Parsons Leigh, Rebecca Brundin-Mather et al.
Microarray patches (MAPs) are an emerging, needle-free vaccination technology with potential to improve vaccine uptake and acceptability. A cross-sectional online survey was conducted to assess parents' perceptions of MAP safety, usability, and acceptability for themselves and their children. Participants were parents of children aged ≤18 y residing in Australia, Canada, the United Kingdom, or New Zealand. Responses were recorded on a 7-point Likert scale. Descriptive statistics and paired t-tests were used for analysis. A total of 102 parents participated (mean age = 40.7 y, SD = 10.6), predominantly from Canada (59.8%) and Australia (35.3%). Parents rated MAP vaccination as safe and effective (mean = 5.13; 95% CI: 4.83-5.43), easy to use (mean = 5.51; 95% CI: 5.26-5.77), and acceptable (mean = 5.43; 95% CI: 5.18-5.68). Respondents preferred MAPs over traditional needle and syringe (N&S) methods for themselves and their children, particularly citing benefits for those with needle-related anxiety. Parents expressed stronger preferences for healthcare provider administration for children compared to themselves. MAP self-administration was also viewed positively. Participants indicated greater willingness to pay more for their child to receive the MAP vaccination compared to themselves. Findings suggest that parents perceive MAPs as a safe, usable, and acceptable alternative to N&S vaccination for themselves and their children.
Matthew N Berger, Erin Mathieu, Cristyn Davies et al.
Understanding parental attitudes and factors influencing selection of influenza vaccines, including live-attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV), provides insights into optimizing influenza vaccine uptake. This online survey evaluated parental knowledge, attitudes, and preferences regarding influenza vaccination for children and examined the impact of providing vaccine-related information on vaccine selection in Nara, Japan where LAIV was recently introduced. Parents of children aged 2 to 18 y reported vaccination preference before and after reviewing standardized vaccine-related information and provided reasons for vaccine selection. In total, 237 parents answered the questionnaire for 302 children. After review of the vaccine information, 27.8% of parents planned vaccination with IIV and 66.2% planned vaccination with LAIV. Preference for LAIV increased significantly after information review compared with baseline (p < .001). Common reasons for LAIV preference included lack of a second dose requirement (92.4%), absence of injection-related pain (74.0%), and expectation of mucosal immunity development (32.8%). Reasons for IIV preference included no prior experience with LAIV (38.2%), higher cost of LAIV (32.7%), and familiarity with IIV (23.6%). Provision of vaccine information increased parental preference for LAIV for their children, suggesting that improved communication may support greater uptake of LAIV.
Taito Kitano, Nami Kurosawa, Shinji Hirano et al.
UNLABELLED: This study characterized physicochemical properties, elemental contamination, and health risks of size-fractionated settled dust in child-relevant microenvironments in Tehran, Iran. Paired indoor and outdoor samples were collected from 50 residential houses and 50 kindergartens (February-July 2023). The < 150 μm fraction was analyzed for potentially toxic elements (PTEs) by microwave plasma-atomic emission spectroscopy. Mineralogy, morphology, and water-soluble ions were determined by XRD, FE-SEM/EDX, and ion chromatography, respectively. Particle size distributions were dominated by coarse material (D50: 29.6-53.3 μm), consistent with a quartz-calcite-clay assemblage. Mean concentrations followed the order Al > Fe > Zn > Mn; Zn (622-1,129 µg/g) and Pb (72-139 µg/g) were the most enriched anthropogenic elements. Contamination factor analysis identified very high contamination by Zn and Pb, while the pollution load index remained below unity (0.24-0.34). Outdoor concentrations explained 82.4% of indoor variability (r² = 0.824; β ≈ 1.09), confirming dominant outdoor influence. Ingestion contributed over 99% of total average daily dose. Non-carcinogenic hazard indices remained below unity but were highest in indoor kindergartens (total HI ≈ 0.73; Pb HI ≈ 0.53). The total carcinogenic risk approached or exceeded 10⁻⁴ in indoor houses, with Ni and estimated Cr(VI) as the principal contributors. Results highlight kindergartens as priority environments for pediatric exposure management and support targeted mitigation strategies, including traffic and construction control near child-occupied locations and enhanced dust-reduction practices. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40201-026-00989-x.
Vajihe Hasanzadeh, Abbas Shahsavani, Anoushiravan Mohseni-Bandpei et al.
UNLABELLED: The risks associated with heavy metals (HMs) in oil are important for health. This study investigated and evaluated the concentration of HMs in oils examined in Iranian studies using a systematic review method. First, published articles were identified in the Science Direct, PubMed, Scopus, and Web of Science databases. The concentrations of HMs were extracted from reliable papers and subjected to risk assessments. This research utilized pooled concentration estimates from the selected articles, integrating them with a Monte Carlo probabilistic framework of 10,000 iterations to assess the uncertainty in both non-carcinogenic and carcinogenic risks for adults and children. After screening and quality control of the articles, 16 valid articles were identified. Rapeseed oil contained the highest amounts of Cd and Cu, soybean oil exhibited the highest level of Fe, corn oil had the lowest amount of As, and olive oil showed the highest levels of Ni, Zn, and Pb. The non-carcinogenic health risk assessment of HMs indicated that the hierarchy of metals, according to the Target Hazard Quotient (THQ) for the exposed population, was as follows: As > Cd > Pb > Ni > Zn > Fe > Cu. Furthermore, THQ of As, Cd, Cu, Fe, Ni, Pb, and Zn for adults were 2.947, 2.187, 0.115, 0.125, 1.321, 1.922, and 0.244, while THQ for children were 6.957, 5.200, 0.264, 0.292, 3.078, 4.414, and 0.566. The lifetime cancer risk (LTCR) for As, Cd, and Pb in Vegetable Oils (VOs) was within the permissible range. Moreover, the carcinogenic risk from As (4.361 × 10- 3) was found to be 1.3 times higher than that of Cd (3.640 × 10- 3) and 23.8 times higher than that of Pb (1.891 × 10- 4). It can be concluded that due to the toxic effects of HMs in VOs, we should be more serious about reducing the risk and pollution levels in this region. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40201-026-00991-3.
Hadi Niknejad, Musa Cheshmi, Mohsen Hesami Arani et al.