Association between the health vulnerability of family members and concern about the contagion of COVID-19 in Peruvian residents after the pandemic

Background

The COVID-19 pandemic has created additional challenges for family health. Worry, fear, and anxiety associated with this disease can affect the perception of family health. The study's objective was to analyze the factors associated with health vulnerability of family members in the Peruvian population after pandemic.

Methods

Observational, cross-sectional, and analytical study. Sampling was nonprobabilistic. The sample consisted of 519 residents who met the following inclusion criteria: Peruvian resident, of both genders, over 18 years of age, who lives with their family, and who agrees to participate in the study. For data collection, the "SALUFAM" and "PRE-COVID-19" scales were used, which measure the health vulnerability of family members and concern about the contagion of COVID-19, respectively. Data collection was done between January and March, 2023.

Results

Living in the Coast region increases by 3.299 times (95% CI = 1.55-9.28; p = 0.003) the probability of lower family health vulnerability compared to residents from the Jungle region. In the same way, having a low concern about the contagion of COVID-19 increases 2.77 times (95% CI = 1.02-7.53; p = 0.044) the probability of less vulnerability to family health, unlike participants who are highly concerned about the contagion of COVID-19.

Conclusions

It should be necessary to design prevention and family health promotion strategies according to the geographical region; it is also essential to provide education on the risks and the importance of prevention measures for COVID-19, regardless of their initial level of concern.

Association Between Family Functioning and Health-related Quality of Life in Stroke Survivor-Informal Family Caregiver Dyads

PURPOSE

Stroke survivors and their informal family caregivers may share the impact of the disease, which may affect family functioning and quality of life (QoL) for both. This study compared the perceptions of stroke survivors and informal family caregivers regarding family functioning and QoL and examined the QoL of those reporting effective versus ineffective family functioning.

METHODS

A cross-sectional study design and convenience sampling were used. Stroke survivor-informal family caregiver dyads were recruited from a medical university hospital. We assessed participants' demographic and clinical variables, including disease severity, family functioning, and QoL. Independent t-test, paired t-test, Wilcoxon signed-rank test, and Mann-Whitney U test were used to analyze the data.

RESULTS

Seventy-one stroke survivor-informal family caregiver dyads participated in the current study. Most stroke survivors and informal family caregivers reported effective family functioning, with no significant differences. However, significant differences existed in the seven domains (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, and role-emotional) of QoL, except emotional health. Stroke survivors reporting ineffective family functioning had a significantly lower mental component summary score, unlike informal family caregivers.

CONCLUSION

Our findings suggest that family functioning is crucial to ensure stroke survivors' QoL, particularly regarding their mental health. Health professionals should prioritize mental health assessments and provide appropriate care interventions for stroke survivors in the first 1-6 months after stroke onset.

Adherence to Covid-19 vaccination during the pandemic: the influence of fake news

OBJECTIVES

to understand how fake news has influenced adherence to Covid-19 immunization, from the perspective of health professionals.

METHODS

a qualitative, descriptive-exploratory study was conducted in Campo Grande - MS. Twenty nursing professionals working in vaccine rooms or managing immunobiologicals participated through semi-structured interviews. The interviews were audio-recorded, fully transcribed, and subjected to thematic content analysis.

RESULTS

two categories emerged in which the professionals highlighted an increase in vaccine hesitancy among the population, influenced by fake news and denialist actions, which negatively interfered with the population's trust in vaccines and in the professionals administering them.

FINAL CONSIDERATIONS

concerns about vaccine safety and denialist actions by authorities and media outlets can contribute to the phenomenon of non-vaccination. The valorization of science, the promotion of educational actions, and raising public awareness about immunization were presented as strategies to increase vaccine coverage.

Primary care physicians' perspectives on the identification and management of postnatal mental health problems

BACKGROUND

Postnatal mental health problems (PMHPs) are prevalent and negatively affect mothers, children, and society. International and local guidelines recommend that Singapore primary care physicians (PCP) screen, assess, and manage mothers with PMHPs. However, little is known about their experiences and views.

METHODS

We conducted semi-structured interviews with 14 PCPs in Singapore. Interview questions elicited perspectives on the identification and management of mothers with PMHPs. The interview guide was developed from a conceptual framework incorporating the knowledge-attitudes-practices, self-efficacy, and socio-ecological models. Interviews were audio-recorded and transcribed. Thematic analysis was used to identify emergent themes.

RESULTS

Singapore PCPs viewed themselves as key providers of first-contact care to mothers with PMHPs. They believed mothers preferred them to alternative providers because of greater accessibility and trust. In detection, they were vigilant in identifying at-risk mothers and favoured clinical intuition over screening tools. PCPs were confident in diagnosing common PMHPs and believed that mothers not meeting diagnostic criteria must be readily recognized and supported. In managing PMHPs, PCPs expressed varying confidence in prescribing antidepressants, which were viewed as second-line to supportive counselling and psychoeducation. Impeding physician factors, constraining practice characteristics and health system limitations were barriers. Looking forward, PCPs aspired to leverage technology and multidisciplinary teams to provide comprehensive, team-based care for the mother-child dyad.

CONCLUSION

Singapore PCPs are key in identifying and managing mothers with PMHPs. To fully harness their potential in providing comprehensive care, PCPs need greater multidisciplinary support and technological solutions that promote remote disclosure and enhanced preparation for their role.

Video versus telephone for telehealth delivery: a cross-sectional study of Australian general practice trainees

BACKGROUND

Remunerated telehealth consultations were introduced in Australia in 2020 in response to the COVID-19 pandemic. Videoconferencing has advantages over telephone-consulting, including improved diagnostic and decision-making accuracy. However, videoconferencing uptake in Australia has been low. This study aimed to establish prevalence and associations of video versus telephone consultations in Australian general practice (GP) registrars' practice.

METHODS

A cross-sectional analysis of data from 2020 to 2021 (three 6-monthly data-collection rounds) from the Registrars Clinical Encounters in Training (ReCEnT) study. GP registrars record details of 60 consecutive consultations every 6-month term, for a total of 3 terms. Univariable and multivariable logistic regression were performed within the Generalized Estimating Equations framework with the outcome video versus telephone.

RESULTS

102,286 consultations were recorded by 1,168 registrars, with 21.4% of consultations performed via telehealth. Of these, telephone accounted for 96.6% (95% CI: 96.3-96.8%) and videoconferencing for 3.4% (95% CI: 3.2-3.7%). Statistically significant associations of using videoconferencing, compared to telephone, included longer consultation duration (OR 1.02, 95% CI: 1.01-1.03 per minute; and mean 14.9 versus 12.8 min), patients aged 0-14 years old (OR 1.29, 95% CI: 1.03-1.62, compared to age 15-34), patients new to the registrar (OR 1.19, 95% CI: 1.04-1.35), part-time registrars (OR 1.84, 95% CI: 1.08-3.15), and areas of less socioeconomic disadvantage (OR 1.27, 95% CI: 1.00-1.62 per decile).

CONCLUSIONS

Registrars' telehealth consultations were mostly performed via telephone. Telephone use being associated with socioeconomic disadvantage has health equity implications. Future research should explore barriers to videoconferencing use and strategies to increase its uptake.

Factors Associated with Family Functioning During Pregnancy by Adolescent and Young Adult Women

Introduction

Pregnancy represents a stressful period for both women and their families. Whether the family maintains functioning during pregnancy could have significant implications on maternal and child health. In this study, we explored individual- and family-level factors associated with family functioning in adolescent and young adult mothers.

Methods

This study was a secondary analysis of 295 young mothers, ages between 15 and 21 years. Multivariate logistic regression models were conducted to estimate adjusted odds ratios of exploratory factors on the risk of being in high family functioning group. The parent study was approved by the Institutional Review Boards at Yale University.

Results

The mean score of family functioning was 5.14 out of 7. With the inclusion of individual-level factors (Model 1), significant associations were observed between high family functioning and having ever attended religious services (OR = 2.22, 95% CI: 1.20-4.09), low perceived discrimination (OR = 3.04, 95% CI: 1.60-5.75), and high perceived social support (OR = 3.74, 95% CI: 2.01-6.95). After including both individual- and family-level factors (Model 2), results identified significant associations between high family functioning and annual household income>$15,000 (OR = 9.82, 95% CI: 1.67-57.67, p = 0.011) and no experience of violence from any family members (OR = 4.94, 95% CI: 1.50-16.21, p = 0.008).

Discussion

The models of care should be structured to support the continuity of maternity care in which health care providers have the opportunity to discover and utilize each family's strengths to provide the optimal caring experience for young mothers and their families as a unit.

Positive Outliers: A Mixed Methods Study of Resiliency to Childhood Obesity in High-Risk Neighborhoods

OBJECTIVE

Despite the high prevalence of obesity and the clustering of risk by neighborhood, few studies have examined characteristics which promote healthy child weight in neighborhoods with high obesity risk. We aimed to identify protective factors for children living in neighborhoods with high obesity risk.

METHODS

We identified neighborhoods with high obesity risk using geolocated electronic health record data with measured body mass index (BMI) from well child visits (2012-2017). We then recruited caregivers with children aged 5-13 years who lived in census tracts with mean child BMI percentile >72 (February 2020- August 2021). We used sequential mixed methods (quantitative surveys, qualitative interviews) to compare individual, interpersonal and perceived neighborhood factors among families with children at healthy weight (positive outliers, PO) vs. families with ≥1 child with overweight or obesity (controls). Regression models and comparative qualitative analysis were used to identify protective characteristics.

RESULTS

Seventy-three caregivers participated in the quantitative phase (41% PO; 34% preferred Spanish) and twenty in the qualitative phase (50% PO; 50% preferred Spanish). Frequency of healthy caregiver behaviors was associated with being a PO (Family Health Behavior Scale Parent Score adjusted β 3.67; 95% CI 0.52-6.81 and qualitative data). Protective factors also included caregivers' ability to minimize the negative health influences of family members and adhere to family routines.

CONCLUSIONS

There were few differences between PO and control families. Support for caregiver healthy habits and adherence to healthy family routines emerged as opportunities for childhood obesity prevention in neighborhoods with high obesity risk.

WHAT'S NEW

In neighborhoods with high risk of child obesity, families with healthy weight children and families with children with overweight/obesity are behaviorally and socially similar. Parental modeling and support for healthy behaviors across children's environments may promote healthy child weight.

Harmonising outcome measurement for child focused domestic abuse interventions. Reflections on the development and implementation of a core outcome set

There is appetite in the UK to better measure the impact of domestic violence and abuse (DVA) interventions on children. The spread of outcomes-based commissioning means outcome measurement is no longer just the territory of academic researchers but is now firmly within the purview of practitioners and policy makers. However, outcomes measured in trials only partially represent the views of those delivering and using services with respect to how success should be defined and captured. Even within trials there is huge inconsistency in the definition and measurement of important endpoints. This yields a body of evidence that is difficult to make sense of, defeating the ends for which it was produced - to improve the response to children and families who have experienced abuse. Development of Core Outcome Sets (COS) is seen as a solution to this problem, by establishing consensus across key stakeholder groups regarding a minimum standard for outcome measurement in trials, and increasingly in service delivery contexts. To date COS development has addressed outcomes relating to health conditions or interventions, with limited application to public health challenges. We reflect on our efforts to develop a COS to evaluate psychosocial interventions for children and families experiencing DVA. We highlight the value of COS development as a mechanism for improving evidence quality and the response to families experiencing abuse. Finally, we make recommendations to researchers and COS guideline developers to support this broader application of COS methodology.

Experiences of family members when accompanying patients in intensive care units: A qualitative study

BACKGROUND

Family members of Intensive Care Unit (ICU) patients encounter numerous challenges while providing companionship to their hospitalized loved ones.

AIMS AND OBJECTIVES

This study aims to explore the experiences of family members with loved ones hospitalized in ICUs.

DESIGN

Qualitative research was conducted using a content analysis approach.

PARTICIPANTS

Ten family members of ICU patients were recruited using purposive sampling.

METHODS

Data were collected through semi-structured, in-depth interviews and analysed following Graneheim and Lundman's suggested steps.

FINDINGS

Analysis of interviews with ten family members of ICU patients revealed a theme of "challenging companionship on an obscure path," encompassing four categories (1-4) and nine subcategories (a, b and c). These included (1) the interplay between the patient and the family: a. family affected by the patient's condition; b. patient affected by the family's condition; (2) mixed emotions of apprehension and anticipation regarding ICU admission: a. fear of ICU hospitalization; b. hope for ICU hospitalization; (3) unaddressed needs and concerns: a. pressure from the ICU's visiting limitations; b. lack of a resting room to settle; c. vague information about the patient's condition; (4) two-way care suffering for families a. direct suffering associated with companionship; b. indirect suffering while observing the patients' suffering.

CONCLUSIONS

Families of ICU patients encounter various challenges, revealing the complex interplay of emotions, needs and challenges within the ICU. This highlights the intricate dynamics in this critical health care environment.

RELEVANCE TO CLINICAL PRACTICE

A holistic and empathetic approach in clinical practice is crucial in ICU care, particularly during the challenging journey patients and their families undergo in this critical setting. Health care systems and providers should adapt ICU rules to address evolving needs, alleviate concerns and enhance the overall family experience during their loved one's hospitalization in the ICU.

How is family health related to health-related quality of life among middle-aged and older adults in rural China? A cross-sectional study

BACKGROUND

Health-related quality of life (HRQOL) is unequal between countries and regions, and the emphasis on HRQOL of populations of low-income countries and regions is unprecedented.

OBJECTIVES

To examine the association between family health and HRQOL among middle-aged and older adults in rural China, and determine whether this association differs by age, gender and chronic disease subgroup.

METHODS

Cross-sectional survey carried out from July to September 2021. The participants were 1059 people aged 46 and over living in rural China. We used the European Quality of Life Five Dimension Five Level (EQ-5D-5L) and Family Health Scale-Short Form (FHS-SF) to assess health-related quality of life (HRQOL) and family health, respectively.

RESULTS

The mean EQ-VAS was 75.66, the mean EQ index score was 0.92, and the mean FHS was 37.90 in rural middle-aged and older adults. After Bonferroni correction, generalised linear regression models showed that FHS was significantly associated with the EQ-VAS (β = 0.829; 95% confidence interval [CI]: 0.660 to 0.997; p < .001) and the EQ index score (β = 0.003; 95%CI: 0.001 to 0.004; p < .001). Binary logistic regression models showed that FHS was associated with three dimensions of HRQOL (mobility, self-care and usual activities) (p < .01). Based on subgroup analyses, the effect of FHS on EQ-VAS and the EQ index score was significant in three subgroups after Bonferroni correction (p < .01), but the association between FHS and the dimensions of HRQOL differed by age, gender and chronic disease group (p > .01).

CONCLUSIONS

This study is the first to explore that family health and its dimensions are significant positive predictors of HRQOL among middle-aged and older adults in rural China. Family-based measures may have more potential and value because better family health significantly improves HRQOL.

IMPLICATIONS FOR PRACTICE

In the health strategy, the government and primary health care workers should include family health as an indicator and assess it before and after the implementation of the strategy.

Measuring continuity in primary care: how it is done and why it matters

Continuity of care (COC) is a foundational element of primary care and is associated with improved patient satisfaction and health outcomes and decreased total cost of care. The patient-physician relationship is highly valued by both parties and is often the reason providers choose to specialize in primary care. In some settings, such as outpatient residency clinics, however, patients may only see their primary care provider (PCP) 50% or less of the time. Considering the many benefits of COC for patients and providers, there is a clear need for us in primary care to understand how to compare different COC measures across studies and how to choose the best COC measure when conducting quality improvement efforts. However, at least 32 different measures have been used to evaluate COC. The manifold variations for measuring COC arise from data source restrictions, purpose (research or clinical use), perspective (patient or provider), and patient visit frequency/type. Key factors distinguishing common COC formulas are data source (e.g. claims data or electronic medical records), and whether a PCP is identifiable. There is no "right" formula, so understanding the nuances of COC measurement is essential for primary care research and clinical quality improvement. While the full complexity of COC cannot be captured by formulas and indices, they provide an important measure of how consistently patients are interacting with the same provider.

Media Use Behavior Mediates the Association Between Family Health and Intention to Use Mobile Health Devices Among Older Adults: Cross-Sectional Study

BACKGROUND

With the advent of a new era for health and medical treatment, characterized by the integration of mobile technology, a significant digital divide has surfaced, particularly in the engagement of older individuals with mobile health (mHealth). The health of a family is intricately connected to the well-being of its members, and the use of media plays a crucial role in facilitating mHealth care. Therefore, it is important to examine the mediating role of media use behavior in the connection between the family health of older individuals and their inclination to use mHealth devices.

OBJECTIVE

This study aims to investigate the impact of family health and media use behavior on the intention of older individuals to use mHealth devices in China. The study aims to delve into the intricate dynamics to determine whether media use behavior serves as a mediator in the relationship between family health and the intention to use mHealth devices among older adults. The ultimate goal is to offer well-founded and practical recommendations to assist older individuals in overcoming the digital divide.

METHODS

The study used data from 3712 individuals aged 60 and above, sourced from the 2022 Psychology and Behavior Investigation of Chinese Residents study. Linear regression models were used to assess the relationships between family health, media use behavior, and the intention to use mHealth devices. To investigate the mediating role of media use behavior, we used the Sobel-Goodman Mediation Test. This analysis focused on the connection between 4 dimensions of family health and the intention to use mHealth devices.

RESULTS

A positive correlation was observed among family health, media use behavior, and the intention to use mHealth devices (r=0.077-0.178, P<.001). Notably, media use behavior was identified as a partial mediator in the relationship between the overall score of family health and the intention to use mHealth devices, as indicated by the Sobel test (z=5.451, P<.001). Subgroup analysis further indicated that a complete mediating effect was observed specifically between family health resources and the intention to use mHealth devices in older individuals with varying education levels.

CONCLUSIONS

The study revealed the significance of family health and media use behavior in motivating older adults to adopt mHealth devices. Media use behavior was identified as a mediator in the connection between family health and the intention to use mHealth devices, with more intricate dynamics observed among older adults with lower education levels. Going forward, the critical role of home health resources must be maximized, such as initiatives to develop digital education tailored for older adults and the creation of media products specifically designed for them. These measures aim to alleviate technological challenges associated with using media devices among older adults, ultimately bolstering their inclination to adopt mHealth devices.

Association between Child Tax Credit advance payments and food insufficiency in households experiencing economic shocks

The COVID-19 pandemic brought increases in economic shocks due to poor health and lost employment, which reduced economic well-being, especially in households with children. The American Rescue Plan Act of 2021 expanded Child Tax Credit (CTC) payments to include eligibility for the lowest income households, boosted benefit levels, and provided monthly advance payments to households with children. Using Census Household Pulse Survey respondent data from January 2021 to July 2022, we evaluated the association between these advance CTC monthly payments and food insufficiency among households with children experiencing health- or employment-related economic shocks (defined as missed work due to COVID-19/other illness or COVID-19-related employer closure/layoff/furlough). Using a triple difference design, we found that the advance CTC was associated with greater reductions in food insufficiency among households with children experiencing economic shocks both compared with households without children and with households with children not experiencing economic shocks. Permanently expanding the advance CTC could create resilience to economic shocks during disease outbreaks, climate disasters, and recessions.

Lived Experiences of Fatherhood After Infertility

OBJECTIVE

To explore the lived experiences of fathers in the perinatal period after infertility.

DESIGN

A descriptive, phenomenological study.

SETTING

Researcher's private office and participants' homes in an Eastern Canadian province.

PARTICIPANTS

Eight fathers who met the eligibility criteria.

METHODS

We recruited a purposive sample of eight participants and held one-on-one interviews in person, by telephone, and via virtual platforms. We analyzed the verbatim transcripts of the audiotaped interviews using Colaizzi's phenomenological data analysis method.

RESULTS

We uncovered seven themes that described the lived experiences of participants: The Journey: A Long Winding Road, Roles and Responsibilities: Supporter and Protector, Support: The Often-Forgotten Parent, Challenges and Hurdles: Bumps on the Road, So Many Feelings: The Rollercoaster, Coping: Living on the Road, and Reflection: An Unforgotten Journey. Participants shared their experiences of the perinatal period after infertility as long journeys and described how bumps along the road marked these journeys. The journeys were essential parts of their lives that they continued to remember years later.

CONCLUSION

The perinatal experience after infertility is an important and remembered time for fathers. It is essential to involve and support them in the perinatal process to facilitate positive experiences and overall family health, especially after infertility. There is an ongoing need to conduct research with fathers and to develop evidence-based programming and resources to assist them in the perinatal period after infertility.

Transgender and nonbinary young adults' depression and suicidality is associated with sibling and parental acceptance-rejection

INTRODUCTION

Transgender and nonbinary young adults (TNB YA) report high rates of depression and more suicidality than their cisgender counterparts. Parental rejection is a known predictor of worse mental health among TNB YA; however, less is known about TNB YA experiences of sibling acceptance-rejection. The purpose of this study was to determine how TNB YA perception of sibling and parental acceptance-rejection are related to TNB YA depression and suicidality.

DESIGN

Cross-sectional.

METHODS

TNB YA (ages 18-25) who had disclosed their gender identity to an adult sibling were recruited to take part in an online study and completed measures of sibling and parent acceptance-rejection, depression, as well as lifetime and past year suicidality. Stepwise regressions were conducted to evaluate associations between acceptance-rejection and TNB YA depression and suicidality.

RESULTS

The sample consisted of 286 TNB YA (Mage  = 21.5, SD = 2.2) who were predominantly White (80.6%) and assigned female sex at birth (92.7%). Each family member's acceptance-rejection was associated with increased TNB YA depression scores when considered independently and combined. Independently, high rejection from each family member was associated with greater odds of reporting most suicidality outcomes. When all family members were considered together, only high rejection from a male parent was associated with four times greater odds of reporting lifetime suicidality. High rejection from both parents was associated with greater odds of reporting past year suicide attempt (OR: 3.26 female parent; 2.75 male parent).

CONCLUSION

Rejection from family members is associated with worse depression and suicidality, and rejection from male parents may be particularly damaging. Sibling acceptance uniquely contributes to TNB YA's depression symptoms alone and in the context of parental support.

[Cross-cultural adaptation and evidence of psychometric validity of the Family Health Scale for Brazilian Portuguese]

This study aimed to translate and cross-culturally adapt the Family Health Scale into Brazilian Portuguese and analyze evidence of its psychometric validity. The 32 items on family health were cross-culturally adapted, using the content validity index to calculate semantic, idiomatic, cultural, and conceptual characteristics of the scale and its items. A pre-test to identify evidence of validity was applied to 40 families. At another time, the instrument was applied to 354 families in a Brazilian northeastern city. The index of agreement between the raters ranged from 0.84 for the scale items to 0.98 for the total scale, according to Kendall's coefficient. According to Cronbach's alpha, evidence of psychometric validity is adequate. Most families had a moderate degree of health, according to the scale. Therefore, the Brazilian version of the Family Health Scale showed conceptual, semantic, cultural, and operational equivalence with the original items, along with satisfactory psychometric properties for use among the Brazilian population with effectiveness and safety.

The Brazilian primary health care response to the COVID-19 pandemic: individual and collective approaches

Objectives

Brazil's PHC wide coverage has a potential role in the fight against COVID, especially in less developed regions. PHC should deal with COVID-19 treatment; health surveillance; continuity of care; and social support. This article aims to analyze PHC performance profiles during the pandemic, in these axes, comparing the five Brazilian macro-regions.

Methods

A cross-sectional survey study was carried out, using stratified probability sampling of PHC facilities (PHCF). A Composite Index was created, the Covid PHC Index (CPI). Factor analysis revealed that collective actions contrastingly behaved to individual actions. We verified differences in the distributions of CPI components between macro-regions and their associations with structural indicators.

Results

Nine hundred and seven PHCF participated in the survey. The CPI and its axes did not exceed 70, with the highest value in surveillance (70) and the lowest in social support (59). The Individual dimension scored higher in the South, whereas the Collective dimension scored higher in the Northeast region. PHCF with the highest CPI belong to municipalities with lower HDI, GDP per capita, population, number of hospitals, and ICU beds.

Conclusion

The observed profiles, individually and collectively-oriented, convey disputes on Brazilian health policies since 2016, and regional structural inequalities.

"I've smoked weed with my daughter": Cannabis Use within Families Affected by Parental Opioid Misuse

Youth with parents who use opioids are more likely to engage in early substance use, especially cannabis use. The purpose of this study was to describe the context of cannabis use among families affected by parental opioid misuse. We conducted 25 in-depth interviews with families affected by parental opioid misuse. Participants were parents with a history of opioid misuse and young adults (ages 18-24) who had parents with a history of opioid misuse. Interviews were digitally recorded and professionally transcribed. Data were analyzed inductively using a qualitative content analytic approach. Familial cannabis use was common among young people and their parents. Participants described familial cannabis use as a bonding activity that felt safe and lightened the mood. Additional research is needed to understand the complex role that cannabis use may play in families affected by opioid misuse. Strategies for intergenerational substance use prevention are discussed.

Fathers' Perspectives on Fatherhood and Paternal Involvement During Pregnancy and Childbirth

There is limited research that specifically explores paternal involvement during pregnancy and childbirth. To address this gap, we completed a series of focus groups with fathers to examine social, cultural, and environmental factors that influence behaviors among new fathers while also providing community perspectives on men's experiences seeking care pre- and postdelivery. We used a phenomenological thematic approach to analyze data from 10 focus groups from five of the six Alliance for Innovation on Maternal Health-Community Care Initiative pilot sites collected between November 2021 and April 2022. The average age of fathers was 33.9 years (range = 24-61 years). The majority (86.25%) of men were African American, and approximately one sixth of focus group participants (16.25%) were Hispanic or Latino. Four key themes emerged: the importance and meaning of fatherhood, accessibility during pregnancy and childbirth, engagement during pregnancy and childbirth, and responsibility of fathers during pregnancy and childbirth. These fathers not only understood and embraced the awesome responsibility they had for their unborn child, but they also recognized and were invested in being present, accessible, engaged, and responsible to the pregnant woman during the pregnancy. Practitioners and policy makers should work to engage fathers as early in the pregnancy as possible; monitor father's mental health and financial stress; provide resources to educate fathers on maternal health, pregnancy, and childbirth; and emphasize fathers' rights, roles, and responsibilities.

Scoping the Priorities and Concerns of Parents: Infodemiology Study of Posts on Mumsnet and Reddit

BACKGROUND

Health technology innovation is increasingly supported by a bottom-up approach to priority setting, aiming to better reflect the concerns of its intended beneficiaries. Web-based forums provide parents with an outlet to share concerns, advice, and information related to parenting and the health and well-being of their children. They provide a rich source of data on parenting concerns and priorities that could inform future child health research and innovation.

OBJECTIVE

The aim of the study is to identify common concerns expressed on 2 major web-based forums and cluster these to identify potential family health concern topics as indicative priority areas for future research and innovation.

METHODS

We text-mined the r/Parenting subreddit (69,846 posts) and the parenting section of Mumsnet (99,848 posts) to create a large corpus of posts. A generative statistical model (latent Dirichlet allocation) was used to identify the most discussed topics in the corpus, and content analysis was applied to identify the parenting concerns found in a subset of posts.

RESULTS

A model with 25 topics produced the highest coherence and a wide range of meaningful parenting concern topics. The most frequently expressed parenting concerns are related to their child's sleep, self-care, eating (and food), behavior, childcare context, and the parental context including parental conflict. Topics directly associated with infants, such as potty training and bottle feeding, were more common on Mumsnet, while parental context and screen time were more common on r/Parenting.

CONCLUSIONS

Latent Dirichlet allocation topic modeling can be applied to gain a rapid, yet meaningful overview of parent concerns expressed on a large and diverse set of social media posts and used to complement traditional insight gathering methods. Parents framed their concerns in terms of children's everyday health concerns, generating topics that overlap significantly with established family health concern topics. We provide evidence of the range of family health concerns found at these sources and hope this can be used to generate material for use alongside traditional insight gathering methods.

Association between hospitalizations for sensitive conditions and quality of primary care

OBJECTIVE

To analyze the association between municipal rates of ambulatory care sensitive conditions (ACSC) hospitalization and the quality of primary health care (PHC), socioeconomic, and demographic variables and those related to local characteristics of the health system from 2010 to 2019.

METHOD

Ecological time series study in Brazilian municipalities analyzing the correlation of ACSC hospitalization rates with PHC quality measured by the three cycles of the Primary Care Access and Program for improving primary care access and quality (PMAQ-AB). The study included municipalities whose teams participated in 80% or more of at least two PMAQ-AB cycles. The correlation between standardized ACSC hospitalization rates and PHC quality and other variables was analyzed. Spearman's test was used between the response variable and numerical explanatory variables. Generalized equations estimation was used as a multivariate model associating ACSC hospitalization rates with the other variables over the years.

RESULTS

A total of 3,500 municipalities were included in the models. The quality of PHC (PMAQ-AB score) showed an inverse association with the variation in ACSC hospitalization rates. Hospitalization rates fell by -2% per year every ten-point increase in the PMAQ-AB score, adjusted by the remaining variables. A one-unit increase in the beds per 1,000 inhabitants variable had an impact of approximately +6.4% on ACSC hospitalization rates. Regarding population size, larger municipalities had lower ACSC hospitalization rates. Increased PHC coverage and lower socioeconomic inequality were also associated with the reduction in hospitalizations.

CONCLUSIONS

The reduction in ACSC hospitalization rates over time was associated with an increase in the quality of PHC. It was also associated with a reduction in the number of hospital beds and municipalities with better socioeconomic indicators.

Family Wellbeing and Sexual Health of Patients Receiving Treatment for Prostate Cancer

Purpose

Prostate cancer and its treatment may affect patients' sexual function and social wellbeing. This study investigated the relationship between social/family wellbeing and sexual health in patients with prostate cancer. Additionally, the moderating effect of clinical characteristics on this relationship was also explored.

Patients and Methods

This is a descriptive correlational study using baseline data of a longitudinal study enrolling 137 patients with prostate cancer. Sexual Function (SF) and Sexual Function Distress (SFD) data were collected using the Symptom Index questionnaire. Demographic data were obtained during study intake and clinical data were obtained from chart review. Bivariate correlation determined the correlations among continuous demographic/clinical data, social/family wellbeing, and sexual health. Moderated regression analysis determined the moderating effects of clinical characteristics on the relationship of social/family wellbeing and sexual health.

Results

Moderate positive correlation was found between social/family wellbeing and SF, whereas a weak negative correlation was noted between social/family wellbeing and SFD. Depression was significantly correlated with social/family wellbeing and SFD. Both sexual health domains were significantly correlated with Gleason score. A significant difference was noted in the social/family wellbeing and both SF and SFD in participants receiving androgen deprivation therapy (ADT) compared to those not receiving ADT. Concomitant ADT use was the only clinical characteristic found to be a significant moderator of the relationship between social/family wellbeing and SFD, but none of the clinical characteristics was found to have a moderating effect on the relationship of social/family wellbeing and SF. Among patients who were not receiving ADT, high social/family wellbeing was associated with low SFD. Patients who were receiving ADT reported slightly higher SFD despite having higher social/family wellbeing.

Conclusion

Ensuring sexual health in patients with prostate cancer requires a comprehensive approach to address factors contributing to sexual health such as side effects of treatment and family wellbeing.

Parents' Perceptions of a Serious Game for Educating Families on Prescription Opioid Safety: Qualitative Pilot Study of MedSMARxT: Adventures in PharmaCity

BACKGROUND

Opioid misuse is a pervasive, worsening problem that affects the health of people throughout the United States, including adolescents. There are few adolescent-focused interventions designed to educate them about opioid medication safety. The MedSMARxT: Adventures in PharmaCity, is a serious educational video game that teaches parents and their youths about safe opioid practices.

OBJECTIVE

This study aimed to elucidate parent's perceptions of MedSMARxT: Adventures in PharmaCity and its potential use by parents and their adolescents.

METHODS

Parents of adolescents aged 12 to 18 years who live in the United States were recruited from April to October 2021 via Qualtrics research panels, social media, email listserves, and snowball sampling. The study participants played MedSMARxT: Adventures in PharmaCity for 30 minutes and then participated in a 30-minute postgame interview via WebEx (Cisco). Questions were developed and piloted to examine adults' perceptions of the game. Participants were asked three sets of open-ended questions: (1) questions about the game and elements of the game, (2) what they learned from the game, and (3) questions about their experience with games. Audio recordings were transcribed verbatim. Interview transcripts were coded using content and thematic analysis by study team members to identify major themes and subthemes from the data.

RESULTS

Parent participants (N=67) played MedSMARxT: Adventures in PharmaCity and completed a postgame interview. Analysis extrapolated four primary themes from the data: (1) participant gaming experience, (2) perception of game features, (3) educational purpose of the game, and (4) future use of the game. Most participants (n=56, 84%), had at least some experience with video games. More than half of the participants (n=35, 52%) participants, had positive reactions to the game characters and scenes depicted in MedSMARxT: Adventures in PharmaCity and stated they were realistic for adolescents. Most participants (n=39, 58%), would recommend the game to others. Significant difficulties with gameplay navigation were reported by 38 (57%) participants, as well as a slow game pace. All participants were able to accurately identify the overarching goal of the game: opioid or medication safety. The game reinforced existing knowledge for participants, though many (n=15, 22%), reported a new awareness of the need to store opioid medications in a locked area and the availability of medication disposal drop boxes at pharmacies. Participants stated that they would recommend the game for future use by families and youths in various health care and non-health care settings.

CONCLUSIONS

The use of a tailored serious game is a novel, engaging tool to educate adolescents on opioid safety. MedSMARxT: Adventures in PharmaCity can be used as a tool for parents and adolescents to facilitate meaningful dialogue about safe and appropriate opioid use.

The mediating effect of family health on the relationship between health literacy and mental health: A national cross-sectional survey in China

BACKGROUND

Mental health problems significantly affect people's well-being and result in a huge health burden. Health literacy and family health are critical to reducing people's mental health problems. However, limited studies have addressed their complex interaction. Thus, this study aims to elucidate the mediating effect of family health on the relationship between health literacy and mental health.

METHODS

A national cross-sectional study based on multistage random sampling was conducted from July 10 to Sep 15, 2021, in China. Information about the public's health literacy, family health, and the level of three common mental health problems (depression, anxiety, and stress) was collected. A structural equation model (SEM) was applied to explore the mediating effect of family health on the relationship between health literacy and mental health.

RESULTS

A total of 11,031 participants were investigated. Approximately 19.93 and 13.57% of participants experienced moderate or severe depressive and anxiety symptoms, respectively. The SEM showed that health literacy was directly associated with mental health, with higher health literacy resulting in lower levels of depression (coefficient: -0.018, p = .049), anxiety (coefficient: -0.040, p < .001), and stress (coefficient: -0.105, p < .001). In addition, family health played a significant mediating effect (p < .001) between health literacy and mental health, contributing to 47.5, 70.9, and 85.1% of the total effect of health literacy on personal stress, anxiety, and depression, respectively.

CONCLUSIONS

This study revealed that the improvement of health literacy is directly and indirectly associated with less likelihood of people's mental health problems via family health. Thus, future mental health interventions should be integrated and targeted both at individual level and the family level.

Women Agro-Entrepreneurship Promoting Vegetables at a Family Level: A Healthcare Approach towards Non-Communicable Disease Risk Reduction

The role of women in promoting the production and consumption of vegetables at a family level towards mitigating the risk of non-communicable diseases (NCDs) is crucial. Women not only select and prepare food items consumed by their families but care about the health issues of family members. As research examining this critical role of women is scant, we attempted to understand how women as agro-entrepreneurs can promote vegetables to enhance healthcare situations. A field study was conducted in a northeastern district of Bangladesh from January to June 2019, adopting qualitative-participatory approaches that involved interviews, focus groups, and workshops. The study revealed that women play a vital role in taking care of the health of the family members, while their role in planning the family diet is exclusive. However, they have limited decision-making authority in the production and consumption of vegetables, and their knowledge and perception of NCDs are limited. The results imply that with enhanced capacity of vegetable production and better knowledge of nutrition and NCDs, women can improve family dietary habits by increasing the consumption of vegetables. Therefore, building the agro-entrepreneurial capacities of women in terms of knowledge, skills, access to finance, and decision-making authority at the family level would be a significant interventional approach for increased production and consumption of vegetables. We argue that public health strategies and policies addressing NCDs should incorporate this family-centric approach by promoting agro-entrepreneurship by women who would promote the production and consumption of vegetables.

The True Price of External Health Effects from Food Consumption

Although global food consumption costs more in terms of impact on human life than money is spent on it, health costs have not been consistently quantified or included in food prices to date. In this paper, a method to determine the external health costs of nutrition and dietetics is developed by employing the cost-of-illness (COI) and true cost accounting (TCA) approaches. This is done exemplarily for the reference country Germany. The results show that 601.50 € per capita and 50.38 billion € in total external health costs are incurred annually due to nutrition. Overall, most costs are accrued through excessive meat consumption (32.56% of costs), deficient whole grain intake (15.42% of costs), and insufficient uptake of legumes (10.19% of costs). Comparing the external health costs with the external environmental costs in Germany, it can be seen that of the total annual costs of around 153.86 billion €, 67.26% originate from environmental impacts and 32.74% from impacts on human life. In order to achieve the 17 Sustainable Development Goals and to increase family as well as public health, there is a need to internalise these external costs into actual food prices.

Early detection of neurodevelopmental disorders in paediatric primary care: A scoping review

BACKGROUND

Earlier detection of children at risk for neurodevelopmental disorders is critical and has longstanding repercussions if not addressed early enough.

OBJECTIVES

To explore the supporting or facilitating characteristics of paediatric primary care models of care for early detection in infants and toddlers at risk for neurodevelopmental disorders, identify practitioners involved, and describe how they align with occupational therapy's scope of practice.

METHODS

A scoping review following the Joanna Briggs Institute framework was used. PubMed Central, Cumulative Index to Nursing & Allied Health Literature, and Scopus databases were searched. The search was conducted between January and February 2022. Inclusion criteria were: children aged 0-3 years old; neurodevelopmental disorders including cerebral palsy (CP) and autism spectrum disorder (ASD); models of care used in the paediatric primary care setting and addressing concepts of timing and plasticity; peer-reviewed literature written in English; published between 2010 and 2022. Study protocol registered at https://doi.org/10.17605/OSF.IO/MD4K5.

RESULTS

We identified 1,434 publications, yielding 22 studies that met inclusion criteria. Models of care characteristics included the use of technology, education to parents and staff, funding to utilize innovative models of care, assessment variability, organizational management changes, increased visit length, earlier timeline for neurodevelopmental screening, and collaboration with current office staff or nonphysician practitioners. The top 4 providers were paediatricians, general or family practitioners, nurse/nurse practitioners, and office staff. All studies aligned with occupational therapy health promotion scope of practice and intervention approach yet did not include occupational therapy within the paediatric primary care setting.

CONCLUSIONS

No studies included occupational therapy as a healthcare provider that could be used within the paediatric primary care setting. However, all studies demonstrated models of care facilitating characteristics aligning with occupational therapy practice. Models of care facilitating characteristics identified interdisciplinary staff as a major contributor, which can include occupational therapy, to improve early detection within paediatric primary care.

The Association Between Family Health and Frailty With the Mediation Role of Health Literacy and Health Behavior Among Older Adults in China: Nationwide Cross-Sectional Study

BACKGROUND

Family health develops from the intersection of the health of each family member and their interactions and capacities as well as the family's internal and external resources. Frailty is the most prominent and typical clinical manifestation during population aging. Family health may be effective in addressing frailty, and this association may be mediated by health literacy and health behaviors. Until now, it is unclear whether and how family health affects frailty in older adults.

OBJECTIVE

This study aimed to examine the associations between family health and frailty and the mediation roles of health literacy and health behaviors.

METHODS

A total of 3758 participants aged ≥60 years were recruited from a national survey conducted in 2022 in China for this cross-sectional study. Family health was measured using the Short Form of the Family Health Scale. Frailty was measured using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale. Potential mediators included health literacy and health behaviors (not smoking, not having alcohol intake, physical exercise for ≥150 minutes per week, longer sleep duration, and having breakfast every day). Ordered logistic regression was applied to explore the association between family health and frailty status. Mediation analysis based on Sobel tests was used to analyze the indirect effects mediated by health literacy and behaviors, and the Karlson-Holm-Breen method was used to composite the indirect effects.

RESULTS

Ordered logistic regression showed that family health is negatively associated with frailty (odds ratio 0.94, 95% CI 0.93-0.96) with covariates and potential mediators controlled. This association was mediated by health literacy (8.04%), not smoking (1.96%), longer sleep duration (5.74%), and having breakfast every day (10.98%) through the Karlson-Holm-Breen composition.

CONCLUSIONS

Family health can be an important intervention target that appears to be negatively linked to frailty in Chinese older adults. Improving family health can be effective in promoting healthier lifestyles; improving health literacy; and delaying, managing, and reversing frailty.

Exploring the Link between Family Health and Health Literacy among College Students: The Mediating Role of Psychological Resilience

Enhancing health literacy is of the utmost importance to enhance the physical and mental well-being of college students. Unfortunately, there has been limited research investigating the means of improving college students' health literacy through the perspective of families. Family health is an interdisciplinary and complex concept that involves multiple factors, and it provides a holistic perspective on the overall well-being of the family unit. Thus, this study aims to examine the relationship between family health and health literacy and scrutinize the mediating role of psychological resilience. A valid sample of 5473 students was collected from a university in November-December 2022 and was assessed using regression analysis. The findings reveal that family health has a positive association with the health literacy of college students (β = 0.56, p < 0.001), with psychological resilience playing a critical mediating role (β = 0.11, 95% CI: [0.09, 0.13]). Therefore, the family ought to be recognized as a fundamental mechanism to enhance college students' health literacy. Additionally, it is essential to emphasize the amelioration of psychological distress among college students and enhance their psychological resilience, which will be helpful for their overall health consciousness and proficiency.

Diabetic Retinopathy Screening Using Non-Mydriatic Fundus Camera in Primary Health Care Settings - A Multicenter Study from Saudi Arabia

Background

Screening of diabetic retinopathy (DR) using the current digital imaging facilities in a primary health care setting is still in its early stages in Saudi Arabia. This study aims to reduce the risk of vision impairment and blindness among known diabetic people through early identification by general practitioners (GP) in a primary health care setting in Saudi Arabia. The objective of this study was to evaluate the accuracy of diabetic retinopathy (DR) detection by general practitioners (GPs) by comparing the agreement of DR assessment between GPs and ophthalmologists' assessment as a gold standard.

Methods

A hospital-based, six-month cross-sectional study was conducted, and the participants were type 2 diabetic adults from the diabetic registries of seven rural PHCs, in Saudi Arabia. After medical examination, the participants were then evaluated by fundus photography using a non-mydriatic fundus camera without medication for mydriasis. Presence or absence of DR was graded by the trained GPs in the PHCs and then compared with the grading of an ophthalmologist which was taken as a reference or a gold standard.

Results

A total of 899 diabetic patients were included, and the mean age of the patients was 64.89 ± 11.01 years. The evaluation by the GPs had a sensitivity of 80.69 [95% CI 74.8-85.4]; specificity of 92.23 [88.7-96.3]; positive predictive value, 74.1 [70.4-77.0]; negative predictive value, 73.34 [70.6-77.9]; and an accuracy of 84.57 [81.8-89.88]. For the consensus of agreement the adjusted kappa coefficient was from 0.74 to 0.92 for the DR.

Conclusion

This study demonstrates that trained GPs in rural health centers are able to provide reliable detection results of DR from fundus photographs. The study highlights the need for early DR screening programs in the rural areas of Saudi Arabia to facilitate early identification of the condition and to lessen impact of blindness due to diabetes.

The Association between Adult Sport, Fitness, and Recreational Physical Activity and Number and Age of Children Present in the Household: A Secondary Analysis Using NHANES

Only one in three adults in the United States meets the weekly recommendation for physical activity (PA). The presence of children in the home may restrict adult PA. The purpose of this study was to examine the association between adult moderate and vigorous sport, fitness, and recreational physical activities and the number and age (0-5 and 6-17) of children in their household. Secondary data were drawn from the National Health and Nutrition Examination Survey (NHANES) from 2007-2016. Adults with complete survey data for self-reported moderate (MPA) and vigorous physical activities (VPA), number of children in the home, and other sociodemographic variables were included. The final sample included 2034 adults from 22-65 years of age. Analyses included ANOVAs and separate multivariable regression analyses to determine if the number of children in the household aged 0-5 and 6-17 were significant predictors of weekly moderate-to-vigorous physical activity (MVPA) after controlling for covariates. For MPA, no differences were found between adult PA regardless of the number and age of children in the home. For VPA, adults with two or more children aged 0-5 reported 80 fewer minutes of weekly VPA (p < 0.05) compared to those with no children or just one child in this age group after controlling for all covariates. Finally, adults with three or more children in the household aged 6-17 reported fifty fewer minutes of weekly VPA (p < 0.05) compared to those with no children, one, or just two in the household. These findings highlight a need to support the vigorous PA behaviors of this population, as the majority of the family-based PA intervention studies to date have primarily focused on family dyads.

Body-Size Misperception among Overweight Children and Adolescents in Greece: A Cross-Sectional Study

Childhood obesity can affect both physical and mental health. Body-size misperception may lead to a lack of motivation to make healthy changes or to engage in unhealthy weight loss behaviors, increasing the possibility for obese children to become obese adults. To estimate the frequency of body-size misperception among children and adolescents, we conducted a cross-sectional study within another study on eating disorders in youth in Greece (National Institute of Educational Policy, act no. 04/2018). Between January and December 2019, two trained assistants visited 83 primary and secondary schools of the Region of Western Greece and interviewed 3504 children aged 10-16 years (CL 99%) and performed anthropometric measurements. Among the 3504 surveyed children, 1097 were overweight, including 424 obese, and 51 were underweight. The "perceived" BMI was not computed in 875 children (25%), who did not state their weight or height and were classified as non-responders. Weight bias was inversely related to BMI, the obese and overweight non-obese children underestimated their weight, while the underweight children overestimated it. Conversely, height bias was positively related to BMI bias. BMI bias was not related to sex, age, parental education, or place of residence. In conclusion, our study lends robust support to the existing evidence on unrealistic body images among overweight children and adolescents. Prompt recognition of such misperceptions may help in increasing motivation towards healthier eating habits, systematic physical activity, and weight-control interventions.

Clinical and Psychosocial Outcomes Associated With a Tele-behavioral Health Platform for Families: Retrospective Study

BACKGROUND

The burden of pediatric mental illness in the United States has steadily worsened over the past decade. A recent increase in employer-sponsored behavioral health programs has focused on the needs of the general population. However, these programs do not provide the specialty mental health care required for children, adolescents, and their families.

OBJECTIVE

This study aimed to evaluate the effects of a technology-enabled pediatric and family behavioral health service on clinical outcomes among children and caregiver strain. The service is available to commercially insured populations and provides educational content; tele-behavioral health care, including coaching, therapy, and psychiatry; and care escalation and coordination.

METHODS

A retrospective cohort analysis of members using the service between February and September 2022 was conducted. Clinical outcomes for children and their caregivers were collected using the Pediatric Symptom Checklist-17 (PSC-17), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire 8-item (PHQ-8), and Caregiver Strain Questionnaire-Short Form 7 (CGSQ-SF7). Rates of reliable improvement were determined by calculating the reliable change index for each outcome. Paired, 2-tailed t tests were used to evaluate significant changes in assessment scores at follow-up compared to baseline.

RESULTS

Of the 4139 participants who enrolled with the service, 48 (1.2%) were referred out for more intensive care, 2393 (57.8%) were referred to coaching, and 1698 (41%) were referred to therapy and psychiatry. Among the 703 members who completed the intervention and provided pre- and postintervention outcomes data, 386 (54.9%) used psychoeducational content, 345 (49.1%) received coaching, and 358 (50.9%) received therapy and psychiatry. In coaching, 75% (183/244) of participants showed reliable improvement on the PSC-17 total score, 72.5% (177/244) on the PSC-17 internalizing score, and 31.5% (105/333) on the CGSQ-SF7 total score (average improvement: PSC-17 total score, 3.37 points; P<.001; PSC-17 internalizing score, 1.58 points; P<.001; and CGSQ-SF7 total score, 1.02 points; P<.001). In therapy and psychiatry, 68.8% (232/337) of participants showed reliable improvement on the PSC-17 total score, 70.6% (238/337) on the PSC-17 internalizing score, 65.2% (219/336) on the CGSQ-SF7 total score, 70.7% (82/116) on the GAD-7 score, and 67.5% (77/114) on the PHQ-8 score (average improvement: PSC-17 total score, 3.16 points; P<.001; PSC-17 internalizing score, 1.66 points; P<.001; CGSQ-SF7 total score, 1.06 points; P<.001; GAD-7 score, 3.00 points; P<.001; and PHQ-8 score, 2.91 points; P<.001).

CONCLUSIONS

Tele-behavioral health offerings can be effective in improving caregiver strain and psychosocial functioning and depression and anxiety symptoms in a pediatric population. Moreover, these digital mental health offerings may provide a scalable solution to children and their families who lack access to essential pediatric mental health services.

Mental Health Is a Family Affair-Systematic Review and Meta-Analysis on the Associations between Mental Health Problems in Parents and Children during the COVID-19 Pandemic

As a multidimensional and universal stressor, the COVID-19 pandemic negatively affected the mental health of children, adolescents, and adults worldwide. In particular, families faced numerous restrictions and challenges. From the literature, it is well known that parental mental health problems and child mental health outcomes are associated. Hence, this review aims to summarize the current research on the associations of parental mental health symptoms and child mental health outcomes during the COVID-19 pandemic. We conducted a systematic literature search in Web of Science (all databases) and identified 431 records, of which 83 articles with data of over 80,000 families were included in 38 meta-analyses. A total of 25 meta-analyses resulted in significant small to medium associations between parental mental health symptoms and child mental health outcomes (r = 0.19 to 0.46, p < 0.05). The largest effects were observed for the associations of parenting stress and child mental health outcomes. A dysfunctional parent-child interaction has been identified as a key mechanism for the transmission of mental disorders. Thus, specific parenting interventions are needed to foster healthy parent-child interactions, to promote the mental health of families, and to reduce the negative impacts of the COVID-19 pandemic.

CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE PERSIAN VERSION OF THE FAMILY FUNCTIONING, HEALTH, AND SOCIAL SUPPORT QUESTIONNAIRE IN A SAMPLE OF HEART FAILURE PATIENTS AND THEIR FAMILY MEMBERS

Background and Purpose: Family functioning, family health, and social support have significant roles in the management of heart failure (HF). This study aimed to translate, adapt, and assess the validity and reliability of the Persian version of the Family Functioning, Family Health, and Social Support (FAFHES) questionnaire. Methods: FAFHES questionnaire was translated into Persian, and an expert panel assessed the cross-cultural adaptation. We examined the construct validity by confirmatory factor analysis and internal consistency by Cronbach's alpha coefficients among 576 participants. Results: The Persian FAFHES confirmed the three-factor structure in the social support and the five-factor structure in the family health scales. However, the family functioning scale yielded the three-factor structure versus the four-factor structure in the original scales. The Cronbach's alpha for the three scales varied from 0.85 to 0.94. Conclusions: The adapted FAFHES seems to be valid and reliable to measure family functioning, family health, and social support in families with HF.

The effects of COVID-19 stressors and family life on anxiety and depression one-year into the COVID-19 pandemic

The purpose of this study was to examine the effects of Coronavirus (COVID-19)-related stressors and family health on adult anxiety and depressive symptoms 1 year into the pandemic. The sample consisted of 442 adults living in the United States who were recruited via Amazon Mechanical Turk. Data were analyzed using multiple logistic regression. Results indicated that compared to a sample 1 month into the pandemic, participants in the current sample reported worse family health and increases in both positive and negative perceptions of the pandemic on family life and routines. COVID-19 stressors and perceived negative effects of the pandemic on family life increased the odds for moderate-to-severe depression and anxiety while having more family health resources decreased the odds for depression and anxiety symptoms. Participants reported lower odds for worse depression and anxiety since the beginning of the pandemic when they reported more positive family meaning due to the pandemic. The results suggest a need to consider the impact of family life on mental health in pandemics and other disasters.

Characterizing Pharmacist Perspectives on Utilizing a Personalized Family Medication Safety Plan for Opioid Education with Adolescents and Parents

BACKGROUND

Exposure to prescription opioids during adolescence is associated with an increased risk of future opioid misuse. The pervasive and growing impact of the opioid epidemic requires evidence-based, co-designed interventions targeted at adolescents. MedSMA℞T Families is an intervention tailored to educate adolescents and their families about opioid misuse prevention and consists of two parts: the MedSMA℞T: Adventures in PharmaCity videogame and the family medication safety plan (FMSP).

OBJECTIVE

This study sought to explore pharmacists' perceptions of using the family medication safety plan to facilitate opioid education among parents and their adolescents. The purpose of this project was to also gather information for iterative adaptations to improve implementation and dissemination of the FMSP in pharmacy settings.

METHODS

Pharmacists were recruited from Pharmacy Practice Enhancement and Action Research Link (PearlRx) and the Pharmacy Society of Wisconsin (PSW). Twenty-one pharmacist interviews were conducted between September 2021 and March 2022. Consenting pharmacists reviewed the FMSP. Then, semi-structured interviews were conducted, recorded, and transcribed. Inductive thematic analyses were performed using NVivo software.

RESULTS

Four prevalent themes emerged: (1) the purpose of FMSP as a communication tool, (2) instructions to clarify how to use FMSP, (3) barriers to using FMSP, and (4) suggestions to improve FMSP format. Most pharmacists described the FMSP as a tool to encourage interactive opioid conversations between adolescents, families, and pharmacists. Pharmacists suggested creating multiple customizable formats and incorporating instructions on how to use the FMSP.

CONCLUSIONS

Pharmacists noted that the FMSP was an interactive and engaging communication tool to tailor opioid consultations with adolescents and their families. Patients might use the FMSP as a visual cue to help think of what question(s) they should ask pharmacists. Pharmacists stated that the FMSP could facilitate tailored opioid safety communication and medication consultations. Insights will inform future medication misuse prevention interventions as well as adaptation.

Parents: A Cross-Sectional Study

Some research suggests that parents on social media have access to greater social support and health information. However, evidence also connects parental social media use to negative outcomes including increased parental stress, depression, and distraction. Using the uses and gratification theory, this study goes beyond measures of parents' individual mental health and explores social media use and its association with family well-being. Family health outcomes were predicted to vary with parents' use and gratifications of social media, with parents who use social media primarily for information and connection scoring higher on family health and parents who used social media for entertainment scoring worse on family health. The sample included 482 heterosexual married or cohabiting partners recruited through a Qualtrics panel. All participants were parents of children ages of 3-13, with mothers and fathers each completing the survey. Findings indicated that fathers' use of social media for entertainment and connecting with family and friends was associated with better family well-being and health resources (p < 0.01). However, mothers' use of social media did not have a statistically meaningful relationship with family health variables. There was no evidence that parental social media use was associated with negative family health outcomes. Longitudinal data is needed to determine the temporal relationship between social media use and family health. Public health professionals interested in improving family health may consider how to better reach fathers on social media to increase health resources.

Inverted U-shaped relationship between education and family health: The urban-rural gap in Chinese dual society

Introduction

The Healthy China Initiative emphasizes family health. Education is an upstream determinant of health, which can both achieve upward mobility and cause class solidification.

Methods

Using nationwide large-scale data collected in 2021, the present study explored the relationship between education and family health in the urban-rural dual society via Oaxaca-Blinder decomposition and propensity score matching.

Results

Our data revealed disparities in family health, educational attainment, household income, healthcare coverage, and job type between urban and rural China. An inverted U-shaped relationship existed between increasing years of education and family health. The upper limit was 17.1 years for urban residents and 13.7 years for rural residents, with limited health benefits from higher education obtained by rural residents. Mediated by work-family conflict, highly-educated people received gradually diminishing health returns. The results of the Oaxaca-Blinder decomposition showed that 25.8% of the urban-rural gap in family health could be explained by the disparity in education. Urban residents could translate cultural capital and economic capital into health capital to a greater extent. After propensity score matching, a robust, inverted U-shaped relationship was found between education and family health. The inverted U-shaped relationship was found to replace family health with self-rated health and quality of life.

Discussion

Family-centered public health and education programs, policies, and goals should be developed to break urban-rural dual structure barriers and advance social equity in China.

Can smartphone use affect chronic disease self-management among Chinese middle-aged and older adults? A moderated mediation model

Introduction

Chronic disease self-management is influenced by many factors. Previous studies have linked patients' media use with chronic disease self-management, but the underlying mechanisms of this relationship are less understood.

Objectives

The purpose of this study is to explore the mediating role of family health (FH) between frequency of smartphone use (FOSU) and self-management behaviors among middle-aged and older patients with chronic diseases (SBAMAOPWCD) through a moderated mediation model, and whether this indirect relationship is modified by the solitary status of middle-aged and older Chinese patients with chronic disease.

Methods

Surveys were collected from 1,424 (N = 1,424; age > 45) middle-aged and older with one or more chronic conditions in China on self-reports of FOSU, FH and Chronic disease self-management behaviors were used to examine the moderated mediation model.

Results

The results showed that the FOSU was significantly and positively associated with SBAMAOPWCD (β = 0.220, p < 0.001; β = 0.170, p < 0.001; β = 0.167, p < 0.001; β = 0.158, p < 0.001); The Family health resources (FHR) dimension of FH and the Family external social supports (FESS) dimension mediated the relationship between the FOSU and SBAMAOPWCD (β = -0.0758, CI: -0.1402, -0.0236; β = 0.0721, CI: 0.0141, 0.1458), Among them, the FHR dimension mediated mainly among FOSU, exercise and cognitive symptom management practices (CSMP; β = -0.0344, CI: -0.0652, -0.0102; β = -0.0401, CI: -0.0725, -0.0138), the FESS dimension of the FH mediated the relationship between the FOSU and communication with physicians (CWP; β = 0.0376, CI: 0.0116, 0.0705); Solitary state played a moderating role in the relationship between FHR dimension and SBAMAOPWCD (live alone β = -0.2395, CI: -0.4574, -0.0661; not live-alone β = -0.0599, CI: -0.1164, -0.0172). In addition, solitary state played a moderating role in the relationship among FHR dimension and CSMP for middle-aged and older patients (live alone β = -0.1095, CI: -0.1961, -0.0378; not live-alone β = -0.0334, CI: -0.0633, -0.0102). Interestingly, the relationship between FESS dimension and SBAMAOPWCD was moderated only by the non-live alone population (β = 0.0676, CI: 0.0008, 0.1478), and not by the live-alone population (β = 0.1026, CI: -0.1061, 0.3278).Unexpectedly, we found that when their FHR were lower, they reported higher levels of chronic disease self-management, middle-aged and older patients with chronic diseases who live alone are more significant in this impact relationship.

Conclusions

The study further deepens our understanding of the mechanisms linking frequency of smartphone use with chronic disease self-management behaviors, and it helps to develop interventions to improve chronic disease self-management behaviors in middle-aged and older adults.

Comprehensive Comparisons of Family Health Between Families With One Immigrant Parent and Native Families in Taiwan: Nationwide Population-Based Cohort Study

BACKGROUND

Mothers and children in families with one immigrant parent have been reported to be healthier than those in native families; however, the health of the fathers in these families has rarely been discussed in literature.

OBJECTIVE

We aimed to comprehensively compare the health of all the family members between families with one immigrant parent (native fathers, immigrant mothers, and their children) and native families (native fathers, native mothers, and their children).

METHODS

We conducted a cohort study by using the Taiwan Maternal and Child Health Database to recruit live-born children and their parents from 2004 to 2016. Overall, we identified 90,670 fathers, 91,270 mothers, and 132,457 children in families with one immigrant parent and 1,666,775 fathers, 1,734,104 mothers, and 2,637,191 children in native families and followed up with them from 2004 to 2017. The outcomes comprised common physical and mental disorders, catastrophic illnesses, mortality, and child adversities and accidents. The covariates comprised the child's year of birth, parental age, low-income status, and physical or mental disorder status. Logistic regression was performed to compare the risks of the outcomes between families with one immigrant parent and native families.

RESULTS

The parents in families with one immigrant parent were more likely to be of low-income status and were older than the parents in native families. After adjusting for the covariates, fathers in families with one immigrant parent were found to have higher risks of physical and mental disorders, catastrophic illness, and mortality than fathers in native families. Conversely, mothers in families with one immigrant parent had lower risks of physical and mental disorders, catastrophic illness, and mortality than mothers in native families. Finally, the children in families with one immigrant parent generally had better physical and mental health but higher risks for leukemia, liver diseases, autism spectrum disorder, and road traffic accidents than children in native families.

CONCLUSIONS

The health status of the members of families with one immigrant parent was nonhomogeneous, and the poorer general health of fathers in such families suggests health inequalities in families with one immigrant parent.

Elderly Mortality due to Ambulatory Care Sensitive Conditions and Primary Health Care Coverage in the Federal District

OBJECTIVES

To describe the mortality coefficients of elderly due to primary care sensitive conditions, from 2008 to 2018, and determine its association with the coverage of the Primary Health Care (Family Health Strategy and Basic Care models) in the Federal District.

METHODS

Ecological time series of mortality in Federal District elderly, from 2008 to 2018. The Poisson regression model was applied, considering as significant those with p<0.05, with a CI of 95%.

RESULTS

There were 70,503 deaths. There was a decrease in the risk of death of elders due to cardiovascular diseases and diabetes. Higher primary care coverage decreased the chance of death by sensitive conditions, both in Basic Care (OR: 0.994, CI: 0.990-0.998) and in the Family Health Strategy (OR: 0.997, CI: 0.995-0.999).

CONCLUSIONS

Primary Care coverage was associated with a lower chance of death of the elderly due to Ambulatory Care Sensitive Conditions, especially in Basic Care.

Getting the FACS: A Protocol for Developing a Survey Instrument to Measure Carer and Family Engagement with Mental Health Services

Government policies recommend, and all stakeholders benefit, when mental health services meaningfully engage with carers and family. However, health service engagement with carers is inadequate, and often non-existent with children whose parents are service users. There are seven fundamental ways that carers and families want to be integrated with and engaged by health services but current survey instruments do not capture these seven engagement practices. This protocol describes the development of two closely aligned Family and Carer Surveys (FACS) to measure engagement of service users in mental health services. The new measures are based on the seven engagement themes and a conceptual distinction between the carer and family, with particular focus on where the service user is a parent. The instruments will be developed in five stages; (1) item generation (2) Cognitive pretesting of survey (3) preliminary item content quantitative assessment (4) psychometric analysis of a large data collection and (5) selection of items for short form instruments. These steps will operationalise the seven fundamental ways that families and carers want to be engaged with mental health services, thereby providing valid and reliable measures for use in research and benchmarking of carer and family engagement.

Evaluating the implementation of user embracement in the healthcare system of Jaboatão dos Guararapes city, Brazil

BACKGROUND

The advent of the Family Health Strategy required healthcare teams to strengthen bonding and accountability towards users. In this sense, humanisation has been the key to a successful care provision and to the acceptance of interventions that can meet demands. Our study aimed to evaluate the implementation of user embracement in Family Health Units of Jaboatão dos Guararapes, Pernambuco, Brazil.

METHODS

The studied population belonged to 48 Family Health teams. Eighty-five healthcare workers with higher education answered the questionnaire, and the registration forms of 272 users were examined, from which sociodemographic information was gathered. These data were analysed according to the degree of vulnerability. Questionnaire results were collected and tabulated using the HCMaps software. Dimensions were analysed through a Likert-type grading scale ranging from 1 to 5. This is an evaluative, cross-sectional study with a quantitative approach, considering the dimensions proposed in the RE-AIM framework.

RESULTS

User embracement was considered unsatisfactory, as were Reach and Adoption. The Effectiveness, Implementation, and Maintenance dimensions yielded satisfactory results. The main ones were the perception of user embracement as a screening process, and the delimitation of open slots and/or schedules.

CONCLUSIONS

The study shows that user embracement has been effective in strengthening bonds, reducing queues, and solving demands. However, the potential user embracement sustainability and implementation have been hampered by factors related to the Adoption of the intervention.

Barriers to assessing vulnerability in pregnant women. A cross-sectional survey in Danish general practice

BACKGROUND

Undetected vulnerability in pregnancy contributes to inequality in maternal and perinatal health and is associated with negative birth outcomes and adverse child outcomes. Nationwide reports indicate important barriers to assessing vulnerability among Danish general practitioners.

OBJECTIVE

To explore general practitioners perceived barriers to vulnerability assessment in pregnant women and whether the barriers are associated with practice organization of antenatal care, general practitioner, and practice characteristics.

METHODS

The questionnaire was sent to all Danish general practitioners (N = 3,465). Descriptive statistics described the barriers to assessing vulnerability in pregnant women. Analytical statistics with ordered logistic regression models were used to describe the association between selected barriers to vulnerability assessment and antenatal care organization, and general practitioner and practice characteristics.

RESULTS

760 general practitioners (22%) answered. Barriers to vulnerability assessment were related to lacking routines for addressing vulnerability, lacking attention to and record-keeping on vulnerability indicators, an insufficient overview of vulnerable pregnant women, and perceived insufficient remuneration for antenatal care consultations. Not prioritizing extra time when caring for vulnerable pregnant women was associated with experiencing more barriers. Always prioritizing continuity of care was associated with experiencing fewer barriers. General practitioners of either young age, male gender, or who did not prioritize extra time to care for vulnerable pregnant women experienced more barriers.

CONCLUSION

Barriers to vulnerability assessment among pregnant women do exist in general practice and are associated with organizational characteristics such as lacking prioritization of extra time and continuity in antenatal care consultations. Also, general practitioner characteristics like male gender and relatively young age are associated with barriers to vulnerability assessment.

Clinical decision support methods for children and youths with mental health disorders in primary care

BACKGROUND

Mental health disorders among children and youths are common and often have negative consequences for children, youths, and families if unrecognized and untreated. With the goal of early recognition, primary care physicians (PCPs) play a significant role in the detection and referral of mental disorders. However, PCPs report several barriers related to confidence, knowledge, and interdisciplinary collaboration. Therefore, initiatives have been taken to assist PCPs in their clinical decision-making through clinical decision support methods (CDSMs).

OBJECTIVES

This review aimed to identify CDSMs in the literature and describe their functionalities and quality.

METHODS

In this review, a search strategy was performed to access all available studies in PubMed, PsychINFO, Embase, Web of Science, and COCHRANE using keywords. Studies that involved CDSMs for PCP clinical decision-making regarding psychosocial or psychiatric problems among children and youths (0-24 years old) were included. The search was conducted according to PRISMA-Protocols.

RESULTS

Of 1,294 studies identified, 25 were eligible for inclusion and varied in quality. Eighteen CDSMs were described. Fourteen studies described computer-based methods with decision support, focusing on self-help, probable diagnosis, and treatment suggestions. Nine studies described telecommunication methods, which offered support through interdisciplinary (video) calls. Two studies described CDSMs with a combination of components related to the two CDSM categories.

CONCLUSION

Easy-to-use CDSMs of good quality are valuable for advising PCPs on the detection and referral of children and youths with mental health disorders. However, valid multicentre research on a combination of computer-based methods and telecommunication is still needed.

Family Health among Families with Primary School Children during the COVID Pandemic in Thailand, 2022

Despite evidence suggesting that the COVID pandemic has negatively affected the mental health and well-being of school aged children and parents, there are limited studies describing the state of family well-being. This study aimed to use the family health lens to assess the well-being of Thai families with primary school children and to identify its associated factors. A cross-sectional survey was conducted during January and March 2022, a period of school closure when onsite education was replaced by online education from time to time. The family health scale (FHS) questionnaire survey was carried out among 701 parents of Thai families with primary school children. The questionnaire comprised 10 questions regarding family belief, health, relationships, financial security, and housing environment. Independent variables included: (1) parental/household factors; (2) online learning related issues; (3) children's mental health; and (4) parents' health behaviors. Multinomial logistic regression was undertaken. Results showed that half of Thai families (54.6%) reported having moderate health status. Factors that were associated with lower levels of family health, such as poor or moderate levels, included families with a child that had mental health problems (adjusted odd ratio (AOR) = 5.0 [95% CI = 2.6-9.5] for poor v. excellent, and AOR = 2.7 [95% CI = 1.9-4.0] for moderate v. excellent), single parents (AOR = 2.5 [95% CI = 1.2-5.2] for poor v. excellent), a higher number (≥3) of children (AOR = 2.1 [95% CI = 1.0-4.0] for moderate v. excellent), and smoking parents (AOR = 6.5 [95% CI =1.2-34.8] for poor v. excellent). During health emergencies, health policy for providing adequate assistance to single parents, especially those that have a child with mental health problems, is of utmost importance. The design of health promotion activities and interventions should be targeted not only at single families, but also families with higher numbers of children and parents who smoke at home.

Family Health of Patients With Heart Failure and Their Family Members Before and During the First COVID-19 Lockdown

Background: Family health plays a vital role in the self-care and lifestyle modifications in families living with heart failure. Objective: To investigate the family health of patients with heart failure and their family members before and during the first COVID-19 lockdown. Method: This was a cross-sectional study design. We included 34 participants before and 34 participants during the first COVID-19 lockdown. Independent t-tests were conducted for comparison of the mean scores of the family health and its dimensions. Results: There was no significant difference between the total score of family health during the first COVID-19 lockdown compared to before the first COVID-19 lockdown in patients and family members. However, the values and ill-being dimensions of family health in patients and ill-being dimension in family members were significantly decreased during the first COVID-19 lockdown. Conclusion: This study indicated the positive and negative impacts of COVID-19 lockdown on family health. Implications for Nursing: Our results may help nurses to identify vulnerable patients with a low level of family health to tailor the best support to them.

Relationship between parental mental health and developmental disorders in early childhood

Social intervention with children with disabilities and their families should be understood through the principles of family-centred practice. In Spain, early intervention is understood as interventions aimed at children from 0 to 6 years old and their families. Professionals carry out the reception, assessment and intervention. This study aims to analyse the relationship between mental and physical health, caregivers' levels of anxiety and depression and the child's development during the fostering and assessment phase. The sample is made up of 135 families using child development centres in the Balearic Islands. Four questionnaires were completed: Health-Related Quality of Life SF-12, Anxiety and Depression Scale, Child Behaviour Checklist (CBCL 1½-5) and socio-demographic questionnaire. The results show that parents of children with disabilities have higher levels of mental health impairment than physical health impairment. They also score higher on anxiety than on depression. It is worth noting that professional discipline is a variable to be taken into account in relation to parents' perception of their child's developmental improvement. In addition, the association between the developmental subscales, where the more the child is affected, the more the parents' mental health is affected. The same pattern occurs with caregivers' levels of anxiety and depression. In short, we propose a reflection on the application of family-centred practices during interventions, understanding the lack of professional training as a predictor of the quality of early intervention.

Association of Parent Preventive Care with their Child's Recommended Well-Child Visits

BACKGROUND

Receipt of recommended well-child care is lowest for children without insurance, many of whom receive care in community health centers (CHCs).

OBJECTIVE

To understand if there is an association between parent preventive care and their children's well-child visits.

METHODS

We used electronic health record data to identify children and link them to parents both seen in an OCHIN network (CHC; n = 363 clinics from 17 states), randomly selected a child aged 3 to 17 with ≥1 ambulatory visit between 2015 and 2018. We employed a retrospective, cohort study design and used general estimating equations Poisson regression to estimate yearly rates of well-child visits based on parent preventive care adjusted for relevant covariates and stratified by child age for 3 linked samples: mother only, father only, and two parents.

RESULTS

We included 75,398 linked mother only pairs, 12,438 in our father only, and 4,156 in our 2-parent sample. Children in the mother only sample had a 6% greater rate of yearly well-child visits when their mother received preventive care (adjusted rate ratio [ARR] = 1.06; 95% CI = 1.03-1.08) compared to no preventive care. Children in the father only sample had a 7% greater rate of yearly well-child visits when their father received preventive care (ARR = 1.07; 95% CI = 1.04-1.11) versus no preventive care. Children in the two parent sample had an 11% greater rate of yearly well-child visits when both parents received preventive care (ARR = 1.11; 95% CI = 1.03-1.19) compared to neither receiving preventive care.

CONCLUSIONS

These findings suggest focusing on receipt of healthcare for the whole family may improve well-child visit rates.