How are parental mental health and parenting practices associated with externalizing behaviors among young children with autism in China? A cross-sectional study and indirect effect analysis

Children with autism are more likely to exhibit externalizing behaviors than children without autism. A cross-sectional study was undertaken to investigate how parental mental health status and parenting practices contributed to the variance in externalizing behaviors among families of young children with autism in Chinese mainland, and whether parenting behaviors had any indirect effects on the relationship between parental mental health symptoms and externalizing behaviors. Data were drawn from the baseline assessment of a quasi-experimental study of a parent training program delivered to Chinese caregivers of children with autism aged 3 to 6 from diverse backgrounds (N = 111). Results showed that parental mental health symptoms and parenting behaviors explained the variance in child externalizing behaviors. Parental mental health problems and parental over-reactivity were linked to higher levels of child externalizing behaviors, whereas positive parenting was associated with less frequent externalizing behaviors. Positive parenting partially explained the relationship between parental mental health symptoms and externalizing behaviors. The findings of this study highlight the importance of actively attending to the psychological and parenting needs of caregivers in autism treatment programs. It points to the need for the development of culturally sensitive strategies to promote parental mental health and increase the use of positive parenting skills among parents of children with autism

Factors associated with violence against children in low- and middle-income countries:A systematic review and meta-regression of nationally representative data

Background: This systematic review and meta-regression sought to identify the relative importance of factors associated with physical, emotional, and sexual violence against children in low- and middle-income countries. Understanding of factors associated with violence is important for targeted programming and prevention on the population level. Methods: We searched 17 electronic databases from 1989 to 2018 and reports from child violence surveys. Nationally representative studies that described evidence on potential factors associated with violence against children under 18 years old were included. The search was restricted to the English language. Factors were synthesized quantitatively using robust variance estimation, with 95% confidence intervals, for each violence type. Results: We identified 8,346 unduplicated studies, and 103 publications met our eligibility criteria. The data distribution was uneven across region, country income status, factors, and violence types. Of the 94 eligible studies quantitatively synthesized, no specific factors were significant for physical violence. Lower household socioeconomic status, being a girl, and primary education of mothers and adults in the household were associated with emotional violence, and being a girl was associated with sexual violence. Conclusion: A broad spectrum of factors merit consideration for physical violence policy and prevention among the general population of children in low- and middle-income countries. Conversely, a tailored approach may be warranted for preventing emotional and sexual violence. Information is unequally distributed across countries, factors, and violence types. Greater emphasis should be placed on collecting representative data on the general population and vulnerable subgroups to achieve national reductions in violence against children. </jats:sec

Parenting interventions during the COVID-19 pandemic: A systematic review of the rationales, process, feasibility, acceptability, and impacts of adaptation

Evidence shows that parenting interventions are an effective method of reducing caregiver-perpetrated child maltreatment. The recent COVID-19 pandemic has changed the provision of parenting interventions worldwide, with many interventions adapting to continue providing services during the crisis. This global systematic review examined how parenting interventions targeting child maltreatment and its risk and protective factors, were adapted during the COVID-19 pandemic. We searched for studies published between 2020 and 2022, and identified 31 eligible studies. The data on the rationale, process, feasibility, acceptability, and impacts of adaptations were narratively synthesized in accordance with the Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions. Results showed that most adaptations were proactive and focused on delivery methods, predominantly digitalization. While feasibility and acceptability were generally observed, the impacts of adapted programs were inconclusive. Inadequate reporting, especially regarding rationale, fidelity, facilitator capacity building, stakeholder involvement, and decision-making processes, was noted. The review recommends enhanced planning, documentation, and reporting of program adaptations using established guidelines, as well as process and impact evaluations

Adaptations and staff experiences in delivering parenting programmes and other family support services in three community-based organisations in Cape Town, South Africa during the COVID pandemic

We explore how organisations working on parenting programmes and other types of family support and violence prevention in low-resource settings experienced the pandemic. In August 2020–May 2021, we interviewed (1) staff from three community-based organisations delivering evidence-informed parenting interventions and other psychosocial services for families in Cape Town, South Africa, (2) staff from a parenting programme training organisation and (3) staff from two international organisations supporting psychosocial services in South Africa. Interviews (22) were thematically analysed, with findings in three areas. First, respondents noted changes in the context, including the job losses, food insecurity, and stress experienced by local communities, and reductions in organisational funding. Second, we found that in response to these context changes, the organisations shifted their focus to food provision and COVID prevention. Parenting and psychosocial programmes were adapted – e.g. by changing the physical delivery settings, reducing group sizes, and taking up digital and phone implementation. Participants reported improved perceptions of remote delivery as a feasible approach for working with families – but internet and phone access remained challenging. Third, the pandemic brought new responsibilities for staff, and both the challenges of working from home and the health risks of in-person work

Adaptations and staff experiences in delivering parenting programmes and other family support services in three community- based organisations in Cape Town, South Africa during the COVID pandemic

We explore how organisations working on parenting programmes and other types of family support and violence prevention in low-resource settings experienced the pandemic. In August 2020–May 2021, we interviewed (1) staff from three community-based organisations delivering evidence-informed parenting interventions and other psychosocial services for families in Cape Town, South Africa, (2) staff from a parenting programme training organisation and (3) staff from two international organisations supporting psychosocial services in South Africa. Interviews (22) were thematically analysed, with findings in three areas. First, respondents noted changes in the context, including the job losses, food insecurity, and stress experienced by local communities, and reductions in organisational funding. Second, we found that in response to these context changes, the organisations shifted their focus to food provision and COVID prevention. Parenting and psychosocial programmes were adapted – e.g. by changing the physical delivery settings, reducing group sizes, and taking up digital and phone implementation. Participants reported improved perceptions of remote delivery as a feasible approach for working with families – but internet and phone access remained challenging. Third, the pandemic brought new responsibilities for Adaptations and staff experiences in delivering parenting programmes and other family support services in three community-based organisations in Cape Town, South Africa during the COVID pandemic staff, and both the challenges of working from home and the health risks of in-person work

The science of scale for violence prevention: a new agenda for family strengthening in low- and middle-income countries

Ending all violence against children by 2030 is a core part of Sustainable Development Goals 5 and 16. A number of promising violence reduction strategies have been identified in research studies. However, we lack an understanding of the implementation and impact of these programs in respect to their delivery at a large scale or within existing service systems, particularly in low- and middle-income countries (LMICs). We advocate for greater collaboration between researchers, policymakers, donors, governments, non-governmental organizations, and program managers and staff to study how violence prevention programs operate on a large scale. We describe a new initiative aiming to foster such collaborations in the field of family strengthening programs

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Parenting interventions that promote child protection and development for preschool-age children with developmental disabilities: a global systematic review and meta-analysis

Global guidelines emphasize the critical role of responsive caregiving in terms of reducing violence against children and promoting early childhood development. However, there is an absence of global evidence synthesis on the effects of early childhood parenting programs for children with developmental disabilities. This systematic review and meta-analysis aims to investigate the effectiveness of parenting interventions delivered for preschool-age children with developmental disabilities in reducing violence against children, altering violence-related factors, and promoting child development. We searched for randomized controlled trials with inactive control. Estimates were pooled using robust variance estimations. Meta-regressions were conducted to explore sources of heterogeneity. In all, 33 studies met the inclusion criteria. The results showed that parenting programs improved child behavior, parental mental health, parenting practices, parental self-efficacy, parent–child interaction, child language skills, and child social skills post-intervention. No studies provided data on the actual occurrence of violence against children. Effects might vary by diagnosis, delivery modality, and world region. The findings supported the delivery of parenting programs to alter factors associated with violence against children and promote child language and social skills for families of young children with developmental disabilities, especially attention deficit hyperactivity disorder, autism, intellectual disability, and language disorders. More research using rigorous methods, long-term follow-ups, and transparent reporting is needed, particularly within more low- and middle-income countries

Feasibility and acceptability of parenting for lifelong health program in Mainland China

Purpose: Parenting for Lifelong Health for Young Children (PLH-YC) is a program to prevent child maltreatment. This study aimed to examine the feasibility, acceptability and preliminary effects of the adapted program for Chinese parents. Methods: A pre–post single-arm pilot trial was conducted with 21 Chinese parents. A mixed-method design was utilized to collect questionnaire-based quantitative data and qualitative data of interviews and focus group discussions. Results: Program implementation was feasible, with overall high recruitment, enrollment, attendance, acceptability and fidelity. Quantitative results demonstrated reductions in general child maltreatment, physical and emotional abuse, child behavioral problems, and improvements in positive parenting. Thematic analyses identified reduced violent discipline, psychological aggression, and child behavioral problems, strengthened parent–child bonds, increased parenting confidence, and decreased family conflict. Conclusion: The adapted PLH-YC program for Chinese parents has shown good feasibility and acceptability, and exhibited a significant association with reduced child maltreatment. Further randomized controlled trials are required