Play spaces are important components of paediatric healthcare environments. They provide children with critical opportunities to experience the social, emotional, and developmental benefits of play ...while in healthcare settings for appointments or hospitalizations. These spaces can help to mitigate stress, provide a sense of normalcy in unfamiliar environments, and facilitate social engagement for children and their families. Given the benefits of play spaces in paediatric healthcare settings, it is important to understand how these spaces can be designed to enhance children's inclusion and quality of care. The aim of this scoping review was to explore the current understanding of paediatric play space design. Using search terms related to children, health care, and play space, six interdisciplinary databases were searched over a 30-year period. The search found 2,533 records from which eighteen were included for review. Findings suggest that although it is well-documented that play spaces offer valuable social and emotional benefits, little is known about the specific design features that can and should be incorporated to enhance play opportunities and ensure that they benefit all children and families. Further, the literature mostly considers play spaces in the context of designated play or recreational rooms. Scholars are encouraged to consider how play opportunities can be incorporated into the designs of paediatric healthcare environments beyond the boundaries of these rooms. Future studies should also consider the diversity of play space users, including children of varying ages and abilities, to create more accessible and inclusive paediatric play spaces for children and their families. Advancing knowledge on play space design can help to optimize the quality of these important spaces and to ensure their designs meaningfully enhance children's play experiences and quality of care.
Background:
Autism is not always considered for girls and women until later along their clinical diagnostic pathways. Misdiagnosis or late diagnosis can pose significant disadvantages with respect to ...accessing timely health and autism-related services and supports. Understanding what contributes to roadblocks and detours along clinical pathways to an autism diagnosis can shed light on missed opportunities for earlier recognition.
Objective:
Our objective was to examine what contributed to roadblocks, detours, and missed opportunities for earlier recognition and clinical diagnosis of autism for girls and women.
Design:
We conducted a qualitative secondary analysis using data from a Canadian primary study that examined the health and healthcare experiences of autistic girls and women through interviews and focus groups.
Methods:
Transcript data of 22 girls and women clinically diagnosed with autism and 15 parents were analysed, drawing on reflexive thematic analysis procedures. Techniques included coding data both inductively based on descriptions of roadblocks and detours and deductively based on conceptualizations of sex and gender. Patterns of ideas were categorized into themes and the ‘story’ of each theme was refined through writing and discussing analytic memos, reflecting on sex and gender assumptions, and creating a visual map of clinical pathways.
Results:
Contributing factors to roadblocks, detours, and missed opportunities for earlier recognition and diagnosis were categorized as follows: (1) age of pre-diagnosis ‘red flags’ and ‘signals’; (2) ‘non-autism’ mental health diagnoses first; (3) narrow understandings of autism based on male stereotypes; and (4) unavailable and unaffordable diagnostic services.
Conclusion:
Professionals providing developmental, mental health, educational, and/or employment supports can be more attuned to nuanced autism presentations. Research in collaboration with autistic girls and women and their childhood caregivers can help to identify examples of nuanced autistic features and how context plays a role in how these are experienced and navigated.
Between 1860 and 1880, the years which hold the richest collection of log books at the Maritime History Archive in St. John’s, NL, an average of 4,400 seafarers died per year working in the British ...merchant marine. Each of these deaths potentially produced an inventory of effects showing the material wealth of working people at sea. These inventories reveal the material possessions of late nineteenth-century seafarers, particularly young working-class men who exposed themselves most to danger but also were the most numerous demographic. By analyzing both what these inventories contain, but also what inventories are missing, it is possible to understand material factors stemming from changing dynamics in a workforce undergoing technological and demographical change.
School climate has long been understood to influence student success, yet the social climate and playspace of recess is often overlooked in overall school improvement efforts. The Recess Project is a ...collaborative action research project that aims to improve the social climate of recess through fostering a sense of belonging and enjoyment. We report a mixed-methods exploratory evaluation of the project based on survey data from 784 students in grades 4-8. Quantitative analysis compared scores for belonging and enjoyment between children who attended Recess Project (RP) schools and those who did not NRP. The RP group reported more enjoyment than the NRP group, while sense of belonging was not significantly different between groups. Belonging and positive affect were positively associated with enjoyment scores in both groups, however, these associations were stronger in the RP group. Qualitative analyses revealed children enjoyed recess for the opportunity to socialise and to have autonomy over their activities. Children who did not enjoy recess reported boredom, bad weather and experiences of victimisation. We discuss the implications for future work on improving the quality of the social climate of recess.
Studies of the effects of biodiversity on ecosystem function (BDEF) have largely found positive, saturating relationships. However, these studies have been criticised for generating species loss ...randomly when real extinctions are strongly biased toward rare species. We investigated BDEF relationships in the mollusc fauna of an intertidal rock platform at Griffiths Point, San Remo, south-east Victoria, Australia. Field surveys found that areas with the lowest function (mollusc biomass) were associated with lowest diversity. Excluding individual species from experimental enclosures affected function differentially depending on species' initial abundance. Rectangular enclosures were attached to the rock platform enabling molluscs to be enclosed while allowing sea water to flow through. Removal of the most abundant species had a positive effect on mollusc biomass, suggesting an inhibition of the other species in the community. In the absence of the most common species, the less abundant species were more productive in combination than when present singly. Taken collectively, these results provide evidence for a relationship between biodiversity and ecosystem function which is a product of both diversity per se and species identity.
Introduction: Overweight and obesity (OW/OB) rates are increasing among Canadian children and youth, with rates currently affecting one-third of 5-17 year olds. OW/OB is associated with numerous ...physical and psychosocial consequences, which are compounded when a child has a pre-existing disability. This is concerning considering children with disabilities experience OW/OB at two to three times the rate of their typically developing peers. While the number of weight management programs have been increasing, they are generally designed to meet the needs of typically developing children and often exclude children with disabilities. This review identifies existing weight management programs for youth with disabilities, and examines their characteristics and outcomes.
Methods: A scoping review was conducted using rapid review principles. Three health and social science databases were searched using terms related to "disabilities", "obesity", and "weight management", limited to 2007-2017. Articles meeting the inclusion criteria were summarized and analyzed thematically.
Results: Five articles met inclusion criteria, and described four separate weight management programs. All included children and youth with intellectual disabilities, with one including children with physical disabilities. Programs had three traits in common: (1) utilizing inter/multidisciplinary teams; (2) using technology to deliver the program; and (3) engaging the family during the entire program. All articles reported that the programs reduced body mass index.
Conclusion: The scarcity of programs designed to meet the unique needs of youth with disabilities is alarming. Although a robust evidence base is lacking, current research provides some directions into components that should be considered when designing future interventions.
Implications for Rehabilitation
1. Clinicians should be aware of the high prevalence of overweight and obesity and the resultant consequences in children with disabilities.
2. The use of inter/multidisciplinary teams, technology, and family engagement all appear to be promising approaches to creating successful weight management programs:
a. Weight-management programs should utilize inter/multidisciplinary teams to consider physical, social and psychological aspects of weight and health, to allow treatment plans to encompass a wider range of suggestions and recommendations.
b. Health care providers should consider using technology as a platform to deliver weight-management programs and services and/or to directly track progress.
c. Families are powerful agents of change, and should be consulted and involved in the delivery of weight-management programs.
Background:
Some children with disabilities (CWD) frequently visit pediatric healthcare settings for appointments. Their age, disability, and regular visits mean that they have unique experiences in ...healthcare settings. While previous research has explored the clinical experiences of CWD, little is known about their experiences of pediatric healthcare built environments, even though these environments may play an important role in shaping their perceptions of care. Given the significant time that some CWD and chronic illnesses (e.g., cancer) spend in healthcare environments and the impact that these settings can have on their experiences, the knowledge gap concerning how they view, and experience healthcare built environments demands attention.
Objective:
To explore how CWD and their families experience pediatric healthcare built environments.
Methods:
A scoping review was conducted by searching five health science and interdisciplinary literature databases using terms related to children, disability, healthcare, and built environment. The search identified 5,397 records that were screened independently by three reviewers.
Results:
Nineteen studies met inclusion criteria and were considered in the final review. Findings indicate that CWD and their families value healthcare built environment features that support social engagement, patient privacy, and parental presence. Further, the age of a child was highlighted as an important factor that influences the built environment preferences of CWD.
Conclusions:
CWD and their families prefer certain healthcare built environment features to optimize their experiences in these settings. Healthcare designers can leverage these findings to advance more inclusive pediatric healthcare spaces to improve care and the quality of life for CWD and their families.
The quality and length of life for boys with Duchenne muscular dystrophy (DMD) has improved due to medical advancements, but obesity has emerged as and may pose a risk to their physical health. ...Clinical guidelines recommend attention to weight management, but healthcare professionals (HCPs) find implementing them in clinical care challenging. Little information is available about the perspectives of children with DMD and their families around weight management. This study explored the key priorities of children with DMD, their parents, and HCPs who treat them, around weight management.
Qualitative, individual, semi-structured interviews were conducted and analyzed using a qualitative descriptive approach.
Participants included parents of children with DMD (n = 13), children with DMD (n = 10), and HCPs (n = 14). Theme one: "Competing priorities between healthcare providers, parents, and boys" contained two sub-themes: (i) Body mechanics and function; and (ii) Psychosocial well-being. Theme two: "The realities of living with Duchenne's Muscular Dystrophy," with subthemes: (i) Striving for normality; (ii) The trajectory of DMD; (iii) The labour associated with DMD.
HCPs, parents, and boys have diverging worldviews around weight management, highlighting the importance of integrating the priorities of families into care, even when not aligned with guideline recommendations.
IMPLICATIONS FOR REHABILITATION
HCPs must understand the competing priorities in the lives of children with DMD and their families when discussing weight, weight management, and lifestyle changes.
Quality of life and living a "normal" life are prioritized by children and families over the surveillance and time demands of lifestyle routines recommended by clinicians for weight management.
Weight management recommendations should be based upon the individual needs and priorities of the family.
Introduction
Due to the increased risk of obesity for boys with Duchenne muscular dystrophy (DMD), recent guidelines recommend that dietary intake is carefully managed. Parents play an important role ...in the development of their child's eating behaviours and patterns. However, despite what is known about the increased risk of obesity for children with DMD, little is known about parental feeding behaviours in this population. The objective of this study was to qualitatively explore the experiences of parents of children with DMD around their child's weight management and understand what influences their feeding behaviours.
Methods
This paper reports a secondary data analysis. Semi‐structured, individual interviews were conducted and analysed using qualitative description.
Results
Thirteen parents were interviewed for the study. Three themes were developed: (1) parent responses to healthcare provider interactions, (2) mixed emotions contributing to feeding approach and (3) variable parenting feeding styles. Within the third theme, two subthemes arose including (1) control and preoccupation and (2) striking a balance.
Conclusion
Given the potential impact of higher weights on the progression of DMD, it is important that healthcare providers explore feeding behaviours with families. However, it is essential that healthcare providers consider the impact of these conversations on parents, as well as the broader issues that may place additional pressure on the lives of families.
This qualitative report is part of a larger action research study on a topic that is often overlooked in school improvement efforts: Recess and its influence on children's social interactions and ...developmental trajectories. We introduced The Recess Project into seven lower-socioeconomic elementary schools in southern Ontario. Our intention for this report was to assess how things were progressing in these schools. We describe the strategies we used and the rationale behind the design of the Recess Project and highlight the dynamics between the setting, the children's patterns of interactions, and the potential developmental outcomes. Participants included students, administrators, teachers, university researchers, and university students. Five themes emerged from our analysis: 1) noticeably less discipline issues, 2) more collaborative play and friendships, 3) noticeably more inclusive behaviors, 4) more refined and prosocial interactions overall, and 5) the children were clearly enjoying themselves. "We discuss the potential implications of these findings on children's overall wellbeing and school engagement."
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