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Predictive student models are increasingly used in learning environments due to their ability to enhance educational outcomes and support stakeholders in making informed decisions. However, predictive models can be biased and produce unfair outcomes, leading to potential discrimination against certain individuals and harmful long-term implications. This has prompted research on fairness metrics meant to capture and quantify such biases. Nonetheless, current metrics primarily focus on predictive performance comparisons between groups, without considering the behavior of the models or the severity of the biases in the outcomes. To address this gap, we proposed a novel metric in a previous work (Verger et al., 2023) named "Model Absolute Density Distance" (MADD), measuring algorithmic unfairness as the difference of the probability distributions of the model's outcomes. In this paper, we extended our previous work with two major additions. Firstly, we provided theoretical and practical considerations on a hyperparameter of MADD, named "bandwidth," useful for optimal measurement of fairness with this metric. Secondly, we demonstrated how MADD can be used not only to measure unfairness but also to mitigate it through postprocessing of the model's outcomes while preserving its accuracy. We experimented with our approach on the same task of predicting student success in online courses as our previous work, and obtained successful results. To facilitate replication and future usages of MADD in different contexts, we developed an open-source Python package called maddlib (https://pypi.org/project/maddlib/). Altogether, our work contributes to advancing the research on fair student models in education.

Marie Costa,1,2 Florian Correard,3,4 Maeva Montaleytang,3,4 Karine Baumstarck,5 Sandrine Loubière,5 Kahena Amichi,6 Patrick Villani,7 Stephane Honore,3,4,8 Aurélie Daumas,7 Pierre Verger1,2 1ORS PACA, Southeastern Health Regional Observatory, Marseille, France; 2Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France; 3AP-HM, Service Pharmacie, Hôpital de la Timone, Marseille 13385, France; 4Laboratoire de Pharmacie Clinique, faculté de pharmacie, Aix-Marseille Université, Marseille 13385, France; 5EA3279, Self-Perceived Health Assessment Research Unit, Aix-Marseille University, Marseille 13385, France; 6Direction de la Recherche Clinique et de l’Innovation (DRCI), AP-HM, Marseille 13354, France; 7Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille 13274, France; 8Service de Pharmacie Clinique, Faculté de Pharmacie Timone, Aix-Marseille Université, Marseille F-13000, FranceCorrespondence: Marie Costa Email Mariecosta1212@gmail.comPurpose: In France, polypharmacy among older people living in nursing homes (NH) is a major public health concern. In this context, the randomized controlled trial TEM-EHPAD was recently launched in various NH in southern France to evaluate the impact of implementing a novel telemedication review (TMR) on hospital admission rates of NH residents at high risk of iatrogenic disease. A qualitative study was integrated into the main trial study to assess general practitioners’ (GP) and other NH healthcare professionals’ (HP) acceptability of the proposed TMR before its implementation.Material and Methods: A qualitative study using face-to-face semi-structured interviews was conducted with 16 HP before the beginning of the intervention. A manual thematic analysis was performed on the transcribed interviews.Results: Four main themes emerged from the thematic analysis: HP perceptions of the TMR, difficulties related to medication management for NH residents, HP perceptions of the roles of different professionals, and facilitators of good practices. Most participants were favorable to the TMR, but some GP expressed fears about loss of control over their prescription writing.Conclusion: This study fulfilled its objective to assess pre-intervention acceptability by GP and other HP. Results provided important information about how to adapt the TMR intervention to make it more acceptable to HP who will be involved in TEM-EHPAD. One of the main recommendations is the importance of providing participating GP with the opportunity to take part in the process of reviewing prescriptions.Keywords: qualitative study, telemedicine, older adults, telemedication review, nursing home, acceptability study, satisfaction assessment

Federal and highly decentralized political systems open different spaces to interpret, adapt, and enact international policy trends and ideas within the same territory. Spain, a country with a highly decentralized educational system and contentious territorial politics, is a very suitable case to analyze these dynamics. Spain and its different regions have not been immune to the influence of global policy ideas that gear around promoting private provision, school choice, and New Public Management (NPM) in education. However, the consolidation of the decentralization project, together with the fact that many regional governments have aimed to construct, for a variety of reasons, singular political profiles, have resulted in markedly different policy trajectories. To show this, this article pays particular attention to recent changes in the educational governance arrangements of two important Spanish regions, Madrid and Catalonia, as they have gone through differentiated processes of educational reform. Albeit the two regional education systems share important features (such as a historical and wide-scale public-private partnership for school provision), they have engaged with, combined, and mobilized exogenous and endogenous privatization policy ideas in remarkably different ways. The article delves into the political drivers behind this policy differentiation process by paying special attention to the relations of coordination, conflict, and competition that prevail within an incomplete federal system, such as the Spanish one.

Abstract Context Clinical data on transgender children and adolescents are scarce, and sample sizes often do not allow for comparisons according to sex assigned at birth. Besides, most gender identity clinics have pointed to a recent switch in favor of an increase in the number of adolescents assigned females at birth (AFAB) over assigned males at birth (AMAB). Method We collected data on sociodemographic characteristics, and psychiatric and social vulnerabilities according to sex assigned at birth for all youths who were treated at the French largest gender identity clinic. In addition, management modalities for gender transition were discussed in multidisciplinary concertation meetings. Results We collected data from 239 youths [162(68%) AFAB, 74(32%) AMAB, and 3(1%) intersex; mean age = 14.5(± 3.16) years]. The distribution of age at referral was better explained by two clusters (C1: N = 61, mean age = 11.3 years, with more AMAB; C2: N = 175, mean age = 15.9 years with more AFAB). 215(91%) youths had gender incongruence, with 32% reporting it before puberty. School drop-out, suicidality, depression, and anxiety were common and occurred significantly more often in the AFAB group. 178(74%) youths experienced social transition within the family, and 144(61%) at school [mean age = 15.13(± 2.06) years]. The social transition was more frequent in the AFAB group. Twenty-six (11%) youths received puberty blockers [mean age = 13.87(± 2.31) years], and 105(44%) received gender-affirming hormones [mean age = 16.87(± 1.4) years]. AMABs were more likely to take puberty blockers, and there was no difference in the proportion of AMAB and AFAB taking gender-affirming hormones. Surgical requests (mainly torsoplasty) were very rare. Conclusion Age at referral should be considered when exploring gender incongruence. During adolescence, we found that gender incongruence has substantial social and psychological effects, particularly on AFAB youths, possibly explaining their higher referral rates to specialized centers, as in other specialized clinics around the world.

Since 2022, Europe has had 4 cases of extensively drug-resistant Neisseria gonorrhoeae, sequence type 16406, that is resistant to ceftriaxone and highly resistant to azithromycin. We report 2 new cases from France in 2023 involving strains genetically related to the 4 cases from Europe as well as isolates from Cambodia.

School systems are shifting towards forms of post-bureaucratic governance (PBG), implying higher levels of school autonomy, choice, and performance-based management. Under this governance approach, which combines forms of administrative and market accountability, schools face greater levels of competition and external pressure to perform. Schools experience such pressures unevenly and address them through different responses. The paper develops a mixed-methods case study conducted in Madrid, a Spanish region where PBG reform has intensified in the last decades, and proposes a novel index to position schools within their reference local education markets. The results show that schools articulate a broad range of logics of action, largely interrelated with their position in the education marketplace. We also show that schools' responses to external pressures are dynamic and marked by tensions of a different nature, which schools need to navigate, often without sufficient support from public authorities.

Despite controversies surrounding faith-based schooling, religious schools continue to play a prominent role in numerous education systems. Nonetheless, empirical research on nonstate religious schools operating in a market context remains limited and fragmented. On the one hand, while religious and cultural studies investigate the evolution of religious education (RE), they tend to focus on state schools while overlooking the impact of market forces. On the other hand, research on education markets often treats religious private schools as a uniform category with a fixed identity. This study aims to bridge this gap by delving into the responses of religious private schools to competitive pressures, focusing on how these schools negotiate their religious identities in a market context. With this objective, the paper presents a case study of Catholic school networks in Catalonia, Spain. We identify three different approaches to RE and religious identity developed by these school networks--confessional, culture-centric and value-centric. The triggering factors and enabling conditions behind these approaches are examined in detail. The study concludes by discussing the relevance of these findings for ongoing debates around the public funding of faith-based schools and the tensions posed by such policies in terms of social cohesion, educational pluralism, and equity.

Contemporary educational reforms emphasise school autonomy, performance-based management, and accountability as necessary policies for attaining improvement goals. Despite their widespread adoption, the configuration and enactment of these policies are discretionary and contingent, deeply influenced by the interaction of local contexts, organisational features, and teachers' beliefs about policy and pedagogy. Apart from these challenges, schools serving disadvantaged students, often targeted for educational improvement, also struggle with significant organisational constraints and policy overload. This study explores how disadvantaged urban schools make sense of their policy environment and engage with the school improvement mandate through different logics and practices. The analytical framework stresses the policy filtering and adaptation processes that school actors undergo when tasked with multiple implementation demands, and how these interact with school contexts to produce diverse responses. This research is conducted in Catalonia, Spain, and adopts a sequential mixed-methods strategy, relying on interviews with principals and teachers, as well as survey and administrative data. The findings are organised in four ideal types of school responses to the improvement mandate, showing the diverging ways schools engage with policy. Disadvantaged schools exhibit diverse improvement approaches despite sharing structural characteristics, explained by the interaction of contextual factors and organisational characteristics. Each ideal type prioritises different aspects, such as performance, innovation, or inclusive practices. The heterogeneity of school responses highlights the necessity for targeted, context-sensitive support to ensure equitable educational practices.

Under test-based accountability, side-effects--including practices to inflate test results, often seen as cheating--are usually associated to so-called high-stakes policies. However, the influence of different types of stakes in the generation of this type of practices has been overlooked in education research. Based on a survey experiment, our results indicate that the type and level of stakes of accountability systems (e.g., high- vs. low-stakes, material vs. symbolic) do not differ in triggering side-effects. Counterintuitively, individual symbolic consequences trigger similar reactions among teachers than material incentives. In-depth interviews give insights into the social mechanisms that lead to symbolic effects having such an influence in understanding teachers' reactivity to accountability.

Creativity researchers are increasingly interested in understanding when, how, and for whom creativity can be beneficial. Previous reviews have demonstrated that creativity research largely ignores the study of its impact on factors that promote health, and well-being among populations of adults. It is unclear, in fact, whether this gap in research also extends to creativity research among young children. This paper addresses this issue. Early childhood is a crucial stage for the cognitive development of young children who remain highly sensitive to stress, and adversity. It is therefore essential to identify and promote factors that are beneficial to early childhood resilience, thereby contributing to documenting more of the effects of creative activities on positive outcomes. This paper presents a review with a bibliometric analysis of 1000 randomly selected articles from the Web of Science, without bias towards any specific peer-reviewed journal. The analysis of 454 included articles shows that approximately 80% of the included studies focus on creativity as an outcome (replicating previous findings with a larger sample), with only 3.78% investigating creative activities as predictors among young children. In this small percentage, most of the studies addressed creative activities in young children related to resilience outcomes.

In recent decades, the governance of educational systems has experienced dramatic changes in many countries. Schools have been given more autonomy whilst being held increasingly accountable at the central level through standardized testing and other forms of external evaluation. The mechanisms of performance-based accountability (PBA) and the consequences attached to test results vary. In high-stakes systems, teachers' careers are more directly connected to students' performance, and low performing schools might risk closure, whereas in lower-stakes systems, the official administrative consequences of accountability for school actors are more symbolic than material. The main aim of this paper is to understand the impact of different forms of PBA on teachers' work from a comparative perspective. Most research on this topic is based on single-context case studies, which makes it difficult to understand the impact of policy factors and professional contexts in teachers' decisions and autonomy. To address this challenge, we review recent investigations (2017-2020) on the topic and compare their findings in different teachers' regulatory contexts. The review includes 101 articles from the SCOPUS and Web of Science databases. We find that evidence on the impact of PBA on teachers' perceptions and beliefs are variegated, and that the implications of PBA on teachers' autonomy does not only depend on the level of accountability stakes, but on teachers' professional regulation.

Surgical resection represents the standard of care for people with newly diagnosed diffuse gliomas, and the neuropathological and molecular profile of the resected tissue guides clinical management and forms the basis for research. The Response Assessment in Neuro-Oncology (RANO) consortium is an international, multidisciplinary effort that aims to standardise research practice in neuro-oncology. These recommendations represent a multidisciplinary consensus from the four RANO groups: RANO resect, RANO recurrent glioblastoma, RANO radiotherapy, and RANO/PET for a standardised workflow to achieve a representative tumour evaluation in a disease characterised by intratumoural heterogeneity, including recommendations on which tumour regions should be surgically sampled, how to define those regions on the basis of preoperative imaging, and the optimal sample volume. Practical recommendations for tissue sampling are given for people with low-grade and high-grade gliomas, as well as for people with newly diagnosed and recurrent disease. Sampling of liquid biopsies is also addressed. A standardised workflow for subsequent handling of the resected tissue is proposed to avoid information loss due to decreasing tissue quality or insufficient clinical information. The recommendations offer a framework for prospective biobanking studies.

Abstract Background The Duchenne and Becker muscular dystrophies (DMD, BMD) are neuromuscular disorders commonly associated with diverse cognitive and behavioral comorbidities. Genotype–phenotype studies suggest that severity and risk of central defects in DMD patients increase with cumulative loss of different dystrophins produced in CNS from independent promoters of the DMD gene. Mutations affecting all dystrophins are nevertheless rare and therefore the clinical evidence on the contribution of the shortest Dp71 isoform to cognitive and behavioral dysfunctions is limited. In this study, we evaluated social, emotional and locomotor functions, and fear-related learning in the Dp71-null mouse model specifically lacking this short dystrophin. Results We demonstrate the presence of abnormal social behavior and ultrasonic vocalization in Dp71-null mice, accompanied by slight changes in exploratory activity and anxiety-related behaviors, in the absence of myopathy and alterations of learning and memory of aversive cue-outcome associations. Conclusions These results support the hypothesis that distal DMD gene mutations affecting Dp71 may contribute to the emergence of social and emotional problems that may relate to the autistic traits and executive dysfunctions reported in DMD. The present alterations in Dp71-null mice may possibly add to the subtle social behavior problems previously associated with the loss of the Dp427 dystrophin, in line with the current hypothesis that risk and severity of behavioral problems in patients increase with cumulative loss of several brain dystrophin isoforms.

Abstract Background Precisely defining the delay in onset of dementia is a particular challenge for early diagnosis. Brain [18F] fluoro-2-deoxy-2-D-glucose (18F-FDG) Positron Emission Tomography (PET) is a particularly interesting tool for the early diagnosis of neurodegenerative diseases, through the measurement of the cerebral glucose metabolic rate. There is currently a lack of longitudinal studies under real-life conditions, with sufficient patients, to accurately evaluate the predictive values of brain 18F-FDG PET scans. Here, we aimed to estimate the value of brain 18F-FDG PET for predicting the risk of dementia conversion and the risk of occurrence of a neurodegenerative pathology. Methods Longitudinal data for a cohort of patients with no diagnosis of dementia at the time of recruitment referred by a tertiary memory clinic for brain 18F-FDG PET were matched with (1) data from the French National Health Data System (NHDS), (2) data from the National Alzheimer Bank (NAB), and (3) lumbar puncture (LP) biomarker data. The criteria for dementia conversion were the designation, within the three years after the brain 18F-FDG PET scan, of a long-term condition for dementia in the NHDS and a dementia stage of cognitive impairment in the NAB. The criterion for the identification of a neurodegenerative disease in the medical records was the determination of LP biomarker levels. Results Among the 403 patients (69.9 ± 11.4 years old, 177 women) from the initial cohort with data matched with the NHDS data, 137 were matched with the NAB data, and 61 were matched with LP biomarker data. Within three years of the scan, a 18F-FDG PET had negative predictive values of 85% for dementia conversion (according to the NHDS and NAB datasets) and 95% for the presence of LP neurodegeneration biomarkers. Conclusion A normal brain 18F-FDG PET scan can help rule out the risk of dementia conversion and the presence of cerebrospinal fluid (CSF) biomarker of neurodegeneration early with high certainty, allowing modifications to patient management regimens in the short term. Trial registration Clinical Trials database (NCT04804722). March 18, 2021. Retrospectively registered.

Abstract Purpose Wood comprises different cell types, such as fibers, tracheids and vessels, defining its properties. Studying cells’ shape, size, and arrangement in microscopy images is crucial for understanding wood characteristics. Typically, this involves macerating (soaking) samples in a solution to separate cells, then spreading them on slides for imaging with a microscope that covers a wide area, capturing thousands of cells. However, these cells often cluster and overlap in images, making the segmentation difficult and time-consuming using standard image-processing methods. Results In this work, we developed an automatic deep learning segmentation approach that utilizes the one-stage YOLOv8 model for fast and accurate segmentation and characterization of macerated fiber and vessel form aspen trees in microscopy images. The model can analyze 32,640 x 25,920 pixels images and demonstrate effective cell detection and segmentation, achieving a $$\hbox {mAP}_{0.5-0.95}$$ mAP 0.5 - 0.95 of 78 %. To assess the model’s robustness, we examined fibers from a genetically modified tree line known for longer fibers. The outcomes were comparable to previous manual measurements. Additionally, we created a user-friendly web application for image analysis and provided the code for use on Google Colab. Conclusion By leveraging YOLOv8’s advances, this work provides a deep learning solution to enable efficient quantification and analysis of wood cells suitable for practical applications.

Abstract Background Healthcare professionals (HCPs) can play an important role in encouraging patients and their caregivers to be vaccinated. The objective of this qualitative study was to investigate HCPs’ perspectives on challenges in vaccine communication and unmet training needs in this domain. Methods Semi-structured interviews were conducted with 41 HCPs (mainly nurses and physicians) with vaccination roles (23 in England; 18 in France), gathering information on: (1) HCPs’ approach to vaccine conversations with patients; (2) Challenges of communicating about vaccines; (3) Vaccine-related training and learning resources available to HCPs, and; (4) HCPs’ training needs around vaccine communication. Results HCPs described a range of communication experiences that indicated insufficient time, information, and skills to confidently navigate difficult conversations with vaccine-hesitant patients. Communication skills were especially important to avoid conflict that could potentially damage the patient-provider relationship. Some HCPs interviewed had received communication training, but for most, this training was not specific to vaccination. Although general communication skills were transferable to vaccine conversations, most HCPs welcomed specific training and informational resources to support countering patients’ misconceptions or misinformation about vaccines. Conclusions HCPs would benefit from training tailored to address vaccine communication with patients, and this should be part of a systemic approach that also provides time and space to have effective vaccine conversations.

Methylene blue liposomes (MB-LPs) intended for photodynamic therapy (PDT) of ovarian cancer were formulated with a negatively charged nucleolipid and phosphatidylcholine using the lipidic film technique followed by an extrusion step. MB-LPs were characterized using dynamic light scattering (DLS), zeta potential (ZP), transmission electron microscopy (TEM), colloidal stability, Fourier-transform infra-red spectroscopy (FT-IR), UV-Visible spectroscopy and cellular studies. MB-LPs were spherical nano-objects with sizes obtained by DLS and TEM between 120 and 130 nm. MB-LPs showed a PDI near 0.10, a negative zeta potential near -42 mV and an encapsulation efficiency around 57 %. Characteristic peaks from ionic interactions of nucleolipids encapsulation of methylene blue were confirmed by FT-IR. Colloidal stability of MB-LPs was slightly affected in complex ionic media, sizes, PDI and ZP remained stable for 4 weeks at all storage temperature tested, allowing a potential use for in vitro and in vivo assays. The use of MB-LPs allowed slightly higher PDT activity based on the production of ROS against SKOV-3 ovarian cancer as compared to MB alone, a reduction of MB dark toxicity and a better protection against oxidation-reduction reactions.

Abstract The ketogenic diet (KD) has been shown to be effective in refractory epilepsy after long-term administration. However, its interference with short-term brain metabolism and its involvement in the early process leading to epilepsy remain poorly understood. This study aimed to assess the effect of a short-term ketogenic diet on cerebral glucose metabolic changes, before and after status epilepticus (SE) in rats, by using [18F]-FDG PET. Thirty-nine rats were subjected to a one-week KD (KD-rats, n = 24) or to a standard diet (SD-rats, n = 15) before the induction of a status epilepticus (SE) by lithium-pilocarpine administrations. Brain [18F]-FDG PET scans were performed before and 4 h after this induction. Morphological MRIs were acquired and used to spatially normalize the PET images which were then analyzed voxel-wisely using a statistical parametric-based method. Twenty-six rats were analyzed (KD-rats, n = 15; SD-rats, n = 11). The 7 days of the KD were associated with significant increases in the plasma β-hydroxybutyrate level, but with an unchanged glycemia. The PET images, recorded after the KD and before SE induction, showed an increased metabolism within sites involved in the appetitive behaviors: hypothalamic areas and periaqueductal gray, whereas no area of decreased metabolism was observed. At the 4th hour following the SE induction, large metabolism increases were observed in the KD- and SD-rats in areas known to be involved in the epileptogenesis process late—i.e., the hippocampus, parahippocampic, thalamic and hypothalamic areas, the periaqueductal gray, and the limbic structures (and in the motor cortex for the KD-rats only). However, no statistically significant difference was observed when comparing SD and KD groups at the 4th hour following the SE induction. A one-week ketogenic diet does not prevent the status epilepticus (SE) and associated metabolic brain abnormalities in the lithium-pilocarpine rat model. Further explorations are needed to determine whether a significant prevention could be achieved by more prolonged ketogenic diets and by testing this diet in less severe experimental models, and moreover, to analyze the diet effects on the later and chronic stages leading to epileptogenesis.

The pandemic dramatically accelerated research on vaccine attitudes and uptake, a field which mobilizes researchers from the social sciences and humanities as well as biomedical and public health disciplines. The field has the potential to contribute much more, but the growth in research and the deeper connections between disciplines brings challenges as well as opportunities. This perspective article assesses the recent development of the field, exploring progress whilst emphasizing that not enough attention has been paid to national and local contexts. This lack of contextual attention limits the progress of research and hinders our capacity to learn from the COVID-19 crisis. We suggest three concrete responses: building and recognizing new publishing formats for reporting and synthesizing studies at a country level; establishing country-level interdisciplinary networks to connect research and praxis; and strengthening international comparative survey work by enhancing the focus on local contextual factors.

ABSTRACTVaccination coverage against hepatitis A virus (HAV), hepatitis B virus (HBV), and human papillomaviruses (HPV) is insufficient among men who have sex with men (MSM), partly because of their high prevalence of vaccine hesitancy (VH) specific to these vaccines. This study aimed to investigate determinants of specific VH in MSM, focusing on characteristics of their sexual activity, propensity to use prevention tools and medical care, disclosure of sexual orientation to health care professionals (HCPs), and perceived stigmatization. A cross-sectional electronic survey (February – August 2022) collected perceptions of HBV, HAV, and HPV, and of their respective vaccines among 3,730 French MSM and enabled the construction of a specific VH variable. Using agglomerative hierarchical cluster analysis, we constructed a typology of MSM sexual and prevention practices. We identified three MSM clusters (low- (C1, 24%), moderate- (C2, 41%), and high- (C3, 35%) “sexual activity/medical engagement”) that showed an increasing gradient in the use of medical prevention with regular medical care and exposure to high-risk sexual practices. A multiple ordinal logistic regression showed that overall specific VH was higher in the C1 cluster and in men who had not informed their physician of their sexual orientation. This typology could usefully help to adapt vaccination communication strategies for MSM prevention program according to patients’ profiles. HCPs should be encouraged and trained to ask men about their sexual practices and to provide appropriate vaccination recommendations nonjudgmentally.

ABSTRACTThis scoping review aimed to provide an overview of the current landscape of pediatric palliative care in Latin America, including policies, regulations, available resources, challenges, barriers, and evidence-based recommendations. We conducted a comprehensive search for peer-reviewed articles related to pediatric palliative care in Latin America, considering both review and empirical articles published in English, Portuguese, or Spanish within the last decade. Our review initially identified 30 publications, which were subjected to a full-text assessment. The majority of these articles originated from Brazil, Mexico, and Chile, highlighting a regional concentration of research efforts. Notably, we observed a scarcity of comprehensive research and specific studies on pediatric palliative care in Latin America. Our findings revealed significant challenges, including resource limitations, the absence of dedicated policies, and the critical need for interdisciplinary teams to address the multifaceted aspects of pediatric palliative care. In light of our review, we emphasise the necessity for more extensive and representative research efforts, as well as the continuous updating of scientific evidence in the field of pediatric palliative care within the Latin American context. The recommendations derived from this review aim to contribute to the enhancement of pediatric palliative care services and accessibility throughout Latin America.

Children with disabilities and their families have the right to access Early Childhood Intervention (ECI). Family members should act as active agents of the intervention. In this sense, service professionals should offer support and intervention to improve family well-being and child development. We analyzed the experiences of parents of children with disabilities users of ECI services and the professional coordinators in the Balearic Islands (Spain) from a phenomenological-hermeneutic approach. Data collection was through semi-structured interviews and focus groups. A total of 5 coordinators and 30 family members participated in the study. The results indicate five categories: making ECI visible, reception phase, family well-being, intervention, and current barriers. The findings project the need to make ECI visible in policies and administrations, as well as plans to raise social awareness of child disability. Protocols must be found to facilitate access to services for children and families. Implications for the improvement of ECI are proposed.