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Background/Objectives: Relatives play the main role as caregivers of autism spectrum disorder (ASD) individuals. Women, specifically mothers, are the majority of caregivers of ASD relatives. In addition, the literature on caregivers has shown that women have worse mental health and higher perceived burdens than men. Therefore, the aim of this work was to evaluate the relationships between psychological distress and burden using a gender approach in caregivers of ASD relatives. Methods: A cross-sectional design was applied in this study with a convenience sample of 250 caregivers of ASD relatives. Most of them were mothers caring for a child who ranged in age from 1 to 31 years. Sociodemographic variables considered were age, education level, marital status, and relation to the care recipient. Additionally, psychological distress and objective burden, in the form of hours/day caring, and subjective burden, in the form of perceived burden, were analyzed. Results: Significant gender differences were found in psychological distress and objective and subjective burden, with women showing higher scores than men. Both types of burden played a serial mediating role between gender and psychological distress. Conclusions: The results highlight the important role of gender, with women bearing the high cost of caring for their children with ASD in the form of high objective burden, caring for more hours, and subjective burden, perceiving more burden and showing poorer mental health than men. These results show the need for specific support and intervention programs targeted to women caregivers to reduce burden and improve their mental health. [ABSTRACT FROM AUTHOR]

The article discusses the formation and implementation of the Mentorship Committee by the Society for Music Perception and Cognition to promote equity and inclusivity in the field, including programs such as mentorship connections, initiatives to improve accessibility, and new awards. The report evaluates the success and challenges of these programs, aiming to provide guidance for similar initiatives in other organizations while reaffirming the commitment to equity and anti-racism.

Background: Electronic early warning systems have been used in adults for many years to prevent critical deterioration events (CDEs). However, implementation of similar technologies for monitoring children across the entire hospital poses additional challenges. While the concept of such technologies is promising, their cost-effectiveness is not established for use in children. In this study we investigate the potential for direct cost savings arising from the implementation of the DETECT surveillance system. Methods: Data were collected at a tertiary children's hospital in the United Kingdom. We rely on the comparison between patients in the baseline period (March 2018 to February 2019) and patients in the post-intervention period (March 2020 to July 2021). These provided a matched cohort of 19,562 hospital admissions for each group. From these admissions, 324 and 286 CDEs were observed in the baseline and post-intervention period, respectively. Hospital reported costs and Health Related Group (HRG) National Costs were used to estimate overall expenditure associated with CDEs for both groups of patients. Results: Comparing post-intervention with baseline data we found a reduction in the total number of critical care days, driven by an overall reduction in the number of CDEs, however without statistical significance. Using hospital reported costs adjusted for the Covid-19 impact, we estimate a non-significant reduction of total expenditure from £16.0 million to £14.3 million (corresponding to £1.7 million of savings – 11%). Additionally, using HRG average costs, we estimated a non-significant reduction of total expenditure from £8.2 million to £ 7.2 million (corresponding to £1.1 million of savings – 13%). Discussion and conclusion: Unplanned critical care admissions for children not only impose a substantial burden on patients and families but are also costly for hospitals. Interventions aimed at reducing emergency critical care admissions can be crucial to contribute to the reduction of these episodes' costs. Even though cost reductions were identified in our sample, our results do not support the hypothesis that reducing CDEs using technology leads to a significant reduction on hospital costs. Trial registration: Current Controlled Trials ISRCTN61279068, date of registration 07/06/2019, retrospectively registered. [ABSTRACT FROM AUTHOR]

In a model with endogenous female labour supply and wages, we show that liquidity constraints that prevent households from buying child care generate an inefficiency and amplify gender gaps in the labour market. We evaluate the relative merits of paid maternity leave, child care subsidies, and government loans in mitigating liquidity constraints and promoting gender equality. While an extension in the duration of the leave has ambiguous effects, child care subsidies and loans in the form of child care vouchers remove the liquidity constraints and reduce gender gaps in participation and wages. We illustrate the mechanisms at play in a numerical example using Spanish data. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to (a) identify the factors most salient to parents when sending their child to summer camp, (b) examine family members' roles in the camp decision‐making process, and (c) compare both by income and other family contextual factors in a sample of parents with a child who enrolled and participated in a summer camp experience. Methods: Survey data were collected from a total of 354 families that included families from high, middle, and lower incomes. Surveys collected data on parental developmental goals for their child, factors related to camp–child and camp–family fit, and the level of involvement of family members in the camp decision‐making process. Results: The study identified three core parental goals for sending their child to camp: interactive learning, intrapersonal development, and fun/belonging. The analysis also identified five essential considerations parents use to consider camp fit: logistics/cost, program quality, child fit, institutional ties, and social connections. One parent, primarily the mother, drives the decision to send a child to camp. Family income was significant predictor of all three developmental goals with parents from higher income families reporting lower levels of developmental goals than parents from lower income families. Income also predicted camp fit considerations related to logistics/cost, institutional ties, and social connections. Parents in the high‐income group reported lower levels of consideration for logistics/cost and institutional ties than parents in the low‐income group. Parents in the high‐income group reported higher levels of consideration for social connections. Conclusion and Implications: Parents, regardless of income, want the best for their children when they go to summer camp. They want their kids to have fun, build social skills, and develop independence and other intrapersonal skills. However, parental decisions of where to send their child to camp and parental evaluations of camp–child and camp–family fit are more nuanced. Unsurprisingly, logistics and cost are major considerations for families with low incomes, and camps need to continue to find ways to reduce barriers for kids from low‐income homes to attend camp through outreach and scholarship programs. [ABSTRACT FROM AUTHOR]

Background: Influenza cause a clinical and economic burden for health systems and society. It is necessary to know the cost of the disease in order to perform cost-effectiveness assessments of preventive or treatment interventions. Objective: Assess the costs of the care of children with influenza in a third level hospital in Mexico. Methods: Longitudinal retrospective study based on the review of clinical files of children hospitalized with influenza. The use of resources used during their hospitalization in the emergency room, general ward, or PICU was logged, and the amount of supplies were multiplied by their corresponding prices to calculate the direct medical expenses. Descriptive statistics were used, and a GLM was adjusted in order to assess the effect of the clinical characteristics of the patients on the cost. Goodness of fit tests were performed. Results: 132 files were reviewed, out of which 95% were of subjects who had comorbidities. Subjects admitted at the PICU generates the highest cost (mean $29,608.62 USD), when analyzing the total cost summarizing the three clinical areas (Emergency room, general ward and PICU) by age group, the highest cost was for patients over age 10 (mean $49,674.53 USD). Comorbidities increase the cost of hospitalization by $10,000.00 USD. Conclusions: Influenza causes a significant financial burden on the health system. Children with comorbidities increase the costs and children over 10 years uses a significant amount of resources and they are not a priority in immunization program. It is necessary to perform studies on the use of resources in the first and second attention levels, which represent the highest incidence of the disease. [ABSTRACT FROM AUTHOR]

Child care costs are of great concern for many families in Canada, yet little is known about net child care costs. Using six "typical" families in ten cities and factoring in tax assistance and means-tested child care subsidies, we find that net child care costs vary significantly across the income distribution and family types. For many families, the combination of subsidies and tax-based supports results in significant cost reductions. However, these measures have limitations. For example, maximum subsidies do not always cover the full cost of care, and tax-based supports may not always alleviate cash flow problems. [ABSTRACT FROM AUTHOR]

Background: Invasive Group A Streptococcal (iGAS) disease exerts an important burden among Australian children. No Australian hospitalisation cost estimates for treating children with iGAS disease exist, so the financial impact of this condition is unknown.Aim: To determine the minimum annual healthcare cost for children (< 18 years) hospitalised with iGAS disease in Australia from a healthcare sector perspective.Methods: A cost analysis including children with laboratory-confirmed iGAS disease hospitalised at the Royal Children's Hospital (Victoria, Australia; July 2016 to June 2019) was performed. Results were extrapolated against the national minimum iGAS disease incidence. This analysis included healthcare cost from the 7 days prior to the index admission via General Practitioner (GP) and Emergency Department (ED) consultations; the index admission itself; and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations. Additional extrapolations of national cost data by age group, Aboriginal and Torres Strait Islander ethnicity and jurisdiction were performed.Results: Of the 65 included children, 35% (n = 23) were female, 5% (n = 3) were Aboriginal and Torres Strait Islander, and the average age was 4.4 years (SD 4.6; 65% aged 0-4). The iGAS disease related healthcare cost per child was $67,799 (SD $92,410). These costs were distributed across the 7 days prior to the index admission via GP and ED consultations (0.2 and 1.1% of total costs, respectively), the index admission itself (88.7% of the total costs); and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations (5.3, 4.5 and 0.1% of total costs, respectively). Based on a national minimum paediatric incidence estimation of 1.63 per 100,000 children aged < 18 (95%CI: 1.11-2.32), the total annual healthcare cost for children with iGAS in 2019 was $6,200,862. The financial burden reflects the overrepresentation of Aboriginal and Torres Strait Islander people in the occurrence of iGAS disease. Costs were concentrated among children aged 0-4 years (62%).Conclusion: As these cost estimations were based on a minimum incidence, true costs may be higher. Strengthening of surveillance and control of iGAS disease, including a mandate for national notification of iGAS disease, is warranted.Trial Registration: The current study is a part of ongoing iGAS surveillance work across seven paediatric health services in Australia. As this is not a clinical trial, it has not undergone trial registration. [ABSTRACT FROM AUTHOR]

Rationale: Clinical decision support (CDS) tools leveraging electronic health records (EHRs) have been an approach for addressing challenges in asthma care but remain under-studied through clinical trials. Objectives: To assess the effectiveness and efficiency of Asthma-Guidance and Prediction System (A-GPS), an Artificial Intelligence (AI)-assisted CDS tool, in optimizing asthma management through a randomized clinical trial (RCT). Methods: This was a single-center pragmatic RCT with a stratified randomization design conducted for one year in the primary care pediatric practice of the Mayo Clinic, MN. Children (<18 years) diagnosed with asthma receiving care at the study site were enrolled along with their 42 primary care providers. Study subjects were stratified into three strata (based on asthma severity, asthma care status, and asthma diagnosis) and were blinded to the assigned groups. Measurements: Intervention was a quarterly A-GPS report to clinicians including relevant clinical information for asthma management from EHRs and machine learning-based prediction for risk of asthma exacerbation (AE). Primary endpoint was the occurrence of AE within 1 year and secondary outcomes included time required for clinicians to review EHRs for asthma management. Main results: Out of 555 participants invited to the study, 184 consented for the study and were randomized (90 in intervention and 94 in control group). Median age of 184 participants was 8.5 years. While the proportion of children with AE in both groups decreased from the baseline (P = 0.042), there was no difference in AE frequency between the two groups (12% for the intervention group vs. 15% for the control group, Odds Ratio: 0.82; 95%CI 0.374–1.96; P = 0.626) during the study period. For the secondary end points, A-GPS intervention, however, significantly reduced time for reviewing EHRs for asthma management of each participant (median: 3.5 min, IQR: 2–5), compared to usual care without A-GPS (median: 11.3 min, IQR: 6.3–15); p<0.001). Mean health care costs with 95%CI of children during the trial (compared to before the trial) in the intervention group were lower than those in the control group (-$1,036 [-$2177, $44] for the intervention group vs. +$80 [-$841, $1000] for the control group), though there was no significant difference (p = 0.12). Among those who experienced the first AE during the study period (n = 25), those in the intervention group had timelier follow up by the clinical care team compared to those in the control group but no significant difference was found (HR = 1.93; 95% CI: 0.82–1.45, P = 0.10). There was no difference in the proportion of duration when patients had well-controlled asthma during the study period between the intervention and the control groups. Conclusions: While A-GPS-based intervention showed similar reduction in AE events to usual care, it might reduce clinicians' burden for EHRs review resulting in efficient asthma management. A larger RCT is needed for further studying the findings. Trial registration: ClinicalTrials.gov Identifier: NCT02865967. [ABSTRACT FROM AUTHOR]

Background: A child's long-term illness or disability is always a serious matter that impacts the whole family. Costs related to an illness can substantially affect a family's financial situation. To date, there is little research on how parents experience available support for financial assistance. Surveys in Finland have found that families of children with long-term illnesses and disabilities could experience financial struggle and perceive the state provided financial support system as too complex. This article aimed to explore how caregivers of children with long-term illnesses perceived their financial situation, need for financial support and experienced its provision by the state in the Helsinki greater region.Methods: Convenience sampling was used. Participants were contacted through peer-support groups on Facebook. Eleven mothers of children with varying long-term illnesses and disabilities residing in the Helsinki greater region were interviewed using in-depth interviews. Recordings of the interviews were transcribed and analysed using framework analysis. An analytical framework was built to label the dataset, which was then charted. Lastly, themes were formed through descriptive analysis.Results: The main findings showed how the burden of caring for a child with a long-term illness or disability causes fatigue, which affects a family's financial situation holistically. This affected both employment and financial management, but also receiving information about and applying for the state provided allowances. Mental resources were further depleted by seeking information and applying for allowances. This contributed to a vicious cycle between parental fatigue and financial struggle. Participants found the allocation of funds inequitable across the country. Finally, participants thought the allowance was insufficient in compensating for time spent caring for their child's illness and did not consider their mental strain.Conclusions: Even in a welfare state such as Finland, caregivers of children with long-term illnesses are at risk of poverty and struggle with the organization of state provided financial support. Policies should be designed to ensure equity across the country and consider how the parental fatigue should be addressed. The study has implications for achieving sustainable development goals on wellbeing and reducing poverty. [ABSTRACT FROM AUTHOR]

This article analyses the socio‐economic determinants of public preferences towards public spending and parental fees for childcare and how they are conditioned by institutional contexts. Previous studies of childcare policy preferences have focused on attitudes regarding the provision of care. However, when it comes to questions of financing, we know astonishingly little about how supportive individuals actually are of expanding pre‐school early childhood education and care, and how support varies across different socio‐economic groups in society. This is an important research gap because childcare provision and how it is financed have redistributive implications, which vary depending on the institutional design of childcare policy. Using novel and unique survey data on childcare preferences from eight European countries, we argue and show that preferences towards expanding childcare are more contested than it is often assumed. The institutional structure of childcare shapes how income matters for preferences towards how much should be spent and how provision should be financed. Where access to childcare is socially stratified, the poor and the rich develop different preferences towards either increasing public spending or reducing parental fees in order to improve their access to childcare. The findings in this article suggest that expanding childcare in systems characterised by unequal access can be politically contested due to diverging policy priorities of individuals from different social backgrounds. [ABSTRACT FROM AUTHOR]

Background: School closures have been enacted as a measure of mitigation during the ongoing coronavirus disease 2019 (COVID-19) pandemic. It has been shown that school closures could cause absenteeism among healthcare workers with dependent children, but there remains a need for spatially granular analyses of the relationship between school closures and healthcare worker absenteeism to inform local community preparedness.Methods: We provide national- and county-level simulations of school closures and unmet child care needs across the USA. We develop individual simulations using county-level demographic and occupational data, and model school closure effectiveness with age-structured compartmental models. We perform multivariate quasi-Poisson ecological regressions to find associations between unmet child care needs and COVID-19 vulnerability factors.Results: At the national level, we estimate the projected rate of unmet child care needs for healthcare worker households to range from 7.4 to 8.7%, and the effectiveness of school closures as a 7.6% and 8.4% reduction in fewer hospital and intensive care unit (ICU) beds, respectively, at peak demand when varying across initial reproduction number estimates by state. At the county level, we find substantial variations of projected unmet child care needs and school closure effects, 9.5% (interquartile range (IQR) 8.2-10.9%) of healthcare worker households and 5.2% (IQR 4.1-6.5%) and 6.8% (IQR 4.8-8.8%) reduction in fewer hospital and ICU beds, respectively, at peak demand. We find significant positive associations between estimated levels of unmet child care needs and diabetes prevalence, county rurality, and race (p<0.05). We estimate costs of absenteeism and child care and observe from our models that an estimated 76.3 to 96.8% of counties would find it less expensive to provide child care to all healthcare workers with children than to bear the costs of healthcare worker absenteeism during school closures.Conclusions: School closures are projected to reduce peak ICU and hospital demand, but could disrupt healthcare systems through absenteeism, especially in counties that are already particularly vulnerable to COVID-19. Child care subsidies could help circumvent the ostensible trade-off between school closures and healthcare worker absenteeism. [ABSTRACT FROM AUTHOR]

Objective: To explore the lived experiences of shared children in stepfamilies (i.e., those born into a repartnered family who live with married parents and older half‐siblings). Background: Shared children have been found to fare worse than other sibling groups on a variety of outcomes (e.g., educational outcomes, antisocial behavior, depressive symptoms). Little is known, however, about the lived experiences of these individuals. Method: Using descriptive phenomenology, we conducted interviews with 20 shared children to answer the following research question: What is the nature of the experience of being a shared child in a stepfamily? Participants ranged in age from 19 to 30 years and lived in the same household with their half‐sibling(s) for at least some time growing up. Results: Shared children's experiences were shaped by living in a hybrid "step‐nuclear" family; their upbringings were characterized by the tension of "reorganizing" as a nuclear unit but doing so within a larger stepfamily structure. The overriding phenomenon of participants' experiences was regulating family privacy boundaries—privacy rules existed surrounding sensitive information about family structure, marital histories, stepfamily dynamics, and more. In the absence of information, these children hypothesized about the topics that were not openly discussed in their families—a key part of their lived experiences. Conclusion: Open communication with shared children surrounding family histories and dynamics may help reduce the ambiguity of living in a step‐nuclear family. Implications: This study is an important step in understanding what about shared children's lived experiences might put them at higher risk for negative outcomes. [ABSTRACT FROM AUTHOR]

Background/objectives: Atopic dermatitis is associated with a decreased health‐related quality of life and contributes to substantial health care costs. It is important to understand what accelerates health care costs to inform various stakeholders, so they can effectively meet health care needs. This cross‐sectional study aims to explore associations between health‐related quality of life, health care costs, and cost‐accelerating variables. Methods: Information on health‐related quality of life (HRQoL) was collected through generic and disease‐specific instruments from caregivers and children <16 years of age with a physician‐confirmed diagnosis of atopic dermatitis. The economic impact of atopic dermatitis was evaluated by analyzing information on health service utilization and other health care costs related to managing the condition. Results: Children with high impact on health‐related quality of life presented an annual health care cost of US$ 3787 compared with US$ 2548 for moderately impacted and US$ 2258 among children for which the condition had low impact. The severity of atopic dermatitis, disease duration, and a lower health‐related quality of life was associated with greater health care costs. Analyses of subdomains of health‐related quality of life revealed correlations between "mood" and "personal relationships" on one hand and caregivers' physical health and health care costs on the other hand. Conclusions: Highly affected HRQoL is associated with increased health care costs and could be a valuable complement to traditional severity assessments. By using HRQoL instruments, burdens and symptoms beyond severity can be identified and addressed with interventions to increase HRQoL and subsequently reduce health care costs. [ABSTRACT FROM AUTHOR]

Severe combined immune deficiency (SCID) is caused by an array of genetic disorders resulting in a diminished adaptive immune system due to impaired T lymphocytes. In these patients, active infection at the time of hematopoietic transplantation has been shown to increase morbidity and mortality. To prevent transmission of infections in SCID patients, standardized infection control precautions should be implemented. An online survey regarding SCID-specific protocols was distributed through several immunodeficiency organizations. Seventy-three responses were obtained, with the majority (55%) of responses from the USA, 15% from Canada, and the remainder from 12 other countries. Only 50% of respondents had a SCID-specific infection control protocol at their center, and while a majority of these centers had training for physicians, a small minority had training for other healthcare workers such as nursing and housekeeping staff. Significant variability of infection control practices, such as in-patient precautions, required personal protective equipment (PPE), diet restrictions, visitor precautions and discharge criteria, was found between different treatment centers. There is a paucity of evidence-based data regarding the safest environment to prevent infection in SCID patients. Institutional protocols may have significant impact on infection risk, survival, family well-being, child development and cost of care. From these results, it is evident that further multi-center research is required to determine the safest and healthiest environment for these children, so that evidence-based infection control protocols for patients with SCID can be developed. [ABSTRACT FROM AUTHOR]

Around the time of childbirth, low-income families are at particular economic risk for reasons including mothers' relatively high levels of separation from work. Lower wage jobs typically come with minimal paid leave that can be used at childbirth. Paid Family Leave (PFL) programs provide partially subsidized wages to new parents. Quantitative research links PFL with greater post-birth work attachment among mothers, including lower wage mothers. This qualitative study sought to explore factors that facilitate – and inhibit – lower income mothers' returns to work following childbirth and the role of PFL programs. Seventy-one percent of the 75 mothers in the study returned to work. They cited their need for income, desire for financial independence, preference for combining work and caregiving, supportive workplace practices, family help, and accessible and trustworthy child care. They described ways PFL supported employment, especially for single mothers and those with the fewest family resources. Twenty-nine percent of the mothers left work after childbirth for reasons including child care costs, a desire (or need) to remain home rather than work, low job quality, lack of job protection, and PFL program limitations. The findings suggest future research directions and pathways for service providers and others to support these families. [ABSTRACT FROM AUTHOR]

Introduction: Inherited bleeding disorders are rare, for some such as haemophilia, there is a growing body of evidence about caregiver burden and associated support needs. Whilst for other disorders, which may be present with less clinically significant bleeding, there is a paucity of data about parents support needs. Aims: To evaluate the supportive care needs of parents of children with a range of inherited bleeding disorders. Methods: A single‐centre pilot study using the validated Parental Needs Scale for Rare Diseases to measure the overall support needs of parents of children with a bleeding disorder. Results: 231 parents, including 99/231 (42.9%) fathers, completed the survey; half had a bleeding disorder themselves. Parents reported a good understanding of their child's condition, and overall were happy with the care provided by the specialist haemophilia team but reported a lack of knowledge in non‐specialist settings. More than half of parents reported experiencing significant emotional issues relating to their child's condition. 42.6%‐46.7% reported financial concerns related to paying for medical care and respite, respectively. Conclusion: Overall, parents are confident about dealing with their child's bleeding disorder and are satisfied with the level of support and care that they and their child are receiving. The emotional and psychological impacts of having a child with a bleeding disorder remain a significant burden for many parents. The financial costs associated with caring for their child further impact on their ability to cope. Regular assessment of parental support needs should be part of routine clinical care. [ABSTRACT FROM AUTHOR]

In 1997, the government of Québec instituted a low‐cost and universal childcare services program most commonly available through the "centres de la petite enfance (CPE)" (early chilldhood centers). Since 2003, this model is being slowly dismantled on account of an explosion in the number of commercial daycare centers and, since 2015, an adjustment of rates according to family revenues. This research article gathers scattered information about the childcare services offer changes in Québec to demonstrate that tearing down a section of the Québécois family policy lowers the collectivization of social reproductive work. [ABSTRACT FROM AUTHOR]

Objective: To economically evaluate a caries-preventive program "Stop Caries Stockholm" (SCS) where a standard program is supplemented with biannual applications of fluoride varnish in toddlers and compared it with the standard preventive program.Material and Methods: Data from the cluster randomized controlled field trial SCS including 3403 children, conducted in multicultural areas with low socioeconomic status was used. The difference in mean caries increment between the examinations; when the toddlers were 1 and 3 years old, was outcome measure of the intervention. The program was evaluated from a societal as well as a dental health care perspective. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental cost for each defs prevented.Results: Average dental health care costs per child at age 3 years were EUR 95.77 for the supplemental intervention and EUR 70.52 for the standard intervention. The ICER was EUR 280.56 from a dental health care perspective and EUR 468.67 and considered high.Conclusions: The supplemental caries intervention program was not found to be cost-effective. The program raised costs without significantly reducing caries development. A better alternative use of the resources is recommended.Trial Registration: www.controlled-trials.com (ISRCTN35086887). [ABSTRACT FROM AUTHOR]

Background: Although concussion-related emergency department (ED) visits increased after the passage of concussion laws, little is known about how the laws may disproportionately impact ED utilization and associated health care costs among children in different demographic groups.Objective: Our aim was to examine the patient and clinical characteristics of pediatric ED visits and associated health care costs for sports- and recreation-related concussions (SRRCs) before and after concussion law enactment.Methods: We retrospectively analyzed ED visits for SRRCs by children ages 5-18 years between 2006 and 2014 in the Pediatric Health Information System database (n = 123,220). ED visits were categorized as "pre-law," "immediate post-law," and "post-law" according to the respective state concussion law's effective date. Multinomial logistic regression models were used to assess the impact of the law on ED utilization.Results: The majority of visits were by males (n = 83,208; 67.6%), children aged 10-14 years (n = 49,863; 40.9%), and privately insured patients (n = 62,376; 50.6%). Female sex, older age, and insured by Medicaid/Medicare were characteristics associated with increased ED visits during the immediate post-law and post-law periods compared to their counterparts. A significant decrease in proportion of imaging use was observed from pre-law to post-law (adjusted odds ratio 0.49; 95% confidence interval 0.47-0.50; p < 0.0001). While annual adjusted costs per ED visits decreased, annual total adjusted costs per hospital for SRRCs increased from pre-law to post-law (p < 0.0001).Conclusions: Concussion laws might have impacted pediatric concussion-related ED utilization, with increased annual total adjusted costs. These results may have important implications for policy interventions and their effects on health care systems. [ABSTRACT FROM AUTHOR]

There is limited information about the effectiveness of transition programs for youth moving from pediatric to adult care with any chronic disease. Two Delphi studies and National Institute for Health and Care Excellence (NICE) guidelines about transition for epilepsy have suggested few critical outcome measures for transition. A single large prospective study found that the most important transition program elements were appropriate parent involvement, promotion of health self-efficacy, and meeting the adult team before transfer. Two Cochrane reviews of the value of transition for epilepsy found insufficient evidence to establish or refute the value of various programs, although evaluation of a few programs suggested a great deal of family/patient satisfaction. The cost of transition programs and their cost effectiveness have also not been established except for renal transplantation where transition programs were associated with fewer losses of the transplanted kidneys, a cost-effective outcome. Published data on the overall cost of care for children and adults with epilepsy may be helpful to establish a business plan for a transition program, and are briefly reviewed. Establishing cost effectiveness of transition programs for epilepsy would promote their establishment and viability. However, a number of studies will be needed based on the nature of the program, the healthcare system where it is carried out, and the type of epilepsy. In fee-for-service health systems, the reevaluation of patients with epilepsy prior to transfer may be sufficient to cover the costs of the transition program, whereas in single payer systems, there may be positive downstream health or societal benefits that justify the costs. A theoretical framework for comprehensive evaluation of epilepsy transition programs is needed. The Triple Aim Framework seems applicable with focus on population health, patient experiences, and cost and has the potential to assess transition interventions in the context of system-wide improvements in healthcare. Transition programs in general have not been well evaluated, and very little evaluation data exist regarding transition programs for epilepsy. We recommend more evaluative research using rigorous methodology to comprehensively assess these programs. • Evaluation of transition epilepsy programs is particularly lacking. • Evaluation of a few programs suggested a great deal of family/patient satisfaction. • Studies to better define the best outcome measures should be promoted. • Establishing cost effectiveness of transition programs for epilepsy would promote their implementation and viability. [ABSTRACT FROM AUTHOR]

This paper examines the factors associated with a gendered division of childcare among parents in Germany. While much is known on the gender division of housework in families and the economic and sociological factors that may be driving it, we still know relatively little about whether and how these factors may affect the division of unpaid childcare in families. We first assess the relevance of partner’s combined gender ideologies and relative resources on the division of unpaid childcare. Second, we assess whether the effect of economic resources may be contingent on the partners’ agreement or disagreement on gender ideologies concerning maternal employment. We address these questions using data from the German Panel Analysis of Intimate Relationships and Family Dynamics (pairfam) and MLM Growth Curve Models. Our findings consistently show a significant positive effect of partners’ combined gender ideologies and her share of income on his share of childcare. These effects are strongest, and robust, among couples with matching ideologies supporting maternal employment, which we term ‘egalitarian island’ couples. Economically efficient divisions of childcare thus appear dependent upon the couples’ ideological pairing and on mothers’ ideologies towards maternal employment. [ABSTRACT FROM AUTHOR]

Anecdotal evidence suggests that the cost of child care in the U.S. has increased substantially over the past few decades. This paper marshals data from a variety of sources to rigorously assess the issue. It begins by using a large survey dataset to trace the evolution in families’ child care expenditures. I find that the typical family currently spends 14 percent more on child care than it did in 1990. This is less than half the increase documented in previous work. In addition, most families allocate approximately the same share of income to child care as they did several decades ago. The next section of the paper examines the trend in the market price of child care. The evidence suggests that after persistent, albeit modest, growth throughout the 1990s, market prices have been essentially flat for at least a decade. In the paper's final section, I analyze several features of the child care market that may have implications for prices, including the demand for child care, the skill-level of the child care workforce, and state regulations. A few findings are noteworthy. First, I show that child care demand stagnated around the same time that market prices leveled-off. Second, although the skill-level of the child care workforce increased in absolute terms, highly-educated women increasingly find child care employment less attractive than other occupations. Finally, child care regulations have not systematically increased in stringency, and they appear to have small and inconsistent effects on market prices. Together, these results indicate that the production of child care has not become more costly, which may explain the recent stagnation in market prices. [ABSTRACT FROM AUTHOR]

Asevere disease or the birth of a disabled child may lead the family into the unexpected 'career' of 'caregiving that causes the whole family to re-evaluate its ways of functioning. The situation may affect the parents' marital relationship, their work and leisure-time activities, siblings and economy. Achild's disability brings the parents face to face with tasks such as helping the child to live with his or her illness or disability and to deal with problems brought along with the disability. At the same time, they have to encourage him/her in developing as normally as possible, and they have to achieve all this in such a manner that the family can function normally as an entity. One factor that will most likely contribute to whether or not this can be done is how the parents can cope with the stress caused by the situation. Research shows that some families manage well but others do not; therefore, it is important to understand what factors contribute to differences between families who seem to manage well from those who seem to encounter large number of problems. The present study focuses on understanding how parents experience their child's disability and how, in their opinion, it has affected both themselves and the functioning of the family. One of the major reasons for undertaking this research is the desire to examine the factors that help families cope well with disabled children, as well as to identify those factors which differentiate between parents who seem to manage well from those who seem to encounter large number of problems. Previous studies have also emphasized that this research area is highly significant one because it is important to find risk factors so as to be able to help families in time. Parents need information, advice and support in order to face up to their child's disability, and to address the problems of their children's upbringing. Families in the present study have expressed strongly the emotional, social and economic cost in caring for a child with a disability. The distress could be alleviated by more aware and responsive support from informal and culturally sensitive formal sources. The goals of a responsive community should be to enhance coping resources that maximize the daily achievement of personal and family goals. Therefore, there should be a focus on community-based strategies that facilitate the inclusion of children with disabilities, as well as direct family support strategies to facilitate positive attitudes to inclusion of children with disabilities to contribute to family coping. [ABSTRACT FROM AUTHOR]

The article discusses the proposed tax benefits related to child care for the low-income families and working class by the U.S. President Donald Trump. Topics mentioned include the importance of subsidized child care and paid family leave to improve health and well-being of the families, to build time and resources for caring the families to promote high-quality child care as a long-term investment for economic growth and to provide income and job security for mothers and children from poverty wherein child care costs have increased.