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Background: In many Western countries, parents have a legal right to be involved and influence children's healthcare decisions, ensuring that children's healthcare is shaped and customised as far as possible to meet the children's and their families' needs and preferences. It is expected that this kind of parental involvement increases patient safety and quality of care. Parental involvement in children's healthcare decisions has been an important area of health services in several countries for many years; however, it has not been sufficiently implemented in clinical practice. Aim: This thesis' overall aim was to gain insight, from a healthpromoting perspective, into parental involvement in decision-making about shaping and customising children's healthcare in an interprofessional hospital environment. The purpose was to enhance the knowledge on parental involvement in these decision-making processes and to identify areas for improvement. The research aims were as following: 1) To describe and establish a synthesis of previous research on parents' perceptions of their participation in decision-making and the challenges they face in healthcare services for children. (Paper I) 2) To explore parents' experiences on parental involvement in decisionmaking about their child's healthcare at the hospital and to identify how health professionals can improve parental involvement. (Paper II) 3) To explore and describe parents' experiences of how healthprofessionals facilitate parental involvement in decision-making surrounding children's healthcare and to identify how health professionals can improve parental involvement in the hospital. (Paper III) 4) To explore health professionals' construction of the phenomenon parental involvement in decision-making about children's healthcare at the hospital and identify how parental involvement can be improved. (Paper IV) Methodology: This thesis uses an explorative, sequential, descriptive, qualitative design; is situated within a constructivist research paradigm; and involves four sub-studies (Paper I-IV). Sub-study 1 is a systematic integrated review on literature, published from January 2000 to February 2011, concerning research aim 1). This review was conducted according to Whittemore and Knafl's framework. Sub-studies 2 through 4 are explorative, descriptive, qualitative studies involving individual semi-structured interviews. Sub-studies 2 and 3 comprise a purposive sample of 12 parents. Qualitative content analysis was performed according to Graneheim, Lindgren and Lundman. Sub-study 4 recruited 12 health professionals using a purposive selection procedure. The construction of the phenomenon in the interviews was analysed according to Silverman. The cultural stories were then interpreted and organised using Graneheim et al.'s qualitative content analysis. Findings: This thesis contributes new insights into parents' and health professionals' roles during decision-making about shaping and customising children's healthcare at hospital. Parents' personal factors seemed to influence their involvement; however, health professionals' individually tailored facilitation of parental involvement appeared to empower the parents and increase active engagement. The health professionals' attitudes and competencies seemed to influence how they involved the parents. Important elements that seem to improve parental involvement included empathetic communication, confidence in the health professional-parent relationship, high-quality intra- and interprofessional collaboration and adequate organisational resources. Conclusion: This thesis highlights the complexity of shared decisionmaking about children's healthcare, including parents' and health professionals' essential, demanding roles. These roles need to be supported according to family-centred care, the World Health Organisation's health promotion strategy and the biopsychosocial theory. The foremost responsibility of healthcare managers is to facilitate health professionals' parental involvement and arrange for adequate organisational resources. Furthermore, this thesis provides new knowledge of how health professionals' practice of shared decisionmaking in paediatric clinical settings influences parents' ability to cope with their parental role and the quality of their children's healthcare. Increased understanding of involving both the paediatric patient and parents in these decision-making processes is required to safeguard the paediatric patients a technical, safe and justifiable healthcare that is in keeping governmental directives, evidence-based practice and the biopsychosocial theory.

'The 'culture of anxiety' that pervades contemporary societies to the detriment of everyday life and experience is nowhere more marked than among parents. This book makes an important and innovative contribution to the investigation of this matter, as it has developed in China. Taking health care and young children as its focus, it provides thought provoking discussion about the interplay between media (including new media) and the workings of risk consciousness, in an economy characterised by rapid change. The empirical work discussed in the book that explores the experience of parents and grandparents is of particular interest methodologically.' - Dr Ellie Lee, School of Social Policy, Sociology and Social Research, University of Kent This book analyses parental anxieties about their children's healthcare issues in urban China, engaging with wider theoretical debates about modernity, risk and anxiety. It examines the broader social, cultural and historical contexts of parental anxiety by analysing a series of socio-economic changes and population policy changes in post-reform China that contextualise parental experiences. Drawing on Wilkinson's (2001) conceptualisation linking individual's risk consciousness to anxiety, this book analyses the situated risk experiences of parents' and grandparents', looking particularly into their engagement with various types of media. It studies the representations of health issues and health-related risks in a parenting magazine, popular newspapers, commercial advertising and new media, as well as parents' and grandparents' engagement with and response to these media representations. By investigating 'a culture of anxiety' among parents and grandparents in contemporary China, this book seeks to add to the scholarship of contemporary parenthood in a non-Western context

This article examines trends in the development of child health care in modern Egypt. The study and systematization of information on the main directions of activities of public authorities in the field of child health protection in Egypt, as well as an analysis of statistical indicators of the birth rate of the child population in this country. ; В данной статье рассматриваются тенденции развития детского здравоохранения в современном Египте. Изучается и систематизируется собранная авторами информация об основных направлениях деятельности органов государственной власти в сфере охраны здоровья детей Египта, а также проводится анализ статистических показателей уровня рождаемости детского населения в данной стране.

Between 1916 and 1924, a Tibetan public healthcare programme that focused on childcare and natal astrology comprised a central aspect of the mission of the Lhasa Mentsikhang (Institute of Medicine and Astrology). Assessing previously unused Tibetan language materials-including the Thirteenth Dalai Lama's edict for implementation and an accompanying childcare manual-the programme is contextualized with regard to regional developments in British India and China. Like British 'mothercraft' education programmes of the same period, the Tibetan initiative links the health of the population (from infancy) to the health of the state and its economy. Rather than appealing to the authority of 'scientific' colonial medicine, however, this paper discusses how indigenous medical techniques and theories are put forward as effective means to prove the nascent Central Tibetan state's benevolence, legitimacy and sovereignty via intervention in the domestic sphere. Such attention to medical reform and to the domestic sphere brings light to an underappreciated effort by the Thirteenth Dalai Lama to cultivate a sense of Tibetan subjecthood and to reconfigure the relationship between his government and various segments of society. Significantly, this childcare initiative was entrusted not just to mothers, and the category of class is here more germane than the category of gender central within British programmes. Various social groups within a specifically delineated Tibetan territory are assigned tasks in the programme's implementation, illustrating the desire to incorporate each into a reorganised Tibetan state bound by a newly articulated Buddhist ideal of shared social responsibility.

The article lists the main factors of children's morbidity and determines that this category of the population is not a stable and unprotected part of society, which needs full recovery in children's healthcare and leisure institutions. Accordingly, the main legal documents of the country, which are used in their activities by children's healthcare and leisure institutions, are presented. It is noted that during the period of quarantine and coronavirus disease, the list of legislative documents governing their activities is increasing, and society and institutions have to work in new harsh conditions. The main modified aspects of the health campaign have been identified, as well as ways to implement a clear mechanism for creating favorable services for children's health and recreation. The relevance of this study is proved. Based on researches of the pedagogical literature the basic tasks, components of readiness, the purpose of the activity, and the maintenance of work of the social worker in establishments of improvement and rest are outlined. The characteristics outlined by us allow us to conclude the constant dynamics, improvement, and expansion of the range of activities of the employee in modern conditions. The article analyzes the new requirements for the organization of the institution and the rules that apply to all participants in the health and recreation process. We have proposed the rules of operation of the children's health and recreation facility for the period of quarantine in connection with the spread of coronavirus disease concerning: transportation, reception, and stay of children in the healthcare and leisure institution; active recreation indoors and outdoors, as well as near the pond; placing them in rooms and pens. It is concluded that the activities of children's health and recreation facilities in the future will be organized with the involvement of social workers as the most qualified specialists. The study of the topic will allow analyzing the activities of the institution during the quarantine and spread of coronavirus disease, as well as the adaptation of children to the new conditions of the institution of health and recreation in subsequent studies. ; У статті наведено перелік основних факторів захворюваності дітей, визначено, що саме ця категорія насе- лення є не стійкою й не захищеною ланкою суспільства, яка потребує повноцінного відновлення в дитячих закла- дах оздоровлення та відпочинку. Відповідно до цього представленні основні нормативно-праві документи країни, якими у своїй діяльності послуговуються дитячі заклади оздоровлення та відпочинку. Зазначено, що в період поширення коронавірусної хвороби перелік законодавчих документів, які регулюють їхню діяльність збільшуєть- ся, а суспільству та установам доводиться працювати в нових жорстких умовах. Визначено основні видозміне- ні аспекти оздоровчої кампанії, шляхи впровадження чіткого механізму для створення сприятливих послуг для оздоровлення та відпочинку дітей. Доводиться актуальність даного дослідження. На основі наукових розвідок педагогічної літератури окресле- но основні завдання, компоненти готовності, мету діяльності й зміст роботи соціального працівника у закладах оздоровлення та відпочинку. Окреслені нами характеристики дають змогу зробити висновок про постійну дина- міку, вдосконалення й розширення спектру діяльності працівника в сучасних умовах. У статті здійснено аналіз нових вимоги до організації діяльності закладу та правила, що розповсюджуються на всіх учасників оздоровчо-відпочинкового процесу. Запропоновано правила діяльності дитячого закладу оздо- ровлення та відпочинку на період карантину у зв'язку з поширенням коронавірусної хвороби що стосуються: перевезення, прийому й перебування дітей в закладі оздоровлення та відпочинку; проведення активного відпочин- ку в приміщенні, на вулиці, біля водойми; розміщення їх в кімнатах і загонах. Зроблено висновок про чітку організацію діяльності дитячих закладів оздоровлення та відпочинку в майбут- ньому із залученням соціальних працівників як найбільш кваліфікованих спеціалістів. Дослідження теми дасть змогу зробити аналіз діяльності закладу в період карантину й поширення коронавірусної хвороби, а також адап- тації дітей до нових умов закладу оздоровлення та відпочинку в наступних дослідженнях.

Acknowledgments: This study was supported by the TECSAL Research Project (CS-2014-59136-P) of the Spanish Ministry of Economy and Competitiveness and the Casper Research Project (2014LLV00033) of the Catalan Government ; This paper analyzes children's imaginaries of Human-Robots Interaction (HRI) in the context of social robots in healthcare, and it explores ethical and social issues when designing a social robot for a children's hospital. Based on approaches that emphasize the reciprocal relationship between society and technology, the analytical force of imaginaries lies in their capacity to be embedded in practices and interactions as well as to affect the construction and applications of surrounding technologies. The study is based on a participatory process carried out with six-year-old children for the design of a robot. Imaginaries of HRI are analyzed from a care-centered approach focusing on children's values and practices as related to their representation of care. The conceptualization of HRI as an assemblage of interactions, the prospective bidirectional care relationships with robots, and the engagement with the robot as an entity of multiple potential robots are the major findings of this study. The study shows the potential of studying imaginaries of HRI, and it concludes that their integration in the final design of robots is a way of including ethical values in it

Disabled children are exposed to a host of remedial treatments, therapies or surgeries seeking to restore the 'normality' of their bodies and minds. The Convention on the Rights of the Child (CRC) in its Article 12 entitles children with the 'right to be heard' in all matters that affect their lives including healthcare. This chapter explores the barriers to participation disabled children may face in the context of healthcare decision-making and examines the synergies between the norms of the CRC and the Convention on the Rights of Persons with Disabilities (CRPD) setting standards for States Parties to eliminate such barriers.

ObjectiveIn this article, I examine how children's and parents' immigration status (U.S. born, legal immigrant, or undocumented) is associated with children's access to insurance and healthcare and with children's physical health.MethodsI use the first wave of the Los Angeles Family and Neighborhood Survey, which is representative of Los Angeles County in 2000–2001, to analyze data on parents' and children's immigration status, children's health insurance coverage, children's healthcare utilization, and children's health, using logistic and ordered logistic regression models.ResultsI find that undocumented immigrant children face severely constrained access to health insurance and a usual source of healthcare, while children with foreign‐born parents have lower global health status than children with U.S.‐born parents. Children with undocumented parents may have less access to a doctor diagnosis for common childhood ailments.ConclusionThese results show that without being eligible for public insurance, many undocumented children lack health insurance and a usual healthcare provider, even in a part of the country with substantial experience serving immigrant families.

Kamena Dorling, Coram Children's Legal Centre's policy and programmes manager, raises concerns about recent restrictions on migrants' access to healthcare which present a barrier to children's wellbeing

IntroductionHealthcare transitions, including from paediatric to adult services, can be disruptive and cause a lack of continuity in care. Existing research on the paediatric-adult healthcare transition often uses a simple age cut-off to assign transition status. This risks misclassification bias, reducing observed changes at transition (adults are included in the paediatric group and vice versa) possibly to differing extents between groups that transition at different ages.
ObjectiveTo develop and assess methods for estimating the transition point from paediatric to adult healthcare from routine healthcare records.
MethodsA retrospective cohort of young people (12 to 23 years) with long term conditions was constructed from linked primary and secondary care data in England. Inpatient and outpatient records were classified as paediatric or adult based on treatment and clinician specialities. Transition point was estimated using three methods based on record classification (First Adult: the date of first adult record; Last Paediatric: date of last paediatric record; Fitted: a date determined by statistical fitting). Estimated transition age was compared between methods. A simulation explored impacts of estimation approaches compared to a simple age cut-off when assessing associations between transition status and healthcare events.
ResultsSimulations showed using an age-based cut-off at 16 or 18 years as transition point, common in research on transition, may underestimate transition-associated changes. Many health records for those aged 14 years were classified as adult, limiting utility of the First Adult approach. The Last Paediatric approach is least sensitive to this possible misclassification and may best reflect experience of the transition.
ConclusionsEstimating transition point from routine healthcare data is possible and offers advantages over a simple age cut-off. These methods, adapted as necessary for data from other countries, should be used to reduce risk of misclassification bias in studies of transition in nationally representative data.

Background: The therapeutic environments of children and adolescents differ from those of adults, and are complex entities. Though studies have been conducted on the built environments of adult healthcare facilities, the impact of therapeutic environments on the health outcomes of pediatric patients is yet to be explored. Objective: The purpose of this study is to investigate design characteristics for creating a pleasant, comfortable, and child-friendly physical environment in children's healthcare settings. Method: After extracting features that influence pediatric healthcare design from the relevant literature, a survey questionnaire, consisting of 45 items from 14 domains, was conducted. Principal component analysis (PCA) using varimax rotation was used to explore the intrinsic concept in an Indian sample (N= 224). Results: PCA with varimax rotation yielded 4- factors: (1) child-centred design characteristics; (2) indoor ambient environmental quality; (3) positive distraction strategies; and (4) sense of autonomy and control, accounting for 78.14% of the explained variance. A factor loading range of 0.41 to 0.93 was found across the four variables, indicating construct validity, and all the factors were found to be significantly related to each other. Conclusions: This study concludes that the built environment of pediatric healthcare settings impacts patients' health outcomes and behaviour, with decreased patient stress & anxiety, and better family experience. The findings suggest the need of providing comfort to the children through several rejuvenating elements such as positive distraction strategies, play opportunities, family and peer interaction, child-friendly design, age-associated characteristics, etc. It also suggests various design characteristics that help contribute the positive patient health outcomes.
Keywords: pediatric therapeutic environment, healthcare design, child-friendly design, therapeutic play, family-centred care