Search Results (77)

Child marriage remains a persistent barrier to girls and young women’s education, health, and socioeconomic advancement in many parts of Sub-Saharan Africa. This paper examines the perceived economic empowerment initiatives contributed to expanding life choices, including the prevention of child marriage and the delay of early marriage, within the Girls Get Equal (GGE) project implemented between 2020 and 2024 across three districts (Nkasi, Kalambo and Sumbawanga DC) in the Rukwa Region of Tanzania between 2020 and 2024. The paper adopted an explanatory mixed-methods case study design to explain aggregated project outcome indicators with participants’ lived experiences captured through focus group discussions and key informant interviews. Endline evaluation interviews and focus group discussions were re-analyzed using a six-stage thematic analysis approach. The paper demonstrates that imparting skills in technical and business fields leads to robust job creation outcomes. A large majority of trained youth transitioned into employment or self-employment and a substantial proportion maintained stable income-generating activities. On top of that, community-based infrastructures, particularly savings and loan groups, emerged as important financial mechanisms as they enabled structures supporting enterprise development and household resilience. The integration of quantitative trends and qualitative narratives suggests that economic empowerment interventions can expand girls’ economic agency and influence their informed decision-making processes related to marriage. Finally, the findings suggest that combining vocational skills development with access to financial capital represents a promising pathway for addressing structural drivers of early and child marriage in economically vulnerable contexts. Full article

Severe Combined Immunodeficiency (SCID), Spinal Muscular Atrophy (SMA), and X-Linked Agammaglobulinemia (XLA) are rare but life-threatening genetic disorders in infants that can lead to severe infections, progressive neuromuscular degeneration, or severe immune dysfunction associated with significant morbidity and mortality if not diagnosed early. Advances in newborn screening (NBS) technologies have enabled pre-symptomatic detection of these conditions, allowing early initiation of life-saving interventions such as hematopoietic stem cell transplantation, gene therapy, and immunoglobulin replacement therapy. However, the absence of a standardized national clinical pathway linking screening, confirmatory testing, and specialist referral in Malaysia continues to contribute to delayed diagnosis and suboptimal patient outcomes. This review examines and synthesizes current evidence on the clinical pathways for early diagnosis and management of SCID, SMA, and XLA, with particular emphasis on diagnostic workflows, screening technologies, and healthcare system challenges within the Malaysian context. The review examines disease epidemiology, consequences of delayed diagnosis, and the role of expanded NBS under the Screening for Health, Intervention, Nurturing of Every Child (SHINE) program in improving early diagnosis and management. In addition, the paper outlines the current NBS landscape, the use of multiplex real-time polymerase chain reaction (PCR) assays for simultaneous detection of T-cell receptor excision circles (TREC), kappa-deleting recombination excision circles (KREC), and survival motor neuron 1 (SMN1) gene deletion of exon 7 from dried blood spot (DBS) samples. A structured diagnostic framework incorporating screening interpretation, confirmatory testing, and urgency-based referral pathways is also proposed. By addressing current operational barriers and coordinating laboratory referral systems, expanding NBS programs could significantly improve early diagnosis and long-term outcomes for infants affected by SCID, SMA, and XLA in Malaysia. Full article

Background: Cardiac tamponade (CT) is a rare but life-threatening medical emergency caused by fluid accumulation in the pericardial sac, impairing cardiac filling and reducing output. More than 20% of CT cases are iatrogenic. CT is a recognized complication of central venous catheter (CVC) placement, with mortality rates in pediatric patients reported to reach 50%. Clinical presentation is often nonspecific, and echocardiography remains the diagnostic gold standard. Case report: We present two pediatric cases of CT due to late CVC migration, managed in the pediatric intensive care unit (PICU). The first case involved a 25-day-old neonate with short bowel syndrome who received prolonged parenteral nutrition via CVC. Four days after catheter insertion, the patient developed sudden cardiocirculatory collapse. The second case featured a 2-year-old child with Leigh syndrome who required mechanical ventilation and multimodal pharmacological therapy. Six days after CVC placement, the patient developed acute hemodynamic deterioration. In both cases, echocardiography confirmed CT, while chest radiography suggested intracardiac positioning of the catheter tip. Management and outcome: Emergency pericardiocentesis and advanced cardiopulmonary resuscitation were performed. Despite transient hemodynamic stabilization, both patients developed multiorgan failure with fatal outcomes. Conclusions: CT is a critical complication in pediatric patients with CVCs. Accurate verification of catheter tip position is essential, and intracardiac placement should be avoided. Any sudden clinical deterioration in a patient with a CVC should raise suspicion of late catheter migration and requires immediate life-saving intervention. Full article

Background/Objectives: Sizeable between- and within-country inequalities in childhood immunization impair progress towards the goals set by the global Immunization Agenda 2030 (IA2030) of achieving universal coverage of all persons with essential life-saving vaccines. Monitoring global trends in immunization inequalities helps to identify population subgroups that are less likely to benefit from vaccines and provides evidence for tracking progress on regional and global goals and informing equity-oriented interventions. This paper assesses the state of within-country inequality in childhood immunization across low- and middle-income study countries. Methods: Using data from household health surveys, the analysis quantifies within-country inequality across up to 92 countries, areas and territories, for nine childhood immunization indicators (seven coverage indicators and two indicators of non-receipt of vaccines) by five dimensions of inequality (child sex, mother’s age, mother’s education, household economic status and place of residence). Absolute and relative summary measures of inequality (difference, ratio, slope index of inequality, relative index of inequality and population attributable risk) were calculated to assess the latest situation of inequality (i.e., using the most recent survey from 2014 to 2023) and change over time (i.e., comparisons with data from 2004 to 2013). Results: The latest situation of inequality revealed overall low or no inequality by child sex, mother’s age and place of residence, with more pronounced inequality related to mother’s education and household economic status. The median differences between the most and least educated subgroups ranged between 9 and 14 percentage points for immunization coverage indicators, and between 6 and 9 percentage points for non-receipt of vaccines indicators. The extent of inequality in childhood immunization tended to remain about the same as the previous decade, with modest reductions in absolute economic-related and place of residence inequality in DTP3 immunization, as well as place of residence inequality in full immunization (declining by 3.25, 2.42, and 2.16 percentage points over 10 years, respectively). Distinct patterns of economic-related inequality were evident across country income groups, with low-income countries reporting larger inequality than lower- and upper-middle-income countries; there was substantial variation at the country level. Conclusions: Economic- and education-related inequalities in childhood immunization within low- and middle-income countries have persisted over the past decade. Full article

Urban playgrounds are vital public spaces that support children’s play, social interaction, and well-being. However, many playgrounds in socially disadvantaged or aging urban areas experience physical deterioration, limited play diversity, and declining use. Although corporate social responsibility (CSR) initiatives have increasingly supported playground regeneration, many projects continue to emphasize short-term physical improvements rather than participatory processes and social value creation. This study conceptualizes CSR-supported, child-participatory playground regeneration as a social value creation process and examines how CSR enables process continuity through a structured six-stage participatory approach spanning planning, design, construction, and post-opening use. Two cases were selected from the “Save the Playground” program in Seoul, Korea: Saerok Children’s Park in a stable residential neighborhood and Mukjeong Children’s Park in a high-mobility, multicultural commercial district. Using a qualitative multiple-case study design, the study triangulates workshop outputs, observational records, facilitator field notes, and official program documents through thematic and cross-case analyses. The findings indicate that CSR support primarily ensured process continuity and facilitated multi-actor coordination across project stages. By securing implementation continuity and stabilizing governance arrangements, CSR support allowed participatory outputs to be iteratively translated into design development and post-opening evaluation. Post-opening outcomes differed by urban context; nevertheless, both cases showed social value creation through strengthened place attachment, responsibility-oriented use, and inclusive mixed-group play. This study advances a cross-case analytical framework linking urban context, participatory mechanisms, and post-opening social value outcomes, contributing to a more context-sensitive understanding of CSR-supported participatory design processes and their implications for sustainable urban public space development. Full article

This study examines the dialectic between “navigating secularism” and “lived religion” in the context of modern Jewish Orthodoxy, focusing on the rulings of Rabbi Shlomo Zalman Auerbach (1910–1995) regarding secular Jews. The research relies on two analytical models: Ravitzky’s theological model, based on the Chazon Ish’s distinction between a “full wagon” and an “empty wagon”; and the phenomenological model of Zohar and Sagi, which examines the halakhic distinction between belonging to the religious collective versus the ethnic collective. Contrary to the consensus of 20th-century halakhic authorities, who applied the category of “captured child” (tinok shenishba) to modern secular Jews, Rabbi Auerbach rejects this categorical expansion and reinstates the traditional halakha: one who publicly desecrates the Sabbath has the status of a gentile in all matters. This normative decision yields far-reaching halakhic implications: prohibition of a secular person’s contact with wine, prohibition of inviting a secular person for festivals, and more. The study identifies an internal tension in Rabbi Auerbach’s rulings: theoretically, he considers whether it might be preferable to die than to live as a gentile, but practically, he permits saving secular Jews on the Sabbath based on extra-halakhic theological reasoning. This tension reflects a conflict between his loyalty to halakhic deontology and his humane character. The study classifies Rabbi Auerbach within the ahistorical approach, which views the halakhic conceptual system as an eternal entity. Nevertheless, the religious public perceives him as a lenient authority toward secular Jews. This gap is explained through Wolfgang Iser’s hermeneutics and the category of “textual indeterminacy”: readers interpret his words through the prism of an expectation for tolerance, based on their perception of his warm personality, thereby creating a subjective textual meaning. Full article

Background: A cesarean section (CS) is a method of childbirth involving a surgical cut made in the abdominal and uterine wall to deliver the infant. But while it saves the lives of women and infants, it has been implicated in several immediate and long-term complications and adverse consequences as a result of its ineffective use. This study attempts to address the major public health issue of the inappropriate use of CS by exploring its impact on maternal, neonatal, and child health. More specifically, the study aims to investigate the immediate and long-term health impacts on the mother, including her physical and mental health, as well as the immediate and long-term psychosomatic consequences on the neonate’s, infant’s, and child’s health as a result of the inappropriate use of CS. Methods: A scoping review was conducted spanning from 2015 to 2025 according to the PRISMA criteria and checklist. Searches were performed in PubMed, Scopus, and Google Scholar. The inclusion criteria comprised original articles with clear exposure and outcome written in English, and studies that did not involve reviews of any kind or letters to the editors. Results: The review identified 42 relevant studies. The results showed several immediate and long-term complications of CS in mothers, neonates, infants, and children, while its ineffective use carries equally high risks, such as high levels of morbidity and mortality. Conclusions: This scoping review presents the problems that arise in the immediate and long-term health of mother and child from the improper use of cesarean section and underlines the need for immediate action and measures to be taken by health policy makers. Full article

This study adopts a systems perspective to examine the persistent effects of China’s One-Child Policy (OCP) on the subjective well-being of older adults, emphasizing structural persistence, reinforcing feedback, and path-dependent lock-in in complex socio-technical systems. Using nationally representative data from the China Longitudinal Aging Social Survey (CLASS-2014), we exploit the OCP’s formal rollout at the end of 1979—operationalized with a 1980 cutoff—as a quasi-natural experiment. A Fuzzy Regression Discontinuity (FRD) design identifies the Local Average Treatment Effect of being an only-child parent on late-life well-being, mitigating endogeneity from selection and omitted variables. Theoretically, we integrate three lenses—policy durability and lock-in, intergenerational support, and life course dynamics—to construct a cross-level transmission framework: macro-institutional environments shape substitution capacity and constraint sets; meso-level family restructuring reconfigures support network topology and intergenerational resource flows; micro-level life-course processes accumulate policy-induced adaptations through education, savings, occupation, and residence choices, with effects materializing in old age. Empirically, we find that the OCP significantly reduces subjective well-being among the first generation of affected parents decades later (2SLS estimate ≈ −0.23 on a 1–5 scale). The effects are heterogeneous: rural residents experience large negative impacts, urban effects are muted; men are more adversely affected than women; and individuals without spouses exhibit greater declines than those with spouses. Design validity is supported by a discontinuous shift in fertility at the threshold, smooth density and covariate balance around the cutoff, bandwidth insensitivity, “donut” RD robustness, and a placebo test among ethnic minorities exempt from strict enforcement. These results demonstrate how demographic policies generate lasting impacts on elderly well-being through transforming intergenerational support systems. Policy implications include strengthening rural pension and healthcare systems, expanding community-based eldercare services for spouseless elderly, and developing complementary support programs. Full article

Premature infants are an especially vulnerable group that often needs extended intensive care. Prematurity naturally hampers the development of the immune system, significantly increasing the risk of infections. In the Neonatal Intensive Care Unit (NICU), antibiotic treatment is often a crucial, life-saving measure. For parents, the birth of a very preterm infant (before 32 weeks of gestation) turns what should be a happy event into a period filled with deep uncertainty and distress. Maintaining hope amid these difficulties relies heavily on maintaining regular communication with and trusting the medical team. Clinical realities in the NICU include a high risk of infection that requires multiple medications, including antibiotics. There is an inverse relationship between gestational age and pharmaceutical exposure. Parents worry about the amount of medication their child receives and the potential long-term effects on development. Over the past thirty years, initiatives such as antimicrobial stewardship programs have worked to reduce antibiotic use and treatment duration in the NICU, emphasizing proper care for premature infants worldwide. This article examines the ethical landscape from the perspectives of three primary stakeholders: parents, healthcare providers, and regulatory bodies. The key ethical question is whether these groups achieve meaningful cooperation or if institutional and professional priorities overshadow clinical practice. In the NICU, decision-making responsibility mainly lies with the medical team, as parents often have limited influence over treatment decisions, and regulatory oversight usually occurs indirectly. This concentration of authority underscores the complex and critical nature of neonatal intensive care. Full article

After the end of the Second World War, Hungary, like other war-torn countries, was left with countless orphaned children. The collapsed state structures were unable to care for them, so only various private or church initiatives—such as Gaudopolis, a children’s home set up by the Lutheran pastor Gábor Szehló—provided a means of survival. However, in East-Central Europe—including Hungary, Poland and Romania—where the Soviet Union had a sphere of influence, the emerging Soviet-style system was aimed at the political re-education of society. Ideological goals categorically excluded the possibility of churches being involved in the care and education of youth beyond the existing legal framework. Any person who engaged in such activities was cracked down upon. This study examines the role and responsibility of church persons in the care and upbringing of orphaned children through the fate of the Roman Catholic priest István Regőczi. In the decades of communist dictatorship, István Regőczi repeatedly reorganised orphanages, where he carried out youth education activities based on principles similar to scouting. The values he imparted to the children—such as the Christian religion, family protection, mutual help and social solidarity—were all values of Christian socialism. However, the communist dictatorship—promoting its own political ideology, Marxism—sought to take control of the upbringing and education of children by nationalising all institutions involved in this activity. Anyone who resisted this—as István Regőczi did—was made impossible in the people’s democracy of the 1950s and 1960s, and his child-saving, educating and teaching activities were prevented, even if the courts sentenced him to longer or shorter prison sentences for the crimes of illegal youth organisation, incitement and the abuse of freedom of association. This study, comparing what is described in István Regőczi’s memoirs with the surviving archival sources, shows how during these terrible decades it was possible to save orphaned, needy children and raise them in a Christian spirit, even against the will of the authorities. Full article

Family structure has long been regarded as an important determinant of household saving, yet the empirical evidence for developing economies remains limited. Using the 2018–2022 panels of the China Family Panel Studies (CFPS), a nationwide survey that follows 16,519 households across three waves, the present study investigates how family size, the elderly share, and the child share jointly shape saving behavior. A household fixed effects framework is employed to control for time-invariant heterogeneity, followed by a sequential endogeneity strategy: external-shock instruments are tested and rejected, lagged two-stage least squares implement internal instruments, and a dynamic System-GMM model is estimated to capture saving persistence. Robustness checks include province-by-year fixed effects, inverse probability weighting for attrition, balanced-panel replication, alternative variable definitions, lag structures, and sample filters. Family size raises the saving rate by 4.6 percentage points in the preferred dynamic specification (p < 0.01). The elderly ratio remains insignificant throughout, whereas the child ratio exerts a negative but model-sensitive association. A three-path mediation analysis indicates that approximately 26 percent of the total family size effect operates through scale economy savings on quasi-fixed expenses, 19 percent is offset by resource dilution pressure, and less than 1 percent flows through a precautionary saving channel linked to income volatility. These findings extend the resource dilution literature by quantifying the relative strength of competing mechanisms in a middle-income context and showing that cost-sharing economies dominate child-related dilution for most households. Policy discussion highlights the importance of public childcare subsidies and targeted credit access for rural parents, whose saving capacity is the most constrained by additional children. The study also demonstrates that fixed effects estimates of family structure can be upward-biased unless dynamic saving behavior and internal instruments are considered. Full article

Liver cirrhosis continues to be a major global health issue, contributing to high morbidity and mortality due to its progressive nature and associated complications. This review explores recent advancements in the diagnosis and treatment of liver cirrhosis and its related syndromes. Non-invasive diagnostic tools, such as elastography and serum biomarkers, have significantly improved early detection, reducing the need for liver biopsies. Advanced imaging techniques, including MRI and CT, further enhance diagnostic accuracy. In parallel, molecular and genomic research is providing new insights into the pathogenesis of the disease, paving the way for precision medicine. On the treatment front, pharmacological innovations, such as antifibrotic agents and targeted therapies, show promise in slowing disease progression. Endoscopic interventions like variceal banding are improving the management of complications, while advancements in liver transplantation and artificial liver support systems offer life-saving alternatives. Regenerative medicine, particularly stem cell therapy and tissue engineering, is emerging as a promising strategy for liver repair. Managing cirrhosis-related syndromes, including portal hypertension, ascites, hepatic encephalopathy, and hepatorenal syndrome, now involves evolving therapeutic approaches such as transjugular intrahepatic portosystemic shunt (TIPS) and novel pharmacotherapies. Prognostic scoring systems like the MELD and Child–Pugh are being refined with new biomarkers for better risk stratification. The future of cirrhosis care will likely involve the integration of artificial intelligence and machine learning for early diagnosis and personalized treatments, alongside emerging therapies currently under investigation. Despite these advancements, challenges such as costs, accessibility, and healthcare disparities remain barriers to widespread adoption. This review highlights the importance of incorporating innovative diagnostic and therapeutic strategies into clinical practice to improve the outcomes for patients with liver cirrhosis and its complications. Full article

Women’s reproductive decisions and life trajectories are shaped by an interplay of biological, social, and ecological factors. While Life History Theory (LHT) has traditionally been applied in biological sciences to examine reproductive trade-offs, its integration with Life Course Theory (LCT) and empowerment frameworks offers a novel approach to understanding how structural and environmental conditions shape women’s reproductive behaviours and household roles. This study applies Categorical Principal Component Analysis (CATPCA) to identify key profiles of women’s lives in two ecologically distinct rural communities in Timor-Leste—Ossu and Natarbora—and examines how these patterns relate to early life conditions. Building on a longitudinal study conducted in these communities, our findings reveal four distinct profiles: (1) Tech and Sanitation, linked to household labour-saving technology and higher education; (2) Traditional, reflecting large household size and livestock ownership; (3) Contraception, associated with fertility control, particularly among younger cohorts; and (4) High Fertility, characterised by more births, greater child mortality, and being born in high-altitude regions. By combining LHT, LCT, and the empowerment framework, this study analyses how reproductive strategies and household ecology intersect with structural inequalities. These findings offer key insights for policies aimed at improving women’s autonomy, access to resources, and reproductive health in rural Timor-Leste. Full article

Introduction: Uterine penetrating wounds in pregnant women are rare. Usually, they are caused by traffic accidents, but sometimes they are an effect of violence, accidental injuries, or deliberate self-harm. Case Report: We present a case of a stab wound to the uterus in a 25-year-old woman in the 37th week of pregnancy, which was the result of a knife attack. Emergency splenectomy and cesarean section were performed less than an hour after the attack. The child required resuscitation and long-term intensive therapy. Both the woman and the newborn survived; however, the newborn’s condition remained poor. The child died a few months later, according to community-acquired pneumonia. Discussion: Cases of wounds penetrating the uterus have been described for many years around the world. They are often the result of violence, most often from the partner. Statistically, pregnant women are more likely to be victims of violence. Sometimes, the wounds penetrating the uterus are accidental and arise, for example, as a result of a fall. A rare but not isolated case is self-mutilation to terminate a pregnancy. Women often inflict such injuries on themselves using sharp tools, sometimes firearms. There are also cases of another person helping to terminate a pregnancy in this way. Conclusions: Violence against women, including pregnant women, remains a significant social problem in all regions of the world and poses a challenge to uniformed services, medical professions, and social services. Regardless of the mechanism of injury, in the event of an imminent threat to the life of the mother and fetus, it is crucial to make quick decisions aimed at saving lives. Full article

Background: In Saudi Arabia, dental trauma is regarded as one of the most important issues affecting schoolchildren. This study evaluated Saudi Arabian schoolteachers’ knowledge, attitude, and practice regarding emergency dental trauma management. Methods: A cross-sectional study was conducted on 263 schoolteachers from 25 schools; 50.9% were females. A questionnaire was used to collect respondents’ personal and professional data and information on managing dental injury scenarios and the respondents’ attitudes toward dental injuries. A multivariate logistic regression analysis was carried out for the independent and outcome variable of inadequate knowledge regarding dental trauma management. Results: Male teachers had better knowledge than female teachers regarding emergency management of avulsed teeth. Compared to female teachers, male teachers would scrub a tooth with a toothbrush to replant it back into its socket if it fell onto the ground and was covered with dirt. Males had a significantly higher percentage of believing it is not teachers’ responsibility to care for tooth injuries in schools. Teachers with teaching experience of 5–10 years had a significantly higher percentage of training in dental emergencies. Teachers with bachelor’s degrees agreed on the need for teacher involvement to save the tooth in a timely manner. Compared to general teachers, physical education teachers would put the tooth back in the mouth and send the child to the dentist immediately if they were hit in the face and the upper front tooth fell out of their mouth. Teachers with a diploma level of education and teachers with a general type of teaching qualification were 2.15 times (CI = 0.98–3.11, p = 0.002) and 3.19 times (CI = 1.71–4.22, p = 0.0001) more likely to have a higher level of inadequate knowledge regarding dental trauma management. Conclusions: There is a need to raise teachers’ awareness and improve their dental trauma emergency management training. Full article