Search Results (221)

Early childhood forest and nature education plays a vital role in shaping values and promoting sustainability throughout life. Conceptualized in Denmark, forest and nature childcare groups have been established in Austria for over 20 years, contributing to mental well-being and supporting both Education for Sustainable Development (ESD) and Early Childhood Education and Care (ECEC). With increasing demand for childcare and a growing disconnect from nature—factors linked to physical and mental health challenges—there is a pressing need to expand these groups and integrate them into formal legal frameworks. This study examines the organization, staffing, infrastructure, risk prevention, and hygiene of 79 Austrian forest and nature kindergarten groups, identifying key areas of improvement to ensure safe access for all children, including those in public childcare. A semi-standardized online survey of 72 groups was analyzed using descriptive and statistical methods, including a Spearman correlation, Kruskal–Wallis test, Chi-square test, and ANOVA. Results revealed three main infrastructure types—house, container/trailer, and tipi—with houses offering the most comprehensive facilities. The ANOVA indicated significant effects of sponsorship type (p < 0.01), caregiver numbers (p < 0.001), and their interaction (p < 0.05) on half-day care costs. Currently, legal frameworks exist only in Tyrol and Salzburg. Broader access requires standardized infrastructure and risk assessment guidelines, collaboratively developed with stakeholders, to ensure safety and inclusivity in Austrian forest and nature childcare groups. Full article

Background: Nemaline myopathy is a rare congenital neuromuscular disease associated with progressive weakness and frequent respiratory complications. In emergency situations, families often serve as the first and only responders. The aim of this study is to explore how parents in Spain care for children with nemaline myopathy during emergency situations, focusing on the clinical responses performed at home and the organizational challenges encountered when interacting with healthcare systems. Methods: A qualitative phenomenological study was conducted with 17 parents from 10 families belonging to the Asociación Yo Nemalínica. Semi-structured interviews were performed via video calls, transcribed verbatim, and analyzed using Giorgi’s descriptive method and ATLAS.ti software (version 24). Methodological rigor was ensured through triangulation, reflexivity, and member validation. Results: Four themes were identified. First, families were described as acting under extreme pressure and in isolation during acute home emergencies, often providing cardiopulmonary resuscitation and respiratory support without professional backup. Second, families managed ambiguous signs of deterioration using clinical judgment and home monitoring tools, often preventing fatal outcomes. Third, parents frequently assumed guiding roles in emergency departments due to a lack of clinician familiarity with the disease, leading to delays or errors. Finally, the transition to the Pediatric Intensive Care Unit was marked by emotional distress and rapid decision-making, with families often participating in critical choices about invasive procedures. These findings underscore the complex, multidisciplinary nature of caregiving. Conclusions: Parents play an active clinical role during emergencies and episodes of deterioration. Their lived experience should be formally integrated into emergency protocols and the continuity of care strategies to improve safety and outcomes. Full article

Background/Objectives: Food allergy (FA) is a growing concern in pediatric care, requiring effective avoidance strategies and timely emergency responses. The role of caregivers is central to the daily management of FA. This study aimed to assess parental knowledge, preparedness, and behaviors regarding pediatric FA management, focusing on both prevention and emergency readiness. Methods: A cross-sectional survey was conducted from December 2024 to April 2025 through the SurveyMonkey^® platform, promoted by the Italian Society of Pediatric Allergology and Immunology (SIAIP). The anonymous, structured questionnaire was distributed online and in two Italian university hospitals. A total of 129 fully completed responses from caregivers of children with FA were analyzed. The survey explored self-perceived knowledge, symptom recognition, preventive actions, emergency preparedness, and communication practices. Results: Only 9.3% of parents considered themselves “very informed,” while 54.3% reported limited or no knowledge. Just 16.0% recognized all symptoms of an allergic reaction, and only 24.0% could distinguish mild reactions from anaphylaxis. Notably, 67.4% reported not knowing how to respond to anaphylaxis, and 83.7% did not possess an epinephrine auto-injector. Preventive measures at home were inconsistently applied, and 41.1% took no precautions when eating out. Communication with external caregivers was often informal or absent. Only 33% updated physicians regularly. Conclusions: The findings reveal significant gaps in parental preparedness and highlight critical areas for educational intervention. Enhanced caregiver training, standardized communication protocols, and improved clinical follow-up are essential to strengthen pediatric FA management and safety. Full article

Prolonged hospital stays separate children from their families and adversely impact the well-being of both. Children with medical complexity (CMC) often have long hospital stays and sometimes spend months to years missing their childhoods, often alone in their rooms. Caregivers of CMC must navigate many barriers to discharge during long hospital stays, which further strains the family system. In this review, we summarize the developmental vulnerabilities of chronically hospitalized CMC and propose that the hospital environment itself confers additional risk for poor neurodevelopmental outcomes. We will discuss the opportunities for pediatric post-acute care (PPAC) hospitals to create spaces where medical treatment, developmental recovery, and family integration in care can exist simultaneously. We then describe how the Care Beyond the Bedside model developed by one PPAC hospital aims to diminish the detrimental effects of prolonged hospitalization on CMC and their families by prioritizing developmental opportunity alongside medical stability. Critical components of this care model are patient and family spaces designed for community, safety training to supervise patients away from the bedside, and investment in staffing and programming to support the model. This care model acknowledges that play and healing are inextricably linked and that children develop best when they are out of bed, participating in life with their families. Full article

In recent years, grain-free pet food has gained increasing attention due to its widespread promotion as a natural and hypoallergenic diet. This trend has prompted us to conduct an in-depth critical assessment of the nutritional implications of such diets. This review systematically analyzed the nutritional components of commercially available grain-free pet food, revealing significant variability in the nutritional composition of commercial pet diets. Moreover, grain-free formulations typically exhibit higher protein and fat levels. On the other hand, this review further explores the multifaceted health impacts of these diets on pets, including digestive function, cardiovascular health, allergic reactions, blood sugar regulation, mycotoxin safety, and palatability. This review points out that grain-free diets may offer potential benefits, such as improved blood sugar control, reduced mycotoxin exposure, and enhanced palatability; however, they also pose clear risks, particularly the potential association with dilated cardiomyopathy (DCM) in dogs. Additionally, the presence or absence of grains in the diet does not mitigate the risk of allergies. A grain-free diet is only intended to help specific individuals (such as those who are sensitive to grains/gluten) avoid allergens. Ultimately, the review emphasizes that nutritional adequacy, balance, and meeting individualized needs are the cornerstones of pet health, aiming to provide valuable insights for pet caregivers, veterinarians, and researchers. Full article

Background: South Africa launched a school-based human papillomavirus (HPV) vaccination programme in 2014 and has achieved a national coverage of more than 80%. However, there is subnational variation in coverage, with eThekwini District in the province of KwaZulu-Natal having the lowest coverage at 40%. Knowledge of the factors associated with vaccine acceptance in this district would inform tailored strategies to improve coverage, which could be extrapolated to similar settings. We conducted this cross-sectional study to assess the factors associated with HPV vaccine acceptance in eThekwini District. Methods: We used stratified random sampling to select caregivers of children aged 9–14 years in the district. We interviewed participants in April–May 2023 and employed bivariate and multivariate logistic regression models to assess the factors associated with HPV vaccine acceptance. Results: Of 793 individuals contacted, 713 (89.9%) participated. Most were women (86.1%) and had a mean age of 42.6 ± 11.6 years and secondary or lower education (83.8%). Most participants knew about the HPV vaccination programme (86.0%) and accepted HPV vaccination (93.5%). The latter includes 42.9% who had already vaccinated their daughters and 50.6% who were willing to allow their daughters to be vaccinated. A negligible proportion was either undecided (2.1%) or unwilling (4.4%) to accept HPV vaccination. Awareness of the programme (adjusted odds ratio [aOR] 5.22; 95% confidence interval [95%CI] 2.01–13.56), confidence in vaccine safety (aOR 19.69; 95%CI 5.86–66.15), and endorsement by religious leaders (aOR 5.06; 95%CI 1.56–16.45) were independent predictors of vaccine acceptance. Conclusions: Our findings highlight the critical role of the provision of information and education about the benefits and safety of HPV vaccination. Full article

Background: The COVID-19 pandemic prompted extensive vaccination efforts globally, yet in the Philippines, many families remained unvaccinated. Caregivers are key decision-makers for family vaccination, but evidence on factors influencing their own vaccine uptake is limited. Methods: A cross-sectional survey of primary caregivers was conducted in low COVID-19 vaccine uptake regions in the Philippines from July to October 2023 using a validated questionnaire. Multivariable logistic regression identified enablers and barriers to vaccine uptake. Results: Among 775 respondents, 72.3% completed primary vaccination, 3.3% had incomplete vaccination, and 24.4% were unvaccinated. Key factors for vaccination included self, family, and community protection, and the influence of government regulations. Distrust in vaccine safety was the main barrier. Positive associations with vaccine uptake were found for age [30–45 years (aOR = 2.23) and 46–59 years (aOR = 2.84)], education [secondary (aOR = 2.25) and tertiary (aOR = 4.93)], and employment (aOR = 1.99). Confidence in vaccine safety (aOR = 1.92), vaccine effectiveness (aOR = 2.23), and satisfaction with vaccination efforts (aOR = 2.39) were additional enablers. Disagreement with restrictions on the unvaccinated was a barrier (aOR = 0.31). Conclusions: This study identified multiple factors influencing COVID-19 vaccination among primary caregivers in low uptake areas of the Philippines. Interventions addressing perceptions about vaccine safety and effectiveness, particularly among younger and less educated caregivers, may improve public trust and satisfaction with vaccination efforts. Full article

In the context of rapid urbanization, urban streets have become critical spatial environments for children’s daily activities, directly influencing their mobility safety, behavioral development, and the spatial equity of cities. However, conventional assessment methods largely rely on subjective surveys and qualitative analyses, lacking objectivity and scalability. To address these limitations, this study takes urban streets in Shanghai as a case study and integrates deep learning technologies to propose a generalizable methodology for developing a child-friendliness evaluation and enhancement system that incorporates multi-source data and perceptual indicators for urban streets. The system extracts spatial features of streets based on urban street environmental information, and incorporates evaluation inputs from intergenerational user groups, including children and their caregivers. A neural network model is trained to enable automated, multidimensional assessment of child-friendliness and to generate context-sensitive and adaptable strategies. The findings reveal significant perceptual differences between user groups: children place greater emphasis on playfulness and interactivity, while caregivers prioritize safety and comfort. This validates the necessity and effectiveness of adopting an intergenerational collaborative perspective for comprehensive child-friendliness evaluation. By overcoming the limitations of traditional approaches in terms of accuracy and efficiency, this research expands the methodological repertoire of child-friendly urban studies and provides data-driven support for the intelligent design and inclusive governance of urban streets. Full article

The challenges and increasing number of elderly individuals requiring remote monitoring at home highlight the need for technological innovations. This study devised an eHealth mobile application designed to detect abnormal movement behavior and alert caregivers when a lack of movement is detected for an abnormal period. By utilizing the built-in accelerometer of a conventional mobile phone, an application was developed to accurately record movement patterns and identify active and idle states. Fuzzy logic, an artificial intelligence (AI)-inspired paradigm particularly effective for real-time reasoning under uncertainty, was integrated to analyze activity data and generate timely alerts, ensuring rapid response in emergencies. The approach reduced development costs while leveraging the widespread familiarity with mobile phones, facilitating easy adoption. The approach involved collecting real-time accelerometry data, analyzing movement patterns using fuzzy logic-based inferencing, and implementing a rule-based decision system to classify user activity and detect inactivity. This pilot study primarily validated the devised fuzzy logic method and the functional prototype of the mobile application, demonstrating its potential to leverage universal smartphone accelerometers for accessible remote monitoring. Using fuzzy logic, temporal and behavioral symmetry in movement patterns were adapted to detect asymmetric anomalies, e.g., abnormal inactivity or falls. The study is particularly relevant considering lonely individuals found deceased in their homes long after dying. By providing real-time monitoring and proactive alerts, this eHealth solution offers a scalable, cost-effective approach to improving elderly care, enhancing safety, and reducing the risk of unnoticed deaths through fuzzy logic. Full article

Background/Objectives: Early care and education programs promote children’s social–emotional development, predicting later school success. The COVID-19 pandemic worsened an existing youth mental health crisis and increased teacher stress. Therefore, we applied an infant and early childhood mental health consultation model, Jump Start Plus COVID Support (JS+CS), aiming to decrease behavioral problems in children post-pandemic. Methods: A cluster randomized controlled trial compared JS+CS to an active control, Healthy Caregivers–Healthy Children (HC2), at 30 ECE centers in low-income areas in South Florida. Participants were not blinded to group assignment. Teachers reported on children’s social–emotional development at baseline and post-intervention using the Devereux Early Childhood Assessment and Strengths and Difficulties Questionnaire. We assessed whether teacher stress, classroom practices, and self-efficacy mediated the relationship between JS+CS and child outcomes. We also explored whether baseline behavior problems moderated JS+CS effects on child protective factors, relative to HC2. Results: Direct group-by-time differences between JS+CS and HC2 were limited. However, JS+CS demonstrated significant within-group improvements in teacher-reported child protective factors, behavior support practices, and classroom safety practices. Classroom safety practices consistently mediated positive changes in child behaviors, including the DECA total protective factor score and subdomains of initiative and self-regulation. Additionally, teacher perceptions of behavior support mediated gains in child attachment. Conclusions: JS+CS shows promise in building protective systems around children through intentional support for teachers, underscoring the value of whole-child, whole-environment approaches in early intervention. Full article

Background: Immunization coverage in Nigeria is low, with many children missing out on important lifesaving vaccines. To enable a better understanding of contextual factors towards increasing uptake, we piloted a Decentralized Immunization Monitoring (DIM) approach in the Kumbotso local government area (LGA) of Kano state, Nigeria, to identify wards with low vaccination rates and understand why this is happening. The findings were used to improve routine immunization (RI) programs and reduce the number of unvaccinated children and children yet to receive their first dose of diphtheria–pertussis–tetanus (DPT) vaccine, referred to as Zero-Dose children (ZD). Methods: This study adopted a cross-sectional design approach using the Behavioural and Social Drivers of Vaccination (BeSD) framework and the Lot Quality Assurance Sampling (LQAS). The study population comprised caregivers of children aged 0–11 months and 12–23 months across the 11 wards in Kumbotso District, Kano State, Nigeria, using a segmentation sampling approach. The study covered 209 settlements selected using probability proportionate to size (PPS) sampling from the wards. Univariate and bivariate analyses were performed to show patterns and relations across variables. Results: Out of 418 caregivers surveyed, 98.1% were female. Delayed vaccination was experienced by 21.9% of children aged 4.5–11 months, while the prevalence of ZD was estimated at 26.8% amongst the older cohort (12–23 months). A total of 71.4% of the delayed group and 89.1% of the ZD group remained unvaccinated. Caregiver education, rural residence, and home births correlated with delayed/ZD status (p < 0.05). Logistic regression associated higher caregiver education with reduced delayed vaccination odds (OR:0.34, p < 0.001) and urban residence with lower ZD odds (OR:1.89, p = 0.036). The antigen coverages of BCG (81.5%), DPT3 (63.6%), and measles 1 (59.7%) all surpassed the national dropout thresholds. Kumbotso, Unguwar Rimi, and Kureken Sani wards were all identified as underperforming and therefore targeted for intervention. Negative vaccine perceptions (50% delayed, 53.6% ZD) and distrust in health workers (46.4% delayed, 48.2% ZD) were significant barriers, though the caregiver intent to vaccinate was protective (OR: 0.27, p < 0.001). The cost of accessing immunization services appeared to have a minor effect on coverage, as the majority of caregivers of delayed and ZD children reported spending less than 200 Naira (equivalent to USD 0.15) on transport. Conclusions: This pilot study highlighted the utility of LQAS and BeSD in identifying low-performing wards, barriers, and routine immunization gaps. Barriers included low caregiver education, rural residence, and negative vaccine perceptions/safety. Caregiver education and urban residence were protective factors against delayed and ZD vaccination, suggesting social and systemic barriers, particularly in rural and less educated populations. Antigen-specific coverage showed disparities, with dropouts for multi-dose vaccines exceeding the national thresholds of 10%. Targeted measures addressing education, trust, and systemic issues are needed. Findings emphasize decentralized monitoring, community engagement, and context-specific strategies to reduce ZD children and ensure equitable vaccination in Nigeria. Full article

Online safety guidance is frequently delivered as a specialist technology issue without considering adolescents’ home lives, offline vulnerabilities, or wellbeing. Yet, while the digital world offers connection, autonomy, and entertainment, vulnerable teens also encounter more violent content, sexual exploitation, and content concerning body image, self-harm or suicide than their non-vulnerable peers. Many struggle with social inclusion or less engaged and credible caregiver e-safety support, which may contribute to their negative experiences online. To improve their online safety and resilience, caregivers and educators might consider offline factors that can mediate exposure to online harms. This study compared the experiences of 213 adolescents with family vulnerabilities to 213 age- and gender-matched non-vulnerable adolescents. The contribution of (a) e-safety education, (b) close friendships, (c) a trusted adult at school, and (d) life-affecting worry was considered. No differences were found for exposure to, or engagement with, e-safety education. However, despite having received e-safety education, those with family vulnerabilities were more at risk of encountering severe online harms. This was mediated by life-affecting worry and parental e-safety guidance. These findings provide unique insights into the impact of family vulnerabilities on adolescents’ exposure to online harms and suggest a more holistic intervention framework for caregivers. Full article

The rapid growth of China’s aging population has made elderly care a pressing social issue. Due to an imperfect pension system, limited uptake of institutional care, and uneven regional economic development, most elderly people in China still rely on home-based care. Elderly people living at home are usually cared for by their family, partners, caregivers, or themselves. However, this often fails to meet their complex health, safety, and emotional needs. Artificial intelligence may provide promising solutions to improve home care experiences and address the multifaceted health and lifestyle challenges faced by homebound elderly people. This review explores the applications of artificial intelligence in home-based care from four main perspectives: home health care, home safety and security, smart life assistants, and psychological care and emotional support. We systematically searched PubMed, IEEE Xplore, CNKI, and Scopus databases, integrated the latest research published between 2015 and 2024, focused on peer-reviewed, practice-oriented research, and reviewed relevant technology development paths and the current status of the field. Unlike previous studies that focused on physiological monitoring, this study is the first to systematically and comprehensively evaluate the role of artificial intelligence in improving the convenience of daily life and mental health support for elderly people at home. By comprehensively reviewing and analyzing the basic principles and application background of artificial intelligence technology in this field, we summarize the current technical and ethical challenges and propose future research directions. This study aims to help readers gain a deeper understanding of the current status and emerging trends of artificial intelligence-enabled home-based elderly care, thereby providing valuable insights for continued innovation and application in this rapidly developing field. Full article

Background: Effective prevention of SIDS/SUID requires a multidimensional approach. It is essential to provide targeted support for marginalized families, improve access to healthcare services, and implement policies aimed at reducing social and economic inequalities. The parallel effective way to reduce the risk of sudden unexpected infant death is through increased awareness of proper infant care. Despite the guidelines available in many countries, the risk of infant death from non-medical causes is still reported. The aim of the study was to assess awareness regarding an infant’s sleep environment and safe sleep practices among Polish caregivers. Methods: The survey was conducted among 451 mothers of infants under 18 months of age. The survey questionnaire was prepared, which consisted of single- and multiple-choice questions with closed and open answers assessing safe sleep practices. Results: Analysis of the survey responses showed that most mothers in the sample (88.9%) were aware that the supine position is the safest. According to the survey, 74.5% of respondents believed that infants should not sleep in the same bed as parents or siblings. In addition, 78.3% of those women stated that infants should sleep separately in their own bed. Despite this knowledge, almost 37.76% of female respondents still put their infants to sleep in their parents’ bed. As many as 98.4% of respondents knew that any items should not be placed in an infant’s crib. Despite this knowledge, a third of respondents still placed additional items in their baby’s crib. In the study 90.7% of women believed that breastfeeding should begin within the first hour after birth. Conclusions: Knowledge of safe sleep recommendations, including sleep environment, sleep position, and spatial organization, does not always translate into proper caregiving practices. Understanding caregivers’ motivations and how they perceive medical information is critical to effective prevention of infant sleep safety. Full article

Clinical education, traditionally linked to university training in health care, has found a new declination at the Fondazione Policlinico Universitario Campus Bio-Medico (FPUCBM) through a free public service aimed at patients, family members, and caregivers. This innovative approach aims to improve health self-management, promote empowerment, and foster the active involvement of patients in their own care pathway. Based on high-quality and safety certified standards (by the Joint Commission International), FPUCBM has launched structured initiatives such as “education box” events to provide clear and accessible information, addressing patients’ educational and emotional needs. The “health education service” integrates several activities, including single-topic educational events, the creation of information materials (brochures and video tutorials), and collaboration with patient associations. Since its launch in 2023, the service has reached more than 400 participants in 22 events, covering topics such as chronic disease management and prevention and the proper use of home devices. In total, 95 information brochures and 9 video tutorials have been produced to expand the available resources. Benefits include improved health awareness, increased confidence in care pathways, and a positive impact on the hospital’s reputation. In conclusion, it represents a replicable model of person-centered health care that combines human care and educational support to promote more effective and informed disease management while improving the overall patient experience. Full article