Search Results (1,129)

Background: Tobacco smoke exposure in the home remains common among U.S. families and has been increasingly associated with adverse mental health outcomes, including anxiety and depression, among children and adolescents. Rising rates of youth anxiety and depression, coupled with evidence that secondhand smoke and related psychosocial stressors may disrupt emotional development, underscore the importance of examining household smoking exposures as a modifiable risk factor for youth mental health. This study examines associations between exposure to smoke in households and the likelihood of caregiver-reported anxiety and depression in US children and adolescents aged 6–17 years, using data from the 2022–2023 National Survey of Children’s Health (NSCH). Methods: A retrospective analysis of NSCH data for two age cohorts, children (6–11 years) and adolescents (12–17 years), for the years 2022–2023 was conducted. Descriptive statistics were generated for the selected sample by frequencies and counts for each of the dependent and independent variables, followed by binary logistic regressions for each measured mental health variable based on current diagnosis, severity levels (not severe, mild, moderate, severe) and household tobacco use. Results: This study found significant associations between parental smoking and increased odds of caregiver-reported anxiety and depression in both children and adolescents. Specifically, children living with parents who smoke had 1.55 times the odds of severe anxiety, while adolescents had 1.38 times the odds of currently experiencing anxiety and 1.31 times the odds of currently experiencing depression. Smoking inside the household was not significantly associated with caregiver-reported anxiety or depression. These findings suggest that parental smoking serves as a marker for broader psychosocial and environmental stressors that contribute to youth mental health outcomes. Conclusions: Parental smoking is a significant, modifiable risk factor for anxiety and depression among US children and adolescents. These results emphasize the need for targeted, evidence-based interventions to reduce parental smoking, improve awareness of associated mental health risks, and address social determinants of health. Policies promoting smoke-free households, integrated cessation support, and culturally tailored education programs are essential to mitigate the impact of parental smoking on child and adolescent mental health. Full article

Background/Objectives: The increasing problem of excess body weight and the resulting dyslipidemia among children and adolescents is a serious health challenge that may have long-term consequences. In this context, the search continues for an optimal diet that will support both body weight normalization and improvement in lipid parameters. In the prevention and treatment of cardiovascular diseases and lipid disorders, limiting highly processed foods and replacing them with natural, minimally processed options lower in fat, saturated fatty acids (SFA), cholesterol, sugar, and salt is recommended. This study aimed to assess the quality and nutritional value of the low-glycemic index (LGI) diet and standard (ST) diet. Methods: Both diets were based on the principal recommendation of the Cardiovascular Health Integrated Lifestyle Diet-2 (CHILD-2). The Diet Quality Index (DQI) was used to assess the diet quality. Moreover, the nutritional value of the diet was assessed before and after 8 weeks of intervention. The study included 40 patients aged 8–16 years with excess body weight and dyslipidemia who completed the entire nutritional intervention. Results: This study demonstrated that both LGI and ST diets were effective in improving diet quality. The nutritional intervention led to an almost 2-fold reduction in the mean DQI score in the LGI diet group and almost 1.5-fold reduction in the ST diet group (significant differences between groups). No participants were classified into a lower diet quality category than at baseline. The percentage of participants with minimum moderate diet quality reached 100% in the LGI diet group and 44% in the ST diet group. Changes in nutritional value were similar in the LGI and ST diet groups. Both interventions resulted in a significant increase in protein and fiber consumption, as well as a decrease in cholesterol, SFA, and sodium. A greater improvement in diet quality was significantly associated with lower fat and SFA, as well as higher vitamin C intake, in both groups; specifically, it was also associated with reduced cholesterol and sugar intake in the LGI diet group, and reduced sodium intake in the ST diet group. Conclusions: These results suggest that in the dietary therapy of children and adolescents with excess body weight and dyslipidemia, the quality of the diet is crucial, as it is associated with beneficial changes in nutritional value, which may have a positive impact on patient health. To achieve this, however, constant and consistent cooperation with a dietitian is necessary to help implement appropriate dietary recommendations in practice. Further long-term, larger-scale studies are needed. Full article

Background/Objectives: This study aimed to investigate the effects of explaining the perioperative process to pediatric patients scheduled for adenotonsillectomy using pictures on their anxiety levels. Methods: A prospective, randomized controlled trial was conducted, enrolling 58 patients. The patients were divided into two groups: Group 1 (n = 29), where the perioperative process was explained using pictures, and Group 2 (n = 29), the control group, where no pictures were used. Child anxiety was assessed using the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF) at five observation time points before anesthesia induction. Parents’ anxiety was measured using the Visual Analog Scale for Anxiety. Results: Patients in Group 1 had significantly lower heart rates during induction and the intraoperative period compared to Group 2 (p = 0.031, p = 0.025, respectively). In terms of anxiety and RSAS scores, patients in Group 1 had significantly lower mYPAS-SF scores at time points t2, t3, t4, and t5 compared to Group 2 (t2: p = 0.001; t3–t5: p < 0.001). No significant difference was observed at t1 (p = 0.068). The mean RSAS scores were also significantly lower in Group 1 (p = 0.029). Parents’ anxiety was significantly lower in Group 1 at all three time points (t1: p = 0.017; t2: p = 0.006; t3: p = 0.036). Conclusions: Our study results demonstrate that illustrating the perioperative process to children undergoing adenotonsillectomy can significantly reduce preoperative anxiety and prevent awakening agitation. Given its ease of implementation, we believe that using visual aids to explain the perioperative process to pediatric patients can facilitate process management for patients, parents, and physicians. Full article

Children and adolescents in hot and humid climates face increasing health risks due to climate change. Although the concept of Health-Promoting Schools (HPSs) is widely recognized, a systematic framework that integrates climate adaptability, child-specific needs, and multidimensional environmental design is still lacking. To address this gap, this study conducted a systematic literature review of 89 publications with three objectives: (1) synthesize research from the past decade on the impact of school physical environments on the health and academic performance of children and adolescents; (2) develop an evidence-based synergistic design framework with a categorized indicator system; and (3) integrate qualitative and quantitative evidence on how these indicators influence different health dimensions. The resulting framework emphasizes multidimensional, synergistic optimization and provides climate-responsive design strategies tailored to educational settings in hot and humid regions. By offering a theory-to-practice pathway, the framework complements existing healthy building guidelines for K–12 schools and supports designers and policymakers in creating environments that enhance thermal resilience, cognitive performance, and holistic child development. Full article

Background/Objectives: The potential of relative grip strength as a biomarker for cardiovascular risk in college students is not well understood. Methods: Blood pressure status and grip strength metrics were analysed with multivariate logistic regression and restricted cubic spline models, utilising nationwide cross-sectional data from 42,591 Chinese college students. Results: After adjustment, higher absolute grip strength increased hypertension risk (High-level OR = 2.66; 95% CI: 2.21–3.20). In contrast, higher relative grip strength not only reduced risk overall (High-level OR = 0.41; 95% CI: 0.36–0.46) but also demonstrated consistent protective effects across all BMI subgroups (e.g., OR = 0.83 in overweight/obese individuals). Conclusions: Relative grip strength may present a valuable biomarker for cardiovascular risk assessment and the easy identification of at-risk individuals in all BMI categories. Full article

Background/Objectives: HPV vaccination is safe, effective, and recommended at ages 11–12, yet uptake remains suboptimal. Serious video games may offer an innovative strategy to deliver brief, engaging education during clinic visits. This qualitative paper, embedded within a mixed-methods study, examined adolescents’, parents’, and healthcare providers’ (HCPs’) perceptions of the acceptability, usability, and perceived clinical applicability of HPV Detective, a tablet-based digital game designed to provide HPV-related education to parent–child dyads during pediatric clinic wait times. Methods: Eight adolescent–parent dyads (N = 16) and three HCPs from university-affiliated pediatric clinics participated in 30–60-min semi-structured Zoom interviews. Interviews were audio-recorded, transcribed, and thematically analyzed by two coders, with discrepancies resolved by consensus and reviewed by a third researcher. Results: Participants identified five key dyadic themes and four HCP themes. Adolescents described the gameplay as intuitive and enjoyable, highlighting interactive challenges and realistic avatars. Parents valued the clarity of HPV information and noted that the game helped initiate health-related conversations. Both adolescents and parents suggested enhancements including voice narration and greater customization and agreed that the game was well suited for 10–15-min clinic wait times, with text messaging preferred for follow-up. HCPs emphasized challenges such as parental hesitancy and competing clinical demands and viewed the game as a feasible adjunct to support vaccine-related discussions. Conclusions: Findings suggest the acceptability, usability, and perceived clinical applicability of a brief, clinic-based digital game for HPV-related education and engagement among adolescents and their parents. Full article

The total cavopulmonary anastomosis (Fontan procedure), a palliative procedure for single-ventricle congenital heart disease, improves survival but is associated with progressive multiorgan complications and high long-term morbidity. Prior blood-based proteomic studies in adults have been limited to targeted antibody-based panels or focused on methodological comparisons. Systemic molecular alterations in younger, clinically heterogeneous patients, particularly in untargeted pathways, remain incompletely characterized. Serum samples from 48 Fontan patients and 48 age- and sex-matched healthy controls were analyzed using mass spectrometry with TMT labeling. 2228 proteins were quantified, of which 124 were significantly differentially abundant (fold change > 1.5 or <0.67, FDR-adjusted p < 0.05). Network analysis identified three major functional clusters: extracellular matrix (ECM) organization (predominantly increased), actin cytoskeleton organization, and platelet-related pathways (both predominantly decreased). Stratified analyses showed reduced ECM protein abundance in high-risk patients, suggesting a shift from active remodeling toward a more established fibrotic state, and uniquely elevated cytochrome b5 reductase 3 (CYB5R3), implicating altered redox homeostasis, nitric oxide metabolism, and cellular aging. Overall, our findings extend prior targeted analyses, reveal potential biomarkers such as CYB5R3 and underscore the complexity of the Fontan circulation, with implications for risk stratification and therapeutic targeting. Full article

Background: Malnutrition and sleep disturbances are common in childhood and are associated with neuropeptides that regulate appetite and circadian rhythms. Hypothalamic peptides such as orexin A, agouti-related protein (AgRP), proopiomelanocortin (POMC), and peptide YY (PYY) play important roles in energy balance and eating behavior; however, their specific functions in pediatric malnutrition remain unclear. This study aimed to determine the levels of these peptides in malnourished children and to examine their relationship with eating and sleep behaviors. Methods: This case–control, cross-sectional study included 99 children aged 5–15 years diagnosed with malnutrition and 85 age-matched healthy controls. Blood samples were collected from all participants, and peptide levels were measured using ELISA. Additionally, the Children’s Eating Behaviour Questionnaire (CEBQ) and the Children’s Sleep Habits Questionnaire (CSHQ) were administered to assess eating patterns and sleep behaviors. Statistical comparisons and hierarchical logistic regression analyses were performed. Results: Orexin A and PYY levels were significantly higher in malnourished children than in controls (p < 0.001). No significant group differences were found for AgRP and POMC, although AgRP tended to be lower and POMC higher in the malnutrition group. Regression analyses identified orexin A and PYY as significant predictors of malnutrition. Orexin A showed a positive correlation with emotional undereating. Sleep habits did not differ significantly between groups. Conclusions: Elevated orexin A and PYY levels may function as potential neuropeptidergic biomarkers of malnutrition. Their association with emotional eating highlights the psychobiological components of malnutrition. Further longitudinal studies are warranted to clarify causal mechanisms and support clinical translation. Full article

Background: Burns represent a public health problem because they generate both physical and psychological damage, especially in the child and adolescent population, and high costs, especially due to the management of scars. Advances in burn care have improved survival and quality of life for this population. New clinical trials have been conducted on the benefits of negative pressure wound therapy (NPWT), showing that it improves the healing of burns and the appearance of scars. Therefore, this study aims to analyze the efficacy of NPWT both alone and as an adjunct to conventional dressings in pediatric and adolescent patients compared with conventional treatments. Methodology: A systematic search was carried out between December 2023 and the last quarter of 2025 in databases such as PubMed, Scopus, CINAHL, and the Cochrane Library. This meta-analysis was performed following the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and was registered in PROSPERO with registration number CRD42024597293. The risk of bias 2 (RoB2) tool was used to assess the risk of bias in the studies. Quantitative meta-analyses using random-model effects were performed only for variables with sufficient comparable data among studies. For other outcomes, where meta-analysis was not feasible due to lack of comparable data or control groups, results were synthesized qualitatively. Results: A total of seven articles (three clinical trials and four retrospective studies), in which a total of 323 subjects participated, were included. The main results demonstrate the efficacy of NPWT, as it decreases the re-epithelialization time, improves the appearance of scars (MD = −1.25 (95% CI between −1.80 and −0.70)), reduces the probability of skin grafts (OR = 0.17 (95% CI between 0.06 and 0.46)), and therefore, as there is less need for surgery and fewer dressing changes, reduces costs. Conclusions: NPWT offers significant clinical benefits in the treatment of burns in children and adolescents. Although a meta-analysis could not be performed due to the lack of a control group in some studies, studies with larger samples and multicenter designs will be necessary to better assess the relevant clinical outcomes. However, the results of this study show that NPWT is effective in treating burns in children and adolescents and that its use in clinical practice may represent a promising adjunctive therapy. Full article

Background: The World Health Organization and the Australian physical activity guidelines, in line with contemporary research, recommend regular muscle-strengthening activities for optimal muscular fitness in children and adolescents. However, the extent to which muscle-strengthening or muscular fitness receives curricular emphasis is unknown in Australia. Objectives: To examine to what extent the Australian Health and Physical Education Curriculum, Foundation to Year 10 (AHPEC; F–10) addresses and/or promotes muscular fitness. Methods: This study involved a mixed-methods content analysis of the AHPEC F–10 using: (i) conceptual analysis to identify muscular fitness-related terms; and (ii) relational analysis to examine alignment between muscular fitness content and curriculum rationale/aims. A search of national and international physical activity guidelines and school-based muscular fitness intervention literature generated a keyword set to guide abstraction from the AHPEC. Curriculum aim, rationale, level descriptions, achievement standards and content were coded to determine the extent to which muscular fitness was embedded. Intercoder reliability was established via consensus meetings. Muscular fitness content coverage was quantified as the proportion of directly aligned muscular fitness relevant content points per stage and aggregated primary (F–6), secondary (7–10), and F–10 scores. Results: A review of 32 national and one international physical activity guidelines identified 88 muscular fitness activities in total, with some activities appearing in multiple guidelines; 53.1% of national guidelines did not provide explicit muscular fitness examples, and where examples existed, they emphasised accessible modes (e.g., climbing, bodyweight tasks, jumping, and lifting). Additionally, analysis of school-based muscular fitness intervention literature identified 22 distinct muscular fitness activities to guide abstraction. Muscular fitness was absent in the AHPEC rationale and aims, was largely inferred in primary years level description and achievement standards and became more explicit in secondary achievement standards. Direct alignment of content with muscular fitness was non-existent or low across stages of learning (Foundation = 0%, Stage 1 = 0%, Stage 2 = 6.1%, Stage 3 = 9.1%, Stage 4 = 8.6%, Stage 5 = 8.8%). Overall, muscular fitness content coverage averaged 3.8% in primary, 8.7% in secondary, and 5.4% across F–10. Conclusions: The AHPEC treats muscular fitness as a low priority in primary schooling and a minor content area in secondary, yielding developmental messaging that is less aligned with contemporary evidence and physical activity guidelines. Full article

Child marriage remains a major threat to adolescent girls’ health, development, and rights worldwide. Despite decades of progress, recent policy backsliding and sociopolitical instability have created new risks, with examples from Iraq, Afghanistan, and The Gambia illustrating how legal and political shifts are reshaping vulnerabilities for girls. This paper presents an integrated framework linking developmental science with legal and policy advocacy, emphasizing how evolving capacities and psychosocial maturity should inform marriage laws and protection mechanisms. It reframes advocacy and rights-based action as essential components of adolescent health systems, drawing on recent policy analyses and country examples to identify actionable, multisectoral strategies. The paper highlights an urgent need for collective, evidence-informed advocacy to protect adolescent girls and advance gender equality, an issue of growing importance amid renewed global attention to legal reforms on child marriage. Full article

Backgrounds/Objectives: Mindfulness-based stress reduction (MBSR) programs may have applications for adults with cerebral palsy (CP), particularly as this population is at increased risk of mental health challenges relative to the general population. However, little is known about the experiences of adults with CP participating in these programs. The aim of this study was to explore the experiences of adults with CP, and a facilitator, who participated in a 9-week MBSR telehealth program. Methods: Adults who attended an MBSR telehealth program were invited to participate in focus groups. If a participant was unable to attend a focus group, they were offered a semi-structured interview. The facilitator participated in a semi-structured interview. Focus groups and interviews were recorded, transcribed verbatim, and inductively thematically analyzed using Framework Analysis. Results: Ten adults with CP and one facilitator participated. Feedback on the program spanned across three themes: (i) learning and creating my mindfulness toolbox; (ii) applying mindfulness to everyday life; and (iii) online together with expert facilitation. Participants appreciated having access to a variety of mindfulness techniques to accommodate individual preferences. Peer-learning in a facilitated, online group context was also valued. Participants recalled implementing mindfulness strategies in everyday life and provided recommendations of how to improve the program. These included incorporating a group orientation, shortening group sessions to reduce fatigue, and follow-up sessions to maintain mindfulness skills after program completion. Conclusions: This study provides new knowledge about the perspectives of adults with CP regarding MBSR delivered via telehealth. Participant recommendations should inform future implementation of group mindfulness telehealth programs for adults with CP. Full article

The aim of this study was to map global research on community-based strategies to reduce risky alcohol consumption and promote health, aiming to clarify growth, leading contributors, thematic structure, and integration with public-health frameworks. Using a PubMed corpus, we analyzed production, authorship, and collaboration indicators, built a thematic map (centrality/density) to identify core topics, and applied Multiple Correspondence Analysis to assess conceptual proximity between alcohol-specific and broader prevention domains. The dataset comprised 2607 documents across 916 sources, with output led by the USA, with substantial contributions from Australia, Canada, the UK, and rising activity in sub-Saharan Africa. The thematic map showed a mature core centered on adolescents and pregnancy, cross-cutting foundations in health education and sexual behavior with substance-related disorders, measurement-oriented niches at the periphery, and emerging work linking family planning. The Multiple Correspondence Analysis positioned alcohol-prevention terms close to health promotion, primary prevention, and epidemiology, with maternal–child health bridging community programs and clinical prevention. Overall, community-based alcohol prevention is expanding, globally distributed, and embedded in mainstream public-health practice. Limitations include the absence of citation data in PubMed, and future work should integrate citation-enabled databases and compare patterns across income groups. Full article

Background: Parental burnout is a state of extreme exhaustion that is detrimental to family life. There is some evidence, albeit limited, that children of exhausted parents are at risk of neglect or abuse. The children’s lived experience remains an underinvestigated issue. This qualitative and participatory study aimed to explore children’s and adolescents’ perceptions and experience of parental burnout, as well as the resources they identify as available to assist them. Methods: We interviewed 24 children of exhausted parents, including children typically developing (n = 17), children with illness/disability (n = 3), and children with learning/behavioral difficulties (n = 4). We used interactive data collection tools, adapted to the participants’ age. The interviews were followed by a participatory validation seminar. Results: We evidenced a high emotional burden experienced by children exposed to parental burden. The children conveyed feeling insecure about what happens, perceiving a mismatch between their own needs and those of their parents, and being afraid both of and for their parents. Conclusions: Our results call for an increased recognition of parental burnout as not only a personal or family problem, but a possibly important societal and public health concern, with implications for child prevention and health promotion. Full article

Background: Overweight and obesity in childhood and adolescence represent one of the most significant public health challenges of our century. Affected children and adolescents often face psychosocial maladaptation, including low self-esteem, depressive and anxiety symptoms, and behavioral problems, many of which may persist till later in life. The aim of our study was to evaluate the impact of a multidisciplinary, personalized lifestyle intervention program on psychosocial and behavioral symptoms, assessed through standardized psychometric questionnaires, and to investigate their relation with cardiometabolic parameters in children and adolescents with overweight and obesity. Methods: In this prospective cohort study, 537 children and adolescents (6–18 years; females: 52.9%; pubertal: 43.6%) with obesity (n = 44.3%), overweight (n = 33.7%), or normal BMI (n = 22%) participated in a personalized lifestyle intervention program for one year. Clinical and laboratory evaluations, including anthropometric, cardiometabolic, and endocrinologic parameters, as well as psychosocial functioning assessed by the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR), were performed at the beginning and the end of the study. Linear regression analyses identified predictors of psychometric change. Results: At initial evaluation, children and adolescents with obesity displayed a less favorable cardiometabolic profile and greater emotional/conduct difficulties compared to their overweight and normal-BMI counterparts. Following the intervention, significant improvements were observed in BMI, anthropometric and cardiometabolic parameters, as well as reductions in internalizing, externalizing, and total problem scores across multiple CBCL and YSR domains (p < 0.05). The improvements in psychosocial functioning were partly independent of BMI reduction. Linear regression analyses identified cardiometabolic and endocrine markers as significant predictors of psychometric change (p < 0.05), highlighting interactions between metabolic recovery, pubertal hormones, and stress physiology. Conclusions: A personalized, multidisciplinary lifestyle intervention program implemented for 1 year led to parallel improvements in psychosocial and cardiometabolic health in children and adolescents with overweight and obesity. Identification of specific metabolic and endocrine predictors provides novel insights into potential biological mechanisms associated with adiposity, emotional well-being, and neurodevelopment. Full article