Search Results (238)

This study examines how religious and spiritual identities relate to depression and anxiety at baseline and longitudinally. Using data from the Family Foundations of Youth Development Project, which sampled parent–child dyads from the Western United States, we investigated how mental health relates to the conjunction of spirituality and religiosity (S/R), the lack of either, or one separate from the other. At baseline, children identifying as “Spiritual but not Religious” (SBNR) reported the highest levels of anxiety and depression, whereas children who identified as “Religious and Spiritual” (RAS) exhibited the lowest levels of depression. The difference between RAS identity and the SBNR identity was significant across all baseline scales, with SBNR individuals demonstrating greater pathology. Among parents, the “religious but not spiritual (RBNS) group” was more depressed than the RAS group, and both RBNS and SBNR parents were more anxious than the “not religious, nor spiritual” (NRNS) parents. Longitudinally, SBNR children uniquely showed significant decreases in their depression levels, and no increases in their anxiety levels, likely reflecting a ceiling effect given their initially high symptoms. Regarding adults, all groups except RBNS decreased in depressive symptoms over time. It is important to note that this study does not investigate the effects of spiritual or religious identity shift: i.e., conversion or deconversion. This study highlights the nuanced relationship between psychological well-being and S/R. It examines participants from the Western United States, in predominantly white, highly homogenous areas, with a large presence of members from the Church of Jesus Christ of Latter-day Saints, and is not generalizable to world populations. It offers possible interpretations, intending to alleviate suffering and encourage flourishing by identifying risk and protective factors. Full article

Objective: To evaluate changes in emotion regulation, skin-picking disorder (SPD) severity, and repetitive thoughts and behaviors in adolescents with attention-deficit/hyperactivity disorder (ADHD) and comorbid SPD during methylphenidate treatment, and to examine the association between emotion regulation and SPD severity. Materials and Methods: This naturalistic follow-up study included 26 adolescents aged 11–17 years with ADHD and comorbid SPD. Participants received methylphenidate and were reassessed after three months. Emotion regulation, SPD severity, and repetitive thoughts and behaviors were assessed at baseline and follow-up using the Difficulties in Emotion Regulation Scale (DERS), Skin Picking Scale–Revised (SPS-R), and Repetitive Thoughts and Behaviors Scale–Child Form (RTBS-CF). Pre–post differences were analyzed using paired-sample tests, and associations were examined using correlation and linear regression analyses. Results: Significant reductions were observed in total DERS scores (p < 0.001, Cohen’s d = 1.35) and all subscales except non-acceptance (p = 0.686, Cohen’s d = 0.08). SPS-R and RTBS-CF scores decreased significantly (both p < 0.001, Cohen’s d = 1.79 and 0.91, respectively). Changes in DERS scores were moderately correlated with changes in SPS-R scores (r = 0.554, p = 0.003). Changes in emotion regulation were significantly associated with changes in SPD severity, accounting for approximately 31% of the variance in this sample. Conclusions: Methylphenidate treatment was associated with significant improvements in emotion regulation and concurrent reductions in skin-picking severity in adolescents with ADHD and comorbid SPD. Given the single-arm, pre–post naturalistic design, these findings should be interpreted as associative and exploratory rather than causal. Full article

Background: Chemical Intolerance (CI), Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactive Disorder (ADHD) are conditions with rising incidence rates not fully explained by greater awareness or changes in diagnostic practices. It is now generally accepted that the interaction between genetic and environmental exposures plays a role in all of these conditions. Prior studies show that these conditions co-occur. This study seeks to explore previous findings using an international sample. Methods: A five-country (N = 5000) stratified panel survey was used to assess self-reported CI in themselves, and ASD and ADHD in their children. A generalized linear model was used to estimate Odds Ratios. Age- and sex-adjusted logistic models used CI as a predictor of ASD and ADHD in separate models. Results: Compared to those classified as Low CI, High levels of CI were associated with greater Odds Ratios (OR) of reporting a child with ASD and ADHD in all countries except Japan. Italy, India, and the USA had over twice the OR of reporting a child with ASD. Mexico had over 1.9 times the OR. The results with ADHD are similar to the ASD results. Conclusions: The results of this study are consistent with two prior U.S. studies, showing an association between ASD and ADHD among women who have CI. However, cross-cultural comparisons, especially prevalence estimates for ASD and ADHD, cannot be interpreted as epidemiologic rates due to serious limitations of the survey methodology. No causal relationship should be inferred from this study. Full article

Background/Objectives: The hypothalamic-pituitary-testis axis is known to be dysregulated in patients with hematological malignancies. However, data on the association between the type of hematological malignancies and semen quality are discordant. In the era of personalized medicine, identifying disease-specific patterns of reproductive impairment is crucial to optimize fertility preservation strategies. While patients with leukemia often show a clear deterioration in semen quality, studies on Hodgkin and non-Hodgkin lymphomas have shown that spermatogenesis is not always compromised. Indeed, some patients may present normospermia before treatment. This study aimed to assess semen parameters in males affected by hematological malignancies compared with a non-cancer population and to explore implications for individualized fertility preservation counseling. Methods: We performed a retrospective monocentric study including all patients affected by hematological malignancies who underwent fertility preservation at the Maternal and Child Department, Gynecology and Obstetrics, Oncofertility Unit, Federico II of Naples, from January 2017 through December 2024. In total, 247 patients with hematological malignancies and 63 non-cancer males undergoing in vitro fertilization for female tubal factor, selected as a control group, were included in the analysis. Sperm parameters (semen volume, sperm concentration, motility, and morphology) were first compared between the hematological malignancy group and the control group, and then among hematological malignancies classified as Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), and leukemia (L). Results: Overall, according to World Health Organization (WHO, 2021) criteria, semen parameters of patients with hematological malignancies were at the 25th percentile, except for motility, which was below the 5th percentile. Significant differences were observed in sperm concentration/mL, total sperm number, and percentage of total sperm motility between the hematological malignancy group and the control group (p = 0.0004; p = 0.0003; p < 0.0001). Based on disease classification, 158 patients had Hodgkin lymphoma, 54 had non-Hodgkin lymphoma, and 35 had leukemia. Significant differences in concentration/mL and total sperm number were found between the Hodgkin lymphoma group and the control group (p = 0.003; p = 0.001). The percentage of total sperm motility was significantly decreased in all subtypes of hematological malignancies compared with controls, especially in the leukemia group (HL p = 0.001; NHL p = 0.004; L p < 0.001). Conclusions: These findings highlight significant impairment of semen quality, particularly motility, reinforcing the role of personalized medicine in tailoring fertility preservation strategies according to malignancy subtype and baseline reproductive risk. Full article

Background: Foster children exhibit higher rates of psychiatric and physical disorders than children living with their biological families. This places a high burden on the parenting skills of foster parents and potentially increases the risk of placement failure. One possibility to increase foster carers’ parenting skills and to reduce child problems is through parent training. In this study, the feasibility and effectiveness of the German-translated version of Fostering Changes, a parent training programme for foster parents, was investigated. The aims of Fostering Changes are the reduction in child behavioural problems, supporting children’s affect regulation, and improving the quality of the foster parent–child relationship through the promotion of foster parents’ sensitivity and parenting skills. Methods: We conducted six Fostering Changes courses in 2022 and 2023, with a total of 33 foster carers (i.e., foster parents) participating. Child behavioural problems (Carer-Defined Problems Scale; primary outcome), child psychopathology (Strengths and Difficulties Questionnaire), carer–child relationship quality (Child Relationship Behavior Inventory, Quality of Attachment Relationship Questionnaire), foster carers’ stress (Parental Stress Scale), and foster carers’ parenting strategies (Parenting Scale) were assessed at the start (t0) and end of each course (t1) and three months after course completion (t2). To examine the effect of training participation, mixed linear models and generalised estimating equations were applied. Additionally, effect sizes (Cohen’s d) were calculated. Results: When comparing t0 with t1 scores, there was a significant reduction in child behavioural problems (d = 1.87) and child psychopathology (d = 0.70), and improvement in foster carers’ parenting skills (d = 0.76) and the quality of the foster parent–child relationship (CRBI: d = 0.77, QUARQ: d = 0.72). Effect sizes for changes in the abovementioned variables between t0 and t2 were also moderate to large, with the exception of child psychopathology (d = 0.44). Conclusions: The results of this feasibility study, which is the first trial of Fostering Changes outside the UK, suggest that the German version of Fostering Changes could be an effective intervention for foster families. The largely comparable results for the periods t0–t1 and t0–t2 suggest constancy of the observed changes three months after course completion. Trial registration: DRKS-ID: DRKS00029014; date of registration: 23 May 2022. Full article

Introduction: Refractory Status Epilepsy Syndrome is a heterogeneous group of diseases associated with status epilepsy. Literature and definition have been conflicting and confusing in terms of their nomenclatures. New-onset refractory status epilepticus (NORSE) is a syndrome characterized by new onset refractory seizures in a previously health child. Febrile infection-related epilepsy syndrome (FIRES) is a similar syndrome now considered a variant of NORSE and is defined as a febrile event taking place between twenty-four hours and two weeks prior to the commencement of refractory status epilepticus. An autoimmune or inflammatory etiology is often implied in both conditions because infection is rarely identified. Aim: This review provides an update on hypotheses, etiology, pathophysiology, clinical features, diagnosis, laboratory evaluation, treatment, and perspectives for NORSE/FIRES. Methods: A PubMed Clinical Queries search is performed using keywords of NORSE and FIRES, on human subjects up to May 2025. All reviews, systematic reviews, case series and case reports were included. Results: Seizures are typically recalcitrant in NORSE/FIRES. Treatments include anti-seizure medications (ASM), ketogenic diet, immunotherapy (intravenous immunoglobulin ± plasmapheresis ± corticosteroid). The prognosis is usually poor. Most children would suffer refractory epilepsy and associated cognitive impairment if they survived. Guidelines and new consensus on NORSE/FIRES terminology have aided clinicians in managing status epilepticus in a previously healthy child that occurs ± a minor febrile episode. When an autoimmune or paraneoplastic condition is subsequently identified, the condition will be named accordingly. Conclusions: NORSE and FIRES are similar conditions except that vagus nerve stimulation appears to be more efficacious in NORSE than FIRES. We propose to define these heterogeneous and confusing conditions as “NOSES” as a two-criteria syndrome: New Onset + Status Epilepticus Syndrome, lasting for over 24 h despite the use of two standard ASM. Autoimmune, paraneoplastic and infectious encephalitis are specific diagnoses of NOSES with etiology subsequently identified. Full article

Background: Central retinal artery occlusion (CRAO) is an ophthalmic emergency attributed to a vessel occlusion with an embolus or a thrombus and may occur during the hypercoagulable state, inflammation, or vasculitis. CRAO may occur in children; however its incidence is very rare. Most pediatric cases have detectable etiologies. Case Presentation: We describe the case of an otherwise-healthy six-year-old female, who presented with the sudden and complete vision loss of the left eye lasting over twelve hours after a six-day chickenpox exanthema, followed by a high fever. All the ophthalmological, laboratory, and instrumental investigations led to the diagnosis of a left CRAO. Laboratory testing was unremarkable except for the transient elevation of D dimers (1363 µg/L), IgM anticardiolipin antibodies (238.5 CU), and IgG anti-beta-2 glycoprotein-1 antibodies (76.1 CU) on admission. Thrombolytic treatment was not exerted because of late presentation to the hospital. Treatment with steroids, antiviral medications, antibiotics, and anticoagulants was obtained, but the visual outcome was poor during the hospitalization and at the last follow-up. We could not ascribe features of this case to any etiological condition apart from the documented ongoing chickenpox infection. Conclusions: This is the first case report of CRAO in a child with transient aPL elevation and acute chickenpox infection. Full article

Background/Objectives: Interpersonal violence is an increasing public health concern, and its prediction and prevention remain global challenges. This study aimed to identify prescribed medications associated with interpersonal violence in Spain. Methods: A descriptive, longitudinal and retrospective study and case-non case study of spontaneous reports of adverse drug reactions corresponding to interpersonal violence recorded in the Spanish Pharmacovigilance Database (FEDRA^®) from 1984 to 31 March 2021. Results: 533 cases were reported in the study period. The mean age was 46.70 years with ages ranging from 1 to 99 years. There were no sex differences except in child and adolescent age group where most reports were from male. Main therapeutic groups involved were nervous system (62.3%), anti-infectives for systemic use (10%) and respiratory system (8.6%). Mostly drugs reported were montelukast, levetiracetam, bupropion, donepezil, perampanel, quetiapine, fluoxetine, and lorazepam. A statistically significant association/disproportion in the notification has been found in the reporting of interpersonal violence and different drugs according to the literature, notably atomoxetine, perampanel, memantine, donepezil, montelukast and methylphenidate. Conclusions: The results highlight that interpersonal violence, while rare, could occur as a clinically relevant adverse reaction to a small subset of medications. They underscore the importance of careful prescribing, especially in vulnerable populations and in individuals with a history of psychiatric disorders. Full article

Twice-exceptional students, those who are both gifted and have an additional educational need, represent a complex and underserved population within education systems. While recognition of twice exceptionality has greatly increased in gifted education literature, little is known about the experiences of students and their families in Ireland, where no national policy or framework currently addresses their dual needs. This exploratory mixed-methods study aimed to examine the perspectives of 232 parents of twice-exceptional children who attended an enrichment summer programme for gifted students. Through an anonymous survey, the researchers investigated the frequency of specialised services provided for both giftedness and disabilities, as well as how satisfied parents were with these services. The findings indicated that, while two-thirds of students did receive special education support, the majority received no services focused on their giftedness. Parents expressed significantly higher dissatisfaction with gifted provisions than with special education, mentioning the lack of differentiation and access to advanced materials in class, as well as an emphasis on their child’s challenges, as opposed to their strengths. The study’s findings highlight substantial policy and practice gaps in Ireland’s current provision for twice-exceptional students and underscore the need for integrated support systems, teacher education, and inclusion of parent perspectives in educational planning. Full article

Background/Objectives: Oxidative stress contributes to the pathogenesis of cirrhosis, but its value as a clinical biomarker remains uncertain. Methods: We retrospectively analysed 90 patients with decompensated cirrhosis. Serum malondialdehyde (MDA) and 8-epi-prostaglandin F2α (8-iso-PGF2α) were measured at admission. Biomarker levels were compared between Child–Pugh classes B and C, across hepatic encephalopathy grades, and ascites severity, using Mann–Whitney, Kruskal–Wallis, and Spearman correlation tests. Results: Median MDA did not differ significantly between Child–Pugh classes B and C (2.67 [2.10–3.20] vs. 2.45 [1.98–3.05] μmol/L; p = 0.331), nor across ascites categories (p = 0.453). Similarly, 8-iso-PGF2α values did not vary between Child–Pugh classes (255.8 [220.0–310.0] vs. 250.1 [210.0–295.0] pg/mL; p = 0.784) or ascites groups (p = 0.828). Spearman analysis showed no significant correlations with albumin, INR, bilirubin, creatinine, or age, except for a non-significant trend with bilirubin (ρ = −0.18, p = 0.09). Importantly, MDA levels increased significantly across encephalopathy grades (p = 0.021), suggesting a link between systemic oxidative stress and neuropsychiatric impairment. Conclusions: In this clinical cohort, oxidative stress biomarkers did not provide discriminatory value for staging by Child–Pugh or ascites, but MDA was associated with encephalopathy severity. These findings highlight both the limitations and potential clinical relevance of oxidative stress markers in cirrhosis management. Full article

Background: Recognizing and balancing internal and external appetite cues is critical for controlling food intake in young children. The main aim of this pilot study was to validate a Hebrew-language Picture-Based Appetite Assessment (PBAA) for 6–9-years-old children. Specifically, the scale’s ability to reflect changes in perceptions of hunger and satiety based on a story and on their actual eating experiences. Methodology: In Part 1 (n = 99), a PBAA was used to rate a character’s hunger level according to a story. In Part 2 (n = 46), the child’s hunger level before and after lunch was assessed, and in Part 3 (n = 55), the child’s hunger level before and after unrestricted snack consumption was assessed. Results: After hearing a story, participants could identify whether a character in a story was hungry (95%) or full (85%) (Part 1). Their reported appetite levels decreased after consuming lunch (p-value < 0.001) (Part 2). When participants were given unrestricted access to snacks, they preferred highly processed sweets with no difference in hunger level before (Part 3). There were no differences between girls and boys except for the reported satiety after lunch, which was greater in older girls compared to younger girls, yet similar between older and younger boys. Conclusions: Participants successfully interpreted the PBAA scale based on the story character and reported lower hunger after eating lunch. Among girls, older age was associated with a greater difference in hunger levels before and after lunch. Most participants reported satiety after consuming unrestricted snacks, which was not related to their hunger level before. Full article

Background and Clinical Significance: In a single phenotypically female patient, we describe the rare co-occurrence of partial androgen insensitivity syndrome (PAIS) and congenital adrenal hyperplasia (CAH). Partial androgen insensitivity syndrome (PAIS) is one of disorder of sex development (DSD) with a 46 XY karyotype. Congenital adrenal hyperplasia (CAH) is a genetic defect in adrenal steroidogenesis. Case presentation: We present the case of a 26-year-old female patient who was observed to have abnormally formed external genitourinary organs. She was diagnosed at the neonatal period. Tests performed showed a 46 XY karyotype, an absence of sex chromatin with a weakly positive DNA test for the SRY gene, an absence of uterine primordium with the presence of male gonads in the perineal skin folds, and a urethral outlet at the base of an undeveloped genital process. The daily urinary steroid excretion profile was normal. The patient was diagnosed with partial androgen insensitivity syndrome (PAIS). As a 4-year-old child, she underwent a bilateral gonadectomy due to possible further virilization and also the risk of testicular malignancy. Despite treatment, progressive androgenization was observed, the cause of which turned out to be congenital adrenal hyperplasia (CAH) in the course of P450 oxidoreductase (POR) disorder. Conclusions: In this article, we highlight the exceptional rarity of the co-occurrence of PAIS and CAH, underscoring the need for a multidisciplinary and individualized approach in the absence of clear guidelines regarding surgical timing and gender identity. Careful clinical evaluation and ongoing observation are essential for accurate diagnosis and optimal patient care. Full article

While pregnancy and anticipation of the birth of the first child may be a stressful experience for women, it may also provide an opportunity for personal growth. The literature shows that stress is a prerequisite for growth. However, studies rarely distinguish between different sources of stress. This study therefore sought to increase the theoretical understanding of personal growth by examining the contribution of different stress sources (exposure to pregnancy-related stressors, experiencing pregnancy stress, stress associated with life events during pregnancy, COVID-19-related anxiety over possible economic damage, and COVID-19-related anxiety over the health of the fetus). In addition, drawing on the Broaden and Build Theory, the contribution of dispositional gratitude to personal growth was examined. The sample consisted of 1378 women expecting their first child, who were recruited through social media. Results show that dispositional gratitude has a significant contribution to personal growth (p < 0.001) and that all stress sources except for pregnancy stress, contributed significantly to personal growth (p < 0.05). The study expands the theoretical knowledge and lends support to the need for a theoretical and methodological distinction between different sources of stress. Full article

This article aims to critically engage with the capability approach by exploring its potential contributions to social work practice, specifically social work focusing on reducing child poverty. In high-income countries, an estimated 69 million children are either living in poverty or at risk of poverty. Despite its comprehensive social welfare system, Switzerland is no exception. This contribution is based on empirical research conducted between 2021 and 2025 in Switzerland with children and young people (CYP). The results of this participatory and artistic research not only demonstrate the value of considering the experiential knowledge of CYP affected by poverty in the context of social intervention, but also the importance of the participation of this social work audience in fostering professional and institutional practices along with promoting fairer, more inclusive and transformative public policies. This research precisely identifies how social work practice could support CYP’s evolving capabilities by applying the capability approach within social services. Specifically, it focuses on capabilities for voice and to aspire, as well as their progression vis-à-vis the transformation of social practice, which could be observed through the participation implemented as a foundational principle of action in social work practice. Full article

There is very limited information available on secure care in Australia. There is no national oversight, standards, or data collection mechanisms. This article aims to outline which Australian states and territories deliver secure care, provide an overview of these interventions, identify trends and outlying practice, and highlight the human rights implications. A comparative systemic methodology was utilised, gathering qualitative data on secure care across Australian states and territories to compare and analyse. The findings are presented descriptively, and a qualitative content analysis was completed. This article identifies that there is secure care in all states and territories in Australia except Tasmania, South Australia, and Queensland. The content analysis identified that the Northern Territory and New South Wales do not have secure care legislation, and that the Australia Capital Territory and New South Wales are the only jurisdictions that require a specific secure care judicial order to authorise admissions. Victoria, the Northern Territory, and Western Australia utilise ‘administrative detention’ to authorise a secure care admission—this is when the admission to secure care of children with the involvement of child protection is authorised by the government, not through a court order via the judicial system. A consequence of the use of administrative detention is that children ‘in care’ in Australia are being deprived of their liberty without legal representation or access to the right to appeal in a court of law. There is minimal publicly available admission data on secure care in Australia. This article argues that secure care’s welfare-based position, conceptualisation, and discourse simultaneously obscures visibility, legitimises depriving children of their liberty and the use of restrictive measures, and undermines a rights-based approach to children experiencing extreme vulnerability. The use of administrative detention undermines system accountability, and the legal safety of children admitted to secure care in Australia. This is placing the rights of children in secure care in Australia as secondary to the management of organisational risk. Full article