Search Results (867)

Aflatoxins, mycotoxins produced by Aspergillus flavus and Aspergillus parasiticus, were discovered sixty-five years ago and remain a significant public health threat, particularly amid increasing instances of extreme weather events. Of the four principal forms of aflatoxins found in foods (B₁, B₂, G₁, and G₂), aflatoxin B₁ is the most potent carcinogen. Aflatoxins commonly contaminate a variety of foodstuffs, with maize being among the most susceptible. Chronic exposure to aflatoxins has been linked to liver cancer, childhood stunting, gallbladder cancer, and other adverse health effects. Due to public health concerns related to the consumption of aflatoxin-contaminated foods, most countries have established regulatory limits. Here, we present estimated aflatoxin exposure per day derived from human biomarker data across many studies around the world spanning more than forty years. We specifically focus on the impact of dietary aflatoxin in northern Latin America, where assessment of the total problem remains limited. These findings suggest a multipronged toolkit could mitigate aflatoxin exposure in the region, which would help to decrease the health burden. Full article

Research suggests that the impact of childhood sexual trauma (CST) on adult well-being varies in relation to characteristics of CST experiences (e.g., age of onset and duration/frequency) that influence the degree of trauma severity. Yet there remains a need for a CST severity measure that consistently delineates survivors with an elevated risk of adverse adult outcomes (AAOs) and accounts for correlations between severity characteristics. We compared two theory-based, categorical proxy measures of CST severity (duration and developmental timing) in their relationship with three AAOs, among a national probability sample of U.S. adult CST survivors (N = 568). We found a strong relationship between CST duration and developmental timing (p < 0.001), and redundancy in their impact on AAOs (i.e., no meaningful difference in how well they predicted AAOs). Participants with more chronic CST (≥4 years duration or occurring across childhood and adolescence) were twice as likely to report AAOs as other participants. Findings support the importance of assessing trauma chronicity in research and practice, to focus prevention and intervention strategies on CST survivors with the greatest long-term health risk. A categorical CST duration measure offers a theory-based assessment strategy that accounts for both the temporal and developmental effects of trauma severity on health outcomes. Full article

Background and objectives: Suicide attempts and self-harm are critical issues in adolescence, often leading to serious and irreversible consequences. These behaviours frequently co-occur and share common biopsychosocial risk factors. Identifying these factors enables a more comprehensive assessment of suicide and self-harm risk, helping specialists recognize high-risk individuals and implement effective preventive measures. This study aimed to examine the association between suicide attempts, self-harm and psychosocial factors among hospitalized adolescents. Materials and methods: A retrospective data analysis was performed using the database of the University Department of Children and Adolescents of the Republican Vilnius Psychiatric Hospital. The study covered patients’ records from December 2022 to February 2025. Information on gender, age, suicide attempts, self-harm, adverse events (bullying, psychological abuse, physical violence within the family, and sexual abuse) and unhealthy habits (smoking, harmful alcohol consumption, and psychoactive substance use), was selected and analyzed in this study. A Chi-square test was used to assess the difference between groups. Results were considered statistically significant when p < 0.05. Results: The study included 599 hospitalized adolescents (26.9% boys; mean age 15.1 ± 1.4 years), of whom 70.8% reported at least one episode of self-harm and 37.8% at least one suicide attempt. Rates of self-harm and suicide attempts were significantly higher in girls than in boys (self-harm: 81.3% vs. 42.2%, $\varphi =0.381$, $p<0.001$; suicide attempts: 45.5% vs. 16.5%, $\varphi =0.304$, $p<0.001$), and adolescents with self-harm had a significantly higher prevalence of suicide attempts than those without self-harm (46.7% vs. 15.8%, $\varphi =0.308$, $p<0.001$). Adverse childhood experiences and unhealthy behaviours were significantly more frequent in adolescents with self-harm and suicide attempts, although effect sizes were small to moderate ($\varphi$ range 0.086–0.230, all $p<0.05$). In multivariable models, female gender ($\beta =0.355$, $p<0.001$) and smoking ($\beta =0.330$, $p<0.001$) were the strongest predictors of self-harm, whereas alcohol use ($\beta =0.337$, $p<0.001$) and self-harm ($\beta =0.232$, $p<0.001$). Conclusions: Exposure to adverse childhood experiences and engagement in unhealthy habits were associated with higher rates of both self-harm and suicide attempts. A comprehensive assessment and early detection of self-harm behaviours and adverse psychosocial circumstances are crucial elements of effective suicide prevention strategies and prompt intervention among high-risk adolescents. Full article

Background/Objectives: Seasonal influenza imposes a significant burden on pediatric public health. Despite official recommendations and full insurance coverage, vaccination rates among children in Slovakia remain critically low. This study aims to analyze the attitudes, beliefs, and determinants of parental hesitancy regarding childhood influenza vaccination in the post-pandemic context. Methods: A single-center cross-sectional survey was conducted between February and March 2025 using convenience sampling among parents of children attending a pediatric immunoallergology center. An anonymous questionnaire collected data on demographics, risk perception, and attitudes. Data from 301 parents were analyzed using descriptive statistics, chi-squared tests, and odds ratios (OR) to identify key predictors of hesitancy. Results: Only 27.6% of parents expressed willingness to vaccinate their children, while 42.5% were opposed and 29.9% hesitant. Statistical analysis revealed no significant association between parental university education and vaccination intent (p > 0.05), indicating that vaccine hesitancy in this specific setting was present across all educational backgrounds. However, the source of information proved to be a critical determinant: consulting a pediatrician significantly increased the odds of acceptance (OR = 6.32; 95% CI: 3.54–11.28), whereas reliance on the internet and social media was a significant predictor of refusal (OR = 0.29; 95% CI: 0.17–0.50). The primary reported barrier was fear of adverse effects (70.4%), which significantly outweighed doubts about efficacy (30.2%). Conclusions: Parental hesitancy in Slovakia is a widespread phenomenon pervasive across all educational backgrounds, driven primarily by safety concerns and digital misinformation. The contrast between the protective influence of pediatricians and the negative impact of digital media underscores that clinical encounters are currently the most effective firewall against hesitancy. Public health strategies must therefore pivot from general education to empowering pediatricians with active, presumptive communication strategies. Full article

Background: Children of mothers exposed to adverse childhood experiences (ACEs) may be at increased risk of sleep disruptions, such as night waking, due to potential suboptimal caregiving or living conditions. Mothers’ ACEs are also associated with maternal depressive symptoms, which in turn are associated with children’s screen time and sleep disruptions, revealing relevant, but unexplored, mediation pathways. This Canadian study investigated if mothers’ ACEs were associated with their 5-year-old children’s sleep disruptions (1) directly and (2) indirectly through independent or serial mediation via maternal depressive symptoms and/or children’s screen time. Methods: Data (n = 622; maternal mean age 32.3 years, 88.4% white) came from the longitudinal APrON Study. ACEs were measured 1 year postpartum. Mother’s depressive symptoms were measured across prenatal and postnatal timepoints. Children’s evening screen time (i.e., number of days in a week children engaged in one hour of screen time before bedtime) and sleep disruptions (number of days in a week their child wakes up multiple times) were measured at 5 years postpartum using adapted scales (52.9% male). PROCESS was used to assess for mediation. Results: Mothers’ ACEs had an indirect effect on their children’s sleep disruptions through mothers’ mean depressive symptoms (effect = 0.018, 95% CI [0.006, 0.034]), but not through children’s screen time. No other effects (i.e., direct, total) were observed. Conclusions: Although replication studies are warranted, this novel study reveals that the effects of maternal ACEs on children’s sleep disruptions may operate indirectly with effects potentiated through maternal depressive symptoms, thus serving as a target for intervention. Full article

Background: Chronic pain is consistently associated with increased vulnerability to suicidal ideation, particularly among individuals with a history of early adverse experiences. However, the cognitive mechanisms linking childhood trauma to suicidal thoughts in this population remain insufficiently understood. Methods: A cross-sectional study was conducted with 251 adults living with chronic pain. Participants completed validated measures assessing childhood trauma, perceived burdensomeness, hopelessness, pain catastrophizing, and suicidal ideation. Correlational analyses were conducted to examine associations among variables, followed by a multiple mediation model to test the mediating role of cognitive processes. Data were analyzed using Pearson correlations and robust-estimation mediation procedures implemented in JASP. Results: Childhood trauma showed positive and significant associations with perceived burdensomeness, hopelessness, pain catastrophizing, and suicidal ideation. Mediation analyses showed that perceived burdensomeness, hopelessness, and pain catastrophizing significantly mediated the relationship between childhood trauma and suicidal ideation, with small-to-moderate indirect effects. These findings suggest that maladaptive cognitive patterns may partially explain how early adverse experiences are associated with suicidal thoughts in individuals with chronic pain. Conclusions: The results highlight the relevance of considering early adverse experiences and pain-related cognitive processes in the clinical assessment of suicidal ideation among individuals with chronic pain. Further research using longitudinal and multimethod designs is needed to refine explanatory models and guide psychological interventions aimed at reducing vulnerability to suicidal ideation in this population. This study expands existing knowledge by simultaneously examining perceived burdensomeness, hopelessness, and pain catastrophizing as mediators between childhood trauma and suicidal ideation in individuals with chronic pain. These findings contribute to refining trauma-informed clinical approaches and identifying specific intervention targets. Full article

Rates of alcohol use and exposure to adverse childhood experiences (ACEs) are elevated among youth in the legal system (YILS) compared to their non-legally involved peers. Exposure to ACEs has been associated with later alcohol use and delinquency, and YILS often engage in delinquent behavior while under the influence of alcohol. The associations between ACEs, alcohol use, and delinquency among YILS are complex and multidirectional; research has yet to explore how these experiences and behaviors influence each other over time, or whether they differ based upon the reason for legal system involvement (status or delinquent petition). This study examined whether YILS’ ACEs were prospectively associated with self-reported delinquent behaviors, and whether self-reported recent alcohol use was an explanatory mechanism for this association. Multigroup mediation analyses were utilized to examine if these pathways differed based on youth’s court petition type. Results indicated that YILS report high rates of ACEs. Frequency of recent alcohol use mediated the associations between ACEs and subsequent delinquency for youth with a delinquent, but not status, petition. Concurrent assessment of trauma exposure and alcohol use when youth first enter the legal system is imperative to inform early intervention needs to reduce the likelihood of continued system involvement. Full article

Housing insecurity is a growing public health concern linked to adverse health outcomes and lifelong vulnerability. Although housing is a well-established social determinant of health, this review employs a life-course framework to explain how housing insecurity contributes to the accumulation of health inequities and chronic disparities across the different stages of human development. A rapid review was conducted across PubMed, Google Scholar, SCOPUS, and Web of Science, focusing on peer-reviewed studies published between 1991 and 2025. Studies were screened using predefined eligibility criteria, and the selection process was documented through a PRISMA flow diagram. Fifty-five studies met the inclusion criteria. Housing insecurity was consistently associated with adverse health outcomes across pregnancy, infancy, childhood, adolescence, adulthood, and older age. Each life stage presents distinct vulnerabilities shaped by environmental and social conditions, which are manifested through physiological and psychosocial pathways. While physical health effects were most frequently reported, developmental and mental health impacts accumulated over time, amplifying overall burden. The findings demonstrate a clear life-course pathway linking housing insecurity to immediate and long-term health risks. Early-life disadvantages create lasting, preventable consequences, underscoring the urgent need for policies that embed housing stability within broader public health planning. Full article

As a distal factor influencing adolescents’ psychological development and behavioral adaptation, the question of whether and how childhood unpredictability is associated with smartphone addiction remains unclear. To address this gap, this study examined the mediating roles of self-concept clarity and self-control, as well as the moderating role of psychological resilience, in the relationship between childhood unpredictability and smartphone addiction. Using a random cluster sampling method, 2262 high school students (51.59% girls; M_age = 17.83, SD = 0.77) were recruited to complete relevant questionnaires. Correlation analyses revealed that childhood unpredictability was negatively correlated with self-concept clarity, self-control, and psychological resilience, and positively correlated with smartphone addiction. Mediation model results indicated that childhood unpredictability contributes to higher smartphone addiction both directly and indirectly through the independent mediating roles of self-concept clarity and self-control and a chained mediation pathway from self-concept clarity to self-control. Moreover, the link between childhood unpredictability and self-concept clarity was moderated by psychological resilience. These findings highlight the critical role and underlying mechanisms of childhood unpredictability in increasing adolescents’ risk of smartphone addiction and emphasize that fostering psychological resilience should be a key target for prevention and intervention efforts aimed at mitigating the adverse effects of childhood unpredictability. Full article

Background/Objectives: Childhood metabolic dysregulation exerts a profound influence on the development of obesity and metabolic diseases. The human gut microbiota, with highly personalized characteristics, plays an important role in host metabolism. However, the dynamics of gut microbial features during this developmental phase are still unclear. This longitudinal observational study collected 204 fecal samples and 153 blood samples from 51 children (aged 8.90 ± 0.78 years) at four timepoints over 52 weeks, aiming to identify dynamic changes in individual gut microbiota and underlying mechanistic interactions that predict measures of pediatric metabolic health. Methods: Fecal samples were subjected to 16S rRNA gene amplicon sequencing and short-chain fatty acid quantification. Serum samples were analyzed for biochemical tests. Dietary intake, physical activity, clinical phenotypes, early-life factors, and fecal characteristics were further assessed. Results: In the results, the fecal microbiota dynamics exhibit inter-individual variation among children, allowing classification into high- and low-stability subgroups based on intra-individual β-diversity variability. Children with low-stability microbiota had adverse blood lipid profiles (p < 0.05). Compared to the high-stability group, the low-stability microbiota demonstrated significant association with low dietary fiber and highly variable amino acid consumption (|r| > 0.3, q < 0.05). Low-stability microbiota exhibited marked fluctuations in Phocaeicola vulgatus, which was strongly linked to both blood triglycerides and lipoprotein(a) levels, as well as dietary fiber and amino acid intake. Baseline depletion of P. vulgatus and Faecalibacterium duncaniae, combined with the children’s physiological status, lifestyle behaviors, and early-life factors, predicted microbial stability classification (AUROC = 0.93). Conclusions: These findings suggested that the variation in the gut microbiota dynamics could be considered as a possible complementary biomarker to understand the individualized responses within dietary interventions aimed at improving metabolic health in childhood. Further well-designed intervention study is needed to define these observational associations. Full article

Background: Vesicoureteral reflux (VUR) contributes significantly to recurrent childhood urinary tract infections and renal scarring, yet predicting which patients will develop adverse outcomes or benefit from specific investigations or treatments remains challenging. Numerous prognostic tools have been proposed, but none have achieved widespread adoption. Methods: A comprehensive search of the literature available on MEDLINE, PUBMED, Embase, Emcare, CINAHL, and Google Scholar was performed to identify combinations of factors, scoring systems, ratios, models, and tools relating to VUR. This included predicting the spontaneous resolution of established vesicoureteral reflux, the risk of breakthrough urinary tract infections (UTIs), and guiding clinical decision making regarding the need for VCUG in patients with UTIs, continuous antibiotic prophylaxis (CAP), or surgical intervention in patients with confirmed VUR. Articles were included if they either described or validated a predictive tool that was designed to aid clinical decision making in patients with either suspected or confirmed VUR with regards to investigation or management strategies. All the studies included were then analysed, and the predictive tools have been summarised in a narrative format. Results: Seventeen predictive tools developed over thirty-nine years were identified: six predicting spontaneous resolution, four predicting breakthrough urinary tract infection (BTUTI) on CAP, two determining which children benefit from CAP, and five estimating the probability of VUR or high-grade VUR after a first febrile UTI. Approaches ranged from radiological ratios to multifactorial clinical–radiological scores and machine-learning models. Only five tools had any external validation, and none demonstrated sufficient reliability for universal clinical use. Significant heterogeneity in design, imaging interpretation, inclusion criteria, and outcome definitions limited comparison and wider applicability. Conclusions: This atlas provides the first consolidated overview of prognostic tools in paediatric VUR. Future development should prioritise multicentre, prospectively validated models that integrate established clinical and radiological predictors with transparent computational methods to create practical, generalisable risk-stratification frameworks for routine care. Full article

Background: Schools play a central role in child development and socialization and can function as protective environments that mitigate the effects of adversity. Building on the Social Ecological Model and Community School Transformation, we propose a “Schools-as-Neighborhoods” framework that conceptualizes schools as intentionally designed microenvironments capable of generating social capital, promoting positive childhood experiences, and buffering harmful neighborhood exposures through trauma-informed programming. Methods: We conducted a convergent mixed-methods study across four public and charter schools in Milwaukee, Wisconsin, serving grades five through nine. STRYV365’s peak team and Brain Agents gamified intervention were implemented between 2022–2024. Quantitative surveys and qualitative data assessed students’ lived experiences, exposure to adversity, emotional awareness, coping skills, and school connectedness/climate across multiple waves. Results: Across the four schools (n = 1626 students), baseline academic proficiency was low, and exposure to adversity was high among surveyed participants (n = 321), including bereavement (74%) and family incarceration (56%). Despite these challenges, qualitative findings revealed strengthened emotional regulation, empathy, motivation, and goal setting among students engaged in trauma-informed programming. Teachers reported improved peer interaction and community building during sustained implementation. Conclusion: The Schools-as-Neighborhoods framework highlights the value of trauma-informed, relationship-centered school environments in promoting student well-being. By positioning schools as cohesive ecosystems that foster belonging and cultivate social capital, this approach offers educators and policymakers a pathway for mitigating the effects of hostile lived environments and supporting students’ mental health, social development, and engagement in learning. Full article

Background: Sleep disorders are common in childhood and adolescence and can negatively affect cognitive development, mood regulation, behaviour, and quality of life. Parents frequently seek complementary therapies such as homoeopathy, yet the scientific evidence for homoeopathic treatments in paediatric sleep disorders remains uncertain. This systematic review examines the effectiveness of homoeopathic interventions for sleep disorders in children and adolescents according to evidence-based medicine principles. Objectives: To systematically review and evaluate the effectiveness of homoeopathic treatments for sleep disorders in children and adolescents, following evidence-based principles. We aimed to summarise current clinical evidence from 2015–2025 on whether homoeopathy improves paediatric insomnia and other sleep-related disorders and to assess the quality of that evidence. Methods: PubMed, Scopus, and allied databases were searched for RCTs and observational studies involving participants <18 years with sleep disorders (insomnia, bruxism, and enuresis) treated with homoeopathy. English-language studies were screened manually, and bias was assessed qualitatively. Results: Five studies (four RCTs, one observational; 451 participants) met inclusion criteria: Two RCTs reported complex homoeopathic remedies showing some improvement over glycine or placebo for insomnia symptoms. A crossover RCT reported nearly significant bruxism improvement with Melissa officinalis 12C versus placebo (Visual Analogic Scale 0–10; ΔVAS −2.36 vs. −1.72, p = 0.05) and significant VAS improvement in comparison to Phytolacca (p = 0.018). A double-blind RCT in enuretic children showed individualised homoeopathy reduced weekly bedwetting episodes (median −2.4 nights, p < 0.04). One observational study also noted symptom improvement of nocturnal enuresis. No serious adverse effects were reported. Bias risk varied: one open-label trial showed high risk; others were adequately blinded. Conclusions: Current evidence suggests preliminary signals that homoeopathy may have modest benefits for paediatric insomnia, bruxism, and enuresis, with an acceptable safety profile. However, the number and quality of studies are limited, and findings should be interpreted cautiously. Larger, high-quality trials are needed to clarify the potential role of homoeopathic interventions in paediatric sleep disorders. Current epistemological advances in study planning and medical student training should be taken into account: critical and intersectional (or better still, transdisciplinary) thinking with retrospective examination of heuristic initial theses, gender aspects, life course health, context variables and criteria for individualised, patient-related precision medicine. Full article

Background and Objectives: Autism spectrum disorder (ASD) is a prevalent neurodevelopmental disorder with an increasing global incidence. Gut microbiota dysbiosis is believed to be playing a role in ASD pathogenesis. Fecal microbiota transplantation (FMT) is emerging as a potential therapeutic strategy to alleviate ASD-related and gastrointestinal symptoms, but data in pediatric ASD populations remain limited. Materials and Methods: We conducted a prospective, single-center, open-label controlled study to evaluate the efficacy of colonoscopic FMT in children with ASD. Participants were allocated to two groups: an intervention group that underwent a single FMT procedure and a control group. Gastrointestinal Symptoms Rating Scale (GSRS), Autism Diagnostic Observation Schedule (ADOS), Childhood Autism Rating Scale (CARS), Child Behavior Checklist (CBCL), and Parent Global Impression (PGI-R) scales were assessed for both groups at baseline and at set time points. Results: 30 participants were enrolled, with 15 in each group. At 8 weeks, no significant between-group differences were observed for the prespecified primary endpoint, change in ADOS scores. The intervention group showed significantly greater improvements in CARS (p < 0.001), PGI-R (p < 0.001), CBCL Internalizing Problems (p = 0.001), and GSRS (p = 0.037) compared with controls; CARS and PGI-R improvements persisted at 6 months. Within the intervention group, sustained improvements were noted in CARS, GSRS, and PGI-R up to 18 months. No serious adverse events were observed; three mild, self-limited adverse events were recorded following FMT. Conclusions: Colonoscopic FMT was associated with significant short-term improvements in gastrointestinal and caregiver-reported ASD symptoms (CARS), but not in ADOS scores. Some effects persisted long-term. However, due to a lack of blinding and possible selection bias, these findings should be interpreted as exploratory. Larger randomized controlled trials are needed to confirm efficacy and optimize protocols. Full article

Overweight and obesity are major public health concerns among children and adolescents worldwide. The most prevalent form is exogenous–constitutional obesity, which is driven by a sedentary lifestyle and an unhealthy diet in which caloric intake exceeds energy expenditure. Beyond their association with chronic disease, these factors are closely linked to deficits in cognitive development and executive functions essential for learning (including working memory, sustained attention, planning, behavioral self-regulation, and cognitive flexibility). Oxidative stress (OS), characterized by the accumulation of reactive oxygen species (ROS) in cells and extracellular fluids, is a significant potential mediator in childhood obesity and an important contributor to its comorbidities. The antioxidant defense system (AOD)’s activity largely depends on levels of trace element cofactors, which determine the body’s resistance to adverse environmental factors (the “maladaptation phenomenon”). OS and trace element deficiencies contribute to the development of morphological changes in the brain, thus serving as a critical connecting link between childhood obesity and cognitive impairment. Non-pharmacological interventions are the most accessible and effective approach for prevention and treatment. Bioactive compounds derived from food and natural plants, classified as antioxidants and phytopreparations, may represent a promising complementary approach. These compounds are most effective when used in combination with sustained lifestyle modifications in children. Research in this area can help define future directions for study and develop targeted intervention strategies in the pediatric population. The aim of this review is to examine the relationship between OS, antioxidant cofactor micronutrients, and cognitive outcomes in childhood obesity and to explore mechanisms, evidence, and therapeutic opportunities. Full article