Search Results (369)

Background: Women’s empowerment has been significantly associated with improved child health outcomes. Cambodia, amid a rapid socioeconomic transition, offers a critical setting to examine how advancements in women’s empowerment over the past decade have influenced child immunization completion within the first two years of life. Methods: Data from the Cambodia Demographic and Health Surveys conducted in 2010, 2014, and 2021–22, encompassing 9222 women with recent births, were analyzed. Empowerment was measured across literacy and information access, employment, and decision-making domains. Multinomial logistic regression assessed associations between empowerment factors and completion of oral polio (OPV), diphtheria–tetanus–pertussis (DTP), pneumococcal conjugate (PCV), and measles–rubella (MR) vaccines, adjusting for demographic and socioeconomic variables. Results: Between 2010 and 2022, women’s empowerment in Cambodia improved significantly, marked by higher literacy rates, nearly half of women completing primary education, and expanded digital access, with 82.4% owning mobile phones and approximately 50% using the internet daily. While non-working women slightly increased, agricultural employment declined by 20%, and cash earnings rose from 48.7% to 82.5%. Most women participated in major household decision-making, either independently or jointly. Completion rates for OPV, DTP, and PCV ranged from 79% to 83%, while just over half of children were fully vaccinated against measles. Higher maternal education and cash earnings were positively associated with OPV, DTP, and PCV completion but negatively associated with measles vaccination. Women in agricultural work were less likely to complete measles vaccination for their children than non-working women. Joint decision-making regarding the use of respondents’ income was associated with a higher likelihood of measles non-completion (OR = 2.26, 95% CI: 1.13–4.51), whereas joint decision-making about respondents’ health care was associated with a higher likelihood of measles completion (OR = 0.42, 95% CI: 0.21–0.83). Conclusions: Women’s empowerment remains a key determinant of vaccination outcomes in Cambodia. The distinct pattern observed for measles suggests that vaccines scheduled for older ages encounter greater structural and behavioral barriers. To overcome these challenges, strategies should focus on enhancing defaulter tracking, implementing reminder systems, expanding outreach and catch-up programs, and improving the convenience of vaccination services. Full article

Background/Objectives: Caring for a child with Autism Spectrum Disorder (ASD) is often associated with elevated psychological distress and reduced life satisfaction. Mindfulness-based interventions may offer substantial benefits by enhancing emotion regulation, reducing maladaptive cognitive patterns, and strengthening mindful parenting. This randomized controlled trial (RCT) examined the effectiveness of an eight-week Mindfulness-Based Cognitive Therapy (MBCT) program, enriched with mindful parenting practices, delivered to parents of children with ASD. The primary aim was to improve parental mental health, while secondary analyses explored potential indirect, parent-perceived changes in child behavior outcomes. Methods: Fifty-six parents of children with ASD were randomly assigned to an MBCT intervention group (n = 30) or a waitlist control group (n = 26). Parents completed assessments at baseline (T0), post-intervention (T1), and at one-month follow-up (T2), including the Depression Anxiety Stress Scales–21 (DASS-21), the Positive and Negative Affect Schedule (PANAS), and the Satisfaction With Life Scale (SWLS). They also rated the overall severity of their child’s behavior problems to explore indirect treatment effects. Results: All parents receiving MBCT (100%) completed the program successfully and reported high acceptability. At baseline, no significant differences were observed between groups. At T1, the MBCT group demonstrated significant reductions in depression, anxiety, and stress, alongside increases in positive affect and life satisfaction. These improvements were maintained or strengthened at T2. However, the control group showed no significant changes over time. Additionally, parents in the MBCT group reported indirect improvements in their children’s behavioral adjustment at T1 and T2. Conclusions: Findings demonstrate that MBCT constitutes an effective intervention for reducing parental psychopathology and indirectly supporting parent-perceived improvements in child behavior, emphasizing the importance of incorporating mindfulness and mindful parenting components into family-centered interventions for parents of children with ASD. Full article

Background/Objectives: Sleep disorders represent a significant health burden among children and adolescents with autism spectrum disorder (ASD), affecting their core symptoms, behavior, and quality of life. While physical activity has shown promise in managing sleep disorders in the general pediatric population, its effectiveness for children and adolescents with ASD remains understudied. Methods: This retrospective cohort study analyzed electronic health records from 132 healthcare organizations, examining 155,860,529 individuals to determine sleep disorder prevalence in ASD populations and evaluate the impact of physical activity interventions. We identified 248,940 children and adolescents with ASD aged 5–18 years, of whom 38,976 had documented sleep disorders. Propensity score matching was performed to compare patients with ASD and sleep disorders who received physical activity interventions with matched controls. Primary outcomes included sleep disorder resolution and medication utilization changes at 1- and 5-year follow-up. Bonferroni correction was applied to secondary analyses to account for multiple comparisons. Results: The prevalence of sleep disorders was markedly higher in children and adolescents with ASD (19.25%) compared to non-ASD peers (3.37%), with risk ratios escalating from childhood (RR = 5.34, 95% CI: 5.28–5.40) to adolescence (RR = 6.12, 95% CI: 6.05–6.19). After matching, 3709 patients were included in each group. Physical activity interventions were associated with significantly higher sleep disorder resolution at 1 year (−59.9% vs. −5.05%, p = 0.001) and sustained benefit at 5 years (−49.83% vs. +7.26%, p = 0.001). After Bonferroni correction, improvement in sleep apnea at 1 year remained statistically significant (−62.26% vs. +9.39%, Bonferroni-adjusted p = 0.040). Improvements in parasomnia and insomnia did not survive correction and were considered exploratory. Age emerged as a key effect modifier: adolescents (12–18 years) demonstrated sustained improvements in overall sleep outcomes at both 1- and 5-year follow-up that met Bonferroni-corrected thresholds, whereas younger children (5–11 years) showed limited and inconsistent responses. Among comorbidity groups, anxiety-comorbid patients exhibited the strongest overall improvement (−58.7% vs. −12.4%, p < 0.01), while reductions in amphetamine use and changes in melatonin prescribing patterns should be interpreted as exploratory findings requiring prospective confirmation. Conclusions: This large-scale observational study suggests structured physical activity interventions are associated with sustained improvements in overall sleep disorders among children and adolescents with ASD. While subtype- and subgroup-specific associations were observed, many attenuate after multiple comparison adjustments, highlighting the need for cautious interpretation. Findings support exploring physical activity in comprehensive care plans, with prospective randomized trials needed to confirm causality, optimize protocols, and address multiplicity. Full article

Background/Objectives: Suicidal behaviors are a major clinical concern in adolescents, particularly among those with disorders marked by emotion dysregulation and impulsivity. Although attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) each heighten suicide risk, little is known about whether their occurrence confers additive or interactive effects in youth. This study examined whether ADHD and BPD diagnoses show additive or interactive associations with the suicide risk in adolescents. Methods: In this cross-sectional observational clinical study, the sample included 108 Polish adolescents (66.7% female; aged 13–17 years) recruited from inpatient and outpatient psychiatric settings (Independent Public Healthcare Facility, Children and Youth Treatment Center in Zabór, the Youth Sociotherapy Center No. 2 in Wrocław, and the District Educational Center in Jerzmanice-Zdrój (Poland)). The data collection for our study was conducted between May 2024 and July 2025. Diagnoses and suicide risk were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID 7.02). Associations of ADHD and BPD with suicide risk were tested using linear and logistic regression models while accounting for age, sex, the current depressive episode, and the use of psychiatric medications. Results: Unadjusted analyses revealed significant main, but not interactive, associations of BPD and ADHD with suicide risk. When covariates were included in the model, BPD remained strongly associated with suicidality severity and with the presence of any suicide risk (adjusted OR = 7.00, 95% CI [1.55–31.57]), whereas the association between ADHD and suicidality was attenuated and did not reach conventional levels of statistical significance (adjusted OR = 3.48, 95% CI [0.93–13.08]). No statistically detectable ADHD × BPD interaction was observed. Estimates for ADHD were directionally consistent across models but characterized by wide confidence intervals. Conclusions: Adolescents with BPD appear to be at particularly high risk of suicide and should receive focused assessment, safety planning, and early intervention as part of routine care. In contrast, suicidality among adolescents with ADHD appears to be influenced by co-occurring clinical conditions, and its independent association with suicide risk remains statistically uncertain after adjustment. Clinicians should therefore remain alert to suicidality in youth with ADHD, while paying particular attention to accompanying symptoms and comorbid diagnoses that may further increase risk. Full article

Objective: To assess the structure and regional variation in mortality among school-aged children in Kazakhstan from 2015 to 2024, and to determine its association with dietary patterns and socio-economic factors. Materials and Methods: An ecological inter-regional analysis was conducted using official statistical data of the Republic of Kazakhstan. Mortality rates among children aged 6–17 years, the distribution of death causes according to ICD-10, indicators of consumption of major food product groups, and poverty levels were examined. Linear mixed-effects regression with a random intercept for region and fixed effects for year and covariates, and spatial description of regional trends were applied. Results: Variation in school-age mortality across regions and calendar years was evident, with external causes predominating, followed by diseases of the nervous system, neoplasms, and diseases of the circulatory and respiratory systems in the mortality structure. In the multivariable linear mixed-effects model, none of the dietary or socioeconomic predictors showed statistically significant independent associations with mortality (all p > 0.05), and the calendar year was not significant (p = 0.180). Model explanatory power was very low (marginal R² = 0.017; conditional R² = 0.020; ICC = 0.005), and residuals demonstrated significant temporal autocorrelation (p < 0.001). Conclusions: The mortality structure among school-aged children is shaped by a complex interplay of medical, social, and behavioral determinants. Dietary and socioeconomic indicators showed only weak ecological associations with mortality and did not retain independent effects after multivariable adjustment, underscoring the multifactorial nature of regional mortality patterns and the need for multisectoral action, including improved access to nutritious foods, enhanced social well-being, and strengthened health system capacity. Full article

Background: Promoting seasonal influenza vaccination among parents may help increase the coverage of seasonal influenza vaccination among both parents and children. This study aims to investigate determinants of behavioral intention to receive a seasonal influenza vaccination among parents of children aged 0–15 years to protect themselves. Methods: A cross-sectional survey was conducted among parents of children aged 0 to 15 years with administrative health records in Shenzhen, China, between September and October 2024. Participants were recruited through multistage random sampling. First, 10 community health centers were randomly selected in Shenzhen. Within each selected center, 200 parents were randomly selected. Multivariate logistic regression models were fitted. Results: Among 1504 parents, 47.6% intended to receive a seasonal influenza vaccination in the next year. After adjusting for significant background characteristics, parents’ intention to receive a seasonal influenza vaccination was associated with a higher intention to vaccinate their children against seasonal influenza (AOR: 20.39). At the individual level, eight items measuring illness representations of seasonal influenza were associated with higher odds of intending to receive such a vaccine (AOR: 1.15–1.25), including identity (identifying symptoms), timeline, negative consequences, personal and treatment control, concern, negative emotions, and coherence. At the interpersonal level, parents who had higher levels of general and family-oriented altruism (AOR: 1.10–2.47), better family harmony (AOR: 1.07), higher exposure to information related to seasonal influenza on social media (AOR: 1.24–1.38), and thoughtful consideration of information veracity (AOR: 1.33) were more likely to report an intention. Conclusions: There are strong needs to promote seasonal influenza vaccination among parents in China. Full article

Background: Childhood overweight and obesity represent growing public health challenges globally, driven by complex interactions between demographic, behavioral, and familial factors. This study assessed the prevalence and determinants of overweight and obesity among school-aged children and adolescents attending urban schools in the Aseer Region of Saudi Arabia (Abha and Khamis Mushait). Methods: A cross-sectional study was conducted among 413 urban school students aged 6–18 years. Anthropometric measurements were obtained using standardized procedures, and lifestyle behaviors were assessed through a structured questionnaire. Data were analyzed using descriptive statistics, Chi-square tests, and multivariate binary logistic regression. Variables with p < 0.05 in univariate analysis, alongside conceptually relevant predictors, were included in the final model. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results: The combined prevalence of overweight and obesity was high, particularly among older age groups and secondary-school students. Significant associations were found between BMI category and age, school level, parental education, and family history of obesity. Lifestyle behaviors including fast-food consumption, low fruit and vegetable intake, prolonged screen time, and short sleep duration showed strong relationships with overweight/obesity. In the adjusted model, key predictors included frequent fast-food intake (AOR = 2.74), low fruit/vegetable intake (AOR = 2.20), physical inactivity (AOR = 1.70), high screen time (AOR = 2.40), short sleep duration (AOR = 1.55), and positive family history of obesity (AOR = 3.10). Conclusions: Childhood overweight and obesity in the Aseer Region are influenced by both modifiable lifestyle behaviors and familial predisposition. Targeted interventions promoting healthy dietary habits, adequate physical activity, reduced screen time, and sufficient sleep are essential. Preventive strategies should prioritize adolescents and children with a family history of obesity to effectively reduce obesity risk. Full article

Background/Objectives: Feeding difficulties are more common in children with autism spectrum disorder (ASD) or other developmental conditions and are associated with nutritional risk and caregiver stress. However, they may be overlooked as growth tends to be preserved. We aimed to identify clinical and behavioral features associated with feeding difficulties among children with developmental conditions. Methods: This cross-sectional study included caregiver–child dyads, with children aged 1–7 years with ASD and other developmental conditions. Caregivers completed the Repetitive Behavior Questionnaire, Second Edition (RBQ-2) to assess child restricted and repetitive behaviors (RRBs) and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) to assess feeding difficulties. Demographics, anthropometric measures and cognitive and adaptive scores were retrieved from medical records. Results: Of the 132 participants (mean age 41.8 months, range 15–67; 74.2% male) included, majority had normal weight (87.7%) and height (89.2%) z scores. Among participants, 54.5% had autism, 26.5% language delay and 18.9% other developmental diagnoses. Over half (53.0%) had elevated BPFAS scores. Children not enrolled in school showed significantly more feeding difficulties compared to those who were enrolled (32.6% vs. 16.7%, p < 0.05). The RBQ-2 total score positively correlated with the BPFAS total frequency score (r = 0.33, p = 0.01) after adjusting for gender, age and developmental diagnosis. Conclusions: Feeding difficulties were common in this sample. Higher RRBs and absence of formal schooling were associated with higher rates of feeding difficulties. Longitudinal studies are needed to ascertain the role of RRBs and school enrollment as clinical indicators associated with feeding difficulties. Full article

Background/Objectives: This study aims to compare adaptive and maladaptive behaviors of children with Autism Spectrum Disorder Level 1 (ASD-L1) and their experiences of bullying in comparison to a matched control group. Additionally, we explored which of such behaviors predicted both victimization and aggression in both samples. Methods: The sample consisted of 96 children and adolescents, 48 with ASD-L1 (31 Colombians and 17 Spanish) and 48 controls (31 Colombians and 17 Spanish), matched by age, gender, and socioeconomic status. Adaptive and maladaptive behaviors, as well as bullying experiences, were assessed. Results: Children with ASD-L1 reported higher levels of clinical and school maladjustment and lower levels of personal adjustment compared to the control group. Although no significant differences were found in bullying victimization, the ASD-L1 group showed higher aggression scores. In this group, lower personal adjustment predicted victimization, whereas higher clinical maladjustment predicted aggression. In contrast, in the control group, aggression was predicted by school maladjustment. Conclusions: Aggressive behavior in children with ASD-L1 was linked to higher levels of clinical maladjustment, while better personal adjustment served as a protective factor against bullying victimization. These findings emphasize distinct socio-emotional mechanisms underlying bullying involvement in autistic and typically developing youth. Full article

Background/Objectives: The increasing prevalence of obesity among children and adolescents is alarming, and the obesogenic environment is considered a major contributing factor to this public health concern. Nevertheless, individuals exposed to the same obesogenic environment exhibit considerable variability in their body weight and eating behaviors. Therefore, this study investigated the relationships between eating behaviors, sensory processing profiles, and peripheral biomarkers in the context of adolescent obesity. Methods: A total of 99 adolescents aged 11–18 years (51 in the obese group and 48 in the control group) were enrolled in the study. Blood and saliva samples were obtained from participants. All participants also completed a Sociodemographic Information Form, the Adolescent/Adult Sensory Profile (A/ASP), and the Dutch Eating Behavior Questionnaire (DEBQ). Results: No statistically significant differences were found between the groups in any of the sensory processing quadrants (p > 0.05). A moderate positive correlation was observed between Sensory Sensitivity (A/ASP) and Emotional Eating (DEBQ) (r = 0.442, p < 0.001), whereas no other associations between A/ASP quadrants and DEBQ subscales reached statistical significance after adjustment for multiple comparisons. After controlling for the effects of sex, BMI and physical activity, plasma leptin, ghrelin, and salivary cortisol levels were not significantly associated with restrained, emotional, or external eating behaviors (p > 0.05). Conclusions: Obese and control group adolescents exhibited similar sensory processing profiles, yet higher sensory sensitivity scores were associated with greater emotional eating. These findings suggest that sensory sensitivity may be relevant for understanding emotional eating in adolescence; however, longitudinal research is required to determine whether this association is causal and to clarify the processes underlying it. Full article

Brain tumors, both malignant and non-malignant, represent a persistent global health challenge. Differences in diagnosis, treatment, and outcomes are influenced by race, ethnicity, socioeconomic status (SES), and geographical location. Brain and central nervous system (CNS) tumors rank 19th in global cancer incidence and 12th in cancer-related mortality. U.S. Incidence is higher in females and individuals with greater socioeconomic means, contrasting with global patterns where males are more affected. Glioblastoma has a wide variation in incidence and survival by state, with rural regions showing higher mortality despite lower incidence, often due to reduced access to specialized care. Non-Hispanic Black children with CNS tumors experience higher mortality than their White peers, even after adjusting for SES. Outcomes are generally poorer in low- and middle-income countries, where healthcare infrastructure remains limited. Biological and genetic differences may also influence treatment response and tumor behavior across population groups. This review outlines key variations in brain tumor care, with a key focus on the United States, and emphasizes the need for patient-centered strategies to ensure timely diagnosis, consistent treatment, and improved outcomes. Full article

This study explores how child emotion regulation (ER) and maternal overinvolvement contribute to the maintenance of anxiety disorders (ADs) in children. Building on the tripartite model on the impact of the family on children’s emotion regulation and adjustment, it experimentally examines the impact of maternal expectations on overinvolvement and child distress. 65 children with ADs (ages 8–15) and 64 healthy controls (HCs) and their mothers participated in a tangram task, with manipulated maternal expectations. Mother–child interactions were observed for maternal involvement and child behavior (ER, distress), with children reporting their emotional reactivity. Against expectations, maternal involvement did not differ between groups and was not influenced by expectations. HC children had better ER abilities than those with ADs. Emotional reactivity moderated the relationship between overinvolvement and ER problems. Children with ADs exhibited more distress, unaffected by maternal expectations. Further research is needed to clarify the relationship between parental behavior and child behavior, particularly regarding emotional reactivity. Full article

Background: The COVID-19 pandemic has imposed significant changes on daily life. It negatively impacts children’s physical activity and lifestyle behaviors, which may cause accelerated weight gain during the COVID-19 pandemic. This study aims to evaluate children’s longitudinal age- and sex-adjusted body mass index (BMI) percentile changes during and after the COVID-19 pandemic. Methods: Height and weight data were obtained from electronic medical records for children (ages 2–18) visiting outpatient clinics during three periods: pre-COVID-19 lockdown, during COVID-19 lockdown, and post-COVID-19 lockdown. According to the availability of anthropometric information, three partially overlapping cohorts were formed: Cohort 1 (N = 934, pre- and during lockdown), Cohort 2 (N = 1129, during and post-lockdown), and Cohort 3 (N = 203, data from all three periods). Results: During the lockdown, the mean changes in percentiles of age- and sex-adjusted BMI were 6% ± 0.23, while after the lockdown, there were smaller mean changes in BMI percentiles (1% ± 0.19). There were significant associations of age and the baseline BMI categories with the change in the means of the adjusted BMI percentile of children during and after the COVID-19 pandemic (p-value < 0.001). In addition, there were significant associations of gender and the baseline BMI categories with the change in the means of the adjusted BMI percentile of children over a three-time series (p-value: <0.04, <0.001, respectively). Conclusions: In conclusion, children experienced increased BMI during and after the COVID-19 lockdown. This result highlights the importance of structured interventions to mitigate the consequences during challenging times on children’s health. Full article

Background: Autism Spectrum Disorder (ASD) affects ~1 in 36 children and is increasingly studied as a candidate for non-invasive neuromodulation. Two of the most widely applied modalities are quantitative EEG (QEEG)-guided repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), both targeting the dorsolateral prefrontal cortex (DLPFC). While both have shown promise, questions remain regarding their relative clinical profiles and scalability. Objective: To conduct a within-cohort reanalysis of QEEG-guided rTMS outcomes in paediatric ASD and to contextualise these findings alongside published reports of home-supervised tDCS. Methods: Individual participant data (n = 56, ages 6–17) from a prospective rTMS cohort were reanalysed, focusing on the Social Responsiveness Scale (SRS-2), Autism Diagnostic Observation Schedule (ADOS-2), Aberrant Behavior Checklist (ABC), Repetitive Behavior Scale–Revised (RBS-R), and QEEG biomarkers. Findings were then situated within a narrative synthesis of published paediatric tDCS trials, which consistently report caregiver-supervised feasibility but did not provide raw, baseline-adjusted data suitable for reanalysis. Results: rTMS was associated with large within-cohort improvements (Hedges’ g ≈ 1.0–1.6), including an 11-point reduction in SRS-2 T-scores, a 12-point reduction in ABC totals, and robust QEEG normalisation (β/γ suppression, α enhancement). Published tDCS studies report moderate, clinically meaningful improvements in social communication, executive functioning, and regulation (Cohen’s d ≈ 0.4–0.6), with excellent adherence and no serious adverse events. Conclusions: rTMS produced robust behavioural and neurophysiological improvements within its cohort, while published tDCS trials demonstrate moderate, feasible benefits in home settings. Because of incomplete baseline data and protocol differences, no direct statistical comparison was possible. These findings suggest complementary roles: rTMS as a high-intensity clinic-based intervention, and tDCS as a scalable, family-centred option. A stepped-care framework that combines both modalities should be considered hypothesis-generating only and requires validation in harmonised, randomised controlled trials. Full article

Parental adverse childhood experiences (ACEs) are linked to negative outcomes in children, including emotional and behavioral problems, developmental delays, and higher risk for psychopathology. Most research focuses on school-aged children or community samples, with few studies examining preschool-aged children in child psychiatric care. Understanding parental ACEs in this population is crucial, as early childhood is a sensitive developmental period, and intergenerational effects may be particularly pronounced in children already presenting with psychiatric symptoms. Background/Objectives: The goal of this study was to analyze how parents of patients in an early childhood (0–5.9 yrs) mental health outpatient clinic differ from the general population in terms of the frequency of ACEs. In addition, we investigated the connection between mental health disorders in young children and the specific ACE scores of their parents. Methods: A total of 116 caregivers (34.45 years (SD = 5.28)) and their children (71.6% boys, 28.4% girls) at an average age of 3.99 years (SD = 1.35, range = 0.31–5.95) were included in the analysis. The legal guardians completed the 10-item ACE questionnaire. The young children were diagnosed as part of outpatient treatment using the DC:0–5 classification system. We analyzed the ACE scores and diagnoses descriptively and in comparison to a community sample. Results: An average value of 2.38 parental ACEs was reported by our sample, and 68.1% (n = 79) reported at least one ACE. The high-risk group with four or more ACEs comprised 30.2% (n = 35). The most common diagnosis in young children was the Disorder of Dysregulated Anger and Aggression of Early Childhood, followed by global developmental delay. Adjustment disorder was third in terms of frequency. Among the examined child psychiatric diagnoses, adjustment disorder showed a significant correlation with parents being affected by the ACE category of neglect (OR = 2.54; 95% CI: 1.012–6.369; p = 0.047). Conclusions: Parents who presented their children at an early childhood mental health outpatient clinic reported significantly more ACEs as compared to representative data on ACEs in adulthood. These results highlight the need for further studies with larger samples to enable a more in-depth analysis of the general intergenerational transmission processes and the differential transmission of specific ACEs to specific diagnoses in preschool-aged children. Full article