Search Results (537)

Background: Obstructive sleep apnea (OSA) is a prevalent disorder in both pediatric and adult populations, characterized by substantial morbidity encompassing cardiovascular, neurocognitive, and metabolic impairments. Management strategies vary by age group and underlying etiology, with orthodontic and non-orthodontic interventions playing key roles. This narrative review synthesizes the current evidence on orthodontic and non-orthodontic therapies for OSA in pediatric and adult populations, emphasizing individualized, multidisciplinary care approaches and highlighting future research directions. Methods: A narrative review was conducted using PubMed, Scopus, and Google Scholar to identify studies on diagnosis and management of OSA in children and adults from 2000 to 2025. Results: In pediatric patients, treatments such as rapid maxillary expansion (RME), mandibular advancement devices (MADs), and adenotonsillectomy have shown promising outcomes in improving airway dimensions and reducing apnea–hypopnea index (AHI). For adults, comprehensive management includes positive airway pressure (PAP) therapy, oral appliances, maxillomandibular advancement (MMA) surgery, and emerging modalities such as hypoglossal nerve stimulation. Special attention is given to long-term treatment outcomes, adherence challenges, and multidisciplinary approaches. Conclusions: The findings highlight the need for individualized therapy based on anatomical, functional, and compliance-related factors. As the understanding of OSA pathophysiology evolves, orthodontic and adjunctive therapies continue to expand their role in achieving durable and patient-centered outcomes in sleep apnea management. Full article

Health literacy improves informal caregivers’ knowledge and ability to provide care. The aim of this study is to analyze the impact of a group-based intervention on the health literacy of informal caregivers of children with special health needs (SHNs). The intervention focuses on movement, hydrotherapy, walking, and relaxation, with three evaluation stages. Participants included 34 informal caregivers of children with SHNs, recruited at a Physical Medicine and Rehabilitation Service. We collected sociodemographic data of the participants and measured their health literacy through the short-form version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). Around 70% of the participants were female, with a mean age of 41.06 ± 4.98 years, and nearly 85% were married or in a de facto union. About 26% were unemployed, and more than 65% had completed secondary education or higher. The mean scores of the HLS-EU-Q16 were statistically significantly higher throughout the intervention, with differences over the evaluation stages [F(2,56) = 75.55; p < 0.05]. A structured, dynamic, and group-based intervention plan showed improvements in the health literacy of the participants, with an increase in the percentage of participants with sufficient and excellent levels of health literacy at the end of the intervention. Full article

This study explores the potential of craft-based activities in the context of special education, focusing on a papier mâché sculpting workshop implemented at the Special Kindergarten of Komotini, Greece, as part of the Horizon Europe Craeft project. The initiative aimed to assess how such creative activities could enhance the learning experience of children with intellectual and motor impairments, foster socialization, and develop fine motor skills. With reference to literature in art therapy, craft education, and inclusive pedagogy, the study applied a mixed-methods approach combining observation, visual analysis, and a survey. The findings indicate that, despite varied levels of participation based on individual needs, all students engaged meaningfully with the materials and activities. School professionals observed increased student engagement, emotional comfort, and communication, while also identifying the activity as well adapted and replicable in similar contexts. The results highlight the value of crafts in special education, not only as a sensory and cognitive stimulus but also as a means of fostering inclusion and self-expression. The study concludes with a call for further research into the role of tactile materials and hand gestures in relation to specific impairments. Full article

This study focuses on the current service/care difficulties and challenges that social institutions in Hungary are facing during their daily operations; how they can react to them utilizing their internal resources, mechanisms, and capacities; and what concrete, tangible needs and demands are emerging in terms of methodological professional support, potential forms, interventions, and direction for professional development. A total of 24 general and 55 specific service and operational problems were identified and assessed in eight different service areas (family and child welfare services, family and child welfare centers, respite care for children, care for the homeless, addiction intervention, care for people with disabilities, care for psychiatric patients, specialized care for the elderly, and basic services for the elderly). The empirical base of the study uses a database of 201 online questionnaires completed by a professional target group working for social service providers in two counties (Győr-Moson-Sopron and Veszprém), representing 166 social service providers. The questionnaires were completed between November and December of 2022. The findings will be used to develop a professional support and development problem map. Social institutions face complex and serious service/care difficulties and challenges in their daily operations. Three distinctive basic problems clearly stand out in both severity and significance from the complex set of factors assessed. The biggest problem in the social care system is clearly the complex challenge of low wages, followed by the administrative burdens in the ranking of operational difficulties, and the third key factor was the psycho-mental workload of staff. Full article

Background and objectives: Neurosurgical intervention on the newborn’s developing brain is a risk factor for neurodevelopmental disorders (NDDs). These patients necessarily require regular, coordinated follow-up. The ventricular subgaleal shunt (VSGS) technique has been used since 2013 at Rouen University Hospital. Like any change in practice, this technique must be evaluated. In this paper, we describe the population of patients with hydrocephalus treated by VSGS, the complications associated with the procedure, and the outcome of these patients at two and six years old. Methods: This study was an observational, descriptive, retrospective, single-center study. Children included were those less than three months old with hydrocephalus treated by VSGS at Rouen University Hospital from January 2013 to December 2023. Data were anonymized and collected using EDSaN software. A descriptive analysis was performed. Results: Thirty-two patients were included in our study. Of these, 22 (69%) were born prematurely; 16 (50%) of these 22 had postnatal intraventricular hemorrhage (IVH) requiring treatment with VSGS. A total of three patients (13.6%) died within the first year of life; twenty-four patients (75%) required definitive shunting. Twenty-two patients were over 2 years old in our study. Only 10 of them acquired the ability to walk (45%). Cerebral palsy was present in 10 (45%) patients. Fifteen patients were over 6 years old; thirteen (87%) attended school, but six (40%) had special needs (the need of an assistant, or part-time schedule). In our study, only 24 patients (82%) were followed by a pediatrician trained in neurodevelopment at Rouen University Hospital, and 27 (93%) were followed by a neurosurgeon. Conclusions: This study describes all patients with hydrocephalus treated by VSGS at Rouen University Hospital between January 2013 and December 2023, as well as their complications and their neurological outcomes. The follow-up of these children at risk of NDDs is essential. Full article

Background and Objectives: The transition from pediatric to adult-oriented healthcare is challenging and data on parental involvement and perception regarding the transition of children with chronic digestive diseases are scarce. Materials and Methods: Legal guardians of adolescents with chronic digestive diseases receiving care at a North-Eastern Romanian tertiary center and private offices were administered a 30-item survey. Results: There were 124 responders; 73.4% lived in rural areas; 81.5% were patients’ mothers. Positive correlations were found between parents’ perception of the child’s readiness for health-related decisions and appreciation of the children’s preparedness for transition (0.544; p = 0.000), between parents encouraging their children to maintain healthcare records and their perception of the children’s knowledge about their disease (0.67; p = 0.000), between parents’ fear of therapeutic breaks during transition and their perception of the need for transition training (0.704; p = 0.000), between fears for children’s impropriate health-related choices, fears of therapeutic breaks (0.573; p = 0.00) and parental perception that the adult physicians would be more patient-oriented and less family-centered (0.453; p < 0.000) and between parents’ trust in their children’s self-management skills and encouraging them to make decisions on their own (0.673; p < 0.000). Conclusions: The results of our study highlight the importance of addressing parental fears during special parent–children counseling sessions and promoting a child’s independence, chronic disease knowledge, records and alone consultations. Full article

Localised cutaneous leishmaniasis (LCL) is a common neglected tropical disease in Ethiopia, which is mainly treated with intralesional (IL) pentavalent antimonial such as sodium stibogluconate (SSG) and/or cryotherapy. Both treatments are painful, and studies are lacking on the pain associated with these or affected individuals’ experiences of them. A cross-sectional, observational study was conducted at ALERT Comprehensive Specialized Hospital, Addis Ababa/Ethiopia. The socio-demographic and clinical data of individuals affected by LCL receiving IL SSG and/or cryotherapy was gathered, and their treatment was observed. Participants quantified their treatment-associated pain using the Wong–Baker Pain Scale. Health-related quality of life was measured using the (Children’s) Dermatology Life Quality Index. Adverse effects, participant experiences with local therapies, and dermatologists’ experiences and opinions of local LCL treatment were assessed using structured questionnaires. Of the thirty-six individuals with LCL included (64% male, 14% children), 52% reported a treatment-associated pain score ≥ 8. Cryotherapy administered with a cotton bud was associated with lower pain scores ≤ 6 (odds ratio: 0.15, 95% confidence interval: 0.03–0.89) compared to a cryotherapy spray device. There was wide variation in treatment administration. Local LCL treatment is painful, and most individuals experience significant pain. This study highlights the need for less painful but effective treatments, structured training, and clear standard operating procedures. Full article

Background and Objectives: Estimating the need for palliative care for children is a crucial step in addressing the needs of children facing life-threatening conditions, while providing a powerful argument to combat unacceptably wide disparities in access to care. The need for palliative care for children in Romania remains insufficiently quantified. More accurate estimates are indispensable to assess the true extent of need and to support adequate policy responses. Materials and Methods: This retrospective cross-sectional study aimed to estimate the need for pediatric palliative care in Romania for 2022–2023. We analyzed secondary data obtained from the General Directorates of Social Assistance and Child Protection (DGASPC) in 41 counties and the six sectors of Bucharest. The analysis focused on life-limiting conditions as defined by the WHO Annex 3, Order no. 253/2018. Results: The study identified 14,499 pediatric cases with palliative care needs, showing a highly uneven national distribution, especially across diagnostic groups and age categories. We observed a higher number of cases in rural areas (7553) compared with urban areas (6946). Our own data do not include resource estimates; however, prior reports indicate only 50 palliative care beds for children in Romania. Conclusions: This study reveals a substantial and unevenly distributed need for pediatric palliative care in Romania, with notable disparities across age groups, diagnostic categories, and urban-rural areas. The identification of 14,499 eligible cases underscores the urgency of developing targeted policies and allocating adequate resources to ensure equitable access to specialized palliative services for all children in need. Full article

Children’s safety, well-being and inclusion in the school environment can be severely impacted by social isolation and bullying. This study examined these threats in a sample of 14 group-classes (291 students) from four different primary education schools. A total of 44 special educational needs (SEN) students and 44 students without SEN were selected. The social network structure of each group-class was analysed, as well as the number of friendship ties, the degree of emotional well-being and social participation (both inside and outside of the school), and the possible cases of bullying. The results show a significantly greater rate of social rejection, emotional distress and risk of exclusion in SEN students with respect to their peers, as well as a considerably higher perception of bullying (38.6% vs. 4.8%). The SEN students who reported bullying were mostly schooled in social networks with a more segregated and fragmented structure. Moreover, the mean value obtained in these groups was lower for all the analysed indicators, although the differences were not statistically significant. These data support the idea that the social capital of the group class could influence the prevention of violence and bullying towards SEN students. However, further studies with larger samples are needed to confirm this. Lastly, strategies to promote the social inclusion of SEN students in primary education schools are discussed. Full article

The integration of digital serious games into speech learning (rehabilitation) has demonstrated significant potential in enhancing accessibility and inclusivity for children with speech disabilities. This review of the state of the art examines the role of serious games, Artificial Intelligence (AI), and Natural Language Processing (NLP) in speech rehabilitation, with a particular focus on interaction modalities, engagement autonomy, and motivation. We have reviewed 45 selected studies. Our key findings show how intelligent tutoring systems, adaptive voice-based interfaces, and gamified speech interventions can empower children to engage in self-directed speech learning, reducing dependence on therapists and caregivers. The diversity of interaction modalities, including speech recognition, phoneme-based exercises, and multimodal feedback, demonstrates how AI and Assistive Technology (AT) can personalise learning experiences to accommodate diverse needs. Furthermore, the incorporation of gamification strategies, such as reward systems and adaptive difficulty levels, has been shown to enhance children’s motivation and long-term participation in speech rehabilitation. The gaps identified show that despite advancements, challenges remain in achieving universal accessibility, particularly regarding speech recognition accuracy, multilingual support, and accessibility for users with multiple disabilities. This review advocates for interdisciplinary collaboration across educational technology, special education, cognitive science, and human–computer interaction (HCI). Our work contributes to the ongoing discourse on lifelong inclusive education, reinforcing the potential of AI-driven serious games as transformative tools for bridging learning gaps and promoting speech rehabilitation beyond clinical environments. Full article

Background: Several studies document the importance of communicative abilities for children’s development. Especially in recent years verbal communication in preschool children with developmental language disorder (DLD) has been studied, relying heavily on statistical analysis, outcome measures, or/and parents’ reports. Purpose: This explorative study investigates the effects of speech therapy on the development of language and verbal communication skills in preschool children with DLD within their peer group in a day-to-day setting using objective video-documentation. Hypothesis: Speech therapy leads to improvement of language, communication, and possibly to concurrent development of both language and verbal communication skills in preschool children. Methods: Preliminary prospective study to assess language and verbal communications skills of nine preschool children (seven boys, two girls, 4–6 y) with DLD in a speech therapy kindergarten using video recordings over a one-year therapy period. The communicative participation of the members of the peer group was assessed and included the verbal address (Av) and the ratio of “verbal address/verbal reaction” (Av/Rv). Results: The investigation results in evidence for two outcome groups: One group with suspected preferential verbal communication disorders (n = 4) was characterised by a high Av/Rv value, meaning they were scored to have a normal or high verbal address (Av) and a low verbal response (Rv) (predominantly interpersonal communication related disorder). This group showed minimal changes in the short term but demonstrated improvement after 5 years of schooling; thus, pedagogical activities seemed to be particularly effective for these children. The second group showed a balanced Av/Rv ratio (predominantly language related disorder) (n = 5); but after five years they demonstrated a partial need for special school support measures. This group may therefore particularly benefit from speech therapy. Conclusions: The present study clearly shows that even with speech-language therapy, the linguistic ability of DLD-disturbed children does not necessarily develop simultaneously with their communication ability. Rather, the investigations provide evidence for two groups of preschool children with DLD and communication disorder: One group demonstrated a predominantly verbal communication related disorder, where pedagogical intervention might be the more important treatment. The second group showed predominantly DLD, therefore making speech therapy the more effective intervention. In this study, all children expressed their desire to communicate with their peers. To the authors’ best knowledge, this is the first study determining the ability to communicate in a preschool cohort with DLD using characterisation with video documentation in a follow-up for 1 year. Full article

Background/Objectives: Unilateral hearing loss (UHL), particularly single-sided deafness (SSD), disrupts spatial hearing in children, leading to academic and social challenges. This study aimed to (1) compare azimuthal sound-localization accuracy and compensatory strategies between children with single-sided deafness (SSD) and their normal-hearing (NH) peers within a virtual reality environment, and (2) investigate sound-localization performance across various azimuths by contrasting left-SSD (L-SSD) and right-SSD (R-SSD) groups. Methods: A cohort of 44 participants (20 NH, 24 SSD) performed sound localization tasks in a 3D virtual environment. Unsigned azimuth error (UAE), unsigned elevation error (UEE), and head movement distance were analyzed across six azimuthal angles (−75° to 75°) at 0°elevation. Non-parametric statistics (Mann–Whitney U tests, Holm–Bonferroni correction) compared performance between NH and SSD groups and within SSD subgroups (L-SSD vs. R-SSD). Results: The SSD group exhibited significantly higher UAE (mean: 22.4° vs. 3.69°, p < 0.0001), UEE (mean: 5.95° vs. 3.77°, p < 0.0001) and head movement distance (mean: 0.35° vs. 0.12°, p < 0.0001) compared with NH peers, indicating persistent localization deficits and compensatory effort. Within the SSD group, elevation performance was superior to azimuthal accuracy (mean UEE: 3.77° vs. mean UAE: 22.4°). Participants with R-SSD exhibited greater azimuthal errors at rightward angles (45°and 75°) and at −15°, as well as increased elevation errors at 75°. Hemifield-specific advantages were strongest at extreme lateral angles (75°). Conclusions: Children with SSD rely on insufficient compensatory head movements to resolve monaural spatial ambiguity in order to localize sounds. Localization deficits and the effort associated with localization task call for action in addressing these issues in dynamic environments such as the classroom. L-SSD subjects outperformed R-SSD peers, highlighting hemispheric specialization in spatial hearing and the need to study its neural basis to develop targeted rehabilitation and classroom support. The hemifield advantages described in this study call for further data collection and research on the topic. Full article

Background/Aim: Dental treatment is typically performed under general anesthesia for children who have difficulty cooperating, as well as for those with mental or physical disabilities requiring special care. This study aims to categorize and evaluate the systemic disease or syndrome status, age, and gender of children who require dental treatment under general anesthesia. Materials and Methods: In this study, the ages, sexes, disabilities (if any), and systemic diseases of patients requiring dental treatment under general anesthesia (GA) between the ages of 1 and 15 were analyzed. The patients were categorized based on having difficulties cooperating or having mental or physical disabilities that require special care. Results: In this study, data from 1666 patients were examined. A total of 955 patients (57.32%) were male, while 711 (42.67%) were female. Overall, 232 (13.9%) patients with disabilities or systemic diseases visited the clinic, including 49 who had epilepsy (2.9%), the highest number among the systemic disease group. This finding was statistically significant in the 4–6 age group (p < 0.00). Conclusions: Among patients with special needs, epilepsy emerged as a disorder that requires the most dental treatment. We believe that providing dental treatment for children with neurological diseases, such as epilepsy, in a fully equipped operating room will be beneficial in managing complications that may arise during treatment. Full article

Background: Childhood obesity is a growing global health concern, with an increasing prevalence of severe obesity among young children. This study aimed to determine the average age of severe obesity onset in Polish children and evaluate the time gap between diagnosis and referral for specialized care. Methods: This data analysis was conducted across four Polish pediatric endocrinology centers specializing in childhood obesity management (Szczecin, Cracow, Zabrze, Rzeszów) between July 2022 and November 2023. The study included 367 children and adolescents (186 boys, 181 girls) aged 0–18 years, diagnosed with severe obesity based on age-specific BMI criteria. Anthropometric measurements were performed during the patient’s inclusion into the study and based on past medical records. BMI and BMI Z-scores were calculated for all current and past measurements. Results: The median age of the study population at the moment of inclusion into the study was 13.7 ± 2.9 years (range: 2.2–18 years). The median BMI was 40.9 ± 5.1 kg/m² (range: 30.1–65.8 kg/m²), and the median BMI Z-score was 2.7 ± 0.4 (range: 2.3–6.2). Out of the 367 children included, 327 (89%) had entered puberty. An analysis of past measurements revealed that 83% of children had severe obesity at their earliest recorded BMI measurement, with n median onset age of 3.2 years. The median age of referral to specialized care was 10 ± 5.0 years, reflecting a delay of almost 7 years from diagnosis to targeted medical care. Conclusions: This study highlights a substantial delay between the onset of severe obesity and referral for specialized care, underscoring the need for earlier intervention strategies tailored to age, sex, and developmental stage. Full article

Neonicotinoids (NEOs) are a class of systemic insecticides widely used in agriculture owing to their high efficacy and selectivity. As one of the most globally consumed beverages, tea may represent a potential dietary source of pesticide residues. However, limited research has examined NEO contamination in tea and its implications for human exposure, highlighting the need for further investigation. Therefore, this study comprehensively evaluated the residue characteristics, processing effects, and human exposure risks of six NEOs—dinotefuran (DIN), imidacloprid (IMI), acetamiprid (ACE), thiamethoxam (THM), clothianidin (CLO), and thiacloprid (THI)—in Chinese tea products. According to the findings, the primary pollutants, ACE, DIN, and IMI, accounted for 95.65% of the total NEO residues in 137 tea samples, including green, oolong, white, black, dark, and herbal teas. The highest total target NEO (∑₆NEOs) residue level was detected in oolong tea (mean: 57.86 ng/g). Meanwhile, IMI exhibited the highest residue level (78.88 ng/g) in herbal tea due to the absence of high-temperature fixation procedures. Concentrations of DIN in 61 samples (44.5%) exceeded the European Union’s maximum residue limit of 10 ng/g. Health risk assessment indicated that both the chronic hazard quotient (cHQ) and acute hazard quotient (aHQ) for adults and children were below the safety threshold (<1). However, children required special attention, as their exposure risk was 1.28 times higher than that of adults. The distribution of NEO residues was significantly influenced by tea processing techniques, such as full fermentation in black tea. Optimizing processing methods (e.g., using infrared enzyme deactivation) and implementing targeted pesticide application strategies may help mitigate risk. These results provide a scientific foundation for enhancing tea safety regulations and protecting consumer health. Full article