Search Results (247)

Background/Objectives: Haematopoietic stem cell transplantation (HSCT) causes substantial morbidity in children and young people (CYP). Although prehabilitation benefits adults with cancer, its role in paediatric HSCT remains underexplored. This study aimed to describe current pre-transplant assessment and supportive care practices across paediatric HSCT centres, explore healthcare professional perspectives on prehabilitation implementation, and integrate patient and public involvement (PPI) to inform future intervention design. Methods: A cross-sectional survey was administered to healthcare professionals across 16 paediatric HSCT centres in the UK and the Republic of Ireland, alongside semi-structured PPI discussions conducted with eight children, young people, and caregivers with direct experience of paediatric HSCT. Survey data were analysed descriptively, free-text responses by qualitative content analysis, and PPI by reflexive thematic analysis. Results: Forty-nine eligible responses were received from healthcare professionals. Formal prehabilitation services were reported by 27 (55.1%) respondents, with substantial within-centre variation. Nutritional advice was the most consistently delivered component, 36 (72%), whilst physical activity interventions were the least consistently provided, 13 (26%). Workforce limitations were identified as the dominant barrier by 37 (95%) respondents. PPI findings described provision as reactive and inconsistent, with families expressing preference for flexible, hybrid, and family-centred delivery models. Conclusions: Prehabilitation provision in paediatric HSCT is variable, often informal, and limited by workforce capacity. CYP and caregivers expressed a desire for prehabilitation, particularly through flexible, hybrid (face-to-face and online), and family-centred approaches. Future research should prioritise co-design and feasibility testing of safe, individually tailored programmes that can be integrated into paediatric HSCT pathways. Full article

The bioecological model emphasizes parent–child interactions as proximal processes associated with children’s development over time, whereas family systems theory highlights the distinct yet interdependent roles of mothers and fathers. However, few longitudinal studies have simultaneously examined the associations of mothers’ and fathers’ parenting styles with preschool children’s social problem-solving skills. This study recruited 275 co-residing mother–father Chinese families and employed a three-wave longitudinal design to investigate the longitudinal associations between fathers’ and mothers’ parenting styles and preschool children’s social problem-solving skills, while considering primary-caregiver status. After accounting for prior levels, mothers’ authoritative parenting at Time 2 was positively associated with children’s social problem-solving skills at Time 3, whereas mothers’ authoritarian parenting at Time 1 was negatively associated with social problem-solving skills at Time 2. Fathers’ authoritative parenting showed no significant longitudinal association. However, the interaction between authoritarian parenting at Time 1 and whether the father was identified as the primary caregiver was significantly associated with children’s social problem-solving skills at Time 2. These findings indicate limited and interval-specific longitudinal associations between parenting styles and children’s social problem-solving skills and the possible relevance of primary-caregiver status. Full article

Children living in agricultural communities are particularly vulnerable to pesticide exposure through multiple environmental pathways, yet community-level public policies specifically designed to protect children remain limited in many low- and middle-income countries. This study aimed to develop a community-based public policy for preventing pesticide exposure among young children in rural Thailand through a participatory action research (PAR) approach. Guided by the Kemmis and McTaggart PAR framework, one complete PAR cycle was conducted between February 2022 and January 2023 in Ban Nangoi Village, Sakon Nakhon Province, Thailand. Purposive sampling recruited 62 stakeholders representing parents, farmers, healthcare personnel, local government representatives, academics, and community members. Data were collected through semi-structured interviews, focus group discussions, participant observations, and community meetings and analyzed using thematic analysis. The PAR process enabled stakeholders to jointly identify local priorities and co-develop a context-specific public policy summarized as the “3 Cs for Farmers, 2 Ps for People, and 1 S for Community” framework. Participants reported greater awareness of pesticide-related health risks, stronger multisectoral collaboration, improved stakeholder communication, and wider adoption of preventive practices. These findings suggest that PAR is a feasible approach for co-creating context-specific public policies while strengthening local environmental health governance. Rather than demonstrating the effectiveness of the policy in reducing pesticide exposure, this study highlights the value of stakeholder participation and policy co-creation in supporting sustainable community action. Future research should incorporate objective pesticide exposure measures, quantitative outcome indicators, and longer-term follow-up to evaluate policy effectiveness across diverse agricultural settings. Full article

This study explores the role of arts-based educational interventions in fostering social mending and urban regeneration in disadvantaged urban contexts. The intervention consisted of participatory mosaic workshops designed to foster cooperation, inclusion, and civic engagement, culminating in the co-creation of public artworks installed in a degraded urban underpass and included 193 children aged 5–15 living in Tor Bella Monaca, a highly marginalized suburb of Rome (Italy). The analysis of the intervention used a mixed-methods approach, based on systematic observation, questionnaires, interviews, and document analysis. The findings indicate that the artistic process acted as a catalyst for both individual and collective transformation: at the individual level, participation enhanced relational skills, emotional expression, and sense of agency; at the community level, the intervention contributed to the reactivation of public space, increased social cohesion, and improved care for the urban environment. We interpret these outcomes through the capability approach, identifying art as a “conversion factor” linking individual capabilities to collective regeneration. The intervention aligns with SDGs 4, 10, 11, and 17 of the 2030 Agenda and supports the relevance of scalable, community-based models for inclusive and sustainable urban policies in deprived areas. Full article

Background/Objectives: Smart home technologies can mitigate the safety risks faced by older adults living alone, yet adoption remains constrained by privacy concerns. Existing research has established that privacy apprehensions deter adoption, but the conditions under which this deterrent effect strengthens or weakens are poorly understood. Drawing on privacy calculus theory, this study examines how health status and children’s support moderate the negative relationship between privacy concerns and smart home adoption intention among solo-dwelling older adults. Methods: A cross-sectional survey of 326 older adults living alone in three Chinese cities was analyzed using partial least squares structural equation modeling. Results: Privacy concerns suppressed adoption intention (β = −0.281, p < 0.001) while perceived safety benefits promoted it (β = 0.358, p < 0.001). Both moderation hypotheses were supported: the deterrent effect of privacy concerns was weaker among participants in poorer health (interaction β = −0.091, p = 0.039) and among those receiving stronger children’s support (interaction β = 0.137, p = 0.001), with the latter reducing the negative effect by approximately two-thirds. Conclusions: These findings demonstrate that the privacy–safety trade-off is contingent rather than fixed and inform health-differentiated privacy design and family co-management strategies for more inclusive smart home adoption. Full article

This study develops a theory of parental engagement by exploring the perspectives of both parents and practitioners within a socio-economically disadvantaged area in Dublin, Ireland. Using Constructivist Grounded Theory, data were generated through focus groups with participants involved in the family literacy programme Breakfast Buddies. Analysis resulted in the development of a substantive theory, The Dance of Engagement, which conceptualises parental engagement as a relational, non-linear, and co-constructed process. The findings identify three foundational tenets—safety, equality and trust—as essential conditions underpinning effective parental engagement. Four interconnected categories describe how engagement unfolds in practice: choosing to engage, co-creating engagement, connecting to engage and sharing. These categories illustrate how engagement is initiated, sustained and extended beyond programme settings into home and community contexts. The study demonstrates that personalised practitioner approaches, relational environments and shared ownership of engagement processes support greater parental confidence, sustained participation and reciprocal learning between parents and practitioners. The resulting theory challenges deficit-oriented and participation-based models of parental engagement by focusing on collaboration and contextual responsiveness. The Dance of Engagement offers a theoretically grounded framework with clear implications for policy and practice, particularly for designing inclusive family literacy practices to improve outcomes for children and families in disadvantaged communities. Full article

Pediatric oncology nursing is among the highest-intensity care specialties, exposing nurses to repeated child death and sustained emotional investment in family relationships. This occupational burden is a recognized psychosocial risk factor and a driver of compassion fatigue, burnout, and reported intention to leave, yet the organizational and educational determinants of this risk remain poorly captured by existing assessment approaches. This study investigated the lived experiences of nurses caring for terminally ill children in a pediatric onco-hematology unit and hospice ward in central Italy (N = 15), using a qualitative descriptive design, informed by a phenomenological sensibility to lived experience, supported by computer-assisted textual analysis. Structured face-to-face interviews were analyzed through thematic content analysis with stepwise replication, while quantitative textual analysis was performed using T-Lab software to map co-occurrence patterns among key lemmas, providing a frequency-based, semantically grounded picture of nurses’ representations of occupational risk. Seven themes emerged, including quality of nursing care, parental relationships, coping with a child’s death, and impact on personal and professional life. Findings showed that reported intention to leave was associated, in participants’ accounts, with absent psychological debriefing, cumulative emotional burden, inadequate end-of-life training, and a near-total absence of organizational vocabulary for peer-level support—a gap directly visible in the co-occurrence structure of nurses’ language. As a secondary aim, by combining qualitative depth with complementary lexical analysis of thematic patterns, this study also offers a methodological example of how psychosocial risk in high-intensity care settings can be assessed and translated into actionable indicators for organizational climate and workforce well-being. The findings inform concrete prevention strategies and policy recommendations for nursing education and occupational health, consistent with this Special Issue’s focus on methodological innovation for psychosocial risk assessment and public health policy design. Full article

More than 43 million children are currently displaced globally, yet the artificial intelligence (AI) systems deployed in their education are rarely designed with cultural identity, linguistic continuity, or belonging as architectural concerns. Existing frameworks treat identity as a contextual consideration surrounding educational technology; this paper argues that identity should be treated as a design variable within AI system architecture itself. The paper develops the AI-Based Identity Support Framework (AISF), a conceptual model constructed through interdisciplinary synthesis across bodies of literature including cultural bereavement theory, narrative identity, ethical AI design, and multilingual AI systems, and informed by the author’s practitioner engagement with displaced communities (2018–2023). The AISF specifies three interlocking domains (cultural anchoring, emotional co-construction, and adaptive belonging), each defined operationally and accompanied by diagnostic indicators, design principles, and a preliminary assessment rubric. The framework is differentiated from trauma-informed pedagogy, culturally sustaining pedagogy, and principle-based AI ethics as a system-architectural rather than pedagogical construct. The paper engages critically with risks internal to identity-supportive AI architectures, including essentialization, surveillance, and algorithmic identity-fixing, and addresses low-resource deployment constraints. The AISF is intended to provide a structured diagnostic instrument for designers, evaluators, and policymakers, aligned with Sustainable Development Goals 4.7, 10, and 16. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly used in youth mental health services, including clinical decision support, risk prediction, and digital therapeutics. However, existing frameworks provide limited guidance for integrating ethical, cultural, and relational considerations into the design, governance, and implementation of AI-enabled mental health technologies. This scoping review examined how digital humanities-informed approaches have been incorporated into AI-supported mental health interventions for children and adolescents. Methods: A scoping review was conducted following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Peer-reviewed literature published between 2015 and 2025 was searched using PubMed and supplemented by semantic searches through Elicit. Systematic reviews, scoping reviews, and meta-analyses examining AI-enabled digital mental health interventions and digital humanities perspectives were included. Data were synthesized using inductive thematic analysis. Results: Seventeen review-level studies met the inclusion criteria. Six recurring themes were identified: engagement, participatory co-design, human oversight, equity, ethical governance, and implementation. Across the included reviews, humanities-informed approaches were associated with greater attention to relational engagement, stakeholder participation, transparency, contextual adaptation, and culturally responsive implementation. Evidence supporting intervention effectiveness was strongest in systematic reviews and meta-analyses, whereas findings related to ethics, governance, equity, and implementation were derived primarily from scoping reviews and conceptual syntheses. Conclusions: This review suggests that digital humanities provides a valuable interdisciplinary perspective for informing the design, governance, and implementation of AI-enabled youth mental health interventions. Although the current evidence base remains heterogeneous, integrating humanities-informed approaches may support the development of AI systems that are more ethical, equitable, and developmentally responsive. Future research should evaluate these approaches through empirical implementation studies and emerging generative AI applications. Full article

Artificial intelligence (AI) is increasingly recognized as a transformative technology in healthcare, with growing evidence supporting its applicability across time-critical clinical environments. This perspective aims to evaluate the integration of AI and machine learning (ML) into pediatric emergency departments (PEDs) across three core domains: clinical decision support, stakeholder engagement, and medical education. Within clinical decision support, ML architectures have demonstrated high predictive performance across several high-acuity clinical scenarios, including triage stratification, pediatric traumatic brain injury risk classification, early sepsis detection and clinical deterioration prediction, and dermatological assessment. Model interpretability and real-world implementability remain critical prerequisites for clinical adoption, with explainability methods representing fundamental instruments to enhance transparency and stakeholder trust. Regarding stakeholder engagement, the triadic dynamic among clinicians, caregivers, and patients defines a unique communication challenge in PEDs, with large language models (LLMs) showing preliminary utility; however, stakeholder-inclusive model validation and robust data privacy protections for minors remain key challenges, particularly regarding legal ambiguities of LLM deployment in clinical pipelines. In medical education, AI-driven simulation platforms and LLM-generated adaptive curricula represent promising tools for competency-based training across pediatric emergency scenarios. Future directions emphasize the imperative of prospective multicenter validation in pediatric-specific cohorts, rigorous data quality standards addressing conformance, completeness, and plausibility, and the development of pediatric-tailored governance frameworks. Real-world implementation will require the systematic involvement of all stakeholders—including children, caregivers, clinicians, developers, and institutions—as co-designers of equitable, transparent, and safe AI systems for this uniquely vulnerable population. Full article

Background: As a traditional Chinese exercise, Wushu has been shown to effectively promote balance and postural stability in various populations. Preschoolers’ capacity for balance control, including static, dynamic, and dual-task balance, is linked to the later development of stability skills in adulthood. However, studies of Wushu intervention focusing on balance ability and the related physical fitness in preschool children are limited. Objectives: This study investigated the effects of a 10-week Wushu program on static, dynamic dual-task balance and physical fitness in children 5–6 years old. Methods: Seventy-three participants were randomly divided into an intervention (INT, n = 39) and a control (CON, n = 34) group. The INT group participated in a 10-week Wushu program that included three 30 min sessions per week, while the CON group engaged in unstructured free play with purposely designed materials. The three key primary outcomes were dominant-leg stance for static balance, the balance beam walk for dynamic balance, and the center of pressure (CoP) path length obtained via a force platform during dual-task balance testing, in which the participants were instructed to count numbers backward. The five derived primary outcomes were non-dominant-leg stance, CoP ML path length, CoP AP path length, CoP sway velocity, and CoP sway area. Secondary outcomes were physical fitness indicators, including sit and reach, grip strength, standing long jump (SLJ), countermovement jump (CMJ), 15 m zigzag run, double-leg continuous jump, height and body weight. The analysis of the outcomes was conducted using analysis of covariance (ANCOVA) and Pearson correlation. Results: At baseline, the CON and INT groups did not differ significantly. The INT demonstrated significant enhancements in comparison with CON in the dominant and non-dominant-leg stance (p = 0.017 and p = 0.005, respectively), the balance beam walk, SLJ, 15 m zigzag run and double-leg continuous jump (all p < 0.05), along with the mediolateral CoP path length (p = 0.012). A strong correlation was found between the balance beam walk and the double-leg continuous jump (r = 0.55, p = 0.001), and between the balance beam walk and the 15 m zigzag run (r = 0.43, p = 0.015). Conclusions: The present study demonstrates that a 10-week Wushu program significantly enhances preschool children’s static balance, dynamic balance, and mediolateral postural control during dual-task condition. The improvements in dynamic balance are correlated with lower-limb coordination and jumping agility. Full article

Digital transformation in education enables the integration of interactive tools that foster engagement, creativity, and sustainability awareness among young learners. GameOn! is a serious game using Minecraft Education Edition (MEE) to promote sustainability, inclusivity, and peace among primary school students aged 6–11. Grounded in Constructionism, Experiential Learning Theory, and Citizen Science (CS), it is designed to support connections between classroom experiences and real-world environmental actions. The project followed a co-design methodology involving international partners and educators to develop the GameOn! MEE world and a complementary teacher toolkit. The game was later tested in three Italian primary schools, involving 100 students through both guided and free play sessions. Findings show that 95% of students enjoyed the game, 89% learned new concepts, and teachers observed great focus and engagement during structured play. These results align with our observations: most children quickly engaged with the game, adapted to its mechanics, and demonstrated understanding of key tasks. Some usability challenges emerged, emphasizing the importance of facilitation. Overall, the findings suggest that GameOn!, consistent with the pedagogical potential of other serious games, could enhance sustainability literacy, active citizenship, and environmental awareness in early education. Future work will expand its implementation and further strengthen the integration of CS-based activities. Future work will expand implementation and strengthen the integration of CS-based activities. Full article

Mycoplasma pneumoniae (MP) is a frequent cause of pediatric pneumonia, but the clinical relevance of respiratory coinfections remains incompletely defined. We conducted a retrospective cohort study of 192 hospitalized children with multiplex RT-PCR-confirmed MP infection between April 2023 and November 2025. Patients were classified as MP monoinfection (123/192, 64.1%), MP with viral coinfection (34/192, 17.7%), or MP with bacterial/mixed coinfection (35/192, 18.2%) and children with coinfection were younger than those with MP infection alone, with median ages of 6.5 years (IQR 1–11) in the viral coinfection group and 5 years (IQR 1–7) in the bacterial/mixed coinfection group, compared with 11 years (IQR 7–14) in children with MP alone (p < 0.001). Respiratory failure occurred in 36% of children with MP infection alone, 65% of those with viral coinfection, and 31% of those with bacterial/mixed coinfection. In adjusted logistic regression, viral coinfection was independently associated with higher odds of respiratory failure relative to MP infection alone (aOR 3.37, 95% CI 1.49–7.94; p = 0.004), whereas bacterial/mixed coinfection was not (aOR 0.85, 95% CI 0.35–2.03; p = 0.725). In multinomial regression, increasing age was inversely associated with both viral coinfection (RRR 0.86, 95% CI 0.79–0.94; p < 0.001) and bacterial/mixed coinfection (RRR 0.79, 95% CI 0.72–0.87; p < 0.001). In negative binomial regression, evidence for longer hospitalization in the viral coinfection group was weaker and imprecise (IRR 1.16, 95% CI 0.99–1.37; p = 0.069). Fibrinogen differed across etiologic groups, with the lowest values in bacterial/mixed coinfection (p = 0.004). In this hospitalized pediatric cohort, MP coinfection was more frequent in younger children, and viral co-detection showed the clearest association with respiratory failure. These findings should be interpreted in the context of the retrospective design, modest subgroup sizes, and the limitations of upper-airway multiplex PCR co-detection. Full article

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for the treatment of type 2 diabetes (T2D), are increasingly used for the management of overweight and obesity in children and adolescents. However, the impact of concomitant lifestyle interventions, which vary in scope, structure, and intensity, remains unclear. Methods: A systematic search of PubMed, Scopus, and ClinicalTrials.gov was conducted from April to December 2025 (last update: 12 December 2025), in accordance with the PRISMA 2020 statement. Randomized and observational studies including patients aged 6–19 years with overweight or obesity, with or without T2D, treated with GLP-1 RAs or dual GIP/GLP-1 agonists, were included. Anthropometric outcomes, metabolic parameters, and the scope and structure of concomitant nutritional and behavioral interventions were assessed. Results: Fifteen studies (12 interventional [RCT/non-RCT] and 3 observational), including 1448 participants, were analyzed: liraglutide (n = 6), exenatide (n = 5), semaglutide (n = 1), dulaglutide (n = 1), tirzepatide (n = 1), and lixisenatide (n = 1). Intervention duration ranged from 6 to 68 weeks. Reported BMI reductions varied across studies and pharmacological agents, with semaglutide trials reporting reductions of up to −16.1%. Lifestyle interventions were heterogeneously reported, ranging from general dietary advice to structured, multidisciplinary programs including nutritional counseling, physical activity, and behavioral or family support. Due to heterogeneity in study design and reporting, the independent contribution of lifestyle interventions could not be determined. Conclusions: Available evidence suggests that GLP-1 RAs may represent an effective therapeutic option for children and adolescents with obesity and metabolic disorders. However, available evidence is largely derived from studies incorporating inconsistently reported lifestyle interventions, limiting the ability to disentangle pharmacological and lifestyle effects. Standardized reporting and studies specifically designed to assess their independent and combined effects are needed. Future research should standardize the reporting of lifestyle protocols (e.g., using TIDieR), incorporate validated measures of eating behavior, food preferences, and dietary intake, and use designs (e.g., factorial or stratified randomization of lifestyle intensity) that allow for the pharmacological and behavioral contributions to be quantified separately. This review highlights a critical and previously underexplored methodological gap regarding the structure and reporting of lifestyle co-interventions in pediatric GLP-1 trials. Full article

Depression and clinical anxiety (also known as ‘internalising disorders’) are commonly experienced by autistic children. Parents play an important role in reducing their child’s risk of developing internalising disorders, and existing technology-assisted parenting programs have shown promise in empowering parents in this role. Yet, existing interventions do not currently meet the unique needs of parents of autistic children. This study aimed to co-design adaptations to an existing technology-assisted parenting program (Partners in Parenting Kids) to enhance its relevance and acceptability for parents of school-aged autistic children. An iterative two-phase co-design study was conducted with parents of autistic children (n = 5) and service providers (n = 5). In Phase 1, semi-structured interviews explored participant experiences and needs in the context of parenting support, as well as perspectives on parenting programs. In Phase 2, eight co-design workshops were conducted with parents and service providers to build on the findings from Phase 1 and to collaboratively adapt the program content, delivery, and design features. Workshops involved participatory design activities to foster collaborative sharing of ideas and decision-making. Transcripts from both phases were analysed using reflexive thematic analysis. Themes identified in Phase 1 included: (1) Day-to-day challenges of parenting an autistic child; (2) Unique parent knowledge base and skill set; and (3) Desired qualities of parenting programs. Themes from Phase 2 of the study included: (1) Meaningful connections with others in the community; (2) Acceptance of autism; and (3) Diversity within the community. These themes are described in terms of their design implications for the resultant parenting program (Partners in Parenting Kids-Autism). The findings provide critical insights into desired qualities of parenting programs for parents of autistic children. Importantly, they also shed light on key design recommendations for future work focused on empowering parents to support their child’s mental health through interventions. Full article