Search Results (994)

General practitioners (GPs) are at the forefront of stunting interventions, but only a few studies have examined their understanding of growth monitoring. Therefore, this study aims to assess the effectiveness of massive open online course (MOOC)-based Continuing Medical Education (CME) programs to increase GPs’ knowledge of nutrition and early detection of growth abnormalities. The study procedures were carried out using a pre- and post-cohort approach involving 121 GPs, mostly working in primary care in Indonesia. The pre- and post-test scores were observed before and after the 12-week MOOC intervention, and the participants were asked for feedback. There were 190 verified participants; the attrition rate was 27.4% (n = 52), and there were six participants with incomplete data, leaving 121 participants as the final sample. The results showed that post-test scores significantly increased after intervention in all domains. These domains included early-life nutrition (7.00 to 9.00), breastfeeding and lactation management (5.56 to 7.78), and feeding problems (7.33 to 8.00) (p < 0.001). Participants reported high satisfaction and preferred a combination of synchronous and asynchronous learning. The feedback suggested improving parental education techniques, specifically in low-socioeconomic settings, and strengthening collaboration between GPs and nutritionists in managing feeding problems. Full article

Background and Clinical Significance: Carbimazole is a widely used medication to treat Graves’ disease, although it can rarely cause acquired aplastic anemia, a complication that happens in less than 0.01% of people. Case Presentation: We report a 36-year-old woman treated with supratherapeutic dose carbimazole who, after approximately six months of treatment, developed high grade fever, severe menorrhagia, spontaneous epistaxis, and pancytopenia. Her bone marrow biopsy showed severe bone marrow failure with only 5% cellularity and trilineage hypoplasia. Other potential causes were ruled out. Immediate discontinuation of carbimazole was done, and supportive care, including blood transfusions, broad-spectrum antibiotics, G-CSF, and eltrombopag, was started. The patient deteriorated during her hospital stay, developed neutropenic sepsis and acute respiratory failure from diffuse alveolar hemorrhage, which required intubation and pulse steroid therapy. She was stabilized and discharged, with a referral to a tertiary medical center for starting antithymocyte globulin (ATG) immunosuppressive therapy, which she subsequently completed; two months after discharge she was transfusion independent with near-normalization of her blood counts. Conclusions: This case serves as a stark reminder of how lethal thionamide-induced bone marrow failure can be, highlighting the vital need for immediate drug cessation, swift intensive care, and thorough patient education on early warning signs. Full article

Flanders, the Dutch-speaking part of Belgium, was the first region in Europe to implement universal neonatal hearing screening (UNHS) in 1998. Early detection of hearing loss, in combination with advances in hearing technology, has provided new opportunities and different challenges especially for children with a severe to profound hearing loss. Both the population of students with hearing loss and their educational contexts and needs have undergone significant changes. The government of education and the government of health care in Flanders created several services to support students with a hearing loss and their families, which we describe in this chapter. Although the demand for specialized staff training to meet all these challenges increased, the availability of such training has declined. Historically, specialized training for professionals in deaf education was always organized by or with the special schools for the deaf. However, the expertise is diminishing as now most children are mainstreamed and the special schools have become much smaller. The specialized training supported by the government of education focuses on education of all types of children with special needs, with limited information about children with a hearing loss. Private organizations, such as ONICI (Independent Information and Research Centre on Cochlear Implants) have taken the initiative to start up training courses on different topics related to hearing loss, with great success. It is hoped that governmental support will expand to sustain these opportunities. Full article

Early childhood education and care (ECEC) systems in equitable welfare states are designed to provide comparatively standardised institutional inputs, yet substantial developmental gaps among children persist. This study examined this configuration—descriptively labelled the “Flemish Paradox”—using data from the OECD’s International Early Learning and Child Well-being Study (IELS 2025) for the Flemish Community of Belgium (2363 five year olds in 200 ECEC centres; parent-questionnaire data were available for a subset of the sample, and missing parent-report data were addressed through multiple imputation). Children’s cognitive and executive skills were measured with standardised direct tablet-based assessments, while home environments were reported by parents, separating measurement sources. Two-level hierarchical linear models with design-based weighting (child weight and 92 BRR replicate weights), pooled across five plausible values and 20 multiply imputed datasets, showed comparatively limited between-centre outcome variation (ICC ≈ 23% for foundational learning, ≈11% for executive function). Within centres, family socioeconomic status (B = 25.11, p < 0.001) and a print-focused home literacy index (PHLI; B = 16.60, p < 0.001) were positively associated with foundational learning, and centre-mean PHLI showed an independent contextual association (B = 24.11, p < 0.001). A positive within-centre indirect association through children’s executive function skills was estimated (3.60, 95% Monte Carlo CI [1.83, 5.40]); a secondary exploratory analysis indicated a parallel between-centre pattern (8.40, 95% CI [1.16, 15.65]). Centre socioeconomic composition was strongly associated with outcomes (B = 36.38, p < 0.001); the analysis did not provide evidence that it modified the within-centre PHLI–learning association (p = 0.219). The findings are consistent with cultural-capital perspectives and indicate that family resources, print-focused home literacy, and EFs are jointly associated with early learning within a multilevel ECEC context. However, the cross-sectional design does not establish temporal or causal mediation, and the results should not be interpreted as evidence regarding the effectiveness of particular family- or centre-based interventions. Full article

Background/Objectives: Liver cirrhosis (LC) is a major cause of morbidity and mortality requiring continuous monitoring and early recognition of clinical deterioration. Home telemonitoring is increasingly considered a supportive strategy for outpatient hepatology care; however, patient acceptance remains insufficiently characterized in Eastern Europe, and no validated instrument currently exists for this population. This study aimed to develop and provide the initial psychometric validation of a Technology Acceptance Model (TAM)-based questionnaire assessing acceptance of home telemonitoring among patients with LC. Methods: In this prospective cross-sectional study, 130 adult patients with LC (Child–Pugh A/B/C) were enrolled. A 25-item questionnaire, including 13 Likert-scale items mapped to Perceived Usefulness (PU), Perceived Ease of Use (PEU), and Intention to Use (ITU), was administered under supervision. Psychometric evaluation included internal consistency, exploratory and confirmatory factor analyses, structural equation modelling (SEM), convergent and discriminant validity, and known-groups validity. Results: Internal consistency was excellent (Cronbach’s α = 0.934; McDonald’s ω = 0.950). EFA identified a 2-factor structure explaining 77.9% of the variance, whereas CFA supported the theoretically driven 3-factor TAM, which showed improved incremental fit (CFI = 0.927; TLI = 0.908) and was retained on theoretical grounds. SEM confirmed the TAM pathway, with PU strongly predicting ITU (β = 0.823, p < 0.001), whereas PEU significantly influenced PU (β = 0.343, p < 0.001) but not ITU directly. The model explained 69.5% of the variance in ITU. Known-groups validity was supported across digital access, IT comfort, education level, and disease severity. Patients with advanced cirrhosis and lower digital confidence showed lower acceptance scores. Conclusions: The proposed 13-item Likert scale demonstrated good initial psychometric performance and may represent a useful tool for assessing telemonitoring acceptance and readiness for digital monitoring among patients with LC. Pending further multicentre validation and assessment of predictive validity, the instrument may support identification of patients requiring additional support for successful telemonitoring adoption. Full article

Scoliosis is a complex three-dimensional spinal deformity that requires early detection, accurate radiological assessment, individualized treatment planning, and long-term monitoring. In recent years, artificial intelligence (AI) has emerged as a promising tool across multiple stages of scoliosis management, including screening, automated imaging analysis, deformity classification, prediction of progression, surgical planning, postoperative outcome assessment, and patient education. This narrative review summarizes current and emerging applications of AI in scoliosis, with particular emphasis on studies published after 2023. Deep learning algorithms, including convolutional neural networks, U-Net-based architectures, transformer models, and generative approaches, have demonstrated high accuracy in automated Cobb angle measurement, vertebral segmentation, coronal and sagittal parameter assessment, and radiation-free screening using surface topography or smartphone-based photographs. Machine learning models have also shown potential in predicting curve progression, treatment response, risk of postoperative complications, and patient-reported outcomes by integrating radiological, clinical, biomechanical, and, increasingly, multimodal data. In parallel, large language models and generative AI tools are being investigated for patient education, communication support, readability improvement, and research hypothesis generation. Despite these advances, important limitations remain, including limited external validation, dataset heterogeneity, potential algorithmic bias, insufficient interpretability, and incomplete integration into clinical workflows. Moreover, while AI systems show strong performance in automated measurement and screening tasks, their role in complex therapeutic decision-making, such as Lenke classification, fusion-level selection, and autonomous surgical planning, remains experimental. Overall, AI has the potential to improve the precision, efficiency, and personalization of scoliosis care; however, prospective multicentre studies, transparent reporting, explainable model design, and regulatory validation are essential before widespread clinical implementation. Full article

Early childhood education and care (ECEC) is significantly shaped by policy and an enduring focus on quality. While policy governs service provision, it is teams of educators who transform policy into practice, defining and enacting understandings of policy and quality through shared decision-making. In Australia, central to the ECEC quality agenda is the educational leader, a role positioned to guide teams of educators in decision-making. This paper examines how the educational leader role is interpreted in centre documents by services and then enacted in practice by individuals, drawing on Foucauldian-informed discourse analysis of a textual archive comprising policy documents, centre documentation, and focus group data from four Queensland long day care centres. Findings indicate a disconnect between policy intentions of the educational leader and centre-level enactment, where the role is both enabled and constrained in various ways. The educational leader is identified as enacted through five discursive practices: the educational leader as an ‘add-on’ role, no degree required, outside the ‘hierarchical box’, compliance officer, and guide and mentor. By making visible the ways centres interpret and individuals enact the role, this study presents pathways forward to revisit policy and reconsider the positioning of the educational leader in centre staffing structures. Full article

Advances in healthcare have led to substantial growth in the global population of cancer survivors, yet young adult cancer survivors (YACS) aged 18–39 years remain an underrepresented population in cancer survivorship research. This review examines the health challenges and psychosocial factors that shape nutritional status in YACS, with the aim of informing age-appropriate nutritional care. YACS face significant financial and psychosocial demands unique to this life stage, balancing education, early careers and family responsibilities. They report greater unmet nutritional and health needs than other age cohorts, in addition to concerns regarding long-term side effects, financial strain, fear of cancer recurrence and increased responsibility for managing their own care. Cancer treatment can cause nutrition impact symptoms (e.g., nausea, taste changes, fatigue, dysphagia and gastrointestinal (GI) disturbances) that may persist for years, and YACS are vulnerable to late effects such as endocrine dysfunction, cardiometabolic disease, chronic pain and osteoporosis, all of which can be influenced by diet. Poor dietary patterns have been observed in YACS, indicating low intakes of fruits, vegetables, fibre and dairy, and higher consumption of saturated fat, sodium and processed foods. This narrative review evaluated fourteen nutritional intervention studies targeting YACS aged 18–39. Most existing interventions demonstrate minimal recruitment and retention rates, small sample sizes, and a reliance on self-report methods rather than objective nutritional measures. These limitations highlight the need for a deeper understanding of YACS’ specific nutritional needs and more effective strategies to engage this cohort. Future research should prioritise larger, more representative samples, incorporate objective nutritional and clinical measures, and explicitly address psychosocial and age-related barriers to healthy eating in young adulthood. Full article

Background: Burn injuries impose substantial physical and psychological burden beyond acute wound care. Anxiety and depressive symptoms are frequent but often underrecognized among burn survivors. Routine patient-reported mental health assessment during hospitalization and after discharge remains limited, particularly in Latin American burn care settings. This study described the early trajectory of patient-reported anxiety and depressive symptoms from hospitalization to three-month follow-up among adult burn patients treated at Fundación Santa Fe de Bogotá, Colombia. Methods: We conducted an observational cohort study including adult patients admitted to the Burn Unit between April 2022 and July 2023. Anxiety and depressive symptoms were assessed during hospitalization and at three months using the Zung Self-Rating Anxiety and Depression Scales. Scores ≥50 were considered clinically relevant. Results: A total of 118 patients with complete paired assessments were included. Clinically relevant anxiety symptoms increased from 19% during hospitalization to 29% at three months, while depressive symptoms were present in 32% and 29%, respectively. Severe burns and low educational attainment were associated with higher odds of clinically relevant symptoms at follow-up. Conclusions: Patient-reported anxiety and depressive symptoms were frequent during early burn recovery, supporting routine PROM-based mental health assessment and timely psychological follow-up. Full article

Drawing on interviews with ten preschool principals who recruit, mentor, and evaluate preschool teachers, this study examines how playfulness is conceptualized as a professional competence within early childhood education and care (ECEC) practice. In Swedish ECEC, play and teaching are conceptualized as intertwined processes, and co-play is positioned as a central pedagogical approach that requires both personal dispositions and ongoing professional development. The study highlights the importance of integrating playfulness into ECEC teacher education in order to strengthen future teachers’ capacity to co-play with children and engage in play-based teaching practices on children’s terms. The findings also suggest that professional playfulness emerges as a multifaceted and context-dependent competence, shaped by institutional conditions as well as individual orientations towards play and teaching. By foregrounding leadership perspectives, the study contributes to ongoing discussions on the role of play in ECEC and emphasizes the need for deliberate efforts to support the development of professional playfulness in both practice and teacher education. Full article

Background/Objectives: The aim of this study is to determine the extent to which early breast cancer detection behaviors in Türkiye are associated with age, education, income, and chronic disease status, and to evaluate the relationship of healthcare service utilization (contact with family physicians/general practitioners and specialists) with these behaviors. Methods: A cross-sectional secondary data analysis was conducted using nationally representative microdata from the Turkish Statistical Institute’s (TUIK) 2022 Turkiye Health Survey. The analysis included 5554 women aged 40–69. Descriptive statistics were calculated using the FERTFACTOR sample weight. Fully adjusted modified Poisson regression models were constructed for recent mammography (within the last 2 years) and monthly breast self-examination (BSE) (adjusted prevalence ratio, aPR), while Classification and Regression Tree (CART) analysis with five-fold cross-validation was applied to identify targetable risk profiles. (The maximum tree depth was set at 3, and the minimum terminal node size at 250 individuals.) Results: The rates of undergoing a recent mammogram and performing monthly BSE were 23.5% and 25.0%, respectively. Both early detection behaviors were more frequent among women who had contact with both a family physician/general practitioner and a specialist physician within the past 12 months. While contact with a specialist physician was independently associated with both behaviors, education level was positively associated with them, whereas the presence of a chronic disease was associated only with having a recent mammogram. In the CART analysis, the initial split occurred based on BSE behavior, and the prevalence of recent mammography varied approximately eightfold across the terminal nodes (cross-validated AUC = 0.681). Conclusions: In Türkiye, behaviors related to the early detection of breast cancer are associated with age, education, and contact with healthcare services. Fewer than one in four women were up to date with mammography, underscoring a substantial early detection gap. Contact with a specialist physician showed the strongest association; however, given the cross-sectional design, causality cannot be inferred and reverse causation cannot be excluded. Systematizing early detection recommendations within primary care and implementing targeted strategies for low-socioeconomic groups may help increase participation in screening. Full article

Background: Health innovation education often lacks focus on local realities and practitioner-led approaches. An international Canada-Brazil academic partnership was developed to address this gap within Brazil’s Unified Health System. Objectives: This paper examines attendees’ perceptions of a short-term, binational educational intervention and identifies perceived gaps in innovation training within a resource-constrained health system. Design: A qualitative, pedagogically focused program evaluation of a short-term binational educational intervention, using participant reflections and post-course survey responses to examine perceived learning, applicability, and curricular gaps. Settings: Two academic and clinical sites in Vitória and Salvador, Brazil. Attendees: Fifty attendees (30 in Vitória, 20 in Salvador), comprising students, faculty, and health and social care professionals. Methods: The 30 h in-person course was delivered in late November (Vitória) and early December 2025 (Salvador) and addressed ‘wicked problems’ through value proposition development, design thinking, and prototyping. Facilitated by a Canadian faculty with English–Portuguese simultaneous translation. The course’s immediate evaluation used daily reflective exercises and a final participant survey. Results: Respondents’ reflections suggested a perceived reframing of innovation from a primarily technology-oriented concept toward a human-centered, context-responsive, and systems-oriented process. Respondents also identified areas requiring further curricular attention, including financial sustainability, implementation planning, and impact evaluation. Conclusions: Findings from this immediate post-course evaluation suggest that short-term, interprofessional innovation education may support perceived shifts in how participants understand health innovation. However, because the evaluation relied on self-reported, post-course qualitative data without pre/post or longitudinal measures, findings should be interpreted as perceived learning and exploratory curricular insight rather than demonstrated competency development or sustained implementation capacity. Full article

Home enteral nutrition (HEN) is essential for patients with a functioning gastrointestinal tract who cannot meet nutritional needs orally, yet outpatient management remains complex, resource-intensive, and supported by a limited evidence base. Artificial intelligence (AI) may augment HEN care by extending monitoring, education, risk assessment, documentation support, and operational coordination into the home environment. Consistent with the narrative review format, this article uses a pragmatic, transparent synthesis of influential HEN-specific literature, relevant clinical nutrition evidence, and background knowledge from adjacent fields, including home healthcare, chronic disease management, oncology nutrition, telehealth, and software regulation. Direct evidence in established HEN populations remains scarce; therefore, most AI applications should be considered hypotheses or early implementation opportunities rather than proven standards of care. The strongest near-term opportunities are clinician-supervised patient education, symptom triage, adherence support, remote monitoring, and workflow automation. Predictive analytics, smart pumps, and precision enteral prescription tools are promising but require prospective HEN-specific validation, interoperability with electronic health records and home-infusion systems, reimbursement pathways, and governance safeguards. Key barriers include dataset bias, limited external validation, alert fatigue, privacy and regulatory concerns, unclear accountability, digital equity, cost uncertainty, and the risk of dehumanizing care. AI should be viewed as a complement to multidisciplinary HEN expertise. Priorities for the near future include HEN registries, standardized outcomes, prospective validation, pragmatic implementation trials, health-economic evaluation, and transparent oversight that preserves clinician accountability and patient-centered care. Full article

Growing concerns regarding children’s disconnection from nature have increased interest in nature-based pedagogies within Early Childhood Education (ECE). This study examined how participation in a Forest School pilot project influenced children’s learning environments, play, human–nature relationships, and science process skills in three ECE settings in Northern Spain. This longitudinal study combined quantitative and qualitative data collection methods to follow 106 children aged 2–5 years throughout a complete academic year of regular Forest School sessions integrated within mainstream schooling. Data collection combined systematic observation scales, semi-structured interviews, environmental attitude measures, and family questionnaires to examine learning environments, children’s play, social interactions, environmental attitudes and science process skills. The findings indicate that forest environments provided richer opportunities for exploratory play, science process skills, and interaction with unstructured materials than conventional playgrounds. Group symbolic play occurred more frequently in forest settings, while lower levels of conflict were observed. Children progressively developed more ecocentric environmental attitudes, empathy toward living beings, and relational forms of environmental care through repeated interaction with nearby ecosystems. Teachers reported that children demonstrated increasing science process skills—including observation, exploration, representation, and communication—through direct interaction with natural phenomena. The study suggests that regular nature-based learning may support the development of science process skills, environmental care, and holistic child development within mainstream ECE contexts. Full article

Background: Early childhood caregivers are exposed to intensive caregiving demands and have a high risk of depression. Guided by the family stress process model and Acceptance and Commitment Therapy (ACT), this cross-sectional study examined whether psychological flexibility mediates the association between parenting stress and depression. Methods: A cross-sectional survey was conducted among 1140 Chinese primary caregivers of infants aged 0–36 months in Ya’an, Sichuan, China, from 9 October 2022 to 8 October 2025 using convenience sampling. Validated scales included the Parenting Stress Index-Short Form (PSI-SF), Acceptance and Action Questionnaire-II (AAQ-II) (Higher AAQ-II scores reflected lower psychological flexibility), and Patient Health Questionnaire-8 (PHQ-8). Hayes’ PROCESS Model 4, with 5000 bootstrap resamples, was adopted for the mediation analysis. Results: Parenting stress was positively associated with depressive symptoms (r = 0.335, p < 0.01) (weak-to-moderate effect size). Psychological flexibility exerted a partial mediating effect between the two variables, and the indirect effect accounted for 45% of the total effect. Caregivers with lower household income, lower educational level, and those caring for children aged 0–12 months reported significantly higher depression (all p < 0.05). Conclusions: Parenting stress is an important risk factor for depression, and psychological flexibility plays a significant partial mediating role in this relationship. ACT-based interventions targeting psychological flexibility may hold implications for depression among early childhood caregivers. Full article