Search Results (252)

Background/Objectives: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental disorder characterized by social, communication, and behavioral challenges. complementary and alternative medicine (CAM) is widely used by parents worldwide, yet research exploring parents’ experiences, particularly in Arab countries, is limited. This study explored mothers’ perceptions and experiences of CAM use for children with ASD, information-seeking behaviors and challenges encountered. Methods: A qualitative study using semi-structured interviews was conducted among twenty mothers at Autism Academy of Jordan in 2024. Inclusion criteria were mothers with children diagnosed with ASD for at least six months and those who had used at least one CAM therapy. Interviews were conducted via Skype, transcribed verbatim, and analyzed using NVivo 12 with inductive thematic analysis. Results: Three major themes emerged in this qualitative study: (1) mothers’ experiences with CAM and perceptions of benefit; (2) sources of information and decision-making processes; and (3) main challenges in selecting and implementing CAM. Mothers reported using therapies such as honey, black seed, camel milk, Hujama, olive oil, supplements, and region-specific programs like Andalosiah. Faith, cultural beliefs, and the desire for natural, safe interventions strongly influenced CAM selection. Internet searches and social media groups were primary information sources. Challenges included financial, logistical, emotional burdens, and lack of trustworthy, Arabic-language information sources. Conclusions: Mothers in Arab countries navigate CAM use for their children with ASD through culturally and religiously informed practices. Interventions should focus on developing evidence-based guidance, culturally sensitive counseling, and accessible information to support families in safe, informed CAM use. Full article

Mesenchymal stem/stromal cells (MSCs) exhibit broad differentiation capability and strong immunoregulatory potential mediated through intercellular communication and the release of diverse paracrine mediators. They represent a promising but still investigational therapeutic approach for managing complications associated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). This review provides an updated synthesis of MSC biology, their bidirectional interaction with immune cells, and their functional contribution to the hematopoietic niche. It also evaluates current clinical evidence regarding the therapeutic roles of MSCs and MSC-derived extracellular vesicles (EVs) in acute and chronic graft-versus-host disease (aGVHD/cGVHD), as well as in poor graft function. Mechanistic insights encompass macrophage polarization toward an anti-inflammatory phenotype, inhibition of dendritic cell maturation, enhancement of regulatory T-cell expansion, and modulation of cytokine signaling pathways. Within the bone marrow milieu, MSCs contribute to stromal restoration and angiogenic repair. Recent phase II/III trials in steroid-refractory (SR)-aGVHD have demonstrated overall response rates ranging from 48 to 71%. Efficacy appears particularly enhanced in pediatric patients and with early MSC administration. Across studies, MSC therapy shows a favorable safety profile; however, heterogeneity in response and inconsistent survival outcomes remain notable limitations. For poor graft function, limited prospective studies indicate hematopoietic recovery following third-party MSC infusions, and combination approaches such as co-administration with thrombopoietin receptor agonists are under investigation. MSC-derived EVs emulate many immunomodulatory effects of their parental cells with a potentially safer profile, though clinical validation remains in its infancy. MSC-oriented interventions hold substantial biological and therapeutic promise, offering a favorable safety margin; however, clinical translation is hindered by product variability, suboptimal engraftment and persistence, and inconsistent efficacy across studies. Future directions should emphasize standardized manufacturing and potency assays, biomarker-driven patient and timing selection, optimized conditioning and dosing strategies, and the systematic appraisal of EV-based or genetically modified MSC products through controlled trials. Full article

Social–emotional development in early childhood lays the groundwork for school readiness, healthy relationships, and long-term well-being. Parents play a pivotal role in this process, shaping children’s emotional awareness, regulation, and social competence through everyday interactions. This literature review synthesizes evidence from 74 peer-reviewed studies to evaluate nine evidence-based parenting interventions targeting parents of preschool-aged children. The programs were analyzed with respect to their objectives, theoretical foundations, components, and the resulting outcomes for both parents and children. Across interventions, consistent benefits emerged in children, including improved emotion recognition, regulation, empathy, and prosocial behavior, as well as reductions in internalizing problems. Parents also gained in confidence and positive discipline practices. Key elements linked to effectiveness included active parent skill-building (such as modeling, role play, and guided practice), structured parent–child interactions, multi-component designs integrating home and school contexts, and flexible delivery formats that adapt to family needs. These findings underscore the critical role of parenting interventions as an evidence-based method to enhance preschoolers’ social–emotional development. Full article

Background: Early childhood caries (ECC) compromise the nutrition, growth, and quality of life in young children, and their relationship with breastfeeding practices remains disputed. Aim: To determine if prolonged breastfeeding increases the risk of dental caries in children aged under 71 months. Material and Methods: A systematic review of PubMed, Multidisciplinary Digital Publishing Institute, and Evidence-Based Dentistry, was conducted through August 2025, including observational studies, randomized trials, narrative reviews, and meta-analyses on breastfeeding and ECC. Results: Thirty-one studies involving 28,000 children were included. Exclusive breastfeeding for under six months halves ECC probability (OR 0.53–0.58), whereas breastfeeding beyond 12 months and nocturnal feeds increase probability by 60–86% (OR 2.35–7.14). Parental factors—high plaque levels, feeding-to-sleep, and skipped post-feed cleaning—strongly predict ECC (OR 8.51–75.6). Interventions combining feeding counseling with home visits or visual aids reduce ECC incidence by 22–32% (RR 0.68–0.78). Conclusions: Exclusive breastfeeding through six months is protective against ECC, but prolonged or nocturnal feeding heightens risk. Integrating structured oral health education into breastfeeding promotion is recommended. Full article

Individuals with developmental disabilities often experience physical and mental chronic conditions from early childhood, which can negatively affect their education, employment, and social participation without appropriate interventions. These impairments frequently limit the acquisition of essential daily living skills, including personal hygiene skills. This study examined a multicomponent intervention package—comprising video prompting, step-by-step instruction based on task analysis, systematic error correction, and reinforcement—to support the acquisition of handwashing skills for two adolescents with developmental disabilities (Autism Spectrum Disorder and Intellectual Disability) and toothbrushing skills for one adolescent. A nonconcurrent multiple-baseline design across participants and skills was employed, including baseline, intervention, maintenance, and generalization phases. The intervention was conducted over eight weeks. The results indicated low and stable baseline performance for both participants, followed by a systematic increase in performance after the introduction of the intervention, reaching accuracy levels between 80% and 91%. Participants demonstrated meaningful improvements in hygiene skill performance following intervention. These gains were maintained over time and generalized to new settings, although a few task steps continued to require prompting. Furthermore, teachers and parents rated the intervention as highly feasible, practical, and useful for supporting hygiene skills, while students reported enjoyment, perceived improvement, and willingness to participate again. Overall, the findings suggest that structured, evidence-based instructional approaches may support increased functional participation in essential daily living skills, particularly when complete independence may not be attainable for all individuals. Full article

Late bedtimes and insufficient sleep duration among children and adolescents have been consistently associated with daytime sleepiness, irritability, and poorer academic performance. To mitigate these adverse consequences of insufficient sleep, it is essential to provide children, students, teachers, and parents with not only knowledge about sleep improvement but also practical tools that facilitate behavioral change. This review synthesizes existing evidence from studies that have addressed this issue by evaluating students’ individual sleep behaviors using checklists of sleep-promoting practices. Drawing on practical examples from school-based interventions, the review highlights the effectiveness of sleep education programs for children and adolescents. These programs aim to bridge the gap between sleep-related knowledge and actual behavioral change by targeting daily sleep habits. Typically, such programs consist of a single 50 min educational session focusing on the importance of sleep and strategies for improvement, followed by a two-week self-help period during which students actively practice and monitor specific target behaviors. Overall, the findings indicate that sleep education programs incorporating self-help components not only enhance sleep-related knowledge but also promote healthier sleep behaviors and improve sleep patterns. Moreover, these programs effectively reduce daytime sleepiness and irritability among children and adolescents, thereby contributing to a healthier and more adaptive school life. Full article

Caregiver-mediated approaches in early intervention can provide impactful support for families of young children with social communication needs. Project ImPACT (PI), a caregiver-mediated naturalistic developmental behavioral intervention, was tested for effectiveness in public early intervention (EI) programs in a randomized waitlist-control community trial across California. Participants included EI service providers (n = 47) and caregiver–child dyads (n = 125; ages 14–32 months). Families received services-as-usual (SAU) or PI following provider training in PI. Multilevel models were used to examine provider coaching, caregiver–child interactions, caregiver PI strategy use, parenting stress, self-efficacy in parenting, and child social communication outcomes across approximately four months of services. Provider use of evidence-based coaching significantly improved after PI training. Caregivers who received PI showed greater gains in some domains of parent–child interaction; PI fidelity scores, stress, and self-efficacy did not differ by condition. Child communication outcomes improved over time in both groups, but differences between conditions were not detected during the study time period. Training community EI providers in PI improved coaching quality and enhanced caregiver–child interaction, demonstrating feasible, scalable use of PI in community settings. Differential child-level effects were not detected, underscoring the need for larger samples and longitudinal follow-up. Full article

Background: Children with autism spectrum disorder (ASD) commonly experience persistent difficulties in social communication, emotional regulation, and social engagement. In recent years, artificial intelligence (AI)-based technologies, particularly socially assistive robots and intelligent sensing systems, have been explored as complementary tools to support psychosocial interventions in this population. Objective: This systematic review aimed to critically evaluate recent evidence on the effectiveness of AI-based interventions in improving social, emotional, and cognitive functioning in children with ASD. Methods: A systematic literature search was conducted in PubMed following PRISMA guidelines, targeting English-language studies published between 2020 and 2025. Eligible studies involved children with ASD and implemented AI-driven tools within therapeutic or educational settings. Eight studies met inclusion criteria and were analyzed using the PICO framework. Results: The reviewed interventions included humanoid and non-humanoid robots, gaze-tracking systems, and theory of mind-oriented applications. Across studies, AI-based interventions were associated with improvements in joint attention, social communication and reciprocity, emotion recognition and regulation, theory of mind, and task engagement. Outcomes were assessed using standardized behavioral measures, observational coding, parent or therapist reports, and physiological or sensor-based indices. However, the studies were characterized by small and heterogeneous samples, short intervention durations, and variability in outcome measures. Conclusions: Current evidence suggests that AI-based systems may serve as valuable adjuncts to conventional interventions for children with ASD, particularly for supporting structured social and emotional skill development. Nonetheless, methodological limitations and limited long-term data underscore the need for larger, multi-site trials with standardized protocols to better establish efficacy, generalizability, and ethical integration into clinical practice. Full article

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

Objectives: Despite high overall vaccination coverage in Galicia, Spain, human papillomavirus (HPV) vaccine uptake remains below the 90% target set by the World Health Organization for 2030. This study aimed to assess baseline knowledge of HPV and attitudes towards HPV vaccination among Galician adolescents and to evaluate the impact of a brief educational intervention delivered as a “pill of knowledge”. Methods: A quasi-experimental pre-/post-intervention study was conducted among 967 students aged 12–16 years from 16 secondary schools in Galicia during the 2023–2024 academic year. A concise, structured 15-min educational session termed a “pill of knowledge” was delivered, and HPV-related knowledge and vaccination intention were measured immediately before and after the intervention using a standardized questionnaire. Results: Following the “pill of knowledge”, the mean proportion of correct responses increased by 30.1 ± 16.6% across all knowledge items. Among unvaccinated participants, intention to accept HPV vaccination rose from 77.7% to 94.4% in girls and from 64.7% to 85.8% in boys. Pre-intervention predictors of vaccination intention included perceived vaccine efficacy and baseline HPV knowledge. Post-intervention independent predictors comprised being female, younger age (12–13 years), and prior sexual education delivered by teachers or parents. The overall predictive accuracy of the logistic regression model for vaccination intention improved from 75.6% before the intervention to 92.7% afterwards. Conclusions: A brief, school-based “pill of knowledge” produced substantial and immediate improvements in HPV knowledge and vaccination acceptance among Galician adolescents. These findings strongly support the systematic incorporation of short, evidence-based educational interventions of this kind into the school setting as an effective public health measure to increase HPV vaccine coverage and advance progress toward WHO elimination targets. Full article

Background: Although there is a considerable body of research evidence on active school travel (AST), the number of children walking to school has decreased over the years in Australia, as well as around the world. Different factors influence AST; the most cited in Melbourne is traffic safety perception. Traffic safety perception is influenced by built environment elements, and improving the built environment can enhance parental perception of traffic safety. Studies have shown that lateral separation from traffic and the provision of a buffer improve the perception of traffic safety, and this has to be explored for children walking to school based on the existing ground situation on a typical street near a school in Melbourne. Based on this background, a pilot study was carried out before the main study to test the reliability and validity of the survey questionnaire. Methods: The survey instrument was developed based on perceptions and/or AST studies, and included safety and probability aspects of the perception construct to elicit responses on perception. The perception of traffic safety was to be rated based on the streetscape videos embedded in the survey. The reliability was tested using Cronbach’s alpha and validity was explored through exploratory factor analysis. The study also checked the feasibility of the recruitment method and whether there would be an observable outcome from the study. The participants were recruited online through community Facebook groups. Results: The survey instrument had excellent reliability (α = 0.945) and was valid. The recruitment method through a Facebook community group was apt for recruiting participants. The preliminary analysis of the pilot data revealed a difference in perception ratings based on the streetscape element intervention. Conclusions: The survey instrument can be used for similar AST research, as it proved to be reliable and valid. Full article

Cardiovascular disease remains the world’s leading cause of death globally, and there is continuing interest in adjunct, diet-based strategies that may support vascular health alongside guideline-directed pharmacotherapy. Anthocyanin-rich berries are one such option: they are widely consumed, generally safe, and can provide substantial amounts of polyphenols in habitual diets. This narrative review focuses on two anthocyanin-rich species, blueberries (Vaccinium spp.) and haskap/blue honeysuckle (Lonicera caerulea L.), and examines the extent to which their intake may influence vascular endothelial function and cardiometabolic risk markers. For blueberries, which are typically dominated by malvidin- and delphinidin-based anthocyanins together with flavonols, phenolic acids and stilbenes such as pterostilbene, randomized controlled trials and meta-analyses have reported improvements in flow-mediated dilation, with modest effects on blood pressure and arterial stiffness in at-risk populations. Haskap berries, characterized by high levels of cyanidin-3-O-glucoside (C3G) and enriched in iridoids and vitamin C, have been studied mainly in cell and animal models, with early human data suggesting potential effects on vascular function, blood pressure and physical performance. Across both berries, emerging evidence indicates that vascular actions are mediated largely by gut- and host-derived phenolic metabolites rather than by transient circulating parent anthocyanins. We synthesize current knowledge on the phytochemical composition of blueberries and haskap, on molecular pathways implicated in endothelial protection (including NO/eNOS signaling, NRF2-mediated antioxidant defense, NF-κB-driven inflammation, lipoprotein metabolism and platelet activation), and on clinical outcomes related to vascular and cardiometabolic health. On this basis, we outline a mechanistic hypothesis that combined blueberry–haskap interventions could provide additive or synergistic effects on vascular function. This hypothesis is currently supported primarily by preclinical and indirect clinical evidence and should be regarded as hypothesis-generating, highlighting priorities for future mechanism-aware trials rather than constituting a practice-changing recommendation. Full article

Background: Picky eating (PE), also termed food selectivity, is one of the most common feeding concerns in childhood. Although often a transient developmental stage, persistent or severe selectivity may lead to nutritional deficiencies, growth impairment, and psychosocial consequences. Methods: This narrative review is based on literature searches conducted in April 2025 across PubMed, Web of Science, Embase, Medline, and Google Scholar. Articles published between 2015 and 2025 were included if they addressed the epidemiology, etiology, assessment, or management of PE in children aged 0–18 years. Additional seminal references predating this period were also considered. Results: Prevalence estimates of PE vary widely (13–50%), with peak incidence between ages two and six. Contributing factors include genetic predisposition, sensory sensitivities, temperament, family feeding practices, environmental influences, and adverse feeding experiences. Distinction from avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) is essential, as these conditions carry greater risk of nutritional and psychosocial impairment. Assessment relies on caregiver-report instruments, clinical observation, growth monitoring, and targeted nutritional evaluation. Effective management integrates parental education, responsive feeding strategies, repeated exposure to novel foods, and, when indicated, nutritional supplementation or referral to multidisciplinary teams. Sensory-based therapies, behavioral interventions, and psychoeducational programs show particular benefit in persistent cases. Conclusions: While most children outgrow PE without adverse outcomes, a subset remains at risk of long-term nutritional compromise and psychosocial difficulties. Early recognition, family-centered guidance, and evidence-based interventions are essential. Future research should refine diagnostic criteria, develop culturally sensitive assessment tools, and evaluate innovative therapies to improve outcomes. Full article

Background/Objectives: Sleep problems are highly prevalent among children with vision impairment and can negatively affect physical, emotional, and cognitive development. There is a need to identify and evaluate effective interventions in this population. This scoping review aimed to map the range of sleep challenges experienced by these children and to summarise the interventions evaluated to date. Methods: Systematic searches were performed in Embase, Medline, and Web of Science Core Collection. Screening was completed in Covidence, and data extraction and descriptive analysis were conducted using Microsoft Excel (version 2510) and IBM SPSS Statistics (version 30). Narrative synthesis was used to summarise findings. Results: Fifteen studies were included, over half of which were case reports. The vast majority (14/15) were conducted in high-income countries, leaving a significant evidence gap for low- and middle-income settings. Reported sleep challenges included delayed sleep onset, non-24-h sleep–wake disorder, early morning waking, and fragmented sleep. Interventions were predominantly pharmacological (11/15), with melatonin the most frequently evaluated. Across studies, melatonin demonstrated short-term effectiveness in improving sleep latency, duration, and parent-reported quality, though prescribing practices, dosages, and availability varied. Other pharmacological options, such as tasimelteon and vitamin B12, were rarely reported. Non-pharmacological strategies were evaluated in only a small number of studies and included behavioural interventions, structured routines, and activity-based therapies. These showed potential benefit but remain under-researched. Conclusions: Overall, the evidence base is small, heterogeneous, and methodologically limited. Further research is needed to develop and carefully test non-pharmacological approaches, and to compare them directly with pharmacological treatments, to provide families and clinicians with effective and sustainable options. Full article

This meta-analysis synthesized 34 published single-case design studies on functional communication training (FCT) for young children with autism spectrum disorder (ASD). A systematic search of electronic databases and reference lists identified studies published between 1996 and 2021 involving 79 children with ASD aged 2 to 8. Quality evaluation using What Works Clearinghouse standards revealed that only 29.4% of studies met standards with or without reservations, primarily due to insufficient data points per phase. Most studies were conducted in home or school settings with therapists/researchers as primary implementers, followed by parents or caregivers. Low reporting rates were found for preference assessment, treatment fidelity, social validity, and maintenance and generalization effects. Overall, FCT demonstrated large effects for reducing challenging behavior (Tau-BC = 0.97) and moderate-to-large effects for increasing replacement behavior (Tau-BC = 0.78). Moderator analyses revealed significantly larger effect sizes in school versus home settings (p < 0.05). These findings further support FCT as an evidence-based practice for young children with ASD, although methodological rigor must be improved. Future research should systematically evaluate maintenance and generalization effects, develop effective parent training and support strategies, and report intervention dosage parameters to strengthen the evidence base and guide clinical implementation. Full article