Search Results (828)

This systematic review explores the role of family cohesion and health literacy in shaping the physical, mental, and behavioral health of parents and adolescents. Family cohesion and health literacy are recognized social determinants that influence communication, shared decision-making, and engagement in preventive health behaviors. Following PRISMA 2021 guidelines, a comprehensive search across major databases identified 16 eligible studies meeting the inclusion criteria between 2010 and 2025. The findings indicate that higher levels of family cohesion promote healthier behaviors, strengthen emotional regulation, and enhance adolescents’ perceived well-being, while also increasing parental involvement in health-related decisions. Health literacy emerged as a key explanatory and contextual factor in the association between family cohesion and health outcomes. However, socioeconomic disadvantages—such as low income, limited access to healthcare, and lower parental education—were shown to weaken these protective pathways, creating disparities in health outcomes. Cultural and contextual factors also influenced the effectiveness of health literacy interventions. Overall, the review underscores the relevance of family-centered, culturally tailored public health strategies that simultaneously strengthen family cohesion and health literacy to support equitable health outcomes for parents and adolescents. Full article

This study examined the association between bullying and cyberbullying, both in victims and aggressors, and students’ perceived competence in English as a foreign language. A cross-sectional study was conducted with 444 Spanish students (50.00% boys, mean age = 13.27 ± 1.64 years). Perceived English competence was assessed using the Questionnaire of English Self-Efficacy (QESE), while involvement in bullying and cyberbullying was measured with the European Bullying Intervention Project Questionnaire (EBIP-Q) and the European Cyberbullying Intervention Project Questionnaire (ECIP-Q). Associations were analyzed using ANCOVA and binary logistic regression, controlling for age, BMI, maternal education level, and weekly physical activity. The results showed that cyberbullying victimization was consistently associated with lower self-perceived competence in all English skills, particularly among boys, who reported scores up to 12.1% lower and were up to 6.3 times more likely to report low self-efficacy in writing. Girls also showed a higher risk, with up to 5.6 times more likelihood of low scores in oral expression. As for aggression, boys involved in both traditional and cyberbullying showed significant reductions in all language domains, especially in writing and reading. Girls demonstrated a more specific pattern, with negative associations mainly in cyberaggression, showing significantly lower self-efficacy competence in all four skills. These findings highlight the need for gender-sensitive interventions that promote emotional safety and reinforce students’ self-efficacy in language learning. Educational programs involving students, teachers, and families are recommended to foster confidence, reduce fear of errors, and create supportive environments for communicative practice. Full article

Background/Objectives: Bullying refers to a specific form of mistreatment that occurs in the school setting and is characterized by intentionality and persistence over time. It should be noted that some elements, such as low self-esteem and lack of social skills, are usually present in both victims and aggressors, so interfering in these aspects can lead to a decrease in the incidence. Thereby, being a victim of bullying is a key factor in the development of multiple mental health issues, such as depression or even suicide. Consequently, mental health nurses play a fundamental role in health education in order to be able to act when necessary and to prevent these types of unfavorable circumstances that can lead to psychiatric disorders. This systematic review aimed primarily to evaluate the effectiveness of psychoeducational programs in reducing school bullying and, secondarily, to analyze their influence on children’s self-esteem. Methods: Data were obtained through a comprehensive search of PubMed, Cochrane, and Scielo, following PRISMA guidelines. Studies evaluating evidence-based interventions, including the Olweus Bullying Prevention Program (OBPP), the KiVa Anti-Bullying Program (KiVa), Positive Behavioral Support systems, and standardized social–emotional learning programs, were eligible for inclusion. Results: Findings revealed that most interventions showed a positive impact on bullying reduction and self-esteem improvement. However, effectiveness differed depending on contextual factors, such as the educational stage, school climate, cultural setting, and the degree of family involvement, as well as the extent to which each program was adapted to the specific needs of each school environment. Conclusions: Psychoeducational programs demonstrate overall effectiveness in reducing bullying behaviors and enhancing self-esteem in children. Nevertheless, outcomes differ depending on school characteristics, cultural context, and the level of family participation, highlighting the need for interventions tailored to each educational setting. Full article

Background: Moral development (MD) arises from the interaction of attachment, temperament, emotion regulation, and decision-making. Children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) frequently show impairments across these domains, suggesting increased vulnerability to disruptions in MD. However, the mechanisms linking ADHD to MD remain poorly understood. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed was searched for studies published between January 2014 and November 2024 examining MD-related constructs, including moral reasoning, fairness, aggression, bullying, callous–unemotional (CU) traits, decision-making, and reward sensitivity, in individuals aged 0–18 years with diagnosed or subclinical ADHD. Due to substantial heterogeneity in study design, measures, and outcomes, a qualitative synthesis was performed. Results: Of the 2104 records identified, 23 studies met inclusion criteria. Insecure or disorganized attachment, difficult temperament, and emotional dysregulation consistently emerged as developmental risk factors for impaired MD. Hyperactivity–impulsivity and deficient inhibitory control were strongly associated with aggressive and antisocial behaviors. Children with ADHD demonstrated a pronounced preference for immediate over delayed rewards, altered decision-making in social contexts, and reduced sensitivity to positive feedback. CU traits and aggression were frequently identified as behavioral correlates of MD impairments, particularly in interaction with family adversity and comorbid externalizing conditions. Social dysfunction, including bullying involvement, peer rejection, and interpersonal difficulties, was common and contributed to elevated long-term psychosocial risk. Conclusions: ADHD is associated with multidimensional vulnerabilities in MD through intertwined cognitive, emotional, and relational pathways. Interventions targeting attachment security, emotion regulation, reward processing, and social skills may foster MD and reduce later social difficulties. Longitudinal and cross-cultural research is needed to clarify causal mechanisms and inform developmentally sensitive prevention and treatment strategies. Full article

Background/Objectives: Children with developmental disabilities (DD) may experience feeding problems that increase their risk of malnourishment. However, data concerning factors linked to feeding problems in children with DD are lacking. The present study aimed to investigate feeding problems and their associated factors in children with DD who are fed orally. This cross-sectional study included data from 160 children with DD aged 2–18 years, recruited from 9 disability centers and schools located in Madinah, Saudi Arabia. Methods: A total of 666 envelopes were distributed randomly to children to take home. Caregivers were asked to provide sociodemographic, health, and nutrition information. Feeding problems were assessed using a validated screening tool for eating/feeding problems (STEP-AR), which included 17 items divided into 5 subdomains (Aspiration risk, Food refusal, Food selectivity, Nutrition behaviors, and Skill). Phone interviews were conducted with caregivers within two weeks of data collection for dietary assessment. Results: The most frequently reported feeding problems involved feeding skills and food selectivity, with 39.3% unable to feed themselves, 33.1% showing overeating behavior, and 31.2% exhibiting pica-like behavior. Chewing difficulties (28.7%), limited food intake (25.6%), and swallowing challenges (21.2%) were moderately reported, while aspiration-related problems were less common. Multiple linear regression analysis revealed significant positive associations between feeding problems and caregiver education level, family income, caregiver’s relationship to the child, and the child’s living arrangement. Dietary intake was not associated with feeding problems. Conclusions: The findings of this study indicate a range of feeding problems and key sociodemographic factors associated with feeding problems in children with DD. These results highlight the need for targeted interventions such as behavioral support and caregiver education to effectively address and manage feeding challenges in children. Full article

Background/Objectives: A neonatal intensive care units (NICU) admission of a premature infant is lifesaving; however, it can also be emotionally devastating experiences for parents. Family-centered care (FCC) interventions are designed to support parents and infants in the NICUs by integrating families into care delivery through partnerships with healthcare professionals. Heterogeneity in outcome reporting across FCC studies limits comparability. Developing a core outcome set (COS) for FCC is essential to address this gap. Aim: The aim of this study was to explore the views of former neonatal patients, parents, and healthcare professionals who have experiences with FCC in neonatal settings and elucidate outcomes that are important to them. Methods: This study followed the Core Outcome Measures Effectiveness Trial Handbook, which suggests involving stakeholders in identifying outcomes to reflect what is important to them rather than to researchers. Nine focus group discussions were conducted with 27 international key stakeholders from multiple countries (former neonatal patient n = 1; parents n = 8; healthcare professionals n = 18), reflecting FCC experiences across different neonatal settings. Data were analyzed using a modified framework analysis. Findings: Five outcome domains were identified including 42 distinct outcomes: (1) Emotional functioning/wellbeing of parents, infants, and healthcare professionals, reflecting emotional responses to a NICU admission of an infant; (2) Role functioning of parents, healthcare professionals, and others, highlighting that FCC strengthens their roles; (3) Delivery of care, highlighting the role of staff attitudes and organizational factors in supporting FCC; (4) Physiological health, reflecting infant physical health; (5) Hospital environment and resource use, reflecting healthcare utilization outcomes. Conclusions: Participants’ experiences provide meaningful insights into outcomes that should be evaluated in neonatal research and practice. These findings will inform the development of a COS for FCC in neonatal settings. Full article

Background: Care homes are complex care environments where supporting residents’ identity, wellbeing, and sense of personhood is central to person-centred care. Reminiscence is widely recognised as a psychosocial approach that can support these outcomes. However, existing evidence has largely focused on group-based interventions, with comparatively limited attention given to how individual reminiscence is implemented and sustained within care home practice. Methods: This study was an implementation-focused qualitative exploration of staff experiences of introducing and embedding individualised reminiscence in care home practice. Care home staff participated in four monthly workshops that introduced principles of individualised reminiscence and supported them to plan and implement reminiscence with at least one resident. Participants used either the InspireD digital reminiscence app (n = 19) or non-digital approaches such as life story books (n = 2), depending on local preferences and perceived suitability. Three focus groups were conducted with 21 care home staff to explore experiences of implementing individualised reminiscence and perceptions of its impact on residents, staff, and families. Data were analysed using reflexive thematic analysis. Results: Four interrelated themes were identified: (1) reminiscence within pressured systems; (2) resident experience and identity; (3) adapting and sustaining practice; and (4) families as partners in reminiscence. Participants described challenges associated with workload pressures, role expectations, and variability in family involvement, which influenced how reminiscence was adopted in practice. Despite these constraints, participants described perceived benefits for residents, including perceived improvements in mood, engagement, and expressions of identity. Participants also discussed perceived increased staff confidence, strengthened staff–resident relationships, and enhanced awareness of person-centred care practices. Conclusions: Findings highlight the perceived potential of individualised reminiscence to support person-centred and relational care in care homes, while identifying key contextual influences on implementation. Further research is needed to examine sustainability and effectiveness using comparative and mixed-method designs. Full article

Family-implemented interventions are evidence-based practices used to support a range of developmental outcomes, including social communication. Social communication is a broad construct that encompasses a variety of skills, from foundational abilities such as joint attention (i.e., two people attending to the same object or event) to more advanced behaviors like triadic interactions (i.e., responding to or initiating conversation that involves reciprocal interactions). In a previous study, we examined the effects of a brief, parent-implemented Naturalistic Developmental Behavioral Intervention (NDBI), delivered over telepractice with video feedback coaching. The intervention resulted in increased strategy use by all mothers and the frequency of communication for three young children. In the current study, we conducted a secondary analysis of those data to explore whether the communication-focused intervention produced a collateral effect on activity-engaged triadic interactions (i.e., mother–child–mother or child–mother–child exchanges while simultaneously engaging in a joint activity). Although a functional relation was not established, critical theoretical implications are posed. These findings highlight the need for future research to break apart complex skills into subskills to detect any subtle changes in child outcomes. Limitations and directions for future research are discussed. Full article

Background: Nurses’ clinical reasoning is increasingly being recognized as a core competence that enhances the quality and safety of care across diverse healthcare settings. Nurses with refined clinical reasoning skills contribute significantly to improved health outcomes and broader health gains. In emergency departments, this competence is essential to rapidly assessing complex problems, anticipating complications, and preventing the deterioration of patients’ clinical conditions. Such expertise enables nurses to discern the severity of clinical situations quickly and intervene effectively. Objectives: The aims of this study were to analyze the clinical reasoning process of nurses and develop a theory that explains this process in emergency care settings. Methodology: This qualitative study explored the following research question: “How do nurses enact the clinical reasoning process in emergency departments?” The Grounded Theory methodology was used, with a theoretical sample of 20 nurses. Data collection methods included in-depth interviews, participant observation, and field notes. Results: The theoretical analysis identified clinical reasoning as a substantive theory composed of two subprocesses: Diagnostic Nursing Assessment and Therapeutic Nursing Intervention. Nurses’ clinical reasoning determines two levels of patient severity—Level I, life-threatening situations (immediate risk), and Level II, non-life-threatening situations (expressed problems)—according to which nursing interventions are adjusted. Conclusions: The Nursing Clinical Reasoning Model is a dynamic and continuous process that involves both Diagnostic Nursing Assessment and Nursing Therapeutic Intervention. It is deeply rooted in the nurse–patient–family relationship and is shaped by the specific care context, which influences nurses’ assessments and interventions and patients’ responses and behaviors. Full article

This study illustrates the application of Acceptance and Commitment Therapy (ACT) for a 12-year-old boy with separation anxiety and his mother. Over 23 sessions, ACT strategies promoted psychological flexibility, values-based parenting, and adaptive behaviors. The intervention reduced the child’s experiential avoidance, anxiety, and depressive symptoms, while increasing value-oriented actions, while the mother showed improved psychological flexibility and life satisfaction. The results were sustained at a three-month follow-up. This case study highlights the potential of ACT in treating childhood separation anxiety by simultaneously involving parents, demonstrating its feasibility and efficacy. The findings provide guidance for adapting ACT for families and child populations. Full article

Background: Although parenting interventions are effective in improving parenting practices and child development, most are developed within Western cultural frameworks that may not align with South Asian collectivist values and family structures. The extent to which cultural adaptation influences the effectiveness of parenting interventions in South Asian populations remains unclear. Aim: To systematically review the effectiveness of parenting interventions on child developmental outcomes, parenting outcomes, and parental health among South Asian families, and to examine whether the depth of cultural adaptation, assessed using Bernal’s Ecological Validity Model (EVM), is associated with intervention effectiveness. Methods: A systematic review and meta-analysis were conducted. We systematically searched CINAHL, MEDLINE, Science Direct, PsychINFO, PubMed, and Cochrane library. Data were extracted from six electronic databases up to August 2023. Quality and risk of bias were appraised using the Revised Cochrane Risk of Bias Tool for Randomized Trials for the quantitative studies and the Critical Appraisal Skill Program (CASP) checklist for the qualitative studies. Results: Seventeen studies (fifteen quantitative, two qualitative) involving 8088 participants were included; ten studies contributed data to meta-analysis. Parenting interventions were associated with moderate improvements in parenting knowledge (SMD = 0.51, 95% CI 0.25 to 0.76) and small improvements in parental involvement (SMD = 0.36, 95% CI 0.00 to 0.72). Significant reductions in parental depression (SMD = −0.77, 95% CI −1.20 to −0.34) and disability symptoms (SMD = 0.82, 95% CI 0.68 to 0.96) were observed, though effects on post-natal depression (SMD = 0.15, 95% CI −1.00 to 1.30) and physical quality of life (SMD = −0.27, 95% CI −1.22 to 1.75) were non-significant. For children, large improvements were found in cognitive (SMD = 0.84–1.48), language (SMD = 0.79, 95% CI 0.25 to 1.33), and social development (SMD = 0.54, 95% CI 0.16 to 0.91), but not in emotional or motor development. Sensitivity analyses indicated larger effects for studies demonstrating deeper cultural adaptation. Qualitative findings highlighted maternal empowerment, improved mental wellbeing, and the importance of family support and culturally congruent facilitators for engagement. Overall certainty of evidence was rated as low due to high heterogeneity, risk of bias, and imprecision. Discussion: Culturally adapted parenting interventions show promising benefits for parenting practices, parental mental health, and child developmental outcomes among South Asian families, particularly when adaptations extend beyond surface-level changes. However, evidence quality is low and inconsistent, highlighting the need for more rigorous trials and clearer reporting of cultural adaptation to optimize effectiveness. Full article

Background: Autism Spectrum Disorder (ASD) necessitates enhanced therapeutic support, especially in rural areas. Individual therapeutic sessions are costly, presenting an economic burden on the family of the child with ASD, as well as on healthcare and educational systems. Therefore, the current investigation aimed to assess the feasibility of a new hybrid therapeutic model involving a combination of remote and in situ interventions, ecologically implemented. Methods: The following outcome measures were used to assess the program’s feasibility and preliminary outcomes. The Preschool Language Scales 5th Edition (PLS-5), the Test of Playfulness 4th edition (TOP-4), and individually tailored goals evaluated using the Goal Attainment Scale (GAS) and the Autism Spectrum Rating Scale (ASRS). The evaluated children with ASD (N = 25), age range of 39–76 months (Mean: 53.1 ± 11.9), were treated with the novel Hybrid Ecological Intervention (HEI) method, where each child received bimonthly frontal therapeutic sessions and bi-weekly remote therapeutic sessions by a health care professional (OT or ST), supported by four weekly frontal sessions by a technological support person supervised by healthcare professionals. Results: All qualitative scales presented were associated with improvements in all evaluated areas. Qualitative data mostly supported the HEI and ways to overcome existing challenges, supporting the use of both evaluation methods. Conclusions: The use of quantitative and qualitative data was found to be efficient and complementary to one another. The scales used (ASRS, GAS) were found to be useful tools for this method and for these participants. The HEI model was found to be associated with improvement in play, communication, social abilities, as well as autism severity. Full article

The human gut microbiota plays a key role in neurochemical communication, especially through the gut–brain axis. There is growing evidence that the gut microbiota influences dopamine metabolism through both production and consumption mechanisms. Two key bacterial enzymes are central to this process: tyrosine decarboxylase (TDC), which primarily catalyzes the decarboxylation of tyrosine to tyramine but can also act on L-DOPA to produce dopamine in certain bacterial strains, and aromatic L-amino acid decarboxylase (AADC), which can convert precursors such as L-DOPA, tryptophan, or 5-hydroxytryptophan into bioactive amines including dopamine, tryptamine, and serotonin. Identifying the bacterial families corresponding to TDC and AADC enzymes opens new avenues for clinical intervention, particularly in neuropsychiatric and neurodegenerative disorders, such as Parkinson’s disease. Moreover, elucidating strain-specific microbial contribution and host-microbe interactions may enable personalized therapeutic strategies, such as selective microbial enzyme inhibitors or tailored probiotics, to optimize dopamine metabolism. Emerging technologies, including biosensors and organ-on-chip platforms, offer new tools to monitor and manipulate microbial dopamine activity. This article explores the bacterial taxa capable of producing or consuming dopamine, focusing on the enzymatic mechanisms involved and the methodologies available for studying these processes in vivo. Full article

Introduction: Cardiomyopathies (DCM, HCM, and ACM) and primary arrhythmogenic disorders (BrS, LQTS, and CPVT) represent the most common causes of sudden cardiac death (SCD) in young individuals. Systematic genome-wide single-nucleotide polymorphism (SNP) analyses and genome-wide association studies (GWASs) have enabled the identification of numerous genetic variants associated with cardiovascular diseases. Body: Genetic testing for cardiomyopathies and inherited channelopathies primarily involves panel testing of genes with definitive and strong evidence of disease association; genes supported by moderate evidence may also be considered. Cardiomyocytes express a variety of proteins implicated in the pathogenesis of genetic cardiomyopathies, including sarcomeric, cytoskeletal, desmosomal, and nuclear envelope proteins. Inherited cardiac channelopathies result from mutations in genes encoding cellular components that influence calcium ion availability or affect membrane ion channels, including sodium, potassium, and calcium channels. Common variants associated with SCD are found in genes encoding cardiac ion channels (e.g., SCN5A, KCNQ1, and KCNH2), calmodulin (CALM2), sarcomeric proteins (MYH7, MYBPC3, TTN, and TNNI3), and desmosomal proteins (RyR2 and DES). Conclusions: This review demonstrates that specific genetic variants are significantly associated with an increased risk of SCD. The evidence underscores the importance of genetic screening and early intervention in individuals with a family history of SCD or other risk factors for inherited cardiac disorders predisposing to SCD. Future research should focus on gene-specific management strategies for familial cardiomyopathies and inherited channelopathies, with the goal of improving targeted genetic therapies and reducing the burden of sudden cardiac death. Full article

There is a global documented rise in depressive symptoms among adolescents. The cross-sectional assessments in representative samples of adolescents would help explore their correlates, which may serve as resources for intervention. Our cross-sectional survey entitled “Békés County Youth Study 2024” involved a representative sample of grade-9 high school students (N = 1590, aged 15–17 years, 56.4% females) from public high schools in the region, Hungary. Besides depressive symptoms (measured by a validated, shortened version of the Children’s Depression Inventory, CDI), a set of psychosocial variables (psychosomatic symptoms, internet addiction, future orientation, social support from family and friends, marks, gender, school satisfaction, and religiosity) was included in the survey. Gender differences in the summary score for CDI were significant: t(1588) = −12.062, p < 0.001, showing a higher rate of females. A total of 22.6% (males: 13% and females: 30%) belonged to the group at risk of depression. All potential predictors proved significant, with the strongest contribution of psychosomatic symptoms (Beta = 0.306, p < 0.001), and the most relevant protective role of family support (Beta = −0.265, p < 0.001). Other than further exploring contextual factors that increase risk for and protect against adolescent depression, mental health promotion in schools should include well-being training. Full article