Search Results (528)

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

Backgrounds/Objectives: Mindfulness-based stress reduction (MBSR) programs may have applications for adults with cerebral palsy (CP), particularly as this population is at increased risk of mental health challenges relative to the general population. However, little is known about the experiences of adults with CP participating in these programs. The aim of this study was to explore the experiences of adults with CP, and a facilitator, who participated in a 9-week MBSR telehealth program. Methods: Adults who attended an MBSR telehealth program were invited to participate in focus groups. If a participant was unable to attend a focus group, they were offered a semi-structured interview. The facilitator participated in a semi-structured interview. Focus groups and interviews were recorded, transcribed verbatim, and inductively thematically analyzed using Framework Analysis. Results: Ten adults with CP and one facilitator participated. Feedback on the program spanned across three themes: (i) learning and creating my mindfulness toolbox; (ii) applying mindfulness to everyday life; and (iii) online together with expert facilitation. Participants appreciated having access to a variety of mindfulness techniques to accommodate individual preferences. Peer-learning in a facilitated, online group context was also valued. Participants recalled implementing mindfulness strategies in everyday life and provided recommendations of how to improve the program. These included incorporating a group orientation, shortening group sessions to reduce fatigue, and follow-up sessions to maintain mindfulness skills after program completion. Conclusions: This study provides new knowledge about the perspectives of adults with CP regarding MBSR delivered via telehealth. Participant recommendations should inform future implementation of group mindfulness telehealth programs for adults with CP. Full article

Background/Objectives: Even with solid proof of its benefits for cardiovascular health and metabolism, adherence to the Mediterranean Diet (MD) in Spain has noticeably declined in recent years. The socioeconomic changes occurring in recent decades have prompted shifts in cooking habits and in how food is socially experienced, particularly among children and adolescents. The MD is more than just food: it is a cultural tradition and a lifestyle, rich in food and cooking skills, and food wisdom passed down over generations. When these practices fade, it affects both health and the environment, making them vital components in strengthening support for food knowledge, cooking abilities, and a healthier lifestyle. Considering these shifting dietary patterns and the growing need for targeted educational strategies, the present study aimed to investigate the association between cooking skills, MD-related health literacy, and adherence to the Mediterranean Diet across different developmental stages: childhood, adolescence, and adulthood in a sample of the Spanish population. Additionally, a secondary objective was to identify potential critical windows for intervention based on the strength of these associations. Methods: This cross-sectional study included 832 Spanish participants grouped by age: children and early adolescents (n = 408), older adolescents (n = 136), and adults (n = 288). Cooking skills were assessed using CooC11 for children and FCSk for older groups. Adults also completed Lit_MEDiet to assess MD-related health literacy. Adherence was measured with KIDMED (children/adolescents) and MEDAS (adults). Spearman correlations and standardized linear regressions were used. All statistical tests were two-sided, and statistical significance was set at p < 0.05. Results: In children, no significant association was found between cooking skills (CooC11) and KIDMED scores (β = 0.008; p = 0.875). Among adolescents, a strong positive association emerged between FCSk and KIDMED (β = 0.313; p < 0.001; ρ = 0.371), indicating a large, standardized effect and suggesting that this stage is particularly sensitive to food skills. In adults (18+), both food and cooking skills (FCSk) (β = 0.189; p = 0.001) and MD-related health literacy (Lit_MEDiet) (β = 0.187; p = 0.004) were moderately associated with MEDAS scores. Conclusions: These findings suggest that mid-adolescence could represent a favourable developmental window where food skills may hold potential to influence positive dietary behaviours. Regarding adults, the results indicate that combining practical and educational components appears to beneficial for dietary quality. Overall, this study supports the relevance of age-tailored public health strategies to potentially enhance long-term adherence to the Mediterranean Diet. Full article

The paper introduces ‘transformative’ curriculum initiatives such as education for sustainable development (ESD) and global citizenship education (GCED), which address ‘macro’ challenges such as climate change, together with ‘holistic’ approaches to student learning such as ‘social and emotional learning’ (SEL) and education for ‘life skills’, ‘21st century skills’, ‘transversal competencies’, AI-related ethics, and ‘health and well-being.’ These are reflected in Section 6 of the 2023 UNESCO Recommendation on Education for Peace, Human Rights and Sustainable Development. It is suggested that such broad goals put forward at global policy level may serve as inspiration for national context-specific programming, while also needing better integration of national insights and cultural differences into global discourse. The paper aims to provide insights to education policy-makers responsible for national curriculum, textbooks and other learning resources, teacher training and examination processes, helping them to promote the human values, integrity and sense of agency needed by students in a time of multiple global and personal challenges. This requires an innovative approach to curricula for established school subjects and can be included in curricula being developed for AI literacy and related ethics. Research into the integration of transformative and holistic dimensions into curricula, materials, teacher preparation, and assessment is needed, as well as ongoing monitoring and feedback. AI-supported networking and resource sharing at local, national and international level can support implementation of transformative and holistic learning, to maintain and strengthen the human dimensions of learning. 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

While there are many approaches in the use of narratives for children and young people as symbolic forms of real-life education, this article specifically investigates the use of narratives as a public health communication and intervention strategy for young people. This strategy foregrounds imaginative stories based on health education messaging that are told from patient perspectives. Through a thematic analysis of 57 research articles, the article explores the themes and discursive strategies of narrative-based health communication, including digital storytelling, in supporting young people to develop coping and resilience skills. The article identifies five interrelated themes, revealing that narratives are not only effective tools for conveying health information but also foster psychosocial support, patient empowerment, and social connection. Such narratives serve as tools for facilitating change and informing decision-making across various stages of health engagement, including prevention, promotion, and management of chronic conditions. These narratives are socially transformative: in assisting young people; they also educate clinical professionals and organizations and thereby inform public health practice at large. In this way the article both consolidates and clarifies the field of literature concerned with the use of story as a health communication strategy for children and young people. Full article

Background: Peer-led Active Rehabilitation Camps (ARC) aim to enhance functional independence and self-management among people with spinal cord injury (SCI). In Poland, where access to specialized spinal units and lifelong follow-up is limited, these programs may help address key health priorities—mobility, bowel and bladder management, sexual well-being, and upper-limb function. This study examined whether participation in ARC helped individuals achieve these priorities and identified factors associated with outcomes. Methods: This prospective cohort study, part of the Inter-PEER project, included 125 adults with SCI who attended one of 16 consecutive ARCs in Poland (2023–2024). Eligible participants used a manual wheelchair, were aged ≥ 16 years, and could complete written questionnaires. Data were collected at camp start (T1), completion (T2), and 3-month follow-up (T3) using surveys and wheelchair skills assessments. Validated instruments (SCIM-SR, MSES, QEWS, WST-Q, LiSat-11) were used and were aligned with the four priority domains. Associations with demographic and injury variables were examined using multivariate regression analyses. Results: Participants showed significant gains across priorities during the 10-day ARC. Mobility improved on all wheelchair-skill measures (e.g., QEWS + 2.6 points, p < 0.001), with most gains sustained at T3. Among participants with tetraplegia, self-care and hygiene scores increased by 24% and remained elevated at follow-up. Confidence in achieving a satisfying sexual relationship increased by camp end and was accompanied by higher sexual-life satisfaction at T3. Regression analyses found only modest associations between outcomes and demographic or injury characteristics. Conclusions: Participation in peer-led ARC programs was associated with rapid, clinically meaningful improvements in several health domains prioritized by people with SCI, especially upper-limb function, sexual well-being, and wheelchair mobility. Our findings highlight the value of integrating structured, peer-based community programs into the continuum of SCI rehabilitation. Full article

Background/Objectives: Hearing impairment in middle-aged adults is a significant, modifiable risk factor for cognitive decline and dementia, and therapy with hearing aids or cochlear implants has been suggested to reduce this risk. However, most research on auditory rehabilitation and cognition has focused on older adults, and evidence regarding cognitive outcomes in middle-aged adults remains scarce despite this group being identified as critical for dementia prevention. Thus, this study aimed to assess cognitive skills in middle-aged hearing-impaired individuals 1 year after receiving a cochlear implant (CI) as part of auditory rehabilitation. Methods: Thirty-two patients with a mean age of 52.4 were enrolled in a prospective pre-post study. Hearing was tested using the Freiburg Monosyllable Test (FS) and the Oldenburg Inventory (OI). Cognitive performance was assessed using the WAIS-IV, operationalized through the Working Memory Index (Digit Span, Arithmetic) and Processing Speed Index (Symbol Search, Coding). Quality of life was assessed with the NCIQ, tinnitus-related distress with the Tinnitus Questionnaire (TQ), and depressive symptoms with the ADS-L. Results: After one year, speech intelligibility (FS) improved from a median of 0 to 70.0 (Wilcoxon Z = −4.864, p < 0.001, r = −0.61), and subjective hearing from a median of 2.55 to 3.18 (Wilcoxon Z = −3.072, p = 0.002). The NCIQ score increased from 52.3 to 60.6 (Z = −3.899, p < 0.001), and tinnitus-related distress decreased from 25 to 21 (Wilcoxon Z = −2.209, p = 0.027). Depressive symptoms declined numerically, although this change did not reach statistical significance. Working memory improved from 82.0 to 89.0 (Wilcoxon Z = −4.090, p < 0.001), and processing speed from 89.5 to 95.5 (Wilcoxon Z = −2.533, p = 0.011). Before CI, WMI and PSI showed a strong correlation (ρ = 0.533, p = 0.002), and WMI correlated moderately with education level (ρ = 0.452, p = 0.012). One year after CI, correlations strengthened between PSI and NCIQ (ρ = 0.510, p = 0.006), PSI and OI (ρ = 0.400, p = 0.039), and WMI and TQ (ρ = –0.459, p = 0.021), indicating emerging associations between cognitive outcomes and auditory or psychosocial measures. Conclusions: One year of CI-based auditory rehabilitation improves auditory function, quality of life, tinnitus distress, and—critically—working memory and processing speed in middle-aged adults. These findings address a previously unfilled research gap and support the relevance of CIs for preserving cognitive health during midlife. Full article

The prevalence of food allergy continues to rise worldwide. The allergen profile of affected individuals changes with age: milk, egg, wheat, and soy allergies are more common in early childhood and often resolve before adolescence, whereas peanut, tree nut, fish, and shellfish allergies tend to persist and become more apparent in teenagers. The aim of this narrative review is to discuss the impact of food allergy and elimination diets on the nutritional status, psychological functioning, and quality of life of adolescents. Although an elimination diet remains the main way of treatment, it may lead to the risk of vitamin D, calcium, iron, and protein deficiencies, and potentially to growth disorders. In adolescents, irregular eating habits and poor adherence to dietary recommendations pose additional challenges. The psychological burden of living with food allergy include fear of accidental contact with the allergen, difficulties in peer relationships, and reduced quality of life, particularly in terms of social and emotional functioning. Lack of training in using an adrenaline autoinjector and embarrassment about its use are further risk factors in this age group. Optimal care for adolescents with food allergies requires a multidisciplinary approach, including an allergist, dietitian, and psychologist. Education, psychological support, and gradual development of self-management skills are crucial to improving the safety and quality of life of adolescents with food allergies. Further efforts by medical societies are warranted to advance the development of alternative therapeutic approaches for food allergy, including immunotherapy and biologic therapies, as well as to strengthen public health strategies for individuals affected by food allergies. Full article

Background: Childhood obesity is a persistent global health challenge, often rooted in early-life dietary patterns shaped within the home environment. Objective: To investigate the association between parents’ culinary skills, children’s eating behavior, and the degree of child involvement in family culinary practices. Methods: A cross-sectional, analytical study. In the public and private schools in southern Brazil. A total of 205 families with children aged 3 to 13 years participated. Parents or caregivers answered a structured questionnaire on culinary skills and sociodemographic variables. Children’s eating behavior was assessed through the validated Brazilian version of the Children’s Eating Behaviour Questionnaire (CEBQ). Student’s T test was used to compare means, and Pearson’s chi-square or Fisher’s exact test to compare proportions. Multivariate linear regression was applied to control for potential confounders. Analyses were conducted using SPSS version 27.0 and R software. Results: Most parents (90.7%) reported cooking regularly, and 65.9% involved children in cooking activities. The predominant culinary profile (40%) was classified as “convenience cooking,” marked by frequent use of processed ingredients. Healthier parental cooking practices were positively associated with adaptive eating behaviors in children, reflected by lower food fussiness, satiety responsiveness, food responsiveness and food refusal scores and higher enjoyment of food scores domains of the CEBQ. Conclusions: Despite the high prevalence of routine cooking, convenience-oriented practices remain dominant, reflecting broader sociocultural patterns. Engagement in healthier cooking practices was positively associated with more favorable eating behaviors in children. These findings underscore the importance of promoting culinary education and parental involvement in cooking as strategies to support healthy childhood eating behaviors. Full article

Background: Inadequate nutrition, poor health care, and limited stimulation constrain early childhood development and cognitive potential. Micronutrient deficiencies during pregnancy and early life are prevalent in low- and middle-income countries (LMICs) and may impair cognitive outcomes. Maternal multiple-micronutrient (MMN) and point-of-use micronutrient powder (MNP) supplements improve birth outcomes and iron status, but their long-term cognitive impact remains unclear. This systematic review assessed the long-term impact of maternal MMN and early-childhood MNP supplementation on cognitive development among children aged 4–14 years in LMICs. Method: Following PRISMA guidelines (PROSPERO CRD42023459846), (cluster) randomized controlled trials were identified from six databases and gray literature (October 2023; updated July 2025). Records were managed in EndNote and screened in Covidence, and data were synthesized using Review Manager. Eligible studies examined MMN or MNP interventions during pregnancy, lactation, or early childhood, reporting cognitive, motor, or socio-emotional outcomes in children aged 4–14. Results: Ten studies met the inclusion criteria: six on maternal supplementation, three on early childhood interventions, and one combining both. Most were conducted in Asia, with one in Tanzania and one in Peru. Although most findings were not statistically significant, two large UNIMMAP-based trials indicated modest long-term improvements in procedural memory and intelligence, while one early childhood point-of-use MNP trial suggested enhanced pre-academic skills. Conclusions: Maternal MMN supplementation may modestly enhance specific domains of cognitive development, whereas evidence on the long-term effects of MMN and point-of-use MNPs on cognitive development remain limited, highlighting the necessity for further research. Full article

Background: Findings show that beetroot-derived nitrates can improve endurance, oxygen efficiency, muscular power, recovery and cardiovascular function, particularly in recreationally active or moderately trained individuals. However, results are mixed in elite athletes, likely due to their already optimized nitric oxide utilization. Cognitive function is a crucial aspect of athletic performance enabling athletes to adapt to dynamic environments and execute skills effectively, but evidence for cognitive benefits of nitrate-rich beetroot supplementation is limited and inconsistent. The combination of improved physical activity and cognitive functions contribute to overall healthy aging and extending life expectancy. This highlights the synergistic role of nutrition, exercise and mental agility in promoting long-term well-being. Methods: The literature review was conducted to summarize and systematize existing evidence on beetroot juice supplementation on physical performance and cognitive function in both, healthy adult population and athletes. Results: Overall, beetroot supplementation demonstrates strong potential as a natural ergogenic aid for enhancing physical performance, but current evidence on cognitive improvement remains inconclusive. Conclusions: Further research, particularly involving female or elite athletes, is needed to establish clear recommendations of beetroot juice supplementation as a supportive element of exercise capacity and cognitive abilities contributing to maintaining health and thus healthy aging. Full article

Background: The aged care sector in Australia is increasingly focused on a personalised care approach which prioritises dignity and respect for older adults. With a growing ageing population, we are also seeing more complexity in health needs and palliative care. Allied health professionals are skilled in the delivery of care that fosters independence and quality of life as health deteriorates. However, in the recent aged care reform, there has been concern that allied health are not clearly recognised for their role in aged and palliative care. Methods: Qualitative study using semi-structured interviews with aged care service providers and allied health peak body representatives and clinicians to understand the perceived impact of aged care reforms in Australia on allied health workforce. Guided by a constructivist epistemology, reflexive thematic analysis was used to understand key themes. Results: Eight interviews were conducted, yielding one key theme and three sub themes. These were person-centred palliative care, advocates, location of care matters, and funding model, with the key theme of the funding model intersecting with all other themes. Conclusions: The issue of recognising allied health best practice in aged and palliative care is multifactorial. At the heart of the problem appears to be how well recognised allied health disciplines are for the value of their contribution, and constraints imposed by funding models and sector priorities on the sufficient input of the full scope of practice. Without a sufficient and skilled workforce supported to enact their full scope, the ability to deliver a personalised care approach and outcomes for our ageing population will suffer. Full article

Background: Primary Sclerosing Cholangitis (PSC), Primary Biliary Cholangitis (PBC), and Autoimmune Hepatitis (AIH) are rare immune-mediated liver conditions that significantly affect patients’ quality of life. In Romania, access to specialized information and patient support resources is limited, underscoring the need for tailored educational tools. The aim was to describe the methodology for developing, implementing, and conducting a feasibility study of an online platform for patients with PSC, PBC, and AIH, as a pilot study, providing early insights. Methods: The platform offers educational materials, registration, a discussion forum, and digital tools for quality-of-life assessment. Data on demographics, usage, and quality of life were collected using standardized questionnaires (CLDQ-PSC, PBC-10) and non-standardized questionnaires, and analyzed with Microsoft Office Excel and DATATab. Results: The website was created using an online platform requiring no advanced IT skills. Content was developed in accordance with international guidelines (EASL, AASLD) and translated and adapted for Romanian patients. As of 15 July 2025, 81 patients had been registered (26% PSC, 68% PBC, 6% AIH), with a predominance of urban participants (all patients: 87% female, mean age at diagnosis = 44.5 years). Most participants used mobile devices and reported improved understanding and engagement with their health after using the platform. Conclusions: The first dedicated digital platform has been established in Romania to address the health literacy needs of patients with PSC, PBC, and AIH. The study offers insights into future directions and a replicable model for similar initiatives. The pilot evaluation of the platform faced several limitations, including self-selection bias, non-standardized assessments, and a small sample size. Full article

The World Health Organization identifies creative thinking as a key life skill essential for health promotion, personal development, and well-being. In line with recent perspectives on motor learning within the ecological dynamics approach, this study highlights the importance of self-organization, free initiative, and divergent thinking as processes that are deeply connected to individual emotional, experiential, and bodily engagement within dynamic environments. With this quasi-experimental study, conducted in Italy, we aimed to examine the impact of a physical education program, designed according to the principles of ecological dynamics, on the development of creative thinking in children. The sample included 107 primary school students (58 girls, 49 boys; mean age = 7.51 ± 0.50 years) who were randomly assigned to either an experimental group (n = 57) or a control group (n = 50). Creative thinking was assessed before and after the intervention using the WCR test. The WCR (Widening, Connecting, and Reorganizing) test assesses three core components of creative thinking through age-appropriate visual and verbal tasks. The results showed that there was a significant improvement (p < 0.05) in cognitive widening for the experimental group compared with the control group. The findings of this study suggest that physical education grounded in the ecological dynamics framework promotes the generation of ideas, cognitive flexibility, and motor adaptability, allowing children to explore original and self-determined movement solutions. Such programs may play a crucial role in supporting creativity and holistic development in educational contexts. Full article