Search Results (350)

Healthy, inclusive, and environmentally supportive educational settings are increasingly recognised as relevant to children’s development, well-being, and equity. However, evidence on the physical environment in early childhood education remains fragmented across outdoor spaces, indoor spatial organisation, indoor environmental quality, materials, and contaminant-related conditions. This systematic review aimed to synthesise current evidence on the relationship between the physical environment of early childhood educational settings and multidimensional indicators of child well-being. The protocol was registered in PROSPERO, and the review followed PRISMA 2020 guidelines. Searches were conducted in Web of Science Core Collection, Scopus, ERIC, and APA PsycInfo. Methodological quality and risk of bias were assessed using ROBINS-I and JBI critical appraisal tools. Eighteen studies were included. Of these, 10 focused on outdoor spaces and schoolyards, five on indoor spaces and spatial organisation, and three on indoor environmental quality, materials, or contaminants. The findings suggest four main interpretive patterns: (i) expanding opportunities for participation through functionally diverse areas and materials; (ii) shaping coexistence and interaction through access to and distribution of resources; (iii) supporting sensory regulation; and (iv) sustaining environmental health and habitability. Overall, more favourable settings were associated with better indicators of activity and play, interaction and coexistence, and involvement and regulation. For indoor environmental quality studies, however, the evidence was mainly indirect, referring to environmental-health, comfort, exposure, or habitability indicators rather than direct child-level well-being outcomes. The certainty of the evidence was moderate to low due to methodological limitations, particularly confounding and selection bias in non-randomised intervention studies and imprecision in the measurement of environmental exposure in several cross-sectional studies. The findings may inform cautious reflection on spatial design, educational practice, and policy, but stronger recommendations require more robust study designs, reproducible exposure metrics, clearer distinction between direct and indirect well-being-related indicators, and comparable outcome measures. Full article

Background: Schools are widely recognized as key settings for promoting healthy eating behaviors and supporting childhood obesity prevention. In recent years, increasing attention has been devoted to experiential and interactive nutrition education strategies designed to actively engage children and adolescents in food-related learning processes. These approaches move beyond traditional didactic teaching and include practical and participatory formats, such as cooking activities, school gardening, digital or app-based learning tools, workshops and educational camps, and game-based learning interventions. Objective: This narrative review aims to provide an overview of experiential school-based nutrition education interventions, describing the main types of programs implemented in school settings and summarizing their reported effects on nutrition knowledge, attitudes, and eating behaviors among children and adolescents. Results: Across intervention studies and systematic reviews, hands-on and interactive educational models, including cooking classes, gardening programs, digital learning tools, workshops or camps, and board game-based interventions, frequently report improvements in nutrition knowledge, attitudes toward food, food-related skills, and self-efficacy. These programs seek to strengthen food literacy by combining experiential learning with educational content delivered within the school environment. Evidence regarding changes in dietary intake, diet quality, and anthropometric outcomes is more heterogeneous, with some studies reporting improvements in eating behaviors and others showing more modest or short-term effects. Program outcomes appear to be influenced by several contextual factors, including intervention duration, curriculum integration, teacher involvement, and the availability of resources supporting implementation. Conclusions: Experiential and interactive approaches represent an increasingly adopted strategy in school-based nutrition education. Their effectiveness appears to depend on the quality of implementation, the degree of integration within the school curriculum, and the broader educational context. Future research should further explore how different experiential formats can be optimally integrated into school systems to support the development of food literacy and sustainable healthy eating behaviors among children and adolescents. Full article

Radiotherapy simulation is essential for accurately targeting tumors while preserving healthy tissue, ensuring treatment precision and safety. This study aimed to develop an integrated radiotherapy simulation system capable of automated segmentation, dose estimation, and collision detection within a virtual planning environment to enhance efficiency and reduce costs in radiotherapy treatment planning. The Point Transformer model was applied to organ point cloud data derived from CT medical imaging for automated segmentation. Farthest point sampling (FPS) was employed to downsample the data before training. To enhance the accuracy and anatomical fidelity of the AI-generated segmentation results, reconstruction and refinement algorithms, including k-d tree, outlier removal, marching cubes, and surface smoothing, were implemented. Beam penetration simulation with the ray casting algorithm was employed for correction-based dose estimation. A collision detection module was incorporated to identify potential machine–machine or machine–patient interactions. The entire workflow was executed within a Unity 3D-based virtual simulation environment. As a result, the Point Transformer model demonstrated high segmentation accuracy, achieving Dice scores of 93.86 $\pm$ 1.50% for single-organ and 91.86 $\pm$ 3.25% for multi-organ cases, surpassing the performance of PointNet++. Applying ray casting for the refined surface meshes generated through post-processing enabled accurate dose estimation with discrepancies of 3.5% (brain), 5.9% (liver), and 13.8% (lung) compared to a Pinnacle TPS. The proposed method provides a low-cost and adaptable solution that enables easy modification and further development, making it particularly suitable for widespread applications in radiotherapy research, education, and clinical workflow optimization. Full article

Improving the health supportiveness of the campus built environment is a key strategy for alleviating health pressures in higher education institutions (HEIs). As a complex environmental system, a university campus requires systematic assessment of its environmental health performance to inform science-based design and planning decisions. This study systematically reviews the environmental characteristics of current healthy-campus assessment tools (HCATs) for HEIs and evaluates their compatibility with a Chinese standards context. A three-phase mixed-methods approach identified 12 HCATs, examined their environmental features, and constructed a content framework. Three representative Chinese alternative tools were compared. The results show that: (1) HCATs vary by development context but consistently prioritize physical environmental resources that support health behaviors, such as abundant and reasonable active transportation and fitness facilities and a health-promoting environmental culture, rather than conventional physics performance. (2) Although Chinese tools overlap with HCATs on certain environmental topics, they cannot replace HCATs in terms of environmental integration, coverage, and applicability to HEI settings. (3) Future Chinese HCATs should strengthen environmental support for behavior change and health promotion and improve operability. This study reveals gaps between current Chinese tools and HCATs, underscores the necessity of developing environment-focused HCATs for Chinese HEIs, and provides a foundation for related tools’ development work. Full article

The Australian University Departments of Rural Health (UDRHs) promote the health and wellbeing of people in rural and remote Australia through health education, research, and advocacy. This narrative review evaluated the extent to which Indigenous health intervention research conducted by UDRHs over a 12-year period (2010–2021) aligned with the Principles and Priorities of the National Aboriginal and Torres Strait Islander Health Plan 2021–2031. The purpose was to reflect on past UDRH research contributions to identify existing strengths and areas for improvement in line with current policy. Thirty-three relevant UDRH publications were identified from a broader database of UDRH research outputs. Each paper was independently coded by at least two authors as demonstrating “yes”, “partial”, or “not evident” alignment with the twelve priorities of the Health Plan. UDRH intervention research demonstrated strengths in genuine shared decision making and partnerships with Indigenous communities, workforce development, health promotion, and identifying and addressing racism. However, gaps were evident in research addressing social and emotional wellbeing, mental health and suicide prevention, promotion of healthy environments, sustainability and preparedness, and transparency regarding shared access to data and information. UDRHs play a key role in building research capacity among staff and communities in rural settings and often maintain long-standing, respectful relationships with local Indigenous communities. While UDRH research aligns with many domains of the national Health Plan, future efforts should prioritise social and emotional wellbeing and mental health. Improved reporting of shared data access represents an immediate opportunity for enhancement. Full article

Background/Objectives: Limited research has examined the correlates among the lifestyle habits of nursing students, whose suboptimal behaviors may compromise their ability to model and promote healthy lifestyles in future professional practice. This study aimed to assess health-promoting lifestyle behaviors, explore interrelationships among lifestyle domains, and identify key correlates of positive health-promoting lifestyle behaviors to inform the development of targeted interventions. Methods: A cross-sectional study was conducted among 476 undergraduate nursing students in Spain. Data included sociodemographic, academic, and health-related variables, along with Health-Promoting Lifestyle Profile II (HPLP-II) scores. Descriptive statistics, correlations, and hierarchical multivariate logistic regression were used to identify factors associated with positive health-promoting lifestyle behaviors. Results: Overall HPLP-II scores indicated modest health-promoting lifestyle behaviors (adjusted mean 2.62 ± 0.33), with the lowest scores observed for health responsibility (adjusted mean 2.20 ± 0.48) and stress management (adjusted mean 2.33 ± 0.44). Health-related variables showed stronger associations with positive health-promoting lifestyle behaviors than sociodemographic or academic variables (p < 0.001). Significant correlates of positive health-promoting lifestyle behaviors included higher adherence to the Mediterranean diet, greater levels of physical activity, and concurrent employment during studies. Conclusions: Support of nutrition, physical activity, and other health-promoting lifestyle behaviors should be strengthened in nursing curricula and training environments. Educational strategies should move beyond theoretical instruction through student-centered approaches, enhancing self-care and the ability to promote health in future professional practice. Full article

This study investigates whether a university teaching complex equipped with CSA S600 continuous air purification and sanitation units can maintain indoor air quality (IAQ) within recommended thresholds under real occupancy conditions and evaluates the impact of renovation works on IAQ. The work provides the first real-world assessment of the CSA S600 integrated monitoring system in an academic environment. CO₂, PM_2.5, PM₁₀ and VOCs were continuously measured over three months; moreover, indoor PM₁₀ values were compared with outdoor data from the regional monitoring network. Indoor CO₂ generally remained below 800 ppm, with short peaks of 1000–1500 ppm during high occupancy. PM_2.5 and PM₁₀ consistently stayed below the latest WHO guidelines, showing uniform recurring temporal patterns overtime; furthermore, indoor PM₁₀ showed limited coupling with outdoor trends, indicating the predominance of internal sources and ventilation dynamics. After renovation of the main Lecture Hall, particulate levels remained low, while VOCs showed a modest increase attributable to new materials. Overall, the findings demonstrate that the CSA S600 system effectively supports healthy IAQ in educational settings and that continuous monitoring is essential for managing occupancy-driven fluctuations and assessing the effects of structural interventions. Full article

Background/Objectives: Transthoracic echocardiography (TTE) is a non-invasive tool for real-time assessment of cardiac motion and blood flow. It is widely used in emergency and bedside settings as a Focus Cardiac Ultrasound (FoCUS) device. However, standardized training methods and adequate educational environments are limited. Methods: A TTE image assessment artificial intelligence (AI) system was developed in this study, focusing on probe positioning and image quality for non-supervised TTE practice. Results: The view classification model achieved a high F1-score of 0.956. The position evaluation model achieved F1-scores of 0.678, 0.864, and 0.831 for the parasternal long-axis, parasternal short-axis, and apical four-chamber views, respectively. The quality evaluation model achieved F1-scores of 0.674, 0.845, and 0.746. Combining the position and quality models improved the F1-score for the parasternal long-axis view to 0.714, showing the benefit of integrating views with lower baseline performance. Conclusions: This study presents a novel AI-based educational system that assesses probe position and image quality in TTE. The model was developed using a custom dataset of healthy young adults that reflects beginner-level training scenarios, including many suboptimal images similar to those commonly acquired by novices. The proposed framework, which integrates position and quality models, lays the groundwork for future AI-assisted ultrasound training, particularly in unsupervised or resource-limited settings. Full article

Background/Objectives: Alcohol and tobacco use in adolescence are major public health concerns that shape long-term health trajectories and undermine healthy behaviour development. Schools are key settings for health promotion, offering structured environments to foster self-regulation, social skills, and protective behaviours. This scoping review mapped recent school-based educational strategies designed to prevent alcohol and tobacco use among adolescents and to examine whether the included studies reported any involvement of school nurses. Methods: Review followed Arksey and O’Malley’s framework and adhered to JBI guidance and PRISMA-ScR. Searches were conducted in PubMed and Web of Science (2019–2024) to identify school-based educational interventions targeting alcohol and/or tobacco use among primary or secondary school children. The primary search targeted prevention strategies, complemented by nursing-related terms to identify nurse involvement. A standardised charting form captured study characteristics, intervention formats, theoretical foundations, implementation factors, and any reported participation of health professionals. Data extraction was performed independently by two reviewers. Results: Eleven studies met the inclusion criteria. Most were randomised controlled trials (81.8%). Educational strategies included online (45.5%), hybrid (27.3%), and face-to-face (27.3%) formats. Programs focused on social skills, self-regulation, harm reduction, or resilience. Digital formats were cost-effective but showed challenges in engagement and sustained participation, while face-to-face or hybrid approaches offered relational support but were vulnerable to implementation drift. No study reported nurse involvement. Conclusions: School-based prevention strategies can contribute to healthier behaviours related to substance use by reinforcing socioemotional competencies and reducing early exposure to substances. However, persistent barriers such as low engagement, inconsistent delivery, and the absence of health professionals limit their impact. The role of school nurses could be considered in future school-based prevention programmes. Full article

Background: Adolescence represents a critical period for the adoption of lifestyle behaviors that may influence physical health, emotional well-being, and health-related behaviors later in life. However, limited evidence exists regarding the combined association of dietary habits and physical activity with motivation toward physical education, particularly among adolescent girls from different residential environments. Objective: This study aimed to examine the relationship between adherence to the Mediterranean diet, physical activity levels, and motivation toward physical education among adolescent girls from urban and rural settings. Methods: A cross-sectional study was carried out involving girls aged 12 to 14 years (n = 217; N_Urban = 108 and N_Rural = 109). Adherence to the Mediterranean diet, physical activity levels, and motivational dimensions toward PE were assessed using validated questionnaires. Differences between groups were analyzed using analysis of variance (ANOVA), and an analysis of covariance (ANCOVA) was performed controlling for physical activity levels. Effect sizes were calculated using partial eta squared (η²p). Results: Significant differences were observed in intrinsic motivation, identified regulation, introjected regulation, and amotivation according to adherence to the Mediterranean diet (p < 0.05), with small to moderate effect sizes (η²p = 0.029–0.040). Post hoc analyses indicated that girls with optimal adherence to the Mediterranean diet exhibited higher intrinsic motivation toward PE compared with those with low adherence. The ANCOVA revealed that higher physical activity levels were significantly associated with greater intrinsic motivation, particularly among girls from urban environments. No significant differences were found between urban and rural environments in overall physical activity levels or dietary adherence. Conclusions: Greater adherence to the Mediterranean diet and higher levels of physical activity are associated with more self-determined motivational profiles toward physical education in adolescent girls. These findings highlight the importance of integrated school-based interventions that promote healthy eating and active lifestyles to enhance motivation and engagement in PE among adolescent girls. Full article

Forests are important food granaries. The accessibility of a healthy diet is the key factor in food and health equity. However, there is a lack of research focusing on its influence on locals at different levels of development. China’s population comprises various groups of farmers, allowing for the comparison of influence pathways across different economic levels of farmers. This research explores the topic with an empirical study conducted in Jiangxi Province, China, using data from 1939 valid responses collected across 216 villages. The analysis was performed using a mixed-effects ordered logistic model and a mediation effect model. The results of the baseline and mediation effect analyses reveal that there are four influence pathways. First, farmers’ forest resource endowments play a significant role in improving farmers’ perception of healthy diet accessibility (direct access type). Second, farmers’ forest resource endowments increase the accessibility of healthy diets by reducing the perceived costs of healthy diets (cost-relieving type). Third, farmers’ forest resource endowments increase the accessibility of a healthy diet by enhancing the perceived quality of the natural environment (quality scarcity type). Fourth, farmers’ forest resource endowments increase the perceived environmental quality, decrease the perceived costs of healthy diets, and affect the perception of healthy diets’ accessibility (cost-reducing type). The results of heterogeneity analysis based on the independent variables (health-related information, age, education level, disposable income, household size, communication and transportation convenience) reveal that for disadvantaged groups, the effect type tends to be the “direct access type” and “cost-relieving type”, and for advantaged groups, the effect type tends to be the “quality scarcity type”. Through empirical analysis, this study explains how forest resource endowments of different farmer groups influence their access to healthy diets, which lays a foundation for better understanding the association and formulating relevant policies. Decision makers should recognize the distinct influence of forest resource endowments on different farmer groups and develop policies related to forest resource management and healthy diets for farmers. Full article

This article maps and prioritises the foundational developmental needs of children and adolescents: social development, cognitive growth, emotional regulation, identity formation, and moral reasoning. Early and excessive digital engagement is then examined for its potential to impact these milestones, with consequences that reverberate through wellbeing, relationships, and lifelong resilience. Arguments which frame digital engagement as an individual right with potential benefits, downplay developmental risks. Drawing on developmental rights and agency frameworks, the current review disputes the prevailing assumption that digital participation should take precedence over healthy developmental trajectories. Instead, the debate is reframed around children’s evolving capacities. It is proposed that digital entitlements are nested within age-appropriate limits and supports. Protecting the best interests of the child requires recognising the risk of addictive technology use. The rights of the child must also ensure cultivation of emotional competence and self-reliance. Overemphasis on digital expression risks elevating performative self-presentation before moral reasoning, critical thinking, and offline social skills have matured, particularly within environments shaped by algorithmic amplification, transient relationships, peer harassment, and the desire for validation. To address these risks, we advocate for a multi-layered public health response: consistent, developmentally attuned messaging; empowered parents and educators; whole-school strategies; and policy reforms that prioritise safety, accountability, and developmental alignment. By situating digital engagement within a developmental framework, this article proposes key principles on which to base the discussion of safeguarding youth wellbeing in the digital era. Full article

This present study analyzed the association between the presence and quality of regulatory measures and the promotion of healthy eating in canteens of 2241 private elementary and secondary schools located in 27 Brazilian state capitals. Three strategic axes were evaluated: food and nutrition education (implementation of actions promoting healthy eating), food commercialization (healthiness index, number of unprocessed, minimally processed or processed foods and culinary preparations based on these foods—UMPCP; ultra-processed foods and culinary preparations based on these foods—UpCP; comparison of UMPCP versus UpCP variety; and prohibition of food sales), and marketing communication strategies (advertising strategies for UMPCP and UpCP). The presence and quality of municipal and state regulations in force up to the month prior to data collection were assessed using a score, with a score ≥8 indicating higher quality. Analyses were conducted using binary logistic regression and adjusted generalized linear models in Stata 17.0. More than half of the canteens (51.1%) were located in areas without regulations, and only 17.8% had high-quality regulations. Canteens in areas with regulations, especially those with a score ≥8, had 1.73 times higher odds of implementing food and nutrition education actions, 2.49 times higher odds of prohibiting the sale of certain foods, and 36% lower odds of selling a higher variety of UpCP compared to UMPCP. The healthiness index was higher, the number of UpCP sold was lower, and the number of UMPCP sold was higher, while the adoption of advertising strategies was less frequent in canteens with higher-quality regulations. These findings indicate that the presence and particularly the quality of regulatory measures is associated with healthier school food environments, highlighting the positive impact of well-structured public policies. Full article

Elevated indoor carbon dioxide (CO₂) concentrations are increasingly recognized as a critical determinant of occupant health and cognitive performance; however, the neurophysiological mechanisms linking CO₂ exposure to daytime sleepiness remain a subject of debate. This study investigated the effects of dynamically rising CO₂ concentrations on subjective sleepiness and neural oscillation patterns in a controlled environment. A within-subject repeated-measures experiment was conducted with 18 healthy university students exposed to CO₂ levels gradually increasing from a baseline of ~800 ppm to ~2000 ppm over a 40-min period. Subjective sleepiness was assessed using the Karolinska Sleepiness Scale (KSS), while electroencephalogram (EEG), heart rate (HR), and heart rate variability (HRV) were monitored continuously. Results indicate a significant increase in subjective sleepiness scores concurrent with rising CO₂ levels (p < 0.001). Power spectral density (PSD) analysis revealed that elevated CO₂ exposure significantly enhanced power in low-frequency EEG bands (δ, θ, and α), indicative of a transition from alertness to drowsiness. Specifically, α-band power peaked between 20 and 30 min (increasing by 0.15 uV² relative to the 0–10 min baseline), while θ and δ bands peaked earlier (10–20 min) and sustained elevated levels through 30 min. Topographic mapping identified the central, parietal, and occipital regions as the primary loci of this low-frequency activity. Additionally, HR and HRV measures showed upward trends, suggesting autonomic modulation. It is noted that low-frequency EEG power declined during the final 30–40 min interval, potentially reflecting physiological saturation or acclimatization. These findings provide objective neurophysiological evidence that dynamic CO₂ accumulation accelerates drowsiness onset, underscoring the necessity of optimized ventilation strategies in educational settings. However, these findings should be interpreted with caution due to the small sample size and the absence of a control group with constant CO₂ concentration. Future studies with larger, diverse samples and stable-concentration control groups are recommended to validate these trends. Full article

This study evaluates the service quality of smart campus dining services as a core element of sustainable school meal governance and health-promoting campus environments. A structured questionnaire grounded in the five SERVQUAL dimensions—tangibles, reliability, responsiveness, assurance, and empathy—was administered to 375 users of a smart campus catering platform, including students, faculty and staff, and education administrators from 20 counties and cities in Taiwan. The data were analyzed using gap analysis, confirmatory factor analysis, multiple regression, and Importance–Performance Analysis (IPA) to identify major service quality gaps and sustainability-oriented improvement priorities. The results show that tangibles, reliability, responsiveness, and assurance significantly predict overall service quality, with assurance exerting the strongest effect, while empathy is highly correlated with the other dimensions. IPA further indicates that outdated or insufficient smart facilities fall into the high-importance/low-performance area and thus represent a critical weakness. These findings provide empirical evidence for data-driven and user-centered management of school meal services, supporting more efficient resource allocation, AI-assisted menu planning, and IoT-based food safety monitoring. By linking service quality assessment with sustainable campus governance, the study contributes to efforts to promote healthy eating, reduce food waste, and strengthen localized food supply collaboration, in line with Sustainable Development Goals related to health, education, and responsible consumption. Full article