Search Results (799)

Background/Objectives: Adolescence is a critical period for the adoption of health-risk behaviors and the development of non-communicable diseases (NCDs). Schools represent a strategic setting for health promotion interventions; however, Italian studies simultaneously assessing NCD-prevention knowledge and lifestyle behaviors in the same adolescent population remain scarce. The study aimed to evaluate improvements in knowledge regarding nutrition and other lifestyle-related behaviors among Italian adolescents following a school-based educational intervention. Secondary objectives included describing lifestyle behaviors within the study population and exploring participants’ evaluation of the intervention. Methods: A quasi-experimental pre-post study was conducted between March and May 2025 in five lower secondary schools. A total of 410 adolescents aged 11–16 years were enrolled through a two-stage cluster sampling procedure. The intervention, lasting approximately two hours, was delivered by a trained nurse-researcher and addressed four health domains: nutrition, physical activity, screen exposure, and substance use. Results: Following the intervention, a measurable increase in overall knowledge scores (mean increase: +3.9 points) was observed, with 88.9% of participants showing improvement. The largest improvements were observed in nutrition-related knowledge and awareness of passive smoking harms. Despite these gains, unhealthy behaviors remained prevalent, including low adherence to physical activity recommendations (36.1%), suboptimal dietary quality (39.9%), and high screen exposure. A linear regression model identified five independent determinants of higher knowledge improvement: older age, female gender, higher screen exposure, having at least one employed parent, and lower pre-intervention test scores. The intervention was positively evaluated, with high levels of satisfaction, clarity, and perceived usefulness. Conclusions: Nevertheless, the persistent gap between knowledge and behavior underscores the need to integrate motivational and environmental components, gender-sensitive approaches, and longitudinal evaluations to foster sustainable, healthy choices and contribute to NCD prevention. Full article

Background: Perinatal death in Neonatal Intensive Care Units (NICUs) represents one of the most emotionally challenging experiences for nurses. While parental bereavement has been widely studied, nurses’ experiences in neonatal end-of-life care remain insufficiently explored. Objective: To explore the experiences of NICU nurses facing perinatal death, focusing on emotional, professional, and institutional dimensions of care. Methods: A qualitative study with a hermeneutic phenomenological approach was conducted through ten semi-structured interviews with NICU nurses in a tertiary-level hospital in Spain. Data were analyzed using reflexive thematic analysis supported by NVivo 15. Results: Seven main themes were identified: emotional responses, therapeutic bond, coping strategies, perceived institutional support, training needs, infrastructure and humanization, and professional repercussions. Nurses reported intense emotional responses, including sadness, guilt, moral distress, and perceived failure, particularly in cases of prolonged hospitalization or unexpected death. Peer support emerged as a key protective factor, whereas the lack of formal psychological support and adequate infrastructural conditions were identified as significant gaps. Conclusions: Strengthening institutional support for NICU nurses through structured debriefing, accessible psychological services, targeted training in neonatal palliative care, and improved care environments may enhance their well-being and resilience, contributing to sustainable and compassionate clinical practice. Full article

Background/Objectives: Person-centred psychosocial and rehabilitation interventions are increasingly relevant in long-term care (LTC) for older people with multimorbidity. Existing classifications describe the technical nature of these interventions rather than the LTC needs addressed by their delivered components. This study aimed to map delivered or reported components from a published parent review onto the World Health Organization long-term care framework. Methods: We conducted a framework-guided secondary analysis of 18 randomised controlled trials, including 9132 participants, from the parent review. Trials were conducted in LTC or settings relevant to LTC. Components were deductively mapped at study level to five framework domains: health care needs, palliative care needs, social care and support needs, person-centred integrated care, and education and training. Mapping followed predefined operational rules, a codebook, and a decision log. Planned-only components were excluded. Results were synthesised descriptively, without reassessing intervention efficacy. Results: Health care needs were identified in 17 of 18 trials, social care and support needs in 14, person-centred integrated care in all 18, and education and training in 17. Palliative care needs were less frequently represented, appearing in four trials. Psychosocial and Rehabilitation components were interpreted as mainly representing the technical-therapeutic core of interventions, while Complementary components were interpreted as supporting the operational infrastructure of care, including assessment, planning, coordination, monitoring, referral, training, documentation, and continuity. Conclusions: This framework-guided secondary analysis suggests broad but uneven coverage of WHO long-term care domains across the included trials. Future trials should more explicitly align targeted needs, delivered components, and outcome assessment, including social, caregiver, palliative, continuity, and person-centred care experience outcomes. Full article

Background: Childhood obesity is a complex public health issue in which parental perceptions and family dietary behaviors are pivotal. This study assessed the feasibility of the Smart Family lifestyle counseling intervention in Greek primary care. It explored changes in children’s dietary behaviors relative to parental weight perception and Mediterranean diet adherence. Methods: A single-arm pretest–posttest pilot study was conducted in Patras, Greece, from Health4EUKids Joint Action. The intervention consisted of four monthly face-to-face counseling sessions using the Smart Family methodology. In total, 49 parent–child dyads (aged 2–12 years) completed the program. Data collection included child anthropometric measurements, validated food frequency questionnaires, parental perception of child weight status, and parental Mediterranean diet adherence. Results: Parents who underestimated their child’s weight status had significantly higher Mediterranean diet scores than those who overestimated (p = 0.032); those with low adherence tended to overestimate and those with moderate adherence to underestimate. The largest reduction was observed for sweets and desserts (median −2.35 servings/week), with significant reductions in sugar-sweetened beverages, grains and cereals, whole wheat products, and dairy. Fish and vegetable intake increased significantly, but fruit intake did not change. Changes in fast food and red meat differed significantly across Mediterranean diet score tertiles, with larger decreases in the lower tertiles. Conclusions: Smart Family counseling was feasible to deliver through trained healthcare professionals in Greek primary care over four months, with reductions in selected discretionary foods observed alongside the intervention. Parental weight perception and Mediterranean diet adherence emerged as potential barriers to change although the findings are exploratory and require confirmation in a future controlled trial. Full article

Per- and polyfluoroalkyl substances (PFASs) are persistent aquatic contaminants whose strong C–F bonds make conventional water treatment ineffective. This review critically synthesizes recent progress in aqueous PFAS degradation through four mechanistic routes: oxidation-driven, biodegradation, reduction-driven, and nonradical processes. Rather than evaluating technologies by parent-compound disappearance alone, we compare their defluorination and mineralization capacities, matrix tolerance, byproduct risks, energy demand, operational stability, and technology readiness. Oxidative and reductive systems can promote rapid degradation or defluorination, but their performance is often constrained by radical/electron quenching, incomplete mineralization, and sensitivity to PFAS structure and water chemistry. Biodegradation and enzymatic approaches offer mild transformation pathways but remain limited by slow kinetics, narrow substrate specificity, and uncertain toxicity evolution. Nonradical and thermochemical processes show stronger potential for deep destruction, particularly in concentrated PFAS streams. Overall, electrochemical oxidation, plasma treatment, and thermal/supercritical oxidation appear closer to practical implementation for spent adsorbents, regenerants, industrial concentrates, and other high-strength wastes, whereas many photocatalytic, biological, and microdroplet systems remain laboratory-stage. Future research should prioritize integrated separation–destruction treatment trains and standardized metrics including total organic fluorine removal, fluoride release, final residual PFAS concentrations relative to regulatory thresholds, transformation-product toxicity, energy consumption, and life-cycle impacts. Full article

Intelligent housing-dimensional urban physical examination requires evaluating complex visual scenes in aging communities. Existing methods and datasets are insufficient for these heterogeneous tasks and severe class imbalances. To address this, we introduce the Housing-dimensiOnal visUal inSpection imagE Dataset (HOUSED) with a hierarchical labeling scheme, and propose a hierarchical Vision Mixture of Experts (VMoE) framework. At its core, the proposed CS-DisVMoE module utilizes a CS-Soft routing mechanism to capture spatial feature correlations, optimizing expert assignment and reducing inference overhead. Additionally, a FENNEL-based non-linear graph partitioning mechanism converts pre-trained dense weights into semantically coherent expert initializations, accelerating convergence while preserving localized visual clustering. To address the hierarchical labels, we design a composite loss function: a Supervised Contrastive Loss acts as a parent-category soft constraint to accelerate convergence, while Focal Loss mitigates data imbalance and handles fine-grained subcategory classification via hard sample mining. Across evaluated datasets, the full proposed framework improves accuracy by an average of 4.3% over the ViT-Tiny baseline and 1.81% over the best-performing VMoE baseline. Furthermore, it achieves these improvements with lower computational costs. Further tests on mixed public vision datasets verify its generalizability and competitive performance for complex-scene applications. Full article

Child and adolescent mental health (CAMH) is a global concern that is increasingly recognized and prioritized. Worldwide, mental health conditions affect a significant number of children and adolescents; however, access to CAMH services remains limited. This study sought to explore the implementation of child and adolescent mental health services in the rural Chris Hani District of the Eastern Cape province, South Africa, from the perspectives of health professionals and teachers, focusing on strengths, weaknesses, opportunities, and threats. Using a qualitative approach, a sample of 36 participants (12 health professionals and 24 teachers) was purposively recruited. Data were collected through face-to-face, semi-structured individual interviews and focus group discussions. Thematic analysis identified several strengths, including effective screening and identification of CAMH problems, training in psychiatry and psychology, teacher support, collaboration with stakeholders, and the availability of policy and guidelines. Key weaknesses included inadequate CAMH training, a limited CAMH workforce, personal barriers, guidelines primarily oriented toward physical health, and insufficient basic infrastructure. Opportunities for improvement include enhancing the skills of the existing workforce, increasing engagement in extramural activities, and empowering parents with knowledge of available CAMH services. Identified threats included the normalization of CAMH symptoms, challenges involving parents and feeder schools, stigma, poor stakeholder collaboration, and inadequate guidelines. Overall, the analysis of strengths, weaknesses, opportunities, and threats reflects the broader challenges present in low-resource settings that hinder the implementation of CAMH services. It also highlights the need for integrative approaches to implementing CAMH services in rural contexts, while identifying opportunities to improve service delivery. Full article

Background: Children and adolescents with autism spectrum disorder (ASD) are generally more sedentary and engage less in physical activity (PA) than their peers. Despite increasing evidence of benefits, practical guidance on implementing adapted PA programs in real-world settings remains limited. This study aimed to document iterative adaptations, implementation processes, and participant experiences in a structured PA intervention for children with ASD. Methods: Nineteen children aged 10–14 years with ASD participated in an adapted PA intervention delivered across three cohorts. The program was progressively modified based on observed barriers and participant feedback. Post-intervention conversations with participants and/or parents were used to assess feasibility and experiences. Results: Most participants trained on-site in small groups and were predominantly boys, many with comorbid ADHD/ADD. Baseline engagement in organized PA was low. Adaptations included adjustments to session structure, group size, instructor-to-participant ratio, and activity content to enhance predictability and autonomy. Individual tailoring and flexible delivery were essential to accommodate neurodevelopmental diversity and fluctuating motivation. Post-intervention feedback suggested generally positive acceptability, while findings should be interpreted descriptively. Conclusions: This study provides preliminary, practice-based insights into how structured PA programs may be iteratively adapted for children with ASD in a supportive clinical context. The findings highlight practical considerations for implementing adapted PA in clinical and community settings. Full article

The occiput posterior (OP) fetal head position is the most common malposition during labor and is associated with prolonged labor, operative delivery, and cesarean section. Conventional assessment often relies on digital examination, and the clinical significance of OP may lie along a spectrum rather than as a binary diagnosis. The Artificial Intelligence Dystocia Algorithm (AIDA) integrates four objective intrapartum ultrasound parameters (Angle of Progression [AoP], Head–Symphysis Distance [HSD], Midline Angle [MLA], and Asynclitism Degree [AD]) into a five-class ordinal classification (Classes 0–4). This investigation is a focused secondary subgroup analysis of 79 OP cases drawn from a single-cohort dataset of 135 nulliparous women with prolonged second-stage labor originally collected for the development of the AIDA. Only Branch 1 of the AIDA (the deterministic threshold-based classification, with cut-offs originally derived via Decision Tree on the parent cohort, N = 135) was applied; Branch 2 (the case-level machine-learning predictors) was not used, and no predictive model was trained or validated in this study. Cesarean delivery rates rose monotonically across AIDA classes, from no cesareans in Class 0 to all cases delivering by cesarean in Class 4, with a clear gradient across intermediate classes; full numerical results, confidence intervals, and effect sizes are reported in the Results section. Because the AIDA thresholds were derived from the same parent cohort, the analysis is best interpreted as a within-cohort subgroup evaluation rather than as independent validation. The observed class-graded outcome distribution is consistent with the hypothesis that in OP labors, the AIDA class assignment itself may carry clinically relevant information on the risk of intrapartum cesarean delivery; this remains hypothesis generating, and confirmation in independent prospective cohorts is required before AIDA-class assignment can be regarded as an established risk-stratification descriptor in OP labors. Full article

Background: Breastfeeding is considered the optimal source of nutrition for infants admitted to Neonatal Intensive Care Units (NICUs). Despite these well-documented benefits, establishing and sustaining breastfeeding in NICU settings remains challenging due to inadequate uptake of breastfeeding support measures. This scoping review aimed to examine the evidence on factors influencing the uptake of breastfeeding support practices in NICUs. Methods: The search was undertaken across four electronic databases: PubMed, MEDLINE, CINAHL, and the Cochrane Library. Primary studies published in English between 1994 and 2025 were included. Eligible studies focused on factors influencing breastfeeding support, implementation, or uptake of breastfeeding-related interventions in NICU settings. Exclusion criteria included studies not involving NICU populations, studies not addressing breastfeeding outcomes or support, secondary literature, and non-English publications. A total of 30 peer-reviewed studies met the inclusion criteria. Data were charted and synthesized using thematic analysis. Results: A total of 30 studies met the inclusion criteria. Four major themes influencing breastfeeding support uptake in NICUs were identified: (1) institutional commitment to the Neonatal Baby-Friendly Hospital Initiative (Neo-BFHI), (2) NICU breastfeeding protocols and care practices, (3) breastfeeding training for NICU staff and mothers, and (4) parental breastfeeding motivation and family support. Across studies, breastfeeding support was strengthened by organizational breastfeeding policies, staff education, lactation support services, family-centred care practices, and parental involvement. However, variations in NICU resources, institutional practices, and staff support contributed to inconsistencies in breastfeeding implementation and continuation. Conclusions: Breastfeeding support in NICUs is influenced by interconnected organizational, clinical, educational, and psychosocial factors. The findings highlight the importance of integrated breastfeeding-supportive approaches that combine institutional commitment, standardized NICU practices, healthcare provider education, and family-centred care to improve breastfeeding support for vulnerable infants in NICU settings. Full article

Background: With the rising demand for psychiatric mental health services and the development of online technology, telemental health services are gaining popularity. Psychiatrists and psychologists differ significantly in service patterns and ethical models. This study investigated their ethical patterns and used the technology acceptance model (TAM) to explore how professionals’ attitudes influence their ethical and regulatory use of telemental health services. Methods: The online survey included their basic information, telemental health service patterns, attitudes toward telemental health services, and ethical norms. This cross-sectional online survey was conducted among psychiatrists and psychologists in China between April and October 2022. Of the 1071 respondents in the parent survey, 690 professionals who reported using telemental health services were included in the present subgroup analysis. Results: In some instances, practitioners offering telemental health services may not adhere to ethical standards, particularly in the case of psychologists. A significant proportion of respondents expressed concerns including potential emergencies, technical issues, and security, suggesting the need for a re-evaluation of the ethical framework. The TAM showed higher behavioral intention was associated with lower ethical compliance scores. Conversely, elevated subjective norms and perceived behavioral control have the potential to encourage ethical compliance. Conclusions: Telemental health services are widely used in China, but important gaps remain in ethical compliance and regulatory implementation. Future efforts should focus on strengthening professional training, improving platform security and emergency response procedures, and developing clearer institutional and professional guidelines for ethical telemental health practice. Full article

Background: Adults closest to children, including parents and caregivers, teachers, and therapists, are major determinants of child mental health outcomes. However, access to high-quality psychological training for these groups remains severely limited and inequitable. Artificial intelligence (AI) tools may offer a scalable, accessible, and low-cost route to training delivery. This review aimed to provide the first systematic synthesis of evidence on AI tools used to train caregivers, educators, and therapists/practitioners in psychological approaches relevant to child and adolescent mental health. Methods: A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420261336167). Five databases, MEDLINE, PsycINFO, Embase, Web of Science, and ERIC, were searched from inception to March 2026, supplemented by reference hand-searching and forward citation tracking. Studies were eligible if they evaluated an AI-based training tool used with adults in caregiving, educational, or therapeutic roles involving children or adolescents aged 0–18 years, delivered a defined psychological approach, and reported at least one training outcome. Owing to substantial methodological and outcome heterogeneity, findings were synthesised narratively, and meta-analysis was not undertaken. Results: Twenty-four studies from nine countries, published between 2019 and 2026, met inclusion criteria. Studies were grouped into caregiver training (Group A, 5 papers), educator training (Group B, 3 papers), and therapist/practitioner training (Group C, 16 papers). Identified AI modalities included natural language processing (NLP)-based chatbots, generative AI/large language model (LLM) systems, AI-integrated virtual reality (VR), and AI-based feedback and analysis tools. Feasibility and acceptability findings were generally positive across groups. However, the evidence base was limited by pervasive methodological weaknesses, including small samples, with most studies enrolling fewer than 30 participants, reliance on unvalidated self-report outcomes, and the absence of follow-up data beyond one month. Conclusions: AI tools show early promise as scalable approaches to psychological training, particularly for procedural skill acquisition and enhancement of practitioner self-efficacy. However, the current evidence base is insufficient to support claims of effectiveness. A structural credibility–accessibility paradox characterises the field: tools with the strongest controlled evidence are the least scalable, while the most accessible tools have the weakest empirical support. Adequately powered, independent randomised controlled trials (RCTs) using validated outcomes, active comparators, and follow-up extending over multiple months are needed across all three population groups. Full article

Transfer learning offers a practical way to improve neural machine translation in low-resource settings, but its effectiveness depends on both the choice of transfer language and the amount of target-language data available for adaptation. In this study, we examine these factors specifically for Polish–English translation using mBART. We evaluate Czech, Russian, and German as parent languages and extend the analysis with a combined Slavic parent model trained on Czech and Russian. The models are compared across 0-shot, 10-shot, 100-shot, 1k-shot, and 10k-shot settings. Within this Polish–English mBART setting, Czech provides the strongest zero-shot performance, while Russian and German improve substantially as Polish fine-tuning data increases and achieve the strongest results at higher shot levels. The paper therefore analyzes selected transfer-language configurations rather than a formally measured similarity variable. The results suggest that, in this setup, transfer-language choice matters most when no Polish supervision is available, whereas larger amounts of Polish data can compensate for weaker initial transfer alignment. Full article

Background: Attention-Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder affecting executive functions such as impulse control, focus, and organization. This study addresses three research questions: current models and gaps in ADHD interventions, ways to enhance strengths and address weaknesses, and program recommendations for various ages. The aim is to develop a comprehensive framework to improve ADHD interventions, with a particular focus on youth and addressing existing gaps to enhance effectiveness. Methods: The current study systematically reviews the literature to answer these research questions. Sources were examined to identify existing intervention models, documented strengths and weaknesses, and recommendations relevant to different developmental stages. Results: Findings show that interventions for ADHD are varied and include psychological or behavioural therapy, family-school issues and parent involvement, school-based approaches, and medication. Key challenges include a lack of evidence-based practices, gaps in translational research, and insufficient teacher training. Notable strengths are family-school conference and family input, though there is less emphasis on building problem-solving capacity and family agency. Conclusions: Program recommendations highlighted in the literature include the need for family involvement, matching intervention intensity to individual needs, and ensuring professional education for special education. Addressing these gaps is essential for strengthening ADHD interventions and improving outcomes for children and youth. Full article

In pre-professional music education, career orientation emerges at the intersection of intensive artistic training and general upper secondary schooling. Although motivation, social support, and well-being in music learning have been examined separately in prior research, fewer studies have integrated these dimensions within a single explanatory framework. The study draws on self-determination theory and positive psychology. It investigates how perceived parental and teacher support, together with psychological resources related to mental health, are associated with music career motivation among students enrolled in upper secondary pre-professional music programmes. Using survey data and multivariate analyses, we examine the relative contribution of contextual and psychological factors to career motivation. The findings indicate that psychological resources are more strongly associated with overall career motivation than external social support. This is particularly evident for self-regulation and perceived competence in goal-directed activity. Social support appears primarily associated with intrinsic motivational dimensions. These results suggest the relevance of the role of internal psychological resources in sustaining career commitment within specialised secondary education contexts. Full article