Search Results (209)

Heavy metal(oid) pollution in tea plantation has become a global concern threatening tea safety, with food safety serving as the cornerstone of the tea industry. In this study, the distribution and migration patterns of seven heavy metal(oid)s in soil-tea systems developed from three parent materials were investigated, in the geologically complex but minimally human disturbed Dabie Mountains. Results showed that although the heavy metal(oid) concentrations in tea at all sampling points meets the food safety standards of China and the European Union, significant differences existed in the bioaccumulation potential of the elements. Hg and Cd showed the highest bioconcentration factors (mean values of 0.45 and 0.33, respectively), while As, Cr, and Pb transfer were inhibited. Geological type significantly influenced the heavy metal(oid) distributions. Random forest models revealed metal-specific transfer mechanisms, with P-related variables (e.g., soil total P, available P, and microbial biomass P) and microbial C-N acquisition enzyme activities serving as key regulatory factors. This study confirms that parent materials indirectly potentially influence heavy metal(oid) bioavailability by shaping soil development and microbial functions, providing scientific basis for geology-informed food safety risk assessment in tea plantations. Full article

Background: Vascular abnormalities (VAs) are a broad category of disorders that include vascular malformations (inadequate embryologic blood vessel development) and vascular tumors (characterized by vascular cell hyperplasia). This sometimes-complicated pathology is increasingly being treated with mTOR inhibitors, particularly sirolimus (rapamycin). Only a limited number of neonates treated with sirolimus have been reported in the literature to date, and there is no consensus regarding the optimal treatment regimen for vascular anomalies in this population. The objective of our narrative review is to summarize the most recent information from the specialized literature regarding the efficacy and safety of sirolimus in newborns. Methods: A methodological search was performed through the available data concerning the indications and safety when using sirolimus to treat VAs in newborns. We evaluated articles from the Embase and PubMed academic search engines using the following search terms: (vascular anomalies OR vascular tumors OR venous malformations OR lymphatic malformations OR capillary malformations) AND (neonate) AND (sirolimus OR rapamycin). Results: We identified a lack of consensus regarding indications for treatment initiation, optimal dosing regimens, and duration of therapy. In most published studies, neonates were analyzed within broader pediatric cohorts that included patients up to 18 years of age, rather than as a distinct population. Moreover, only a limited number of investigations have specifically focused on neonates treated with sirolimus and evaluated outcomes from a neonatal subgroup perspective. The available evidence largely consists of isolated case series and reports describing sirolimus use in fetuses and neonates, most commonly for lymphatic malformations or kaposiform hemangioendothelioma; in some instances, sirolimus was administered in combination with propranolol, corticosteroids, or other therapeutic modalities. Nevertheless, across studies and case reports involving fetuses or neonates, sirolimus is generally reported to be effective and well tolerated, with adverse effects that are minimal and reversible. Conclusions: For neonates and even fetuses with large, complex VAs, sirolimus appears to be an effective treatment with no serious adverse events reported to date. Decisions regarding off-label sirolimus initiation should be made by a multidisciplinary team, and parents must be thoroughly informed about potential adverse events. Well-designed randomized controlled trials or high-quality observational studies are needed to further evaluate the efficacy and safety of sirolimus in the neonatal population. Full article

Background/Objectives: Seasonal influenza vaccination is pivotal for protecting high-risk populations, including those with chronic health conditions (CHCs), from severe complications and outcomes. This study aims to describe the sociodemographic characteristics of unvaccinated children (6 months–17 years old) with CHCs, the reasons why vaccine hesitant parents chose not to vaccinate their children, and the factors associated with seasonal influenza non-vaccination among these children. Methods: This cross-sectional analysis used a sub-sample from the 2023 Childhood COVID-19 Immunization Coverage Survey, which captured data between April and July 2023. Parent and child characteristics were explored, using frequencies and proportions. Weighted unadjusted, partially adjusted (with child age and sex at birth), and fully adjusted multivariable quasi-Poisson models were designed to identify socio-demographic factors associated with seasonal influenza non-vaccination. Results: A total of 649/1187 (55%) children with CHCs were unvaccinated against influenza during the 2022–2023 influenza season. Vaccine hesitant parents with unvaccinated children expressed concerns with vaccine effectiveness (39.1%) and safety (27.5%), as did parents who refused vaccination for their child (56.1% and 35.8%, respectively). Unvaccinated parents (RR: 4.549, 99% CI: 4.480, 4.619) and parents with low household income (RR: 1.428, 99% CI: 1.400, 1.456) were more likely to have unvaccinated children, whereas children who received an annual influenza vaccine (RR: 0.097, 99% CI: 0.094, 0.100) and did not have a disability (RR: 0.913, 99% CI: 0.904, 0.922) had a lower likelihood of non-vaccination. Conclusions: These findings highlight the need for renewed messaging and educational resources targeting vaccine hesitancy and misinformation prevalent among parents with vulnerable youth. Full article

Since MDCK cells are inherently tumorigenic, their safety in vaccine production has long been a concern; thus, establishing a screening method for low-tumorigenic cells is of great significance for influenza vaccine development. This study successfully obtained a low-tumorigenic MDCK cell line through monoclonal screening and systematically evaluated its potential as a cellular substrate for influenza vaccines using male nude mice (BALB/c nu/nu, 4–7 weeks old) for tumorigenicity assessment. Comprehensive analysis of the biological characteristics of the screened cells—including growth curves and transcriptomic features—showed that the cell line exhibits stable growth and consistent traits. Transcriptomic comparison was performed between two defined biological states: parental MDCK cells (SQ group) and the low-tumorigenic clone MDCK-20B9 (SH group). Transcriptomic analysis revealed good dispersion among samples and an overall consistent gene expression distribution. Differential expression analysis identified a total of 2198 differentially expressed genes, including 902 upregulated and 1296 downregulated genes. GO functional enrichment analysis indicated that these genes are mainly involved in biological processes such as acute-phase response, retinol metabolism, mitotic chromosome condensation, and cell migration; are enriched in cellular components such as kinetochores and the extracellular matrix; and are associated with molecular functions including calcium ion binding and the Wnt signaling pathway. KEGG pathway analysis further revealed that the differentially expressed genes are significantly enriched in key pathways such as cancer pathways, cell cycle, and cell adhesion molecules. The expression trends of five key differentially expressed genes were validated by RT-qPCR. In summary, this study successfully screened a stable and consistent low-tumorigenic MDCK cell line, providing a theoretical basis and practical foundation for its use as a cellular substrate in influenza vaccine development. Full article

As natural nanoscale intercellular messengers, exosomes exhibit considerable potential in modulating inflammation, angiogenesis, immunoregulation, and tissue remodeling, making them attractive candidates for regenerative medicine. However, their clinical translation remains limited by rapid systemic clearance, nonspecific biodistribution, insufficient lesion retention, and functional attenuation in hostile pathological microenvironments. In this review, we propose that biomaterial engineering should evolve from providing passive exosome carriers to constructing active regulatory platforms capable of precise spatiotemporal control. We summarize engineering strategies along two complementary dimensions. In the temporal dimension, biomaterials can enable sustained, sequential, or microenvironment-responsive release to match the dynamic phases of tissue repair. In the spatial dimension, biomaterials can improve local retention, tissue anchoring, structural guidance, endogenous cell recruitment, and lesion-specific delivery. Using cutaneous wound healing, osteochondral regeneration, myocardial repair, and neural regeneration as representative examples, we further analyze these strategies through a “clinical challenge–engineering strategy–biological mechanism” framework, with particular attention to how engineered systems influence key signaling pathways such as PI3K/Akt, Wnt/β-catenin, NF-κB, and PTEN/PI3K/Akt/mTOR. We also discuss translational barriers, including exosome heterogeneity, safety concerns inherited from parental cells, large-scale GMP-compliant manufacturing, product standardization, storage stability, and regulatory classification of exosome–biomaterial hybrids. Finally, we highlight emerging directions, including multi-mechanism combinational systems, closed-loop responsive platforms, and artificial intelligence-assisted design for personalized exosome therapeutics. This review provides a design-oriented framework to accelerate the bench-to-bedside development of biomaterial-enabled precision exosome therapy. Full article

This cross-sectional study explored whether the relationship between adolescents’ physical activity and related factors (such as personal and social factors, and parental safety concern) differed according to adolescents’ levels of access to play spaces. Data from Wave 3 of the Growing Up in Ireland (GUI) national longitudinal study, a nationally representative sample of 5212 adolescents aged 17–18 years, was analyzed. Key study variables included adolescents’ physical activity, personal factors (gender, health status, parents’ education and physical activity levels, and active commuting), social factors (number of friends, family support), and parental safety concerns (perceived safety of walking/playing and neighborhood safety). Two structural equation models (SEMs) were employed to compare relationships among physical activity and related factors for adolescents with high and low access to play spaces. Results showed that adolescents living in areas with high access to play spaces reported significantly higher levels of physical activity. Parents’ levels of education and the number of friends available for play had significant impacts on adolescents’ physical activity, regardless of access to play spaces. However, parental perception of the safety of walking and playing was only significant for adolescents with low access to parks. The associations between related factors and adolescents’ levels of physical activity differed for those with high and low access to play spaces, suggesting that interventions promoting adolescents’ physical activity may not yield equal results across these groups. A key limitation of this study is its cross-sectional design and reliance on self-reported measures, which preclude causal inference. Full article

This study maps the global scholarly landscape on digital parenting and children’s digital device use through bibliometric analysis of 628 Scopus articles (2010–2025). Using PRISMA-guided screening and science-mapping visualisations (VOSviewer and CiteSpace), the review identifies publication growth, influential sources, intellectual structures, and thematic clusters shaping the field. The mapped knowledge structure is dominated by health and media-effects traditions, with major research fronts centred on parental mediation, screen-time outcomes, online safety, and digital wellbeing. Crucially, the analysis shows that parenting perspectives remain weakly represented within this global corpus, with limited engagement with faith-based concepts that could shape mediation practices and moral reasoning in households. This underrepresentation contributes to a Western-centric evidence base, indicating a need for Islamically situated digital parenting research that integrates developmental concerns with ethics and culturally grounded mediation strategies. The study concludes by proposing a focused research agenda to strengthen theory building and empirical work in family contexts. Full article

Background: The ketogenic diet has gained substantial popularity in recent years, and an increasing number of caregivers of children with type 1 diabetes are considering it as a nutritional strategy to improve glycemic control. Reported benefits include fewer postprandial glucose fluctuations, lower insulin requirements, and reduced insulin-associated weight gain. However, the use of this diet in children with type 1 diabetes remains highly debated, and scientific evidence regarding its safety and long-term effects in the pediatric population is limited. This narrative review aims to explore the motivations that lead parents to initiate a ketogenic diet in their children with type 1 diabetes and to summarize current knowledge on its potential metabolic and developmental consequences. Methods: A narrative review of the literature was conducted, including original research articles, case reports, and existing reviews addressing the use of ketogenic diets in children with type 1 diabetes. Clinical observations and published accounts of family experiences were also examined to contextualize emerging concerns and motivations. Results: Parents most commonly adopt a ketogenic diet for their children due to the desire for tighter glucose control, concerns about insulin-related weight gain, and the influence of information shared on social media. Some observational data suggest improvements in glycemic stability and reduced insulin requirements under ketogenic dietary regimens, while available evidence also highlights several potential risks, including dyslipidemia, increased susceptibility to hypoglycemia, slowed linear growth, and possible neurocognitive and psychosocial effects. Long-term safety data remain scarce, and current findings are insufficient to establish clear clinical recommendations. Conclusions: Interest in ketogenic diets among families of children with type 1 diabetes is growing, yet existing evidence suggests that the diet may pose significant metabolic and developmental risks in this population. Further well-designed studies are needed to evaluate its safety and efficacy. This review may assist clinicians in counseling families and underscores the need for evidence-based guidelines regarding restrictive dietary patterns in youth with type 1 diabetes. Full article

Background: Parents serve as the primary decision-makers for childhood vaccination while also making decisions regarding their own vaccination, yet vaccination decision drivers are typically studied separately by vaccine type or target population. Methods: This study investigated parental decision-making processes for two self-paid and non-National Immunization Program vaccines in China, childhood rotavirus vaccine and adult influenza vaccine, by utilizing a structured survey grounded in the World Health Organization Behavioral and Social Drivers of Vaccination framework. Spearman’s rank correlation coefficients were used to assess the consistency of parental attitudes toward the two vaccines across behavioral and social driver domains. Structural equation models were conducted separately for childhood and adult vaccines to examine decision-making pathways. Results: The findings indicated that parental drivers related to awareness, social processes, and practical issues showed a high consistency across adult and childhood vaccination decisions (r > 0.7), whereas the consistency in vaccination behaviors remained low (r = 0.21). Compared with adult vaccination, childhood vaccination decisions were more strongly influenced by vaccine safety concerns and healthcare practitioners’ recommendations, which emerged as key drivers. Furthermore, family norms emerged as an effectively shared driver of vaccination decisions for both adult and childhood vaccines (adult: β = 0.784; childhood: β = 0.970). Conclusions: By jointly synthesizing adult and childhood vaccination decisions from a parental perspective, this study provides crucial evidence to support the development of integrated, family-centered strategies to improve vaccine uptake. Full article

Antibiotic residues in water buffalo milk are a food-safety concern, yet depletion data are scarce. The purpose of this study was to characterize the depletion profiles of amoxicillin (AMOX) and its two major metabolites, amoxicilloic acid (AMA) and amoxicillin diketopiperazine-2′,5′-dione (2,5-DKP), in Anatolian water buffalo milk after a single intramuscular administration and to estimate a milk withdrawal time relative to the EU MRL. We tested the hypothesis that AMOX concentrations would decrease below the EU MRL over successive milkings and that AMA and 2,5-DKP would exhibit depletion kinetics distinct from the parent compound. Five lactating Anatolian water buffaloes received a single intramuscular injection of amoxicillin (15 milligrams per kilogram). Milk was collected at each milking (twice daily) for seven days and analyzed by liquid chromatography–tandem mass spectrometry with quantification limits below the European Union maximum residue limit for amoxicillin in milk (4 micrograms per kilogram). Amoxicillin peaked at the second milking (mean 13.65 micrograms per kilogram), mean concentrations fell below the maximum residue limit from the sixth milking, and they became non-quantifiable from the tenth milking onward. Two major metabolites, amoxicillinic acid and amoxicillin diketopiperazine-2′,5′-dione, peaked earlier (2,5-DKP Tmax 12 h) or at higher concentrations (AMA Cmax 32.64 µg/kg vs. AMOX 13.65 µg/kg) and remained detectable up to the thirteenth milking, with longer apparent terminal half-lives (32.0 and 52.8 h) than amoxicillin (23.5 h); the mixed-effects model confirmed different depletion rates among analytes (milking × analyte interaction p = 4.63 × 10⁻⁵). A log-linear withdrawal model applying the EMA 95/95 tolerance limit indicated that the first time point at which the upper tolerance limit fell below the EU MRL was 84.7 h after dosing; rounded up to the next 12 h milking interval, this corresponds to a reported withdrawal period of 96 h (≈8 milkings). These results provide species-specific residue kinetics for amoxicillin in Anatolian buffalo milk and support considering metabolites in monitoring and withdrawal-time decisions. Full article

Background: The efficacy of pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) has been confirmed in numerous controlled studies. However, in clinical practice, pharmacological treatment is heavily dependent upon the parents or guardians of patients. Parental attitudes are shaped not only by medical knowledge but also by parental beliefs about the use of pharmacotherapy and psychoactive substances, including ADHD pharmacotherapy. Parental beliefs about the safety and possible side effects of pharmacotherapy significantly influence their decision to accept or reject pharmacotherapy. This study aimed to explore parental beliefs and attitudes toward ADHD pharmacotherapy and their association with parental treatment acceptance and treatment-related decision-making. Methods: The cross-sectional online survey included 506 parents of children diagnosed with ADHD, recruited through closed social media groups. Parental treatment acceptance and decisions regarding initiation of pharmacotherapy were examined. Results: Parents of children with experience of pharmacotherapy more frequently considered pharmacotherapy safe (83.4% vs. 39.7%, p < 0.001) and expressed readiness to start treatment immediately (73.8% vs. 32.5%, p < 0.001). In this group, 72.6% of parents indicated that the benefits of pharmacotherapy outweigh potential risks. However, concerns about addiction were similar in both groups (49.4% vs. 45.3%, p = 0.400). In a gendered analysis, fathers were more likely than mothers to consider pharmacotherapy unnecessary for treating ADHD (35.3–22.4%; p = 0.002; V = 0.142) or disbelieve in ADHD treatment (25.7–15.1%; p = 0.005; V = 0.132). Furthermore, fathers were more likely than mothers to support limiting the use of pharmacotherapy for treating ADHD to those over 18 (41.3% vs. 26.5%; p < 0.001; V = 0.156), and to report parental opposition (28% vs. 8.1%; p < 0.001; V = 0.264), with a minimal to moderate effect size. Conclusions: Parental treatment acceptance decisions were associated with more favorable parental beliefs, although subjective concerns about addiction remained. Given the study’s cross-sectional and exploratory nature, causal interpretations should be avoided. Parental gender was associated with differences in beliefs and attitudes toward the use of pharmacotherapy for treating children diagnosed with ADHD, especially regarding necessity, consent and age-specificity. In our surveyed sample, fathers tended to be more restrictive or cautious than mothers. The findings also highlight the importance of psychoeducation and partnership-based communication between clinicians and families as key factors that may help support treatment acceptance-related decision-making in ADHD. Full article

Background: Human papillomavirus (HPV) vaccination is a major concern and highly effective strategy for preventing cervical cancer and other related diseases. Despite the inclusion of the HPV vaccine in the Saudi national immunization program and recent school-based initiatives, vaccine uptake remains suboptimal, mainly due to the hesitancy of parents. Evidence regarding HPV vaccine hesitancy in the Aseer region of Saudi Arabia is limited. Objectives: This study aimed to assess the level of the HPV vaccine hesitancy, knowledge, attitude and barriers among parents in the Aseer region of Saudi Arabia using the World Health Organization (WHO) HPV Vaccine Hesitancy Scale (VAS). Methods: A cross-sectional study was conducted among parents residing in the Aseer region, Saudi Arabia. Data were collected using a structured questionnaire that included sociodemographic characteristics, knowledge, barriers and the validated nine-item WHO HPV Vaccine Hesitancy Scale. Data was expressed in numbers (%) for categorical variables and mean ± SD for continuous variables. Independent t-tests and one-way ANOVA were used for inferential statistics. Results: A total of 379 parents participated in the study. Overall, 49% of parents exhibited high HPV vaccine hesitancy. The most frequently reported barriers were safety concerns (82.6%), insufficient information (80.3%) and fear of side effects (79.4). Lower hesitancy scores were observed among parents aged ≥ 46 years than among those aged 18–25 years (p = 0.022), and respondents with postgraduate education were less hesitant than those with a high school education or less (p = 0.030). Parents whose children were fully vaccinated exhibited significantly lower hesitancy scores compared with those whose children were unvaccinated (p = 0.004). Conclusions: The HPV vaccine hesitancy among parents in the Aseer region is greatly influenced by the age of the parents, their educational level, and the child’s vaccination history. Higher hesitancy among younger parents, those with lower educational levels, and parents of unvaccinated children highlights priority groups for targeted interventions. Strengthening healthcare-provider recommendations and implementing culturally tailored, evidence-based communication strategies may improve HPV vaccine acceptance and support national cervical cancer prevention efforts in Saudi Arabia. Full article

Background/Objectives: Social vulnerability is linked to unhealthy eating habits, low physical activity, and, overall, increased health risks and low well-being. This study examined self-perceived barriers and facilitators to engaging in obesity prevention policies for children at risk of poverty and social exclusion in Greece from the perspective of parents, caregivers, and community representatives. Methods: A qualitative study was conducted from November to December 2023 in three geographically diverse Greek regions, namely Attica, Thessaly, and Crete. A qualitative study was conducted between November and December 2023 in three geographically diverse regions of Greece. In total, seventy-two individuals participated in the study through individual interviews and focus groups. Forty-five parents of children with disabilities took part in individual interviews, equally represented in all three regions (fifteen participants per region). Among focus group participants: Twenty-one caregivers from child protection units participated in six focus groups (two per region), with focus group sizes ranging from three to five participants. In addition, six Roma community representatives participated in three focus groups (one per region), with focus group sizes ranging from one to four participants. Inductive and deductive thematic analysis were performed using NVivo 14 software to identify key themes. Results: Most factors that increased engagement were perceived by participants as both barriers and facilitators. These factors were classified at the individual, sociocultural, or structural level, and similar themes emerged across groups. Common barriers to poor engagement included low health literacy, financial difficulties and underfunding, social exclusion, a lack of targeted nutrition interventions, concerns related to training opportunities and support, and the adequacy and safety of built environments. Common facilitators of enhanced engagement included increased awareness and motivation to support vulnerable children, the availability of community- and school-based initiatives, and free school meal provision. Conclusions: Engagement in obesity prevention policies targeting vulnerable children is influenced by multiple interrelated factors. Understanding these barriers and facilitators from the participants’ perspectives can guide policymakers and practitioners in designing more effective obesity-related interventions for socially vulnerable groups of children. Full article

Objective: To evaluate the level of knowledge, attitudes, and practices of Hungarian general practitioners (GPs) concerning human papillomavirus (HPV) infection, cervical cancer prevention, and HPV vaccination, and to identify physician-level factors associated with proactive recommendation practices. Methods: A cross-sectional nationwide survey was conducted between 30 April and 1 June 2024. The online questionnaire was distributed to practicing Hungarian GPs listed in the National Health Insurance Fund database. Anonymous responses were collected on demographic data, knowledge of HPV transmission and oncogenic potential, awareness of vaccination guidelines, and clinical counseling habits. Descriptive and inferential statistical analyses were performed. A total of 413 responses were received. Results: Most respondents were female (72.6%) with an average of 22.4 ± 9.6 years of professional experience. Although 89.8% correctly identified the causal link between HPV and cervical cancer, only 56.2% were aware of the complete vaccination schedule recommended for adolescents initiating after age 15. Knowledge scores were significantly higher among female physicians, urban practitioners, and those with postgraduate preventive medicine training. While the overall attitude toward HPV vaccination was positive (mean 4.6/5), 38.4% of respondents reported parental hesitancy as a common barrier, often citing misinformation regarding vaccine safety (64.9%) and lack of perceived need for boys (58.7%). Regression analysis revealed that familiarity with WHO and national vaccination guidelines independently predicted proactive vaccine recommendation (β = 0.43, p < 0.001). Conclusions: Hungarian general practitioners demonstrate good baseline awareness of HPV and its oncogenic role; however, knowledge gaps persist regarding vaccination schedules and counseling practices. Enhancing continuous medical education and communication training could strengthen GPs’ role as key advocates in HPV vaccine promotion. Full article

Bullying and school violence contribute directly to mental health difficulties among youth in the United States. Background/Objectives: This study describes the development and initial evaluation of a technology-enabled, multi-component school safety framework designed to support bullying prevention in middle and high schools. Methods: Students (n = 46), school personnel (n = 79), and parents/caregivers (n = 28) participated in three waves of usability and feasibility testing focused on a mobile application (Speak Out with Advocatr), companion classroom instructional materials, and guidelines for a school-wide safety campaign. Quantitative data were summarized using descriptive statistics and benchmark comparisons, and group differences across respondent roles were examined using analysis of variance with post hoc pairwise tests. Given small and unequal sample sizes, bootstrap resampling with 1000 resamples was used to obtain robust estimates of group means and confidence intervals. Qualitative responses were analyzed using content analysis. Results: Across waves, mean ratings generally met or exceeded predefined usability benchmarks, indicating favorable perceptions of the system. Findings indicated strong student acceptance and engagement with the framework. Adult participants expressed particular interest in restorative approaches to addressing student conflict, as well as concerns about preventing the recurrence of bullying behaviors. Conclusions: Findings provide initial support for the usability and feasibility of a multi-component, technology-enabled approach to school-based bullying prevention. Results also highlight the value of role-specific feedback for refining integrated mental health and safety interventions within school settings. Full article