Search Results (1,819)

The growing prevalence of gaming disorder (GD) in adolescents is a global concern. Despite parents’ critical role in addressing GD, how dysfunctional parenting practices are associated with adolescent GD remains understudied. This study assessed the association between dysfunctional parenting practices and adolescent GD among Japanese male junior high school students. Data were collected in 2024 via web-based, self-administered questionnaires from 300 parents (183 fathers and 117 mothers), each reporting on one male junior high school student. Suspected GD was assessed using a validated parent report measure (i.e., the Gaming Disorder Scale for Parents). Dysfunctional parenting practices were measured using the Parenting Scale, comprising two dimensions: Overreactivity and Laxness. Mean factor scores of Overreactivity and Laxness were compared between the suspected and non-suspected GD groups using a t-test. Logistic regression models assessed the association of Overreactivity and Laxness with suspected GD, controlling for covariates. The mean score of Overreactivity was significantly higher in the suspected GD group than in the non-suspected group, whereas that of Laxness was not. After adjustment, overreactive parenting was significantly associated with suspected GD (adjusted odds ratio: 1.89, 95% CI [1.31, 2.74]). This study showed that overreactive parenting was independently and significantly associated with increased odds of suspected GD. Full article

Objective: Based on the Person-Centered Approach, this study targeted parents of very preterm (VPT) infants in Neonatal Intensive Care Units (NICUs) from Italy and Portugal. The primary aim was to classify parents by identifying latent classes of perceived risks (NICU stressors) and resources (sources of social support). Potential specificities in class membership according to Country of Belonging and sociodemographic factors were also investigated. Methods: Overall, 303 parents (92 Italian; 211 Portuguese) completed a survey including sociodemographic factors, Parental-Stressor-Scale-NICU, and Multidimensional-Scale-of-Perceived-Social-Support. Data were analyzed by multigroup latent class analysis and multinomial logistic regression. Results: Three statistically valid and cross-country classes were identified and labelled as Class 1, Adjusted/Beneficial-and-Supported-System, Class 2, Stressed-and-Supported-System, and Class 3, Parental-Role-Alteration-with-Family-Supported-System. Portuguese parents were mainly grouped in Classes 1 and 2, while Italian parents were in Class 3. Men were less likely to belong to Classes 2 and 3, while older parents having another child were more likely to belong to Class 3. Conclusions: The experience of parents of VPT infants in NICUs is inherently challenging, yet identifying specific risk profiles featured by the unique nuances of stressors and sources of support while accounting for further factors (Country of Belonging, Gender, Age, Having another child) can foster the customization of interventions aimed at providing parents with the necessary resources for adjusting to this extremely demanding experience. Full article

Background/Objectives: Dental anxiety (DA) is a well-known obstacle affecting dental care in children. Children living in orphanages are a special population with healthcare needs. The aim of the study was to assess DA among children living in orphanages compared to those living with both biological parents. Methods: This frequency-matched case–control study included 61 children living in orphanages in Jeddah city and 122 age- and gender-matched peers living with both parents in Jeddah, Saudi Arabia. Demographic and background data, including medical history, dental visit history, and Adverse Family Experiences (AFEs), were completed by the caregiver. Dental anxiety was assessed subjectively using the self-reported Abeer Children Dental Anxiety Scale (ACDAS) and objectively by the Venham Clinical Anxiety Rating Scale (VCARS). Results: The prevalence of children with DA in the study sample among those living in orphanages was 18%. AFEs were significantly higher among children living in orphanages (96.7% vs. 32%, p < 0.001). ACDAS and VCARS showed fewer children with DA living in orphanages compared to children living with both parents. Logistic regression showed that living in orphanages decreased the adjusted odds ratio (AOR) of dental anxiety according to ACDAS (AOR = 0.36; p = 0.06) and VCARS (AOR = 0.43, p = 0.040). Conclusions: Although children living in orphanages presented with lower DA than those living with both parents, this may point to differences in emotional expression rather than true emotional state. Clinicians should not rely only on behavioral observations when treating institutionalized children. Full article

Background/Objectives: Childhood vaccine refusal may negatively affect immunization programs in Türkiye, where regional clusters of hesitancy have emerged despite high national coverage. This study aimed to identify sociodemographic, behavioral, and vaccine confidence-related factors independently associated with childhood vaccine refusal in Konya, Türkiye. Methods: An unmatched case–control study was conducted between July and October 2025 in family health centers across Konya. Cases were parents who had refused at least one routine childhood vaccine (n = 406); controls were parents whose children had completed all routine vaccinations (n = 412). Data were collected through face-to-face interviews using a 47-item structured questionnaire and the Turkish version of the Vaccine Hesitancy Scale (VHS). Independent associations were assessed using multivariable logistic regression, with multicollinearity evaluated by variance inflation factors. Results: Maternal employment (aOR = 0.371, 95% CI: 0.218–0.633), parental COVID-19 vaccination (aOR = 0.131, 95% CI: 0.086–0.200), mother’s complete childhood immunization (aOR = 0.418, 95% CI: 0.262–0.667), tetanus vaccination during pregnancy (aOR = 0.259, 95% CI: 0.159–0.421), and neonatal vitamin K administration (aOR = 0.256, 95% CI: 0.132–0.497) were independently associated with lower refusal odds. Higher number of children (aOR = 1.281) and perceived vaccine-related adverse events in the social environment (aOR = 16.982, 95% CI: 9.914–29.089) increased refusal odds. VHS scores were significantly lower in the refusal group (22.2 ± 6.4 vs. 39.8 ± 6.5; p < 0.001), indicating greater hesitancy. Notably, 21.9% of refusing parents reported being advised by a healthcare professional not to vaccinate. Conclusions: Childhood vaccine refusal in Konya was associated with sociodemographic, behavioral, preventive health-related, and vaccine confidence-related factors. The findings suggest relatively reduced engagement with selected preventive health practices, greater reliance on non-professional information sources, and lower vaccine confidence among refusing parents. Interventions should focus on strengthening healthcare-professional communication, trust-building, transparent risk communication, and evidence-based social media strategies. Full article

Persistent organic contaminants and complex wastewater matrices challenge conventional treatment because parent-compound removal does not necessarily imply mineralization, detoxification, or improved environmental safety. Advanced oxidation processes can address these limitations, but practical effectiveness is often constrained by oxidant activation, gas–liquid mass transfer, reagent distribution, light penetration, catalyst contact, energy demand, and matrix scavenging. This work critically examines hydrodynamic cavitation-assisted advanced oxidation processes for water and wastewater treatment, including systems based on hydrogen peroxide, ozone, Fenton and Fenton-like reactions, persulfate, peroxydisulfate, peroxymonosulfate, UV irradiation, photocatalysis, cold plasma, multi-hybrid configurations, and emerging reduction-oriented approaches. The discussion covers reactor configurations, target contaminants, real matrices, and sustainability-related performance metrics. The central argument is that hydrodynamic cavitation is not automatically sustainable as a stand-alone treatment. It becomes relevant as a sustainable intensification module only when measurable improvements are demonstrated in oxidant activation, mass transfer, treatment depth, biodegradability, toxicity reduction, process integration, or scale-up at acceptable energy and chemical cost. A reporting framework is proposed based on mineralization, COD/TOC reduction, by-products, toxicity, biodegradability, normalized energy consumption, chemical efficiency, real-matrix validation, reproducibility, and cost-relevant indicators. Future progress should move from isolated degradation tests to integrated, controllable, and scalable treatment frameworks. Full article

Large language models (LLMs) are increasingly being used in radiology-related workflows, but their application to reference, regulatory, and methodological queries remains limited by hallucinations and the static nature of model knowledge. This study aimed to develop and evaluate a retrieval-augmented generation (RAG) system for radiologists designed to provide grounded responses to such queries. A knowledge base was created through a survey of practicing radiologists and expert validation of sources, resulting in a corpus of 1049 documents. The system incorporated structured document parsing, a two-level parent–child vector database, hybrid dense–sparse retrieval, reranking, and a local large language model. Performance was assessed through functional testing, automated LLM-as-a-judge metrics, and multireader expert evaluation by 16 radiologists using 400 technical queries. No hallucinations were detected in the 77-query functional testing set during expert review. On the full technical dataset, automated Contextual Precision, Contextual Recall, and Answer Relevancy were 0.735, 0.881, and 0.890, respectively. Expert evaluation showed high response accuracy (mean, 4.53/5) and high expert-assessed Contextual Precision (0.886). Inter-expert agreement was substantial to excellent for most Likert-scale criteria. These findings suggest that a hierarchical RAG architecture can provide reliable access to radiology-specific reference information, although external validation and automated updating of the knowledge base remain necessary. Full article

Background/Objectives: Children of families facing unmet social needs experience higher rates of adverse outcomes compared to those not experiencing unmet social needs. This study aimed to identify factors associated with families’ unmet social needs as reported by parents or guardians at their children’s primary care visits. Methods: This cross-sectional study recruited English-speaking primary caregivers of children less than 18 years of age from the Southwestern Ohio Ambulatory Research Network (SOAR-Net) who were surveyed between January 2023 and August 2024. Surveys included the Maternal Social Support Index, Social Capital Scale, RAND Depression Screener, Children with Special Health Care Needs Screener, Medical Expenses of Children Survey, a 10-item social needs screener, and demographics. Data were analyzed with chi-square or Fisher’s exact tests, adjusted logistic regression, and ANOVA. Results: Among 1167 respondents (78% response rate), 1114 provided complete data. Primary caregivers were predominantly mothers (79.9%) or fathers (13.6%), White (72.0%) or Black (16.0%), and had an associate’s degree or less (65.1%). The mean (SD) index child’s age was 6.4 (5.3) years, and 52.4% were female. Underinsurance, positive depression screens, and poor child health were positively associated with unmet social needs. Higher scores for social support and social capital were associated with fewer social needs. Multinomial logistic regression revealed significant relationships with reporting two or more unmet social needs with the following variables: childhood underinsurance, household annual income < $50,000, positive depression screens, raising a child with a chronic health condition, and Black race/ethnicity. Conclusions: Several significant social factors were independently associated with a greater number of unmet social needs. These findings highlight the complex interplay among social factors in children’s healthcare. Future research should explore the putative longitudinal stability of these relationships. Full article

This study examined the associations of self-reported emotional intelligence and self-regulation with children’s well-being among fourth-grade elementary school students in Mersin, Türkiye. The sample comprised 627 students, predominantly aged 9 to 10 years, from seven public elementary schools selected to reflect different district and school contexts. Data were collected in person after ethics committee approval, institutional permissions from the Turkish Ministry of National Education, and written parental consent. The Children’s Emotional Intelligence Scale, the Self-Regulation Scale, and the Stirling Children’s Well-Being Scale were administered. Descriptive statistics, Pearson correlations, simple and multiple linear regressions, and a cross-sectional indirect association analysis using PROCESS Model 4 with 5000 bootstrap resamples were conducted. Emotional intelligence was positively associated with children’s well-being and self-regulation, while self-regulation showed a weaker positive association with well-being. Emotional intelligence explained 31.4% of the variance in well-being, self-regulation explained 8.6% when examined alone, and both variables jointly explained 31.9%, indicating only a marginal increase over emotional intelligence alone. Thus, most of the explained variance was accounted for by emotional intelligence, whereas self-regulation made a very small incremental contribution beyond it. The indirect association analysis indicated a small but statistically supported pattern of indirect association between emotional intelligence and well-being through self-regulation within this cross-sectional design; the association between emotional intelligence and well-being remained significant after self-regulation was included in the model. The findings suggest that emotional intelligence is the stronger socio-emotional correlate of children’s well-being in this sample, whereas self-regulation shows a limited complementary association. Given the cross-sectional design and reliance on self-report measures, the findings should be interpreted as correlational associations rather than evidence of causal effects, temporal ordering, or developmental change. Future studies should use longitudinal, intervention-based, and multi-informant designs to further examine these associations. Full article

Background: Robot-assisted total knee arthroplasty (raTKA) improves the precision of component positioning and coronal alignment restoration, but it remains uncertain whether that technical accuracy modifies the clinical effect of alignment strategy in different varus phenotypes. The present report evaluates alignment strategy and correction magnitude, explicitly as a post hoc exploratory deformity-subgroup analysis within a randomized raTKA cohort. Methods: This single-center, open-label, randomized study enrolled 296 patients with varus knee osteoarthritis who underwent raTKA between 2023 and 2025 using either mechanical alignment (MA; n = 149) or limited/restricted kinematic alignment (lim.-KA; n = 147). The parent randomized comparison was conducted at the whole-cohort level; the deformity-based subgroups reported here were defined after the whole-cohort analysis and are therefore post hoc and exploratory. Patients were stratified according to preoperative varus severity into a mild-deformity subgroup (≤10°; lim.-KA-I n = 99, MA-I n = 102) and a moderate-deformity subgroup (11–20°; lim.-KA-II n = 48, MA-II n = 47). Outcomes included hip–knee–ankle angle (HKA), correction angle, range of motion (ROM), visual analog scale (VAS; 0–10 points), Knee Society Score (KSS; knee and function), Oxford Knee Score (OKS), and Forgotten Joint Score-12 (FJS-12) over 12 months. Estimates are presented with 95% confidence intervals where applicable. Because multiple post hoc subgroup comparisons were performed without formal multiplicity adjustment, p-values are interpreted descriptively and in conjunction with effect sizes and 95% confidence intervals. Results: The primary whole-cohort randomized comparison did not demonstrate an overall between-group advantage of either alignment strategy. The post hoc moderate-varus subgroup showed favorable unadjusted 12-month differences for lim.-KA versus MA in KSS-knee (+6.8 points; 95% CI 5.3 to 8.3; nominal p < 0.001), KSS-function (+4.0 points; 95% CI 2.7 to 5.2; nominal p < 0.001), OKS (+6.4 points; 95% CI 4.5 to 8.3; nominal p < 0.001), and FJS-12 (+11.3 points; 95% CI 9.4 to 13.1; nominal p < 0.001). In contrast, ROM favored MA rather than lim.-KA in the moderate-varus subgroup (−11.8°; 95% CI −16.6 to −7.0; nominal p < 0.001), indicating greater 12-month ROM after MA, and VAS pain, reported on a 0–10 scale, did not support a lim.-KA pain advantage (+0.26 points; 95% CI 0.05 to 0.48; higher scores indicate worse pain; nominal p = 0.018). Exploratory, unadjusted, post hoc 12-month alignment-by-deformity interaction terms were significant for ROM, KSS-knee, KSS-function, OKS, and FJS-12, but not for VAS. Because multiple post hoc comparisons were performed without formal multiplicity adjustment, the results are interpreted descriptively, along with effect sizes and confidence intervals. Conclusions: The primary randomized comparison did not demonstrate a clinical advantage of lim.-KA over MA in the whole cohort. In post hoc exploratory analyses, mild varus deformity was associated with outcomes broadly similar to those after both alignment strategies. In the moderate-varus subgroup, patient-level analyses suggested a possible phenotype-dependent signal for KSS-knee, KSS-function, OKS, and FJS-12 after lim.-KA, whereas ROM favored MA, and VAS pain did not support a lim.-KA pain advantage. These subgroup findings should be interpreted separately from the primary randomized result, considered hypothesis-generating only, and not used in isolation to change clinical practice without prospective confirmation. Full article

Background: Parents play a pivotal role in influencing children’s oral health; thus, effective oral health education (OHE) is essential to equip them with the knowledge needed to support their children’s oral health care. In countries such as Pakistan, apart from limited access to dental care and socioeconomic barriers, the widespread lack of OHE is also an important factor contributing to the high prevalence of oral diseases. Conventional OHE approaches are often limited by passive delivery, lack of tailored content and poor accessibility. Social media platforms such as Facebook offer an accessible platform for health education; however, structured, validated, and tailored content is required. Aim: This study aims to develop and validate an online OHE module for Pakistani parents using the ADDIE instructional design model. Materials and Methods: The study was conducted in two phases using the ADDIE model. Parental OHE needs were identified through a questionnaire. An Urdu-language module was developed based on these needs and expert recommendations. Content validation was performed by six experts, followed by face validation with 15 parents. Results: Needs assessment guided the development of a culturally appropriate module covering six main topics. Item-level Content Validity Index ranged from 0.83 to 1.00, with a Scale-level Content Validity Index of 0.94 and a Scale-level Face Validity Index of 0.97. Conclusions: The developed Facebook-delivered OHE module demonstrated high content and face validity and may serve as an accessible and practical strategy for improving parental OHE. Further studies are required to evaluate its effectiveness in improving oral health-related behaviours and outcomes. Full article

Background/Objectives: Parents of children with autism spectrum disorder (ASD) often face sustained emotional, practical, and social demands. However, evidence from Romania remains limited, particularly regarding the combined assessment of caregiver burden, emotional distress, and coping strategies of parents. This exploratory study compared these outcomes between parents of children/adolescents with ASD and parents of typically developing children and examined whether coping patterns varied according to selected sociodemographic characteristics. Methods: We conducted a cross-sectional comparative study in Târgu-Mureș, Romania, between 2024 and 2025. The sample included 92 parents: 46 parents of children/adolescents with clinician-confirmed ASD and 46 parents of typically developing children. Participants completed a demographic questionnaire, the Caregiver Burden Inventory (CBI), the Depression Anxiety Stress Scales-21 (DASS-21), and the Strategic Approach to Coping Scale (SACS). DASS-21 data were available for 44 ASD caregivers and 46 controls. Between-group comparisons were performed using t-tests, Mann–Whitney U tests, chi-square tests, or Fisher’s exact tests, as appropriate. Results: The groups were comparable in sex, age, residence, number of children, and household size, but differed significantly in marital status and educational level. Clinically relevant caregiver burden (CBI ≥ 36) was more frequent among parents of children with ASD than among controls (30% vs. 17%), although this difference was not statistically significant. Parents of children with ASD showed trend-level higher depressive and anxiety symptoms, with small effect sizes, whereas stress scores were similar between groups. Coping patterns varied according to sociodemographic characteristics. Marital status was associated with aggressive coping, urban residence was associated with indirect and aggressive coping, and number of children was associated with seeking social support. Conclusions: Parents of children with ASD showed a higher proportion of clinically relevant caregiver burden and trend-level elevations in depressive and anxiety symptoms, while stress scores were comparable between groups. Exploratory adjusted analyses suggested that ASD caregiver status remained associated with caregiver burden and depressive symptoms after controlling for educational level and marital status. Coping strategies appeared heterogeneous and context-dependent. Given the exploratory design, modest sample size, and multiple comparisons, these findings should be interpreted as preliminary and hypothesis-generating. Full article

This study examined whether family functioning and impulsivity differentiate offense categories or represent shared vulnerability factors among justice-involved adolescents. A cross-sectional survey was conducted in two juvenile correctional facilities and included 159 incarcerated male adolescents aged 13–18 years (mean 16.3 ± 1.1). Participants completed a case report form, the Family Assessment Scale (FAS), and the UPPS Impulsive Behavior Scale. Offenses were classified as property crimes (42%), crimes against persons (31%), sexual offenses (17%), and drug-related crimes (10%). Substance use was highly prevalent (smoking 86.8%; alcohol 61.0%), and 34.6% had experienced repeat incarceration, most frequently in property and drug-related offenses (p < 0.001). Peer influence was the most commonly reported reason for delinquency (44.7%). Family dysfunction was common across the sample, particularly in domains related to parental involvement and behavioral control with some variation across offense categories. In contrast, impulsivity levels were elevated but did not significantly differ between crime categories. These findings support a shared vulnerability perspective, suggesting that dysfunctional family environments and substance-related risk contexts operate across offenses, while impulsivity may represent a general risk rather than an offense-specific determinant. These results highlight the importance of family-centered and developmentally informed interventions in juvenile justice settings. Full article

Background/Objectives: Children’s mental health and positive development are shaped by family, environmental, and individual factors. Although neurodevelopmental disabilities (NDDs) are well-established correlates of poorer mental health outcomes, few national-scale studies have simultaneously modeled positive (flourishing) and negative (anxiety, depression) outcomes within a unified ecological framework. This study examined how parent mental health, peer victimization, neighborhood and school context, and four NDD diagnoses (autism spectrum disorder [ASD], attention-deficit/hyperactivity disorder [ADHD], developmental delay, and learning disability) are associated with flourishing, current anxiety, and current depression in a national sample of U.S. children aged 6–17 years. Methods: Cross-sectional data from the 2023–2024 National Survey of Children’s Health (NSCH; N = 71,172) restricted to ages 6–17 with complete data (unweighted n = 64,263; weighted population estimate ≈ 44.6 million children) were analyzed using Complex Sample logistic regression (SPSS 30), accounting for stratified design (state × stratum), household clustering, and sampling weights. Three hierarchical models were estimated for each outcome. NDD-stratified subgroup analyses (n = 13,971; weighted ≈ 8.6 million) triangulated moderation findings. Multiple imputation (m = 5) sensitivity analyses confirmed robustness. Results: Weighted prevalence was 60.7% for flourishing, 13.2% for current anxiety, and 5.1% for current depression. In Block 2 models, poorer parent mental health and more frequent bullying victimization were robustly associated with all outcomes (flourishing OR = 0.62 and 0.65; anxiety OR = 1.64 and 1.63; depression OR = 1.95 and 1.75; all p < 0.001). Supportive neighborhood (flourishing OR = 1.40, depression OR = 0.80) and safe school (flourishing OR = 1.20, anxiety OR = 0.87) were protective. ADHD was the strongest disability-specific correlate (flourishing OR = 0.29; anxiety OR = 4.69; depression OR = 4.27). Three of the twelve interaction terms were significant, all involving ADHD. Relative to children without any NDD, subgroup analyses suggested attenuated associations of parent mental health and bullying with anxiety and depression among children with any NDD (e.g., bullying on anxiety: no-NDD aOR = 1.73 vs. Any-NDD 1.52); however, formal interaction tests identified ADHD as the only significant moderator of these associations. On the absolute-risk scale, however, the increase in internalizing problems with more frequent bullying was larger in children with ADHD. Conclusions: Family mental health support and bullying prevention are universally relevant levers for improving children’s mental health and flourishing. Although attenuation of the odds-ratio associations was observed primarily in ADHD-related analyses, specifically for the internalizing outcomes (anxiety and depression), universal anti-bullying and parent mental health interventions remain relevant for children with NDDs, supporting integration into pediatric clinical and public-health programs alongside disability-specific support pathways. Full article

While recent studies have begun to investigate the interaction between individual characteristics and parenting practices in the development of child-to-parent violence, empirical evidence remains limited, particularly among young adults. This study examines the role of youth impulsivity as a moderator of the relationship between parental punitive discipline and child-to-parent violence. The sample consisted of 1041 young adults (51.1% women, 48.9% men), aged between 18 and 25 years (M_age = 21.41, SD = 1.94), who lived with their parents. Participants completed the Child-to-Parent Violence Questionnaire, the Inventory of Parental Discipline Methods, and the Barratt Impulsivity Scale. Results indicated that parental punitive discipline and impulsivity were positively associated with violence toward both fathers and mothers. Impulsivity moderated only the relationship between punitive maternal discipline and child-to-parent violence (toward both the father and the mother). Specifically, this effect was stronger at higher levels of impulsivity. These findings highlight the importance of considering both individual traits and parental practices, as well as their interaction, in understanding child-to-parent violence during emerging adulthood. They also have important theoretical and practical implications for prevention and intervention. Full article

Background/Objectives: Parent report is often used to assess dental fear in early childhood, but its association with later child-reported dental fear remains unclear. This study primarily examined whether parent-reported dental fear at age 5 was associated with child-reported dental fear at age 9, and secondarily explored two options derived from the modified Children’s Fear Survey Schedule–Dental Subscale (CFSS-DS-M): a single general dental fear item and a pragmatic multi-item score. Methods: This secondary longitudinal observational analysis used data from the FinnBrain Birth Cohort Study. Mothers and fathers rated child dental fear at age 5 using the CFSS-DS-M. Children self-reported dental fear at age 9 using the Modified Dental Anxiety Scale (MDAS). Associations of the single item and five-item score with age-9 MDAS score were examined separately for mother- and father-reported data using Spearman correlations and adjusted linear regression models. Exploratory factor analysis examined the structure of the five-item score. Results: Treatment-specific CFSS-DS-M items frequently received “no experience” responses. The pragmatic five-item score showed an exploratory one-factor structure and was more feasible than the full 11-item score. Associations with age-9 dental fear were small. In adjusted analyses, both mother-reported measures were positively associated with age-9 dental fear. In father-reported data, the single item was not associated, whereas the five-item score showed a positive predictor-level association, although the adjusted model was not statistically significant. Conclusions: Parent-reported dental fear at age 5 provides modest information about later child-reported dental fear. In population-based cohorts in early childhood, less treatment-specific items may be useful when assessing dental fear. Full article