Search Results (307)

Previous studies have suggested that the COVID-19 pandemic exposed children to an increased risk of greater body weight accumulation; however, the evidence found is limited to examining relatively short periods in children from Asian, European, and North American countries and, in most cases, using cross-sectional designs, while studies with longitudinal designs are scarce. To our knowledge, to date, no study involving Brazilian children has examined temporal trends in body weight during the pandemic period using a longitudinal approach. Objective: To report the weight status of children aged 6 to 11 years pre-, during, and post-school closures in response to restrictions imposed by the COVID-19 pandemic, using a six-year school-based longitudinal cohort design (2020–2025). Method: Weight status was analyzed using the body mass index and diagnostic criteria proposed by IOFT. Initial data collection took place in 2020 (baseline—pre-school closures), in 2021 and 2022 (pandemic period—school closures), and in 2023, 2024, and 2025 (post-pandemic period—after the reopening of schools). Results: The data collected confirmed that restrictions imposed to mitigate the adverse impact of the COVID-19 pandemic, including the full or partial closure of schools, substantially increased children’s weight above what would be expected for their gender and age. After two years of the pandemic period, 23% of children identified in the baseline pre-school closures with normal body weight migrated to overweight, while 34% of overweight children became obese. Data equivalent to the post-pandemic period showed signs of a reduction in the excess body weight accumulated during the pandemic; however, the prevalence rates of overweight and obesity remained significantly higher than pre-school closures. Conclusions: The findings suggest that the harmful effects contributing to the greater accumulation of body weight during the COVID-19 pandemic tended not to reverse spontaneously, even five years after its onset. Therefore, specific actions to prevent, combat, and control overweight and obesity are essential to avoid present and future adverse consequences for children’s health. Full article

Community pharmacies in the United States (US) face an increasingly unsustainable future due to declining third-party reimbursement (remuneration) and ongoing cash flow challenges following the elimination of retroactive direct and indirect remuneration (DIR) fees. These pressures have contributed to widespread pharmacy closures, the emergence of pharmacy deserts, and reduced access to care for millions of patients. Despite these challenges, community pharmacy remains the most common employment setting for pharmacy school graduates in the US. However, currently required community pharmacy Advanced Pharmacy Practice Experience (APPE) student rotations may offer limited exposure to business, management, and entrepreneurial activities, potentially leaving students underprepared for practice in this setting. US colleges and schools of pharmacy are uniquely positioned to address this gap by partnering with their community pharmacy APPE rotation sites to intentionally integrate business- and practice-focused knowledge, skills, and attitudes (KSAs) into the APPE. Equipping students with these KSAs may enhance early career readiness while also supporting the financial sustainability of US community pharmacies through the development of innovative, revenue-generating services. These efforts further align with the 2025 Accreditation Council for Pharmacy Education (ACPE) Standards and may help advance the profession. Future research should examine optimal community pharmacy APPE structures, models, and assessment strategies to maximize student preparedness and long-term community pharmacy sustainability. Full article

Background: The COVID-19 pandemic significantly altered the daily routines of young adults. This study investigated alcohol consumption patterns and associated factors among young adults in Romania during this period. Method: A cross-sectional study was conducted using an online survey. Participants were asked to retrospectively report their alcohol consumption patterns before and during the COVID-19 pandemic, including the period of university campus closures. A cohort of 249 young adults (68.6% female) participated in an online survey focused on their alcohol consumption patterns, utilizing the standardized AUDIT-C questionnaire and some modified questions to better establish the habit of drinking. Results: In total, 41.7% of the included subjects were in medical school, 10% in IT, and 44% in various areas of work. Most respondents were female, between 20 and 25 years old (65%) and living in urban areas, with wine being the most favorable drink. Regarding AUDIT scores, approximately 90% fall into low-risk drinking or even abstinence, 10% belong to the high-risk group of alcohol consumption, and 3 people have a high score, which suggests drinking abuse and the likelihood of developing alcohol dependence. A comparison of pre- to post-closure drinking among medical students showed statistically significant changes in the typical number of drinks per week (from 11.5 to 9.9) and maximum drinks per day (from 4.9 to 3.3) and a slight increase in typical drinking days per week (from 3 to 3.2), p < 0.05, outlining a decrease in alcohol consumption. Conclusions: The study highlights specific drinking patterns during the pandemic. While some individuals decreased consumption, a significant portion remained at risk for alcohol-related complications, emphasizing the need for targeted screening and prevention programs. Full article

School classrooms represent complex, interconnected systems where indoor environmental quality critically influences student health, cognitive performance, and educational equity. Yet traditional approaches operate in disciplinary silos, creating systemic failures in design, operation, and maintenance. This narrative review adopts a systems engineering framework to demonstrate how integrated interventions—spanning policy, design, technology, and operations—create resilient, sustainable, and healthy classroom climates. Amid escalating climate change impacts (rising temperatures, heatwaves, wildfires) and emerging threats (airborne pathogens, urban pollution), reactive measures like school closures prove pedagogically counterproductive. This review synthesizes evidence on natural, mechanical, and mixed-mode ventilation systems optimized through advanced control strategies, smart technologies, and health-centred policies. Key findings reveal that synergistic integration of Policy, Management, Construction, Operation, and Smart Technologies, in a systems engineering framework, outperforms singular strategies. Critical interventions include hybrid ventilation coupled with layered defences (HEPA filtration, UVGI), AI-driven adaptive controls using IoT sensors and Model Predictive Control to optimize energy while managing pollutant concentrations, and mandatory IAQ standards rooted in stakeholder education. By framing classrooms as interconnected engineering systems, this work provides actionable insights for architects, engineers, policymakers, and administrators, positioning future school design toward resilience, sustainability, and human-centred health outcomes. Full article

Early pandemic disruptions exposed critical vulnerabilities in special education systems, particularly in referral and evaluation processes governed by the Individuals with Disabilities Education Act (IDEA). This convergent mixed-methods study examined how 86 educational diagnosticians across Louisiana experienced and responded to these disruptions. Quantitative results showed a 38% decline in referrals during school closures followed by a 62% rebound, prolonged evaluation timelines, and notable increases in emotional/behavioral disabilities, other health impairments, and specific learning disabilities. Qualitative findings elaborated on these patterns, revealing challenges related to assessment validity, communication barriers, workload strain, and professional learning needs. Interpreted through systems theory and planetary health frameworks, the findings position special education evaluation systems as critical social infrastructure that links educational continuity, equity, and population well-being. Strengthening diagnostic capacity, digital infrastructure, and crisis-responsive practices is therefore essential not only for IDEA compliance, but for advancing planetary health goals related to resilience, justice, and sustainable human development. Full article

Community detection plays a central role in understanding the modular structure of complex networks. This work introduces Spider Community Detection, a hybrid local–global algorithm that constructs communities through a depth-bounded geodesic expansion process. Each spider originates from a structurally strong seed node selected using a composite score based on degree, triangle participation, and local clustering. From each seed, the algorithm grows a localized spider-shaped subgraph through bounded breadth-first exploration, where candidate nodes are evaluated using true modularity gain together with a triangle-closure signal. After the initial spider construction, the method applies modularity-guided attachment of the remaining vertices, Louvain-style local refinement, and greedy merge matching under conductance constraints to reconcile local structure with global partition coherence. Experimental evaluations on real and benchmark datasets, including Karate Club, High School, Political Blogs, Cora, and DBLP, show that Spider produces partitions that are competitive with the established methods in terms of ground-truth recovery and structural quality, while yielding communities with sharp boundaries under conductance-sensitive evaluation. Full article

Background and Objectives: Public health emergencies, such as the COVID-19 pandemic, significantly impact individuals and families, particularly in educational settings. School closures and changes in daily routines reduced students’ opportunities for learning and social interaction, affecting their mental health. Caregivers also faced increased responsibilities and stressors. This study aimed to evaluate a predictive model of mental health outcomes—specifically posttraumatic stress symptoms (PTSSs) and posttraumatic growth (PTG)—in Chilean schoolchildren and their caregivers. Materials and Methods: A total of 489 students (48% female sex; aged 10–17) from educational communities in various Chilean cities participated in the study, along with their caregivers (aged 21–69; 86.5% female), including mothers, fathers, and guardians. Mental health variables were assessed through self-report instruments. Hierarchical linear regression and path analyses were used to evaluate predictive models for PTSSs and PTG in students. Results: The model predicting PTSSs in students was significant. Key predictors included female sex, aggressive behavior, coping strategies such as keeping problems to oneself, cognitive avoidance, and intrusive rumination, and caregiver PTSSs. The model for PTG was also significant, with predictors including active problem-solving, communication, a positive attitude, and deliberate rumination. These results indicate distinct psychological processes underlying negative and positive outcomes following trauma. Conclusions: The findings underscore the complexity of mental health outcomes among school-aged children and the influence of caregiver well-being. The study highlights the importance of supporting both students and caregivers through targeted interventions. Multi-level strategies addressing emotional regulation, communication, and coping mechanisms may foster resilience and psychological growth in educational communities facing the aftermath of public health emergencies. Full article

Background/Objectives: This ecological study aimed to investigate changes in the time-varying reproduction number (Rt) of SARS-CoV-2 across six regions of Massachusetts from 2020 to 2022 and to evaluate the impact of various nonpharmaceutical interventions (NPIs) implemented in 2020 by examining associated changes in the Rt. Methods: COVID-19 incident case data from the Johns Hopkins University database were adjusted for reporting delays using deconvolution and for underreporting via a Poisson-distributed multiplier of 4. Negative and zero counts were corrected using imputation. Rt was estimated using R package EpiEstim (Version 2.2-4) with a 7-day sliding window from 2020 to 2022 and with non-overlapping time windows between policy changes in 2020. Results: From 2020 to 2022, Massachusetts experienced five COVID-19 surges, linked to the wild-type strain and emerging variants, with Rt exceeding 1 during each wave and stabilizing at or dropping below 1 during low-incidence phases. School closure and gathering restrictions, the first major intervention, were associated with a 14.7% statewide reduction in Rt (95% credible interval (CrI): −23.6%, −5.6%), with greater reductions in high-density areas such as Boston (−16.9%; 95% CrI: −26.9%, −7.5%). No statistically significant changes in Rt were found to be associated with other NPIs in 2020, including the mask mandate, reopening phases, travel restrictions and quarantine requirements, and curfews. Conclusions: Our findings highlight the different NPIs’ varying impacts on COVID-19 transmission dynamics across regions in Massachusetts in 2020 and underscore the importance of early interventions for future pandemic preparedness. Full article

This study examines how the explanations about school violence are constructed in Chilean online newspapers after the country—which had the longest period of school closures—returned to in-person classes. During early 2022, several complaints of school violence surged compared to the lockdown years, prompting questions about how the media shaped public interpretations of this rise. Using a content analysis of three Chilean online newspapers (“SoyChile”, “ElMostrador”, and “LUN”), this study reconstructed the Subjective Theories (STs) conveyed in their coverage. All articles (n = 50) published during three strategic periods of the 2022 school year were analyzed to identify explicit and implicit theories about the causes, intervening conditions, and strategies for addressing school violence. The most prevalent ST framed school violence as a structural problem, appearing 27 times. This narrative portrays the phenomenon as both inevitable and beyond the control of key actors, such as caregivers, teachers, school leaders, authorities, and students, ultimately reducing perceived accountability and agency in prevention or intervention efforts. Media discourse tended to legitimize explanations that locate school violence outside the sphere of individual or institutional responsibility. Full article

Children remain underrepresented in environmental health studies, and evidence on how climate-related exposures affect pediatric health and school absenteeism is limited. This pilot cross-sectional study reports pediatric symptoms, school attendance, and perceptions of climate change among 300 Bangladeshi children ages 6–12 years old in three sites: Barhatta, Galachipa, and Sarankhola. Health status, climate-related perception, and educational disruption were assessed with validated questionnaires. Clinical staff measured peak expiratory flow rate, hemoglobin, and blood lead concentrations. Rash (48%), asthma (21%), and positive screening for epilepsy (17%) were most prevalent in Sarankhola. Mean hemoglobin was lower in Sarankhola (11.0 g/dL) than in the other sites. Awareness of climate change was 100% in Galachipa and Sarankhola, while 32% in Barhatta, with television and health workers being the common sources of information. Almost one in every three children missed at least three days of school in the last month with illness, climate-related emergencies, and unexpected school closures being frequent causes. These findings indicate that Bangladeshi children, especially those living in coastal areas, face the health and educational risks related to climate change, and that longitudinal and environmental monitoring studies are needed. Full article

The present study aimed to evaluate the effect of maternal involvement in children’s home-based learning activities during the COVID-19 lockdown on mothers’ parenting stress, the quality of maternal care perceived by offspring, and the level of children’s internalizing/externalizing symptoms. This study recruited 415 subjects from the general population. To assess parenting stress, mothers were administered the Parenting Stress Index–Short Form; to assess children’s perceived quality of maternal care, this study used the Parental Bonding Inventory; and the Child Behavior Checklist/6–18 was used to assess internalizing/externalizing symptoms in children. Correlations showed that the amount of time spent by the mother supervising children’s self-study was highly and positively correlated with parental stress and offspring’s externalizing (but not internalizing) symptoms, and highly and positively correlated with the subscale of maternal overprotection in the children’s perceived quality of maternal care. Moreover, the multiple regression analyses conducted based on the above significant correlations showed that the amount of time spent by the mother overseeing children’s study was associated with parental stress, children’s externalizing symptoms, and maternal overprotection. Overall, the current study contributes to showing the burden families had to face as a result of school closures and accompanying distance learning during the COVID-19 epidemic. Full article

Transportation systems are particularly vulnerable to disruptions such as pandemics, which create significant challenges for maintaining efficiency, safety, and service quality. This study focuses on rail passenger transport in the Slovak Republic and develops a simulation framework to evaluate system performance under crisis conditions. Weekly data from the national rail operator for the period 2019–2021 were combined with information on governmental restrictions, standardized into a five-level framework. A nonlinear autoregressive model with exogenous inputs (NARX), implemented and validated in MATLAB R2021b (MathWorks, Natick, MA, USA), was applied to simulate the impact of restrictive measures on passenger demand. The results revealed a strong relationship between the severity of measures and ridership levels, with the most significant effects observed in education, workplace access, movement limitations, and retail. For instance, during complete school closures, passenger volumes declined by up to 75% relative to the pre-pandemic baseline. Based on the simulation outcomes, recommendations were formulated for adapting railway operations, including dynamic adjustments of transport capacity (10–40%) according to restriction levels. The proposed modelling and simulation approach offers transport authorities a cost-effective tool for scenario testing, disruption management, and the design of resilient passenger rail systems capable of adapting to crises and uncertainties. Full article

The year 2025 marks the fifth anniversary of the COVID-19 pandemic, a crisis that profoundly disrupted secondary schools in England and intensified existing inequalities, including those experienced by LGBTQ+ students. Through an analysis of teacher interviews and the lens of intimate citizenship, this article explores how pandemic-driven changes, such as remote learning, school closures, and ‘social bubbles’, exposed the precariousness of LGBTQ+ inclusion and embodiment within educational institutions. The research highlights how cisheteronormativity was sustained through symbolic institutional compliance and cisheteronormative fragility, as LGBTQ+ inclusion was deprioritised through the erasure of safe spaces and restrictions on self-expression. While previous research has primarily focused on students’ well-being, this article centres the perspectives of teachers to consider what can be learned from their experiences to better support students in future crises. The pandemic revealed critical gaps in inclusion efforts, underscoring the urgent need for proactive strategies that extend beyond individual teacher initiatives or informal, hidden curriculum practices. The findings emphasise that LGBTQ+ visibility and inclusion must be structurally embedded within curricula, school policies, and teacher training and that the emotional and relational labour of inclusion must be institutionally recognised rather than left to individual educators. Full article

School refusal behavior, defined as a child’s prolonged voluntary absence from school for reasons unrelated to illness and/or economic hardship, is a growing concern in Japan. The COVID-19 pandemic has worsened this issue by disrupting children’s lives. This review summarizes the prevalence, contributing factors, and health implications of school refusal, particularly in the context of COVID-19. A literature review of government reports and PubMed-indexed studies indicates that school refusal in Japan has been rising for eleven years, reaching a record 340,000 cases in 2023. Middle school students (6.7%) were the most affected, followed by elementary school students (2.1%). The pandemic intensified school-related, family-related, and child-related risk factors. School closures disrupted routines, reduced peer interactions, and increased social isolation, contributing to higher rates of anxiety and depression. Reports of suicides and mental health disorders among children have also surged. Family stressors, including economic hardship and parental mental health struggles, further exacerbate school refusal. Additionally, remote learning has widened socioeconomic disparities in access to education, leaving vulnerable children at greater risk. Addressing school refusal requires a multifaceted approach involving schools, families, healthcare providers, and policymakers. School-based interventions, mental health approach, and flexible educational programs would be essential. The Japanese government’s “COCOLO Plan” represents progress toward a more inclusive education system, and a comprehensive, interdisciplinary strategy is needed. Ensuring all children receive the necessary support to reengage with education is critical to overcoming the long-term challenges posed by school refusal. Full article

Background: The COVID-19 pandemic exposed major structural deficiencies in global health governance, including stark inequities in vaccine access, intervention timing, and mortality outcomes. While economic resources played a role, the influence of governance performance remains insufficiently examined. This study addresses a significant gap by integrating governance metrics with pandemic response data to assess how governance quality, independent of income level, affected national outcomes. Although the Oxford COVID-19 Government Response Tracker (OxCGRT) dataset has been widely used to document policy responses, this study offers a novel contribution by linking these policy interventions with governance performance and evaluating their joint effect on health outcomes and vaccine equity. Methods: This mixed-methods study combines quantitative analysis of global datasets with a qualitative literature review. Quantitative data were mainly obtained from the Oxford COVID-19 Government Response Tracker (OxCGRT), the World Bank’s Worldwide Governance Indicators (WGIs), and World Bank/WHO databases. A governance performance index was constructed using two WGI components: Government Effectiveness and Regulatory Quality. Countries were grouped into high, medium, or low governance categories. Statistical tests included ANOVA, Kaplan Meier survival analysis, and multivariable OLS regression. The qualitative component reviewed 45 academic and institutional sources on governance performance during COVID-19. Results: Countries with high governance performance had earlier public health interventions, lower mortality, and broader vaccine coverage, independent of income level. Kaplan Meier analysis revealed faster school closures in these countries (p < 0.01). Multivariable regression showed governance remained a significant predictor after adjusting for income and health spending. Qualitative findings highlighted recurring weaknesses in legal enforceability, intergovernmental coordination, and global financing mechanisms. Conclusions: Governance performance had a decisive impact on pandemic outcomes. The COVID-19 crisis revealed the need for robust governance systems capable of responding to complex emergencies that extend beyond the health sector into institutional, economic, and social spheres. Full article