Search Results (686)

Background and Objectives: The long-term renal and cardiovascular effects of neonatal acute kidney injury (AKI) in preterm infants remain unclear. This study investigated whether neonatal AKI leads to persistent subclinical kidney injury and blood pressure changes in school-aged children born preterm. Methods: In this prospective cohort, preterm-born children (≤35 weeks’ gestation) with (n = 19) and without (n = 38) neonatal AKI were evaluated at 7–12 years. A term-born control group (n = 44) was included for biomarker comparison. Assessments included perinatal data, anthropometry, office and ambulatory blood pressure monitoring (ABPM), and renal ultrasonography. Kidney function was evaluated using serum creatinine (sCr), cystatin C, and estimated glomerular filtration rate (eGFR). Tubular injury was assessed using urinary kidney injury molecule-1/Cr (KIM-1/Cr), neutrophil gelatinase-associated lipocalin/Cr (NGAL/Cr), and trefoil factor 3/Cr (TFF3/Cr) ratios, as well as serum TFF3. Results: Conventional kidney function markers were similar among groups. However, the AKI group had higher serum cystatin C, lower cystatin C–based eGFR, and elevated urinary KIM-1/Cr and NGAL/Cr compared to no-AKI and term controls. Serum TFF3 was also higher in the AKI group. ABPM revealed higher nocturnal systolic blood pressure and blood pressure load in the AKI group. Kidney size did not differ between preterm subgroups. Conclusions: Neonatal AKI in preterm infants is associated with subtle alterations and potential renal stress or injury at school age, detectable only with sensitive biomarkers and ABPM. Further prospective studies are needed to validate these biomarkers and determine their role in predicting long-term outcomes in preterm infants with neonatal AKI. Full article

Aims/Background: Polypharmacy, or the concurrent intake of five or more medications, is a significant issue in clinical practice, particularly in multimorbid elderly individuals. Despite its importance for patient safety, medical education often lacks systematic training in recognising and managing polypharmacy within the framework of patient-centred care. We investigated the impact of a structured learning intervention introducing polypharmacy as a chronic condition, assessing whether it enhances medical students’ diagnostic competence, confidence, and interprofessional collaboration. Methods: A prospective cohort study was conducted with 50 final-year medical students who received a three-phase educational intervention. Phase 1 was interactive workshops on the principles of polypharmacy, its dangers, and diagnostic tools. Phase 2 involved simulated patient consultations and medication review exercises with pharmacists. Phase 3 involved reflection through debriefing sessions, reflective diaries, and standardised patient feedback. Student knowledge, confidence, and attitudes towards polypharmacy management were assessed using pre- and post-intervention questionnaires. Quantitative data were analysed through paired t-tests, and qualitative data were analysed thematically from reflective diaries. Results: Students demonstrated considerable improvement after the intervention in identifying symptoms of polypharmacy, suggesting deprescribing strategies, and working in multidisciplinary teams. Confidence in prioritising polypharmacy as a primary diagnostic problem increased from 32% to 86% (p < 0.01), and knowledge of diagnostic tools increased from 3.1 ± 0.6 to 4.7 ± 0.3 (p < 0.01). Standardised patients felt communication and patient-centredness had improved, with satisfaction scores increasing from 3.5 ± 0.8 to 4.8 ± 0.4 (p < 0.01). Reflective diaries indicated a shift towards more holistic thinking regarding medication burden. The small sample size limits the generalisability of the results. Conclusions: Teaching polypharmacy as a chronic condition in medical school enhances diagnostic competence, interprofessional teamwork, and patient safety. Education is a structured way of integrating the management of polypharmacy into routine clinical practice. This model provides valuable insights for designing medical curricula. Future research must assess the impact of such training on patient outcomes and clinical decision-making in the long term. Full article

This study addresses fairness in machine learning for student academic performance prediction using the UCI Student Performance dataset. We comparatively evaluate logistic regression, Random Forest, and XGBoost, integrating the Synthetic Minority Oversampling Technique (SMOTE) to address class imbalance and 5-fold cross-validation for robust model training. A comprehensive fairness analysis is conducted, considering sensitive attributes such as gender, school type, and socioeconomic factors, including parental education (Medu and Fedu), cohabitation status (Pstatus), and family size (famsize). Using the AIF360 library, we compute the demographic parity difference (DP) and Equalized Odds Difference (EO) to assess model biases across diverse subgroups. Our results demonstrate that XGBoost achieves high predictive performance (accuracy: 0.789; F1 score: 0.803) while maintaining low bias for socioeconomic attributes, offering a balanced approach to fairness and performance. A sensitivity analysis of bias mitigation strategies further enhances the study, advancing equitable artificial intelligence in education by incorporating socially relevant factors. Full article

Academic performance has become a consolidated indicator of a nation’s educational and social equity. Consequently, increasing attention has been paid to determining the factors associated with school performance, particularly in the case of students with extreme academic outcomes. The aim of this study is to identify and compare the factors related to the level of mathematical competence of Spanish students with low and high levels of achievement, based on data from the Spanish sample of PISA 2022 (n = 30,800). The results of the multilevel quantile regression analysis reveal that the social, economic, and cultural status of the students have a significant and positive effect on both groups. Other variables, such as gender, grade repetition, and length of pre-primary education, show differentiated effects depending on the level of competence. Moreover, school-related factors, such as school location and competition among centres, exhibit opposite effects. Finally, aspects such as school ownership, average class size, and the degree of curricular autonomy only have a significant impact on the mathematical competence of low-achieving students. These findings highlight the need for differentiated educational policies that address the specific needs of each group of students. Full article

Background/Objectives: Hispanic adolescents experience elevated rates of disordered eating behaviors and body dissatisfaction, yet limited research has examined how gender and weight status interact to shape these risks within this population. Methods: A cross-sectional survey was conducted among 680 Hispanic adolescents (ages 9–15) from a predominantly Mexican-American middle school. Participants completed the Modified Kids Eating Disorder Survey (M-KEDS), and height and weight were objectively measured to determine BMI-for-age percentile. Chi-square tests, Mann–Whitney U tests, and logistic regression were used to assess differences by gender and weight status, including interaction effects. Bonferroni correction was applied for multiple comparisons. Effect sizes (Cramér’s V, odds ratios with 95% CI) were reported. Results: Approximately 73% of participants reported body dissatisfaction, with significant differences observed by gender and weight status. Adolescents with overweight/obesity reported significantly higher negative weight attitudes and extreme weight control behaviors than healthy-weight peers (p < 0.001), with large effect sizes. Females endorsed more disordered attitudes and behaviors, except for exercise to lose weight, which was more common among overweight/obese males. Conclusions: These findings underscore the high prevalence and significance of disordered eating behaviors in Hispanic adolescents, including those at a healthy weight. Results highlight the importance of culturally tailored, gender-sensitive screening and prevention strategies. Schools serve as critical settings for early identification, and tools like the M-KEDS can help address disparities in care access and improve outcomes among Hispanic youth. Full article

Emergency preparedness training in organizations frequently involves simple evacuation drills triggered by fire alarms, limiting the opportunities for broader skill development. Digital technologies, particularly virtual reality (VR), offer promising methods to enhance learning for handling incidents and evacuations. However, implementing VR-based training remains challenging due to unclear integration strategies within organizational practices and a lack of empirical evidence of VR’s effectiveness. This paper explores how VR-based training tools can be implemented in schools to enhance emergency preparedness among students, teachers, and staff. Following a design science research process, data were collected from a questionnaire-based study involving 12 participants and an exploratory study with 13 participants. The questionnaire-based study investigates initial attitudes and willingness to adopt VR training, while the exploratory study assesses the VR prototype’s usability, realism, and perceived effectiveness for emergency preparedness training. Despite a limited sample size and technical constraints of the early prototype, findings indicate strong student enthusiasm for gamified and immersive learning experiences. Teachers emphasized the need for technical and instructional support to regularly utilize VR training modules, while firefighters acknowledged the potential of VR tools, but also highlighted the critical importance of regular drills and professional validation. The relevance of the results of utilizing VR in this context is further discussed in terms of how it can be integrated into university curricula and aligned with other accessible digital preparedness tools. Full article

Background: Childhood obesity is a significant public health issue linked to poor diet, low physical activity, and limited access to supportive environments. Green schoolyards may promote physical activity and improve health outcomes. This study evaluated the impact of the Green Healthy Primary School of the Future (GHPSF) intervention—greening schoolyards—on children’s BMI z-scores, waist circumference, and hip circumference over 18 months, and compared these effects to those observed in the earlier Healthy Primary School of the Future (HPSF) initiative. Methods: This longitudinal quasi-experimental study included two intervention and two control schools in Limburg, a province both in the Netherlands and Belgium. Children aged 8–12 years (n = 159) were assessed at baseline, 12 months, and 18 months for anthropometric outcomes. Linear mixed models were used to estimate intervention effects over time, adjusting for sex, age, country, and socioeconomic background. Standardized effect sizes (ESs) were calculated. Results: The intervention group showed a greater reduction in BMI z-scores at 12 months (ES = −0.15, p = 0.084), though this was not statistically significant. Waist circumference increased in both groups, but less so in the intervention group, at 12 months (ES = −0.23, p = 0.057) and 18 months (ES = −0.13, p = 0.235). Hip circumference and waist–hip ratio changes were minimal and non-significant. GHPSF effect sizes were comparable to or greater than those from the HPSF initiative. Conclusions: Though not statistically significant, trends suggest that greening schoolyards may support favorable changes in anthropometric outcomes. Further research with larger samples and longer follow-up is recommended. Full article

Youth unemployment remains a pressing issue in many emerging economies, where educational disparities and demographic pressures interact in complex ways. This study investigates the links between higher-education enrolment, demographic structure and youth unemployment in eight developing countries from 2009 to 2023. Panel cointegration techniques—Fully Modified Ordinary Least Squares (FMOLS) and Dynamic Ordinary Least Squares (DOLS)—are applied to estimate the long-run effects of gross tertiary-school enrolment on youth unemployment while controlling for GDP growth and youth-cohort size. Robustness is confirmed through complementary estimations with pooled-mean-group ARDL and system-GMM panels, which deliver consistent coefficient signs and significance levels. Results show a significant negative elasticity between enrolment and youth unemployment, indicating that wider access to higher education helps lower joblessness among young people. Youth-population growth exerts an opposite, positive effect, while GDP growth reduces unemployment but less uniformly across regions. The evidence points to an integrated policy mix—expanding tertiary (especially vocational and technical) education, managing demographic pressure and maintaining macro-economic stability—to improve youth-employment outcomes in emerging economies. Full article

Background/Objectives: This exploratory study examined the potential effectiveness of cognitive enhancement interventions targeting basic cognitive prerequisites and communicative abilities in girls with Rett syndrome. Special attention was given to evaluating telerehabilitation as a feasible alternative to traditional in-person therapy, particularly for individuals with severe impairments and limited access to care. Methods: Twenty-four girls diagnosed with Rett syndrome (mean age = 13.7 years, SD = 7.1), all meeting the basic cognitive prerequisites defined by the GAIRS scale, were randomly assigned to two groups: a telerehabilitation group (n = 12) and an in-person rehabilitation group (n = 12). Interventions were delivered in school settings and focused on two core areas: basic cognitive skills (e.g., object recognition, spatial and temporal concepts, form and color discrimination, and cause–effect reasoning) and communication skills (e.g., comprehension and expression through gestures, images, or verbal output). Results: Both groups showed significant improvements in the cognitive and communicative domains, with generally comparable outcomes. Notably, the telerehabilitation group demonstrated relatively greater gains in verbal expression and cause–effect understanding. Correlational analyses indicated positive associations between the cognitive and communicative improvements, particularly between spatial understanding and expressive abilities. However, these findings should be interpreted with caution due to the sample size and study design limitations. Conclusions: These preliminary findings suggest that cognitive enhancement programs may support developmental gains in girls with Rett syndrome and that telerehabilitation could represent a viable alternative for those unable to access in-person care. Given the limited sample size and absence of qualitative measures, further research is necessary to validate its effectiveness and understand its role within comprehensive care models. Full article

Background/Objectives: Children with above-average cognitive functioning often present complex developmental profiles, combining high cognitive potential with heterogeneous socio-emotional and learning trajectories. Although the cognitive and behavioral characteristics of giftedness have been widely studied in Anglophone countries, evidence remains limited in Southern Europe. This study aimed to investigate the cognitive, academic, and emotional–behavioral profiles of Italian children and adolescents with above-average cognitive functioning, using an inclusive, dimensional approach (IQ > 114). Methods: We analyzed a cross-sectional sample of 331 children and adolescents (ages 2.11–16.5 years), referred for clinical cognitive or behavioral evaluations. Participants were assessed using the WPPSI-III or WISC-IV for cognitive functioning, the MT battery for academic achievement, and the Child Behavior Checklist (CBCL) for emotional and behavioral symptoms. Comparative and correlational analyses were performed across age, gender, and functional domains. A correction for multiple testing was applied using the Benjamini–Hochberg procedure. Results: Gifted participants showed strong verbal comprehension (mean VCI: preschoolers = 118; school-aged = 121) and relative weaknesses in working memory (WM = 106) and processing speed (PS = 109). Males outperformed females in perceptual reasoning (PR = 121 vs. 118; p = 0.032), while females scored higher in processing speed (112 vs. 106; p = 0.021). Difficulties in writing and arithmetic were observed in 47.3% and 41.8% of school-aged participants, respectively. Subclinical internalizing problems were common in preschool and school-aged groups (mean CBCL T = 56.2–56.7). Working memory negatively correlated with total behavioral problems (r = −0.13, p = 0.046). Conclusions: These findings confirm the heterogeneity of gifted profiles and underscore the need for personalized educational and psychological interventions to support both strengths and vulnerabilities in gifted children. Caution is warranted when interpreting these associations, given their modest effect sizes and the exploratory nature of the study. Full article

Objectives: This study evaluated the effectiveness of Experience New Days (END), a school-based smoking cessation program, on smoking dependence and mental health among Korean adolescent smokers. Methods: A single-group pretest–posttest study was conducted from April to June 2024 with 40 adolescent smokers from three high schools. The program consisted of weekly 50 min sessions over an 8-week period. Smoking dependence was measured using FTND and CDS-12, while mental health was assessed through PHQ-9 and GAD-7. Urine cotinine test was used as a biomarker. Results: The results showed significant improvements with moderate to large effect sizes in nicotine dependence (p = 0.033, d = 0.25), cigarette dependence (p = 0.034, d = 0.31), depression (p = 0.013, d = 0.37), and anxiety (p = 0.043, d = 0.40). Daily cigarette consumption decreased by an average of 2.57 cigarettes per day (p = 0.002, d = 0.52), with 15% of participants achieving complete smoking cessation and 42.5% showing reduced smoking behaviors. Conclusions: The results suggest that the END program was associated with reduced dependence and improved mental health outcomes among adolescent smokers. The positive memory reinforcement had a beneficial effect on mental health. Full article

The number of studies suggesting that social networking services (SNSs) use poses a risk to children’s body image continue to expand, but most studies have focused on adolescents. The study aimed to examine the associations between SNS use and body image among elementary school children in Japan. This study examined the relationship between SNSs use and body size perception and preference, body size misperception, and ideal body image among 1261 preadolescents (611 boys and 650 girls), aged 8–12 years (mean age = 9.64; SD =1.15; 52% girls), separately by sex. Using hierarchical multivariate linear regression analyses and logistic regression analyses, we examined body image factors and SNS use as the dependent and independent variables, respectively. Findings indicate that children who use SNSs do not significantly differ from nonusers regarding body dissatisfaction. However, SNS use is positively associated with body size misperception in girls. Additionally, for boys and girls, SNS use seems to increase the likelihood of admiring the body image of media figures rather than friends or classmates. Understanding how SNS use influences body image remains important for promoting healthy development in children. Full article

Background/Objectives: Systemic sclerosis (SSc) is a multisystemic chronic autoimmune disease, which leads to disability and possibly early retirement. The objective of our study was to explore the associations between employment status (ES) and demographic, clinical and functional features in a single-center EUSTAR cohort. Methods: Consecutive patients with SSc examined between November 2011 and June 2023, who were under the age of retirement in our country (62 years for women, 65 for men at the time), were included. All patients underwent a comprehensive clinical assessment and filled in a work assessment questionnaire as well as two validated health-related questionnaires: the Scleroderma Health Assessment Questionnaire (SHAQ) and the Duruoz Hand Index (DHI). Associations between ES and potential predictors (education level, disease characteristics, work conditions, SHAQ and DHI) were tested using logistic regression adjusted for age and gender. Results: Ninety-one patients (mean ± SD age 53.7 ± 11.8 years, twenty-two with diffuse skin involvement, fifty-six with a history of digital of digital ulcers (DUs)), were included. Only 22 patients were still employed, while 69 were retired, of which 38 retired because of SSc. Among the employed, nine performed manual labor, nine spent many hours standing and three had to work in a cold environment. When potential predictors were tested separately, adjusted for age and sex, patients with higher education (OR (95% CI) 11.36 (2.03–63.36), p = 0.006) and no history of digital ulcers had higher odds of being employed. The presence of joint contractures and weightlifting as a work demand were associated with unemployment. In a multivariable model, higher education (OR 5.91, 95% CI 0.97–36.09, p = 0.054 and younger age (OR 0.90, 95% CI 0.85–0.96, p = 0.001) were independently associated with continued employment. High school education did not show a significant effect (OR 0.089, 95% CI 0.015–0.530, p = 0.008). Patients with a history of digital ulcers had the lowest employment rates compared to those with no digital ulcer history. No significant associations were found between employment status and SHAQ or DHI scores. Conclusions: SSc is associated with significant work disability and early retirement. Higher education, the lack of Dus and younger age were highly associated with staying employed. Given the rarity of SSc, we consider that our good sample size (n = 91) reflects disease prevalence, but results should be tested in other studies and the single center should be considered when interpreting generalizability. Full article

This study investigates the factors affecting the choice of school travel mode among students in Mersin, Türkiye, focusing on walking, private car, public transit and school bus. A two-step modeling approach was adopted. First, a latent class cluster analysis (LCCA) was applied to identify subgroups of students with similar characteristics. Then, separate multinomial logit (MNL) models were estimated for each cluster. The data come from the 2022 Urban Transport Master Plan household survey and include 2798 students from 2092 households. The results show that trip distance is the most consistent and significant factor across all clusters, as increasing distance makes students more likely to use motorized modes instead of walking. Gender also demonstrates a consistent influence in specific clusters, where male students are less likely to travel by private car. Similarly, residing in a single-family house consistently increases the likelihood of car use in multiple clusters. Conversely, the influence of household structure, parental education, income, and household size differs significantly between clusters, underlining the importance of considering group-level differences in school travel behavior. These findings suggest that policies aiming to promote sustainable school travel should be sensitive to the needs of different student groups. Integrating land use and transportation planning may help to support active and shared modes of travel. Full article

This study compares the views of mathematics teachers in private and public schools on mathematics education during the COVID-19 pandemic from their perspectives after the pandemic, focusing on factors influencing secondary and high school mathematics education. In this study, the survey method was used to collect data. The survey method was employed to obtain information for this investigation. During the 2023–2024 school year, 644 math teachers took part in the study. Of these, 260 were from private schools, and 384 were from public schools. There are 10,323 teachers in public schools and 694 in private schools, and this sample size is more than the 371 participants that are needed for statistical purposes (based on Cochran’s formula at a 95% confidence level and a 5% margin of error). A scale consisting of thirteen 5-point Likert-type questions was developed by researchers for data collection, and mathematical modeling techniques were employed. Factor analysis using SPSS 24.00 revealed four key factors influencing teachers’ responses: teachers’ professional development and support, job satisfaction, students’ engagement, and teaching experience. The results highlight significant disparities between public and private schools in mathematics education, attributed to various factors to be elucidated further in the subsequent discussion. Full article