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17 pages, 1065 KB  
Article
Excess Weight and Dyslipidemia in Seri (Comcáac) Indigenous Children: A Cross-Sectional Study of Prevalences and Associated Factors
by Yazmín Hugues Ayala, María A. Leal-Serna, Yamili Rojo-Medina, José M. Moreno-Abril, Ana C. Gallegos-Aguilar, Heliodoro Alemán-Mateo, Silvia Y. Moya-Camarena, Araceli Serna-Gutiérrez, Karely Pérez-Gil and Julián Esparza-Romero
Epidemiologia 2026, 7(3), 84; https://doi.org/10.3390/epidemiologia7030084 - 16 Jun 2026
Viewed by 162
Abstract
Background/Objectives: Excess weight and dyslipidemia are health conditions growing worldwide in children, including indigenous populations. The concern is their related comorbidities, which could appear at an early age. Given limited information on Seri children, this study aimed to evaluate the prevalence of [...] Read more.
Background/Objectives: Excess weight and dyslipidemia are health conditions growing worldwide in children, including indigenous populations. The concern is their related comorbidities, which could appear at an early age. Given limited information on Seri children, this study aimed to evaluate the prevalence of excess weight and dyslipidemia, and to identify factors associated with BMI-for-age Z-score and dyslipidemia. Methods: This cross-sectional study was conducted among Seri children aged 3–11 years. For prevalence analysis, the BMI-for-age Z-score was calculated as an indicator of excess weight. Dyslipidemia was assessed only in school-age children. Information was collected on potential associated variables, including maternal nutritional status, children’s sleep behaviors, physical activity, diet, and cardiovascular health, as well as household characteristics such as the modernity index and food insecurity. Results: A total of 154 Seri children were evaluated. Among preschoolers, 18.8% were classified at risk of overweight. In school-age children, the combined prevalence of overweight and obesity was 32.8%. Maternal BMI and weight, the modernity index, and being a boy were positively associated with the BMI-for-age Z-score, whereas having food insecurity, cardiovascular health score, and sleep time were negatively associated. Dyslipidemia prevalence was 46.1% among school-age Seri children. Having dyslipidemia was positively associated with maternal BMI, percentage of energy intake from ultra-processed products, paternal occupation as a merchant, and child age, and negatively associated with the number of remunerative maternal economic activities. Conclusions: These findings provide evidence on the prevalence of excess weight and dyslipidemia and their associated factors among Seri children and may inform future research and health strategies in Seri and other vulnerable populations. Full article
(This article belongs to the Special Issue Advances in Environmental Epidemiology, Health and Lifestyle)
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17 pages, 614 KB  
Systematic Review
Are School-Based Programs Effective in Tackling Childhood Obesity in Europe? A Systematic Review
by Cíntia Carneiro Gomes, Christos Triantafyllou and Joao Breda
Nutrients 2026, 18(12), 1916; https://doi.org/10.3390/nu18121916 - 12 Jun 2026
Viewed by 215
Abstract
Background: Childhood obesity remains a major public health challenge worldwide, with increasing prevalence across Europe. Schools represent an important setting for promoting healthy lifestyles through physical activity and nutrition-related interventions. This systematic review aimed to evaluate the effectiveness of school-based interventions promoting physical [...] Read more.
Background: Childhood obesity remains a major public health challenge worldwide, with increasing prevalence across Europe. Schools represent an important setting for promoting healthy lifestyles through physical activity and nutrition-related interventions. This systematic review aimed to evaluate the effectiveness of school-based interventions promoting physical activity and healthy eating behaviours among children and adolescents aged 6–18 years in European countries. Methods: A systematic literature review was conducted using PubMed and Scopus. Studies were eligible if they were conducted in school settings, targeted children and adolescents aged 6–18 years, were implemented in European countries, had a minimum duration of nine months, and assessed anthropometric and/or behavioural outcomes related to obesity prevention. Methodological quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Results: Sixteen studies conducted across nine European countries met the inclusion criteria. Intervention duration ranged from nine months to five years, and most studies employed multicomponent approaches combining physical activity promotion, nutrition education, environmental modifications, and parental involvement. Seven studies were rated as strong quality, six as moderate quality, and three as weak quality. Among the fourteen studies assessing BMI or other anthropometric outcomes, eleven (78.6%) reported statistically significant improvements in at least one obesity-related measure, including BMI, BMI z-score, waist circumference, waist-to-height ratio, body fat percentage, or overweight/obesity prevalence. Evidence regarding physical activity and nutrition-related outcomes was more heterogeneous, although several studies reported improvements in dietary behaviours, nutrition knowledge, sedentary behaviour, and physical activity levels. Positive anthropometric effects were more commonly observed in interventions lasting at least one academic year and in multicomponent programmes. Some studies also reported differential effects according to sex and parental educational background. Conclusions: The findings of this review suggest that long-term, multicomponent school-based interventions can contribute to improving obesity-related anthropometric outcomes among children and adolescents in European countries. However, evidence regarding sustained changes in physical activity and dietary behaviours remains less consistent. Future research should focus on identifying the most effective intervention components and strategies for achieving long-term behavioural change across diverse populations and educational contexts. Full article
(This article belongs to the Special Issue Nutritional Strategies in Pediatric Obesity and Metabolic Health)
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17 pages, 407 KB  
Article
School-Based Intervention to Improve Nutrition Knowledge and Lifestyle Awareness Among Adolescents: Results from an Italian Quasi-Experimental Study
by Gaia D’Antonio, Vincenza Sansone, Giovanna Paduano and Gabriella Di Giuseppe
Nutrients 2026, 18(12), 1861; https://doi.org/10.3390/nu18121861 - 9 Jun 2026
Viewed by 164
Abstract
Background/Objectives: Adolescence is a critical period for the adoption of health-risk behaviors and the development of non-communicable diseases (NCDs). Schools represent a strategic setting for health promotion interventions; however, Italian studies simultaneously assessing NCD-prevention knowledge and lifestyle behaviors in the same adolescent population [...] Read more.
Background/Objectives: Adolescence is a critical period for the adoption of health-risk behaviors and the development of non-communicable diseases (NCDs). Schools represent a strategic setting for health promotion interventions; however, Italian studies simultaneously assessing NCD-prevention knowledge and lifestyle behaviors in the same adolescent population remain scarce. The study aimed to evaluate improvements in knowledge regarding nutrition and other lifestyle-related behaviors among Italian adolescents following a school-based educational intervention. Secondary objectives included describing lifestyle behaviors within the study population and exploring participants’ evaluation of the intervention. Methods: A quasi-experimental pre-post study was conducted between March and May 2025 in five lower secondary schools. A total of 410 adolescents aged 11–16 years were enrolled through a two-stage cluster sampling procedure. The intervention, lasting approximately two hours, was delivered by a trained nurse-researcher and addressed four health domains: nutrition, physical activity, screen exposure, and substance use. Results: Following the intervention, a measurable increase in overall knowledge scores (mean increase: +3.9 points) was observed, with 88.9% of participants showing improvement. The largest improvements were observed in nutrition-related knowledge and awareness of passive smoking harms. Despite these gains, unhealthy behaviors remained prevalent, including low adherence to physical activity recommendations (36.1%), suboptimal dietary quality (39.9%), and high screen exposure. A linear regression model identified five independent determinants of higher knowledge improvement: older age, female gender, higher screen exposure, having at least one employed parent, and lower pre-intervention test scores. The intervention was positively evaluated, with high levels of satisfaction, clarity, and perceived usefulness. Conclusions: Nevertheless, the persistent gap between knowledge and behavior underscores the need to integrate motivational and environmental components, gender-sensitive approaches, and longitudinal evaluations to foster sustainable, healthy choices and contribute to NCD prevention. Full article
(This article belongs to the Section Nutrition and Public Health)
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20 pages, 1250 KB  
Article
Environmental, Family, and Disability Correlates of Flourishing, Anxiety, and Depression Among U.S. Children Aged 6–17 Years: A Cross-Sectional Analysis of the 2023–2024 National Survey of Children’s Health
by Joungmin Kim
Children 2026, 13(6), 791; https://doi.org/10.3390/children13060791 - 6 Jun 2026
Viewed by 230
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Parental Mental Health and Child Development (2nd Edition))
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18 pages, 587 KB  
Article
Retrospective Cohort Study of Transgender Adolescents at Strasbourg University Hospital
by Camille Schunder, Agnès Gras-Vincendon and François Brezin
Children 2026, 13(6), 789; https://doi.org/10.3390/children13060789 - 6 Jun 2026
Viewed by 361
Abstract
Introduction: Medical care for transgender minors is understudied, largely because these forms of care are relatively recent. The primary objective of this work was to describe the cohort of transgender adolescents who initiated follow-up at the Strasbourg University Hospital before the age of [...] Read more.
Introduction: Medical care for transgender minors is understudied, largely because these forms of care are relatively recent. The primary objective of this work was to describe the cohort of transgender adolescents who initiated follow-up at the Strasbourg University Hospital before the age of 18, whether or not they began hormone therapy prior to reaching adulthood. Method: This was an observational, retrospective, single-center, descriptive study conducted among adolescents who had attended at least one consultation in our center before the age of 18 between January 2017 and March 2024. Results: Our population consisted of 115 patients predominantly made up of transmasculine (AFAB) adolescents (68%). Compared with the general population, we observed significantly higher rates of psychiatric co-occurrences, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). Only 46.1% initiated gender-affirming hormone therapy (GAHT) in our cohort, and just 34.8% before age 18. A total of 6% of adolescents received puberty blockers as monotherapy. The mean age at GAHT initiation was 16.99 years. Transition pathways appear to differ according to the adolescent’s type of schooling. The rate of retransition/treatment interruption in our sample ranged from 0% to 6.1%, depending on the criteria applied. We did not identify any adolescent who retransitioned to their sex assigned at birth after starting GAHT by the end of the data collection. Discussion: The high prevalence of psychiatric co-occurrences raises important questions regarding how to improve care for these adolescents. The predominance of AFAB adolescents similarly prompts reflection on the barriers that transfeminine adolescents may face when seeking to transition before adulthood. In addition, the substantial number of adolescents presenting with ASD or ADHD underscores the need for particular vigilance regarding their specific needs and overall well-being. Finally, the variability in retransition rates depending on the criteria applied highlights the absence of a consensual definition, which limits the comparability and validity of existing studies. Conclusions: Long-term prospective studies are needed to objectively demonstrate the effectiveness of current transition pathways. Academic research in this field should be strengthened, along with the development of larger prospective datasets, to improve the overall health of this population. Full article
(This article belongs to the Special Issue Mental Health and Well-Being of Children with Gender Variability)
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17 pages, 285 KB  
Article
Assessment of a Non-Randomized Education Intervention for Primary School Aimed to Promote the Inclusion of People with Celiac Disease: Zeliakide Project (Part II)
by Maialen Vázquez-Polo, Virginia Navarro, Arrate Lasa, Idoia Larretxi, Gesala Perez-Junkera, Silvia Matias, Edurne Simón and Itziar Churruca
Nutrients 2026, 18(11), 1798; https://doi.org/10.3390/nu18111798 - 3 Jun 2026
Viewed by 278
Abstract
Background and Aim: The gluten-free diet (GFD) can have a huge impact on the quality of life of people with celiac disease (CD), especially on a social level. The objective of this work is to evaluate a structured nutrition education program focused on [...] Read more.
Background and Aim: The gluten-free diet (GFD) can have a huge impact on the quality of life of people with celiac disease (CD), especially on a social level. The objective of this work is to evaluate a structured nutrition education program focused on CD and GFD that aims to increase knowledge and improve inclusion attitudes about the disease in children. Methods: This is a one-month intervention for school children aged 10–12 years called Zeliakide (8 sessions). It was carried out through a STEAM methodology, using inquiry-based learning. The participants responses were evaluated through questionnaires before and after the intervention, and participants were also followed up one month later. The control group was a similar group of students who followed their regular school curriculum. Results: 299 children from one school of Vitoria-Gasteiz took part in the study (155 intervention group; 144 control group). Zeliakide significantly improved knowledge about CD and GFD in children, and this knowledge was retained for one month. Concretely, students increased their ability to explain what CD is, to assess gluten, and to classify food groups according to gluten content. The intervention contributed to augmenting the selection of behaviors to overcome differences between individuals, assessed one month after the intervention. In addition, the program allowed students to understand the work of scientists. Conclusions: Zeliakide can contribute to nutrition education initiatives that aim to improve knowledge of CD and GFD in the general population, while promoting empathetic behavior towards people with CD. Registration: clinicaltrials.gov, NCT05467865 on 21 July 2022. Full article
(This article belongs to the Section Nutrition and Public Health)
16 pages, 276 KB  
Article
Predicting Intrinsic Motivation After an Adventure Education Program in Primary Schools: Enjoyment, Self-Confidence and Resilience According to Gender
by Andrés Calmaestra-Sánchez, Antonio Baena-Extremera, Josué González-Ruiz and José Antonio Sánchez-Fuentes
Behav. Sci. 2026, 16(6), 874; https://doi.org/10.3390/bs16060874 - 1 Jun 2026
Viewed by 239
Abstract
This study aimed to describe the pre–post changes in intrinsic motivation observed following the implementation of a parkour-based Adventure Education (AE) program in primary school students, and to examine the role of enjoyment, self-confidence, and resilience as variables statistically associated with intrinsic motivation, [...] Read more.
This study aimed to describe the pre–post changes in intrinsic motivation observed following the implementation of a parkour-based Adventure Education (AE) program in primary school students, and to examine the role of enjoyment, self-confidence, and resilience as variables statistically associated with intrinsic motivation, considering differences according to time (pre-test–post-test) and gender. The sample consisted of 492 fifth- and sixth-grade primary education students (249 boys and 243 girls) with a mean age of 10.67 years, enrolled in 12 Spanish schools. A quasi-experimental design with pre-test and post-test measures was used following the implementation of a seven-session program based on the Pedagogical Model of Adventure Education. Data were collected using instruments validated in the Spanish population: the intrinsic motivation subscale of the Perceived Locus of Causality Scale, the Physical Activity Enjoyment Scale to measure enjoyment, the self-confidence subscale of the Competitive State Anxiety Inventory, and the Connor–Davidson Resilience Scale to assess resilience. Statistical analysis was performed using SPSS 28.0 software, conducting descriptive analyses, correlations, and hierarchical multiple linear regressions to examine the statistical associations among the variables at each measurement point, along with a 2 × 2 repeated-measures ANOVA (time × gender). Post-test scores were significantly higher than pre-test scores for intrinsic motivation, enjoyment, self-confidence and resilience. Enjoyment was the variable most strongly statistically associated with intrinsic motivation, followed by self-confidence and resilience. The ANOVA showed a significant main effect of time, while no significant time × gender interaction was detected, meaning that the study found no evidence that the pre–post change differed between boys and girls. Given the single-arm pre–post design and the absence of a control group, these findings should be interpreted as preliminary descriptive evidence of pre–post change and associations, and not as a causal test of the program’s effectiveness. Full article
(This article belongs to the Special Issue Self-Determination and Motivation in Physical Education)
20 pages, 2076 KB  
Article
Awareness, Knowledge, and Self-Reported Clinical Experiences Related to Glucose-6-Phosphate Dehydrogenase Deficiency in Sardinia (Italy): A Descriptive Cross-Sectional Survey
by Gabriele Serreli, Maria Paola Melis, Claudia Guerriero and Monica Deiana
Nutrients 2026, 18(11), 1648; https://doi.org/10.3390/nu18111648 - 22 May 2026
Viewed by 401
Abstract
Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells, with particularly high prevalence in Sardinia, where it is strongly associated with favism. Public awareness remains incomplete and misconceptions persist—particularly regarding symptom onset from fava bean pollen or [...] Read more.
Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells, with particularly high prevalence in Sardinia, where it is strongly associated with favism. Public awareness remains incomplete and misconceptions persist—particularly regarding symptom onset from fava bean pollen or odors. This cross-sectional survey assessed G6PD self-reported deficiency, population knowledge, and persistence of false beliefs in Sardinia. Methods: A 16-item structured questionnaire was disseminated online (May–June 2025) to adults across diverse age groups and educational backgrounds. Results: Among 536 respondents (74.25% female; 97.39% Sardinia residents), 43.47% of respondents self-reported as G6PD-deficient, a figure substantially above the expected population estimate of 8–15% and consistent with affected-network recruitment. Moreover, 49.07% self-reported as non-deficient, and 7.46% were unaware of their status. While 99.07% correctly identified fava bean ingestion as a trigger and 74.25% identified certain medications, 62.50% incorrectly attributed hazard to pollen inhalation and 25.93% to pea consumption. Only 3.92% reported a hemolytic crisis, whereas 25.93% reported feeling unwell after smelling beans or inhaling pollen. Family and friends (49.81%) and healthcare providers (42.16%) were the primary information sources; schools (25.75%) and online resources (14.55%) were underrepresented. Overall, 90.45% perceived public information as insufficient—uniformly across G6PD strata (χ2 = 0.09, p = 0.955). Exploratory analyses suggested lower perceived information adequacy among younger respondents (Cochran–Armitage Z = 2.92, p = 0.002) and, less robustly, among female respondents (χ2 = 3.90, p = 0.048; borderline significance, unadjusted). Conclusions: Although recognition of fava bean ingestion as the principal dietary trigger is nearly universal, substantial gaps persist regarding non-ingestive exposures, less-recognized dietary triggers, and pharmacological risks. Perceived information insufficiency was independent of G6PD status but associated with younger age and female sex. Integrating targeted nutritional education into school curricula, primary care, and digital platforms is warranted for these priority groups and for G6PD-endemic populations worldwide. Full article
(This article belongs to the Section Nutritional Policies and Education for Health Promotion)
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17 pages, 702 KB  
Article
Psychological Burden and Quality of Life After Pediatric Liver Transplantation: A Cross-Sectional Study
by Serkan Suren, Deniz Yavuz Baskiran, Irem Tulum, Adil Baskiran and Sezai Yilmaz
J. Clin. Med. 2026, 15(11), 3994; https://doi.org/10.3390/jcm15113994 - 22 May 2026
Viewed by 373
Abstract
Background/Objectives: Survival rates after pediatric liver transplantation have improved substantially over recent decades, yet the psychiatric consequences for recipients remain a concern that warrants closer attention. We sought to map the psychiatric symptom burden across multiple domains in this population and to determine [...] Read more.
Background/Objectives: Survival rates after pediatric liver transplantation have improved substantially over recent decades, yet the psychiatric consequences for recipients remain a concern that warrants closer attention. We sought to map the psychiatric symptom burden across multiple domains in this population and to determine which symptom clusters carry the greatest impact on health-related quality of life (HRQOL). Materials and Methods: Fifty liver transplant recipients between the ages of 8 and 18 were enrolled at a single center. Children and their parents completed four psychiatric measures—the CBCL, CDI, SCARED, and CRIES-13—alongside the parent-proxy PedsQL to capture HRQOL across physical, emotional, social, and school functioning domains. Correlations between instruments were calculated, and linear regression was used to determine which psychiatric variables independently predicted PedsQL Total scores. Results: Across all psychiatric measures, higher symptom scores were associated with lower HRQOL, with school functioning recording the lowest absolute PedsQL domain score, while emotional functioning demonstrated the strongest and most consistent inverse correlations with all psychiatric symptom measures across instruments. CBCL Total (r = −0.607), SCARED Total (r = −0.557), and CRIES-13 Total (r = −0.548) scores all correlated meaningfully with overall HRQOL. When entered into multivariable analysis, anxiety symptoms measured by the SCARED (β = −0.295, p = 0.032) and post-traumatic stress symptoms measured by the CRIES-13 (β = −0.400, p = 0.004) stood out as the two independent predictors of worse PedsQL Total scores. Conclusions: Even in medically stable recipients, anxiety and post-traumatic stress symptoms were independently associated with lower daily functioning scores and overall quality of life. These findings suggest that routine psychosocial screening and trauma-informed approaches may warrant integration into post-transplant care protocols, and that prospective, adequately powered studies are needed to confirm and extend these associations. Full article
(This article belongs to the Special Issue Advances in Posttraumatic Stress Disorder (PTSD): Clinical Update)
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16 pages, 274 KB  
Article
An Integrated Care Pathway for Pediatric Oral Health: Baseline Multicenter Analysis of Dental Caries, Malocclusions, and Oral Hygiene in Three Italian Regions
by Erika Roncarati, Dorina Lauritano, Saverio Ceraulo, Luigi Baggi, Roberta Calcaterra, Roberto Gatto, Silvia Caruso, Stefano Cianetti, Guido Lombardo, Gianmaria Fabrizio Ferrazzano and Francesco Carinci
Children 2026, 13(5), 714; https://doi.org/10.3390/children13050714 - 21 May 2026
Viewed by 340
Abstract
Background: Dental caries remain a major public health issue among Italian children, with prevalence exceeding 60% in specific subgroups and marked socioeconomic gradients. Objectives: This multicenter study aimed to describe baseline caries experience, malocclusions, and oral hygiene status in pediatric populations residing in [...] Read more.
Background: Dental caries remain a major public health issue among Italian children, with prevalence exceeding 60% in specific subgroups and marked socioeconomic gradients. Objectives: This multicenter study aimed to describe baseline caries experience, malocclusions, and oral hygiene status in pediatric populations residing in three Italian regions and to develop and preliminarily evaluate the feasibility of an integrated care pathway for the prevention and management of caries and malocclusions. Materials and Methods: Within the CCM 2024 program (ID 10), a cross-sectional baseline assessment was conducted on 795 children aged 6–11 years, examined in school settings and via mobile dental units. Caries experience was assessed using the dmft/DMFT indices and International Caries Detection and Assessment System (ICDAS) criteria. Malocclusions were evaluated using the Index of Orthodontic Treatment Need (IOTN). Oral hygiene was assessed through standardized clinical indices. The proposed care pathway comprises three tiers: (1) universal, school-based oral health education; (2) targeted clinical preventive and interceptive interventions; and (3) telemedicine/AI-supported follow-up for high-risk children. Descriptive and multivariable statistical analyses were performed. Results: At baseline, overall caries burden was low. No statistically significant differences in dmft/DMFT were observed between males and females. A non-significant trend toward higher caries indices was found among children with a positive breastfeeding history. By contrast, oral hygiene level was strongly associated with caries indices: children with insufficient hygiene had the highest dmft/DMFT, those with moderate hygiene showed intermediate values, and those with optimal hygiene presented the lowest caries experience. In multivariable models, oral hygiene emerged as the main independent predictor of dmft/DMFT. Conclusions: In this low-caries cohort, oral hygiene was confirmed as the principal modifiable determinant of caries risk. A tiered, school- and community-based care pathway focused on hygiene promotion, early screening, and minimally invasive clinical interventions appears feasible at baseline and may be scalable, with the aim of reducing the burden of caries and malocclusions and improving equity in pediatric oral health. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
17 pages, 1127 KB  
Article
Measles in the Post-COVID Era: Incidence Trends, Vaccination Coverage, Demographic and Subnational Distribution in Saudi Arabia, 2015–2024
by Lama Alzamil
Vaccines 2026, 14(5), 445; https://doi.org/10.3390/vaccines14050445 - 16 May 2026
Viewed by 416
Abstract
Background/Objectives: The COVID-19 pandemic disrupted routine immunisation globally. Saudi Arabia presents a unique epidemiological context for measles, combining high vaccination coverage with mass pilgrimages and a large expatriate workforce. This study examined measles incidence trends, vaccination coverage, and demographic and geographic burden distribution [...] Read more.
Background/Objectives: The COVID-19 pandemic disrupted routine immunisation globally. Saudi Arabia presents a unique epidemiological context for measles, combining high vaccination coverage with mass pilgrimages and a large expatriate workforce. This study examined measles incidence trends, vaccination coverage, and demographic and geographic burden distribution in Saudi Arabia (2015–2024), with comparative analysis against GCC countries, the Eastern Mediterranean Region (EMR), and global data. Methods: Annual incidence and vaccination coverage data were obtained from the WHO Global Health Observatory and WHO/UNICEF WUENIC; monthly, regional, age- and nationality-stratified data from the Saudi Ministry of Health Annual Statistical Book (2015–2024). Incidence was expressed per 1,000,000 population across three epochs: pre-COVID-19 (2015–2019), pandemic disruption (2020–2021), and post-COVID-19 rebound (2022–2024). Descriptive analyses included period means, percentage changes, rate ratios, and rate differences. Results: Pre-COVID-19 incidence (mean 19.7/1,000,000) remained below EMR and global averages. The pandemic produced near-complete suppression (−96.6% to 1.1/1,000,000 in 2020), exceeding global (−82.2%) and EMR (−61.2%) declines. A marked rebound occurred in 2023 (67.8/1,000,000), surpassing the pre-pandemic peak despite MCV1/MCV2 coverage above 96%. Non-Saudi nationals bore disproportionate burden in 2021 (20.7 vs. 1.1/1,000,000) and 2023 (70.4 vs. 64.8/1,000,000). Children under 15 accounted for 71.6–90.6% of annual cases, with the 5–<15-year group’s contribution rising from 12.7% (pre-COVID mean) to 27.7% in 2024. Geographic burden shifted annually with no consistently dominant region. Conclusions: Saudi Arabia’s post-pandemic rebound despite high national coverage implicates sub-population susceptibility gaps among non-national residents and school-age children, alongside importation risks from mass pilgrimage. Targeted strategies addressing demographic and geographic heterogeneity are essential to meet WHO 2030 elimination targets. Full article
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12 pages, 265 KB  
Article
Determinants of Physical Activity Engagement Among Male Adolescents in Riyadh, Saudi Arabia: A Comparative Study of Athletes and Non-Athletes
by Abdulrahman I. Alaqil and Fahad Bin Radhyan
Behav. Sci. 2026, 16(5), 789; https://doi.org/10.3390/bs16050789 - 15 May 2026
Viewed by 288
Abstract
Background: Physical inactivity among Saudi Arabian adolescents is a critical public health concern due to its contribution to the rising prevalence of overweight, obesity, and non-communicable diseases. Despite this, the motivational profiles and perceived barriers that differentiate athletic from non-athletic adolescents remain [...] Read more.
Background: Physical inactivity among Saudi Arabian adolescents is a critical public health concern due to its contribution to the rising prevalence of overweight, obesity, and non-communicable diseases. Despite this, the motivational profiles and perceived barriers that differentiate athletic from non-athletic adolescents remain understudied in the Saudi literature, particularly within the school Physical Education (PE) context. Grounded in Self-Determination Theory (SDT), the present study examined the factors preventing and motivating Saudi adolescents to engage in physical activity (PA) and discusses findings in terms of their implications for PE teachers and school-based intervention. Method: A cross-sectional study was conducted with 124 male high school students in Riyadh (mean age: 16.79 ± 0.66 years). Participants were categorized as either athletes (n = 70) or non-athletes (n = 54) based on pre-defined engagement criteria: athletes were required to report vigorous-intensity sport participation on three or more days per week for a minimum of 60 min per session. Anthropometric measurements, lifestyle behaviors (diet, screen time, sleep), motivations, and barriers were assessed using the validated Arab Teens Lifestyle Study (ATLS) questionnaire. Independent samples t-tests and chi-square tests were used to compare between-group differences; effect sizes are reported. Result: Non-athletes had a significantly higher mean BMI (29.40 ± 6.77 kg/m2) and waist circumference (98.65 ± 21.63 cm) compared to athletes (BMI: 22.19 ± 4.44 kg/m2; waist: 78.84 ± 9.51 cm; both p < 0.001). No significant differences were observed in screen time, sleep duration, or dietary habits. The primary motivations for PA among athletes were health benefits (27.1%), recreation (25.7%), and competition (20.0%), reflecting an autonomous motivational profile consistent with SDT. Among non-athletes, the predominant barriers were the lack of suitable facilities (25.9%) and the absence of an exercise partner (22.2%); reflecting unmet SDT needs for competence and relatedness respectively, while only 9.3% cited having a lack of time. Conclusions: Non-athletic participants face a significant health disadvantage characterized by higher rates of overweight and central obesity. In contrast to global trends, where academic commitments dominate barriers to PA, the principal barriers in this population are environmental and social, reflecting unmet psychological needs that PE teachers are uniquely positioned to address. Rather than focusing solely on infrastructure, PE promoters should implement need-supportive teaching practices, including competence-building tasks and cooperative peer structures, to foster the intrinsic motivational profile observed in the athletes and promote long-term PA adherence among non-athletic students, in alignment with the health objectives of Saudi Vision 2030. Full article
(This article belongs to the Special Issue Self-Determination and Motivation in Physical Education)
12 pages, 445 KB  
Article
Association Between Socioeconomic Status and Incident Sarcopenic Obesity: A 17-Year Prospective Cohort Study
by Hye Rang Bak, Nak Gyeong Ko, Hyun-Min Koh, Ji-Yong Jang, Jeong Gyu Lee, Yu Hyeon Yi, Seunghun Lee, Duk-Young Cho and Young Hye Cho
J. Clin. Med. 2026, 15(10), 3816; https://doi.org/10.3390/jcm15103816 - 15 May 2026
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Abstract
Background: Sarcopenic obesity, defined as the coexistence of low muscle mass and excess adiposity, is an emerging public health concern in aging populations. However, longitudinal evidence on the association between socioeconomic status (SES) and incident sarcopenic obesity remains limited, particularly in Asian populations. [...] Read more.
Background: Sarcopenic obesity, defined as the coexistence of low muscle mass and excess adiposity, is an emerging public health concern in aging populations. However, longitudinal evidence on the association between socioeconomic status (SES) and incident sarcopenic obesity remains limited, particularly in Asian populations. This study aimed to investigate the association between SES and the long-term incidence of sarcopenic obesity in a large Korean cohort. Methods: We conducted a prospective cohort study using data from the Korean Genome and Epidemiology Study (KoGES). Community-dwelling adults aged ≥ 40 years without sarcopenic obesity at baseline were followed for a mean of 17 years. Sarcopenic obesity was defined as low body mass index (BMI)-adjusted skeletal muscle mass (sex-specific lowest 20th percentile) combined with obesity (BMI ≥ 25 kg/m2). SES indicators included educational attainment, household income, and marital status. Kaplan–Meier methods were used to estimate cumulative incidence, and Cox proportional hazards models were applied to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) with sequential adjustment for demographic, lifestyle, and metabolic factors. Results: In the fully adjusted model, participants with elementary school education showed a higher hazard ratio of incident sarcopenic obesity compared with those with college education or higher (HR 1.39; 95% CI 1.11–1.73; p = 0.003). Similarly, individuals with a household income < 1.0 million KRW per month had a higher hazard ratio compared with those earning ≥4.0 million KRW (HR 1.31; 95% CI 1.02–1.70; p = 0.037). Unmarried participants also showed a higher hazard ratio compared with married individuals (HR 1.31; 95% CI 1.09–1.57; p = 0.003). Conclusions: Lower SES was independently associated with a higher incidence of sarcopenic obesity over long-term follow-up in this population-based cohort. These findings highlight the importance of considering socioeconomic factors in the prevention of sarcopenic obesity. Full article
(This article belongs to the Special Issue Clinical Management for Metabolic Syndrome and Obesity)
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15 pages, 283 KB  
Article
Association Between Childhood Asthma and Oral Health-Related Quality of Life in Young Children: A Cross-Sectional Study Using the SOHO-5
by Susana Valbom Morgado, João Gaspar Marques, Margarida Tejada Nunes, Ana Coelho Canta and Paula Faria Marques
Dent. J. 2026, 14(5), 297; https://doi.org/10.3390/dj14050297 - 13 May 2026
Viewed by 342
Abstract
Aim: Asthma is a chronic condition with high prevalence in pediatric populations and may negatively influence oral health. The primary aim of this study was to evaluate the association between asthma and oral health-related quality of life (OHRQoL) in Portuguese children aged 6 [...] Read more.
Aim: Asthma is a chronic condition with high prevalence in pediatric populations and may negatively influence oral health. The primary aim of this study was to evaluate the association between asthma and oral health-related quality of life (OHRQoL) in Portuguese children aged 6 to 8 years. Secondary aims included comparing caries experience, salivary parameters, and other clinical oral health indicators between asthmatic and non-asthmatic peers. Materials and Methods: A cross-sectional study was conducted with 89 child–parent pairs using a convenience sampling approach. Children with asthma were recruited from a hospital immunoallergology service, and healthy controls were recruited from a primary school. Data collection included parent-administered questionnaires on sociodemographic and behavioral factors, the Portuguese version of the SOHO-5 (child self-report and parent proxy forms), and standardized intraoral examinations assessing caries (WHO criteria, 5th edition), malocclusion, gingival bleeding, dental erosion, mucosal lesions, and molar–incisor hypomineralization. Stimulated salivary flow was measured. Bivariate statistical analyses and multivariable regression models were performed using SPSS (v.29), with a significance level set at p < 0.05. Results: Asthmatic children had significantly higher caries prevalence in both primary (52.6% vs. 27.5%, p = 0.027) and permanent dentition (32.4% vs. 0%, p < 0.001), as well as higher mean dmft scores (2.68 vs. 1.14, p = 0.026), reduced stimulated salivary flow (78.9% vs. 41.2% with low flow, p < 0.001), and worse child-reported SOHO-5 scores (mean 2.42 vs. 1.25, p = 0.004). After multivariable adjustment, asthma remained a significant independent predictor of low salivary flow (OR = 4.017, 95% CI: 1.443–11.178, p = 0.008), while the association with caries was attenuated and no longer significant (OR = 1.345, p = 0.590). Pain experience in the past year was the strongest predictor of OHRQoL across all multivariable models (SOHO-5 child: B = 1.583, p = 0.006; SOHO-5 total: B = 4.970, p < 0.001), indicating that children with pain history reported substantially worse OHRQoL. After adjustment, asthma did not reach statistical significance for either child-reported (B = 0.732, p = 0.090) or total OHRQoL scores (B = 0.693, p = 0.293). These findings should be interpreted cautiously given the limited number of covariates included in the models, constrained by the available sample size. Conclusions: Within the limitations of this cross-sectional study, including a small and non-probabilistic sample, asthmatic children presented a higher caries burden and a markedly higher prevalence of low stimulated salivary flow compared with non-asthmatic peers. Asthma remained a significant independent predictor of low salivary flow after multivariable adjustment, while the association with caries was attenuated, suggesting partial confounding by dietary habits. These findings highlight the importance of integrating oral health surveillance into the routine care of asthmatic children, with particular attention paid to salivary function and caries prevention. Full article
(This article belongs to the Special Issue Oral Health-Related Quality of Life and Its Determinants)
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16 pages, 504 KB  
Article
Growth Patterns and Factors Associated with Short Stature in Saudi Children and Adolescents with Type 1 Diabetes Mellitus: A Retrospective Cross-Sectional Study
by Youssef A Alqahtani, Ayed A. Shati, Ayoub Ali Alshaikh, Zeinh Hussein Fardan, Roaa Saad Alhuwail, Dalia Salem A Almosleh, Abeer Mohammed Alshehri, Maram Hadi A Asiri, Shaden Essa Hammati, Reema Abdullah S. Alsharif and Ramy Mohamed Ghazy
J. Clin. Med. 2026, 15(10), 3629; https://doi.org/10.3390/jcm15103629 - 9 May 2026
Viewed by 407
Abstract
Background: The impact of Type 1 Diabetes Mellitus (T1DM) on linear growth in children remains unclear, with conflicting evidence regarding the roles of glycemic control, disease duration, and nutritional factors. This study aimed to assess growth patterns and identify factors independently associated [...] Read more.
Background: The impact of Type 1 Diabetes Mellitus (T1DM) on linear growth in children remains unclear, with conflicting evidence regarding the roles of glycemic control, disease duration, and nutritional factors. This study aimed to assess growth patterns and identify factors independently associated with short stature among Saudi school-age children and adolescents with T1DM, comparing them to a healthy control group. Methods: A retrospective cross-sectional study was conducted at an endocrinology clinic, including 250 patients with T1DM aged 5–18 years and 267 healthy controls. After propensity score matching, 231 patients were matched to 231 controls. Data were extracted from electronic medical records using a standardized form. Anthropometric measurements were converted to Z-scores and percentiles using validated Saudi growth charts. Short stature was defined as height below the third percentile for age and gender. Univariate and multivariable logistic regression analyses were performed to identify factors associated with short stature among T1DM participants. Results: The median age of the 250 T1DM participants was 13.0 [10.0–15.0] years, with a slight male predominance (58.0%). Of them, 6 (2.4%) children were tall, 30 (12.0% were short), and 214 (85.6%) were normal. A significantly higher proportion of short stature was observed in the T1DM group compared with the control group (6.1% vs. 1.7%; p = 0.016). Among T1DM participants, the proportion of short stature increased progressively with diabetes duration: 3.0% in new-onset disease, 14.9% in intermediate duration (2–5 years), and 25.0% in long-standing disease (>5 years) (p = 0.001). Age at onset of T1DM was also significantly associated with having short stature (p = 0.036). In multivariable analysis, intermediate duration (adjusted odds ratio [aOR] = 5.72, 95% CI (1.02–32.1); p = 0.047) and long-standing duration (aOR = 11.03, 95% CI: (1.09–111.45); p = 0.042) remained significant independent predictors of short stature. In contrast, glycemic control (HbA1c), vitamin D status, time in range, and treatment adherence were not significantly associated with short stature after adjustment. Conclusions: Children and adolescents with T1DM have significantly lower height percentiles and a higher prevalence of short stature compared to their controls. Diabetes duration is a strong, independent predictor of short stature in this population, with progressively higher risk as disease duration lengthens, regardless of glycemic control status. These findings underscore the necessity of systematic longitudinal growth monitoring, particularly in patients with disease duration exceeding five years, to enable early identification and intervention for those at highest risk of growth impairment. Full article
(This article belongs to the Special Issue New Insights in Paediatric Endocrinology)
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