Search Results (81)

Background: Childhood obesity is a growing public health concern globally and is associated with a wide spectrum of comorbidities, including sleep-disordered breathing (SDB). SDB remains under-recognized in pediatric population with obesity, particularly in Middle Eastern settings, despite its significant impact on cognitive, behavioral, and metabolic health. Objectives: To assess the prevalence of SDB among children with obesity aged 6–12 years attending King Faisal University polyclinics in Saudi Arabia and to identify key demographic and anthropometric predictors, with particular emphasis on the mediating role of neck circumference. Methods: A cross-sectional study was conducted involving 130 children with obesity aged 6–12 years. Data collection included sociodemographic characteristics, anthropometric measurements (BMI percentile, neck and waist circumference), and screening for SDB using the validated Arabic version of the Pediatric Sleep Questionnaire Sleep-Related Breathing Disorder (PSQ-SRBD) scale. Logistic regression and mediation analyses were performed to examine associations and pathways between obesity parameters and SDB risk. Results: Of the 130 participants, 37.7% screened positive for SDB risk. SDB prevalence was higher among males and older children. Neck circumference and BMI percentile were independently associated with SDB risk, with neck circumference mediating the relationship between BMI and SDB. The mediation model indicated that increased BMI contributes to SDB risk both directly and indirectly through increased neck circumference. Conclusion: SDB is highly prevalent among obese Saudi children, and neck circumference is a significant mediator of risk. Incorporating SDB screening and neck circumference measurements into routine pediatric obesity care can facilitate early detection and management. These findings support the need for integrated, multidisciplinary approaches to improve pediatric health outcomes. Full article

Background: Chinese adolescents face a dual burden of malnutrition, yet the weight-status-specific mechanisms underlying physical activity (PA) participation remain underexplored. Methods: We conducted a cross-sectional study among 1573 adolescents (aged 9–15 years) in Shangrao City, China. Validated scales measured social-ecological factors (family/peer support, physical environment), psychological factors (stage of change, self-efficacy, decisional balance), and PA participation. Data preprocessing utilized full information maximum likelihood to handle missing values. Confirmatory factor analysis was performed to validate the measurement model, followed by multi-group structural equation modeling to analyze pathway configurations across underweight (n = 187), normal-weight (n = 1070), and overweight/obese (n = 316) groups. Mediation effects were tested using bootstrapping with 5000 resamples. Results: Clear weight-specific patterns emerged. Normal-weight adolescents presented a fully functional comprehensive model where PA was predicted by the stage of change (β = 0.211, p < 0.001), friend support (β = 0.120, p < 0.001), self-efficacy (β = 0.092, p < 0.05), and perceived benefits (β = 0.095, p < 0.01). Underweight adolescents primarily relied on internal readiness driven by stage of change (β = 0.270, p < 0.001) and self-efficacy (β = 0.164, p < 0.05), with family support only indirectly influencing participation via psychological mediators. In contrast, overweight/obese adolescents showed a “socially dependent” pattern: friend support directly predicted PA levels (β = 0.136, p < 0.05), significantly enhanced self-efficacy (β = 0.370, p < 0.01), and effectively lowered perceived barriers (β = −0.165, p < 0.05). Additionally, the physical environment strongly impacted perceived benefits (β = 0.471, p < 0.01) but did not translate into action. Conclusions: These findings underscore the significant differences in PA determinants across the spectrum of malnutrition, necessitating targeted public health interventions to support the Healthy China 2030 initiative. Full article

Background: Therapeutic applications of saline solutions in oral healthcare range from mineral waters to standardized sodium chloride preparations. Despite widespread traditional use, their scientific foundation remains inadequately characterized. This scoping review aimed to systematically map the available evidence for salt-based oral health interventions, characterize study populations and outcomes, and identify research gaps to guide future investigations. Methods: Following JBI methodology and PRISMA-ScR guidelines, four electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) were systematically searched for publications from 2000 to 2025. Studies were classified along a spectrum from geological mineral waters to artificial preparations. Narrative synthesis was employed with systematic gap identification. Results: Seventeen studies met inclusion criteria, with a median sample size of 41 participants and a median follow-up of 4 weeks. Evidence distribution revealed concentration on hypersaline Dead Sea derivatives (n = 7, 41%) and European thermal waters (n = 5, 29%), with limited representation of marine-derived (n = 1, 6%) and simple saline solutions (n = 3, 18%). Reported outcomes included periodontal parameters, xerostomia symptoms, viral load, mucositis severity, and dentin hypersensitivity, with variable methodological quality across studies. Heterogeneity in interventions, comparators, and outcome measures precluded direct comparisons. Conclusions: The current evidence base for salt-based oral interventions remains limited and methodologically heterogeneous. While preliminary findings suggest potential applications across multiple clinical domains, small sample sizes, short follow-up periods, and inconsistent outcome measures preclude definitive recommendations. Standardized protocols and adequately powered trials are needed before evidence-based clinical integration. Full article

Background: In Ethiopia, children identified with autism spectrum disorder (ASD) and their families face substantial challenges in obtaining timely diagnosis and appropriate services, including limited public awareness, cultural stigma, and shortages of trained professionals. Understanding how social and communication difficulties manifest in children identified with ASD within Ethiopian service settings is essential for designing culturally and contextually responsive interventions. Objectives: This study aimed to describe the social-communication characteristics of children enrolled in two major autism-focused centers and to examine contextual influences shaping their communication profiles. Methods: A mixed-methods approach was employed. Quantitative data were collected from parents or guardians of 110 children using the Social Communication Questionnaire (SCQ). Qualitative data were gathered through five focus group discussions with 56 service providers. Descriptive and inferential statistical analyses were applied to SCQ scores, while thematic analysis was used to analyze qualitative transcripts. Results: Overall, 90% of participating children scored above the SCQ clinical cutoff of 15, indicating pronounced social and communication challenges, though these scores represent symptom patterns rather than confirmed diagnoses. No significant differences in SCQ scores were observed by age or gender. Thematic analysis identified four major contextual influences on children’s social-communicative behaviors: cultural beliefs about disability, multilingual communication environments, systemic barriers to service access, and persistent community stigma. Conclusions: These findings underscore the need for culturally adapted screening tools and community-based interventions that account for sociocultural and structural influences on communication. Strengthening early identification, reducing stigma, and improving service accessibility may enhance support for children with ASD in low-resource, collectivist settings. Full article

Research on physical activity (PA) interventions for individuals with autism spectrum disorder (ASD) has shown benefits in various domains, yet questions remain about how to implement such interventions in adolescents effectively. This study case-series study explores the contribution of a PA program integrated with applied behavior analysis (ABA) strategies in improving motor skills and reducing repetitive behaviors in three adolescents with ASD. The study used a pre-post case series design, with assessments at three time points (baseline, 6 months, and 9 months). The intervention consisted of 29 two-hour training sessions, held once a week in a public gymnasium. Standardized tools, including the Checklist for Autism Spectrum Disorder (CASD), the Social Responsiveness Scale (SRS-2), the Vineland Adaptive Behavior Scales (VABS), the Repetitive and Restricted Behavior Scale (RRBS), and the Movement Observation and Valuation for Individual Training (MOVIT), were utilized. Participants showed consistent improvements in all six motor skills evaluated by the MOVIT, with individual variations. The most significant gains were observed in intersegmental coordination, with acquisition rates increasing from 70% to 90%. Repetitive behaviors decreased, particularly restricted behaviors and modulation insufficiency, while changes in sensorimotor stereotypies were more modest. The preliminary results suggest that a PA program integrated with behavioral strategies is efficacious in improving motor skills and reducing repetitive behaviors in adolescents with ASD. These findings support the integration of physical activity into comprehensive educational interventions for this population. Full article

Background: Food and Nutrition Security (FNS) policies in Brazil aim to ensure a broad spectrum of rights and were formulated based on the complex relationship among the State, Society, and Market in the capitalist order. The human right to adequate food (HRAF) is reflected in the guidelines of the National School Feeding Program (Programa Nacional de Alimentação Escolar—PNAE), which is implemented and monitored by the National Education Development Fund (Fundo Nacional de Desenvolvimento da Educação—FNDE). The PNAE consolidates part of the strategies adopted by the Brazilian State to combat hunger among children and adolescents and promote healthy habits by offering food in schools. However, there is no recent evaluation on the aspects of management, financing, and monitoring of the PNAE in the Brazilian Federal District. Objective: This study aims to contribute to the debate on health promotion and the right to adequate food by analyzing documents and legislation in force until 2024 related to the PNAE, as well as those that maintain a correlation with food and nutritional security policies in Brazil, verifying the scope and guarantee of rights and their applicability based on a critical analysis of the selected database. Methods: Brazilian official documents and legislation related to FNS and school meals were reviewed for inclusion in the database. The historical-dialectical materialist method was employed for content analysis, and the analyzed documents underwent a critical reading and the coding process, grouping common themes, utilizing MaxQda^® software for support. Results: The word cloud (20 words) shows that the document groups emphasize food as a right, with 6038 occurrences found and relating to the “rights” approach with 2365 occurrences found, highlighting words related to FNS policies. Public actions to achieve health and food supply were expressed through the words “public” (381 occurrences) and “DHAA” (510 occurrences). The code cloud highlights social control as the most frequently attributed code in the set of documents, with 105 codified segments, indicating that democratic control and societal participation are crucial for achieving the PNAE’s objectives. Conclusions: The analyses underscored the importance of social control, as evidenced by the exploration of the research corpus and demonstrated in the code cloud. The role of monitoring and social control falls to the School Feeding Council (CAE), being the body responsible for verifying compliance with the Program’s objectives, enabling the adoption of timely measures to correct the PNAE’s course and contribute to achieving its objectives. Full article

Urban parks are vital public spaces that provide opportunities for recreation, relaxation, and social interaction. At night, their accessibility and functionality depend strongly on the quality of artificial lighting, which must balance user safety and comfort with ecological sustainability. This study investigates public perceptions of urban park lighting through a mixed-method approach combining participatory workshops and surveys. A workshop (n = 15), involving local residents recruited through community networks, included introductory presentations, group discussions, and open voting to map the related problems in the park activities. Data were collected through participant notes, visuals, and sketches. In parallel, an online and on-site survey (n = 144) was distributed via Google Forms during winter 2025. Results reveal three main themes. First, users consistently emphasized safety and orientation as the most critical functions of park lighting, though the 52.5% perception of safety remained moderate even in lit areas. Second, respondents and workshop participants expressed a preference for adaptive, functionally targeted lighting over uniform illumination. Third, ecological awareness was evident as more than half of the respondents recognized the negative effects of artificial lighting on the natural environment, with strong support for warm-spectrum lighting and light zoning to protect biodiversity. These findings highlight the potential of participatory methods to inform evidence-based, ecologically sensitive lighting strategies for urban parks. Full article

Background: Bullying is a major public health issue with long-term psychological consequences, particularly for individuals with Autism Spectrum Disorder (ASD) or subthreshold autistic traits, known as “broad autistic phenotype” (BAP). Prior studies have suggested increased vulnerability to victimization and mood disorders in these populations, but the association between bullying, autistic traits, and affective symptoms remains underexplored. Methods: A total of 98 individuals with at least one ASD symptom (BAP group) and 159 healthy controls (HCs) were recruited. Participants were classified into four groups based on ASD symptoms and bullying history. Standardized self-report instruments (AdAS Spectrum, AQ, MOODS-SR) assessed autistic traits, mood symptoms, and suicidality. Group comparisons, correlation analyses, and multiple regression models were conducted to evaluate the relationships between bullying, autistic traits, and mood disturbances. Results: BAP individuals, particularly those with ASD, reported significantly higher rates of bullying than HCs. Bullied BAP participants exhibited the highest burden of mood symptoms and suicidality. Regression analyses identified both autistic traits and bullying history as significant predictors of suicidal ideation and overall suicidality, though only autistic traits predicted suicidal behaviors. AQ and MOODS-SR scores were positively correlated, especially in depressive and rhythmicity domains. Conclusions: Autistic traits and bullying experiences independently and interactively contribute to increased mood symptomatology and suicidality. These findings underscore the importance of early identification and targeted support for at-risk individuals with ASD or BAP, particularly those with a history of victimization. Full article

This exploratory study analyzes how ordinary citizens from seven European countries perceive and construct the meaning and legitimacy of responsible entrepreneurship. Drawing on a qualitative and social constructionist approach, 104 open-ended interviews were conducted, eliciting participants’ narratives and metaphors about the purpose of business, the figure of the entrepreneur, and the ethical challenges of entrepreneurship. The analysis reveals that most citizens associate entrepreneurship with “growth,” “prosperity,” and positive societal impact, but also express skepticism regarding the authenticity of sustainability claims. Metaphors and narratives show a broad spectrum of public imaginaries: positive images (“captain,” “gardener”) reinforce legitimacy, while negative or ambivalent metaphors signal doubt, ethical tension, or perceived opportunism. The study demonstrates that legitimacy is shaped not only by economic or institutional factors, but by symbolic narratives and ethical expectations rooted in civic discourse. These findings underscore the need for greater public dialogue in defining responsible entrepreneurship and highlight the value of integrating citizens’ voices in entrepreneurship research, policy, and practice. Full article

Background: Cognitive behavioral therapy (CBT) has shown consistent efficacy in individuals with psychosis, as supported by many trials. One classical distinction is that between affective and non-affective psychosis. Few studies have specifically examined the possible moderating role of substantial affective elements. In this systematic review and meta-regression analysis, we assess how CBT response differs across the affective spectrum in psychosis. Methods: We included studies assessing various CBT modalities, including third-wave therapies, administered in people with psychosis. The study protocol is published in the Open Science Framework. Meta-regression was conducted to assess whether the proportion of participants with affective psychosis (AP), as proxied by a documented diagnosis of schizoaffective (SZA) disorder, moderated CBT efficacy across positive, negative, and depressive symptom domains. Results: The literature search identified 4457 records, of which 39 studies were included. The median proportion of SZA disorder participants was 17%, with a total of 422 AP participants represented. Meta-regression showed a trend toward lower CBT efficacy for positive symptoms with a higher SZA disorder proportion (β = +0.10 SMD per 10% increase in AP; p = 0.12), though it was not statistically significant. No significant associations were found for negative (β = +0.05; p = 0.73) or depressive symptoms (β = −0.02; p = 0.78). Heterogeneity was substantial across all models (I² ranging from 54% to 80%), and funnel plot asymmetry was observed in negative and depressive symptoms, indicating possible publication bias. Risk of bias assessment showed the anticipated inherent difficulty of psychotherapies in blinding and possibly dropout rates affecting some studies. Conclusions: Affective symptoms may reduce the effectiveness of CBT for positive symptoms in psychotic disorders, although the findings did not reach statistical significance. Other patient-level characteristics in psychosis could indicate which patients can benefit most from CBT modalities. Full article

The current proceedings summarize the presentations delivered during the third International Electronic Conference on Microbiology (ECM 2025), which was held online from 1 to 3 April 2025, via the SciForum platform. This virtual event brought together researchers from around the world to share recent advances in microbiological sciences. The ECM 2025 highlighted recent developments across a broad spectrum of microbiological research, including antimicrobial resistance, gut microbiota, infectious diseases, and environmental microbiomes. Participants shared their work through online presentations and abstracts, with selected submissions invited for full publication. The event fostered global collaboration, promoted open-access science, and showcased innovative tools for studying and managing microbial systems in health, agriculture, and industry. The multidisciplinary program was organized into several thematic sessions: S1. Gut Microbiota and Health Disease. S2. Foodborne Pathogens and Food Safety. S3. Antimicrobial Agents and Resistance. S4. Emerging Infectious Diseases. S5. Microbiome and Soil Science. S6. Microbial Characterization and Bioprocess. S7. Microbe–Plant Interactions. This conference report presents summaries of the contributions made by participating authors over the three-day event. Full article

Background/Objectives: The co-occurrence of Attention-deficit/hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) is very common and worsens adaptive functioning. This systematic review evaluates both pharmacological and non-pharmacological interventions in this underserved population. Methods: Registered on PROSPERO (CRD42024526157), a systematic search was conducted on PubMed, Embase, and Web of Science until 5 April 2025. The review includes (a) pilot studies and RCTs, (b) participants aged <18 years, (c) diagnoses of ASD and ADHD based on DSM-IV/V or ICD-9/10, (d) at least one group receiving any intervention, and (e) publications in English, Italian, Spanish, or German. Newcastle Ottawa Scale tools for non-randomized studies and the Cochrane Risk of Bias Tools for randomized controlled trials were used to assess studies’ quality. Results: A total of 32 studies were included: 87.5% concerning pharmacological treatments. Specifically, methylphenidate (MPH, n = 11), atomoxetine (ATX, n = 11), guanfacina (n = 4), clonidine (n = 1), or atypical antipsychotics (n = 1) were examined. MPH and ATX were most frequently studied, with both showing positive effects in reducing ADHD core symptoms compared to placebo. ATX also reduces stereotyped behaviors and social withdrawal, although more withdrawals due to adverse events (AEs) were reported for ATX than MPH. Four studies (12.5%) examined non-pharmacological interventions, including treatment with virtual reality tools, digital platforms, educational animations, and biomedical protocols; improvements in emotion recognition, behavioral regulation, attention, and social functioning were found. Conclusions: While limited data prevent definitive conclusions, MPH and ATX appear to be relatively safe and effective on hyperactivity-impulsivity symptoms, even in individuals with ASD. Evidence on non-pharmacological treatments is limited, and further studies are needed to better establish their therapeutic potential. Full article

Autism Spectrum Disorder (ASD) has been associated with disruptions in one-carbon metabolism and vitamin D pathways. Nutritional exposures—particularly vitamin D, vitamin B₁₂, and homocysteine—may influence neurodevelopmental outcomes. However, a comprehensive, lifespan-spanning synthesis of these modifiable nutritional biomarkers has not been conducted. This systematic review and stratified meta-analysis critically synthesized data on vitamin D, vitamin B₁₂, and homocysteine to elucidate their relationships with ASD risk and symptomatology. Our central question was: How do levels of vitamin D, vitamin B₁₂, and homocysteine—measured before and after birth—affect the risk, severity, and potential treatment outcomes for ASD? We conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) compliant systematic review and stratified meta-analysis (2015–2025) of 35 studies (11 randomized controlled trials, 24 observational), examining prenatal, neonatal, and postnatal biomarker levels. Eligibility criteria were defined using the PICOS (Population, Intervention, Comparator, Outcome, and Study Design) framework to ensure scientific rigor and clinical relevance, including studies involving human participants aged 0–18 years with a formal Autism Spectrum Disorder (ASD) diagnosis or prenatal exposures potentially linked to later ASD onset, while excluding animal studies, adult-only ASD populations, and studies lacking ASD cohorts or biomarker data. The search strategy, developed according to PRISMA, and Cochrane best practices, encompassed five major databases (PubMed/MEDLINE, Cochrane Library, Google Scholar, ClinicalTrials.gov, and ProQuest) alongside manual searches of key references, grey literature, and clinical trial registries to ensure comprehensive retrieval of both published and unpublished studies. Study quality was assessed using version 2 of the Cochrane risk-of-bias tool for RCTs (RoB2) and the Newcastle–Ottawa Scale (NOS) for observational studies; certainty of evidence was graded via GRADE (Grading of Recommendations Assessment, Development and Evaluation). Random-effects meta-analyses were stratified by biomarker and study design. Heterogeneity, small-study effects, and publication bias were evaluated using Cochran’s Q, I², Egger’s test, and trim-and-fill. Prenatal vitamin D deficiency was associated with approximately two-fold increased odds of Autism Spectrum Disorder (ASD) in offspring (pooled OR ≈ 2.0; p < 0.05), while excessively elevated maternal B₁₂ concentrations, often co-occurring with folate excess, were similarly linked to increased ASD risk. Meta-analytic comparisons revealed significantly lower circulating vitamin D (SMD ≈ −1.0; p < 0.001) and B₁₂ levels (SMD ≈ −0.7; p < 0.001), alongside elevated homocysteine (SMD ≈ 0.7; p < 0.001), in children with ASD versus neurotypical controls. Early-life vitamin D/B₁₂ insufficiency and elevated homocysteine are important, modifiable correlates of ASD risk and severity. Adequate maternal and child nutritional status could have risk-reducing and symptom-mitigating effects, although causality remains to be confirmed. This evidence supports tailored nutritional interventions as a component of ASD risk reduction and management strategies, within the bounds of overall developmental healthcare. The article processing charges (APC) were supported by “Dunărea de Jos” University of Galati, Romania. No external funding was received for the execution of the research. The review was not prospectively registered in PROSPERO or any other systematic review registry. Full article

Background: Although screening for early signs of autism spectrum disorder (ASD) using the Modified Checklist for Autism in Toddlers (M-CHAT) has been recommended by the Brazilian Ministry of Health since 2014, the feasibility of this intervention and its effects in primary care have not been sufficiently investigated. Objectives: (1) to verify the feasibility of implementing the M-CHAT in the Brazilian Unified Health System, through routine childcare vaccination; (2) to evaluate the level of knowledge and practices of nursing professionals in Brazilian primary health care in relation to ASD to check the expertise to apply M-CHAT to verify early signs of this condition; (3) to verify, after implementation, the frequency of children with possible early signs of ASD using the M-CHAT. Methods: This is an observational, cross-sectional study conducted in a medium-sized city in southeastern Brazil. A total of 97 nursing professionals from 21 health facilities participated. The professionals answered a questionnaire on knowledge and practices regarding ASD, attended training on early signs of ASD and for the use of M-CHAT. Finally, they administered the M-CHAT to 267 parents of children aged 16 to 57 months in primary care settings. Results: Insufficient knowledge of ASD was identified among the nursing professionals evaluated. Approximately 80% agreed that the training was satisfactory, and 88% agreed that they felt competent to use the M-CHAT; 74% agreed with the benefits of using the M-CHAT to detect early signs of ASD in public health settings. However, 91% of the professionals reported that incorporating the M-CHAT into the day care routine overloaded their work, and less than 50% agreed that the instrument should continue to be used in the day care routine. Sixty-seven (25.09%) children screened positive for possible early signs of ASD by M-CHAT. Conclusions: The insufficient level of knowledge on ASD found among nursing professionals suggests gaps in Brazilian academic and professional training in this area. Although most participants recognized the importance of early detection of signs of ASD in primary care settings, the implementation of the M-CHAT in the routine primary care settings was not well accepted for most participants due to work overload, which indicates the need for public health policies to offer working conditions that minimize the overload of professionals, maintaining early screening interventions for ASD in Brazilian primary care institutions. Full article

Introduction: The significant impact of nonalcoholic fatty liver disease (NAFLD) on public health, combined with the limitations of current diagnostic approaches, demands a more comprehensive and accurate method to identify NAFLD cases in large general populations. Methods: In this cross-sectional study, we recruited 3733 individuals (average age 51.8 years) who underwent health check-ups between October 2015 and October 2016. NAFLD was diagnosed using ultrasound; 114 serum metabolites were measured using gas chromatography–mass spectrometry. We adopted the least absolute shrinkage and selection operator (LASSO) method to build a metabolomic-based diagnostic model. Results: NAFLD was diagnosed in 826 participants. While each metabolite exhibited a limited diagnostic ability for NAFLD when used individually, compared with BMI, the model constructed using the LASSO demonstrated adequate diagnostic power (area under the curve [AUC] 0.866, 95% confidence interval 0.847–0.885 in test set) and even for lean (BMI < 23) populations (AUC for LASSO 0.828, for BMI 0.78). Moreover, the LASSO model-derived ‘pre-NAFLD’ condition showed a potential association with insulin resistance and elevated triglycerides. Conclusions: Our metabolomic-based approach provides a comprehensive evaluation of NAFLD or ‘pre-NAFLD’, both considered parts of a hypothetical ‘NAFLD spectrum’, independent of body type. Metabolomics could offer additional diagnostic benefits and potentially expand the disease concept. Full article