Search Results (131)

Background/Objectives: This study aimed to translate the Child Coeliac Disease Food Attitudes and Behaviours Scale (Child CD-FAB) into Brazilian Portuguese and to evaluate its reproducibility and internal consistency. Methods: Three steps were carried out: (i) translation and cultural adaptation of the Child CD-FAB into Brazilian Portuguese; (ii) pre-test; and (iii) psychometric evaluation of the Child CD-FAB-BR. The Child CD-FAB was translated and back-translated, and then discussed with and approved by the author of the original instrument. The translated version was tested on five children and adolescents (aged 8 to 16 years) with coeliac disease to assess comprehension. Subsequently, psychometric evaluation used responses from 20 participants with the same characteristics, assessing reproducibility (test–retest reliability) via intraclass correlation coefficient (ICC) and internal consistency via Cronbach’s alpha. Results: The Child CD-FAB was successfully translated to Brazilian Portuguese (Child CD-FAB-BR), and it presented good internal consistency (α = 0.892) and an excellent intraclass correlation coefficient (ICC = 0.923). Conclusions: The Child CD-FAB-BR is the first instrument to evaluate food attitudes and behaviours in Brazilian children and adolescents with CD, showing good psychometric properties. This instrument will support future research and clinical practice by guiding behaviour-based strategies to enhance nutritional education and public policies for this group. Full article

Infant clothing represents a critical yet overlooked exposure pathway for heavy metals, with significant implications for child health and sustainable consumption. This study investigates cadmium (Cd) and chromium (Cr) contamination in 33 textile samples, integrating in vitro bioaccessibility assays, cytotoxicity analysis, and risk assessment models to evaluate dermal exposure risks. Results reveal that 80% of samples exceeded OEKO-TEX Class I limits for As (mean 1.01 mg/kg), Cd (max 0.25 mg/kg), and Cr (max 4.32 mg/kg), with infant clothing showing unacceptable hazard indices (HI = 1.13) due to Cd (HQ = 1.12). Artificial sweat extraction demonstrated high bioaccessibility for Cr (37.8%) and Ni (28.5%), while keratinocyte exposure triggered oxidative stress (131% ROS increase) and dose-dependent cytotoxicity (22–59% viability reduction). Dark-colored synthetic fabrics exhibited elevated metal loads, linking industrial dye practices to health hazards. These findings underscore systemic gaps in textile safety regulations, particularly for low- and middle-income countries reliant on cost-effective apparel. We propose three policy levers: (1) tightening infant textile standards for Cd/Cr, (2) incentivizing non-toxic dye technologies, and (3) harmonizing global labeling requirements. By bridging toxicological evidence with circular economy principles, this work advances strategies to mitigate heavy metal exposure while supporting Sustainable Development Goals (SDGs) 3 (health), 12 (responsible consumption), and 12.4 (chemical safety). Full article

Family structure has long been regarded as an important determinant of household saving, yet the empirical evidence for developing economies remains limited. Using the 2018–2022 panels of the China Family Panel Studies (CFPS), a nationwide survey that follows 16,519 households across three waves, the present study investigates how family size, the elderly share, and the child share jointly shape saving behavior. A household fixed effects framework is employed to control for time-invariant heterogeneity, followed by a sequential endogeneity strategy: external-shock instruments are tested and rejected, lagged two-stage least squares implement internal instruments, and a dynamic System-GMM model is estimated to capture saving persistence. Robustness checks include province-by-year fixed effects, inverse probability weighting for attrition, balanced-panel replication, alternative variable definitions, lag structures, and sample filters. Family size raises the saving rate by 4.6 percentage points in the preferred dynamic specification (p < 0.01). The elderly ratio remains insignificant throughout, whereas the child ratio exerts a negative but model-sensitive association. A three-path mediation analysis indicates that approximately 26 percent of the total family size effect operates through scale economy savings on quasi-fixed expenses, 19 percent is offset by resource dilution pressure, and less than 1 percent flows through a precautionary saving channel linked to income volatility. These findings extend the resource dilution literature by quantifying the relative strength of competing mechanisms in a middle-income context and showing that cost-sharing economies dominate child-related dilution for most households. Policy discussion highlights the importance of public childcare subsidies and targeted credit access for rural parents, whose saving capacity is the most constrained by additional children. The study also demonstrates that fixed effects estimates of family structure can be upward-biased unless dynamic saving behavior and internal instruments are considered. Full article

Background/Objectives: This retrospective cohort study compared well-child visits (WCVs) and immunization encounters from birth to age three among rural and urban South Carolina (SC) Medicaid-enrolled children with neonatal opioid withdrawal syndrome (NOWS). Methods: We applied logistic and Poisson regression models to examine associations between rural status and the number of WCVs, WCV adherence, and immunization encounters. Results: The sample included 833 urban and 161 rural children with NOWS born between 2006 and 2014. Significant differences existed between groups in the number of WCVs and immunization encounters each year from birth to age three (p = < 0.01 for all the comparisons). After covariate adjustment, rural compared to urban status was associated with decreased WCVs from birth to 11 months (incidence rate ratio (IRR): 0.85; 95% CI: 0.77–0.93) and 12 to 23 months (IRR: 0.80; 95% CI: 0.69–0.93). Rural status was not significantly associated with decreased WCVs from 24 to 35 months (IRR: 0.81; 95% CI: 0.63–1.03). Rural compared to urban status was associated with a 34% lower odds of WCV adherence from 12 to 23 months (odds ratio (OR): 0.66; 95% CI: 0.44–0.99). Furthermore, rural compared to urban status was associated with decreased immunization encounters from birth to 11 months (IRR: 0.60; 95% CI: 0.52–0.69), 12 to 23 months (IRR: 0.61; 95% CI: 0.50–0.71), and 24 to 35 months (IRR: 0.55; 95% CI: 0.40–0.76). Conclusions: Rurality was associated with decreased WCVs and immunization encounters among children with a history of NOWS residing in SC. Policy interventions, including telehealth services and expanded Medicaid access, could improve WCV and immunization rates among these children. Full article

Background: The provision of education, health, and social care for children with special educational needs and disabilities (SEND) in England has long been criticised for its inequities and chronic underfunding. These systemic issues were further exacerbated by the onset of the COVID-19 pandemic and the accompanying restrictions, which disrupted essential services and resulted in widespread unmet needs and infringements on the rights of many children with SEND. This study aimed to use a three-phase consensus-building approach with 1353 participants across five stakeholder groups to collaboratively develop evidence-informed priorities for policy and practice. The priorities sought to help address the longstanding disparities and respond to the intensified challenges brought about by the pandemic. Methods: A total of 55 children with SEND (aged 5–16), 893 parents/carers, and 307 professionals working in SEND-related services participated in the first phase through online surveys. This was followed by semi-structured interviews with four children and young people, ten parents/carers, and 15 professionals, allowing for deeper exploration of lived experiences and priorities. The data were analysed, synthesised, and structured into five overarching areas of priority. These were subsequently discussed and refined in a series of activity-based group workshops involving 20 children with SEND, 11 parents/carers, and 38 professionals. Results and Conclusions: The consensus-building process led to the identification of key priorities for both pandemic response and longer-term recovery, highlighting the responsibilities of central Government and statutory services to consider and meet the needs of children with SEND. These priorities are framed within a children’s rights context and considered against the rights and duties set out in the United Nations Convention on the Rights of the Child (1989). Priorities include protecting and promoting children with SEND’s rights to (1) play, socialise, and be part of a community, (2) receive support for their social and emotional wellbeing and mental health, (3) feel safe, belong, and learn in school, (4) “access health and social care services and therapies”, and (5) receive support for their parents/carers and families. Together, they highlight the urgent need for structural reform to ensure that children with SEND receive the support they are entitled to—not only in times of crisis but as a matter of routine practice and policy. Full article

Adequate and diverse diets are essential for children’s physical and cognitive development, yet food insecurity and malnutrition continue to threaten this fundamental right, which remains a pressing concern in many resource-poor settings. This study investigated food and nutrition security in Early Childhood Development (ECD) centres in Makhanda, South Africa, through a community-based participatory research approach. Using a mixed-methods approach combining questionnaire interviews, focus group discussions, direct observations, and community asset mapping across eight ECD centres enrolling 307 children aged 0–5 years, the study engaged ECD facilitators and analysed dietary practices across these centres. Results indicated that financial constraints severely affect the quality and diversity of food provided at the centres, thus undermining the ability to provide nutritionally adequate meals. The average amount spent on food per child per month at the centres was R90 ± R25 (South African Rand). Although three meals were generally offered daily, cost-driven dietary substitutions with cheaper, less diverse alternatives, often at the expense of nutritional value, were common. Despite guidance from Department of Health dieticians, financial limitations contributed to suboptimal feeding practices, with diets dominated by grains and starchy foods, with limited access to and rare consumption of protein-rich foods, dairy, and vitamin A-rich fruits and vegetables. ECD facilitators noted insufficient parental contributions and low engagement in supporting centre operations and child nutrition provision, indicating a gap in awareness and limited nutrition knowledge regarding optimal infant and young child feeding (IYCF) practices. The findings emphasise the need for sustainable, multi-level and community-led interventions, including food gardening, creating ECD centre food banks, parental nutrition education programmes, and enhanced financial literacy among ECD facilitators. Strengthening local food systems and establishing collaborative partnerships with communities and policymakers are essential to improve the nutritional environment in ECD settings. Similarly, enhanced government support mechanisms and policy-level reforms are critical to ensure that children in resource-poor areas receive adequate nutrition. Future research should focus on scalable, locally anchored models for sustainable child nutrition interventions that are contextually grounded, community-driven, and should strengthen the resilience of ECD centres in South Africa. Full article

Background/Objectives: The number of children with overweight and obesity is gradually increasing worldwide. This is an emergent public health problem as overweight and obesity persist through the next stages of human life, being associated with high risk of morbidity and mortality. In this respect, the purpose of the current cross-sectional survey is to explore whether the overweight/obesity of children aged 6–9 years may be related to the risk of developing perceived stress and poor sleep quality symptoms. Methods: This study recruited 4350 primary school children from diverse Greek rural and urban regions. The mothers of the enrolled children completed relevant questionnaires on children and maternal sociodemographics, anthropometric parameters, perinatal outcomes, breastfeeding practices, and lifestyle factors. The enrolled mothers also completed the Perceived Stress Scale (PSS) and the Pittsburgh Sleep Quality Index (PSQI) to evaluate the perceived stress and sleep quality of their matched children, respectively. Results: Our analysis reveals independently significant associations between diverse factors and children’s overweight/obesity such as child’s gender, family economic status, maternal gestational weight gain, childbirth weight, kind of delivery, exclusive breastfeeding, and children physical activity. Childhood overweight and obesity were independently associated with a more than three-fold higher risk of perceived stress and a more than two-fold higher likelihood of poor sleep quality after adjustment for multiple confounding factors. Conclusions: Obesity and overweight are related to enhanced risk of perceived stress and poor sleep quality in children aged 6–9 years. Public policies and dietary counseling interventions should be applied to inform new mothers about the harmful effects of childhood overweight/obesity and to direct them to adopt healthy dietary practices for their children. Full article

Background: Stunting remains a significant global health issue, particularly in low- and middle-income countries (LMICs). Globally, around 22% of children under five are affected, with high rates persisting in South and Southeast Asia. This review examines government-led programs in high-performing LMICs (Nepal, Bangladesh, and Vietnam) to identify key strategies and opportunities for effective intervention. Methods: A literature search was conducted on PubMed using keywords and Medical Subject Heading terms, including “stunting”, “child undernutrition”, “malnutrition” and the names of the three specified countries. Articles were evaluated for relevance based on their focus on stunting prevalence, risk factors, and interventions in these countries, without restrictions on publication date or language. Results: Stunting prevalence among children under five has significantly declined in Nepal, Bangladesh, and Vietnam over the past two decades, reflecting the impact of sustained nutrition and health interventions. Nepal reduced stunting from 55.8% in 2000 to 26.7% in 2022, Bangladesh from 54.7% to 26.4%, and Vietnam from 41.5% to 19.3%. Successful strategies included multisectoral approaches integrating nutrition-specific and nutrition-sensitive interventions, enhanced policy frameworks, and strong governance. Despite progress, challenges remain, such as high wasting prevalence in Nepal and disparities among marginalized communities in Vietnam, emphasizing the need for targeted, context-specific interventions. Conclusions: Effective stunting reduction requires multisectoral strategies addressing underlying, intermediate, and immediate determinants. Insights from Nepal, Bangladesh, and Vietnam highlight the importance of sustained government commitment, robust policies, and coordinated interventions. Adapting these successful strategies to local contexts can support stunting prevention and management, promoting healthier and more resilient communities. Full article

Stakeholders from parents to policy-makers are concerned about youth online safety. Present solutions are frequently punitive and often lack opportunities for youth to make mistakes and try again in a safe environment. This paper proposes a new framework, based on trauma-informed child psychology models and research by computer scientists and human-centered design scholars, entitled Pause, Reflect, and Redirect (PRR). The PRR framework offers three levels of intervention ranging from casual engagement to coached engagement with crisis response. To further develop and validate PRR as a framework, PRR was implemented within a web-filtering software that was installed in a public middle school comprising grades 6 to 8 (i.e., ages 11–14) in an urban charter district. Preliminary results from the deployment of the software suggest that it may help youth make better choices with respect to their online behaviors. Full article

More than three decades ago, the Supreme Court of the United States (SCOTUS) ruled that individuals who are not competent (alternatively referred to by the Court as insane) at the time of their scheduled execution cannot be put to death. Despite the years that have passed since the Court’s decision and the literal life-or-death stakes involved, competency for execution (CFE) remains underexplored in the psychological, psychiatric, and legal literature. A number of important legal and ethical issues that arise when a person on death row maintains they are not competent to be executed are still unresolved even after the landmark Supreme Court cases such as Ford v. Wainwright (1986), Panetti v. Quarterman (2007), and Madison v. Alabama (2019). In this first-of-its-kind descriptive study, we analyzed the demographic and case characteristics of the 28 successful Ford claimants—individuals in the United States who have been found to be incompetent to be executed and compared them to the general death row population and homicide cases nationwide. Our findings reveal some similarities but also some differences between these claimants and the general death row population and homicide cases: the successful Ford claimants are exclusively male (in keeping with the general prison population on death row), relatively older, and underrepresented among White and Latinx inmates (i.e., Black claimants are more successful than their White and Latinx counterparts at evading execution). Nearly all (96%) suffer from schizophrenia, with 79% experiencing psychiatric comorbidity, yet only 54% received any significant treatment before or after the criminal offense. The claimants’ cases also involve a higher proportion of child victims, male family members, and female non-family member victims, as well as more multiple-victim cases (not indiscriminate) and fewer intraracial homicides. Fewer victims are male, and more are female. However, the cases do not align with typical male-on-male violent crimes or femicide patterns, such as those involving sexual or domestic violence. Additionally, systematic psycho-legal deficiencies are prevalent, including a low rate of mental health evidence (61%) presented at trials and some cases lacking psychiatric involvement in CFE evaluations. Temporal influence and drastic state variations on CFE evaluation are also noted. Although the small sample size limits generalizability, this small-scale descriptive study offers a number of important insights into the complexities of CFE decisions and lays the groundwork for future research and policy development. Full article

(1) Hidden workers include those who are unemployed or underemployed or discouraged workers. This study analyses the probabilities of becoming a hidden worker between males and females in three age groups (youth, young adults, and mid-life) and identifies the extent to which these factors explain the gender gap among hidden workers in Australia. (2) Using the Oaxaca–Blinder decomposition approach, this study aims to contribute to the discussion by highlighting the impact of gender on the hidden worker population, further illustrating how the explained and unexplained impacts on hidden workers differ between the gender groups. (3) Results: Age not only raises the likelihood of being a hidden worker in both gender groups but also contributes to the widening gender gap among hidden workers, especially those in the child-rearing stage of their life. Human capital, including education, health endowment, and social capital, is negatively associated with the likelihood of being a hidden worker and reduces the gender gap. Childcare responsibilities and other care duties are associated with a greater likelihood of being a hidden worker for females and are among the greatest contributors to the gender gap. Local resources are associated with the likelihood of being a hidden worker and widen the gender gap within the 45–64-year old group. (4) Conclusions: The gender gap among hidden workers is widened by care responsibilities and locally available socio-economic resources. On the other hand, it is narrowed by education, individual health endowment, and social capital. The findings of this study corroborate the fact that a wide extent of the gender gap among hidden workers in Australia is socially and politically produced and is thus potentially avoidable through public policy. Greater attention from researchers and policy makers regarding hidden workers should be devoted to reducing this gender gap to prevent further social implications. Full article

Although global neonatal mortality rates have significantly decreased, Black infant mortality in the US continues to be a major issue. This study identifies, assesses, and illustrates women’s views on infant mortality and the resources needed to address the problem. Women of diverse demographic backgrounds were recruited via purposive sampling, with 91 participating. Seventy percent of participants were aged 18 to 39 (n = 64), and forty three percent lived in Indiana (n = 39). Access to care, sleeping issues, supporting breastfeeding, awareness, affordability challenges, healthcare provider factors, and creating sustainable programs and policies to address infant mortality emerged as prominent themes in the data. This study highlights the importance of cultural congruency in addressing maternal and child health issues, emphasizing the need for stakeholder involvement to ensure interventions are acceptable, practical, and sustainable. Full article

Despite the improvements in enhanced child protection, there is an increasing concern about the vulnerability and cases of child trafficking in Spain, the southern gateway to Europe from the African continent. Analyzing 23 interviews with professionals in the field, this article identifies the factors that contribute to high levels of child trafficking in Spain. This study identifies three primary results: (1) The dangers of residential childcare as places of recruitment; (2) The southern European and Spanish border as a place of elevated risk for the recruitment of children; (3) The stereotypes regarding child trafficking make invisible male victims, other types of trafficking for non-sexual purposes, domestic trafficking, and individual trafficking. Therefore, it remains imperative to advance a set of policies that: (i) invest in specific residential childcare resources for child victims either alone or with family members; (ii) invest in smaller residential childcare to prevent abuse; (iii) invest in mentoring programs for children previously under state guardianship; (iv) improve the working conditions and the training of residential childcare staff; (v) increase the visibility and diversity of child trafficking while avoiding stereotypes; (vi) improve the regional coordination; (vii) invest in campaigns to inform children about the dangers involved in running away, exploitation and abuse. Full article

In Mexico, 1.9% of child mortality among children aged 3 to 15 years is attributed to waterborne gastrointestinal diseases (WGD). This study employs a generalized bivariate logit econometric model to simulate the relationships between mortality risks and seven explanatory variables. Based on the model results and sensitivity analysis of the estimated parameters, a set of policies was designed to reduce the likelihood of child mortality. The proposed strategy involves implementing the following public policies, primarily targeting communities with extreme and high marginalization: increasing access to drinking water, improving housing conditions, expanding parental basic education coverage, and providing nutrition and healthcare to children from an early age. The findings reveal that children who speak an indigenous language face a mortality risk from WGD that is three times higher than those who do not, while children who receive medical services have a 29% lower risk of mortality compared to those who do not have access to them. It is recommended to offer free medical care in indigenous languages within high-marginalization communities. The combined impact of these policies is expected to significantly reduce child mortality due to WGD. Full article

Despite the growing awareness of healing hospitals, they are still far from being globally widespread, and traditional hospital building models are increasingly unable to address the serious resource constraints and environmental stresses that we face today. In addition, sustainable development concepts have become key driving forces in the construction process of healing buildings. Currently, while research on healing hospital design continues to grow, there is relatively little that specifically addresses the integration of sustainable development concepts. Hence, this paper aims to explore the current state of development and knowledge structure of sustainable healing and therapeutic design (HTD) in hospital scenarios using a systematic methodology that integrates macro-quantitative bibliometric analysis and follow-up micro-qualitative content analysis methods based on data from the Web of Science (WOS) database, which investigates eight research objectives, including the background, current state, hotspots, high-frequency words, integration with sustainable development goals (SDGs), particularly SDG3, “Ensure healthy lifestyles and promote well-being of people of all ages”, and the challenges posed by public health emergencies, such as the COVID-19 era, for sustainable HTD in hospitals. This paper identified six main clusters: the environment of a hospital, mental health, quality of life, illness and care, COVID-19, and wound healing. These clusters were taken from keyword network visualization analysis, emphasizing key terms focused on wound healing, mental health, quality of life, nursing, children, and evidence-based design via high-frequency keyword analysis. These have been further grouped into three categories: strategy, approach, and method. Subsequently, this paper further explores how hospital HTD relates to SDG 3 targeted on reducing child mortality (SDG 3.2), promoting mental health and physical health (SDG 3.4), and achieving universal health coverage (SDG 3.8) to explore wound healing, mental health, quality of life, nursing, and children, which are stressed in the results of both macro-quantitative bibliometric and follow-up micro-qualitative content analyses. In addition, it is shown that more changes should be made to sustainable hospital HTD in the context of the pandemic era to cope with unpredictable crises. Finally, the expression HTD is discussed to justify the keywords. The results of this study complement sustainable hospital HTD and provide assistance to future architects, policy makers, and healthcare professionals. Full article