Search Results (153)

The parks and open spaces of planned neighbourhood are generally underutilized in cities due to the lack of a Child-Friendly Environment (CFE). The quality of parks and open spaces can be elevated by addressing and improving the deficiencies identified in their conditions. There is a need to identify the parameters for rating neighbourhood parks and open spaces. This research aims to understand the level of CFEin the planned neighbourhood parks of a metropolitan city. The research considers three parks as case study areas, Gandhi Park, Maharanapratap Park, and Balmiki Park in the city of Lucknow, the state capital of Uttar Pradesh, India’s most populous state. The research employed the Analytical Hierarchy Process (AHP) method to rate the parks with the use of a nine-point weighting scale. The research identified various dimensions under five major parameters of CFE, namely: perception, physical, social, cognitive, and emotional. The cognitive and perception parameters are observed to play the most significant role in generating CFE. The research result could be used in planning and developing CFE parks and open spaces in neighbourhoods by incorporating the critical dimensions and key elements of the identified parameters in policy guidelines, norms and standards. Full article

Extreme hydro-meteorological events are intensifying under climate change, disproportionately disrupting last-mile healthcare in flood-prone geographies. In this study, flood-adaptive primary care clinics (FAPCCs) integrated with islandable smart microgrids and a rapid-deploy medical technology stack (MedTech) are developed and evaluated to ensure continuity of essential services (triage, maternal and child health, vaccination cold-chain, minor procedures, diagnostics, and telemedicine) during fluvial, pluvial, and coastal flooding. Evidence on resilient health facilities, microgrid architectures, distributed energy resources, and modular clinical systems is presented in a multi-layer systems design: (1) a modular, amphibious, and elevatable clinic chassis; (2) a photovoltaic–battery–diesel hybrid system with demand-aware energy management; (3) redundant connectivity long-term evolution/fifth-generation, satellite, and very high frequency; (4) a rapid-deploy MedTech kit including point-of-care diagnostics, low-temperature cold-chain, negative-pressure isolation, and sterilization modules; and (5) flood-aware logistics using unmanned aerial vehicle/unmanned surface vehicle. A mixed-integer linear programming sizing is formulated and dispatched with a continuity-of-care reliability metric that couples energy availability to clinical throughput. Simulation across three archetypal sites (peri-urban delta, inland riverine, coastal estuary) shows that FAPCCs achieve the service availability of higher than 99.5% across 7-day grid outage scenarios while reducing fuel use by 62–81% relative to diesel-only baselines, maintaining vaccine temperatures within 2–8 °C with <0.1% thermal excursion time, and sustaining telemedicine quality of service with <150 ms median uplink latency in hybrid networks. A life-cycle cost analysis indicates a 7.1–9.8 year discounted payback from fuel displacement and avoided service loss. Deployment playbooks and policy guidance are also proposed for Ministries of Health and Disaster Agencies in monsoon-impacted regions. Full article

Background/Objectives: Social vulnerability is linked to unhealthy eating habits, low physical activity, and, overall, increased health risks and low well-being. This study examined self-perceived barriers and facilitators to engaging in obesity prevention policies for children at risk of poverty and social exclusion in Greece from the perspective of parents, caregivers, and community representatives. Methods: A qualitative study was conducted from November to December 2023 in three geographically diverse Greek regions, namely Attica, Thessaly, and Crete. A qualitative study was conducted between November and December 2023 in three geographically diverse regions of Greece. In total, seventy-two individuals participated in the study through individual interviews and focus groups. Forty-five parents of children with disabilities took part in individual interviews, equally represented in all three regions (fifteen participants per region). Among focus group participants: Twenty-one caregivers from child protection units participated in six focus groups (two per region), with focus group sizes ranging from three to five participants. In addition, six Roma community representatives participated in three focus groups (one per region), with focus group sizes ranging from one to four participants. Inductive and deductive thematic analysis were performed using NVivo 14 software to identify key themes. Results: Most factors that increased engagement were perceived by participants as both barriers and facilitators. These factors were classified at the individual, sociocultural, or structural level, and similar themes emerged across groups. Common barriers to poor engagement included low health literacy, financial difficulties and underfunding, social exclusion, a lack of targeted nutrition interventions, concerns related to training opportunities and support, and the adequacy and safety of built environments. Common facilitators of enhanced engagement included increased awareness and motivation to support vulnerable children, the availability of community- and school-based initiatives, and free school meal provision. Conclusions: Engagement in obesity prevention policies targeting vulnerable children is influenced by multiple interrelated factors. Understanding these barriers and facilitators from the participants’ perspectives can guide policymakers and practitioners in designing more effective obesity-related interventions for socially vulnerable groups of children. Full article

Introduction: Resting-state EEG (rsEEG) is a scalable window onto trait-like “executive readiness,” but findings have been fragmented by task impurity on the executive-function (EF) side and heterogeneous EEG pipelines. This review synthesizes rsEEG features that reliably track EF in healthy samples across development and aging and evaluates moderators such as cognitive reserve. Materials and methods: Following PRISMA 2020, we defined PECOS-based eligibility (human participants; eyes-closed/eyes-open rsEEG; spectral, aperiodic, connectivity, topology, microstate, and LRTC features; behavioral EF outcomes) and searched MEDLINE/PubMed, Embase, PsycINFO, Web of Science, Scopus, and IEEE Xplore from inception to 30 August 2025. Two reviewers were screened/double-extracted; the risk of bias in non-randomized studies was assessed using the ROBINS-I tool. Sixty-three studies met criteria (plus citation tracking), spanning from childhood to old age. Results: Across domains, tempo, noise, and wiring jointly explained EF differences. Faster individual/peak alpha frequency (IAF/PAF) related most consistently to manipulation-heavy working may and interference control/vigilance in aging; alpha power was less informative once periodic and aperiodic components were separated. Aperiodic 1/f parameters (slope/offset) indexed domain-general efficiency (processing speed, executive composites) with education-dependent sign flips in later life. Connectivity/topology outperformed local power: efficient, small-world-like alpha networks predicted faster, more consistent decisions and higher WM accuracy, whereas globally heightened alpha/gamma synchrony—and rigid high-beta organization—were behaviorally sluggish. Within-frontal beta/gamma coherence supported span maintenance/sequencing, but excessive fronto-posterior theta coherence selectively undermined WM manipulation/updating. A higher frontal theta/beta ratio forecasts riskier, less adaptive choices and poorer reversal learning for decision policy. Age and reserve consistently moderated effects (e.g., child frontal theta supportive for WM; older-adult slow power often detrimental; stronger EO ↔ EC connectivity modulation and faster alpha with higher reserve). Boundary conditions were common: low-load tasks and homogeneous young samples usually yielded nulls. Conclusions: RsEEG does not diagnose EF independently; single-band metrics or simple ratios lack specificity and can be confounded by age/reserve. Instead, a multi-feature signature—faster alpha pace, steeper 1/f slope with appropriate offset, efficient/flexible alpha-band topology with limited global over-synchrony (especially avoiding long-range theta lock), and supportive within-frontal fast-band coherence—best captures individual differences in executive speed, interference control, stability, and WM manipulation. For reproducible applications, recordings should include ≥5–6 min eyes-closed (plus eyes-open), ≥32 channels, vigilant artifact/drowsiness control, periodic–aperiodic decomposition, lag-insensitive connectivity, and graph metrics; analyses must separate speed from accuracy and distinguish WM maintenance vs. manipulation. Clinical translation should prioritize stratification and monitoring (not diagnosis), interpreted through the lenses of development, aging, and cognitive reserve. Full article

Quantifying geographic variation is crucial for policy evaluation, yet researchers often rely on complex national surveys not designed for sub-national inference. This design-analysis mismatch creates two challenges when decomposing variance across domains like states: informative sampling confounds substantive heterogeneity with design artifacts, and finite-sample variance inflation conflates sampling noise with signal. We introduce the Bayesian Hybrid Framework that reconciles design-based and model-based inference through Bayesian Pseudo-Likelihood for design consistency and a hybrid generalized linear mixed model that simultaneously estimates substantive domain effects and nuisance design effects (strata, PSUs). We propose a Dual Estimand Framework distinguishing between Descriptive (total observed variance) and Policy (substantive variance net of design) estimands, with explicit de-attenuation to correct finite-sample inflation. Simulations based on the 2019 National Survey of Early Care and Education demonstrate negligible bias and superior efficiency compared to standard alternatives. Applied to subsidy receipt among home-based child care providers, we find the observed between-state variation (16.7%) reduces to only 5.4% after accounting for design artifacts and sampling noise. This three-fold reduction reveals that local factors, not state policies, drive most heterogeneity, highlighting the necessity of our framework for rigorous geographic variance decomposition in complex surveys. An accompanying R package (version 0.3.0), bhfvar, implements the complete framework. Full article

Newborn screening (NBS) is a cost-effective public health strategy for the early detection of congenital disorders that cause neonatal/infant morbidity and mortality. It is standard care in many high-income and emerging economies. Nigeria, despite its high birth number, has no newborn screening (NBS) programme for any disorder, causing missed opportunities for early therapy. This manuscript is a workshop report and expert consensus of a three-day national workshop organised by the Newborn Screening Consortium–Nigeria (NSC-N) in conjunction with The Federal Ministry of Health Nigeria, Revvity, and international partners. The first meeting comprised experts in different fields of newborn screening and newborn care who reviewed priority congenital disorders, implementation barriers, and national NBS needs in Nigeria. Experts presented pilot data, opinions, and global best practice evidence. Contributions were examined and debated and conclusions were reached by guided discussions and consensus agreement for a pragmatic nationwide NBS plan. The key outcomes were the urgency for Nigeria to begin an integrated, comprehensive NBS programme. Based on standard prioritisation criteria, sickle cell disease and congenital hypothyroidism were selected. Key implementation strategies included integration into routine maternal and child health services, establishing a national screening database, and developing a robust legislative and policy framework. The NBS workshop developed a framework to commence and incorporate integrated NBS into the Nigerian healthcare system. Two conditions were selected to kickstart the programme and establish a foundation for future expansion. This would improve neonatal health outcomes and reduce the long-term burden of congenital disorders. Full article

Francophone populations outside Quebec were disproportionately affected by the COVID-19 crisis. Despite French being one of Canada’s official languages, access to information and services in French remains limited. This study examined Francophone families’ (FF) post-pandemic health and well-being needs (PPHW) in the Canadian Prairie provinces. An online survey assessed PPHW needs among 319 FF in Alberta (AB), Saskatchewan (SK), and Manitoba (MB). Respondents ranked PPHW needs from a predefined list; logistic regression analyzed socio-demographic influences. Divided into AB/SK and MB cohorts, sociodemographic profiles were statistically distinct for many variables, but with similarities found in gender of respondents (women: 73% in AB/SK, 79% in MB), marital status (married: 81% in AB/SK, 88% in MB), area of residence (urban: 86% in AB/SK, 81% in MB), and number of children (2 children: 49% in AB/SK, 41% in MB). Three high-priority needs were shared across provinces: (1) access to recreational, athletic, and artistic activities in French for children (variations by child gender); (2) access to French healthcare professionals (variations by education level and language difference); and (3) social activities in French for families. AB/SK respondents prioritized mental health services in French for adults and youth. MB families prioritized belonging to a Francophone community (variations by gender of children) and education services in French (variations by age of children). Understanding these common and province-specific priorities can inform policy and service planning. Full article

Adolescent sexual assault survivors have myriad post-assault needs. However, if and how they access resources to attend to those needs can be complicated due to their legal status as minors and child abuse mandatory reporting policies. Such policies that require specific entities to be notified when a sexual assault involving a minor has occurred might deter adolescents from seeking post-assault care. However, no studies to date have examined how mandatory reporting laws inform adolescents’ post-assault decisions and experiences. Through semi-structured qualitative interviews with twenty-one survivors of adolescent sexual assault in one Northeastern US state, we found that mandatory reporting actively deterred sixteen survivors from seeking formal help; would have deterred two survivors from seeking formal help had they known about it; and was a nonissue for three survivors who chose to seek formal help in an attempt to have very specific needs met. Survivors of adolescent sexual assault had serious concerns about losing agency and control and about unwanted involvement from police, parents, and child protective services. Individual providers, organizations, and whole communities must seriously consider the potential harm of mandatory reporting policies and think creatively and collaboratively alongside adolescent survivors to ensure they can access the care they need and deserve. Full article

China has experienced a population decline since 2022, and its total fertility rate has dropped to about 1.0 in 2025. This is despite the lifting of the one-child policy in 2015 and the pivot to the two-child policy and three-child policy in, respectively, 2016 and 2021. Based on a review of recent research, this paper provides an interpretation that the continued fertility decline reflects a perfect storm of socioeconomic and demographic processes, long-term effects of the one-child policy, and unprecedented social changes in Chinese society. Socioeconomic and demographic changes since the 1950s prepared the ground for the “late, sparse, few” policy, resulting in a sharp fertility decline in the 1970s. While the one-child policy that followed did not result in a fertility decline in the 1980s, its effects appear to be long-lasting, including concentrated investment by the “inverted family” in the only child that drives up society-wide childrearing costs. Significant improvement in women’s educational attainment, individualistic orientation that prioritizes personal goals, increased diversity in family structure, such as one-person households, and changing views about getting married and having children have all contributed to continued downward pressure on fertility. These findings hint at the relevance of the concept of the second demographic transition for China and suggest that policy is only effective if it is aligned with what people want. Full article

The promotion of clean cooking energy use (CCEU) in rural areas is a key part of energy transformation. At present, the understanding of the relationship between environmental regulation and household CCEU remains limited. We primarily focus on the “Air Pollution Prevention and Control Action Plan” (APPCAP), which is regarded as China’s strictest command-and-control environmental regulation. This provides us with a quasi-natural experimental setting in evaluating the impact of environmental regulation on rural households’ CCEU. Empirical results indicate that APPCAP has significantly promoted CCEU among rural households in China. The transmission of this effect occurs primarily through three channels, including non-farm employment, health awareness, and peer effects. A heterogeneity analysis reveals that the impact of APPCAP is more pronounced among vulnerable rural groups with lower education levels and lower income. Furthermore, households with smaller family sizes, heavier dependency burdens, and a male eldest child are more responsive to the APPCAP. Further analysis confirms the sustainability of the policy effects. These findings provide evidence for accelerating the energy transition in developing regions. Full article

Background: Coeliac disease (CD) is an autoimmune chronic condition that requires a strict diet without gluten as a single effective treatment. However, adherence to a life-long gluten-free diet (GFD) may promote psychological suffering and disordered eating. The Coeliac Disease Food Attitudes and Behaviours Scale (CD-FAB) is the only instrument specifically designed to evaluate these aspects in individuals with CD. Objective: This study aimed to translate the CD-FAB and test its reliability in the Brazilian population. Methods: The research was conducted in three stages: (i) translation and cultural adaptation of CD-FAB into Brazilian Portuguese; (ii) pretesting with Brazilian individuals diagnosed with CD to assess item understanding; and (iii) psychometric evaluation through reproducibility (test–retest reliability) via intraclass correlation coefficient (ICC) and internal consistency via Cronbach’s alpha. Results: The CD-FAB was successfully adapted to the Brazilian CD population (Child CD-FAB-BR) and demonstrated strong internal consistency (α = 0.807) and an intraclass correlation coefficient (ICC = 0.928). Conclusions: The Brazilian version of CD-FAB proved to be reliable for assessing food attitudes and behaviours in people with CD, potentially allowing for the identification of factors to guide research and clinical practice by driving behaviour-based strategies to improve nutritional education and strategic policies for coeliac patients. Studies with larger and more diverse samples are recommended to provide external validation of the instrument. Full article

Background and Objectives: Paediatric palliative care in Romania is underdeveloped and unevenly distributed, which creates major difficulties in accessing services for children with life-limiting illnesses and their families. The lack of a dedicated national strategy, the shortage of specialised staff, and socio-economic barriers exacerbate the vulnerability of these groups. This study aimed to explore parents’ and caregivers’ experiences, to analyse the perspectives of public institutions and NGOs involved in supporting these children, and to identify the main barriers and facilitators in accessing paediatric palliative care. Materials and Methods: Given that all data were collected exclusively through focus group discussions, this study employed a qualitative design based on three focus groups guided by a semi-structured interview guide. The analysis was conducted using MAXQDA software, which enabled the coding and synthesis of emerging themes. Participants were parents/caregivers of children with life-limiting illnesses, representatives of public institutions, and members of relevant NGOs in Bacău County, Romania. Purposive sampling was used to capture diverse and experience-based perspectives, resulting in a total of 24 participants across three focus groups—parents and caregivers (n = 11), public institution representatives (n = 7), and NGO representatives (n = 6). No individual semi-structured interviews were conducted. Results: The analysis highlighted a complex typology of medical, emotional, social, educational, and spiritual needs of children and their families. Parents reported experiences of abandonment in the curative system, emphasising the importance of pain control, safety, and community support. Public institutions acknowledged the lack of skills and inter-sectoral coordination, while NGOs pointed to structural barriers and the low visibility of these children. Major needs include access to specialised care, psychological support, respite services for carers, financial and administrative assistance, education, and spiritual counselling. A significant obstacle is the lack of up-to-date statistical data needed to inform public policy. Conclusions: Paediatric palliative care should be considered a national priority through the development of a dedicated strategy, the expansion of specialised services, and the strengthening of partnerships between the public and non-governmental sectors. An integrated, child- and family-centred approach addressing the medical, social, emotional, and spiritual dimensions of care is essential. The results highlight the need for continuous staff training, information campaigns, and community support mechanisms to reduce inequalities and improve the quality of life of children with life-limiting illnesses. Full article

Background/Objectives: Under the urban–rural dual structure, rural children’s health security faces multiple challenges. These stem from geographical disadvantages, inadequate resources, and systemic flaws in medical insurance design. The outpatient cost-sharing policy is a key design to address these issues. Methods: Using data from the 2018 China Household Income Project (CHIP), this study employs Propensity Score Matching, Ordered Probit, Logit, and a Two-Part Model to examine the association between the policy and the health and economic outcomes of rural children. Conclusions: The results show that the policy is significantly associated with better child health scores and a higher probability of reimbursement. These positive associations appear to be connected to three potential factors: higher use of outpatient services, better mother’s health, and greater school-related food and accommodation expenses. In contrast to adult populations, no significant substitution between outpatient and inpatient services was observed for children, suggesting the non-discretionary and rigid nature of pediatric hospitalization decisions. This research provides robust empirical evidence for the policy’s potential benefits, offering important implications for optimizing the child medical security system. Full article

This study investigates the complex relationship between the performance of logistics and Environmental, Social, and Governance (ESG) performance, drawing upon the multi-methodological framework of combining econometrics with state-of-the-art machine learning approaches. Employing Instrumental Variable (IV) Panel data regressions, viz., 2SLS and G2SLS, with data from a balanced panel of 163 countries covering the period from 2007 to 2023, the research thoroughly investigates how the performance of the Logistics Performance Index (LPI) is correlated with a variety of ESG indicators. To enrich the analysis, machine learning models—models based upon regression, viz., Random Forest, k-Nearest Neighbors, Support Vector Machines, Boosting Regression, Decision Tree Regression, and Linear Regressions, and clustering, viz., Density-Based, Neighborhood-Based, and Hierarchical clustering, Fuzzy c-Means, Model-Based, and Random Forest—were applied to uncover unknown structures and predict the behavior of LPI. Empirical evidence suggests that higher improvements in the performance of logistics are systematically correlated with nascent developments in all three dimensions of the environment (E), social (S), and governance (G). The evidence from econometrics suggests that higher LPI goes with environmental trade-offs such as higher emissions of greenhouse gases but cleaner air and usage of resources. On the S dimension, better performance in terms of logistics is correlated with better education performance and reducing child labor, but also demonstrates potential problems such as social imbalances. For G, better governance of logistics goes with better governance, voice and public participation, science productivity, and rule of law. Through both regression and cluster methods, each of the respective parts of ESG were analyzed in isolation, allowing us to study in-depth how the infrastructure of logistics is interacting with sustainability research goals. Overall, the study emphasizes that while modernization is facilitated by the performance of the infrastructure of logistics, this must go hand in hand with policy intervention to make it socially inclusive, environmentally friendly, and institutionally robust. Full article

Objective: This study on children in low-income families explored whether their mental health problems are attributable to distress from five socioeconomic disadvantage factors playing roles in the multiple disadvantage model. These factors are social disorganization, social structural factors, social relationships, health/mental health, and access to care factors. Methods: The present study employed data extracted from the 2021 National Survey of Children’s Health, describing 7540 low-income children. Weighted logistic regression was conducted (with robust standard errors). Results: It showed that such children were more likely to have mental health problems when seven variables were present. The variables were argumentative children, parents’ difficulty with parenting, children’s difficult peer relations, children being bullied, families’ problematic substance use, families’ use of public health insurance, and families’ difficulty accessing mental health services. In turn, children were less likely to have mental health problems in the presence of six variables: a rundown neighborhood, an unsafe neighborhood, children’s Hispanic ethnicity, children’s Asian ethnicity, children’s general good health, and parents’ good mental health. The present study’s findings support the multiple disadvantage model. Conclusions: That is, the five types of factors key to the model (social disorganization, social structural, social relationships, health/mental health, and access to care) were observed to be related to low-income children’s mental health problems. These findings’ three main implications for practice are that it is crucial to (a) ensure children receive mental health services they need; (b) facilitate effective parent–child communication; and (c) provide low-income families with psychoeducation. Their main implications for policy involve two domains. Improving physical environments and safety in poor neighborhoods is necessary, as is enforcing schools’ anti-bullying rules and using schools to foster students’ assertiveness. Full article