Adolescent health care has been structured around present-focused approaches: rights, holistic health, risk, and gender.These frameworks have led to substantial progress, but they share a limitation: they describe the adolescent's current state without offering a systematic way to project their future trajectory.We present the prospective-dynamic approach, a conceptual framework that integrates these frameworks with an explicit temporal orientation and draws on self-determination theory, motivational interviewing, the future-oriented perspective on adolescent development, the life-course perspective, and positive adolescent development.The prospective-dynamic approach is organized into five operational componentscomprehensive assessment with a temporal perspective, exploration of desires and purpose, construction of trajectories and scenarios, definition of microgoals, and periodic follow-up checkpoints-which can be incorporated into routine consultations without replacing current approaches.This article discusses its rationale, clinical application, and limitations.
Objective To estimate the lifetime and cumulative direct medical burden associated with childhood overweight and obesity in Kazakhstan using a dynamic age-structured modeling approach. Methods A dynamic age-structured Markov cohort model was developed to simulate the progression of children aged 5–9 years through successive age groups and weight states (normal weight, exclusive overweight, and obesity). Transition probabilities were reconstructed using a synthetic cohort approach based on repeated cross-sectional prevalence data and were calibrated to reproduce observed epidemiological patterns. State-specific annual direct medical costs were estimated using a normative costing approach based on national clinical protocols and tariffs. Lifetime burden was calculated as the discounted sum of future medical costs (3% discount rate). Furthermore, cumulative short-term was estimated for the period 2024–2035. Deterministic sensitivity analysis and structural scenario analysis were conducted to assess model robustness. Policy scenarios examined the impact of reducing childhood obesity prevalence by 5 and 10%. Results The average discounted lifetime cost per child was 96,996.26 KZT (USD 206.37), resulting in a total national lifetime financial impact of 194 billion KZT (USD 413 million) for the 2024 cohort of children aged 5–9 years. Over the 2024–2035 horizon, cumulative discounted direct healthcare expenditure reached 128.72 billion KZT (USD 273.9 million), with approximately 71% attributable to obesity. Sensitivity analysis showed that model results were most responsive to parameters related to obesity prevalence and costs. Structural scenarios indicated that the base-case model likely underestimates cost, with age-varying adult costs increasing estimates by up to 13.6%. Policy scenarios demonstrated that a 5 and 10% reduction in childhood obesity prevalence could reduce lifetime burden by 4.8 and 9.4%, respectively. Conclusion Childhood obesity imposes a substantial and persistent economic impact on Kazakhstan's healthcare system. Preventive interventions targeting obesity in early life may yield significant long-term cost savings and should be prioritized in national health policy.
Berik Koichubekov, Khamida Abdikadirova, Nazgul Omarbekova et al.
We present a STEM-based learning trajectory, centered on the phenomenon of earthquakes, that aims to develop spatial reasoning in eight-year-old children. The trajectory has as an end product the design of an evacuation route. Based on a framework integrating spatial reasoning actions, reference frames, and the differentiation of micro-, meso- and macrospaces, the trajectory tasks combine concrete resources (measuring tools, recycled materials) with digital ones (e.g., Google Maps, Google Earth, LightBot) so that students can analyze representations, measure distances, as well as construct and test instruments and artifacts (e.g., a seismograph) not usually included in the primary school curriculum. It is designed to help students articulate and move between different spatial sizes and their representations and use adequate measuring instruments for each. Within a design-based research (DBR) study, the trajectory was implemented with groups of children from a disadvantaged context in Mexico, in two phases and in different modalities: online, during the Covid-19 pandemic, and face-to-face the following year. We describe the pedagogical framework, learning environment, and trajectory design, and report results derived from the analysis of the implementation data –video and audio recordings, photos and student productions. We discuss the practical implications of combining digital and concrete resources, mathematics and the other STEM disciplines; we argue that this can be considered an extended sense of blended learning that helps build a classroom culture of inquiry and gives children agency over their own reasoning. We end by acknowledging the constraints of our work and discuss the accessibility limitations of the online modality in our implementation.
Ana Isabel Sacristán, Andrea Ortiz-Rocha, Ivonne Sandoval
In modern Russia, the family is at a difficult stage of its development Family difficulties manifest themselves in the following trends: the spread of cohabitation, the prevalence of families with one child, the increase in the number of divorces, the decrease in the birth rate, and the increase in the proportion of women who give birth after the age of 25. In this regard, the problem of preparing students for family life and knowing their opinions about modern values and readiness to start a family is very relevant. Purpose: To study the opinion of medical university students about marriage, family, and children. Materials and methods: The study was conducted in 2022 using a voluntary anonymous online questionnaire through a Google form using a random sample method. The sample included 633 students of the Federal State Budgetary Educational Institution of Higher Education "Smolensk State Medical University" of the Ministry of Health of the Russian Federation. Sociological, analytical, and statistical methods were used. Results and discussion: The study revealed that the majority of medical students surveyed plan to start a family at the age of 25–34; 56.4 % of respondents accept the conclusion of one marriage for life; 69.3 % ‒ believe that marriage is one of the main criteria of the well-being of society; 63.3 % ‒ prefer to start a family on love; 84.8 % ‒ positively react to the large family. Among males: 17.3 % did not see the point in getting married, 85.2 % preferred civil marriage, expressed a negative attitude towards marriage (54.9 %) and the birth of a child (94.4 %) during their studies, and 19.8 % perceived unwanted pregnancy as a reason for abortion. Conclusions: In the value system of medical students, marriage and children occupy a dominant position, but there is a preference for civil marriage and a tendency towards later marriages. The adherence to family traditions and scenarios plays a significant role in shaping the students' marriage strategies. Most students approach pregnancy and childbirth planning responsibly.
Erosive lesions may occur in the gastric mucosa after exposure to toxic substances such as alcohol, non-steroidal anti-inflammatory drugs, or iron. Candies rarely contain compounds that cause mucosal erosions. However, Scotch mints in combination with carbonated sodas are known to cause vigorous effervescence. The microporous surface of Scotch mint candy allows for rapid release of dissolved carbon dioxide from carbonated soda that produces carbon dioxide bubbles. We report a case of a 3-year-old child who presented with abdominal pain and feeding refusal and was found to have erosive chemical gastropathy. Dietary history revealed ingestion of Scotch mint candies and lemon-lime soda for 2 days prior to the onset of symptoms. This case demonstrates the potential for mucosal injury when ingesting excessive amounts of Scotch mint candy and carbonated soda and the importance of a careful dietary history in children with gastrointestinal mucosal injury.
Social criticism is an analytical approach used to examine social structures, institutions, and power relations in order to reveal inequalities and injustices within a society. This study investigates the forms of social criticism presented in Charlotte Brontë’s novel Jane Eyre using a Marxist theoretical framework developed by Karl Marx. The data were collected from the novel through a qualitative descriptive method focusing on narrative events, character interactions, and social settings. The analysis reveals the rigid class hierarchy of Victorian English society, in which the bourgeoisie controlled economic resources and social power, while the proletariat experienced dependency, exploitation, and alienation. The findings show that the novel portrays various forms of social inequality through the experiences of Jane Eyre as an impoverished orphan and governess navigating a stratified social structure. Furthermore, the social criticism expressed in the novel remains relevant to contemporary societal issues, including gender oppression, power imbalances in the workplace, and struggles for individual autonomy. Therefore, Jane Eyre can be understood as a significant literary work that not only reflects social realities of its time but also encourages readers to critically examine injustice and inequality in modern society.
Andi Nurul Mawaddah Malik, Burhanuddin Arafah, Herawaty Abbas et al.
Objectives This study investigated the effects of a nanocomposite comprising N-acyl -homoserine lactonase Est816 and silver nanoparticles (Ag-Est816) on the microbial community of an enriched in vitro biofilm model derived from supragingival plaque of children with early childhood caries (ECC). Materials and methods Supragingival plaque samples were collected from 30 children aged younger than 6 years (15 males and 15 females) diagnosed with ECC. These samples were cultured in vitro to form biofilms, which were then treated with or without the Ag-Est816 composite for two days. The composition of the biofilms was analyzed by 16S rRNA sequencing to assess changes in α - and β -diversity, taxonomic composition, and predicted microbial functions. Biofilm morphology and biomass were evaluated using scanning electron microscopy (SEM) and crystal violet assays. Results The Ag-Est816 composite significantly reduced microbial α -diversity, including species richness and phylogenetic diversity (Chao1, Observed species, Faith's PD, p < 0.05). It also significantly altered overall bacterial community composition, as demonstrated by principal coordinate analysis (PCoA) and paired permutational multivariate analysis of variance (PERMANOVA), although the effect size was modest ( R 2 = 0.0286, P = 0.002). At the genus level, the abundances of Actinomyces , Lactobacillus , and Moryella were markedly decreased, whereas Haemophilus and Granulicatella were enriched. LEfSe analysis revealed Actinomyces and Lactobacillus as characteristic taxa enriched in the Control group, while Enterococcus and Granulicatella were significantly enriched following treatment. Functional prediction revealed that Ag-Est816 influenced pathways related to carbohydrate metabolism, amino acid biosynthesis, nucleotide metabolism, and nucleotide sugar biosynthesis. SEM imaging and biomass quantification confirmed that the Ag-Est816 composite disrupted biofilm architecture and significantly reduced total biomass. Conclusion The Ag-Est816 composite suppressed several low-abundance cariogenic genera while reducing overall community richness, altered microbial metabolic functions, and compromised biofilm structural integrity. These findings indicated this non-invasive nanocomposite has potential as an adjunctive therapy for caries prevention in children.
Background The progressive loss of kidney function is a major cause of morbidity and mortality in children with neurogenic bladder dysfunction. A consequent follow-up, including repeated urodynamics combined with detection of vesicoureteral reflux (VUR) is crucial for the individual treatment of the urinary tract. The aim of our study is to investigate whether contrast-enhanced voiding urosonography -urodynamics (ceVUS-UD) can be used in routine urological diagnostics. Due to its radiation-free nature in a more comfortable environment, this would allow the examination to be performed frequently enabling more accurate monitoring of bladder function. Methods Since January 2025, 19 patients with neurogenic bladder dysfunction have undergone simultaneous ceVUS as part of urodynamic follow-up. The children were 11.4 years old on average (9 male, 10 female) and showed one of the following underlying conditions: spina bifida, detrusor hyperactivity after spinal cord injury, caudal regression syndrome, epispadias, infantile cerebral palsy or myotonic dystrophy type 1. Two-thirds of the patients performed self-intermittent catheterization. Results CeVUS-UD can be safely performed as part of routine urodynamic testing without interfering with urological measurements. Previously unknown secondary VUR (sVUR) was detected in six patients (31.6%). In one case, a significant decrease of vesical pressure during the occurrence of reflux was observed. For five children, this led to a change in treatment . Conclusions In this study, CeVUS-UD provides a feasible, safe and radiation-free tool for characterizing neurogenic bladder dysfunction. Whether ceVUS-UD can serve as an alternative to video urodynamics (VUD), and whether routine monitoring of sVUR translates into improved long-term kidney outcomes, remains to be established in further studies.
Social-emotional learning (SEL) is increasingly recognised as an important approach to adolescent mental health promotion in school settings. However, evidence regarding culturally adapted and technology-supported SEL interventions in non-Western educational contexts remains limited. This study reports the expert-validation and pilot-feasibility components of the REAL™ (Read Emotion and Learn to Regulate) module, a culturally adapted, virtual reality (VR)-integrated SEL intervention developed for Malaysian lower-secondary students. These developmental phases preceded a subsequently completed and separately reported randomised controlled trial (RCT). A sequential two-phase design was used. In Phase 1, six Malaysian experts from psychiatry, psychology, education, and social-emotional learning completed a three-round Modified Delphi process evaluating 15 module structure and delivery components and 12 activity stations on a 5-point Likert scale. Content validity was assessed using the item-level content validity index (I-CVI), scale-level average content validity index (S-CVI/Ave), and interquartile range (IQR). In Phase 2, a single-session school-based feasibility pilot was conducted with 15 lower-secondary students, four facilitators, and one school administrator to assess practical implementation of one chapter from the initial 12-station module. In Round 1, the S-CVI/Ave across 15 module structure and delivery components was 0.92. In Round 2, five of 12 activity stations did not meet the I-CVI retention criterion of ≥0.83 (S-CVI/Ave = 0.65). Following module revision and reassessment, 11 of 12 stations met the retention criterion in Round 3. Manage Your Emotions VR improved following revision and was retained, whereas The Drama of Life received uniformly unfavourable ratings (I-CVI = 0.00) and was removed because of concerns regarding suitability, feasibility, and potential physical safety in school settings. The final S-CVI/Ave across the 11 retained stations was 0.85. The findings provide developmental evidence that informed refinement and subsequent evaluation of the REAL™ module. Pilot findings should be interpreted cautiously because of the small, teacher-selected, single-site sample and use of a researcher-developed feedback measure without established psychometric properties.
Aimi Nur Athira Putri Baharuddin, Nik Ruzyanei Nik Jaafar, Normala Ibrahim et al.
