Background- In India, 26 million children are born every year. These Children (0-6 years) comprise 13% of the country's population. Undernutrition is fallout of malnutrition, malabsorption, and nutritional imbalance which causes problem of underweight in children. It can affect child’s brain development and other developmental milestones. Methods- We used anonymized, publicly available secondary data from the India National Family Health Survey (NFHS-5). Descriptive statistical analysis, correlation coefficient analysis, and regression analysis of the data have been done. Results- Multiple linear regression for independent variables, operational AWCs (%) and women with Internet access (%), and dependent variable underweight children per state (%) developed the model, Underweight children (%) = 37.1607 + 0.5659. operational AWCs (%) – 0.2907. women with Internet Access (%). It shows Ꞵ0= 37.1607, Ꞵ1= 0.5659, and Ꞵ2= -0.2907 as well as R squared value as 0.5709. This shows independent variables have a significant influence on the number of underweight children in the state. Results of the Pearson correlation indicated that there is a significant large positive relationship between operational AWCs (%) and the percentage of underweight children in the state, (r(34) = .58, p < .001). Whereas there is a significant large negative relationship between Internet access to women (%) and the percentage of underweight children in the state, (r(34) = .733/-0.733, p < .001). Conclusion- The study clearly shows that when compared, community daycare centers (AWCs) have a limited role in the child's nutrition, but Internet access to the mothers can be a determinant of the child's nutrition. The internet access to women can help to reduce the number of underweight children under five years and improve overall maternal and child health as well as public health.

Background: COVID-19 is a respiratory illness caused by SARS-CoV-2 that has become a global pandemic. Although children can contract the virus, they are generally less likely than adults to develop severe symptoms. Parents and caregivers should monitor their children for symptoms and seek medical attention if their child becomes ill. Practicing good hygiene and social distancing can help prevent the spread of the virus. Vaccines are available for children and can provide additional protection against COVID-19. Understanding the impact of COVID-19 on children is crucial for developing effective public health strategies to control the pandemic.Objectives: The current study aims to determine the prevalence of Covid-19 in pediatric age group in Duhok province and Zakho city, in Kurdistan region. among the children who tested positive for IgG test. If IgG antibodies are detected in a person's blood sample, it suggests that they have been infected with SARS-CoV-2 at some point in the past and their immune system has responded by producing antibodies against the virus.Methods: A cross-sectional investigation was undertaken involving youngsters aged 5 to 12 years. The study encompassed a total of 330 participants, selected between October and December 2022. The children underwent testing to detect IgG antibodies. Moreover, a questionnaire was employed to gather demographic and individual information from each contributor.Results: Among the studied sample, 302/330 (91.5%) of children were positive to IgG antibody test. No gender difference for COVID-19 was found in pediatric age group. Case fatality rate was 0%. 22/302 (6.6%) cases were symptomatic during the infection. However, 282(93.4%) cases were asymptomatic. Conclusions: Covid-19 infection in pediatric age group has good prognosis compared to adults. Intensive care unit (ICU) and death are rare. High-risk groups should be targeted for education and immunization/vaccination. Furthermore, more studies are needed to be conducted in order to investigate the risk factors of the infection and to assess the awareness among the general population about the risk of infection.

Many relevant health social actors have voiced concerns about the danger of self-medication in times of growing use of over-the-counter medicines and, in some contexts, unregulated selling of them. Previous research has examined the incidence of parental self-medication as well as the use and abuse of antibiotics without professional advice. However, these studies have limited evidence on the role of family doctors and the perceived severity of self-medication in the case of parents. Based on Health Belief Model, our research tested the effects of exposure to medical information on the perceived level of self-treating the children without medical advice. Specifically, we aimed to assess whether exposure to information warning about the risks of treating children without a medical prescription influences parents' attitudes toward administering medicines to their children without medical advice. The results showed that our respondents evaluated the practices of self-medication negatively, especially when it came to treating their children without medical advice. However, their attitudes towards self-medication varied depending on their beliefs about administering certain medications. Additionally, the results showed that the perceived level of satisfaction with the family physician could be a significant factor in controlling and avoiding the treatment of children without professional advice.

Background: Lipid disorders are one of risk factors for cardiovascular diseases. The aim of the study was to determine the lipid profile in early childhood in the group of Polish children born small for gestational age (SGA). Materials and Methods: The study included 140 children (93 SGA and 47 controls) aged 5 to 11 years. All children underwent a physical examination and blood tests for the glucose and lipid profile. SGA group was divided in subgroups: symmetrical and asymmetric intrauterine growth restriction (IUGR). Results: Blood sample analysis revealed higher levels of total cholesterol levels (SGA group 190.61 +/- 24.66 mg/dl vs control 143.23 +/- 23.90; p&lt;0.001). The analysis of particular fractions of cholesterol showed significantly higher mean values of triglycerides, LDL-cholesterol as well as lower mean values of HDL-cholesterol in children born as SGA. Children in both groups did not differ significantly according to weight and body mass index. A statistically significantly higher glucose concentration was obtained in the group of children with IUGR with symmetrical type of IUGR. Conclusions: Children born SGA even in their early childhood, without overweight or obesity, have abnormal lipid profile, which may be a risk factor of cardiovascular diseases in adulthood.

Aim was to develop a population pharmacokinetic model for methotrexate (MTX) during high-dose treatment (HDMTX) in pediatric patients with acute lymphoblastic leukemia (ALL) and non-Hodgkin’s lymphoma (NHL) and to describe the sources of variability. The study included 50 patients (1-18 years) who received 3 or 5 g/m2 of HDMTX. Nonlinear mixed effects modeling approach was applied for data analysis. Parameter estimation was performed by FOCEI, whereas stepwise covariate modeling was used to assess variability factors. The final two-compartment model incorporates the effect of body weight using allometric scaling and the influence of hemoglobin and serum creatinine on MTX clearance (CL). Population pharmacokinetic values for a typical 70 kg subject were: 11 L/h for clearance (CL), 46.5 L and 16.4 L for volume of central (V1) and peripheral compartment (V2), respectively, and 0.168 L/h for intercompartmental clearance (Q). According to the final model, MTX CL decreases with increasing serum creatinine, whereas a positive effect was captured for hemoglobin. A difference of almost 30% in MTX CL was observed among patients’ hemoglobin values reported in the study. In addition to renal function and body weight, it describes the influence of hemoglobin on CL, allowing better understanding of its contribution to HDMTX disposition.

Background: Music therapy (MT) is a non-pharmacological treatment increasingly used to reduce stress and anxiety in hospitalized children affected by cancers. The aim of this study was to eval-uate the impact of MT on quality of life of children with cancer. Methods: We have conducted a quasi-experimental study between April 1 and August 31, 2021 at Bechir Hamza children's Hos-pital in Tunis, including children treated for cancer. The child or the parent completed PedsQL Module Cancer french version 3.0 questionnaires before and after four weekly music therapy ses-sions. Child's respiratory and heart rate were measured before and after each session. Results: We included 20 children whose mean age was 7 ± 4.5 years [2-14]. The median value of the total questionnaire score increased from 57 [46; 70] to 72 [67; 85] (p < 10-3) with a significant reduction in pain (p = 0.02), nausea (p = 0.009), anxiety related to medical procedures (p = 0.009) and worry about the future (p = 0.005). We highlighted a significant decrease in respiratory and heart rate after MT (p<0,05). Conclusions: MT has positive impact of on quality of life of children with cancer.

Autism spectrum disorders (ASD) is a heterogeneous group of neurodevelopmental disorders characterized by food selectivity in a significant portion of the population. The nature of this selectivity remains unclear, with hypotheses suggesting associations with sensory disorders or stereotypical and repetitive patterns of activity and interests. This study aimed to determine the prevalence and nature of food selectivity traits in individuals with ASD compared to the neurotypical population. The study involved 219 participants, with 115 diagnosed with autism and 92 without. 12 children undergoing diagnosis were excluded from the analyses. Findings revealed that food selectivity traits are more common in individuals with ASD, with differences in preferences mainly involving structure, color, taste, and serving method. Children with ASD had more food selectivity traits than those without, and certain food characteristics could alter intake as they grow. Selectivity occurred for both sensory and stereotypical reasons, but stereotypical features significantly differentiated neurotypical individuals from those with ASD.

Background: The Covid-19 pandemic has globally impacted the lives of individuals, families, and children. In Italy, measures such as lockdowns and distance learning were implemented in schools, which affected the mental health of children and families. Methods: This article employs qualitative methodology to explore the experiences of children, parents, and teachers during the pandemic and lockdown, as well as the implementation of a death education project aimed at primary school children to help them process emotions and losses experienced during this period. Results: Distance learning posed challenges to the learning process and exacerbated social inequalities. Children suffered from limited social contact with friends and experienced negative emotions, including anger, fear, and concern for the health of their loved ones. The death education project provided a safe space for emotional expression and facilitated the acquisition of coping strategies. Open communication between adults and children about illness and death proved effective in mitigating the psychological impacts of loss and preventing traumatic bereavement. Conclusions: The findings highlight the utility of death education in enhancing children's ability to express their emotions and approach the topic of death morefrankly.

This article presents the main results of the Kids in Action (KIA) project, which aimed to promote physical activity and sport among children aged 3 to 11, by linking the education, sports and family sectors. It applies the concepts of proximity consumption and the 15-minute city to sustainable and healthy habits. This study aims to evaluate the application of the concept of proximity to the provision of physical sports activities from an early age, to reduce the drop-out rate of PA, through collaboration between schools, local government and the sports sector. A mixed methodology was used, applying a survey and interviews with the stakeholders to identify good practices in the promotion of physical activity at an early age. A total of 147 children and 10 adults (3 family members, 4 school managers or teachers and 3 sports managers) participated. The main results included the importance of introducing sport and providing adequate facilities, especially through guided workshops, as this not only influences the actual participation in sport but also the intention to continue practising it. It is observed that children with less affinity towards conventional sports benefit particularly from initiatives such as the KIA programme. On the other hand, the lack of available resources and the influence of the sports culture in families are identified as the main barriers, factors that harm the quality of participation.

The assessment of disability related costs among children remains a largely under-researched subject with related questions rarely included in surveys. This paper addresses this issue through a unique mixed methods study conducted in the Philippines combining a nationally representative survey and in-depth interviews with families and health professionals. To quantify the extra costs associated with disability the research used the standard of living approach, whereby expenditure levels of families with children with and without disabilities are compared in relation to different measures of living standards. The results find consistent evidence of high extra costs among households that have children with disabilities and point to health expenses as the leading source. Using an asset index as the indicator of living standards, a child with disability is estimated to require between 40 and 80% extra expenditure to reach the same living standard of other children. However, the size of extra costs is substantially higher when the measure of standard of living relies on a broader set of deprivations. In such cases, higher estimates of extra costs are likely to be the result of the lack of an inclusive environment. Critically, this points to the need not only to provide financial support, but also inclusive services, especially in health and education.

Background: Children suffering from COVID-19 constitute about 10% of the entire population infected with the virus. In most of them, we observe asymptomatic or mild course; however, about 1% of affected children require a stay in the pediatric intensive care unit (PICU) due to the severe life-threatening course. The risk of respiratory failure, as in adults, is associated with the coexistence of concomitant diseases. The aim of our study was to analyze patients admitted to PICUs due to severe course of SARS-CoV-19 infection. Methods: A retrospective multi-center study, the analysis covered all children with a confirmed diagnosis of SARS-CoV-2 virus infection, who were admitted to PICUs, in the period from November 2020 to August 2021. We studied epidemiological and laboratory parameters, and the endpoint – survival or death. Results: The study analyzed 45 patients (0.075% of all children hospitalized in Poland due to COVID-19 at that time). Mortality calculated in the entire study group was 40% (n=18). Statistically significant differences between the compared groups (survived and died) concerned the parameters of the respiratory system, Lung Injury Score and Pediatric Sequential Organ Failure Assessment . A significant correlation between disease severity and the patient's prognosis was shown by the liver function parameter AST (p=0.028). Analyzing patients requiring mechanical ventilation and assuming survival as the primary outcome, a significantly higher oxygen index on the first day of hospitalization, lower pSOFA scores and lower AST levels (p: 0.007; 0.043; 0.020; 0.005; 0.039, respectively) were found. Conclusions: As in adults, children with comorbidities are most frequently at risk of severe SARS-CoV-2 infection. Increasing symptoms of respiratory failure, the need for mechanical ventilation and persistently high values of aspartate aminotransferase are indicators of poor prognosis.

There has been a rise in the prevalence of atopic dermatitis (AD) globally especially in low-and middle-income countries such as Nigeria. The condition has been linked to genetic predisposes, living conditions, and environmental factors. Environmental factors are considered a significant contributor to AD in low- and middle-income countries. This study determined the prevalence of AD in southwestern Nigeria and identified risk factors in home and school environments that children aged 6 to 14 years are exposed to. A cross-sectional study was adopted, and the total sample size was 349. Four randomly selected health facilities were used for the study. A questionnaire was used to determine the risk factors in the population. Data analysis was done using the latest version of Statistical Package for Social Science (SPSS). The prevalence of atopic dermatitis in this study is 25%. Atopic dermatitis was found to be common in females ( 27%). Children who lived where trucks pass on the street almost daily had the highest cases of atopic dermatitis (28%). Children with rugs in their houses and those whose houses are surrounded by bushes also had higher cases of atopic dermatitis at 26% and 26% respectively. Children who played on school grass, attended creche with rubber toys, and attended a school where wooden chairs and chalkboards were used had higher numbers of AD cases at 26%, 26%, 28%, and 27% respectively. This study identified home and school exposure that predisposes children to AD. It is envisaged that the study will serve as a basis for possible research on evidence-based treatment options.

Educators' subject-matter knowledge and their understanding of the many ways in which technology may be used to enhance student learning can both benefit from the usage of pedagogical technology, which is the primary goal of this kind of technology. The goal of this study is to determine the extent to which kids with special needs might benefit academically by adopting various forms of technology into their daily routines. This work makes use of descriptive qualitative research together with the methodology and processes that come with case study research. The emphasis of this study was placed on three institutions that welcome students of all abilities. According to the results of the qualitative research, inclusive schools do not universally possess the resources necessary to successfully incorporate technology into the classroom. The results suggest that this teacher occupies a position that is about equivalent to the center of the acceptable range. This displays the instructor's existing proficiency in the use of technology to enhance the results for their students.

Despite the impact that climate change is having on our planet and considering its consequences for future generations, much of the academic literature focuses on adolescent and adult percep-tions, giving little relevance to children's perceptions. Children's voices have the potential to in-fluence public opinion, which may in turn determine the direction of a new policy on the cli-mate crisis. In this context, it is urgent that we understand how children perceive this problem. This quantitative study was based on the application of 245 questionnaires to children aged be-tween 9 and 13 years old from five schools in north-eastern Portugal, more specifically in the region of Trás-os-Montes. To collect the data, we used a questionnaire with 26 questions, being 24 of closed response, Likert type, one of them open response, and one multiple choices. The da-ta were statistically treated using SPSS software. The results show that most of the children ex-press concern about the study's potential problem. However, they show some doubts and a lack of knowledge about some of the themes. We found differences between the two study cycles, with children in the 6th grade having a higher average in the understanding of the phenomenon, as well as the level of education of the parents being positively correlated with a more ecocen-tric posture. The female students also showed a slightly more ecological posture, i.e., an eco-friendlier posture. From the results obtained, we can open new paths for future research and contribute to the definition of policies and educational practices since the school has the respon-sibility to cooperate in the production of values, attitudes, and pro-environmental behaviours.

(1) Background: When the Omicron variant of SARS-CoV-2 first emerged in Germany in January 2022, data on related disease severity among children and adolescents was not yet available. Given Omicron’s high transmissibility, the ability to assess its impact on admission and hospitalization rates in children’s hospitals is critical for the purpose of understanding the scope of its burden on the German health care system. (2) Methods: From January 24, 2022 to July 31, 2022, SARS-CoV-2 cases admitted to German pediatric hospitals were monitored via a national, clinician-led reporting system (CLRS) established by the German Society for Pediatric Infectious Diseases (DGPI). Cases treated on general wards and intensive care units, as well as patient age and need for respiratory support were recorded. (3) Results: From January to July 2022, a median of 1.7 cases (range 0.4–3) per reporting pediatric hospital per day were hospitalized on general wards, whereas a median of 0.1 cases (range 0–0.4 cases) were on intensive care units. Of all hospitalized patients, 4.2% received respiratory support. (4) Conclusions: Despite the high incidence rates documented in connection with the Omicron variant in early 2022, the number of pediatric hospital admissions, and especially the number of cases with need for intensive care treatment and respiratory support due to a symptomatic SARS-CoV-2 infection, remained relatively low. Higher Omicron incidence rates had only a modest impact on SARS-CoV-2-related admissions and hospitalization in German children’s hospitals.

Abstract: Background: Stunting is primarily a public health concern in LMIC. The involvement of Integrated Service Post cadres is one of the strategies to combat stunting in Indonesia. Objective: This study aimed to determine the effect of a short course on cadres knowledge. Method: A single group pre-post test design was conducted in Yogyakarta, Indonesia, from March to May 2022. Thirty cadres were selected based on the following criteria: willingness to participate, the number of stunted children in their Integrated Service Post (Posyandu), and full attendance at short course. The knowledge scores were measured by a structured questionnaire after short course (post-test 1) and 4 weeks later (post-test 2). We apply STATA 16 to calculate the mean difference (MD) using a t-test and Generalized Estimated Equation (GEE). Furthermore, the adequacy of the short course was evaluated with in-depth interviews. Result: On post-tests 1 and 2, cadres' knowledge of IYCF, children growth monitoring (CGM) and children development monitoring (CDM) significantly improved. The GEE analysis showed that a short course significantly improves cadres' knowledge after age control, education, occupation, and years of experience. Conclusion: Short course in-creased their affection, self-efficacy, and confidence, hence, they are capable of assisting children through home visits.

Parents’ attitudes and practices may support the children’s reactions to treatments for leukemia and their general adjustment. This study has two aims: to explore parenting depending on child's age and to develop and test a model on how family processes influence the psycho-social development of children with leukemia. Patients were 118 leukemic children and their parents recruited at the Haematology-Oncologic Clinic of the Department of Pediatrics, University of Padua. All parents were Caucasian with a mean age of 37.39 years (SD = 6.03). Children’s mean age was 5.89 years (SD = 4.21). After the signature of the informed consent, the parents were interviewed using the EFI-C from which we derived Parenting dimension and 3 parental perceptions on child’s factors. One year later, the clinical psychologist interviewed again parents using the VABS scales. The analyses revealed the presence of a significant difference in parenting by child’s age: Infants required a higher and more intensive parenting. Child’s coping to medical procedures at the second week after the diagnosis, controlled for parenting effect, impacted upon child’s adaptation one-year post diagnosis. Specific intervention programmes are proposed in order to help children more at risk just after the diagnosis for developmental delays.

(1) Background: Research has shown that thoughts about pain are important for the management of chronic pain in children. In order to monitor changes in thoughts about pain over time and evaluate the efficacy of treatments, we need valid and reliable measures. The aims of this study were to develop a questionnaire to assess a child’s concept of pain and to evaluate its psychometric properties; (2) Methods: This is a cross-sectional, two-phase, mixed-method study. A total of 324 individuals aged 8 to 17 years old responded to the newly created questionnaire. The Survey of the Concept of Pain (SOCOPA) was calibrated using the Rasch model. The chi-square test was used for the fit statistics. Underfit and overfit of the model were determined and a descriptive analysis of infit and outfit was conducted to identify who responded erratically. Internal consistency was measured using the Person Separation Index (PSI); (3) Results: Fit to the Rasch model was good. Suitable targeting indicated which items were simple to answer; Person Fit identified 9.56% children who responded erratically; PSI=0.814; (4) Conclusions: The findings suggest that SOCOPA is a measure of a child’s concept of pain that is easy to administer and respond to. It has a good fit and a good internal consistency.

During this epidemic of COVID-19, children are in need of much concentration and profound love of the senior family members. Although the measures taken by the organizations are necessary to prevent the spread of the novel coronavirus, they may be causing widespread mental health issues, including depression and loneliness. Therefore, it is imperative that parents have to spend the lion-share of time with children while listening to them cordially. Parents can participate in sports with them to help them stay fit so that they can enjoy commemorating moments. However, in this additional time, the parents can also make them habituated to practice the rules of health, so does social distancing.

Background: The question of whether children are less likely to pass on SARS-CoV-2 is important for planning society’s response to the pandemic. A document available on the Charité hospital website has not been formally published but is frequently referred to as supporting the notion that viral loads are similar in children and adults. Methods: The summary data from this document was extracted and used to produce summary statistics for three age groups: younger children (ages up to 11), older children (ages 12 to 19) and adults (ages 20 and above). Viral loads between the two children’s groups and the adult group were compared using Welch’s t test, which only requires group means and standard deviations and which is robust against moderate departures from normality. Findings: Viral loads were significantly lower than in adults for both younger children (p=0.04) and older children (p=0.04). Overall, viral loads were lower in children than adults (p=0.005). Interpretation: For both younger and older children, on average those with detectable SARS-CoV-2 have significantly lower viral loads than adults. Funding: No funding was received for this analysis.

Robots for communication are developed extensively with emphasis on sympathy. This study deals with the growth of character and the control of its operation accordingly. The child has time to be alone with the nature of his/her robot friend. The child can interact with other people's emotional expressions through a robot. Step by step, the robot character will grow as the child grows. Through design studies, qualitative processes such as {customer experience audit, eye tracking, mental model diagrams, semantic differences} have been executed for the results. The participatory behavior research approach through user travel is mapped from the user's lead to the evidence-based design. This research considers how the synthetic characteristics can be applied to the physical growth of robot toys through the product design process. With the development of robot toy "Buddy", we tried making two variations on the robot to achieve recognizable growth. (1) A one-dimensional height scaling and (2) facial expression including the distance between two eyes on the screen. Observations represented children's reactions when "Buddy" was released to with the children. As an independent synthetic character, the robot was recognized by children who had the designed function. Robots for training may require more experimentation.

The COVID-19 pandemic caused many enduring changes in everyday life of families with negative effects on parents’ and children well-being. However, literature lacks of studies exploring emotional reactions and coping strategies of both mothers and children of different ages. Furthermore, most studies used only self-reports. This study aimed to identify the emotions and coping strategies of children, adolescents and their mothers and to verify the association between maternal and children well-being. A mixed-method design using interviews and questionnaires was applied to collect information on well-being (emotional reactions, behavioral/emotional problems) and coping strategies of both mothers (n=65), and their children (n=35, 8-10 year; n=30, 11-13 year) during the second wave of the pandemic (December 2020). No differences between the groups emerged concerning the emotional reactions reported. In contrast, mothers and children of different ages reported different self-regulation and other-regulation strategies. Moreover, maternal strategies had different effects on children well-being. The integration of qualitative and quantitative results was informative to understand how families adapted to the radical changes of everyday life caused by the pandemic. Implications for developing interventions in such similar stressful situations to promote family well-being are discussed.

Background: We aimed to investigate the effectiveness of postnatal ultrasonography in determining congenital anomalies of the kidney and urinary tract in term infants with or without a history of congenital anomalies of the kidney and urinary tract in the prenatal period. Methods: In this retrospective cohort study, the records of term infants aged between six weeks and three months undergoing urinary system ultrasonography during routine child care were examined. Results: Congenital anomalies of the kidney and urinary tract was determined in 121 (4.62%) of the 2620 cases included in the study. The most common anomaly was hydronephrosis (in 69.4% of the congenital anomalies of the kidney and urinary tract cases and 3.21% of all cases). Thirty-two of the 84 (38.1%) hydronephrosis cases detected by postnatal ultrasonography, three of the nine (33.3%) renal agenesis cases, four of the seven (57.1%) horseshoe kidneys cases, one of the four (25%) multicystic dysplastic kidney cases and two of the two (100%) duplex system cases could not be detected by prenatal ultrasonography. On the other hand, hydronephrosis was not detected at postnatal ultrasonography in 29 (1.1%) cases which detected mild or moderate hydronephrosis by prenatal ultrasonography scanning. Conclusions: In our study, it was observed that approximately one-third of the cases of hydronephrosis, unilateral renal agenesis, duplex system, horseshoe kidney, and ectopic kidney could not be detected at prenatal ultrasonography screening. We therefore believe that, in addition to prenatal ultrasonography screening, postnatal ultrasonography screening of all children for urinary tract anomalies would be beneficial.

There is still little research on psychological wellbeing and reported problems in preadolescents and adolescents under therapy for leukemia, also comparing them with their healthy peers. The present study aims to analyze the life perceptions, psychological well-being and problems’ intensity in these patients during the first year of therapy and to compare these reports with those of matched healthy peers adopting a battery of self-report questionnaires. Mann-Whitney tests identified the younger patients more at risk than older ones in their problems’ intensity and psychological symptoms. Older patients resulted instead more vulnerable regarding past life perceptions. Wilcoxon test with 2 dependent samples analyses showed that: healthy peers have a better perception of current life and lower percentage of somatization symptoms than patients after 6-months post-diagnosis. On the other hand, healthy peers reported more problems dealing with impulsivity, mood, disorganization, concentration and memory than patients both at 6-months and 1-year from diagnosis. Healthy peers reported also more anxiety and depression symptoms than patients and worse past and future life perceptions than patients at 1-year from diagnosis. The clinical aim is to perform a psychological screening of preadolescents and adolescents in order to prepare ad hoc psychological interventions.

School meals can have a key function in promoting children’s health. However, simply providing a free school meal is not a guarantee that pupils will actually eat the food. The purpose of this study was to explore factors influencing pupils’ participation in free school meal schemes in Oslo The study has a qualitative research design, inspired by grounded theory. Data were collected through interviews with pupils, teachers and parents, and participant observations in two schools participating in a pilot project funded by Oslo Municipality. Line-by-line coding, memo writing and a constant comparative technique were used to analyse the data. One primary school and one lower-secondary school in different districts in Oslo that were implementing two different free school meal models. 39 pupils (5th–10th grade), 15 parents and 12 school employees were included. Four main factors related to pupils’ participation to free school meals emerged from the analysis: the popularity of the food served, the attraction to the nearby shopping centre, social aspects and predictability. To promote pupils’ participation in free school meal schemes, schools need to solve the challenges of balancing between healthy food and popular but often unhealthy food. Children and parents involvement, regularity of the meals provision, a good flow of information and the creation of a friendly eating environment are recommended

Background: Left ventricular noncompaction (LVNC) is a genetically determined cardiomyopathy, that occurs following a disruption of endomyocardial morphogenesis. The purpose of this study was to identify the clinical characteristics and genetic profile of children with LVNC. Methods: From February 2008 to July 2020, a total of 32 children (median 11.5 years) with LVNC were prospectively enrolled and followed up for the median of 4.02 years. Diagnosis was made based on characteristic features of LVNC in echocardiography and cardiovascular magnetic resonance (CMR). Patients’ clinical symptoms, family history, ECG, Holter ECG and genetic tests were also evaluated. Results: The most common presenting symptom was heart failure (31% of children). ECG abnormalities were noted in 56% of patients. The most prominent features were ventricular arrhythmias, sinus bradycardia and paroxysmal third-degree atrioventricular block. Most of the patients (94%) met the criteria for LVNC and CMR confirmed this diagnosis in 82% of cases. The molecular etiology was found in 53% of children. Conclusion: Although heart failure and arrhythmias were very frequent in our study group, thromboembolic events and genetic syndromes were rare. For accurate and reliable assessment of children with LVNC, it is necessary to get to know their family history and detailed clinical profile.

While there is a coordinated effort around reaching zero dose children and closing existing equity gaps in immunization delivery, it’s important that there is agreement and clarity around how ‘zero dose status’ is defined and what is gained and lost by using different indicators for zero dose status. There are two popular approaches used in research, program design, and advocacy to define zero dose status: one uses a single vaccine to serve as a proxy for zero dose status, while another uses a subset of vaccines to identify children who have missed all routine vaccines. We provide a global analysis utilizing the most recent publicly available DHS and MICS data to compare the number, proportion, and profile of children 12 to 23 months who are ‘penta-zero dose’ (have not received the pentavalent vaccine), ‘truly’ zero dose (have not received the BCG, polio, pentavalent, and measles vaccines), and ‘misclassified’ zero dose children (those who are penta-zero dose but have received at least one other vaccine). Our analysis includes 194,829 observations from 82 low- and middle-income countries. Globally, 14.2% of children are penta-zero dose and 7.5% are truly zero dose, suggesting that 46.5% of penta-zero dose children have had at least one contact with the immunization system. While there are similarities in the profile of children that are penta-zero dose and truly zero dose, there are key differences between the proportion of key characteristics among truly zero dose and misclassified zero dose children, including access to maternal and child health services. By understanding the extent of connection zero dose children may have with the health and immunization system and contrasting it with how much the use of a more feasible definition of zero dose may underestimate the level of vulnerability in the zero dose population, we provide insights that can help immunization programs design strategies that better target the most disadvantaged populations. If the vulnerability profiles of the truly zero dose children are qualitatively different from that of the penta zero dose children, then failing to distinguish the truly zero dose populations, and how to optimally reach them, may lead to the development of misguided or inefficient strategies for vaccinating the most disadvantaged population of children.

People are increasingly encouraged to reduce animal food consumption and shift towards plant-based diets, however the implications for children’s health are unclear. In this narrative review of research in high-income settings, we summarize evidence on the increasing consump-tion of plant-based diets in children, and update an earlier systematic review regarding their associations with children’s health outcomes. The evidence indicates that vegan but not vege-tarian diets can restrict growth relative to omnivorous children, and increase the risk of being stunted and underweight although the percentage affected is relatively small. Bone mineral content is reduced in vegetarian and especially vegan children, compared to omnivores. Both vegetarian and vegan children who do not use vitamin B12 supplements manifest with B12 defi-ciency, however supplementation rectifies this problem. Both vegetarians and vegans have lower concentrations of 25 (OH)D if unsupplemented, and lower body iron stores, but usually have normal iron metabolism markers. Both groups are at risk of iodine deficiency and this might affect thyroid health. Children consuming a vegan diet have more favorable lipid profile than omniv-orous children, however the results for vegetarian diet are inconsistent and vary by outcome. Based on the same scientific evidence, national and international dietary recommendations are heterogeneous, with some countries supporting plant-based diets among infants, children and adolescents, and others discouraging them. We offer a research roadmap, highlighting what is needed to provide adequate evidence to harmonize dietary recommendations for plant-based diets in children. A number of measures should urgently be introduced at international and na-tional levels to improve the safety of their use in children.

Background: Low-income families often depend on fuels such as wood, coal, and animal dung for cooking. Such solid fuels are highly polluting and are a primary source of indoor air pollutants (IAP). We examined the association between solid fuel use (SFU) and acute respiratory infection (ARI) among under-five children in Afghanistan and the extent to which this association varies by socioeconomic status (SES) and gender. Materials and Methods: This is a cross-sectional study based on de-identified data from Afghanistan’s first standard Demographic and Health Survey conducted in 2015. The sample consists of ever-married mothers with under-five children in the household (n=27,565). We used mixed-effect Poisson regression models with robust error variance accounting for clustering to examine the associations between SFU and ARI among under-five children after adjusting for potential confounders. We also investigated potential effect modification by SES and sex. Additional analyses were conducted using an augmented measure of the exposure to IAP accounting for both SFU and the location of cooking/kitchen (High Exposure, Moderate, and No Exposure). Results: Around 70% of households reported SFU, whereas the prevalence of ARI was 17.6%. The prevalence of ARI was higher in children living in households with SFU compared to children living in households with no SFU (adjusted prevalence ratio [aPR]= 1.10; 95%CI: 0.98, 1.23). We did not observe any effect modification by SES or child sex. When using the augmented measure of exposure incorporating the kitchen’s location, children highly exposed to IAP had a higher prevalence of ARI compared to unexposed children (aPR 1.17; 95% CI: 1.03, 1.32). SES modified this association with the strongest associations observed among children from the middle wealth quintile. Conclusion: The findings have significant policy implications and suggest that ARI risk in children may be reduced by ensuring clean cookstove as well as clean fuels and acting on the socio-environmental pathways.

Background: The role of NFATC genes expression in BAV progression is not fully understood. Aim of study is to determine the significance of NFATC1 and NFATC4 gene expression for myocardial changes in children with BAV. Methods: In 47 children with BAV the standard Doppler echocar-digraphic characteristics were detected and the expression of the NFATC1 and NFATC4 genes was studied. Results: PWTd, AoPPG, in BAV patients were significantly higher compared to healthy controls (PWTd median(min-max) 9 (7-10) mm vs 7 (6-8) mm), AoPPG median (min-max) 7,79 (2,98-15,09) mm Hg vs 2,94 (2,42-3,72) mm Hg. Expression of NFATC1 gene in BAV children was significantly higher compared to NFATC4 (NFATC1 median (min-max) 70,88 (8,79-106,51) e.u. vs 7,72 (1,74-22,67) e.u., respectively p<0,05). Significant correlation of NFATC1 expression with Ao found (R=+0,53, p<0,05). In BAV patients with PWTd > 8 mm and Ao> 21 mm the NFATC1 expression was significantly higher compare to those with PWTd< =8 mm and Ao<=21 mm NFATC1 median (min-max) 45,49 (5,01-101,52) e.u. vs 15,53 (2,36-44,40) e.u., p<0.05 and 81.11 (20.27-101.10) e.u. mm vs 12.16 (2,40-45.49) e.u., p<0.05, respectively) Conclusion: in children with BAV the high expression of the NFATC1 calcineurin signalling pathway gene is associated with elevated PWTd and Ao.

Children five years or younger in low- and middle-income countries (LMICs) are severely affected by diarrhoea disease, especially in the sub-Saharan region. Hence, the study aimed at determining the prevalence and determinants of diarrhea disease among children under 5 years in Epworth Township, Zimbabwe. A descriptive cross-sectional study was conducted at a local clinic in Epworth Township, Harare. A convenience sampling strategy was used to recruit study participants for participation and 386 children were enrolled in the study. The majority were male children (n=229; 59.3%), while there were more female caregivers (n=370; 95.9%) than male caregivers (n=16; 4.1%). The prevalence of diarrhea disease in the study was 25.1%. The determinants associated with diarrhea were being partially vaccinated (OR 2.38, CI 95% 2.80–8.22), collecting water more than 1 kilometre from a household (OR 4.55; CI 95% 2.10–9.85) and using untreated water (OR 6.22; CI 95% 2.13–18.20). The age of the caregiver and using a clean water container (OR 0.05; p=0.020) were protective factors. Provision of primary health care, especially prevention of disease through immunization and rendering environmental health services could reduce the prevalence of diarrhea in disadvantaged townships.

This paper describes a research project carried out in an Italian public school to assess whether parents were willing to take part in food procurement decisions, as well as their ability to accurately predict what foods children would pick at school lunch and their propensity to support sustainable food choices made by the school. The methodology included a questionnaire to 500 parents and an in-depth study of 138 child/parent pairs. The study comprised: (i) presentation of an innovative recipe in the weekly menu of the school canteen; (ii) meal observations of children’s intake at school lunch during the week of the menu modification; (iii) collection of both parents’ and children’s reports on their choices of recipes from the modified weekly menu. The results are commented in light of two important changes that have recently affected Italian public school food procurement: the opening of school canteens to lunches brought from home and the measures adopted since 2020 to contain the Covid-19 pandemic. Both events go in the direction of delegating to parents the multifaceted role of the school in the food arena. The article concludes that the results of the study should discourage this approach.

Background: Self-harm (SH) refers to self-injury or intentional self-poisoning with varying degrees of suicidal intent and is a major public health issue for children and adolescents (C&A) worldwide. Given significant gaps exist in our understanding of the associated psychopathology in C&A, this paper outlines the protocol for a prospective clinical study examining risk factors of SH and additional candidate parameters (not routinely assessed) during an acute SH episode. Methods: The EXPAAND (EXploring Psychiatric and Attentional risk-factors in Adolescents Needing intervention for Deliberate self-harm) is a randomised control trial to assess additional novel candidate risk factors for SH in C&A and to evaluate the effectiveness of SH-targeted brief psychological intervention (Therapeutic Assessment (TA)), within a real-world acute clinical setting, as we include neurodiversity and gender diversity in this study. EXPAAND is conducted in 4 phases: (i) recruitment & randomisation; (ii) extended assessment; (iii) randomised intervention; and (iv) follow-up observational period to ascertain clinical outcomes for comparison. Expected Results: We envisage that by diagnosing and treating attentional disorders when detected will mitigate potential confounding effects of these conditions. We also expect that SH-focused TA will be effective in reducing subsequent SH and in improving engagement in follow-up and subsequent treatments.

Lead, known as a metal with high neurotoxicity to children, cadmium, which is a carcinogenic and bioaccumulative contaminant, and arsenic, a class 1 carcinogenic according to the International Agency for Research on Cancer, are toxic elements (TEs) whose relevant route of exposure may be diet. We determined the bio-accessible fraction of lead, cadmium, and arsenic from the diet of preschool children from two day care centers (DCC). A cross-sectional study was conducted with 64 one–four-year-old children from two DCCs where the 24-h duplicate diet samples were collected. The diet samples were analyzed by ICP-MS for lead, cadmium, and arsenic total concentrations (n = 64) and their bio-accessibility were analyzed for a subsample (n = 10). The dietary intake (DI) mean for lead, cadmium, and arsenic were 0.18 ± 0.11 µg kg⁻¹ bw, 0.08 ± 0.04 µg kg⁻¹ bw, and 0.61 ± 0.41 µg kg⁻¹ bw, respectively. All DI calculated for TEs, considering total intake, were found lower than the tolerable limits (TL) (European Union, or World Health Organization, WHO, when applicable) except for one child’s Pb intake. Bio-accessibilities ranged between 0% to 93%, 0% to 103%, and 0% to 69%, for lead, cadmium, and arsenic, respectively. Although DI for TEs has been found lower than TL, these reference values have been recently decreased or withdrawn since it was for lead and arsenic whose TL were withdrawn by WHO.

Background: Vaccinating children against COVID-19 is an essential public health approach for preventing infection in children and adults. This study aimed to explore parents' attitudes toward and the rate of COVID-19 vaccine hesitancy among children in Oman. Methods: This cross-sectional study used an online, self-administered questionnaire. The 9-item questionnaire was validated earlier and administered between June 2021 and May 2022. Multiple logistic regression was used to determine the factors associated with vaccine hesitancy. The parents received a pre-validated Google questionnaire. Responses from the parents of children younger than 11 years of age were accepted. Results: 384 participants completed the questionnaire, including 207 males (54%). The response rate was 86% (384/447). Of the 384 participants, 69% of the parents hesitated to vaccinate their children aged 1-11-year-old children). In parents of children aged 1–4 years, parental vaccination status was significantly associated with vaccine hesitancy (odds ratio [OR]: 0.116, 95% confidence interval [CI]: 0.044–0.306; p < 0.001). Additionally, vaccine hesitancy was significantly more common in mothers than in fathers (OR: 0.451, 95% CI: 0.240–0.848; p = 0.013). . Mothers of children were 77% more likely to be hesitant than fathers (.78, 95% confidence intervals (CI) = 0.50–0.1.23; p = 0.283). Conclusion: Many parents hesitated to vaccinate their children against COVID-19. Consequently, future awareness campaigns and strategies should target new vaccines. The results of our study show that the Arabic version of the 5-point Likert Scale for Vaccination Hesitancy is a valid and reliable tool.

The study aimed to review the management of pediatric digestive duplications (DD) with regards to clinical presentation, operative procedures and complications in a single institution in Bucharest, Romania. A retrospective analysis was performed using patient records from ‘Grigore Alexandrescu’ Emergency Children’s Hospital from 2013 to 2023. All patients with a postoperative diagnosis of DD were selected. A total of 39 children (19 boys, 20 girls) with DD have been treated in our hospital in the past 10 years. Only N=5 of them have been diagnosed antenatally. In N=22 cases patients were referred to our hospital for tumors, while N=17 cases involved an acute setting. Comorbidities were encountered in N=16 patients. Duplications involved several parts of the digestive tract: ileal (N=19), colonic (N=10), esophageal (N=2), jejunal (N=2), gastric (N=2), duodenal (N=1), ileocecal (N=1), esogastric (N=1) and rectal (N=1). Two of the duplications were intraluminal, while the rest were cystic. There were N=28 open interventions and N=11 laparoscopies. Conversion was needed in N=2 cases due to (a) overdistended bowel and (b) dense adhesions between the ileum and the tumor. The tumor was resected in N=17 cases, while intestinal resection was required in N=22 cases. A drain was used in N=21 patients. The average hospital stay for open procedures was 10 days and for laparoscopic procedures 8 days. Complications arose in N=7 patients who had an open procedure and N=1 patient who had a laparoscopic procedure. There were no mortalities. With a low rate of antenatal diagnosis (12.82%), 43.58% of DD appeared in an acute setting. Open procedures were favored in acute cases and patients with comorbidities, but required a longer hospital stay. Laparoscopic management had a 18.18% conversion rate and a low rate of complications (9.09%).

Recent findings have demonstrated an increase in the prevalence of childhood obesity and overweight in Portugal, urging the need to study modifiable risk factors such as parental feeding practices. The Comprehensive Feeding Practices Questionnaire (CFPQ) is an important self-report measure assessing a broad range of responsive and non-responsive feeding practices. However, the CFPQ has not yet been validated in Portugal. Therefore, the present study aimed to test the validity of this measure with Portuguese parents of 2- to 8-year-old children. A sample of 409 parents completed a Portuguese-adapted version of the CFPQ and the already validated Child Feeding Questionnaire (CFQ). Confirmatory Factor Analysis (CFA), Exploratory Factor Analysis (EFA), and psychometric analysis were conducted. CFA demonstrated the original 12-factor structure did not fit the sample. EFA identified an 8-factor structure, comprising 29 items: Monitoring, Modeling, Environment, Involvement, Emotion Regulation, Restriction for Weight Control, Restriction for Health, and Pressure. Findings suggest that parental feeding practices are sensitive to parents’ background culture and children’s developmental period.

Background and objective: Research shows that 60–90% of school children have caries, representing a serious public health issue. Here, we present a model of oral health promotion that has been conducted in the Primorje-Gorski Kotar County (PGC), Croatia, from 2008 to 2019. We assessed the oral status of first and fifth grade elementary students and determined the sustainability and influence of our model on the status and behavior regarding the children’s oral status. Additionally, during the observed period, promotional and preventative activities aiming to improve oral health were conducted. Since 2014, the Program has begun to be continuously, comprehensively, and systematically introduced into preschools as well. Material and methods: We assessed the number of children with caries by analyzing the changes in the decayed, missing, and filled teeth for primary teeth (dmft)/decayed, missing, and filled teeth for permanent teeth (DMFT) index mean during the observed period. Results: From 2008 to 2019 we assessed 44422 children in the PGC (21714 first grade and 22708 fifth grade students). The average response rate throughout the Program has been 83%. We have noted a dmft/DMFT index decrease from 4,66 to 3,73 (first graders) and from 2,50 to 1,00 (fifth graders). Conclusions: The Program has improved the behavior and oral health of children; stakeholders from various professions have been included, such as health visitors, school medicine teams, and pediatricians, avoiding additional financial expenses, increasing the number of children in care, and proving the sustainability of our oral health improvement model.

Universal education is an elusive goal in many countries, especially for disabled children. Nonetheless determined efforts around the globe have shown that it can become a reality once existing systems were re-imagined by practitioners who arguably have been to the fore more so than academic researchers. Their efforts have identified new ways of thinking about children’s disabilities, the introduction of new practices in schools, forging partnerships between teachers and parents, and mobilising community resources. Societal change is both a consequence of, and a support to these local systems. The complexity of creating education for all may be daunting but it is achievable when driven by committed, creative and inspirational leadership from practitioners as is evident from the examples provided in this paper which have been further validated by research and evaluation into their efforts.

Background: Vitamin B12 is a water-soluble vitamin with important cellular functions and is an essential vitamin. The aim of this study is to determine the B12 levels of children in the period from the 6th month when they start taking additional foods to the age of 7 and the risk factors affecting them. Methods: One hundred pediatric patients aged 6-72 months who were diagnosed with vitamin B12 deficiency and their parents who agreed to participate in Istanbul Atlas University, Medical Faculty, “Medicine Hospital” Pediatric Clinic between September 2022 and June 2023 were prospectively included in this study. Results: B12 deficiency was significantly higher in the 6-11 (25%) month group than those in the 12-23 (5.8%) and 24-47 (2.8%) month groups. Homocysteine levels were highest in those with insufficient B12 levels compared to the other groups. There was no statistically significant difference in weekly dairy and meat consumption levels between age groups. B12 levels were lower in the 6-11-month group than in the other groups. Homocysteine levels were highest in those with insufficient B12 levels [<200 pg/mL (148 pmol/L)]. Folic acid levels were lower in the 24-47 month and 48-72 month groups than in the 6-11 month and 12-23 month groups. Conclusions: The results obtained in this study showed that low vitamin B12 and increased homocysteine levels seem to be important risk factors in children, especially from the 6th month when they start taking additional foods. The diagnosis of B12 deficiency can be confirmed by elevated serum total homocysteine levels, which are evidence of functional cobalamin deficiency.

Crohn's disease (CD) is a chronic, immune-mediated inflammatory bowel disease characterized by transmural damage of various parts of the gastrointestinal tract. The aim of the study is to present our experience in pre-surgical diagnosis, selection of surgical tactics and volume of intervention in different variants of gastrointestinal tract lesions and disease activity. We undertook cross-sectional, retrospective-prospective study of 64 children who underwent surgery due to complicated CD. We analyzed CD activity via PCDAI, medications used, inflam-mation localization, and changes in mass-growth parameters at pre-surgery stage. Three patients from the group of 44 children with two-stage surgical treatment later showed inefficacy of GEBD in post-operative period. The disease progression was revealed and, therefore, subtotal colectomy was required. Three children had secondary adhesion of surgical wounds by means of active immunosuppressive therapy at preoperative period, and five patients developed suture sinuses at post-operative period. Early adhesive intestinal obstruction was revealed in 3 (4.7%) cases, and they required re-surgery. Personalized approach to the surgical treatment of children with complicated CD has shown its efficacy due to the small percentage of postoperative complications with re-surgery. There was significant improvement in mass-growth parameters, recovery of albumin levels, and anemia decrease in 96.9% of cases in the long-term postoperative period (6 months or more). Two children (3.1%) had the narrowing of anastomotic zone lumen, thus, without any obstruction. These cases were associated with violations in drug treatment

Introduction: Child stunting remains a public health concern. It is characterized as poor cognitive and physical development in children due to inadequate nutrition during the first 1,000 days of life. Across South Asia, Pakistan has the second-highest prevalence of stunting. This study has assessed the most recent nationally representative data, the National Nutrition Survey (NNS) 2018, to identify the stunting prevalence and determinants among Pakistani children under five. Methods: The NNS 2018, a cross-sectional household-level survey, was used to conduct a secondary analysis. Data on malnutrition, dietary practices, and food insecurity was used to identify the prevalence of stunting among children under five years by demographic, socioeconomic, and geographic characteristics. The prevalence of stunting was calculated using the World Health Organization (WHO) height for age z-score references. Univariate and multivariable logistic regressions were conducted to identify factors associated with child stunting. Results: Analysis showed that out % of 52,602 children under five, 40.0% were found stunted. Male children living in rural areas were more susceptible to stunting. Furthermore, stunting was more prevalent among children whose mothers had no education, were between 20 and 34, and were employed. In the multivariable logistic regression, male children (AOR=1.08, 95% CI[1.04-1.14], P<0.001) from rural areas (AOR=1.07, 95% CI [1.01-1.14], P=0.014), with the presence of diarrhea in the last two weeks (AOR=1.15, 95% CI [1.06-1.25], P<0.001), with mothers who have no education (AOR=1.57, 95% CI [1.42-1.73], P<0.001) or lower levels of education (Primary: AOR=1.35, 95% CI [1.21-1.51], P<0.001; Middle: AOR=1.29, 95% CI [1.15-1.45], P<0.001) had higher odds of stunting. Younger children aged <6 months (AOR=0.53, 95% CI [0.48-0.58], P<0.001) and 6-23 months (AOR=0.89, 95% CI [0.84-0.94], P<0.001), with mothers aged 35-49 years (AOR=0.78, 95% CI [0.66-0.92], P=0.003) had lower odds of stunting. At the household level, the odds of child stunting were higher in the poorest households (AOR=1.64, 95% CI [1.46-1.83], P<0.001), with ≥7 members (AOR=1.09, 95% CI [1.04-1.15], P<0.001), with no access to improved sanitation facilities (AOR=1.14, 95% CI [1.06-1.22], P<0.001) and experiencing severe food insecurity (AOR=1.07, 95% CI [1.01-1.14], P=0.02). Conclusion: Child stunting in Pakistan is strongly associated with various factors, including gender, age, diarrhea, residence, maternal age and education, household size, food and wealth status, and access to sanitation. To address this, interventions must be introduced to make locally available food and nutritious supplements more affordable, improve access to safe water and sanitation, and promote female education for long-term reduction in stunting rates.

Shape of supracondylar fracture of the humeral of pediatric patients is analysed with Procrustes method. XR–images of fractures are considered both in anterio-posterior (AP) view (66 images) and in a lateral (L) view (24 images). Applying Procrustes method for both views mean images are constructed and compared. Variability of shapes is quantified with a shape principal component analysis. Non-parametric tests (permutational and bootstrap) do not indicate statistical difference between Procrustes mean shapes in anterio-posterior and lateral projections. It is shown, however, that AP and L shapes of humeral fractures differ in their variability quantified by shape principal components.

Sex/gender (S/G) differences in ASD language profiles have been poorly investigated. The present study aims to explore whether male (M) and female (F) children with ASD and with normal non-verbal cognitive abilities differ in their linguistic profiles. A sample of 76 Italian children with ASD (range: 4.9 – 8 years), including 50 M and 26 F, was retrospectively recruited. Language profiles were analyzed using standardized tests for the evaluation of receptive and expressive vocabulary as well as grammar. Grammatical comprehension was the most impaired domain compared to the other language measures in both M and F children. Comparing language profiles between S/G, F showed significantly better scores than M in grammatical production (p=.002), and M showed better active negative sentences comprehension (p=.035). Moreover, comparing the language profiles between M and F with receptive disorder, F had significantly worse grammatical comprehension and better grammatical production than M. Even among children without receptive disorder, F had significantly higher grammatical production scores. The S/G differences in language profile, particularly better expressive language in F than M, can partially contribute to the delayed ASD diagnosis or underdiagnosis of F without intellectual disability. Finally, our results document the importance of accurately investigating both expressive and receptive abilities in children with ASD.

Abstract Background. There is an inherent limit in the accuracy of our measurements, set by nature itself and predicted by Heisenberg's uncertainty principle, which defines the properties of nature in the microcosmos. There is a fundamental limit to the accuracy with which complementary phys-ical quantities of a particle can be predicted from their initial conditions. As classical physics is essentially considered at borderline of quantum mechanics, so the power of uncertainty princi-ple is limited in describing everyday life perceived or managed phenomena. Method. In this study, we apply Heisenberg's uncertainty principle to children under diagnostic uncertainty re-garding appendicitis. We analyze this phenomenon in clinical practice. Results. Medical practice is full of uncertainty. False negative decisions correlate with delays in treatment and adverse outcomes in children with atypical appendicitis. On the other hand, false-positive surgery deci-sions result in negative appendectomies. With improvement of technology, the incidence of complicated appendicitis or negative appendectomies due to diagnostic uncertainty has de-creased but cannot be ignored or eliminated. Conclusion. According to the principle, there is a fundamental limit to the accuracy with which the complementary variables of negative appen-dectomy and complicated appendicitis can be observed or measured simultaneously. What does all this mean for the physician?

Access to healthcare services is an essential component of promoting public health and sustainable development. Our aim was to assess socio-demographic correlates of barriers to access healthcare services among children in Albania, a post-communist country in Europe. An online survey was conducted in September 2022, including a nationwide representative sample of 7831 schoolchildren (≈54% girls) pertinent to grades 6-9 from all regions of Albania. A structured and anonymous questionnaire was administered to all children inquiring about a range of potential barriers to access healthcare services. Overall, about 42% of the children reported that they had barriers to access healthcare services. There were no gender differences, but significant: ethnic differences (51% among Roma/Egyptian children vs. 42% among the general sample of the children); urban/rural differences (46% rural vs. 39% urban); and socioeconomic differences (52% among children with a lower maternal education vs. 31% among children with a higher maternal education; 66% among children from poor families vs. 35% among children with a higher family income). In transitional Albania, children residing in rural areas, children from Roma and/or Egyptian communities and especially those pertinent to low socioeconomic families report considerably more barriers to access healthcare services, which is a cause of concern.

Today, various questionnaires are available to assess Adverse Childhood Experiences (ACEs) in children; however, it is uncertain if these questionnaires comprehensively address the adversities of vulnerable subgroups, specifically refugee children. This review's objectives are to (1) identify current ACE questionnaires and determine if they are suitable for assessing refugee children’s adversities, and (2) identify those previously used within a refugee population. A systematic literature search was conducted across five databases for articles published since 2010, including studies using an ACE questionnaire that recognized multiple adversities in healthy children and were published in English. A total of 103 ACE questionnaires were identified in 506 studies. Only 14 of the 103 questionnaires addressed a refugee-specific adversity. Their ability to capture refugee children’s experiences was limited: available questionnaires used a maximum of three items to assess refugee-specific adversities, covering only a fraction of forms of adversities relevant to refugee children. Psychometric characteristics were rarely reported. In addition, only two ACE questionnaires were used within a refugee population. With the tools currently available, it is not possible to comprehensively assess the exposure to and severity of the adversities faced by refugee children. The perpetuation of ongoing crises necessitates assessing refugee children's adversities to understand how their well-being is affected and to identify children at risk.

Background: Chronic disease is the leading cause of death and disability in children. Various complex stressors faced by children due to illness and a series of treatments can negatively impact children's welfare, which can negatively affect children's quality of life.Objectives: This literature aims to study the philosophy of spiritual-based care interventions to improve the quality of life of children with chronic diseases viewed from three philosophical perspectives, namely ontology, epistemology, and axiology.Methods: A literature search was performed on five databases, namely SCOPUS, PubMed, ProQuest, ScienceDirect, and SAGEPub. Population limitations and diagnoses in this literature of children with chronic disease. This research is a quantitative study focusing on publications between 2017-2021.Results: The philosophy of spiritual care intervention is humanistic, pragmatic, and religious intervention. Humanistic interventions are interventions in which nurses are actively involved in spiritual care. Pragmatic intervention is the activeness of a nurse in assessing the spiritual needs of patients. Meanwhile, religious intervention is an intervention that is directly related to the practice or ritual of a specific belief system. Spiritual care is an essential part of holistic care, which is considered an indicator of improving the quality of care. It will ultimately affect the optimal quality of life of children.Conclusion: Spiritual-based care interventions are essential to improve the quality of life of children with chronic diseases. Spiritual care given to children with chronic illnesses must consider all aspects such as developmental stage, life experience, and socio-cultural of the child.

Background: Asthma is the most common chronic disease affecting children and altering their quality of life. The severity of asthma is often modulated by immunoglobulin E (IgE)-mediated allergen sensitization and is associated with comorbid allergic dis-eases. Omalizumab is a humanized monoclonal antibody anti-IgE, the first biological therapy approved to treat patients aged ≥6 years with severe allergic asthma. The primary objective of our study was to investigate the efficacy and safety of Omali-zumab in Romanian paediatric patients with severe allergic asthma. Methods: In this observational real-life study, 12 children aged 6 to 18 years, (mean age 12.4 years ) with severe allergic asthma received Omalizumab as an add-on treatment. The levels of asthma control, exacerbations, lung function and adverse events were evaluated at baseline and after the first year of treatment. Results: We noticed general improvements in total asthma symptom scores and the rate of exacerbation of severe asthma. Omalizumab increased the initial variables of lung function, and no serious adverse reactions were reported. FEV1 improved statistically significant after one year of treatment with Omalizumab, [ΔFEV1 (% pred.) =18.3, and similarly, ΔMEF50 (%) = 25.8]. The mean severe exacerbation rates due to asthma decreased from 4.1 (2.8 SD) to 1.15 (0.78 SD) during the treatment year (p<0.0001) with Omalizumab. Conclusions: Treatment with Omalizumab can be an effective and safe therapeutic option for Romanian children with severe allergic asthma, providing clinically relevant in-formation on asthma control and exacerbation rate in children and adolescents. The results highlighted the effect of Omalizumab in young patients, starting from the first year of treatment.

Multisystem inflammatory syndrome related to SARS-CoV-2 infection (MIS-C) is a rare severe illness affecting pediatric patients. No data are available in literature about the presence of SARS-CoV-2 RNA in faeces in patients with MIS-C. The SARS-CoV-2 positivity was evaluated in fecal samples obtained in a prospective cohort of pediatric patients admitted to our tertiary Hos-pital and diagnosed with MIS-C or COVID-19 between April 15, 2020, and February 29, 2021. The real-time RT-PCR was performed using a validated kit. The assay measures 3 target genes: SARS-CoV-2 gene E, gene N, gene ORF1ab. Overall, 16/63 (25%) fecal samples revealed the pres-ence of SARS -CoV-2 RNA. No differences were detected about time from presumptive viral ex-posure and the time of stool collection (14 vs 8 days, p> 0,05) as well as about the presence of gas-trointestinal symptoms (p>0.05) between patients with positive (+) stools for SARS-CoV-2 RNA and patients tested negative (-). Among children with MIS-C, stools were collected 27.5 days as median (95% CI 14-34) after presumed contact and the positivity rate was 12.5% (4/32). According to our data, we could suggest contact precautions with all patients with MIS-C. Further sample collection is ongoing to verify our preliminary data.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, which predispose to more serious hepatic conditions. It ranges from simple liver steatosis to nonalcoholic steatohepatitis (NASH), which may progress to cirrhosis and even end-stage liver disease. Since obesity became one of the most important health concerns wordwide, a considerable increase in the prevalance of NAFLD and other metabolic implications has been observed, both in adults, and children. Due to the coexistence of visceral obesity, insulin resistance, dyslipidemia, NAFLD is considered to be the hepatic manifestation of metabolic syndrome (MetS). These relationship between NAFLD and MetS led to set up in adults new term combining both of these conditions, called metabolic dysfunction-associated fatty liver disease (MAFLD). Based of these findings, we propose set of criteria, which may be useful to diagnose MAFLD in children and adolescents.

School closures (SC) were adopted globally as a COVID-19 disease pandemic containment strategy. This extreme measure provoked a disruption of the educational system involving hundreds of million children worldwide. The return of children to school has been variable and is still an unresolved and contentious issue. Importantly the process has not been directly correlated to the severity of the pandemic s impact and has fueled the widening of disparities, disproportionately affecting the most vulnerable populations. Available evidence shows SC added little benefit to COVID-19 control whereas the harms related to SC severely affected children and adolescents. This unresolved issue has put children and young people at high risk of social, economic and health-related harm for years to come, triggering severe consequences during their lifespan. In this article we describe the process of SC and the reopening timetable across the globe. We highlight the data regarding the international state of educational systems around the world, putting emphasis on the rights of children to come back to school.

Respiratory syncytial virus (RSV) is associated with adverse outcomes among immunocompromised patients. Inhaled ribavirin has been shown to improve mortality rates. The Small-Particle Aerosol Generator delivery system (SPAG-2) is the only FDA-cleared device to deliver inhaled ribavirin. However, it is difficult to set up and maintain. We developed a method for delivery of this medication using the vibrating mesh nebulizer (Aerogen®). We did not observe any adverse events with this method.

We analyzed the characteristics of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infected children during lock-down period in Catalonia (Spain), and their transmission role within the households. Among 295 traced household contacts of 89 pediatric patients, children were classified as final index cases in only 3.4% of the traced homes.

The study presents a comparison of the common Child Restraint Systems (CRS) which reduces the value of dynamic loads affecting the child's body during car accidents. The analyzed systems were: child seats, Combi Booster Seats, and straps adjusting vehicle seat belts to children's sizes. The effectiveness of the analyzed devices was assessed on the basis of experimental tests carried out in the accredited laboratory approving the Child Restraint Systems. The tests were carried out accordingly to the new Regulation No. 129 UN / ECE. Whether the tested devices meet the guidelines of the new Regulations No. 129 despite approval in accordance with Regulation No. 44. Based on the research result, better safety parameters of some new solutions dedicated to children’s safety could be observed. The final results show that there is still space for improving the safety of young vehicle passengers.

The study presents a comparison of the common Child Restraint Systems (CRS) which reduces the value of dynamic loads affecting the child's body during car accidents. The analyzed systems were: child seats, Combi Booster Seats, and straps adjusting vehicle seat belts to children's sizes. The effectiveness of the analyzed devices was assessed on the basis of experimental tests carried out in the accredited laboratory approving the Child Restraint Systems. The tests were carried out accordingly to the new Regulation No. 129 UN / ECE. Whether the tested devices meet the guidelines of the new Regulations No. 129 despite approval in accordance with Regulation No. 44. Based on the research result, better safety parameters of some new solutions dedicated to children's safety could be observed. The final results show that there is still space for improving the safety of young vehicle passengers.

For the past several decades, abdominal prenatal ultrasonography has been the most significant technology in obstetrics with a long-established application. However, the frequency, exposure time, thermal and cavitation exposure indices, and increased acoustic output of the ultrasonic waves may be harmful to the embryo/fetus and might increase susceptibility to Autism Spectrum Disorder (ASD). The increase in the prevalence of ASD is associated with an affluent ethnicity, high socioeconomic status, and high parental education where prenatal ultrasonography is readily available and affordable. Enhanced biophysical adverse effects may link the analogous increase in prenatal ultrasonography and autism, and prenatal ultrasonography may emerge as a risk factor for autism. Radiography usage provides historical evidence for this fact: the predominant past opinion was that exposure to X-rays during pregnancy caused no significant risk to a fetus. However, the association between X-ray exposure and childhood leukemia was only established 40 years after X-ray use began. This review focuses on excessive PUS usage and ASD development. Public Abstract Advancements in medical technology over the past several decades have made prenatal ultrasound more frequently accessible to expecting mothers during their pregnancy, especially for the affluent. A parallel development in health care is the increase in autism diagnoses (Autism Spectrum Disorder, or ASD) in children of affluent families. There is a general lack of studies of the impact of prenatal ultrasound on fetuses, especially around varying attributes such as frequency, duration of exposure, and thermal and cavitation indices. There is also a historical precedent set, where exposing fetuses to X-rays was not found to be harmful until it was linked to the development of childhood leukemia decades later. This paper seeks to establish a need to further study these attributes of prenatal ultrasound overuse and their possible impact on a developing fetus, with a special focus on the occurrence of Autism.

This research revealed the children with difficulties in attentional functions in healthy children attending primary school and aimed to identify the possible socio-demographic factors such as child’s age, gender and school’s grade that could influence attentive performance. The participants were 105 children aged 6-10 years (M age=8.6; SD=1.04), 57 females, attending primary schools. Family economic condition attested mostly at a medium level (63.5%) and parents had more frequently 13 years of schooling. The computerized test KiTAP was administered to children to assess attentional functions. Results showed higher frequency of omissions and false alarms and a reduced speed in Alertness, Go/No go and Sustained Attention tasks comparing to Italian norms. A series of hierarchical regression analyses were run with school grade, gender and current age as independent variables and mean reaction times (and standard deviation), number of omissions and of false alarms as dependent ones. Results showed male gender and attending a lower primary school grade impacting on lower attentional performance in several subtests. Females showed the best performances in distractibility and impulsive reaction tendencies tests, while higher school grade positively influenced the divided and sustained attention. These results could be useful to identify children with major attentional difficulties and some recommendations for futures studies and implement attention empowerment programmes were proposed.

Many parents have difficulty managing childhood asthma. In Hong Kong (HK), while medication is the primary form of treatment, traditional Chinese medicine is another favored option. In addition, HK follows a dual-track healthcare system, which may pose unique experiences for Chinese parents in childhood asthma management. This qualitative descriptive study aimed to explore the experiences of HK Chinese parents in caring for their children with asthma. Methods: Fourteen HK Chinese mothers of children (aged 3-10) suffering from asthma were purposively sampled to participate in individual, semi-structured interviews. A realist approach following conventional content analysis was used to interpret the interviews. Results: The mothers expressed feelings of uncertainty, fear of asthma crises, and searching for ways to cope. These feelings triggered various strategies to control their child’s asthma. As long as the child’s asthma symptoms recurred, the mothers’ distress continued. Their distress was sometimes exacerbated by self-doubt and worries about whether they would receive adequate support from their family and healthcare professionals. Conclusion: Helping parents to understand their limits may help them be more open to varied aspects of their caregiving experiences, and thus to cope better. Psychological interventions together traditional educational training may help to alleviate parents’ psychological difficulties.

Background: Two years after the first cases, critical gaps remain in identifying prognostic factors in multisystem inflammatory syndrome in children (MIS-C). Methods: This retrospective study included 99 patients with MIS-C hospitalized between August 2020 and March 2022 in a pediatric tertiary center. The patients were divided into two groups according to clinical severity (low and high-risk). Prognostic values of baseline clinical and laboratory characteristics were evaluated with advanced statistical analysis, including machine learning. Results: Sixty-three patients were male, and the median age was 83 (3–205) months. Fifty-nine patients (%59.6) were low-risk cases. Patients aged six years and over tended to be at higher risk. Involvement of aortic or tricuspid valve or &gt;1 valve was more frequent in the high-risk group. Mortality in previously healthy children was 3.2%. Intensive care unit admission and mortality rate in the high-risk group were 37.5% and 7.5%, respectively. At admission, high-risk patients were more likely to have reduced lymphocyte count and total protein level and increased brain natriuretic peptide (BNP), ferritin, D-dimer, and troponin concentrations. The multiple logistic regression model showed that BNP, total protein, and troponin were associated with higher risk. When the laboratory parameters were used together, BNP, total protein, ferritin, and D-dimer provided the highest contribution to the discrimination of the risk groups (100%, 89.6%, 85.6%, and 55.8%, respectively). Conclusions: Our study widely evaluates and points to some clinical and laboratory parameters that, at admission, may indicate a more severe course. Modeling studies with larger sample groups are strongly needed.

Background: The high prevalence of learning disabilities among children confirm that learning disabilities are surprisingly common. In absence of routine screening, many children still go undetected with a huge individual and family burden, while at the same time existing interventions are conflicting. The purpose of the study is to report on the design, implementation and evaluation of an innovative pilot intervention aiming to improve the quality of life of the family of students with specific learning disabilities. Method: For the purposes of this study, we used an experimental research design, using two groups (intervention and control). The intervention included four meetings with parents of children from the intervention group. To assess the quality of life of the students' family and the parenting style, the following measuring tools were used. They conducted at times and locations convenient to each participant. The instruments used to measure outcomes were two standard weighted questionnaires, the parenting style questionnaire and the family quality of life questionnaire. Findings: The results showed that the intervention program had significantly positive effects on both parenting style and children’s quality of life. Specifically, a decrease in parental authoritarianism and an increase in parental support were observed. Also, an increase in child-parent interaction, emotional and general well-being was found. Conclusion: The intervention program did improve the quality of life of the children by increasing all the variables related to the measurement of their quality of life.

BACKGROUND: Probiotics may prevent the allergic response’s development due to their anti-inflammatory and immunomodulatory effects. The aim of this study is to determine if the prophylactic treatment with a mixture of Bifidobacterium animalis subsp. Lactis BB12 and Enterococcus faecium L3, would reduce symptoms and need for drug use in children with allergic rhinitis (AR). METHODS: The study included 250 children aged from 6 to 17 years, affected by AR. Patients were randomly assigned to the intervention group (117) or to the placebo group (86). Patients of the intervention group, in addition to conventional therapy (local corticosteroids and/or antihistamines), were treated, in the 3 months preceding the development of AR symptoms, with a daily oral administration of a probiotic mixture containing the Bifidobacterium animalis subsp Lactis BB12 DSM 15954 and the Enterococcus faecium L3 LMG P-27496 strain. Nasal Symptoms Score(NSS) was used to evaluate AR severity before and after the treatment with probiotics or placebo. RESULTS: 96% of the patients in the intervention group showed a significant decrease in their NSS after the probiotic treatment as well as a decrease in the intake of pharmacological therapy. GPower software was used to calculate the test power. Given the probability of error α = 0.05, the total sample size n = 117 and the effect size ρ = 2.0651316, the power of the test is 1 - β = 1. CONCLUSIONS: When administered as a prophylactic treatment the mixture of BB12 and L3 statistically decrease signs and symptoms of AR and reduces significantly the need of drugs.

Background: Left ventricular noncompaction (LVNC) is a genetically and phenotypically heterogeneous cardiomyopathy characterized by a two-layered myocardium consisting of compacted and noncompacted segments, prominent ventricular trabeculations, and intertrabecular recesses. Patients with LVNC are at increased risk to develop heart failure, atrial and ventricular arrhythmias, and/or systemic thromboembolic events. Familial forms of primary sinus bradycardia have been attributed to mutations in HCN4. There are very few reports about the association between HCN4 mutations and LVNC. The aim of our study was to characterize the clinical phenotype of families with LVNC and sinus bradycardia caused by mutation of the HCN4 gene. Methods: From March 2008 to July 2021 we prospectively enrolled 6 patients from 4 families with diagnosed isolated LVNC based on the clinical presentation, family history and echocardiographic and cardiovascular magnetic resonance (CMR) evidence of LVNC. Next generation sequencing (NGS) analysis was undertaken for evaluation of the molecular basis of the disease in each family. Results: A total of 6 children (median age 11 years) were enrolled and followed prospectively for the median of 12 years. All 6 patients were diagnosed with LVNC by echocardiography and 5 participants additionally by CMR. The presence of LGE was found in 3 children. Sinus bradycardia and dilation of the ascending aorta occurred in 5 studied patients. In 4 patients from 3 families the molecular studies demonstrated the presence of rare heterozygous HCN4 mutations. Conclusion: (1) The HCN4 mutation influences the presence of a complex LVNC phenotype, sinus bradycardia and dilation of the ascending aorta. (2) HCN4 mutation may be associated with the early presentation of clinical symptoms and the severe course of the disease. (3) It is particularly important to assess myocardial fibrosis not only within the ventricles, but also in the atria in patients with LVNC and sinus bradycardia.

Introduction: Oral health knowledge, beliefs and attitudes of parents have a direct influence on their child’s oral health maintenance, dietary habits and encourage healthy behaviors. The aim of this study was to assess the knowledge, and attitude of parents with regards to the oral health practice of their children and its associated factors. Methods: A self -administered structured questionnaire was administered to parents or guardians of learners aged 5 to 12 years at a low socio-economic rural primary school in the uGu district, KwaZulu Natal, South Africa to collect demographic variables, knowledge of dental health, use of toothbrush, use of toothpaste, dietary practices and dental visits; practice with respect to dental care and attitudes towards oral health. The questionnaire was translated from English to IsiZulu was used. Bivariate and multivariate logistic regressions were used to assess the association between parent’s sociodemographic factors with their oral health knowledge and practice scores. Results: One hundred and forty four completed survey instruments were received with an eighty percent (118) representation of mothers. Ninety five percent of the parents (136) had a positive attitude towards oral health with 86% (124) of the children brushed their tongue and 89% (128) of the children brushed their teeth happily. The mean knowledge score was 70% with a median of 72%. Children were significantly more likely to brush their tongues (AOR: 3.20 95% CI: 1.06-9.66) and were more likely to be happier when brushing their teeth (AOR: 4.65 95% CI: 1.41-15.38) when the caregivers were their mothers, and when parents had an above average knowledge score (AOR: 1.86 95% CI: 0.72-4.85) and had positive attitudes (AOR: 3.20 95%CI: 0.46-22.00). Conclusion: To reduce the gaps in knowledge, oral health promotion should be integrated into all point of care contact with parents at health facilities, increased community awareness and advertising campaigns as well as a more focused school health oral program that addresses primary prevention, screening and appropriate referrals to health facilities

Introduction: Obstructive Sleep Apnea (OSA) is a respiratory condition identified by the partial or complete obstruction of the upper air passages during sleep. These episodes can lead to complications in neurobehavioral and cognitive domains and cardiovascular issues, especially in children. The involvement of OSA in ocular health during adulthood has been reported, but it remains a topic of debate in pediatric cases. Objective: This review aims to analyze the correlation between OSAS and ocular health in children. Specifically, it investigates the effects of OSA on ocular structures and conditions and explores potential improvements through treatment. Subjects and Methods: The research employed three search engines: PUBMED/MEDLINE, SCOPUS, and WebOfScience. After initial identification, 120 irrelevant articles were excluded. Of these, 10 pertained to the adult population, and 110 focused on the pediatric population. Following a careful selection process and the application of enrollment criteria, six relevant articles were included, all in English, focusing on the effects of OSA on children's eyes. Among these, three studies explored correlations with choroidal alterations, while three investigated retinal and optic nerve changes. Two studies analyzed post-otorhinolaryngological intervention ocular changes. Results: OSA leads to increased intraocular pressure and reduced optic nerve thickness in adults, but treatment alleviates this condition. An immediate correlation between OSA and optic nerve thickness in children does not readily emerge, although age appears to play a role. Pediatric patients with OSA exhibit corneal anomalies and an increase in optic nerve thickness, possibly due to intermittent hypoxia. Studies indicate that OSA can influence retinal vascular density in children, with an increase observed after treatment and reduced choroidal thickness in cases of adenotonsillar hypertrophy. Conclusion: This literature review has highlighted how OSA in children can significantly impact ocular health, with observed alterations in the optic nerve, choroid, retina, and cornea. While the direct correlation with the optic nerve may not always be evident, OSA can elevate intraocular pressure and lead to structural changes. However, treatment appears to bring about improvements. The necessity for regular monitoring to detect potential adverse effects underscores the importance of promptly addressing childhood OSA.

Background: To compare the clinical efficacy of Japas osteotomy of the middle foot and first metatarsal sequence osteotomy in treating children with cavovarus foot deformity. Methods: A retrospective analysis was performed on the clinical effect of cavovarus foot surgery from January 2012 to January 2019. Thirty light and medium cavovarus foot cases underwent osteotomy based on soft tissue release. Among them, 16 cases of 22 feet underwent first metatarsal sequence osteotomy, and 14 cases of 21 feet underwent middle foot Japas osteotomy. Ankle-posterior foot (Wicart) scoring system was used to evaluate the good and good rates of the two surgical methods. X-ray films were taken before and after the last follow-up in a standing weight-bearing position, and Meary Angle, Hibb Angle, and Pitch Angle were measured to compare the clinical efficacy of the two surgical methods in correcting the light and medium-cavovarus foot deformity.Results: (1) All patients were followed up for an average of 30 months. There was no significant difference in Meary, Hibb, and Pitch Angle between first metatarsal osteotomy and middle foot Japas osteotomy before surgery, indicating that the severity of malformation was similar between the two groups. (2) The Meary, Hibb, and Pitch Angle of the last follow-up were compared between the two groups (P>0.05), which showed no statistical significance, indicating that the two surgical methods had similar effects on cavovarus deformity correction. (3) At the most recent follow-up, there was no statistically significant difference between the two groups regarding the percentage of patients who achieved an excellent or good Wicart score; for the first metatarsal osteotomy group, the rate was 87%, and for the Japas osteotomy group was 90%; the Fisher test p>0.05 indicates that the postoperative excellent and good rates of the two treatments are comparable.II (4) Comparison of operation time and intraoperative blood loss between the two groups, P<0.05, showed statistically significant differences, indicating that the first metatarsal osteotomy had obvious advantages over Japas osteotomy operation time and intraoperative blood loss. Conclusions: There is no significant difference in postoperative efficacy between first metatarsal osteotomy and Japas osteotomy for light and medium-cavovarus with the apex of the deformity located at the medial cuneus or navicular cuneiform joint. However, the intraoperative blood loss and operative time of first metatarsal osteotomy are superior to Japas osteotomy of the middle foot, and the trauma to children is less. Therefore, the first metatarsal osteotomy can be considered a surgical procedure.

The aim of the study was to assess the relationship between the shape of the anterior-posterior curvature of the spine and body composition in school-children. The study included 257 children, aged 11-12. Correct spinal curvature was established in 106 (41.08%) subjects. Other types included: decreased kyphosis and correct lordosis - 40 participants (15.50%), correct kyphosis and decreased lordosis - 24 individuals (9.30%), increased kyphosis and correct lordosis - 17 subjects (6.59%), correct kyphosis and increased lordosis - 22 children (8.53%), decreased kyphosis and decreased lordosis - 32 people (12.40%), decreased kyphosis and increased lordosis - 4 of the examined subjects (1.55%), increased kyphosis and lordosis - 13 people (5.04%). In addition, 134 (51.94%) demonstrated scoliotic posture and 8 (3.10%) scoliosis. There were significant relationships between the shape of the anterior-posterior curvatures and body composition in school-children. Those with a strong body build (predominance of mesomorphs) were generally characterised by the correct formation of these curvatures. In contrast, lean people (with the predominance of ectomorphic factors) were more likely to experience abnormalities. No correlations with body composition were observed in the group with scoliotic posture or scoliosis.

(1) Background: SARS-CoV-2 infection is mostly accompanied by mild COVID-19 symptoms in children. However, the multisystem inflammatory syndrome (MIS-C) and long-term sequelae are often severe complications. Therefore, the protection of the pediatric population against SARS-CoV-2 with effective vaccines is particularly important. Here we compare the humoral and cellular immune responses elicited in children (n=15) aged 5-11 years vaccinated with RBD-based vaccines combined in a heterologous scheme of SOBERANA® 02 and SOBERANA® Plus with those from children (n=10) aged 4-11 years who recovered from mild symptomatic COVID-19. (2) Methods: Blood samples were taken 14 days after last dose for vaccinated and 45-60 days after the infection diagnosis for COVID-19 recovered children. Anti-RBD IgG and ACE2-RBD inhibition were assessed by ELISA; IgA, cytokine and cytotoxic related proteins profile were determined by multiplex assays. Total B and T cell subpopulations and IFN-γ release were measured by multiparametric flow cytometry using a large panel of antibodies after in vitro stimulation with S1 peptides. (3) Results: Significant higher levels of specific anti-RBD IgG and IgA and ACE2-RBD inhibition capacity were found in vaccinated children in comparison to COVID-19 recovered children. Th1-like and Th2-like CD4+ T cells were also significantly higher in vaccinated subjects. IFN-γ secretion were higher in central memory CD4+ T cells of COVID-19 recovered children, but no differences between both groups were found in CD4+ and CD8+ T cells effector, terminal and naïve T cell subpopulations. High levels of IL-2, IL-6, IFN-γ and IL-10 in contrast to low levels of IL-4 suggesting a predominant Th1 cell polarization. Cytotoxic-related proteins granzyme A and B, perforin and granulin were also found in the supernatant after S1 stimulation in both vaccinated and recovered children. (4) Conclusions: Vaccination with the heterologous scheme of SOBERANA® 02/ SOBERANA® Plus induces strong antibody and cellular immune response compared to natural infections of young children.

Tyrosine Kinase Inhibitors work by blocking the tyrosine kinases responsible of the dysregulation of intracellular signalling pathways in tumour cells. This study looked at the impact of age and sex on the levels of imatinib, dasatinib, nilotinib, and ponatinib in plasma and cerebrospinal fluid samples of patients with chronic myeloid leukaemia. Imatinib and dasatinib were used to treat the majority of the enrolled patient and most of them were paediatrics. The 82.4% of patients were men; however, sex-related differences in drugs pharmacokinetics were not found. Age and imatinib plasma concentration were found to be inversely correlated: as patients ages increased, drug levels decreased. The dasatinib concentrations in plasma were found to be substantially lower than those found in cerebrospinal fluid, particularly in paediatrics. Analysing the obtained data, we can state that Therapeutic Drug Monitoring is a useful method for adjusting a patient treatment schedule depending on drug concentrations in biological fluids. The use of Therapeutic Drug Monitoring in conjunction with Tyrosine Kinase Inhibitors for the treatment of chronic myeloid leukaemia is supported by a number of sources of evidence. As a result, as the research develops, Tyrosine Kinase Inhibitors Therapeutic Drug Monitoring classification needs to be refined in terms of factors like sexes and ages.

Objectives: The aim of our study was to evaluate patients after suicide attempts treated at the Department of Trauma Surgery for Children before and after the outbreak of the Covid-19 pandemic. Material and methods: Retrospective review of the medical database at equal time intervals of 24 months to identify patients treated before and after the COVID-19 was done. Thorough analysis including injury mechanism, medical procedures, history of previous mental disorders or suicidal behavior was performed. Furthermore, results were compared with the Polish police suicide statistics. Results: Based on our retrospective review we found 4 patients treated in our department before the pandemic and 10 patients treated after COVID-19 outbreak. The group before SARS-Cov-2 era consisted of three girls and one boy with a mean age of 14.97 (12.7-17.6). The group treated in the pandemic crisis consisted of 8 boys and 2 girls, the mean age was 15.49 (10.8-17.2). In the pre-COVID-19 group, 2 out of 4 patients had received psychiatric treatment before, but none had attempted suicide before. In the COVID-19 group, 6 out of 10 patients had previously received psychiatric treatment, moreover 3 of them attempted suicide before. Based on our analysis, the number of individuals who displayed suicidal attempts has raised. Between 2018 and 2021 the largest number of suicides concerned the 13-18 y.o. group, both for the Silesian Voivodeship (H=9.374; p=0.0092) and for the whole country (H= 10.203; p=0.0061). Conclusions: 1. Results of our study indicate that the pandemic may have caused a wide range of negative mental health consequences for young individuals; 2. During the SARS-Cov-2 era, we observed an alarming 2.5-fold increase in the number of patients treated after suicide attempts at the children's orthopedic trauma department; 3. Suicide attempts in children are often related with high energy trauma.

Malnutrition is the main cause of child mortality in developing nations, especially in Sub-Saharan Africa and South Asian countries. This undernutrition status is predominantly higher among primitive tribal (ST) children under 5 years of age. The nutritional status of tribal children is a serious concern in India. For this, there should be intends to examine the prevalence and determinants of primitive tribal children's nutritional status. To investigate the effect of household, child’s & maternal characteristics on biological children under 5 years of age. The study aims to find out the association between some selected determinants on scheduled tribe child’s nutritional status. The study used some selected variable of scheduled tribe mothers, household characteristics and their children anthropometric indices from DHS datasets of India, which was published by the NFHS datasets of India. In this study People datasets and Children (Under 5 years of age) of interviewed women file datasets of NFHS-IV & V is taken. The datasets of West Bengal, ST mothers, and their child into consideration as per the research interest. Then to analyze the determinants of ST children (U5 age) nutritional status, some determinant factors are taken from mothers, children and household characteristics. Children’s stunting, wasting and underweight as dependent variable and the mothers, child’s and household’s characteristics as independent variable. The statistical analysis was done by using Pearson Chi square test used to analyze the association between dependent and independent variables. The study results shows that the mother’s educational status, child’s age, birth order, size of child at birth, type of residence had significant associations with stunting. Mother's anemia status and mother age had significant associations with wasting. Mother education, currently breastfeeding, child age, sex of the child, birth order, size of child at birth, type of residence, wealth, toilet facility, and cooking fuel shows a significant association with underweight. The results found that many determinant factors had a significant role among ST children's (U5 age) nutritional status. Thus, the findings will help to achieve tentative resource allocation, and utilization through various programs and policies to improve the ST children (U5 age) nutritional status. There is a need to take a multisectoral and multidimensional approach to develop for those primitive tribal children.

Acute appendicitis is the most common surgical emergency worldwide with peak incidence in the age range of 10 – 19 years, and the standard treatment procedure is the surgical removal of the appendix to avoid complications such as its rupture, peritonitis, and sepsis. The COVID-19 pandemic required the global population to stay indoors to stop the spread of virus, which led to a decline in the number of patients visiting the hospital for non- COVID -19 related emergencies. This is a case of a 9-year-old girl who tested positive for COVID -19 and developed acute appendicitis and benefited from individualised classical homeopathy. Further scientific investigation is necessary to establish the relevance of individualised classical homeopathy in treating serious acute conditions such as acute appendicitis.

Background: Left ventricular noncompaction (LVNC) is a distinct cardiomyopathy characterized by the presence of a two-layer myocardium with prominent trabeculation and deep intertrabecular recesses. The diagnosis of LVNC can be challenging because the diagnostic criteria are not uniform. The aim of our study was to evaluate echocardiographic and CMR findings in a group of children with isolated LVNC. Methods: From February 2008 to July 2021, pediatric patients under 18 years of age at the time of diagnosis with echocardiographic evidence of isolated LVNC were prospectively enrolled. The patients underwent echocardiography and contrast-enhanced cardiovascular magnetic resonance (CMR) with late gadolinium enhancement to assess myocardial noncompaction, ventricular size, and function. Results: A total of 34 patients with a median age of 11.9 years were recruited. Patients were followed prospectively for a median of 5.1 years. Of the 31 patients who met Jenni’s criteria in echocardiography, CMR was performed in 27 (79%). Further comprehensive analysis was performed in the group of 25 patients who met the echocardiographic and CMR criteria for LVNC. In echocardiography, the median NC/C ratio in systole was 2.60 and in diastole 3.40. In 25 out of 27 children (93%), LVNC was confirmed by CMR according to Petersen’s criteria, with a median NC/C ratio of 3.27. Conclusions: 1) Echocardiography precisely identifies patients with LVNC. 2) Echocardiography is a good method for monitoring LV systolic function, but CMR is indicated for the precise assessment of LV remodeling and RV size and function as well as for the detection of myocardial fibrosis.

Air pollution is now considered to be the world’s largest environmental health threat accounting for millions of deaths globally each year. The social group that is particularly exposed to the harmful effects of air pollution is the children. A daily route to school can constitute an important component of children’s physical activity, but air pollution can pose a threat to their health. Numerous studies have proved high loads of PM can be effectively reduced by vegetation. Little is however known, whether vegetation can also reduce PM during the leaf dormancy period. In this study, we investigated the role of trees in PM removal on children’s routes to schools during winter. We investigated walking routes to selected schools in Warsaw, by examining the adjacent vegetation and PM2.5 and PM10 concentrations and the presence of local black-smoke-belching stoves. We found that proximity to local CHP emitters had the strongest impact on pollution on the way to schools, while not finding a significant relationship between dense greenery and PM loads. Even more, the highest density of vegetation along walking routes tended to stimulate higher PM concentrations. The results obtained show the poor performance of tree canopy in reducing PM loads during winter.

It is well known that low back pain (LBP) prevalence is high during the course of school age children’s lives. However, literature concerning the initial onset of back pain between ages of 3 and 11 years remains scarce. The present study aimed to analyze the prevalence of LBP in kindergarten and primary school students. 278 (9.9±2.1 years old; 52.2% girls) students from two public kindergarten and primary schools in Valencia, Spain participated in this cross-sectional study. The Nordic questionnaire on LBP was used to ask questions related to the duration of LBP symptoms over time. The lifetime prevalence of LBP was 47.5% (n = 132), a last year prevalence of 44.2% (n = 123), and a last week prevalence of 18.8% (n = 50) was reported. Boys and girls reached lifetime prevalence of 52.3% (n = 64) and 47.7% (n = 82) (χ2 = 1.978, p = .099), respectively. By age group, lifetime episodes of LBP also showed a higher prevalence with increasing age (χ2 = 32.637; p &lt; .001). In summary, our findings suggest that LBP increases with age. In addition, our results further strengthen the evidence that LBP onset could start as young as 10-years-old.

With the arrival of SARS-CoV-2 vaccines, a new stage of the pandemic commenced, with new challenges ahead. During the coming months, countries will be implementing their COVID-19 vaccination programs depending on their implementation of vaccine availability and its prescription on risk stratification. Although children will not benefit from active immunization programs, now, with the beginning of the era of the anti-COVID19 vaccines, the suffering of children can no longer be ethically tolerated or neglected. The time has come to provide specific lasting strategies for children living in the COVID-19 era. Here we propose a child-focused indirect COVID-19 vaccination strategy.For better or worse, children depend on their natural caregivers (adults) and the rest of society for their well-being and achieving their full potential. We believe that including in the priority categories also those adults in close contact with children could ensure a safety net of child protection.A child-focused vaccination strategy would allow the faster return to "normality" for children and their families. Such an approach would not only enable the reopening and continuity of essential services for children but also would allow adults to return to their routine economic/productive activities.

A Tangible User Interface (TUI) is a new interaction option that uses nontraditional input and output elements. A tangible interface thus allows the manipulation of physical objects using digital information. The exploration and manipulation of physical objects is a factor to be considered in learning in children, especially those with some kind of disability such as hearing, who maximize the use of other senses such as vision and touch. In a tangible interface, three elements are related - physical, digital and social. The potential of IoT for children is growing. This technology IoT integrated with TUI, can help for that parents or teachers can monitoring activities of the child. Also to identify behavior patterns in the child with hearing impairment. This article shows four case studies, where had been designed different products of Internet of Things Tangible applied a several contexts and with products of low cost.

The prevalence of autism in children in the world is estimated as one per 62 children, higher levels reported in some countries. These children experience significant problems with the development of social, behavioural and verbal and non-verbal communication skills. The skills impairment levels varies from an individual to another and that made teaching autistics a challenge for caregivers such as teachers and relatives. Hence, there are quite a number of frameworks of a software learning systems which focus on gaining the children’s attention using representational visual illustration as a learning method instead of the textual form. However, majority of these tools are lacking the personalisation ability to suite everyone in the spectrum. Assistive technology offers an alternative way to attract children with autism. Therefore, this research is proposing an Adaptive Content Management Learning System (ACMLS) model to assist caregivers to produce, design and fine-tune or customise the learning materials appropriately so that the system interface and the materials are suitable for every individual in the spectrum according to each child personal profile aiming to make learning attractive and to contribute in improving their social, communication and behavioural skills and nonetheless, their attention level to the delivered educational topics. The ACMLS model design adopts four main components which are: (1) Design component: which covers the visual design, design principles and the mental model of the children with autism. (2) Technology component: which covers the assistive technology tools and the architecture of the ACMLS system. (3) Education component: Which covers the learning objectives, styles, strategies, methods and the cognitive model. (4) Participants component: which covers the main participants who’re playing a role in the ACMLS model such as: caregivers and children with autism.

The prevalence of obesity and eating disorders varies by sex, but the extent to which sex influences eating behaviors, especially in childhood, has received less attention. The purpose of this paper is to review the literature on sex differences in eating behavior in children and present new findings supporting the role of sex in child appetitive traits and neural responses to food cues. In children, the literature shows sex differences in basic taste response, food acceptance, eating self-regulation, and appetitive traits. New analyses demonstrate that sex interacts with child weight status to differentially influence appetitive traits and neural responses to food cues. Further, neuroimaging results suggest that obesity in female children is positively related to brain reactivity to higher-energy-dense food cues in regions involved with learning, memory, and object recognition, while the opposite was found in males. In addition to differences in how the brain processes information about food, other factors that may contribute to sex differences include parental feeding practices, societal emphasis on dieting, and peer influences. Future studies are needed to confirm these findings, as they may have implications for the development of effective intervention programs to improve dietary behaviors and prevent obesity.

This study examined the eye movement patterns of 317 elementary students across reading conditions (audio-assisted reading (AR) and reading-only (R)) and text types (fiction and non-fiction), and identified eye movement parameters that predict their literal comprehension (LC) and inferential comprehension (IC). Participants, randomly assigned to either reading condition and either text type, answered questions assessing their LC and IC. Average fixation duration (AFD), total fixation duration (TFD), and scanpath length were used as eye movement parameters. There were main effects of age on all parameters and interaction effects between age and reading condition on TFD and scanpath length. Controlling for age, TFD had a positive impact on LC of both text types in the AR, while under the R, it affected negatively on IC of both text types. Longer scanpaths predicted IC of fiction in the AR, LC and IC of non-fiction under the AR, and LC of non-fiction within the R. AFD influenced negatively on IC of fiction in the AR, LC and IC of non-fiction in the AR, and LC of non-fiction under the R. These eye movement patterns and predictors indicate children employ different reading strategies based on reading modality and text type.

Reading is one of the essential processes during the maturation of an individual. It is estimated that 5-10% of school-age children are affected by dyslexia, the reading disorder characterised by difficulties in the accuracy or fluency of word recognition. There are many studies which have reported that colour overlays and background could improve the reading process, especially in children with reading disorders. As dyslexia has neurobiological origins, the aim of the present research was to understand the relationship between physiological parameters and colour modifications in the text and background during reading in children with and without dyslexia. We have measured differences in electroencephalography (EEG), heart rate variability (HRV), electrodermal activities (EDA), and eye movement of the 36 school-age children (18 with dyslexia and 18 of control group) during the reading performance in 13 combinations of background and overlay colours during the reading task. Our findings showed that the dyslexic children have longer reading duration, fixation count, fixation duration average, fixation duration total, and longer saccade count, saccade duration total, and saccade duration average while reading on white and coloured background/overlay. It was found that the turquoise, turquoise O, and yellow colours are beneficial for dyslexic readers, as they achieved the shortest time duration during the reading tasks when these colours were used. Also, dyslexic children have higher values of beta and the whole range of EEG while reading in particular colour (purple), as well as increasing theta range while reading on the purple overlay colour. We have observed no significant differences between HRV parameters on white colour, except for single colours (purple, turquoise overlay and yellow overlay) where the control group showed higher values for Mean HR, while dyslexic children scored higher with Mean RR. Regarding EDA measure we have found systematically lower values in children with dyslexia in comparison to the control group. Based on present results we can conclude that both colours (warm and cold background/overlays) are beneficial for both groups of readers and all sensor modalities could be used to better understand the neurophysiological origins in dyslexic children.

This study aimed to present a systematic meta-analysis examining the association between Helicobacter pylori (H. pylori) infection, hemoglobin A1c levels, and the development of type 1 diabetes mellitus. The initial search identified 451 articles related to the association between H. pylori infection and T1DM. Among them, 14 articles had 2,971 participants meeting the inclusion criteria for advanced meta-analysis. A significant association was observed between H. pylori infection and T1DM, with an odds ratio (OR) of 1.87 (95% confidence interval [CI]: 1.27–2.78, p = 0.002). A subgroup analysis on H. pylori status showed that a longer duration of diabetes diagnosis and higher hemoglobin A1c levels were significantly associated with H. pylori infection (p < 0.001 for both). However, there was no significant association between H. pylori infection and the diagnostic age of diabetes (p = 0.306). These findings contribute to the understanding of the association between H. pylori infection and T1DM, thereby highlighting the potential role of H. pylori in influencing the duration and glycemic control of diabetes.

Early stroke diagnosis remains a big challenge in healthcare partly due to the lack of reliable diagnostic blood biomarkers, which in turn leads to increased rates of mortality and disability. Current screening methods are optimised to identify patients with a high risk of cardio-vascular disease, especially among the elderly. However, in young adults and children, these methods suffer low sensitivity and specificity and contribute to further delays in their triage and diagnosis. Accordingly, there is an urgent need to develop reliable blood biomarkers for triaging patients suspected of stroke in all age groups, especially children and young adults. This review explores some of the existing blood biomarkers, as single biomarkers, or biomarker panels, and examine their sensitivity and specificity for predicting stroke. A review was performed on PubMed and Web of Science for journal articles published in English during the period 2001 to 2021 which contained information regarding biomarkers of stroke. In this review article, we provide comparative information on the availability, clinical usefulness, and time-window periods of eight single blood biomarkers and six biomarker panels that have been used for predicting stroke in emergency situations. The outcomes of this review can be used in future research for developing more effective stroke biomarkers.

Nowadays, mindfulness-based interventions (MBI) have experimented a remarkable development of studies among childhood and adolescent interventions. For this reason, dispositional mindfulness (DM) measures for children and adolescents have been developed to determine the effectiveness of MBI at this age stage. However, little is known about how key elements of DM (f. e., cognitive de/fusion or experiential avoidance that both conform psychological inflexibility) are involved in the mechanisms of the children and adolescents’ mental health outcomes. This research examined the mediating effect of cognitive fusion between DM and anxiety and other negative emotional states in a sample of 318 Spanish primary-school students (aged between 8 and 16 years, M=11.24, SD=2.19, 50.8% males). Participants completed the AFQ-Y, which is a measure of psychological inflexibility that encompasses cognitive defusion and experiential avoidance; CAMM (DM for children and adolescents), PANAS-N (positive and negative affect measure for children, the Spanish version of PANASC), and STAIC (an anxiety measure for children). The study accomplished ethical standards. As MBI relevant literature has suggested, cognitive defusion was a significant mediator between DM and symptoms of both negative emotions and anxiety in children and adolescents. However, experiential avoidance did not show any significant mediating relationship. Probably, it is needed improvement of the assessment of experiential avoidance. MBI programs for children and adolescents may include more activities for reducing the effects of the cognitive defusion on their emotional distress.

ETS exposure has been shown as an important environmental risk factor in vulnerable population groups. The aim of the project is to analyze the relationships among the ETS and behavior and health in 6−15-year-old children in Slovakia. The status of physical and mental health of children in relation to exposure to tobacco smoke was examined in the representative group of 1478 school children. The methods used, included anonymous questionnaires filled in by parents, Columbia Impairment Scale (CIS), Behavior Problem Index (BPI) and anthropometry. The prevalence of passive smoking is the highest in the capital (27%) and southern cities. Significant relationships have been confirmed between ETS and the age, socio-economic status, the incompleteness of the family, the level of mother's education and the significantly higher prevalence of respiratory diseases (26.7%).The relationships of ETS with emotional (CIS scores ≥16) and behavioral functions (BPI score ≥14) were significant in children exposed to mother‘s and father‘s smoking at home. In the multivariate analysis this association was not significant; the factors such as income and completeness of the family were dominant. The results confirmed the impact of ETS and social factors on health state and health behavior and could be the argumentation for legislative changes.

The post-hoc analysis presented here aimed to address the influence of endogenous vitamin D in the immunological mechanism underlying effective mite allergoid-immunotherapy (AIT). Previously, we have shown that one subpopulation of T regulatory cells results in phenotypically identifiable as functionally potentiated and memory cells in allergic children after 12 months of this immunoactive treatment. Indeed, AIT is the only known treatment able to reshape the detrimental immune response against the allergen into a not noxious one. Besides, VD is widely considered an immunoregulatory molecule endogenously produced and exogenously provided with foods and supplements that might interact with AIT mechanism and affect its outcome. Therefore, a post-hoc analysis of the clinical and immunological data of three different cohorts of allergic patients was performed. One cohort (N=70) was on standard symptoms-controlling pharmacological treatment while the other two (N=60 and N=35, respectively) were treated with AIT for 12 months. Among the first were observed a lower mean endogenous VD level (&lt;22 ng/ml) along with worse symptoms and higher use of medications. Remarkably, the comparison between two sub-cohorts of patients with serum VD above (N=32) or below (N=28) a cut-off value set at mean value (27 ng/ml) revealed that optimal improvement of all clinical and immune parameters was achieved (as expected by effective AIT), irrespective of the VD level. Notably, the third analysis, carried out on one cohort of AIT patients also taking concomitantly VD3 as food supplement (N=19), was distinguished by uppermost overall treatment outcome (amelioration of symptoms, lowest medications requirement, and reduction of total and allergen-specific IgE) as well as the increase of allergen-specific tolerogenic memory T regulatory cells. These findings suggest that endogenous VD level affects allergy severity and allergen immunotherapy effectiveness. Also, VD3 might be investigated as an add-on supplement to get the best out of immunotherapy in VD deficient/insufficient allergic patients. The immunogenic but low-allergenic mite allergoid used as bioactive agent might have contributed to minimize allergic and highlight immunological effects described here.

There are few studies of the psychological effects of language brokering (speaking on behalf of) among minors migrated to Europe, even though language brokering is becoming more current in many migrant families. As the psychological implications of language brokering remain controversial, further investigation is needed. Earlier studies have documented that language brokering is sometimes linked with emotional maladjustment and developmental drawbacks, but other studies have shown faster acquisition of social and Language skills. The present study assessed the relation of language brokering with psychological well-being in a sample of Latino migrant adolescents living in Italy; the dependent variables were depression, anxiety, and emotions. Statistically significant differences between boys and girls confirmed the sex-specificity of language brokering and the lack of statistically significant negative association between language brokering and psychological well-being.

Purpose of the study: to reveal how the transfusion and the refraining from it affects the neuro-vascular unit in the congenital heart defects correction with cardiopulmonary bypass. Materials and methods: in vitro research, we formed a model of a neurovascular unit, which contains neu-rons, astrocytes and endothelial cells. This cellular model was cultivated in hypoxia conditions with the oxygen saturation levels of 1, 2, 3, 4%. In addition, this unit was cultivated with the pa-tient's serum adding in two different groups - with minimal and maximal levels of system in-flammatory response that we estimated by IL-6 level. Results: We found that during incubation in hypoxic conditions, the level of transendothelial resistance changed in groups with oxygen levels of 1% and 2% only after 4 hours. When we cultivated neurovascular unit cells with patients' sera, we found a minimal level of transendothelial resistance at 4 hours that increased after 24 hours. Permeability analysis showed that its level significantly decreased in the 1% and 2% oxygen group at 60- and 90-minutes relative to the control group. Conclusion: the system inflammatory response has more expressed but less long effect on the neurovascular unit model than hypoxia.

On 17 June 2022, the U.S. FDA authorized the Pfizer-BioNTech and Moderna COVID-19 (SARS-CoV-2) vaccines for emergency use in children ages 6 months – 4 years. Seroprevalence has increased during the current Omicron variant wave for children under 5 years and the burden of hospitalization for this age group is similar or exceeds other pediatric vaccine preventable diseases. Research following the October 2021 approval of vaccines for children 5 – 11 indicates high prevalence of parental vaccine hesitancy and low uptake, underscoring the urgency of understanding attitudes and beliefs driving parental COVID-19 vaccine rejection and acceptance for younger children. One month prior to FDA approval, in the present study 411 U.S. female guardians of children 1 – 4 years from diverse racial/ethnic, economic, and geographic backgrounds participated in a mixed method online survey assessing determinants of COVID-19 pediatric vaccine hesitancy. Only 31.3% of parents intended to vaccinate their child, 22.6% were unsure, and 46.2% intended not to vaccinate. Logistic regression indicated significant barriers to vaccination uptake including: Concerns about immediate and long-term vaccination side effects for young children, the rushed nature of FDA approval and distrust in government and pharmaceutical companies, lack of community and family support for pediatric vaccination, conflicting media messaging, and lower socioeconomic status. Vaccine-resistant and unsure parents were also more likely to believe children were not susceptible to infection and that the vaccine no longer worked against new variants. Findings underscore the need for improved public health messaging and transparency regarding vaccine development and approval, the importance of community outreach, and increased pediatrician attention to parental concerns to better improve COVID vaccine uptake for young children.

Eukaryotic enteric pathogens (EEP) are a public health issue in tropical areas. Yet, their interactions with the gut mycobiota remain poorly understood. We conducted a cross-sectional study in Malian children to analyze the impact of EEP on the gut fungal community. EEP were assessed by qPCR and the gut mycobiota was characterized by ITS1-2 metabarcoding in stool samples collected from 296 children. The 100 controls, in whom no EEP was detected, were compared to: a) 196 children with ≥1 EEP; b) 91 with only Blastocystis; c) 35 with only Giardia intestinalis; and d) 12 with another (&lt;1% each) EPP. The gut fungal community structure was homogenous in each children’s group. Linear size-effect discriminant analysis highlighted five relatively more abundant species, including Fusarium longipes and Penicillium caseifulvum, in children with ≥1 EEP, whereas 28, including Aspergillus sydowii and Microdochium colombiense were more abundant in controls. Fusarium, Pyxidiophora, and Stereum abundance was higher in Blastocystis-infected children, whereas Ogataea and Allocryptovalsa were more abundant in controls. Sordariales and Mortierellales abundance was higher in Giardia intestinalis-infected children, whereas Agaricales and Capnodiales abundance was higher in controls. In conclusion, EEP do not significantly alter the gut fungal community structure, and further studies are warranted to confirm our findings that particular taxa are associated with susceptibility or resistance to specific EEP.

Antibiotics’ effect on Mycoplasma pneumoniae (MP) infection still remains controversial. A prospective study of 257 children with MP pneumonia during a recent epidemic (2015-2016) was conducted. All MP pneumonia patients were treated with corticosteroids within 24-36 h after admission. Initially, oral prednisolone (1 mg/kg) or intravenous methylprednisolone (IVMP) (1-2 mg/kg) was administered for mild pneumonia patients, and IVMP (5 -10 mg/kg/day) for severe pneumonia patients. If patients showed persistent fever for 36-48 hours or disease progression, additive IVMP (5 mg/kg or 10 mg/kg) was given. Eighty-five patients received only a broad-spectrum antibiotic without macrolide. The mean age and the male:female ratio were 5.6 ± 3.1 years, respectively. Seventy-four percent of patients (190/257) showed immediate defervescence within 24 h, and 95.7% (246/257) of patients showed defervescence within 72 h with improvements in clinical symptoms. Eight patients who received additive IVMP also showed clinical improvement within 48 h without adverse reactions. There were no clinical or laboratory differences between patients treated with a macrolide (n = 172) and without (n = 85). Early corticosteroid therapy might reduce disease morbidity and prevent disease progression in MP pneumonia patients without side effects, and antibiotics may have limited effects on MP infection.

The introduction of stool as a readily obtainable sample and the recently developed simple-one-step (SOS) stool processing method offer an opportunity for TB diagnosis in children. We conducted this study at secondary health facilities in Ethiopia which are the first level referral facilities for childhood TB diagnosis and treatment with the aim to determine if stool-based TB diagnosis can be performed with reasonable level of concordance with sputum tests in using Xpert MTB/RIF Ultra. Eligible children 0-14 years with presumptive pulmonary TB were asked to provide stools in addition to routinely requested sputum samples. We computed Cohen’s kappa statistic in SPSS to determine the level of agreement between stool and sputum test results. Of the 373 children included in the study, 61% were &lt;5 years of age and 56% were male. Thirty-six children (9.7%) were diagnosed with TB and all started treatment. The rate of concordance between stool and sputum was high with kappa value of 0.83 (P&lt;0.001). There were more Xpert ultra positive test results on stool (n=27 (7.2%)) than on sputum/NGA (n=23 (6.2%)). Laboratories in secondary hospitals can perform stool-based TB diagnosis in children with high concordance between stool and sputum test results reaffirming the applicability of the SOS method.

Traditional Medicine (TM) is a culturally-rooted healthcare practice, and its use, including for treating illnesses among children, has been reported in many countries. Despite the cultural significance of TM in managing children’s illnesses, evidence suggests that child mortality remains high in many settings. This indicates that the sole use of TM within families and communities might act as a barrier to using biomedical services, contributing to avoidable deaths. Globally, Indonesia is in the top 10 countries with the highest child mortality rates. In addition, Belu is a district in East Nusa Tenggara province, Indonesia that exhibits a high number of child deaths within the last three years. However, the use of TM for the treatment of illnesses among children in Indonesia has received minimal academic attention. This study aimed to understand parental beliefs, knowledge, views, and perceptions of TM and the impact on the use of TM and biomedical services in the treatment of illnesses among their children in Belu district, Indonesia. The participants (n=25) were parents with the real-life experiences of using TM for treating their children’s illnesses. They were recruited using the snowballing sampling technique. Data were collected using in-depth qualitative interviews. A thematic data analysis was performed and guided by a qualitative data analysis framework. The findings were grouped into four main themes: (i) parental beliefs, knowledge, views, and perceptions of TM, (ii) the influence of these factors on parental use of TM and biomedical services for the treatment of children’s illnesses, (iii) social and cultural influences on the use of TM and biomedical services among their children, and (iv) the impact of the sole use of TM or late medical diagnosis on the health condition and the death of children. The findings show that the use of TM is a common practice within families and communities in Belu, however evidence suggests that child mortality remains high in the setting, indicating less effectiveness of the sole use of TM. Thus, there is a need for the development of collaborative models of healthcare programs and service delivery fostering mutual respect and understanding between traditional healers and healthcare professionals, which could significantly contribute to improving parental use of biomedical services for the treatment of their children’s illnesses.

Political and legal debate about freedom of religion and belief (FoRB) in Australia has intensified since the Same-sex marriage postal survey in 2017. Central to this debate has been children, their parents and institutions (Schools). This paper outlines the place of children in the Australian FoRB since 2017, focusing on the Same-sex marriage postal survey debate and subsequent reviews into freedom of religion. In particular it highlights the links drawn between same-sex marriage or marriage equality and the Safe School Coalition Australia campaign, the emphasis on parental rights in relation to education about marriage in schools and the ongoing debate about potential reform to Australia’s suit of anti-discrimination laws

Background and Objectives: In the current Covid-19 pandemic, children below the age of 12 could manifest Covid-19 symptoms and serve as a reservoir for the virus in the community. The present study was conducted to evaluate the reactogenicity, and immunogenicity of BBIBP-CorV, prior to involving this age group in the vaccination program in the kingdom of Bahrain. Subjects and Methods: The study included 582 children from 3 to 12 years old of Bahraini and non-Bahraini nationality, all of which contributed to the reactogenicity study. Of those, 401 contributed to the immunogenicity study. All children received 2 doses of BBIBP-CorV inactivated virus 3 weeks apart. To assess reactogenicity, children were followed up for 5 weeks to evaluate any vaccine-related adverse events (AE). To assess immunogenicity, blood was collected on day 0 and day 35 to assess antibody titer against S, N, and neutralizing antibody. Results: Of the 582 participants, (45.4%) were female, (54.61%) were male, with 49% in 9-12 age group. Of the 401 children contributing to the immunogenicity study, 274 (68.3%) had no prior exposure to Covid-19. The overall incidence of AE was 27.7%. No significant difference was found among different age groups. The most frequent AE was local (at the injection site) and occurred in 16% of children, followed by fever in 9.3%. No serious adverse events were reported. The Seroconversion rate was 100% among children with no prior exposure to Covid-19. Children with previous Covid-19 exposure had higher averages of anti-S (2379 U/ml compared to 409.1), anti-N (177.6 U/ml compared to 30.9) and neutralizing antibody (93.7 U/ml compared to 77.1) than children with no prior exposure at day 35. Conclusions: Two doses of COVID-19 BBIBP-CorV on the subjects aged between 3 to 12 has good safety and tolerance and can induce an effective immune response and neutralizing antibody titer.

Despite concerns about the negative effects of social distancing and prolonged school closures on children’s lifestyle and physical activity (PA) during the COVID-19 pandemic, robust evidence is lacking on the impact of the COVID-19 pandemic on children’s wellbeing and daily life. This study aimed to examine changes in the PA levels, sleep patterns and screen time of school-aged children during the different phases of COVID-19 outbreak in Hong Kong using a repeated cross-sectional design. School students (Grades 1 to 12) were asked to report their daily electronic device usage and to fill in a sleep dairy recording their daily sleep and wake-up time. They were equipped with a PA monitor, Actigraph wGT3X-BT, to obtain objective data on their PA levels and sleep patterns. Students were recruited before the pandemic (Sep 2019 – Jan 2020; n=577), during school closures (Mar 2020 – Apr 2020; n=146), and after schools partially reopened (Oct 2020 – Jul 2021; n=227). Our results indicated lower PA levels, longer sleep duration, and longer screen time among participants recruited during school closures than those recruited before the COVID-19 outbreak. Primary school students were found to sleep on average for an extra hour during school closures. Our findings illustrate the impact of social distancing policies during the COVID-19 pandemic on the sleep pattern, screen time, and PA level in school-aged children in Hong Kong. Professionals should reinforce the importance of maintaining a physically active lifestyle, good sleep hygiene, and healthy use of electronic devices to parents and school-aged children during the COVID-19 Pandemic.

The authors determined mass concentrations of 12 elements (As, Cd, Cr, Cu, Mn, Ni, Pb, Se, Sr, Tl, V, Zn) in blood and urine taken from 100 rural children living in unremarkable condition in the West Ural region of the Russian Federation. We applied inductively coupled plasma mass spectrometry in conformity with Methodical Guidelines 4.1. 3230-14 (FR.1.31.2014.17064) designed by us and detailed in the paper. The article contains setting parameters for Agilent 7500cx quadrupole inductively coupled plasma mass spectrometer . The authors present grounds for an optimal scheme of samples preparation which helps to eliminate "matrix" effect and explain why it is advisable to use reaction/collision functioning mode as it enables interference overlaps suppression.To prepare whole blood samples for analysis, we used acid dissolution in concentrated nitric acid followed by centrifugation. The arithmetic mean (AM) of element content in blood amounted to 0.34 µg/l (As); 0.39 µg/l (Cd); 6.41 µg/l (Cr); 866.11 µg/l (Сu); 13.73 µg/l (Mn); 5.86 µg/l (Ni); 23.65 µg/l (Pb); 87.43 µg/l (Se); 33.54 µg/l (Sr); 0.04 µg/l (Tl); 0.16 µg/l (V); 4713.48 µg/l (Zn). The validity of the results was confirmed by means of SERONORM ^TM Whole Blood L2 standard samples (Norway). Urine samples were directly analyzed after 1/10 (V/V) dilution with 1% nitric acid solution. The arithmetic mean of element content of urine corresponded to 18.99 µg/l (As); 0.12 µg/l (Cd); 1.91 µg/l (Cr); 13.28 µg/l (Сu); 0.96 µg/l (Mn); 1.84 µg/l (Ni); 0.83 µg/l (Pb); 22.55 µg/l (Se); 239.09 µg/l (Sr); 0.16 µg/l (Tl); 0.68 µg/l (V); 270.56 µg/l (Zn). The validity of the results was confirmed by analyzing the SERONORM ^TM standard urine samples (Norway). Regional differences from levels found in other countries included higher concentrations of Cr, Mn and Ni in blood and lower levels of Se and Zn levels in West Ural children. Urine concentrations of West Ural children showed higher levels of As and Sr.

Objective: This study investigated the effects of an easily implemented 8-week program centered around jump rope exercise (JRE) on executive function among children with ADHD. Methods: Using the Stroop Color Word Test to assess inhibitory control, the n-back task (1- and 2-back) to assess working memory, and task switching to assess cognitive flexibility. Results: After the intervention, there were within-group effects only for the experimental group, with higher accuracy on the 1-back working memory task (t= -2.79，p= 0.011< 0.05，Cohen’s d= 0.60) and on task switching after compared with before the JRE intervention (t= -4.00，p=0.01<0.05，Cohen’s d= 0.85), but with no change in reaction time. There was no significant within-group difference on the Stroop test (P> 0.05). Additionally, there were no between-group effects as assessed by one-way analyses of variance. Conclusion: 8-week program focused on JRE improved two aspects of executive function, working memory and cognitive flexibility, with no significant effect on a third aspect, inhibitory control, among children with ADHD aged 7 to 12 years.

This study aimed evaluating 7 years’ outcome in 118 very preterm newborn (VPN, gestational age=26±1.4wks) involved in a randomized controlled trial. They presented neonatal respiratory distress (RDS) requiring ventilation for 14±2 days post-natal age (PNA). Repeated instillation of 200mg/kg Poractant alfa (SURF) did not improve early bronchopulmonary dysplasia, but SURF infants needed less re-hospitalization than controls for respiratory problem at 1- and 2-years PNA. There was no growth difference at 7.1±0.3 years for 41 SURF vs. 36 controls (80% eligible children); 7.9% SURF vs. 28.6% controls presented asthma (p=0.021). Children underwent cogni-tive assessment (WISC IV) and pulmonary function testing (PFT) measuring spirometry, lung volumes and airway resistance. Spirometry showed differences (p<0.05) between SURF and con-trols (mean±standard deviation (median z-score)) for FEV1 (L/s) (1.188±0.690(-0.803) vs. 1.080±0.243(-1.446)); FEV1 after betamimetics (1.244±0.183(-0.525) vs. 1.091±0.209(-1.342)); FVC (L) (1.402±0.217 (-0.406) vs. 1.265±0.267(-1.141)), and FVC after betamimetics 1.452±0.237 (-0.241) vs. 1.279±0.264(-1.020)). PFT showed no difference in volumes or airway resistance. Global IQ median [Inter-quartile Range] was 89[82:99] vs. 89[76:98] with 61% children >85 in both groups. Former VPN presenting severe neonatal RDS treated with repeated Surfactant have improved lung function and less asthma at 7 years PNA. There were no differences in neurodevelopmental outcome

The aim of the study was to identify the existence of positive relationships between certain psychomotor behaviors, which we consider specific to swimming, and learning the execution technique of some styles (front crawl and backstroke). The study was carried out during 10 months, including 76 children (40 boys and 36 girls) aged between 6-9 years who practice recreational swimming in a Romanian city. Several tests were used: Tapping test for manual dexterity and laterality, the Goudenough test for body schema, the Flamingo test for static balance, the horizontal buoyancy test for body balance on the water. Results indicated better ratings on all psychomotor behaviors analyzed by gender (in favor of girls compared to boys), except for laterality. The levels of all analyzed psychomotor behaviors are directly proportional to the age of the subjects. Also, moderate positive correlations of manual dexterity (rs = 0.63 in front crawl; rs = 0.57 in backstroke) and strong correlations were identified for body scheme, laterality, static balance and buoyancy, coordination with the learning of the two styles of swimming (r or rs between 0.77 and 0.85). In conclusion, psychomotor behaviors can be predictors for learning swimming styles.